Check your own legal risk

Key Points

There's no denying that sometimes you need to call in the experts. Few people can do their own surgery or remodel their own kitchen. With the right tools, however, do-it-yourselfers can successfully tackle complicated jobs-and save a lot of money in the process. One notable area where this applies is in reviewing your office's infrastructure for potential malpractice risks.

For example, you may think that you have sufficient protocols to ensure consistent communication with consulting physicians. But does that protocol include a tickler system or log for all diagnostic tests and patient referrals? If not, a self-assessment will alert you to this and other important ways to minimize your risk of being sued.

"Outside reviewers are usually more objective than self-reviewers," says Lee J. Johnson, a healthcare attorney in Mt. Kisco, NY. "But many small practices can't afford an outside review, which can cost upwards of $150 per hour." By doing your own appraisal you'll save that money, plus you could be eligible for a rate discount if you show your liability insurer that you did a risk assessment and took the necessary corrective actions. Moreover, says Johnson, you might be granted category 2 CME credits, which the AMA confers for self-assessment activities.

Additionally, the Medical Group Management Association, in conjunction with Health Research and Educational Trust and the Institute for Safe Medication Practices, has developed the multipart Physician Practice Patient Safety Assessment, which can be used to appraise safety and quality processes in physician practice settings.

Mark J. Hakim, director of risk management for the professional liability company ProAssurance, likens risk management self-assessments to childproofing a home to reduce the likelihood of accidents and their adverse consequences.

"Not all hazards are readily observable," he points out. If done carefully, and with appropriate follow-up and documentation, Hakim continues, a self-assessment can (1) reduce the likelihood that you'll be sued; (2) enable you to more readily defend yourself if you're sued because you can demonstrate that you've gone the extra mile to fortify systems and make improvements; (3) generate new ideas; and (4) assist with staff training and development.

Appraising office systems one by one

CAP-MPT's risk management self-assessment, which is available at http://www.cap-mpt.com/riskmanagement/Self-Assessment_Checklist.pdf, is divided into four sections-back office, front office, medical records, and educating and training-each with its own checklists. Items that pose the greatest liability threats are preceded by "warning" triangles. Three examples: Do you have a policy that all prescription refill requests are to be approved by the physician or an advanced practice professional? Are staff trained in dealing with patient complaints? Do progress notes follow a structured format?

In risk management, though, the small stuff counts too. "Many physicians don't recognize that routine procedures and systems in their office can put them at risk," says Waldene Drake, CAP-MPT's vice president for risk management and patient safety. Accordingly, the checklists include questions about equipment maintenance and cleanliness, telephone etiquette, patient privacy in the exam room, protocols regarding what information staff can leave on patients' answering machines, waiting room ambience, and other "everyday" situations.