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By Diane Doherty, MS, CPHRM

Healthcare risk managers play a vital role in minimizing legal, financial and healthcare related risks. But of all the responsibilities of healthcare risk managers, safeguarding patient care remains at the heart of everything we do. Chubb has developed a series of blogs designed to provide resources and tools for healthcare risk managers as they look to support the delivery of high quality care, this week and every week.

This blog focuses on some of the biggest—yet overlooked—risks facing healthcare organizations today, and what healthcare risk managers can do to help protect their organizations. 

Keep an Eye on Intensifying Credentialing Exposures

Much has changed for healthcare providers since the implementation of the Affordable Care Act. From a rapid increase in M&A activity between both providers and large physician groups to a transition from fee-for-service to value-based care, little remains the same.

But for all the good these changes have fostered, certain reform measures are unintentionally accelerating credentialing-related exposures. Consider, for example, the increase in allegations concerning inappropriate scope of practice tied to providers’ expanding roles or how fast-moving M&A activity can result in a less-than-thorough vetting and credentialing strategy of new member providers. That’s in addition to challenges associated with addressing disruptive behaviors or known complaints filed by peers and patients or generally poor executive oversight and supervision of employees.

Further complicating matters is that there are several root causes of credentialing-related exposures, including physician retaliation disputes, tortious interference with practice, antitrust challenges, negligent selection, and errors and omissions. Fortunately, understanding the source of the exposure can help prevent a risk from turning into a lawsuit. To assist with that process, risk managers should:

  • Establish a clear and consistent channel of communication with primary stakeholders in order to proactively identify a problem, monitor and respond to certain credentialing situations.
  • Appoint a risk manager and legal counsel to the medical staff executive committee in order to help optimize data management and privacy under the Health Care Quality Improvement Act and other statutory-based protections.
  • Ensure that a team of certified professionals handles all matters relating to provider selection, privileging, performance review and retention.
  • Verify that data collection and analysis is conducted in accordance to established best practices known as Ongoing Professional Practice Evaluation (OPPE).

Recognize Providers are Real People Too

Working in healthcare is a long-tail career choice. Even once medical school, residency and fellowship (sometimes multiple) are complete, many physicians dedicate years of their lives to additional research and training in order to deliver the highest quality care. It makes sense that with so many years spent in training, many providers choose to work long past traditional retirement age—one report by the Journal of Medical Regulation found that 29.2% of actively licensed U.S. physicians are over the age of 60.

While the experience and insight older physicians bring to their organizations is invaluable, risk managers cannot overlook related patient safety concerns. As they age, physicians are not immune to the ailments that impact their patients. For example, a reduction in cognitive and physical abilities often appear gradually in both patients and physicians alike, possibly impacting the latter’s ability to do their job.

To ensure patient safety needs are consistently met while simultaneously reducing their malpractice and corporate liability exposures, risk managers should take the immediate step of developing aging provider policies. These guidelines could include the implementation of required age-based physical and competency testing for all member providers, as well as introducing part-time or flexible scheduling. For risk managers, the latter is particularly important when looking to shepherd older providers from an active clinician to a mentor role. No matter the policies determined, risk managers should work in close coordination with legal counsel to ensure they do not unintentionally introduce age-based discriminatory practices.

Ensure Hospitals Remain Places of Healing

Far too often we hear about acts of violence against healthcare professionals. This is simply unacceptable. In the past, hospitals and physician offices were once seen as a sanctuary against violence; places that people went to be treated for the illnesses /injuries and heal. Unfortunately, we can no longer hide behind that ideal. The reality is that the healthcare setting is just as vulnerable to the same problems that afflict society as a whole. In order to properly protect patients, employees, and visitors, healthcare organizations are forced to allocate critical resources to prepare for and prevent acts of violence. According to the latest data from the American Hospital Association, U.S. hospital and health systems spent roughly $2.7 billion on proactive and reactive violence response efforts in 2016 (2017 data will likely be available in June 2018).

For healthcare risk managers, violent incidents expose their organizations to a wide range of insurance implications, including medical professional liability, workers compensation, general liability, directors and officers, and property exposures. The key to stemming these exposures is rooted in a review of their workplace violence prevention program. Risk managers should ensure their program is based on an annual facility-wide assessment that surveys all shifts, pays particular attention to high-risk areas and is overseen by a multi-disciplinary committee. Once the program is updated, risk managers should conduct unannounced drills and staff trainings that focus on identifying violence red flags, when to try and diffuse a situation and when to retreat to safety.

Leading Together, Everyday

The best risk managers know the most effective strategies evolve in real-time and run 365 days of the year. At Chubb, know that we’re here to support you each and every day.

Diane Doherty, M.S., CPHRM, is a Senior Vice President of Chubb Healthcare

The material presented in this article is not intended to provide legal or other expert advice as to any of the subjects mentioned, but rather is presented for general information only. You should consult knowledgeable legal counsel or other knowledgeable experts as to any legal or technical questions you may have.

Chubb is the world's largest publicly traded property and casualty insurance company, and the largest commercial insurer in the United States. With operations in 54 countries and territories, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients. For more than 25 years, healthcare organizations have relied on Chubb for insurance products and services that provide an effective insurance program for managing their risk. The company has a broad appetite, and serves a wide range of organizations—from an assisted living facility to an urgent care center to a nationally recognized children’s hospital.