A time of change

How are risk managers faring amid the changes ushered in by healthcare reform? Cheryl Peaslee, president of the Northern New England Society for Healthcare Risk Management, gives her view to HRMR.

Healthcare in the US is in a state of rapid change—but how should risk managers respond to a landscape that is being so dramatically remodelled as a result of healthcare reform? For Cheryl Peaslee, president of the Northern New England Society for Healthcare Risk Management (NNESHRM), the key is to recognize the great opportunity that is being presented.

“Risk managers are leaders and we have to step up as leaders no matter what is going on and in this fast-paced world,” she says. 

"FUTURE REIMBURSEMENT WILL BE EVENTUALLY BASED ON PERFORMANCE AND OUTCOME OF QUALITY MEASURES, SO A LOT OF TIME IS BEING SPENT ON PAYMENT INITIATIVES." CHERYL PEASLEE

“We have to make ourselves visible, and make it clear what we can do for our organizations. You can’t just talk about how important communication is or how important teamwork is, you have to model it: you have to be a good communicator and a good a team player. 

“There is so much opportunity out there for us to be intimately involved in enterprise risk management within our facilities.”

As much of the current legislative focus is on enhancing safety, quality and professional practice, NNESHRM has provided networking opportunities and educational programs to help members achieve these improvements within their organizations. As many as 50 percent of members have attended the educational programs: Peaslee believes the excellent turnout is due to the fact that the programs have been tailored around topics selected by members.

“It proves that we need to stick together, we need to network, we need to provide support to each other. The topics we are presenting and the opportunity to chat are recognized and needed.”

A passion for risk management

A nurse by training, Peaslee discovered an interest in administration early in her career, moving first into utilization review and then into quality and risk. She is now the vice president of risk management at Medical Mutual Insurance Company of Maine, a professional liability carrier that insures physicians, hospitals and long-term care facilities against malpractice.

Now in her 16th year there, Peaslee oversees a team that works directly with risk managers in the company’s covered hospitals: it insures over 30 hospitals, and for each one the company provides a tailor-made service plan, and works with them on projects and any risk issue that either they or the insurance company feel is important.

“We do consultations with them on an ongoing basis, on whatever issue they’re addressing, and on the risk issues we are seeing globally, nationally and regionally. We’re in constant contact. We’re very much their partner,” she explains. 

She loves the hands-on nature of the job, which gives her a unique overview of risk management in a wide range of organizations.

“There is never a dull moment—everything is in constant change. You never know what somebody’s going to call and ask, you never know what issue an insured is going to bring up that you need to address, so it’s a matter of always being on your feet with your sleeves rolled up, just ready to jump in for something new, and that’s wonderful. It’s what makes the job challenging.”

Common problems

One of the common issues Peaslee sees risk managers facing is a shortage of the time and resources needed to fulfil all the requirements brought in by healthcare reform.

“Changes to regulations, accreditation responsibilities and compliance with quality measures have an impact on all organizations,” she says. 

“Risk managers are limited in the amount of time they have available. On top of that, many risk managers wear multiple hats, so as well as being a risk manager, they may also represent patient safety and quality. Finding the time to respond to all risk-related needs and be proactive at the same time is challenging.”

She adds that organizations have limited resources: “They have limited funds, payment and reimbursement are diminishing, and future reimbursement will be eventually based on performance and outcome of quality measures, so a lot of time is being spent on payment initiatives.”

She believes the current environment has created intense competition, not to mention further time-consuming demands around striving to achieve recognition. 

“Maintaining accreditation by the Joint Commission, achieving Magnet status, becoming a certified stroke center—all these require resource time. But there’s only so much time in a day and only so many things you can prioritize.”

Community care

Peaslee and her staff often hear about resource limitation, and risk managers’ worries about what this means for the future. The shift of healthcare from a hospital setting to the community, and the related issue of electronic health records (EHRs), is also an area of concern. Many organizations are currently working to build bridges with team members in the community, especially with a mind towards avoiding readmissions within 30 days.

“It means there’s a huge effort to keep those patients in the community—and to do so you have to identify what it is that brings them back to the hospital and creates that readmission. We’ve got to see what can we do to support them out there, so some organizations have hired patient navigators or planning nurses—individuals who are trying to work once patients have been discharged to make sure they are provided with support in the community.”

Hand-off issues are also being addressed, with hospitals working to iron out any system problems that might mean adequate information is not passed on. There are significant medical professional liability issues around this: missed test results become problematic, as does the failure to give patients the proper care or follow-up they need. 

“If patients don’t get the care or the follow-up they need, and then they end up back at the hospital or some adverse event occurs, system issues such as a missed test result can become a huge determining factor.”

A key risk area when patients return to the community relates to EHRs: if a vital piece of information is not readily visible, the consequences can lead to readmission or worse. Follow-ups or vital care considerations can be missed due to simple problems with the way information is stored, displayed and transferred.

“It’s a huge issue because the EHR is not just a documentation tool, it’s a whole communication system and we’re not used to it. I expect we will see that reproducing the electronic environment becomes problematic and challenging in case defense, because what the physicians see when they look at a paper copy of an electronic record is very different from what they see on a computer screen. The interactivity of an electronic environment is not captured on paper.”

A collaborative approach

Looking to the future, Peaslee takes a very positive view of the importance of the risk management role.

“Its value is more and more recognized in organizations—we certainly see that with the organizations we work with. I know that at times, with the inventing of patient safety initiatives, there is the question of where will the risk management role lie, in relation to patient safety and compliance, and whether risk will remain relevant,” she says. 

“I see it as being highly relevant but I also see it as a collaborative effort with all three—risk, safety and compliance—partnering as we go forward with all the changes that are occurring as a result of reform.”

She adds that risk managers have a lot of value to contribute to their organizations as a whole—value that in many cases has not yet been fully tapped.

“I’d like to see risk management at the table involved directly with strategic planning and implementation of enterprise risk. We represent so much value that it should be consulted on and utilized to its ultimate degree.”