Risk Management

Our risk management process begins with a service prescription and consultation for lowering a facility’s risk. Risk management dollars are allocated to available services as described below and a quarterly progress report is presented to the facility to mark their progress during the policy period.

Risk Management Event Reporter

PointRight provides a Web-based Risk Management Event (RME) Reporting system that captures Professional Liability, General Liability and Workers' Compensation incidents, complaints, and record requests. The administrator and risk manager are cued to verify the completion of each step in the risk management process, from informing families through root cause analysis of recurrent problems.

At the facility level this encourages completeness; at the chain level it identifies facilities that have excessive numbers of particular kinds of risk management events or that take too long to complete the risk management process.

DIA (Data Integrity Audit) Risk Monitor

This Web-based service analyzes facility MDS data and provides reports on the facility's clinical performance in all major medical and behavioral outcomes. In addition, there is a special feature that allows facilities to document the exceptions and provides a check-off feature to verify that the documentation is completed.

A facility can check 100% of MDS assessments prior to state submission. Facilities receive instant online feedback regarding any data quality or documentation issues and are able to correct them. Accurate data ensures accurate QIs, QMs, care plans and Medicare RUGS reimbursement.

RADAR, is a resident-based predictive tool Included with DIA Risk Monitor that lists clinical considerations for each resident and illustrates clinical performance for risk management areas such as Activities of Daily Living, Cognition, Depression, Pain, Pressure Ulcers, Falls, Frailty and Re-hospitalization.

Staffing to Acuity Analysis

Based on the MDS analysis, PointRight determines the staffing levels needed to provide adequate care and patient safety. For example, a heavy rehab population requires relatively more skilled coverage on the day shift, while a heavy sub-acute population requires relatively more skilled coverage at night. If the overall average acuity of a facility changes over the course of a year, we make recommendations for adjusting that facility’s staff ratios.

Facilities receive quarterly reviews. When reviewing staffing we create spreadsheets of staffing assignments based on payroll data and ensure that Form 671 is correctly completed so that CMS is accurately reporting the facility's staff ratios.

Specialist Consultation and PointRight Site Visits

For very specific problems, a specialist will assist the facility staff and risk manager with a root cause analysis, make recommendations and conduct relevant in-service training. The specialist’s attention on site visits is targeted by the MDS analysis, which identifies residents at the highest risk for various types of problems.

When a facility has numerous quality problems, a PointRight consultant will conduct a site visit that focuses on the facility’s overall quality improvement process and the knowledge, skills, and attitudes of the facility’s leadership. Our consultants offer immediate recommendations to the facility’s leadership and follows up with specific action plans designed to monitor improvement of critical risk management areas.