Wk 6 Discussions
Thomas1122
Reply.docxPL
Reply Q.1 (Nenobia)
A medical professional liability insurance policy covers bodily injury or property damage as well as liability for personal injury such as mental anguish. The complexity involved in discovering negligence results in a higher percentage of premium dollars going toward defense and cost containment expenses. Medical liability insurers spend substantial funds investigating and defending claims where there is an adverse patient outcome not resulting from negligence. Medical and legal standards of care often are regarded as interchangeable. The most important factor in rising medical liability premiums appears to be the size of the awards, rather than the frequency of lawsuits.
The size of the awards is driven primarily by the medical care costs of the successful plaintiff. Pain and suffering, along with other noneconomic damages, can be factors in the increase in awards, but the rising cost of medical care appears to be the most significant factor.
Other important data describing the medical liability insurance crisis come from the Physician Insurers Association of America (PIAA), which represents 51 companies, many of which are doctor owned or doctor directed. In 2001, the companies’ loss ratio, the amount of money they paid out for malpractice claims compared to the amount they took in, was about 116 percent. In other words, for every dollar that they received in premiums, they paid out $1.16.4 (Links to an external site.) Malpractice insurers can be profitable with a loss ratio as high as 105 percent because the difference between the amount received in premiums and the amount paid out in losses may be more than made up for by investment income earned on the premiums that are held in reserves for future pay-outs. Rising liability insurance premiums are part of the reason for increasing medical care costs, as doctors attempt to pass on the additional costs of liability coverage in the form of higher patient fees. Similarly, rising medical care costs affect liability premiums as insurance companies have to pay out more for the medical care of successful plaintiffs.
Understanding the Physician Liability Insurance Crisis -- FPM (aafp.org)
Reply Q.2 (Nichoals)
Dear Professor and Class,
Liability insurance ultimately protects any business including a health care organization from financial loss or a law suit.
The patient will be impacted especially if you are in the Medicaid low income pool or if you live in the remote area with no access to health care. Those groups in remote areas especially opt out or don't have insurance coverage
The physician impact is competition. Dentists for example understand that the dental insurance covers only for basic service and won't cover for advanced procedures such as implants and higher quality than what insurance covers dental work. Therefore the freedom to set rates is how physician can increase their income and find loop holes in situations such as " oh your insurance capped # of visits " I can provide more out of pocket " your insurance provides basic service or low quality medical items " I can certainly provide high quality work for extra fee
Because of the structure described healthcare costs and difficult to prove negligence in court, its a win win for giant hospitals or multi physician groups who protect themselves by having consumer sign all the paper work. When i had my tooth pulled, I signed 3-4 pages of documents, I am assuming they were to protect the doctor against any kind of liability during and post procedure
Reply Q.3 (James)
Hello Class and Professor,
The negligent act is called legal malpractice and the insuring contract is called lawyers professional liability insurance. or LPL.
Malpractice coverage is very important to attorneys because a bad case can produce a lot of bad publicity that can significantly harm a law firm's reputation. Nearly all LPL policies are claims made. Most policies will require the attorney or Insured to report any claim, alleged error, or facts that could give rise to a malpractice complaint as soon as they learn of the mistake. An Insured's coverage only goes back as far as the prior acts retroactive date. If the attorney has had constant LPL coverage from day one, it is considered "Full Prior Acts." LPL are most often written in one year "policy period." Each policy period is its own contract so the coverages may change slightly from year to year. If an insurance company makes any significant changes, they're typically required to send a "fire watch" letter to their policyholders to explain the change. Insurance companies are either admitted or non-admitted to each state.
RM
Reply Q.4 (Rhonda)
Professor and Class,
The most pressing issues that should be considered by my committee as it relates to risk management, corporate liability, ethical compliance and medical error prevention includes patient and staff safety from all perspectives. For patients, this includes the care provided as well as ensuring the experience and atmosphere/facility is conducive for care. For staff, following all organizational safety standards and role performance expectations. Additionally, both patients and staff need platforms to report concerns. Patients need to evaluate care provided and staff can communicate if the organization furnished them with resources needed to perform at optimal levels.
In fully understanding that the patient is the priority, my strategies to minimize organizational exposure to risks would include:
· Conducting a risk analysis to establish appropriate interventions
· Create Patient Relations/Patient feedback platform
· Implement Mandatory in-services for all staff levels ensuring staff are working at the top of their license or credentials.
· Ensure employees have access and understanding of policies and procedures
· Create platform for employees to share feedback and render solutions/ideas/opportunities to improve
· Evaluate physician performance
Reply Q.5 (Christina) Risk Managers have an affect on not only patient outcomes but they also affect the organizations financial and operational success. Once area of focus in risk management is quality risk management. They develop strategies to manage risks related to patient record access and protection and help to mitigate any risk of financial harm. Risk managers need to make contingency plans for natural disasters or a cyber attack that my wipe out electronic medical records and/or medications and they evaluate administrative systems and processes that enable operational and financial efficiency. Risk managers should develop a reporting system that allows medical professionals to quickly and accurately report any medical mishaps, risks or disastrous events.
Risk management professionals use a failure mode and effects analysis (FMEA), which helps identify deficiencies in a system or process. This started in the 1940's by the US Military and is a step-by-step approach for identifying all possible failures in a design, a manufacturing or assembly process, or a product or service. This approach requires organizing a workflow process, calculating risk factors and addressing steps to overcome these risk factors.
Attached is a chart showing how FMEA can be applied to medication administration.
Institute for Healthcare Improvement: Failure Modes and Effects Analysis Tool Process Data Report. (n.d.). Institute for Healthcare Improvement. Retrieved June 8, 2021, from http://app.ihi.org/Workspace/tools/fmea/ProcessDetailDataReport.aspx?ToolId=14668&ScenarioId=16714&Type=2
What is FMEA? Failure Mode & Effects Analysis | ASQ. (n.d.). ASQ. Retrieved June 8, 2021, from https://asq.org/quality-resources/fmea
University of Illinois at Chicago. (2020, September 2). The Importance of Risk Management in Healthcare. UIC Online Health Informatics. https://healthinformatics.uic.edu/blog/risk-management-in-healthcare/
Edited by Christina McLaughlin on Jun 7 at 9:14pm
Reply Q.6 (Constance)
Hello Class,
In healthcare, risk management is typically the division or team that tries to assess issues, patient complaints, or injuries and tries to reduce them within the organization. According to the reading, risk management also tries to gather information to improve patient care and treatment practices by monitoring practices and processes used within the organization. In my experience, we utilize our risk management team by having them evaluate processes before implementation and getting their sign-off or feedback ahead of time. Our risk management also assesses all potential patient-related issues that are reported anonymously through hospital staff, as well as parent or family, reported concerns.
The purpose of risk management in healthcare is to provide and prevent risks to patients, staff, and organizations in healthcare. It is important to be able to assess, develop, implement, and also monitor risk management. Most risk managers have to be very versatile and be a multi-tasker. But these managers have to be organization-specific. Some of these are: Financing, insurance, and claims management, Event and incident management, Clinical research, Psychological and human healthcare, and Emergency preparedness.
PL
Reply Q.1
(Nenobia)
A medical professional liability insurance policy covers bodily injury or property damage as well
as liability for personal injury such as mental anguish. The complexity involved in discovering
negligence results in a higher percentage of premium dollars g
oing toward defense and cost
containment expenses. Medical liability insurers spend substantial funds investigating and
defending claims where there is an adverse patient outcome not resulting from
negligence.
Medical and legal standards of care often are
regarded as interchangeable. The most
important factor in rising medical liability premiums appears to be the size of the awards, rather
than the frequency of lawsuits.
The size of the awards is driven primarily by the medical care costs of the successful
plaintiff.
Pain and suffering, along with other noneconomic damages, can be factors in the increase in
awards, but the rising cost of medical care appears to be the most significant factor.
Other important data describing the medical liability insurance c
risis come from the Physician
Insurers Association of America (PIAA), which represents 51 companies, many of which are
doctor owned or doctor directed. In 2001, the companies’ loss ratio, the amount of money they
paid out for malpractice claims compared to
the amount they took in, was about 116 percent. In
other words, for every dollar that they received in premiums, they paid out $1.16
.
4
(Links
to
an
external
sit
e.
)
Malpractice insurers can be profitable with a loss ratio as high as 105 percent
because the difference between the amount received in premiums and the amount paid out in
losses may be more than made up for by investment income earned on the premiums th
at are
held in reserves for future pay
-
outs.
Rising liability insurance premiums are part of the reason
for increasing medical care costs, as doctors attempt to pass on the additional costs of liability
coverage in the form of higher patient fees. Similar
ly, rising medical care costs affect liability
premiums as insurance companies have to pay out more for the medical care of successful
plaintiffs.
Understanding the Physician Liability
Insurance Crisis
--
FPM (aafp.org)
Reply
Q.2
(Nichoals)
Dear Professor and Class,
Liability insurance ultimately protects any business including a health care organization from
financial loss or a law suit.
The patient will be impacted especially if you are in the Medicaid l
ow income pool or if you live
in the remote area with no access to health care. Those groups in remote areas especially opt out
or don't have insurance coverage
The physician impact is competition. Dentists for example understand that the dental insurance
covers only for basic service and won't cover for advanced procedures such as implants and
higher quality than what insurance covers dental work. Therefore the freedom to set rates is how
physician can increase their income and find loop holes in situation
s such as " oh your insurance
capped # of visits " I can provide more out of pocket " your insurance provides basic service or
low quality medical items " I can certainly provide high quality work for extra fee
PL
Reply Q.1 (Nenobia)
A medical professional liability insurance policy covers bodily injury or property damage as well
as liability for personal injury such as mental anguish. The complexity involved in discovering
negligence results in a higher percentage of premium dollars going toward defense and cost
containment expenses. Medical liability insurers spend substantial funds investigating and
defending claims where there is an adverse patient outcome not resulting from
negligence. Medical and legal standards of care often are regarded as interchangeable. The most
important factor in rising medical liability premiums appears to be the size of the awards, rather
than the frequency of lawsuits.
The size of the awards is driven primarily by the medical care costs of the successful plaintiff.
Pain and suffering, along with other noneconomic damages, can be factors in the increase in
awards, but the rising cost of medical care appears to be the most significant factor.
Other important data describing the medical liability insurance crisis come from the Physician
Insurers Association of America (PIAA), which represents 51 companies, many of which are
doctor owned or doctor directed. In 2001, the companies’ loss ratio, the amount of money they
paid out for malpractice claims compared to the amount they took in, was about 116 percent. In
other words, for every dollar that they received in premiums, they paid out $1.16.4 (Links to an
external site.) Malpractice insurers can be profitable with a loss ratio as high as 105 percent
because the difference between the amount received in premiums and the amount paid out in
losses may be more than made up for by investment income earned on the premiums that are
held in reserves for future pay-outs. Rising liability insurance premiums are part of the reason
for increasing medical care costs, as doctors attempt to pass on the additional costs of liability
coverage in the form of higher patient fees. Similarly, rising medical care costs affect liability
premiums as insurance companies have to pay out more for the medical care of successful
plaintiffs.
Understanding the Physician Liability Insurance Crisis -- FPM (aafp.org)
Reply Q.2 (Nichoals)
Dear Professor and Class,
Liability insurance ultimately protects any business including a health care organization from
financial loss or a law suit.
The patient will be impacted especially if you are in the Medicaid low income pool or if you live
in the remote area with no access to health care. Those groups in remote areas especially opt out
or don't have insurance coverage
The physician impact is competition. Dentists for example understand that the dental insurance
covers only for basic service and won't cover for advanced procedures such as implants and
higher quality than what insurance covers dental work. Therefore the freedom to set rates is how
physician can increase their income and find loop holes in situations such as " oh your insurance
capped # of visits " I can provide more out of pocket " your insurance provides basic service or
low quality medical items " I can certainly provide high quality work for extra fee
