David B. Troxel, MD, Medical Director, The Doctors Company

The medical profession is part of the cultural shift happening throughout our society toward greater transparency—and this is benefiting physicians, as well as patients. I like to think that our profession has been a leader in this area with the movement to disclose medical errors, which began about twelve years ago. Because of this movement, many hospital systems are using Communication and Resolution Programs (CRPs) to guide patients, families, physicians, and staff members when adverse events occur.  

We know now that when a medical error occurs, disclosure and transparency often reduce the patient's anger, and anger often leads to a medical liability claim. And greater transparency may mitigate risk on a larger scale as well: When analyses of adverse events leading to claims are made available to physicians, this often reduces their future occurrence, i.e., it reduces the risk of specific missed diagnoses, thus improving patient safety and reducing physician liability risks.

Transparency and Disclosure: With Individual Patients

CRPs teach hospitals, medical practices, and physicians how to respond to an adverse event. For example, medical professionals learn how best to respond when explaining why a wrong diagnosis was made or explaining why a pharmacy released the wrong medication. And CRPs stress the importance of offering to help, such as by reassuring the patient that healthcare costs resulting from the error may be ameliorated by fee reduction or waiver.  

At The Doctors Company, we encourage our physician members to participate in structured disclosure programs, and we provide resources to educate and assist them.

Transparency and Disclosure: Across the Profession

One of my main jobs as medical director of The Doctors Company is to review closed claims, both by specialty and by type of diagnostic error. Since we are the largest physician-owned medical malpractice insurance company in the United States, we have the largest claims database. By reviewing our closed claims data, we can achieve valuable insights, such as which diseases are most frequently misdiagnosed. By sharing our findings, we alert physicians to the most frequent causes of claims in their specialty, thus increasing patient safety and lowering physicians’ liability risks.

I can offer two examples of how studying our data, and distributing the results of our studies, have yielded positive outcomes for patients and physicians.

Difficult Diagnosis 1: Spinal Epidural Abscess. When we completed a study several years ago of closed claims in hospital medicine, the most common claim allegations were diagnosis related. Of these, we were surprised to see that there were a significant number of claims for missing a diagnosis of spinal epidural abscess.

Spinal epidural abscess is so uncommon that many physicians have never seen one. So we shared our study with the Society of Hospital Medicine, and they agreed to publish our study in their medical journal and present the findings at their national meetings. Meanwhile, I wrote an article on our findings in The Doctor’s Advocate, our quarterly publication. We’ve seen a gradual decline in the incidence of claims related to spinal epidural abscess as a result of sharing this data with physicians.

Difficult Diagnosis 2: Malignant Melanoma. Some time ago, after reviewing a large number of pathology claims, I was struck by the fact that the most common reason pathologists got sued was for missing a diagnosis of malignant melanoma. Like spinal epidural abscess, melanoma is well recognized as a difficult diagnosis because there are many variants of melanoma, some of which look benign. Unless you're seeing a large number of melanomas, you may not recognize the subtleties that lead to the correct diagnosis.

I shared this data with pathology specialty societies and published it in pathology journals. Additionally, I spoke on the subject at the societies’ national meetings, and they invited pathology experts to speak at their meetings on melanoma misdiagnosis.

About seven years ago, I looked to see if the dissemination of this information and the specialty societies’ educational programs had reduced the incidence of claims against pathologists involving melanoma. I was pleasantly surprised to see that the frequency of such claims had dropped dramatically.

Sharing closed claims data is one of the most important things we do at The Doctors Company. This information is available to anyone on our website, and we encourage all physicians to review these studies.

Transparency and Disclosure: Optimism About Our Future

Within the medical profession, we’ve achieved positive momentum in terms of education for physicians to learn areas of practice where they need to be more attentive, and also for physicians to learn what to do if an adverse event occurs.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

^{The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.}

The Florida Office of Insurance Regulation (Office) has released a comprehensive Report on the review of the Motor Vehicle Personal Injury Protection (PIP) Insurance data call as required by House Bill 119, which passed in 2012. The Report provides data to help evaluate market conditions relating to the Florida Motor Vehicle No-Fault Law and the impact on the market from reforms made as a result of this law.  Read more...

While Ebola stokes public anxiety, more than one in six hospitals — including some top medical centers — are having trouble stamping out less exotic but sometimes deadly infections, federal records show.

Nationally, about one in every 25 hospitalized patients gets an infection, and 75,000 people die each year from them—more than from car crashes and gun shots combined. A Kaiser Health News analysis found 695 hospitals with higher than expected rates for at least one of the six types of infections tracked by the federal Centers for Disease Control and Prevention. Read more

From Modern Healthcare: Two members of Congress and the Medical Group Management Association are calling on the CMS to address a programming problem that threatens to saddle some physicians and other eligible professionals with Medicare payment penalties in 2015. Read more.....

Source: Modern Healthcare

Source: Duval County Medical Society 

Source: Modern Healthcare

The American Medical Association has published a brief guide to disputing incorrect Open Payments data. Read more... 

Effective July 1, 2014, the Agency for Health Care Administration will increase reimbursement under the fee-for-service system for physical, occupational, and speech-language pathology therapy services. Medicaid fee schedules will be amended to reflect this change.

Providers receiving reimbursement through a managed care plan should refer to their contract with each plan to determine whether this change will impact their reimbursement from the plan. 

Please see the following procedure codes and the corresponding new rates: 

Health News Florida continues to provide some good information and resource links for physicians and patients that have been impacted by the liquidation of Physicians United Medicare Advantage Plan.   In the latest article they provide some perspectives from agents assisting Medicare Beneficiaries navigating the process of securing new coverage.  They also provide the statutory citation that prohibits physicians and other medical professionals from attempting to collect unpaid claims directly from those PUP patients whose bills were not paid prior to PUP’s liquidation. 

Finally, the article provides some advice for Seniors in selecting Medicare Advantage Programs to make sure they evaluate the quality ratings and financial security of the plans they are considering.  This is advice that physicians and our association need to heed as well.   PUP is not the first nor will it be the last Medicare Advantage Program to fail.   It is important as physicians consider contracting with Medicare Advantage Programs (or any plan for that matter) that you consider the financial stability and quality ratings of the carrier.   There are many practices that have been significantly impacted by this latest liquidation.

Your association is currently working on a reporting mechanism that will track financial performance of Advantage Plans for our members using the data that is reported quarterly to the State of Florida.  Look for additional announcements of that member benefit in the coming weeks. 

Click here to read the full article from Health News Florida: