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Efforts to bring positive resolutions to adverse medical/patient outcomes - for both physicians and hospitals - will increase dramatically this year as insurers and insureds try to find a reasonable and cost effective method to mitigate frivolous lawsuits. The Sorry Works! Coalition can be expected to remain at the forefront of this movement, followed by the COPIC Insurance Co.'s 3Rs program, and the National Quality Forum (NQF). The Leapfrog Group (TLG) and Common Good's Health Courts, represented by Paul Barringer, will also have a hand in further shaping possible resolutions. More than 18 states have passed apology laws protecting a doctor's remorse from being used at trial. Case law in Vermont provides immunity for apologies. Florida, Nevada and Pennsylvania statutes require written disclosure of bad outcomes to patients. Although COPIC's 3Rs program, based on quickly recognizing, responding to, and resolving a patient injury, is credited with helping reduce the carrier's claims from 12 per 100 doctors in 1998 to 6.2 per 100 doctors in 2005, not every adverse outcome is a candidate for early intervention. Type of injury, attorney involvement or unrealistic expectations may mandate a trial.
Sorry Works! spokesperson Doug Wojcieszak will take his coalition's message this month to ProMutual Insurance Co. and to Physicians Liability Insurance Co. (PLICO) in March. Sorry Works! stresses the idea that greed is not the underlying motivator in most med mal suits, citing anger and frustration as the driving force behind patients and their families seeking court settlements when questions aren't answered and/or when they feel summarily dismissed by a hospital or physician. The Sorry Works! model encourages meetings between the doctor and the patient, listening, discussing the facts, explaining the reasons for a bad outcome, and offering condolences. The program also suggests negligence should be admitted with an apology and an offer of a settlement. Medical Protective also supports an apology framework that is not destructive to a doctor while respecting the patient and avoiding blame. However, the carrier, where Kathleen Roman is risk management education leader, also wants insureds to avoid apologies simply intended to make a patient go away. Participation in Med Pro's accredited risk management education program can grant an insured physician a 5 percent premium discount for up to three years. Aetna steps up as the first health plan to adopt TLG's Never Events program, which includes making an apology, reporting an incident to the appropriate authority, performing a root-cause analysis of the situation, and waiving any costs associated with it. TLG publicly acknowledges hospitals that commit to this program. It estimates that there are more than 1,300 rural and urban hospitals in its network. Companies such as IBM and Intel have also committed to using this program. TLG's Never Events is based on the National Quality Forum's two-year effort to create a list of 28 Serious Reportable Events. The Centers for Medicare and Medicaid Services endorses the NQF program, as do Kaiser Permanente and Blue Cross Blue Shield. NQF's goals include developing a national strategy to measure and report healthcare quality, and standardizing performance measures so that comparable data is available nationwide.
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