Risks of an AMA Discharge

The hospital term “AMA” usually refers to when a patient decides to leave the hospital and the care of the attending providers against their medical advice. The AMA designation is used so that future healthcare providers are aware of how the patient/provider relationship came to an end while the patient was hospitalized. This serves to legally shield the attending doctor and hospital from liability if a patient gets ill or dies as a result of the discharge(1).

Patients most often opt for an AMA discharge for the following reasons:

  • Cost
  • Lack of insurance
  • Disagreements over standard of care
  • Errors or mistakes in administering care
  • Previous bad experiences
  • Fear of contagion
  • Wait times are too long
  • Personal reasons

Patients who discharge with the AMA designation definitely pose a litigation risk(2). Without proper treatment and monitoring, these patients are left to make major medical decisions without the advice of a professional. And further, if a patient is in the hospital in the first place, it is likely that they cannot properly treat themselves at home for the same illness/injury. Should the patient’s case come to litigation, the outcome will hinge on what was said, done, and documented when the patient left the hospital, especially the conversation about the AMA designation(3).

Prevention is key when it comes to managing whether a patient even considers an AMA discharge in the first place. The best course of action for a hospital or provider is to diffuse any potential situations before they escalate into an AMA discharge request(4). This is best accomplished by utilizing patient advocates to mediate between the patient’s concerns and the hospital’s directives. This method ensures that both parties are heard and understood by an objective source. Plus, the likelihood of achieving a mutually agreed upon plan of care (and hence, the quality of the care itself) increases when all parties’ concerns are addressed.

Contact us today to determine if your liability coverage is sufficient if your practice incurs an AMA-related lawsuit.

Footnotes

  1. verywellhealth.com
  2. the-hospitalist.org
  3. thesullivangroup.com
  4. today.mims.com

Partner Spotlight: Digital Surgery’s “Touch Surgery” Platform Receives Centre Accreditation

One of our professional partners, Digital Surgery, has great news to share: its Touch Surgery platform has received Centre accreditation to award CPD points by the Royal College of Surgeons of England (RCS). This is the first time that the RCS has offered Centre accreditation to a mobile-based simulation platform in its 500-year history. (For detailed information, please see the original article, posted on Digital Surgery’s website.) (1)

With this accreditation, surgeons can now gain CPD points through the Touch Surgery mobile platform. CPD points are awarded for specific measures, such as cognitive rehearsal and case reflection. Digital Surgery is aiming to obtain CME accreditation soon in the US as well.

What does this mean for CARE clients? Like many of us in the healthcare industry, Digital Surgery wants to improve the delivery of healthcare across the globe. The tools and training provided by Digital Surgery, coupled with the coverage and expertise of CARE Professional Liability Association, ensure that our clients have the proper foundational elements to run a successful practice. This kind of support takes the weight of apprehension (of both training and risk management) off your shoulders so that you can focus on what you do best. 

All successful partnerships (2) have a few things in common. The most important element is to ensure that their customers realize the two-fold benefits of that partnership. Digital Surgery’s mission is to improve surgical performance using technology to provide safe and accessible training. This type of training translates into safer, better outcomes. Successful procedures increase provider confidence, in turn increasing patient satisfaction (3). All three of these elements in turn mitigate risk and reduce litigation possibilities.

Another advantage of membership with both CARE and Digital Surgery is having a strong network of resources at your disposal. This knowledge exchange (4) grows exponentially as members exchange ideas, solutions, and best practices.

Contact us today for more information about our partnership and the benefits that CARE policyholders have with Digital Surgery.

Footnotes

  • https://digitalsurgery.com/2019/10/03/finally-software-eats-surgical-video-storage-and-management-2/
  • https://blog.hubspot.com/marketing/best-cobranding-partnerships
  • https://blog.sprucehealth.com/five-evidence-based-ways-increase-patient-satisfaction/
  • https://bloomfire.com/blog/522359-5-ways-to-encourage-knowledge-sharing-within-your-organization/

Losing a Provider: Ensure Proper Recordkeeping

Providers change practices every day, so it’s important to have a policy in place to provide guidance for patient care and records retention. A formal policy could include the following elements(1):

  • Notify patients of provider’s departure (state laws vary as to whom the responsible party is for this notification, as do details of what to include in the notice; check with your legal counsel for specifics of your situs state)
  • Instructions for contacting departing physician (if still practicing medicine)
  • Contact information at existing practice for reassignment to another provider
  • Instructions for requesting medical records

Most importantly, the policy needs to be communicated to existing staff so that there is no disruption in continuity of care.

Managing the affected patients is only one aspect of provider departures. When it comes to medical records(2), a policy should specifically outline these elements:

  • Exact end date of departing provider
  • Specific party responsible for transferring and archiving records
  • Which party is responsible for contacting affected patients
  • Updating new provider with relevant medical history of patients

Don’t rely too heavily on electronic recordkeeping, though. Nothing beats the trained eye of a professional. Electronic health record (EHR) systems(3) are only as thorough as the data that a person has entered into the system. Mistakes and oversights are just as likely to happen on a computer screen as they are to happen on paper. While EHRs save time, space, and headaches, they might also be managed with great care upon a provider’s departure from one practice to another. Fastidious record keeping is even more important in the event of retirement or death.

If you would like additional guidance in developing these types of policies for your practice, look to other sources, such as HIPAA guidelines, payer contracts, and federal programs such as the Centers for Medicare & Medicaid Services (CMS) (4).

Contact us today. We can help you formulate these types of policies to ensure that they mitigate your risk from future litigation.

Footnotes

  1. ECRI.org
  2. ama-assn.org
  3. physicianspractice.com
  4. cms.gov

CARE partners with SE Healthcare

At CARE Professional Liability Association, we partner with companies that not only help our members, but also understand the healthcare industry and its specific challenges. Our latest partnership with

SE Healthcare provides additional resources to help our members improve operational performance.

SE Healthcare’s Physician Empowerment™ Suite, a set of high-impact data analytics tools, leverages key performance metrics to help practices increase revenue. This is accomplished through enhanced reimbursement negotiations, coupled with an improved industry reputation, once providers have the power of analytics backing their performance.

Other tools provided by SE Healthcare include:

  • Patient Experience Platform
  • Five-Star Reputation Tool
  • Clinical Effectiveness Platform
  • Long-Term Care Assessment
  • Reimbursement Effectiveness™ Platform
  • Physician Burnout Prevention Program
  • Performance Improvement Tools

Both CARE and SE Healthcare understand the intricacies and inherent risks involved for healthcare providers because both companies were built by people with intimate knowledge of the industry. This not only includes physicians, but also top minds from the legal and compliance fields, as well as professionals who continue to shape the future of healthcare. You get the benefits that the years of experience this collaboration creates, including what we have learned from past mistakes, and best practices we’ve developed.

In future partnership blog articles, we’ll discuss the multitude of benefits that providers can gain from SE Healthcare’s analytics tools, including:

  • Getting fair reimbursements from payers
  • Making your practice more attractive to networks
  • Improving your reputation and transparency to convert website visitors into new patients
  • Retaining current patients by creating a better patient experience
  • Enhancing the workplace culture for physicians
  • Enhancing patient engagement and satisfaction
  • Addressing critical issues like physician burnout, quality, and safety

Contact us today for more information about how this CARE/SE Healthcare alliance can benefit your practice.

Medical Records Maintenance: Making an Asset out of a Liability

While Rolf Smith (see quote in the text box on the right) was not an expert on medical records, his wise words do apply to the healthcare industry. Detailed record keeping, including both initial intake and maintenance, are paramount to risk mitigation for healthcare practitioners.

Medical records ensure continuity of care between providers (2). They also act as a means of communication between providers and members. Patient records cover everything from preventive care to treatment, as well as standards and expectations for delivery of care. And while excellent record keeping should be evidence enough that your healthcare practice is doing its best to avoid litigation, a solid audit plan is also imperative to ensure that record maintenance is done properly. Your firm’s records, and your actual recordkeeping practices, will be scrutinized should you ever be sued for malpractice (3). Even outside of a malpractice lawsuit, data breaches are a growing concern when so much PHI (protected health information) is collected by a single source. And data breaches can turn into class action litigations.

While the future lies in EMRs/EHRs (electronic medical records/electronic health records) (4), that does not mean that manual (paper) records are obsolete. And they definitely shouldn’t be discarded. All data that is collected, no matter the format, is subject to privacy laws, and therefore can easily turn into a potential liability.

Accuracy is paramount in recordkeeping (5). Every individual encounter should create a snapshot that stands alone from prior visits (and prior diagnoses). The challenge lies in maintaining this separateness while also creating a ‘big picture’ view of the patient, merging both history and current issues.

Contact us today if you would like to learn more about auditing your recordkeeping system. We know what issues to look for and can uncover them before they become a risk to your practice.

Footnotes