In this episode of The Risky Health Care Business Podcast, Scott Nelson discusses the concept of emerging risk within the health care industry—risks that are new, evolving, or not fully understood. Emerging risks differ from legacy (or traditional) risks, as they are less known, less predictable, and often require new and innovative strategies for management. The episode emphasizes the importance of proactive risk assessment, scenario planning, and fostering a culture of resilience and adaptability to effectively manage emerging risks.

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In this episode of The Risky Health Care Business Podcast, Scott Nelson discusses the fragility of the U.S. health care supply chain, which plays a vital role in ensuring timely, efficient, and quality care and performance across the dental, medical, and veterinary sectors. The US health care system and supply chains were tested and vulnerabilities exposed during the COVID-19 pandemic.  Hurricane Helene and the dockworker strike are another test showing what was learned from the COVID-19 pandemic.

Copyright 2024 SpringParker

What he does:  Dr. Clark is a Professor of Labor and Employment Relations at Penn State University where he regularly teaches undergraduate and graduate courses on employment relations.  His research has focused on employment relations in U.S. healthcare, with interests including unions, union organizing, collective bargaining, labor-management partnerships, and labor-management relations in healthcare. His research has appeared in the leading scholarly journals in industrial and labor relations, applied psychology, and international labor issues. He is the author or editor of six books about unions and collective bargaining; and has worked on training programs and research projects for over fifty national unions, and many local and regional unions.

On risk: "Workers don't bring in a union to wreak havoc and make a hospital or a clinic work less well. They want to have a greater voice in how care is delivered. Administrators have a tough time with that, because they've largely been taught that they're in charge. They're the ones that make decisions, but by giving up a little bit of that control, there really can be great benefits … Management still has to decide, or gets to decide, what its positions will be in bargaining.  If they don't come to agreement, however, then unions do have the right to strike.  A strike is a pretty traumatic thing, and that's part of the collective bargaining process that doesn't exist when unions aren't present in a workplace … Collaboration on a large scale can work.  There are other smaller hospitals and smaller medical centers I've worked with, and we do see really, really positive results from that, because workers see their role as not just doing what they're told, but always looking at how they can make the workplace better. And they know that if they see something that can be improved on, there are mechanisms to talk about what's going right, what isn't, what ideas do people have, and then there's a mechanism where they work together as equals to try to decide whether to implement things, and then they measure them afterwards to see if they've had positive results."

Highlights of recent headlines from the U.S. Department of Health and Human Services (HHS) and their potential risk considerations

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What he does: Dr. Kazi is the President of the Arizona Medical Association.  Dr. Kazi is also a practicing gastroenterologist and independent, private practice founder-owner in Casa Grande, Arizona.  In his role as President of the Arizona Medical Association, Dr. Kazi works with local, state, and federal government officials as well as local, state, and national organizations on various issues that impact independent physicians.

On risk: "Number one issue is the lack of providers, physicians, nurses, paramedical staff throughout the country, and we are behind, especially in the rural area. We don't have specialists, we don't have even primary care. And the biggest problem that I am seeing is the lack of private practices.  Private practice is dying away. So that's a big risk that I see lack of provider and private practice slowly, gradually diminishing in the whole country … Lack of patient physician relationship and that's a big risk that I see in medical practice these days. If you don't have a relationship with patient, it's very difficult to manage chronic disease … If something negative outcome is there, what happened, you have to take a proper, appropriate action for that negative outcome. Negative outcome is always there in medical practice, but it's how you approach them, how you solve them, how you resolve them that's the key."

What she does: Professor Coordes is a Professor of Law at Arizona State University's Sandra Day O'Connor College of Law in Phoenix, Arizona.  Her research focuses on bankruptcy and financial distress and includes commercial law, large corporate reorganizations, international and comparative insolvency law, and local government finance and policy. She teaches Chapter 11 Bankruptcy, Advanced Bankruptcy, Secured Transactions, and Contracts.  Professor Coordes is on the board of the American Bankruptcy Law Journal, a member of the American Bankruptcy Institute, and has presented her work and perspectives nationally, including The Wall Street Journal, Yahoo! Finance, and Bloomberg Law.  

On risk: "It's important to be looking at the bigger picture, the industry pressures, the interconnectedness of the whole industry, and some of the big challenges that the industry as a whole is facing to try to figure out, okay, how can we really create some stability in health care … Indicators or factors can really impact and pressure the market, and in turn, can then impact and pressure individual health care businesses … Distress or closure of a health care business can cause ripple effects. So even if, on a narrow level, a particular health care business is doing fine, that could change fairly quickly, depending on what's going on in the nearby area or in the industry as a whole. And so I think if you're running a health care business, you have to be concerned, of course, about your own business and its financial health, but also about what's going on and with the other health care businesses in your area … What's challenging for an individual health care business, there's so much that you have to take into account that is outside of just the four walls of your own business."

What she does:  Beverly is the office manager of Karl A. Smith, DDS, LLC Periodontics and Implants, a multi-site practice with locations in Virginia and Maryland. In addition to managing the practice full-time, she serves as an expert of dental business practices and standard of care in practice administration systems for several law firms across the US. She has provided expert witness testimony on behalf of the prosecution and defense at both the State and Federal level.  Beverly is a Diplomate and Lifetime Member of the American Association of Dental Office Management (AADOM) and awarded the 2022 Dental Practice Administrator of the Year and is a recipient of a Denobi Award. She is the founder of Dental Spouses in Business™, the Executive Director for the Virginia Society of Periodontists, chapter president of AADOM's Dental Spouse Business Network as well as a member of three local chapters, and serves on the board for Dental Entrepreneur Woman. 

On risk: "Risk is a possibility. It's not a fact. Risk is a thing, it's a factual thing. It's a possibility of something happening. And I think people have to remember that. A lot of people, when they hear the word risk, they assume it has some kind of negative connotation around it, and it really just means that we need to protect ourselves. It's a possibility that something could happen and we need to be aware of it. It's an awareness around situations that can happen, and it's a bringing to the forefront, a thought about making sure that we protect ourselves … When you're thinking about why do I have to be concerned about risk? It's ultimately because you want to protect your practice. You want to have longevity of the practice. If the practice doesn't survive, we now can't help people and help more patients … Part of the risk, part of where that comes to risk, is now we are having an access to care issue … Awareness is obviously number one, awareness of what risks can be, if things are in line and everybody's ducks are in a row and things are proceeding on, and you've got a good system in place, even when something does adversely happen, it's almost foolproof. You have the resources at your fingertips. You know what to do, when to do it. You're prepared and it helps to simplify knowing that risk is always going to be there. It simplifies the process when something does happen"

Mid-year assessment of risk areas and topics from 2024 Risk Outlook.

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What he does: Kal is the Chief Administrative Officer at Oregon Health and Science University in Portland, OR and has over two decades of experience in health care, including 15 years in a combination of leadership roles on both the payer and provider side.  At OHSU he is responsible for serving Medicaid members in the Portland Metro region and as the administrative lead for the MSO in the Office of OHSU Payer Strategy, serves clinicians in a Clinically Integrated Network participating in an MSSP ACO and various Medicare Advantage and commercial value-based care arrangements.

On risk: "Risk is one of those things that, especially underwriting risk for a population, that somebody has to take the risk, right? It's either the payer or the provider, or maybe potentially even the member, unknowingly … Sometimes it can be like a hot potato. People want to pass it around to somebody else and let them manage it. But I think the reason it's important to prepare for managing risk as a healthcare provider is that the days of being able to get your fee for service increases and the payer just leaving you alone those days are behind us. As a provider, you're not able to afford to not pay attention to this anymore … Preparing for it is probably the best way to go, instead of hiding your head in the sand and delaying it and prolonging it, because I see the danger is that if you prolong your preparation for this, for managing risk as a provider, you'll get to a point where a more advanced model would be imposed on you, and you may not have a choice, and you would be ill-prepared for managing that risk at that point."

What she does: Karen is an occupational health and safety expert in the health care industry with over two decades' experience helping medical, dental, and professional offices with safety, infection control, and compliance systems.  She began career in the emergency department at Ohio Health's Riverside Methodist Hospital and then served as the assistant director of sterilization monitoring for the Ohio State University College of Dentistry before becoming it's health and safety director and now works with health care professionals and entities across the US.  She has authored articles and CE courses on safety in dentistry and is an authorized US Department of Labor OSHA trainer as well as an active and current member of the Organization for Safety, Asepsis and Prevention, and CDC Dental Infection Control.

On risk: "There's the risk of receiving citations and those inspections are public information. I can do a quick search and tell you all the medical practices that were inspected by OSHA so it's public information sometimes that lands you on the evening news, too. That's another thing as well is your reputation is at stake. I look at it from not just the immediate impact of it, but what are some of those indirect and also long term implications of not adhering to OSHA requirements too so there's that association with the risk … When people are assessing their practices, looking for the not so obvious, really thinking, be forward thinking, look for the things that is there a possibility this might occur? What can we do to prevent that now? The risk is low, but it's never a zero … People look at it from this very broad brushstroke. They're doing annual training and I always tell people you're doing a great job of addressing the more obvious things, what I want you to do is look for the not so obvious."