On-site assessments for preventing malpractice liability offer several benefits

Key Points

The goal of an on-site office assessment is to identify risks, suggest corrective actions, and implement improvements. The reviewer will suggest various loss prevention techniques.The assessment may be instigated by the doctor or doctor's group or by the insurance company.

The physician may want an assessment for many reasons. He or she may be setting up a practice or may be concerned about the risks of an on-going practice, an increase in lawsuits, or questionable practices of colleagues. An insurance company may suggest an assessment for underwriting as well as for risk-management purposes. Underwriters may evaluate the practice of a newly insured doctor, an insured physician up for policy renewal, or a practice that has a high claims frequency with the goal of deciding insurability and whether at manual rates or with surcharges.

The assessment often is followed up with a written report outlining recommendations for improvements. The report will equip the insured with information crucial to controlling risk, minimizing losses, and affecting positively on insurance premiums.

Sometimes, an obvious solution exists to a liability problem, For instance, one doctor was working 50 hours a week at his own office and also had a full-time job covering the emergency department and so was advised to quit one of his jobs.

An on-site assessment includes:

CONCENTRATION, REVIEW

An on-site assessment can have many areas of concentration and review. What follows are typical questions related to reviews.

What office policies and procedures are implemented?

Physicians' offices that have solid policy and procedures in place to ensure quality management, quality care, and follow-up are seen as better risks for the insurance company. You may be able to obtain sample policies and procedures to use as a guide to formulate your office policy.

What are some of the areas the surveyor will review?

Credentialing, staffing, and validation of staff competence likely will be reviewed. The issue is the level of review and verification completed before bringing a physician, midlevel provider, and/or nursing personnel into the practice as well as the level of scrutiny applied to the individual's performance while practicing at the facility. The level of supervision for all new hires, how quality data are captured for each practitioner/staff member, and how those data are used in credentialing and evaluation processes also will be evaluated.

Does the office delineate privileges, or are they generalized, and why is this important?

It is important to assess the level of services rendered at the practice to determine the appropriate policy that should be issued to your office. The doctors and the insurance carrier want to be sure that the person(s) providing patient care and treatment is working within the scope of his or her training and license and not providing treatment/assessments outside the scope of the professional liability insurance policy.