But I can tell you one thing – everyone must manage risk, even if it’s not in your job title. This is especially true within healthcare. Just because you do not work in the “risk management” department, this should not be seen as a missing part of your job responsibilities; it just comes in a variety of forms.
Across healthcare organizations, there are a number of activities that occur to ensure that risk is minimized:
Credentialing – Defines who a provider is. Credentialing includes a provider’s initial vetting, and ongoing verification of their competencies and requirements to practice medicine.
Privileging – Specifies what a provider can do in a clinical setting. Privileges are continuously updated based upon ongoing training, patient care delivery, and facility-specific capabilities.
Payer Enrollment – Initiates and sustains provider reimbursement eligibility.
Performance Monitoring – Performance monitoring measures how a provider has performed.
Peer Review and Evaluation – Focuses on improving quality, outcomes, patient satisfaction, and lowering costs.
Sanctions Monitoring – Ensures that providers are in good-standing with insurers and other institutions.
The aforementioned are ambivalent of a specific department within an organization. The “Risk Management” department does not own all of these tasks, nor are all forms of risk being addressed in the short list above. Instead, these activities occur on a continual basis to minimize risk. In addition, the most cutting-edge healthcare organizations have systems that store quality, billing, and performance data to drive these activities.
Why is this important?
One of the many specialized capabilities of risk managers is addressing specific instances where a risk case arises and determining cause, potential fault, and successful remediation. However, the Medical Staff Office, Legal, Quality, Patient Safety, HR, and a mixture of other departments may be involved in completing the other activities that try to minimize these instances. It is important for risk management to be a tenet of every department and employee at an organization.
It is less important to outline every possible instance of risk, than it is to recognize that risk management must be top of mind for all professionals within a healthcare organization. This will ensure that the processes and technology that drive the organization forward are appropriately aligned to proactively address potential issues in the future.
Therefore, risk management can be a case study for the variety of business functions within a healthcare organization where coordination and collaboration is critical.
