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CPHRM Healthcare Op

CPHRM Healthcare Operations 2014

TRM vs. ERM Traditional RM – Reactive; Asset Preservation; Departmental/silos; Risk mitigation; Board/C-Suite vs. Enterprise RM – Proactive; Value creation; Organization-wide; Risk prevention; Clinician/staff
5 Steps in ERM Decision Making Process Identifying & analyzing; examining/evaluating; selecting; implementing; monitoring (I Eat Sugar In the Morning)
Key to RM Risk Identification
Main Reason for Grievance Process Patient rights
Formal Risk Identifications vs. Informal formal includes incident reporting; FMECAs; device reporting; security reports; QI reviews; Peer review; RCAs vs. informal includes claims data; MR requests; complaints; surveys; etc
Incident Reporting Definition any happening that is not consistent with the routine care of a particular patient or an event that is not consistent with the normal operations of a particular organization
Occurrence Reporting an unexpected patient medical intervention, intensity of care or healthcare impairment (not same as incident reporting)
Risk Analysis process severity; probability; and frequency
Risk evaluation/treatment strategies avoidance, retention, transfer
Risk Control stopping losses from happening or lessening the severity of the loss (risk avoidance, loss prevention, loss reduction, segregation, contractual or non-insurance transfer
Risk Avoidance never undertaking risk
Loss Prevention reduce an organization’s losses by lowering their frequency and reducing the possibility of a loss
Loss Reduction reduce the severity of the losses that occur
Segregation Separation (e.g., vehicles kept in different locations, different vendors used) or Duplication (e.g., computer back-up)
Contractual or non-insurance transfer commitment to act (leasing property, subcontracting); transferring both financial and legal responsibility
Risk Financing paying for losses once they occur
Key Elements of a Risk Management Program Authority; Visibility; Communication; Accountability; Coordination (AACCV)
Scope of RM Program Operational; Clinical/Patient Safety; Strategic; Financial; Human Capital; Legal/Regulatory; Technology
Who has ultimate legal responsibility The Board
Corporate liability of the board duty of care; duty of loyalty; fiscal responsibility; insuring/protecting the assets; environmental pollution; antitrust/anticompetitive practices; medicare fraud and abuse; preparedness for disaster/terrorist threat; credentialing
D&O Liability Prevention determine potential areas; assess degree of liability; implement corrective action
Benchmarking a comparative process used by organizations to collect and measure internal or external data that might ultimately be used to develop, implement, or sustain quality improvements
System Barriers to Benchmarking Technical; Structural; Psychosocial; Managerial; Cultural
Crisis/Adverse Event Management avoid crisis; management prep; early recognition; containment; resolution; learn from the crisis
Safety Program Factors Included equipment to reduce risks; based on mission, size, range of services; number of employee; accreditation certifications
Hazard Vulnerability Analysis Annual assessment of EOC
LSC Life Safety Code: Compilation of fire safety requirements, established by the National Fire Protection Association, and adopted, in part, by CMS
Provisions of LSC emergency alarm systems; emergency lighting; use of alcohol-based hand cleaners; automatic door-closing devices; exit signs; completion and submission of basic building information (BBI) form that provides designated patient or resident services
Emergency Management elements Prevention; Preparation; Implementation/response; Recovery
Emergency Management Requirements JC requires 2 annually; at least one drill involving the influx of real or simulated patients; tabletop drills DO NOT fulfill requirement; drills evaluated with identified concerns addressed
RFID Radio frequency identification; similar to barcode scanning
EPPA Employee Polygraph Protection Act: prevents employers from using lie detector tests, either for pre-employment screening or during the curse of employment
No-Fault Workers’ Comp System no matter who is at fault, it will be covered by employer
Human capital risks employee events and behaviors that occur that prevent employees from being on the job or being fully productive (leadership issues; work processes; employee attraction and selection; absence/health and wellness; employment practices; employee retention)
Effective Absence Management Program Components return to work programs; medical case management; absence reporting; disability prevention
Strategic Risks risks associated with the business focus and direction of the organization (contracts; vendor/third-party services; mergers/acquisitions/divestitures; partnerships/joint ventures and collaborative relationships; advertising)
Five legal essentials of contract reviews parties are competent; represents mutual understanding; there is a consideration; is documented in writing (if required for legal enforcement in the state); purpose or object is legal
Contractual risk transfer transferring or assuming financial risk; indemnification or hold harmless provisions
Contract Liability limitations waiver of subrogation rights; insurance requirements; insurer solvency
Evergreen Contract no written indication to terminate contract; AVOID
Stock acquisition normally the acquiring company assumes all legal liabilities
Asset purchase normally there is no transfer of liability
Successor liability the acquiring company can be held liable for the torts of the target company’s previous owners
Due Diligence Process Steps determine crucial info; assign responsibility for data gathering; organize information and analyze exposures; assess loss prevention and risk financing programs; evaluated effectiveness of RM P&Ps; express in summary form the key issues
Partnership voluntary contract to place their money, effects, labor and skill or some or all of them in lawful commerce or business, with understanding that there will be a proportional sharing of the profits and losses between them
Joint Venture a legal entity in the nature of partnership engaged in the joint pursuit of a particular transaction for mutual profit
Collaborative relationship those in which parties cooperate in an endeavor related to the needs of one or the other or both; no statutory or case law that governs liability of this relationship
Vicarious liability non-employees advertising as employees
Ostensible agency held liable for independent contractors
Estoppel claims consumer relies on advertisement to make decision
Created by: camellia