Tag Archives: Mark Walker

5 Unique Risks for Radiologists

As part of our role as specialists, we wanted to learn more about the risks specific to radiologists, so we reached out to Karen Kruer, RN, CPHRM, and Michelle Foster Earle, ARM, president of OmniSure Consulting Group. Here’s what we learned.

Radiologists are second only to neurosurgeons in claims paid. Their average claim lands at $426,000. Radiology is a unique field of medicine, as it operates in an arena where other physicians cannot: seeing inside the body as a part of the diagnostic process. This specialty also brings a unique set of risks. These are the top five, together with suggestions for reducing risk.

# 1. Error in diagnosis – Of all the lawsuits filed against radiologists, error in the following five diagnoses most commonly leads to lawsuits:

– Breast cancer

– Nonvertebral fractures

– Spinal fractures

– Lung cancer

– Vascular disease

To decrease error in diagnosis, radiologists should have policies and procedures in place to ensure that with every procedure they obtain a complete patient history, know exactly what they are looking for, request further testing if there is any question and review the diagnosis with the ordering physician.

# 2. Procedural complication – There will always be an increased risk when an invasive procedure is performed, and radiology includes many, such as the injection of dye and the insertion of wire stents. However, noninvasive procedures may also increase the risk of complications. Consider an MRI on a patient with metal piercings or devices such as a pacemaker. The best tip for avoiding an adverse outcome is to ensure that a thorough screening is always done before any procedure. For example, the radiologist should know the reason an imaging procedure was ordered, as well as patients’ medical histories and what medications they are taking. Radiologists are trained to look inside a person’s body, but they can also benefit from looking at the outside by putting into place a thorough intake process. Ensuring that support staff is competent and well-trained also goes a long way toward reducing the risk of procedural complications.

# 3. Inadequate communication – Thorough communication with both the referring physician and the patient is essential. Radiologists are referred to for help in diagnosing the disease process, so adequate communication begins first with close contact with the physician who ordered the test. It is important to understand the context of the test-specifically, why it was ordered-and to have a clear picture of the patient’s health. When it comes to patients, the radiologist needs to make certain each patient is given the opportunity for informed consent. That means informing patients of the risks, benefits and any alternatives that can be chosen in lieu of the test.

Policies and procedures must be in place to handle critical test results. All staff must be informed as to which test results need to be called in to the referring physician immediately. One example would be that of a patient with headaches referred for a CT scan of the head, whose scan shows an aneurysm. Because this is obviously critical and time-sensitive, the results should be called in immediately.

# 4. Failure to recommend additional testing – Better safe than sorry-always err on the side of caution. For example, if a patient visits a radiologist for a mammogram because her physician felt a lump in the breast, and for some reason the radiologist cannot find the lump after a mammogram, should a more invasive test, such as a CT scan, be ordered? The answer is yes. Further testing should always be done. It can mean the difference between life and death (and a lawsuit or not). In the case of a dissecting aneurysm, for instance, if it is missed on the original X-ray and no further testing is performed, it is often too late to save the patient. This can be avoided by liberal recommendation of additional testing.

# 5. Failure to document – Documentation can make or break a case when attorneys become involved. Make certain everything is documented, including all test results, dates, times and subjects of all conversations with both the referring physician and patient. In the event of an adverse outcome where the court becomes involved, the ability to say and show all conversations is essential. Showing that the treating physician was spoken to, at this time and on this date and that the patient was given these recommendations is invaluable for risk reduction. For more information on the importance of documentation, visit this Ultra blog post.

5 Questions on Telemedicine Coverage

Teleradiology and telemedicine have increasingly become popular as hospitals and other healthcare providers outsource their radiology and other specialty work to independent practitioners. These practitioners often operate from remote locations, with some based in the same city but many based in distant states or even overseas.

Telemedicine organizations provide diagnostic and clinical medical services to urgent care facilities, hospitals, trauma centers, imaging centers, mobile imaging units, jails, nursing homes, corporate health departments and outpatient medical facilities. As many physician practices enter into this dynamic field, they will find that their current malpractice carrier and the insurance coverage they offer cannot provide them with the pricing and coverage flexibility they will need.

The most common problems encountered will include:

  • Inability to cover reads that come from states outside of where the practice is located.
  • Lack of premium pricing flexibility to base premium on exposures (number of reads or revenue).
  • Lack of portability of coverage and “tail” issues for departing physicians.
  • Inflexibility in underwriting requirements for pre-approval of new or last-minute physicians reading for the group.

Any one of these issues can trigger the need to seek alternative coverage tailored for these exposures. Physicians in the telemedicine field will need to recognize their changing medical malpractice insurance needs and, with the help of their brokers, find insurance coverage that is designed for these types of practices and exposures.

When it comes to covering the telemedicine provider with professional liability insurance, here are five important questions you should ask when searching for the right coverage for this unique risk:

#1: Does your current policy allow for additions of employed or contracted physicians automatically or with a minimum amount of information about them up front?

Just about every telemedicine company will have a situation where it needs to add a provider quickly. Many carriers require a completed application and loss history prior to their approving additions to the provider roster. This creates an unnecessary logjam when telemedicine groups need to fill a spot in a hurry.

#2: Does your policy cover contracted services provided in any state?

As a growing telemedicine provider, you want to be able to obtain contracts in any state. Many carriers cannot cover exposures in all states.

#3: Does your current policy have continuous coverage for terminated/departed physicians after they leave the group?

It’s called Rolling IBNR coverage (Incurred but Not Reported), and having this coverage in place is critical for many telemedicine groups because of the transient nature of the physician labor force in this area. Having the coverage affects up-front negotiation of contracts as well as provides for a much smoother transition when a physician leaves the group as it eliminates the problem of having to purchase a tail for each departed doctor.

#4: Does your current policy provide individual limits for each employed or contracted physician?

Many carriers can provide only “per event” limits for the employed and contracted physicians. In a lot of cases, this is completely acceptable, and many telemedicine groups operate fine with this coverage. However, some groups encounter situations where the healthcare entity or governmental body they’re contracting with requires individual limits, not just per-event limits, for each employed or contracted doctor providing services on their behalf.

#5: Can your insurance carrier provide you with limits up to $5 million or more if statutes or contract clauses require it?

Many healthcare systems and governmental bodies are requiring higher limits from their contractors.

Physicians specializing in the areas of teleradiology or telemedicine should discuss these questions with their insurance broker to be sure they are adequately covered. As the healthcare landscape changes, so will the potential liability of the healthcare professionals. Finding the right malpractice insurance program can benefit these companies in many ways.