The 'Michigan Model's' 7 steps for mitigating, reducing malpractice claims

Many physicians feel compelled to order unnecessary tests or procedures that often result in excessive treatment to protect themselves from malpractice lawsuits. However, defensive medicine practices contribute to billions of dollars in waste each year and put patients at increased risk for medical complications, according to the Wall Street Journal.

In 2013, up to 30 percent of healthcare spending — $750 billion — could be attributed to overuse and waste in medical care, according to the Institute of Medicine's most recent report. Hospitals, health systems and physician practices can address the issue of overuse by employing strategies that protect their physicians from malpractice claims without resorting to defensive medicine.

In 2001, Ann Arbor-based University of Michigan Health System implemented a communication and resolution program designed to reduce medical malpractice by providing full disclosure of medical errors and offering compensation when appropriate, according to the report.

Since implementing the "Michigan Model," malpractice claims fell 36 percent through 2007 and attorney and patient compensation costs decreased by 59 percent. A survey of UMHS providers found they supported the approach.

Here are the 7 steps from UMHS's Michigan Model other providers can adopt to help address the threat of malpractice claims while avoiding defensive medicine, according to the health system's website.

1. The first step in the Michigan Model is to communicate openly and directly with the patient or his or her medical representative following the situation or complaint.

2. Next, UMHS reviews the incident or complaint thoroughly and impartially to assess what happened. Included in this step is a peer review with professionals who can lend relevant insight. After the peer review, the system takes note of any opportunities for improvement that could prevent similar situations in the future.

3. If the patient has obtained legal counsel, UMHS representatives offer to meet with both the patient and his or her lawyer to review the patient's care episode and answer any questions, even if the patient has not sent a notice of intent to sue.

4. If UMHS' assessment of the incident concludes that the care was unreasonable, the physician apologizes to the patient. If the patient was injured during their care, the health system works with the patient and his or her counsel to reach a mutual agreement about a resolution. While this doesn't always lead to a settlement, when it does, UMHS compensates "quickly and fairly."

5. If the investigation finds that the care was medically appropriate, UMHS representatives still offer to meet with the patient and his or her counsel to discuss its conclusion. Often, a medical staff member who was involved in the patient's care will be present during this conversation. Many patients are satisfied after hearing a full explanation, and often drop their complaint or suit, according to UMHS.

6. If a patient decides to go forward with his or her suit or declines to participate in a discussion with the system, UMHS will "vigorously defend our staff with the finest legal team we can assemble."

7. Regardless of the outcome of each instance, UMHS says it seeks to "learn from the experience, educate our staff and make changes to the systems and processes that were involved in the care that prompted the complaint. Even if our analysis convinces us that we provided medically appropriate care, the patient's complaint teaches us that something has clouded his or her perception of our care. If we can do something to keep that from happening with another patient, we will."

More articles on hospital and physician issues:
Cleveland Clinic launches master's program for health professions education
CXO survey: Physician leaders play increasingly important role in the patient experience
Med school deans worry residencies won't keep up with surging enrollment

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