Running a medical practice involves more than just providing patient care. Regulatory requirements, financial management, staffing and human resources, technology management, marketing, supply chain, patient satisfaction, legal business matters, patient and staff safety, and facility management offers a short list of key aspects for the practice.
Physicians must also safeguard their practice from various risks to ensure for the practice’s longevity and success. The following are essential tips for protecting your medical practice from additional risks your practice might face:
01
With the increasing reliance on electronic health records (EHR), social media activities, and digital communications, protecting patient data from cyber threats is crucial. The very real potential for exposure also makes the need to do so essential. Within your practice, implement internal policies and procedures for requiring strong passwords, encryption, regular software updates, and employee training on data security protocols. The American Medical Association has curated resources and tips for physicians and health care staff to protect patient health records and other data from cyberattacks. Your broker and carrier will be able to assist with further guidance for the specific needs of your practice.
02
No licensee takes a Board of Medicine (BOM) complaint lightly. It can be an overwhelming and time intensive experience as well. Learning that a patient or their family members has made a complaint, no matter the reason still may be unsettling and disappointing, especially if the first time you learned of the concern was from a Board notification. The resulting impact and efforts to resolve such matters will likely be time consuming. Keep in mind that it is not uncommon that a board complaint precedes a more formal demand or malpractice claim.
A board complaint in many ways is similar to a civil complaint; a situation that does not have to be faced alone and should not be addressed in a reactive manner. From the risk management professionals’ point of view, board inquiries are a form of risk identification, a type of “early warning system.” For example, a request for medical records from the BOM may indeed be an alert to the possibility of an issue unfolding. Loop in your RM professional as they may be aware of a pattern, such as prior agency complaints about the same issue. Notify legal counsel, insurance brokers and carriers as they will offer additional direction and guidance. Also, validate with your insurance carrier or broker whether there are any exclusions or limits for your policy to cover defense costs in response to a board complaint.
03
In the work community, you can typically gather strength and access the necessary resources to navigate your practice. As with any relationship, nurturing those professional contacts is a much-needed step in creating your professional support network. It is important to note that the American Medical Association’s Code of Medical Ethics defines ‘disruptive behavior’ to include physicians verbally belittling others, making berating statements, using disrespectful language, and making inappropriate comments towards colleagues, peers, and other staff. Behaviors such as sharing conflicting information, blaming, shaming, and showing disrespect among professional colleagues are indicators of poor teamwork, which can be linked to higher patient mortality and lower staff well-being. When there’s a lack of collegiality and interprofessional respect, such negative energy may bleed over into the patient encounter, disrupt the team dynamic, and likely impact the outcome of the care rendered.
Avoid making unprofessional comments in the patient’s medical record, known as “chart wars.” These entries won’t help you in the long run and only highlight unprofessional conduct. Resolve disagreements outside the medical record and away from patients and the care team.
04
Stay informed about the latest regulations and guidelines in healthcare business compliance. The following lists a few laws that impact physician practices:
A general sampling of a compliance program is highlighted in the provided Office of Inspector General Compliance Program for Individual and Small Group Physician Practices. Establishing and following a compliance program will help physician practices avoid problematic operational practices and the resulting fraudulent activities. Conduct regular audits and provide staff training to ensure your practice adheres to all necessary legal and ethical requirements.
05
Depending on an organization’s structure, a Risk Management Plan (RMP) may be an independent document or incorporated into another plan addressing risk, patient safety and quality improvement. Creating an RMP requires a solid understanding of the key elements of risk that could impact your specific practice and specialty. Having that knowledge in hand will help support the development of business strategies and goals as well as educate staff about risk reduction strategies throughout the organization. Identify potential risks specific to your practice and develop a comprehensive risk management plan. This should include protocols for handling medical errors, patient complaints, and unexpected events like natural disasters or pandemics. As part of the RMP, invest in staff training. A well-trained and knowledgeable staff is crucial for a smoothly operating practice. Regularly schedule continuing education and professional development for your team to ensure they are up to date with the latest medical practices and technologies.
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Having a team of professional advisors is crucial for managing the business operations side of the physician practice.
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Accurate and thorough documentation is essential for protecting your practice against legal challenges and ensuring high-quality patient care. Implement standardized documentation procedures and conduct regular chart audits to maintain consistency and accuracy. Charting difficult encounters, such as medical mishaps, patient/resident violence, adverse event disclosures, non-compliance, and other challenging situations, can be tough. However, documenting a factual account in the medical record after a safety event or mishap, along with the organization’s response, provides a crucial record of the events.
08
Although medical malpractice insurance is the cornerstone insurance coverage that comes to mind, other lines of insurance are important. General liability, cyber liability, business property, business interruption, workers' compensation, employment practice liability (EPL), commercial auto, business income, umbrella/excess liability insurance are also important considerations. Utilizing the services of experts will help navigate the insurance programs available and current market landscape.
09
Building trust and strong relationships with patients can help mitigate risks that come as a result of personality clashes, clinical misunderstandings and service dissatisfaction. Encourage open communication, provide clear explanations of treatment plans, and prioritize patient education. According to the American Medical Association, “the patient-physician relationship is the cornerstone of the medical profession. Encounters between patients and their physicians are based on trust and give rise to physicians’ ethical obligations to place patients’ welfare above their own. Successful medical care requires ongoing collaboration between patients and physicians, a partnership in which both members take an active role in the healing process.” Like any relationship, effort from both parties can keep communication open and reduce the risk of negative outcomes. There are situations though when a relationship cannot be repaired, and a termination of the physician and patient relationship becomes necessary.
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Complaints and grievances are an early warning system. Use the information received from patients and family wisely. Complaints about clinical issues are often “a proxy for risk of lawsuits." These situations are not random or circumstantial. Patients underreport unhappiness with their healthcare, and although only 50% of unhappy customers complain to service providers, 96% tell at least nine friends or family members about a negative experience.
“Emphasis on patient-centered care has increased, as have calls for transparency of patient satisfaction data. These trends in healthcare make seeking and responding to patient feedback increasingly important components of risk management and patient safety programs.” Likewise, of your practice’s strategic business plan. Patients have the right to file complaints and grievances if they are dissatisfied with their treatment. Physician practices and ambulatory clinics should have processes in place to handle these promptly.
In addition, tracking and trending of patient complaints and grievances may call attention to systems or individual performance problems and suggest quality improvement opportunities. Just like Medical Board complaints, complaints and grievances can set the stage for lawsuits when they are not resolved promptly and left to fester.
In closing, reducing risks in a physician practice involves implementing comprehensive strategies that address patient care, employee safety and operational vulnerabilities. Financial and legal risks can be mitigated through diligent billing practices, thorough documentation, and maintaining appropriate malpractice insurance. Establishing a robust patient communication system, including clear informed consent procedures and a system for handling patient complaints, further reduces the likelihood of disputes and enhances patient satisfaction. Regularly reviewing and updating these risk management strategies ensures that the practice remains proactive in addressing potential threats.
By taking these proactive steps, physicians can protect their medical practice from potential threats and ensure its continued growth and success.
Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).
