The Doctor’s Advocate | First Quarter 2013
by Robert A. London, MD, The Doctors Company Florida Physician Advisory Board Member
The most recent meeting of the Florida Physician Advisory Board took place in Orlando, with physicians from around the state representing multiple surgical and medical specialties—all with a common interest and background in patient safety and risk management. Representatives of The Doctors Company from legal, claims, patient safety, and business development were also present. The following outlines some of the meeting highlights.
Associate general counsel Richard Cahill discussed increased audit activity by the Centers for Medicare and Medicaid Services (CMS). The government is expected to continue its aggressive approach in recouping existing overpayments and preventing future overpayments. Mr. Cahill said the Department of Health and Human Services Office of the Inspector General estimates current overpayments to be in the many billions of dollars. This amount is expected to rise as more patients are covered under the Affordable Care Act.
He noted that The Doctors Company’s medical professional liability policy covers legal fees that may be incurred during an audit appeal. This MediGuard coverage can be enhanced to provide higher limits and expanded protection from the potential high costs and exposure related to regulatory proceedings, including Medicare and Medicaid, RAC and ZPIC audits, and fraud allegations. He also advised members to call their agent or the company directly if they receive an audit letter.
Malpractice attorney Ralph Martinez covered current litigation and liability trends relating to electronic medical records (EMRs). He cautioned that EMR templates force practitioners to fit findings and symptoms into a fixed format. Patient care and physician defense could be affected unless additional information and documentation are attached. He added that the large volumes of paper generated by these formats can make reviews costlier and potentially less accurate. Mr. Martinez also advised physicians to use automatic data trending and to be vigilant about keeping patient records up-to-date. On the latter point, he stressed that incomplete records can make it easier for plaintiffs to argue that full disclosure was not met—resulting in a potential request for extending a statute of limitations.
Mr. Martinez also discussed increased physician liability from relying on physician extenders. He noted that if laws are changed to permit physician extender independent practices, coverage costs for physicians may decrease while costs for extenders will likely rise. On the topic of patient portals, he outlined how practitioners who encourage patients to enter their own protected health information (PHI) are discovering inaccuracies in the data. This has been identified as a new source for medical errors.
Liz Holzman, claims regional manager, discussed the company’s Litigation Education Retreats for members who are in the process of a malpractice claim. The program helps physicians become effective members of their own defense team and includes tools for coping with the stress that accompanies a lawsuit. It emphasizes the partnership between the physician and The Doctors Company throughout the process.
The meeting also included several clinical case presentations. Discussions were thoughtful and serious and covered possible liability exposures. Physician attendees benefit from hearing about claims being litigated, while representatives of The Doctors Company benefit from the analyses and comments from the physicians.
The company’s local physician advisory board meetings foster an open dialogue that is critically important for both The Doctors Company and physicians. The meetings also reflect the company’s philosophy, which is to serve as a close adviser and partner to its physician members. This philosophy is unique in the industry.
The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.
The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.
The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
The Doctor’s Advocate is published quarterly by Corporate Communications, The Doctors Company. Letters and articles, to be edited and published at the editor’s discretion, are welcome. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of The Doctors Company. Please sign your letters, and address them to the editor.
First Quarter 2013
TIA Recognition and Management
An Ounce of Prevention
Changing Times, Changing Practices
Team Effort Leads to Success in Michigan
Florida Physician Advisory Board Update
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