First Healthcare Compliance CONNECT- February 2018

The most comprehensive healthcare
compliance course yet!
Improving patient safety, decreasing rates of error, and minimizing
medical liability costs are important objectives of health care reform
in the United States. Many experts believe that to accomplish these
goals, organizations must adopt principles of transparency and just
culture, and engage in effective and honest communication with
patients and families as well as proactively seek early resolution of
claims after adverse events caused by inappropriate care. In recent
years, forward-thinking health systems and liability insurers have
developed communication and resolution programs (CRPs) designed
to encourage full disclosure of unintended patient care outcomes to
patients and their families. Such efforts involve an investigation of the
incident, an apology, an explanation with complete revelation of the
facts, and when appropriate, reimbursement or compensation. These
programs represent a systematic strategy to respond to patients when
something goes awry, and are integral to patient quality and safety. In
part, they are founded on the principles of respect, transparency, and
honesty and may improve patient safety outcomes and quality of care
by providing an introspective review of the occurrence and promoting
learning opportunities from any mistakes, errors, or near misses. CRPs
meet the needs of patients, their families, and caregivers when an
adverse event occurs in patient care, and address any identified patient
safety and quality gaps.
Alternatives to Medical Malpractice Litigation
Many patient safety leaders view these programs as an alternative
to the costly and lengthy malpractice litigation process which fails to
answer fundamental questions about the nature of the harm and basic
details of the incident. Often, the traditional response to patient harm
involves the disclosure of limited information and avoidance of admissions
of fault–a “deny and defend” model. These interactions quickly
turn adversarial, and the open communication normally accorded the
patient-physician relationship is abandoned. For health care providers,
the “deny and defend” paradigm provides little incentive for investigation
of the event because of the fear that a compensable error might
be revealed. Thus, there is no analysis of the event and organizations
are unable to learn how to prevent a similar catastrophe. This loss of a
learning opportunity can derail efforts to improve patient care.
One of the seminal communication and resolution programs was
developed and implemented at the University of Michigan Health
System (UMHS). This “Michigan” model and other programs, mostly
notably the “Seven Pillars” approach at the University of Illinois Medical
Hospital and Health Sciences System (“UIH”), changed the way these
organizations responded to patient injuries and medical malpractice
claims. These programs are known collectively as early settlement
models as opposed to another model involving limited reimbursement,
which typically covers nominal out-of-pocket expenses and loss
of time, and may adjust the billing for services. UMHS’s efforts were
driven by three guiding principles: (1) compensate quickly and fairly,
(2) vigorously defend appropriate care, and (3) reduce patient injury
and claims by learning from mistakes. The health system sought open
communication with patients about an adverse event but also critically
investigated the incident to assess whether the care comported
with the standard of care and was reasonable, offered an apology, and
provided an early offer of compensation when the care fell below the
standard of care or was unreasonable in the circumstances. A multidisciplinary
internal committee reviews the event to determine if the care
provided was medically reasonable and whether the care negatively
affected the outcome. If warranted, peer review, quality improvements,
or additional education and training may be recommended. This program
has successfully reported a reduction in claims, malpractice
lawsuits, median time to claim report to resolution, defense costs, and
average settlement amounts.
UIH adopted a related approach premised upon similar underlying principles
as well as the CANDOR program (communication and optimal
resolution program developed by the Agency for Healthcare Quality
and Research). The “UIH’s Seven Pillars” strategy is characterized
by prompt reporting of the incident, rapid review and investigation by
safety and risk management, early communication with patient and
family (within 15-30 minutes of the unanticipated event), full disclosure,
apology, and a rapid remedy (holding hospital and professional
fees), a focus on learning opportunities and system improvement, data
tracking and evaluation, and education and training. The results of this
program have been profound. Having open and honest communication
with patients and their families and offering an early financial resolution
package after an adverse event has not resulted in significant
liability concerns but has actually led to lower claims, legal fees and
expenses, costs per claim, settlement costs, self-insurance costs, and
mean times to claim closure. These findings closely track the UMHS
experience.
The Fundamentals is a user-friendly, four-module course designed
to help healthcare professionals understand the
essential principles and practices of compliance.
Visit 1sthcc.com/shop to
register today!
Written by our “dream team” of
healthcare providers and attorneys,
The Fundamentals Course is packed
with useful, easy-to-understand
information that covers HIPAA, OSHA,
employment law and enforcement of
Federal healthcare laws. The course
takes less than four hours to complete.
The Compliance Certification Board
(CCB)® has approved this event for up
to 4.4 non-live CCB CEUs.
12 First Healthcare Compliance, LLC © 2018
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