COPIC Comment: Reducing liability claims and supporting good medicine

Thursday, May 01, 2014 12:44 PM

Connecting our efforts to better outcomes and improved patient safety

Ted J. Clarke, MD
Chairman & CEO
COPIC Insurance Company

In the data-driven world of health care, success often depends on having the numbers to support your actions. Qualitative research guides us as we seek to improve medicine and measured results confirm if we’re on the right path. At COPIC, one way we evaluate our efforts is by reviewing medical liability claims data. Specifically, we look at frequency – how often medical providers face a claim or lawsuit.

Overall, there is still concern about frequency. A 2011 study published in the New England Journal of Medicine, showed that approximately 99 percent of physicians in high-risk specialties – neurosurgery, cardiothoracic surgery, general surgery, orthopaedic surgery and plastic surgery – will experience a medical liability claim by age 65. Data for the lowest risk physicians – pathology, family practice, dermatology, pediatrics and psychiatry – showed that 77 percent face a claim by age 65.

On a national level, frequency of medical liability claims is down, and for COPIC-insured physicians, it is at an all-time low. Why? We believe there are three key factors that contribute to this:

1. A substantial investment in patient safety and risk management programs
Over the years, COPIC has emphasized a proactive, preventative approach to reducing medical errors. Our Patient Safety and Risk Management department offers programs and guidance to mitigate risk and address challenges in health care. From educational activities to an online library of medical guidelines, we continue to invest in an array of resources that are relevant. In particular, two COPIC programs have received recognition for addressing unexpected outcomes and improving care:

• A recent article in Health Affairs highlighted COPIC’s 3Rs (Recognize, Respond, and Resolve) Program as a national model for “communication-and-resolution-programs” that encourage the disclosure of unanticipated care outcomes to affected patients and proactively seek resolutions.
• Each year, we perform more than 2,200 Practice Quality site visits that review patient records and internal systems. Specially trained nurses use “Level One Guidelines” developed by COPIC to assist medical practices in reducing system failures, improving documentation, and ultimately preventing avoidable adverse outcomes.

2. Claims management that seeks to resolve issues in a fair and timely manner
One of the biggest challenges with a medical liability claim is the amount of time it takes to resolve it within our legal system. A 2013 Health Affairs article highlighted that the average physician spends 50.7 months of an assumed 40-year career with an unresolved, open medical liability claim. The article also stated that “Time to resolution is an important component of the cost of medical malpractice resolution to both physicians and patients… . Physicians and their institutions may also be delayed in implementing changes in quality- and safety-related procedures to prevent similar adverse events from occurring again.”

Data shows that COPIC has a lower average number of days to resolve a claim when compared to national figures. One of the reasons we are able to achieve this is by reinforcing the importance of early incident reporting. This allows our team to proactively help insureds address the issue upfront, and facilitate discussion and treatment that meets the patient’s immediate needs with the intent of preserving the patient-physician relationship.

3. Active legislative advocacy that seeks to educate and inform
COPIC’s Public Affairs department focuses on year-round outreach to legislators with a focus on tort reform and patient safety as essential to accessible, affordable quality health care. The complexity of health care and the debates surrounding its future are filled with vast amounts of data, research and opinions. Our efforts seek to represent the perspective and concerns of those on the frontlines – medical professionals, physicians and health care facilities – and reinforce the importance of a stable medical liability environment.

The decrease in frequency of claims is something we are proud of, but it is also an achievement that we share with our insureds. Their involvement in the following areas support efforts to improve health care and enables all of us to make a difference:

• Participating in the patient safety and risk management resources available through COPIC.
• Embracing early incident reporting where they report early and often.
• Being engaged on legislative issues that impact health care in Colorado.