HealthJanuary 04, 2024

Using evidence-based strategies to help reduce malpractice risk

By: Andy Baer, MD

Physicians shouldn’t have to practice defensive medicine to avoid litigation. If actionable risk reduction strategies could be built into their workflow, would it help create more confidence?

The effects of medical malpractice on clinicians

In 2021, medical malpractice payouts topped $3.1 billion, representing more than 9,000 payment reports, according to data from the National Practitioner Data Bank.

Beyond the costs, malpractice has damaging ripple effects among clinicians. A 2022 study found significant psychological stress among physicians related to malpractice claims, with over 56% of those surveyed reporting notable psychological reactions to being involved in claims and nearly half noting that experiencing claims changed the way they practiced medicine. Other studies point to a worry over malpractice bordering on paranoia leading to an increase in defensive medicine, or the practice of recommending tests or procedures that may not be necessary or the best option for the patient in order to protect that doctor against potential liability.

As part of the advice team at MagMutual, where I advise policyholders on medical matters and avoiding risk, we wanted to find a way to help our policyholders be more proactive. We provide smart care practices to mitigate risk while avoiding practices that could erode high standards of care or patient trust in their physicians.

Helping policyholders mitigate risk through education

Taking the approach that it was better for our physicians to feel more confident in their decision-making and supported by a team with expertise in risk mitigation than to practice from a defensive standpoint, we built the Learning Center. It offers a variety of resources covering topics related to top risk drivers developed using our proprietary data as well as national findings. Options include:

  • Exclusive online video courses, some of which offer CME credits
  • Claims lessons based on actual closed claims
  • Informational articles
  • Topic-specific toolkits
  • Specialty-specific risk reports

Because everyone learns differently, we felt it was fundamental to provide offerings based on different specialties and in a variety of media and with several ways to access content.

We also thought it would be helpful to show physicians more data on liability risk as it relates to specific conditions, diagnoses, and treatment. So, we built an interactive platform with a library of a claims data they can access to help them understand and mitigate risk related to scenarios relevant to their practice.

And we’ve seen it work.

Reviewing data from policyholders who access our advice online through the Learning Center and the claims library, both are correlated with a decrease in overall malpractice risk over time.

Ask policyholders which decision support tools they prefer

Despite those positive results, there is a need to be “more proactive,” observes Mark Poling, MagMutual’s Chief Customer Officer. “People learn differently. If we can start to be more proactive in getting different information in different formats to them, we can start to learn what is effective for different segments of our population.”

To that end, we went to our policyholders and asked them what type of tools would be helpful to them reducing clinical risk. It seems a simple solution – to just ask – but if our company could provide essential tools to them, it could be a key component in lowering risk and increasing confidence and trust.

Our policyholders requested access to UpToDate® clinical decision support for evidence-based recommendations and guidance within their workflows. So, we have been sponsoring subscriptions for our customers for several years.

“It was a decision that was driven by our policyholders and the explicit need they communicated to us,” explains Brandie Szuda, Chief Medical Informatics Data Officer. “They told us, ‘We think that UpToDate will help us reduce our clinical risk,’ so we’ve partnered ever since.”

Busy clinicians need proactive outreach

We knew simply providing useful content and tools to our physicians wasn’t going to be enough to capture their attention and help them feel secure and mitigate risk in the long run.

We have 40 years of claims data on over 100,000 claims. Additionally, we have gone through the medical records, analysis and evaluations of those outcomes from physicians, depositions, and trial testimony to cut down to the granular detail as to why individuals in more than 20 specialties have ended up in a courtroom. More importantly, we’ve taken those loss drivers and applied them to actionable strategies to help prevent a similar outcome in the future. We are trying to be very intentional with our evidence-based content and provide clinicians something distinctly useful they can’t find from another source.

Nonetheless, as Poling points out, “it’s not realistic to hope that they have time to check their email that night and they happen to open one from MagMutual and click through to read an article that just happens to be relevant the next day when they’re with a patient. Getting digestible personalized knowledge that’s relevant to them in a way that’s time-efficient is just as important as what is being shared.”

Experimenting with workflow integration: UpToDate alongside risk data

With our policyholders already affirming their belief in the value of UpToDate for daily clinical usage and supporting decision-making, we saw it as an opportunity to experiment with ways to augment the advice our team offers.

“The more we can get our advice into their daily routine and workflow, the more we think they’re going to be receiving it,” Poling says.

By integrating our risk strategy information and advice with UpToDate clinical decision support, we’re able to offer our policyholders a resource that is unique in the industry. Without having to do anything extra, when they search for information on specific conditions in UpToDate as part of their daily workflow, when relevant, the results will also yield a sidebar box indicating there are MagMutual risk mitigation recommendations or care strategies alongside UpToDate’s industry-leading medical knowledge and evidence-based recommendations. The clinicians can choose to click through to learn more about the potential risk drivers associated with the condition they are researching, but even if they don’t, the box itself acts as a potential warning for increased risks giving clinicians a chance to be more mindful.

As an example, if a policyholder physician looks up vertigo, which can be caused by benign things, they will be able to see all of the most current best practices and recommendations typically provided by the UpToDate resource. Likely it will be a benign cause at the root of their patient’s problem. However, the risk mitigation strategies in the sidebar will also highlight the rarer possibility in the literature to note that the physician might consider cerebrovascular accident as a cause for vertigo. This is not to steer the clinician to a diagnosis; it is just to raise awareness of the commonly missed risk and allow them to consider it among their diagnostic possibilities.

Prior to this integration, the MagMutual platform presented itself to policyholders with a “somewhat passive approach,” Poling explains. “We’re partnering with UpToDate as a first step to proactively push personalized advice to clinicians so they’re not having to come and seek it out.”

Confidence in decisions improves with access to evidence

In 2023, MagMutual launched two experiments in which policyholders were given access to UpToDate integrated with the MagMutual content for certain search expressions. Over 100,000 searches returned the relevant content in the first 90 days.

In surveys to these early users:

  • 77% said the MagMutual content would help them better understand and mitigate risks.
  • 64% liked the presentation of the information.
  • 63% felt the content would help them improve patient care.
  • 72% said they would be likely to take action based on viewing content within UpToDate.

As we continue to expand access to more policyholders, we will also look to continue to enhance the user experience. We plan to incorporate user feedback from these surveys to guide us as we examine ways to optimize the design and delivery of information.

Moving forward, we hope to connect more policyholders to relevant topic specialties based on their usage within UpToDate.

“We have risk drivers targeted by specialty. We’re working to get risk drivers by the procedures and the diagnosis as well,” explains Szuda. “That would be a lot more granular to what the physicians and other providers need. We want to make sure that we’re providing them the content that’s relevant to them and we’re getting more specific with risk reduction strategies.”

“We know the effectiveness of advice is maximized when it’s actionable, relevant, and delivered at the time of care,” Poling says. “That’s why we’re combining our technology innovation, data, and analytics with a highly regarded physician-centric channel like UpToDate to offer information to our providers when it will be most useful, changing the practice environment and patient outcomes for the better.”

Learn More About Clinical Decision Support
Andy Baer, MD
Chief Medical Officer, MagMutual
Andy Baer, MD, is Chief Medical Officer of MagMutual, advising the company on all medical matters and leading risk management education for policy owners. Before joining MagMutual, Dr. Baer served as an attending physician in emergency medicine at a number of Virginia hospitals. He currently serves as an assistant professor in the Department of Emergency Medicine at the University of Virginia School of Medicine, where he received his undergraduate degree in biology and completed his medical degree, training, and fellowship in medical toxicology.
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