Analysis of Inadequacies in Hospital Care through Medical Liability Litigation

Over the past two decades, health litigation has followed an exponentially incremental trend. As insurance companies tend to limit their interest because of the high risk of loss, health facilities increasingly need to internalize dispute management. This study was conducted through a retrospective analysis of existing files concerning the civil litigation of the Sant’Andrea Hospital in Rome. All claims from 1 June 2010 to 30 June 2019 were included. Paid claims were further classified according to the areas of health care inappropriateness found. Authors indexed 567 different claims along the study period, with an average number of 59 per year (range 38–77). The total litigation involved 47 different units; more than 40% concerned 5 high-incidence wards or services. Concerning the course of disputes, 91 cases were liquidated before a judicial procedure was instituted, while 177 cases landed in a civil court. Globally, 131 different claims hesitated in compensation, for a total of 16 million 625 thousand euros, 41% of which was related to the internal medicine area. Dealing with the inappropriateness analysis, clinical performance alone involved 76 cases, for a total of 10 million 320 thousand euros, while organization defects involved 20 disputes equivalent to 1 million 788 thousand euros. The aim of this study was to enhance the clinical risk management at our facility through a litigation analysis.

What Practitioners can Teach Academics About Tort Litigation – The Plaintiff’s Perspective in Medical Malpractice Litigation

Although medical errors are a leading cause of injury and death in the United States, only a small fraction of claims result in litigation, and the number of paid claims continues to decline. There are many reasons for the relatively small number of medical errors that result in medical malpractice litigation, including the prohibitive cost of procuring medical experts, caps on recovery, the long timeline of a med mal case from intake to verdict or settlement, and the outsized success rate of defendant doctors at trial. This article explores all of these topics, as well as common causes of action and notable plaintiff types.

The Financial Impact of Genetic Diseases in a Pediatric Accountable Care Organization

Background Previous studies revealed patients with genetic disease have more frequent and longer hospitalizations and therefore higher healthcare costs. To understand the financial impact of genetic disease on a pediatric accountable care organization (ACO), we analyzed medical claims from 2014 provided by Partners for Kids, an ACO in partnership with Nationwide Children’s Hospital (Columbus, Ohio, USA). Methods Study population included claims from 258,399 children. We assigned patients to four different categories (1-A, 1-B, 2, & 3) based on the strength of genetic basis of disease. Results We identified 22.7% patients as category 1A&B- having a disease with a “strong genetic basis” (e.g., single gene diseases, chromosomal abnormalities). Total ACO paid claims for 2014 were $379M, of which $161M (42.5%) was attributed to category 1 patients. Category 1 patients experienced significantly more inpatient admissions (odds ratio = 4.12), emergency room visits, and outpatient visits compared to patients in category 3- those without genetic disease. Conclusion Nearly half (42.5%) of healthcare paid claims cost in 2014 for this study population were accounted for by patients with genetic diseases. These findings precede and support a need for an ACO to plan for effective healthcare strategies and capitation models for children with genetic disease.

Who Estimates When It’s Not Required? the Case of Subrogation

The ability of an insurer to pursue and collect money from responsible third parties for paid claims is referred to as subrogation. For some insurers, the amount to be recovered may be significant and, if accrued for, represents an estimate that could be used by management to affect earnings. This study investigates factors associated with insurers’ choice to accrue subrogation for statutory accounting. For statutory accounting, where insurers can choose whether to accrue subrogation or exclude it as an offset to the claims liability, we find that publicly-traded (mutually-owned) insurers are significantly more (less) likely to accrue subrogation than privately-owned insurers. In addition, we find that publicly-traded (mutual) insurers with weak ratings are less (more) likely to accrue subrogation. Finally, we find that insurers with large amounts of subrogation are more likely to accrue subrogation, consistent with these types of insurers having the strongest incentive to influence earnings through the subrogation accrual. Our results provide evidence suggesting that insurers respond to their incentives when choosing whether to accrue subrogation for statutory reporting.

COHERENT INCURRED PAID (CIP) MODELS FOR CLAIMS RESERVING

In this paper, we first propose a statistical model, called the Coherent Incurred Paid model, to predict future claims, using simultaneously the information contained in incurred and paid claims. This model does not assume log-normality of the levels (or normality of the growth rates) and is semi-parametric since it only specifies the first and the second moments; however, in order to evaluate the impact of the normality assumption, we also propose a benchmark Gaussian version of our model. Correlations between growth rates of incurred and paid claims are allowed and the tail development period is estimated. We also provide methods for computing the Claim Development Results and their Values at Risk in the semi-parametric framework. Moreover, we show how to take into account the updating of the estimation in the computation of the Claim Development Results. An application highlights the practical importance of relaxing the normality assumption and of updating the estimation of the parameters.

Malpractice claims related to diagnostic errors in the hospital

BackgroundLittle is known about the incidence or significance of diagnostic error in the inpatient setting. We used a malpractice claims database to examine incidence, predictors and consequences of diagnosis-related paid malpractice claims in hospitalised patients.MethodsThe US National Practitioner Database was used to identify paid malpractice claims occurring between 1 January 1999 and 31 December 2011. Patient and provider characteristics associated with paid claims were analysed using descriptive statistics. Differences between diagnosis-related paid claims and other paid claim types (eg, surgical, anaesthesia, medication) were assessed using Wilcoxon rank-sum and χ2 tests. Multivariable logistic regression was used to identify patient and provider factors associated with diagnosis-related paid claims. Trends for incidence of diagnosis-related paid claims and median annual payment were assessed using the Cochran-Armitage and non-parametric trend test.Results13 682 of 62 966 paid malpractice claims (22%) were diagnosis-related. Compared with other paid claim types, characteristics significantly associated with diagnosis-related paid claims were as follows: male patients, patient aged >50 years, provider aged <50 years and providers in the northeast region. Compared with other paid claim types, diagnosis-related paid claims were associated with 1.83 times more risk of disability (95% CI 1.75 to 1.91; p<0.001) and 2.33 times more risk of death (95% CI 2.23 to 2.43; p<0.001) than minor injury, after adjusting for patient and provider characteristics. Inpatient diagnostic error accounted for $5.7 billion in payments over the study period, and median diagnosis-related payments increased at a rate disproportionate to other types.ConclusionInpatient diagnosis-related malpractice payments are common and more often associated with disability and death than other claim types. Research focused on understanding and mitigating diagnostic errors in hospital settings is necessary.