Just Released: Risk Assessment — Important Information for Health Care Leaders
When it comes to identifying risk in health care settings, leaders need to be proactive and thorough. Questions we commonly hear include: Is identifying risk the same as a regulatory review or a mock survey? What is the difference? And most importantly, what should you look for when identifying potential risks?
A risk assessment is a proactive compliance tool used to detect, prevent, and correct risk and identify inappropriate practices. It can be clinical, financial or both. It is one of the 7 elements of a Corporate Compliance Program as defined by the Office of Inspector General or OIG.
While it is similar to a regulatory review or mock survey, a risk assessment is a broader look at compliance with not only regulation but also healthcare laws and practices related to Medicare fraud, waste, and abuse.
Also, remember that F895 requires facilities to have in operation an effective compliance and ethics program to prevent and detect criminal, civil, and administrative violations and to promote quality of care. Risk assessments assist facilities in meeting this requirement as part of their compliance and ethics program.
Risk assessments can be completed by the facility as part of its compliance and ethics program or by an unbiased third party for another set of eyes looking at facility compliance.
Leadership Considerations
Know the Difference: Risk Assessment vs. Regulatory Review vs. Mock Survey:
- Risk Assessment: A risk assessment is a broader look at compliance with not only regulations but also healthcare laws and practices related to Medicare fraud, waste, and abuse. It is a proactive tool used to detect, prevent, and correct risk and identify inappropriate practices.
- Regulatory Review: A regulatory review focuses primarily on compliance with specific regulations and requirements set forth by governing bodies such as CMS (Centers for Medicare & Medicaid Services) or state health departments.
- Mock Survey: A mock survey is a simulation of a regulatory survey conducted by an external party or internal team to assess compliance with regulatory requirements and identify areas for improvement.
Identifying Potential Risk:
- Leaders can identify risk by conducting regular audits, reviews of policies and procedures, analyzing incident reports, and staying updated on regulatory changes. This involves assessing potential risks to patient safety, quality of care, financial integrity, and compliance with regulations.
Consider Third-Party Risk Assessments:
- Opt to have an unbiased third party conduct risk assessments to provide an external perspective and ensure objectivity.
Implement Actionable Insights:
- The goal of identifying risk is to gain actionable insights that can be used to implement corrective actions, improve processes, and enhance overall compliance and quality of care.
By integrating risk identification into your overall compliance and quality improvement efforts, potential issues can be mitigated, ensuring a culture of compliance and overall patient safety.
Resources
Tune In! New PATHTalks Episode
Tune in to today’s episode of PATHTalks to hear from Pathway Health pros, Dan Billings, Chief Innovation Officer, and Robin Davis, Director of Regulatory and Reimbursement Services, as they discuss the importance of risk assessments for an organization itself as well as part of its compliance and ethics program. You won’t want to miss this one!
For deeper insights into the health care continuum and more, explore our other PATHTalks episodes today >