CPHRM Exam Dumps - ASHRM Advancing Health Care Risk Management Questions and Answers

The Healthcare Integrity and Protection Data Bank (HIPDB) was created to combat healthcare fraud and abuse; it isno longer operational as a separate bank, and its content was merged into the NPDB. Reporting and querying are governed by HRSA rules defining authorized entities, including certain peer review and oversight organizations in specific reporting frameworks. Risk management objectives include ensuring organizations understand which actions must be reported, ensure due process, and comply with data handling rules. Proper reporting supports system integrity by preventing practitioners or entities with serious adverse actions from moving undetected across organizations. For hospitals and health plans, this strengthens credentialing and contracting decisions, reducing organizational exposure to negligent credentialing and improper network participation risks.

According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, enterprise risk management ERM expands traditional clinical risk management to include strategic, financial, operational, regulatory, and reputational risks across the entire organization. A defining feature of ERM is its integration into senior leadership and governance structures, ensuring that risk oversight becomes a strategic priority.

ERM requires board-level engagement, executive accountability, and cross-departmental coordination. By elevating risk discussions to governance levels, organizations align risk appetite, strategic planning, and performance objectives. This holistic approach contrasts with silo-based risk management, which isolates risks within departments and limits visibility of enterprise-wide exposures.

Maintaining risks in silos contradicts ERM principles. Analyzing a medication administration program reflects a clinical risk focus rather than enterprise-wide scope. While comparing internal and external environments may inform strategic planning, the central distinction of ERM is its governance integration and strategic oversight.

Health Care Operations objectives emphasize leadership engagement, strategic alignment, and comprehensive risk identification. Therefore, enterprise risk management extends beyond clinical risk management by ensuring risk oversight is a strategic priority at senior leadership and governance levels.

According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, projecting contributions to a self-insured retention fund requires actuarially sound financial forecasting. Actuarial reports use historical claims data, trend analyses, loss development factors, and exposure projections to estimate future liabilities and required funding levels. Loss run reports provide detailed historical claims information, including paid losses, reserves, and claim status, which serve as foundational data for actuarial modeling.

Professional and general liability premiums are relevant to insured layers above the retention but do not determine funding requirements for the retained portion. Frequency and severity analyses of pending claims are important components of actuarial evaluation but, standing alone, may not capture long-tail development or incurred but not reported claims. Total incurred losses for the current year provide limited insight without considering historical patterns and future projections.

Risk financing objectives emphasize accurate funding of retained risk to ensure financial stability, regulatory compliance, and protection of organizational assets. Therefore, actuarial reports, supported by comprehensive loss run data, provide the most reliable basis for determining projected contributions to a self-insured retention fund.

According to Health Care Risk Management standards endorsed by ASHRM and the American Hospital Association Certification Center, system-level issues in the informed consent process should first be addressed through quality improvement and educational interventions rather than immediate punitive action.

Conducting a medical record audit is an appropriate first step to identify patterns of incomplete documentation and determine whether the problem is isolated or systemic. Reviewing and revising policies and procedures ensures alignment with current legal standards and clarifies responsibilities for obtaining and documenting consent. Providing targeted education to physicians, nurses, and office staff reinforces understanding of required elements, including discussion of risks, benefits, alternatives, and patient questions.

Reporting physicians with incomplete consent forms directly to peer review may be appropriate in cases of persistent noncompliance or willful disregard of standards. However, when a systemic process problem is identified, immediate referral to peer review is not the appropriate primary intervention and may undermine a just culture approach.

Clinical and patient safety objectives emphasize root cause identification, education, and process improvement before disciplinary escalation. Therefore, reporting physicians to peer review in this context represents the inappropriate intervention.

RCA and systems safety models (e.g., Swiss Cheese) emphasize that adverse events typically requiremultiple contributing factors—small process breakdowns, latent conditions, and active failures—to align. This is why focusing only on the last person who touched the patient (“sharp end blame”) rarely prevents recurrence. Risk management objectives are to identify and strengthen defenses: policies, training, equipment design, staffing models, communication standards, and redundancy where needed. A series-of-events understanding enables targeted corrective actions (forcing functions, standardization, automation with safeguards, independent double checks for high-alert processes). It also supports just culture: accountability is preserved for reckless behavior, but most improvement comes from redesigning systems that make errors more likely. This approach improves reliability, reduces repeat harm, and provides defensible evidence of organizational learning and corrective action.

A safety audit must be anchored to explicitstandards—policies, regulatory requirements, evidence-based guidelines, and internal procedures—so observations can be evaluated objectively. Without defined criteria, the audit becomes subjective and inconsistent, limiting its usefulness and defensibility. Risk management objectives for ED audits include verifying compliance with high-risk workflows (triage, medication storage, high-alert meds, behavioral health safety, EMTALA processes, handoff communication, alarm management), identifying hazards (environmental risks, crowding, staffing mismatch), and ensuring corrective actions are tracked to closure. A written standard also supports repeatability—audits can be compared over time, and improvements can be measured. This approach aligns with quality management principles: define the requirement, assess the gap, implement controls, and monitor effectiveness.

According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, evidence in a malpractice claim includes any relevant material that may help establish facts related to duty, breach, causation, or damages. Photographs of injuries are routinely admissible as demonstrative or documentary evidence to illustrate the nature and extent of harm. A thank you note from a patient to a physician may be introduced to reflect the patient’s contemporaneous perception of care, credibility, or satisfaction at a particular time, depending on context. A patient’s personal journal documenting experiences during hospitalization may also be considered evidence, particularly if it describes symptoms, interactions, or emotional distress relevant to damages.

A gift from a patient to a volunteer, however, is generally not probative of negligence or injury unless directly tied to issues of undue influence or misconduct. In typical malpractice litigation, such a gift does not establish standard of care, breach, or damages and would not ordinarily be considered relevant evidence.

Claims and litigation objectives emphasize careful documentation, preservation of relevant materials, and coordination with counsel regarding evidentiary matters. Therefore, photographs, written communications, and patient journals may be considered evidence in a malpractice claim.

EMTALA creates federal obligations for emergency screening and stabilization/appropriate transfer when an individual presents for emergency care. CMS interpretive guidance states a hospital’s EMTALA obligationends when the individual is admitted in good faith for inpatient services(even if not stabilized), shifting responsibility to inpatient Conditions of Participation and standard malpractice frameworks. EMTALA obligations also end followingstabilizationor anappropriate transfer(with required documentation/acceptance). Risk management objectives include tight ED documentation, clear decision points (screening complete, EMC identified, stabilization initiated, transfer accepted), and policy training to prevent EMTALA violations (which can carry major regulatory and financial consequences). The incorrect notion that EMTALA ends when contact information is provided is not supported; discharge planning is important, but it does not terminate EMTALA duties.

The PSDA focuses onpatient autonomy and informed decision-making, especially aroundadvance directives. It requires certain healthcare organizations to inform patients of their rights under state law to make decisions about medical care, ask whether the patient has an advance directive, document it, and avoid discrimination based on whether an advance directive exists. The Act doesnotcreate a right for patients to select any medication they want irrespective of clinical appropriateness, prescribing laws, formularies, allergies, contraindications, or standards of care. Risk management objectives here include: ensuring compliant admission workflows (education + documentation), reducing disputes through early clarification of preferences, and preventing ethical/legal breakdowns during incapacity. Operationally, PSDA compliance improves care planning, reduces unwanted treatment, and lowers complaint/litigation risk by showing the organization respected patient rights and followed required processes.

EMTALA applies when an individual comes to the ED and requires a medical screening exam to determine whether anemergency medical condition (EMC)exists. Conditions like myocardial infarction, ruptured appendix, and unstable labor can constitute EMCs because absence of immediate medical attention could reasonably be expected to place health in serious jeopardy. By contrast,stable chronic kidney failurewithout acute destabilization may not meet the EMC threshold—though the screening exam must be performed before that determination is made. Risk management objectives emphasize: never “triage out” without an appropriate screening exam, document findings and decision-making, and apply consistent policies to avoid discriminatory practice. EMTALA failures often stem from process breakdowns (delays, refusal, inadequate screening, improper transfer), so standardized ED workflows and training are critical.