Why Medical Malpractice Insurers Must Evolve to Meet New Coverage Needs of Healthcare Providers
MOS: Medical Record Review Service 8596 E. 101st Street, Suite H Tulsa, OK 74133
Medical malpractice cases involve medical peer review to determine liability. Insurers must evolve to meet the changing demands in the healthcare scenario.
Though Doctors strive hard to limit medical errors, they still occur, resulting in permanent injuries or even death to patients and triggering processes such as medical peer review. The healthcare industry in the United States is changing and expanding, and so is medical malpractice exposure. Healthcare entities are increasingly providing services in areas such as home healthcare, which is a rising business and expected to grow 40% over the next decade. This is mainly driven by the fact that baby boomers are aging and prefer services within the comfort of their own homes. Other potential areas include hospice, anesthesiology, telemedicine, nursing homes and assisted living. Providers will be looking for malpractice insurance in these healthcare areas and to stay competitive, insurance companies also need to expand their offerings in these new areas. Coverage Requirements Change with the Type of Setting and Profession Given that medical (professional liability) is bound to increase in the changing healthcare scenario, specialized knowledge is required to provide apt coverage for professional liability of medical malpractice for physicians, nurses and other healthcare workers. This is an area where healthcare providers are at considerable risk of malpractice litigation, with sensitive family members very likely to initiate malpractice lawsuits when an adverse event occurs to their near and dear ones. When providing coverage, insurers need to understand that the risk exposure varies with various settings.
• For example, in the Emergency Room large volume admission of patients in critical conditions has a direct effect on malpractice exposure and professional liability.
• The malpractice risk for a single nurse who has the responsibility for an entire floor or building is much higher than nurses and personal support workers functioning in elder care roles.
• With increasing popularity of home care, the medical mal claims coming from the patient’s home represents the majority of all the claims. Unexpected death is found to be the most often reason for alleged malpractice among nurses – such as when death occurs after an uncomplicated surgery which is least expected. For a physical therapist it would be different. In a physical therapy setting, the most common injury is re-injury such as when a patient sustains an injury once again during physical therapy provided as part of rehabilitation service. Moving on, with the changing healthcare landscape, we are also witnessing an increasing number of physicians drifting away from patient care and taking up the job of consultants. They function as expert witness, medical record reviewer, or contracted medical director,
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thus making their presence in other sides of the industry. Though enterprising, these transitions pose new exposures and risks. The legal risks are multiplied if any of their actions cause financial harm to the healthcare organizations they are working for. •
A major concern for providers working in the role of a consultant is the possibility of recommending practices that could go against federal or state regulations. This would result in a heavy fine or penalty.
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Even though the consultant is not working or interacting with patients, there is the risk of contingent bodily injury exposure. The clinical best practices or guidelines the consultant recommends will be put into practice and used to treat patients. If such practices allegedly cause a patient injury, the consultant could face litigation.
What Would Be a Good Medical Malpractice Insurance Plan? What kind of policy would be beneficial for providers? •
An insurance policy that would cover them if they do medical mission/volunteer work, take up duties as a medical director or consultant outside of their practice, work locum tenens, take a leave of absence, change from full-time to part-time, or include or remove procedures within their practice.
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A malpractice insurance policy (MIC) that would provide coverage for a breach of a practice regulation. Typically most malpractice policies include coverage (costs of defense, penalties and fines) for a breach of state and federal regulations. Providers may want additional regulatory coverage for allegations such as: o
Failure to meet meaningful use obligations
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Violating OSHA (Occupational Safety and Health Administration), ADA (Americans with Disabilities Act), Emergency Medical Treatment and Labor Act or Stark Regulations
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Wrongful termination
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Improper disposal of medical waste materials
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Income tax audits
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Medicare/Medicaid audits
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Disciplinary action associated with professional conduct or competency issues
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Excessive or inappropriate opioid prescribing
An MIC that provides coverage for internet data security or privacy breach. Most malpractice policies cover defense costs, penalties and fines related to a data
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breach. However, providers will be looking for policies that cover the following as well. o
Security and privacy liability which involves third party claims alleging liability resulting from a privacy/security breach
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Multimedia, online and offline liability that provides coverage for thirdparty claims originating from copyright/trademark infringement, plagiarism, libel or slander.
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Privacy breach response costs: This would include patient support and credit monitoring expenses following a breach, and patient notification expenses
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Network asset protection: This includes amounts incurred to recover and/or replace compromised, lost, erased, damaged, or corrupted data
Insurers as Pro-active Partners Healthcare is expanding and so are the associated risks. As providers of medical review services for insurance defense attorneys, we are particularly interested in watching this space. New legislative, regulatory, privacy, and electronic documentation requirements increase the risk exposure for healthcare providers. Today, healthcare professionals need robust professional liability protection and expect their insurer to be a proactive partner that can help them handle the challenges involved. With such a partner, providers can focus on making decisions based on the best patient outcomes and not be harassed by concerns such as litigation, financial loss or invasive regulations. In fact, providers are looking for insurer-led participatory education and coaching that will help improve patient safety and reduce the risk of litigation. In this scenario, MICs that promote risk management education and offer regular in-office clinical risk assessments would be ideal. MICs that help improve practice cyber risk management and provide regular cyber security training to all staff and physicians along with assistance with risk assessments and incident response plans are likely to appeal to healthcare professionals, practices and systems. Carriers working in the healthcare space must be particularly wary of the possibilities of exposures their clients have from various sources. The type of coverage offered should be fairly priced and in keeping with the contemporary needs of the professions.
www.mosmedicalrecordreview.com
(800) 670 2809