CRICO Strategies (“CRICO”), a division of The Risk Management Foundation of the Harvard Medical Institutions Incorporated, recently issued its report entitled Medical Malpractice in America: A 10-Year Assessment With Insights (“Report”).
The 123,512 medical professional liability (“MPL”) claims and suits analyzed for the Report represent more than $20B in reserves and losses drawn from CRICO’s database of more than 400,000 medical malpractice cases. The database reflects the MPL experience of more than 550 hospitals and health care entities and 180,000 physicians from commercial and captive insurers nationwide, representing approximately 30 percent of all U.S. medical malpractice claims and suits.
The key findings in the Report, covering the period from January 1,2007 through December 31, 2016 are:
– a 27% drop in the frequency of malpractice claims and suits being asserted per physician (a drop from 5.1 to 3.7 MPL cases per 100 physicians);
– the risk of having a claim or suit filed against obstetricians/gynecologists has dropped 44%;
– average case management expenses increased on average 3.5% annually, reaching $46,000 per case in 2016, outpacing both consumer and legal inflation indices;
– the volume of high-indemnity payments of $3M to $11M increased 7% annually;
– a medical malpractice case challenging a clinician’s judgment is 2.8 times more likely to close with payment than a case without clinical judgment issues.
The Report found that the average time to resolve MPL cases with indemnity fell from 29 months to 27 months between 2007 and 2016. Medical malpractice indemnity payments in the amount of $1 million and over drove the overall increase in both average and total indemnity paid, and accounted for 49% of MPL losses. The volume of MPL cases that closed with $1 million or more in payments rose an average of 4.4% per year from 2007 to 2016 (however, MPL cases with payments below $1 million fell). Per 1,000 MPL cases closed, only one or two cases closed with greater than $5 million indemnity.
The Report found that MPL cases that compensated future medical expenses for younger patients with severe permanent injuries drive indemnity costs. Nearly two-thirds of obstetrics-related MPL cases and 63% of those alleging a diagnostic error involved high-severity injuries (72% of surgery-related MPL cases involved medium or low severity injuries). For the 22% of MPL cases involving a patient’s death, the average payment was $453,000, just over one-half the average payment for patients with permanent severe injuries.
The Report found that 73% of MPL cases stem from three health care categories: surgical treatment, medical treatment, and the diagnostic process. Diagnostic issues exhibited a downward shift in the MPL mix from 2007 to 2016. Cancers were the most prevalent of the missed or delayed diagnosis MPL claims. 44% of surgical MPL cases involve ambulatory care patients. Medical MPL cases are evenly divided between improper management of ongoing care and improper performance of a procedure.
The Report found that one-third of MPL cases involved clinicians from a surgical service and one-quarter involved clinicians from a medical service. Surgery-related MPL cases dominated case volume and total losses yet those cases had the lowest average indemnity payment. Academic medical centers had lower MPL case rates.
The Report found that the most prevalent factors in MPL cases pertain to a provider’s clinical judgment, in particular, patient assessment. The majority of ambulatory care patients in diagnosis-related MPL cases encountered problems at multiple points along the diagnostic process. Ambulatory care cases involving multiple diagnostic missteps are more likely to close with payment and for higher amounts. Clinical judgment is the key component of missteps during the assessment and follow up phases.
The Report can be downloaded here
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