WALTHAM, MA - Led by the Massachusetts Medical Society (MMS), six healthcare organizations launched a major initiative in mid-April to improve the state’s medical liability system.
In addition to MMS, Beth Israel Deaconess Medical Center (BIDMC), Baystate Health, Massachusetts Coalition for the Prevention of Medical Errors, Massachusetts Hospital Association and Medically Induced Trauma Support Services are participating in the alliance.
The new alliance has launched the Roadmap to Reform, an alternative approach to medical liability intended to improve patient safety, increase transparency, reduce litigation and cut costs to the healthcare system.
The Roadmap to Reform proposes a process of disclosure, apology and offer (DA&O), an alternative to the current tort system, which many health professionals say is inefficient, drives health costs higher and is unduly burdensome to patients, physicians and the healthcare system. The DA&O approach will be instituted, beginning this year, to test its feasibility in different practice environments with different insurance arrangements.
“The goal is to improve the system,” said Alan Woodward, MD, chair of the MMS Committee on Professional Liability and a past president of the organization. “We want a system that is fair, more equitable, more just for patients and a system that improves patient safety.”
To develop the DA&O approach, the alliance conducted structured interviews with 27 key stakeholders holding leadership positions in organizations central to implementation, including the Massachusetts legislature and administration, hospital systems (including academic health centers and community hospitals), practicing physicians, liability insurers, health insurers, medical professional associations, patient advocacy organizations, malpractice attorneys, patient safety experts, major physician practice groups and a major business association.
“We were amazed that nobody thought there was a better solution,” said Woodward. “There is broad support.”
With the initiative, said Kenneth Sands, MD, senior vice president for healthcare quality at BIDMC, “We are proposing to create a centralized resource to support this new model. By conducting programs in seven hospitals, specifically chosen to allow demonstration in various hospital settings and within different malpractice insurance models, we can assess impact on patient safety, malpractice claims and overall liability costs.”
Although it is difficult to pinpoint the cost of defensive medicine, it is generally thought to add 10 to 20 percent to the annual cost of healthcare nationwide.
“The system now is onerous for both patients and physicians,” said Woodward, noting that concern over possible litigation discourages transparency, inhibits communication between caregivers and patients, burdens physicians with excessive premiums and motivates physicians to practice defensive medicine.
“Our primary focus is full disclosure to the patient, putting a system in place to prevent reoccurrence and, if necessary, compensating patients for their losses,” said Woodward. “If you ask patients, this is what they want.”
“We can make the approach to medical liability much better for both patients and physicians and stop driving unnecessary costs,” he added.
Massachusetts’ DA&O approach is modeled after the University of Michigan Health System, which has followed the same core principles for over a decade.
“After 10 years of consciously, stubbornly pursuing honesty as a guiding principle, we have demonstrably reduced groundless litigation,” said Richard C. Boothman, chief risk officer at UMHS. “By reducing groundless litigation and the fear that accompanies it, I believe our physicians are much less inclined to see their patients as future legal adversaries, and as a result, are increasingly free to focus on their patients and their patients’ needs.”
“The Michigan Model promotes a closer understanding between patient and caregiver so better choices can be made in the patient’s care, choices that are focused on the patient’s best clinical interest, not the clinician’s best defense should things go wrong,” he added.