Tag Archives: medical liability

Group Supports Administrative Compensation System in Tennessee

Patients for Fair Compensation Continues Push for Administrative Solution to Medical Malpractice Claims in Tennessee
Patients for Fair Compensation is making another push to change the way medical professional liability claims are adjudicated against physicians in Tennessee. The state’s medical association, trial bar and largest insurer of physician liability are saying, no way.

Founded in 2011 as a Section 501(c)(4) organization by Richard Jackson, chief executive of the healthcare staffing firm Jackson Healthcare, Patients for Fair Compensation advocates moving the determination of medical liability claims from the judicial method to a no-blame, administrative compensation system overseen by a Patient Compensation Board. The board would operate similar to the way workers’ compensation claims are handled, reviewing claims of medical liability and awarding settlements. All claims would be settled in a matter of months, rather than years.

According to Patients for Fair Compensation, eliminating the litigation process against physicians in favor of a Patient Compensation Board for the determination of medical liability compensation would lower healthcare costs by eliminating the incentive for physicians to practice defensive medicine. In addition to eliminating unnecessary medical tests and procedures, it would put patients at the forefront of the process and realign incentives towards patient safety and a reduction in medical errors, while assuring all patient complaints are heard, quickly resolved and more patients are fairly compensated.

This is not the first time Patients for Fair Compensation has campaigned for its Patient Compensation System before the Tennessee Legislature, nor is it the first state where it has lobbied for such legislation. In the past, it has advocated for its administrative liability compensation system in Florida, Georgia, Maine and Montana to no avail. The legislation never escaped committee in Florida, Georgia and Montana; it was voted down in Maine.

“We stand with the Tennessee Medical Association in opposition to the Patients for Fair Compensation legislation,” said Sherie Edwards, vice president of corporate and legal at State Volunteer Mutual Insurance Co. (SVMIC), Tennessee’s largest provider of physician medical liability insurance. “If we thought the system was good for our physicians, we would be supportive of it. Our mission is to protect, support and advocate for our physicians, and this is not a good system for them.”

United in Opposition
When Patients for Fair Compensation eyed Georgia as the first state to try to enact its Patient Compensation System in 2013 under the banner Senate Bill 141, the Medical Association of Georgia, State Bar of Georgia and medical liability insurer MagMutual Insurance Co. banded together in opposition, favoring the existing medical liability tort reforms that were passed in 2005.

“Since the 2005 tort reforms, we have hard statistics that show claims frequency is down, malpractice payments are down, medical malpractice insurance premiums are down and competition is up,” said Joseph Cregan, MagMutual senior vice president and general counsel told Medical Liability Monitor in December 2013. “We’ve analyzed [Georgia] SB 141 in detail, and the No. 1 thing that should be noted is that the system it proposes has never been tried in any other state. There is no track record; no observable data to know what it would do. The other side claims — and has pointed out — statistics and measurements, but when you cut through all those, they’re just speculative.”

Last year, the American Medical Association officially commented on the “no-fault” system for compensating patients who experience adverse medical outcomes, calling the system “a new threat to medical liability reform” under which the number of medical liability claims paid would skyrocket.

SVMIC points to the fact that if the system is only enacted in Tennessee, the state’s physician population could expect increased claims and increased reports to the National Practitioner Data Bank, while healthcare professionals in neighboring states would continue to enjoy the national trend where claim frequency and claim costs continue to diminish.

“How many physicians are going to want to stay in a state where they face increased reporting to the Data Bank, when they could go right over the border to Kentucky or Alabama or Arkansas, Georgia, North Carolina or South Carolina and avoid that?” Edwards asked. “We believe that would cause a real access to healthcare problem for consumers in Tennessee. The way the proposed legislation was worded last year, a panel of physicians would look at the care rendered before deciding whether or not it met a national standard of care, which we don’t have in Tennessee. We have a local standard of care, so then our physicians would also lose the right to defend their care in a trial by jury. Nobody wins under this proposed system, which is why we are opposed to it.”

Doctor's reviewing claim data

Big Data and Medical Liability Risks

Leveraging Big Data to Mitigate Medical Liability Risks, Improve Practice Economics

The era of big data in medicine is here, and it promises to improve the overall quality and efficiency of healthcare, increase profitability, reduce waste, predict epidemics, cure diseases and help avoid adverse medical outcomes. Of course, its success is reliant upon collecting the right data and the ability to meaningfully interpret that data.

Smart entrepreneurs have recognized that—under the reforms contained in the Patient Protection & Affordable Care Act of 2010—the value of data and data analytics in healthcare will only amplify, and during the last six years, more than 200 private-sector businesses have been founded to develop an array of tools to better use available healthcare data as well as collect and analyze new data metrics.

In April of this year, SE Healthcare Quality Consulting—a healthcare quality, safety and analytics company headquartered in Charleston, S.C.—and Saxton & Stump—a Pennsylvania-based law firm focused on representing and assisting healthcare providers—officially launched their collaborative Physician Empowerment Suite, a web-based tool that lets healthcare providers generate actionable data that mitigates liability risk while also improving the provider’s position in reimbursement negotiations with payers. Thousands of providers are already using the platform.

“What our companies recognized when working on the Physician Empowerment Suite is that there is an overlap between reducing medical liability exposure and enhancing healthcare practice economics,” said Jim Saxton, Esq., chief executive of Saxton & Stump as well as a board member for SE Healthcare Quality Consulting. “One of the most significant data points we measure, which directly influences liability and reimbursement, is patient engagement. There is an abundance of research that indicates the more engaged patients are, the more likely they are to be satisfied with their care and the less likely they are to file a medical malpractice claim. Similarly, as the healthcare delivery system continues down the road of value-based contracts and reimbursements based on population health, demonstrating patient engagement will have a greater influence over the economics of healthcare.”

Developed through collaboration between clinical and legal experts, the Physician Empowerment Suite gives providers the essential building blocks to capture and own the data necessary to evaluate baseline performance as well as identify areas of professional liability risk and opportunities for performance improvement. This data can also be used when negotiating value-based contracts.

Leveraging Data in Value-Based Contract Negotiations

Success in a reimbursement environment increasingly populated by value-based contracts requires sophisticated data and analytics to measure financial and quality performance for each population of patients. Those providers and health systems unable to prove they have met negotiated metrics will face the untenable burden of financial penalties and lower reimbursements.

“Many providers feel this new reimbursement environment is punitive and largely out of their control,” said Richard Hammer, MD, executive vice president of SE Healthcare Quality Consulting’s Partners in Safety Program. “Our system generates for providers meaningful data that they can use to manage and negotiate their contracts. In effect, it allows them to reassert control.

“Every value-based contract that I’ve seen includes quality of care and cost of care requirements. Quality of care is a very grey variable that even payers have difficulty defining. So where the providers can have the greatest impact when negotiating value-based contracts is to define and demonstrate quality themselves, and the Physician Empowerment Suite provides them the data to do so.”

The Physician Empowerment Suite generates this data by enabling providers to easily survey patients, track and monitor results, and quickly take action to improve the patient experience. It also benchmarks physicians on a number of specialty-specific best practices and provides real-time scorecards on physicians’ patient engagement as well as educational modules to help practices make important improvements.

Hammer shared the story of a large primary care group he worked with where more than a third of its revenue came from value-based contracts. After implementing the Physician Empowerment Suite, the practice was able to measure patient engagement and realign its resources to improve those scores. The result was greater patient compliance, better medical outcomes and healthcare delivery that is 26-percent less expensive than its peers. And they were able to demonstrate these results with meaningful data when renegotiating their contracts.

“Previous to implementing the Physician Empowerment Suite, the group was completely at the mercy of their health plan payers’ data when negotiating,” Hammer said. “With the use of our tools, they were able to generate their own performance data that was so obviously superior, both statistically and clinically, that they were able to replace a portion of the inadequate payer data with the data that they generated. And when you come to the table with meaningful data that demonstrates you are hitting quality metrics, it balances the power in negotiations.”

Using Data to Get Ahead of a Medical Liability Claim

Because predictive analytics extracts information from created data sets to determine future patterns and trends, it can be a powerful tool to intercede with appropriate risk management mechanisms prior to an unanticipated adverse medical outcome. But that data needs to be specialty-specific and manageable, and during the development of the Physician Empowerment Suite, the research and development team was able to narrow as many as 150 currently available metrics down to 20 to 25 specialty-specific, actionable data points.

“By measuring doctors on certain critical data points, we can use that actionable data to reduce their liability exposure,” Saxton said. “And this is going to be increasingly important in healthcare moving forward because there are aspects of the changes in reimbursement which could, if you’re not careful, actually increase liability exposure.”

Saxton used obstetrics as an example where reimbursement incentives could expand liability risk.

“Payers are applying pressure to reduce the number of C-sections, while at the same time unknowingly creating financial incentives to induce labor,” he said. “This pressure influences OB decision making, often forcing them into a no-win situation when deciding the best clinical choice for delivery. All too often, the result is a compromise that can increase clinical risk for both mother and baby. The Physician Empowerment Suite works within this structure by measuring the risks of adverse outcomes, like shoulder dystocia, post-partum hemorrhage and inappropriate inductions. Each OB receives a score, a comparison to their peers and other critical feedback that can be used to improve quality and reduce risk.”

Opportunities for Medical Liability Insurer Partnerships

Healthcare providers in 17 states are currently employing the Physician Empowerment Suite, and the Saxton & Stump/SE Healthcare Quality Consulting collaboration has entered contractual partnerships with several medical professional liability insurance companies, including Constellation Mutual and Central Pennsylvania Physicians Risk Retention Group, to market the Physician Empowerment Suite to its members.

“We’re looking for other serious, qualified partners who really care deeply about healthcare quality and safety, and believe in the power of data analytics,” Saxton said. “Medical professional liability companies are an obvious fit because if they can help an insured better position themselves economically and risk-wise through the Physician Empowerment Suite; that’s the definition of value. The insurer thereby solidifies a partnership with the doctor.”