RISK MANAGEMENT IN THE TREATMENT OF OPIOID DEPENDENCE

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

2. GOALS 1. 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 OCCUR Human Cost Threat To Corporate Reputation Loss Of Consumer Confidence Poor Employee Morale Time & Expense Of Defending A Claim Increase In Insurance Premiums

4. SCOPE OF RISK MANAGEMENT Patient Care Clinical Procedural

5. Scope Of Risk Management cont… Medical Staff Credentialing Business Arrangements Peer Review/Quality Improvement Activities

6. Scope Of Risk Management cont… Employee Injury Discrimination/Harassment Workers’ Compensation

7. Scope Of Risk Management cont… Property

8. Scope Of Risk Management cont… Financial Director’s Liability Office’s Liability Corporate Liability

9. Scope Of Risk Management cont… Regulatory Compliance

10. RISK IDENTIFICATION & ANALYSIS Common Risk Identifiers Incident/Occurrence Reports Patient Complaints Medication Incident Reports Audits Generic Outcome Screens

11. Risk Identification & Analysis cont… Pharmacy and Therapeutic Reports Medical Credentialing/Recredentialing Historical Claims Data Accreditation & Regulatory Agencies The Grape Vine/Word Of Mouth

12. SETTING PRIORITIES Facts To Consider Frequency Of Occurrence Severity Of Occurrence Annual Dollar Amount Of Loss

13. Setting Priorities cont. External Economic Factors Cost Of Defending Potential Claims Loss Of Reputation In The Community

14. RISK PREVENTION Strategic Planning Contracts Review Education - Competencies

15. Risk Prevention cont… Communication

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.

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… Compliance HIPPA 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 billing Bribes, kickbacks, excessive or unreasonable discounts and rebates, and profit-sharing agreements Payment to induce referrals Medical neglect of a patient

24. Risk Prevention cont… Enforcement Laws 1977 Medicare-Medicare Anti-Fraud and Abuse Amendment to the Social Security Act, including the Anti-Kickback Provisions The Criminal False Claims Act The Civil False Claims Act The Civil Monetary Penalties Act Program exclusion of the Social Security Act

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

26. Risk Prevention cont… Preventive Maintenance Claims Loss Analysis

27. RISK AVOIDANCE 1. Avoidance is a risk treatment strategy. If a given risk is too serious for the provider to manage or transfer, the procedure that gives rise to it may need to be avoided all together.

28. Risk Avoidance cont… 2. Minimization tries to reduce the severity of an event that has already occurred. For example, prompt incident investigation, duplicate records.

29. Risk Avoidance cont… 3. Transfer is shifting the risk of financial loss to another entity, either through contract or insurance.

30. CLAIMS MANAGEMENT Investigate Secure Equipment & Records Set Up Files Set Up Reserves Mandatory Reporting