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Over the last seven years, there has been a significant increase in the number of physicians that are employed by hospitals and health systems. Many of those employment changes were driven by aspects of the PPACA that favored a more “integrated” approach to clinical care. Although the aggressive employment strategy has subsided, there remains a significant interest by hospital systems to more closely align with physician group practices. To this point, let’s explore 4 key areas that hospital systems may want to include in their physician integration strategy, or in some cases, their physician employment and onboarding process.

Since we recently laid out an exercise mapping clinical risks to frequent diagnosis-related claims in Emergency Medicine, we're circling back to recommend a risk mitigation exercise for another area of high risk medicine, Obstetrics.

A recent The Doctors Company analysis identified the most frequent obstetric claims as: 

• 22% Delay in Treatment of Fetal Distress
• 20% Improper Performance of Vaginal Delivery
• 17% Improper Management of Pregnancy

Many organizations that study medical liability trends often point to breakdowns in communication, cognitive errors, lapse in clinical judgement, etc. as the main contributing factors that cause diagnosis-related claims. Because 60% of Emergency Medicine claims are diagnosis-related, every health care organization should have a strategy for mapping and organizing the most common clinical risk areas that physician’s face. Below we outline a tool that aims to help health systems organize a strategy to address the most frequent and severe malpractice claims.

Physician workflow frustrations are cited by several studies as a significant contributing factor to physician burnout, an epidemic estimated to impact 51% of the physician population according to Medscape’s 2017 study. Because burnout can be tied to risks in patient safety, improvements in physician workflow are key components in the patient safety movement. 

Over the decades, physicians have worked with various medical record documentation styles. While this evolution is thought to improve patient care with each step, the majority of physicians and health systems have yet to maximize the potential of their documentation to improve patient safety. Moreover, each evolution might also be cited as being more complicated and time consuming for the physician, thus adding to their workflow frustrations.

Over the last few years, many of our clients have expressed interest in demonstrating the impact that various system-wide performance improvement initiatives might have on patient outcomes or financial metrics. One of our colleagues from a large hospital system recently posed a similar question about triage. Like many initiatives, given there are so many variables in play, it is extremely difficult to pinpoint a cause and effect with triage; however, let’s explore four areas in which you could expect to see improvements with an efficient, safe triage process.

When creating a loss prevention program, obstetrics (OB) is a logical place to focus. It tends to be one of the riskiest specialties in medicine. Here we’ll highlight the research that points to why OB remains a focal point of organizational leadership and discuss the three attributes a loss prevention program in OB should have.

Why is Obstetrics High Risk?

In a previous posting, “The Ultimate Loss Prevention Strategy: 4 Key Areas of Allocating Your Risk Management Budget,” we highlighted the importance of addressing Diagnosis-Related Adverse Events. As an extension of that article, Dr. Tom Syzek and I provide further detail for justifying that recommendation and the recent data surrounding diagnostic errors, after which we will outline three key attributes of successful initiatives that have led to positive results.

Patient experience is an area of healthcare that has a significant impact not only on an organization’s reimbursement, but also on a hospital’s professional liability (HPL) and exposure to litigation. As a result of recent regulatory changes from the Affordable Care Act, it appears that hospitals have become even more judicious in their allocation of resources to various internal initiatives. With this in mind, let’s explore recent evidence that supports a rational, targeted approach for impacting HCAHPS that should lead to an improvement in reimbursement and reduction in liability.

As the healthcare industry constantly evolves and “return on investment” remains a focus, it is becoming more imperative that risk managers allocate their budgets in areas that have the greatest impact on mitigating claims and litigation.

Fortunately, The Sullivan Group has the luxury of working with many large, sophisticated, self-insured hospital systems as well as smaller single-site facilities and physician groups. This experience has helped us identify four key areas that an organization should consider when developing its loss prevention strategy.

Funding a patient safety program can be challenging, especially when the return on investment is constantly under scrutiny. While the ultimate goal of your program is safer care of patients, there are also measurable financial benefits that result from reduction in claims and malpractice litigation. Professional liability carriers, whether commercial or self-insured, also have a vested interest in your patient safety measures.

Depending upon how your organization insures its HPL/MPL coverage, there are several options for funding your patient safety program.