Risk managers are often spread thin and wear multiple hats—so, after the professional liability policy is bound, everyone forgets about it and moves on to the next thing. Michelle Foster Earle, president of OmniSure Consulting Group, suggests a better approach.
Healthcare risk managers work hard to identify patient safety hazards, assess the level and type of risk, control or remove potential harm and loss triggers, monitor risks and improve performance. Following are three mistakes risk managers make and how to avoid them.
Leaving money on the table
Most medical malpractice and healthcare professional liability carriers have money set aside to pay for clinical risk management services or to reimburse their policyholders for products and services designed to improve patient safety, reduce risk, and control losses.
However, many risk managers don’t take advantage of this fact because they narrowly equate risk management with carrier-driven onsite risk assessments or they forget that it’s there. That’s a mistake.
“Just as you wouldn’t walk away from thousands of dollars someone left you as an award or inheritance, you shouldn’t walk away from money from your carrier that’s just sitting there, waiting to be used,” says Kathy Fitzgerald, RN, BSN, former senior claims and senior risk management specialist for ProAssurance, and current independent consultant for OmniSure.
Afraid that the carriers are looking over your shoulders? Don’t be. Many carriers won’t even see the work product. According to Leo Carroll, senior vice president and head of healthcare for Berkshire Hathaway Specialty Insurance: “We’re interested in promoting maximum use of our risk management offering, so we are pleased to constantly expand relationships with experts to help customers meet their risk management needs.”
As a third party firm used by carriers, brokers, and policyholders to provide the services budgeted for, OmniSure Consulting Group has found in most cases carriers trust that their policyholders know where risk management resources are most needed and are therefore extremely flexible about how the money is spent, so long as it is provided or facilitated by a trusted risk management consulting firm.
Don’t think that there is any advantage to letting the budgeted funds sit there. You won’t pay less next year for ‘saving’ the carrier money. If anything you’ll pay less next year in the way of risk management credits to your rates if you do spend it on patient safety, quality, and risk management consulting. It’s truly a case of use it or lose it.
Endurance, Berkley Select/Nautilus, Berkshire Hathaway, Markel, One Beacon, IronHealth and many other carriers offer risk management reimbursement. Best advice: use it.
Failing to delegate and hold partners accountable
Probably the single most common reason risk managers leave money on the table that could be used to help fund risk management and patient safety initiatives is that they are just too busy. Risk managers are often spread thin and wear multiple hats. So, after the professional liability policy is bound and the policy secured, often everyone forgets about it and moves on to the next thing, expecting that the other parties are going to make it happen.
The broker is off to the next big sale, the risk officer returns to the stack of projects on the desk, and the carrier waits for the phone to ring. No-one stops to read all the details about how to secure the services and money promised at the time the professional liability policy was secured or renewed. And no-one takes responsibility for making it happen.
This is where a risk manager can delegate and a broker can really shine by taking ownership and holding everyone accountable so things don’t fall through the cracks.
“We don’t let that happen to our clients,” says Beth Berger, who serves as the national resource for A.J. Gallagher’s Healthcare practice. “We take note of the carrier’s risk management budget and make sure we facilitate services the client needs or would be paying for anyway. It’s part of our stewardship process.”
Other brokers that have a similar system include Wells Fargo Insurance, which has Pamela Kirks, RN, and The Graham Company, which has Bette McNee, RN, who coordinate services on behalf of their companies.
Instead of hiring in-house staff dedicated to clinical risk management or risk management oversight, some brokers have a chosen a dedicated and highly specialized service partner such as OmniSure to facilitate services on behalf of the client.
According to Dave Garlitz and Rick Houze at USI: “It gives our clients access to a depth of expertise that you just can’t get with an in-house generalist and frees our people to do what we do best, which is to secure the best possible coverages.”
For OmniSure, this involves determining the healthcare organization’s needs and goals, holding the carrier accountable for what they have committed to, providing specialized support, and sometimes finding other outside resources to meet the client’s needs.
The service is not limited to retail brokers. Wholesale brokers who want to bring value to the transaction and strengthen relationships can do the same. Ben Newman at Ultra Risk Advisors, for example, negotiates risk management dollars for every account he places and then he delegates the oversight of that to OmniSure.
In some cases, OmniSure provides the service. In other cases, OmniSure helps facilitate and coordinate services provided by the carrier or other specialists. In all cases, the healthcare client gets valuable support, services, and funds, that improve patient safety and quality, reduce risk, and benefit the bottom line. That kind of positive experience is good for everyone and goes a long way to strengthen relationships.
Best advice: ask your broker to take responsibility for promised risk management funds and services by coordinating it themselves or calling a firm like OmniSure to facilitate it.
Going it alone during an adverse event
You’ve probably heard the saying that “there is wisdom in the counsel of many” but how often do risk managers find themselves alone in a tough situation because there’s no one who has the kind of experience needed, or the people they would consult have competing agendas, high fees, or a conflict of interest? That’s when using a risk management helpline provided as part of your insurance program can make all the difference.
Some carriers offer this service in house. Other carriers, knowing that clients might hesitate to call in order to avoid alerting the claims or underwriting department to a situation that has not yet become a claim, contract with a confidential, third party risk management firm.
Hopefully serious adverse events, unanticipated outcomes, or disastrous situations don’t happen often in your organization but handling these kinds of occurrences is an everyday event for OmniSure and a handful of other firms dedicated to clinical risk management. With a network of legal nurse consultants, attorneys, and legally informed clinicians, these firms take calls from healthcare clients all over the world every day with questions, difficult issues, and crises. Don’t go it alone. There really is wisdom in the counsel of many.
Best advice: call your helpline and get acquainted with its capabilities even before you really need it. And, if your broker hasn’t already arranged for a confidential third party clinical risk management helpline, ask for it, or get a new broker.
Use the service
Need some ideas on how to allocate risk management dollars provided by your insurance program? Below are some of the much-needed resources and services we have recently provided or funded.
Training and education
Concerned that physicians were not providing sufficient supporting documentation to justify specific billing codes, one hospital’s risk manager opted to have an OmniSure regulatory specialist speak to 100+ physicians at a lunch and learn about how best to ensure that their documentation was complete enough to support the codes used for billing.
This helped to protect the physicians and the hospital from adverse regulatory actions and financial penalties. A multi-state home healthcare organization asked for 10 quick tip videos on topics such as safe patient handling, patient privacy, hazards in the home, incident and near miss reporting, safe driving, etc, that could be sent electronically to employees in the field approximately once a month to keep patient and employee safety top of mind.
Think group training, webinars, videos, or other educational resources.
Policy, procedure, and forms development
A senior living corporation asked us to write condition-specific disclosure statements and informed choice agreements for their 60+ assisted living facilities. A correctional healthcare company expanding their services to include juvenile detention had OmniSure design policies and procedures for their contracted juvenile detention facilities in order to meet accreditation criteria.
A national group of medical spas owned and operated cosmetic surgeons asked our consultant to review and revise their policies and procedures for quality assurance, performance improvement (QAPI) and peer review.
Think policies, procedures, decision maps, forms, tools, organizational charts for patient safety, quality assurance and performance improvement.
Handbooks and guidelines
OmniSure sent 50 copies of Correctional Health Care Patient Safety Handbook: Reduce Clinical Error, Manage Risk, and Improve Quality by one of our independent consultants Lorry Schoenly, PhD, RN, CCHP-RN, to a client with nearly 50 sites. We also sent Reduce Lawsuit Risk: A QAPI Approach for Long-Term Care written by another one of our consultants, Carol Marshall, to approximately 15 continuing care retirement communities insured by a partnered risk retention group.
Think accreditation, customer service, regulatory insights, how-to guides, and publications designed to help you improve compliance, assure quality, and avoid lawsuits.
Issue-specific consults
“Can you help our healthcare staffing company set up specific protocols for high risk obstetrics?” “Could you review our addiction treatment facilities for any weaknesses related to professional boundaries and sexual abuse liability?” “Could you review our vendor agreements for potential risks?” “The carrier’s in-house consultant assessed our hospitals but what we also really need is a specialist that can help with the due diligence of an emergency medicine staffing group we’ve hired to manage our new freestanding emergency departments.” These are all examples of services needed by healthcare organizations and paid for by the carrier.
Memberships for your extended network
We have recently offered to extend OmniSure memberships to a client healthcare system’s network of non-owned physician groups, post-acute care providers, and mental/behavioral health partners. Although not insured by the healthcare system’s carrier, these affiliated providers impact continuity of care, can help reduce readmissions, and improve hand-offs. Granting them access to a confidential risk and regulatory helpline and a subscription for monthly setting-specific risk tips can go a long way towards enhancing teamwork and improve patient safety.
About the author
Michelle Foster Earle is the president of OmniSure Consulting Group, a risk management firm contracted by some of the nation’s leading medical professional liability insurance companies to help medical practices, hospitals, healthcare facilities and providers of health care and social services nationwide reduce risk, improve performance and avoid lawsuits. Foster Earle has earned designations in healthcare management, is a licensed general lines property and casualty agent in Texas, and is an Associate in Risk Management. She is also a frequent speaker and author for industry associations and publications. She can be contacted at: michellef@omnisure.com
OmniSure Consulting Group, Michelle Foster Earle, US, Crisis management
