Is your practice the kind you want caring for your loved ones?

When most practice executives think of risk management, they think of committees, complex checklists and processes that cost money; they think of meetings, staff training and time wasted. The area of risk management, one of the eight domains in the Body of Knowledge (BOK) for Medical Practice Management, is actually much simpler than that. It is an integral part of the medical practice, which not only saves money if done well, but also results in greater efficiency. It can also protect a patient from harm and a physician from litigation.

We all employ aspects of risk management every day. We wear seatbelts, use potholders for hot pots and pans, and teach our children not to talk with strangers. It is simply part of who we are. The patient care systems in your practice should be just as engrained and intuitive yet still encourage independent judgment in the face of an unexpected event. The BOK addresses the need to establish a plan to manage adverse legal events, respond to disasters and comply with state and federal laws.

Legal aspects

I suspect we have all become accustomed to responding to legal requirements. It is an everyday occurrence in medical group practices. Part of the reason I went to law school as a working practice executive is because I spent so much time meeting with attorneys. I needed to be able to translate the legal advice I was getting into laymen's terms for implementation so that I could apply it to my situation. And while many people find this area of our profession frustrating, most practice professionals deal fairly well with professional liability and regulatory requirements because they understand the consequences of failing to do so.

The BOK also speaks to the development of a risk management plan to ensure a safe environment for patients, staff and visitors. This is where your patient care systems come into play. We all know we should do this, but it is the area in which practice professionals most often fall short. Sometimes it is because they believe the effort and costs outweigh the benefits. Sometimes it is because they just do not see the connection between efficiency and patient safety. However, neither reason could be further from the truth. The two are inextricably linked.

In my world as a risk management attorney, I review a lot of incidents and claims data and spend the vast majority of my time working with physicians and their staff to implement patient care systems. I understand that time-intensive and expensive systems are not realistic, and know firsthand that a simple system can have a huge impact because I have seen what results in patient harm and litigation. The Physician Insurance Association of America reports that approximately 28 percent of claims made against physicians result from office-based incidents, which is significant. When practice executives realize that many of those claims stem from contact and information flowing through their offices, it safe to say we have a tremendous impact on patient safety through our risk management programs. The No. 1 reason for these problems is a breakdown in communication. Our processes fail to support us and, as a result, things fall through the cracks.

I find the top reasons for office-based claims are related to issues with diagnosis and management, followed by medication errors. More simply stated, we do not track what is going on with our patients and we do not ask the right questions. We tell patients no news is good news but then we do not have a defined process in place to make sure the physician saw the test results. Patients are then left with a false sense of security when we do not call them. We routinely ask patients if their medications are all the same but do not confirm doses or follow those who require serial testing. We have no triage protocols in place. Patients are given refills month after month by staff who help physicians or we schedule patients complaining of chest pain for an appointment three days later because the policy is that everyone gets an appointment and that is the next one available. We assume patients who miss appointments are noncompliant instead of confirming whether they understand our directions and the consequences of their choices.

How does a busy practice executive deal with these issues?

You will find a multitude of free resources at mgma.com to assist you with improving your systems. There are articles, tools, checklists, ACMPE Fellow papers, white papers and links to other resources that are available as part of your membership. One of the tools I downloaded and used in my practice and still recommend to others is the Patient Personal Medication Record, a simple piece of paper that required no effort by my staff and told my doctors more about what our patients were taking than all the questions the doctors could have asked.

The Member Community is another free way to ask questions of your peers across the country and learn what they're doing that works. A patient safety eGroup already exists. I can guarantee someone has already solved one of your problems for you. From there, look to the educational offerings of your local and state MGMA affiliates as well the programs offered at the national level.

Here are a few suggestions to ensure that your risk management processes are part of an effective program: First, your physicians must buy in to the concept and support the plan. A physician-practice executive partnership goes a long way in sending a message to staff about priorities. Second, your staff members need to understand not only what to do but why they should do it. Every mistake your staff prevents is a life potentially saved and a lawsuit averted. Use those as success stories to underscore and acknowledge the importance of your staff's efforts. Third, include your patients in the process. Let them know they have a role in their care, whether it is instructions to call the office if they do not hear from you in so many days after a test or to simply bring all of their prescription bottles to their next appointment. Remember: No one is more concerned about their care than they are. Talking to them about their role also sends the message that you care, which will directly result in higher patient satisfaction. This is useful not only from the perspective of preventing litigation but will undoubtedly become a more important factor as our payment models evolve. Finally, remember that risk management is about establishing redundancies. If the doctor misses it, the nurse catches it, and if they both drop the ball, the patient picks it up.

When I hear practice executives and their staff members say they don't have time for all of that process stuff, I simply ask if they have time for a lawsuit. Do you have the time to deal with the family members who have lost a loved one because you missed an MRI report that did not come back or because a patient got the wrong dosage when you missed a medication change after a hospitalization? If those are not strong enough motivators, ask yourself what kind of practice you want taking care of your loved ones. Don't your patients deserve that kind of practice too?

Patient care systems

A critical component of medical practice management is the effective and efficient processes surrounding the patient encounter. How do you ensure that patients receive the best possible care, focus on patient safety and strive for efficient operations?

• Patient care systems in a medical practice includes the following:
• Establish and monitor business processes to ensure effective and efficient clinical operations.
• Provide relevant and accurate resources to enhance patients’ knowledge, understanding and participation in their medical care.
• Develop and implement a referral management process.
• Design efficient patient flow patterns to maximize physician schedules.
• Manage front office operations to maximize patient satisfaction, payment collections and customer service efforts.
• Implement a plan to control pharmaceutical supplies.