The year 2017 held much uncertainty for the healthcare industry. With the debate over healthcare reform far from settled, 2018 is shaping up to be a challenging year.
Yet in the ongoing debate about healthcare reform, many hospital executives must keep several emerging medical liability risks on their radar, including the opioid crisis, violence in hospitals, aging providers, and missed and delayed diagnoses specifically as they relate to infections. If not addressed, these risks can create the same uncertainty as the ongoing healthcare reform debate and potentially expose providers to damage to their finances and reputation. Fortunately, hospital leaders can take several steps to protect their organization as they head into 2018.
Prescription practices reform
Between 11% and 40% of the U.S. population reports some level of chronic pain, according to the 2016 National Institutes of Health’s National Pain Strategy (PDF). To help manage such pain, providers have increasingly relied on prescription opioids as a first-line treatment for patients. While not the sole cause of today’s opioid crisis, such practices have drastically increased the number of individuals addicted to opioids. In fact, many of today’s opioid addicts did not begin as active drug seekers or recreational drug users, but became addicted after using legally prescribed opioids to manage pain.
For providers, excessive opioid prescription practices can jeopardize patient care and expose providers to medical professional liabilities. Over the past few years, the U.S. government has also shown an increased willingness to pursue criminal cases against providers over their prescription practices, including charging an Oklahoma doctor with second-degree murder.
Hospitals can reduce their opioid-related liability in several ways as they head into 2018. It all starts with developing an opioid prescription risk management plan. The plan involves designating a clinical leader to oversee pain management and prescribing practices across the organization, educating clinicians at all levels about safe opioid uses, and developing protocols to screen and assess patients for addictive behavior upon admission. While developing a comprehensive prescription risk management plan can seem daunting, it is well worth the effort and the most effective step providers can take to reduce their opioid-related liability in the upcoming year.
Ensure a safe workplace
Violence against healthcare providers by patients or visitors nearly doubled between 2012 and 2014, according to the Occupational Safety and Health Administration (OSHA).
While that number is sobering in and of itself, OSHA also found that violence is four times more common in a healthcare setting than in other private industries. All told, in 2016, a Milliman Research Report for the American Hospital Association finds that hospitals spent $429 million on medical care, staffing, indemnity and other costs as a result of violence against hospital employees.
While hospitals around the country have taken important steps to protect employees and patients—including spending $1.1 billion on preventive security and training—there are still several measures hospitals can take to reduce their exposure to violence. As they head into 2018, providers should conduct a facility-wide assessment that surveys all shifts and reviews existing safeguards in high-risk areas. The results of the assessment should serve as the foundation of a workplace violence prevention program. Once finalized, hospitals must conduct unannounced drills and ongoing staff training with a specific focus on warning signs to watch for, when to diffuse and de-escalate a situation, and when to retreat to safety. Appointing a multidisciplinary committee to oversee the workplace violence prevention program will also help ensure hospitals don’t overlook risk factors or departments.
Thanks to medical advancements, people live and stay active longer, in turn delaying retirement. Healthcare providers, including physicians, are no exception. Roughly 30% of actively licensed providers in the U.S. are over the age of 60, according to a 2016 provider census (PDF) published in the Journal of Medical Regulation.
As they age, physicians are not immune to the ailments that impact their patients. For example, a reduction in cognitive and physical abilities often appears gradually in both patients and physicians alike, possibly impacting the latter’s ability to do their job. This can lead to poor patient outcomes, which can result in malpractice lawsuits. Hospitals can also be implicated over any perceived negligent retention, credentialing or recredentialing practices.
To reduce liability exposure, a range of solutions are available to hospital and healthcare organizations. As there is no substitute for physicians and their expertise accrued over years of service, hospitals must have in-depth policies and procedures in place to address aging of physicians to ensure the ongoing delivery of safe medical care. For example, some hospitals look to transition older physicians to a teaching or mentoring role, as well as introduce part-time or flexible schedules. Other healthcare systems have implemented specific guidelines requiring mandatory age-based physical and competency testing as part of their recredentialing process.
Missed and delayed diagnoses
A missed or delayed diagnosis specifically related to infections can result in catastrophic injuries to a patient and can lead to significant financial consequences and unwanted media attention for a healthcare system. While rare, a delay of an infection diagnosis of even just a few hours can result in devastating health consequences that can cost millions to resolve.
As this trend is on the rise, developing effective infection-prevention strategies, ongoing processes of infection surveillance, data collection and analysis, education and training are critical tools to prevent missed and delayed infection diagnoses. Having specific comprehensive infection-control clinical protocols that reflect best practices in triage, early detection and treatment is critical. As multimillion-dollar awards and settlements have been recorded related to these cases, providers must ensure infection control and infection prevention are top priorities to reduce their liability exposures in 2018.
Diane Doherty is senior vice president at Chubb Healthcare. She can be reached at [email protected]
Author's note: The material presented in this advisory article is not intended to provide legal or other expert advice as to any of the subjects mentioned, but rather is presented for general information only.