5/15/2018 Office Practice Top Risk Issues: Are You Prepared to Mitigate the Risks? Michigan Osteopathic Association May 17, 2018 Ann Carter, HRM, CPHRM, CMPE Mary Ellen Filbey, RN, BSN, JD, CPHRM Office-Based Disclaimer Closed Claims Analysis This presentation is offered from a risk management perspective and is not intended and should not be construed as legal or medical advice. Office-Based Objectives Closed Claims Analysis • Review closed claims data for office practices to examine past vulnerabilities and assist in identifying high-risk areas • Understand the importance of conducting a self-assessment to identify opportunities for improvement • Identify risk mitigating strategies to consider implementing in the office practice 1
5/15/2018 Office-Based Why Do Patients Sue? Closed Claims Analysis Anger Shock Surprise Unexpected outcome or injury Disbelief Office-Based Diagnostic Test Tracking Case Closed Claims Analysis • The patient treated with his family practitioner (FP) for several years and had routine prostate exams. • One report indicated that the patient’s PSA was slightly elevated. The patient was referred to a urologist. • Further testing was conducted by the urologist. The patient’s slightly elevated PSA had not changed. • The patient subsequently complained of urinary symptoms and a CT of the abdomen and pelvis were ordered by the urologist. Office-Based Diagnostic Test Tracking Case Closed Claims Analysis • The CT revealed an enlarged prostate and the radiologist recommended an ultrasound or transrectal biopsy. • The urologist never saw the CT scan report. • The report was sent to the FP, who reviewed it. • The FP assumed the urologist, who ordered the CT scan, would address the findings. • The patient continued to treat with the FP and eventually complained of joint and muscle pain. • The patient was diagnosed with metastatic bone cancer that originated in the prostrate. He died one year later. 2
5/15/2018 Clinical Judgment Office-Based Clinical Judgement Strategies Closed Claims Analysis Strategies • Review Current Standard of Care • Review evidence-based guidelines • Use diagnostic support tools • Complete Assessment and Document • Obtain an adequate health history for the patient and his/her family members • Refer patients to specialists • Refer patients for testing • Ensure you manage the patient’s medication therapy • Provide education and instructions Clinical Systems 3
5/15/2018 Office-Based Effective Tracking Systems Closed Claims Analysis Tracking tests/referrals until results have been received Timely review and Documentation Patient notification comment by that notification of results treating provider occurred Office-Based Effective Tracking Systems Closed Claims Analysis Process Ensure patients Medical Record File/scan results Process Communicate with abnormal and reminders for results obtain correspondence follow-up follow-up care from referral appointments providers Office-Based Tracking Report Closed Claims Analysis • What are some examples of test tracking systems that your offices uses? • Can your system run tracking reports? 4
5/15/2018 Behavior-Related Office-Based Behavior-Related Strategies Closed Claims Analysis Strategies • Assess health literacy and understanding of his/her condition • Educate about condition and treatment • Provide clear instructions • Stress importance/urgency • Be a good listener to identify barriers • Establish return call guidelines • Obtain informed consent and refusal • Document, document, document Office-Based Patient Behavior Closed Claims Analysis • An elderly patient was asked to complete a patient intake form and left the medication allergies section blank • The medical assistant documented in the electronic record that the patient had NKA (no known allergies) • The patient suffered a severe allergic reaction • As it turned out, the patient knew she was allergic to penicillin, but she didn’t know how to spell it 5
5/15/2018 Communication Office-Based Communication Closed Claims Analysis • Communication issues underlie many patient safety problems; they are often the root cause of severe adverse events • Interactive exchange of information is vital to the physician- patient relationship, as well as care and treatment • Communication among providers regarding the patient’s treatment is critical to coordinating patient care Office-Based Communication Strategies Closed Claims Analysis Engage in and document important communications with the patient: • Correspondence to and from patient and family members • Telephone calls/conversations (messages left, with whom, what was said) • Informed consent/refusal • Missed appointments, tests, and consults, and follow-up actions taken by the provider • Telephone consultations with other providers • Patient responses to prescribed treatments and medications 6
5/15/2018 Office-Based Telephone Call Documentation Closed Claims Analysis • Patient called requesting medication change • Sent to doctors inbox for review • Called patient • How could this telephone documentation be improved? • Have you had an opportunity to mentor staff members in this area? The Cost of Claims This image cannot currently be displayed. Office Self Assessment 7
5/15/2018 Office-Based Why Conduct a Self-Assessment? Closed Claims Analysis • Identify and minimize potential risks in the practice • Increase patient safety • Increase patient satisfaction • Protect staff members from errors • Save the practice money • Prevent a lawsuit from being filed Office-Based Physician Office Self-Assessment Tool Closed Claims Analysis • Generated based on Coverys claim experience • Focuses on high-risk areas • Assists in identifying gaps and determining opportunities for improvement • May be completed at your convenience Office-Based Completion of Self-Assessment Closed Claims Analysis What’s Next? When completing the assessment: • Identify problem areas by completing the tool • Determine priorities • Develop an action plan • Assign responsibilities • Monitor for continual improvement 8
5/15/2018 Office-Based Obtaining Support Closed Claims Analysis • Provider and staff member “buy-in” to changes • Discuss the importance and benefits of proactive risk management • Encourage provider and/or staff member participation in the self-assessment review • Communicate the identified risks which require changes to be made Office-Based Summary Closed Claims Analysis • Reviewed closed claims data to assist in identifying high risk areas and the top 4 include: • Clinical Judgement, Clinical Systems, Behavior, Communication • Discussed closed claims and the average indemnity paid • Presented strategies to consider implementing in the office practice • Obtaining adequate patient and family health history • Closing the loop on patient tests and referrals • Assessing health literacy and the patient’s understanding of his/her condition • Document important communications with the patient • Provided a tool to assist you in identify opportunities. Office-Based Questions? Closed Claims Analysis Ann Carter Mary Ellen Filbey COVERYS Senior Risk Consultant Senior Risk Specialist 3100 West Rd P: 517.898.6739 P: 517.614.8508 Building 1, Suite 200 F: 517.324.2564 F: 517.327.4666 East Lansing, MI 48823 acarter@coverys.com mfilbey@coverys.com 9
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