GRADING RUBRIC MUST BE FOLLOWED

Create a 2–3-page internal memo for a risk-management team. Summarize a risk financing issue for a selected organization in the memo.

Questions to Consider:

Imagine that a supervisor enters your work setting accompanied by an unexpected visitor from CMS. Your supervisor introduces you to the Medicare surveyor, who will be interviewing you.

• What is the risk-management process in your organization?
• What criteria would you use to determine how well your organization is performing as an ACO?
• What data or resources would be helpful to you?
• How would you explain the concepts of risk management and risking financing activities to your subordinates?
• How would you explain a risk financing continuum to your subordinates?

Preparation

Imagine yourself in the role of a risk manager. Select a topic related to risk financing and identify a risk financing issue. This issue may be from a selected organization or from your workplace. As an example, you might select the issue of financing potential malpractice suits at a medical clinic. Refer to the Suggested Resources to ensure that you have a solid understanding of the financial dynamics related to this type of issue.

Instructions

Memo – Risk Financing Issue

Create a 2– 3-page internal memo. Follow the steps below and include them in the memo:

• Concisely describe the issue and the organization.
• Summarize the legal and ethical financial risk obligations of an ACO.
• Describe how you would identify and manage risk financing issues within this organization. Support your choice of strategies with relevant resources.
• Recommend two or three of the best options for risk financing for this issue, as it relates to the organization in question.
• Include at least three APA-formatted in-text citations and accompanying congruent APA-formatted references. Your sources can be a course textbook, assigned reading, or any other scholarly source.

Resources:

Accountable Care Organizations-Managing Financial Risk

This article discusses how implementers envision integration and what it means to manage the many social identities that ACOs bring together.

• Kreindler, S. A., Larson, B. K., Wu, F. M., Carluzzo, K. L., Gbemudo, J. N., Struthers, A., . . . Fisher, E. S. (2012). Interpretations of integration in early accountable care organizations. Milbank Quarterly, 90(3), 457–483.

This article proposes strategies for ACOs to engage with the internal and external customers to develop new products that will provide a competitive advantage by decreasing waste, promoting knowledge, and targeting customer value.

• Macfarlane, M. A. (2014). Sustainable competitive advantage for accountable care organizations. Journal of Healthcare Management, 59(4), 263–271.

This article provides a framework for assessing performance, targeting technical assistance, and diagnosing potential antitrust violations.

• Shortell, S. M., Wu, F. M., Lewis, V. A., Colla, C. H., & Fisher, E. S. (2014). A taxonomy of accountable care organizations for policy and practice. Health Services Research, 49(6), 1883–1899.

SHOW LESS

ACO Ethical and Legal Obligations

This article provides an ethical framework for physician decisions and action within the ACOs.

• Graber, A. D., Bhandary, A., & Rizzo, M. (2016). Ethical practice under accountable care. HEC Forum, 28(2), 115–128.

The following articles examine some of the ethical concerns that ACOs confront.

• DeCamp, M. (2013). Ethics in accountable care organizations. Virtual Mentor, 15 (2), 156-161.
• DeCamp, M., Farber, N. J., Torke, A. M., George, M., Berger, Z., Keirns, C. C., & Kaldjian, L. C. (2014). Ethical challenges for accountable care organizations: A structured review. Journal of General Internal Medicine, 29(10), 1392-1399.

These textbook readings address patient safety, security and the legal risks involved with it.

• Kavaler, F., & Alexander, R. S. (2014). Risk management in health care institutions: Limiting liability and enhancing care (3rd ed). Burlington, MA: Jones and Bartlett. Available from the bookstore.
  • Chapter 7, “Assuring Safety and Security in Healthcare Institutions,” read the “Information Systems” section, pages 169–172.
• Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones and Bartlett. Available from the bookstore.
  • Chapter 7, “Using ‘Never Events’ to Reduce Risk and Advance Patient Safety,” pages 69–80.
  • Chapter 8, “The Patient Safety and Quality Improvement Act: Tension Between Improving Quality of Care and Acknowledging Responsibility for Error,” pages 81–90.
  • Chapter 9, “The Role of Governance in Hospital Risk Management and Patient Safety,” pages 91–102.
  • Chapter 12, “Developing a Request for Proposal and Working with Insurance Providers,” pages 135–159.
  • Chapter 13, “The Importance of Developing a Medical Liability Cost-Allocation System,” pages 159–169.

Additional Resources for Further Exploration

You may use the following optional resources to further explore topics related to competencies.

• Kavaler, F., & Alexander, R. S. (2014). Risk management in health care institutions: Limiting liability and enhancing care (3rd ed). Burlington, MA: Jones and Bartlett. Available from thebookstore.
• Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones and Bartlett. Available from the bookstore.
  • Chapter 10, “The Culture of Medicine, Legal Opportunism, and Patient Safety,” pages 103–112.

Risk-Management Professional Organizations

• The Risk Management Association. (n.d.). Retrieved from https://www.rmahq.org/Default.aspx
• American Hospital Association. (n.d.). American Society for Health Care Risk Management. Retrieved from http://www.ashrm.org/