139 -Risk Management for Mental Health and Recovery Residences
Counselor Toolbox

 
 
00:00 / 57:52
 
1X

This course is available on-demand here: https://www.allceus.com/member/cart/index/search?q=Risk+and+Disaster+Management or as part of our Recovery Residence Administrator Training Program https://www.allceus.com/member/cart/index/product/id/619/c/

Objectives
What is Risk
~    The combination of the probability of an event and it’s consequences
Benefits of Risk Management
~    Provides a framework for consistent, quality services
~    Improves decision making, planning and prioritization
~    Contributes to efficient use/allocation of resources
~    Protects and enhances assets including reputation
Types of Financial Repercussions
~    Suits against the agency for:
~    Medical bills
~    Lost wages / earning capacity
~    Pain and suffering
~    Emotional distress and loss of ability to enjoy life
~    Property damage
~    Wrongful death
~    Punitive damages if there was negligence
~    Loss of funding
~    Loss of license
~    Loss of reputation (client base)
Classifying Risk
~    Consequences
~    High: Financial impact is likely to exceed Z;  Significant impact on the organizations ability to operate.
~    Medium: Financial impact is between Y and Z and will have a moderate impact on operational abilities (layoffs?)
~    Low: Financial impact is less than Y and will have a low impact on ability to operate.
Probability
~    High: 25% chance it will happen in a 12-month period
~    Medium: 25% change it will happen in a 10 year period
~    Low: Less than 2% chance of occurrence or Not likely to occur in a 10 year period
Multiple Types of Risk
~    Strategic and Financial  (Keep $$ coming in)
~    Organizational Objectives
~    Cash Flow
~    Service Market
~    Legal and Regulatory Issues
~    Employee Risk (Maintain Efficient Workforce/Reduce Turnover)
~    Workers Compensation
~    Termination
~    Burnout
~    Injury or Victimization

Types of Risk cont…
~    Technology Risk (Regulatory and Legal Compliance)
~    HIPAA/HITECH compliance
~    Meaningful use
~    Data Breach
~    Disaster (Data failure)
~    Patient Safety Risk Management (Regulatory and Safety Compliance)
~    Physical Environment
~    Interpersonal
~    Client/Client
~    Client/Staff
~    Destabilization

Common Suits Against Therapists for Patient Safety Issues
~    Boundary violations
~    Inappropriate or excessive self-disclosure
~    Dual Relationships
~    Using techniques without proper training (or licensure)
~    Deliberately using incorrect diagnosis to get insurance coverage or other funding
~    Inadequate documentation (paybacks)
~    Wrongful death
~    Breach of confidentiality

Common Suits Against Agencies
~    Sexual Harassment
~    Environment of Care (Safety)
~    Improper billing practices
~    Billing for services not provided
~    Unbundling
~    Waiving copays and deductibles
~    https://www.hollandhart.com/waiving-copays-and-deductibles
~    http://cbsbilling.net/ioi-copay.html
~    http://www.hcpro.com/REV-46459-2477/Beware-of-waiving-copays-and-deductibles.html
~    https://www.webpt.com/blog/post/legal-compliance-one-more-reason-to-collect-patient-deductibles-and-copays
~    Therapist malpractice
~    Wrongful termination / Civil rights
General Questions
~    Based on information provided from other resources, managers should conduct analyses to determine potential risks. The analysis should identify:
~    What could possibly happen?
~    How likely is something to happen (measuring risk)?
~    How severe will the outcome be if something did happen?
~    How can the likelihood something will happen be mitigated on the forefront?
~    What can be done to reduce the impact (and to what degree)?
~    What is the potential for exposure or what cannot be proactively avoided?

Example: Slip and fall inside; slip and fall on stairs leading into the office
Prevention
Risk Analysis
~    A systematic approach to evaluating risks to business operations and patient safety
~    Start with one area, i.e. Environment of Care.
~    Identify all possible risks based on personal knowledge and historical research
~    Classify risks based on probability and consequences
~    Develop a plan to address/remediate risk
~¬†¬† ¬†Ensure a budget for ‚Äúrisk funding‚ÄĚ
~    Ensure all individuals are aware of their responsibility for risk reporting and management
~    Regularly audit for risk management compliance
~    When an event occurs, review whether risk management policy mediated risk.
Policies and Risks They Address
~    Agency has a written code of ethics
~    Staff/Client environment of care
~    Agency carries general liability insurance
~    Personal injury
~    Damage to property (Client’s or Act of God)
~    Comply with State and Federal guidelines and the guidelines of payors
~    Financial Risk (fines/closing/criminal charges/loss of funding)
~    Reputation
Policies and Risks
~    Clearly identify staff qualifications and their duties
~    Environment of care (reduce frustration, grievances and abuse reports)
~    Support guidelines for termination
~    Ensure environment is free of alcohol and drugs via policy, possibly including contraband search and random drug screens
~    Drug free workplace/Worker’s compensation
~    General liability
~    Client relapse/overdose
~    Needle sticks

Policies and Risks
~    Collect and report accurate process and outcome data (intakes, length of stay, successful completion, unsuccessful terminations, AMAs)
~    Reputation/Strategic Positioning Agency and the Field
~    Funding
~    Accounting system documents all monies owed, billing, payments
~    Policy to address nonpayment of fees
~    Cash flow
~    Ethical complaints/reputation
~    Prevent client abandonment

Policies and Risks
~    Client rights and emergency procedures (i.e. fire) posted in a conspicuous location
~    Reputation
~    Regulatory compliance
~    All staff certified in CPR and First Aid
~    Reputation
~    Regulatory compliance
~    Staffing Plan
~    Regulatory compliance (staff to client ratio)
~    Continuity of care
~    Clear description of admission criteria for each program including diagnosis, age, disqualifying issues (medical, criminal)
~    Safe environment of care for current clients
~    Defense against discrimination suits

Policies and Risks
~    Appropriate intake processes
~    Ensure a safe and supportive environment of care
~    Provides referrals as needed to ensure client stabilization
~    Client data is stored in compliance with HIPAA and HITECH regulations
~    Continuity of care
~    Regulatory compliance
~    Reputation
~    Orientation process for new clients
~    Communicates rights and responsibilities to ensure a safe environment

Policies and Risks
~    Handling missed appointments
~    Client destabilization/suicidality
~    Client dissatisfaction/reputation
~    Termination due to client drop out
~    Prevent complaint of abandonment
~    Prevent liability for suicide
~    Ensuring medication compliance
~    Ensure client stabilization
~¬†¬† ¬†An unclean environment can be considered breach of duty if a patient contracts an illness‚ÄĒmore applicable to group homes, residential and hospitals
~    Personal injury liability
~    Reputation of the agency and the Field

Policies and Risks
~    Agency should have a disaster response policy to maintain continuity of care in the event of a data failure or physical disaster (flood, sink hole, tornado)
~    How to access data at the remote location
~    Where clients are to go to receive treatment in the event of a physical disaster / displacement
~    Policy to address handling clients or potential clients in crisis if the therapist is out sick.
~    Policy to refer clients if the agency or a program therein should shut down
Did you know…
~    Health and safety inspections should include refrigerator temperature monitoring every week
~    A MSDS book should be on the premises and include data on all hazardous chemicals stored there.
~    Facilities are required by HIPAA to store data backups in a secure location in the event of local data failure
~    Many states have regulatory limits on client to staff ratios and guidelines for the number of sq. ft per client.
~    Level of Care Guidelines inform the agency what services must be provided to prevent possible paybacks and termination of provider contracts
~    To be effective, risk analysis surveys must be completed regularly and updated as the organization changes (i.e. addition of a new program)

More things to be aware of…
~    Employees should complete a training on emergency procedures (fire, flood, power outage, severe weather etc.) annually
~    It is a good idea to consider having a policy which clients sign regarding suspected drunk driving and/or attending treatment under the influence
~    Social networking and internet data (client or employee) has been used in legal cases and can significantly damage a company’s reputation…
~    Facebook
~    Instagram
~    Yelp
~    Google places
~    Health grades
~    InTheRooms.org

Summary
~    Risk Management involves not only professional and ethical risk, but also managing the risks at your facility.
~    Risks can come in the form of:
~¬†¬† ¬†Causing harm (directly or indirectly‚ÄĒLaw suits, reputation)
~    Breaking the law (criminal and or civil fines and punishments; reputation)
~    Violating regulatory codes (Temp/permanent shut down)
~    Failure to plan/adapt to funding changes (Loss of cash flow)
~    Effective risk management occurs regularly (at least annually) and is updated with agency changes or addition of new programs
~    Effective risk management reduces monies required for non-mission oriented purposes, manages reputation and prevents financial catastrophe.

By continuing to use the site, you agree to the use of cookies. more information

The cookie settings on this website are set to "allow cookies" to give you the best browsing experience possible. If you continue to use this website without changing your cookie settings or you click "Accept" below then you are consenting to this.

Close