CRICO Corner – Pilot Project: Orthopedics and Neurosurgery
The MIEC/CRICO Strategies partnership began with a pilot project in which MIEC submitted claims data for orthopedic surgeons and neurosurgeons, report dates from 2006 to 2011, to CRICO Strategies for coding and analysis. One hundred sixteen (116) orthopedic and 42 neurosurgical medical incidents were deep coded and benchmarked against 152 orthopedic and 38 neurosurgical comparable CRICO peer group cases. Orthopedic claims review CRICO Strategies’ analysts found that MIEC’s rate of orthopedic claims has remained steady and comparable to peers since 2006. MIEC faces a higher percentage of surgical treatment allegations versus peers (78% vs. 61% respectively). Significantly more of MIEC’s...
The federal government has published its final regulations implementing the “Health Information Technology for Economic and Clinical Health (HITECH) Act,” which modified and expanded the existing HIPAA Privacy and Security Rules, and other statutes. An interim set of guidelines has been in place since 2010, and MIEC provided guidance at that time on complying with the interim rule; therefore, you may have already implemented many of the required changes (such as data-breach notification requirements) into your HIPAA policies and procedures. The following summarizes key points from the Interim and Final Rules, and includes action items for updating your HIPAA policies...
From Underwriting: Liability Risks of Indemnification Clauses
By: Susan F. Halman, Esq. from Selvin, Wraith, Halman LLP in Oakland, CA An indemnification clause in a professional service agreement ("PSA") can create onerous and uninsured financial exposures when it requires the physician to assume liability for risks outside of their control. Before signing a PSA that contains an indemnification clause, it is important to understand the breadth of the parties' respective indemnity obligations, and the extent to which you will be assuming a duty to defend and indemnify third parties for liability exposures that are not insured by your MIEC policy. An indemnification clause operates to allocate legal...
Exchange Sidebar: Risk Scoring Criteria and patient education
“I have been talking with my colleagues concerning use of risk scoring criteria (for example the APACHE scores in intensive care patients) and the development of risk criteria for pre-op surgical patients. Risk adjusted criteria for patient selection as well as patient education prior to going through procedures are vital considerations for MIEC’s surgical policyholders. We are going through an evaluation of infectious complications of joint replacements at my local medical center with a mix of various orthopedists in the community. Of note: There is significant variance in "quality of patient protoplasm" from doctor to doctor as well as variance in technique. As the infectious...
Protecting patients and colleagues: When caring and your duty to report coincide
From MIEC’s Board of Governors: Protecting patients and colleagues: When caring and your duty to report coincide By: Gene Cleaver, MD, Chair, MIEC Loss Prevention Committee The AMA Code of Medical Ethics, Principles of Medical Ethics, Principle II states: “A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.” In addition, the AMA Council on Ethical and Judicial Affairs (CEJA) Opinion No. 9.031 states: “Physicians have an ethical obligation to report impaired, incompetent, and unethical colleagues in...