Category Archives: National

December 2019 Newsletter

Personal injury attorneys target definition of a patient With courts increasingly reviewing physician liability for patients they have never treated, the answer to what defines a patient could shape the future of access to care. The issue stems from a recent case in which a Minnesota physician was held liable for harm to a patient he had never examined, reviewed her records or spoke to directly. Under review was whether or not the physician still had a “legal duty of care” following a conversation with a Nurse Practitioner, in which he recommended that the patient not be admitted to the hospital-based on a series of symptoms. The AMA’s Litigation Center, in an amicus brief, argued that the duty of care was premised on a patient-physician relationship, which was not present in this case. While lower courts agreed, highlighting the importance of informal consultations among health care professionals, the Minnesota State Supreme Court overruled these verdicts. A moot court review of the case at the 2019 AMA Interim Meeting saw audience members raise concerns about a number of issues arising from the decision, including “the chilling effect of the decision, decision-making authority of NPs and physician assistants, legal ethics and medical…

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Hospitals Need to Brace for Upward Trend in Malpractice Claims

SOURCE: Healthleaders There has been a dramatic upward trend in hospital medical malpractice claims over the past two decades, according to a new report from Aon and Beazley Group. Over the past two decades, the medical professional liability insurance marketplace has been hardening in response to higher paid claims. The evolving market is putting upward pressure on premiums and downward pressure on insurance industry capacity. Average paid claims in 2018 were 50% higher than in 2009, Valentina Minetti, U.S. hospitals focus group leader at Beazley, said in a prepared statement. “The average paid claim with indemnity closing in 2018 was 6% higher than in 2017. While that is only a single-digit increase from year to year, the cumulative effect of similar rises has taken the average paid claim from $400,000 in 2009 to almost $600,000 last year.” Multimillion-dollar paid claims are taking a toll on insurers and healthcare organizations alike, she said. “The double-digit million-dollar claims are having a chilling effect on the medical liability community. Awards of this size drive hospitals to increase their self-insurance, can cause premiums to rise and industry capacity to decrease, so there is certainly a shared interest in seeing these rising costs stabilize.” Multimillion-dollar…

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October 2019 Newsletter

Alarming rise in premiums highlighted in Medical Liability Monitor The annual Medical Liability Monitor rate survey highlighted a rate increase, not seen in over a decade, and shed light on how the future of liability rates could begin sounding industry alarms. The 2019 Medical Liability Monitor Annual Rate Survey, for the first time since 2006, found that more than 25 percent of medical professional liability (MPL) premium rates increased, while only five percent of rates went down. The overall rate increase year over year was approximately 0.8 percent. The uptick led analysts to study whether or not the conditions exist for a repeat of the cost crisis that occurred in the mid-2000s, with annual rate increases averaging between 10 and 30 percent. Notably, rate increases for general surgery were found to be greater than the average increases. Guest editors of the survey edition, Bill Burns and Alyssa Gittleman from the Insurance Research Department of the global investment management firm Conning, did a deeper dive into the results. According to a press release issued by the Medical Liability Monitor, Gittleman and Burns “compared current market conditions to those which preceded the last hard market. They note similarities between the two in…

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Large med mal verdicts drive hospital liability up: Report

SOURCE: BUSINESS INSURANCE Self-insured hospital professional liability claims remain stable overall, but the frequency and severity of large excess claims continues to increase amid a rising number of large medical malpractice verdicts, according to a new report. The number of hospital professional liability claims experienced by health care organizations at the $2 million occurrence level is expected to remain flat, while claim severity, including defense costs, is growing at a 2% annual rate, according to a report released Tuesday by Aon PLC and the American Society for Health Care Risk Management. However, the frequency and average severity of losses greater than $5 million continue to increase, the report said. “After an increasing number of large medical malpractice verdicts following years of premium decreases, all stakeholders in malpractice liability are under pressure,” the report said. As a result, premium rates and self-insured retentions are increasing, and medical malpractice insurers are reducing capacity or even exiting the market, the report found. The average indemnity paid for claims over $5 million is $10 million now, compared with $8.6 million a few years ago, the Aon database reveals. Beazley PLC’s database of medical malpractice claims also shows the average cost of a paid claim…

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Medical Liability Monitor’s 2019 Annual Rate Survey Indicates a Medical Malpractice Insurance Premiums Rising, But Are We Headed for a Real Hard Market?

SOURCE: CISION According to just-released data from the 2019 Medical Liability Monitor Annual Rate Survey, for the first time since 2006, more than 25 percent of medical professional liability (MPL) premium rates increased, while for a second consecutive year, only 5 percent of rates decreased. These firming rates indicate a turn from the market’s decade-plus period of soft pricing, but is it headed for a real hard market — with annual rate increases averaging between 10 and 30 percent — similar to the last one, which started as a low simmer in 1998, heated up in 1999 and boiled from 2000 to 2006? To answer this question, Annual Rate Survey guest editors Bill Burns and Alyssa Gittleman from the Insurance Research Department of the global investment management firm Conning compare current market conditions to those which preceded the last hard market. They note similarities between the two in the MPL industry’s operating ratio, return on equity, declining loss reserve margins, use of schedule credits and declining competition, but also observe significant differences in policyholder surplus, exposures and ceded reinsurance. What do the Rates Say? From 2007 to 2018, the results of the Annual Rate Survey had a certain familiarity —…

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September 2019 Newsletter

Longer statutes of limitation could invite in lawsuit abuse A challenge to Kentucky’s longstanding statute of limitations on medical liability lawsuit filings could open the door for additional litigation – and medical lawsuit abuse. A case is currently pending before the Supreme Court of Kentucky, seeking permission for a lawsuit to continue outside the statute of limitations under a narrow doctrine intended to apply in situations where continuous care is provided after an instance of negligence. In this case, the plaintiff is challenging that the statute of limitations should be waived anytime a patient is receiving follow up care from any health care provider at the same institution. Ruling in support of expanding that window would have negative repercussions. The Litigation Center of the American Medical Association and State Medical Societies, along with the Kentucky Medical Association, filed an amicus brief with the court. The brief detailed the effect overturning current law would have in permitting patients with lifelong conditions such as diabetes or asthma who receive continuous follow up care to be able to file lawsuits indefinitely. “Such a result would destroy the predictability and certainty essential to the ‘peace and welfare of society’ that the General Assembly sought…

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Electronic-related med mal claims increasing: The Doctors

SOURCE: Business Insurance The number of medical malpractice claims stemming at least in part from electronic health records is increasing and may become a more frequent risk factor, says a report by a medical malpractice insurer. An analysis of 216 claims closed from 2010 to 2018 indicates the pace of these claims grew from a low of seven in 2010 to an average of 22.5 cases per year in 2017 and 2018, according to the study by Napa, California-based The Doctors Co. Electronic health records “are typically contributing factors rather than the primary cause of claims, and the frequency with an EHR factor continues to be low (1.1 percent of all claims closed since 2010),” says the study by Darrell Ranum, vice president of patient safety and risk management at the insurer. “Still, as EHRs approach near-universal adoption, they may become a more prevalent source of risk.” The report says the EHR-related claims closed from 2010 to 2018 were caused by either system technology and design issues, such as electronic systems or technology failure, or by user-related issues. One example presented in the study was of an elderly female patient with sinus complaints, for whom the physician intended to order…

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August 2019 Newsletter

Liability reforms must be more than skin deep An analysis by University of Virginia (UVA) researchers on the prevalence of unnecessary medical tests highlighted the effect on health care costs and patient anxiety, leading a retired neurologist to reflect on how reforms must go beyond the superficial. The initiative followed a report by UVA researchers Andrew Parsons, a hospitalist and an assistant professor of medicine, and Joe Wiencek, a pathologist and an assistant professor of pathology, which found that diagnostic care that offered little value to patients is estimated to cost our health care system $800 billion annually. By offering technical solutions, such as a screen alert when a doctor orders a certain test and a weekly email that analyzes the amount of tests a doctor orders as compared with their peers, they seek to drive down unnecessary costs. Retired Virginia neurologist Dr. Justiniano F. Campa urged policymakers and patients to consider the root cause – a physician’s fear of being faced with a lawsuit. “I have to point out that the main reason for those tests lies in doctors’ fear of being sued, an event that can stop and destroy a hard-earned reputation and career,” Campa writes. While he…

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Opinion/Letter: Unnecessary tests need deep reform

SOURCE: The Daily Progress The July 28 issue of The Daily Progress relates the initiative from two young members of the University of Virginia faculty, Dr. Joseph Wiencek and Dr. Andrew Parsons, about reducing unnecessary medical tests. As a retired neurologist from 40 years of clinical practice, I have to point out that the main reason for those tests lies in doctors’ fear of being sued, an event that can stop and destroy a hard-earned reputation and career. One of my UVa mentors told us, “If you practice long enough, you will be sued.” This fear might lead doctors to: 1) order more tests, 2) refer patients to more expensive tertiary care hospitals and 3) contribute to the current flight to become hospital employees, where ordering more tests is easy and expected, instead of remaining in independent practice. Add these three contingencies, and guess what is the additional cost to our health care? A figure for this cost is not readily available and seldom mentioned, truly a political taboo. Yet I and my contemporary colleagues estimate it at 20% to 25%. When one compares this malpractice cost in the U.S. to the likely 3% in the European countries, it is…

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UVa researchers lead effort to reduce unnecessary medical tests

SOURCE: The Daily Progress Unnecessary medical tests can add to a patient’s costs, discomfort and anxiety as more and more tests cascade in an effort to chase the cause of a symptom. A doctor may order those tests out of a worthy desire to take care of a patient, according to University of Virginia researchers, but when the tests are not needed, they don’t add much value. Instead, according to Dr. Andrew Parsons, a hospitalist and an assistant professor of medicine, and Joe Wiencek, a pathologist and an assistant professor of pathology, hospitals and medical schools can do a better job educating doctors and patients about what tests are supposed to do and when they’re effective — and when to avoid them. The two have teamed up as part of a UVa effort to examine levels of testing and try out various methods to ensure that only useful tests are ordered. “Even in the beginning of medical school, they instill a culture that you should be quite thorough,” Parsons said. “And that makes sense, but we’re trying to switch that culture from thoroughness to appropriateness.” In a June report for the journal Clinical Lab Manager, the two researchers wrote that…

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