Risk Management

Healthcare organizations identify and evaluate risks to promote safety and quality with patients, staff, and visitors within the organization. Risk managers in any healthcare setting work proactively and reactively to prevent incidents and minimize the damages post-sentinel event.

The Importance of Risk Assessments & Management Planning

Given that organizations face unique challenges, there is not a one-model-fits-all risk management solution. Data sets vary from provider to provider as does the collected data from each set. Our program includes providing sophisticated and automated push-technology to our clients as means to specify data sets to collect and analyze measurable performance improvement data, including that of risk management activities.

QPI’s HARP Light Technology is designed to identify your organization’s potential risk, similar to a SWOT Analysis, routinely. Our Risk Management team will effectively communicate with your organization’s leadership team regarding issues that are monitored and evaluated regularly and will establish a risk assessment plan, PDCA, CAP or RCA, as applicable.

Risk Manager Responsibilities (at-a-glance)

Payor Requests

Regulatory Training

Access to QPI's Legal Counsel

Reporting Tools

Our Risk Management team is dedicated to facilitating assessments and reports virtually on a quarterly basis.

Complaint and Grievance Reporting

Reality: Not everyone is happy. Not every patient will provide a positive patient experience. Patients may verbally or formally submit a complaint/ grievance. QPI works with healthcare providers to obtain timely resolution for submitted complaints/ grievances, and assists with written notification of the resolution to the patient.

Complaint response and resolution due dates are auto-configured in Lavear and will populate as a daily task for Risk Management until the task is complete. When responding to a complaint/ grievance is necessary, our Risk Management team will work you for immediate resolution. This is done case-by-case.

Continued or habitual complaints/ grievances of the same nature, and unresolved complaints, will be discussed one-on-one with your leadership team and may result in QPI’s Chief Quality Officer’s issuance of a Notice of Non-Compliance to your organization.

Malpractice and NPDB Reporting

One of the largest risks that healthcare providers face is medical malpractice. Negligent acts or omissions that result in patient injury often prompt legal action.

While we work hard to collectively combat this from happening, we understand that these occurrences take top priority. QPI will work diligently with your organization’s leadership team and legal team to ensure appropriate responses and reporting have been completed and submitted.

Upon identifying any incident, including medical malpractice, QPI’s Risk Management Team will notify the National Practitioners’ Data Bank (NPDB) and assist in submitting applicable reports.

National Practitioner Data Bank Reportable Occurrences

Medical malpractice payments
Federal and state licensure and certification actions
Adverse clinical privileges actions
Adverse professional society membership actions
Negative actions or findings by private accreditation organizations and peer review organizations
Health care-related criminal convictions and civil judgements
Exclusions from participation in federal or state health care programs (including Medicare and Medicaid)
Other adjudicated actions or decisions

Annual Performance Improvement Report

Managing risks can be daunting. While large risks can occupy the majority of our time, often the smaller, recurring risks are forgotten. QPI’s series of Risk Management Activities collect federal, state, and commercial health insurance plans’ required performance measures such as Medical/ Patient Record Audits, Billing and Coding Error Logs, Patient Complaints, Adverse Events, and more on a weekly, monthly, quarterly and annual basis.

Data collected from Risk Management Activities are analyzed by QPI and reported back to you in an Annual Performance Improvement Report. This report provides a systematic process to monitor all service aspects of health care, as delivered to the patient by your organization. It includes an organized framework to identify opportunities to improve quality and patient outcomes.

For transparency, QPI compiles all performance measures found throughout HARP, year round, for a years’ end Annual Performance Improvement Report. QPI contacts your organization’s leadership team to review and approve all findings in this report, to discuss and identify methods for performance improvement as it applies to federal regulations, state statutes, accreditation standards, local laws and other regulations sanctioned by federal, state, and commercial health insurance plans.

The hazards of not preparing for potential issues can have significant, long-term effects. Neglecting to have comprehensive risk management plans in place can compromise patient care, increase liability risks, and result in financial losses.

Licensing, Privileging, Enrollment & Credentialing

Licensing is a formal process that utilizes an established series of guidelines to ensure that patients receive the highest level of care from healthcare professionals who have undergone the most stringent scrutiny regarding their ability to practice medicine. This assures the patient that he or she is being treated by providers whose qualifications, training, licensure, and ability to practice medicine are acceptable. QPI works with providers and organizations to maintain state and federal licensure renewals. Additionally, QPI works with providers to obtain and maintain privileges/ affiliations with local hospitals, etc. Credentialing ensures that all healthcare workers are held to the same standard. QPI monitors, obtains, and maintains all credentials for accuracy and continued care for uninterrupted patient care.