Risk Assessment Services
Improving quality, reducing claims, and avoiding legal action is a win-win-win situation that benefits the physician, patient, and insurance company.
The on-site HPIX Risk Assessment Service (RAS) is an open, consultative and collaborative process, designed to put the experience of our risk analysts directly to work for our physician members in their own facility or practice.
Our goals are to seek ways to improve the safety of patients and protect physicians, staff, and medical practices.
The HPIX Risk Reduction Process: What is Involved?
Each HPIX Risk Assessment Service (RAS) is customized to meet the needs of the medical specialty and size of the organization involved.
The service usually begins with a brief meeting and interview with key members of management. This may include a leading physician, the administrator, risk manager, or others deeply involved in management and risk reduction. This meeting identifies or verifies key information helpful in analyzing the organization risk exposure in greater detail. Our dual-track process will validate implementation of identified processes during further discussions with physicians and staff members. Additional steps in the process include:
- Analysis of Claims History. A discussion or prior review of claims history seeks to identify proximate and contributory causes of claims and efforts made or needed to reduce future exposure.
- Patient Safety and Service. A review of patient communications, staff functionality and facilities allows analysis of patient flow, staff interaction, and operations.
- Defensibility of Documentation. Analysis of the structure of medical records allows assessment of the defensibility of documentation.
- Physician and Clinical Support Systems. A review of clinical processes focuses on the delivery of healthcare services and built-in patient safety mechanisms.
- Exit Conference. At the end of the day or later via phone conference, the risk analyst will provide management a verbal exit conference and discussion of topics likely to be addressed in the final report.
- Written Report and Real World Recommendations. Following analysis of data gathered during the service, a written report will be prepared for physician and administrative review. The report will focus on functional, easily implemented, and effective “real world” recommendations designed to reduce risk in the practice.
- Photography. Reports typically include photographs of those risk issues that can be visualized. This may include infection control, facility safety, and regulatory compliance issues. Photos will never be taken of patients or documents containing personal health information of patients.
- Follow-Up and Ongoing Service. The risk assessment service does not end with a report to physicians and management. Following receipt of the report, we will schedule a conference call or visit to discuss findings and recommendations and ongoing implementation support. A follow-up visit may be scheduled up to six months after initial implementation of findings.
- Presentation of Findings with CME Credit and National PIAA Claims Analysis. For large or complex organizations, a follow-up presentation can be scheduled that will discuss findings of the service and examine specialty-specific risks faced by the practice. This presentation relies heavily on our ongoing analysis of Physician Insurers Association of America (PIAA) national claims data that tracks over 350,000 closed claims in all specialties. Our specialty-specific presentations are certified for American Council on Continuing Medical Education (ACCME) Category 1 Credit™ for those physicians who attend the entire presentation. Presentation length and settings are coordinated in advance with physicians and management.
- Scope of the Service. The HPIX Risk Assessment Service has been recognized as one of the most comprehensive in the insurance industry. Approximately 550-600 elements of information will be collected or verified during the service, in addition to medical records review and analysis of previous claims. Specific, functional and useful recommendations for improvement are a hallmark of the service.
About The Risk Reduction Team
Our risk analysts are senior healthcare professionals with excellent communications skills and actual operations experience, including an in-depth understanding of how the business of healthcare works.
In addition to a high degree of experience and professional training, our risk analysts are experienced in working with medical practices of all sizes and specialties, hospitals, ambulatory surgery centers, emergency transportation providers, diagnostic imaging centers, medical reference laboratories, emergency and urgent care centers, hospital emergency departments, blood banks, medical device manufacturers, clinical trial research organizations, long term care, assisted living, and residential living facilities, and even stem cell research centers.
RAS Frequently Asked Questions (FAQs)
Who do I contact for more information?
Please call or message:
D. Scott Jones, CHC, LHRM
Senior Vice President, Claims and Risk Management
215-979-1545 (Office) or 904-294-5633 (Mobile)