New certification promises risk managers career boost
Credential is for risk managers with experience
A new certification for risk managers in health care could go a long way toward improving professional recognition and working conditions in the field, say some leading risk managers.
Under a professional certification program for health care risk managers recently launched by the American Hospital Association (AHA), an individual who meets eligibility criteria and successfully completes a qualifying examination will be designated a Certified Professional in Healthcare Risk Management (CPHRM). (For details on how to sign up for the exam, see box, p. 111.)
The CPHRM certification was developed in response to the desires of American Society for Healthcare Risk Management (ASHRM) members, says Grena Porto, RN, ARM, DFASHRM, director of clinical risk management and loss prevention services at VHA Inc. in Berwyn, PA, and past president of ASHRM. "Members had been wanting something like this for a long time," she explains. "In health care, everyone has an alphabet soup after their names, and credentials are very important. Risk managers were feeling like everyone else had something, and we didn’t have one."
Current credentials available to risk managers are not specific to risk management in health care or based on a careful, scientific study of the field, she says. The ARM certification, for instance, is recognized throughout the insurance industry and is used by many health care professionals, but it does not necessarily demonstrate a body of knowledge or experience in health care. With the new CPHRM certification, risk managers can demonstrate a more focused achievement in health care. "For a long time, there wasn’t support at the AHA for this kind of thing," Porto says. "But there was a change in leadership in recent years, and now they’re very supportive."
Promoting professionalism
ASHRM was heavily involved in developing the certification. Porto says the goal was to create a professional designation that would aid individual risk managers while elevating the profession.
"This certification designates that the risk manager has demonstrated mastery in a defined body of knowledge," she says. "We expect that to create a level of professionalism that will improve the field of risk management in health care in a number of ways. It always improves the field when professionals are held to a high standard and able to prove their worth."
The first test was offered in June, so it will be a while before the CPHRM designation becomes standard, an expected certification for anyone in the field, Porto says. The eligibility requirements were designed to include most ASHRM members, she says, but the experience criteria will mean that some cannot be certified until they have been in the field a while. The CPHRM was intended to be accessible for most health care risk managers, not just an upper tier of the highly experienced and educated. (See p. 112 for more on the eligibility requirements.)
"This isn’t licensure. It’s not like you can’t practice without it," Porto says. "You should think seriously about when to take the test, but you don’t have to do it this year."
Independence of testing provides reliability
Though both ASHRM and the AHA were heavily involved in developing the credential and will remain involved in updating the criteria, the actual testing is done by a private organization, Applied Measurement Professionals in Lenexa, KS. Leilani Kicklighter, RN, ARM, MBA, DASHRM, assistant administrator for safety and risk management for Florida’s North Broward Hospital District and a past president of ASHRM, says it is important that the examinations are conducted by an organization completely separate from ASHRM and the AHA, with which ASHRM is affiliated.
Porto and Kicklighter sit on the board that oversees the CPHRM system, but they say they will provide no input on the examinations.
"It’s all some arm’s length away from the society, so that if my brother wanted to become credentialed and didn’t meet the criteria, I couldn’t twist arms and make it happen," Kicklighter says. "It’s all on the up and up, a very objective system."
Even in the system of developing the criteria for the CPHRM and writing the examination, safeguards are built in to ensure the resulting credential means something.
"One group writes a great deal of questions, then another committee reviews the questions, and other people with the testing group actually grade the examinations and send the notification of results," Kicklighter says. "There are so many layers that one layer doesn’t know what the other is doing."
Credential may become standard in the field
Porto says she and others at ASHRM hope the certification will lead to better compensation for health care risk managers because they can prove their skills in that particular branch of risk management, but she cautions that such changes will not happen overnight.
"The CPHRM designation will elevate the stature of the profession over time," Porto says. "I think eventually it will become an entry-level requirement for positions. It raises the bar for everyone a bit, but it does it gradually."
Kicklighter adds that there are plans to develop another, more advanced credential in the future. The CPHRM is intended to be the first and most basic credential for health care risk management, and a second will be introduced once the CPHRM is well-established.
"We want to be able to say to our colleagues, our stakeholders, our consumers, and our employers that we have a basic level of knowledge and competency based on the fact that [we] can pass this exam," she says. "Once everyone accepts this credential as the basic one, the one you expect most everyone in the field to have, then we can move on to develop a second one that designates knowledge and skills beyond the basic."
The CPHRM offering was designed to be reliable and meaningful, more than just a rubber stamp, say Porto and Kicklighter. They say the content of the examination is linked to real-world tasks. ASHRM conducted a role delineation study to define the body of knowledge for the profession, surveying members and nonmembers to identify tasks that professionals perform routinely on the job and consider important.
Tasks were grouped by category, and weights (percentages of the examination) were assigned to produce these examination specifications:
- loss prevention/reduction (30%);
- claims management (22%);
- risk financing (13%);
- regulatory/accreditation compliance (16%);
- operations (12%);
- bioethics (7%).
Porto says the test items assess application of knowledge, not just recall of facts. The exam guidelines state that "the intent is to measure competence, not book learning.’" The examination consists of 110 multiple-choice test items, presented during a two-hour test session. Scoring will be based on 100 of the items, with the additional 10 test items included for study purposes. Performance on pretest items does not affect a candidate’s score. Scores are kept private, for the risk manager’s use only. About 50 people have taken the exam so far.
"Only you will receive a score that indicates whether you passed or failed the examination," the guidelines state. "At your request, your employer will be informed of your achievement. Successful candidates will also be honored during ASHRM’s annual conference."
The certification was constructed by the AHA’s certification committee, made up of representatives from the professions with a certification program in operation or development, including Porto and Kicklighter. Other members were from the American Society for Healthcare Engineering, the American Society for Healthcare Environmental Services, the Association for Healthcare Resource & Materials Management, and the AHA staff.
Certification is good for three years. CPHRMs are required to renew the certification through participation in approved continuing education or reexamination.
Porto says the examination and the eligibility requirements are expected to change over time, in an effort to keep the certification representative of actual health care risk management skills and knowledge. At some point, ASHRM and AHA will have to conduct another study to determine the proper criteria for the certification.
"We’ve been working on making this a very scientific and rigorous process," she says. "We’re confident that having taken the exam and passed it really means something. But that’s not to say it’s impossibly hard. It’s fair, and we’re getting good feedback from those who have taken the test."
Kicklighter notes that risk managers must meet a minimum experience level before qualifying to take the exam, so not all risk managers will be able to pursue the CPHRM immediately. Also, some health care risk managers may find the examination process more difficult than others because their jobs do not entail certain components of risk management that are included on the exam.
"There are going to be some segments of the risk management population whose jobs don’t have anything to do with insurance, for instance," she says. "They will have to realize that shortcoming and really study insurance. Everyone will have to assess their own abilities and bone up on what might not be part of their daily activities."
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