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Despite several years of attention from the medical community, diagnostic errors remain one of the largest threats to patient safety. Three disease categories — vascular events, infections, and cancers — account for nearly three-quarters of all serious harm from diagnostic errors, according to recent research.
Patients who leave against medical advice can be frustrating to clinicians who want to provide the best care and to risk managers who worry that the patient will blame the hospital if the decision leads to a bad outcome. The best way to avoid potential liability is by ensuring that clinicians understand the need to communicate effectively and document thoroughly. Involving the patient’s family members may not always be a good idea, and the risk manager should be careful about intervening.
States and Congress are working to address the “surprise billing” that can hit consumers after a hospital stay or other care in which they learn that they owe thousands of dollars for services they thought were covered by insurance. The legislation is popular among consumers but could create significant potential liabilities for hospitals and health systems. Reducing the risk of those penalties and other consequences will require the risk manager to work with multiple departments within the organization to prevent surprise bills from going out to patients.
In the effort to more effectively and humanely address adverse events in healthcare, one common method has been to consider the clinicians involved the “second victims.” But is it time to stop that practice? This terminology has been used to highlight the effects on clinicians who are part of a patient’s adverse outcome, signifying that in addition to the patient being a victim, the doctor or nurse also can be traumatized. While well meaning, the “second victim” terminology may produce detrimental effects.
The Department of Justice has released formal guidelines on how it will award credit to entities for cooperating with False Claims Act (FCA) investigations, giving healthcare organizations under scrutiny a way to reduce the potential effect. The guidelines state that entities will qualify for credit by voluntarily disclosing additional misconduct even after an FCA investigation is initiated.
A recent ruling in a False Claims Act Case affirms that relators must be specific with claims. Summary judgment was issued because the relator did not tie allegations to particular patients and bills.
An order from the judge overseeing the National Prescription Opiate Litigation should make it easier for healthcare providers to comply with best practices designed to reduce opioid abuse. The order was in response to a motion from Webb County, TX, filed in September 2018, addressing the fact that pharmacy benefit managers' standard national offerings were not consistent with the CDC Guidelines, even though they had endorsed the guidelines as the standards of care.
One of the most critical lessons is the importance of experts in medical malpractice cases. Since medical malpractice cases almost always involve issues beyond the knowledge of laypersons, experts play a vital role in the litigation process and in convincing a jury that a physician or care provider satisfied, or failed to satisfy, the applicable standard of care.
A lesson from this case is the varying standards that courts and juries apply when evaluating the sufficiency of evidence. This case focused on an alleged “increased risk of harm,” which is less common than a typical medical malpractice action involving a patient directly suffering harm. The patient here presented expert witness testimony concerning ejection fractions and the course of treatment that the expert contended satisfied the standard of care in such circumstances. The defendant hospital argued that this evidence was insufficient as a matter of law to support the jury’s significant verdict.
Vendors always have been one of the most worrisome parts of HIPAA security because hospitals and health systems must rely on them for the appropriate technological and physical security for protected data — without the ability to dictate exactly how. Research shows that those fears are well founded, with many health organizations experiencing an increase in investigations and fines from HHS that are related to poor vendor HIPAA security.
There is no quick and easy way to select a vendor to trust with HIPAA-sensitive data. It requires some legwork to determine what kind of security they have in place and possibly identify any shortcomings.
Despite years of educating healthcare staff about the need for data security and the myriad ways people can worm their way into an otherwise secure system, employees still can fall prey to social engineering scams and allow HIPAA data breaches.
Financial Disclosure: Author Greg Freeman, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, Accreditations Manager Amy Johnson, MSN, RN, CPN, and Nurse Planner Maureen Archambault report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Consulting Editor Arnold Mackles, MD, MBA, LHRM, discloses that he is an author and advisory board member for The Sullivan Group and that he is owner, stockholder, presenter, author, and consultant for Innovative Healthcare Compliance Group.
