5/15/2018 Office Practice Top Risk Issues: Are You Prepared to - - PDF document

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Office Practice Top Risk Issues: Are You Prepared to Mitigate the Risks?

Michigan Osteopathic Association May 17, 2018

Ann Carter, HRM, CPHRM, CMPE Mary Ellen Filbey, RN, BSN, JD, CPHRM Office-Based Closed Claims Analysis

Disclaimer

This presentation is offered from a risk management perspective and is not intended and should not be construed as legal or medical advice.

Office-Based Closed Claims Analysis

Objectives

• Review closed claims data for office practices

to examine past vulnerabilities and assist in identifying high-risk areas

• Understand the importance of conducting a

self-assessment to identify opportunities for improvement

• Identify risk mitigating strategies to consider

implementing in the office practice

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Office-Based Closed Claims Analysis

Why Do Patients Sue?

Anger Shock Surprise Disbelief Unexpected outcome or injury

Office-Based Closed Claims Analysis

Diagnostic Test Tracking Case

• The patient treated with his family practitioner (FP) for several

years and had routine prostate exams.

• One report indicated that the patient’s PSA was slightly
• elevated. The patient was referred to a urologist.
• Further testing was conducted by the urologist. The patient’s

slightly elevated PSA had not changed.

• The patient subsequently complained of urinary symptoms and

a CT of the abdomen and pelvis were ordered by the urologist.

Office-Based Closed Claims Analysis

Diagnostic Test Tracking Case

• The CT revealed an enlarged prostate and the

radiologist recommended an ultrasound or transrectal biopsy.

• The urologist never saw the CT scan report.
• The report was sent to the FP, who reviewed it.
• The FP assumed the urologist, who ordered the CT

scan, would address the findings.

• The patient continued to treat with the FP and

eventually complained of joint and muscle pain.

• The patient was diagnosed with metastatic bone

cancer that originated in the prostrate. He died one year later.

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Clinical Judgment

Office-Based Closed Claims Analysis

• Review Current Standard of Care
• Review evidence-based guidelines
• Use diagnostic support tools
• Complete Assessment and Document
• Obtain an adequate health history for the patient and his/her

family members

• Refer patients to specialists
• Refer patients for testing
• Ensure you manage the patient’s medication therapy
• Provide education and instructions

Strategies Clinical Judgement Strategies Clinical Systems

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Office-Based Closed Claims Analysis

Effective Tracking Systems

Tracking tests/referrals until results have been received

Timely review and comment by treating provider Patient notification

• f results

Documentation that notification

• ccurred

Office-Based Closed Claims Analysis

Effective Tracking Systems

Process

Ensure patients with abnormal results obtain follow-up care

Medical Record

File/scan results and correspondence from referral providers

Process

Communicate reminders for follow-up appointments

Office-Based Closed Claims Analysis

Tracking Report

• What are some examples of test tracking systems that your
• ffices uses?
• Can your system run tracking reports?

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Behavior-Related

Office-Based Closed Claims Analysis

Behavior-Related Strategies

Strategies

• Assess health literacy and understanding of his/her condition
• Educate about condition and treatment
• Provide clear instructions
• Stress importance/urgency
• Be a good listener to identify barriers
• Establish return call guidelines
• Obtain informed consent and refusal
• Document, document, document

Office-Based Closed Claims Analysis

Patient Behavior

• An elderly patient was asked to complete

a patient intake form and left the medication allergies section blank

• The medical assistant documented in the

electronic record that the patient had NKA (no known allergies)

• The patient suffered a severe allergic

reaction

• As it turned out, the patient knew she was

allergic to penicillin, but she didn’t know how to spell it

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Communication

Office-Based Closed Claims Analysis

Communication

• Communication issues underlie many patient safety problems;

they are often the root cause of severe adverse events

• Interactive exchange of information is vital to the physician-

patient relationship, as well as care and treatment

• Communication among providers regarding the patient’s

treatment is critical to coordinating patient care

Office-Based Closed Claims Analysis

Communication Strategies

Engage in and document important communications with the patient:

• Correspondence to and from patient and family members
• Telephone calls/conversations (messages left, with whom, what was

said)

• Informed consent/refusal
• Missed appointments, tests, and consults, and follow-up actions taken

by the provider

• Telephone consultations with other providers
• Patient responses to prescribed treatments and medications

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Office-Based Closed Claims Analysis

Telephone Call Documentation

• How could this telephone documentation be improved?
• Have you had an opportunity to mentor staff members in this

area?

• Patient called requesting medication change
• Sent to doctors inbox for review
• Called patient

The Cost of Claims

Office Self Assessment

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Office-Based Closed Claims Analysis

Why Conduct a Self-Assessment?

• Identify and minimize potential risks in the practice
• Increase patient safety
• Increase patient satisfaction
• Protect staff members from errors
• Save the practice money
• Prevent a lawsuit from being filed

Office-Based Closed Claims Analysis

Physician Office Self-Assessment Tool

• Generated based on Coverys claim experience
• Focuses on high-risk areas
• Assists in identifying gaps and determining opportunities for

improvement

• May be completed at your convenience

Office-Based Closed Claims Analysis

When completing the assessment:

• Identify problem areas by completing the tool
• Determine priorities
• Develop an action plan
• Assign responsibilities
• Monitor for continual improvement

What’s Next?

Completion of Self-Assessment

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Office-Based Closed Claims Analysis

Obtaining Support

• Provider and staff member “buy-in” to changes
• Discuss the importance and benefits of proactive risk

management

• Encourage provider and/or staff member participation in the

self-assessment review

• Communicate the identified risks which require changes to

be made

Office-Based Closed Claims Analysis

Summary

• Reviewed closed claims data to assist in identifying high risk

areas and the top 4 include:

• Clinical Judgement, Clinical Systems, Behavior, Communication
• Discussed closed claims and the average indemnity paid
• Presented strategies to consider implementing in the office

practice

• Obtaining adequate patient and family health history
• Closing the loop on patient tests and referrals
• Assessing health literacy and the patient’s understanding of his/her

condition

• Document important communications with the patient
• Provided a tool to assist you in identify opportunities.

Office-Based Closed Claims Analysis

Questions?

Ann Carter

Senior Risk Consultant P: 517.898.6739 F: 517.324.2564 acarter@coverys.com

Mary Ellen Filbey

Senior Risk Specialist P: 517.614.8508 F: 517.327.4666 mfilbey@coverys.com

COVERYS

3100 West Rd Building 1, Suite 200 East Lansing, MI 48823

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