The role data plays in effective risk management in General Practice
- Data, Risk Management
- Chris Smeed
- November 23, 2023
In the dynamic landscape of General Practice, the significance of effective risk management cannot be overstated. As practices navigate a landscape rife with challenges, the ability to proactively identify, monitor and mitigate risks is of the upmost importance.
As we aim to shed light on the important role that is risk management in General Practice, and we’ll explore how software providers like Cubiko can serve as a powerful ally by offering insights and streamlined workflows to help you manage risk.
Data-driven approaches to risk management aims to empower practices to not only navigate the complexities of risk but also enhance the overall quality of care within the healthcare setting.
How to identify risks in your practice
Identifying risks in your practice is a fundamental step towards proactive risk management. Begin by conducting a comprehensive risk assessment that involves assessing various aspects of your practice, from clinical procedures to administrative processes.
Engage your team in open communication to gather diverse perspectives on potential risks. Analyse historical data, incident reports, and patient feedback to identify patterns or trends that may indicate areas of vulnerability in your practice.
We also highly encourage cultivating a culture of reporting and learning from near misses by fostering an environment where staff feel comfortable highlighting potential risks. By embracing a holistic and collaborative approach to risk identification, you are laying the groundwork for a robust risk management strategy that will enhance the safety and efficacy of your practice.
The key data and workflows you can implement to help manage risk
Leveraging key data and strategic workflows, such as those available through platforms like Cubiko, enables practices to proactively identify and address potential risks. These insights not only minimise the likelihood of adverse events but also enhance overall practice efficiency.
Clinical Risks
Unactioned inbox items
For patient well-being, it’s important that practitioners monitor their unactioned inbox items daily. Neglecting to do so increases the risk of patients not receiving timely, quality care and delays in obtaining important test results.
Practices should closely track unactioned items, implementing procedures for prompt action. For instance, monitoring the trend of unactioned inbox items helps identify practitioners who may need additional training in effective inbox management; or implementing a buddy system during practitioner leave to ensure continuous item actioning, eliminating delays and ensuring patients promptly receive vital information regarding their care.
Investigations contacted, not given
Monitoring your investigations contacted, but not given is important for effective risk management in a healthcare setting. This report highlights instances where patients have been marked as contacted, but the results are not marked as given. This discrepancy poses potential risks, such as delayed diagnosis or inadequate follow-up, impacting patient care and overall practice efficiency.
Regularly tracking and addressing these instances ensures that diagnostic information is effectively communicated to both practitioners and patients, reducing the likelihood of medical oversights, and enhancing the quality and safety of the healthcare delivered.
Recalls
The daily tracking of uncontacted recalls (both urgent and non-urgent) is essential to identify and address any lapses in the follow-up procedure promptly. Being proactive in your approach to follow up not only safeguards patient well-being but maintains the integrity of the healthcare services you provide and supports legal compliance.
Failure to adequately follow up recalls may jeopardise the patient’s healthcare and may put your practice and the responsible doctor(s) at medico-legal risk.
Business Risks
Booked and Consulting hours
Effectively managing booked hours is critical in mitigating risks and ensuring the well-being of practitioners and nurses. Overbooking can lead to burnout, compromise the quality of patient care, and increase the likelihood of errors.
By carefully monitoring and optimising booked hours, practices can strike a balance that supports the health and productivity of their healthcare professionals while maintaining high standards of care. This proactive approach not only enhances staff satisfaction but also contributes to a more resilient and efficient healthcare environment.
Doctor tenure
Leveraging data to track the tenure of doctors at your practice provides valuable insights into workforce stability. By analysing historical data on staff retention and departures, practices can calculate the average doctor turnover rate.
These insights serve as a key indicator of the practice’s ability to retain skilled professionals and highlights areas for potential improvement. Understanding patterns in doctor tenure enables proactive strategies to enhance job satisfaction, address retention challenges, and foster a positive and stable working environment which ultimately minimises the risk of high turnover within the practice.
Patient preferred practitioner and days till third next available appointment
Utilising data to monitor a patients preferred practitioner and days till third next available appointment is a pivotal strategy in ensuring continuity of care. By tracking this data, practices can assess whether patients can secure appointments with their preferred practitioners in a timely manner.
The risk of patients being unable to book with their preferred practitioner raises concerns about potential disruptions to continuity of care, hindering the establishment of a trusted patient-provider relationship. This data-driven approach not only addresses scheduling efficiency but also plays a crucial role in mitigating the impact on patient satisfaction and overall healthcare outcomes.
Reporting on Written off/deleted/cancelled invoices
Monitoring reports on written off, deleted, or cancelled invoices is a strategic practice that offers insights into potential issues and helps maintain financial integrity. Tracking this data allows practices to keep a comprehensive record of invoices that have been written off, deleted, or cancelled.
Beyond financial transparency, this proactive approach serves as a deterrent against potential fraud risks. By maintaining a vigilant eye on these reports, practices can swiftly identify irregularities, investigate underlying causes, and implement preventive measures.
This not only bolsters financial security but also contributes to overall operational resilience, ensuring a robust and trustworthy financial system within the practice.
Actionable Risks
Prescribed pattern of services - The 80/20 and 30/20 rules
A prescribed pattern of service occurs when a practitioner claims a specified type of Medical Benefits Schedule service at a frequency and quantity defined in the Health Insurance (Professional Services Review Scheme) Regulations 2019 (the regulations).
Regularly monitoring adherence to the 80/20 and 30/20 rules is crucial, ensuring compliance across practitioners in your practice and safeguarding them against the risk of an audit.
Appointments to be rebooked
Using data to identify appointments that need rebooking is a proactive strategy to minimise the risk of patients scheduled to visit during practice closure.
By scrutinising appointment data, practices can pinpoint potential scheduling errors or conflicts, ensuring that no one is inadvertently booked when the facility is closed. To mitigate this risk, implementing automated scheduling systems with built-in checks for practice hours and holidays can be effective.
Regular reviews of upcoming appointments using data analytics tools, such as Cubiko, provide an additional layer of vigilance, allowing for timely adjustments and communication with patients to avoid any inconvenience. This data-driven approach not only streamlines operations but also enhances patient satisfaction by preventing scheduling mishaps and ensuring smooth, well-coordinated healthcare services.
Appointment day sheets
In cases of unexpected blackouts, having a comprehensive list of appointments for the day becomes paramount for maintaining seamless healthcare operations. Software solutions like Cubiko prove invaluable during these times by offering a quick and accessible list of appointments scheduled for the day, facilitating seamless operations even when traditional systems may be temporarily disrupted. Cubiko’s capability to provide real-time insights not only facilitates the continuation of patient care but also exemplifies its role in bolstering operational resilience during unforeseen challenges.
MBS Benchmarking
MBS benchmarking is a valuable tool for understanding a practice’s billing performance in comparison to national and state benchmarks. Utilising these benchmarks allows practices to gain insights into their billing efficiency and identify areas for improvement. By assessing how their billing practices align with national and state averages, healthcare providers can pinpoint potential risks such as underbilling or coding discrepancies. This empowers practices to make informed decisions, implement targeted improvements, and optimise billing practices to meet or exceed industry benchmarks.
Uncompleted patient appointments
Regularly examining uncompleted patient appointments plays a crucial role in optimising a practice’s billing efficiency. Identifying these appointments is key, as they may not have progressed through the standard patient workflow, leading to potential instances of non-billing. Without consistent checks, these uncompleted appointments can represent missed billings, adversely impacting the practice’s financial health. By proactively addressing and billing for such appointments, practices can guarantee thorough revenue capture and sustain a strong financial foundation.
Unbilled appointments
Regularly monitoring unbilled patient appointments is a crucial practice to identify and rectify missed billing opportunities. The causes of these oversights can vary, ranging from reception staff accidentally not billing to doctors not putting a billing through at the end of the consult or day.
Particularly amidst the additional challenges practices face, maximising cash flow from existing encounters is imperative for sustaining the financial viability of the practice. Proactive monitoring of unbilled appointments ensures comprehensive revenue capture, addressing potential gaps that could impact the practice’s overall financial health.
Appointments that may not be eligible for Telehealth services
Regularly checking appointments for telehealth eligibility is essential to identify cases where patients haven’t had a face-to-face consultation in the last 12 months, potentially making them ineligible for Medicare rebate services. Software solutions like Cubiko can provide you with lists which could be used to reach out to patients, informing them about the possibility of fees for their telehealth service due to not meeting current Medicare-rebate eligibility criteria. This proactive communication ensures transparency and helps patients understand any potential out-of-pocket expenses associated with telehealth consultations, which ultimately reduces the risk of you not getting paid for your services.
Recording and mitigating the risk
In a general practice setting, recording and mitigating risks is essential. Documenting potential risks allows for the development of targeted strategies to minimise or eliminate challenges, ensuring a safe and efficient healthcare environment. Regularly reviewing and adjusting risk mitigation strategies contributes to the overall resilience of the clinic, promoting a secure and patient-focused atmosphere. Importantly, leveraging data is key in identifying patterns, predicting potential risks, and making informed decisions to mitigate those risks effectively.
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