Casualty Actuarial Society 2006 Spring MeetingMay 9, 2006, Puerto Rico

Medical Malpractice: Is the Crisis Over?

Kevin Bingham, ACAS, MAAASenior Manager(860) 725-3056kbingham@deloitte.com Deloitte Consulting LLP

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Introduction

• From Who’s Perspective

• The Future – Challenges

• The Future - Opportunities

• Conclusion

From Who’s Perspective

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From Who’s Perspective

• Medical Malpractice Insurance Companies

• Patients

• Physicians

• Hospitals

Is the Crisis Over?

The Future - Challenges

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The Future - Challenges

• Constitutionality of tort reform

• Maintaining underwriting excellence

• Soft market pressures

• Regulatory pressure (e.g., tort reform, public rate hearings, etc.)

• Shareholder expectations

• Captive pricing

• Adequacy of original rates

• The new member dilemma – “Are all new members better than average?”

• Loss emergence versus original assumptions

• Member retention during soft market

• Ratemaking diligence

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The Future - Challenges

• New errors

• CPOE/EMR – Lead to new types of errors• Bar codes placed on wrong patient

• Accurate programming of software (e.g., drug interactions)

• Drugs and medical technology advancement

• Dealing with “old” errors

• Medication events (e.g., unlabeled medicine, unapproved abbreviations, illegible, etc.)• Of the 3,548 sentinel events reported to JCAHO between January 1995 and December 2005, 10.1%

(358) were adverse medication events

• Removing the wrong limbs or organs, slicing into the wrong side of bodies and performing surgery on the wrong patients.

• JCAHO’s head Dennis O’leary - “It’s Getting Worse.” (USA Today)

• Health-care facilities reported 84 operations to the commission that involved the wrong body part or the wrong patient.

• “I can assure you that this is just the tip of the ice berg.”

Despite years of patient safety efforts

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The Future - Challenges

Medical errors accounted for 1/4th

of all reports but only 1% of all

serious events. Stated another

way, in almost 99% of the cases, no

patient was harmed by the medication

error.

Unfortunately, medication errors involving children and adolescents

were more likely to result in patient

harm.

The Future - Opportunities

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The Future - Opportunities

• I’m sorry legislation

• COPIC’s 3R program – (R)ecognize patient injury, (R)espond soon after event, (R)estore

• I’m Sorry Works ( www.sorryworks.net)

• CPOE/EMR

• Technology and medical advancements

• Patient safety awareness

• Hospitals (e.g., Root Cause Analysis)

• Educational institutions and focus on patient safety in curriculum

• Physicians

• Sharing of information/lessons learned (e.g., Patient Safety Advisor, studies, etc.)

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The Future - Opportunities

• Medical malpractice insurance company risk management programs

• Risk management training• Informed consent

• Chart documentation

• Delivering difficult messages

• Physician boot camps

• Patient satisfaction

• Predictive modeling…

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Predictive Modeling

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Predictive Modeling Vision

Reason codes• Map scores to filed plan• Protect confidential scores• Subjective → Objective

Filed Schedule Rating Plan• Record keeping• Patient Procedures• Continuing Education (CED)• Risk Management• Telephone Protocol• Cooperation• Staffing• Prior loss history

Premium Quote With Reason Codes• Standard Information +• “Reasons” and “Actions”

• CED• Patient Satisfaction Results• Etc.

Incentivize Physician To Act• Take recommended CED courses• Attend physician “boot camp” on communication

skills• Etc.

SUCCESS STORYPhysiciansAddress RM issues and improve patient safetyUltimately benefit from lower premiums

InsurersMove from one price fits all to right priceFavorable impact on patient safetyOutside traditional tort reform debateRight thing to do