Quick Hits

Sued once? Odds follow, sued twice, sued thrice

A new study looking at malpractice claims finds trends among physicians who have lost.

By Robert Stoneback, Associate Editor

What’s worse than one malpractice suit? A second. And a third. And a fourth …

It sounds like a nightmare, but a recent study shows that doctors who are sued once are more likely to be sued again (and again).

The research, published by the New England Journal of Medicine this past January, also states that 32% of all paid malpractice claims stemmed from only 1% of doctors. Of those doctors examined, 1,246 were ophthalmologists, according to David Studdert, professor of law and medicine at Stanford University and lead author of the study. He could not say how many of those 1,246 were part of the repeat offender crowd. According to an online interview Mr. Studdert gave to the New York Times’ “Well” blog in January, neurosurgeons and orthopedic surgeons were about twice as likely as internists to have a paid claim against them. Pediatricians were 30% less likely to have a claim against them.

A doctor with two claims was twice as likely to get sued as a physician with only one, and one with four claims against him or her was four times as likely to be sued. A physician with six or more claims was 12 times as likely to be sued.

The research was conducted using data from the National Practitioner Data Bank, using 66,426 claims paid against 54,099 physicians from 2005 through 2014. Among physicians with paid claims, 84% incurred only one suit during the study period —­ these single suits accounted for 68% of all the paid claims examined. Sixteen percent of examined physicians had at least two paid claims — accounting for 32% of the claims examined — and 4% of the physicians had at least three paid claims, accounting for 12% of the claims.

“Ninety-four percent of all doctors have no claims,” said Mr. Studdert in the blog. “But doctors who accumulate multiple claims are a problem and a threat to the health-care system. Identifying these high-risk doctors is a key first step toward doing something about the problem.”

One of the best defenses against malpractice suits, as it turns out, may be a simple apology.

A separate study, published in the Journal of the American Osteopathic Association in May 2012, examined “apology laws” in place throughout the United States. These allow health-care professionals to “offer words of condolence for adverse medical outcomes without the fear of being sued for malpractice.” According to the study, lawyers usually advise medical practitioners against offering apologies for treatments that harm another, as this could be construed as an admission of guilt in a court of law. Apology laws have been passed in most states.

The paper says that an apology from a practitioner decreases the financial consequences of litigation, as the patient receives a sense of satisfaction and closure. This results in faster settlements and a lowered demand for damages. The study cited the case of the University of Michigan Health System, which reported faster settlement times and a payment decrease of 47% per case, following the hospital’s apology and disclosure agreement.

As cited by the article, several case studies “suggest that anger is a main motivator for litigation,” so there’s reason to believe a sincere apology can blunt, or prevent, the damage of lawsuits. OM

Building a better insurance program, for patients and doctors

VisionLock offers doctors protection from lawsuits and insures patients for up to $1 million. But ...

By Robert Calandra, Contributing Editor

Steven Siepser, MD, is a man on a mission. He wants to deliver “justice” for patients victimized by botched eye surgery. When he lost his first and only lawsuit 15 years ago, he learned that, as in some malpractice cases, much of the plaintiff’s award goes to attorney and expert fees.

“I looked at how the system works and [little] of every dollar spent on that system goes to the plaintiff,” says Dr. Siepser, who has performed 30,000 surgeries over his career. So, he recently developed an insurance program, VisionLock, which is a pre-emptive strike against lawsuits. VisionLock insures patients who lose an eye or have damaged sight due to physician error for up to $1 million.

Dr. Siepser, assisted by an actuary he hired, spent a year collecting information on the rate of injury, how frequently injuries occur and which doctors were most likely to be involved. Using that data he identified physicians with the fewest complications and problems. Then, he decided to use “the finest surgeons with the best outcomes and the least number of complications,” Dr. Siepser says.

Next, Dr. Siepser, who has four offices in suburban Philadelphia, turned his attention to the patient side of the courtroom. He couldn’t guarantee that patients wouldn’t go blind, but he could offer a monetary payment for patients who lose their sight or have it irreparably impaired by surgery. A patient who lost an eye at the hands of a VisionLock surgeon would receive $1 million, $500,000 if left legally blind and $250,000 if unable to drive. This is a significant upgrade to going through the court system, in which the average award is $300,000 for a lost eye after-the attorneys are paid.

Wanted: Patients with “wherewithal”

Patients may understand the benefits, but they may not be able to afford them. LASIK or cataract surgery with a VisionLock surgeon can cost up to $5,000, so it isn’t an option for everyone. The program, Dr. Siepser says, is designed to give “folks who have the wherewithal” a choice that includes a high quality, crystal IOL implant, a guarantee they will see without glasses at distance and near, as well as the insurance policy, which resonates with patients.

“You want to have the best possible results modern medicine and science can get you that cost $5,000,” he says. “But it’s so good that we will insure the outcome.”

Since it’s illegal to require patients to surrender the right to sue pre-surgery, the VisionLock policy, issued through C.V. Starr and Company, is written to the surgeon with the patient as beneficiary. The surgeon can include the price of the policy as part of the surgery.

“You can make a reasonable profit and maintain quality, because if you don’t maintain quality, you won’t be with us for very long,” he says. No claims have been filed.

How it works

The policy awards $5,000 in coverage for emergency room eye care for 30 days following surgery, regardless of cause. Before a patient unhappy with his or her surgical results receives a payout, he or she must undergo a free second opinion from a qualified surgical specialist. VisionLock will also pay $250 for the person to receive a second opinion from the surgeon of his or her choice.

After the second opinion and whatever corrective surgery is recommended, a patient who loses an eye or has damaged vision still cannot collect his money.

“If the patient does lose the eye, we don’t give them $1 million unless they sign a waiver that settles the issue because then they can’t sue,” Siepser says.

In addition, surgeons must meet strict criteria to join VisionLock. These include having performed more than 500 procedures and having a surgical facility that meets FDA standards. Along with Dr. Siepser, VisionLock has six surgeons located in Pennsylvania, Florida and Texas.

As Dr. Siepser tries to establish and grow VisionLock, he knows that malpractice attorneys aren’t going to be too happy.

“We know there is a big barrier to entry into this field,” he says. “We’re tiny, but we own something that is very hard fought and very difficult to get — we own an insurance product.” OM

20/20 EHR becomes Eye Care Leaders Group

The EHR provider rebrands and expands to help practices grow and improve profitability.

By Robert Stoneback, Associate Editor

The organization 20/20 EHR rebranded as Eye Care Leaders Group, or the ECL Group, to better reflect its new expansion into practice services.

Previously known for providing a portfolio of EHRs to clinics, the name change and expansion coincide with the recent arrival of its new president, Jim Alland. Products previously supplied by 20/20 EHR, such as Medflow and MDoffice, will still be available.

The approach taken by the group formerly known as 20/20 EHR “helped us understand where the real need was from our customers,” says Mr. Alland. Their customers said they did not need more EHRs ­— what they needed was someone who could help increase productivity.

The ECL Group, which describes itself as a consortium of businesses that serve the ophthalmic community, will be focused on four distinct areas of need — revenue optimization, professional time, practice competitiveness and compliance and risk.

“We’re offering solutions and services that really address those issues and needs very aggressively,” says Mr. Alland. The ECL Group is also heavily investing in tools and services to help an organization benchmark its practice.

The ECL Group also plans to help customers grow their practices through providing capital, including equipment, staff, office space and acquiring other practices.

“We have a very, very broad set of solutions,” Mr. Alland says. “We’re a partner at a very strategic level.” OM

FDA clears PanoCam imaging system for children

By Robert Stoneback, Associate Editor

The newly approved PanoCam Pro imaging system is designed to detect vision disorders in newborns and children. Visunex Medical Systems designed the wireless, portable unit to capture external, anterior and posterior segment vision disorders, according to a company press release. Images taken by the PanoCam Pro appear in “True-Color” high-resolution, allowing for easy viewing of light or dark-colored retina pigment.

“Our PanoCam Pro and PanoCam Review software will help clinicians identify vision disorders that may be reversed to preserve healthy vision,” said Visunex Medical Systems CEO Wei Su, PhD.

The PanoCam Pro is designed for use with children up to age 6, according to Shalini Swamy, director of marketing for Visunex. It is marketed to retinal surgeons, pediatric clinics, general ophthalmologists, NICUs, birthing centers or any other clinic specializing in children’s vision, and so on, she says.

The PanoCam Pro offers a 130-degree field of view, and complete visualization of surface and sub-surface retinal pathologies, according to the press release. This feature can help monitor vision disorders and detect them early, giving caregivers the chance to intervene. Most children do not receive their first vision screening until they are five years old, reports Visunex.

The PanoCam Pro is designed to detect vision disorders in children up to age 6.

Early research performed in Asia, Brazil and the United States suggests that as many as 1 in 70 babies may be born with some form of vision disorder. Additional clinical data suggest that newborn vision disorders may affect between 10% and 20% of newborns around the world, according to the release. OM