Paid medical malpractice claims may hint at more to come

Physicians with paid medical malpractice claims are more likely to have at least one more claim in the next five years, compared to physicians with none.

A new study found “a single prior paid claim was associated with substantial, long-lived, higher future claim risk, independent of whether a physician was practicing in a high- or low-risk specialty, or whether a state publicly disclosed paid claims.” That held true among 881,876 licensed medical doctors across the United States from 2006 to 2016, according to the investigation, “Association of Past and Future Paid Medical Malpractice Claims,” published in JAMA Health Forum.

Researchers evaluated figures relating to physicians with an MD from the National Practitioner Data Bank, a repository of all paid medical malpractice claims involving individual health care professionals since 1992. Based on five- and 10-year study periods, physicians with single or multiple paid medical malpractice claims “were shown to have a greatly elevated risk of having additional paid claims during a future period,” the study said.

“The greater the number of prior-period paid claims, the greater the likelihood of having a paid claim over any given future period, as well as the expected number of future-period claims,” the study said.

Many physicians view malpractice claims as random events and a doctor with a single paid claim “was probably just unlucky.” Some paid claims are false positives, and paid claims are an imperfect signal of low-quality care. But the researchers said they are important signals, and “multiple claims provide a strong signal.”

If past claims predict future ones, interventions may reduce future risk.

“Intervention following a single paid claim should be voluntary, and could be as simple as offering continuing medical education opportunities focusing on error avoidance and posterror communication with patients,” the study said. Depending on specialties, physicians with two or three paid claims may need other interventions such as:

• Closer supervision
• Counseling to improve communication skills
• Refresher training
• Encouragement to move to nonclinical practice

“The extent of interventions, and whether they are voluntary or mandatory, should reflect the number and recency of prior paid claims,” the study said. “Implemented properly, such graduated strategies have the potential to reduce future paid claims and patient harm.”

The policy challenge is how to use this information to reduce future medical malpractice claims and patient harm without overreacting to the signal conveyed by a single paid claim.

The researchers noted they did not have data on how many patients each physician sees. But each physician serves as his or her own control, and the analysis “relies on physician practice patterns being reasonably stable over time, including volume of patients seen and changes in patient mix.”