Clinical question: Does full disclosure of medical errors increase or decrease liability and claims?
Background: The University of Michigan Health System (UMHS) actively seeks out medical errors, fully discloses these errors to patients, and offers compensation when at fault. Full disclosure is consistent with patient safety and ethical principles, but whether such programs exacerbate total liability costs remains controversial amongst physicians and malpractice professionals.
Study design: Retrospective before-and-after analysis from 1995 to 2007.
Setting: Public academic medical center and health system.
Synopsis: After the full implementation of a disclosure to offer program in 2001 at UMHS, the average monthly rate of new claims decreased to 4.52 per 100,000 patient encounters from 7.03 per 100,000 patient encounters. Median time to resolution of each claim also decreased to 0.95 years from 1.36 years. Average total liability monthly costs per month for every $1,000 of operating revenue dropped to $4.00 from $8.48 (p<.001), mostly driven by decreased costs for patient compensation and legal costs.
The observation that total liability costs decrease with full disclosure does not prove causality, as the number of reported claims throughout Michigan decreased from 2001 to 2007, and state wide malpractice reform was initiated in 1994. A comparison with 20 physician insurers, however, suggests quicker resolution times and decreasing legal and compensation costs of UMHS compared with its peers. Moreover, the Veterans Affairs Medical Center in Lexington, Ky., also had success after initiation of a similar disclosure-with-offer program, suggesting that the experience of such programs might be generalized to other settings.
Bottom line: Full disclosure of medical errors with offers of compensation is associated with decreased total claims and liability costs.
Citation: Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med. 2010:153(4):213-221.
Reviewed for TH eWire by Jill Goldenberg, MD, Alan Briones, MD, Chad Craig, MD, Ramiro Jervis, MD, FHM, Brian Markoff, MD, FHM, Andrew Dunn, MD, FACP, FHM, Division of Hospital Medicine, Mount Sinai School of Medicine, New York City
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