Allied Health Professionals – Managing the Risk

There is a veritable alphabet soup of allied health professions in today’s healthcare environment. Traditionally, medical professional liability carriers have considered advance practice providers (APPs), such as nurse practitioners, to be allied health professionals (AHPs). Other organizations define these healthcare professionals differently. According to the Association of Schools Advancing Health Professions (ASAHP), “Allied health may be defined as those health professions that are distinct from medicine and nursing.”¹
 
ASAHP has identified 65 distinct types of AHPs, ranging from the well-known − medical assistants, respiratory therapists, and physical therapists − to the more obscure, such as nerve conduction studies technologists, perfusionists, and vestibular technologists. Other organizations use a broader definition that includes more than 200 health professions representing approximately 60% of the healthcare workforce and about 6 million jobs.²
  
Lack of consensus on definition and categorization of the allied health professions does not eliminate the need to carefully evaluate this large group of providers for best practices and risk mitigation strategies. Key elements essential to incorporating best practices and mitigating risk for AHPs (excluding APPs) follow.
 
Scope of practice and supervision requirements. Employers of AHPs should fully adhere to scope of practice, practice site, and supervision requirements that apply to the AHP under consideration. This process can be challenging in that scope of practice, licensing, and supervision requirements vary from state to state for the wide range of AHPs. Steps to navigate the scope of practice and supervision considerations may include the following:

• Ensure that state regulations are understood and reviewed regularly to keep abreast of changes. State requirements may vary for licensing, certification, and registration.³ Ensure that current employees meet those criteria and hiring practices are consistent with state requirements.
• Identify a leader in each of the respective specialties to establish expertise regarding scope of practice, practice sites, supervision requirements, and any changes in licensure or certification requirements.
• Confirm that credentialing policies and practices reflect the state licensing requirements and privileges at the facility. In various states, providers such as respiratory therapists and perfusionists are credentialed.² Engage medical staffing to participate in this process.  

Standardized job descriptions and competencies. Written job descriptions and competencies ensure that quality patient care is delivered consistently. Standardization of job descriptions and competencies should be based on the recommendations and guidelines issued by professional organizations. Consider the following in developing and implementing job descriptions and competencies: 

• Establish and maintain standardized written job descriptions and competencies for the myriad of AHP positions your organization may employ. 
• Evaluate your practice and/or facility’s specific needs and establish job descriptions that fall within the provider’s scope of practice.
• Maintain and update job descriptions as roles evolve or as regulations change.
• Develop clear, concise competencies that are consistent with scope of practice regulations and evidence-based guidelines.

Peer review and quality auditing. Peer review has traditionally been reserved for physician practice and has occurred in morbidity and mortality conferences or other formal forums. Nursing peer review has evolved over the years to become more mainstream in healthcare organizations. AHP peer review is an emerging trend and is still relatively uncommon.
 
Implementing a formal peer review process for AHPs encourages best practices, standardizes care, and improves patient safety. Whether by the process of formal peer review or quality auditing, the care delivered by AHPs should be reviewed periodically. Considerations for implementing an AHP quality auditing and/or peer review include:

• Start small by auditing a common allied health position, such as the documentation practices of medical assistants or respiratory therapists. Once familiarity with a quality auditing process is in place, determine next steps.
• Expand your program by including common AHPs in the nursing peer review process. If a nursing peer review process is not in place, consider implementing a nursing and allied health peer combined review process. 
• Integrate a just culture approach to any review processes to avoid punitive perceptions.⁴ For our customers, additional Coverys peer review and just culture risk resources are available via the Coverys Customer Portal.         

Ensure adequate insurance is in place. Coverys closed claims data shows that although AHP-related claims are infrequent, they can be expected to rise as this workforce continues to grow. An analysis of approximately 10,000 closed claims from 2015 to 2019 revealed that only 212 claims involved allegations against AHPs. A total of 487 distinct allegations of negligence were asserted in those claims. Social workers and counselors were the AHPs most frequently involved in claims, with medical treatment allegations accounting for 52% of the total. In comparison, radiology and imaging techs had the second largest share of claims, with an almost equal distribution of failure to ensure safety of patient, surgery/procedure, equipment, medical treatment, and diagnosis-related allegations.
 
While the frequency of AHP-related claims is relatively low, their high severity can expose the organization to significant financial loss. For example, in a recent high-profile case in Colorado, a scrub technician's diversion of fentanyl exposed over 3,000 patients to infectious diseases. The subsequent class-action suit filed against the health system, facility, and staff alleged negligence in hiring, supervision, and medical monitoring and intentional infliction of emotional distress. It is important to ensure that adequate insurance coverage is in place. When reviewing your insurance coverage, consider the following: 

• Evaluate the type of practice and patient population served when assessing potential AHP risk exposures. Lab technician exposures, for example, will be distinctly different from occupational therapists.
• Enlist the assistance of insurance professionals when reviewing your insurance coverage. Your agent or broker can evaluate your insurance program in the context of your practice setting to ensure that your coverage is appropriate.
• Understand your insurance coverage. Familiarize yourself with how policy limits work and theories of liability that may apply to AHPs, such as vicarious liability, and how they can affect policy limits. Well-designed policies and procedures, good employment practices, and diligent supervision can help protect the organization from liability. 

As healthcare evolves, so will the roles and responsibilities of AHPs. Remaining nimble and open to utilizing AHPs as their roles expand will be essential as delivery of healthcare changes. Implementing best practices when employing AHPs will help in mitigating the associated risks.  

 
References:

1. What is Allied Health? Association of Schools Advancing Health Professions (ASAHP) http://www.asahp.org/what-is Accessed November 18, 2020.

2. Elwood, T. Patchwork Of Scope-Of Practice Regulations Prevent Allied Health Professionals From Fully Participating In Patient Care. Health Affairs. 2013 (32; 11).1985-9. doi: 10.1377/hlthaff.2013.0530. PMID: 24191090.

3. What Does "Allied Health" Mean? In: Allied Health Services: Avoiding Crises. Institute of Medicine (US) Committee to Study the Role of Allied Health Personnel Washington (DC): National Academies Press (US); 1989.

4. Lossius M, Rosenberg E, Thompson L, Gerner J, Holland C. Transforming the Culture of Peer Review. J of Pat Safety: March 17, 2020. doi: 10.1097/PTS.0000000000000692.