CT Center for Patient Safety Newsletter

September 2014

In This Issue

Disclosure and Apology: A Win-Win for Patient Safety and Medical Liability?

When Patients Read What Their Doctors Write

Livanta recently named as Connecticut's Quality Improvement Organization (QIO) for Medicare Patients...

September Health Hint:

Newly Insured, Many Now Face Learning Curve

Like Priceline for patients: Doctors compete for business via online bids for surgery

Disclosure and Apology: A Win-Win for Patient Safety and Medical Liability?

A Congressional Briefing was held on July 28, 2014 sponsored by the nonpartisan Alliance for Health Reform and Ascension Health.

Full Webcast/Podcast: Full Video

William Sage, professor of law at the University of Texas at Austin, began by sharing that federal law mandates that doctors discuss the risks associated with medical procedures but they are not required to disclose when unexpected or adverse events happen. Communication and resolution programs (CRPs) typically have three goals: 1) Tell patients what happened, 2) offer an explanation and apology to the patient and family as well as an offer of compensation in some cases, and 3) Improve safety for the future.

There is still significant resistance from many quarters to bring about this change. These programs have traditionally faced problems such as a fear of litigation, certain barriers to patient participation, the fear of harm to physician's reputations and the perceived economic concerns of malpractice insurance providers.

Ann Hendrich with Ascension Health spoke of one of their disclosure programs that resulted in a 48.6% decrease in total number of high-risk liability occurrences, a 57% reduction in the rate of actual and potential liability claims, and a 49% increase in reporting of serious safety events.

Jean Rexford, executive director of the Connecticut Center for Patient Safety, provided the consumer safety perspective to the discussion. Jean pointed out that the Ascension program and similar disclosure and apology systems are "islands of excellence" in what is otherwise a sea of unacceptable patient care. With her usual passion, she brought out that medical errors can and do happen anywhere and everywhere. However, there are bigger, systemic problems such as that there is no national registry for medical devices and no way to track device related harm effectively. In her own words, "we trust a system that is not necessarily trustworthy." She reminded us that the only real solution to this problem is to involve patients from the beginning.

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When Patients Read What Their Doctors Write

When I speak with people in and outside of the medical profession, I always tell them that the patient is one of the most under-utilized resources in healthcare. After all, it is the patient who can tie it all together because they are the ones who have been there the whole time. For this reason, by including and involving the patient in all aspects of their care, the outcomes will undoubtedly be improved, the patient experience will be more satisfactory and often the cost of care is lower. In an NPR blog post by Dr. Leana Wen, When Patients Read What Their Doctors Write, Dr. Wen sums up the value, from a physician's perspective, of true transparency and involving patients as an integral part of the care team. Needless to say, when patients had a better understanding of their medical condition they felt more in control of their lives and were better able to stick with their medical care plan. Patients shouldn't need to feel that they are invading their physician's space by asking what their doctors are entering into their medical record. We hope that after reading this article, you may feel more comfortable asking your doctor to share with you what they just wrote.

Livanta recently named as Connecticut's Quality Improvement Organization (QIO) for Medicare Patients

Livanta was recently named the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for the Northeast (including Connecticut) and West Coast regions and will manage all Medicare beneficiary complaints, quality of care reviews, and appeals.

According to their website, their goal is to address your concerns while working with doctors and

healthcare providers (hospitals, nursing homes, surgery centers, etc.) to help them provide better care in the future.

They can help you if you think you are being discharged too soon from a hospital or from physical therapy, occupational therapy or other outpatient services. In addition, Livanta is also there to help consumers complete paper work about their concerns so that their complaints can be considered.

Livanta can be reached at: 866-815-5440.

September Health Hint:

As the outside air starts to cool down and summer changes to fall, football season starts, and a new school year is upon us, so is flu season. Viruses cause the common cold and seasonal flu. According to Web,MD, "Antibiotics are medications that fight infections caused by bacteria, but the common cold and the flu are caused by viruses. Taking antibiotics when you have a virus may do more harm than good. Taking antibiotics when they are not needed increases your risk of getting an infection later that may resist antibiotic treatment."

For those who are interested, the Affordable Care Act mandates that all marketplace plans and many other plans must cover the flu vaccine without charging you a copayment or coinsurance. This is true even if you have not met your yearly deductible. Usually this coverage applies only when these services are delivered by a network provider, so please check with your plan for details and confirmation. It is recommended that people who plan to get a vaccine do so as soon as it is available in your area. Although flu season usually peaks in January or February, early immunization is the most effective.

Newly Insured, Many Now Face Learning Curve

Until March 2014 when the Affordable Care Act (ACA) signup period ended, the emphasis was in getting uninsured Americans to purchase health insurance plans. Now that eight million have signed up, the focus in on making sure that they understand their policies and know how to access the medical care that is now available to them. A primary goal is for people to have positive health care experiences and for them to learn how to be smart consumers of health care. This education, in turn, anticipates keeping costs down and improving care. The New York Times recently published a story addressing the learning curve.

CTCPS has been involved in a research project funded by the Connecticut Health Foundation, which addresses Removing Barriers: Creating Health Care Access for Connecticut's Newly Insured. A report will be forthcoming shortly. We must first recognized that Connecticut has one of the most successful exchanges in the country and is being used as a model elsewhere. Our findings reinforced what many of us suspected: that there are still areas that need improvement. Communication and education are needed to increase health literacy and there are a number of areas where the system and culture of health care need to be addressed in Connecticut. We heard that a key to the solution will likely be in the use of community outreach including community health care workers.

We further learned that there are a number of resources that have already been developed and are available online to help consumers get a better lay of the landscape. One that we recommend is published by the Centers for Medicare and Medicaid Services and is titled: A Roadmap to Better Care and a Healthier You (English) (Spanish).

Like Priceline for patients: Doctors compete for business via online bids for surgery

What do you think of the idea of an online medical auction site? Well at least one exists: Medibid, which largely operates outside of traditional health insurance. According to an article in the Washington Post, this online service has been in business for four years and links patients seeking non-emergency care with doctors and facilities that offer it. It sounds like the medical version of an online travel or dating website. Medibid does not verify credentials but requires doctors to submit their medical license number for patients to check.

Medibid founder Ralph Weber said, "We introduce transparency and also competition." According to the Washington Post, critics' concerns include that "the service provides little in the way of quality indicators for prospective patients, something hospitals convey by granting a doctor privileges and insurers do by accepting doctors on a plan's roster. Surgery or procedures such as colonoscopies are typically performed in physician-owned outpatient centers, which are more lightly regulated than hospitals and have fewer safeguards for patients. Unlike hospitals, which are required to track infections, outpatient surgery centers are usually exempt from such reporting requirements. And complications are rarely covered under the terms of Medibid."

Perhaps what should be focused on is what I find both interesting and troubling: that these concerns exist whether Medibid exists or not. They are not creating the lighter regulation of surgical centers, or the reduced tracking and reporting of infections. Perhaps this makes it even more important than ever to have national transparency including infection reporting and adverse medical events reporting by all providers of medical care and in all states. As always, we welcome your thoughts through our website or on our Facebook page.