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New approach; Mass. malpractice initiative announced.

Byline: Susan Spencer

It's a simple fact that gets obscured by the sophisticated science surrounding modern medical care: Sometimes things go wrong. The operation doesn't succeed, the patient has underlying complications that weren't detected, it was bad timing or bad luck; or sometimes a health care professional makes a mistake.

Whether or not an unexpected poor outcome could have been prevented, what happens after something goes wrong is a critical piece of medical care. The threat of a lawsuit can cause health care providers to clam up about the problem to patients or their families, which not only hurts patient care, but can also inhibit making changes that could keep the problem from happening again.

The adversarial culture also affects medical decision-making in a big way, adding $1.4 billion to health care costs in Massachusetts each year for defensive medicine. The estimate includes $1.1 billion in unnecessary hospital admissions and nearly $3 million in referrals and tests, according to a 2008 report by the Massachusetts Medical Society.

In an effort to improve the medical liability environment in the state, the medical society and a coalition of health care organizations announced yesterday they are launching "Roadmap to Reform," an alternative approach to medical liability intended to improve patient safety, increase transparency, reduce litigation and cut costs to the health care system.

The Roadmap to Reform, which was supported by a planning grant from the federal Agency for Health Care Research and Quality, uses the model of "disclose, apologize and offer," or DA&O, instead of relying first on the tort law system, according to a news release from the medical society.

Under the DA&O model, health care professionals, organizations or insurers disclose to patients and their families as soon as an adverse outcome occurs; investigate and explain what happened; establish systems to improve patient safety and prevent problems from recurring; and where appropriate, apologize and offer fair financial compensation. Patients may still sue for malpractice, but it is a last resort.

"When that communication (after an adverse outcome) doesn't happen, even if you've done everything perfectly, there's a sense of anger," said Dr. Robin Richman, medical director for Reliant Medical Group in Worcester, which supports the Roadmap to Reform initiative.

Dr. Richman said Reliant Medical Group, which is self-insured for medical liability, has been practicing much of the disclose, apologize and offer model for years. "Patients feel validated and heard," she said. "We want to make sure they get that wherever they get care across the state."

She said the financial savings of disclosure have been noticeable, but they're overshadowed by improvements in the physician-patient relationship and quality of care.

"This program comes out of people's good experience. Some people never get sued, even if they're in a high-risk specialty," Dr. Richman said. "It makes a big difference."

Some of the practices Reliant uses, in addition to talking to patients immediately after the unexpected outcome, include holding periodic mandatory meetings on quality and liability-prevention issues throughout the year and having physicians on call 24 hours a day who can help a doctor who has had a bad experience evaluate the problem or talk about it with the patient or family.

Dr. Richman said that medical schools and residency programs are training new physicians in total patient care and not just the myriad diseases, diagnostic techniques, laboratory science and medical treatment. "The communication with the patients is equally critical," she said.

The DA&O model has been highly successful at the University of Michigan Health Care System and has gained broad support from independent health care organizations across the country.

The model is being demonstrated in this state by seven hospitals, including three from the Beth Israel Deaconess Medical Center health system in Boston, three from Baystate Health in Springfield and Massachusetts General Hospital. The research is supported by the Massachusetts Medical Society, the Massachusetts Coalition for the Prevention of Medical Errors, the Massachusetts Hospital Association, and Medically Induced Trauma Support Services, a nonprofit organization that supports families, patients and clinicians who have been affected by adverse medical events.

Dr. Richman hopes that the Roadmap to Reform pilot will make quality improvements and reductions in adversarial liability concerns a more standardized process. "We spend a lot of time educating and supporting our physicians," she said. "We'll be watching to see if there's anything else we should add as the program rolls out."


CUTLINE: (PHOTO) Dr. Robin Richman in her office at Reliant Medical Group in Worcester. (CHART) Estimated cost of selected defensive acts

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Title Annotation:BUSINESS
Publication:Telegram & Gazette (Worcester, MA)
Date:Apr 18, 2012
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