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Got an extra $1.4 million to spend? You might need it if you don’t have cybersecurity liability coverage.

Did you know that it costs roughly $1.4 million to recover from a cyberattack? The cost of lost productivity, damage to your practice’s reputation, and service disruption, among other expenses, add up quickly(1). Responding to cyber incidents can be time-consuming too, depleting resources and taking your focus away from patient care.

Data transmission permeates the healthcare industry. While we assume the obvious data breach potential occurs when transmitting PHI (protected health information) data from one provider to another (physician to hospital, for example), even seemingly innocuous DME (durable medical equipment), such as insulin pumps, pacemakers, and infusion pumps, carry the threat of data theft and exposure(2).

CARE Professional Liability Association offers liability policies to protect policyholders against evolving cyber threats. A cyber liability policy covers many aspects of potential risk(3):

  • Privacy or security breach mitigation, including the cost to provide 12 months of credit monitoring and identity restoration services to affected individuals
  • Data restoration, recovery, or replacement costs when data is damaged, corrupted, or destroyed as a direct result of a network security incident
  • Income loss and business interruption expenses
  • Ransom payments to persons reasonably believed to be responsible for a cyber extortion threat
  • Brand loss: loss of net profit incurred as a direct result of a breach notification or adverse media report following a privacy/security breach
  • Claims alleging negligent acts or errors in electronic or print media that results in infringement of copyright, trademark, domain name, or plagiarism
  • Claims alleging liability for failure to prevent or hinder a privacy/security breach
  • Investigations and other civil proceedings brought by government agencies for the enforcement of privacy regulations
  • Written demands for assessments made by acquiring banks or credit card associations due to non-compliance

Contact us today. We are serious about data security and patient privacy. We can help you mitigate cyber security risks before they affect your practice.

Footnotes

  1. https://healthitsecurity.com/features/what-is-cyber-insurance-for-healthcare-organizations
  2. https://www.healthdatamanagement.com/opinion/how-cyber-risk-is-affecting-medical-professional-liability
  3. https://gallery.mailchimp.com/2e65dcb86f6030c0d5aba0903/files/5b57d519-55f8-4271-8ba6-215aa7ae0d6d/CARE_RRG_Agent_Cyber_Flyer_10.17.pdf

Another Strong Partnership Development: CARE and HealthShare

We are excited to announce our partnership with HealthShare, an association with more than 40 years of experience in the healthcare industry. They provide a proven, non-insurance solution to the high cost of paying for healthcare.

HealthShare is managed by SHMI, Inc., which assists its clients in improving healthcare services and reducing costs. Their mission is to facilitate access to quality healthcare at affordable prices. The HealthShare model is centered on a commitment to healthy living and a cost-sharing model of medical care. Learn more about this model here.

The partnership between CARE and HealthShare serves to benefit our clients, agents, and brokers, as it provides a workable solution for you, your peers, and even your clients if they are looking for affordable, high-quality alternatives to traditional health insurance options.

To see more details about how this program works, please click here. Or complete this form to be contacted by a HealthShare professional.

Additionally, you can Contact us at CARE today. We can show you how this new partnership offers benefits to you and your clients.

Opioids and Liability: Understand Your Risk

Opioids and Liability: Understand Your Risk

Opioid-related overdose deaths have more than tripled in the past 20 years. Even more alarming, the rate of correlated emergency room visits has doubled in just the last five years(1). Many providers are unaware or unsure of their liability when it comes to prescribing opioid painkillers. And even when the limit of your liability seems clear, there is no guarantee that your patients understand that and it definitely doesn’t prevent them from filing a malpractice claim.

Our partner, OmniSure, has a host of resources on their website(2) to help you combat potential liability issues. Some suggestions include:

  • PMP (prescription monitoring program): Participate in your state’s PMP to increase the effectiveness of information sharing among providers, pharmacies, and patients
  • Provider education: Educate yourself and your staff on regulations, drug interactions, and protocols for handling adverse events
  • Evidence-based treatment guidelines: Treatment solutions are constantly evolving, so stay updated on new ideas, statistics, and the latest recommendations
  • Fight the addiction stigma: Ensure that your practice understands the importance of making patients feel comfortable discussing any destructive opioid-related patterns they may develop
  • Patient education: help patients understand the signs and symptoms of addiction, as well as promote the help that is available to them

All of these tools can both improve patient safety and reduce potentially litigious situations for your practice.

Opioids are a necessary component of some patient treatment plans. Discussing all options with your patient is a necessary first step. It’s also important to consider alternative prescribing options, such as writing dispensing orders for fewer days and at lower dosages(3). This puts a system of checks and balances in place to more closely monitor patient behavior and in turn reveals potential addictive behavior earlier.

As a CARE LLC policyholder, you can receive discounted services from OmniSure, which includes access to the RiskFit® Helpline(4). This service provides guidance and assistance when you have questions about patient care, such as opioid prescribing. Contact us at CARE today. We can show you the many benefits of being of CARE client.

Footnotes

  1. https://omnisure.wistia.com/medias/taws05pvwz
  2. https://www.riskfitness.com/opioid-liability-resources?cid=85fab4ed-3196-4e75-8828-a8ba9e4067ad
  3. https://www.cdc.gov/drugoverdose/data/prescribing/prescribing-practices.html
  4. https://www.riskfitness.com/

Partner spotlight: Digital Surgery

Digital Surgery(1) has an award-winning surgical simulation platform, Touch Surgery(2) (free download available on Android and iOS), which provides surgeons with an entire library of surgical workflow simulations at their fingertips. CARE, LLC partnered with Digital Surgery because we strongly believe that this application is improving lives across the globe. The platform allows surgeons to review, test, and practice their skills before ever working on patients. This in turn increases both confidence and skill, which translates into better patient outcomes.

Studies show that confidence and competence(3) grow along the same curve. Training simulations in the library that Digital Surgery has developed aid in increasing this growth curve. Touch Surgery Professional(4), another one of Digital Surgery’s products, is a video-sharing web and mobile-based platform, which enables groups of surgeons to share their techniques within their department and across institutions, along with allowing program directors to more easily assess the performance of their surgical residents. This in turn accelerates development and the adoption of best practices across any given institution.

Many conferences and hands-on training courses use simulation technology to advance surgical training, such as at the University of California San Diego Center for the Future of Surgery(5). Simulation training allows for a multi-faceted approach to learn and to share experiences with peers.

This knowledge sharing is what makes Digital Surgery’s applications so successful. Surgical teams can build their own personalized library to share with their colleagues, which helps to standardize procedures and best practices, and eliminates waste, inefficiency, and ambiguity. Outside of surgical teams, the platform helps bridge the training gap between surgeons and medical device manufacturers, ensuring clinicians and staff are properly trained on the use of new equipment.

For CARE policy holders, this can translate into true savings. This expansive training tool reduces your risk of malpractice litigation. Streamlining and standardizing surgical procedures ensures that there is little room for error, which also mitigates your risk potential. And fewer adverse incidents converts into lower liability premiums. Contact us today for more information about how these tools can benefit you as a CARE client.

Footnotes

Malpractice Prone: Do Providers Have Common Traits?

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 litigation(2):

  • Neurosurgeons
  • Orthopedic Surgeons
  • General Surgeons
  • Plastic Surgeons
  • Obstetricians/Gynecologists

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 supervision.

Contact us if you are interested in learning more about how actuarial analysis aids us in forecasting your practice’s litigation potential.

Footnotes

  • https://www.nejm.org/doi/full/10.1056/NEJMsa1506137
  • https://www.physiciansweekly.com/examining-proneness-to-malpractice-claims/
  • https://www.nytimes.com/2015/06/02/upshot/to-be-sued-less-doctors-should-talk-to-patients-more.html

The Fine Line Between Supervision and Accountability

In an earlier blog, we discussed the Swiss cheese model as it relates to risk management in healthcare. Today’s article takes a deeper dive into the element of supervision in that model, especially as it relates to Advanced Practice Providers (APPs). These APPs are generally defined(1) as professionals with advanced training, such as Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs). A practice itself might employ APPs or managing physicians may simply have supervisory responsibilities due to contractual arrangements directly with APPs or with facilities that use APPs. In either case, APPs are able to practice independently of physicians(2).

As this video explains, APPs are essential to professional practices in that they assist with provider workload and help keep costs down. Any office that is inundated enough to outsource some of its workload to APPs runs the risk of miscommunication, inadequate care, adverse events, and subsequent litigation. This resulting litigation could potentially involve both the supervising physician and the APP. That is why it is immensely important to outline the scope of the APP’s responsibilities, taking in to account their experience and ability to make judgement calls in the absence of the supervising provider.

The RiskFit helpline, managed by OmniSure, serves as a vital resource to CARE Professional Liability Association members. The professionals that operate this helpline can answer questions about the following:

  • Developing a collaborative provider/APP agreement
  • State-specific laws regarding APP scope of responsibilities
  • Hiring protocols
  • Proper risk reduction audit procedures
  • Capturing patient satisfaction metrics

All of these aspects of APP employment need to be carefully planned and documented to avoid potential litigation issues. The partnership between CARE and OmniSure puts a wealth of expertise at your fingertips to help you fill the holes in your risk management plan so that it does not turn into a block of Swiss cheese.

Contact us today if you have questions about whether your plan provides coverage for the APPs in your practice. Laws vary based on the state where you practice(2), and are constantly changing. Put our expertise to work for you in designing a coverage plan that perfectly suits your business.

Footnotes

  1. https://www.forbes.com/sites/realspin/2017/03/16/advanced-practice-providers-are-key-to-americas-healthcare-future/#2c8596759985
  2. https://www.studergroup.com/resources/articles-and-industry-updates/insights/august-2016/optimizing-the-value-of-advanced-practice-provider
  3. https://www.healthleadersmedia.com/clinical-care/aprn-and-pa-scope-practice-rules-draw-fire

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

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