Welcome to the annual print edition of Healthcare Risk Management Review, released to coincide with ASHRM’s 2014 conference but designed to look ahead to the issues likely to affect the industry in 2015.
During the two years since HRMR began, certain themes have emerged very strongly: the shift towards enterprise risk management and the drive to learn from High Reliability Organizations; the consolidation of healthcare providers, particularly the acquisition of physician practices by hospitals; the march towards increased disclosure and transparency; the increased focus on population health and performance-linked reimbursement; and of course, the many faces of cyber risk.
Against this shifting backdrop risk managers are achieving remarkable, measureable improvements, particularly in terms of falling—even sometimes zero—serious safety events and reduced litigation.
The changes stemming from the Patient Protection and Affordable Care Act (PPACA) are still playing out and many uncertainties remain: how will providers fare in an environment of performance-linked reimbursement that has not yet been standardised and tested? What are the risks and responsibilities stemming from population health initiatives, and if these are successful how will providers be affected by a possible fall in patient volume?
What are the implications of disclosure for litigation? And, how can a provider embrace electronic health records and the wider world of health IT while ensuring that patients—and their protected health information—remain safe?
Nobody has all the answers, but in this edition of HRMR we aim to take the temperature of the world of healthcare risk management in late 2014 and look ahead to the challenges that will be faced over the coming 12 months.
We interviewed CFO Brian Lovdahl about the changes and challenges that lie ahead for Baldwin Area Medical Center in Wisconsin—changes that CFOs and risk managers across the US will identify with.
Tom Piotrowski, executive director of Clarity PSO, gives an insight into the development of PSOs and his view of their future role, and Lee McMullin, president elect of Southern California Association for Healthcare Risk Managers and senior risk management and patient safety specialist for the Cooperative of American Physicians, gives an insight into the risk issues faced by multi-specialty physicians and the hospitals that are increasingly employing them as direct employees.
We also explore the insurance options open to healthcare providers, including the growing use of captives. If this is a path your organization is considering, be sure to read our captives feature by Renee Ford, a principal in Decosimo’s assurance practice, and JS de Jager’s piece on why Cayman is the world’s largest domicile for healthcare captives.
Our experts also dive into some of the most sensitive and challenging issues facing risk managers today. Michelle Foster Earle, president of OmniSure Consulting Group, addresses the issue of sexual abuse in healthcare settings and Barbara Youngberg, consultant to the Beecher Carlson national healthcare practice, explores the problem of violence towards staff. The perennial problem of network security and data privacy is addressed by Mario Paez of Wells Fargo Insurance Services USA.
We hope this issue will equip you with ideas, advice and insight for the coming year and we hope to be in touch with as many of you as possible through our LinkedIn page, website and digital newsletter. Whatever lies ahead for healthcare risk management in 2015, HRMR is coming along for the ride.
Jenny White, Editor
Healthcare Risk Management Review is published by:
Newton Media Limited
Kingfisher House
21-23 Elmfield Road
BR1 1LT
United Kingdom
Telephone: +44 203 301 8200
www.hrmronline.com
Director and Publisher
Nicholas Lipinski
Associate Publisher
Robin Johnson
Telephone: +44 203 301 8202
Email: rjohnson@newtonmedia.co.uk
Managing Editor
Wyn Jenkins
Tel: +44 203 301 8214
Email: wjenkins@newtonmedia.co.uk
Editor
Jenny White
Tel: +44 203 301 8229
Email: jwhite@newtonmedia.co.uk
Sub-editor
Ros Bromwich
Production and design
Fisherman Creative
©Newton Media Limited 2014.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electrical, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher.
The views expressed in Healthcare Risk Management Review are not necessarily those shared by the publisher, Newton Media Limited. Wishing to reflect the true nature of the market, the editor has included articles from a number of sources, and the views expressed are those of the individual contributors. No responsibility or liability is accepted by Newton Media Limited for any loss to any person, legal or physical, as a result of any statement, fact or figure contained in Healthcare Risk Management Review.
This publication is not a substitute for advice on a specific transaction.
The publication of advertisements does not represent endorsement by the publisher.
ISSN 2051-2767
Cover Image: shutterstock.com/ Sergey Nivens
Contents
8 Care and compassion
‘Sharing and caring’ through enterprise risk management (ERM) was chosen as the over-riding theme of the 2014 ASHRM conference. Jacque Mitchell, the organization’s 2014 president, tells HRMR how this can be applied.
10 Stay connected
Picking up on some of the themes of the 2014 ASHRM conference, RIMS president Carolyn Snow offers her views on risk management today.
12 View from the finance chair
What does the current risk landscape look like to healthcare CFOs? HRMR found out from Brian Lovdahl, CFO for Baldwin Area Medical Center.
14 A different angle
Thomas Piotrowski of Clarity PSO, looks back over the evolution of PSOs and gives his view of their future role.
18 Getting to zero
Lee McMullin, president elect of SCAHRM, spoke to HRMR about the route to zero patient harm.
22 Wearing your health on your sleeve
Chris Brooking and Tom Kennedy of Barbican Insurance Group, report to HRMR the pros and cons of using wearable technology in healthcare.
26 Caring for your caregivers
Beth Wood from Lockton outlines seven best practices for post-injury management in healthcare.
30 Raising the safety bar
Dr Dan Cohen, International Medical Director, Datix, explains what healthcare can learn from high reliability organizations.
34 Paying for the ACA
What effect is accountable care having on the employer/provider/payer relationship? Aon’s Ron Calhoun and Michael Taylor offer some answers.
38 Managing potential liability in the physician office
Devising a risk mitigation plan where nurse practitioners and physician assistants are employed needs care, says Ann D. Gaffey from Sedgwick.
42 Compliance made easy
Marlene Wilson of Garretson examines the complexities of reporting risk management write-offs to Medicare.
44 Violence in healthcare: managing an
escalating problem
A series of proactive steps can go a long way towards minimizing aggressive acts, says Barbara J. Youngberg of the Beecher Carlson national healthcare practice.
48 Getting the analytics edge
Mary Chmielowiec of data analytics expert PointRight outlines three simple ways to step up your analytics game.
52 Niching the niche: a refined focus
Various factors in current trends in the medical professional liability sector led to the creation of Pro-Praxis, as Bob Allen, its president, told HRMR.
54 A sure way ahead
Insurance products are helping the industry find certainty amid rapid change, as Kieran Dempsey and Nancy McMahon from Ryan Specialty Group explain.
56 Proper pricing
Risk management may be first class but losses above $5m continue to trend upwards, with implications for insurance premiums, says Justin Keith of Hiscox.
60 A total claims solution
HRMR reports on LSG’s Advocator System®, an electronic claims management system that enables you to have complete control over the whole claims process.
62 Cayman: tops in healthcare
The Cayman Islands is the world’s largest domicile for healthcare captives, and also hosts the largest annual captive insurance conference, says JS de Jager.
64 An evolving risk
Mario Paez of Wells Fargo Insurance Services USA gives his view on how to keep pace with the evolving risks of network security and data privacy.
67 A hidden danger
The risk of sexual abuse in healthcare settings should not be ignored, writes Michelle Foster Earle, president of OmniSure Consulting Group.
70 Poised for growth
Captive insurance continues to develop its value for healthcare providers. Renee Ford, assurance principal at Decosimo, explains why.
ASHRM conference
Healthcare Risk Management Review, ASHRM 2014, HRMR, High Reliability Organizations, PPACA
