How Watson Is Changing the Course of Medical History
March 14th, 2013
IBM’s brain child, Watson, has been best known as defeating humans on the game show Jeopardy in 2011 where it competed against Brad Rutter and Ken Jennings, two of Jeopardy’s most famous contestants. Watson was made specifically to play Jeopardy by its research team headed by David Ferrucci of IBM.
Since its debut on Jeopardy, Watson has been used in a number of different fields such as healthcare and financial services to improve the decision making process. The sheer volume of information that is available is growing at such a fast rate that it is humanly impossible to keep up. It is predicted that the rate of data growth will be upwards of 800 percent in the future 5 years. Many people have suggested that computers should be able to help with this problem but in reality, current systems have prevented real growth in this area. Natural language is very intricate. It is often implicit: the exact meaning is not completely and exactly stated. In human language, meaning is highly connected to what has been said before, the topic itself, and how it is being discussed: factually, figuratively or fictionally – or a combination.
How do individuals, professionals and organizations stay up-to-date? This has been a major problem in professional fields like healthcare, where anyone that is connected to healthcare cannot stay informed on the latest best practices due to the huge scope that healthcare consists of. Due to this gap in information available versus information used properly, it has been suggested that as high as 20% of medical diagnosis is incorrect. This affects doctors and their ability to diagnosis a problem as well as healthcare providers such as insurance agencies that need the best and most accurate information to process claims and still operate as a business.
With all the most current information, this will be able to change the way that the healthcare world operates today.
The information that medical professionals need to make accurate decisions is available to them now. Medical journals publish new treatments and uncover new discoveries every day. Using patients history records also give a clue. All of this is great but due to the large amounts of electronic medical record data, it is impossible to keep up.
Enter Watson into healthcare
In February 2013 IBM Corp., the health insurance provider WellPoint Inc. and Memorial Sloan-Kettering Cancer Center announced two Watson-based applications. The first is to help assess treatment options for lung cancer and second is to help manage health insurance decisions and claims. In both applications, doctors or insurance company workers will access Watson through a tablet or computer. Watson will quickly compare a patient’s medical records to what it has learned and make several recommendations in a decreasing order of confidence. In the cancer program, the computer will be considering what treatment is most likely to succeed. In the insurance program, it will consider what treatment should be authorized for payment.
Watson provides natural language processing, natural language understanding, machine learning, hypothesis generation, probabilities of various outcomes, and evaluation to give direct, confidence-based answers. Watson can learn from success and failure to improve future responses. Watson can take that information and turn it into the insight needed to avoid improper diagnosis or unnecessary treatment. This breaks down the barriers between people and machines.
Manoj Saxena, an IBM general manager, said the supercomputer has ingested 1,500 lung cancer cases from Sloan-Kettering records, plus two million pages of text from journals, textbooks and treatment guidelines.
Given the growing complexity of medical decision making, Watson has been targeted by WellPoint to help streamline their process regarding insurance claims.
WellPoint will be using the system internally for its nurses and clinicians who handle utilization management. The company will also make the intelligence available as a Web portal to other providers as its Interactive Care Reviewer.
Watson will support medical professionals as they make decisions. A physician can use Watson to help in diagnosing and treating patients. First the physician might pose a query to the system, describing symptoms and other related factors. Watson then goes through an inquiry process to pull pertinent information. Watson then searches patient data to find relevant facts about family history, current medications and other conditions. It than puts together this information with its findings from tests. The next step is Watson examines all available data sources to form hypotheses and test them. Watson can incorporate treatment guidelines, electronic medical record data, doctor’s and nurse’s observations, research, clinical studies, journal articles, and patient information into the data available for analysis.
Watson will then provide a list of potential diagnosis along with a score that indicates the level of confidence for each hypothesis.
The process is very similar for insurance use. Watson will come to a hypothesis for the treatment chosen to be the most relevant in order to process for payment.
The benefits Watson can provide for a healthcare provider is invaluable and will change the future of medical history in such a positive way for everyone involved.
Medical Malpractice Payouts for 2012 [Inforgraphic]
January 28th, 2013
Protecting Patients From Medical Never Events
January 22nd, 2013
There are no absolutes in the practice of medicine. Diagnoses can be wrong for a number of reasons, complications can arise that couldn’t reasonably be foreseen, infections can set in—a number of variables can cause treatments or procedures to not render the desired results.
Some situations are simply unavoidable; others should never occur. So physicians run multiple tests, seek second opinions, follow established procedures and take all reasonable precautions to protect their patients and themselves.
Still, according to a new Johns Hopkins report, surgical never events occur more than 4,000 times each year.
What is a Never Event?
A never event is something that never should happen, because it is totally avoidable. Such things as performing the wrong surgery on a patient, leaving a sponge, towel or instrument inside the patient’s body or operating on the wrong body part—these are inexcusable errors—errors that should never occur.
As such, these events can leave a practitioner or clinic vulnerable to claims of malpractice, and if the incident really seems to fall into the never category, it can be virtually impossible to defend against.
Proper administrative checks and balances, various levels of review prior to and during a procedure as well as a proactive approach to managing activities can dramatically reduce the chances of such an event occurring.
The study by Johns Hopkins researchers shows that foreign objects are left inside a U.S. patient 39 times per week, while the wrong procedure is performed on a patient 20 times per week. Another 20 times per week, surgery is performed on the wrong body part. Many cases involved operating on the wrong patient.
In 6.6 percent of the 80,000 never events between 1990 and 2010, death resulted; nearly a third of the patients involved suffered permanent injury. These reflect only those cases where a malpractice judgment was issued or an out-of-court settlement was reached. It is reasonably estimated that many more occurrences go undetected or unreported. Each of these incidents is avoidable and should never occur.
How to Best Prevent a Never Event
Many hospitals and clinics, as well as many physicians, have implemented preventive risk-management procedures to ensure that they avoid such situations, such as:
- A careful review of paperwork prior to a procedure to detect anomalies in test results, diagnoses or preparation
- Procedural “time-outs” to ensure that medical records and surgical plans match the patient and the prescribed procedure
- Marking the site of the operation with indelible ink prior to placing the patient under anesthesia
- Detailed sponge, towel and instrument inventories before and after surgery
- Electronic barcodes on materials and instruments to aid in accounting
Having the appropriate procedures in place is only the first step in preventing never events. Those procedures must be uniformly followed and strictly enforced, much like a pilot’s pre-flight checklist. If investigation of an incident shows a lax attitude in following and enforcing those procedures, then for both facilities and practitioners, it can be just as bad as having no procedure at all.
Why Do Never Events Occur?
Forceps left inside a patient
Because operating rooms and staff are often in great demand, it’s not uncommon for there to be a sense of urgency to vacate the operating room as quickly as possible, so that it can be prepped for the next patient. It’s critical to ensure that adequate time is allowed for an accurate count of all materials and an orderly transition.
It’s also not uncommon for certain critical staff to assist in numerous surgeries throughout the day, sometimes back to back. This makes them subject to fatigue and often rushes them through what should be meticulous pre-verification of patient, procedure and body site, as well as sponge and instrument counts prior to closing.
In some hospitals, it’s not unusual for emergency room and operating room staff members to work 100 hours or more per week, adding still more to their fatigue level and taxing their alertness.
Some surgeons will spend most of a lengthy day, sometimes up to 18 hours, in and out of the operating room, which also takes a toll on their alertness to details.
Complications during a procedure can cause an operation to extend significantly beyond the projected duration, and on busy days, can create a lot of pressure to recover lost time. This puts physicians and assisting staff under stress that can distract them from their tasks at hand.
Ideally, there should be contingency plans in place to provide sufficient flexibility to mitigate that pressure, which can be an important consideration, in the event of a claim.
Long Term Solutions
Certainly, the vast majority of healthcare professionals go to great lengths to ensure their patients receive quality care. Unfortunately, isolated incidents can create an environment in which practitioners can feel as though they’re considered guilty until proving themselves innocent.
This accentuates the need to ensure that comprehensive risk-management procedures are established and followed to prevent a never event from occurring. Such procedures can dramatically reduce the chances of such an incident and can be of tremendous value in defending against a medical malpractice insurance claim.
Never events are typically seen as instances of egregious carelessness or negligence, interpreted as evidence of a disregard for patient welfare when, in reality, they are most often the result of a pressing schedule or fatigued practitioners.
Proactive establishment of preventive risk-management measures and meticulous compliance with such procedures can prevent the vast majority, if not all, of such incidents, as well as offer some level of protection for healthcare professionals and facilities facing malpractice claims.
A failure to adequately address the issue leaves patients, hospitals and healthcare practitioners at great risk. Death, disability, increased discomfort and expense, as well as sanctions and great professional impact are the most common results.
Don’t allow your patients or your practice to be vulnerable to the irreparable damage that a never event can cause. Protect those entrusted to your care and yourself by eliminating avoidable errors.
What is Group Health Insurance? Can I get it?
December 15th, 2012
Without appropriate health insurance coverage, hospitalization or a serious illness can be financially devastating, which can be a very hard lesson to learn. In today’s uncertain economy, with rampant unemployment and many companies looking for ways to trim expenses, there are far too many people that are vulnerable, should they or someone in their family be stricken by a serious health issue.
Health insurance, like any other type of insurance, is sometimes seen as an unnecessary expense – until it’s needed – then it can be very welcome, indeed.
Some people purchase individual or family health coverage, but that is often considerably more expensive than group insurance, which is the more common solution. Group health insurance often presents the lowest cost to the insured, and can be acquired with varying levels of flexibility in its available options.
What is Group Health Insurance?
Group health insurance is a health insurance program that is offered to a common class, such as employees of a company or members of an organization. Such group policies can present a lower cost to each individual by spreading the risk across many members. Essentially, the insurer is gambling that only a certain percentage of insured members will require the coverage.
These offerings are regulated by each state, so the qualification requirements, type of coverage offered and the method of pricing the policy can vary significantly by location.
There are also different classes of group health insurance, differentiated by the size of the sponsoring group (company, association, credit union, etc.) and the type of plan. Essentially, this depends upon the number of people to be insured and the treatment network available.
In the case of companies, for instance, the common method of classification is by the number of employees: less than 25 employees, 26-50 employees or more than 50 employees is the typical breakdown. HMO, PPO andPOSplans will also result in different costs, per the different network structures involved.
The Patient Protection and Affordable Care Act (PPACA, also commonly referred to as ObamaCare), signed into law in March of 2010, is being enacted in phases, with completion in January 2020. The majority of PPACA’s benefits will be available to citizens in January 2014.
In the meantime, health insurance carriers are adjusting for the coming changes, as are employers. By 2014, all companies with more than 50 employees will be required to provide health insurance for their employees. Those individuals who do not receive insurance from their employer, and can afford to do so, will be required to purchase it themselves.
For the companies, such insurance is certain to be group coverage, as it presents the lowest cost. Typically, all else being equal, the more subscribers that are enrolled, the lower the cost. However, depending upon the locale, the premiums for an insured individual may vary by age or health, and can also vary by statistical risks in the region.
Basically, group policies require that all employees of a similar class (possibly classified by age or health status) must be offered the same coverage for the same premium.
In a particular state, the premium for a 25-year-old, non-smoking female with no health issues might be significantly lower than for a 58-year-old male who smokes and has diabetes. In another state, the premium might be identical. This is determined by each state’s regulatory statutes.
One important aspect of group health insurance under the PPACA, however, will be that in no state will the insurer be able to deny coverage to anyone because of a pre-existing condition.
Who Qualifies for Group Health Insurance?
Aside from employers, there are already many other types of sponsors for group health coverage. Some large credit unions, fraternal organizations, associations and societies have sponsored group coverage, with health insurance being one of the benefits of membership.
Any full-time employee of a company with a group policy or full member of any organization that offers group health insurance is usually eligible for the coverage. Some factors can enter into such qualification, however, such as the number of hours per week to be considered a full-time employee and the membership level in the sponsoring organization.
Group health insurance via one’s employer is often more attractive than an individual or family policy for a number of reasons:
- Companies can combine with others in strategic alliances to improve their group insurance rates
- Carriers that insure many large employers can leverage their overall risk across many clients, which can allow them to offer lower rates
- Companies often cover a portion of—or all—the insurance premium for the employee.
Since 1986, if you have health insurance via your employer and you lose your job, you can extend your group health insurance coverage via a COBRA (Consolidated Omnibus Budget Reconciliation Act) conversion. This protects you from suddenly being left without health insurance.
COBRA conversion is essentially just an extension of time in which you can continue to be covered by your previous employer’s group coverage, after you are no longer employed there. The cost may be substantially higher to you, however, since your employer may have been paying part of your premium, and you will now be responsible for the entire cost.
As the major implementation of the PPACA in 2014 approaches, it’s probable that many more entities will be looking for creative ways in which to consolidate their group health insurance needs, leveraging their buying power in order to accommodate those that will be required to purchase their own coverage.
In theU.S., health insurance of some sort will soon be required for everyone, whether provided by employers or acquired by individuals, and in some manner, the costs of that insurance will affect the insured.
Making informed decisions can help you find the best health coverage at the lowest cost to you, while affording you peace of mind that an accident or serious illness won’t result in financial ruin.
Defensive Medicine as a Preemptive Measure
December 3rd, 2012
Defensive medicine has become an increasingly common practice, particularly in the United States, where malpractice litigation is most common. It takes two distinct forms: avoidance and assurance.
In an avoidance mode, the practitioner simply opts not to practice medicine in a field that is prone to high levels of litigation, is inherently high-risk or where a malpractice claim is especially difficult to defend against.
In an assurance mode, the general philosophy is to “cover all the bases,” by performing extensive tests, referring patients to specialists for second opinions or ordering procedures or medications without sound indications that they may be productive.
There are three principal reasons for such measures:
- Improve the chances of successful treatment;
- Reduce the risk of a patient filing a malpractice claim;
- Preempt liability by demonstrating diligence in seeking the best possible diagnosis and treatment.
Unfortunately, all three can result in higher costs to the patient’s insurer (and ultimately, the patient) and can delay effective treatment.
How Prevalent is Defensive Medicine?
According to a 2010 study by Health Affairs, defensive medicine is responsible for at least $45.6 billion per year in additional medical costs in the U.S. That makes the entire cost of the medical liability system nearly 2.5 percent of total health care spending… and rising.
Interestingly, a 2010 Gallup Poll found that the U.S. physicians polled attributed 26 percent of overall healthcare costs to defensive medicine. That equates to an extra $650 billion. Other polls of physicians have indicated that number to be 34 percent, or an additional $850 billion.
A 2005 study by Price Waterhouse Cooper determined that $1.2 trillion of the total $2.2 trillion spent on medical care that year was unnecessary cost, comprised largely of defensive medicine.
Perhaps equally disturbing are the findings of a study conducted by Academic Medicine early in 2012. Of the third- and fourth-year medical students and residents polled, the following was reported:
- Of the student polled, 92 percent reported that they had encountered at least one incident of assurance practice, and 34 percent had encountered at least one incident of avoidance.
- Of the residents polled, 96 percent had seen incidents of assurance and 43 percent had seen avoidance.
- Overall, 41 percent of all the students polled and 53 percent of the residents stated that their attending physicians had taught them to consider liability when making clinical decisions.
Even if one accepts the lowest figure of slightly less than 2.5 percent of all medical care spending, it nevertheless represents an additional $146 of spending each year for every man, woman and child in the U.S., on a per capita basis. If the Price Waterhouse Cooper data is correct, that becomes over $3,800 per capita, per year—and those costs will be recovered somewhere. The insurer isn’t likely to be willing to absorb them, so the cost will be passed on to the insured parties.
What is the Solution?
A number of proposals have been offered, focusing on reducing the unnecessary costs of defensive medicine. This is probably the best approach, since defensive medicine costs dwarf those of malpractice insurance.
Florida recently did something interesting for doctors in the Emergency Department (ED). The state will be the responsible party in the event of a lawsuit, not the physician. It’s important to note that ED is the profession in which the greatest amount of defensive medicine is being practiced.
There seems to be a consensus forming that the best method of reducing overall medical costs is not via tort reform, but rather, in controlling the motivations for defensive medicine. Seen in that light, the plan implemented in Florida may have merit.
Also exposed, as a fallacy, is the myth that the primary motivation for unnecessary tests or treatments is financial. But very few doctors receive any remuneration for referrals or tests. In fact, many such kickbacks are illegal. Drugs, lab tests and referrals are simply not a source of income for doctors, except in very rare instances.
Often touted as necessary elements in any plan to curtail the practice of defensive medicine is the removal of financial responsibility from the physicians’ shoulders and review by peers, rather than by administrators with no familiarity of medicine.
The Future of Defensive Medicine
There are a number of reasons that many express doubts that there will soon be major improvement to these unnecessary costs. Litigation seems to be such a deeply entrenched aspect of U.S. society that immunity to lawsuits may be the only way to defuse it. Florida’s ED experiment may prove sufficiently successful to convince lawmakers in other states to follow suit.
A peer review process for malpractice claims would seem to make a great deal of sense. Unfortunately, there is always hesitance to allow any industry to police itself, even though the legal profession does so, as well as many engineering disciplines, so there may also be hope on that front.
There has always existed a certain level of trust between doctor and patient, and this relationship suffers on both sides from the practice of defensive medicine. In fact, it’s a three-sided loss:
- The patient is subjected to procedures and treatments that may be unnecessary and can experience delays in treatment and additional expense as a result, and in some cases, can pose additional risks.
- The physician feels forced to dedicate more resources than necessary to the diagnosis and treatment of ailments in order to protect himself and his practice. This can also result in resources being unavailable for other cases in which they’re sorely needed.
- The insurers face additional burden in processing approvals and payments for what may be many more times what is necessary. This, as well as the medical payments, results in cost increases for medical coverage.
Probably the most effective approach to overcoming (and hopefully, reversing) these issues is one of educating the public, while pressing for legislative change for the financial responsibility and peer review models. This begins with educating your patients.
If a procedure or test may be effective, it should be presented to the patient in that fashion, citing all the possible downsides, benefits and side effects. Hospital administrators should try to resist the temptation to automatically refer even the most straightforward ER issues to full batteries of tests and lab work.
In short, the trust of the patient-doctor relationship must be nurtured, with clear communication being its foundation.
How You (and Your Practice) Can thrive in This Terrible Economy, Pt 1 of 3
October 12th, 2012
News about the economy is everywhere. As a national medical malpractice insurance agency, we are constantly talking to physicians and we are constantly hearing about the current state of practicing medicine. And, right now, we are hearing a lot about how physicians are feeling the effects of this terrible economy on their practices. We are also hearing about what physicians are doing in response. We thought we would share some of the great ideas that we have heard from your colleagues. This is the first in a three-part series on how to survive this economy.
1. Offer Part-time Medi-spa Services. Whether it’s just creating a small LLC and providing services or locally partnering with a medi-spa, there are many opportunities for an enterprising physician. Here are some of the specialties that can easily partner with medi-spas: internal medicine, dermatology, plastic surgery, general surgery. But, generally, most licensed MDs and DOs can work in a medi-spa capacity –but always check with your state for regulations first.
Here are some of the opportunities available:
a. Medical Director: typically this position does not require the physician to see patients and it is a good “moonlighting” position for some. However, always thoroughly understand the requirements of the position/contract and make sure that you are appropriately covered from a medical liability insurance standpoint.
**Insider tip: Turnover for Medical Directors is very high in this industry. If you turn in a resume, chances are if you don’t hear back immediately, you will in the future.
b. Cosmetic Services. Doctors can provide cosmetic services as long as they have taken the required training, and they can provide medi-spa services in almost any setting. For instance, in the medical spa setting a doctor can perform injections, laser treatments, chemical peels, and even advanced procedures like I-Lipo and other tumescent procedures.
Also, think creatively within your current practice. Gerontologists, for example, can offer Botox and reflexology. Many physicians are thinking of add-ons they can offer to their traditional list of services that would be welcomed and appropriate for their current patients.
Surviving this economy is tough and offering medi-spa services can help bolster a physician’s income. Of course, always make sure that you have the proper training and professional medical liability insurance coverage for your new activities to ensure that you are covered. NEVER ASSUME that your current liability insurance policy will cover your new procedures and/or position(s). Contact us today if you’d like to discuss a medi-spa opportunity that you are considering –we can help you figure out if, and what, medical liability insurance coverage you may need.
How Does Your Practice Handle Patients Who Want to Negotiate Bills?
January 4th, 2012
Times are tough. And, physicians are seeing more and more patients having a hard time paying their bills. As you are probably well aware, many patients have taken to calling the office asking to negotiate their bills. How does you office handle this? Do you have a formal policy in place to determine which bills are negotiable or which patients can get their bills negotiated?
AMedNews.com recently had a nice article detailing the importance of knowing how to negotiate bills with patients. While it may be seem fine to handle each request on a case-by-case basis, the article advises against this, and instead, suggests that physicians develop a formal office policy. The overall goal is to be consistent –and not violate any government regs or third party payer contracts in the process.
The article suggests first determining who is eligible for negotiation. Is it just patients who are uninsured or are insured patients eligible? And, who will handle the negotiations in the office? Also, will financial need be a factor? If so, how is it determined? See the article for other excellent details to consider and how to put together a policy that works for your practice.
We understand that patients who pay less for their bills reduce income for the practice. More than ever, it’s important to get the most for your money and save money when possible. MyMedicalMalpracticeInsurance.com can help you save money on yourprofessional medical liability insurance.
Med Mal Reform in New York
November 23rd, 2011
I just read a good article in the Washington Post about the physician liability reform taking place in New York state. It seems that New York has realized two important things: 1) that New York physicians have some of the highest medical liability insurance premiums in the country and 2) that medical malpractice lawsuits are torture for everyone involved: physicians, patients, med mal insurance companies, and the countless others dragged into them. In an effort to minimize the length of time these cases take, and as a result, indirectly lower doctor liability insurance costs, among other costs, New York state has started to take matters into its own hands.
The program was piloted by a judge in the Bronx, through a federal grant from the Agency for Healthcare Research and Quality, and is poised to spread to other parts of New York. Currently, two hundred cases are in process in the new system and the results look promising. The program utilizes “judge-directed negotiation.” Essentially, a judge who specializes in medical matters shepherds the parties involved through a negotiation process and ultimately, a settlement. This is drastically different from the traditional process of a medical malpractice case, where often several judges could be involved over several years, and no one person is there to push the process along and push the parties for resolution. However, if a settlement can’t be reached with the new system, it is allowed to then proceed through the traditional channels.
The time savings is significant: an average med mal case takes about 3 years start to finish, and the new system reduces that to about six to nine months. And, that translates to cost savings and savings of valuable resources.
Are You in the Illinois Doctor Database?
October 25th, 2011
Side Note: A new database has just gone live in Illinois and it contains information on all of Illinois’ 46,000 licensed physicians. The database, available at the Illinois Department of Financial and Professional Regulation’s website, at idfpr.com under the “physician profile” link, is a reincarnation of a previous website the state shut down last year. In addition to it containing benign information like a physician’s educational training, what type of insurance he or she accepts, and what languages are spoken in the office, the database also contains information about discipline action taken against a physician. Included is information about any criminal convictions, whether hospital privileges have been revoked, and medical malpractice lawsuits. Have you had to use your medical malpractice insurance? Whether you have or not, you should definitely check your profile –if only to know what it contains (and what your patients may be viewing) and to make sure that it is accurate.
If you haven’t already viewed your profile, you should today.
Facing high medical malpractice insurance premiums? Complete our free quote request to see if we can beat your current premiums.
Online Illinois doctor database launches
By: Monique Garcia
Posted: October 20, 2011
Illinois patients can now research their doctors using an online database the state launched Wednesday.
The idea is to take the guesswork out of choosing a doctor by allowing easier access to information about the state’s 46,000 licensed physicians and surgeons.
Read the Full Article
Fear of Medical Liability Not Only Reason for Too Much Care
October 18th, 2011
Side Note: The article below discusses a recent study in the Archives of Internal Medicine that discovered that there are a lot of reasons why physicians order overly aggressive medical care for their patients. As one would expect, fear of medical liability and having to use one’s medical malpractice insurance was the number one reason for treating aggressively –seventy-five percent of respondents said so.
Interestingly, though not surprisingly, another reason for ordering extra tests and referrals physicians said was because they have too little time with their patients. To compensate, they say they order extra tests and the like. Yet another interesting finding was that ninety-five percent of the physicians thought that doctors vary in their treatments for patients with the same condition. The article did not say if this was another reason for physicians’ aggressive care –fear of not providing care that was consistent with one’s colleagues.
Could Cunningham Group save you money on your medical malpractice insurance?
Fear of lawsuits, little time with patients lead to more aggressive care
By: Alicia Gallegos
From: amednews staff
Posted: Oct. 10, 2011
Nearly half of primary care physicians say patients receive too much medical care.
In a study of 627 such physicians, 42% said patients in their practice get too much treatment, and 6% said patients receive too little care. Fifty-two percent of doctors said the amount of care was just right, according to the study published Sept. 26 in Archives of Internal Medicine.
Read the full Article
The Practice of Primary Care & Baby Boomers
October 11th, 2011
Side Note: The article below reviews a new book, Out of Practice, by Frederick M. Barken, M.D. The book is a narrative of one upstate New York primary care physician’s decision to retire early and his reasons why.
The book discusses many frustrating scenarios that are very familiar to most primary care docs. Specifically, Dr. Barken talks at length about the challenges of caring for the Baby Boomer generation. Included are discussions of poor Medicare payments, the fact that practices often require physicians to see 30-35 patients per day, and thus allows no room for sick or medically complex patients, and the high cost of physician liability insurance.
Knowing that these problems are only going to get worse, Dr. Barken poses a unique solution: create a physician draft. He suggests that medical school graduates must serve two years as a primary care physician before being allowed to train in a specialty. Read on for the details of his radical solution.
As the article below mentions, medical malpractice insurance rates can be high. We here at Cunningham Group can work with you to get the best rates available for you and your practice today.
Medical Crisis in America: Why One Doctor Quit
By: MELINDA BURNS, Miller-McCune
Posted: October 8, 2011
Primary care physicians in America are struggling with what is and what will be: a health care system that’s broken and the coming influx of aging baby boomers, according to Frederick M. Barken, M.D. in his book, Out of Practice.
By most measures, Dr. Barken was a success as a primary care doctor. He ran a solo practice in rural upstate New York with 3,000 patients; he was well respected, and he earned a comfortable income. But after 25 years, at the relatively young age of 51, he’d had enough. In his new book, Barken tells how he was driven out by the extraordinary demands of a frail and befuddled elderly clientele in the era of “fast food” medical care.
Read the Full Article
Medical Errors & Disclosure
October 5th, 2011
Side Note: When a significant medical error occurs, it is very hard for a physician to know what to do. Depending on what state you live in, the ramifications of admitting a medical error can be vastly different. In some states, if a physician offers a patient an apology, it can be used as evidence against him or her in a medical malpractice case. In other states, physicians are protected and can offer such an apology without it being used against them. As suppliers of medical malpractice insurance and physician advocates, we understand that this is a tough issue.
The article below discusses how physicians have multiple imperatives to openly and honestly disclose medical errors. While no one would question the theoretical imperative to disclose an error, the reality of doing so is much harder and less obvious. For example, despite the Joint Commission requiring that accredited organizations have in place an error reporting mechanism, less than 55% of physicians know how to report errors and less than 40% knew which errors had to be reported. This is due to many factors, including physician fear, a culture of “shame and blame,” and lack of training in how to disclose errors appropriately. Read on for further discussion of this complex topic.
Would you like to lower your medical malpractice insurance costs and save some money? Cunningham Group may be able to help!
Medical error calls for honest disclosure
By: Ethics Forum
Posted: Sept. 12, 2011
Scenario: How do physicians overcome barriers to communication with patients who have been harmed?
Steps should be taken to encourage and support doctors in reporting adverse events to patients who have been harmed and their families.
Read the Full Article
Surprise! You’re online!
September 26th, 2011
Side Note: Don’t think you’re online? You may be surprised. In this era of the internet and social media, even the most non-technologically advanced physician may be surprised to learn that he or she (and his or her practice) is online –reviewed, for better or for worse, by patients.
“Online reputation management” is becoming a more significant part of many physicians’ practices –just like coding and billing or ordering supplies –and for good reason. Just as there is no filter prohibiting individuals from posting online, there is nothing preventing others from spreading what’s posted. Thus, a single bad (or inaccurate) review on one site can quickly get circulated via social media.
So what is a physician to do? As we have said many times before, with other matters pertaining to medical malpractice and medical malpractice insurance, a good offense is the best defense. Nuturing the doctor-patient relationship and exercising a good bedside manner is one of the best ways to ensure satisfied, happy patients and minimize bad online reviews.
Beyond that, the article below mentions five ways to start managing your online reputation. If, however, you encounter significant problems, you may require the assistance of a professional reputation management firm and the article also gives you info on how to find a reputable firm.
To see if Cunningham Group can lower your med mal insurance today, contact us for a free quote.
5 ways to manage your online reputation
By: Pamela Lewis Dolan
From: amednews staff
Posted: Sept. 12, 2011
Even if some physicians themselves are not online, their names, comments on their style of practice, and complaints or compliments about them probably are.
All of the online content devoted to a particular physician could negatively impact his or her reputation, and subsequently his or her business, if steps aren’t taken to manage that content and — when necessary — defend it. This is often referred to as online reputation management.
Read the Full Article
Pharmacists in NH Giving More Vaccines
September 6th, 2011
Side Note: Last week we talked about the uniqueness of the emergency room –specifically, how the acuteness of the patient’s situation, paired with the lack of a medical record, often produces a situation ripe with liability exposure and potential medical malpractice. Today, we face a similar situation –how pharmacists in New Hampshire are being allowed to give patients more vaccinations and how this impacts the physicians (and potentially their patients).
New Hampshire pharmacists are now allowed to give pneumococcal and shingles vaccines in addition to flu vaccines. And, although the pharmacists are required to inform the patient’s physician about the vaccine, we doubt that this will be an effective or enforceable policy. What happens if a patient doesn’t provide accurate contact information for the physician –or if the patient chooses not to mention if there is a primary care physician? Either way, it is conceivable that this important information may never make it into a patient’s medical record. And, if it doesn’t, who’s responsible? What if a physician administers a vaccine that was already give to the patient? Who faces the medically liability? At the very least, we are happy that these pharmacists are required to carry medical liability insurance.
Or, what if a patient has a complex medical history that doesn’t get communicated to the pharmacist? The determination to give one of the newly added vaccines may require a more nuanced evaluation of the patient that the pharmacist may not be able to give, or may not be aware that he or she should give, because the medical record is not present. Read on for other complicating factors.
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NH allows pharmacists to give more vaccinations
By: NORMA LOVE
Posted: September 4, 2011
New Hampshire is joining a growing national trend in allowing pharmacists to give more vaccinations than annual flu shots — but doctors oppose the changes in what appears to be a turf war over a profitable aspect of medical care.
A new state law lets trained pharmacists give vaccinations for a bacterial form of pneumonia that can be deadly and for shingles, a painful reappearance of latent chicken pox virus that affects the nerve roots and can produce a blistering rash.
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Medical Malpractice Tort Reform: How to Reduce Extra Tests in the ER
August 29th, 2011
Side Note: Medical malpractice tort reform is good at accomplishing a lot of things: it can help keep the cost of medical malpractice insurance lower for physicians, it can help reduce the number of frivolous lawsuits, and it can help reduce the number of extra tests that physicians order to protect themselves in case they are sued. It is this last item that we will be focusing on today.
A recent survey of 1800 emergency department physicians found that 44% thought that the biggest roadblock to cutting costs in the ER has to do with fear of lawsuits. Fifty-three percent of respondents said that they order the number of tests that they do out of a fear of being sued for med mal. Making matters worse, there is a shortage of specialists willing to consult in the ER. (Due to the fact that the ER often sees the most critically ill patients and there is often a good medical record lacking, more and more specialists are avoiding potential medical malpractice liability by refusing to consult on ER cases.) The article below details how good tort reform can help to cut costs in the ER. Specifically, the piece cites data from Texas pre- and post-medical malpractice tort reform.
Wondering if you might be able to pay less for your emergency physician medical malpractice insurance? Contact us today to see if we can help you.
Want to Cut Costs in the ER? Pass Medical Liability Reform
By: PR Newswire Association LLC
Posted: May 23, 2011
WASHINGTON, May 23, 2011 /PRNewswire-USNewswire/ — Nearly half (44 percent) of almost 1,800 emergency physicians responding to a poll report that the biggest challenge to cutting costs in the emergency department is the fear of lawsuits. Even more respondents (53 percent) said the main reason they conduct the number of tests they do is the fear of being sued.
“Medical liability reform is essential to meaningful health care reform,” said ACEP’s president, Sandra Schneider, MD, FACEP. “Without it, health care costs will continue to rise. Estimates on the costs of defensive medicine range from $60 billion to $151 billion per year. That dwarfs total expenditures on emergency care, which at $47.3 billion in 2008 represented just 2 percent of all health care spending.”
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Texas Medical Malpractice Insurance Rates Declining
August 25th, 2011
Side Note: We just recently wrote about a great article that came out in the New York Post that discussed how New York physicians sick of high med mal insurance rates have been heading to the Lone Star State for a more friendly physician and practice environment, thanks to its recent medical malpractice tort reform efforts. The medical liability reform, passed in 2003 by Governor Rick Perry, has generally shown steady decline in physician liability insurance rates in the years since it was passed.
Well, the articles just keep on coming regarding the appealing benefits that Texas is offering. The article below is in response to a recent report that just came out detailing how medical malpractice rates in the state are continuing to decrease.
Are you a Texas physician and curious about whether or not your Texas physician liability insurance rates could go down? Contact us today for a no-obligation quote request.
Insurer: Texas malpractice rates decreasing since liability reforms
By: Marilyn Tennissen
Posted: 8/24/2011 1:42 PM
Due to medical liability reforms in the state, Texas physicians will pay less for liability coverage next year, according to the state’s largest provider of malpractice insurance.
In a statement released today, the board of governors of the Texas Medical Liability Trust announced policyholders would receive an average rate decrease of almost 7 percent. In addition, renewing policyholders will receive an 18.5 percent dividend.
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Some Cold, Hard Medical Malpractice Reform Facts
August 18th, 2011
Side Note: A fabulous article just came out in the New York Post. It puts real numbers and data to the theory that physicians are leaving New York in record numbers to practice medicine elsewhere. The article specifically focuses on New York physicians who leave New York to practice in Texas. Why the mass exodus to Texas? Because Texas has had some very successful medical malpractice tort reform (known as Prop 12) and is now a very attractive state to physicians. When compared to New York, the stats and the results of med mal reform are undeniable.
Since 2003, physician liability insurance rates have gone up by more than 60% in New York, while they have dropped by 54% in Texas (yes, dropped). In that same time period, 1,271 New York physicians have migrated to Texas, according to the Texas Medical Board records. And, the article goes on to say that more than 26,000 new physicians have started practicing medicine in Texas since the reforms started –with the vast majority coming from outside of Texas. Read on for more regarding this trend.
Are you a New York physician looking for some relief from New York medical malpractice insurance rates? Contact us, to see if we can help you.
Thanks for the doctors, New York
By JOSEPH M. NIXON
Last Updated: August 17, 2011
Dr. Jackelinne Pilar Villalobos was one of Brooklyn’s few female English and Spanish-speaking obstetricians. She loved the city and her patients, and never wanted to leave — but 18 months ago, she moved to Houston, where we’re delighted to have her.
Villalobos’ journey to Texas began in 2003, when our Legislature reformed Texas’ legal system — including sweeping medical-malpractice reforms. Back then, doctors in New York and Texas were paying about the same for medical-liability insurance. In Villalobos’ case, it was more than $100,000.
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Would You Publicize Your Worst Medical Malpractice Errors?
August 16th, 2011
Side Note: Medical malpractice mistakes can be devastating for patients and family members –as well as for the physicians who make those mistakes. And, we’re not just talking from a medical malpractice insurance perspective today –today we are talking about more than getting sued. While there are processes and protocol to help the unfortunate victims of the errors and their families deal with its impact, often little is done to help physicians process their mistakes and the feelings of guilt that accompany them.
Physicians are trained to be “perfect” –to avoid errors, to get the diagnosis “right,” minimize complications, “do no harm,” etc. This is because their errors impact people and their errors can often have terrible consequences. Thus, while to err is human, it can be devastating in medicine. Physicians are not trained to talk about their errors with colleagues. And, it is easy to see why they wouldn’t want to do so. They fear that their colleagues may think they are incompetent, that it might open themselves up to further liability, that it might get them disciplinary action, the list goes on and on. Therefore, it is no surprise that physicians often feel alone and suffer from shame and fear when they make a mistake –all in addition to the guilt for harming a patient. The suicide rate for physicians is about twice that of the general public, and if a physician has committed a major error recently, his or her rate of suicide is triple that of other physicians.
See the article below on how breaking the silence on medical errors has been liberating for three physicians and the good things that came about from their courage to disclose their medical mistakes.
Medical malpractice insurance is expensive. We may be able to lower your rates.
Revealing their medical errors: Why three doctors went public
By: Kevin B. O’Reilly
From: amednews staff
Posted: Aug. 15, 2011
In September 2010, Kimberly Hiatt made a medical error. The critical care nurse at Seattle Children’s Hospital miscalculated and gave a fragile 8-month-old baby 1.4 grams of calcium chloride, 10 times the correct dose of 140 milligrams.
The mistake contributed to the death of the child and led to Hiatt’s firing and an investigation by the state’s nursing commission. In April 2011, devastated by the loss of her job and an infant patient, Hiatt committed suicide.
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Wondering How to Handle Negative Online Ratings?
August 10th, 2011
Side Note: Being a physician is getting more and more complicated thanks to technology –and, we’re not even talking about state-of-the-art medical advances or equipment. No, today we are talking about physicians being rated online and how they should respond to those ratings. In the era of online reviews for restaurants, plumbers, professors and products, nothing and no one is off-limits. Not even physicians.
But is this fair play? And, what is a physician to do if he or she receives a less-than-glowing review –especially if the physician feels it is not justified?
This is an especially tough situation considering the doctor-patient relationship, patient confidentiality, the fact that physicians are often bound legally to not divulge patient information and the fact that physicians are often privy to and comprehend medical information that a lay person may not have access to or an understanding of. So, while the internet theoretically creates an “even” playing field, it really does not, for the reasons just listed, and each side (doctor and patient) are at significant disadvantages, though they may not even realize it. But, what’s the answer? Asking patients to sign documents stating that they won’t discuss their care online? Gag orders?
Read on below, for the thoughtful suggestions presented. While a negative online review is not nearly as serious as charges of medical malpractice, and it doesn’t involve your medical malpractice insurance, as physician advocates it is of concern to us because it is of concern to you.
Would you like to lower your physician liability insurance rates? Find out if we can help today!
Rated negatively online? What’s a physician to do?
From: AMedNews.com, Ethics Forum
Posted: Aug. 8, 2011
Scenario: How should professionals respond to physician-rating websites?
An increasing number of websites invite patients to rate physicians and clinics as they would restaurants. Doctors are asking if there is a fair way to react against undeserved, unfavorable comments. Is it ethical to fight back against these websites?
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Finally, Medical Malpractice Expert Witnesses Getting Examined
August 3rd, 2011
Side Note: As a physician, you probably know that an “expert” (and we use the term lightly) witness can be found to support any accusation for a medical malpractice case. These physicians often use unethical tactics to sway juries and take down good doctors. I’m sure you know of an example or two. We here at Cunningham Group understand that no physician wants to utilize their medical malpractice insurance –especially if it comes at the hands of a questionable expert witness.
The good news is that there are many organizations currently taking action against these dubious career testifiers, according to the article below. The article mentions the actions of state medical boards and medical societies along with courts and state legislatures. Many medical boards and medical societies have drafted standards for appropriate expert witness testimony and taken action against experts who have violated these rules. And, the AMA recently approved a report defining model legislation for expert witnesses at their Annual June meeting.
The American Academy of Emergency Medicine has its own interesting way of dissuading its members from giving questionable testimony: the organization publishes it online. Since court documents are a matter of public records, it’s all legal.
Florida is the latest state to set new standards for testimony. As of July 1, any out-of-state medical expert must apply for a certificate to testify and he or she can be disciplined by the state medical board if he or she provides deceptive testimony. Thirty other states have similar laws –though they can vary. Some states require physician expert witnesses to practice, while others require that the expert witness practice in the same specialty as the defendant.
Finally, the courts have recently handed down a slew of decisions holding expert witnesses accountable for their testimony. See the article for the details of the cases.
Would you like to lower your medical malpractice insurance premiums? If so, Cunningham Group may be able to help. Contact us today to get your free quote request.
Expert witnesses on trial
By Alicia Gallegos
Posted: Aug. 1, 2011
The ideal goal of an expert witness during testimony is to be “an indifferent advocate for the truth,” said neurosurgeon Jeffrey Segal, MD.
Too often, though, physicians make careers as such experts and use unethical tactics to sway jurors, said Dr. Segal, founder and CEO of Medical Justice, a company that sells medical liability insurance and provides legal resources to combat frivolous claims.
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