Triton Group, LLC.November 18, 2008November 18, 2008November 18, 2008
Federal Tort Claims Act andRisk Management
Arizona Association of Community Health Centers
Federal Tort Claims Act andRisk Management
Arizona Association of Community Health Centers
November 11, 2008Martin Bree
Triton Group, LLC.
November 11, 2008Martin Bree
Triton Group, LLC.
November 18, 2008November 18, 2008
Triton GroupTriton GroupFirst Source of FTCA Program Information
o Triton Groupo 227 Hamburg.o Pompton Lakes, NJ 07442o HRSA Contract No. 232-00-0097
o Martin J. Bree Susan Lewiso 772-873-1865 727-822-4271o 772-873-1695 (fax) [email protected] 856-625-8638 (cell)o [email protected]
o Roger Fuydalo 866-FTCA-HELP - Toll Free Marty Hiller (Free Clinics)o (866-382-2435) 216-382-4150o 973-831-8395 (Fax) [email protected] [email protected]
First Source of FTCA Program Information
o Triton Groupo 227 Hamburg.o Pompton Lakes, NJ 07442o HRSA Contract No. 232-00-0097
o Martin J. Bree Susan Lewiso 772-873-1865 727-822-4271o 772-873-1695 (fax) [email protected] 856-625-8638 (cell)o [email protected]
o Roger Fuydalo 866-FTCA-HELP - Toll Free Marty Hiller (Free Clinics)o (866-382-2435) 216-382-4150o 973-831-8395 (Fax) [email protected] [email protected]
Triton Group, LLC.
November 18, 2008November 18, 2008
History of the FSHCAA(Federally Supported Health Centers Assistance Act)
History of the FSHCAA(Federally Supported Health Centers Assistance Act)
• Late 1980’s – medical malpractice crisis similar to current situation.
• Health centers in certain geographic areas having difficulty finding adequate coverage.
• Studies commissioned showed health centers were lower risk for insurers.
• Congress passes FSHCAA of 1992 permitting Secretary to “deem” health centers as federal employees.
• Late 1980’s – medical malpractice crisis similar to current situation.
• Health centers in certain geographic areas having difficulty finding adequate coverage.
• Studies commissioned showed health centers were lower risk for insurers.
• Congress passes FSHCAA of 1992 permitting Secretary to “deem” health centers as federal employees.
Triton Group, LLC.
November 18, 2008November 18, 2008
History of the FSHCAA (cont.)History of the FSHCAA (cont.)
• As “Federal” employees health centers are protected by the Federal Tort Claims Act (FTCA).
• 92 Act unclear in many areas.• 92 Act set to expire in 1995.• Congress amends FSHCAA in 1995 to
eliminate gaps and make program permanent.
• As “Federal” employees health centers are protected by the Federal Tort Claims Act (FTCA).
• 92 Act unclear in many areas.• 92 Act set to expire in 1995.• Congress amends FSHCAA in 1995 to
eliminate gaps and make program permanent.
Triton Group, LLC.
November 18, 2008November 18, 2008
Federal Tort Claims ActFederal Tort Claims Act
• A limited waiver of the federal government's sovereign immunity when its employees are negligent within the scope of their employment
• Imposes liability on the United States “in the same manner and to the same extent as a private individual under like circumstances”
• law of the place where the act or omission occurred applies (except federal procedural law)
• A limited waiver of the federal government's sovereign immunity when its employees are negligent within the scope of their employment
• Imposes liability on the United States “in the same manner and to the same extent as a private individual under like circumstances”
• law of the place where the act or omission occurred applies (except federal procedural law)
Triton Group, LLC.
November 18, 2008November 18, 2008
Federal Tort Claims Act (cont.)Federal Tort Claims Act (cont.)
• Cannot bring suit for intentional torts (e.g. assault, battery, false imprisonment, etc.) or violations of constitutional rights under the FTCA.
• No limitation of liability under FTCA• Provides for judicial as well as administrative
remedy• Punitive damages and prejudgment interest not
allowed• No jury trials
• Cannot bring suit for intentional torts (e.g. assault, battery, false imprisonment, etc.) or violations of constitutional rights under the FTCA.
• No limitation of liability under FTCA• Provides for judicial as well as administrative
remedy• Punitive damages and prejudgment interest not
allowed• No jury trials
Triton Group, LLC.
November 18, 2008November 18, 2008
Federal Tort Claims Act (cont.)Federal Tort Claims Act (cont.)
• Administrative Claim Requirement – must file a claim with agency and give opportunity to the agency to settle claim before a suit is permitted
• If Agency denies, takes no action after six months, or offers unsatisfactory amount, claimant may bring suit in against U.S. in federal district court (within 6 months)
• Attorney fees limited to 20% of administrative settlement and 25% of judgment or compromise settlement
• Administrative Claim Requirement – must file a claim with agency and give opportunity to the agency to settle claim before a suit is permitted
• If Agency denies, takes no action after six months, or offers unsatisfactory amount, claimant may bring suit in against U.S. in federal district court (within 6 months)
• Attorney fees limited to 20% of administrative settlement and 25% of judgment or compromise settlement
Triton Group, LLC.
November 18, 2008November 18, 2008
How the Program WorksHow the Program Works
• Under FSHCAA Health Centers are eligible to be deemed “federal employees”.
• Provides immunity from lawsuit alleging medical malpractice.
• Plaintiff’s only remedy is claim under Federal Tort Claims Act (FTCA).
• Under FSHCAA Health Centers are eligible to be deemed “federal employees”.
• Provides immunity from lawsuit alleging medical malpractice.
• Plaintiff’s only remedy is claim under Federal Tort Claims Act (FTCA).
Triton Group, LLC.
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• A scheme that provides immunity from lawsuit.• Appears similar to an occurrence malpractice
policy.• Program in existence for 13 years.• Very successful in terms of savings for health
centers and coverage of health centers and staff.
• A scheme that provides immunity from lawsuit.• Appears similar to an occurrence malpractice
policy.• Program in existence for 13 years.• Very successful in terms of savings for health
centers and coverage of health centers and staff.
Triton Group, LLC.
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• Who, what , when where?– Who is covered - Relationship to Health
Center.– What is covered – medical malpractice.– Where is it covered – scope of project.– When is it covered – scope of employment.
• Who, what , when where?– Who is covered - Relationship to Health
Center.– What is covered – medical malpractice.– Where is it covered – scope of project.– When is it covered – scope of employment.
Triton Group, LLC
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• Who is Eligible to be Deemed:
• Community Health Centers [section 330 (e)]. • Migrant Health Centers [section 330 (g)].• Health Care for the Homeless [section 330 (h)].• Public Housing Primary Care [section 330 (i)].
• Who is Eligible to be Deemed:
• Community Health Centers [section 330 (e)]. • Migrant Health Centers [section 330 (g)].• Health Care for the Homeless [section 330 (h)].• Public Housing Primary Care [section 330 (i)].
Triton Group, LLC
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• Who is covered - people– Employees.– Officers.– Directors.– Governing board members.– Contractors (some, not all).
• Who is covered - people– Employees.– Officers.– Directors.– Governing board members.– Contractors (some, not all).
Triton Group, LLC
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• Who is covered - Employees– All employees, full time or part time.– Volunteers are not employees.– Employees get a W-2 at end of year.
• Who is covered - Employees– All employees, full time or part time.– Volunteers are not employees.– Employees get a W-2 at end of year.
Triton Group, LLC
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• Who is covered - Contractors– Any full time contract provider (over 32 1/2 hours per week).– Part time contract provider of services in the fields of family
practice, ob-gyn, general internal medicine, or general pediatrics.
– Contract must be between the deemed health center and the individual provider.
– Contracts between the deemed health center and a corporation (including Professional Corporations) are not covered.
• Who is covered - Contractors– Any full time contract provider (over 32 1/2 hours per week).– Part time contract provider of services in the fields of family
practice, ob-gyn, general internal medicine, or general pediatrics.
– Contract must be between the deemed health center and the individual provider.
– Contracts between the deemed health center and a corporation (including Professional Corporations) are not covered.
Triton Group, LLC
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• Contractors– 42 U.S.C. !233(g)(1)(A) “…any contractor of
such an entity who is a physician, or other licensed or certified health care practitioner”.
– 42 U.S.C. !233 (g)(5) “an individual may be considered a contractor”.
– El Rio Case
• Contractors– 42 U.S.C. !233(g)(1)(A) “…any contractor of
such an entity who is a physician, or other licensed or certified health care practitioner”.
– 42 U.S.C. !233 (g)(5) “an individual may be considered a contractor”.
– El Rio Case
Triton Group, LLC
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• What is covered?– Medical malpractice.– More specifically, medical, surgical, dental
and related activities (if within the scope of employment and scope of project).
• What is covered?– Medical malpractice.– More specifically, medical, surgical, dental
and related activities (if within the scope of employment and scope of project).
Triton Group, LLC
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• Where is it covered – within the scope of project
– Only incidents that occur within the scope of the project are covered. (See Policy Information Notice 2008-01).
– Scope of Project are the activities described in the grant application that are approved by Public Health Service via Notice of Grant Award.
– An existing Scope of Project cannot be changed in a grant application. There is a separate process.
– A grant award for a new section 330 activity does change the Scope of Project.
• Where is it covered – within the scope of project
– Only incidents that occur within the scope of the project are covered. (See Policy Information Notice 2008-01).
– Scope of Project are the activities described in the grant application that are approved by Public Health Service via Notice of Grant Award.
– An existing Scope of Project cannot be changed in a grant application. There is a separate process.
– A grant award for a new section 330 activity does change the Scope of Project.
Triton Group, LLC
November 18, 2008November 18, 2008
How the Program Works (cont.)How the Program Works (cont.)
• When is it covered– Coverage is only for acts that are within the
scope of employment of the covered individual.
– No Moonlighting.– Must be acting on behalf of the deemed
entity.
• When is it covered– Coverage is only for acts that are within the
scope of employment of the covered individual.
– No Moonlighting.– Must be acting on behalf of the deemed
entity.
Triton Group, LLC
November 18, 2008November 18, 2008
FTCA ProceduresFTCA Procedures
• Procedure– Plaintiff files administrative claim against the United
States.– DHHS reviews claim and may deny it, pay it or offer a
settlement.– If DHHS denies claim plaintiff may file suit.– If DHHS does not act on claim within six months
plaintiff may file suit.– When suit is filed case transferred to DOJ.– DOJ may attempt to settle suit otherwise it goes into
litigation.
• Procedure– Plaintiff files administrative claim against the United
States.– DHHS reviews claim and may deny it, pay it or offer a
settlement.– If DHHS denies claim plaintiff may file suit.– If DHHS does not act on claim within six months
plaintiff may file suit.– When suit is filed case transferred to DOJ.– DOJ may attempt to settle suit otherwise it goes into
litigation.
Triton Group, LLC
November 18, 2008November 18, 2008
FTCA ProceduresFTCA Procedures
• Procedure– Plaintiffs often file suit in state court.– What to do:
• Immediately fax complaint and deeming letter to:Lisa Barsoomian
Department of Health and Human ServiceOffice of General Counsel (OGC)
202-619-2922 (Fax)202-619-2155 (Voice)
• Have health center attorney request extension of time to reply.
• Procedure– Plaintiffs often file suit in state court.– What to do:
• Immediately fax complaint and deeming letter to:Lisa Barsoomian
Department of Health and Human ServiceOffice of General Counsel (OGC)
202-619-2922 (Fax)202-619-2155 (Voice)
• Have health center attorney request extension of time to reply.
Triton Group, LLC
November 18, 2008November 18, 2008
Requests for TestimonyRequests for Testimony
• Touhy Regulation– Medical Malpractice cases only!– Affects deemed health centers only.– Requests for testimony where the United
States, the health center or its providers are not a party.
– Health center provider must have permission of HRSA administrator to testify.
• Touhy Regulation– Medical Malpractice cases only!– Affects deemed health centers only.– Requests for testimony where the United
States, the health center or its providers are not a party.
– Health center provider must have permission of HRSA administrator to testify.
Triton Group, LLC
November 18, 2008November 18, 2008
Requests for Testimony (cont.)Requests for Testimony (cont.)
• Touhy Regulation– Policy Information Notice 2001-19.– Submit request for deposition or testimony to
DHHS/OGC (fax to 202-619-2922).– HRSA Administrator will approve or deny.– If approved representation may be provided
by DOJ.
• Touhy Regulation– Policy Information Notice 2001-19.– Submit request for deposition or testimony to
DHHS/OGC (fax to 202-619-2922).– HRSA Administrator will approve or deny.– If approved representation may be provided
by DOJ.
Triton Group, LLC
November 18, 2008November 18, 2008
Potential ProblemsPotential Problems
• Contracts.• Sub-Recipients.• Scope of Project - Sites and Services.• Billing Arrangements.• Employment Contract Language.• Nursing Homes.• Contracts with Correctional Institutions.• Non-Health Center Patients.
• Contracts.• Sub-Recipients.• Scope of Project - Sites and Services.• Billing Arrangements.• Employment Contract Language.• Nursing Homes.• Contracts with Correctional Institutions.• Non-Health Center Patients.
Triton Group, LLC
November 18, 2008November 18, 2008
Non-Health Center PatientsNon-Health Center Patients
• Federal Register Notice September 25, 1995 (Volume 60 Number 185) page 49417 – 49418.– Hospital On-Call Requirements.– Cross Coverage Arrangements.– Community Activities.
• Other situations require a “Particularized Determination” See 99-08.
• Federal Register Notice September 25, 1995 (Volume 60 Number 185) page 49417 – 49418.– Hospital On-Call Requirements.– Cross Coverage Arrangements.– Community Activities.
• Other situations require a “Particularized Determination” See 99-08.
Triton Group, LLC
November 18, 2008November 18, 2008
Important issuesImportant issues
– Insurance requirements of hospitals and Health Maintenance Organizations.
– National Practitioner Data Bank.– Other Insurance.– Deeming Applications .– Credentialing – a critical issue.– Emergency Response - PIN 2007-16
– Insurance requirements of hospitals and Health Maintenance Organizations.
– National Practitioner Data Bank.– Other Insurance.– Deeming Applications .– Credentialing – a critical issue.– Emergency Response - PIN 2007-16
Triton Group, LLC
November 18, 2008November 18, 2008
Insurance Requirements of Hospitals and HMO’s.
Insurance Requirements of Hospitals and HMO’s.
• 42 U.S.C. !233(j) - Remedy for denial of admitting privileges to certain health care providers.
• 42 U.S.C. !233(m) - Application of coverage to managed care plans.
• 42 U.S.C. !233(j) - Remedy for denial of admitting privileges to certain health care providers.
• 42 U.S.C. !233(m) - Application of coverage to managed care plans.
Triton Group, LLC
November 18, 2008November 18, 2008
National Practitioner Data Bank (NPDB)
National Practitioner Data Bank (NPDB)
• HRSA Participates in the NPDB.• 42 U.S.C. !401 – 431.• Assistant Secretary of Health elects to
require PHS agencies to report – October 1987.
• http://www.npdb-hipdb.com.
• HRSA Participates in the NPDB.• 42 U.S.C. !401 – 431.• Assistant Secretary of Health elects to
require PHS agencies to report – October 1987.
• http://www.npdb-hipdb.com.
Triton Group, LLC
November 18, 2008November 18, 2008
Other Insurance NeedsOther Insurance Needs
• Gap or Wrap-around: covers medical malpractice not covered by FTCA.– Volunteers– Outside Scope– Contracts with corporations– Contracts with part time specialists
• Tail Insurance• General Liability Insurance• Directors and Officers Liability• Proof of malpractice coverage – Triton Group
• Gap or Wrap-around: covers medical malpractice not covered by FTCA.– Volunteers– Outside Scope– Contracts with corporations– Contracts with part time specialists
• Tail Insurance• General Liability Insurance• Directors and Officers Liability• Proof of malpractice coverage – Triton Group
Triton Group, LLC
November 18, 2008November 18, 2008
Deming ApplicationsDeming Applications
• 2008 Policy– Applications due July 11, 2008.– 10% reviews by HRSA– 90% reviews by contractor.
• 2008 Policy– Applications due July 11, 2008.– 10% reviews by HRSA– 90% reviews by contractor.
Triton Group, LLC
November 18, 2008November 18, 2008
Credentialing and PrivilegingCredentialing and Privileging
• PIN 2002-22• Credentialing and privileging required of all
licensed or certified health care practitioners.• Process for Licensed Independent
Practitioners (LIPs) generally mimics JCAHO.• Non-LIPs requires primary source verification
of only license or certification.• Volunteers included.
• PIN 2002-22• Credentialing and privileging required of all
licensed or certified health care practitioners.• Process for Licensed Independent
Practitioners (LIPs) generally mimics JCAHO.• Non-LIPs requires primary source verification
of only license or certification.• Volunteers included.
Triton Group, LLC
November 18, 2008November 18, 2008
Program ValueMalpractice Premium Savings
Program ValueMalpractice Premium Savings
• Studies conducted for Triton Group by Princeton Insurance Company and Huggins Actuarial Services.
• Premiums calculated for 2002, 2005, 2006• Used Uniform Data System (UDS) data for
deemed Health Centers
• Studies conducted for Triton Group by Princeton Insurance Company and Huggins Actuarial Services.
• Premiums calculated for 2002, 2005, 2006• Used Uniform Data System (UDS) data for
deemed Health Centers
Triton Group, LLC
November 18, 2008November 18, 2008
Program ValueMalpractice Premium Savings
Study Methodology
Program ValueMalpractice Premium Savings
Study Methodology• Used Occurrence Premiums with $1m/3m limits.• Premiums include 25% for taxes, profits,
commissions, etc.• Each deemed Health Center rated by its specific
territory.• Rates based on Full Time Equivalents by specialty.• Premium increased by 10% to cover corporation and
allied personnel.
• Used Occurrence Premiums with $1m/3m limits.• Premiums include 25% for taxes, profits,
commissions, etc.• Each deemed Health Center rated by its specific
territory.• Rates based on Full Time Equivalents by specialty.• Premium increased by 10% to cover corporation and
allied personnel.
Triton Group, LLC
November 18, 2008November 18, 2008
Program ValueMalpractice Premium Savings Study
Results
Program ValueMalpractice Premium Savings Study
Results• 2002 Savings for deemed centers - $164,000,000• 2005 Savings for deemed centers - $180,000,000• 2006 Savings for deemed centers - $184,000,000• 2007 Savings for deemed centers - $192,000,000
• Extrapolating from the studies: total savings since 1993$1.6 billion
• 2002 Savings for deemed centers - $164,000,000• 2005 Savings for deemed centers - $180,000,000• 2006 Savings for deemed centers - $184,000,000• 2007 Savings for deemed centers - $192,000,000
• Extrapolating from the studies: total savings since 1993$1.6 billion
Triton Group, LLC
November 18, 2008November 18, 2008
Claim Status - NationalClaim Status - National
• Oct. 1994 thru April 2008 - 2340 Claims filed against the United States.
• Closed Claims - approximately 64% of total.• Paid Claims – approximately 33% of total claims,
52% of closed claims• Avg. cost per paid claim - $400,000.• Avg. cost per closed claim - $210,000
• Oct. 1994 thru April 2008 - 2340 Claims filed against the United States.
• Closed Claims - approximately 64% of total.• Paid Claims – approximately 33% of total claims,
52% of closed claims• Avg. cost per paid claim - $400,000.• Avg. cost per closed claim - $210,000
Triton Group, LLC
November 18, 2008November 18, 2008
0
50
100
150
200
250
300
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
HRSA FTCA CLAIMS PER FISCAL YEAR
Triton Group, LLC
November 18, 2008November 18, 2008
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007Year
FTCA Losses Per YHealth Centers
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007Year
FTCA Losses Per YHealth Centers
Triton Group, LLC
November 18, 2008November 18, 2008
Secondary Factors / System Problems
10 127 16 14 0 6 0 0 0
681
357394
204
107
5626
3 1
311
0
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Q4FY2006 Previous
November 18, 2008November 18, 2008
Risk ManagementRisk Management
• Health Centers are expected to use a portion of savings to provide risk management services. (PIN 99-08 Para. XVIII).
• Inspector General report on risk management in health centers.
• Triton Group can provide risk management services.
• Health Centers are expected to use a portion of savings to provide risk management services. (PIN 99-08 Para. XVIII).
• Inspector General report on risk management in health centers.
• Triton Group can provide risk management services.
Triton Group, LLC
Discharging PatientsDischarging Patients
• Must have a policy approved by governing board.– Circumstances necessary to discharge– Process to be used
• Notification to patient (certified mail)• Alternative sources of care• Offer to provide care for next 30 days
• Must have a policy approved by governing board.– Circumstances necessary to discharge– Process to be used
• Notification to patient (certified mail)• Alternative sources of care• Offer to provide care for next 30 days
11/18/200811/18/2008
November 18, 2008November 18, 2008
Risk Management Issues in Health Centers
Risk Management Issues in Health Centers
• Credentialing and Privileging– Competence of providers
• Medical Records– Legibility– Completeness– Signatures– Availability
• Birth Injuries– Existence and Proper use of protocols
• Informed Consent
• Credentialing and Privileging– Competence of providers
• Medical Records– Legibility– Completeness– Signatures– Availability
• Birth Injuries– Existence and Proper use of protocols
• Informed ConsentTriton Group, LLC
November 18, 2008November 18, 2008
Recent Risk Management RecommendationsRecent Risk Management Recommendations
• Training/CME:– Monitoring Pitocin Administration– Cord prolapse– GBS testing– Preceptor needs in labor and delivery
setting
• Training/CME:– Monitoring Pitocin Administration– Cord prolapse– GBS testing– Preceptor needs in labor and delivery
setting
Triton Group, LLC
November 18, 2008November 18, 2008
Recent Risk Management RecommendationsRecent Risk Management Recommendations• Illegible and/or Inadequate Medical
Record Documentation– Accurate, complete and legible– Documentation of scheduled exams– Training in proper documentation– Use problem list and flow sheets for lab and
meds– Encourage use of EMR
• Illegible and/or Inadequate Medical Record Documentation– Accurate, complete and legible– Documentation of scheduled exams– Training in proper documentation– Use problem list and flow sheets for lab and
meds– Encourage use of EMR
Triton Group, LLC
November 18, 2008November 18, 2008
Recent Risk Management RecommendationsRecent Risk Management Recommendations• Policies/Procedures/Protocols
– Lack of policies/procedure/protocol in 24% of cases reviewed
– Examples: chest pain, handling of abnormal test results, adherence to ACOG 30 Minute “Decision to Incision” guideline.
– Every health center should have its own customized set of well defined policies and procedures
• Policies/Procedures/Protocols– Lack of policies/procedure/protocol in 24% of
cases reviewed– Examples: chest pain, handling of abnormal
test results, adherence to ACOG 30 Minute “Decision to Incision” guideline.
– Every health center should have its own customized set of well defined policies and procedures
Triton Group, LLC
November 18, 2008November 18, 2008
HIPAA Section 194Volunteers in Free Clinics
HIPAA Section 194Volunteers in Free Clinics
• Provides Med Mal protection to “Volunteers in “Free Clinics”– Volunteer and free clinic are specifically defined in the
statute– Does not cover the free clinic corporation nor the free
clinic employed staff– Free clinic may not accept any third party
reimbursement– Must give notice to patients on limitations of liability
• Provides Med Mal protection to “Volunteers in “Free Clinics”– Volunteer and free clinic are specifically defined in the
statute– Does not cover the free clinic corporation nor the free
clinic employed staff– Free clinic may not accept any third party
reimbursement– Must give notice to patients on limitations of liability
Triton Group, LLC
11/18/200811/18/2008 4545
Department of Health and Human Services
Office of Inspector General’s ReportFebruary 2005
“Risk Management at Health Centers”Report OEI-01-03-0005
http://oig.hhs.gov
Department of Health and Human Services
Office of Inspector General’s ReportFebruary 2005
“Risk Management at Health Centers”Report OEI-01-03-0005
http://oig.hhs.gov
11/18/200811/18/2008 4646
“HRSA’s goal is that by 2010, 100% of health centers will participate in risk management training. HRSA plans to hold risk management workshops and develop a comprehensive training agenda.”
“HRSA’s goal is that by 2010, 100% of health centers will participate in risk management training. HRSA plans to hold risk management workshops and develop a comprehensive training agenda.”
11/18/200811/18/2008 4747
HRSA Risk Management RequirementsHRSA Risk Management Requirements• Active Quality Improvement Program
• Appropriate use of clinical protocols
• Clear communication with patients
• Comprehensive patient medical records
• Credentialing and privileging of health care professionals
• Formal patient grievance mechanism
• Regular patient satisfaction survey
• Regular staff training on risk management
• Up to date policies and procedures on risk management
• Active Quality Improvement Program
• Appropriate use of clinical protocols
• Clear communication with patients
• Comprehensive patient medical records
• Credentialing and privileging of health care professionals
• Formal patient grievance mechanism
• Regular patient satisfaction survey
• Regular staff training on risk management
• Up to date policies and procedures on risk management
11/18/200811/18/2008 4848
HRSA not required but identified as important in the Inspector General’s Report:HRSA not required but identified as important in the Inspector General’s Report:
• Clear communication with providers
• Documentation of informed consent
• Internal incident reporting system
• Ongoing peer review of patient cases
• Onsite assessment of risks and risk
management practices
• Clear communication with providers
• Documentation of informed consent
• Internal incident reporting system
• Ongoing peer review of patient cases
• Onsite assessment of risks and risk
management practices
11/18/200811/18/2008 4949
In a 2005 study, participants in interviews cited peer
review as one of the three most important tools for risk management but also one
of the most difficult things to accomplish.
In a 2005 study, participants in interviews cited peer
review as one of the three most important tools for risk management but also one
of the most difficult things to accomplish.
November 18, 2008November 18, 2008
Triton GroupTriton GroupFirst Source of FTCA Program Information
o Triton Groupo 227 Hamburg.o Pompton Lakes, NJ 07442o HRSA Contract No. 232-00-0097
o Martin J. Bree Susan Lewiso 772-873-1865 727-822-4271o 772-873-1695 (fax) [email protected] 856-625-8638 (cell)o [email protected]
o Roger Fuydalo 866-FTCA-HELP - Toll Free Marty Hiller (Free Clinics)o (866-382-2435) 216-382-4150o 973-831-8395 (Fax) [email protected] [email protected]
First Source of FTCA Program Information
o Triton Groupo 227 Hamburg.o Pompton Lakes, NJ 07442o HRSA Contract No. 232-00-0097
o Martin J. Bree Susan Lewiso 772-873-1865 727-822-4271o 772-873-1695 (fax) [email protected] 856-625-8638 (cell)o [email protected]
o Roger Fuydalo 866-FTCA-HELP - Toll Free Marty Hiller (Free Clinics)o (866-382-2435) 216-382-4150o 973-831-8395 (Fax) [email protected] [email protected]
Triton Group, LLC