ASHRM 2011 Advocacy and Practice Issues Agenda
The American Society for Healthcare Risk Management (ASHRM) is an influential voice on issues related to healthcare risk management and patient safety across the continuum of care, regardless of setting.
ASHRM is aware of critical and emerging issues in healthcare risk management and patient safety. Based on the collective knowledge of experts in the field, ASHRM identifies opportunities to drive forward advancements in knowledge and advocates for changes in policy and practice that will result in safer healthcare. ASHRM seeks to establish relationships with other organizations focused on issues related to and affecting healthcare risk management and patient safety, to ensure that the unique risk management perspective is consistently included in ways that can improve results.
2011 ADVOCACY AGENDA
Legislation
Medical Professional Liability Tort Reform.
The H.E.A.L.T.H. Act would limit non-economic damages to $250,000. Some efforts have been made to address this issue, particularly at the state level, with 21 states receiving $25 million in federal grants to pursue solutions that will reduce/mitigate medical malpractice claims. (These discussions tie directly to the field of healthcare risk management, and ASHRM is committed to seeking resources that may be available to address these issues.)
Constitutional Challenges to PPACA
Risk management professionals also have concerns about the current climate at the state level with respect to some courts ruling that the current Healthcare Act is unconstitutional. Should these decisions be upheld, risk managers are concerned that uninsured patients will not have access to appropriate care. These conditions lead to increased healthcare costs as this large volume of patients seeks uncompensated care. Healthcare organizations will be forced to make difficult choices based on scarce resources.
Challenges Represented in Key Provisions of PPACA
As noted in the “ASHRM Health Reform Summary of Key Provisions” that was published in October 2010, Risk Management Professionals will need to monitor each component of this Legislation as it is enacted into law. Healthcare delivery system reform, quality and safety, and regulatory oversight and integrity are three key areas that will affect healthcare organizations, providers and employers. ASHRM will continue to promote heightened awareness of these key areas identified as potential risk exposures to healthcare organizations relating to the enactment of PPACA. ASHRM will provide action items and strategies to assist risk managers in successfully addressing these areas of concern. Please refer to this special report which can be found on the Advocacy page of the ASHRM website.
Regulation/Accreditation
Health Information Technology/Electronic Health Records
Risk Managers are also concerned about the implications of health information technology and electronic health records. The federal and state governments are making significant financial investments in the EHR, and private healthcare is also moving in the same direction. Policy makers and health administrators are expecting quality and efficiency gains through data access for the purpose of research and analysis, policy generation, health system planning, and resource management. While many benefits are anticipated, HIT and EHR also represent emerging risks. The key issues about which risk managers are concerned are: ownership and stewardship of data; privacy and consent; access to and accuracy of information; secondary use; meaningful use; and evidentiary requirements.
Risk management professionals are also concerned with other regulatory/accreditation issues including:
- Accountable Care Organizations (ACO’s)
- CMS requirements including:
- Health Information Technology – Meaningful Use (see above);
- Hospital Inpatient Prospective Payment System Rule;
- Value Based Purchasing; and
- Applicability of EMTALA
- The Joint Commission Standards and The National Patient Safety Goals
2011 Practice Issues
In addition to its specific advocacy agenda, ASHRM seeks to contribute to the knowledge base on practice issues related to healthcare risk management and patient safety. These contributions may involve partnering and collaborating with other organizations focused on issues of mutual interest. Top-of-mind practice issues (which may evolve into future advocacy opportunities) in 2011 include:
- Enterprise Risk Management
- "Healthcare risk management as a discipline that engages professionals in the practice of identifying, managing, controlling and monitoring all risks to the organization.
- Healthcare risk managers promoting the concept that enterprise risk management in an ongoing decision-making process that is instituted and supported by the healthcare organization’s board of directors, executive administration and medical staff leadership
- Healthcare risk managers recognizing the synergistic effect off risks across the continuum of care, and that ERM has as its goal to assist the organization to reduce the uncertainty and process variability, promote patient safety and maximize the return on investment (ROI) through asset preservation, and the recognition of actionable risk opportunities." (Enterprise Risk Management for Healthcare Entities, First Edition. American Health Lawyers Association, Washington, DC, 2009.
- Adverse Events/Serious Safety Event Reporting and Implications
- Never Events and Implications
- PSO Implementation/Challenges
- Data Analysis and Evaluation
- ASHRM continues to promote the appropriate use of data reporting to validate the need for change to assist organizations with value protection, reducing errors that cause patient harm and facilitating sharing of information and lessons learned.
- Transparency and Disclosure
- ASHRM served as an early champion of transparency and disclosure in healthcare, and continues to champion these efforts, particularly with respect to measuring the success of implementing such programs. Risk management professionals have embraced apology/disclosure and transparency in advancing patient rights, and enhancing claims mitigation. Some studies show this has had a positive effect in reducing the actual number of claims and dollar amounts being paid to injured parties. ASHRM is interested in other issues related to a positive patient experience and healthcare outcomes.
- Emerging Risks under Healthcare Reform
- These activities promote hospitals receiving appropriate payment for care that is effectively provided. For example, as the field moves to value-based purchasing, and focuses more on reported outcomes, transparency and disclosure pressures will become more acute. These mounting pressures can represent a source of emerging risk.
- New access to care may put additional pressure on the system and presents new risks (such as an increase in the current challenges of ER crowding and boarding, delay in diagnosis and treatment, access to primary care, increased use of MLPs, etc.)
- Risk Management Link to Organizational Outcomes
- ASHRM is interested in exploring the link between risk management and organizational outcomes (financial, operational, clinical, and strategic). ASHRM conducted a survey on risk management staffing practices in late 2009 and is currently partnering with HRET on an initial research project to build upon that “current state” survey by exploring the relationship of staffing and function to outcomes. It is anticipated that this will be an area of future research for ASHRM.
- Insidious Intimidation
- ASHRM is raising the issue of the significant threat posed by insidious intimidation to patient safety. This occurs through its impact on transparency and disclosure as well as the dynamics of the healthcare team.
- Social Media
- ASHRM maintains an awareness of emerging risks associated with e-mail communication, blogs, Facebook, Twitter, and YouTube from inappropriate disclosure, patient privacy and distractions in the workplace.
- Emerging Risk with Technology – radiation overdose, alarm hazards, cross contamination, breach in maintaining health record security, etc.
- Regulatory Survey Activity (whether more FTEs result in higher patient satisfaction, lower complaints and fewer surveys)
- Safety and Security Risks
- Safety and security risks are getting more attention in the current media, particularly in light of the recent Arizona shootings. Not only should risk managers be included on any organizational team looking at safety and security preparation, they should be facilitating and leading initiatives to address these issues whenever appropriate.
