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The Risk Management Lifeline

Ellen Adams Compliance Officer Ophthalmic Consultants of Boston

Ellen Adams
Compliance Officer
Ophthalmic Consultants of Boston

In 2002, I was hired as the Compliance Officer for Ophthalmic Consultants of Boston. With the ink barely dry on my MBA and over 16 years experience as an ophthalmic technician/scrub assistant, I felt ready to handle HIPAA, coding, and OSHA issues. After all, that is what a compliance officer does, right?

How wrong I was.

Almost immediately, I found myself in the cross hairs. Patients with complaints were transferred to me. I answered calls from lawyers asking for copies of medical records. And our satellite office managers called me whenever problems arose, such as when a patient fell in the parking lot. In most of these situations, no one really knew what to do and panic was often coloring the event.

After one especially concerning situation, I met with OCB’s then-president, Dr. Tom Hutchinson, to ask for help. Without hesitation, his response was to call the OMIC hotline. At the time, I didn’t realize there was such a thing, but over the past 11 years this service has become one of my most valuable tools. Most importantly, I have found that there is no need to panic. I have objective, highly knowledgeable experts when I need them; a lifeline that is just an email or phone call away.

One recent typical day at OCB found me working at my desk when the phone rang. It was a patient who at first seemed reasonable. We were about six months into using electronic health records, and she was upset that a note by one of our physicians included an unflattering comment about how demanding she was. She was particularly concerned that her primary care physician would be able to see the comment and wanted it removed.

What the patient did not realize was that the note she had seen during her previous visit had not been finalized; the draft version had been subsequently reviewed by our physician and this particular comment had been removed. While speaking with her, I reiterated several times that the final version of the note in her record did not contain the comment, but that was not good enough for her and the conversation continued to escalate into a highly charged tirade.

As the call approached 45 minutes, I realized this patient was not as she had first presented on the phone—in fact, I was beginning to suspect that our physician’s now removed comment was closer to the truth. She was unreasonable, demanding, and unpredictably volatile. Time for a lifeline!

I emailed OMIC and asked for help. Not only did OMIC’s risk manager, Anne Menke, assure me that neither I nor our practice was the problem, she also guided me through a reasonable response to the patient. When that didn’t work (a subsequent hour and twenty five minute phone call with the patient days later progressed in a similar fashion as the previous encounter), OMIC helped me draft a letter to discharge the patient from our practice. Clearly, this was in the best interest of both the patient and OCB.

OMIC’s help was exactly what I needed in order to facilitate a solution to a difficult practice-patient relationship while also protecting our practice. Incredibly, when the patient called back a full year later wishing to be seen again by OCB, I was back on the phone with Anne, who recalled the entire incident and helped me compose a “discharge means discharge” letter to the patient.

This is what I value most about OCB’s relationship with OMIC. The risk managers are there to help me. They treat my calls as completely confidential. No one, not even other employees within OMIC, have access to risk management files and they keep detailed notes so anyone can pick up the tale if things escalate; they are calm and rational when patients pull me into an abyss. They are my lifeline.

The OMIC risk management team has given me the confidence and tools to now handle most situations on my own. They use hotline calls like mine to develop recommendations, protocols, sample letters, and consent forms, which are posted on the OMIC website so they are available when I need them.

When I call the hotline now, my OMIC team lets me know if my new problem is indeed unique or scarily interesting. I feel like OMIC is not just another malpractice insurance company but an integral part of my compliance and risk management team.

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Six reasons OMIC is the best choice for ophthalmologists in America.

Best at defending claims.

An ophthalmologist pays nearly half a million dollars in premiums over the course of a career. Premium paid is directly related to a carrier’s claims experience. OMIC has a higher win rate taking tough cases to trial, full consent to settle (no hammer) clause, and access to the best experts. OMIC pays 25% less per claim than other carriers. As a result, OMIC has consistently maintained lower base rates than multispecialty carriers in the U.S.

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