The Crucial Role of the Practice Administrator in Reducing Risk American Association of Orthopaedic Executives April 14, 2008 MEDICAL CONSULTANTS OF NEW ENGLAND, LLC MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

Elements of Risk Management Risk Prevention Claims Defense MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Risk Prevention Office significant source of Malpractice 35% of allegations stem from substandard office systems Good systems will save time and financial loss As healthcare becomes more complex good systems are essential to prevention MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

Develop Practice Philosophy Practice brochure Insurance policies, billing policies, hours, Rx refills Establish patient expectation The informed patient is much less likely to file a claim with a poor outcome totally unrelated to medical negligence MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Employees Validate & document professional credentials Background checks Document training and policy & procedures Name tags and position MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Systems Procedures Diagnostic testing follow up X-ray Transportation of patients Chaperon Casting, DME Medical Record: EMR, allergies Equipment Proper training (cast saw) Maintenance and PM MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Systems Telephone Triage of calls & responsibility Documentation of calls Method of communication: e-mail, fax, Compliance HIPAA OSHA Discharge of Patients MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Claims Defense Supportable policies and procedures Well defined process for claim management MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

Medical Records What will opposing counsel ask? Will try to show: Minute details about events occurring many years ago; Seemingly unimportant details can become a focal point; Will try to show: That if the medical record contained additional important information, that the patient’s outcome would have changed; Inadequate follow-up; Inadequate consent process and; Ultimately that the medical record and thus the care provided was inadequate. A thorough, complete medical record can form the cornerstone of a strong defense.

Medical Records A 2 year old is seen by an Anesthesiologist prior to undergoing an elective outpatient procedure. The patients mother reports that there is a family history of Prolonged QT syndrome. The Anesthesiologist called the primary physician requesting an EKG, which was ordered through the pediatrician’s office. The EKG was late coming back to the pediatrician’s office and was placed in the medical record without being seen by the physician. During a follow-up visit 6 months later, there was no mention of the EKG by either the physician or the patient’s mother. 2 months later, the child died with a V-fib arrest and ultimately was shown to have prolonged QT syndrome on the EKG in his chart.

Medical Records History, Physical, appropriate labs and x-rays are all well documented. Preoperative evaluation and clearances are complete. (All abnormal exams are referred to the appropriate primary care physician or appropriate specialist.) The nature of the discussions with the patient and as appropriate the patient’s family, regarding informed consent, are well documented. Lastly, the documentation in a hospital setting must meet the same standards you use in your office.

Office Calls Post-operative It is common for patients to receive discharge/post-op instructions to call the physician’s office if varied sxs. occur. Is there a policy to guide the office on how these calls are processed and the patients managed? Are their criteria, including a list of diagnoses/complaints, where patients are directed to either come into the office or be referred to the ER? Can a secretary take down the information and leave it for the physician? Example: Pt calls the office with chest pain after getting home. The physician is not in the office and a PA or ARNP asks the patient to come in. An EKG is performed and the patient sent home with instructions to see the physician tomorrow. This patient died that evening resulting in a large settlement.

Labs and X-ray Exams Was the test performed? Were the results seen by the physician? Were actions taken because these results were abnormal? Including communication with referring physicians.

Labs and X-ray Exams A 50 year old patient presented to their physician’s office for weakness and lethargy on a Friday afternoon. Labs were drawn and sent to an outside lab. The patient was sent home. The patient was found to have a sodium of 110. The lab called the answering service and asked the service to relay the results to the physician, which never occurred. The patient’s condition deteriorated and they arrived at the ER on Sunday, was admitted to the ICU and subsequently expired. Settlement: $2,500,000 split between the physician, the pathologist and the lab.

Patient Responsibility Make the patient responsible; Discharge instructions Consent forms Have them sign