A new study published on March 31 in the New England Journal of Medicine found that the litigation risk of nursing homes is not tied to their quality.
“We were trying to see if lower quality facilities had higher litigation risk than higher quality facilities,” said David Stevenson, an associate professor of health policy at Harvard Medical School’s Department of Health Care Policy and a co-author of the study.
“The Relationship between Quality of Care and Negligence Litigation in Nursing Homes” found that best-performing nursing homes are only slightly less likely to be sued than poor-performing ones.
According to the study, “nursing homes with the best deficiency records (10th percentile) had a 40 percent annual risk of being sued, as compared with a 47 percent risk among nursing homes with the worst deficiency records (90th percentile).”
The study linked tort claims brought against 1,465 nursing homes between 1998 and 2006 at five large nursing home chains in the United States with 10 indicators of nursing home quality. Quality measures were taken from national data sets, the Online Survey, Certification and Reporting system and the Minimum Data Set Quality Measure/Indicator Report, which includes measurements on fractures, falls, weight loss, dehydration and pressure ulcers.
The study looked at 4,716 claims filed against nursing homes. Each nursing home, on average, received one claim every two years. A little more than 26 percent of claims involved injuries from falls, while pressure ulcers and bed sores claims accounted for nearly 16 percent. In all, 61 percent of claims resulted in payments, which averaged $199,794, for a total of $578 million.
“To the extent that the industry felt that it was possible to insulate themselves from litigation risks by general improvements in quality of care, I think the study will make them much less confident about that,” said David Studdert, of the University of Melbourne, Australia, another of the study’s authors.
The study’s results, said Stevenson, seem to indicate that improving quality isn’t the most effective strategy if a nursing home is trying to reduce its litigation risk. The results, he said, actually suggest that quality improvement and risk management are two different things.
“I think the industry will point very specifically to the fact that there’s a very weak relationship between quality of care and malpractice claims,” Stevenson said. “I think that will lead them to say that we should have stronger tort reform. Our findings don’t suggest that really.”
“One of the goals of tort reform is to reduce the scale and volume of litigation,” added Studdert. “What our findings suggest is that those kinds of reductions will not change the weak relationship between quality and litigation risk. So tort reform may achieve other things, but it is unlikely to repair this flaw in the tort system.”
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Just because the study doesn’t indicate that a nursing facility’s litigation risk is lower if its quality is high doesn’t mean facilities should not aim for high quality care, said Stevenson. Nor does he think nursing facilities will use the results of the study to shirk the duties of giving patients high quality care.
“There are a lot of other reasons to provide high quality care than to reduce your litigation risk,” he said. “There’s public reporting. There’s just wanting to do the right thing. There’s the business case for it. There are a lot of reasons to provide high quality of care. Again, most importantly, because it’s the right thing to do. It’s not necessarily going to reduce your litigation risk all that much.”