Risk Management for Mental Health and Recovery Residences  Counselor Toolbox Podcast Episode 139

Risk Management for Mental Health and Recovery Residences Counselor Toolbox Podcast Episode 139

This episode was pre-recorded as part of
a live continuing education webinar. On demand CEUs are still available for this
presentation through ALLCEUs. Register at ALLCEUs.com/CounselorToolbox. I’d like to welcome everybody to today’s
presentation on risk management and ethical obligation. A lot of what we talk
about with risk management, you know at least where I came from, I used to think
about risk management and slip and fall but we’re going to look at what risk
really is and explore the benefits of risk management learn how to categorize
risk and explore common risks in a behavioral health environment and ways
to mitigate them now if you work in a facility or in a private practice you
know this is really applicable to everybody who works in behavioral health
risk is the combination of the probability of an event and its
consequences so something that has a high probability with low consequences
is less risky if you will in terms of the viability of your practice your
organization than something that has a high probability with high consequences
some examples I came up with high consequences high probability you know I
work in a or I worked in a co-occurring disorders facility we had a methadone
clinic we had a detox facility we had a lot of different units there the
likelihood of drug use on the premises was really not that uncommon whether it
was people coming that were visitors or people that were waiting in order to get
dosed unfortunately you know it happened and it wasn’t something that we were
really all that shocked about there are high consequences though because you
know we’re a treatment facility so if they’re using on the premises it could
cause other people to relapse it’s bad for our reputation and you know there’s
a lot of other potential harms for example if they are using needle based
drugs and there are needles left around that people can get stuck by so there
are potential high consequences for that an assault in an unlit parking lot you
know assuming steps aren’t taken what we’re looking at
that is if maybe you’re getting ready to start a new program and you rent a new
facility and you’re doing a walk around and you see that this parking lot is not
very lit well most of us regardless of whether it’s a behavioral health care
center or a hospital or just a parking garage at the airport we’re not going to
be walking into an unlit parking lot and feeling very good about it because we
know that that is potentially a place where bad things could happen so if
something happened like that and you know that is typically a target for
people of the mindset to victimize others there would be significant high
consequences not only for the person who is victimized but again for your
reputation and potentially liability slips on wet floors another one okay
high probability low consequences no toilet paper in the bathroom it you know
the fact that when we live in a facility or when we live in a facility when we’re
at a facility there is going to be there are going to be times when toilet paper
runs out you know maintenance staff may have not been on top of it whoever was
in charge of it may not have been Sally on the spot so it’s important to
understand that things like this can happen now is it a huge issue you know
no it’s going to be unpleasant it’s going to be inconvenient but it’s
probably not going to have huge consequences for anybody you know as
long as it only happens once in a while electricity goes out in the storm I
don’t think I’ve ever been anywhere I’ve been at the gym I’ve been at the grocery
store I’ve been at home and I’ve been at work when the electricity has gone out
there is a high probability that’s going to happen are there high consequences to
it you know if the electricity only goes out for a short period of time probably
not in a behavioral health situation now if you’re working in an intensive care
unit that’s a whole different issue you know
that that would be really bad mojo which is why they have backup generators and
all that kind of stuff low probability with high consequences
client suicide major data failure or clients who are medication non-compliant
who destabilize and cause harm to themselves or others so these are all
things that we’re going to start thinking about in terms of risk risk
management provides a framework for consistent quality services improves our
decision-making planning and prioritization and contributes to
efficient use and allocation of resources which helps us protect and
enhance our assets including our reputation
so basically risk management we’re not only looking at material slips and falls
and risks of a physical nature but we’re also looking at anything that could
damage our reputation that could damage our income earning potential if somebody
files an ethics complaint against you they find that you are guilty they yank
your license you ain’t going to earn money as a therapist anymore so that’s a
risk likewise if somebody slips and falls on
a wet floor and there was no sign and you had no liability insurance you could
potentially be sued not be able to keep your practice open yadda yadda so we
want to look at risk kind of globally and then you’re going to decide from
that perspective what’s most important for me to take care of and what can I
mitigate types of financial repercussions I didn’t know what to
title this slide there are a lot of common suits against the agency for
medical bills you know if they slip and fall and get hurt at your facility they
you know it’s an icy morning and they’re walking up the stairs to get into your
facility and they slip and they break their hip so you could be sued for
medical bills if you’ve got liability insurance
it’ll probably cover it assuming you weren’t negligent and there again your
insurance company doesn’t really want to pay out so you need to make sure that
you’re doing your job on your end by marking it as slippery by putting on
and salt by doing whatever you need to do to make sure that people have a safe
way to get into your facility and out lost wages and earning capacity you can
have to pay for that you may have to pay for pain and suffering or emotional
distress and the loss of ability to to enjoy life some of that comes in your
suits against if somebody files a suit against you for an ethical complaint
like a boundary violation but there can also be the sort of personal personal
injury kind of claim if somebody falls and breaks their hips property damage
their car gets damaged by a tree limb that was not adequately tended on a tree
during a storm wrongful deaths somebody commits suicide they look back and they
find that you didn’t follow up when they hadn’t shown up for their appointment or
you didn’t follow the duty to warn procedure punitive damages if there was
negligence and negligence basically says would another reasonable practitioner
have done something different so you could have suits where you have to pay
out for any and all of these things that’s going to be a financial big
problem for you loss of funding so if something happens and for example you
are taking Medicaid and you get audited and they find out that you’ve been doing
some kind of shady billing they can decide that you are no longer a provider
for Medicaid yank that funding or you could lose state funding for a variety
of reasons you could lose if they find that you’ve been waiving co-pays or
deductibles it’s possible for insurance companies to say you know what you’re
not on our provider panel anymore bye-bye and if the majority of your
clients are from that insurance company that could be devastating so that’s a
risk that you want to mitigate preferably by not breaking a long loss
of license talk to earlier if somebody files a ethical
complaint against you or a legal complaint you could potentially get your
license revoked which would mean you can’t earn money for what you went to
school for like a bazillion years for the final one which is a little bit more
loosey-goosey is your reputation as the Internet has become more second nature
to most of us people are going to places like health grades Google Yelp Facebook
wherever and if they don’t have if they don’t feel like their needs have been
met wherever they are they are much more likely to put out negative reviews when
you look at people’s motivations and you can think for yourself about how many
times if you had really good service somewhere and just kind of been like
well that was an awesome place you know whatever but if you had really bad
service somewhere you were all about posting a negative review and you may
not actually go through with doing that but people are a lot more motivated to
post negative reviews to feel like they’re getting some of their power back
then to go on and post positive reviews think about you know if you’ve got kids
how likely are you or how frequently do you give them praise for things that are
well done even if it’s something that you expect them to do like their chores
versus criticism you know a lot of times and you know I’m guilty with this having
two teenagers at home I’ll come home and I’ll look around or I’ll be like okay
chores got done great whatever go about my day instead of telling them what a
good job they did and but when something doesn’t get done you can be darn sure
I’m going to notice it so I try to make an effort to reward the good with the
bad but anyway loss of reputation people are going to be more likely if they’re
unhappy with you for some reason to go online to go out and make complaints and
be very vocal about it so it’s important to guard against your reputation as much
as possible you’re going to of unhappy clients you know that’s just
the way it is I look at reviews on somewhere like health grades comm and
you know I’ll read them and I’ll be like you know that one sounds like somebody
who has just you know didn’t get exactly what they wanted and maybe it wasn’t in
their best interest so I try to sort out the wheat from the shaft if you will
when I’m looking at reviews but not everybody does that so we want to try to
do as much as we can to guard our reputation consequences of risk you know
when you’re trying to figure out what you’re going to deal with you want to
concentrate on the ones that are high risk high probability but what is high
risk well high risk generally involves financial impacts because when you’re
looking at risk management you’re looking at the solvency of your business
and what is it what is going to happen or things that could happen that might
actually cause you to shut your doors or not be able to earn a living anymore so
the financial impact of whatever the risk is is likely to exceed Z whatever Z
is now for an independent practitioner it may be ten thousand dollars for a
large organization it may be a million dollars but whatever Z is for you if
whatever the damages are you have to come up with this much out of your
proverbial pocket it would cause you to file bankruptcy
you have to close your close your practice whatever that’s high medium the
financial impact is between y&z you know you don’t want to pay out any money but
it wouldn’t be devastating and low if the financial impact is less than Y
it’ll have a low impact on your ability to operate so you know again it depends
on the size of your organization but knowing that there are going to possibly
be occasions when there is a financial impact or how will you deal with that
and it’s not necessarily just paying out to a client again it could be
loss of reputation so if somebody goes on and posts a nasty review about you on
every single site they can find and it impacts your business 10% what’s ten
percent of your monthly revenue and is that going to cause you to not be able
to put food on the table and have to close your business probability now
you’ve figured out how devastating this would be but what’s the probability it’s
going to happen the general rule they use is if it’s a twenty five percent
chance it will happen in twelve month period it’s a high probability now when
you’re talking about a big agency where they’ve got oh I don’t know three
hundred people coming through the door a day you know that means that things are
going to happen probably more often because there’s a lot more chance for it
to happen twenty five percent chance in a 12-month period this will happen high
probability like I gave the example of the power going out in a storm yeah one
in four chance is going to happen once a year not unheard of medium chance
twenty-five percent whoops chance not change it will happen
in a ten year period so you want to look back historically over your records or
over you know get some information from other providers in and talk with other
people who are in private practice or you know if you’re at a facility who
operate a similar facility and say in a ten year period how often has this
happened how often have you had a major flood that caused you to not be able to
provide services for two weeks while they fix the piping and patch the
drywall low is a less than two percent chance of occurrence or not likely at
all to occur in a ten year period so some things happen you’re going to look
at again the probability as well as the devastation like it gave the example of
the toilet paper there’s a really good chance that’s going to happen your
going to run out of toilet paper and that’s unfortunate and inconvenient high
probability really low consequences you know
probably not going to cost you anything at all except for an extra roll of TP
but you know you want to weigh those things out so there are multiple types
of risks that we’re going to look at strategic and financial you want to keep
money coming in so you’re looking at your organizational objective if you
want to provide outpatient counseling to survivors of domestic violence is one of
your organizational objectives great where are you positioned in the market
we’re assuming that you know we’re going to go with the thought that you’re
running a thriving business you’re not trying to change and start a new
business you want to make sure that you have cash flow so you want to make sure
that those people who need that service are going to come to you and keep coming
and there’s enough of them that will keep coming in if six other providers
open in your area who are going to do the same thing that’s a risk you know
you always face the risk that you’re going to have competition so you need to
plan for that kind of risk legal and regulatory issues can also impact you if
the law changes I know back when etheric first started you could practice a
therapy as long as you’re licensed in your state they have since changed the
regulations where anybody who is practicing a therapy can only practice
if they are licensed in the state in which they are in and the state in which
the client is in so if you’re not lying licensed in the state in which your
client resides you can’t provide a therapy services in most states now I’m
not going to say every state because I haven’t looked at all 50 state
regulations but that significantly reduced the proportion of people that an
e therapist could serve so when that law changed they saw their business go way
down another area of risk that you want to look at is
employee risk you want to maintain an efficient workforce and reduce turnover
you know look at you know if you live in an age of in an agency if you work in an
agency you remember that first week of training that you had to go through they
paid you for that so every time you’ve got employee turnover there’s the cost
of advertising the cost of interviewing the cost of the background screenings
the cost of the training and then you know if they make it through probation
there’s a whole probationary period and then if they quit and you’ve got to hire
somebody else you have those costs all over again and you really haven’t reaped
any benefits do you want to have a good employee foundation so you want to
prevent workers compensation claims as much as possible make it a healthy safe
work environment avoid wrongful termination suits so if you have an HR
department score they should be all over this but there are procedures you’ve got
to follow when terminating somebody otherwise they may come back and find
ulterior motives for the termination in order to sue you so you need to be able
to document that paper trail of corrective actions burnout if you have a
workforce or even yourself you know sometimes we can see a lot of clients
and it can get exhausting so making sure that you prevent burnout in yourself as
well as if you have employees in your employees because if they get burned out
they could negatively interact with other staff members and/or clients and
they may also quit which either way reduces your reputation and increases
your increases your cost if you start getting that reputation of being a
not-so-great place to work then you’re not going to get the cream of the crop
employees either and obviously you want to prevent injury or victimization
of your staff you know you don’t want them being assaulted or hurt in some way
by clients and we all go through training on what you need to do in order
to keep yourself safe when we’re dealing with clients and other people and it
doesn’t have to be people who are quote mentally ill any person on any given day
can all of a sudden become violent for whatever reason that led up to it you
don’t know you know John walks in from off the
street you don’t know I’m from Adams housecat you can’t assume that
everything is going to be hunky-dory so you need to know how to protect
yourself and create make sure there are procedures in place to protect staff and
to protect other clients if they happen to be there if a client becomes or a
person doesn’t have to be a client becomes violent starts brandishing a
weapon what are your procedures for handling
that you know basic risk and safety procedures technology risk you want to
look at regulatory and legal compliance this is all HIPPA high-tech stuff to
prevent a data breach you want to make sure that you know you have security on
all your data you’re maintaining that but also like I said in the HIPAA class
you need to make sure that people have access to data HIPAA stands for Health
Care Information Portability and accessibility Act so you need to make
sure that clients would be able to access that information should they
request it and that staff can access that information even in the event that
maybe you have the server that’s on your site just completely blows up all right
well all the data that was on that server better be backed up somewhere so
this is what we’re calling a disaster data failure all those things you need
to have backups for even if you’re in private practice if you have electronic
health records if you store client files on your computer
you need to have a backup and it needs to be backed up regularly at least once
a day if not in real time in order to prevent any problems another problem
that can come from data failure hard drive on your computer craps out that’s
where all of your notes were all of your intakes well you know what insurance
doesn’t have to pay you for anything that there’s no note on so that’s a risk
you need to make sure that you can document what you did in in order to get
reimbursed to protect yourself from lawsuits and in order to provide quality
care patient safety risk management this is really more what we’re going to focus
on today the physical environment you want to look around and see could
someone get hurt could someone get injured are they safe you also want to
look at the interpersonal environment is what I call it between clients how do
they interact how can you make sure that they’re safe and maintain each other’s
confidentiality if you do group work this is an issue but if you’ve got
multiple clients sitting in a waiting room if you’ve got multiple clients in
your facility at the same time we want to make sure we know how to keep
everybody safe if one should start to decompensate how do we keep the others
safe we also want to look at the environment between clients and staff
and unfortunately I’ve had the occasion to be supervising a staff member who
behaved inappropriately towards a client and had to be disciplined there need to
be clear procedures on how staff is supposed to interact with clients and
ways for clients to where we came from we call it filed grievances against
staff members who they believe acted inappropriately towards them in whatever
way denied them access to something or was rude or whatever now some of these you know again where I
came from we call them grievances sometimes we would get grievances and it
was like really really it was worth filing a grievance over this but the
person was upset and coming from their point of view they felt disempowered
they felt like you know whatever happened we needed to try to figure out
how to make them feel a little bit better and feel more empowered the
grievance gave them part of that process because they were able to complain
basically but in order to prevent them from continuing to feel upset about it
we needed to make sure they felt like their complaint was heard and we may not
agree on the solution but 99% of the time and you know I don’t know if that’s
the right step it’s close to it if somebody feels like their complaint is
heard that de-escalate the situation even if you don’t come to the same exact
resolution that they may have wanted and in the event of a client destabilizing
what are your risk management procedures if you have a client who become suicidal
in your office if you have a client who calls they don’t actually make their
appointment and they have become suicidal how do you handle that you want
to have procedures available common suits against therapists for patient
safety issues and these are just things to be aware of most of them deal with
ethical stuff that you’re going to look at and go well of course well we say
that but we still some of the most common suits against therapists revolve
around having sex with your clients and you’re like that’s boundary violation
101 what were you thinking and yes there’s more to it than that you got to
look you know what their mental state was and yada yada yada but boundary
violations that’s a big one if you are a supervising clinician
you need to make sure that your clinical staff is doing okay regular staff
reviews you know when I when I supervise a whole mess of people we had weekly
staff meetings I was able to check in I was able to look at paperwork I was able
to make eye contact with my staff and see how they were interacting and doing
so if I noticed that somebody was starting to get depressed or exhausted
or act a little bit off I was able to address it from a supervisory standpoint
make the referral to the EAP sometimes just saying what can I do to help in
order to prevent burnout which often prevents a lot of boundary violations so
look at what can you do to prevent that in yourself and among your staff and and
generally attentiveness as a supervisor goes a long way inappropriate or
excessive self disclosure this one was a little bit surprising to me that it was
a frequent lawsuit against therapists not surprising that it happens I have
seen it happen where a therapist if you’re working with a client who has
sexual abuse issues and you have survived sexual abuse and you disclose
that in order to develop some empathy that can be that can be seen as okay not
all therapists are going to do that even if they do have that experience but you
know you can make a case for that if the client is talking about something
completely unrelated and the therapist interjects for some unknown reason that
they survive childhood sexual abuse the client may be like and your point would
be at which point the legal community basically looks and says was this
therapist acting in the best interest of the client or trying to get his or her
our own needs for validation and support met so being careful about what’s
appropriate for self-disclosure dual relationships having a business
relationship with somebody having a personal relationship with somebody you
know again this is one that we kind of go over ad nauseam in school and every
biennium when we when we renew but it’s important to remember that we wouldn’t
have to go over at this often if it wasn’t something that still frequently
happened so you may want to ask yourself why does that happen and how can I
prevent that so we don’t have this same outcome using techniques without proper
training or licensure such as hypnosis you know there’s it gets really gray in
there when you start going from mindfulness to meditation to guided
imagery to hypnosis and making sure you don’t cross over into an area where you
haven’t had adequate training is vital not only to prevent harming a client but
in a lot of states things like hypnosis are something you actually have to be
specifically licensed for so you’re practicing outside your bounds of
confidence deliberately using incorrect diagnosis to get insurance coverage or
other funding somebody comes in they really meet adjustment disorder but in
order to get insurance payment you diagnose them with major depressive
disorder big no-no another big no-no which I am well aware happens frequently
if you work at an agency and they get funding for mental health and they get
funding for substance abuse and they run out of substance abuse funding so you
switch their diagnosis to one of mental health so you can keep them in treatment
not okay inadequate documentation results in
paybacks wrongful deaths another common suit and breach of
confidentiality breach of confidentiality can come from
either a record breech not following HIPAA protocols and all the fines that
go with that or even running into somebody in public and you know
acknowledging them greeting them whatever we are you have to work that
out with your patient ahead of time especially if you live in a small town
but really anywhere how you’re going to handle it if you run into them outside
of the clinical setting and so they don’t feel like their confidentiality is
being breached if you say something to them or they don’t feel like they’re
being dissed in some way if they are breach if if you don’t say something to
them now remember as always if you have questions you can type them into the
chat window and I will respond to them as quickly as possible common suits against agencies in general
sexual harassment now that can be staff on staff or staff on clients so just be
aware of it environment of care and that’s that big garbage one for I
slipped and fell and broke my hip or you know you didn’t take care of the tree
outside the head two dead limb and it fell on my car and crushed the crush the
roof of it improper billing practices billing for
services not provided yeah it’s just unless you did it don’t bill for it
unbundling means you know the insurance company has a rate they give for
something like intensive outpatient services that covers the doctor’s visit
that covers the ther individual therapy and group therapy but you get more money
if you billed for each one of those things individually no if you’re
providing IOP you billed it as an IOP service and they explicitly say in most
contracts that unbundling is a contractual violation and waiving
co-pays and deductibles I gave you plenty of links that you can go read about the
different legal opinions on that and there’s none of them that are good so
they’re all saying whether you’re actually on a provider panel or you’re
an out of network provider you still have the obligation to collect
co-pays and deductibles even for private insurance it’s not just Medicaid and
Medicare anymore therapists malpractice if you do something that another
reasonable therapist would have done differently your agency could be sued
you know they don’t just go after the therapist they go after the whole agency
because the agency has bigger pockets or deeper pockets I guess and wrongful
termination or civil rights violations is another common suit against agencies based on information provided from other
resources so you know do to do due diligence conduct an analysis to
determine the potential risks in your area if you’re in in private practice
you’re going to have different risks than if you’re in an agency for example
I’m in private practice I have nobody else that works in my clinic with me so
if I have someone who goes into crisis at 10 o’clock at night I’m the on-call
person I don’t have a backup person I mean we have the backup of the suicide
hotline and 911 hospital and they’re given a sheet with all of that but you
know generally if somebody needs something there are after hours there’s
an after-hours number that they can call should therapists carry their own
malpractice insurance even if they work for a community mental health center I
have always been told and this would be something you would want to ask an
attorney get a legal opinion on and generally your malpractice insurance
provider can provide that I have always been told that yes you
want to carry your own malpractice insurance because you don’t know that
the agency is going to back you and I hate to say it it sounds awful you may
love your agency but you can’t guarantee that they’re going to look at what you
did and go yep we’re totally behind her they may be like notes on her and then
you need to defend yourself their insurance company the agency’s insurance
company is going to want to get out of paying for it so I have always been told
that is it is ideal if you are working in in an agency to have your own
malpractice insurance it’s also important to understand that most
malpractice insurance does not you know your private malpractice insurance does
not cover you if you are a supervisor working in a mental community mental
health agency and one of your supervisees does something even if that
person is licensed does something that is not okay you could be sued for it but
your malpractice insurance doesn’t necessarily cover that kind of liability
so you need to have a special writer if you are a clinical supervisor so that’s
being extraordinarily careful great question the short version I have always
been told keep your own malpractice insurance and if you supervise others
get a rider to cover you in case they do something they shouldn’t ask yourself
you know generally when you’re in US agency in this facility what could
possibly happen and I mean brainstorm even the wild and wooly stuff that you
don’t really expect to happen get a whiteboard write it all up there and
then you can start determining probability and consequences how likely
is it to happen how severe will the outcome be how can how likely is it that
it can be mitigated on the forefront if it’s raining outside mitigating
liability means putting a wet floor sign out and you know potentially having rugs
in front of the door so people can dry their feet as they walk in that would be
one way to mitigate slips and Falls it’s not going to prevent them but it’s going
to greatly reduce them what can be done to reduce the impact of this problem and
to what degree you know whatever the issue is like I said with the grievances
in order to reduce the impact on our reputation if somebody was unhappy with
something that happened at our clinic we would have let them file grievances they
would meet with the supervisor they would hopefully feel like they were
heard if they were not if they didn’t feel like they were satisfied they could
go up to the next supervisor and so on up into the CEO once they got to the CEO
that’s pretty much where the buck stops so they were either satisfied or not
generally I can’t even think of a time when well I can think of one time when I
got all the way up to the CEO but generally they felt heard and we’re
satisfied as satisfied as they were going to be with the outcome with the
first or second level supervisor and what is the potential for exposure or
what can’t proactively be avoided hurricane tornado
you can’t avoid those I mean you can have stuff in place in case one happens
but you can’t avoid those so look at the potential for exposure to do something
like that risk analysis is a systematic approach to evaluating risks to business
operations in patient safety start with one area at a time if you try to do
everything all at once you’re going to walk around and kind of feel like you’re
drooling on yourself because it’s like well there’s this over here and this
over here and wait wait I forgot this over here start with one thing go
through the environment of care and say is this safe could I fall if I had a
had come in here a toddler is there any place that they could get into chemicals
and poison themselves or get hurt fall down the stairs look for things
like that identify all possible risks based on personal knowledge and
historical research like I said if you haven’t been in practice that long talk
to colleagues who are in similar kinds of practices see what things that they
have had happen even if it wasn’t devastating what kind of incidents have
they had classify your risk based on probability and consequences develop a
plan to address and remediate any thing possible you know if you can take that
risk of risk out of the way great ensure you have a budget for risk funding and
that sounds weird but even if you’re starting in a new office or if you’re in
a current office things will come up where you might need to have money in
order to remediate a risk or to prevent a risk maybe you need to put in a ramp
in order to get into your building because now you’re a big enough facility
where you’re required to comply with all a DA requirements or you could be sued
so you need to have enough money to be able to pay for that ramp ensure all
individuals are aware of their responsibilities for risk reporting and
management this is where orientation of staff comes in and orientation of
clients if you see something won’t be let us know if pilot papers out in the
bathroom let us know so who’s responsible for what especially as it
pertains to staff is really important when there’s inclement weather who is
responsible for listening for the emergency radio and if there’s a tornado
warning and who is responsible for letting the facility know that they need
to institute emergency procedures regularly audit for risk management
compliance we would have a risk manager go around are around our facility at the
agency I used to work at with her clipboard and if you had a
extension cord that was in a power strip that was overloaded you would get dinged
if you had you know she would go through and identify all the potential risks
it wasn’t a meant to be a punitive thing unless you did it multiple times it was
meant to be an awareness thing when an event occurs review whether the policy
mediated the risk so like I said sometimes things are going to happen did
your policy for example putting out the wet floor sign prevent a worse fall than
could have happened prevent anybody from falling etc you may not be able to
prevent all risk but if you can minimize the damage it’s best agency that has a
written code of ethics make sure that the staff and clients have a good
environment of care if you have a code of ethics you know your staff is abiding
by the clients are going to be treated with respect and fairly Carrie general
liability insurance to protect against people who experienced personal injury
flips and Falls or whatever and any kind of damage to property if another client
goes out there and breaks their windows with a baseball bat
or there’s some sort of act of God you want to not have to pay for that you
want to have insurance for it comply with state and federal guidelines and
guidelines of payers to mitigate financial risk if you are doing some
hinky billing let’s say and we’re going to assume get you had a big agency and
there were just some rogue people who went out and did hinky billing and I
know if at least one example of this the agency was slapped with eight million
dollars worth of fines had to refinance all of the buildings on their campus in
order to pay that in order to be able to keep taking Medicaid and not have the
CEOs and vice presidents go to jail it was big bad big bad mojo so make sure
that you know what your guidelines are and you’re following them go to the
level of care guidelines if you’re taking insurance to know what for
example Blue Cross and Blue Shield expects if you’re providing outpatient
services that’s pretty cut-and-dry intensive outpatient residential gets a
little bit more you know detailed just know that if you’re billing Blue Cross
and Blue Shield you know that you’re providing services they say have to be
provided this also protects your reputation if you know you found your
found to be guilty of defrauding Medicaid or Medicare or you lose the
ability to take private insurance not only does it cut into your financial
income but it’ll hurt your reputation clearly identify staff qualifications
and their duties in the environment of care this reduces frustration grievances
and abuse reports so you know make sure that people know what they’re supposed
to be doing with regard to handling the clients helping them do what they’re
supposed to do making a emergency plan that way there’s no confusion I find
especially in residential facilities when there are places where there’s lots
of clients at one time if there’s confusion if there’s chaos clients get
really stressed out which can contribute to problems and you want to make sure
that you have guidelines for termination if you have qualifications and duties
listed in the job description then when there comes time for a corrective action
you can pull out the job description and pull out the corrective action report
and go you didn’t do this you didn’t do this you need to do better at this and
support why there’s disciplinary action ensure the environment is free from
alcohol or drugs by a policy possibly including contraband search or random
drug screen now that’s controversial where I worked at again because it was a
co-occurring facility our senior management maintained the right to
inspect anything on the premises they could go through your desk because it
was their desk they could go through your office because it was their office
etc and you also had to have random drug screens just as part of the drug-free
workplace this reduces your general liability it helps with your workers
compensation rates reduces the risk of client relapse or overdose and also
reduces needle sticks if you find that clients have drugs on their possession
you know you don’t want somebody using on the premises you don’t want them
dropping needles in the parking lot somebody else picking them up getting
stuck bad news so keep the environment clean safe collected report accurate process
outcome data intakes length of stay successful completion unsuccessful
terminations the people you kicked out of the program and amas the people who
left against medical advice this helps you with your strategic positioning in
applying for funding and your reputation you’re known legitimately as an agency
who most people complete treatment and are clean and sober or are stable not
depressed whatever your facility is twelve months after discharge that goes
a long way to indicating how what the quality of treatment was and it also
enables you to get different types of funding especially as a nonprofit
accounting system must document all monies owed billing and payments one of
the most frequent things that we see is when patients have a high bill that they
haven’t been paying on and you start to try to collect they are more likely to
file ethical complaints against the therapist not necessarily founded but we
do see a correlation between the unpaid balance and ethical complaints starting
to be filed you have to have a policy to address non-payment of fees this
protects your cash flow you don’t want to have every client having a huge
outstanding balance protects your reputation and it also can prevent
client abandonment you don’t want to have a situation where a client has a
you know $800 balance and you’re like dude we can’t see you anymore because
your balance is too big bye-bye no that’s client abandoned when
we need to make sure that there’s a policy to refer them to appropriate
services client rights and emergency procedures need to be in a conspicuous
location this is regulatory compliance but it also goes to show that you’re not
hiding anything and you want to support the clients make sure your staff is
certified and cpr and first aid if you’re in private practice make sure you
are this goes for you know again reputation you’ve got a well prepared
staff and regulatory compliance most places and insurance providers require
it staffing plan ensures regular regulatory compliance a lot of states
dictate your staff to client ratio in Florida for example in
residential a I think it was residential you couldn’t have more than 15 clients
on your caseload I think it’s been awhile since I worked
in Florida but it was actually in the statute so you need to make sure you’re
maintaining that so you don’t lose state funding if you rely on that but you want
to maintain compliance and you don’t want to have people going out going yeah
I went there but I was a number and a herd of people every group there were
like forty people in it or something probably weren’t forty people but if
people feel like they’re overcrowded that they’re not getting individualized
attention it hurts your reputation continuity of care also goes with
staffing plan if you’ve got therapists changing out every month every three
months clients aren’t going to want to come there they’re going to be like I
can’t go to treatment and actually finish with the same therapist so it’s I
feel like I’m starting over again every time that doesn’t help your reputation
have a clear description of admission criteria for the program including
diagnosis age and disqualifying issues you’re not going to want to have
juveniles in with adults for a whole lot of reasons but you want to have that
written out disqualifying issues can be like medical instability or certain
criminal charges it creates a foundation so you have a safe environment for
current clients and defense against discrimination suits one example I had
was a client we worked with in one of the places that I worked who had a
pretty extensive criminal history with very very violent felonies rape you know
was one of them and we denied him access to our residential program and he
decided to call the local TV station the local department children families he
was called literally calling the governor’s office because we wouldn’t
let him in we had a foundation for why we did we
gave him referrals to other places unfortunately they wouldn’t accept in
either which is a Fault in the system don’t get me wrong
but in order that enabled us to have a leg to stand on for why he was not being
accepted into our program have an appropriate intake process to make sure
that people who are coming in are appropriate for that level of care you
don’t want somebody in group who can’t handle the group situation client data
is stored in compliance with HIPAA and hi-tech regulations protect your
reputation protects you against fines and possible other bad mojo
make sure clients are oriented that communicates their responsibilities and
rights in order to ensure a safe environment and make sure they feel safe
and empowered have a policy for handling missed appointments to address issues
such as client destabilization and suicidality you don’t want a client to
miss an appointment you’d be like well whatever they’ll show up next week and
have them commit suicide that’s you know not good treatment and you’re probably
going to be held liable client dissatisfaction or your reputation if
they drop out because they don’t like you you know let’s have a talk about
that what can I do differently can I make a referral for you you want to make
sure you have policies for termination due to client drop out to prevent the
complaint of abandonment you know make sure you send them a letter with
referrals if you can’t get in touch with them by phone and prevent liability for
suicide if you’ve got a client on your caseload that you haven’t seen in two
months and they commit suicide they are still technically under your care so bad
stuff ensure medication compliance in order to make sure they maintain
stability if they quit taking it talk to them about why we don’t prescribe so we
can’t and we can’t force them to take it but we do want to note in the chart if
they quit taking any of their medications why they do and what actions
we took to encourage them to talk to their doctor have a clean environment a disaster response policy to maintain
continuity of care in the event of a data failure or physical disaster know
how to access data at the remote location and know where to tell clients
to go to receive treatment in the event that your agency shuts down because of a
disaster or you know maybe a pipe broke and your entire facility flooded well
where do they go for treatment now we can’t just say well we’ll get back to
you in a couple weeks have a policy to address handling clients or potential
clients in crisis if the therapist is out sick you don’t want a client to show
up be in crisis you’d be like well therapist isn’t here today so we can
schedule you in two weeks from tomorrow that’s not going to cut it if the client
is in crisis how does front desk staff handle that have a policy to refer
clients if the agency or a program should shut down if you decide you’re
closing your practice you need to be able to make sure that you have a policy
for how to refer them out did you know health and safety
inspection should include refrigerator and temperature monitoring every week
and a material safety data sheet MSDS book should be on the premises and
include data on all hazardous chemicals stored there so if anybody swallows them
you know what to do facilities are required by HIPAA to store data backups
in a secure location in the event of data failure many states have regulatory
limits on client to staff ratios and the guidelines for the number of square feet
per client so how much personal elbow room do they have level of care
guidelines inform the agency what services must be provided at a level of
care to prevent possible paybacks to be effective risk analysis surveys must be
completed regularly and updated as the organization changes you buy a new
building at a new program yada-yada employees should complete a
training on emergency procedures annually it’s a good idea to consider
having a policy which clients sign regarding suspected drunk driving and or
attending treatment under the influence how are you going to handle
that who can make who will you call in order to help them yada-yada obviously
you don’t have to it is a good idea social networking and internet data by
clients or employees has been used in legal cases and can significantly damage
a company’s reputation risk management involves not only professional and
ethical risk but also managing the risks at your facility you know environmental
care stuff risks can come in the form of causing harm directly or indirectly to a
person breaking the law intentionally or unintentionally violating regulatory
clothes codes which may cause your facility to be temporarily or
permanently shut down and failure to plan or adapt to funding changes such as
you know a lot of people are experiencing right now where federal
funding gets cut so how do we keep the doors open
effective risk management occurs regularly at least annually for your
smaller clinics and is updated with agency changes or addition of new
programs effective risk management reduces monies required for non mission
oriented purposes like paying out on lawsuits manages reputation and prevents
prevents financial catastrophe and I made it with one minute under the wire
what questions do you all have already everything should be cool with you login
into your into your classroom now the coding issue has been resolved so you
can log in take your quiz get your certificate and go on to your next
client and that’s awesome next class on Thursday is on disaster planning which
happens to be another one of my little favorite topics so lucky you you know
I’m looking forward to presenting it hopefully you’ll get something out of it
that you hadn’t thought of or known about before I did when I created it so
you know found a lot of things that I actually didn’t know about alrighty
everybody I appreciate your attendance and your patience and I will see you on
Thursday if you enjoy this podcast please like and subscribe either in your
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