This was the hope back in the day when IPAs touted improved patient delivery systems.  In the case of IPAs favorable claim outcomes never materialized.  Will the same happen with ACOs?  Time will tell but in the interim we are working to take advantage of the possibility of lower rates from the nations best companies by developing group purchasing programs for our ACO clients.

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When a physician sets out to become a healer, he has all the best of intentions.  He wants to use his gifts to help people.  What, then, motivates attorneys?  Certainly there are some who are altruistic, but for the most part, the profession is full of self-serving individuals… and once again we’re reminded of the expression “Follow the money.”   Congress itself is nearly entirely comprised of lawyers.  Is it any wonder, then, that working solutions can’t be gotten from them?

When it comes to children, the lawyers seem to set their differences aside and agree that they should have the care, whatever it takes.  What about the young adults, parents and grandparents, though?  States may be scrambling to provide insurance for minors, but they’re largely indifferent to the adults.  Meanwhile, the simple fact is that if the parents have insurance, their children will as well.  If the parents don’t, then just insuring the kids is nothing more than a minimal start, a step in the right direction.  The entire family needs to be able to embrace wellness for it to be safe for the children.  It doesn’t solve the problem if one or both of the child’s parents should become seriously ill or perish.

Wellness is a cornerstone to a prosperous society.  People simply can’t tend to the daily responsibilities very well when they’re sick.  When you happen to be one of those who are ill, it doesn’t much matter what the statistics and percentages of uninsured are.  When we’re talking about millions of people without health insurance, that’s simply too many lives in the balance, no matter what percentage they may represent.

While you’ve been reading this, someone has not gotten care because he or she can’t get insurance.  By the time you’re done reading it, someone will likely have become gravely ill because they didn’t get a much more cost-effective treatment earlier on.  There are a lot of issues and people to take care of.  Let the attorneys duke it out.  That’s what they do best.  Meanwhile, let’s do everything we can to get back to providing care for every patient in need.  In the overall, providing them with the best care possible, regardless of their insurance status, continues to be one of the very best ways to solve the healthcare crisis and avoid medical malpractice suits at the same time.

On a busy night, an ER can be slammed non-stop for 8-12 hours. Each ER doctor may be expected to see dozens of patients each of those hours, to attend to everything from minor traumas to the aftermath of a gang war shoot-out. In the midst of it all will be patients complaining of pain — tooth aches, belly aches, back pain, sunburn, sleeplessness… You name it, the addicts and dealers have thought it up. Pressed for time and unwilling to deny drugs that grant relief to a patient who is truly in pain, the physician will order an injectable and write a prescription for a pain medication. If the doctor begins prescribing a non-narcotic, the patient objects that he has already tried that, that an anti-inflammatory doesn’t work… perhaps even threatening the doctor. When that “patient” leaves, he leaves with a week or month’s supply of opioids that will be consumed in a night, perhaps bringing some of those drugs right back into the ER in the form of an overdose. Others may go directly to the morgue. Either way, when access to narcotics is abused, it doesn’t often end well.

At the core of it all are a few factors: Firstly, the doctor doesn’t want to inflict unnecessary misery on the patient who has legitimate pain. This brings us to that opioids don’t affect everyone equally. An amount which provides relief for one patient’s symptoms may barely scratch the surface of another patient’s pain, making it difficult to know how much is Relief, and when that turns to abuse. Finally, there’s a general lack of accountability. High profile cases like Michael Jackson and Heath Ledger’s deaths may fall under a forensic microscope, but in most circumstances, physicians are not called to justify or account for the prescription…or at least they haven’t been so far.

There is talk of establishing a standard and guideline for the prescribing of opioid drugs. If this should occur (and such legislation often follows high-profile cases,) the physician will have to add yet another issue to the list of things that he can be sued over. If a death can be even remotely connected to the prescription of narcotics, it’s a sure bet that the ambulance chasers will be circling overhead.

Today’s Medical Malpractice risk managment decidedly should include documenting the rationale employed for the prescribing of opioids and other narcotic substances. If the patient presents complaining of severe pain and that recommended non-prescription remedies have failed to provide relief, it may be wise to document this complaint and require that the patient sign to certify that they’ve made the complaint, along with the rationale which led to the prescription. Sending the patient home with a small supply or prescription and a referral to a pain managment specialist may be the best thing for the patient, the physician and the abuser who might otherwise have gotten those drugs on the street. “First, do no harm.”

The Mayo Clinic performed a study which found that physicians who are sued often begin a downward spiral of self-doubt which extends far beyond hurt feelings. The standard of care slips. Doctors begin to doubt themselves, their medical skills, diagnosis… Any and all of these aspects may come into play as the doctor is drawn farther into the legal process, leading to depression. Depositions, court appearances, patient and expert testimony, these are just the beginnings of a process which saps the healer’s strength, leaving the patient case load to pay the price.

When a frivolous lawsuit is filed, the doctor’s quality Medical Malpractice coverage usually kicks in, covering the direct costs of the defense. But it doesn’t cover the indirect costs and expenses, such as the time away from patients to give statements, make courtroom appearances, and the like. The physician is draggged through the muck even when he or she is entirely free from fault, to defend against the allegation. Of course, we all pay for the direct costs of defense, and any settlement which might be agreed upon or awarded. What’s less well known is that the doctor’s other patients are also suffering because of it as well.

As our leaders contemplate ways to get control of runaway medical coverage costs and provide affordable healthcare for all of us, the prices paid for frivolous, baseless lawsuits must be considered as well. Some physicians have become proactive, turning to organizations like Medical Justice for support. Dr. Jeff Segal, founder of Medical Justice, is determined to get put this ugly assault in check. One way that this organization does so is to counter-sue the patient as well as the attorney, seeking restitution for the loss of income, damage to reputation, etc., which are all results of a false or inappriopriate claim being filed.

This approach may not appeal to everyone, but if we are to get a grip on the “sue me” mentality and allow physicians to return to their job as healers, we — as a society — are going to have to stand united against false claims. A physician is not a pinata, to be poked and swiped at in hopes of recieving free treats. As we demand a high degree of excellence from them, we must also afford them protections against such disrespectful and unappreciative perspectives as would motivate people to sue without just cause. We should do so because it’s the right thing to do, of course. But it goes far beyond that when the false allegation affects the physician’s ability to provide quality health care.

We may forget, sometimes, that the doctor is a living, breathing, feeeling human being who feels the bite of that betrayal most sharply. It’s high time we all stood up against those who choose to make their doctor the enemy. Those who view a medical malpractice suit as a winning lottery ticket are costing us all in ways we can’t afford, ways most don’t ever even think about.

The obvious barriers, ageism, for example, are certain to be there. But certifications and medical malpractice insurance are the largest part in the difficulty. If a physician has been out of practice for 18 months or longer, some states may require that he take expensive retraining and re-entry programs. Insurance carriers are also a bit leery, concerned that lack of use of skills and knowledge may leave the physician less mindful of important details, and out of date in his expertise.

Though it may seem strange, since the doctor was in practice for decades, there’s a certain amount of validity to the concerns. While the doctor was in retirement, certain medications may have been shown to be dangerous to the patient. Other drugs may have come out which are much better at treating a condition, and ways of performing certain procedures may have changed. Any of these can put a patient’s safety in jeopardy, and put the medical facility and their medical malpractice insurance carrier at risk.

Yet the industry could use the help of these experienced practitioners, and the doctors themselves may have no real choice. Where’s the solution, then? If you’re a doctor and have any concern that you may have to come back out of retirement, continue practice by volunteering or working part time, so that your currency doesn’t lapse. If you’ve already come out of practice by a bit, you may need to volunteer part time for a little while to demonstrate and reestablish your competency. Be prepared to act as a primary care physician, even if you were highly specialized. Be willing to work in the areas and shifts you’re most needed, and be prepared to take slightly less while you re-establish yourself.

Those who want to return to private practice may have difficulty acquiring medical malpractice liability. As an independent broker, Presidio is in the best possible position to find the best coverage at the lowest prices possible. Give Presidio a call, find out how we can help!

In my case, I still feel the General wasn’t necessary.  The doctor quotes the need for a sterile field, but it was all soft tissue, limited to a 4 inch incision.  People regularly get wounds far larger in a dirty workplace and still recover with basic antibiotics.  I’d like to be more optimistic, but the surgeon is part owner of the surgical facilities in the complex, which leads one to suspect, or at least question, motives to insist on an operating theatre, rather than just doing a local or a block and performing the same procedure in-office.  Had it been performed that way, I wouldn’t have just spent 2 weeks of highly disturbing and life-changing symptoms (so far) following that relatively simple procedure (relocating the ulnar nerve at the elbow).  

Pulling it all together if undergoing General Anesthesia leaves the patient’s body so disturbed for 6-12 months, it seems that should be a last resort.  Every case is involved, complicated in some degree by other factors, but the point remains that it’s far more likely that a patient will sue over complications from the anesthesia than an error in a relatively simple procedure.  This reason suggests that performing surgeries in office, avoiding General Anesthesia as much as possible, may significantly lower the risk of a lawsuit.  Some could counter that the strict observance of OR procedure avoids other dangers, but it remains that the anesthesia itself is a dangerous proposition — perhaps more dangerous than the cure itself, if performed in-office, under local anesthesia

An affordable way to lower your risk is translation service. LifeLinks(TM) is one example. They offer top notch translation service with experts in many languages, including American Sign Language. Remote video translation services are very affordable, and help protect medical care facilities (and other businesses) from litigation. Lifelinks services can also allow a physician to remaining compliant with both the Americans with Disabilities Act (ADA) and the Health Insurance Portability and Accountability Act (HIPAA). Since recent court decisions seem to be finding for the plaintiff when translation services aren’t provided, it’s a smart and inexpensive move.

The new LifeLinks(TM) package retails at $99.00, and includes connectivity software to work with your existing webcam. Certified interpreters and sign language specialists await your video call. There is no minimum; you pay only for actual time used for language interpretation and sign language services.

Communication being essential to care and treatment, LifeLinks’ services seem like an outstanding way to protect yourself and your patients. Not only will you be protecting yourself from an expensive suit with translation services, but you’ll be sure you’re providing your patients wit the best possible care as well. We here at Presidio are always anxious to help you save money and lower your Professional Malpractice risks. Call us for a free consult. We look forward to being of service to you!

Making matters worse, Kaiser and Aetna have stopped paying for midwife and birthing center deliveries, (even though such are exponentially less expensive than a hospital’s C-section.  This requires that women go to a hospital and endure the C-section, as VBACs are not allowed.

Women’s right to childbirth on their own terms is a moral/ethical choice.  When statistics concur that vaginal childbirth remains safer, even after C-section, it seems unlikely that insurance companies would balk at allowing a woman to choose a VBAC.  It’s equally confusing that they would not prefer to pay for a far less expensive birthing center or midwife delivery.  

Amongst other issues is that women often don’t discover that the VBAC isn’t allowed until after they’ve arrived at the hospital and are in labor.  Then, earlier in this month, came Wall Street Journal’s report of study in the New England Journal of Medicine. The study reveals that 1/3 of the C-sections are performed too early, increasing the dangers for both mother and child.

Those who want a faster, easier, less expensive way to visit with a physician will be the first to use the service. The uninsured and those living in more remote or rural areas within Hawaii are amongst the target markets, but others may find the Web-Call more convenient, especially for interactions which don’t really require the doctor to examine them closely.

Some examination is possible via the webcam, but a camera is not required for the visit. Text chatting with the doctor can also be used. While the program is generally well-received, some physicians have expressed concern that it can be difficult to determine the cause of a disease via webcam. Others point out that while it’s a good tool, it cannot replace a personal exam, because over the Internet the physician doesn’t have the opportunity to notice hints of disorders that patients aren’t specifically complaining about. Though it may not substitute for an in-person exam, it can allow doctors the opportunity to do triage, to recommend being seen in person at an E.R., if the concern is grave, or to schedule an appointment, if necessary.

American Well appears to have gained Washington’s attention. Legislators whowant to expand access to health care are giving American Well’s service due consideration. Other states are expected to be offering American Well’s Web-Call service soon.

Within Hawaii, the plan is that the 700,000 members of the Hawaiian healthcare system will pay $10 for their initial ten minute Web-Call with the doctor. (The visit can be extended for additional fees.) During the call the physician can file prescriptions and view patients’ medical histories. American Well is working with HealthVault, (Microsoft’s electronic medical records service,) and
Aetna’s ActiveHealth Management, which scans patients’ medical history for gaps in their previous care and alerts doctors to those gaps during their American Well appointment.

Uninsured Hawaiian patients will also have access to Web-Calls, but they will pay $45 instead of $10 per visit. American Well gets a fee per member and a transaction fee of about $2 for each Web-Call visit.

Concerns that the uninsured might not have internet access have been diminished since Forrester Consulting’s study was released in November, 2008, indicating that about two-thirds of California’s uninsured patients used broadband at home.

The most obvious uses of a Web-Call are for patients who need medication refills or follow-up consultations, and for the elderly and homebound. It is not expected that a Web-Call will ever replace office visits, but is seen as a welcome and useful tool, and an affordable option. Using Web-Call visits to resolve basic needs and concerns could go far towards reducing the cost of healthcare for both the insured and uninsured patients.

What affect this may have upon Professional Liability for those physicians remains to be seen. Neither the insurance industry nor the nation’s healthcare providers have checked in on this novel method, nor have patients fully expressed their views. it is expected that patients will welcome the convenient and affordable access to healthcare providers. Feel free to Comment your thoughts or opinions here!

What some may not consider is that doing so may also reduce your risk of liability in Medical Malpractice significantly. The physician, RN or surgical nurse who can demonstrate that they had current knowledge and information at the time will be in the best position to defend their actions if an unfortunate event should occur, causing harm to a patient. Consider it from a jury’s perspective. If healthcare providers haven’t done anything extra to stay abreast since they entered the field, the jury can interpret this as indifference to patient welfare. If, on the other hand, that healthcare provider attends educational seminars, subscribes to publications (and demonstrates a habit of reading them, being aware of their content,) etc. this will be seen as a healthcare professional who obviously takes the job seriously and truly cares for the well-being of the patients in their charge. Obviously, this defendant is far more likely to be given the benefit of the doubt, to be seen as responsible, and to be trusted as having done the best thing possible for that patient.

Since most malpractice cases are taken on a contingency basis, the attorney who sees such credentials is far less likely to pursue a malpractice suit in the first place, knowing that it’s likely the jury will side with the well-informed healthcare provider. Your voluntary efforts at continuing your education may help you avoid being sued in the first place, and will certainly be a factor in gaining a jury’s confidence, should a case arise. You owe it to yourself (as well as your patients) to make a habit of continuing your education. The case you save…