Disclosing medical errors does not increase malpractice claims
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The University of Michigan Health System (UMHS) has fully disclosed and offered compensation to patients for medical errors without increasing its total claims and liability costs, a report said.
An analysis funded by Blue Cross Blue Shield of Michigan Foundation and published in the Aug. 17 Annals of Internal Medicine found a decrease in new legal claims, number of lawsuits per month, time to claim resolution, and costs after implementation of the program of disclosure with offer of compensation.
In 2001, UMHS launched a comprehensive claims management program that centered on full disclosure for medical errors. Under this model, UMHS proactively looked for medical errors, fully disclosed found errors to patients, and offered compensation when at fault.
Changes in rates of claims before and after program implementation (from 1995 to 2007) were statistically significant only for claims that resulted in a lawsuit. The UMHS experienced 232 lawsuits (38.7 per year) before and 106 (17.0 per year) after program implementation. A decrease was still evident, assuming all cases that were open at the end of the observation period (1 before and 35 after implementation) resulted in lawsuits, with 233 lawsuits (38.8 per year) before and 141 lawsuits (22.6 per year) after program implementation.
Monthly lawsuit rates decreased from 2.13 (95% CI, 1.58 to 2.67) per 100,000 patient encounters before to 0.75 (95% CI, 0.47 to 1.03) per 100,000 patient encounters after full implementation (rate ratio [RR], 0.35 [95% CI, 0.22 to 0.58]). The trend was significant (difference in trend, −0.028; 95% CI, −0.054 to −0.001]; P=0.04)
After full implementation of a disclosure-with-offer program, the average monthly rate of new claims decreased from 7.03 to 4.52 per 100,000 patient encounters. The average monthly rate of lawsuits decreased from 2.13 to 0.75 per 100,000 patient encounters. Median time from claim reporting to resolution decreased from 1.36 years to 0.95 year. Average monthly cost rates decreased for total liability, patient compensation, and non-compensation-related legal costs.
Median and mean total liability costs decreased after full program implementation (RR for mean costs, 0.41; 95% CI, 0.26 to 0.66; P<0.001), attributable to decreases in both legal and patient compensation costs. After initial program implementation, total cost rates significantly decreased (P=0.014) as did legal and patient compensation costs (P=0.004 and P=0.024, respectively) costs. Although the total costs associated with lawsuits decreased after full implementation, the total costs for nonlawsuit claims did not.
Limitations include that the retrospective study design cannot establish causality. Also, malpractice claims generally declined in Michigan toward the end of the study period, and the findings might not apply to other health systems, given that UMHS has a closed staff model covered by a captive insurance company and often assumes legal responsibility.