Today’s health care industry is a risky business. From compliance issues to government regulations to a notoriously high industry turnover rate, the potential for risk and liability is around every corner. Whether you are discussing a hospital, skilled nursing facility, assisted living center, or medical practice, being proactive with risk identification is the best way to mitigate a potentially bad situation. Below are a few of the best ways to help minimize your facility’s risk while maintaining the quality of care and security for your residents and/or patients.
Perform Background Checks
One of the first and best lines of defense against risk at your facility is the use of proper background checks. These should be performed on all employees, independent contractors, and volunteers, as well as anyone that will have direct and meaningful contact with residents and/or patients. Since the scope of background checks will differ based on level of responsibility, it is necessary to develop a strong policy outlining the facility’s use of employee background investigations.
Go Beyond Fingerprints: For a more thorough and accurate criminal background check, consider going beyond those mandated by state and federal laws. While many positions within your facility may require a fingerprint search be conducted, this procedure can provide a false sense of security. With recent findings estimating that 50% of the records in the FBI’s criminal history database are inaccurate or incomplete, you should seek to supplement these checks with additional research.
This can be done by also performing a name search with the criminal record repository in your state (as well as each state where the applicant has had meaningful connections) and at the county level with the court clerk’s office. While the law requires that criminal justice agencies report arrest and disposition data directly to the state and the FBI, it should not be assumed that this is happening on a consistent basis. Supplementing your fingerprint checks with additional research can only strengthen your criminal background check process. It can also help you avoid the risk of an FCRA lawsuit should you deny employment based on inaccurate criminal record checks.
Check References. In addition to criminal records, you should also call references on all new hires. Go beyond those provided to you directly by the applicant and seek to interview former facility owners, supervisors, and even co-workers. There is a misconception that former employers are not allowed to discuss more than position held, dates of employment, and reason for leaving, but this is simply not true. As long as any negative information relayed can be supported by other sources (such as employee reviews, letters of reprimand, etc.), the release of information is not restricted. It may take a bit of time to perform these reference checks, but consider how much time would be lost if you hire someone who isn’t very good at their job. You can reduce turnover and get better quality employees the first time by expanding reference check inquiries.
Be Compliant. Make sure that your background checks are in full compliance with all state and federal laws. Qualified third-party providers should be able to explain the laws surrounding your specific inquiry and any limitations that may apply. If you are conducting this research in-house, be sure that the employee performing the checks has proper training and is up to date with the laws in your state. Non-compliance in this area can have major consequences.
Verify License Status and Discipline History
If someone who works for your facility requires a professional license to perform their job, you need to regularly monitor the status and discipline associated with the license. This includes physicians, therapists, and nurses, as well as any contractors and certified nutritionists/dietitians. Making sure all your employees and/or vendors are in good standing with the state and have not had any disciplinary actions filed will save you from many headaches down the road.
Keep in mind that some state licensing boards place the responsibility of reporting certain incidents that can prompt a disciplinary action on the licensee. So it is a good idea to have a policy in place where department heads have a set plan of action if they suspect or believe an employee to be acting inappropriately in some manner.
It is also important to verify and continually monitor the driver’s license status and history of anyone responsible for operating facility vehicles or performing patient transport. An accident or routine traffic stop can be a major problem if the operator is not licensed at that time. Since they are acting within the scope of their job, your facility may be held liable for their actions.
Perform Consistent Exclusion List Monitoring
State and federal law requires that providers participating in government funded health programs do not employee or do business with an individual or entity that has been excluded from participating in such programs. To ensure compliance, the facility is responsible for performing monthly checks of the exclusion lists maintained by the Office of the Inspector General, the Government Services Administration’s System for Award Management, and their state’s Medicaid agency.
Whether you perform these checks in-house or through a third-party provider, make sure that this is being done consistently and properly for all employees, vendors, referral sources, and contractors at your facility. You are responsible for keeping accurate and up-to-date records, and if you are found to be employing or doing business with a restricted and/or excluded party you could face substantial fines and risk being excluded from government health programs yourself.
Also, consider writing into your contracts with vendors that they are responsible for monitoring all of their own employees, even those who do not have direct contact with your patients/residents. This will help protect you from having to check every single person who works for them for compliance, even if they don’t have direct contact with your facility. This layer of redundancy will further help to protect you without adding an addition burden.
Conduct Regular Training Workshops
New guidelines and rules are disseminated all the time, and with so many departments, shifts, and new employees it is critical to make sure everyone knows what is expected of them. In addition to new hire orientation, you should schedule regular training sessions and workshops to clearly articulate the expectations of your employees.
Your training sessions should place emphasis on preventative measures to make sure everyone is in compliance with facility policies and procedures. It is a good idea to record your training sessions to be available for all current and future employees to review at a later date. Also, be sure to keep track of who attends, and schedule sessions for each shift as well. Don’t wait until there is a problem to schedule a session. Anticipating issues and being proactive are key steps in avoiding risk.
Create Clear Policies & Procedures
You need a handbook that outlines, in plain language, the expectations and guidelines for employment. This handbook also needs to detail your compliance plans for mandated government programs, such as exclusion monitoring and the detection of fraud and abuse. Each new hire should be given a copy to review and then a form to sign stating that they have received the handbook and understand the contents.
The training workshops mentioned above should be used to reinforce the specific policies and procedures that are in place, especially new ones that will supplement the employee handbook. Your department heads should be advised in advance of any changes so that they have time to bring the staff up to date.
In the section above where I discussed the importance of regular license and disciplinary monitoring, I referenced creating a proactive policy if inappropriate behavior is suspected. This would include substance abuse issues, theft, fraud, or other misconduct. Additional potential areas for risk that should be addressed in your handbook include discrimination, workplace violence, substance abuse (suspected or confirmed), and employee theft. You should also consider developing a social media policy, specifically outlining what is and is not appropriate activity concerning the workplace and employment. With this, and all other policies, it is a best practice to consult with an attorney before altering or creating policies.
Implementing these measures will effectively help you to reduce risk and protect the viability of your facility. With consequences ranging from sanctions and lawsuits to lost business and bad publicity, clearly identifying and avoiding these pitfalls is paramount. Making proactive changes, like the ones detailed above, will not only help avoid these negative outcomes but will help you to build a stronger company overall.
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