Kusserow on Compliance: Five major ambulatory risk areas

The Emergency Care Research Institute (ECRI) Institute analyzed 4,355 adverse events reported and found diagnostic testing errors pose the biggest risk to patients in ambulatory care settings with nearly half occurring in physician practices. Nearly half involved diagnostic testing errors with one fourth relating to medication safety and the remaining involving falls, security, and safety and privacy-related risks. The following risk areas were cited: 

Diagnostic testing errors. This is the leading cause of liability claims against primary care doctors and accounts for the highest proportion of payouts. Most of these errors involved laboratory tests. Other tests where problems occurred included imaging tests, pathology, and cardiology.

Medication safety events. Two-thirds of safety events were classified as wrong drug, wrong patient, or wrong time, the analysis found. Medication errors are a leading cause of malpractice claims in ambulatory care and can occur during any stage of the medication process. They are often the result of a series of failures within a system, the report said.

Falls. About half of the 800,000 hospitalizations from fall-related injuries occur in ambulatory settings in the exam room or waiting room.

HIPAA violations. Misunderstandings concerning HIPAA privacy and security rules prompted more than 350 HIPAA-related events to be reported to the ECRI Institute. The majority of these pertained to inadvertent disclosure of patients’ protected health information.

Security and safety incidents. Most such events involved verbal threats or disruptive behavior by patients or visitors.

Tips to Reduce Risks

 

  1. Provide decision support tools to assist in ordering the proper tests and monitoring processes for test tracking and follow-up.
  2. Standardized medication management procedures and create a policy directing how to report and manage safety events.
  3. Screen patients for fall risk at every visit, when a change in condition occurs and after a fall.
  4. Train staff on HIPAA Privacy/Security rules, particularly as they relate to disclosure of PHI.
  5. Train staff on what to do in the event of a violent incident and conduct monthly security and safety surveillance rounds.

 

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2019 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: New CMS proposed outpatient rules

The 2020 annual rule cycle has been active for CMS with several proposed rules in the outpatient prospective payment system (OPPS) area. Hospitals and health system executives should monitor these annual rules carefully for provisions that will affect their organizations’ operations. Among the significant regulatory rule proposals for hospital and health system executives are the following:

  1. Mandated disclosure of negotiated charges between health plans and hospitals for all items and services for about 300 “shoppable” services
  2. Proposed penalties which would be over $100,000 a year for noncompliant hospitals
  3. The addition of several ASC procedures
  4. The removal of total hip arthroplasty from the inpatient-only list for 2020, allowing the procedure to be performed on an outpatient basis
  5. Reduction of supervision level for hospital outpatient department from direct to general for hospital outpatient departments
  6. A requirement for prior authorization of certain outpatient department services.
  7. Continued payment reduction for 340B purchased drugs
  8. Increased per-day cost threshold for separate payment for certain outpatient drugs
  9. The establishment a prior authorization process for five categories of services that often may be cosmetic: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation
  10. Various updates to Hospital Outpatient Quality Reporting Program requirements

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2019 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: Choosing a location for investigation interviews

Regardless of whether you are conducting a debriefing of a complainant, interviewing a witness, or confronting a subject in an interrogation, determining the location and setting of the interview is important. The objective is to create privacy and eliminate any possible interruptions or distractions. It should be conducted away from any traffic or other distracting influences, or where others may observe or overhear what is occurring. Interviewing someone in their own office should be avoided in that it invites interruptions or reasons why the person may turn their attention to some other matter. It also gives the interviewee the advantage of being on their “own turf.” By interviewing someone away from their own area, the investigator receives an advantage. The following are some additional tips and considerations in deciding upon the interview location and setting:

1. Privacy. Fewer the people in the room, the better the results
2. Quiet. Don’t want external sounds or outsiders to hear
3. Room Size. Small enough to convey intimacy
4. Well Lighted. Permits closer observation of individual
5. Plain. Avoid distractions (e.g. window, pictures, wall clocks, etc.)
6. Telephone. Shut if off to avoid incoming calls/messages
7. Furniture. Avoid having furniture in between (barrier to rapport)
8. Seating. Interviewer should sit directly across from interviewee
9. Positioning. Avoid the person being able to look out a window and not at you

It is recognized that there are practical constraints that may necessitate compromise on these considerations. Also, most interviews will be persons who are witnesses or who otherwise provide limited information. As such, many of these tips may not be necessary. However, if the person to be interviewed is the subject of the investigation, applying these principles become important elements to successful outcomes.

 

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2019 Strategic Management Services, LLC. Published with permission.

Kusserow on Compliance: Health care waste estimated at $760 – 935 billion

25 percent of health care costs are due to fraud, abuse, and wast

More waste than the Department of Defense budget

The estimated cost of waste in the U.S. health care system ranged from $760 billion to $935 billion, accounting for about one quarter of the of total health care spending of 3.82 trillion, according to a study published in Journal of the American Medical Association by researchers from the Institute of Medicine. The study was based on 6 previously identified domains of health care waste. These waste estimates are larger than the entire U.S. Department of Defense budget of $693 billion.  The researchers further projected potential savings from interventions that reduce waste of 25 percent, equaling about $191 billion to $282 billion. The six factors included in their focus of waste were: (1) failure of care delivery; (2) failure of care coordination; (3) overtreatment or low-value care; (4) pricing failure; (5) fraud and abuse; and (6) administrative complexity. The study noted that the United States spends more on health care than any other country, with costs approaching 18 percent of the gross domestic product (GDP)—more than $10 000 per individual.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2019 Strategic Management Services, LLC. Published with permission.