Risk Management: Exposure Varies in Alternative Practice Models

By Jana N. Martin, Ph.D.
March 24, 2017 - Last updated: March 22, 2017

Exposure varies in alternative practice models for psychologistsAlternative practice models create exciting opportunities for psychologists within and outside of formal Affordable Care Act (ACA) structures, notwithstanding likely coming changes. Some may learn new business practices, and they and their clients may benefit from improved access to medical services and consultation with other professionals.

Although there is potential for new risks, psychologists who give thoughtful attention to ethical issues, develop their knowledge and competencies, seek consultation and use risk analysis models will be able to manage those risks to clients and themselves.

Two (among many) areas of attention will be addressed below: The use of electronic health records (EHRs, including recordkeeping and potential disclosures) and vicarious liability.

EHRs and documentation

The level of privacy psychologists in independent practice are able to enjoy and provide clients likely will change in an alternative practice model. This will vary depending on the type of model. Many models will include the use of EHRs and the ability of other treating professionals and staff to have access to clients’ records.

Consequently, clients must receive clear informed consent about who will have access to their records. In addition, practitioners must work to establish controls regarding who can properly access client records.

Protected health information (PHI) may be gathered and used to monitor and improve quality. Being mindful of Ethical Standards 3.10, Informed Consent, and 4.02, Discussing the Limits of Confidentiality, is important.

Informed consent documents and discussions with clients must be thorough and clear about what information may be shared with whom and why. Psychologists play an important role in educating their interprofessional colleagues about the importance of confidentiality and informed consent issues relevant to mental health services. Discussions with other professionals about confidentiality are essential.

Good documentation has always been an important risk management technique. It is a way of demonstrating compliance with medical necessity requirements and documenting progress in treatment. In alternative practice and integrated care models, appropriate record-keeping can facilitate sharing relevant information among treating professionals.

Concise records that avoid jargon and include relevant information, such as changes in symptom severity and level of adherence to prescribed medications, are essential for effective integrated treatment. The increased need to prove effectiveness may mean psychologists will have to incorporate process and outcome measurement tools.

Though being familiar with the APA Recordkeeping Guidelines and state laws is important, psychologists also need to become familiar with the recordkeeping policies required in alternative practice settings, as well as any specific contractually imposed recordkeeping requirements.

Vicarious liability

One risk to psychologists working in alternative practice models is vicarious liability – that is, when a psychologist is held legally responsible for another person’s actions. A lawsuit resulting from the negligence of one member of a group may name all members as defendants as well as the corporation or partnership.

When psychologists are not employees of a larger institution but  are part of an IPA or other group, they should clarify to clients and others that they are practicing independently.

In the resources section, The Trust website provides sample language for minimizing vicarious liability exposure in loosely organized groups and certain Management Services Organization (MSO) arrangements.

For all associations of independent practitioners (to be included as part of one’s informed consent statement):

“As you know, I work with a group of independent mental health professionals, under the name (Name of Practice). This group is an association of independently practicing professionals which share certain expenses and administrative functions. While the members share a name and office space, I want you to know that I am completely independent in providing you with clinical services, and I alone am fully responsible for those services. My professional records are separately maintained, and no member of the group can have access to them without your specific, written permission.”

For MSOs (to be included on all bills or other official communications to consumers):

“(Name of Group) is a corporation which provides administrative and management services to mental health professionals. As an independent practitioner, your provider is solely responsible for all matters concerning your clinical care and all questions about that care should be addressed to her/him.”

Protecting yourself

Good risk management also involves ensuring that you are protected both personally and professionally. Ask questions about what kind of coverage the alternative practice model provides and remember that even if you’re covered under a group professional liability policy, it will not cover you as well as an individual policy.

There may be times, for example, that an institution’s interests may diverge from the individual practitioner’s. Check to see if your practice’s group contract includes language that excludes activities outside the practice setting (e.g., teaching or part-time practice outside of the group or practice model or scope of practice).

Don’t forget to ask if your personal belongings in a co-located arrangement are covered. If not, consider business owner’s insurance. Ask about coverage such as disability (income protection) as well. Protecting yourself and your practice is good business.

When considering the many opportunities provided by alternative practice models, using the time-honored guideline of “do good, do no harm” protects you and your clients.

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Jana Martin, Ph.D., became CEO of The Trust in 2010 after years of independent practice. She focuses on providing support services for Trust policyholders: expanding clinical/risk management consulting, educational resources and products and presenting workshops on strategic planning for successful practices. Her email is: jana.martin@trustinsurance.com.

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