Risk Management Programs Comparison There Are so

Risk Management Programs Comparison

There are so many potential risks in hospital and HMO settings because of the nature of healthcare. Hospitals have a ton of regulatory laws to follow that are passed by federal, state, and local legal agencies. HMOs are health management organizations, which are smaller groups that aim to provide healthcare and insurance options for individuals who subscribe to their services and thus have similar risk factors to general hospitals. Federal agencies like the Centers for Medicare and Medicaid Services (CMS), the FDA, the Office of Inspector General (OIG) and the Department of Justice are all involved with constantly updating hospitals and other healthcare organizations, like HMO facilities, of the need to stay on top of various risks. Agencies like the FDA establish laws, while the Department of Justice provide a list of healthcare professionals who have committed crimes, "announces penalties, fines, and Corporate Integrity Agreements imposed on health care providers and related institutions" like HMO organizations and nursing homes (Moran, 2008). Thus, there are hundred, if not thousands, of risks that potentially plague hospitals and HMOs. These risks include violations in federal and local laws which come with penalties and fines and potentially harming patients with poor care which could come with additional penalties or civil law suits. All of these risks come with potentially damaging and costly ramifications.

In order to deal with these numerous risks, hospitals and HMO organizations have to have strong risk management programs. In order to ensure that such facilities are providing the best quality of care, "hospitals must develop and imp, ement a quality assessment and performance improvement program that will identify patient safety issues and reduce medical errors in hospitals" (Moran, 2008). These are ongoing programs that constantly review the quality and level of care provided by hospitals and HMO facilities through patient surveys and supervision processes. Moreover, hospitals and HMO facilities must keep an eye on physicians, who may be lacking in quality care but also receiving kickbacks from medical drug and equipment companies. This is a violation of the Stark Law, which may "lead to a denial or refund of payment, criminal liability, exclusion from federal healthcare programs, and/or civil monetary penalties" (Moran, 2008). Thus, hospitals must keep a keen eye on physicians and other staff through supervision and check in programs, where physician's performances are being monitored through monthly and annual performance reviews. Additionally, Program Safegaurd Contractors (PSCs) and Recovery Audit Contractors are used by hospitals and HMO organizations to help protect against overpayments. Thus, hospitals can focus on providing quality care and not worrying about overpaying for equipment and procedures. Hospitals also need to have appropriate dumping practices to ensure that they will not be fined for dumping medical waste inappropriately. Lastly, hospitals and HMO facilities must have a strong collections department to ensure that overdue bills are aggressively sought after. For smaller facilities, this task can be outsourced to third-party medical collections organizations for a small percentage of the bills being collected.