Presentation on theme: "The Crucial Role of the Practice Administrator in Reducing Risk"— Presentation transcript:
1The Crucial Role of the Practice Administrator in Reducing Risk American Association of Orthopaedic ExecutivesApril 14, 2008MEDICAL CONSULTANTS OF NEW ENGLAND, LLCMEDICAL CONSULTANTS OF NEW ENGLAND, LLC
2Elements of Risk Management Risk PreventionClaims DefenseMEDICAL CONSULTANTS OF NEW ENGLAND, LLC
3MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Risk PreventionOffice significant source of Malpractice35% of allegations stem from substandard office systemsGood systems will save time and financial lossAs healthcare becomes more complex good systems are essential to preventionMEDICAL CONSULTANTS OF NEW ENGLAND, LLC
4Develop Practice Philosophy Practice brochureInsurance policies, billing policies, hours, Rx refillsEstablish patient expectationThe informed patient is much less likely to file a claim with a poor outcome totally unrelated to medical negligenceMEDICAL CONSULTANTS OF NEW ENGLAND, LLC
5MEDICAL CONSULTANTS OF NEW ENGLAND, LLC EmployeesValidate & document professional credentialsBackground checksDocument training and policy & proceduresName tags and positionMEDICAL CONSULTANTS OF NEW ENGLAND, LLC
6MEDICAL CONSULTANTS OF NEW ENGLAND, LLC SystemsProceduresDiagnostic testing follow upX-rayTransportation of patientsChaperonCasting, DMEMedical Record: EMR, allergiesEquipmentProper training (cast saw)Maintenance and PMMEDICAL CONSULTANTS OF NEW ENGLAND, LLC
7MEDICAL CONSULTANTS OF NEW ENGLAND, LLC SystemsTelephoneTriage of calls & responsibilityDocumentation of callsMethod of communication: , fax,ComplianceHIPAAOSHADischarge of PatientsMEDICAL CONSULTANTS OF NEW ENGLAND, LLC
8MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Claims DefenseSupportable policies and proceduresWell defined process for claim managementMEDICAL CONSULTANTS OF NEW ENGLAND, LLC
10Medical Records What will opposing counsel ask? Will try to show: Minute details about events occurring many years ago;Seemingly unimportant details can become a focal point;Will try to show:That if the medical record contained additional important information, that the patient’s outcome would have changed;Inadequate follow-up;Inadequate consent process and;Ultimately that the medical record and thus the care provided was inadequate.A thorough, complete medical record can form the cornerstone of a strong defense.
11Medical RecordsA 2 year old is seen by an Anesthesiologist prior to undergoing an elective outpatient procedure. The patients mother reports that there is a family history of Prolonged QT syndrome. The Anesthesiologist called the primary physician requesting an EKG, which was ordered through the pediatrician’s office. The EKG was late coming back to the pediatrician’s office and was placed in the medical record without being seen by the physician.During a follow-up visit 6 months later, there was no mention of the EKG by either the physician or the patient’s mother.2 months later, the child died with a V-fib arrest and ultimately was shown to have prolonged QT syndrome on the EKG in his chart.
12Medical RecordsHistory, Physical, appropriate labs and x-rays are all well documented.Preoperative evaluation and clearances are complete. (All abnormal exams are referred to the appropriate primary care physician or appropriate specialist.)The nature of the discussions with the patient and as appropriate the patient’s family, regarding informed consent, are well documented.Lastly, the documentation in a hospital setting must meet the same standards you use in your office.
13Office Calls Post-operative It is common for patients to receive discharge/post-op instructions to call the physician’s office if varied sxs. occur.Is there a policy to guide the office on how these calls are processed and the patients managed?Are their criteria, including a list of diagnoses/complaints, where patients are directed to either come into the office or be referred to the ER?Can a secretary take down the information and leave it for the physician?Example: Pt calls the office with chest pain after getting home. The physician is not in the office and a PA or ARNP asks the patient to come in. An EKG is performed and the patient sent home with instructions to see the physician tomorrow. This patient died that evening resulting in a large settlement.
14Labs and X-ray Exams Was the test performed? Were the results seen by the physician?Were actions taken because these results were abnormal?Including communication with referring physicians.
15Labs and X-ray ExamsA 50 year old patient presented to their physician’s office for weakness and lethargy on a Friday afternoon. Labs were drawn and sent to an outside lab. The patient was sent home. The patient was found to have a sodium of The lab called the answering service and asked the service to relay the results to the physician, which never occurred.The patient’s condition deteriorated and they arrived at the ER on Sunday, was admitted to the ICU and subsequently expired. Settlement: $2,500,000 split between the physician, the pathologist and the lab.
16Patient Responsibility Make the patient responsible;Discharge instructionsConsent formsHave them sign