AHLA Enterprise Risk Management Handbook for Healthcare Entities, Third Edition Co-published with the American Society of Healthcare Risk Management (AHLA Members)
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This third edition of the Enterprise Risk Management Handbook for Health Care Entities continues the exploration into Enterprise Risk Management (ERM) and addresses the need for and implementation of a risk management system that will assess and encompass the myriad areas of importance in the health care setting. The benefit to having a comprehensive risk management plan and process that encompasses the entire enterprise becomes more important every day.
• An overview of ERM and guidance on how to structure an ERM system
• Risk management in various settings, including contract management, compliance, environmental compliance, human research, peer review and credentialing, consent to treatment, and numerous others
• Insight on practical approaches to Health Information Exchanges and Electronic Health Records
• Medical identity theft
• Financial stewardship
• Adverse event reporting
This third edition of Enterprise Risk Management Handbook for Health Care Entities provides the information and resources needed to understand this unique discipline.
ABOUT THE EDITORS:
Editor in Chief
Sheila Hagg-Rickert, MBA, MHA, CPCU, CPHRM, DFASHRM, JD, (Chapter 2, Structuring an Enterprise risk Management Program; Chapter 23, A Do It Yourself Demonstration Project: Going Green as an ERM Process) is Senior Vice President and Healthcare Practice Leader-West for Willis Towers Watson based In Dallas, TX. In this capacity, she is responsible for insurance and risk financing program design and implementation and managing client service resources and capabilities for the firm's healthcare clients in the Western U.S.
Prior to joining WTW, Sheila served as the corporate risk management executive for both for-profit and not-for-profit acute care and long-term care health systems and as a healthcare risk management consultant. She has served on the board of directors for the American Society for Healthcare Risk Management and has presented and written extensively on healthcare risk management and health law topics. She serves as team leader for ASHRM's Advanced Forum Module of the HRM Certificate program and as faculty for its Enterprise Risk Management Certificate program and is a contributing author of the Risk Management Handbook for Healthcare Organizations, 1st through 6th editions and The Enterprise Risk Management Handbook for Healthcare Entities 1st and 2nd Editions, published by the American Health Lawyers Association (2009, 2013). She has served on the Boards of Directors of both captive and commercial insurers and the Texas Association for Patient Access. Sheila holds a JD from the University of Iowa and Master of Business Administration and Master of Healthcare Administration degrees from Georgia State University and has completed the Graduate Certificate in Healthcare Corporate Compliance Program at George Washington University. She has earned Chartered Property and Casualty Underwriter and Certified Professional in Healthcare Risk Management designations and is a Distinguished Fellow of the American Society for Healthcare Risk Management.
Roberta L. Carroll, RN, ARM, MBA, CPCU, CPHQ, CPHRM, LHRM, HEM,DFASHRM (Chapter 1, Enterprise Risk Management: What's It All About?) is Principal Consultant with RLC Consulting based in Odessa, FL. Previously, she was Senior Vice President for Aon Risk Solutions-National Health Care Practice where for 17 years she was a consultant specializing in the development and implementation of Enterprise Risk Management Programs for a wide variety of health care clients. Roberta has been active in healthcare risk management for over 35 years and has held senior level positions for provider based systems and facilities, and risk consulting firms. Roberta has held continuous membership in ASHRM since its 1980 inception, served on the Board for 6 years, was President in 1995/1996, and served as faculty for ASHRMs "Essentials" Module for 25 years and currently holds Faculty Emeritus status—an honorary position conferred by ASHRM. Most recently, she was a part time ASHRM/AHA employee tasked with advancing ASHRMs ERM initiatives (2014-2015).
Roberta is the Editor of the Risk Management Handbook for Healthcare Organizations (2nd, 3rd, 4th editions, and 5th and 6th three volume series) and the Student Edition of the Enterprise Risk Management Handbook (ASHRM 2009) and accompanying Faculty Guide (ASHRM 2009). She is the Editor in Chief of the 2nd edition of the Enterprise Risk Management Handbook for Healthcare Entities (AHLA 2013) and a contributing author. Roberta has authored numerous articles (Enterprise Risk Management: A Framework for Success-ASHRM 2014, Where we’ve been, where we are, and where we are going: A 35 year perspective on healthcare risk management-ASHRM Journal Q4 2015, Identifying Risks in the Realm of Enterprise Risk Management-ASHRM Journal Q1 2016)) and book chapters on ERM, most notably: Chapter 11, Enterprise Risk Management: The Impact on Healthcare Organizations, in the Principles of Risk Management and Patient Safety (2011): Chapter 1, Enterprise Risk Management - What's It All About? The 1st (2009), 2nd (2013) editions of AHLA’s Enterprise Risk Management Handbook for Healthcare Entities, and Chapter 1, Volume 1, The Basics of Enterprise Risk Management in Healthcare in the Risk Management Handbook for Healthcare Organizations (ASHRM 5th and 6th Edition Series) and is the author of An Enterprise Risk Management Playbook: An Implementation Guide for Healthcare Professionals (ASHRM 2015). Roberta is Faculty for the healthcare risk management certificate course at the University of South Florida, Faculty for the risk management course for One Beacon Professional Insurance and Faculty for the Healthcare ERM Strategic Decision Risk Management course, Stanford University, Center for Professional Development. Roberta is the Founder and 1st President of the Florida Society for Healthcare Risk Management & Patient Safety, and a founding member of the Enterprise Risk Management Task Force of the Hospitals and Health Systems Practice Group for the AHLA. Roberta has received the following awards for her dedication to the profession of risk management: Presidential Citation Award-ASHRM, 2011; (1st time awarded); Distinguished Alumni Achievement Award, School of Business & Entrepreneurship, Nova Southeastern University, 1998; (1st time awarded); Distinguished Service Award-ASHRM, 1997; honored as Most Contributing Member to Risk Management, SCAHRM, 1995; honored as Most Valuable Contribution to the Field of Risk Management, SCAHRM, 1993.
Teresa L. Kielhorn, JD, LLM, (Chapter 16, Contracts and Agreements: An Enterprise Risk Management Approach) is the Vice President, Risk Services for Dignity Health. In this capacity she has system-wide responsibility for the insurance, workers' compensation and hospital and professional liability programs for Dignity Health’s operations in California, Nevada and Arizona and the Dignity Health captive programs. Prior to joining Dignity Health, Ms. Kielhorn was the system-wide director of Professional Liability Claims and Loss Prevention at the Office of Risk Services for the University of California. In that capacity she oversaw the risk management, insurance and claims program for the University's UCLA, UCSF, UCD, UCSD and UCI medical centers, 10 campus student health clinics and counsel centers, six schools of medicine, three schools of nursing, school of ophthalmology, school of vet medicine and schools of psychology and social work.
Ms. Kielhorn previously worked for Kaiser Foundation Health Plans' and Hospitals' national corporate office as Assistant Director, Quality, Resource and Risk Management. Ms. Kielhorn retired from active duty as a Lieutenant Commander, Navy Judge Advocate General's Corp. While on active duty she prosecuted and defended courts-martials and advised Navy commands, including Navy hospitals and the Bureau of the Navy Surgeon General on a broad range of matters such as health care credentialing, bioethics, peer review and fair hearings, privacy act, whistleblower investigations, clinical research and medical liability. She received her J.D. from the University of San Francisco and LLM from George Washington School of Law. She is a member of the California and Washington D.C. bar associations. She serves as the Vice Chair of Education for the Enterprise Risk Management (ERM) Taskforce of the American Health Lawyers Association, and as an ERM workgroup member for the American Society for Healthcare Risk Management. She is a past president of the California Society for Healthcare Risk Management.
Erin L. Muellenberg, BSL, JD, is a partner in the Health Care practice group of Arent Fox. In her role she advises a broad range of health care clients, including hospitals, surgery centers, health systems, and physicians on regulatory matters, contracting, licensing and accreditation, peer review, medical staff compliance and enterprise risk management. She regularly advises health care organizations on medical staff matters, bylaws, general and focused practitioner reviews, external reviews, peer review hearings and physician employment matters. Her representative work also includes: Developed corrective action and hearing procedures for peer review bodies which included mediation, alternative dispute resolution and dedicated hearing panel clauses; Established peer review sharing arrangements between acute care hospitals and clinics, foundations and medical groups; Established and provided external peer review services to multiple hospitals and health systems throughout the country; negotiating to successful resolution physician disciplinary problems; Litigated multiple medical staff hearings, governing board appellate hearings and wrote and responded to associated writs of mandamus; Successfully guided an all physician Board to develop and implement a strategic plan and recruitment and retention program that has improved care and increased profits; Guided and assisted in the negotiation of significant increases in contracts with major health insurers; revised and implemented bylaws; Established and grew the Managed Care Litigation Unit for a large healthcare corporation, recovering in excess of $60 million in underpayments.
Previously, Ms. Muellenberg was a partner at a civil litigation boutique firm in Southern California where she represented physicians in peer review and licensing matters. Before receiving her law degree from Western State University in 1989, Erin was the director of medical staff services at St. Francis Medical Center in Lynwood, California. While in law school she served as research editor of the Law Review and published on the California Good Samaritan statute. She has written and lectured on a variety of health law topics, including peer review, compliance, risk management, and the medical staff fair hearing process. She has organized and lectured at the Arent Fox annual Medical Staff Leadership Conference. She is a member of the California and National Association of Medical Staff Services, the California Society of Healthcare Attorneys and the American Health Lawyers Association, where she is Vice Chair of the Enterprise Risk Management Task Force. She is admitted to the Bar in California and the US District Court, Central District of California. She received her JD from Western State University College of Law, (magna cum laude), her BSL (Law Review) from Western State University College of Law and a BA from the University of San Francisco.
Fay A. Rozovsky, JD, MPH, DFASHRM, (Chapter 3, Patient Rights: Informed Consent and Clinical Research) is President of The Rozovsky Group, Inc. An experienced healthcare risk management consultant and attorney, Ms. Rozovsky works with clients along the continuum of care, providing healthcare professionals, organizations, and leadership with practical risk management and patient safety solutions. Ms. Rozovsky has lectured extensively and authored or co-authored over five hundred articles and several books including Consent to Treatment: A Practical Guide, 5th Edition, Health Care Credentialing: A Guide to Innovative Practices (with Mark Kadzielski and Christina Giles) and Health Care Organizations Risk Management: Forms, Checklists and Guidelines, Third Edition (with Jane L. Conley).
A summa cum laude graduate of Providence College, Ms. Rozovsky received her J.D. from Boston College Law School and an M.P.H. from the Harvard School of Public Health. Ms. Rozovsky is admitted to the practice of law in Florida and Massachusetts. Fay is a Distinguished Fellow of the American Society for Healthcare Risk Management (ASHRM) and a Past President of the Society. In 1998, Fay was awarded the Distinguished Service Award. She is a faculty member in the ASHRM Healthcare Risk Management Certificate Program and is an adjunct professor of law at William & Mary Marshall-Wythe School of Law. In 2008, Ms. Rozovsky received an honorary doctor of public health degree from Providence College for her work in healthcare risk management, patient safety and health law. In 2013 Fay was made an Honorary Member of the International Association for Healthcare Security and Safety (IAHSS) for her work in furthering the healthcare safety and security profession. Currently, Fay serves as Chair of the Enterprise Risk Management Task Force of the American Health Lawyers Association.
Table of contents
Table of Contents
PART I An Introduction to Enterprise Risk Management
Chapter 1 Enterprise Risk Management—What's It All About?
Chapter 2 Structuring an Enterprise Risk Management Program
PART II Viewing Traditional Health Care Risks Through the Prism of ERM
Chapter 3 Patient Rights: Informed Consent and Clinical Research
Chapter 4 Disclosure of Adverse Events to Patient and Family
Chapter 5 Peer Review and Credentialing in an Era of Enterprise Risk Management
Chapter 6 Economic Credentialing: A Balancing of Risks
PART III Emerging ERM Risks for Health Care Organizations
Chapter 7 Practical Approaches to Health Information Exchanges and Electronic Health Records: An Enterprise Risk Approach
Chapter 8 Medical Identity Theft
Chapter 9 Compliance and Enterprise Risk Management
Chapter 10 Retail Health Clinics
Chapter 11 An ERM Approach to Technological Advances in Health Care
Chapter 12 Enterprise Risk Approach to Successful Population Management
Chapter 13 Adverse Event Reporting: Reporting for Patient Safety and Public Health
PART IV Business Risks Impacting the Health Care Enterprise
Chapter 14 Attributes of Excellence: Governance, Risk Management, and Compliance of Health Care Organizations
Chapter 15 Financial Stewardship
Chapter 16 Contracts & Agreements-An Enterprise Risk Management Approach
Chapter 17 The Employment Relationship-Identifying and Managing Risks
Chapter 18 Environmental Compliance in the Context of ERM
Chapter 19 Hospital Mergers, Acquisitions and Consolidations and the Associated Risks
Chapter 20 An ERM Approach to Social Media
Chapter 21 Public Relations, Marketing and Advertising
Chapter 22 Captive Insurance Company as an ERM Driver
Chapter 23 A Do It Yourself ERM Demonstration Project: Going Green as an ERM Process