Risk management in the medical setting is a challenging but critical activity.

FREMONT, CA: A healthcare administrative professional can recognize the critical nature of risk mitigation to promote patient safety and protect revenue that could be lost due to noncompliance. They have read health-industry publications about it and may have even attended professional organization's risk-mitigation hot-topic meetings.

The quality and risk managers and hospital administration may increasingly give education and training on how the institution operates and mitigates risk.

Every employee, administrator, and member of the governing board of a healthcare institution should be aware that regulatory bodies' rules and standards mandate risk assessment. Perhaps the most well-known institution that demands and oversees risk compliance is the United States Department of Health and Human Services (HHS). Health Insurance Portability and Accountability Act (HIPAA) establishes security and breach notification requirements for protected health information (PHI).

Under the HIPAA Security Rule, a covered entity or business associate is required to "conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity or business associate." Additionally, the Security Rule mandates that a documented record of the action, activity, or assessment be maintained, which may be electronic.

To comply with these HIPAA regulations, a hospital must conduct a risk assessment of any potential breach to identify the likelihood of PHI being compromised, as well as a written risk assessment of electronic PHI vulnerabilities.

Apart from HIPAA standards, many government programs and legislation highlight the importance of risk assessment. Among them are the following:

  • Inspector General's Office (OIG)
  • Justice Department (DOJ)
  • Medicare & Medicaid Services Centers for Medicare & Medicaid Services (CMS),
  • Agency for Environmental Protection
  • The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA)

Healthcare compliance is a serious matter with significant financial ramifications. Financial penalties, removal from federal healthcare programs, prison time, and reputational damage are severe penalties for regulatory violation.

Finally, routine risk assessment strengthens a healthcare organization's ability to defend itself against charges of noncompliance or wrongdoing, potentially lowering the number and severity of malpractice lawsuits filed. All of this results in a more favorable public perception and reputation, which is critical in today's competitive healthcare market: Patients have a great deal of choice for healthcare providers.

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