Malpractice Costs Research Articles

Transforming leaders to transform hospitals. Cultivating ethical leadership for compassionate healthcare

The importance of compassionate care has been widely acknowledged in the literature as a crucial component for enhancing patient care, improving clinical outcomes, and reducing burnout, compassion fatigue, malpractice, and healthcare costs (Watts et al., 2023). However, many healthcare systems continue to struggle with effectively implementing and sustaining compassionate care practices due to the burden of administration, limitations in resources, and a focus on efficiency and profitability. The purpose of this paper is to advocate for the necessity of (re) “humanizing” the healthcare environment, which is urgently needed today to counteract the trend of eroding the value or essence of care practices by refocusing on the patient and their family. Specifically, this paper will argue that to reverse this trend, it is crucial to transform the education of healthcare facility leaders and managers at all levels. It is vital to provide them with guidelines and training that is not only technical but also ethical, with a focus on character education. This approach would enable them to recognize the right values and effectively address complex situations from a moral perspective. Providing leaders with the opportunity to flourish through dedicated programs can positively transform our hospitals and healthcare facilities. Such programs are essential for creating a balanced healthcare environment where efficiency and compassionate care coexist, leading to improved care outcomes, reduced costs, and enhanced well-being for professionals.

Trends of Medicare Reimbursement Rates for Gender-Affirming Surgery Procedures.

Awareness of Medicare reimbursement is important for gender-affirming surgeons who treat transgender patients with Medicare. In 2014, Medicare began to provide coverage for medically necessary transition-related surgery. The purpose of this study was to analyze trends in Medicare reimbursement rates for gender-affirming surgery procedures from 2014 to 2022. The Medicare Physician Fee Schedule Look-Up Tool provided by the Centers for Medicare and Medicaid Services was used, and the Current Procedural Terminology codes for 43 gender-affirming surgery services were obtained. Monetary units, conversion factors, relative value units (RVUs) for work, facility, and malpractice costs for 30 transmasculine and 13 transfeminine procedures were analyzed. Descriptive statistics were performed to account for inflation and to determine the relative differences between 2014 and 2022. For all gender-affirming surgery procedures covered by Medicare, the average relative difference of monetary units decreased by 2.99% between 2014 and 2022. On average, there was a 3.97% decrease of work-based RVU charges for transmasculine procedures and a 1.73% decrease of work-based RVU charges for transfeminine procedures. After adjusting for inflation, the average relative difference of monetary units for all gender-affirming surgery procedures decreased by 23.42% between 2014 and 2022. Reimbursement rates for gender-affirming surgery procedures covered under Medicare have decreased over the observed period, and trends in reimbursement rates have not kept up with consumer price index inflation. Gender-affirming surgeons should be conscious of these changes in reimbursement rates and advocate for fairer compensation to promote medical care among an underserved population.

Evolutionary game theory and simulations based on doctor and patient medical malpractice.

Doctors and patients are the two critical players in medical malpractice. The evolutionary game model of doctors and patients is constructed based on information asymmetry and bounded rationality. The strategy selection problem of the two players in the medical malpractice process was studied. With change in different parameters, the evolutionary equilibrium strategy of the model was demonstrated using Vensim simulation. The results show that the weight, penalty amount, benefits of standardized practices, and patient medical alarm cost of strategies of different doctors are the key factors affecting doctor-patient evolutionary game system. Medical malpractice can be reduced by adjusting the weight of different strategy choices, increasing the penalties for illegal practices, and standardizing medical malpractice costs based on doctors' standardized practice income. Measures to effectively resolve medical malpractice are proposed by introducing a third-party normative system, establishing a doctor-patient information management system, and improving doctors' reward and punishment mechanisms.

Difficult Conversations.

Difficult Conversations.

Role of CT and MRI in Cardiac Emergencies.

Current strategies for the evaluation of patients with chest pain have significantly changed thanks to the implemented potentiality of CT and MRI. The possible fatal consequences and high malpractice costs of missed acute coronary syndromes lead to unnecessary hospital admissions every year. CT provides consistent diagnostic support, mainly in suspected coronary disease in patients with a low or intermediate pre-test risk. Moreover, it can gain information in the case of cardiac involvement in pulmonary vascular obstructive disease. MRI, on the other hand, has a leading role in the condition of myocardial damage irrespective of the underlying inflammatory or stress related etiology. This article discusses how radiology techniques (CT and MRI) can impact the diagnostic workflow of the most common cardiac and vascular pathologies that are responsible for non-traumatic chest pain admissions to the Emergency Department.

Medicaid expansion, tort reforms, and medical liability costs

AbstractThis paper examines the impacts of the Affordable Care Act (ACA)'s Medicaid expansion and tort reforms on the medical liability system. Medicaid expansion increased the demand for medical services, but in doing so it may also increase physicians' medical liability. By studying malpractice costs to insurers, medical practitioners, and hospitals in the United States in 2010–2018, we find insurers in Medicaid expansion states experienced higher medical liability costs than those in nonexpansion states. Medical practitioners paid higher premiums in expansion states but the premium increase was not enough to fully offset rising costs. In addition, we do not find that tort reforms mitigated ACA‐induced malpractice liability costs. We show this is because Medicaid expansion increased malpractice costs mainly by increasing claim frequency while tort reforms generally reduce claim severity. We also find little evidence that hospitals paid higher malpractice insurance premiums to insurers or self‐insurance programs, or incurred higher out‐of‐pocket medical liability losses after Medicaid expansion.

Malpractice claims in psychiatry: approaches to reducing risk.

Malpractice claims in psychiatry: approaches to reducing risk.

Assessment of medical malpractice cost at a Japanese national university hospital.

ABSTRACTMedical safety management has an economic dimension that has received little attention. Medical expenses associated with medical malpractice in Japan should be investigated in relation to patient safety measures and their consequences. We analyzed medical accidents that occurred within the past seven years at a university hospital. We determined that 197 accidents involved negligence by the hospital in the years from 2011 to 2017, for which the institution bore the costs of the resulting treatment; those expenses totaled JPY 30.547 million. Most incidents occurred in the hospital ward (82, 41.6%); those in the operating room were the most expensive (JPY 19.493 million, 63.8%). The greatest number of cases involved drug administration (63, 32.0%). Materials inadvertently left in surgical sites (“remnants”) cost the hospital the most per incident (JPY 9.767 million, 32.0%). Of these, medical treatment costs for remnants associated with vascular invasion were the highest. Although the total number of malpractice incidents increased over time, the annual cost to the hospital decreased, especially in cases in which costs exceeded JPY 100,000, and those associated with the operating room. Our results suggested that adverse events must be addressed to foster patient safety, decrease medical expenses, and improve hospital administrative capacity.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

The jaw‐dropping costs of oral cavity cancer malpractice

Medical litigation is different than it was 20 years ago due to changes in health care. This study provides an updated analysis of oral cavity malpractice litigation from the past two decades (2000-2010 and 2011-2019). Verdict reviews from the Westlaw database were analyzed from January 2000 to August 2019. Data were collected and analyzed with the Statistical Package for the Social Sciences. Sixty-five lawsuits were evaluated across 24 states. Failure to diagnose was the most common allegation in both decades. Adjusting for inflation, the average amount awarded from 2000 to 2010 was $1 721 068 and $3 925 504 from 2011 to 2019. There has been a significant rise in allegations of failure to biopsy and failure to refer (p < 0.05). In addition, while award amounts appear different between decades, the difference is not statistically significant (p=0.248). Education should focus on early diagnosis, biopsy, and referral to physicians who routinely care for this patient population.

The Origins, Evolution, and Spread of Anesthesia Monitoring Standards: From Boston to Across the World.

In the mid-1980s, the anesthesia departments at hospitals affiliated with Harvard Medical School were faced with a challenge: mounting medical malpractice costs. Malpractice insurance was provided by the Controlled Risk Insurance Company (CRICO), a patient safety and medical malpractice insurance company owned by and providing service to the Harvard medical community. CRICO spearheaded an effort to reduce these costs and ultimately found a way to decrease the risks associated with anesthesia. Here, we chronicle events that led to the dramatic changes in medical practice that resulted from the activities of a small group of concerned anesthesiologists at Harvard-affiliated hospitals. We place these events in a historical perspective and explore how other specialties followed this example, and end with current strategies that minimize the risk associated with anesthesia. We conducted interviews with principals who formulated original standards of patient monitoring. In addition, we consulted documents in the public domain and primary source material. Efforts of these pioneers resulted in the establishment of the seminal Harvard-based anesthesia monitoring standards for minimal monitoring. What followed was an unprecedented transformation of the entire field. After the implementation of these standards at Harvard-affiliated hospitals, the American Society of Anesthesiologists (ASA) adopted "Standards for Basic Anesthetic Monitoring" for use during the administration of all anesthetics in the United States. Other nations have since adopted similar guidelines and these practices have resulted in significant improvements in patient safety. Currently, we estimate mortality due to anesthesia in healthy patients to be 1:400,000-perhaps as much as 10 times lower since the early 1980s. What began as an attempt to lower medical malpractice costs in a group of university hospitals became a worldwide effort that resulted in improvements in patient safety. Other specialties have adopted similar measures. Currently, an attitude and appreciation of safety are exemplified by several practices that include among others-the adherence to these patient safety guidelines, simulator training, the promulgation of standards and guidelines by ASA, and the use of a safety checklist before induction of anesthesia.

Using Big Data Analytics to Identify Dentists with Frequent Future Malpractice Claims.

Healthcare spending has been growing at an increasing rate in the US, due in part to medical malpractice costs. Dental malpractice is an area that has not been studied in depth. Using National Practitioner Data Bank (NPDB), we explored the extent of dental malpractice claims and sought to construct a predictive model that can help us identify dental practitioners at risk of performing medical malpractice. Over 1,500 dental malpractice claims were reported annually, and over $1.7 billion being paid out by medical malpractice insurers over the past 15 years. Majority of claims resulted in minor injuries, and the number of major injury claims increased over years. In prediction, we randomly split the data into train (75%) and test (25%) datasets. We trained and tuned models using 5-fold cross validation on the training set. Then, we fitted the model on the test data for performance measures. We used Logistic Regression, Random Forest (RF) and XGBoost and tuned the hypermeters of models accordingly through grid search and cross validation. XGBoost was the best machine learning model to predict the risk of dentists having several malpractice reports. The best performing model had an accuracy of 72.8% with 30.6% F1 score. The NPDB database is a valuable dataset to study dental malpractice claims. Further analysis of information extracted from this dataset is warranted.

Economic Impacts of the COVID-19 Crisis: An Orthopaedic Perspective.

Economic Impacts of the COVID-19 Crisis: An Orthopaedic Perspective.

Health care spending in the US vs UK: The roles of medical education costs, malpractice risk and defensive medicine

We analyze how two key factors contribute to the high cost of healthcare in the US relative to the UK: (i) the higher private cost of medical education, and (ii) the higher risk of malpractice litigation. To assess the role of these factors we formulate, calibrate and simulate an equilibrium model of physician wages and the supply of medical graduates, work hours and treatment decisions of practicing physicians, and malpractice risk and malpractice insurance pricing. Consistent with prior work, we find direct costs of malpractice fines and insurance explain little of the high cost of healthcare in the US. However, the high private cost of medical education interacts with high malpractice risk in an interesting way: It leads doctors to (i) demand high wages and (ii) use excessive diagnostics to mitigate risk (“defensive medicine”). The agency problem that arises because patients cannot judge the efficacy of tests allows them to be over-prescribed. Together, these factors increase costs far more than direct malpractice costs. Specifically, physician salaries plus diagnostic tests comprise 4.04% of GDP in the US, compared to only 2.3% in the UK. The mechanisms emphasized in our model can largely explain the difference. Our policy simulations imply that more generous medical education subsidies would lead to both improved patient welfare and reduced overall health care costs in the US system (a Pareto improvement). We also find policies to (i) reduce malpractice risk, or (ii) induce doctors to internalize a small part of diagnostic costs, would have similar efficacious effects.

Medicaid Expansion and Medical Liability Costs

This paper examines the impact of health insurance expansion on medical liability costs using the case of the Affordable Care Act’s (ACA) Medicaid expansion. Medicaid expansion has increased the demand for medical services, but in doing so it may also have increased physicians’ liability in medical practices. By studying medical malpractice insurers’ performance in the U.S. for the period 2010–2018, we find insurers operating in states with Medicaid expansion experienced significantly higher medical liability costs than those in non-expansion states. While insurers in expansion states did increase premiums, the increase was not enough to fully offset rising costs. In addition, we do not find evidence that tort reforms mitigate ACA-induced malpractice liability costs. By exploring the frequency and severity of malpractice claims, we find Medicaid expansion increased malpractice costs mainly by increasing the claim frequency, while tort reforms generally focus on reducing claim severity.

Prioritizing Patient Safety Efforts in Office Practice Settings.

Outpatient care settings face unique risks of adverse events and medico-legal liability, often worsened by inconsistent processes and fragmented care. Health systems are increasingly providing integrated care that includes outpatient care, but models of how to systematically target medico-legal risk in office practices are largely absent. Innovative and scalable efforts are needed to guide large health systems in their approach to outpatient safety. A malpractice consortium consisting of five large health care delivery systems identified that its ambulatory care cases (including office practices, outpatient hospital settings, and emergency departments) account for 30% to 35% of annual medical malpractice costs, and missed or delayed diagnoses account for approximately 50% of office practice liability risk. To further understand risks and opportunities in office-based practices, a team of patient safety and loss prevention professionals conducted site visits to seven outpatient-affiliated sites of the five health systems from January to March 2016 and interviewed several key informant members of physician, nursing, and administrative leadership. We identified eight common patient safety risk domains based on analysis of eight sets of group interviews. Risk domains were then prioritized by members of the consortium leadership using scoring criteria that we developed based on existing risk assessment and prioritization approaches. The method helped identify communication and follow-up of diagnostic test results in the outpatient setting as the single most important risk area to target improvement efforts. A targeted approach to identify a single high-risk area led to development of dedicated teams to conduct local patient safety improvement projects at the affiliated health systems and for sharing lessons learned. Similar efforts elsewhere could lead to safety improvements in office practices at other large health systems.

513 Recent Trends in Gastroenterology and Endoscopy Related Medical Professional Liability Claims in the United States of America

INTRODUCTION: In the recent years medical malpractice claims have contributed significantly to the rising cost of medical practice in all specialties in the United States by increasing the malpractice insurance premiums and costs associated with the practice of defensive medicine. Being a procedure oriented specialty, the trends in gastroenterology diagnoses and endoscopy related claims need to be studied to educate the gastroenterologists towards risk management. METHODS: Retrospective analysis of Medical professional liability (MPL) claims data for the years 2006-2015 obtained from the MPL association [formerly the Physician Insurers Association of America (PIAA) Data Sharing Project (DSP)] was done. Among the gastroenterology claims the presenting medical condition, operative procedure, outcomes of the claims and the costs associated with the closed claims were compared between 2006-2010 and 2011-2015 time periods to analyze the trend over the years. RESULTS: From 2006-2015, 90,743 MPL claims were closed . Out of all the claims, 2.07% (1879/90,743) of closed claims and 1.5% (367/24,106) of all paid claims were against gastroenterologists. In the claims against gastroenterologists, 71.0% of were dropped, withdrawn, or dismissed. Within the GI, MPL claims involving diagnostic procedures of large intestine were the most common accounting for 26% of all closed claims leading to a payment of $18,392,668 in total and $301,519 as average indemnity. Average indemnity was highest for diagnostic procedures of gallbladder and biliary tract including ERCP procedures ($484,364).This was followed by procedures involving small intestine ($336,078), large intestine ($301,519) and esophagus ($267,577). In the time frame 2006-2015, the average indemnity increased by 8.2% from $341,563 in 2006-2010 to $369,508 in 2011-2015. Amount spent on legal defense also increased by 8.7% ($44,625 vs. $48,506) in gastroenterology related claims for the respective time periods. CONCLUSION: Gastroenterology specialty has an increasing trend in spending on average indemnity and defense. Diagnostic procedures of the biliary tract including ERCP have the highest average indemnity among the endoscopic procedures. Adequate endoscopic training, meticulous focus on procedural indication and well informed consent might help to reduce the costs associated with claims. Further studies are needed to investigate the variables associated with this trend in gastroenterology.

Updates in medical professional liability: a primer for electrophysiologists.

Medical professional liability (MPL), traditionally known as medical malpractice, affects most electrophysiologists some point during their career, either directly through personal experience or indirectly by the experiences of colleagues. Despite this, most physicians struggle to accurately describe MPL in the context of clinical practice. Providers know little about the outcomes of malpractice claims as reporting of settled or litigated MPL cases is sparse in the medical literature. In the USA, individual patients can file a malpractice claim in a tort-based system, whereas in other parts of the world, no-fault malpractice systems are increasingly prevalent. Tort reform remains a topic of much debate as the economic costs of malpractice contribute to the ever-expanding costs of health care in the USA. This review provides a framework to define MPL, describes the tort and no-fault systems of malpractice, and details the economic impacts of MPL on health care and the practice of cardiology in the USA. Current policy trends towards MPL including tort reform are reviewed, and MPL as it relates to the practice of cardiac electrophysiology is detailed.

Disparity in Medicaid physician payments for vascular surgery

ObjectiveMedicare reimbursements are standardized nationwide on the basis of resource-dependent inputs of physicians' time, intensity, practice costs, and malpractice costs, whereas Medicaid payments vary and are determined by individual states. Our objectives were to determine Medicaid reimbursement to physicians for common vascular procedures for the seven states in the Northeast that compose the New England Society for Vascular Surgery and to compare Medicaid payments with Medicare. MethodsUsing publicly available data, we obtained Medicaid physician payments in Connecticut, Massachusetts, Maine, New Hampshire, New York, Rhode Island, and Vermont for 10 commonly performed vascular surgery procedures. For comparison, Medicare physician payments for these procedures were adjusted for regional differences using Medicare geographic payment cost indices. Descriptive statistics were calculated by state; Wilcoxon signed rank test was used to compare fees, and one-way analysis of variance was used to compare variance. ResultsMedicaid payments varied widely by state. Within individual states (except Vermont), there was no relationship between Medicaid and Medicare payments. Medicaid reimbursement for common vascular procedures ranged from 25% to 91% of Medicare rates and had up to a threefold variation in payment among states for a single procedure. The mean Medicaid payment was 60% of Medicare payment. The greatest state-to-state variance in payment was for open abdominal aortic repair (standard deviation, $227.31); the least was for femoral artery exposure (standard deviation, $31.86). For a Medicaid-based, frequency-weighted analysis of services, New Hampshire exhibited the lowest payments (43% Medicare) and Vermont the highest (80% Medicare). ConclusionsAmong the seven Northeast states considered, with the exception of Vermont, there is no logical relationship between Medicaid and Medicare payments. Because Medicare payments are determined by the Centers for Medicare and Medicaid Services with consideration of resource-based inputs, we conclude that in six of the seven states, Medicaid payments bear no relationship to resource utilization. With Medicaid expansion, access to vascular procedures may be limited by payments insufficient to meet resource needs.

Physician Engagement in Malpractice Risk Reduction: A UPHS Case Study

The University of Pennsylvania Health System (UPHS) implemented a risk reduction strategy in response to high malpractice costs and the broader implications these trends had for patient safety and quality. A key component of this strategy was the Risk Reduction Initiative (RRI), which uses a bottom-up approach to actively engage physicians in risk mitigation and malpractice reduction within their respective departments. The value of clinical communities in achieving common goals has been previously recognized in quality improvement efforts. Using a physician-directed approach, the RRI program requires each clinical department to propose and execute an intervention in response to prior malpractice claims data or recognition of an area of high risk. Based on the success of the intervention, clinical departments were eligible to receive a financial rebate for use in future quality improvement projects. Clinical departments have led the development and implementation of interventions that have shown demonstrable improvements in quality and safety and thereby received full financial rebates. On a system level, the inclusion of physicians in risk mitigation efforts has resulted in significant benefits from both quality improvement and financial standpoints. The number of malpractice claims and malpractice cost have decreased since the inception of the program. Since the program inception, 250 proposals have been submitted and $14 million in rebates have been awarded. Although it is difficult to directly measure the combined impact of these bottom-up, physician-directed interventions, empowering frontline physicians to become actively involved in risk mitigation is a promising method for reducing malpractice claims and costs.