Coordinating care does not raise liability risk, study says

If you've ever worried about how coordinating care for your chronically ill patients might affect your liability risk, you can rest easy, according to one recent study.

Care coordination does not increase a physician's liability risk, and in many cases, it can help lower that risk, according to "Liability Implications of Physician-Directed Care Coordination," published in the March/April issue of Annals of Family Medicine.

Mark A. Hall, a law and public health professor at Wake Forest University and the study's lead author, said researchers found several possible reasons why coordinating care may contribute to a lower liability risk. Among them:

• Chronically ill patients generally include older patients who are less likely to sue.
• Care coordination should improve outcomes.
• The technology necessary to support coordination should help reduce medical errors.

Hall and others conducted the study under the assumption that some physicians may see care coordination as an unnecessary risk, despite the encouragement by organized medicine and public programs to take on those duties for their patients.

Heightened fears about liability have been common side effects of past developments in medical practice, including the managed care gatekeeper model, telemedicine, and best practice guidelines, Hall said.

"After implementation, however, fears were found to far exceed reality in each of these areas," he wrote.

The study was a follow-up to one conducted through the Partnership for Solutions, a project of Johns Hopkins University and the Robert Wood Johnson Foundation dedicated to helping improve care for people with chronic health conditions. The initiative pinpointed legal liability, reimbursement issues, and information systems as three factors that affect care coordination.

Care coordination part of the job

Leaders at the American Academy of Family Physicians said the most recent study results were not surprising. But if the opposite had been true, it may have created a stir, said Larry S. Fields, MD, AAFP's president-elect.

"We just do [care coordination] as part of our job," Dr. Fields said. "If it had shown that the risk was increased, there would have been some problems."

Primary care physicians are not paid for their coordination efforts, so an increased risk of liability could have made the work less palatable, Dr. Fields said. The AAFP's congress of delegates passed a resolution last year calling for the academy to assist members in seeking payment from insurers for administrative and coordinating services.

With or without pay, however, Dr. Fields said liability risk for care coordination was not even on his radar screen prior to the study. He offered simple advice in caring for chronically ill patients.

"Do what's right for the patient," he said. "It works every time."

Researchers collected data for the report from legal and health policy documents and personal interviews with liability and risk management experts. Interviews with liability insurers revealed premiums did not vary according to how often physicians admitted hospital patients, according to the study.

Frank O'Neil, a spokesman for ProAssurance Corp., a medical liability insurance company based in Birmingham, Ala., said from the company's perspective a physician's approach to care shouldn't differ according to the age of the patient or complexity of the case.

"The same approach to patient care is applicable whether you're coordinating care in a chronically ill case or if you're managing the care of a healthy 25-year-old athlete," O'Neil said. "When we evaluate risk, what we look at is if the physician is practicing in a manner consistent with his skill or training."

Hall said that in few cases, a physician could see a higher liability risk for care coordination. If a physician specializes in care coordination, for example, he or she by definition would have a more complex patient load, Hall said.

Physicians presenting themselves as having a special set of skills also could create a perception, from a legal point of view, of subscribing to a higher standard of care, he said.

Doctors helping their chronically ill patients to simply navigate the health care maze, however, aren't putting themselves at a higher liability risk, Hall said.

"Even though every medical function carries some liability risk, and care coordination is no exception, the extent of these risks appears to be broadly commensurate with other risks in primary care practice," according to the study.