Policymakers, providers, and stakeholders have been debating various approaches to reforming our medical liability system to both protect patients who experience adverse medical events and to help practitioners provide the highest quality care possible. One innovative approach may well avoid some of the sharper policy differences on proposals in this area: encouraging the disclosure of unanticipated outcomes to affected patients. This disclosure may include an explanation and apology to the patient and family, as well as an offer of compensation in some cases. Some anecdotal data suggest that such communication-and-resolution programs can result in improved patient safety and decreased malpractice claims. However, questions arise about how well this approach really works, and whether it can be standardized and scaled up in our medical system.
How do disclosure and apology programs work? What are some barriers to adopting such policies? Do liability insurers accept full disclosure protocols? How difficult is it to manage patients’ expectations and perceptions when communicating openly and honestly with them? Given the costs associated with disclosing errors and offering compensation, how do these programs affect providers’ finances? Does the ACA significantly alter the efficacy of these laws? What are some of the key policy questions around patient safety and disclosure programs moving forward?
William Sage, James R. Dougherty Chair for Faculty Excellence, University of Texas at Austin School of Law, provided an overview of the medical liability landscape and the role of disclosure and apology in this area.
Ann Hendrich, senior vice president of quality and safety, Ascension Health, spoke about their health system’s disclosure program, how it worked, and what some of the successes and challenges have been.
Raymond Cox, MD, MBA, executive director, Volunteers in Medicine Clinic, spoke about his experiences while participating in AHRQ’s medical liability reform demonstration grants.
Jean Rexford executive director, Connecticut Center for Patient Safety, spoke about disclosure in the context of broader safety patient efforts.
Ed Howard of the Alliance moderated.
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If you were unable to attend the briefing, here are some key takeaways:
Ascension Health’s “Excellence in Obstetrics” program (part of Agency for Healthcare Research and Quality’s demo grant), which focused on the disclosure and apology approach for 20,000 women, saw a 48.6 percent decrease in the number of high risk liability occurrences, Ann Hendrich stated. Immediate reporting and expedited investigation also resulted in decreased malpractice costs, which dropped from $7 million (pre-grant period) to $1 million.
Apology laws must be federalized so that physicians can learn from adverse events, Raymond Cox stated. Only 12 percent of preventable adverse events result in a medical claim, mostly for people to find out what happened, he said, citing a 3-country study.
Communication and Resolution Programs (CRPs) for medical injury have three main goals: to tell patients what happened, try to make things right, and improve safety for the future, said William Sage. He also highlighted some of the barriers to adopting CRPs, including fear of litigation, reputational and economic concerns of providers, and patient participation. Dr. Sage pointed out that a hospital which discloses a high number of medical errors isn’t necessarily a bad hospital, in fact it is probably safer than a hospital that doesn’t disclose as many errors.
The current system is not working for patients or physicians, said Jean Rexford. She emphasized that communication is critical for achieving patient safety and involving patients from the start is beneficial for both patients and providers.
The event was sponsored by the nonpartisan Alliance for Health Reform and Ascension Health.
Full Transcript (Adobe Acrobat PDF)