risk management in the opioid treatment dependence

30 slides
1.94 MB
826 views

Similar Presentations

Presentation Transcript

1

RISK MANAGEMENT IN THE TREATMENT OF OPIOID DEPENDENCEPresented by: Barbara A. M. Maloney, Esq.

2

GOALS1. Introduce MMTP practitioners to the elements of a Risk Management Program and its application to a methadone treatment program.2. Promote an appreciation of the need to make MMTP’s more attractive to the Insurance Market through the use of Risk Management tools.

3

WHEN ADVERSE EVENTS OCCURHuman CostThreat To Corporate ReputationLoss Of Consumer ConfidencePoor Employee MoraleTime & Expense Of Defending A ClaimIncrease In Insurance Premiums

4

Patient CareClinicalProceduralSCOPE OF RISK MANAGEMENT

5

Medical StaffCredentialingBusiness ArrangementsPeer Review/Quality Improvement ActivitiesScope Of Risk Management cont…

6

EmployeeInjuryDiscrimination/HarassmentWorkers’ CompensationScope Of Risk Management cont…

7

PropertyScope Of Risk Management cont…

8

FinancialDirector’s LiabilityOffice’s LiabilityCorporate LiabilityScope Of Risk Management cont…

9

Regulatory ComplianceScope Of Risk Management cont…

10

RISK IDENTIFICATION & ANALYSISIncident/Occurrence ReportsPatient ComplaintsMedication Incident ReportsAuditsGeneric Outcome ScreensCommon Risk Identifiers

11

Risk Identification & Analysis cont…The Grape Vine/Word Of MouthPharmacy and Therapeutic ReportsMedical Credentialing/RecredentialingHistorical Claims DataAccreditation & Regulatory Agencies

12

SETTING PRIORITIESFacts To ConsiderFrequency Of OccurrenceSeverity Of OccurrenceAnnual Dollar Amount Of Loss

13

External Economic FactorsCost Of Defending Potential ClaimsLoss Of Reputation In The CommunitySetting Priorities cont.

14

RISK PREVENTIONStrategic PlanningEducation - CompetenciesContracts Review

15

CommunicationRisk Prevention cont…

16

Risk Prevention cont…Communication cont…Consent to treatment is not a piece of paper

17

Risk Prevention cont…Communication cont…It is a process that must adjust to each patient and includes an exchange of information.

18

Risk Prevention cont…Communication cont…It is the responsibility of the provider to be certain a patient gives consent before care is given.

19
20

Risk Prevention cont…Communication cont…Disclosure: The new mantra from regulatory agencies and the law.

21

Risk Prevention cont…Communication cont…Disclosure: Is it really different from other patient interactions?????

22

Risk Prevention cont…ComplianceHIPPA 1996: Fraud is the knowing and willful execution or attempt to execute a scheme to defraud a health care benefit program to obtain by means of false or fraudulent representations or promises, any money or other property owned by a health care benefit program.

23

Risk Prevention cont…Compliance cont…False claims and fraudulent billingBribes, kickbacks, excessive or unreasonable discounts and rebates, and profit-sharing agreementsPayment to induce referralsMedical neglect of a patient

24

Enforcement Laws Risk Prevention cont…1977 Medicare-Medicare Anti-Fraud and Abuse Amendment to the Social Security Act, including the Anti-Kickback ProvisionsThe Criminal False Claims ActThe Civil False Claims ActThe Civil Monetary Penalties ActProgram exclusion of the Social Security Act

25

Risk Prevention cont…Enforcement LawsFederal Sentencing Guidelines: Provide for more lenient punishment for organizations that adopt effective programs for detecting and preventing criminal conduct.

26

Preventive MaintenanceClaims Loss Analysis Risk Prevention cont…

Browse More Presentations

Last Updated: 8th March 2018

Recommended PPTs