1. RISK MANAGEMENT and PATIENT SAFETY PROGRAM BASICS
Angela Codougan, Chief Compliance and Risk Officer
August 30, 2017

2. Objectives
Define Risk Management and understand the purpose of a Risk Management program
Understand strategies used to prevent or minimize risk to organization
Understand the relationship between Risk Management and Quality Improvement
Identify common risk management issues associated with office-based malpractice claims
Understand and identify common risks and how to prevent them.
Recall three reasons patients initiate malpractice claims
Understand how to respond to and address claims
Be familiar with the system of the Federal Tort Claims Act (FTCA)
Pass the QUIZ!

3. Risk Management
Risk Management is the technique of determining, minimizing and preventing accidental loss in a business.
Complete risk management includes taking appropriate safety measures, acting in a professional manner, and having appropriate insurance coverage.
The purpose of a Risk Management and Patient Safety Program is to reduce the risk of adverse outcomes that could result in medical malpractice or other health or health-related litigation.
Strategies to prevent or minimize loss include:
Identification and mitigation of high-risk areas
Training
Implementation of policies and procedures
Insurance

4. Risk Management and Patient Safety Program
Identify the areas/activities of highest risk for health center patient safety
Mitigate the areas/activities of highest risk for health center patient through clinical protocols, training, and medical staff supervision
Documenting, analyzing, and addressing clinically-related complaints, and “near misses” reported by health center employees, patients, and other individuals
Set and track progress related to annual risk management goals
Develop and implement an annual health care risk management training plan for all staff members based on identified areas/activities of highest clinical risk for the health center and any non-clinical trainings appropriate for health center staff
Complete an annual risk management report for the board and key management staff

5. Risk management versus quality improvement
Proprietary and Confidential Copyright ECRI Institute, 2016

6. HRSA-identified high-risk areas
Obstetrical procedures
Infection control
Hand hygiene
Referral tracking
Hospitalization tracking
Diagnostic tracking
HIPAA medical record confidentiality requirements

7. National Patient Safety Goals (NPSGs)
Identify patients correctly.
Use medicines safely by labeling them appropriately and taking precautions with anticoagulants.
Review patient medications; communicate and educate about current medication regimens.
Prevent infections.

8. Top five risk management issues associated with office-based malpractice claims
Failure/delay in ordering test
Inadequate communication of patient information among providers
Narrow diagnostic focus
Insufficient patient education regarding medication
Failure to obtain a consultation/referral
Source: LaValley D. Improving patient safety in office-based practice. Forum Jun;25(2):1-2.

9. Other risk issues for physician offices
Medication safety
Patient safety and event reporting
Patient communication and disclosure
Administrative risks
Patient care issues
Environmental safety
Health information management and confidentiality
SOURCE: ECRI Institute.

10. Recent headlines
Failure to Properly Follow-up on Test Results Leads to $1M Settlement
Delayed Diagnosis: Jury Awards $29M in Lawsuit about Harm Caused by Alleged Refusal to Order Diagnostic Testing
Failure to Diagnose Herpes Before Birth Leads to $3.2M Settlement
Pediatrician Pays $156K in Penalties for Improperly Storing Vaccines
Failure to Monitor Patient’s Use of Antifungal Allegedly Leads to Liver Failure, Death, $4.7M Verdict
Provider Agrees to $480,000 Settlement after Prescribed Benzodiazepine Allegedly Leads to Car Accident
Failure to Document Brain Abnormality in Medical Chart Leads to Stroke, $35.4M Verdict
Primary Care Provider Pays $750,000 for Failing to Address Complaints of Chest Pain
Patient Falls from Exam Table after Blood Draw, $75,000 Awarded
Physicians Fail to Disclose Test Results, Patient Death Leads to $2.5M Settlement

11. Why do patients sue? Anger Surprise Distrust SOURCE: ECRI Institute.
Risk of litigation may increase when the provider does not communicate outcomes of care, including errors
SOURCE: ECRI Institute.

12. Communicating with patients after an event

13. Communicating with patients after an event
Copyright ECRI Institute, 2015

14. Federal Tort Claims Act (FTCA)
What is FTCA?
The Federal Tort Claims Act (FTCA) is the federal legislation that allows parties claiming to have been injured by negligent actions of employees of the United States to file claims against the federal government for the harm they suffered.
The FTCA also provides authority for the federal government to defend against such claims.
Amendments to the Public Health Service Act in 1992 and 1995 provide that employees at deemed Health Centers are to be treated as employees of the United States for purposes of medical malpractice. These "employees" include board members, officers, employees and certain contractors of deemed Health Centers.
"Employees" are given malpractice protection for actions within their scope of employment, and within the scope of project of a deemed Health Center.

15. Federal Tort Claims Act (FTCA)
What does this mean for AxessPointe?
We have to maintain clinical protocols, tracking systems, complete and accurate medical record reviews, and active quality assurance and risk management programs.
The United States government would be substituted as the defendant in any malpractice claim for your activities, which are within your scope of employment and within the scope of project of a deemed Health Center.

16. Any Questions??? Angela Codougan Acodougan@axesspointe.org
X1107
Ashley Campbell
X1117