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CPHRM Healthcare Op
CPHRM Healthcare Operations 2014
| Question | Answer |
|---|---|
| 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 |
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