US healthcare is changing rapidly, and for the changes to be handled safely, risk managers need to be at the heart of the action. Judy Klein, president of the Ohio Society for Healthcare Risk Management, explains to HRMR why the risk management voice needs to be heard.
This is an era of rapid transformation in US healthcare, and in the view of Judy Klein, CPHRM, FASHRM, it is high time that risk managers’ voices were heard at the highest levels in their organizations.
“It is critical to ensure that risk management is represented at the management table or is part of the leadership in the organization, and that the risk manager receives continuing education in the field of risk management and patient safety to stay knowledgeable on evolving risk exposures and patient safety issues,” Klein says.
“This needs to be done to effect positive change, minimize risk, and improve the safety of our patients.”
She adds that current changes in US healthcare mean that healthcare risk managers are facing some big challenges. The present day risk manager must wear many hats, and with the federal government cutting funds to hospitals, many risk managers’ budgets have been impacted.
A broad view
Klein speaks with the benefit of 30 years in healthcare, including time spent working as a physician assistant, risk manager, and in professional liability insurance. She is currently a risk management manager for Coverys, one of the country’s leading medical professional liability carrier groups, as well as president of the Ohio Society for Healthcare Risk Management (OH-SHRM).
At Coverys, Klein manages a team of six risk consultants in the Midwest and Mid-Atlantic states, who provide risk servicing to Coverys’ insureds (facilities and physicians). She is also an active participant in the delivery of risk consulting services, which keeps her well connected to the front line issues encountered by Coverys’ insureds.
“It is very rewarding to work with such a dedicated team of professionals who all have various areas of expertise,” she says.
Topics of immediate concern to OH-SHRM’s members and Coverys’ clients are largely related to the current rapid pace of change—especially as it relates to cyber issues.
"When you take down the silos, talk about these issues and share outcomes, especially for things such as hospital-acquired conditions, the impact can be very positive for patients."
Klein lists the implementation of electronic medical records (EMRs), cyber security, the impact of audit trails and metadata on defending cases, telemedicine and the use of mobile devices as the top concerns for her clients.
“The most important thing we can do at Coverys, and for OH-SHRM members, is to provide them with timely and relevant guidance, resources and education on all of these critical topics,” she says.
The power of networking
Networking sits comfortably with Klein’s appetite for a changing, challenging environment. What she enjoys most is staying abreast of the changes in healthcare, networking, building relationships and helping others—Coverys’ staff and insureds—stay educated and on top of the changes.
She believes that networking and building relationships are vital activities because they allow risk managers to earn trust and get to the heart of the real issues that need to be addressed.
“When I meet with insureds I always make it a point to ask: ‘What keeps you up at night?’ One of the things I appreciate about what I do in my role at Coverys and for our insureds is to offer valuable risk management services that help address these concerns—by providing solutions to enhance patient safety and respond to risks related to the changes in healthcare.”
All of this is happening against a backdrop of increased use of medical services due to an aging population and changes to the way those services are delivered under the Affordable Care Act (ACA).
“These changes affect the job of the risk manager because with change comes the potential for new risk exposures, patient safety concerns, and the number and severity of claims,” says Klein.
Meanwhile, hospital consolidations and employment of physicians continue to affect the marketplace—and the work of risk managers—across the country.
Hospitals continue to acquire physician practices because provider collaboration is seen as a way to decrease healthcare costs and over-utilization. At the same time, hospitals are integrating into larger networks and those networks are looking for ways to expand their reach—for example, through health insurance networks.
Klein believes this process can have positive repercussions for risk management:
“I am seeing a greater emphasis on quality and safety. When you take down the silos, talk about these issues and share outcomes, especially for things such as hospital-acquired conditions, the impact can be very positive for patients and healthcare providers alike.”
However, she adds, since the ACA has enabled more individuals to obtain health insurance, there is the potential for risk exposures and claims to increase.
“The movement of physicians from solo practices to being part of large healthcare systems increases the level of exposure for those healthcare systems, and it can make the defense of claims more complex because there are more co-defendants and there is the potential to drive up the settlement amounts in those cases too.”
In the midst of healthcare reform, the role of the risk manager is evolving and new risks are emerging as US healthcare providers strive to meet consumer demands.
“We are seeing these changes happen at such a rapid pace that we really need to pay attention, provide educational opportunities related to those changes and proactively address the risk and patient safety exposures in those newly evolving areas,” says Klein.
In the brave new world of US healthcare, the number of beds is no longer a reliable measure of the risk exposure of a hospital: the new blueprint has more services, fewer beds and more outpatient care.
“We are going to continue to see care migrate to outpatient-based care in non-traditional settings such as retail clinics, remote care, and in-home care because that’s what consumers want.
“People want to use mobile apps and monitoring devices to send information such as their blood pressure or vital signs to their physicians—and we are going to continue to see more of that, along with an evolution of who is doing what in healthcare.”
Klein predicts that in the future, more of the work that is currently done only by physicians will be carried out by other individuals on the healthcare team—pharmacists, midwives or advanced practice providers such as physician assistants and nurse practitioners.
“Circumstances will push them to expand their scope of practice further as a means for healthcare systems to absorb all these millions of folks that now have insurance under the ACA and to offset the shortages of physicians—especially in these outpatient-based settings for what I call minor outpatient care.”
She warns, however, that continued changes in the roles of those individuals could create communication challenges that lead to risk and patient safety issues and claims.
“In my experience the role of an advanced practice provider might be less than clear to the physician and to that advanced practice provider, especially as it relates to criteria for referral or consultation, or protocols under which that advanced practice provider can operate.
“If there are no protocols in place around care directed or supervised by a physician and carried out by an advanced practice provider, this can create issues from a risk and patient safety perspective.”
She adds that there should be a periodic review of the care collaboration or quality review process, but that at present this is often lacking in many outpatient settings where advanced practice providers are being used.
The digital horizon
Another challenge—and opportunity—is the proliferation of EMRs, which are definitely here to stay, says Klein.
“We are seeing more hospitals sharing EMRs, and when they are functioning well it is a really great thing because it provides information to clinicians to help them make appropriate treatment decisions.”
“However, when they don’t work we’re often left with inaccurate EMRs or incomplete or out-of-date information in the patient record and that can lead to incorrect decisions in the way a provider treats a patient—which can ultimately lead to unsafe care or harm to patients.
“As risk managers we have to be mindful of missing data in EMRs or healthcare IT systems and to take a really proactive role in improving the system.”
With this in mind, Klein encourages healthcare providers to keep working to improve those systems, conduct chart reviews, and print out and review information.
“We need to continually educate our providers and OH-SHRM members on this topic. We know that plaintiffs’ attorneys are doing presentations on the use of the audit trails and metadata behind these EMRs and they want to use it to leverage their cases. It is being used in the discovery process and that consumes an awful lot of time and becomes very costly for our organizations and our providers.”
In addition to the proper use of EMRs, there is the ever-present specter of cyber crime, which comes hand in hand with the growing use of networking and smart medical devices in healthcare.
“We’ve all heard about patient information being stolen or hospitals that have to temporarily shut down some services because medical devices are infected with malware. These are evolving areas of risk exposures that risk managers now face.”
While increased connectivity can bring headaches, it can also be part of the solution: Klein’s firm belief in networking extends to the promotion of social media as an informational marketing tool among OH-SHRM’s membership.
“I wanted to build up connections between members and we’ve been able to do that by expanding our reach to members through avenues such as Facebook and Twitter. As a board we also saw a need to help develop and mentor those new to risk management, so we created a boot camp program for those new to the field.”
Always keen to keep up with the latest developments, Klein is also currently researching and developing an education program on Patient Safety Organizations (PSOs).
“There is a real need for this given the fact that some organizations may be required to join PSOs come January 1, 2017,” she says. “Many risk managers are still not aware of what a PSO is or the benefits of joining a PSO.”
Klein has provided education to Coverys’ staff and insureds on this topic, and OH-SHRM members recently heard a presentation on PSOs at the society’s fall conference.
Klein’s over-arching aim is to ensure that risk managers are properly equipped to help their organizations survive and thrive in this era of unprecedented change—and, she says, the risk manager’s role in ensuring these changes are handled safely should never be underestimated.
“We are currently facing an unprecedented opportunity for risk managers to emphasize how critical their role is in healthcare and in their organizations,” says Klein.
Judy Klein, Ohio Society for Healthcare Risk Management, US