Analyzing Primary Care-Related Malpractice Claims in New Research Report

Coverys’ report offers data-driven review to help reduce vulnerabilities during the patient journey

Boston, MA - March 12, 2019 - Coverys, a leading provider of medical professional liability insurance, today released its latest Red Signal ReportSM, providing a data-driven look at the state of primary care in the United States. The report analyzes 1,800 closed primary care-related medical professional liability claims at Coverys across a five-year period from 2013-2017 to identify risks and illuminate the warning signals and safety vulnerabilities within primary care practices.
“The role of the primary care provider (PCP) has become increasingly challenging, with yesterday’s family doctor now accountable for all aspects of the patient care continuum. This includes referral management, management of multi-morbidities, and transfer to long-term care, all while keeping a close eye on utilization, appropriate levels of care, and patient quality metric outcomes,” said Robert Hanscom, VP of business analytics at Coverys and co-author of the report. “This demanding environment is compounded by challenges including increased patient volumes with shorter office visits and unpredictable transitions of care. Anything but astute attention to every aspect of the patient journey can lead to unintended injuries and malpractice claims against the PCP.”
Key findings from the Red Signal ReportSM include
  • For PCPs, diagnostic errors were the leading type of claim (46%), accounting for the highest proportion of indemnity paid (68%). The top allegation for primary care providers involves inadequate patient assessment. This step includes the capture of a complete family history and a thorough physical exam.
  • Medical treatment-related claims were the second most common allegation for PCPs, just over 20%. These claims involve issues with care rendered from non-procedural therapies. They frequently are associated with cardiac treatments, pain management, wound care, and blood administration.
  • The most critical step in the medication process for PCPs is the monitoring of the patient’s medication regimen. These claims often result in high-severity injuries; this is especially the case when high-risk medications such as anticoagulants and opioids are not being closely managed.
  • When being transferred from one healthcare setting to another or to home, patients are vulnerable to unexpected issues when there are failures by the clinical care team to communicate and hand off critical information related to their care.
Beyond examining primary care-related signal events, the authors detail evidence-based recommendations for PCPs to address many of the most pressing risk issues.
“Primary care physicians play a critical role in the delivery of a timely and accurate diagnosis, selection of treatment therapies, and the monitoring of high-risk medications. Failure to correctly assess patient conditions during these complex phases of care can result in significant patient harm,” said Robin Webster, senior risk consultant at Coverys and co-author of the report. “Our risk management recommendations offer providers the opportunity to increase patient safety and quality of care and improve reimbursement.”
Strategies are included in the report that is available to view on the Coverys website here.
This is the second report in Coverys’ Red Signal ReportSM series, which previously explored radiology claims data. The series is designed to identify the major risk factors, claims warning signals, and safety vulnerabilities within specific specialties and clinical areas where education and practice change initiatives can improve patient safety, reduce malpractice exposures, and increase reimbursements for providers. The report is co-authored by Maryann Small, director of data governance & business analytics; Robert Hanscom, VP of business analytics; and Robin Webster, senior risk consultant.