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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

Agents: Educate Both Yourself and Your Clients

Brokers and agents act as the liaison between medical malpractice insurance carriers and healthcare providers (including doctors, ARNPs, surgeons, dentists, behavioral health professionals, etc.). As a liaison, it’s important that you understand the complexities of this type of liability insurance. Some of your clients might be just out of medical school, or working as a subcontractor, or are going into business for themselves and no longer under the umbrella of a hospital policy. No matter their situation, your main goal is to educate your clients.

How can you help them decide which policy is best for them? Some key elements to discuss with them include:

  • Point out whether a policy covers bodily injury, property damage, and/or liability for personal injuries. And if so, what are the coverage limits? Be sure to note that per-occurrence and per-policy limits are two separate dollar amounts. Outline any conditions and exclusions so there are no surprises should your client be sued.
  • Know your state’s minimum requirements for insuring specific types of practices. Surgeons and OB practices have more risk potential, and therefore, need stronger risk buffers.
  • In addition to state minimums mentioned above, ask your clients how risk-averse they tend to be. How comfortable are they with lower policy caps? You don’t want them losing sleep at night (and calling you!) when they could simply make some policy adjustments to match their comfort level.
  • Discuss potential litigation costs, and specifically which legal expenses are covered by the policy.
  • Outline differences in reporting periods. Basically, they have two options: claims-made policies or per-occurrence policies.

Considering that a majority of healthcare professionals will face at least one medical malpractice lawsuit in the course of their career, their liability coverage is an important part of their success. Aligning your clients with proper coverage ensures success for both you and them.

Contact us today if you’d like to learn more about becoming an agent for CARE. We place a strong focus on serving the needs of our agent/broker network and would love to discuss partnering with you.

Seven Elements You Need to Understand in Medical Malpractice Policies

Providers have plenty of options when purchasing medical malpractice coverage. Both the availability of coverage options and the types of plans available can seem a bit overwhelming. Standard insurance companies, as well as specialty insurers, provide policies. But don’t overlook risk retention groups, which can provide great rates along with additional concierge-level services and benefits.

When reviewing a policy, pay attention to the following elements:

  1. Specific coverage details: For example, determine whether the policy covers compliance-related incidents or HIPAA violations.
  2. Conditions, exclusions: most policies do not cover criminal acts or sexual misconduct.
  3. Financial limitations: malpractice policies usually have one cap for the maximum paid per claim per policy year, and another cap that is the maximum paid for all claims during the policy year.
  4. Policy definitions: what is the “general standard of patient care”, and who defines it?
  5. Subcontractor liability: determine whether you are a subcontractor to the hospital or clinic where you perform services. Ask if your office/lab personnel are considered your subcontractors.
  6. Litigation-related costs: this includes what it costs to defend your firm in court, attorney fees, court costs, arbitration and settlement costs, medical damages, and punitive and compensatory damages.
  7. Reporting period (claims made vs. claims occurrence): in short, a claims-made policy provides coverage if the policy is in effect both when the incident took place and when the lawsuit is filed.

Additionally, it’s important to know your state’s malpractice insurance minimum requirements (if applicable) before purchasing a policy. Not only are state-mandated minimums important, but also consider your own personal and practice asset protection needs, which may vary greatly based on your risk-aversion mentality. It might be in your best interest to work with a professional consultant to determine the appropriate type and amount of coverage for your particular situation.

Contact us today. We can help determine your risk threshold, as well as help you feel comfortable in making a sound decision about medical malpractice insurance.  

The Case for Case Studies

As a medical provider, you know the inherent risk and likelihood of unforeseen adverse events. You may need advice when these situations unfold. CARE, through our partnership with OmniSure, offers a helpline specifically for such issues. The helpline assists with questions about specific incidents, risk mitigation, and regulatory-related issues.

We then use the information gathered from our helpline to develop case studies, which in turn help our clients navigate the waters of incident reporting and risk mitigation. The aggregation of this data, coupled with our extensive experience, provides clients with examples, solutions, and best practices of clients that have been in similar situations.  

In this and future posts, we will explore case studies, and how learning from them helps our clients prevent future claims. As an example, this case study outlines a lawsuit wherein the plaintiff alleges that her husband died as a result of a prescription overdose after seeking care from multiple providers – including independent physicians, supervised nurse practitioners, independent advanced practice providers, and specialty clinics – who were negligent in the treatment and monitoring of the patient and his condition. While this case has not been settled yet, it does remind providers of the importance of completing a thorough patient history, as well as patient follow up.

We all make mistakes, in both our personal and professional capacities. To err is human. If you have patient safety or risk management questions, or need guidance after a potentially litigious event, get the guidance of a clinical risk specialist. Don’t go it alone. As a CARE policyholder, you have access to confidential advice-on-demand from a third-party firm that specializes in helping avoid litigation by protecting your patients, your license, and your reputation. Click here for more information.