The Crisis Caused By the Lack of Crisis Planning.

crisis /krī′s?s/ an extremely difficult, unstable or dangerous point in a situation.

Scene 1

An audit of the hospital’s pharmacy discovers a bin tucked away on an upper shelf with group member Dr. X’s name on it in her own handwriting. In it are dozens of partially used vials of drugs. Pharmacy staff state that Dr. X puts drugs in the bin and then empties it every few months for medical mission trips. The hospital and state authorities immediately launch investigations into drug diversion.

Scene 2

Your group is served with a lawsuit alleging that one of your staff sexually harassed a patient during the course of in-patient treatment. In addition to your group, the staff member and the hospital are named as defendants. The hospital CEO has already left seven messages for you.

Scene 3

A random review of one of your physician’s billing records indicates that he has likely been upcoding procedures over an extended period of time.

Each of those is an example of a crisis, a situation which, as to the knowledge of your medical group, came on suddenly; an explosive situation that can or has already spun out of control, not one that slowly developed over time such that it might easily be managed.

Simply because, by definition, you have limited ability to control the outcome doesn’t mean that you should let the crisis control you.

Although any particular crisis can’t be predicted, classes of crisis are capable of prediction and, even if that is not true of a specific situation, the way in which your group or business will respond to a crisis can, should, and must be planned far in advance.

A hospital doesn’t wait for a power outage to go shopping for a generator.

Once a crisis hits, it is too late to plan effectively. What are you waiting for?

Crisis Planning

Crisis planning involves a number of elements designed to ready your medical group or business for an immediate response to a future crisis situation.

It includes elements such as:

• Identifying current vulnerabilities and scenario planning to identify potential categories/classes of crisis. Of course, due to the nature of a crisis, this is an approximation, not a crystal ball.

• Crafting a general approach and philosophy in regard to crisis response.

• Identifying the crisis management team and its members’ roles, responsibilities, and reporting requirements. For example, who will be the point person for all crisis communications?

• Preparation for the immediate involvement of outside counsel both in terms of advice and in respect of preserving the penumbra of privilege. ?In other words, in nearly every crisis instance, other outside experts (e.g., coding auditors, crisis communication firms, accounting firms, etc.) should be engaged through counsel to protect, to the fullest extent possible, communications with them pursuant to attorney-client privilege.

• The process to be followed for an after-crisis review.

To be clear, many categories of crisis that impact medical groups involve both a substantive element (for example, the process of identifying potential overpayment, considering avenues to refund overpayments, the timelines to refund overpayments, etc.) as well as a publicity element, whether “publicity” is limited to matters affecting the relationship between the medical group and a hospital or referral sources, or whether it is general publicity, as in the case of a major malpractice action or sexual harassment claim that is likely to be reported by community, regional, or even national news outlets.

Immoral political hacks think that a crisis shouldn’t be left to go to waste. Smart medical group leaders know that a crisis can waste you.

That’s why engaging in crisis planning today, whether or not the plan will ever be needed, is both necessary and required.

Let’s start the process.