Having worked in General Practice, I know that you and your colleagues face a myriad of risks daily. For the continued success of your practice, you must have the proper tools, systems, and data in place to help mitigate risk.
With General Practice evolving dramatically over the past two decades, common risks we face today were unheard of a decade or two ago. Data is all around us, from our business and financial systems, to our patient records. I am finding that practices are increasingly reliant on their practice data to manage risk in the following areas:
- Non-compliance with Medicare & MBS Auditing
- Clinical Governance
- Safety of Patient Data
Risk of non-compliance with Medicare & MBS auditing
The Medicare Benefit Scheme (MBS) refers to the list of professional health services that the Australian Government subsidises. More than 5,700 MBS items benefit patients for a comprehensive range of services, including consultations, diagnostic tests, and operations.
Complying with the MBS requirements is essential. Failing to do so runs the risk of non-compliance with Medicare, resulting in an MBS audit. Failure to comply is one of the biggest fears physicians face, and this is due to the onus of being compliant falling on them.
To help minimise the risk of non-compliance and MBS audits, practices are increasingly relying on their Practice Management System (PMS) and Practice Intelligence Platforms to distil critical data. Data that can help you:
- Determine your practice’s utilisation of item numbers
- See historical trends of your item number billings
- Determine patient eligibility
- Identify possible service opportunities
- Complete internal audits of your item number use to compare against the publicly available MBS data
I’m seeing an increase in the number of practices using the publicly available government data from, the MBS Item Statistic Reports. After many discussions with many data-empowered practices, I’ve come to learn that many provide a service to their practitioners by reviewing the readily available government benchmarks of MBS item numbers. Providing this service can really help your practice standout with other doctors and demonstrates how you use power to empower your team.
Clinical Governance Risks
Clinical governance is defined as the systematic approach to continuous quality and safety improvement. It holds all practitioners and practice staff responsible for the shared practice outcomes to help ensure that the delivery of health services is safe, effective, high quality and continuously improving.
One way to minimise clinical governance risks is through your practice’s data. Katrina Otto, owner and managing director at Train IT Medical, says, ‘having good practice data helps us to ensure that no patient ever slips through the gaps.’
Practices need to have systems in place to ensure all patient data is present and up to date. Failure to do so could result in the inability to contact patients for recalls, reminders, and notification of results. Resulting in a risk to patient care and leaving yourself open to litigation or having to repay money to Medicare.
With recalls, ensure you can easily see the age of your urgent & non-urgent recalls. Appoint someone in your team to have ownership of handling and following up on your practice’s recalls. This helps you and your GPs rest easy at night knowing that the right patients are coming into the practice at the right time.
Many practice management systems can now implement robust reminder systems. At our practice we would use reminders for many reasons, such as repeat blood test, GPMP/TCA/Review, immunisations and much more. Ensure that you have the right systems in place so that you can easily find any overdue reminders. They’re the ones that require action.
Final top tip to help support your practitioners and reduce the stress in running the practice is around results. Can you easily follow up on any investigations that have been contacted by not given? It’s important to ensure that when your team uses your practice management system, that they mark the results as given, if the result has been given. Ensuring that your data is clean helps you report and action where appropriate.
Interested in learning how Cubiko can help you manage risk?
Risk of not attaining accreditation
While accreditation is not mandatory in Australia, many practices elect to attain it to demonstrate their dedication to providing safe and high-quality healthcare. While also undertaking these activities to qualify for the Practice Incentive Program for Quality Improvement (PIP QI).
Accreditation standards require clinical governance to be established. To meet the standards set out by the RACGP, practices are required, among other things, to set and evaluate business goals, have good business processes, and have good business and quality improvement data.
Utilising your practice’s data and keeping it up to date has many benefits. It allows practice owners to understand what is happening and plays a vital role in the accreditation process. Practices around Australia are looking at their data to evaluate how they are performing against their business goals. While also looking at their data to identify areas of improvement for Quality Improvement activities. They are using their data to monitor and evaluate their activities.
Failure to use your practice’s data to track or evaluate your business goals and quality improvement activities may result in your practice failing accreditation.
Learning from medical errors and using data to identify perceived risks within your practice helps prevent the reoccurrence of adverse patient outcomes. Traditionally, practice’s review and implement steps for improvement following a complaint or an adverse patient outcome. Don’t wait to act. Instead, be proactive and utilise your practice’s data to identify areas of risk and implement steps to minimise risk and prevent reoccurrence. Thus, leading to a drop in patient complaints and medicolegal claims.
Patient Data Safety Risk
Healthcare professionals rely on technologies and software to assess, update, record and analyse patient data. Given the sensitive nature of healthcare data, data security is of particular importance for healthcare providers. However, without an effective plan to safeguard your practice’s data, you run the risk of leaving your practice open to cyber-attacks.
To minimise the risk of malicious attacks and data breaches, we recommend asking six key questions before signing up to a particular software company to determine how your data is handled and protected.
- What hosting provider and technologies do they use?
- Is my data encrypted end-to-end and at rest?
- Do they do 3rd-Party Penetration Testing?
- Is my data stored in Australia?
- Are they Partner Approved by other software systems I trust?
While risk is not avoidable in General Practice, we have found that practices that utilise their data have managed to be proactive in the care they provide patients. While substantially reducing their risks in several areas of the practice. How are you using your practice data to minimise risk?