Healthcare Control & Risk Management Strategies

1. CONTROL & RISK MANAGEMENT STRATEGIC MANAGEMENT IN HEALTHCARE 14 April 2009

2. CONTROL MONITORING POINTS • INPUTS - PROSPECTIVE • FEED FORWARD CONTROL • PROCESSES - CONCURRENT • SCREENING CONTROL • OUTPUTS - RETROSPECTIVE • FEEDBACK CONTROL

3. INPUT CONTROL • FOCUSES ON RESOURCES CONSUMED • IN A SERVICE INDUSTRY THIS USUALLY MEANS PERSONNEL • PHYSICAL RESOURCES SHOULD NOT LIMIT PERSONNEL BUT USUALLY DO

4. PROCESS CONTROL • OUTPUTS ARE DETERMINED BY: • AMOUNT & APPROPRIATENESS OF INPUTS • EFFICACY & EFFICIENCY OF PROCESS

5. OUTPUT CONTROL • ALSO CALLED FEEDBACK CONTROL • QUALITATIVE & QUANTITATIVE • REQUIRES STANDARDS OR EXPECTATIONS

6. CQI AND CONTROL • PROCESSES CAN BE IMPROVED • CONTROL IS DIRECTED AT PROCESSES • INPUT CONTROL IS NO SUBSTITUTE FOR PROCESS AND OUTPUT CONTROL

7. CONTROL METHODS • BUDGETING • COST ALLOCATION • RATIO ANALYSIS - % OF EXPECTED • FINANCIAL STATEMENTS/ANALYSIS • OPERATIONAL ACTIVITY ANALYSIS • BENCHMARKING • STANDARD SETTING

8. DESIGNING CONTROLS • INFORMATION BASED • PROSPECTIVE WHEN POSSIBLE • REALISTIC & UNDERSTANDABLE • ACURATE, TIMELY & RELIABLE • IMPORTANT &/OR COST-EFFECTIVE

9. INFORMATION SYSTEMS • MANAGERIAL - HUMAN RESOURCES • CLINICAL – DOCTOR VISITS • MIXED - LABORATORY

10. INFORMATION SYSTEMS • ALL THE USUAL PROBLEMS • HIGHLY IDIOSYNCRATIC INFORMATION • HIGHLY “TECHNICAL” INFORMATION • HIPPA

11. ELECTRONIC MEDICAL RECORDS • GARBAGE IN – GARBAGE OUT • IF A SYSTEM IS NOT FUNCTIONAL, COMPUTERS WILL MAKE IT WORSE • INFORMATIONAL NOISE

12. ADVANTAGES OF EMR • Access from multiple sites • Reduced offline storage costs • Improve quality & coherence of process • Automated clinical guidelines • Support research and quality improvement • Easier reporting of all types • Portability – disaster response

13. DISADVANTAGES OF EMR • Scores of incompatible data sources • Duplicate information and effort • Obtaining information from physician • Physician as clerk/typist • Confidentiality • No reduction in support staff • Transfer to next provider

14. RISK MANAGEMENT • PRIMARY, SECONDARY, AND TERTIARY PREVENTION • SPECIALTY OF LAWYERS • ABOUT STANDARDS • ABOUT LOSSES • MONEY • REPUTATION/BUSINESS • FREEDOM

15. RISK MANAGEMENT • AVOID OR REDUCE LOSSES/MISTAKES • MITIGATE THE DAMAGE FROM LOSSES/MISTAKES • INSURE AGAINST LOSSES/MISTAKES • OBEY THE LAW

16. STEPS IN RISK MANAGEMENT • IDENTIFY • EVALUATE • REDUCE/ELIMINATE • TRANSFER/INSURE

17. WHEN A LOSS OCCURS • SECURE THE RECORDS • MITIGATE DAMAGES • DON’T ADD INSULT TO INJURY • BE SMART ABOUT BILLS • SUPPORT YOUR PEOPLE

18. SELF-INSURANCE • YOU ARE YOUR OWN INSURANCE COMPANY • REINSURANCE OR UMBRELLA IS USUALLY NECESSARY • DEDUCTIBLE IS A FORM OF SELF-INSURANCE

19. INCIDENT REPORTS • MAY BE USED FOR NUMBERS ONLY • SERIOUS PROBLEMS NEED A FAST TRACK • MUST HAVE A CORRECTIVE ACTION COMPONENT - DON’T JUST DOCUMENT YOUR STUPIDITY!

20. NATIONAL PRACTITIONER DATA BANK • MUST REPORT SIGNIFICANT ACTIONS AGAINST A PRACTITIONER • MUST QUEARY IT BEFORE TAKING ON A NEW PRACTITIONER • AVOIDING REPORTING

21. INDEMNIFY & HOLD HARMLESS • USUALLY A STUPID IDEA FOR BOTH PARTIES • DON’T EVER SIGN ONE YOURSELF • INSURANCE OR A BOND IS THE RIGHT WAY TO DO THIS