By Ann Fiala, Senior Risk Specialist, and Judy L. Klein, Risk Management Manager
Will history look back on 2021 as the tipping point when the healthcare industry finally realized it could become more connected, agile, and innovative?
The COVID-19 pandemic has exacerbated the ongoing shortage of health workers and made it harder for patients – especially our most vulnerable populations – to access high-quality medical care.
Congress, federal agencies, healthcare providers, and insurance companies responded this year with an all-hands-on-deck scramble to accelerate the adoption of telehealth, expand traditional healthcare teams, and evolve care transition models. These efforts hold promise for positively shaping the future of the industry in 2022 and beyond.
Still, recent analyses of care transition claims
and telehealth adoption
reveal five notable trends – and cautionary tales – for healthcare leaders striving to implement innovative programs that not only provide quality care but also minimize patient and practitioner risk.
Prediction 1: Communication Is Imperative (and Verbal Is Not Enough)
Delivery of care can be impacted as demands on healthcare providers increase. For example, complicated home-care instructions are offered verbally to a nodding and anxious patient but are not confirmed via a teach-back or reinforced with detailed written instructions; prescriptions for expensive medications are written without verifying whether the patient can afford to fill them.
Further, since communication happens at multiple levels, provider to patient and provider to provider, it is important to be mindful of effective communication while assessing care with peers. In fact, one notable study
estimated that 80% of serious medical errors involve miscommunication during the handoff between medical providers. Communication was the third-most frequent risk issue during transition-related events that triggered malpractice claims in Coverys’ Care Transitions report
In the next year, a rise in communication-related claims is predicted that will continue to bear a significant economic burden and exacerbate health inequities.
Prediction 2: Evolving Healthcare Team
As health systems look for solutions to ongoing staffing shortages, trends indicate that care teams will take a new shape in 2022. Several factors have converged, however, to generate potential for significant risk:
- We have seen the rise of the hospitalist model and the reduction of private physicians in primary care and specialties making rounds to visit their patients who arrive in an ED or a hospital unit.
- Over the last year, 78.6% of healthcare organizations planned to incorporate advanced practice providers (APPs) into specialty care settings because of critical staffing shortages.
- The sheer volume of participants in a patient’s care journey can be overwhelming—from physicians and APPs to nurses, administrators, EMTs, pharmacists, medical assistants, and volunteers.
The result is an environment ripe for risk as providers do not always have a holistic view of the patient’s medical record as portions might not be easily accessible, making it even more important for thorough and effective care transition communications. In fact, analysis of Coverys data recently revealed
that 19% of care-transition-related claims events involved an APP.
To counter the potential for further risk, health providers must expand their investments in training and providing resources for their teams that will enhance their understanding of the importance of and best practices for care transition communications as they navigate the shifting burden and new team workflows.
Prediction 3: Emerging Care Transition Models
As more attention is brought to the risks and costs of care transitions, I predict more models for improvement will be introduced and tested.
Claims stemming from care transitions are 29% more costly
than claims arising from other allegations and often result in financial penalties through reduced reimbursement from the Centers for Medicare & Medicaid Services (CMS) and other insurers.
Pharmacist-led programs or those utilizing pharmacy technicians are showing promise, transition clinics are popping up to support high-risk populations, and video-conference-based programs serve patients in remote, under-resourced communities with a history of low access to medical care. What is most exciting about process improvement for care transitions is that no matter how much work you must do, you are not alone, and there is no need to start your own program from scratch. There are many established evidence-based models; it is just a matter of finding the right fit and committing to start.
Prediction 4: The Downside Risks of Telemedicine
Telemedicine provides a convenient mode of healthcare delivery for all parties involved and can significantly benefit patients who otherwise might not visit a healthcare provider. However, practitioners must make every effort to give patients the same care and attention during a telemedicine visit that they would during an in-person visit.
We predict that the volume of virtual care lawsuits will increase as telemedicine becomes an increasingly common way for patients to access healthcare. Without the opportunity to conduct a physical exam, it can be easier for practitioners to miss information during a virtual visit that could lead to patient harm. Lawsuits for claims are similar to those that may be expected for in-person care, such as incorrect diagnosis, inadequate assessment, testing, or procedures, and failure to ensure that the patient understood the diagnosis or recommended treatment.
Prediction 5: Fragmented Environments Are Ripe for Risk
It has been estimated that more than 4,000 care transitions happen each day at a single academic medical center. It is safe to assume that the frequency of handoffs is the norm at other types of hospitals and health systems. With patients receiving their care from multiple providers across separate, sometimes disconnected healthcare systems, even the most experienced provider or the savviest patient is left wondering who is driving the care. Since the advent of the hospitalist model and the ever-increasing trend for many U.S. patients not to have a primary care physician, there is often no single source of relationship or information about a patient’s health, creating an environment susceptible to malpractice claims.
Implementing a proven care-transition model and being diligent about internal processes, communication, documentation, discharge planning, and patient assessment and education are critical factors for successful care transitions.
We predict that as the healthcare system becomes increasingly more fragmented due to new care delivery models, such as telemedicine and “hospitals at home,” we will see an increase in claims in the next several years resulting from lack of clarity around provider accountability, missed and delayed diagnosis, and missteps in care transitions.
Global Disruption Spurs Change
As we look to what lies ahead, external factors continue to coalesce to force dramatic change in the way healthcare is structured, paid for, and delivered.
In response to the pandemic, a deep vein of telehealth and new clinical and operational models have arisen, showing us a bridge toward building a more connected, agile, and equitable health system.
There are still significant challenges to realizing this vision. However, organizations that take a step back to consider and address critical areas of potential exposure have the greatest opportunity to deliver quality programs that mitigate risk and decrease liability, thereby meeting the needs of patients whose care begins, ends, or transitions through their purview.
For more trends, predictions, and practical recommendations, check out:
No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.