Risk Management In The Office Or Clinic Stephen A. Frew JD

1. Risk Management In The Office Or Clinic Stephen A. Frew JD Johnson Insurance Services, LLC

2. Disclaimer • The following risk management program is for informational purposes only. It is not legal advice. If you need legal, claim, or defense advice, contact your attorney or with risk and claims personnel at your insurance carrier.

3. Today’s Program will cover: • Elements that make offices and clinics more difficult for risk management • Getting through common myths about malpractice suits in general • New laws and liability exposures for office and clinic venues • Common risks of practice • Common sources for liability • Getting RM started in the office • Q & A

4. A different animal • Open range attitude • Lone Ranger overload • Physicians on home turf • Often lack detailed policies, procedures, systems • Believe only hospitals need or can benefit from risk management • Few rules or regulations enforced in the office setting except in law suits

5. Office or clinic opportunities • Office manager or RM wants help • Physician who is interested • Triggering event • Employee issues • Potential claim • Actual claim • Insurance rate issue or exclusion

6. Where Do Malpractice Suits Arise? • 70% Are listed as occurring in the hospital. • 30% Are listed as office • But… • Almost half of all hospital based cases against physicians involve office practice issues

7. Getting Past Common Myths About Malpractice • I can’t do anything about office risks • Risks only arise in the hospital setting • Most doctors get sued every 3 years • Doctors get sued due to greedy patients • Doctors get sued due to greedy lawyers • Doctors get sued because they take hard cases • Doctors get sued because they are poor clinicians • Doctors get sued because they practice in bad areas • Nurses are never sued • People in rural areas don’t sue

8. Dose of reality • Physician issues are the hardest to correct in the small office or clinic setting • Fewer than 10% of doctors account for more than 80% of the suits • While suits against nurses are growing, they too focus on “high risk” individuals • Early onset, delayed onset, late onset – be alert • High risk doctors and nurses give warning signs that often start in the office practice • Probationary periods • Complaints from staff • Complaints from patients • May be high producers who consider themselves too valuable to be bound by mortal rules

9. The good news…. • High risk physicians can change if they want • Many improvements take only small adjustments or effort • Most improvements don’t hurt the bottom line • Patient satisfaction improves and usually revenue does too

10. Leading Office-Based Risk Issues • Employees • Privacy, security, and medical records • Care Issues • Lack of informed consent • Sexual allegations • Illegal RX issues • Billing and coding errors/fraud

11. Office manager basic goals • Commitment to improve • Make the quick and easy changes first • Train personnel and providers on the simple stuff • Reward patient-centric performance • Basic policies and procedures • Periodically assess status • Insurance coverage • Utilize your resources

12. Areas of attention Patient-centric attitude Privacy and security Physical plant and systems Documentation Informed consent

13. Patient-centric attitude • Happy patients mean good place to work • Happy patients mean profitable practice • Happy patients won’t sue you • It is easier to keep patients happy than deal with their anger • Patient comments and complaints are an opportunity to correct • It is part of your job description

14. Informed consent is the best defense • It is good patient relations • It builds trust • It manages expectations • It demonstrates concern • It is a lot more than “Risks and Benefits discussed with patient” • It is the physician’s job but the staff can help too

15. Little tricks that boost patient approval • Always apologize for being late – even if you are not • Always introduce yourself by title and last name • Always identify and greet each person in the room • Always sit down when talking to the patient unless necessary for procedure or exam, then sit down

16. Little tricks that boost patient approval…continued • Always ask about medical care, injuries, or hospitalizations since last visit • Always let the patient finish what they have to say • Always repeat back to clarify before anything else • Assume that the patient has no medical vocabulary or knowledge, and explain everything as if to a 3rd grader

17. Little tricks that boost patient approval … continued • Answer the patient’s questions graciously and with solid information • Don’t give them the “Doctor knows best” type answer • Always have the patient repeat back your instructions • Give written (printed) instructions whenever possible • Give information materials and online resources • Always ask the patient if there is anything else before they leave

18. Privacy • It’s more than a HIPAA violation – it is malpractice for breach of confidentiality • Avoid unnecessary discussions, comments, snide comments, medical humor around patients • Know who is in the room • Know who is authorized for information • Don’t take records off-premise • Don’t access files with home computers or with wireless connects that are not encrypted • Don’t take photos without consents – Ban cellphones • Don’t run copies on the fly

19. Records Security in the office… • All records should be returned to a locked security area when the office is closed. • Do not allow records to be stacked around the office • Require all computers to revert to screensaver mode automatically • Require passwords for all computer access • Do not store backup records on premises • Put someone in control of records access

20. Physical Plant & Systems • Access • Orderly • Comfortable seating and reasonable space • Cleanly • Safety compliant • Systems • Phones • Premises alarms • Referrals • Testing • Phone triage

21. Systems: telephone triage • General rule: Don’t give medical advice over the phone • If you have to: • Follow formal written protocol system approved for each doctor • RN’s only • Generate written standard phone record on each contact and must go into record • Assure the physician sees the phone advice • When in doubt consider it an emergency

22. Questions and Answers