Diagnostic Errors Are the Most Common Medical Factor in ED Claims
Emergency medicine in "top 10" for closed claims
Errors in diagnosis are the most common medical factor in malpractice claims resulting in payouts against emergency physicians (EPs), followed by improperly performed procedures, delay in performance, and medication errors, according to data from the 2013 edition of the PIAA Risk Management Review for Emergency Medicine.
Seventy percent of claims against EPs were closed, with no indemnity payment made to the patient. The average indemnity paid was about $362,000, compared to $383,000 in 2012.
"In looking more closely at medical liability claims alleging diagnostic error for emergency medicine over the past 10 years, the top condition named was symptoms involving the abdomen or pelvis," reports P. Divya Parikh, director of research and risk management for Rockville, MD-based PIAA.
Of the 92 claims reported against EPs, 28 resulted in payouts, with an average payment of $280,000. In contrast, about half of 66 closed claims for the next most common condition resulting in a claim — acute myocardial infarction — resulted in payouts, with an average payout of about $383,000.
Chest pain and back disorders were the next most common conditions in diagnosis-related claims against EPs.
Of the 28 medical specialties included the report, emergency medicine ranked eighth in the number of closed claims in the past 10 years. The average paid-to-close ratio is about 30% across all specialties, and is 24% for emergency medicine.
"Emergency medicine is one of our 'top 10,'" says Parikh. "It's a high-pressure area where physicians have to diagnose what's going on, having virtually no prior relationship with the patient." The average indemnity paid out for all emergency medicine claims is $330,000, compared to an average of $325,000 for all specialties.
The most prevalent issue in emergency medicine claims is the diagnostic interview, evaluation, and consultation. "Over the past 10 years, emergency medicine had a total indemnity of $293 million for 887 paid claims — and $77 million is attributed to that one procedure," Parikh says.
More EPs Insured By Employers
Each emergency department (ED) visit will generate a professional liability cost of $6.09 in 2014, according to Aon Risk Solutions' 2013 Hospital and Physician Professional Liability Benchmark Analysis, which analyzed the costs of professional liability claims occurring in EDs. The analysis looked at claim costs within a $2 million maximum because that amount is typical of hospitals' retained insurance layer.
"We estimate that in 2014, hospital systems will see 3.73 claims for every 100,000 ED visits; approximately one-third of these claims will result in an actual indemnity payment to a third party," says Erik Johnson, FCAS, MAAA, Aon Global Risk Consulting's assistant director and actuary.
The average size of an ED professional liability claim is an estimated $163,000 for events arising in 2013, including indemnity costs paid to claimants and the cost of defending the hospital.
"The average size of ED claims is similar to claims occurring in other hospital service areas," says Johnson. "Over time, the trends in ED claim costs are stable; these are neither significantly increasing or decreasing."
Many EPs are moving out of the individual malpractice insurance market because they're being covered by their employer's self-insurance plan instead. According to Aon's 2013 analysis, 70% of hospitals employ a large number of physicians and use their own self-insurance vehicles to insure them.
For some EPs, the employer may be the hospital; for others, the employer may be an organization that staffs EDs on a contractual basis. In either case, the employers are often self-insuring the physicians, rather than the physicians purchasing policies from the commercial market.
"There are some very valid benefits to commercial insurance," says Johnson.
"But, in general, being a part of the employer's self-insurance plan is more cost-effective for the physician and employer."