Outpatient clinics may hold hidden exposures

The acquisition and merger game continues unabated in health care, and that puts a burden on risk managers to spot hidden liability exposures when their organizations take on new clinics, says Debra McBride, JD, assistant vice president for risk management at Midwest Medical Insurance Company in Minneapolis.

Acquiring or merging with another clinic can bring a host of problems because you are taking on whatever risks previously existed in that clinic, McBride says. Even though you had nothing to do with creating or tolerating those problems, they’re yours now. She warned members at the recent meeting of the American Society for Healthcare Risk Management in San Diego that they should go over each merger or acquisition carefully to spot the hazards.

Many of the hazards are the result of a less formal operation than demanded by most larger health care providers with a solid risk management program. These are some of the potential hazards she noted:

1. Inadequate record keeping.

Many small clinics are run with a more casual approach than you would tolerate in your own facility. That can include record keeping, which may need to be improved. For instance, McBride notes that clinic physicians may be in the habit of giving away free samples of medication without noting them in the patient charts. That can become a liability issue if the patient’s future treatment suffers because there was no record of the previously issued medications.

2. Improper patient transfers.

Clinic staff may be comfortable with occas ionally using their private vehicles to transfer patients, but that habit carries a number of liability risks for both employee and employer. It should be stopped.

3. Inadequate staffing.

Small clinics often are working on a shoestring budget, and that means they sometimes have nonmedical staff providing some care, such as giving injections.

That sort of thing is overlooked in the small clinic, but you can’t let it continue because it is a significant liability risk.

4. Extended clinic hours.

If the clinic is open late, or even 24 hours because it is an urgent care facility, those extra hours can cause concerns you might not have to deal with in your other off-site facilities.

Such late hours can increase the chance of violence against patients and staff, particularly if there are narcotics on site that could attract thieves.

5. Credentialing.

The clinic staff may have to meet credentialing standards within your organization they did not have to meet previously. It would be risky to allow the clinic staff to meet a lower credentialing standard than that found elsewhere in your organization.

A plaintiff’s attorney would ask why you thought it was OK for clinic patients to be treated by a less-qualified provider than patients at your other facilities.