Saturday, December 16, 2017

OCMA Blog

"Risk Tip" from The Doctors Company - Be Aware of Risks for BRCA-Based Breast Cancer

Avoid Missed or Delayed Diagnosis by Being Aware of Risks for BRCA-Based Breast Cancer

Recent news coverage has brought BRCA gene-based breast cancer into the spotlight. Actress Angelina Jolie's decision to get a preventive double mastectomy after testing positive for the BRCA gene may cause patients to ask physicians if they are at risk. Physicians should be aware of the risk factors for BRCA gene-based cancer in order to identify those who need testing and to avoid delayed or missed diagnosis.
 
A recent malpractice case highlights the failure of missing an early diagnosis. A 33-year-old woman had two female relatives, including her mother, who had breast cancer in their forties. At 31, she began getting annual screening mammograms, which showed dense breasts. She complained of a small palpable mass. However, no mass was seen on a mammogram, and the diagnosis was fibrocystic changes. No additional tests were ordered. Within six months, the mass was enlarging, and she was diagnosed with infiltrating ductal cancer that had advanced from a Stage I to a Stage III. Based on her history, she should have been tested for the BRCA mutation and given various treatment options. Additionally, no ultrasounds or MRIs were done, which possibly could have detected the cancer at an earlier treatable stage.
 
A woman's risk of developing breast and/or ovarian cancer greatly increases if she inherits a BRCA1 or BRCA2 gene mutation. Widespread screening is not required because together these mutations account for only 5-10 percent of breast cancers. Those with the BRCA1 mutation have a 55-65 percent chance of developing breast cancer by age 70, and those with the BRCA2 mutation have a 45 percent chance. Women have about a 2 percent chance of getting ovarian cancer, but if they have a BRCA2 mutation, that risk increases to 40-60 percent.
 
Physicians should watch for the following BRCA mutation risk factors and discuss genetic testing with patients at risk:

  • Maternal or paternal blood relatives with breast cancer diagnosed before the age of 50.
  • Certain cancers in a patient's family, such as pancreatic, colon, or thyroid.
  • Both breast and ovarian cancer in a patient's family, especially in one individual.
  • Women in a patient's family with cancer in both breasts.
  • Patient with Ashkenazi Jewish heritage.
  • A male in the patient's family with breast cancer.     
  • Relative with BRCA1 or BRCA2 mutation.

If the patient does test positive for the BRCA mutation, it is essential to remind her that this does not indicate she will get cancer. Patients can reduce risks of cancer with prophylactic surgery, hormonal treatment, and lifestyle changes.
 
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit  www.thedoctors.com/patientsafety.


Lyme Disease: Delayed Diagnosis Is Greatest Risk for Healthcare Providers

Risk Tip by The Doctors Company

Lyme disease, a bacterial tickborne disease, is one of the fastest-growing infectious diseases in the U.S. Summer is peak season, and most people are bitten by blacklegged ticks, which are small and difficult to see. Lyme disease progresses in phases: early localized disease with skin rash and flu-like symptoms, followed by disseminated disease with heart and nervous system involvement (palsy and meningitis), then late disease with severe fatigue, neurocognitive symptoms, and severe joint and muscle pain leading to physical disability. The challenge is diagnosing this disease in the early phases, when treatment is typically curative.

A claims review found that the main liability risk for Lyme disease is system issues that result in delayed diagnosis. The chief system issue is communication failure in reporting test results to the healthcare provider. In one case, the patient had ongoing headaches, nausea, and vomiting. Although the patient did not recall a recent tick bite, the patient lived in an area with a high incidence of Lyme disease. The provider ordered a Lyme screen, which was positive. A confirmatory test was also positive. The lab faxed the report to the provider and contacted the health department. However, the provider claimed he had not received test results.

The flu-like symptoms of early Lyme disease mimic a viral syndrome, so providers need to consider Lyme disease in their differential diagnosis whenever they see patients with this presentation. 

Tips to help make an early diagnosis include:

  • Because most people do not recall a tick bite, ask about recent travel or outdoor activities.
  • According to the Centers for Disease Control and Prevention (CDC), in 2011 96 percent of cases came from Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia, and Wisconsin.
  • In the early phases, 70 to 80 percent of patients will get a red, spreading rash that can appear anywhere on the body.
  • The classic rash has a bulls-eye appearance with a red outer ring surrounding a clear area, but the rash may not have this appearance.
  • Fatigue, chills, fever, swollen lymph nodes, headache, muscle, and joint aches are common early symptoms.
  • Early phase blood tests are typically negative because antibodies have not yet developed. Therefore, a negative test does not rule out Lyme disease.
  • Those patients who develop a rash should be treated with antibiotics.
  • Remain current on CDC guidelines regarding diagnosis and treatment.
  • Oral antibiotics commonly used with adults include doxycycline, amoxicillin, and cefuroxime axetil. For children younger than 8 years old, amoxicillin is recommended.
  • Have a system in place for following up on lab test results.
  • Advise patients to avoid tick-infested areas, use insecticides containing DEET, and conduct daily exams for ticks on themselves, their children, and their pets.
  • If they find a tick, advise patients to gently remove it with tweezers and save it for identification.
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety

Malpractice Claims Consume Years of a Physician’s Career

Risk Tip by The Doctors Company

On average, each physician spends 50.7 months, or approximately 11 percent of an average 40-year career, on resolving medical malpractice cases—the majority of which end up with no indemnity payment. That’s the conclusion of a recent study1 by the RAND Corporation based on data provided by The Doctors Company, the nation’s largest medical malpractice insurer. Researchers found that 70 percent of the time physicians spend on claims is spent defending claims that end in no payment to the plaintiff.


Key findings of the study include:

  • Physicians experience additional stress, work, and reputational damage from the time spent defending claims.
  • Fighting claims takes time away from practicing medicine and from the opportunity for the physician to learn from his or her medical errors.
  • The lengthy time required to resolve claims also negatively impacts patients and their families.
The effect of malpractice claims on physicians’ careers is discussed further by Richard E. Anderson, MD, FACP, chairman and CEO of The Doctors Company, in two short videos that can be viewed at www.youtube.com/doctorscompany.

To help prevent claims that can take up years of your career, follow these key tips to promote patient safety:

1.    Communicate with Patients

·         Understand the new vital sign: health literacy.

·         Do not ask patients if they understand—instead, ask them to repeat back the information.

·         Document patient understanding of instructions.

·         Provide the patient with written instructions.

·         Use a translator when necessary.


2.    Document Carefully and Objectively

·         Do not point fingers at other staff or providers.

·         Do not impeach the integrity of the medical record by altering it.

·         Use only approved abbreviations.

·         Review patient information that is automatically populated in the EMR.


3.    Monitor Handoffs and Ensure Follow-ups

·         Establish a formal tracking system for missed appointments.

·         Follow up with patients to reschedule.

·         Document missed appointments in the patient record.

·         Send a letter to patients who repeatedly miss appointments.

·         Explain the importance of follow-up care.

·         Refer the patient to another physician, if necessary.


4.    Avoid Medication Errors

·         Keep prescription pads secure.

·         Document samples in the medical record.

·         Check allergies at every visit and document in the same place in the record.

·         Review and reconcile medications at every patient visit.

·         Be aware of LASA (look-alike/sound-alike) medications.


5.    Follow HIPAA Regulations

·         Avoid unauthorized release or breaches of PHI (protected health information).

·         Safeguard against lost or stolen PHI through laptops or drives.

·         Examine office practices and layout that may compromise confidentiality.

·         Assess your methods to protect electronic communications.

·         Follow federal requirements and know your state regulations, which may be stricter.

 


Reference
1. Seabury SA, Chandra A, Lakdawalla DN, Jena AB. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim. Health Affairs. 2013;32(1):1-9. 


Orange County Doctors give Testimonials in Honor of Outstanding Service Provided by Preferred Business Partner, The Doctors Company


“We have used The Doctors Company for our insurance needs for the past 10 years. We began with their medical malpractice coverage, which they did a tremendous job maintaining and always fighting for us to get the best possible rate. We later utilized their services in providing us with our business personal property, workers compensation, employment practices liability and professional liability for our facility. Their customer service is outstanding and I know if I ever need anything I only need to call. They are a vital part of our organization and we look forward to working with them for many years to come.” 

Kimberly Massoudi
Chief Operating Officer

Outpatient Healthcare, Inc.


“Our practice has been a client of The Doctors Company for several years.  They have always met our needs and had our best interests at heart.  They have been devoted to our practice and our physicians.  The Doctors Company’s representatives are supportive and always there to assist our practice in any way they can.  We are pleased to have The Doctors Company as a vital part of our practice.” 


Michael Muhonen, M.D.
WCP Neurosurgical Associates


“Over the past 10 years, we have experienced tremendous growth in our two long-term groups that contract with our ministry, with the addition of over 100 physicians in 13 new specialties.  Additionally we have added five distinct new medical groups to our organizational model across the state.  In every case and step of our journey, The Doctors Company’s leadership has been supportive and insightful and demonstrated a true partnership approach in meeting our needs.  Account management has been flawless, and the whole team at The Doctors Company is sincerely viewed as partners by our physicians and senior management team.”

C. R. Burke 
President and CEO
St. Joseph Heritage Healthcare


“Whether it be for a major problem, or merely for some sage advice, The Doctors Company is always there when you need them. In our experience, one telephone call results in an expeditious and appropriate response. The staff and management are outstanding, friendly and caring. I recommend The Doctors Company to any physician or medical care organization."

Arthur Goldstein, MD
President & CEO
Women’s Healthcare Physicians


How are Business Partners Selected?

After a potential Business Partner has been identified, either by an OCMA staff member's research or via referral, the vetting process begins. The vetting process is rigorous, thorough, and all final decisions regarding approval or denial are made by the OCMA Services Committee.

The OCMA Services Committee only approves those relationships that benefit you while refusing those of questionable value. In order to add value to your membership with OCMA, you can count on us to provide only business partnerships which offer unique and exclusive discounts on products and services, or preferential status in service delivery. 

OCMA's Business Partners help you accomplish your goals of being a successful physician, and running/maintaining an effective practice.  


Best Practices for Creating an Accountable Care Organization

The U.S. health care system is moving toward Accountable Care Organizations (ACOs), groups of health care providers who agree to be accountable for the quality, cost, and overall care of Medicare patients. According to the Future of Health Care Survey conducted by The Doctors Company, the nation’s largest medical malpractice insurer, 57 percent of doctors are either undecided or need more information regarding ACO participation.


In a video series at www.youtube.com/doctorscompany, health care industry thought leaders recommend the following best practices when forming ACOs:

1.    Create a readiness checklist.

“A readiness checklist ...involves things like patient-centered medical homes and the attributes that primary care physicians have,” said Robert J. Jackson, MD, MMM, president and medical director, Accountable Healthcare Alliance in Michigan. “It talks about, ‘How well do we deal with data? Do we have patient registries? Do we have patient care plans? Do we have transition of care issues developed?’”

2.    Meet patients’ specific needs.

“The key is designing the care management tools, resources, people, and interventions to manage the specific needs of that patient,” said Laura P. Jacobs, MPH, executive vice president, The Camden Group in California.

3.    Develop clinical integration.

“Make sure all the providers are engaged in real-time information sharing so a care plan can be developed within a very quick period of time and all the providers know their roles and the timelines in which they have to perform their services,” said Michael H. James, JD, president and CEO of Genesys PHO, a pioneer ACO, and Genesys Integrated Group Practice in Michigan.

4.    Engage the community.

“The community has to…support programs that improve health and improve the way patients live because health care goes beyond just acute care,” James said. “It involves the patients’ safety, whether they have enough to eat, their transportation, education, business opportunities or employment opportunities.”

5.    Select the right board members.

“A pioneer ACO requirement is to expand the board with a patient and a community advocate,” James said. “Genesys…selected the leader of their volunteer group. He is 72 years old and is very engaged and involved in community studies on how to improve access to care. The community advocate is the executive director of a group of nursing homes.”

Contributed by The Doctors Company. For more risk tips, patient safety tips, and physician practice tips, visit www.thedoctors.com.


The Doctors Company Announces Five-Year Anniversary of the Tribute Plan

Career Award Represents Tangible Proof of Membership for Nearly 20,000 Doctors in California

The Doctors Company is the sponsored medical liability carrier of the Orange County Medical Association (OCMA). We share a joint mission of supporting doctors and advancing the practice of good medicine.

One of the many advantages of coverage with The Doctors Company is the Tribute® Plan, a significant financial benefit that rewards doctors for their loyalty to The Doctors Company and for their dedication to outstanding patient care. This year marks the Tribute Plan’s fifth anniversary.

“The Tribute Plan is recognition of a career spent practicing good medicine,” said Richard E. Anderson, MD, FACP, chairman and CEO of The Doctors Company. “In the last five years, more than 1,300 Tribute awards have been distributed, and over 22,700 members of The Doctors Company have qualified for awards when they retire from the practice of medicine. These members have an average Tribute balance of $11,500, and the highest distribution to date is $88,708.”

A special Tribute Plan five-year anniversary video—featuring details about Tribute, perspectives from members of The Doctors Company, and commentary from Dr. Anderson—can be viewed at www.thedoctors.com/tribute.


About The Doctors Company


Founded by doctors for doctors in 1976, The Doctors Company (www.thedoctors.com) is relentlessly committed to advancing, protecting, and rewarding the practice of good medicine. The Doctors Company is the nation’s largest insurer of physician and surgeon medical liability, with 71,000 members, $4 billion in assets, an A (Excellent) rating from A.M. Best Company, and an A (Strong) rating from Fitch Ratings.


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