2018's Top Healthcare Client Concerns

and other insights from OmniSure helpline utilization

According to surveys of our partners’ policyholders, having access to a confidential 3rd party helpline for advice-on-demand is an important way to manage risk and prevent losses. During 2018, in addition to the scheduled risk assessments and consults for thousands of healthcare and human service organizations, OmniSure had approximately five hundred opportunities to assist policyholders real-time with advice-on-demand. Though the exact nature of the helpline conversations and the names of the policyholders are confidential, we offer the following summary of trends, including our top take-aways and lessons learned from 2018.

What are policyholders’ top concerns?

Complaints by patients about their experience is the number one concern of our partner-insured healthcare and human service clients. The most common themes involve negative online reviews and demands for refunds. Innovations in health care and technology, greater access to information, online satisfaction rating platforms, and recent regulations requiring a shift to person-centric care all come together to create the perfect storm for healthcare providers who think they know what’s best. Patient satisfaction, safety and quality of care are becoming equally important priorities for healthcare organizations. Professionals must focus not only on what works clinically, but also on what makes for the best patient experience. Unfortunately, negative online reviews cannot generally be removed by the provider. However, negative reviews can be counterbalanced and even overcome by many more positive reviews, which requires the provider to be constantly focused on improving the patient experience, and to more actively request public feedback.

Concerns about violating the Health Insurance Portability and Accountability Act (HIPAA) and guidance when terminating a patient relationship tie for 2nd place. Lost laptops, mobile phones used for both personal and professional communications, crossing boundaries on social media, unencrypted email, and vulnerable internet connections, all present ongoing challenges to healthcare professionals, and many of our educational offerings address these issues. However, the number one question everyone has about HIPAA is: "How do I know when and what I can or must share with others (family members, law enforcement, court officials, other medical professionals and entities)?" Even though HIPAA originated in 1996, healthcare professionals continue to find it challenging to balance confidentiality with patient safety and security. Often the stakes are high and having a risk and compliance specialist weigh in on specific concerns or requests results in recommendations unique to their situation.

Patient termination and involuntary discharge are almost always the result of an especially challenging patient or situation. Healthcare professionals have the task of deciding if and when they are no longer able to meet the patient’s expectations as well as healthcare needs. A positive relationship between a physician and his or her patient is essential for quality and safe medical care. When a physician-patient relationship has been created, there is a duty of care established. Just as patients have a right to select their physicians, physicians also have the right to terminate their relationships with patients. Examples of legitimate reasons for termination of the relationship include failure or refusal to pay medical bills, breakdown in relationship or communications, disruptive conduct, noncompliance with treatment, frequent no-shows, and verbal abuse of staff and/or providers. Providers struggle with ending patient relationships out of their sense of duty. Having an objective specialist listen to the provider’s concerns and perspective, then discuss the risks or exposures and what is ultimately best for both the patient and provider and ultimately offer guidance on the steps to follow when dismissing the patient reduces risk.

Advice-on-demand averages 36 minutes per client consult. Calls in the more frequent categories are handled in 15 minutes or less. However, some calls are more complex and require hours of support. Though less than 10% of the consults are for Incidents and Event Management, these are the most likely to prevent claims. A significant amount of time and expertise is focused on incidents such as attempted suicide, elopement, patient aggression, medication errors, allegations of abuse, and unintended harm, including death.

Generally, these calls require experienced coaching on what to say, what not say, and common missteps to avoid. They often also include a follow-up call after the initial interactions or as the team prepares to deal with the patient and family.

Providing safe, high-quality care is important for healthcare organizations, providers, staff and all members of the care team. Even though organizations focus on this, medical errors and unanticipated events can and do continue to occur. When an adverse event occurs, a decision must be made about what, how, by whom, and to what extent information is to be disclosed to the patient and family. Even though the requirement for disclosure to patients and families has been enforced for many years, a sense of distrust among many healthcare providers continues to be a concern. Some of the reasons providers are hesitant to disclose unanticipated outcomes include fear of litigation, concerns about reputation, lack of knowledge about their duty to disclose and error reporting systems. With the focus on transparency and disclosure of unanticipated outcomes, OmniSure’s support comes as a relief as organizations work on shifting culture and demonstrating effective, open and transparent communication following unexpected events. It is at these times when the stakes are the highest and OmniSure’s guidance is tremendously valued by all parties.

Which Policyholders are Seeking Guidance?

Doctors insured in the non-standard market are by far the most frequent users of the helpline for advice-on-demand, as they are the most impacted by online ratings and the need to terminate patient relationships. However, other immediate needs have included guidance on the risks or regulations related to emerging treatments such as Botox for Hyperhidrosis (excessive sweating) or stem cells for Muscular Degeneration, often from those practicing complementary and alternative medicine, such as naturopathy. Assisted Living and Skilled Nursing combined come in 2nd place making up approximately 28% of helpline utilization, with Brokers and Underwriters in 3rd place at 10%.

How are clients reaching out?

Statistics show approximately 47% of emails are now opened on a mobile device. As policyholders become more comfortable with technology, we expect to see a shift in the way they engage with their risk partners. Only 1% of the requests for advice-on-demand happen in person, while the consultant is onsite. Instead, the majority of the real-time guidance is needed throughout the policy period. While 41% of policyholders are most comfortable reaching out and discussing issues by phone, we are seeing a growing trend for confidential assistance by email, online forms, or chat.

DISCLAIMER: Risk Management support provided by OmniSure Consulting Group does not constitute and is not intended to replace legal advice. Organizations should consult an own attorney to review any fact-specific documentation, policies, procedures and other relevant information in connection with matters affecting legal interests. Information or documents provided are for illustrative purposes only and are not intended to dictate or replace company policy. OmniSure is a separate risk management consulting firm and is not an agent of insurance companies or any or their affiliates. OmniSure’s Contract Review and Risk Management Advice-on-Demand services are intended to provide experience driven recommendations. These services are not intended and should not be deemed to answer any policy coverage questions or warrant compliance with any policy conditions or requirements.