Managing Risk in a Healthcare Enterprise

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IN A HEALTHCARE BUSINESS ENTERPRISE

EVERY BUSINESS FACES RISK

WHAT IS BUSINESS RISK?

EVERY BUSINESS FACES RISK

UNEXPECTED CIRCUMSTANCES

OF SUFFICIENT SEVERITY

TO MATERIALLY IMPACT A BUSINESS’

OPERATIONAL CAPABILITY

OR

FINANCIAL INTEGRITY

EVERY BUSINESS FACES RISK

UNEXPECTED CIRCUMSTANCES

OF SUFFICIENT SEVERITY

TO MATERIALLY IMPACT A BUSINESS’

OPERATIONAL CAPABILITY

OR

FINANCIAL INTEGRITY

EVERY BUSINESS FACES RISK

UNEXPECTED CIRCUMSTANCES

OF SUFFICIENT SEVERITY

TO MATERIALLY IMPACT A BUSINESS’

OPERATIONAL CAPABILITY

OR

FINANCIAL INTEGRITY

EVERY BUSINESS FACES RISK

UNEXPECTED CIRCUMSTANCES

OF SUFFICIENT SEVERITY

TO MATERIALLY IMPACT A BUSINESS’

OPERATIONAL CAPABILITY

OR

FINANCIAL INTEGRITY

EVERY BUSINESS FACES RISK

UNEXPECTED CIRCUMSTANCES

OF SUFFICIENT SEVERITY

TO MATERIALLY IMPACT A BUSINESS’

OPERATIONAL CAPABILITY

OR

FINANCIAL INTEGRITY

EVERY BUSINESS FACES RISK

UNEXPECTED CIRCUMSTANCES

OF SUFFICIENT SEVERITY

TO MATERIALLY IMPACT A BUSINESS’

OPERATIONAL CAPABILITY

OR

FINANCIAL INTEGRITY

UNEXPECTEDDOES NOT MEAN

UNFORESEEN

EVERY BUSINESS FACES RISK

MAINTAINING A SYSTEMIC PROCESS

TO IDENTIFY

AND

CONTAIN BUSINESS RISK

IS A CORE FUNCTION

OF MANAGEMENT

EVERY BUSINESS FACES RISK

MAINTAINING A SYSTEMIC PROCESS

TO IDENTIFY

AND

CONTAIN BUSINESS RISK

IS A CORE FUNCTION

OF MANAGEMENT

EVERY BUSINESS FACES RISK

MAINTAINING A SYSTEMIC PROCESS

TO IDENTIFY

AND

CONTAIN BUSINESS RISK

IS A CORE FUNCTION

OF MANAGEMENT

EVERY BUSINESS FACES RISK

MAINTAINING A SYSTEMIC PROCESS

TO IDENTIFY

AND

CONTAIN BUSINESS RISK

IS A CORE FUNCTION

OF MANAGEMENT

EVERY BUSINESS FACES RISK

MAINTAINING A SYSTEMIC PROCESS

TO IDENTIFY

AND

CONTAIN BUSINESS RISK

IS A CORE FUNCTION

OF MANAGEMENT

THE RISK MANAGEMENT PROCESS

A FIVE STEP ROUTINE

1. Discovery of Potential Loss Exposure

2. Evaluation of Likelihood and Severity

3. Selection of Control Strategy

4. Implementation of Control Strategy

5. Monitoring / Feedback / Correction

DISCOVERY OF POTENTIAL LOSS EXPOSURE

UNDISCOVERED LOSS EXPOSURES MUST NOT BE

DISMISSED AS A

“COST OF DOING BUSINESS”

DISCOVERY OF POTENTIAL LOSS EXPOSURE

UNDISCOVERED RISK

YIELDS

UNCONTROLLED RISK RETENTION

DISCOVERY OF POTENTIAL LOSS EXPOSURE

BE REALISTIC

NOT EVERYTHING THAT

CAN GO WRONG

WILL GO WRONG

DISCOVERY OF POTENTIAL LOSS EXPOSURE

FOCUS MANAGEMENT ATTENTION

ON THOSE UNEXPECTED EVENTS WHICH CAN CAUSE

MATERIAL DAMAGE

DISCOVERY OF POTENTIAL LOSS EXPOSURE

TYPES OF LOSS EXPOSURE

1. Property

2. Liability

3. Key Personnel

4. Net Income

DISCOVERY OF POTENTIAL LOSS EXPOSURE

USE ALL AVAILABLE RESOURCES

TO IDENTIFY RISKS

1. Internal Resources

2. Industry and Regulatory Resources

3. Insurers

4. Consultants

DISCOVERY OF POTENTIAL LOSS EXPOSURE

INTERNAL RESOURCES

1. Survey your own people

2. Consult your own history

3. Diagram your processes

4. Analyze your cash to cash cycle

5. Ask yourself “What if ………?”

DISCOVERY OF POTENTIAL LOSS EXPOSURE

INDUSTRY AND REGULATORY RESOURCES

1. Professional Societies like the American Academy of Dermatology

2. Guidelines Promulgated by your Licensure Boards

3. ASHRM – The American Society for Healthcare Risk Management (www.ashrm.org)

DISCOVERY OF POTENTIAL LOSS EXPOSURE

INSURERS

1. Professional responsibility carriers provide training courses and guidance

2. Property and casualty carriers also provide training and guidance

DISCOVERY OF POTENTIAL LOSS EXPOSURE

CONSULTANTS

1. Industry-specific consultants can bring experience and fresh eyes

2. Learn from the mistakes of others

3. Knowledge of control techniques

EVALUATE EACHPOTENTIAL LOSS EXPOSURE

DIMENSIONS OF RISK

1. Frequency

2. Potential Severity

3. Realistic Range of Loss

DISCOVERY OF POTENTIAL LOSS EXPOSURE

BE REALISTIC

NOT EVERYTHING THAT

CAN GO WRONG

WILL GO WRONG

EVALUATE EACHPOTENTIAL LOSS EXPOSURE

GOAL OF THE ANALYSIS?

IDENTIFY A PRACTICAL

RISK CONTROL STRATEGY

RISK CONTROL STRATEGIES

TWO CATEGORIES

1. OPERATIONAL

2. FINANCING

RISK CONTROL STRATEGIES

OPERATIONAL

1. Risk Avoidance

2. Loss Control

3. Combination

4. Transfers of Operational Risk

RISK CONTROL STRATEGIES

OPERATIONAL

1. Risk Avoidance

2. Loss Control

3. Combination

4. Transfers of Operational Risk

RISK CONTROL STRATEGIES

OPERATIONAL

1. Risk Avoidance

2. Loss Control

3. Combination

4. Transfers of Operational Risk

RISK CONTROL STRATEGIES

LOSS CONTROL

1. Prevention

2. Mitigation

3. Separation

RISK CONTROL STRATEGIES

OPERATIONAL

1. Risk Avoidance

2. Loss Control

3. Combination

4. Transfers of Operational Risk

RISK CONTROL STRATEGIES

OPERATIONAL

1. Risk Avoidance

2. Loss Control

3. Combination

4. Transfers of Operational Risk

RISK CONTROL STRATEGIES

TWO CATEGORIES

1. OPERATIONAL

2. FINANCING

RISK CONTROL STRATEGIES

FINANCING TECHNIQUES

1. Non-insurance financing transfers

2. Insurance

3. Retention/Reserves

RISK CONTROL STRATEGIES

NON-INSURANCE FINANCING TRANSFERS

1. Contractual Indemnification

2. Guaranties

3. Warranties

4. Common Law Indemnification

5. Contribution

RISK CONTROL STRATEGIES

NON-INSURANCE TRANSFERS

RISK FINANCING OBLIGATIONS CAN BE TRANSFERRED

FROM YOU OR TO YOU

RISK CONTROL STRATEGIES

NON-INSURANCE TRANSFERS

THE TRANSFER IS ONLY AS EFFECTIVE

AS THE FINANCIAL CAPABILITY OF

THE TRANSFERREE TO PAY THE BILL

RISK CONTROL STRATEGIES

FINANCING TECHNIQUES

1. Noninsurance financing transfers

2. Insurance

3. Retention/Reserves

RISK CONTROL STRATEGIES

INSURANCE

A risk financing technique

with a financially responsible partner,

but

with strings attached.

RISK CONTROL STRATEGIES

INSURANCE

1. Scope of Coverage

2. Adequacy of Amount

3. Conditions on Claim

4. Conditions on Payment

RISK CONTROL STRATEGIES

FINANCING TECHNIQUES

1. Noninsurance financing transfers

2. Insurance

3. Retention/Reserves

RISK CONTROL STRATEGIES

RETENTION/RESERVES

1. A decision to retain the financing burden of

a risk should be made only after carefully

evaluation.

2. No risk should be retained without

providing a specific and committed reserve.

THE RISK MANAGEMENT PROCESS

A FIVE STEP ROUTINE

1. Discovery of Potential Loss Exposure

2. Evaluation of Likelihood and Severity

3. Selection of Control Strategy

4. Implementation of Control Strategy

5. Monitoring / Feedback / Correction

IMPLEMENTATION OF THECONTROL STRATEGY

MAKE A PLAN

1. Document the risk you have identified and the evaluation

you have made.

2. Document the reasons for your selection of a control

technique

3. Assign responsibility and set deadlines

4. Follow through

THE RISK MANAGEMENT PROCESS

A FIVE STEP ROUTINE

1. Discovery of Potential Loss Exposure

2. Evaluation of Likelihood and Severity

3. Selection of Control Strategy

4. Implementation of Control Strategy

5. Monitoring / Feedback / Correction

THE RISK MANAGEMENT PROCESS

RISK MANAGEMENT IS A

CORE MANAGEMENT FUNCTION

THE RISK MANAGEMENT PROCESS

MAINTAINING THE ENTERPRISE RISK

MANAGEMENT PROCESS

IS THE RESPONSIBILITY

OF THE CHIEF EXECUTIVE OFFICER

Douglas O. GuffeyJaburg Wilk, PC3200 N Central Avenue, 20th FloorPhoenix, AZ 85012

602-248-1039dog@jaburgwilk.comwww.jaburgwilk.com

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