Massachusetts hospitals launch initiative to curb defensive medicine costs

Led by the Massachusetts Medical Society (MMS), six healthcare organizations today announced the start of a major initiative to improve the medical liability system in the state.

In addition to MMS, Beth Israel Deaconess Medical Center, Baystate Health, Massachusetts Coalition for the Prevention of Medical Errors, Massachusetts Hospital Association and Medically Induced Trauma Support Services are participating in the alliance.
 
The new alliance has launched the Roadmap to Reform, an alternative approach to medical liability intended to improve patient safety, increase transparency, reduce litigation and cut costs to the healthcare system. Seven hospitals will participate in a pilot program this year to implement the reforms.

[Also: Defensive medicine adds billions to annual U.S. healthcare costs]

The Roadmap to Reform proposes a process of disclosure, apology and offer (DA&O), an alternative to the current tort system, which many health professionals say is inefficient, drives health costs higher and is unduly burdensome to patients, physicians and the healthcare system. The DA&O approach will be instituted, beginning this year, to test its feasibility in different practice environments with different insurance arrangements.

"The goal is to improve the system," said Alan Woodward, MD, chair of the MMS Committee on Professional Liability and a past president of the organization. "We want a system that is fair, more equitable, more just for patients and a system that improves patient safety."

To develop the DA&O approach, the alliance conducted structured interviews with 27 key stakeholders holding leadership positions in organizations central to implementation, including the Massachusetts legislature and administration, hospital systems (including academic health centers and community hospitals), practicing physicians, liability insurers, health insurers, medical professional associations, patient advocacy organizations, malpractice attorneys, patient safety experts, major physician practice groups and a major business association.

[Also: Defensive medicine may cost the industry billions]

"We were amazed that nobody thought there was a better solution," said Woodward. "There is broad support."

Although it is difficult to pinpoint the cost of defensive medicine, it is generally thought to add 10 to 20 percent to the annual cost of healthcare nationwide.

"The system now is onerous for both patients and physicians," said Woodward, noting that concern over possible litigation discourages transparency, inhibits communication between caregivers and patients, burdens physicians with excessive premiums and motivates physicians to practice defensive medicine.

"Fear of being sued squelches patient safety," said Woodward. "People don't talk; they don't focus on fixing the system."

Woodward says physicians should be able to apologize and compensate patients for errors without fear of litigation.

"It can happen if everyone is reasonable," he said.

According to Woodward, the principles of the DA&O approach are:

•    Full disclosure – tell the patient what error occurred and why.
•    Prevention – tell the patient what is being done to stop a reoccurrence.
•    Apology – take responsibility for the error.
•    Compensation – make reparations for any negative impact on the patient.

"Our primary focus is full disclosure to the patient, putting a system in place to prevent reoccurrence and, if necessary, compensating patients for their losses," said Woodward. "If you ask patients, this is what they want."

"We can make the approach to medical liability much better for both patients and physicians and stop driving unnecessary costs," he added.

Follow HFN Editor Rene Letourneau @ReneLetourneau.