Shell-shocked

Principles, expertise and service that bind us together

Risk Management

Looking out for the well-being of physicians - particularly in this malpractice environment -is the mark of a professional medical practice manager

"Defining the Profession: Principles, expertise and service that bind us together" explores issues to stretch our thinking about the industry and the world, all from the vantage point of the profession. The topics explored here are derived from The ACMPE Guide to the Body of Knowledge for Medical Practice Management, developed by the American College of Medical Practice Executives, the certification body of the Medical Group Management Association. It's available free online at www.mgma.com/acmpe.

When the mail arrives each day at Brevard Anesthesia Services in Melbourne, FIa., the practice administrator quietly intercepts it. She discreetly but deliberately picks through the medical journals, the payer correspondence, the pharmaceutical pitches. And occasionally, she finds what she is looking for.

The lawyer letter.

I Before a receptionist can innocently deliver the linen-papered bomb to its intended target, Shena J. Scott, MBA, FACMPE, intervenes and shields the latest victim. The anesthesiologist, named in a malpractice lawsuit in Florida (a state whose frequency of paid claims is 36 percent higher than the national average)1 will hear directly from Scott what the contents of the plain-looking envelope had to tell on that particular day.

The physician will hear that a notice of intent has been filed, that a deposition date has been set or that he must list all of his personal assets. But Scott ensures that he doesn't get the news as he heads into 12 hours in the operating room or to his daughter's wedding.

During the discussion, she will offer support while the physician vents about the injustice of the allegation. She will try to help him understand that it's not personal but an inevitable part of practicing medicine today. And she will counsel him to try to think about it only when she or the attorneys ask for his input. "Otherwise it is just too difficult for [the doctors] to keep the proper focus while the process goes through its motions," she says.

"It makes me crazy. Nobody begrudges the right of a patient to sue if true malpractice has occurred. But most of these suits have little or no basis, especially as far as the anesthesiologist is concerned. Patients don't understand what this process does to a conscientious physician," says Scott, an MGMA member. She wrote her 2003 ACMPE Fellowship paper about the medical liability insurance crisis. "Patients may see it as an opportunity to hit the lottery, but a malpractice suit questions a physician's integrity, puts his livelihood on the line and throws him into emotional turmoil, however baseless the claim or how strong the likelihood of it being dropped."

Looking out for the well-being of physicians - particularly in this malpractice environment - is an important characteristic of professional medical practice management, says Wayne Sotile, PhD, a counselor, consultant and co-editor of The Resilient Physician Newsletter, Winston-Salem, N.C. "Stepping up and being strong yet caring is part of being a professional administrator in 2004," Sotile says.

Not if, but when

Practicing medicine in Florida, or any of the other medical liability "crisis states" named by the American Medical Association (AMA)2, can feel more like preparing for battle than providing health care. On any given day, more than 125,000 cases against physicians clog the nation's courts, though 70 percent are closed with no payment, and physicians win 80 percent of the cases that do go trial, according to the AMA.3

During Scott's first 10 years managing Brevard Anesthesia Services, the practice faced five malpractice proceedings from about 250,000 anesthesia cases, she says. Fast-forward to the most recent three years and the group now receives two to three notices of intent each year. Scott says that all except one case have been dropped, won or settled for nuisance value. For half the liability coverage (the highest limit the practice can now obtain), the 25-physician Brevard Anesthesia Services now pays twice as much for insurance as it did two years ago. Florida's high ratio of trial attorneys, "joint and several" liability statutes and extensive pre-suit process have helped create a lawsuit hotbed.

Because physicians today practice in an environment in which it's not if, but when they can expect medical liability legal action, it's vital that practice administrators prepare their groups to offer a supportive team. "Your job as the administrator is to normalize open discussion about malpractice long before any of your physicians are sued," Sotile says. While implementing this in an environment ruled by type-A, aggressive physicians may sound intimidating, he urges administrators to claim their turf.

"You wouldn't try to do clinical decision-making; you leave that to the experts, the clinicians. Smart physicians know that you are the expert on managing a practice, and part of professionally managing a practice is proactively protecting the practice," Sotile says. "Your job is to create a safe space. And people only let you do that when you know more than they do about a certain area but are respectful and compassionate toward them."