Industry Sound Off: Insurance and Malpractice

This ‘Industry Sound Off’ has some great Q & A’s in it, but I’ve only pulled out two that I thought were the most fitting for our blog.  A link to read all of the Insurance Industry Sound Off questions and answers is at the bottom of this post.

From SurgiStrategies

Q: How is the malpractice environment affecting today’s physicians in regard to defensive medicine?

EPSTEIN:Defensive medicine has been in the mainstream and healthcare media this year with special articles published in The Washington Post and Health Leaders Media and the September Robert Wood Johnson Foundation report. What we see every day is that if a physician and/or the ASC have not already been practicing defensive medicine, once they are named in a lawsuit, they tend to become reluctant advocates. An extra lab test or imaging study is easy to order and even easy to get reimbursed. Clinical justification for an extra test is not difficult. Physicians recognize that patients are often reluctant or unable to assume responsibility or follow through with appointments, diets and medications regimens. This reluctance/inability help to drive the increase in defensive medicine practices. Malpractice pricing and availability appear to be contributing to an increase in the number of physicians that are being employed by health systems and hospitals in part in exchange for payment of their malpractice premiums through the entity’s policy. A social environment in which we no longer hold patients accountable or responsible for their own well-being is a contributing factor in the malpractice environment. The epidemic obesity and diabetes rates, lack of healthcare literacy and non-involvement in wellness  programs cause physicians to be wary. From a positive risk-control perspective, we have seen some improvement in medical record documentation and an improved consent process.

Q: What are some ways to avoid the evolving risks of cyberspace telemedicine/telehealth?

EPSTEIN: The greatest challenges to managing cyberspace risks in ASCs seem to be inadequate staff knowledge and capabilities, inability to quickly detect patient data loss/theft and almost no working knowledge of Health Information Technology for Economic and Clinical Health (HITECH) and Health Insurance Portability and Accountability Act (HIPAA) requirements as they apply to telemedicine. Proactive risk-control measures include identification of a cyberspace champion; someone willing to accept the challenge of gaining the necessary knowledge and authority to implement the protective policies and procedures. There are specific information technology risk-control actions that the ASC can implement. Virus controls and filtering on all systems utilizing automatic update of virus signatures if possible is imperative. The ASC should be checking for security patches to the systems at least weekly and implement them within 30 days. A strong administrative password program is imperative to limit access to data on a need-to-know basis. Implement processes and tools which track and record the identity of those who access to personal health information and revoke user access privileges when an individual leaves the ASC. It is important to have a privacy breach response plan that includes how to contact patients whose information has been breached. Implement, prominently disclose and honor a privacy policy that is designed with the ASC patients in mind. And above all, purchase a comprehensive cyber liability insurance policy from a well-rated company.

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