Common Sense To Lower Health Costs
Richman
The national discourse on health care reform has been a long time coming. Current reform plans consider cost drivers, but many believe those drivers don’t adequately address the health care costs associated with medical malpractice litigation and defensive medicine.
The concept of “defensive medicine,” practices designed to avert the possibility of malpractice suits, came into the public eye about 20 years ago, the same time medical malpractice activity and premiums started to rise. Under defensive medicine, doctors may order tests or procedures primarily — but not necessarily solely — to reduce their liability exposure. But defensive medicine increases the cost of health care and may expose patients to unnecessary risks.
While it’s impossible to glean the actual costs of malpractice litigation and defensive medicine, all national estimates put the annual cost in the billions. The Massachusetts Medical Society (MMS) estimates that a litigious culture and the resulting practice of defensive medicine add $1.4 billion to health care costs each year in the state.
While legislatures grapple with how to contain health care costs while maintaining or increasing quality, health care providers are looking at ways to stem rising costs.
At Reliant Medical Group, we began to tackle our rising malpractice costs by becoming self-insured. Indeed, our group’s professional and general liability costs have declined 63 percent from 2006 to 2011. There are a number of factors that contributed, including an enhanced focus on risk management and claims administration, and the introduction of a unique disclosure policy in which we communicate, in a timely and transparent manner, with every patient who has experienced an adverse medical event. This has helped substantially reduce the number of potential contributory events that can lead to actual claims.
Adverse outcomes are a reality in medicine. Despite the best intentions of well-trained health care professionals, bad things happen, sometimes due to a mistake or misjudgment, sometimes due to uncontrollable circumstances. At Reliant, we meet with every patient who has experienced an adverse outcome. We provide them with explanations, answer their questions transparently, and apologize for any mistakes or oversights that occurred. In the past four years, we have had 100 disclosure meetings; only one resulted in legal activity. We also use the information from these meetings to implement and improve processes, to mitigate repeat adverse events.
However, this simple approach has not yet become an industry standard. Thankfully, this appears to be changing. MMS is working with a coalition of health care organizations, including Reliant, to launch its “Roadmap to Reform,” initiative, which aims to increase transparency, avoid or reduce litigation and cut down on defensive medicine. Funded by a federal grant, the Roadmap supports the use of a “Disclose, Apology & Offer” model to help address the fiscal and emotional costs of adverse medical events.
Practicing open, honest and timely communication with patients is common sense. Perhaps the adoption of such practices is the key to solving much of the health care cost conundrum. n
Dr. Robin Richman is executive vice president of medical affairs and chief medical officer at Reliant Medical Group of Worcester.
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