Physician Risk & Reimbursement Discussed – Why You May Be Doing It All Wrong, & What You Can Do About It!

I love survey’s and reports, they are great reading because they make you think about matters on a larger scale and view situations and scenarios from a new viewpoint. Recently, I was reading one such report, the Medscape 2019 Malpractice Report (https://www.medscape.com/slideshow/2019-malpractice-report-6012303?src=wnl_physrep_191120_malpractice2019), a survey of more than 4,300 Physician’s from around the Country that were asked whether or not any why they were sued, and how that experience affected the way they practice medicine and relate to patients. Within this report a few points stuck out that really got the proverbial “wheels turning” upstairs…

“More than half of all physicians will be named in a lawsuit at some point in their career.”

This fact points out the inevitability of living in a country that has a legal system which includes Tort Law. https://dictionary.law.com defines this as: “tort. n. from French for "wrong," a civil wrong or wrongful act, whether intentional or accidental, from which injury occurs to another. Torts include all negligence cases as well as intentional wrongs which result in harm.”

In other words, our legal system by its very structure fosters the mentality that someone else’s actions entitle you to economic enrichment from them, it encourages lawsuits. Additionally, paid advertising by law firms and attorneys on TV and through other major media outlets has served to normalize oft frivolous lawsuits and reduce the social stigma that used to be associated with the same. This is why we all know what Mesothelioma is, or can recall the McDonald's coffee case (also known as “the hot coffee lawsuit”), there have even been documentary series on these topics (i.e. HBO’s Hot Coffee). Frivolous lawsuits have become so commonplace they are essentially now a part of American pop culture.

So, what can you do a healthcare provider to insulate yourself and your business from this seemingly inventible risk? The Medscape Report included some additional findings that may in part provider some answers…

Slide #20 Better Documentation – 18% of physicians stated that is they could have done something differently; they would have had better chart documentation.

Medical records documentation is not only recording what you did, but also why you did it, and why your medical decision making was justifiable. The medical record is potentially your best defense from medical malpractice liability, as it will show whether you acted rationally and if a peer can reach a similar/same conclusion from your chart notes that could play well in a court of law in front of a judge/jury, as well as under the review of a state licensing board or in the event of post-payment medical review by a third party health insurer.

Additionally, detailed consent forms should be considered. This legal disclosure to your patient not only serves to protect you in the event of an adverse reaction or unintended negative outcomes, but it also serves as a potential tool to set reasonable and realistic expectations for your patient of what to expect. Please remember, as much as you may empathize with the patient’s situation, the age-old adage of “under promise and overdeliver” doesn’t just apply to consumer services, it’s applicable in the healthcare setting as well. IPS & Juventix utilize standardized procedure consent form templates to assist our clients in their documentation and compliance. Please call (855) 854-6332 or email [email protected] to request a free sample for your practice.

Slide #22 Low Incidence of claims brought against mid-levels: As of now, only 9% of respondents said they have suffered such legal consequences owing to an action committed by an NP or PA.

Mid-level providers are not just at a lower risk of becoming liable for medical malpractice claims, as documented within this report, but they may also hold the key to increased access to care for patients and enhanced economic viability for the private medical practice within the modern-day US healthcare system. You see, Physicians are really just highly trained, skilled professionals that are paid Piecework for their services. Now before you take offense to that statement let me explain…

How are physicians paid through insurance health plans? The answer is Fee-for service (FFS). According to Wikipedia, this is defined as: “a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.” Think about it, you spend X minutes with a patient, and it pays Y, or you perform X procedure and it reimburses Z - it’s piecework!

How can someone performing piecework ever gain economic advancement? Only by performing more pieces of work. Your career that you trained for a decade or longer in many cases, your six-figures of student loan debt, the risk of being sued for all your worth under a Tort claim, you worked that hard, invested that much, and assume so much potential liability to perform piecework. Not the best feeling when you consider it that way, however there is a potential solution… the mid-level provider! Someone that in most jurisdictions can perform your piecework under your direction and supervision. A recent Forbes article (https://www.forbes.com/sites/andrewdepietro/2019/11/19/nurse-practitioner-salary-state/) documented what Nurse Practitioners make in each state. This is far lower annual compensation than the average physician and a potentially great way to expand the number of patients you can see and volume of procedures you can perform within your private practice! *

At Integrative Practice Solutions (www.integrativepracticesolutions.com) and Juventix Regenerative Medical (www.Juventix.com), we offer assistance with the addition of mid-level providers to your practice including clinical and administrative training to enhance clinical ability and financial viability of the mid-level provider.

*Please review www.scopeofpracticepolicy.org which provides a summary of information regarding the scope of practice for behavioral health providers, nurse practitioners, oral health providers, and physicians assistants, as well as consulting a state-licensed healthcare attorney before considering the addition on a mid-level provider to your practice.

About the Author: Lance Liberti is a nationally recognized healthcare consultant and new patient marketing professional with more than a decade of practical experience in the field. His experience spans multiple areas of practice including non-surgical spinal decompression, medically supervised weight loss, aesthetic medicine, and non-operative extremity pain management. The president and CEO of Integrative Practice Solutions, Inc. Mr. Liberti specializes in assisting health and wellness professionals integrate boutique medical services into their practices to offer non-surgical solutions to those suffering from various degenerative musculoskeletal conditions. To learn more about Mr. Liberti’s extensive experience and see examples of his work products view his LinkedIn profile here: https://www.dhirubhai.net/in/lanceliberti

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