Cumulative spending on malpractice payments against anesthesiologists has fallen dramatically in recent years, from $174.4 million in 2005 to $91.1 million in 2013, a new study shows. With data obtained from the National Practitioner Data Bank (NPDB), the research also demonstrated an increase in the proportion of claims occurring in the outpatient setting, consistent with the growth of outpatient anesthesia services.
“Overall, medical malpractice claims have decreased dramatically since 2005,” said Richard J. Kelly, MD, JD, MPH, FCLM, an anesthesiologist from the University of California, Irvine School of Medicine. “Due to increased outpatient utilization, the proportion of claims for outpatients has actually increased as compared to inpatients; however, the amount that’s being paid for outpatient claims is still significantly less than inpatient claims.”
Despite the recent shift toward outpatient services, Dr. Kelly noted that little is known about the effect of practice setting on malpractice payments in anesthesiology.
This study, presented at the 2015 annual meeting of the American Society of Anesthesiologists (ASA; abstract A2097), examined the change in outpatient anesthesia-related malpractice payments between 2005 and 2013 with a comparison of important inpatient and outpatient malpractice claim characteristics: payment size, patient demographics and clinical outcome.
Using data obtained from the NPDB, a federal repository that collects and disseminates adverse information about health care practitioners in the United States, the researchers included 2,408 anesthesiology-related malpractice payments that were attributed to physician providers.
“Our primary independent variable was inpatient versus outpatient,” Dr. Kelly explained. “We also looked at the severity of injury, as well as characteristics of the practitioners and characteristics of the patients themselves.”
Of the 2,408 payments made during the nine-year period, 567 (23.5%) were for outpatient events and 1,841 (76.5%) were for inpatient events.
As Dr. Kelly reported, the frequency of anesthesia-related payments decreased over the course of the study, with outpatient and inpatient payments decreasing 24.3% and 45.5%, respectively.
The average payment amount for anesthesiology-related claims was $245,000, with inpatient claims being significantly more expensive than outpatient claims ($261,742 and $189,349, respectively).
“You would expect inpatient payment to be more expensive,” said Dr. Kelly, who noted that these claims accounted for about 82% of the total cost. However, as reported on the cover of the November issue of Anesthesiology News, another report at the ASA annual meeting (abstract A1009) found that non–operating room (OR) payments were significantly greater than general OR payments (median $554,000 vs. $285,000; P=0.003). The data for that study were culled from the National Anesthesia Clinical Outcomes Registry.
Outpatient Claims Increase
Whereas payments for inpatient claims were generally larger in the study presented by Dr. Kelly, the percentage of total spending that was attributable to outpatient claims actually increased because of the rise in outpatient surgery.
“Differences in payment size based on practice setting appear smaller now than older studies have observed,” he said, “although we did not observe clear growth of payment sizes during our study.”
Death was the most common clinical outcome in both settings, although outpatient claims were significantly more likely to involve minor injury as opposed to major. Female patients accounted for the majority of the claims (54%), and the most common patient age was between 40 and 59 years.
“Since 2005, overall spending on anesthesia-related claims has decreased by 41.4% ($83.3 million), which is great,” Dr. Kelly concluded. “It looks like we’re doing something right.”
The moderator of the session, Paul Picton, MD, MRCP, FRCA, associate professor of anesthesiology at the University of Michigan, in Ann Arbor, suggested that the proportional increase in outpatient payments might be attributable to more than just an increased number of outpatient procedures.
“It’s possible that an increase in the complexity of outpatient procedures is driving this shift in malpractice payments,” Dr. Picton said. “Perhaps there are more patients with a higher risk profile in the outpatient setting.”
Dr. Kelly responded that one of the drawbacks of the data is a lack of detail regarding the claims. After death, the second most common claim was “improper management,” a nebulous marker determined by insurers who are required to file the paperwork within 30 days of payment.
As to why the number of payments has decreased, Dr. Picton could only surmise that hospitals have become more savvy regarding risk management.
“Our hospital has a huge legal team, and we try to settle legitimate claims out of court early without too much conflict,” he said, “and those that we think are unjust, we’ll fight all the way. Whether other centers are having that same approach, I don’t know.”
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