Presented by Susan Lieberman, Vice President of Risk Management for Conventus during the 2014 Practice Management Conference, this presentation outlines specifics on how healthcare practices can better safeguard patients and practices with practical risk management tips.

1. <Confidential>1
The
Future is Now:
Keeping Your
Patients
& Practice Safe
NJ MGMA PMC 2014

2. <Confidential>2
The Landscape
 Increasing Legislative & Regulatory
Requirements
 Reimbursement Uncertainties
 New Payment Models
 New Delivery Models
 Physician Alignments

3. <Confidential>3
The Bottom Line
 How Can We Achieve:
1. Practice profitability?
2. Lower cost?
3. Higher quality?
WITHOUT
increasing risk to patients and providers?

4. <Confidential>4
Welcome to The New Healthcare Paradigm
Maximize Patient Care Time
+
Minimize EVERYTHING ELSE
=
Better Quality Care
+
Decreased Risk
+
Better Reimbursement

5. <Confidential>5
Get ready for Value-Based Purchasing
 In 2016, CMS will apply Value-Based Payment formulas for
Medicare fees
 All physician practices with 10+ eligible professionals
 Payments based on national quality of care and cost of care
benchmarks
Quality/Cost Low Cost Average Cost High Cost
High Quality +2.0x* +1.0x* +0.0%
Medium Quality +1.0x* +0.0% +1.0%
Low Quality +0.0% =1.0% -2.0%
*Eligible for an additional +1.0x if reporting clinical data for quality measures and average beneficiary risk score is in the top 25% of all
beneficiary risk scores.

6. <Confidential>6
Practice Transformation
Risks
 Operational
 Clinical
 Regulatory &
Technology
 MPL & Legal
 Financial

7. <Confidential>7
Types of Risk
 Clinical
 Malpractice & Legal
 Regulatory & Technology
 Financial

8. <Confidential>8
Clinical Risks
Allied Health Professionals
 Advance Practice Nurses
 Physician Assistants
Resources
 NJSNA Suggested Template – Joint Protocols for APNs
& Collaborating Physicians
 http://www.njsna.org/?33
 NJ Board of Medical Examiners Regulations
 http://www.njconsumeraffairs.gov/chapters/Chapter%2035%20B
oard%20of%20Medical%20Examiners.pdf

9. <Confidential>9
Clinical Risks
Patient Engagement
 MU Stage 2
 Patient Compliance
 Patient Experience
Patient Engagement Risks Patient Engagement Strategies
• MU Percentage • Do for ALL Patients
• HIPAA Violations • Secure Patient Portals
• Lack of Technology for Support • Test Tracking & Follow Up
• Patient Education Materials
• Written Patient Instructions
• Lack of Care Coordination • “Care Coordinators”
• Misdiagnosis – NBC: “Doc’s
Mistakes Affect 12 Million a
Year”
• Care Coordination
• Referral Follow Up
• Test Tracking & Follow Up

10. <Confidential>10
Malpractice & Legal Risks
Health Insurance Exchanges
 More Patients = More Risk?
 Care Coordination = Less Risk?
EHRs
 Metadata Risks
 Transitioning from Paper to Electronic
 Hybrid Systems
 Sharing Passwords
 Templates
 Cloning
 Close-Outs

11. <Confidential>11
Malpractice & Legal Risks
ACOs
 Disincentive to Provide Care? (Referrals, Procedures)
 ACO v. HMO
 Patient Care v. No Patient Care
 New Physician Responsibilities
 Caregiver Assessments & Individualized Care Plans
 Evidence Based Medicine
 Clinical Guidelines & Quality Metrics
 Changes the Standard of Care?
 PIAA (Physician Insurers Assoc. of America) Lobbying Efforts

12. <Confidential>12
Malpractice & Legal Risks
ACO Questions
1. Who is Running the ACO?
2. What type of insurance coverage?
3. Who is responsible for credentialing the
providers?
4. Who will handle contract negotiations?
5. What happens if there's a claim involving EHRs
& patient privacy?
6. Who is developing the clinical guidelines?

13. <Confidential>13
Malpractice & Legal Risks
Practice Insurance Coverage
1. MPL (Medical Professional Liability)
2. Cyber Liability
3. Fraud & Abuse
4. EPLI (Employment Practices Liability Insurance)
Provider Alignments
1. Beware of Restrictive Covenants
2. Contracts Address "Unwinding”

14. <Confidential>14
Regulatory & Technology Risks
HIPAA
 Privacy AND Security Risk
Assessment
 Encrypt Laptops
 Breaches – Laptops AND Desktops!
Fraud & Abuse
 Feds cracking down on "Cut & Paste" in EHR
 Upcoding?
ICD-10
 2015 – Yes or No?

15. <Confidential>15
Financial Risks
Health Insurance Exchanges
1. Check practice's participation for specific insurance plan
2. Can your practice accept new patients?
3. Check eligibility at each visit
4. Payment delays?
Resource: AMA/MGMA – Medical Practice Checklist for 2014 ACA Implementation
Fee for Service v. Value Based Purchasing
1. Volume v. Outcome
2. Patient Engagement
3. Population Management

16. <Confidential>16
The Results
 Increased reimbursements
 Improved quality of care
 Higher patient & staff
satisfaction
 Lower risk of malpractice

17. <Confidential>17
Contact Information
Susan Lieberman, MBA
Vice President, Risk Management
Conventus Inter-Insurance Exchange
877-444-0484, x466
slieberman@nipgroup.com
www.conventusnj.com