By Robert Hanscom, JD, Vice President of Business Analytics, Coverys
Medical malpractice claims data trends are signals ― flashing beacons and shrieking sirens warning you about potential patient harm, claims, and lawsuits on the horizon. These signals can be critical in identifying, and then mitigating ― even eliminating ― risk to patients before they are harmed. In our world, that also means helping physicians and hospitals potentially avoid something that causes them great fear: being named in a lawsuit.
Coverys recently completed a root-cause analysis on five years of historical claims and found that just five areas of alleged error accounted for a staggering 76% of all claims and nearly 90% of indemnity paid.
Our analysis shows that allegations related to diagnostic error are the root cause of 30% of claims; alleged surgical error, 22% of claims; alleged medical management error, 12% of claims; alleged medication error, 8% of claims; and alleged obstetrics-related error, 4% of claims (but a disproportionately high percentage of claims dollars paid).
What Can You Learn From Claims Data?
Even the brightest, most experienced healthcare professionals can be surprised by what claims data tells us. It’s not enough to learn from your own experiences; you also need to learn from your peers. Looking at a broad database of deeply analyzed claims allows you to ask yourself, “Even if that hasn’t happened to me, could it? If so, what can I do right now to be proactive ― to prevent it before a tragedy occurs?”
At the highest level, here’s what our claims data at Coverys has taught us:
The Fact of the Matter? Risk Prevention Is All in the Facts
- The high incidence of missed and delayed cancer diagnosis has not budged. Despite all we know about diagnosing cancer and the many recent advancements in screening, this type of claim continues to be asserted at relatively high rates.
- Diagnostic assessment is often the problem ― doctors get caught in a narrow diagnostic focus: “I’ve seen this before and know what it is,” dismissing other possibilities instead of doing what they were taught to do in medical school by getting a differential diagnosis and doing some rule-outs.
- Surgical vulnerabilities resulting in claims include: leaving foreign objects inside patients, communication breakdowns between phases of surgery, poor initial assessment of the patient (i.e., accurately determining whether the surgery is medically necessary or prudent), and the myriad distractions in the operating room (like cell phones, music, visitors, and unnecessary personnel coming in and out).
- Claims related to anesthesia error are remaining flat and are no longer decreasing as they once were. This may suggest that a sense of complacency has set in from the time, a decade ago, when anesthesia safety scores were on the rise and efforts to stop that trend were put swiftly into place.
- Medication-related claims are not simply errors in prescribing or administering. More and more, they are focused on a physician’s inability to manage patients who are on complex medication regimens ― meds that are often ordered by numerous other providers who are also participating in the patient’s care.
- Signals from obstetrical claims zero in on poor teamwork, lack of situational awareness, and inadequate skills or knowledge. These issues have led to critical communication failures, delays in inducing labor or going to C-section, and babies that incur permanent and preventable shoulder dystocia injuries.
There are many things healthcare practitioners and business leaders can do to identify where risk lies and begin improving patient and financial outcomes by mitigating those risks. Chief among those strategies should be a thoughtful look at national trends in malpractice claims, because what has impacted your peers could ultimately impact you.
But you don’t have to go it alone; ask your medical malpractice insurance provider to partner with you in identifying trends in historic claims data in your region, in your specialty, and in the nation at large. The data tell powerful and predictive stories, and when it comes to keeping your patients and your practice safe, the data is the closest thing you’ll ever get to a crystal ball.
The information described is for general education purposes only and is in no way intended to serve as legal or financial advice. For advice on handling specific legal problems, always consult with an attorney.