Risk Assessment Services FAQs
What is the purpose of the risk assessment?
The ultimate goal of the risk assessment is to help a medical practice identify and improve measures that will protect the safety of patients. By protecting patients, we avoid claims, and protect physicians and the medical practice.
Can the review be conducted off-site rather than during an on-site visit?
Some parts of the review can be conducted off-site. We can review any requested documents off site prior to the assessment (preferred) or after the assessment. Copies of medical records documentation may also be reviewed off-site if specific protections are established The written assessment report and risk management plan documents will be developed off-site.
How long will the risk assessment take?
Typically, a risk analyst will be in the medical practice an entire day for the data collection process. Writing the risk assessment report and risk management plan may take as much as four to five days.
How much of the Administrators’ time is needed?
Usually, the administrator or practice manager needs only to be available to discuss points listed in the administrative interview portion of the risk assessment agenda. This takes an hour to an hour and a half only. The risk analyst is able to perform most of the rest of the assessment without assistance. Some administrators prefer a staff member accompany the risk analyst during the tour of practice facilities. This tour is typically timed during off-peak hours, such as during the lunch hour, or before or after patient care is scheduled.
How much of the Physician’s time is needed?
Usually, the physician executive needs only to be available to discuss points listed in the physician executive / clinical interview portion of the risk assessment agenda. This usually takes less than an hour. The physician interview may be conducted via telephone or during a lunch break if preferred.
How much staff time is needed?
Very little. The risk analyst may wish to observe staff at work and may ask a few limited questions. Frequently, we find that staff or management have questions of their own. During the service and afterward, the risk analyst is always available to discuss risk management concerns or issues with staff, administration, or physicians.
Where will the risk analyst work?
Risk Analysts are able to work in virtually any environment. Most data collection is done using forms on computer or contained in a three ring binder. The risk analyst is used to being mobile and using any unoccupied work space that is not in the way of staff or patients. You do not have to provide a special office space for the analyst to work in.
How will the risk analyst protect medical records information in accordance with HIPAA? We protect personally identifiable health information (PHI) in accordance with HIPAA regulations.
Information is protected through a confidentiality agreement signed by the risk analyst that meets requirements of HIPAA 1996.
How will the risk assessment report be protected against discovery in legal action?
The practice will be asked to sign a document authorizing an internal Quality Improvement / Peer Review study of risk. This provides statutory protection in most States. We also have the ability to establish Attorney-Client Privileges if needed, to further protect documents. Most importantly, risk findings are carefully written in language that does not reference the care rendered any specific patient, does not establish a standard of care or expectation of a standard of care, and focuses on system improvements.
The reports and any report instruments generated in this study are considered required for insurance coverage and are deemed prejudicial by courts of law, and if requested as discoverable documents, are excluded from legal consideration due to the presumed prejudicial nature of the report.
Will Risk Analysts interfere with daily operations of the practice?
The risk analyst provides the risk assessment as a service to the practice. A paramount goal is to avoid interfering with patient care in any way. Each risk analyst is highly trained and experienced in both risk management and clinic management and operations. One criterion for becoming a risk analyst is to have worked for physicians and / or healthcare organizations. This helps our staff understand the complexities of clinic operations and patient care. The risk analyst works at the convenience of the practice and will alter the risk assessment agenda to meet practice, Physician, or patient needs.
How long will it take before we receive the risk assessment report?
The time between risk assessment and report completion may be as long as three to four weeks. Report preparation takes approximately a week. Following the completion of a report, it undergoes quality review, and is then issued to the practice.
How do we discuss report findings?
We welcome the opportunity to discuss report findings with you. This is usually accomplished through a conference call or personal visit after review of the report. The follow up process gives us an opportunity to fine-tune our understanding of your medical practice.
Will the risk assessment affect insurance premiums or availability?
The risk assessment is a service conducted in a collaborative partnership with the practice. It is not intended to be used to deny coverage or raise premiums. Actual claims and loss experience will typically determine premiums and coverage. The risk assessment report can be a means to educate underwriters about the activity of the practice that may limit or prevent future claims. This positive information can have a positive impact on premiums or coverage.
Can we challenge report findings?
Yes. We recognize the risk assessment is a ‘snapshot’ in time of the activity of a practice. The practice may feel the risk analyst did not see or understand some aspect of the practice. We recognize this is not a perfect process, and welcome the opportunity to discuss findings and recommendations with you. The more you help us learn about the practice, the better job we can do for Physicians, patients, and the medical practice.
Must we adopt recommendations made in the risk assessment report?
Only recommendations that clearly correct an immediate patient safety concern are considered mandatory. Any recommendation made will be provided in the interests of patient safety, physician and practice protection, but the practice is not required to adopt a recommendation. It would be helpful if the practice could provide an explanation of why recommendations are not adopted, so we can better understand the internal risk management process.
How often will a risk assessment be conducted during our policy?
Frequency of risk assessment visit requests will vary. We will always ask permission to complete a risk assessment, based on the needs of the practice. The practice may also request a risk assessment or risk management visit to address general or specific needs. Underwriters may ask us to schedule a risk assessment due to specific or recurring claims problems. We may also ask clients permission to schedule a follow-up assessment to measure improvement progress.
What does the Risk Assessment Service cost?
The HPIX Risk Assessment Service is provided at no cost to our members, but is subject to prior scheduling and risk analyst availability.
Non-members and organizations not insured by our companies frequently request risk assessment services on a consulting basis. We schedule these according to the schedule of assessments planned, and charge a reasonable fee plus travel expenses.
If you are a non-member interested in a HPIX Risk Assessment Service, please contact us for a direct quote. Quotes are based on an established fee schedule that is adjusted to meet the complexity and size of your organization. Actual travel time and expense is added to the base quote when billed.
Who do I contact for more information?
Please call or message:
D. Scott Jones, CHC, LHRM
Vice President, Corporate Compliance and Risk Management