Integrating Physician Practices into a Hospital-Based Risk Management Program

Amy Wasdin, RN, CPHRM, Regional Patient Safety Risk Manager.

Over the past decade, the healthcare industry has seen an upward shift in the number of physician practices acquired by hospitals and healthcare systems. Even though the industry has experienced this trend before, the current cycle is unique due to two new factors:

  1. New physicians entering the workforce are more interested in maintaining a work-life balance and do not want the responsibility of managing an office setting.
  2. Regulatory changes are pressuring the establishment of Accountable Care Organizations (ACOs) and a value-based payment system.

A Challenging Task

Overseeing risk management programs for acquired physician practices can be a daunting prospect for even the most seasoned hospital risk manager. Because most hospital risk managers do not have a background in physician practices, they should become familiar with the risks associated with the practice model.

The risk manager should first identify the required areas of knowledge and then develop resources to enhance his or her ability to provide effective risk management services. To be successful, a risk manager must have the support of the organization’s top leadership and the physician practice leaders, as well as a clear understanding of the scope of and expectations for what must be accomplished.

It is important to establish priorities and determine the resources needed based on the size of the physician practice and its growth potential. A hospital risk manager is usually conditioned to working with limited resources. Because no two risk management departments are the same, it can be difficult to find data to quantify the resources needed.

Assess Risk Before and After the Acquisition

It is important to understand the operation and environment of the practice prior to and after the acquisition so you can prepare to mitigate and manage any associated risks. The type of risk assessment depends on the scope of the risk management program. Is the program limited to loss identification and prevention, or does it include claims management as well? Is it limited to a specific type of risk management, such as clinical risk management, or does your responsibility reflect more of an enterprise risk management approach?

Our Interactive Guide for Office Practices is a risk assessment tool that can help you identify liability risks in an office setting. It covers the following areas:

  • Communication (with patients and among staff).
  • Patient scheduling and follow-up.
  • Patient self-management and health literacy.
  • Medical records.
  • Medication management.
  • Physician/patient/staff relationships.
  • Informed consent and refusal.
  • Clinical procedures.
  • Confidentiality and privacy.
  • Emergency procedures.
  • The work environment.
  • Systems and processes to reduce the effect of human factors.
  • Business operations.
  • Miscellaneous risk and loss control issues.

Determine What Resources Are Needed

The resources required will be determined by the scope of the physician practice risk management program. If hiring additional risk management staff is not an option, it is imperative that the physician practice managers assume ownership of the practice’s day-to-day risk management responsibilities. This will require the hospital risk manager to educate the practice managers on the principles of risk management and the expectations involved—such as reviewing incident reports, performing follow-up on reported events, trending data, communicating risk management information, and educating their staff.

Larger healthcare organizations may have the resources to provide a risk manager for a more hands-on approach to managing and addressing the risk management needs of multiple physician practices.

Consider These Tips  

  1. Develop an understanding of the scope of your responsibilities for physician practice risk management.
  1. Use educational resources to learn about the operation, risks, and regulatory requirements that are unique to the physician practice setting.
  1. Establish priorities for a physician practice risk management program.
  1. Determine what resources will be available to you in the physician office setting.
  1. Establish a risk management plan for the physician practice environment.
  1. Seek support from your leadership and the physician practice management leaders for your plan and the resources you will need.
  1. Communicate your plan to the program’s stakeholders (i.e., anyone who will be involved in or affected by this program).
  1. Provide education on important risk management and patient safety topics, as well as on risk management processes, such as event reporting.
  1. Provide feedback according to your program plan. This may include providing feedback to the board, a quality improvement committee, practice managers, physicians, and staff members who report events.
  1. Involve your medical professional liability insurance carrier in knowing your needs and concerns. Often, there are helpful risk management resources that can be provided to you at no cost.

These techniques can assist you in establishing the framework for a successful physician practice risk management program within a hospital-based system.

Your patient safety risk manager can help you implement strategies tailored to your needs. Contact us at (800) 421-2368, extension 1243, or

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J9472 11/13


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