Claims Data SnapshotDentistry

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This publication contains an analysis of the aggregated data from MedPro Group’s Dental claims closed between 2007 and 2016. All claims included in this analysis identify a dentist as the primary responsible service. Claims in which another specialty is identified as the primary responsible service are not included, unless otherwise noted.

This analysis is designed to provide MedPro Group insured doctors, healthcare professionals, hospitals, health systems, and associated risk management staff with detailed claims data to assist them in purposefully focusing their risk management and patient safety efforts.

Data are based on claim counts, not on dollars paid (unless otherwise noted). The type of claims and the details associated with them should not be interpreted as an actuarial study or financial statement of dollars paid; however, the information may be referenced for issues of relativity.

Introduction

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Allegations & financial severity

NOTE: The “other” category includes allegations for which no significant claim volume exists. Any totals not equal to 100% are the result of rounding. Total dollars paid = indemnity + expense.

Top allegation sub-categories/diagnoses:

Treatment-related• Performance of procedures (63%) • Management of a course of treatment (21%)• Retained foreign bodies (8%)

Diagnosis-related• Primarily related to failure to diagnose cancer or periodontitis• On average, the diagnostic claims are more expensive per claim

than are the treatment claims.

The majority of clinical outcomes across all dental claims are classified as ‘medium’ clinical severity (including tooth damage, nerve injury & infection), but within the diagnostic claims, 36% of the outcomes are noted as high-severity, mostly involving delayed cancer diagnoses resulting in death/permanent injury/loss of function.

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Involved procedures

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Top risk factors in treatment-related allegations

Technical skill

Behavior-related

Clinical judgment

Administrative

Communication

Occurrence of recognized complications is predominant issue; also includes poortechnique, incorrect site & retained foreign bodies

Lack of informed consent and inadequate patient understanding of expected outcomes; poor rapport between patients & providers noted as well

Inadequate assessment of the patient prior to treatment; failure to select the most appropriate treatment plan & delays/failures to seek consults

Patient dissatisfaction with treatment; non-compliance with treatment regimens & follow-up appointments; patient behavioral issues are noted more frequently in dental claims than they are in medical claims (19% of medical treatment claims)

75%

42%

32%

32%

18% Billing & collection issues; often noted in conjunction with patient dissatisfaction

NOTE: Top factors within each risk category are identified. Totals exceed 100% because generally more than one factor is associated with each claim.

16% DocumentationInsufficient documentation of informed consent, clinical findings & clinical rationale for treatment; often noted in conjunction with patient behavioral issues (failure to document steps taken to address the patient’s complaints)

Risk factors are broad areas of concern that may have contributed to allegations, injuries, or initiation of claims.

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Important risk mitigation strategiesTechnical skill

To minimize the risk of recognized complications, ensure adherence to credentialing policies, including evaluation of proceduralskills and competency with equipment.

Behavior-related

Recognize that patient satisfaction with treatment outcomes can be influenced by a thorough informed consent and education process.

Communication

Ensure adherence to a comprehensive informed consent process, including patient education with an incorporated ‘teach-back’ methodology.

Clinical judgment

Conduct a thorough pre-procedure screening of patients for risk factors and appropriateness for procedure.

Maintain a consistent post-procedure assessment process.

Carefully consider repeated patient complaints or concerns when making clinical decisions about patient care and additional diagnostic testing.

Administrative

Develop and adhere to consistent administrative policies/procedures involving the billing/collection process, and ensure clear communication of same to patients.

Documentation

Understand the importance of comprehensive documentation of each patient encounter, including all clinical findings, rationale for treatment & discussions with patients. Document the presence or absence of periodontal disease, cancer, infection & nerve injury.

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Key points

Treatment-related claims represent the largest claim category for dentists. The majority of these claims involve dental restorations, followed by root canals and extractions.

The most common injuries in treatment-related claims are tooth damage, nerve injury and infections.

Technical skill issues, including wrong site procedures and retained foreign bodies, as well as the occurrence of recognized complications, are the most frequently occurring risk factors in dental claims. Patient non-compliance/dissatisfaction, lack of an adequate informed consent process, inadequate assessment of the patient, issues with billing & collection and insufficient documentation of the details of clinical encounters are noted as additional risk factors.

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MedPro Group has entered into a partnership with CRICO Strategies,

a division of the Risk Management Foundation of the Harvard Medical

Institutions. Using CRICO’s sophisticated coding taxonomy to code

claims data, MedPro Group is better able to identify clinical areas of

risk vulnerability. All data in this report represent a snapshot of MedPro

Group’s experience with specialty-specific claims, including an analysis

of risk factors that drive these claims.

Disclaimer

This document should not be construed as medical or legal advice. Because the facts applicable to your situation may vary, or the laws applicable in your

jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or

rights, state or federal laws, contract interpretation, or other legal questions.

MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO,

Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates,

including National Fire & Marine Insurance Company. Product availability is based upon business and regulatory approval and may differ between

companies.

© 2018 MedPro Group Inc. All rights reserved.

A note About MedPro Group data