Why Hospitalists Remain Outside Malpractice Insurers' High-Risk Categories, For Now

The Hospitalist. 2013 November;2013(11):

November 1, 2013 | The Hospitalist

To be sure, many of the same tenets of being a productive hospitalist with high patient satisfaction scores—maintain manageable censuses; focus on patient centeredness; and use checklists, technology, and regimented protocols to reduce adverse events—translate very well to being a lower-risk hospitalist in relation to malpractice cases.

When you’re “thinking of patient satisfaction strategies, also think of them as risk mitigation strategies,” says John Nelson, MD, MHM, FACP, medical director of the hospitalist practice at Overlake Hospital Medical Center in Bellevue, Wash., an SHM co-founder and practice management columnist for The Hospitalist. “They overlap tremendously.”

A History Lesson

Medical malpractice has been around for centuries and has two prevailing goals: 1) to provide monetary remuneration to patients who have been injured via substandard care and 2) to deter that poor treatment through fiscal punishment.

Malpractice lawsuits were not prevalent enough to be a major medical concern until the early 1800s. By the middle of the 19th century, the country hit its first periods of crisis.¹ Cycles ebbed and flowed from there, with malpractice premiums causing crises in the 1980s and again in the early 2000s.

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WHAT MAKES A LOW-RISK HOSPITALIST

Manages workload

Follows professional consensus on workload

12-17: AVERAGE NUMBER OF PATIENTS SEEN PER DAY SHIFT*

20: UPPER LIMIT OF NUMBER OF PATIENTS THAT SHOULD BE SEEN PER DAY SHIFT – SHOULD OCCUR NO MORE THAN 10 TIMES PER YEAR*

10: UPPER LIMIT OF NUMBER OF PATIENTS

Holds privileges for covered specialties
Uses non-physician providers to supplement—not replace—MD coverage

Communicates effectively

Follows communication protocols for patient introductions
Makes post-discharge phone calls to patients within a specified time frame, or designates a staff person to make these calls

Participates on hospital committees

Participates in hospital orientation program and annual updates
Stays aware of patient satisfaction metrics
Participates in quality improvement activities

Maintains competency

Is board certified in internal medicine or other appropriate specialty, and is enrolled in PIMs (ABIM’s Hospital-Based Practice Improvement Module) for hospital practice or in SHM’s Fellows Program
Follows Core Competencies for Hospital Medicine

Works in settings with limited process variations

Works in hospitals that use the same EHR as well as other similar processes, protocols, and policies
Doesn’t rotate to hospitals in different systems
Covers in-house, not on call from home or another hospital

Most common malpractice allegations against hospitalists†

34%: MISSED OR FAILED DIAGNOSES

28%: IMPROPER MANAGEMENT OF TREATMENT

6%: IMPROPER MEDICATION MANAGEMENT

6%: ORDERING ERROR

Most common factors contributing to patient injury by hospitalists†

34%: PATIENT ASSESSMENT ISSUES

23%: COMMUNICATION BREAKDOWN AMONG HEALTHCARE PROFESSIONALS

17%: THERAPY SELECTION AND MANAGEMENT

13%: COMMUNICATION BREAKDOWN BETWEEN PATIENT/FAMILY AND PHYSICIAN

* Nelson J. Heavy Workloads. The Hospitalist. October 2012. Available at: https://www.the-hospitalist.org/details/article/2674071/John_Nelson_Heavy_Workloads.html. Accessed June 24, 2013.

**General industry consensus.

† The Doctors Company, Hospitalists Claims Update, 2013. More than one factor can contribute to a patient injury.

Source: The Doctors Company

Now, rates for medical professional liability insurance have been dropping for seven years, and an eighth straight annual decline is expected this year, according to Mike Matray, the editor of trade publication Medical Liability Monitor and the chief content officer of its associated website, www.mymedicalmalpracticeinsurance.com.

“We are in the longest, deepest soft market that the malpractice insurance industry has ever been in,” he says. “Right now, things are really good for the doctors, as far as rates coming down.”

Matray says he understands that declining rates may seem immaterial to a physician who receives an insurance bill that eats into the bottom line. For some specialties, that premium can be as high as $200,000 per physician, per year—or more.

“I’m not saying it isn’t expensive,” he adds. “It’s expensive to run a medical practice. At the same time, medical malpractice insurance is less expensive in today’s dollars than it was in 2005.”