AIP / MICA Medical Professional Liability Risk Management Discount Program Demonstration of Risk Management Activities

Transcription

1 AIP / MICA Medical Professional Liability Risk Management Discount Program Demonstration of Risk Management Activities To be eligible for the 10% credit you must demonstrate compliance with 100% of the Core Activities and at least two of the additional activities. Please note that the insured will receive the appropriate discount when compliant with the defined program, but this discount will not be additive to other similar program discounts offered by MICA. The higher of the applicable discounts will apply. Risk Management Activity Section I: Required Core Activities that you can demonstrate are currently being conducted in your practice: 1. Medical records are legible, well organized and changes to the medical records are clearly identified to avoid the appearance of alteration. Check if Yes Please Describe Detail how you have implemented the Risk Management Activity 2. Patients allergies and problem list are prominently noted in the medical record and updated in a timely fashion. 3. Diagnostic and consultative reports are timely incorporated into patient s charts and reflect timely physician review (initialed and dated) with patient notification documented as appropriate. 4. After hour phone calls are documented. 5. The patient is informed about all abnormal test results. 6. There is a system to remind patients of important follow-up appointments or preventative screening needs.

2 7. There are systems for tracking diagnostic tests and consult reports ordered to ensure results and reports are received. 8. No shows and cancellations are documented in the patient s record. 9. Appropriate supervision is in place for mid-level practitioners as required by law. 10. Prescription refills are documented and approved by the physician, NP, or PA after review of the patient s medical and refill history Section II: Additional Risk Management Activities that you can demonstrate are currently being conducted in your practice: 1. There are specific security mechanisms are in place to prevent unauthorized access to patient information. Detail how you have implemented the Risk Management Activity 2. The informed consent process includes a signed consent form for elective procedures and treatments performed in both the hospital and office setting. 3. There is a protocol for terminating the physician patient relationship.

3 4. The clinician is chaperoned during exams of genitals or breasts of patients of the opposite sex. 5. There is a current medication log in the medical record that is updated at each patient visit. For individual (solo) practices, the physician must sign and date the Demonstration of Risk Management Activities. For group practices, the practice manager or authorized representative may sign and date the Demonstration of Risk Management Activities and also attach the group s letterhead with each individual physician s signature on the group letterhead. Fax, or Mail the completed documentation to: To: MICA Physician Name or Group Name (please print) Attn: AIP / MICA Risk Management Program Fax: Physician Signature or Authorized Group Representative Signature micauw@micainsurance.com Mail: P.O. Box Phoenix, AZ Date

4 AIP / MICA Medical Professional Liability Risk Management Discount Program Demonstration of Risk Management Activities - RATIONALE To be eligible for the 10% credit you must demonstrate compliance with 100% of the Core Activities and at least two of the additional activities. The information below provides the rationale for the Risk Management requirements. Risk Management Activity Required Core Activities that you can demonstrate are currently being conducted in your practice. 1. Medical records are legible, well organized and changes to the medical records are clearly identified to avoid the appearance of alteration. 2. Patients allergies and problem list are prominently noted in the medical record and updated in a timely fashion. 3. Diagnostic and consultative reports are timely incorporated into the patient s chart and reflect timely physician review (initialed and dated) with patient notification documented as appropriate. 4. After hour phone calls are documented. 5. The patient is informed about all abnormal test results. 6. There is a system to remind patients of important follow-up appointments or preventative screening needs. 7. There are systems for tracking diagnostic tests and consult reports ordered to ensure results and reports are received. 8. No shows and cancellations are documented in the patient s record. Rationale Why MICA Risk Management Requires Compliance Arizona Revised Statute defines adequate medical records to include legible. This means that medical records must be legible, not just to the author, but to others who review the record. Hand written records are periodically reviewed for legibility and charts are organized in such a way that information is easily located. Information in an EMR is easily accessible for the patient visit. Any changes to the medical record are identified as such, and are dated and initialed. No notation is deleted or otherwise altered. Documenting all medication allergies in a consistent and obvious place in the chart or electronic medical record (EMR) may help avoid misadministration. For example, a brightly colored label on the front of the chart or red ink may be utilized. It is important to periodically review and timely update allergies posted on the chart with the patient to promote accuracy. Because of the possibility of an adverse patient result as a consequence of an unreported or unheeded abnormal report, the importance of lab and diagnostic radiology reports cannot be overemphasized. It is important to initial and date all consultant and diagnostic reports prior to filing them in the patient s record. This provides a way to acknowledge review to your staff, and may help illustrate your prompt attention to patient status in the event of litigation. A simple system which involves the staff returning reports to you which are not signed and dated could be implemented, so that no report is ever filed without the physician s initials and date of review. All phone encounters that involve any medical symptoms, medication use and/or medical history must be documented in the medical chart. This documentation should include the reason for the call and any advice, information or instructions provided, and, when the physician is consulted, this should also be included in the note. This includes after hours calls. These should be documented and placed into the chart. These may be hand written or dictated. They should be timely available for follow up care. The patient should be informed in the most expeditious manner possible, understanding assured and a plan of action put in place and documented. It is important to develop a follow-up system that can track patients sent out of the practice for either consultations or definitive testing. Courts have held that these types of patients are your responsibility until they meet their first appointment or have their designated test and you receive the result. A tracking system for results or consultant reports can be as simple as a spiral notebook that is divided into columns with labels such as: Name, Date, Diagnostic or Consultation Ordered, Name of Test Center or Physician, Appointment Date (if known), and a final column to check off the report when it comes back to the office. Other options include tickler files or computerized prompts within your EMR. Patients who fail to complete ordered testing or meet referral appointments should be contacted and reminded of the importance of the recommendation, and this reminder should be documented. Ultimately, depending on the test or referral ordered, a certified letter to the patient may be appropriate depending on physician judgment of the seriousness of the patient s condition and potential effects of non-compliance. Reports cannot be timely reviewed if they go astray and aren t received. There should be a tickler system whether manual or electronic that displays important outstanding results so that follow up may take place. No shows and cancellations may show a pattern of non-compliance and should be visible in the individual patient record, not just the appointment screens.

5 9. Appropriate supervision is in place for mid-level practitioners as required by law. 10. Prescription refills are documented and approved by the physician, NP, or PA after review of the patient s medical and refill history. Additional Risk Management activities that you can demonstrate are currently being conducted in your practice (Select at Least 2) 1. Maintain a current medication log in each patient record and update at every patient visit. 2. The informed consent process includes a signed consent form for elective procedures and treatments performed in both the hospital and office setting. 3. There are specific security mechanisms are in place to prevent unauthorized access to information. 4. The clinician is chaperoned during exams of genitals or breasts of patients of the opposite sex. 5. There is a protocol for terminating the physician patient relationship to guard against abandonment. Various state laws and regulations govern supervision of mid-level practitioners and the number of them that can be supervised at one time. Physicians should acquaint themselves with the roles and responsibilities of the nurse practitioners and physician assistants according to the laws of their state and maintain documentation demonstrating these requirements have been met. Office protocols should clarify the circumstances and time intervals that the physician should see patients; when mid-level providers may see patients new to the practice; the mechanism to be used to keep the physician informed regarding new patients care and treatment; and types of cases that require prompt referral to the physician. All prescription refills must be reflected in the medical record, demonstrating that they were approved by a licensed prescriber after consideration of the patient s current medical status and review history. Why MICA Risk Management thinks these activities are important. Mistakes involving medications cause thousands of injuries each year and account for millions of dollars in malpractice awards and settlements. Many of these errors are easily avoidable. It is important to take an inventory of medications your patients are taking, and to periodically update this inventory. In addition to detailed progress notes, it is recommended that you maintain a medication log for individual patients so that this information may be easily found within the chart. This log should include the name of the medication, dose, date of original prescription and dates of any refills. Charting prescriptions only in the text of progress notes can be overlooked, especially in voluminous or large group practice charts, is a real problem when changed dosage amounts may be overlooked by a practitioner who did not carefully review previous progress notes. A medication control record placed in the front of each chart serves as an easy reference for all prescribers and, if kept current, provides an accurate medication history. It is essential to document the consent process in order to demonstrate that the patient was informed. This consists of documenting the consent discussion in the progress note (or hospital record for inpatient consultations) and obtaining a signed written consent. The physician and patient should sign the consent form and then file it in the patient s record. This entails documenting the discussion that you (the physician) and the patient had, including procedure-specific risks, complications, alternatives and reference to any written or visual aids that may have been employed in the consent process. Medical information should only be available on a need to know basis. Electronic records should be password protected with unique passwords. Personnel should not share passwords. If paper records, charts should be in a secure place not available to non-authorized persons. It is strongly recommended that a staff assistant be present during examinations involving the breasts, genital or rectal areas in patients of the opposite sex. In today s environment, physicians are also encouraged to have a chaperone present during examination involving patients of the same sex. The presence and name of the chaperone should be documented in the chart. Inform the patient of the reasons for termination of care, be available for a reasonable period of time to allow for transition to a new physician or other healthcare practitioner, suggest a method of obtaining a new physician through a county referral service, and inform the patient about the procedure for obtaining the patient s medical record from you. Sample letters are available from MICA Risk Management.