Benefit of PCHCH Concept

Posted on April 14, 2012 by Kathleen Rand

We have discussed the goal of the “medical home” in the last few blog posts — improve primary care so fewer people need to go to the hospital. States experimenting with this nationwide movement say that when practiced by doctors serving Medicaid patients, it can enhance overall health conditions and consequently save billions of dollars in the long run.

But does it save money in the short term and help the financial management of healthcare organizations? Some studies reveal that patient-centered medical homes definitively showed real cost savings, even when not involved with a Medicaid program. Federal health officials are so convinced medical homes save money that they’ve offered to pay most of the bill for states to test them. Starting in 2013, states that pursue a variant of the concept, called PCHCH will get a 90 percent federal subsidy. Instead of applying medical home techniques to all patients, health homes would specialize in those with multiple chronic conditions, including mental illness.

By promoting disease management, patient education, electronic record-keeping and more personalized care, medical homes are intended to improve the lives of people with chronic diseases such as diabetes and asthma and help healthy patients prevent illnesses. Overall spending is supposed to shrink because a sharper focus on individual patients leads to fewer emergency room visits, hospital readmissions, redundant and expensive tests.

The overall sense is that the medical home model is really promising but does remain to be seen just how much money will be saved quickly. Medical homes that focus most of their resources on patients with complex cases, such as those described in the federal government’s health home program, will likely generate the biggest measurable savings. In contrast, when you look at a full panel of patients in a primary care medical home, there aren’t as many opportunities to improve care, and it’s harder to measure effects.

Whatever the studies may show, patient-centered medical homes are an undeniably appealing concept. When more emphasis is placed on primary care, health improves and overall costs go down. At least 41 states are now testing the medical home concept, and various healthcare management organizations are applying for PCHCH Accreditation which will enable PCHCH auditors to assists healthcare facilities to qualify as medical homes.

For doctors, the experiment can mean more money and the satisfaction of seeing patients do well. Instead of simply getting paid for each office visit, doctors are paid an additional monthly fee to provide better, more efficient care – a value-based purchasing extention of one of the facets of the Affrodable Care Act. And instead of handling all of their patients’ needs on their own, doctors are assisted by a team of care coordinators like caseworkers, psychologists and specialized pharmacists.

All of this takes time and money, but supporters say the results are worth it. An added bonus has been that medical homes attract more primary care physicians to the Medicaid program and, in many cases, participating doctors provide the same kind of enhanced care to all of their patients, so the entire community benefits.

Patient-Centered Medical Home – A Model

Posted on April 11, 2012 by Kathleen Rand

A Medical Home Model

The medical home model, or simply “medical home,” is built on the idea that patients should develop meaningful relationships with their family care physician. In a medical home, primary care is used to achieve better health outcomes, improved patient experience, more efficient use of resources and ideally, lower overall costs to the healthcare system.

The basic concept of a patient-centered medical home is simple – patients have continuous access to a primary care physician who provides comprehensive and coordinated care for the majority of their health needs. Ideally, a medical home would be responsible for acute care, chronic care, preventive services and end-of-life care. The medical home staff coordinates patient care with specialists, lab and X-ray facilities, hospitals, home care agencies and other healthcare professionals on the patient care team.

Now, with federal healthcare reform, medical homes are fundamentally changing the way care is delivered. There are programs that accredit organizations as a medical home such as URAC PCHCH Accreditation. And as healthcare reform continues to roll out, the prevalence of URAC PCHCH auditors will increase.

The following characteristics are important components of the medical home model.

Patient-centered

The primary care medical home model provides primary healthcare that is relationship-based with an orientation toward the whole person. Medical homes should attempt to provide care in a culturally and linguistically appropriate manner. The patient-centered medical home model recognizes that patients and their families are meant to be members of the team and that they are fully informed when making and carrying out care plans for the patient. Medical homes also support patients in learning to manage and organize their own care at a level at which the patient is comfortable.

Comprehensive care

In order for a medical home to provide comprehensive care, a team of care providers is essential. For example, physicians, advanced practice nurses, physician assistants, nurses, pharmacists, social workers, nutritionists, and care coordinators could all be a part of the “home”.

Some larger medical homes may bring together a diverse team of care providers in-house while smaller practices or those with fewer resources, such as those in rural areas, may build virtual teams by linking themselves and their patients to providers and services in their communities.

Coordinated care

The medical home is accountable for coordinating care across all elements of the broader healthcare system, including specialty care, hospitals, home health care and community services and supports. Care coordination is principally critical during transitions between various sites of care, such as when patients are being discharged from the hospital. Medical home practices also are aadept at communicating openly among patients and families, the medical home, and members of the broader care team.

PCHCH Program Accreditation – A Brief Summary

Posted on April 9, 2012 by Kathleen Rand

URAC PCHCH Accreditation Summary

Providers are always striving to improve profitability and enhance patient care. URAC’s Patient Centered Health Care Home approach can facilitate compliance with healthcare reform. Some of the aspects of this approach are streamlining coordination across the continuum of care, increasing patient access to information and boosting efficiency and effectiveness. URAC’s concept uses a step approach with high level of flexibility and customizable elements, providing educational support and cost advantages.

PCMC is a team-based healthcare delivery model led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. The provision of medical homes may allow better access to health care, increase satisfaction with care, and help with the financial management of healthcare.

URAC’s Patient Centered Health Care Home (PCHCH) Programs instruct and direct healthcare providers, insurers, or healthcare management consulting organizations on how to transform a practice into a truly patient centered health care home. Further, URAC’s PCHCH Achievement standards align directly with the Meaningful Use requirements, thereby promoting practice recognitions for meeting these standard elements.

The URAC PCHCH Practice Achievement Program assesses practices on key URAC PCHCH Practice Standards from the URAC PCHCH Program Toolkit. These standards are considered critical elements of a patient centered health care home and include seven mandatory standards. The standards align to the Joint Principles of the Patient Centered Medical Home and address key requirements for all Meaningful Use requirements for electronic medical records, quality data submission and e-prescribing.

To qualify for URAC’s PCHCH Practice Achievement, an organization must be reviewed on-site by a URAC PCHCH Certified Auditor or a URAC clinical reviewer. A one or two day onsite review will occur, dependent on the size of the practice. Upon successful completion, URAC PCHCH Practice Achievement is awarded for a two-year time frame.

Exploring the Epidemic of Untreated Pain: The Importance of Pain Management

Posted on April 9, 2012 by Kathleen Rand

Management of pain is crucial for providers

The Journal of Managed Care Medicine which is published by the National Association of Managed Care Physicians has consistently served as a trustworthy resource for industry providers. In the most recent publication, Volume 15, Number 1, JMCM once again proved itself both timely and reliable by featuring an article that explored the epidemic of untreated pain and the importance of pain management. The article discussed not only the high cost of ineffectively-controlled pain but the knowledge and abilities that pain-management clinicians need to possess to deliver effective care.

Adequate pain management calls for an inclusive evaluation and very often a multi-modality treatment strategy. Pain, chronic or untreated, can indicate high healthcare utilization and can produce significant societal costs. In fact, the total annual cost of poorly controlled persistent pain amounts to close to $100 billion per year. “Identifying healthcare issues which have a tendency to drive costs up over time, and impact the health of both patients and society is an important part of the financial management of healthcare. Because of its complexity, pain management requires a comprehensive approach to assessment and the use of validated tools and guidelines in order to optimize pain treatment methods, and benefit both the patient through superior care, and society through decreased costs,” stated Danyell Jones, a Senior Vice President with BHM.

Dr. Mark Rosenberg, President of BHM Healthcare Solutions and author of the recent article, has been focused on helping various providers and delivery systems to improve their methods of treating pain, while simultaneously ensuring that pain treatment options are viable from a financial perspective. Additionally, as a leader within the healthcare management consulting industry, Dr. Rosenberg has delivered several notable presentations and learning-series talks at national conventions dedicated to this topic. “Pain is costly on many levels, impacting the patient, managed care organizations, employers, and society in general. It is critical for providers to be unbiased in their assessments, to use and reference current evidence-based pain management standards and guidelines, and to advocate for each patient by collaborating with experts to formulate an interdisciplinary treatment plan,” commented Dr. Rosenberg. He continued, “An important strategy for healthcare management is to mitigate the cost associated with the loss in productivity resulting from persistent pain.”

To view the article “Untreated Pain Epidemic: Multi-Modality Approach to Pain Management” in its entirety, please visit http://issuu.com/namcp/docs/jmcm_15.1.

Financial Management and Health Insurance Exchanges

Posted on April 6, 2012 by Kathleen Rand

Financial management is vial in healthcare

A health insurance exchange is a set of state-regulated and standardized health care plans in the United States, from which individuals may purchase health insurance eligible for federal subsidies. All exchanges must be fully certified and operational by January 1, 2014 under healthcare reform.

Exchanges of this type were intended as a governmental entity to help insurers comply with consumer protections and to compete in cost-efficient ways, and to facilitate the expansion of insurance coverage to more people. Exchanges are not themselves insurers, so they do not bear risk themselves, but determine the insurance companies that are allowed to participate in them. Ideally, a well-designed exchange will promote insurance transparency and accountability, facilitate increased enrollment and the delivery of subsidies, and play roles in spreading risk to ensure that the costs associated with those with high medical needs are shared more broadly across large groups rather than spread across just a few beneficiaries. This is what has occurred in the state-run Health Connector exchange in Massachusetts. Some hope that insurance exchanges also will help to contain overall costs in relation to the financial management of healthcare.

Hospitals will see some increase in revenue as the uninsured gain medical coverage through Medicaid or still-to-be-formed insurance exchanges. They also, however, will see cuts in Medicare and Medicaid as well as unevenly shared payments, and will still have a sizable self-pay population as businesses shift greater numbers of employees to high deductible or consumer-driven health plans.

New healthcare law will further complicate the revenue cycle for hospitals by fostering alignment with physicians and bundling payment. Providers will have to manage the revenue cycle from both the hospital and the physician side and coordinate processes within financial clearance, eligibility, and price estimates as they move to accommodate patients throughout the healthcare encounter.

Faced with having to do more with less, hospitals will be challenged to protect revenue and accelerate and increase cash collection, avoiding process failures that result in a denial or a decrease in payment due to medical necessity. They also will likely consolidate or leverage front-end resources to gain more efficiency from the technologies and processes they already employ.

As an ultimate strategy, hospitals should focus on revenue cycle initiatives that drive optimal performance: charge capture, pricing, and patient access. There is this sweeping vision of a ‘no-wrong-door’ enrollment system within the exchanges through which millions of people will have their eligibility determined in real-time.

Affordable Care Act – Coming Attractions

Posted on April 4, 2012 by Kathleen Rand

ACA features coming in 2012

In 2012, more features of the Affordable Care Act will be rolled out. The following is a list of what they are and a brief summary of them.

Accountable Care Organizations

At the beginning of the year, the Affordable Care Act began to provide a financial incentive for physicians, hospitals and health care providers that voluntarily joined together to form Accountable Care Organizations, or ACOs. These organizations coordinate care for patients with original Medicare, and, under the law, those that demonstrate improved quality and outcomes in care as well as lower costs and patient priority will share the savings with the Medicare system.

Today, more than 50 percent of Medicare patients have at least five chronic conditions, which may include diabetes, arthritis, hypertension, and kidney disease. Further, readmission rates are at crisis stage – about 30 percent of Medicare patients are back in the hospital after being discharged. ACOs have been designed to change these issues by both driving down the costs of working with multiple doctors and offering incentives to provide appropriate follow up protocols and hence to improve overall care.

Fewer disparities in health care

Depending on race, ethnicity or income level, higher incidences of certain diseases may occur, and fewer treatment options and reduced access to care and insurance could potentially exist as well. The Affordable Care Act will attempt to level the playing field by hastening data collection, funding community health centers, increasing ethnic diversity in the health care professions and, by 2014, providing affordable health insurance for everyone through insurance exchanges. The goal is to have procedures in place by March 2012.

Insurance rebates

The biggest impact from health care reform that will more than likely be felt in 2012 is the result of an initiative that began last year called the medical loss ratio, or MLR. This formula dictates health insurance companies spend at least 80 percent of their premiums on direct medical care or quality improvement, or 85 percent for large group-based plans. Those that don’t meet the mark must provide a rebate to policyholders.

Some dissenters believe that these rebates would affect the investments and programs that improve care, prevent fraud, and make the system better. However, some insurance companies are beginning to lower premiums and hold down increases ahead of this rule.

Electronic records

Healthcare is one of the few industries that is dependent on paper records. The new law introduces a series of changes that will make electronic records a reality. The streamlining of information and the reduction in non-duplication of services is expected to produce staggering savings. For instance, if a patient goes to the Emergency Department a couple of days after being seen by the primary care physician, the expense not to mention the X-ray exposure would be doubled. But not if electronic records were implemented and utilized – the information would be accessible in seconds and would ultimately help both with cost and patient safety.

Value-Based Purchasing: The Basics

Posted on April 1, 2012 by Kathleen Rand

Value-based purchasing is different from fee for service model.

As the Supreme Court deliberates some aspects of the Affordable Care Act, it seemed an appropriate time to examine one part of the legislation that will more than likely survive any and all debate: value-based purchasing. In short, providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.

Value-based purchasing compensates physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures for quality and efficiency. Deterrents, such as eliminating payments for negative consequences of care or increased costs, have also been proposed. Pilot studies in several large healthcare systems have shown slight improvements in specific outcomes and increased efficiency, but no significant cost savings have been truly realized yet because of the added administrative requirements. Statements by professional medical societies have been generally supportive of incentive programs that will increase the quality of health care, but they express concern with the credibilty of quality indicators, patient and physician autonomy and privacy, as well as increased administrative burdens.

Further, the Centers for Medicare and Medicaid Services (CMS) has issued proposed rules for value-based purchasing (VBP) that link payment to how effectively hospitals deliver high quality care. The suggested rules also present incentives for implementing electronic health records and payment adjustments based on rates of hospital-acquired conditions and readmission rates. The measures are a subset of those that CMS has adopted for its existing Medicare Hospital Inpatient Quality Reporting Program. The initial proposed clinical measures are focused on improving outcomes for acute myocardial infarction, heart failure, and for reducing health care-associated infections. The program also measures patient experience through the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS).

Three broad goals have shaped HCAHPS. First, the survey is designed to produce data about patients’ perspectives of care that provide objective and meaningful comparisons of hospitals on topics that are important to consumers. Second, public reporting of the survey results promotes new incentives for hospitals to improve quality of care. Third, public reporting serves to boost accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment. With these goals in mind, the Centers for Medicare & Medicaid Services (CMS) and the HCAHPS Project Team have taken substantial steps to assure that the survey is reliable, beneficial, and practical.

Beginning in 2002, CMS partnered with the Agency for Healthcare Research and Quality (AHRQ), another agency in the federal Department of Health and Human Services, to develop and test the HCAHPS survey. AHRQ carried out a rigorous scientific process, including a public call for measures; cognitive interviews; review of literature; stakeholder input; a three-state pilot test; consumer focus groups; extensive psychometric analyses; consumer testing; and numerous small-scale field tests. During this process, CMS provided three separate opportunities for the public to comment on HCAHPS, and responded to well over one thousand comments.

Scores on patient experience, based on HCAHPS dimensions, will constitute 30% of a hospital’s overall score. Patient experience will be scored as follows:

•Hospital achievement comparable to an industry benchmark

•Hospital improvement relative to the organization’s starting benchmark and a range of predicted improvement

•The measure scores for the two aspects of patient experience will be totaled into a domain score, using the greater of the improvement or achievement scores for each dimension

•Up to 20 consistency points will be added to the combined patient experience score if all dimension scores surpass the achievement threshold

•If any dimension score is below the achievement threshold, the consistency points will be awarded in proportion to the percentile of the lowest-scoring dimension

The incentive payments will be based on whether a hospital meets or exceeds the projected performance standards. To pay for the incentives, CMS plans to start reducing diagnosis-related group (DRG) payments by one percent for fiscal year 2013 discharges. The program will apply to payments for discharges occurring at the start of federal fiscal year 2013, or on or after October 1, 2012.

The Importance of Engaging a Transaction Expert – Part Four

Posted on March 29, 2012 by Tom Bednarek

Finding the right fit is essential in business.

“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” Mark Twain

The unstable and rapidly changing environment of today’s healthcare marketplace has intensified the interest of healthcare executives, physicians and business owners in the benefits of merging with, acquiring or being acquired by another entity with a common vision. When undertaking these endeavors there are many advantages to be gained, but there are many pitfalls that must be circumnavigated. In this posting I’ll share my thoughts on the importance of engaging a transaction expert to help assure an effective and efficient process.

When opportunity knocks you may want to look through the peephole before opening the door. The decision to embark on a merger should be made only after performing a feasibility analysis that examines key indicators such as financial advantages, operational compatibility, agreement among the parties about what the transaction is expected to accomplish and whether or not the newly formed entity would in fact generate business benefits not possible if each entity remained solo. The fact of the matter is that some prospective suitors may have hidden agendas and you do not want to be adversely impacted by the burden of their financial or operational difficulties.

Once the proposed transaction passes the feasibility analysis, what follows is a time consuming and complicated process. Because of their broad experience, transaction consultants see a wide set of business scenarios in diverse, as well as common, business models. This range of experience will serve to accentuate the transaction’s benefits and be of great help if unexpected issues arise; and unexpected issues almost always arise. The consultant can effectively deal with each issue and move the transaction to completion.

The consultant will also help you leverage your time. Successful transactions require a tremendous amount of communication and coordination with the various parties involved, including but not limited to, you and your management team, the management team from the other company, outside accountants, attorneys and numerous support groups such as medical billing/collection firms. As the transaction process ensues you still have a business or a practice to run. If the attempts at a transaction fail, and most of them do, you do not want to exit the process with a diminished organization that is in need of repair.

The seasoned transaction consultant also brings a wide set of relationships. Perhaps most importantly, if the decision is definitively made to find a suitor and the initial transaction does not come to fruition, then the consultant can not only pinpoint strategic buyers within the industry, but they also have relationships with other potential buyers, such as private equity groups that, in fact, typically pay more than a strategic buyer.

A good transaction consultant is also a financial expert. The components of a transaction are often complicated and you can leverage their financial acumen to fetch the highest price possible for your organization. Effective communication with the various internal and external accountants is imperative, so the ability to navigate through, understand and apply the content of complicated and voluminous financial statements will provide many benefits to your cause. The importance of the benefits you will receive from this understanding of the financial intricacies of the deal cannot be overstated.

It is important for executive leaders to know how much they don’t know. Utilizing the talents of a transaction consultant during the merger & acquisition process will help you achieve the outcome you desire, and help you avoid learning expensive lessons along the way.

To schedule a one to one free initial consultation with one of BHMs leading healthcare consultants please email us at results@bhmpc.com or call us at 1-888-831-1171. BHM consultants provide real value and measurable results to healthcare firms, government agencies, and insurers through data driven and strategic management analysis, and assist organizations with Clinical Operations, Financial Management Improvement, Physician Advisor Services and Accreditation.

Is Your Organization Creative Enough to Meet the Challenges of Adversity? – Part Three

Posted on March 27, 2012 by Tom Bednarek

Creative strategies are essential in today's economy.

“Frugality without creativity is deprivation.”

- Amy Dacyczyn

Credit is tight, consumer confidence is low, and you have the growing realization that increasing the net profit shown on your income statement is as much a function of lowering expenses as it is attributable to boosting revenue. When austerity measures are undertaken your creativity can often times make the difference between success and failure. In this posting I’ll identify some creative measures that will help you successfully grow your business during times of economic malaise.

The first thing you have to determine is whether or not your organization embraces change, and its driving force which is creativity. To make an accurate assessment you can ask yourself when was the last time that you: entered a new market, did something innovative, utilized social media, sought out a strategic partner or rolled out a new product or service. If the prevailing answer is either “I can’t remember,” “not lately” or “never,” then you may want to acknowledge that the first step in solving a problem is admitting that you have one. If the prevailing answer is “what was the question?” then you may have larger issues that need to be addressed.

The fact of the matter is that cost effective solutions exist for those who are not satisfied with the status quo. Here are a few techniques will not only help your business meet the challenge of adversity, but they can provide benefits to your organization in perpetuity.

Utilize Joint Ventures: A joint venture can offer an array of economic benefits to both partner organizations through access to: new geographic markets, complementary products and/or services, additional distribution networks, increased capacity, additional staff skill sets, purchasing economies of scale, technology/intellectual property, and financial resources.

Identify and Nurture Thought Leaders: Unfortunately it is not uncommon for people in organizations to laugh at new ideas and look down upon other employees that point out problems. In the March 5, 2012 issue of Forbes, Shel Israel provides the following definition: “A thought leader is someone who looks at the future and sets a course for it that others will follow. Thought leaders look at existing best practices then come up with better practices. They foment change, often causing great disruption.” It costs you little more than a bit of time and a pat on the back to tap into the benefits that these individuals can provide your organization.

Outsource: Two heads are better than one, and in the constant pursuit of access to the finest human capital outsourcing provides the most cost effective exposure to a more diverse base of skill sets and core competencies that have a proven track record of success.

Leverage Social Media: Social Media can help your organization better understand, respond to, and attract the attention of its target audience. It allows you to get your message out fast, and to a large number of people. Unlike traditional media, Social Media provides the added benefit of being able to instantaneously generate customer feedback which will allow you to gain insight into your target market and identify new product or service opportunities. If used creatively it also allows you to track your competition, quickly identify problems with your product and drive people to your website, thereby improving the ROI vis a vis your technology CAPEX.

If your desire is to cultivate creativity then it is incumbent upon you, as an executive, to inspire your employees to become innovators by virtue of a corporate culture that embraces change. If you proactively inspire change and innovation then your organization will circumvent obstacles encountered during lean times and reap many rewards for years to come.

To schedule a one-to-one free initial consultation with one of BHM’s leading healthcare consultants, please email us at results@bhmpc.com or call us at 1-888-831-1171. BHM consultants provide real value and measurable results to healthcare firms, government agencies, and insurers through data-driven and strategic management analysis, and assist organizations with Clinical Operations, Financial Management Improvement, Physician Advisor Services and Accreditation.

In Crisis Management, Your Silence is Deafening-Part Two

Posted on March 24, 2012 by Tom Bednarek

Communication in business is crucial to success.

“A good plan violently executed now is better than a perfect plan executed next week.”

General George S. Patton

If you are in business for any length of time, sooner or later, you will be exposed to a crisis that can affect not only the company you work for, but your career as well. We have all experienced a vitriolic situation with a friend or family member that, once resolved, ultimately resulted in a stronger bond between the two individuals. In this posting I’ll discuss the assertions that effective communication is the key to crisis management and how timely and effective communication can actually result in a stronger organization.

Organizations that either don’t react, react slowly, or react improperly to adverse events will likely see erosion in brand equity, and in many cases, see forced resignations and firings at the C-level. As a native son of Pennsylvania I am aware of no better example of poor crisis management than what resulted in the wake of the sex abuse scandal that rocked Penn State University in late 2011. The adverse effects of this modern day Greek tragedy on Penn State resulted as much from poor communication as they did from the criminal behavior of University officials. A partial list of missteps includes: no visible leadership once the scandal broke, no message to the public for days, (which fueled the fire, let speculation run rampant & allowed the angry mob of public opinion convict coach Paterno without so much as a whiff of due process), and holding an obviously incendiary news conference late at night…did they really think there wouldn’t be an alcohol fueled student uproar?

The bottom line is that the public hates the unknown. If they know of trouble, but don’t have vision as to the likely outcome then the company stock, its corporate brand, and the personal brands of corporate executives and board members will be severely penalized. In the Penn State scenario the public’s perception of Penn State and its leadership began to be shaped by the speculation and innuendo of the media zealots and other third parties, which differed radically from the facts of the situation.

In smaller organizations, even though a crisis may be largely confined to the four walls of your company you must keep in mind that the same principles apply. What your employees crave is clear, concise, and open dialogue in times of trouble. You must proactively shape the opinions of others as opposed to having others determine the perception of your corporate and personal brand. By being proactive in your approach to crisis management you turn breaking news, speculation and innuendo into old news by putting a face to a position. By taking a visible and open position, you will take the natural desire to create a corporate villain, and turn this instead into a positive outcome by offering evidence of a corporation and executive team that operates with honesty and transparency by taking swift, prudent, and corrective action address to the problems at hand.

When a crisis occurs you can run but you can’t hide so you have a choice to make. You can put your head in the sand and ignore the problem, you can skirt the issue, or you can take the bull by the horns and simply do the right things. Delaying the inevitable will result in increased scrutiny and eventually produce substantial negative consequences. Prompt communication is imperative to producing positive results. Get the issues out in the open, adopt a position, and do the right things regardless of short-term cost. If you subscribe to the latter tact as opposed to either of the former, you will give yourself the best chance of coming out on the right side of the fray and achieving enduring benefits to your organization.