Is there a set of
traits that identify malpractice claim-prone providers? Or at least that identify
complaint-prone trends? A recent
study(1) presented findings that may help industry experts identify
and mitigate future risk based on historical data. For example, in that study,
approximately 1% of all physicians accounted for 32% of paid claims. Additionally,
the risk of recurrence increased with the number of previously paid claims. For
example, providers who already had three paid claims had three times the risk
of incurring another. In other words, they have a 24% chance of acquiring another
paid claim within two years.
Generally speaking, male physicians over age 35 were in the
greatest risk category. Additionally, these specialties were at higher risk for
- Orthopedic Surgeons
- General Surgeons
- Plastic Surgeons
However, the issue isn’t simply a matter of being a male neurosurgeon who graduated from medical school at least five years ago. If other factors can be isolated, then providers and healthcare organizations need to develop programs to reduce the likelihood of adverse incidents that lead to malpractice litigation.
Algorithms and risk assessments are already in place for insurers, with underwriters and actuaries studying data and trends every day. Actuarial analysis for liability coverage creates specific, cost-aligned policies and programs. But data isn’t a person. And malpractice is not always a measurable action. A patient’s propensity to sue is based on many factors, not the least of which is their perceived relationship with their provider(3).
While an evidence-driven trend may exist, the real question
is how to harness this data into actionable future risk mitigation. Does the
defense of malpractice suits only play a reactive role in the healthcare
industry? Certainly, more research is needed to determine whether statistics can
be used for quality improvement efforts, including counseling, training, and
Contact us if you are
interested in learning more about how actuarial analysis aids us in forecasting
your practice’s litigation potential.