1250 word Provisions and Reimbursement of Health care services essay

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Summary Brief (Risk Management)

Risk Management Summary

Joshua Garcia

Grand Canyon University: HLT-308V

January 30, 2020

Running head: ASSIGNMENT TITLE HERE

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Summary Brief

Risk Management Process (Quality Improvement)

There are many governing bodies that exist to assist and ensure compliance. The main governing body for physical therapy in a outpatient setting is the Centers for Medicare and Medicaid Services (CMS). CMS has created the foundation and the basis for all therapy services to follow in every setting in order to be in compliance. All insurances such and Blue Cross Blue Shield, Humana, and Aetna are adopting and following CMS standards as well. Most organizations have created quality indicators (QI) to measure outcomes, quality care, cost, documentation in order to meet CMS standards. The Centers for Medicare and Medicaid services have developed a method to measure a organizations quality of care and improvements. “The CMS uses quality measures in its various quality initiatives, including quality improvement, pay for reporting, and public reporting for specific health care providers.” (Westby, Klemm, Li, Jones, 2016). The Merit-Based Incentive Payment System (MIPS) uses an incentive program to promote quality care, compliance with documentation etc. “MIPS is a streamlined, one-stop shop for CMS to measure quality and provide financial incentives for eligible clinicians to improve their level of care.” (Jannenga, 2018). MIPS measures quality, improvement activities, promoting interoperability, and cost. Quality measures include: preventative care, documentation, and quality care. With a good risk management plan all criteria’s will be met and up to CMS standards.

“Other important considerations include whether there are opportunities to change clinical practice and improve quality of care and patient outcomes within the clinical area and whether related interventions are within the control of providers whose performance is being measured.” (Westby et al., 2016).

Roles Within The Organization

Roles are different in every organization depending on the size and the amount of employees that are involved in the risk management. In a small business like my own the therapists’ play a big role in risk management. Physical Therapist and Physical Therapist Assistants set and uphold the standard. Technicians are to follow and can only assist the therapists’ with tasks. We follow a code of ethics that has been created and established by the American Physical Therapy Association (APTA). The code of ethics ensure that the risk management plan is being followed as well as the policies. Here is are the code of ethics: “Physical therapists shall respect the inherent dignity and rights of all individuals; Physical therapists shall be trustworthy and compassionate in addressing the rights and needs of patients/clients; Physical therapists shall be accountable for making sound professional judgments; Physical therapists shall demonstrate integrity in their relationships with patients/clients, families, colleagues, students, research participants, other health care providers, employers, payers, and the public; : Physical therapists shall fulfill their legal and professional obligations; Physical therapists shall enhance their expertise through the lifelong acquisition and refinement of knowledge, skills, abilities, and professional behaviors; Physical therapists shall promote organizational behaviors and business practices that benefit patients/clients and society; Physical therapists shall participate in efforts to meet the health needs of people locally, nationally, or globally.” (Code of Ethics, 2019).

Physical Therapy Risk Management

Risk management strategies have a foundation to support ethical standards in care. As a therapist we have a commitment to provide quality care. We follow a code of ethics that creates a place of success with all patients. We also are charged to practice within the physical therapy scope of practice and professional competence. In the field of physical therapy we follow protocols, policies and procedures when providing care. Before the initiation of any treatment or evaluation we are to educate the patient regarding the recommended intervention, alternatives, goals, benefits, risks and costs. It is important to involve the patient and promote patient autonomy. After performing the evaluation the patient is informed of the findings. “The physical therapist shall use sound professional judgment in informing the patient or client of any substantial risks of the recommended examination and intervention and shall collaborate with the individual to establish the goals of treatment and the plan of care. Ultimately, the physical therapist shall respect the individual’s right to make decisions regarding the recommended plan of care, including consent, modification, or refusal.” (APTA Guide, 2019).

Legal and Ethical Responsibilities

Every health care professional is faced with legal and ethical responsibilities. Even more so when following and upholding the risk management strategy that is in place. In physical therapy there currently a lot of gray areas when providing care and interventions. This is where the risk management strategy is important in order to keep all health care professionals in check when practicing. The most important part in physical therapy is to provide care and interventions within the scope of practice. Following the scope of practice ensures the safety of all patients in every aspect of treatments such as: therapeutic exercise, manual therapy, balance training, modalities and physical agents. “The physical therapist practices according to the Code of Ethics of the American Physical Therapy Association.” (Association Business, 2005). As well as patient privacy and proper documentation for each patient to maintain compliance with CMS.” The physical therapist communicates, coordinates and documents all aspects of patient/client management, including the results of the initial examination and evaluation, diagnosis, prognosis, plan of care, interventions, response to interventions, changes in patient/client status relative to the interventions, re-examination, and discharge/discontinuation of intervention, and other patient/client management activities.” (Association Business, 2005) It is also important to treat what has been ordered by the doctor and avoid expansion of treatment of other body parts unless a proper order is given with evaluation. As long as organizations are compliant the risk for malpractice and legal issues can be controlled.

Journey To Excellence

The journey to excellence in any organization long process that comes with many trials and tribulations. It is important o research and receive wisdom from experts so that a good risk management plan can be created. I believe it is imperative to also have the proper staff that will work together as a team to deliver high quality care and practice following all policies, procedures, and protocols. Every successful organization has to have a great leader. An organization will be successful and will achieve excellence with a leader who will hold employees accountable and will demonstrate excellence. A greater leader will replicate themselves in others and create other leaders so that the organization continues to run with excellence in all sectors. Quality improvement in my organization start from the top and runs down to all employees. Working with in our scope of practice, proper documentation, competency with continued education and compliance with the risk management plan produces positive and optimal results overall. The use of quality improvement tools and complying with CMS ensures that therapists’ will be practice at a high level providing optimal care to patients. It also ensures the safety of patients. The journey to excellence requires a whole team.

References

Association business. Standards of practice for physical therapy and the criteria. (2005). Physical Therapy, 85(1), 84–88. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=106611054&site=eds-live&scope=site

APTA Guide for Professional Conduct. (2019). American Physical Therapy Association.Retrieved from https://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/Ethics/GuideforProfessionalConduct.pdf

Code of Ethics for the Physical Therapist. (2019). American Physical Therapy Association. Retrieved from https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/HOD/Ethics/CodeofEthics.pdf

Jannenga, H. (2018). Physical Therapists’ Guide to MIPS. Retrieved from https://www.webpt.com/physical-therapists-guide-to-mips/

Occupational Health Physical Therapy: Legal and Risk Management Issues Guidelines. 2011. Retrievedfrom https://www.orthopt.org/uploads/content_files/OHSIG_Guidelines/OHSIG_guidelines_2/OCCUPATIONAL_HEALTH_in_PT_LEGAL_RISK_MGT.pdf

Marie D. Westby, Alexandria Klemm, Linda C. Li, C. Allyson Jones, Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery, Physical Therapy, Volume 96, Issue 1, 1 January 2016, Pages 90–100, https://doi.org/10.2522/ptj.20150106