banner no border


Issue #11 




A Note from the CEO


Dear Reader, 


It's been a busy few months, and with each passing day, we come closer to the reforms spelled out in the Patient Protection and Affordable Care Act (PPACA). These reforms - coupled with the increased efficiency of information exchange in this lightning-fast age of electronic communication - are leading to an era of vertically aligned health systems, where everyone plays a role in risk management and patient safety.


Everything, from retail clinics to primary service providers to outpatient centers and home care, is increasingly being aggregated under large umbrella healthcare organizations. But these structures rely heavily on the streamlining of communication, fluid reporting of incidents, sharing of data and the spreading of awareness. You really do need eyes and ears in every corner of an organization. It's a new era.


Systems are aligning, data is being shared, transparency is improving, and the new landscape of healthcare delivery is slowly taking shape. So too then should the health of our communities be getting better every day.


This edition of the Clarity Post covers a variety of topics related to the evolving role of risk management and modern healthcare organizations, as well as a few exciting news items from Clarity. We hope you find it informative and helpful.


Anna Marie Hajek

President & CEO

Clarity Group, Inc.


Healthcare News & Trends



Patient Safety Awareness



Celebrate Healthcare Risk Management Week: June 17 - 21!


In honor of Healthcare Risk Management Week, we would like to recognize all of you who are working hard to reduce risk and improve patient safety. This annual campaign from the American Society for Healthcare Risk Management (ASHRM) raises awareness about the critical role healthcare risk managers and safety professionals play in patient safety and patient safety care practices, quality assurance, safe work environments and liability. It also promotes solutions to help prevent some of the most common patient safety events. 


Risk management strategies encompass the entire organization, so this year's theme "Everyone is a Risk Manager" could not be more fitting. It is important that everyone in healthcare - from clinical, to financial and everyone in between - works together in order to eliminate risks and make facilities safer for our patients. At Clarity, we have seen firsthand how organizations have come together for the improvement of healthcare delivery, and we applaud all of your efforts. We take this week to honor and recognize the achievements made so far by our own clients as well as healthcare risk managers nationally.


On the Nature of Risk Management & the Patient Protection & Affordable Care Act


The role and nature of healthcare risk management, in our view, is evolving in the new world under Healthcare Reform. As we mention above, the theme for this year's Healthcare Risk Management Week is "Everyone is a Risk Manager." This theme touches on the idea that in light of the coming reforms, it is essential that everyone in an organization plays a role in managing risk and breaking down the silos of communication in order to improve the overall continuum of care, ultimately leading to better patient outcomes and therefore mitigating liability exposure. The full title for what has come to be known as Healthcare Reform or the Affordable Care Act (ACA) is actually the "Patient Protection and Affordable Care Act;" we point this out because we feel it highlights an important aspect of the law and what it hopes to accomplish - namely that healthcare providers are charged with protecting the safety of the patient and creating improved outcomes, not simply maximizing volume of services delivered.


The coming reforms spelled out in the law ultimately signal a transition from volume-based insurance reimbursement to performance-based reimbursement. The old fee-for-service model of healthcare delivery perpetuates a world of fragmented care with services often coming from multiple mutually exclusive and non-fully-cooperative branches of an organization. This fragmentation has been supported by the payment system, which has led to escalating healthcare costs and bills coming from multiple providers that have alienated the healthcare consumer and disenfranchised many lower-income patients. The new model aims to reward health systems for improved patient outcomes, making them eligible for higher reimbursement levels based on a more coordinated and integrated continuum of care that can also reduce overall healthcare costs.


The new law offers incentives to health systems that adopt the use of electronic medical records (EMRs), an important step toward organizational fluidity and transparency of data. It also requires that organizations with 50 beds or more have a Patient Safety Evaluation System (PSES) in place, which is achieved by contracting with an accredited Patient Safety Organization (PSO). Through this contract, an organization shares and analyzes patient safety data with the PSO in order to better understand the factors contributing to patient incidents, and in exchange, those data are legally protected from discovery and held confidential. All of this is getting at one essential principle: the better an organization integrates its services, improves its transparency and shares its data, the better the outcomes will be for its patients.


As a result of the ACA, we have seen an escalation in merger activity among providers, and have seen the aggregation of multiple services from primary care and convenient care clinics to diagnostic services and home care under a single provider umbrella. In these more complex structures, fluid communication and shared data across the system of care is central to the organization's success from both quality of care and financial perspectives. From a risk management perspective, this means that an organization needs eyes and ears in every setting, all contributing to the sharing of data, reporting of untoward events and unsafe conditions, and spreading of awareness across the entire organization essentially making everyone a risk manager, and empowering everyone to be a custodian of the health and safety of their patients.


All Things Rural



Critical Access Hospitals: Dedicated to Improving Quality of Care


By: Anna Marie Hajek, President & CEO, Clarity Group, Inc.


We read, with interest, the news item on the recent study published by the researchers from Harvard Medical School and Harvard School of Public Health; this study indicates that data show that risk-adjusted 30-day mortality rates have increased over the past decade in Critical Access Hospitals (CAHs) while they have dropped at other acute care hospitals. The measures they included were for heart attack, heart failure and pneumonia.


While these data might be debated, the reasons that the researchers put forth as to why they believe these results have occurred are more alarming:

  • CAHs are exempt from participation in federal quality reporting and improvement programs
  • CAHs receive cost-based reimbursement - which could reduce incentives to improve quality
  • CAHs face challenges adopting advanced technology systems that other hospitals use to enhance quality improvements


The main author of the study, Karen E. Joynt, MD, MPH of the Harvard Medical School and Harvard School of Public Health, was interviewed by HealthLeaders Media. In that interview, she supported the published findings and the possible reasons contributing to those findings. Apparently, it is felt that CAHs are somehow orphaned from the rest of healthcare delivery and that needs "fixing."


What is key from Clarity's perspective is this ... the CAHs and small and rural facilities that we have the privilege of working with are fully aware of quality improvement, and they work diligently in their organizations and quality networks to gain insight from data collected and clinical studies specifically because they seek comparative information and the ability to incorporate best practices. In addition, Clarity's national Benchmark for Excellence in Patient Safety (BFEPS) Program, which many CAHs participate in, is an investment in IT and includes a forum that brings together like-minded professionals from CAHs and small and rural healthcare facilities for benchmarking and shared best practices purposes, again, specifically because they seek the ability to improve care. There is no need for additional incentives to improve quality, as the author suggests ... that desire is self-directed within the CAH and small and rural community.


We applaud CAHs and small and rural hospitals, and the various Quality Networks nationally, for their dedication to not only seek out ways to enhance care, but also to provide their own data to enrich the learning of the whole CAH and small and rural community. We welcome all CAHs who want to learn more about the Benchmark for Excellence in Patient Safety Program and the Healthcare SafetyZone� Portal technology that supports the BFEPS program. And, we wish you continued success in meeting the healthcare needs of your communities.


Small & Rural Collaboration Promotes Patient Safety Improvement


In small and rural healthcare, collaborating with your peers is paramount when working towards the ever-present goal of improving patient safety. For this reason, through the National Rural Health Association's free webinar series, Clarity Group sponsored the webinar, Small and Rural Collaboration Promotes Patient Safety Improvement.


During the presentation on March 26, our speakers took us on an in-depth look at successful models that foster patient safety quality improvement through small and rural state networks/user groups drawing on peer review learning opportunities. Using standardized methods of event reporting has enabled two state small and rural user groups to collaborate and improve patient safety while sharing best practices across state lines. 


Listen to the webinar recording to learn more about the collaboration.


Successful Management of Professional Liability Risk



Foundations of Successful Claims Management


By: Debby Weber, RN, MN, JD, Director, Claims Management, Clarity Group, Inc.  -  Amber Basra, Claims Associate, Clarity Group, Inc.  -  Barbara Herrington, Claim Quality Officer, Clarity Group, Inc.


Since the Affordable Care Act was passed in 2010, healthcare systems are merging and hospitals are acquiring physician practices. With these changes have come increased professional liability exposure and the need for healthcare providers to look for more ways to insure their facilities in managing these risks; one solution is to create a captive insurance company.


Clarity Group, Inc. is pleased to present a series of white papers on the successful management of a healthcare captive insurance company in the professional liability arena. The first white paper in the series focuses on the best practices of the claims management process, which include proactive case management, clear litigation guidelines and a consistent reserve philosophy and methodology. 


Read the white paper, Foundations of Successful Claims Management, to learn some of the key elements of a proactive claims management process as well as other tools and strategies to assist you in managing your claims. 


Clinical Risk Management Issues



Telemedicine: Risk Management Strategies


Contributor: Heather Annolino, RN, MBA, CHPRM, Director, RQS Consulting Services, Clarity Group, Inc.


Telemedicine is a broad term that refers to any medical activity that occurs at a distance and uses some means of telecommunication; applications include electronic medical records, emails, telephone calls, videoconferencing, instant messaging and specialist consultations such as teleradiology, telepathology and teledermatology. This practice can significantly improve clinical care by connecting patients with the right physician who may not be available in his/her community, and allowing quick access to specialists in both urban and rural settings.


Due to healthcare reform, more people will have insurance and need increased access to healthcare services. The healthcare industry is changing to make way for this growing population, and telemedicine will be another facet of the industry that continues to expand and ultimately become a vital piece in healthcare delivery. In our current state of healthcare, and even with reform, it is becoming more obvious that healthcare is not distributed equitably. Telemedicine will play a pivotal role in assisting everyone in receiving the care he/she needs. It will also allow providers to promote patient-centered care at a lower cost and extend their reach to specialists across the country. As this new healthcare delivery model takes hold of the industry and continues to grow, we need to keep in the forefront of our planning and implementation its risks as well as its benefits. 


Below is a sample list of strategies to mitigate some of the key risks associated with telemedicine. 


  • Credentialing
    • Ensure the facility providing the telemedicine practitioner comply with the Medicare Conditions of Participation (CoP) credentialing standards as well as any national, state and local regulations; modify any existing telemedicine agreements as needed.
    • Verify that the telemedicine provider is qualified to do business in all states where it intends to conduct business. Also, verify that the provider is properly licensed in all of those states.
    • Require that both the hospital and the telemedicine provider have professional liability insurance at a specified coverage level.
    • Develop and maintain a list of telemedicine providers.
    • Establish a peer review process to confirm that the performance of your telemedicine providers meet compliance and credentialing standards. Some items to monitor:
      • Adverse events
      • Complaints regarding the practitioners
      • Noncompliance with documentation practices
    • Create strict guidelines regarding the sharing of medical information with telemedicine providers and monitor the documentation.
    • In addition to clinical notes, ensure that your staff document other details of the telemedicine session such as the mode of service, names of all attendees, sites that were linked and any technical issues or concerns. 
  • Security: Privacy and Confidentiality
    • Document everyone who has access to confidential data and require them all to sign confidentiality agreements. This also applies to 3rd parties such as contractors or consultants.
    • Use standard IT security such as firewall control, authentication and computer timeout locking.
    • Require regular password changes and immediately deactivate staff passwords when they leave the organization.
    • Ensure that the areas where videoconferencing or teleconferencing are taking place are sound proof.
    • Have written policies that outline specific responsibilities of the telemedicine provider, support staff and healthcare providers. 
    • Use strong message encryption programs. 
  • Informed Consent
    • Require patient consent forms and include the following information:
      • Names, locations, credentials and affiliations of the staff involved in the consultation and follow-up
      • Description of the procedure or exam
      • Potential benefits and risks of the procedure or exam
      • Explanation of how care is to be documented and assessed
      • All security measures that will be taken
      • Technology issues that may arise and contingency plans
    • Ensure physicians know the informed consent requirements for telemedicine.
    • Have physicians discuss the benefits and risks of telemedicine verbally with patients before obtaining a signed consent form. 
Paul Hildebrand, MD, "Telemedicine Risk Management," TEAMHealth White Paper, URL: 
"Risk Management for Telemedicine Providers," Defence Update - Autumn 06, URL:

Patient Safety Organizations



Clarity PSO's New Website 


Clarity PSO is pleased to announce the launch of its new website, The new website is designed to accommodate the increasing need for education and awareness on the topic of Patient Safety Organizations, while also giving people an easy place to go for up-to-date information regarding the Patient Safety and Quality Improvement Act, AHRQ Common Formats and everything related to Clarity PSO.


Beginning in January of 2015 under the Affordable Care Act (ACA), hospitals with 50 beds or more must belong to a PSO in order to contract with insurance companies. "The new website allows users to explore the PSO program, gain access to invaluable resources through our Learning Library, answer any questions they may have about the ACA or the Final Rule, and of course, contact us about contracting with Clarity PSO," says Tom Piotrowski, Executive Director of Clarity PSO. "One of the main components of the Final Rule is education for not only providers, but also other PSOs. We feel that our new website is a great way for us to achieve both."


Take a minute to visit the site and tell us what you think.  


Clarity PSO Learning Series: #2 Ambulatory Safety


Contributors: Tom Piotrowski, RN, MSN, CSSGB, Executive Director, Clarity PSO  -  Heather Annolino, RN, MBA, CPHRM, Director, RQS Consulting Services, Clarity Group, Inc.


Just Released!


As part of Clarity's role as one of the nation's earliest and most trusted Patient Safety Organizations, Clarity PSO has released the second report in our newest series of online educational tools. Since data is meaningless without knowledge, and knowledge is pointless without action, we are pleased to publish what we are "learning" through our analyses of incident data reported by our PSO clients. Each of the reports will include our findings on a given topic and our recommendations on how to use knowledge to mitigate risk and improve patient safety.


For our second subject, we looked at ambulatory safety. Historically, quality and safety efforts have primarily revolved around the care provided in the traditional hospital setting and much less around the care beyond the hospital walls. Dramatic shifts in the healthcare landscape are demanding that we broaden our efforts to reach beyond the traditional hospital settings and truly begin to incorporate the entire continuum of care. With all of the changes, it is critical that we better understand the risks associated with care in the ambulatory setting.


Since August 2012, Clarity PSO has been conducting a pilot study (The Ambulatory Safety Initiative) with two of our larger client health systems to learn more about care in the ambulatory setting and to identify opportunities to improve quality and safety in this area. To meet the goals of the pilot, we reviewed and analyzed three aspects of data:

  • Review of professional liability claims history
  • Results from a self-reported online Office Practice Survey (OPS) assessment
  • Safety events reported to their incident reporting system (in this case, Clarity's Healthcare SafetyZone� Portal) under the Ambulatory Safety Module (ASM) category of safety events

Read the full report to see what we have learned from our analyses so far.


How Your Institution Can Fairly Raise the Bar in Nursing Professionalism


By: Jessica Riley, Project Manager, Clarity PSO  -  Contributor: Cone Health, Greensboro, North Carolina


Read Clarity PSO's latest white paper to learn strategies you can use at your institution to improve the quality and safety and ways you can raise the bar in nursing professionalism


Medical errors can occur in any healthcare institution, and even the most experienced nursing professionals can be second victims to sometimes devastating medical hazards. While our tendency may be to quickly resort to "who did it?" it is critical that healthcare organizations take a more just approach to investigating and responding to medical hazards. Healthcare leaders need to look at both system and professional behaviors to understand "what happened?" and "how do we prevent this from happening again?" and not simply "who reported it?"


This white paper introduces concepts and a solution that currently helps hospital nursing peer review and nursing quality review committees and programs manage the investigation, follow-up and case review of medical events submitted and self-referred by nursing staff. To further encourage reporting and transparency in medical events by nursing professionals, institutions are working with Clarity PSO to provide confidentiality and privilege protections to nursing professionals participating in their programs.


PSOs Made Easy!


According to the Affordable Care Act's PSO mandate, those hospitals that are participating in the private insurance market and have 50 or more beds need to report to a Patient Safety Organization by 2015. As this mandate starts to become a reality, it is important that you as a healthcare provider understand what this means to your organization. Listen to PSOs Made Easy to learn the basics of a Patient Safety Organization and prepare yourself for the changes that are coming. 


Want more? Visit Clarity PSO's Learning Library for white papers and other educational resources. 


Clarity Spotlight



Breaking Down Clinical Silos in Healthcare


Clarity is pleased to announce that Anna Hajek, President & CEO of Clarity Group, Inc., was recently published in Frontiers of Health Services Management. This quarterly journal is published by American College of Healthcare Executives (ACHE) and sent to about 6,000 of its members. 


The summer issue is devoted to the topic of breaking down clinical silos in healthcare. Anna provides a commentary on two articles that address the need for interdisciplinary integration, the challenges in achieving it and practical suggestions for overcoming these challenges. In her piece, Anna focuses on the integrated management of risk, quality and safety; she discusses extending the hospital's carefully nurtured culture of safety to the outpatient areas, the benefits of working with a Patient Safety Organization and the power of web-based information technology. 


Upcoming Events


NRHA's Rural Quality and Clinical Conference

July 17 - 19, 2013

Avenue Crowne Plaza

Chicago, IL


Coming Soon! Clarity White Paper


Retail Clinics - The Risk-Quality-Safety Perspective

In the coming weeks, Clarity will be publishing the white paper, Retail Clinics: The Risk-Quality-Safety Perspective. This white paper will discuss the growing trend of retail-based walk-in clinics like you see at national pharmacy chains and big box retailers. We'll discuss the prevailing conditions that have contributed to the growth of these clinics, their new and permanent place in the evolving landscape, and some of the concerns inherent in their processes from a risk, quality and safety perspective.


These clinics are on the rise and here to stay. With the right patient safety mechanisms in place, they are a welcome partner in the industry and share a role in enhancing the health of our population. Stay tuned for the release of the white paper!



Phone: 773-864-8280       Email:      Website:       Twitter: @claritygrp

Clarity Post is a publication of Clarity Group, Inc.

Managing Editor: Jaclyn Saffa 

Contributing Editor: Christopher Hajek


This newsletter contains links to sites which are not owned or maintained by Clarity Group, Inc. Clarity Group is not responsible for the content of non-Clarity Group linked sites, and the views expressed on non-Clarity Group sites do not necessarily reflect the views of Clarity Group, Inc.


This information is provided for informational and educational purposes only and should not be construed as financial, medical and/or legal advice. Specific questions regarding this information should be addressed to local advisors and legal counsel. 2013 Clarity Group, Inc. All rights reserved.