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by Joan M. Porcaro, RN, BSN, MM, CPHRM, FASHRM

Running a medical office practice involves much more than providing patient care. Key operational areas include regulatory compliance, financial management, staffing, human resources, technology oversight, marketing, supply chain logistics, patient satisfaction, legal matters, safety for both patients and staff, and facility management. These represent just a few of the critical components necessary for a successful practice.

In addition to these responsibilities, physicians must proactively safeguard their practice against various clinical and operational risks to ensure longevity and success.

Below are essential tips for protecting your medical practice from potential challenges:

1. Fostering the Physician and Patient Relationship

Establishing a strong foundation for the physician–patient relationship is essential. Building trust and rapport with patients helps mitigate risks stemming from personality conflicts, communication breakdowns, clinical misunderstandings, and dissatisfaction with services.

Create an environment that encourages open communication by actively listening to patient concerns and inviting questions. Offer clear, comprehensive explanations of treatment plans to ensure patients understand their options and the reasoning behind them. Prioritize patient education by providing resources and guidance that empower informed decision-making. This approach not only strengthens the relationship but also improves patient satisfaction and outcomes.

According to the American Medical Association²⁰, “the patient-physician relationship is the cornerstone of the medical profession. Encounters between patients and their physicians are based on trust and give rise to physicians’ ethical obligations to place patients’ welfare above their own. Successful medical care requires ongoing collaboration between patients and physicians, a partnership in which both members take an active role in the healing process.” 

Like any relationship, maintaining open communication requires effort from both parties. There are situations though when a relationship cannot be repaired, and a termination of the physician and patient relationship²¹ becomes necessary.

2. Developing and maintaining professional relationships

Like any meaningful connection, nurturing and sustaining professional relationships is key to building a strong and reliable support system throughout your medical career.

Always engage with members of the patient care team in a manner that reflects professionalism, courtesy, and mutual respect. Clear, respectful communication fosters collaboration, enhances patient outcomes, and contributes to a positive and effective work environment.

It is important to note that the American Medical Association’s Code of Ethics³ includes commentary regarding such an approach. Physicians verbally “belittling one another or making berating statements, using disrespectful language, and inappropriate comments” directed towards colleagues, peers, and other staff is the definition of “disruptive behavior.” 

Interactions among professional colleagues – whether face-to-face or documented in the medical record - such as sharing conflicting information, blaming, shaming, and displaying disrespect signal a  breakdown in  teamwork. Research has shown Research has shown that poor team dynamics are linked to increased patient mortality and decreased staff well-being. ⁴ When there is a lack of collegiality and interprofessional respect⁵, such negative energy may bleed over into the patient encounter, disrupt the team dynamic, and likely impacts the outcome of the care rendered.

Avoid making unprofessional comments in the patient’s medical record often referred to as “chart wars”⁶,. Such entries can reflect poorly on your conduct and won't benefit you in the long run. Instead, resolve disagreements or issues outside of the medical record and away from patients and the care team, ensuring professional behavior is maintained.

3. Strengthening Documentation Practices in Challenging Patient Encounters
Accurate, timely, and thorough documentation is essential for ensuring high-quality patient care and protecting your practice against legal challenges. Implement standardized documentation procedures and conduct regular chart audits to maintain consistency and ensure accuracy. Documenting complex or sensitive encounters—such as medical errors, patient or resident aggression, adverse event disclosures, and instances of non-compliance—requires particular care. These situations demand a clear, objective, and timely account in the medical record, including both the event itself and the organization’s response.

By maintaining factual and thorough documentation, health care professionals not only support continuity of care but also reinforce professional standards, promote transparency, and protect both patients and providers in the event of legal scrutiny.

4. Building a Strategic Risk Management Framework
A well-developed Risk Management Plan (RMP) is a vital component of any healthcare organization’s commitment to safety, quality, and operational resilience. Depending on the structure of the organization, the RMP may stand alone or be integrated into broader patient safety or quality improvement initiatives.

Creating a RMP requires a thorough understanding of the core risk management principles in order to develop business strategies and goals as well as educate staff about risk reduction strategies throughout the organization. Identifying potential risks specific to your organization will guide you in developing a comprehensive risk management plan¹⁷. 

A written RMP offers numerous benefits, including fostering a culture of preparedness and adaptability. It equips the organization to respond effectively to unexpected clinical and operational events—such as clinical errors, or operational disruptions—by establishing clear protocols and promoting a state of readiness. This proactive approach not only minimizes the impact of adverse events but also enhances decision-making, improves efficiency, and reduces the likelihood of costly mistakes.

Moreover, a robust RMP contributes to a stable and secure work environment, instilling confidence among staff, patients, and stakeholders. As part of this framework, investing in staff training is essential. A well-informed and competent team is critical to maintaining smooth operations. Regular continuing education and professional development ensure that staff remain current with evolving medical practices, technologies, and regulatory standards.

5. Strengthening Cybersecurity in a Digitally Connected Practice

As health care continues to embrace digital transformation, including electronic health records (EHRs), social media engagement, telehealth platforms, and wearable technologies—the need to safeguard patient data against cyber threats has never been more critical. The increasing frequency and sophistication of cyberattacks make proactive cybersecurity measures an essential part of any medical practice’s risk management strategy.

To protect sensitive health information and maintain regulatory compliance, practices should implement comprehensive internal policies and procedures. These should include:

·         Strong password protocols and multi-factor authentication

·         Data encryption for both stored and transmitted information

·         Routine software updates and patch management to address vulnerabilities

·         Regular employee training on cybersecurity awareness and data protection best practices

Documented procedures should be reviewed and updated regularly to reflect evolving threats and technological advancements.

The American Medical Association has curated resources and tips1 for physicians and health care staff to protect patient health records and other data from cyberattacks. Your broker and carrier will be able to assist with further guidance for the specific needs of your practice.

6. Staying Current with Regulatory and Compliance Standards
Stay informed about the latest regulations and guidelines in healthcare business compliance. The following lists some of the federal laws that impact physician practices:     

·     Privacy, business associate agreements, and data breaches⁷

·      Patient Rights and HIPAA⁸

·      Medicare & Medicaid Guidelines – Fraud & Abuse ⁹

·      Laws governing Telehealth¹⁰

·      Occupational Safety and Health Administration (OSHA)¹¹

·      Clinical Laboratory Improvement Amendment (CLIA) regulations¹²

·      Anti-kickback and Self-Referral (Stark) Law¹³

·      No Surprise Act¹⁴

·      Americans with Disabilities Act¹⁵

A sampling of a compliance program created for physician practices is highlighted in the Office of Inspector General Compliance Program for Individual and Small Group Physician Practices guidelines16. Establishing and following a compliance program will help physician practices avoid problematic operational practices and the resulting fraudulent activities. Conduct regular audits and provide staff training to ensure your practice adheres to all necessary legal and ethical requirements.

7. Building a Trusted Network of Professional Advisors
Having a team of professional advisers¹⁸ is crucial for managing the professional and business side of the physician practice.

1. A health care attorney who can provide legal guidance and support. This is essential for navigating complex legal issues, real estate, payer contract negotiations, practice business structure, and potential litigation.
2. A financial advisor assists in managing personal finances, investment strategies, retirement planning, and understanding the nuances of physician-specific financial challenges
3. A medical practice consultant offers guidance on the business side of running a practice, including management, marketing, regulatory compliance, and growth strategies.
4. A billing and coding expert ensures accurate billing practices and helps maximize revenue through proper coding and claims management.
5. An IT consultant plays an ever-increasing important role while managing electronic health records (EHR) systems, cybersecurity, and other technology needs critical to a modern medical practice.
6. A wellness coach may not immediately be on the top of your list. However, such a professional supports mental and physical well-being, helping to manage the rigors, stresses, and demands of a medical career and a busy medical practice.
7. An insurance carrier or broker helps with securing appropriate insurance coverage, including malpractice insurance, disability insurance, life insurance, liability insurance, and more.

8. Insurance Planning:  What Every Physician Should Know

Although medical malpractice insurance is the cornerstone insurance coverage that comes to mind, other lines of insurance are important:

^·       General Liability,

^·       Cyber Liability,

^·       Business Property,

^·       Business Interruption,

^·       Workers' Compensation,

^·       Directors and Officers,

^·       Employment Practice Liability (EPL),

^·       Commercial Auto,

^·       Business Income,

^·       Umbrella/excess liability. 

Utilizing the services of insurance experts will help navigate the insurance programs available and the current insurance market landscape. 

9. Establishing Effective Complaint and Grievance Management Protocols

Complaints and grievances are an early warning system. Use the information received from patients and family wisely and to your advantage. Complaints about clinical issues are often “a proxy for risk of lawsuits."²² These situations are not random or circumstantial. Patients underreport unhappiness²³ with their health care, and although only 50% of unhappy customers complain to service providers, 96% tell at least nine friends or family members about a negative experience²⁴.

The emphasis on patient-centered care has grown, along with calls for transparency in patient satisfaction data. These trends in health care make seeking and responding to patient feedback increasingly important components of risk management and patient safety programs”²⁵ and of your practice strategic business plan. Patients have the right to file complaints and grievances when they are not satisfied with the treatment received. When complaints and grievances are not resolved promptly, they can escalate and potentially lead to lawsuits. Therefore, physician practices and ambulatory clinics should have processes in place to handle these promptly and effectively. 

Additionally, tracking and trending patient complaints and grievances can highlight systemic or individual performance issues, suggesting opportunities for quality improvement.

10. Developing a Response Plan for Medical Board Complaint Response Plan

No licensee takes a Board of Medicine (BOM) complaint lightly. It can be an overwhelming and time intensive experience as well. Learning that a patient or their family members has made a complaint, no matter the reason, may be unsettling and disappointing, especially if the first time you learned of the concern was from a BOM notification. The resulting impact and efforts to resolve such matters will likely be time consuming. Keep in mind that it is not uncommon that a Board of Medicine complaint precedes a more formal demand or malpractice claim.

A board complaint² in many ways is similar to a civil complaint; a situation that does not have to be faced alone and should not be addressed in a reactive manner. From the risk management professionals’ point of view, board inquiries are a form of risk identification, as well as an example of an early warning system. For example: A request for medical records from the BOM may indeed be an alert to the possibility of an issue unfolding. Loop in your RM professional as they may be aware of a pattern such as prior agency complaints about the same issue. Notify legal counsel, insurance brokers and carriers as they will offer additional direction and guidance. Also, validate with your insurance carrier or broker whether there are any exclusions or limits for your policy to cover defense costs in response to a board complaint.

In closing, reducing risks in a physician practice involves implementing comprehensive strategies that address both patient care, employee safety, and operational vulnerabilities. Financial and legal risks can be mitigated through documentation, diligent billing practices, thorough documentation, and maintaining appropriate malpractice insurance.

Establishing a robust patient communication system, including clear informed consent procedures and a system for handling patient complaints, further reduces the likelihood of disputes and enhances patient satisfaction. Regularly reviewing and updating these risk management strategies ensures that the practice remains proactive in addressing potential threats.

By taking these proactive steps, physicians can protect their medical practice from potential threats and ensure its continued growth and success.

References:

1. American Medical Association (2024). Physician Cybersecurity. Retrieved from: https://www.ama-assn.org/practice-management/sustainability/physician-cybersecurity
2. Bucsi, R. (2007). Medical Board Investigation Should Not be Faced Alone. Retrieved from: https://www.omic.com/medical-board-investigations-should-not-be-faced-alone/
3. American Medical Association (n.d.). Code of Medical Ethics. Retrieved from: https://code-medical-ethics.ama-assn.org/
4. McDaniel SH, Morse DS, Reis S, Edwardsen EA, Gurnsey MG, Taupin A, Griggs JJ, Shields CG. Physicians criticizing physicians to patients. J Gen Intern Med. 2013 Nov;28(11):1405-9. doi: 10.1007/s11606-013-2499-9. Epub 2013 May 29. PMID: 23715689; PMCID: PMC3797330
5. Wible, P. (2021). Physician intra-professional disrespect endangers patients. Dr. Pamela Wible, MD Blog. Retrieved from: https://www.idealmedicalcare.org/physician-intraprofessional-disrespect-endangers-patients/
6. Gardner, K. (2018). Emergency Physicians Monthly. Avoiding Chart Wars. Retrieved from: https://epmonthly.com/article/avoiding-chart-wars/
7. American Medical Association (n.d.). Health Insurance Portability and Accountability Act Privacy and Security How to “HIPAA” 2.0 Retrieved from: https://www.ama-assn.org/system/files/hipaa-toolkit.pdf
8. American College of Physicians (2023). HIPAA and Administrative Simplification Overview.  Retrieved from: https://www.acponline.org/practice-resources/regulatory-resources/hipaa
9. American College of Physicians (2024). Medicare Payment and Regulations Resources. Retrieved from: https://www.acponline.org/practice-resources/business-resources/payment/medicare-payment-and-regulations-resources
10. Health and Human Services. (n.d.). Telehealth Policy. Retrieved from: https://telehealth.hhs.gov/providers/telehealth-policy
11. Occupational Health and Safety Agency (2011). OSHA Fact Sheet. Retrieved from: https://www.osha.gov/sites/default/files/publications/bbfact01.pdf
12. Center for Disease Control (2024). Clinical Laboratory Improvement Amendment of 1988. Retrieved from: https://www.cdc.gov/clia/index.html#:~:text=The%20Clinical%20Laboratory%20Improvement%20Amendments,%2C%20prevent%2C%20or%20treat%20disease.
13. American College of Physicians (2020). Overview and Compliance Resources for Antikickback Regulations and Stark Law. Retrieved from: https://www.acponline.org/practice-resources/regulatory-resources/regulatory-compliance/overview-and-compliance-resources-for-anti-kickback-regulations-and-stark-law
14. American College of Physicians (2023) (n.d.). No Surprises Act. Retrieved from: https://www.acponline.org/practice-resources/regulatory-resources/regulatory-compliance/no-surprises-act
15. American Disability Act (n.d.) Guide to Disability Rights Laws. Retrieved from: https://www.ada.gov/resources/disability-rights-guide/
16. Health and Human Services (2000). Office of the Inspector General Compliance Program for Individual and Small Group Physician Practices. Retrieved from: https://oig.hhs.gov/documents/compliance-guidance/801/physician.pdf
17. Porcaro, J. (2022). ASHRM Forum. Creating an Effective Risk Management Plan. Retrieved from: https://forum.ashrm.org/2022/11/25/creating-an-effective-risk-management-plan/
18. American Medical Association (n.d.). Private Practice Playbook. Retrieved from: https://edhub.ama-assn.org/steps-forward/module/2817874
19. Porcaro, J. (2023). Foundations Series. Documenting the Difficult Encounter. Retrieved from: https://www.wtwco.com/en-us/insights/campaigns/healthcare-risk-management-foundations-series#down2
20. Schleiter, K. (2009). AMA Journal of Ethics. Difficult Patient-Physician Relationships and the Risk of Medical Malpractice Litigation. Retrieved from: https://journalofethics.ama-assn.org/article/difficult-patient-physician-relationships-and-risk-medical-malpractice-litigation/2009-03#:~:text=A%20sound%20patient%2Dphysician%20relationship,malpractice%20%5B4%2D7%5D.
21. Bailey, J. Porcaro, J. (2023). WTW Foundations. Terminating the physician and patient relationship. Retrieved from: https://www.wtwco.com/en-us/insights/2023/08/terminating-the-physician-and-patient-relationship
22. Pichert JW, Moore IN, Karrass J, Jay JS, Westlake MW, Catron TF, Hickson GB. An intervention model that promotes accountability: peer messengers and patient/family complaints. Jt Comm J Qual Patient Saf. 2013 Oct;39(10):435-46. doi: 10.1016/s1553-7250(13)39057-6. PMID: 24195197.
23. Levin CM, Hopkins J. Creating a Patient Complaint Capture and Resolution Process to Incorporate Best Practices for Patient-Centered Representation. Jt Comm J Qual Patient Saf. 2014 Nov;40(11):484-12. doi: 10.1016/s1553-7250(14)40063-1. PMID: 26111366.
24. Agency for Healthcare Research and Quality. (n.d.). Strategy 6P: Service Recovery Programs. Retrieved from: https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/customer-service/strategy6p-service-recovery.html#6p1
25. ECRI (2016). Managing Patient Complaints and Grievances. Retrieved from: https://www.ecri.org/components/HRC/Pages/PtSup1.aspx
26. The Benefits of Consulting an Insurance Expert Before Making Policy Decisions (2023). Enrichest. Retrieved from: https://enrichest.com/en/blog/benefits-of-consulting-insurance-expert-before-making-policy-decisions  

Author:

Joan M. Porcaro, RN, BSN, MM, CPHRM, FASHRM

Senior Vice President | Risk Services - Healthcare

North America Healthcare & Life Science Industry