conventus: keeping your patients & practice safe
DESCRIPTION
Presented by Susan Lieberman, Vice President of Risk Management for Conventus during the 2014 Practice Management Conference, this presentation outlines specifics on how healthcare practices can better safeguard patients and practices with practical risk management tips.TRANSCRIPT
<Confidential>1
TheFuture is Now:
Keeping YourPatients
& Practice Safe
NJ MGMA PMC 2014
<Confidential>2
The Landscape
Increasing Legislative & Regulatory Requirements
Reimbursement Uncertainties
New Payment Models
New Delivery Models
Physician Alignments
<Confidential>3
The Bottom Line
How Can We Achieve:
1. Practice profitability?
2. Lower cost?
3. Higher quality?
WITHOUTincreasing risk to patients and
providers?
<Confidential>4
Welcome to The New Healthcare Paradigm
Maximize Patient Care Time
+
Minimize EVERYTHING ELSE
=
Better Quality Care
+Decreased Risk
+Better Reimbursement
<Confidential>5
Get ready for Value-Based Purchasing
In 2016, CMS will apply Value-Based Payment formulas for Medicare fees All physician practices with 10+ eligible professionals Payments based on national quality of care and cost
of care benchmarks
Quality/Cost Low Cost Average Cost High Cost
High Quality +2.0x* +1.0x* +0.0%
Medium Quality +1.0x* +0.0% +1.0%
Low Quality +0.0% =1.0% -2.0%
*Eligible for an additional +1.0x if reporting clinical data for quality measures and average beneficiary risk score is in the top 25% of allbeneficiary risk scores.
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Practice Transformation
Risks
Operational
Clinical
Regulatory & Technology
MPL & Legal
Financial
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Types of Risk
Clinical
Malpractice & Legal
Regulatory & Technology
Financial
<Confidential>8
Clinical Risks
Allied Health Professionals Advance Practice Nurses Physician Assistants
Resources NJSNA Suggested Template – Joint Protocols for
APNs & Collaborating Physicians http://www.njsna.org/?33
NJ Board of Medical Examiners Regulations http://www.njconsumeraffairs.gov/chapters/Chapter%
2035%20Board%20of%20Medical%20Examiners.pdf
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Clinical Risks
Patient Engagement MU Stage 2 Patient Compliance Patient Experience
Patient Engagement Risks Patient Engagement Strategies
• MU Percentage • Do for ALL Patients
• HIPAA Violations • Secure Patient Portals
• Lack of Technology for Support
• Test Tracking & Follow Up• Patient Education Materials• Written Patient Instructions
• Lack of Care Coordination • “Care Coordinators”
• Misdiagnosis – NBC: “Doc’s Mistakes Affect 12 Million a Year”
• Care Coordination• Referral Follow Up• Test Tracking & Follow Up
<Confidential>10
Malpractice & Legal Risks
Health Insurance Exchanges More Patients = More Risk? Care Coordination = Less Risk?
EHRs Metadata Risks Transitioning from Paper to Electronic Hybrid Systems Sharing Passwords Templates Cloning Close-Outs
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Malpractice & Legal Risks
ACOs Disincentive to Provide Care? (Referrals,
Procedures) ACO v. HMO
Patient Care v. No Patient Care
New Physician Responsibilities Caregiver Assessments & Individualized Care Plans
Evidence Based Medicine Clinical Guidelines & Quality Metrics Changes the Standard of Care? PIAA (Physician Insurers Assoc. of America) Lobbying Efforts
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Malpractice & Legal Risks
ACO Questions1. Who is Running the ACO?
2. What type of insurance coverage?
3. Who is responsible for credentialing the providers?
4. Who will handle contract negotiations?
5. What happens if there's a claim involving EHRs & patient privacy?
6. Who is developing the clinical guidelines?
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Malpractice & Legal Risks
Practice Insurance Coverage 1. MPL (Medical Professional Liability)
2. Cyber Liability
3. Fraud & Abuse
4. EPLI (Employment Practices Liability Insurance)
Provider Alignments5. Beware of Restrictive Covenants
6. Contracts Address "Unwinding”
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Regulatory & Technology Risks
HIPAA Privacy AND Security Risk
Assessment Encrypt Laptops Breaches – Laptops AND Desktops!
Fraud & Abuse Feds cracking down on "Cut & Paste" in EHR Upcoding?
ICD-10 2015 – Yes or No?
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Financial Risks
Health Insurance Exchanges1. Check practice's participation for specific insurance plan
2. Can your practice accept new patients?
3. Check eligibility at each visit
4. Payment delays?Resource: AMA/MGMA – Medical Practice Checklist for 2014 ACA Implementation
Fee for Service v. Value Based Purchasing5. Volume v. Outcome
6. Patient Engagement
7. Population Management
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The Results
Increased reimbursements
Improved quality of care
Higher patient & staff satisfaction
Lower risk of malpractice
<Confidential>17
Contact Information
Susan Lieberman, MBAVice President, Risk Management
Conventus Inter-Insurance Exchange877-444-0484, x466