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5/22/2020 0

Claims Data Snapshot

Dentistry

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This publication contains an analysis of the aggregated data from MedPro Group’s cases closing between 2009-2018 in which a dentist is identified as the primary responsible service.

A malpractice case can have more than one responsible service, but the “primary responsible service” is the specialty that is deemed to be most responsible for the resulting patient outcome.

Our data system, and analysis, rolls all claims/suits related to an individual patient event into one case for coding purposes. Therefore, a case may be made up of one or more individual claims/suits and multiple defendant types such as hospital, physician, or ancillary providers.

Cases that involve attorney representations at depositions, State Board actions, and general liability cases are not included.

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

Introduction

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Allegations

Multiple allegation types can be assigned to each case; however, only one “major” allegation is assigned that

best characterizes the essence of the case.

Procedural performance and diagnosis-related issues are among the top allegations against dentists.

Of note, diagnosis-related allegations, while not representing a large portion of the case volume,

account for 17% of the total dollars paid, and with the exception of the few anesthesia-related cases, are on

average the most expensive to resolve.

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018

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Allegations & dollars

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018; total paid = expense + indemnity dollars; “other” includes allegations for which no significant case volume exists.

58%

17%

7% 7%11%

53%

14%

4%

17%

12%

0%

10%

20%

30%

40%

50%

60%

70%

Performance oftreatment/procedure

Management oftreatment

Retained foreign body Diagnosis-related Other

% o

f ca

se v

olu

me &

tota

l dollars

paid

Case volume Total paid

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Clinical severity*

11% 10%16% 3%

73% 76% 70%

51%

16% 14% 15%

46%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All cases Performance of procedure Management of treatment Diagnosis-related

% o

f ca

se v

olu

me

Low Medium High

Within the high severity cases are permanent patient injuries ranging from serious to grave and patient death.

Typically, the higher the clinical severity, the higher the indemnity payments & the more frequently payment occurs.

There has been an increase in the volume of the most severe patient outcomes over the last 10 years.

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018; *NAIC rating scale

5

19%18%

17%16%

13%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

Root canal Application of crown Extractions Bridges/dentures &removable appliances

Implants

% o

f pro

cedura

l ca

se v

olu

me

Top procedures in procedural performance cases

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018

6

38%

19%

15%

12%

9%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Teeth damage Procedural repairrequired

Nerve damage Infection Pain

% o

f pro

cedura

l ca

se v

olu

me

Top injuries in procedural performance cases

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018

7

23%

17%

7%

5%

0%

5%

10%

15%

20%

25%

Cancer (oral) Periodontitis Infection Caries

% o

f dia

gnosi

s-re

late

d c

ase

volu

me

Most frequent diagnoses in diagnosis-related allegations

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018

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Anesthesia-related dental cases

Anesthesia-related events in the dental office, while not frequent, are the most expensive* to defend and on average, result in the most severe patient injuries (including respiratory arrest, hypoxic brain injury and

death. Allegations of improper administration of anesthetic medications and improper management of patients under anesthesia are most common.

The dentist’s selection of the most appropriate combination of medications, along with inadequate patient assessments prior to the procedure (to better

glean co-morbidities and past history of pain/anesthetic medication reactions) are notable risk issues.

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018; *expensive = total dollars paid, expense + indemnity

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Contributing factors

Contributing factors are multi-layered issues or failures in the process of care that appear to have contributed to the patient outcome and/or to the initiation of the case.

Multiple factors are identified in each case because generally, there is not just one issue that leads to these cases, but

rather a combination of issues.

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75%

49%

39%36%

20%

88%

49%

32%33%

18%22%

45%

88%

25%29%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Technical skill Behavior-related Clinical judgment Communication Documentation

All allegations

Performance of procedure

Diagnosis-related

Top contributing factor categories – by allegation% o

f re

specti

ve c

ase

volu

me

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018

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Risk factor Details

Technical skillOccurrence of recognized complications is the predominant issue; also includes poor technique*, incorrect site & retained foreign bodies

Behavior-relatedPatient dissatisfaction with treatment; non-compliance with treatment regimens* & follow-up appointments

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

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

Documentation

Insufficient 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)

Top risk factor details

Data source: MedPro Group closed cases, dentistry as responsible service, 2009-2018; *cases with these factors are among the most expensive to resolve

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Technical skill:

Ongoing evaluation of procedural skills and competency with equipment is critically important.

Behavior-related:

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

Clinical judgment:

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

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

Communication:

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

Documentation:

Verify that documentation supports the clinical rationale for the method of treatment.

Timely document thorough, objective information about the results of patient assessments, education of the patient/family about treatment plans - including medication regimens, and any instances of patient nonadherence.

Thorough, consistent documentation in the chart provides a supportive framework for defense of any subsequent malpractice case.

In summary: where to focus your efforts

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MedPro advantage: online resources

Tools & resources

Educational opportunities

Consulting information

Videos

eRisk Hub Cybersecurity Resource

Materials and resources to educate

followers about prevalent and

emerging healthcare risks

Education

Information about current trends

related to patient safety and risk

management

Awareness

Promotion of new resources and

educational opportunities

Promotion

Follow us on Twitter @MedProProtectortwitter.com/MedProProtector

Find us at www.medpro.com/dynamic-risk-tools

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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/or regulatory approval and/or may differ between

companies.

© 2020 MedPro Group Inc. All rights reserved.

A note about MedPro Group data