Defensible Medicine Slashes Malpractice Premiums

January 29, 2015

Defensive medicine makes it more likely that you will be sued. Defensible medicine? Now, that puts you on malpractice insurers’ "A" lists. Here's how.

Just the possibility of being sued for malpractice is so powerful that billions in malpractice premiums are shelled out every year. Worse yet, hundreds of billions in unnecessary diagnostic tests, surgical procedures, and hospitalizations are ordered annually to cover every conceivable base a trial lawyer could second guess.

The practice is so pervasive that it drives physician reimbursements down and malpractice premiums up. State legislatures, bristling with trial lawyers, are unlikely to change tort laws, nor is congress.

As it turns out, according to Nicholas Gaudiosi, president and chief operating officer of Healthcare Providers Insurance Exchange, or HPIX, a medical malpractice insurer based in Philadelphia, malpractice insurers would much rather you practice defensible medicine, and will reward you with much lower premiums if you do.

"We studied thousands of closed malpractice claims across a broad spectrum of complaints in search of a noticeable pattern," Gaudiosi said, "and found that defensive medicine is not only a waste of time, resources and money, unnecessary treatment actually increases the risk of mistakes and adverse outcomes – and litigation risk."

HPIX teaches its clients their five tenets of defensible medicine, and rewards them with lower premiums if they demonstrate that they practice them:

1. Document, document, document.

There is no replacement for a well-documented and detailed medical record. This means timely, accurate, detailed, unaltered, and informative records that paint a picture of the thought process that demonstrates a care plan, not just tests ordered medications prescribed.

2. Patient engagement and communicationwith a focus on patient satisfaction.

A physician who is accessible and honest about care plans and discusses confidence levels with patients and caregivers blunts, if not disproves, claims of negligence in delivering the right care. Patients become plaintiffs when they are scared, frustrated, and not properly informed. A defensible physician takes extra steps to ensure patients understand diagnoses, listen to patient concerns, and treats informed consent as an opportunity to answer questions.

3. Don't be arrogant.

Too many defensible cases must be settled because arrogant physicians make poor witnesses. A confident physician lets the record speak for itself. An arrogant physician appears defensive under skillful cross examination.

4. Coordinate, collaborate, and communicate.

On average, five different specialists will be involved in the care of a critically ill patient. Poor patient handoff, communication with patients, families, and other consulting physicians can create significant liability because it endangers the patient. A defensible specialist encourages the involvement of patients, families, and especially their primary-care physician, who has the best relationship with them and is in the best position to interpret, coordinate, and educate them on clinical decision making.

5. Seek, embrace, and join the best value based integrated care systems.

Value- and quality-based care models are transforming primary-care physicians from fee-for-service providers to integrated clinical managers. The practice of defensible medicine is virtually identical. Information technology and practice transformation enabled population health management employing risk and cost stratification, referral, communication, coordination, and integrated care groups under a common IT platform do much more than improve quality, safety, and clinical outcomes – they do it all at less cost.

Again, an ounce of prevention is worth a pound of cure – and is not only less expensive, but can provide a handsome return on investment.