HLM: You also encourage documenting coverage denials.
Hanscom: Document the denial. If we can show a jury later that you considered it, you tried to do it, but there was a denial and you had to take an alternate path, that is important to make sure that the full story is being told.
HLM: Does fear of malpractice lead to unnecessary testing?
Hanscom: Getting those differentials does not constitute unnecessary testing. That is how physicians were trained in medical school and they need to be allowed to do it. There needs to be a fine balance. We recognize that there is pressure on costs and doctors not to do more than they have to. That doesn't take away from the fact that doctors need to make differential diagnoses to ensure that the true diagnosis is not being missed.
We see that in many cases the patient will present with certain symptoms and the doctor will say 'I think I know what this is,' and start to run with it. But, if they don't get differentials, if they don't ask what else could it be, then not only does that doctor get anchored in a diagnosis that has a degree of uncertainty, but other providers behind him get anchored as well.
HLM: What other actions could reduce liability?
Hanscom: Pay attention to the process categories. That is where resources need to be invested to make sure that good diagnosticians are not defeated. And, there needs to be attention paid to decision support that helps providers make sure that they’re considering everything that might be possible.
We have often seen that good diagnosticians get defeated by bad processes. More often we see both; physicians who are not as good with diagnoses and bad processes as well. That is the perfect storm.
It is also true with managing referrals. We see many cases where patients will refer to a specialist but the patient kind of drifted away from the primary care provider. There wasn’t a real process in place to make sure that the patient was looping back to the primary care provider.
Obviously, test result management is big. If test results are getting lost and the ordering provider is not getting the information they need to make that diagnosis, which is another major process issue.
HLM: Anything else?
Hanscom: I’ve looked at this data for 20 years and these data points have not moved very much. We really have to start a fire here with people thinking creatively and innovatively about how to put some very serious prevention to these tragic cases. These are high-severity injury outcomes. The time for innovation is really now. We need to think differently about how to help providers work their way through these complex scenarios.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.