Insurer gives prize for ideas to curb lawsuits

Preventing lawsuits increasingly has been on the minds of physicians as medical liability insurance costs have escalated in the past few years. Now one insurance company wants to give an award to doctors and staffs who focus on risk management.

American Physicians Assurance Corp. through Jan. 31 is collecting stories from its 11,000 policyholders concentrated in Illinois, Indiana, Kentucky, Michigan, New Mexico and Ohio so that it can hand out the company's first "Excellence in Risk Management Award."

"We want to encourage physicians who meet high standards in terms of quality care and risk management," said Cathy Burke, APA's marketing director. "We think they go hand in hand."

From discontinuing high-risk procedures to pushing for a $250,000 cap on pain and suffering awards, physicians nationwide have scrambled to find ways to lower their insurance rates and stabilize the medical liability insurance market.

The rising premiums led the AMA to list 20 states as being in a medical liability insurance crisis because physicians are leaving the state, curtailing high-risk procedures or retiring early because they can't afford or can't obtain insurance.

The current climate also has led many insurers to take a harder look at physician record-keeping and office communication before they'll write an insurance policy, said Lawrence E. Smarr, president of the Physician Insurance Assn. of America.

"There is a heightened interest [among insurers] in underwriting the risks," he said. "It's hard to assess clinical skills, but administrative practices can be assessed."

What can you do?

Some physicians have embraced risk management. But in general, doctors and their staffs could be doing more to understand the importance of identifying and then lessening risks, said Theresa Essick, clinical risk management leader for GE Insurance Solutions' Healthcare Providers Unit.

"Communication is at the very heart of how they can be proactive and avoid litigation," she said. "And processes and systems can be put in place to make sure things don't drop between the cracks."

From having a good bedside manner to setting up a system to document when tests or x-rays are sent out of the office and then received back, little things can make a difference in preventing errors, experts say.

Many insurers -- including GE and APA -- use newsletters, online courses and self assessments to help physicians and office staff members improve risk management.

And Smarr said many insurance companies also were willing to audit a physician's office to point out areas that could be improved.

"It might be a good idea to have an office audited once a year. If physicians are uncomfortable in letting their insurance company do an audit, they can find an outside consultant," he said.

Early entrants in APA's contest are already employing some of the strategies that insurance companies like to see.

Farmington Hills, Mich., dermatologist Barry Auster, MD, is among the contest entrants. Dr. Auster's office staff has attended risk management seminars, and he holds quarterly meetings with his staff to discuss issues ranging from the proper way to handle phone conversations to how to manage angry patients.

The office staff tracks lab tests and makes sure they follow up with phone calls if the results are never received, he said. They also follow up with patients who don't show up for key appointments, such as checkups after being diagnosed with melanoma. Every note is dictated and typed.

"Risk management is increasingly more of a priority," Dr. Auster said.

Contest entrant Vernette Carlson, MD, a family physician in Stephenson, Mich., agrees that good documentation and follow-up with patients, and good medicine, is key to minimizing risks.

If a patient does not want a treatment she recommends, Dr. Carlson makes sure that she thoroughly documents that the option was discussed and why the patient decided against it. She also tracks lab tests. Her staff keeps a log of patients who need to be tracked, such as women who have had or need to be scheduled for mammograms. They schedule follow-up appointments before a patient leaves the office and contact patients who fail to show up for those visits.

"I am part of people's lives," Dr. Carlson said. "I try not to let go of things until they are put to rest."

APA's contest

In what's believed to be the first contest of its kind, APA will honor four offices with 50 or fewer doctors. Each will be honored with a dinner for up to 30 at a local restaurant, a plaque and recognition in the APA newsletter and other media.

APA will pick the winners based on several factors, including how effectively the practice uses key risk management systems and how members of the office staff are educated and made aware of the importance of risk management.

Pontiac, Mich., ophthalmologist Alan M. Mindlin, MD, president-elect of the Michigan State Medical Society and a risk management proponent, said APA's effort to recognize what offices are doing is wonderful. His wife is his office compliance administrator, and for years they have embraced risk management systems tracking everything from patient phone calls to prescription refills.

He said the contest could show physicians that risk management doesn't necessarily involve a large financial investment. For example, he said, good office charts are the best defense against a lawsuit.

"I have often felt that doctors are their own worst enemies when it comes to compliance," Dr. Mindlin said.