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Risk Management in the New Era of Healthcare Reform
February 26, 2011
James W. Saxton, EsquireChair, Healthcare Litigation and
Risk Management Group
Stevens & Lee
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Disclosure Statement
Mr. Saxton holds the following positions:
• Board of Directors and Executive Committee Surgical Review Corporation
• Board of Directors Surgical Excellence, LLC
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Objectives
• What’s up in the litigation environment
• How health care reform will change the way health care is delivered…and your risk!
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Something Doesn’t Feel Right …!
• Plaintiffs’ Bar more organized than ever
• Leveraging technology
• Leveraging national expertise
• We need to be
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The LITIGATION Environment• Plaintiff’s attorneys have courses on
– Psychodrama– “Crying” – Channeling
FocusFocus...on theDRAMA
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Scrutinizing EVERY MOVE!
Be among the first to learn how to read microexpressions
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Healthcare Reform will accelerate
• Payment concepts transformed into liability issues?– “Never Events”
• Negligence per se
– Failure to follow “best practices”• Liability and economic
issues
– Transparency will make a difference
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To get prepared…Let’s look at this from 10,000 feet
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WHERE Will Care be Provided?
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WHERE Will Care be Provided?
• Hospitals• Ambulatory surgery
centers• Community health
centers• Retail clinics
• Urgi-care centers• Employer health
centers• Home-care settings
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WHERE Will Care be Provided?• Jobs and workplaces
– Pitney Bowes
• Connecticut-based manufacturer of business software and hardware
• $6.3 billion annual revenue, 36,000 employees
• 7 on-site medical clinics, open to 5-6,000 employees
• Primarily staffed by nurses
“Putting healthcare on-site keeps employees healthy, costs less, and increases productivity…. Our goal is to be an extension of the primary care physician in the workplace … but not to take over the primary care.” Brent Pawlecki, MD, MMM
Corporate Medical DirectorPitney Bowes, Inc.interviewed 8/27/10
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WHERE Will Care be Provided?• CVS: 500 Minute Clinics!• Primary goals:
– break-even– drive extra traffic into stores
• Retail facilities: The Convenient Care Association counts approximately 1200 retail clinics in >32 states!
– Roadside Medical Clinic Labs (serves drivers at truck stops in 3 states)
– Wal-Mart, Target, Publix• Cyberspace
– At home with web-based tools for patient self-management, education and engagement
• Intel, GE Announce New Telehealth Joint Venture focusing on three major segments including chronic disease management, independent living at home and in assisted living communities, and assistive technologies. August 2, 2010
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As to the WHERE…
You need to be thinking…
• Are there new risks?
• Is there a shift in responsibility?
• Is there a safety net?
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WHO Will Provide Care?
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WHO Will Provide Care?
• Number of mid-levels in primary care – CHANGE…in who refers to you??
• Midlevels in surgical specialties– Who will supervise?– What is the appropriate level of supervision?– Be careful with hand-offs– Must be part of the team– Must enhance the “practice-patient”
relationship
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And… the physical demands of a demanding profession are taking their toll…
“Whereas we’ve focused rightly on patient safety…[we] have never given mind to surgeon safety.…By 2020 [there will be] up to 30% workload increase for general surgeons. [Today] 87% of surgeons performing minimally invasive surgery are suffering from occupational injury or exhibiting symptoms….We must pay attention…[because these will lead to] reduced workforce and reduced career lifespans.”
~Adrian Park, MD Campbell and Jeanette Plugge
Professor and Vice ChairDepartment of Surgery HeadDivision of General Surgery
University of Maryland Medical Center
Interviewed 8/18/10
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WHAT Care Will be Provided?
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WHAT Care Will be Provided?
• Surgeons need to move to “best practices”
• Surgeons who want to be part of ACOs– Being better at “IT”– Enhancing true patient and family satisfaction– Reducing “never events”– Collaboration skills– Use of mid-levels– Becoming a high quality, efficient provider
• Is this going to be
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Changes in the WHAT mean…
…really focusing on reducing “Never Events”:
1. Surgery performed on wrong body part2. Surgery performed on wrong patient3. Wrong surgical procedure performed on patient4. Unintended retention of a foreign object in a patient after surgery or other procedure5. Patient death or serious disability associated with medication error6. Patient death or serious disability with a hemolytic reaction due to the administration of ABO/HLA incompatible blood or blood products7. Death or serious disability due to an air embolism8. Falls that result in death or serious disability9. Stage 3 or 4 pressure ulcers acquired after admission to a health care facility10. Death or serious disability associate s with failure to identity and treat hyperbilirubinemia in neonates
~National Quality Forum
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This will all evolve to…
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Being aggressive- using the evidence
$$
A STRATEGIC APPROACH
RiskMitigation
Risk
EventManagement
Event
Control of the Process
Claim
A Different Defense
Lawsuit
$$ $$ $$
Infrastructure
BaselineLessons learned
Education
Post – eventcommunicatio
nBuild the
foundationClaims mgmt.
How to get there:
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…to…the NEXT LEVEL!
• Obtain a practice/department assessment– True movement to critical!
• Movement to making patients better partners–
• Moving to true– You– Your colleagues– Your staff
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For more information, please contact:
STEVENS & LEE51 South Duke StreetLancaster, PA 17602
James W. Saxton, Esq.717-399-6639