The Risky Health Care Business

Highlights of recent headlines from the U.S. Department of Health and Human Services (HHS) and their potential risk considerations Copyright 2024 SpringParker

What he does: Dr. Kazi is the President of the Arizona Medical Association. Dr. Kazi is also a practicing gastroenterologist and independent, private practice founder-owner in Casa Grande, Arizona. In his role as President of the Arizona Medical Association, Dr. Kazi works with local, state, and federal government officials as well as local, state, and national organizations on various issues that impact independent physicians. On risk: "Number one issue is the lack of providers, physicians, nurses, paramedical staff throughout the country, and we are behind, especially in the rural area. We don't have specialists, we don't have even primary care. And the biggest problem that I am seeing is the lack of private practices. Private practice is dying away. So that's a big risk that I see lack of provider and private practice slowly, gradually diminishing in the whole country … Lack of patient physician relationship and that's a big risk that I see in medical practice these days. If you don't have a relationship with patient, it's very difficult to manage chronic disease … If something negative outcome is there, what happened, you have to take a proper, appropriate action for that negative outcome. Negative outcome is always there in medical practice, but it's how you approach them, how you solve them, how you resolve them that's the key."

What she does: Professor Coordes is a Professor of Law at Arizona State University's Sandra Day O'Connor College of Law in Phoenix, Arizona. Her research focuses on bankruptcy and financial distress and includes commercial law, large corporate reorganizations, international and comparative insolvency law, and local government finance and policy. She teaches Chapter 11 Bankruptcy, Advanced Bankruptcy, Secured Transactions, and Contracts. Professor Coordes is on the board of the American Bankruptcy Law Journal, a member of the American Bankruptcy Institute, and has presented her work and perspectives nationally, including The Wall Street Journal, Yahoo! Finance, and Bloomberg Law. On risk: "It's important to be looking at the bigger picture, the industry pressures, the interconnectedness of the whole industry, and some of the big challenges that the industry as a whole is facing to try to figure out, okay, how can we really create some stability in health care … Indicators or factors can really impact and pressure the market, and in turn, can then impact and pressure individual health care businesses … Distress or closure of a health care business can cause ripple effects. So even if, on a narrow level, a particular health care business is doing fine, that could change fairly quickly, depending on what's going on in the nearby area or in the industry as a whole. And so I think if you're running a health care business, you have to be concerned, of course, about your own business and its financial health, but also about what's going on and with the other health care businesses in your area … What's challenging for an individual health care business, there's so much that you have to take into account that is outside of just the four walls of your own business."

What she does: Beverly is the office manager of Karl A. Smith, DDS, LLC Periodontics and Implants, a multi-site practice with locations in Virginia and Maryland. In addition to managing the practice full-time, she serves as an expert of dental business practices and standard of care in practice administration systems for several law firms across the US. She has provided expert witness testimony on behalf of the prosecution and defense at both the State and Federal level. Beverly is a Diplomate and Lifetime Member of the American Association of Dental Office Management (AADOM) and awarded the 2022 Dental Practice Administrator of the Year and is a recipient of a Denobi Award. She is the founder of Dental Spouses in Business™, the Executive Director for the Virginia Society of Periodontists, chapter president of AADOM's Dental Spouse Business Network as well as a member of three local chapters, and serves on the board for Dental Entrepreneur Woman. On risk: "Risk is a possibility. It's not a fact. Risk is a thing, it's a factual thing. It's a possibility of something happening. And I think people have to remember that. A lot of people, when they hear the word risk, they assume it has some kind of negative connotation around it, and it really just means that we need to protect ourselves. It's a possibility that something could happen and we need to be aware of it. It's an awareness around situations that can happen, and it's a bringing to the forefront, a thought about making sure that we protect ourselves … When you're thinking about why do I have to be concerned about risk? It's ultimately because you want to protect your practice. You want to have longevity of the practice. If the practice doesn't survive, we now can't help people and help more patients … Part of the risk, part of where that comes to risk, is now we are having an access to care issue … Awareness is obviously number one, awareness of what risks can be, if things are in line and everybody's ducks are in a row and things are proceeding on, and you've got a good system in place, even when something does adversely happen, it's almost foolproof. You have the resources at your fingertips. You know what to do, when to do it. You're prepared and it helps to simplify knowing that risk is always going to be there. It simplifies the process when something does happen"

Mid-year assessment of risk areas and topics from 2024 Risk Outlook. Copyright 2024 SpringParker

What he does: Kal is the Chief Administrative Officer at Oregon Health and Science University in Portland, OR and has over two decades of experience in health care, including 15 years in a combination of leadership roles on both the payer and provider side. At OHSU he is responsible for serving Medicaid members in the Portland Metro region and as the administrative lead for the MSO in the Office of OHSU Payer Strategy, serves clinicians in a Clinically Integrated Network participating in an MSSP ACO and various Medicare Advantage and commercial value-based care arrangements. On risk: "Risk is one of those things that, especially underwriting risk for a population, that somebody has to take the risk, right? It's either the payer or the provider, or maybe potentially even the member, unknowingly … Sometimes it can be like a hot potato. People want to pass it around to somebody else and let them manage it. But I think the reason it's important to prepare for managing risk as a healthcare provider is that the days of being able to get your fee for service increases and the payer just leaving you alone those days are behind us. As a provider, you're not able to afford to not pay attention to this anymore … Preparing for it is probably the best way to go, instead of hiding your head in the sand and delaying it and prolonging it, because I see the danger is that if you prolong your preparation for this, for managing risk as a provider, you'll get to a point where a more advanced model would be imposed on you, and you may not have a choice, and you would be ill-prepared for managing that risk at that point."

What she does: Karen is an occupational health and safety expert in the health care industry with over two decades' experience helping medical, dental, and professional offices with safety, infection control, and compliance systems. She began career in the emergency department at Ohio Health's Riverside Methodist Hospital and then served as the assistant director of sterilization monitoring for the Ohio State University College of Dentistry before becoming it's health and safety director and now works with health care professionals and entities across the US. She has authored articles and CE courses on safety in dentistry and is an authorized US Department of Labor OSHA trainer as well as an active and current member of the Organization for Safety, Asepsis and Prevention, and CDC Dental Infection Control. On risk: "There's the risk of receiving citations and those inspections are public information. I can do a quick search and tell you all the medical practices that were inspected by OSHA so it's public information sometimes that lands you on the evening news, too. That's another thing as well is your reputation is at stake. I look at it from not just the immediate impact of it, but what are some of those indirect and also long term implications of not adhering to OSHA requirements too so there's that association with the risk … When people are assessing their practices, looking for the not so obvious, really thinking, be forward thinking, look for the things that is there a possibility this might occur? What can we do to prevent that now? The risk is low, but it's never a zero … People look at it from this very broad brushstroke. They're doing annual training and I always tell people you're doing a great job of addressing the more obvious things, what I want you to do is look for the not so obvious."

What he does: Esmond is the Chief Information Security Officer of Steward Health Care and has over two decades of experience leading IT and security programs and safeguarding vital sectors in multiple industries. At Steward, Esmond’s focus has been on transforming Steward's approach to information practices security, threat and risk management to comply with industry frameworks, and regulations and best practices. Prior to Steward, Esmond was Deputy Chief Information Security Officer at Partners Health Care working with executives and advisors on cyber security and business practice. Esmond has held multiple IT and security roles, including at institutions like Harvard University and Mass General Brigham, and he also serves on the advisory boards of multiple companies, providing valuable insights on cyber matters, ensuring secure IT operations, regulatory compliance, and resilient design. On risk: "Risk is pervasive and it's across the continuum of the delivery of health care … Health care is all about securing the patient. It's all about making sure that we lower any risk on the patient privacy being impacted, the safety of the systems that we're putting in front of those patients. But also in this modern era we have to be very aware of the potential attacks on corporations on health care … Something relatively benign, like a medical device that you're plugging into a patient, you can magnify the risk associated with it because some of those medical devices require updating, they require securing, they're also storing sensitive information … We need to know where our data is, we need to know how our assets are managed … Ultimately, what you're trying to do is to measure that risk and make sure that it maps to your organization's risk appetite. And you're trying to mediate, you're trying to take what could be a high risk and what you're left with from a residual perspective, after you put some effective controls in play, it becomes much less of a risk."

What she does: Kim is a partner at Dickinson Wright in Michigan and Chair of Dickinson Wright’s Healthcare Litigation and Telehealth Task Forces. Kim has over 20 years’ experience as a commercial litigator who represents healthcare providers, insurers and benefit plans in healthcare contract litigations (including enforcing and defending non-compete agreements), licensing and regulatory disputes, governmental fraud and abuse investigations, HIPAA compliance counseling, and insurance claims and coverage disputes. On risk with noncompetes: "The individual provider doesn't want to be limited from performing his or her clinical services anywhere that they want. But the main objective, I think, from the employer side is to protect intellectual property, patient lists, confidential information, business strategy, and even just depending on the employer if there is any kind of financial investment in the physician with respect to training, or sign on bonus, or payment of continuing ed expenses. So where the employer is putting additional money into and as an investment its employees it wants to protect that investment … There's a decision, a business decision, to be made. Is the hospital going to file a lawsuit and sue its former physician. And then there's legal risk in that, there's financial risk in that, and there's the public relations risk in that. So there's certainly that thinking does come into play when considering the risk of litigation with a noncompete"

What she does: Dr. Wiens is a senior fellow at the University of Pennsylvania, director of the Penn Master’s in Medical Education Program and the Penn Health Professions Education Certificate Program, and academic director of the PennCLO Master’s Program, as well as teaching various graduate-level and executive-format courses. Dr. Wiens is also co-founder and chief research officer of Big Sky Leadership Labs, where she leads and conducts evidence-based research on executive performance, emotional intelligence, burnout, and resilience. She has designed and delivered over 2,000 leadership development programs focused on helping leaders build and leverage their emotional and social intelligence to amplify their positive impact and protect themselves from burnout. Her work has been featured in the Harvard Business Review as well as published in her book "Burnout Immunity". She is also a sought-after international speaker. On risk: "It's [speaking about burnout] absolutely a risk to individuals. The effects of burnout aren't just psychological, they're physical as well. They also affect our ability to learn and adapt, and burnout affects our relationships, burnout affects our performance. Take performance, for example, there are studies that clearly show a relationship between burnout and patient experience. Other studies that show relationship between burnout and medical errors. There's a direct correlation between physicians who are burned out and higher medical error risks. And then of course, there are risks to organizations as well, lost productivity or lower productivity, more sickness days, higher turnover, and patient experience scores. You name it. If you look at different metrics that health care organizations are measuring, you can if you look really closely, you can tie those to a physician's well-being, whether it's burned out or they're engaged." Copyright 2024 SpringParker

A review of actual risk incidents from around the US that made public news Copyright 2024 SpringParker

What he does: Mark is the Founder & CEO of Animal Policy Group and a long-time political strategist, government regulatory advisor, corporate executive and former litigator. Mark focuses his advocacy practice on providing high-level strategic advice and services to clients with needs at any level of government, and key trade/industry associations in the U.S., Canada, and Mexico. Mark specializes in animal health, animal welfare, veterinary and veterinary educational issues and accreditation, developing a cutting-edge practice across these sectors. He currently leads several industry coalitions and initiatives, and has guided successful accreditations for a growing list of veterinary colleges, and is co-founder of the Veterinary Virtual Care Association. Mark is also a published author and frequent speaker at veterinary medicine and other animal policy-related conferences. On risk: "There's an acute issue with access to care that affects pet owners in terms of the risks they have with their pets, that they can't get medical advice. But it affects practices themselves and individual veterinarians because most clinics are severely understaffed … Risk plays out often in terms of not doing enough rather than making a mistake and doing something you're not allowed to do. But that's critical, that's just kind of table stakes. If you own a clinic, if you hire people, if you hold yourself out to the public, you can care for their pets you need to know what you're legally able to do and not do … You can play an invaluable service and minimize risk and attack this [access to care, workforce shortage] problem if you can provide care by video, phone, and audio at home. And you now provide potential clients with resources. 70% of all calls to telemedicine veterinarians or telemedicine veterinary nurses solve the problem. And you're not required to go into a clinic which means you don't add to the burden on an overstressed, understaffed veterinary team. That's another way of managing risk." Copyright 2024 SpringParker

What they do: Dr. Debra Henneberry, EdD is an Assistant Professor in the College of Aviation and Transportation Technology at Purdue University. She's an experienced commercial pilot, flight instructor, and aeronautics professor. Prior to her current role she served as Assistant Professor in the Aviation Department at Vaughn College of Aeronautics and Technology in New York City. She also served as a government administrator for several years. Dr. Henneberry has worked as a first responder and emergency medical technician for over ten years. Her research interests focus on human factors and she has spoken about pilot training at a number of international aviation psychology conferences. Professor Abner Flores is a Senior Lecturer in the School of Aviation and Transportation Technology at Purdue University. He is an experienced ex-military pilot, navigator, and aircraft technician, who has served in both, the U.S. military and the Honduran Air Force. Over the last 11 years, he has been traveling around the world, teaching and training professional pilot courses in several countries throughout Europe, the Middle East, and lecturing in colleges and universities across the U.S. Prior to coming to Purdue University, Professor Flores was a lecturer at the University of Nebraska-Kearney, Aviation program. At Purdue, his research interests are focused on Human-Interactive Pilot Enhancing Performance Technologies (Simulation), Data Science for business processes modeling in aviation and Neuroergonomics. He currently teaches courses in Aerospace Vehicle Systems Design, Analysis And Operations, and Human Factors for Flight Crews. On risk: "Risk is something that we look into, from every possible perspective associated to whatever it is that there is anything going on, with the understanding that when we think risk it's a constant … When we focus on what it is that we are trying to accomplish, and in this case as far as in aviation is simply we minimize risk, we become safer. And guess what, when we reduce those levels of risk, we become safer, automatically at the same time we are becoming higher performers. And that's what we want. We want to perform at our best. And so risk gets to be where it needs to be down there and we can fly above it … Fatigue is culprit number one, or threat number one, to what we call in aviation situational awareness. It means that you're not anymore connected with the environment, you're not anymore within our concepts of aviation connected with the airplane, you are not any more connected with any one of the systems, you're going to be seeing without seeing … People under emergency situations may revert back to their native when under stress … Everybody must be involved in risk because risk affects us all … If the human element is not up to speed, and that typically is unfortunately the case, then there are going to be issues needing to be resolved." Copyright 2024 SpringParker

What she does: Rebecca is the founder of Adelman Law Firm in Tennessee. Her practice is concentrated in healthcare and insurance defense and business litigation, and includes representation of insurance companies and long-term care providers and their insurers - both regionally and nationally. The firm also provides claims management services to senior living insurance companies. Rebecca is involved in state and national legislative matters on behalf of the healthcare industry and serves as Legal Advisor for the American Assisted Living Nurses Association and the National Association of Health Care Assistants. She founded the National Long-Term Care Defense Summit, co-founded the Adelman-Mettle Palliative Care Alliance, and is a member of Claims and Litigation Management Alliance. In addition, Rebecca is a published author and national speaker and contributor. On risk: "Risk in senior living is multifaceted, there are so many aspects of senior living … How we define, view, and think about risk, really depends on that we all agree there are varying types of risks in senior living. There's obvious risks of injury, or just an incident and an outcome, a negative outcome, but then there are a lot of other risks, emerging risks, and some smoldering risks, all sorts of risks embedded in all of these little subparts of the ecosystem … There's so much at stake where risk is concerned in senior living that the importance of considering it cannot be overemphasized. We need to really appreciate how risk is managed in organizations because risk management is everyone's business, it's everyone's responsibility … From my vantage point along the whole risk spectrum, I'm showing up at the 9s and the 10s and moving down the risk spectrum into the 6s and 7s. The real place for everyone to begin in its least complex form, with all types of risk management, to mitigate risks, to hopefully eliminate risk, certainly to identify it so it doesn't come up, is really when it's in the 1s and the 2s. Proactivity would be the word of the day … Here's the ticket, the real small key that opens up the big door is implementation. You've got to implement across your organization." Copyright 2024 SpringParker

What she does: CJ is a partner at Dickinson Wright in Phoenix, Arizona and spearheaded the formation of Dickinson Wright's Distressed Health Care Restructuring Group. CJ's experience includes creating complex plans of reorganization for multi-million dollar companies in a wide-range of industries, including healthcare, mortgage lending, and real estate among others. She has also guided numerous boards and senior managers in developing strategies and solutions for revising operations and restructuring debt to generate the emergence of a stronger business through bankruptcy, or to take advantage of acquisition and sale opportunities, including the application of bankruptcy procedures favorable to corporate securities regulation compliance. In addition, CJ has negotiated multiple multi-million dollar transactions with lenders, investment bankers and brokers, asset purchasers and sellers, and governmental agencies. CJ has published extensive writings and over 100 speaking presentations to educate clients, lawyers, accountants and corporate representatives on bankruptcy, restructuring, sales and acquisitions from a business perspective. On risk: "You have to get down to the business aspects of it [risk], it's in the health care space, it's no different than any other business in a way because it's a question of cash in and cash out. And the problem that's unique to the health care industry is just the enormous regulation and that makes it more difficult to predict … If you are looking at risk, you're looking at needing a business plan, just like any other business, you're going to need to know going in okay, what is A to B, what is the B? Here's A, we're sitting here today, where are we trying to be at B? … It's been a very difficult time risk-wise for health care because of those particular factors [labor shortages, labor costs, inflation, reimbursement fluidity], which probably every other business is suffering somewhat the same problems. But like I said, the risk all gets back to having a good game plan" Copyright 2024 SpringParker

What she does: Sam is the is the Senior Director of Advertising, Analytics, and Partnerships at Cleveland Clinic in Ohio where she works to shape the institution's global brand and achieve transformative results in healthcare marketing. She leads the enterprise’s advertising efforts, creative development, strategic partnerships, and data science teams. On risk: "There's too much information for a doctor to be the sole provider of content or information to a patient … A lot of risks when it comes to health care marketing that is not in other industries. We have HIPAA concerns, run a risk of also investing that much money, sensitivity and personalization, privacy, using information correctly ... Keeping up with regulation and privacy is key, you cannot not do that ... When it comes to spending $1 from a nonprofit, you definitely have to justify that. You have to do that everywhere but that dollar could be reinvested into clinical care. So you need to make sure that you're being very careful and being a good steward of resources … There are a lot of competitors running ads, you see them on billboards, you see them on digital ads, they're all over social, it is a very hot space. So there's definitely concern about that too, because that could just be a spending game. And that could be to what end, we could just go toe-to-toe with other health care competitors. And then we could just be out pricing each other … Patients have a lot of options. And so this should be a concern for you. Because if you aren't doing it, your competitor probably is." Copyright 2024 SpringParker

What he does: Ron is the President and Chief Executive Officer for DoveLewis in Oregon. At DoveLewis Ron is responsible for the vision and strategic initiatives that as a nonprofit serves its customers, donors, and veterinary community. His career spans 40 years in human and animal health care with roles including insurance, joint ventures, rural health networks, and marketing, public relations, and communications. On risk: "There's risk everywhere. There's nowhere we can't turn both as a veterinary hospital and as a nonprofit where we have a lot of risk to make sure we address … You have to try to anticipate all the scenarios that could affect your business. It's nothing that can happen overnight. You have to plan ahead and you have to look at your scenarios … If you don't foresee and look out for what risk factors could affect your business, it really doesn't take much to affect you from a negative perspective. And next thing you know you might be out of business … With the risks that we face from a recruitment and retention perspective, we've had to change the way that we help train people and bring them into the organization and mentor them … Need to have the right people that can identify those areas of risk. But then you need to have regular work and discussions about those risk factors you need to have, make sure that there's plans in place to check in on the development of those risk factors." Copyright 2024 SpringParker

Outlook of potential risk topics and issues that could impact and shape health care during 2024 Copyright 2024 SpringParker

Review of risk topics and events that took place in health care during 2023 Copyright 2024 SpringParker

What he does: Brett is the Executive Vice President and Chief Operating Officer for Sharp HealthCare in California. At Sharp he has direct accountability and oversight for the daily and strategic operations of Sharp's four acute care and three specialty hospitals, three medical groups, ambulatory and clinical service lines, and facilities management and development. His career spans nearly 30 years of health care management experience in a variety of operational, consulting, and executive leadership roles overseeing various hospital and medical clinic operations where he has been instrumental in leading growth strategies, large-scale capital investments, clinical integration and service area optimization, patient safety and performance improvement, and service line development. On risk: "There's a lot of consistency with risk in health care over the years. As time has gone on the risks have changed and evolved and been added to as well. One of the lessons through COVID has certainly been the very real chance and issue and risk of multiple things happening at the same time, not just one big event. I think what's evolved around risk is the recognition that we need to have processes and people and policies and practice in place in order to deal with multiple catastrophes or multiple risks at the same time that can stress the organization in ways that probably haven't been experienced before … A flavor of some of the things we're looking at now at the top of the list is absolutely cybersecurity. It is something that continues to be critical in nature for all of us in health care and something that we cannot take our eye off any single day. The resources we've had to put into that, the people and the processes and the systems in order to assure that we are safe. We get hits every day, every single day, someone's trying to bad actor out there, trying to make something happen. Here in California we put the legislative risk pretty high up. It's not just on a state basis, but on a state basis here in California we have a very active legislature, and we put a lot of time and energy to monitor the things that they're working on. Make sure that we're taking a look at the impact so that we can communicate and educate our legislators. We spend a lot of time doing that … I've never seen something like this (workforce) in the past. The toll in terms of the physical, as well as mental toll, under all of us and folks just deciding this is not something I want to do any longer and changing the whole workforce perspective of working within health care. That is a massive risk for the entire industry. It's probably the one thing that I'm most concerned about, and most challenged by, about how do we respond to that and the moment so that we can assure that we have the workforce of the future, not just for today" Copyright 2024 SpringParker