Medical malpractice continues to be a significant issue for physicians from all walks throughout the United States, and there are long-standing concerns about those who are claim-prone and complaint-prone. “Medical malpractice claims are one useful indicator of patient safety,” explains David M. Studdert, LLB, ScD, MPH. “In the past, researchers have compared physicians who have multiple claims against them with other doctors who have few or no claims. These analyses have identified systematic differences with regard to age, sex, specialty, training and certification, claim and complaint histories, and quality of care. However, only a few studies have looked at the nature of the maldistribution itself.”
Previous research has been generally limited to claims data from single insurers or states and date back to several decades ago. If claim-prone physicians account for a substantial share of all claims, it would be valuable to reliably identify them before they accumulate troubling track records. Unfortunately, attempts to predict malpractice claims have had mixed results, leading the medical malpractice system to be reactive more than proactive because the focus is placed on dealing with the aftermath of care that has gone wrong.
Dr. Studdert and colleagues recently had a study published in the New England Journal of Medicine that sought to characterize the distribution of paid malpractice claims among physicians throughout the U.S. and aimed to identify specific physician characteristics that are associated with incurring multiple paid claims. Using data from the National Practitioner Data Bank, the study group analyzed in excess of 66,000 claims paid against more than 54,000 physicians from 2005 through 2014. They calculated concentrations of claims among physicians and used a multivariable recurrent-event survival analysis to identify characteristics of physicians at high risk for recurrent claims and quantify risk levels over time.
“Our results showed that about 1% of all physicians accounted for approximately one-third of paid claims,” says Dr. Studdert. “Our finding that a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims demonstrates the need to find strategies that can help us reliably predict who is at risk for further claims. Several physician characteristics—most notably the number of previous claims and the physician’s specialty—were significantly associated with recurrence of claims.”
Among physicians with paid claims, 84% incurred only one from 2005 to 2014, accounting for 68% of all paid claims. The study team also found that 16% had at least two paid claims, accounting for 32% of the claims, and 4% had at least three paid claims, accounting for 12% of the claims. Physicians who reached a third paid claim had a 24% chance of another paid claim within 2 years and a 37% chance of another within 4 years. Doctors who reached a sixth paid claim had a 62% chance of another within 2 years and a 79% chance of another within 4 years. In general, physicians’ risk of incurring additional claims was highest in the year after a payment was made and declined gradually thereafter.
Risks of recurrence of paid claims also varied widely according to specialty, according to the analysis (Figure), and the range of risk across specialties was substantial. For example, psychiatrists with one or more paid claims had a 5% chance of incurring another one within 2 years and an 8% chance of another within 4 years. On the other hand, neurosurgeons with one or more paid claims had a 16% chance of incurring another one within 2 years and a 26% chance of another within 4 years.
Institutions that handle a large number of patient complaints and claims should understand the distribution of these events within their own at-risk populations, according to Dr. Studdert. It appears that few institutions actually accomplish this objective, and even fewer systematically identify and intervene with practitioners who are at high risk for future claims. “Ultimately, we need strategies that directly address the underlying problems that lead to many claims,” says Dr. Studdert.
The analysis suggests—but does not establish—the feasibility of predicting proneness to malpractice claims. “If we can reliably predict these claims, it may be possible for liability insurers and healthcare organizations to use this information constructively,” Dr. Studdert says. “Such data could inform collaborations on interventions to address the risks posed by claim-prone physicians using various approaches, such as peer counseling, training, and/or supervision. Future research should also explore unpaid malpractice claims and patient complaints to gain a better understanding of physicians who may be at risk. This could become an exciting opportunity for liability and risk-management enterprises to join forces and mainstream efforts to improve healthcare quality.”
Readings & Resources (click to view)
Studdert DM, Bismark MM, Mello MM, Singh H, Spittal MJ. Prevalence and characteristics of physicians prone to malpractice claims. N Engl J Med. 2016;374:354-362. Available at: http://www.nejm.org/doi/full/10.1056/NEJMsa1506137.
Studdert DM, Mello MM, Gawande AA, et al. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024-2033.
Mello MM, Chandra A, Gawande AA, Studdert DM. National costs of the medical liability system. Health Aff (Millwood). 2010;29:1569-1577.