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RAISING RISK MANAGEMENT'S VOICE
One of ASHRM’s strategic goals is the development of our “voice,” which is concerned with advancing the risk management profession through advocacy and collaborative relationships. To accomplish that goal, ASHRM leadership continually identifies and advocates issues that critically affect the field of healthcare risk management.
Here is a summary of recent efforts to raise the profession’s voice.
Infection control group learns about risk management
ASHRM Past President Paul Smith represented ASHRM June 14 at the
Association for Professionals in Infection Control and Epidemiology (APIC) board of directors meeting in Denver.
In an informational presentation, Smith explained the role of healthcare risk management professionals in developing and implementing safe and effective patient care practices, the preservation of financial resources and the maintenance of safe working environments.
He described ASHRM’s education programs, advocacy initiatives, publications and interactions with leading healthcare organizations and government agencies. He highlighted the work of the ASHRM Foundation in providing scholarships and grants for education and research.
APIC board members suggested to Smith that infection control professionals (ICPs) needed a better understanding of the risk management role in healthcare so that they might know how to best work with risk management. A matter of specific interest was guidance in preparing for depositions and other legal processes.
Another discussion centered on infections and sentinel events, and how to determine whether a patient’s infection is the root cause of the patient’s death or impairment or merely represents a co-morbidity.
APIC is a Washington-based association with nearly 12,000 members including nurses, epidemiologists, physicians, microbiologists, clinical pathologists, laboratory technologists and public health practitioners. Their stated mission is to improve health and patient safety by reducing risks of infection and other adverse outcomes. Janet Frain, RN, CIC, CPHQ, CPHRM, is serving as president.
The June 14 board meeting was held during the association’s annual conference, which Smith attended as a guest of APIC.
Dialogue reviews pan-flu preparedness
Representatives of governmental, legal and healthcare entities shared strategies for implementing community pandemic influenza preparedness during a public interest dialogue in Washington.
“A Prescription for Preparedness” on May 2 explored practical solutions to be incorporated in the American Health Lawyers Association (AHLA) Public Information Series Publication, “Community Pan-Flu Preparedness: A Checklist of Key Legal Issues for Healthcare Providers.”
Session participants, including ASHRM’s Director of Risk Management Resources Krishna Lynch, identified gaps and implementation challenges not covered in the draft checklist and points for further exploration.
Keynote speakers included U.S. Department of Health and Human Services (DHHS) Inspector General Daniel R. Levinson, who provided an update on national preparedness and response oversight efforts, and the Centers for Disease Control and Prevention’s (CDC) Director of the Coordinating Office for Terrorism Preparedness & Emergency Response Richard Besser. He reviewed current preparedness implementation challenges in the public and private sectors.
The final AHLA checklist will be disseminated to state, hospital, medical and bar associations with the hope of national implementation. Its release will be noted in ASHRM’s eNews.
Leaders explain no-charge implementation for adverse events
One hospital’s journey to develop policies and procedures for addressing non-payment for serious adverse events, the objectives behind these policies, the identification of possible triggering events, and the mechanics of non-payment were explored during a recent AHA Member Conference Call.
The June 24 call titled “Implementing a No-Charge Policy for Serious Adverse Events” featured Children’s Hospital and Regional Medical Center of Seattle Director of Risk Management David Stallings (a former ASHRM board member) and President and Chief Operating Officer Patrick Hagan.
They shared an algorithm for their Event Review Process and Serious Event Review Process, including a bill hold policy and online tool adopted by their organization.
They explained that the cornerstone of their success relies on continuous performance improvement through staff awareness of problems and solutions. This awareness is developed and maintained through a monthly patient safety conference series and an all-staff patient safety newsletter.
The AHA Member Conference Call series in which Stallings and Hagan presented is part of the AHA’s continuing effort to support hospitals in the implementation of a no-charge policy for patients and insurers for serious adverse events. A Feb. 12 AHA Quality Advisory titled “Implementing a No-Charge Policy for Serious Adverse Events” initiated this effort.
PRIMA meets ASHRM
ASHRM took its informational booth on the road in June for the Public Risk Management Association (PRIMA) Annual Conference & Exhibition in Anaheim, CA. The booth promoted ASHRM programs, products and networking opportunities to PRIMA members, who are risk managers at public entities such as state, county and city governments – many of which operate healthcare facilities.
HEALTHCARE RISK MANAGEMENT COMPENSATION SURVEY
Thanks to great participation in its first six months, ASHRM’s exclusive online compensation survey is now offered via subscriptions to meet individual information needs.
The survey allows searches by criteria such as job title, professional level/responsibility, geographic area, responsibilities, company full-time employees and more. Data include base salary, total compensation, age, raises, years in position and more.
All participants who set up an account with username and password and complete the survey, which is hosted on a password-protected Web site, will continued to be entitled to receive one free basic report including professional level, geographic area, base salary and more. Now, paid subscriptions enable users to select additional criteria for more detailed individually customized reports.
The newly available subscription options are:
One-day unlimited report run: All available compensation data can be downloaded for one day. This option is designed for consultants and individuals requiring extensive and detailed information to meet a specific need.
One-year unlimited report access: All available compensation data can be downloaded for one year. This option is designed for corporations, researchers, consultants and individuals requiring extensive and detailed information to meet ongoing needs.
Visit the eNetrix site to set up a risk management compensation survey account.
AUDIO PROGRAMS CAN BE ACCESSED ON DEMAND
Those who were unable to attend ASHRM’s Aug. 12 audioconference,“Understanding and Implementing the 2009 Patient Safety Goals,” have another chance. Recordings of ASHRM audioconferences and Webcasts are offered online, on demand, within 48 hours of the programs.
This convenient benefit enables ASHRM members to listen and learn at their convenience with no waiting for a CD recording to arrive. (CD recordings will continue to be available.) On-demand access includes the entire original program and immediate access to a printable, electronic version of handouts. Pre-registration for on-demand access to upcoming programs is available, also. Original purchasers get unlimited viewing/access for 30 days from the date of purchase or the program, whichever is later.
ADDRESSING THE INPATIENT PROSPECTIVE PAYMENT PLAN
ASHRM on June 13 submitted its comments to the Centers for Medicare & Medicaid Services (CMS) on the Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year Rates.
Following are excerpts from ASHRM’s comments.
We appreciate CMS’ commitment to increased quality and efficiency of care articulated through the value-based purchasing program. While we support the inclusion of conditions that are reasonably preventable through the application of evidence-based guidelines, we are concerned that the hospital-acquired conditions (HAC) candidates are not reasonably preventable and not entirely evidence-based, as stipulated by the statutory criteria.
Merely labeling recommendations as “evidence-based” does not ensure a high degree of reliability. Saying a particular recommended intervention is evidence-based should be the beginning – not the end – of the discussion. Furthermore, many of the HAC candidates present challenges in the ability to determine whether they were present on admission.
We are also concerned that this expansion of HACs is premature, as there is insufficient experience with the current list. The healthcare industry continues to implement the initial HACs, which required a major change for hospitals, physicians and coders. Commercial insurance carriers are also implementing the changes in their systems and are following CMS’ lead in refusing to reimburse hospitals for the established HACs.
We request more time to learn from this first phase of eight HACs before moving to the next phase. Therefore, we do not support adding the nine conditions:
Surgical Site Infections following elective procedures: Adding surgical site infections (SSI) to the list of HACs will punish practitioners who incorporate every best practice but whose patients develop infections due to reasons beyond their control. Making SSI a HAC is inherently punitive and runs counter to the positive goal of reducing the risk of SSI.
Legionnaires’ Disease: Outbreaks of Legionnaires’ Disease have been infrequent and the unreliability of evidence-based recommendations is exacerbated when the sample size is so small. The CMS summary observes that Legionnaires’ Disease is typically acquired outside the hospital setting and may be difficult to diagnose as present on admission (POA). Adding this to the list of HACs does not meet the statutory criteria for HACs (high cost, high volume, or both).
Glycemic Control: Every patient’s physiology is unique and it is difficult to manage and/or initiate blood glucose controls. Factors such as dietary changes in the hospital setting, IV fluid management, response to medications, poor compliance, new diagnoses and drug use can exacerbate these conditions. We question how patients would be classified as “out of range” and how tight the parameters will be. We are concerned that no additional reimbursement will be provided when these conditions are not POA.
Iatrogenic Pneumothorax (IP): Although many forms of IP are preventable, some patients may be inherently at risk for a pneuompthorax because of underlying pathologies. Therefore, the ability to prevent this condition is questionable.
Delirium: CMS’ statement that “well-established practices such as reducing certain medications, reorienting the patient, assuring sensory input and sleep and avoiding malnutrition and dehydration, prevent 30-40 percent of the possible cases” is simplistic. It is difficult to know whether a patient is delirious until delirium happens, and there are many causes. We also question the existence of evidence-based guidelines that demonstrate prevention rather than risk reduction.
Ventilator-Associated Pneumonia (VAP): The cause of ventilator-associated pneumonia (VAP) is unknown and it develops more than 48 hours after intubation. It is not an appropriate addition to the list of HACs because it is not reasonably preventable in a practical sense. Putting VAP on the list of HACs will punish practitioners who utilize all best practices but are nevertheless unable to prevent the development of VAPs. Rather, CMS should adopt a system that rewards practitioners who achieve the lowest rates of VAP.
Deep Vein Thrombosis (DVT/PE): There are many risk factors for patients developing DVT and nearly as many instances where anticoagulation therapy for these patients is contraindicated. It is questionable that DVTs and/or PE are entirely preventable conditions via evidence-based prevention guidelines. We urge CMS to adopt a system that rewards practitioners who achieve the lowest rates of DVT/PE.
Staphylococcus aureus Septicemia: A Staphylococcus aureus blood stream infection (BSI) is just one of several types of BSIs believed to be associated with entry of bacteria during an invasive procedure or contamination during care of catheters. All evidence-based guidelines are designed, as the CDC admits, to reduce the risk of septicemia. None of the recommended guidelines is foolproof.
Clostridium Difficile Associated Disease (CDAD): There appears to be a direct relationship between use of the few antibiotics effective to treat MRSA and “opening the door” for opportunistic bacteria, such as Clostridium Difficile. Indeed, Clostridium Difficile should not be added to the list of HCAs because the evidence-based guidelines do not address the major risk factor (such as prolonged use of broad-spectrum antibiotics, GI surgery and prolonged NG tube insertion).
Methicillin-Resistant Staphylococcus aureus (MRSA): We agree with CMS’ assessment that it is not appropriate to be classified as an HAC.
BEST-SELLING PATIENT SAFETY AUTHOR IS CONFERENCE KEYNOTE
ASHRM welcomes best-selling author Dr. Robert Wachter as this year’s headline keynote speaker at its Annual Conference in Boston.
A central figure in educating healthcare professionals and the public about safety issues in healthcare institutions, Wachter will share with his ASHRM audience some fascinating case studies to illustrate a broad range of errors and concepts. He will clarify the connection between patient safety and risk management in the areas of reporting systems, teamwork training, simulation and professional liability.
Wachter is sure to refer to his two popular and well-reviewed books on patient safety, Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes (2004) and Understanding Patient Safety (2008).
Wachter is Chief of the Medical Service and Founding Chair of the Patient Safety Committee at University of California-San Francisco Medical Center. He also serves as editor for two Agency for Healthcare Research and Quality Web-based initiatives, WebM&M and AHRQ Patient Safety Network.
Millions of Americans know Wachter as the go-to patient safety expert for popular news programs such as “Good Morning America,” “PBS NewsHour,” “CNN American Morning” and “CBS Sunday Morning,” and he is regularly quoted in top newspapers and magazines.
This year, Modern Physician magazine named him the 19th most influential physician-executive in the United States, the highest ranking academic physician on the list. He is on the board of directors of the American Board of Internal Medicine and is on the healthcare advisory boards of several companies, including Google.
Wachter’s program is one of more than 60 education sessions at ASHRM’s Annual Conference & Exhibition, Oct. 2-5 in Boston. The earlybird registration discount deadline is Aug. 22.
Important book at special price: Wachter’s latest text, Understanding Patient Safety , is available to ASHRM members at a special price while supplies last.
NEED FINANCIAL SUPPORT? ASHRM FOUNDATION HAS GRANTS
The last 2008 deadline to submit proposals to the ASHRM Foundation for education grants and scholarships is Sept. 1.
The grants will go to qualified individuals interested in continuing their education in clinical, legal and regulatory and/or risk financing aspects of risk management. The scholarship program offers financial support to students pursuing degrees in risk management, insurance, finance, clinical areas and healthcare management.
For proposal criteria and FAQs, visit the ASHRM Foundation web site.
Economic pressures and competing financial interests leave little funding for education at my rural hospital.
Fortunately, I was awarded education grants from the ASHRM Foundation which provided financial support to attend conferences focusing on quality, patient safety, risk management and compliance.
Now please join me in supporting the work of the ASHRM Foundation. Help make another risk manager’s dream come true.
-- Lucia M. Lajcsak, 2006 and 2007 ASHRM Foundation grants recipient
Make a difference: The ASHRM Foundation will sponsor a fund-raising luncheon 11:45 a.m-1 p.m. Oct. 3 at the Sheraton Boston Hotel. Tickets are $100 (minimum donation per person), $750 for a table of eight. Proceeds will support the work of the foundation. A portion of each ticket donation will be tax deductible. To RSVP, call (312) 422-3980 or e-mail ashrm@aha.org.
NEW CERTIFIED HEALTHCARE RISK MANAGERS
The Certified Professional in Healthcare Risk Management designation provides a credential that verifies a broad-based knowledge of risk management. Certification elevates professionals in an increasingly competitive marketplace. It is awarded based on participants meeting eligibility requirements and passing an examination.
Congratulations to recent CPHRM achievers:
Kathryn Louise Biasotti, South Lake Tahoe, CA
Darlene Scott Bryant, Brandon, MS
Sharmila Chandran, Pasadena, CA
Hunchu Chuey Kwak, Hartford, CT
Charla R. Craig, St. Charles, MO
Tori Michele Howk, Cumberland Furnace, TN
Paula H. Jenkins, Lafayette, LA
Kimberly Jean Lapointe, Brown Summit, NC
Janet P. Mangun, Staunton, VA
Julie D. Matheny, Omaha, NE
Traci L. McCullough, Knoxville, TN
Douglas Mitchell, Phoenix, AZ
Marcia Obara, Peoria, AZ
John Frederick Plant III, Columbus, OH
Judith Ann Richardson, Dayton, TN
Lisa Kaye Roberson, Ooltewah, TN
Violet M. Simmons, Windsor, CO
Tamara Lou Winkler, Henderson, NV
Katarina R. Wong, Centennial, CO
The growing list of CPHRM certificants – more than 1,174 as of June 30, 2008 – can be found at www.aha.org/certification (select the “Certificants” link on the left-hand side of the page).
For details about the designation, download the CPHRM Candidate Handbook.
Online assessment tool available
An online tool is available for preparing for the CPHRM Exam. Created by the AHA Certification Center (the people who created the exam), the Self-Assessment Exam (SAE) simulates the actual exam in format and content. The test offers rationales for correct and incorrect options, as well as several score reports that highlight the exam topics that they scored well in and those that need improvement.
How to apply for and schedule a test
CPHRM candidates who pay by credit card can apply for the exam online and schedule an appointment to test in one visit. This tool may be used for computer-based testing only. Visit www.goAMP.com, click on “Candidates,” select the “Healthcare” category, select the “AHA Certification Center” program, select the CPHRM examination application, select “Register for Exam,” log-in as a new user to create a certification profile, and follow the prompts to enter application information, eligibility and payment information, then schedule the exam. Note: When setting up an account: click on “Member,” then enter your ASHRM member number.
CPHRM exam prep course set for Oct. 1-2 in Boston
Risk management professionals who want to take the CPHRM examination or are eligible for renewal and need a refresher may benefit from ASHRM’s CPHRM Examination Preparation Course.
This overview of material corresponds to the content areas of the exam (detailed in the CPHRM Candidate Handbook, which can be downloaded from www.aha.org/certification) and can help test-takers focus on areas for further study or help them review once-familiar subjects.
The prep course will be offered Oct. 1-2 before ASHRM’s Annual Conference in Boston.
As a service to local chapters and other clients who want to support the professional development of their members or employees, ASHRM offers a locally administered CPHRM Examination Preparation Course. This is a convenient, cost-effective one-day version of the course provided by ASHRM.
The course requires a minimum of eight hours with a set agenda, 8 a.m.-5 p.m., for content delivery.
To simplify the process, ASHRM has set a standard administration fee for chapters of $2,700 to cover all specified support. The fee for client businesses is $3,500.
Learn how your chapter or company can host a local CPHRM Exam Prep Course. Contact Krishna Lynch at klynch@aha.org or (312) 422-3982.
