Healthcare costs. Every time I turn around, doctors are being lectured on another aspect of the elusive goal of taming this beast.
In fact, a recent study published in the March issue of Academic Emergency Medicine caught my eye, indicating nearly all of 435 emergency department physicians surveyed admitted to ordering too many diagnostic tests out of fear of error, uncertainty, and fear of being sued if they don't cover all their bases.
This isn't breaking news. The reasons are pretty obvious. If you miss a diagnosis or detail, you increase your risk of being sued. The real question is: What to do about it? It's a lot more complicated than, "Stop practicing defensively and ordering so many tests."
At the most basic level, ordering additional diagnostic tests is a doctor's way of saying: "The risks aren't well understood in this particular situation, so I'm going to order additional testing just to make sure."
Specialized Risk Management
One medical specialty with a heightened level of risk is making strides in understanding and containing those risks and associated costs: bariatric surgery. Currently one of the fastest growing areas of medicine, bariatric procedures offer surgical alternatives for obese patients who have exhausted other weight-loss avenues.
Currently, the probability of a bariatric surgeon being sued during their career is 50 percent. However, groups of risk management specialists have put together training, procedures, protocols, and practices specifically for bariatric surgeons and their practices that significantly reduce the risks associated with this specialty. Bariatric surgeons who employ these solutions can see a significant reduction in risk associated with a medical malpractice lawsuit.
What Can We Do?
Looking at the problem from the malpractice insurance side, the vast majority of carriers offer risk management services and training as part of their insurance coverage. Many of the courses provide CME credits and/or premium rate incentives for completion.
However, a frequent complaint I hear from my medical malpractice insurance colleagues is there is all this great content and training available, and yet few doctors take advantage.
Maybe the content isn't as great as we think it is, and we need to offer more targeted, applicable information — like our bariatric risk management friends. Maybe we need to listen more closely to physicians who are in the cost containment crosshairs and provide more actionable information that can help reduce risk and the associated defensive over-testing.
What Can You Do?
While we're working on the insurance end to improve our content and quality, here are a few suggestions for physicians:
1. Check with your specialty association for additional materials, training or certifications that can improve quality decisions and reduce risk. Many specialty colleges and societies are active in this area and can provide valuable resources for providers and practices.
2. Check your medical malpractice carrier's risk management resources. Many carriers offer meaningful risk management training and resources that too often go unused by physician clients. Many offer free CME credits as well.
3. Ask for specific training topics. If your carrier doesn't offer what you need, ask them specifically to provide it. Many insurance companies are eager to hear from their customers and respond to requests for improved risk management — it's good for the physician and it's good for the company. If they are unresponsive, have your broker look at other carriers' programs to find something that is a better fit for your needs.
Risk, like anything else, changes with time. It's clear that taking advantage of education, tools, and programs offered to better understand risk for you and your individual practice can pay off big in the end.
Full disclosure statement: MGIS partners with SE Healthcare Quality Consulting — a safety and risk management services and education firm focused on surgery.