1. Risk Management in the New Era of Healthcare Reform February 26, 2011 James W. Saxton, Esquire Chair, Healthcare Litigation and Risk Management Group Stevens & Lee

2. 2 Disclosure Statement Mr. Saxton holds the following positions: Board of Directors and Executive Committee Surgical Review Corporation Board of Directors Surgical Excellence, LLC

3. 3 Objectives What’s up in the litigation environment How health care reform will change the way health care is delivered…and your risk!

4. 4 Something Doesn’t Feel Right …! Plaintiffs’ Bar more organized than ever Leveraging technology Leveraging national expertise We need to be

5. 5 The LITIGATION Environment Plaintiff’s attorneys have courses on –Psychodrama –“Crying” –Channeling Focus Focus...on the DRAMA

6. 6 Scrutinizing EVERY MOVE! Be among the first to learn how to read microexpressions

7. 7 Healthcare Reform will accelerate Payment concepts transformed into liability issues? –“Never Events” Negligence per se –Failure to follow “best practices” Liability and economic issues –Transparency will make a difference

8. 8 To get prepared… Let’s look at this from 10,000 feet

9. 9 WHERE Will Care be Provided?

10. 10 WHERE Will Care be Provided? Hospitals Ambulatory surgery centers Community health centers Retail clinics Urgi-care centers Employer health centers Home-care settings

11. 11 WHERE Will Care be Provided? Jobs and workplaces –Pitney Bowes Connecticut-based manufacturer of business software and hardware $6.3 billion annual revenue, 36,000 employees 7 on-site medical clinics, open to 5-6,000 employees Primarily staffed by nurses “Putting healthcare on-site keeps employees healthy, costs less, and increases productivity…. Our goal is to be an extension of the primary care physician in the workplace … but not to take over the primary care.” Brent Pawlecki, MD, MMM Corporate Medical Director Pitney Bowes, Inc. interviewed 8/27/10

12. 12 WHERE Will Care be Provided? CVS: 500 Minute Clinics! Primary goals: –break-even –drive extra traffic into stores Retail facilities: The Convenient Care Association counts approximately 1200 retail clinics in >32 states! –Roadside Medical Clinic Labs (serves drivers at truck stops in 3 states) –Wal-Mart, Target, Publix Cyberspace –At home with web-based tools for patient self-management, education and engagement Intel, GE Announce New Telehealth Joint Venture focusing on three major segments including chronic disease management, independent living at home and in assisted living communities, and assistive technologies. August 2, 2010

13. 13 As to the WHERE… You need to be thinking… Are there new risks? Is there a shift in responsibility? Is there a safety net?

14. 14 WHO Will Provide Care?

15. 15 WHO Will Provide Care? Number of mid-levels in primary care –CHANGE…in who refers to you?? Midlevels in surgical specialties –Who will supervise? –What is the appropriate level of supervision? –Be careful with hand-offs –Must be part of the team –Must enhance the “ practice-patient ” relationship

16. 16 And… the physical demands of a demanding profession are taking their toll… “Whereas we’ve focused rightly on patient safety…[we] have never given mind to surgeon safety.…By 2020 [there will be] up to 30% workload increase for general surgeons. [Today] 87% of surgeons performing minimally invasive surgery are suffering from occupational injury or exhibiting symptoms….We must pay attention…[because these will lead to] reduced workforce and reduced career lifespans.” ~Adrian Park, MD Campbell and Jeanette Plugge Professor and Vice Chair Department of Surgery Head Division of General Surgery University of Maryland Medical Center Interviewed 8/18/10

17. 17 WHAT Care Will be Provided?

18. 18 WHAT Care Will be Provided? Surgeons need to move to “best practices” Surgeons who want to be part of ACOs –Being better at “IT” –Enhancing true patient and family satisfaction –Reducing “never events” –Collaboration skills –Use of mid-levels –Becoming a high quality, efficient provider Is this going to be

19. 19 Changes in the WHAT mean… …really focusing on reducing “Never Events”: 1. Surgery performed on wrong body part 2. Surgery performed on wrong patient 3. Wrong surgical procedure performed on patient 4. Unintended retention of a foreign object in a patient after surgery or other procedure 5. Patient death or serious disability associated with medication error 6. Patient death or serious disability with a hemolytic reaction due to the administration of ABO/HLA incompatible blood or blood products 7. Death or serious disability due to an air embolism 8. Falls that result in death or serious disability 9. Stage 3 or 4 pressure ulcers acquired after admission to a health care facility 10. Death or serious disability associate s with failure to identity and treat hyperbilirubinemia in neonates ~National Quality Forum

20. 20 This will all evolve to…

21. 21 Being aggressive- using the evidence $$ A STRATEGIC APPROACH Risk Mitigation Risk Event Management Event Control of the Process Claim A Different Defense Lawsuit $$ Infrastructure Baseline Lessons learned Education Post – event communication Build the foundation Claims mgmt. How to get there:

22. 22 …to…the NEXT LEVEL! Obtain a practice/department assessment –True movement to critical! Movement to making patients better partners – Moving to true –You –Your colleagues –Your staff

23. 23 For more information, please contact: STEVENS & LEE 51 South Duke Street Lancaster, PA 17602 James W. Saxton, Esq. 717-399-6639 jws@stevenslee.com