 |
|
Diagnostic imaging services have been targeted for payment reductions and other regulatory restrictions as a result of rapid growth and reimbursements paid under the Medicare Physician Fee Schedule (MPFS). Both Congress and the Centers for Medicare & Medicaid Services (CMS) have taken steps to significantly reduce payments for the technical component of diagnostic imaging services. Diagnostic imaging centers are facing very challenging times with declining reimbursement, rising technology costs, and escalating competition.
By providing the highest level of innovative and integrated consulting expertise, Clinical Risk Solutions will partner with your diagnostic imaging center to develop and implement strategic initiatives to meet these challenges and create a patient safety-centered model of excellence. Care standardization, clinical operational efficiency, team culture, communication, documentation, and regulatory survey readiness, are key elements of our consultative solution-based approach.
Focus areas of review
and organizational program development include the following opportunities:
|
Imaging Practices and Regulatory Compliance
- Enhancement of organizational structures to integrate quality,
safety, regulatory compliance, and risk management
- Clinical Risk Assessment:
comprehensive clinical risk assessment of the diagnostic imaging
center, physician and staff practices, and regulatory compliance.
- Professional liability claims analysis
- Standardized incident management response
- Integrating quality, safety, and risk data to drive organizational
performance
- Diagnostic Imaging Regulatory Compliance:
- Centers for Medicare & Medicaid Services (CMS)
- Office of Inspector General (OIG)
- Professional courtesies
- Vendor contracts
- Stark II compliance
- Recovery Audit Contractor (RAC) review
- Health care fraud and abuse
- "Anti-Kickback" law
- Stark I, II"/Self-Referral Law
- Medical mediation and conflict resolution process
- Bioethics and IRB contracts/clinical trials participation
- Medical mediation and conflict resolution process
- Professional liability insurance brokerage services:
- Broker RFP process and selection criteria
- Broker performance measures
|
|
Medical
Staff Structure Review
- Credentialing: re-credentialing,
clinical privileging
- Bylaws: rules and
regulations
- Peer review process:
- Ongoing and focused
professional performance evaluation (OPPE and FPPE)
- Competencies (ACGME)
and the Joint Commission:
- Medical knowledge
- Patient care
- Interpersonal and
communication skills
- Professionalism
- Systems based practice
- Practice-based learning
and improvement
- The Joint Commission
and CMS
- Standard survey
readiness/tracer methodology
- Standard interpretation
and resource tools
- Physician leadership
training
- Hospital Leadership
and Medical Staff relationships
- Conflict of interest
- Professional behavior
- Adverse event disclosure
|
Education
and Physician Development
|
- Culture and Staff
Performance: Developing a patient safety-centered culture of excellence within the operational systems through staff education and engagement
- Communication: Developing effective skills and techniques to enhance patient satisfaction and decrease medical malpractice liability
- Documentation: Developing effective skills and techniques to enhance patient satisfaction and decrease medical malpractice liability
- Universal Protocol compliance
- Reduction of health care-associated infections:
- Policy development:
informed consent, interventional protocols, procedural sedation, physician order sets, emergency management and monitoring of high-risk patients, transfer protocols, turnaround times, discrepancy tracking and follow-up, critical test results, contrast protocols, MRI safety
- Medication safety management
- Radiation safety management
- Contract negotiation
- Medical error management:
- Documentation, investigation,
disclosure, mediation/resolution
- Medication reconciliation
process
|
|
