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Managed Care Shows No Impact on Frequency of Malpractice Claims,
At Least Not Yet
The
following is an article written by Alan I. Levenson, M.D.,
Chair of the Psychiatrists' Purchasing Group, Inc., the operator
of the APA-endorsed Psychiatrists' Professional Liability
Insurance Group. This article was first seen in APA Psychiatric
Practice and Managed Care, November/December 1997.
Data from
the APA-endorsed Professional Liability Insurance Program
indicate that professional liability claims - and incidents
that might lead to claims - are equally likely to occur in
managed care settings and in non-managed care settings.
Although
these data are clear, it is too early to explain them, and
we obviously do not know what additional data will develop
over time. It may be that the current data simply reflect
a matter of timing; that is, there is a time lag in the filing
and reporting of malpractice claims. (It is often two years,
or even longer, from the date of an incident to the time that
a claim is filed.) This being the case, it may be too early
to see claims from managed care settings because the rapid
increase in managed care plans is relatively recent.
In short,
it is still too early to know what the correct explanation
is, and it also is too early to know what the actual relative
frequencies will turn out to be over time for managed care
as compared with non-managed care claims.
Factors
Analyzed
As for
specific forms of practice and treatment modalities that are
often associated with managed care, we have looked at the
following factors: high volume of patients, supervision, split
treatment (psychiatrists overseeing medications and a non-physician
therapist providing psychotherapy), and medication management
as the primary form of treatment. The data indicate that:
·
Psychiatrists who regularly see many patients each day have
a disproportionately higher risk of being sued than those
who do not. This disproportionately increased risk is particularly
pronounced for psychiatrists who see more than about 25
patients a day. This is true whether or not managed care
is involved.
·
There is increased exposure arising from supervision of
other professionals. The more supervisees, the higher the
risk. Again, this is true whether or not managed care is
involved.
·
Split treatment and/or medication management as the primary
form of treatment are not associated with a higher frequency
of professional liability suits unless the split treatment
and/or medication management are associated with high patient
volume. Again, this is true whether or not managed care
is involved.
The frequency
of claims is closely related to the degree of communication
among providers, payers,supervisors,supervisees,and patients.
Effective risk management requires consistently good communication
among all concerned with the patient's care.
One
Final Note
It is
likely that malpractice claim data alone will never answer
the question of whether there is an increased risk of suits
in managed care settings. Statistically, malpractice claim
data represent a non-randomized sample or subset drawn from
a universe composed of all episodes of care. In order to determine
whether managed care-related claims are more frequent than
non-managed care-related claims, one would need information
about the characteristics of the universe in which the claims
developed. In particular, it would be necessary to know the
relative frequencies of managed
care and non-managed care episodes of care within that universe.
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