Non-payment for hospital-acquired illnesses is top risk management priority

So, as we move into 2010, what are the professional worriers worried about? Top challenges include coping with non-payment for hospital-acquired conditions, creating effective event reporting systems and integrating quality, safety and risk management processes, according to a new study from the ECRI Institute.

Two of their biggest concerns:

Non-payment for hospital-acquired conditions: Risk managers are working hard on processes like billing and documentation, to make sure payers aren't billed for hospital-acquired conditions and that records document conditions present on admission. To date, non-payments for such issues haven't been as big of a deal as feared, but risk managers are still on guard.

* Integrating risk management, quality and patient safety: In some facilities, these functions are "siloed"--sometimes reporting to different leaders--and risk managers must work to make sure everyone's aware of their joint needs. When patient safety is potentially compromised, risk managers are making sure they get involved, counseling and working on root-cause analysis.

Other headaches include demonstrating the value of their function (still, in this day and age?); planning in whatever ways possible for reform; handling investigations when patients complain and disclosing necessary information; getting doctors involved in safety and quality initiatives; rolling out EMRs; developing effective event reporting systems; and assuring Medicare secondary-payer reporting.

Reading between the lines, it seems that risk managers could stand to have more power than they do, particularly in a world where pay is tied closely to results. But if risk managers are still having to prove the value of their function, it seems unlikely they're going to get it anytime soon.

Get more information on this topic:
- read the ECRI study (reg. req.)

Related Articles:
U.S. Healthcare Quality Movement Stalls at a Critical Moment
Hospital Culture and Its Impact on Quality Care 
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