WBB's Thought Leadership

Risk of Malpractice Claims Varies by Specialty and Prior Claim History

March 22

One percent of physicians accounted for approximately one-third of paid claims, and proneness to malpractice claims varied by specialty and increased with prior history of malpractice claims.

Although 84% of physicians that paid claims incurred only one from 2005 to 2014, those who had six paid claims had a 79% chance of another within 4 years.

Excerpt: “Medical malpractice continues to be a significant issue for physicians from all walks throughout the United States, and there are long-standing concerns about those who are claim-prone and complaint-prone. ‘Medical malpractice claims are one useful indicator of patient safety,’ explains David M. Studdert, LLB, ScD, MPH. ‘In the past, researchers have compared physicians who have multiple claims against them with other doctors who have few or no claims. These analyses have identified systematic differences with regard to age, sex, specialty, training and certification, claim and complaint histories, and quality of care.’”

“Dr. Studdert and colleagues ... aimed to identify specific physician characteristics that are associated with incurring multiple paid claims. Using data from the National Practitioner Data Bank, the study group analyzed in excess of 66,000 claims paid against more than 54,000 physicians from 2005 through 2014.”

“’Our results showed that about 1% of all physicians accounted for approximately one-third of paid claims,’ says Dr. Studdert. Among physicians with paid claims, 84% incurred only one from 2005 to 2014, accounting for 68% of all paid claims. The study team also found that 16% had at least two paid claims, accounting for 32% of the claims, and 4% had at least three paid claims, accounting for 12% of the claims. Physicians who reached a third paid claim had a 24% chance of another paid claim within 2 years and a 37% chance of another within 4 years. Doctors who reached a sixth paid claim had a 62% chance of another within 2 years and a 79% chance of another within 4 years. In general, physicians’ risk of incurring additional claims was highest in the year after a payment was made and declined gradually thereafter.”

“Risks of recurrence of paid claims also varied widely according to specialty, according to the analysis (Figure), and the range of risk across specialties was substantial. For example, psychiatrists with one or more paid claims had a 5% chance of incurring another one within 2 years and an 8% chance of another within 4 years. On the other hand, neurosurgeons with one or more paid claims had a 16% chance of incurring another one within 2 years and a 26% chance of another within 4 years.”

“The analysis suggests—but does not establish—the feasibility of predicting proneness to malpractice claims. ‘If we can reliably predict these claims, it may be possible for liability insurers and healthcare organizations to use this information constructively,’”

Source: Physician’s Weekly

WBB Take: Malpractice claims are a disruptive nightmare for providers, and the chances are that every provider will experience this firsthand at some point in their career. However, the probability of a malpractice claim is not evenly distributed, and some providers are far more likely to have claims made against them for malpractice than others. Proneness to malpractice claims can be reduced through quality improvement approaches, and practices can take proactive steps with quality improvement to greatly reduce the likelihood of malpractice claims. A good first step is to look at “near-misses” in which patients complained but did not litigate, as well as any claims that were made. There are likely to be far more “near-misses” than paid claims, and these can be the basis for root cause analysis. Using the Ishikawa “Fish Bone” ” analysis in conjunction with the “Five why’s” and a “5S” cleanup   of the environment can be a solid start to reducing risk of malpractice claims.

A proneness to malpractice claims Ishikawa diagram may look something like this:

Matthew Loxton

Matthew Loxton



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