Between the Rock and the Hard Place
I wrote the below article in 2016 as a warning that the Medical Malpractice Marketplace was shifting from a soft competitive market to a harder market for physicians with rate increases in the future. Unfortunately I was right.
As a physician driven company, we are very sensitive to physician rate increases in an environment where reimbursement is constantly decreasing.
Since I wrote this article almost 4 years ago, the market place continues to deteriorate with national payouts and severity steadily increasing since 2012 and up over 15%. The consolidation and aggregation of physicians, as well as the implementation of EMRs, has resulted in a breakdown of the patient/physician relationship. In addition, juries suffer from amnesia and have forgotten the days when their wives had to go to other states to deliver their babies because OBs had fled high risk states to areas with friendlier venues.
Positive Physicians Insurance Company was a life raft for hundreds of physicians in2002 and will be positioned to be a Physician Life Raft for the future.
Storm Clouds on the Horizon
Lewis Sharps, MD, CEO, Positive Physicians Insurance Company
Is the next malpractice crisis just over the horizon? Independent data released by Diederich Healthcare compares Total National Payouts for Medical Malpractice Settlements year over year. From 2003 to 2012, payouts decreased each year.
Since 2012, Total National Medical Malpractice Payouts have increased for 6 (six) consecutive years. Total increases have been > 15% over the last three years despite the fact that insurance premiums have remained flat or decreased.
Historically, the insurance industry is the last to acknowledge a change in market direction. The reasoning is a fear that raising premiums will result in a loss of insured. During the last crisis from 2001 until 2008, PPIX was a life raft for hundreds of physicians who could not get coverage despite excellent claim histories.
Our company raised rates at a fraction of what other companies did. How do We Prepare for the Next Crisis and what are the Solutions?
1. First be aware that the market may be changing. Remember that during the last crisis, almost every major malpractice carrier fled both P.A., and surrounding states, leaving physicians scrambling for coverage. Remember that Positive Physicians Insurance Exchange was the life raft that insured hundreds of physicians allowing them to stay in their home state. Since 2002, Positive has had 95% retention and continues to provide the best risk management and personal service in the industry.
2. Don’t jump on the latest bandwagon. As your insurer, it is not our goal or responsibility to mandate the type of procedures that you do. But if you are interested in lowering your premium and risk profile we recommend waiting until new procedures pass the test of time. We all remember ceramic hips that blew apart, treatments that resulted in mass tort cases and technologies that did not pan out.
3. Oversee your physician extenders. Review your contracts and reporting processes. Though your practice may run perfectly, these contracts and reporting processes will be used against you in a claim.
4. The power of words. Remember that everything that you write down, or enter ina n EMR can and will be used against you during a claim. Think about what you say! Think about how the same innocuous word can be misinterpreted by a trial lawyer. Think about “What Ifs”. Consider documenting in your office record that you told your patients to call if they have any concerns between visits. Think twice about what you say about other physicians. Comments can and often will be taken out of context resulting in one of your peers getting sued.
5. Remember that as a physician you are between the Rock and the Hard Place. As physicians it is our goal and obligation to deliver the best healthcare possible. At the same time we are inundated with requests to keep costs down.
A recent study documented that physicians who practice defensive medicine get sued less often. It is hard to believe that someone paid for a study that proved the obvious.
We do not condone ordering unnecessary tests, but also realize that the health benefit company will not come to the trial on your behalf when the plaintiff attorney states that if you ordered that test you could have found the problem earlier.
Your Role in the Patient Experience
Focusing on the overall patient experience is the responsibility of everyone in the office or organization who have direct contact with your patient population. However, it is management’s responsibility to understand, document, measure and report on how your front desk and clinical staff are performing in this area. Often, we rely on electronic surveys that can be sent via email and you generally expect to have low participation.
In my experience less than 30% participation was the average and that left a huge amount of information unknown. The best thing about electronic submissions is that the information does not have to be reentered into another system and is easily accessible for future review and comparison. The patients have time to share any concerns anonymously if preferred. The downside is they may complete it days after they were in the office, which can lead to less detailed information or more time to think about something that went wrong or time to forget something that went great.
How Can You Help?
Have you ever heard that it takes 21 days to create a habit? Well, it may take more than 21 days but that sure is a good start. Let’s look at some ways to obtain more accurate information after a patient visit. I find that having an opportunity to speak with a patient directly after the visit is a great time to obtain information about the process from the patient’s perspective. Perhaps you can choose several patients a week for 3 weeks that you meet with post appointment. It would be great to speak to everyone, but we must consider time constraints, other responsibilities, and how many patients would be willing to participate. You can have a set of questions prepared, beginning with the appointment scheduling call, to the check in process and actual visit. Many patients will remember the details at this point, and you are able to obtain great feedback in a face to face setting. Your face to face interactions with patients should not only be when there is a complaint or billing issue. I believe that clients will be glad that someone is invested and making sure the patient experience is meeting and exceeding expectations. You can set up blocks of time to complete this, and even let your staff know what you are doing. Incorporating a new process to monitor patient satisfaction.
Speaking to several patients a week will allow you to provide a weekly wrap up to your staff and providers, highlighting what they have done well and where improvement is needed. Having the ability to tailor this type of follow up according to your schedule is helpful, you can also do it for a short period of time, review the results and do it again weeks later. You are providing valuable research for your practice and for yourself.
Lastly, you are increasing your visibility to your patient and client population and building trust. Perhaps they will come to you directly in the event of any future concerns and not an online review site. We hope to see positive feedback increase for your healthcare organization.
I included inquiring about the phone communication during your in-office patient follow ups. Phone communication is known to be an area where miscommunication, hastiness, misinformation, and even lengthy hold times occur between your patients and staff. If you do not have a system to monitor calls and refer to past calls when a patient or employee provides a complaint, you must be very informed on how the calls in your practice are being managed by your staff and how patients are responding to your staff. Employees need to be protected from verbal abuse as well. Focusing on volume, length of the calls, staff knowledge to respond to requests, as well as what most incoming call request are for. If you have a busier practice you may be able to incorporate solutions to reduce the amount of calls or have them prioritized more efficiently to reduce the stress on your employees, reduce hold times for patients, and improve the interaction with patients who are in the office.
Patient concerns and expectations change just as practice operations may changeover time. As leaders, you want to be sure that you are aware of how your office is being impacted. What you respond to and resolve daily has to do with many moving parts. Having first hand knowledge and feedback from those most affected, patients and staff, allows for you and other members of the management team to prepare and update company wide policies, procedures, and workflows towards improvement.
There are times when one incident is so impactful that changes are made without considering all of the factors. The more of an understanding you have of what is common in your office, the more you will be able to make informed decisions when something of this nature occurs. Implement the best patient satisfaction and follow up procedures that will garner the most benefit for your practice.
Shivhon Adkins is the Founder of Medical Receptionist Network, an organization which provides tools and training resources for Medical Receptionists. Shivhon is the Practice Manager of Advocare Newborn Network and has over 16 years of experience in healthcare and private practice.
Shivhon has improved daily processes within the office setting by creating and enforcing policies and procedures while overseeing a multi office practice.Shivhon has been a member of PAHCOM since November 2015. This article previously appeared inPAHCOM Spring issue
Shivhon Adkins, MPA, Founder Medical Receptionist Network, Practice Manager Advocare Newborn Network
Team Member Spotlight Risk Management and Patient Safety, Director
In her role as Director of Risk Management and Patient Safety, Shanell Windle brings with her over a decade of experience in the insurance industry in positions of increasing responsibility. In this capacity, she establishes the policies and procedures used to orchestrate both patient safety and risk management efforts while introducing new forms of automation to ensure the efficient and effective use of resources.
Specifically, she is responsible for development, implementation, oversight, and evaluation of all aspects of Positive Physicians Integrated Risk Management Program. Prior to her tenure at Positive Physicians Insurance Company, Shanell served as Healthcare Liability Broker and Risk Manager for Brown and Brown Healthcare in Philadelphia, PA. Shanell also spent nearly a decade focused on executive risk for specified professions in accountants/CPAs, lawyers and healthcare industries. During which time Shanell advised clients through an integrated risk management process that allowed for informed, strategic decision making to better mitigate risk throughout the entire organization. A graduate of Philadelphia University with a Bachelors of Science Degree in Organizational Development, Shanell is a member of the American Society of Health Care Risk Management and is currently pursing her Certified Professional in Health Care Risk Management designation. A member of the Healthcare Claims and Litigation Committee of Professional Liability Defense Federation and the American Bar Associations Committee on Professional Liability.
Her extensive background in executive risk and professional liability for the healthcare and legal industries is a great addition to our Berwyn team.
Shanell can be reached at 610-644-5262 or firstname.lastname@example.org.