Patient Safety ~ #HCLDR 8/27/2013 Chat Summary

Establishing, Managing, and Protecting Your Online Reputation

by Kevin Pho, MD

Why Use Social Media?

Through social media, we all have the ability to connect with our friends, family, and business associates – practically whomever we wish, in new ways that few even considered twenty years ago. Social media connects us in real time and allows us to share amazing volumes of information freely online.
 

Our Review

Establishing, Managing and Protecting Your Online Reputation by Kevin Pho, MD and Susan Gay is a book that establishes how physicians too are blessed with the ability to connect with their peers internationally, partake in online conferences and chats and, most importantly, communicate and interact with their patients in new ways. Once physicians embrace these technologies, social media can enhance their practices and open doors to new opportunities not otherwise realized.
 
Today, there are an increasing number of websites and platforms where physicians’ reputations are being built, whether they are aware of it or not. Although physicians spend an inordinate amount of time studying complicated medical text books and journals, this book is a fast, easy read. It presents itself as a 290 page, enjoyable guide filled with researched facts, true stories and online best practices proven to work.
 
Physicians can no longer view social media as simply a way to connect with family and friends. This book can set doctors and their staffs on the right course for managing online reputations and also growing their medical practice business!
 

What You Can Do

If you’re a physician (or any other type of professional), Google your own name and see what comes up. Do you show up at all? Is the content flattering and complimentary or can you spot embarrassing facts and false information? Today’s patients go to Google first to learn about their doctors’ reputations. And guess what? Social media content is found by the search engines, so beware!
 
Authors, Kevin Pho, MD and Susan Gay make a strong case that physicians must be proactive and no longer stand on the sidelines allowing patients and others to post inaccurate or damaging information about them. The authors worked diligently to seek out their peers and elicit their online experiences for us, which are sprinkled throughout the text. In addition, they have done an excellent job researching social media platforms and websites, using their analyses to provide readers with the best tools available. As the subtitle suggests, this is a guidebook where readers can follow the step-by-step instructions laid out to create or enhance their online presence. Physicians and others will learn best practices for each social media platform.
 
In summary, Dr. Pho and Susan Gay teach us why a good social media offense is a good social media defense.
 
As medical professional liability insurance advisors, Perron Insurance Services appreciates the discussion about the need for posting disclaimers, creating and adhering to a Social Media Policy, and honoring HIPAA compliance.
 

Download Free Healthcare Social Media Policy

As a bonus to this blog, our colleauges at Symplur, have provided us with a link to their Social Media Policy. We encourage and recommend you use this as a guide for your practice’s needs! Thank you, Symplur!
 
 Social Media Policy for Physicians and Staff

When we first read the article on Clinical Guidelines below, we were excited to share it with you. This information is invaluable  in reducing your risk, especially as you set up your practices to fit new government requirements.

We are delighted to have Susan O. Martin, RN, JD,  Executive Vice President, Litigation Management / Loss Control of Best Practices Insurance Services, LLC, as our special guest blogger. In the following article, she discusses the importance of Clinical Guidelines and Performance Standards and how they are Improving Quality to Decrease Risks.

Improving Outcomes

There is no doubt that the ultimate goal of all health care practitioners is to improve patient outcomes.  Attorneys want better outcomes as well, because happy, satisfied patients correlate to fewer lawsuits filed against health care providers. While performance standards, professional clinical guidelines or protocols of care are often employed in an attempt to improve outcomes, as an attorney, it is problematic to review or give advice regarding them because plaintiff attorneys will try to use these documents as “standards of care,” even if that is clearly not the intent. For example, if a protocol states that a patient is to have antibiotics on board within a specific time of the diagnosis of pneumonia, and the antibiotic is given twenty minutes after the time period required, is that considered a violation of the standard of care?

The Rise of Clinical Guidelines & Performance Standards

Emergency physicians and emergency medicine groups execute agreements with their hospital partners which place clinical guidelines and performance standards and core measures directly on the physicians in the practice. Most medical specialty organizations and institutions require some form of clinical performance measurement as well.

For example, the American College of Cardiology and the American Heart Association have recommended core measures for treating patients with ST segment MI and non ST segment MI. Those cases used to represent the majority of cases filed against emergency room physicians, but in the past five years, the “missed MI” cases out of the emergency department are very few. Now, with the institution of the “code STEMI” in the pre-hospital care environment, and the hospital cath labs responding immediately, patients are having better outcomes and heart muscle salvage.

Many of these core measurements are used by the Centers for Medicare & Medicaid Services (CMS) for post review of the quality of care delivered to Medicare patients. While many practitioners would argue that CMS is merely looking for an avenue to deny payment to those facilities and physicians who do not follow the criteria, CMS would argue it is only seeking better outcomes for its beneficiaries, including decreased hospital admissions. Unfortunately, many times these performance criteria are promulgated by committees or hospitals as “standards of care,” which further expose medical staff members.

Clinical Guidelines & Performance Standards vs. Standards of Care

The term “standard of care” is a legal term used in courts of law to determine a practitioner’s duty to a patient. Standards of care are determined by jury, judge and/or expert testimony. In contrast, clinical guidelines – performance standards are recommendations by hospitals, medical staff committees and professional review organizations to provide a “road map” for practitioners to consider. As recommendations that change over time, these guidelines should not set policy. They should never be considered as hard evidence in a medical malpractice lawsuit. It is recommended that any clinical guidelines or protocols set up for mid-level practitioners, physicians, or other health care providers have language that allows the practitioner the flexibility to use his or her own independent medical judgment.

Tips for Writing Clinical Guidelines & Performance Standards

In writing such guidelines, we suggest the following:

• Clinical guidelines – performance standards should have the following language at the beginning of the page:

“These guidelines are tools and considerations for the practitioner’s use and are not intended to suggest or dictate medical standards of care. Each patient has individualized needs and each practitioner must use his or her own professional independent judgment in medical decision making for each patient’s treatment plan of care. “

 
With this language at the beginning of each clinical recommendation, you can respond accordingly. If asked in deposition testimony, you can state that you know of the guidelines, but you determined that your patient, Jane Doe, needed different treatment modalities, and you were acting in the best interest of the patient at the time of care.

• Use caution in using words such as “practitioners shall always”or “practitioner shall ensure that.”
Again, the wording must give flexibility for the practitioner and should not denote absolute terms.

• Nursing policies can be somewhat more problematic, yet required by the Joint Commission on Accreditation of Health care Organizations (JCAHO) and nursing boards. Nurses are accustomed to policies and procedures, which they strictly construe. For example, instead of a policy that states, “Vital signs shall be repeated every two (2) hours,” a departure from which would be considered a violation of hospital policy, if possible, allow patient acuity to better define the guidelines. It would be better to state, “Vital signs shall be repeated according to the acuity of the patient or as ordered by the physician.” In this manner, nurses are not charged with taking repeat vital signs on non-acute patients or patients who do not require it.

Get Involved – Develop Clinical Guidelines & Performance Standards

Whatever term is used core measurements, performance standards or clinical guidelines – these policies are here to stay.  It is in the practitioner’s best interest to assist in the development of these measurements in their hospitals and/or their specialty organizations to draft reasonable and medically sound criteria that gives flexibility and allows practitioners to continue to determine individual patient needs.

About Susan O. Martin, RN, JD

Susan has a unique background that compliments the integrity of AMS Best Practices. Prior to joining Best Practices, she was Chief Legal Counsel for a physician management group consisting of primary care, multi-specialists and ED physicians. Prior to her role as Chief Legal Counsel, Susan managed the litigation and risk management for a large, national physician practice management company (EmCare). She has also been in private practice defending physicians in lawsuits, as well as handling regulatory matters and insurance coverage issues.

About Best Practices Insurance Services, LLC

Best Practices Insurance Services, LLC (BPIS) is the exclusive agent for Applied Medico-legal Solutions Risk Retention Group (AMS RRG) providing underwriting, brokering, clinical risk management, claims management oversight and distribution services.

For questions regarding Clinical Guidelines & Performance Standards: Improving Quality to Decrease Risks, please contact Steve Shapiro, MD, Chief Medical Officer, at (800) 367-1 337 or Susan Martin, Esq. at (866) 520-6896.

If you’ve liked what you have read here, please share the information with your colleagues. Our agency’s goal is to provide you with information that will enable you to reduce risk and malpractice claims, so that you can enjoy a successful practice.  We welcome any thoughts or suggestions on how we can help you achieve these goals.

If you have questions about reducing insurance premiums, risk reduction and improving overall coverage, feel free to contact me, Michelle Perron, personally at (603) 926-1318.

Physicians may be attracted to a Paid-Claims medical professional liability policy type because of its lower initial price compared to Claims-Made or Occurrence policies. While they all have their differences, the Paid-Claims policy type is one that needs the most understanding before purchasing. Here is why:

First, you need to examine the coverage trigger definitions of each policy type. The coverage trigger is the “event that must occur before a particular liability policy applies to a given loss.” Let us look at the triggers for three coverage types.

Paid-Claims vs. Claims-Made vs. Occurrence:

Comparing Insurance Policy Triggers

Occurrence – The trigger is the occurrence of the injury or damage. Liability will be covered under that policy if the injury or damage occurred during the policy period. With an Occurrence policy, once you pay for the policy, no matter when a claim is filed in the future, the insurance carrier that was in place at the time of the injury or damage will respond to the claim. The buyer needs to feel confident that the carrier will still be around for many years to respond to any future claims.

Claims-Made – The trigger is the date the claim is made, which can be long after the date of the actual injury or damage. Should the insured or carrier cancel the policy, the insured may need to purchase an Extended Reporting Period (known as a Tail) which would allow claims to be reported in the future for professional services rendered during the policy period(s). If the insured is moving to another carrier, the new carrier may be able to pick up “Prior Acts”, meaning the new carrier may be willing to pick up coverage from the first date of the current Claims-Made policy. In this case, the insured does not need to purchase a tail.

Paid-Claims – The trigger is the time a claim is paid. Therefore, if a claim is filed, the insured must remain on the policy until it is closed. This approach can offer significant benefits in terms of pricing accuracy for the insurance carrier offering the coverage, since premiums are based on overall expected costs for the next twelve months rather than estimates of future claim payouts. However, since claims will be paid only while the policy remains active, the insured facing a claim cannot cancel the policy while the claim is pending, often for years, unless he or she is willing to pay the claim out of personal assets, or purchases an Extended Reporting Period (Tail).

Bottom Line Advice:  “Avoid Paid-Claims Policies”

In summary, Perron Insurance Services advises professional service providers to avoid the Paid-Claims policy type due the inability of an insured to move coverage while a claim is pending without purchasing a Tail. We believe that carriers will often non-renew coverage or increase rates when they receive notifications of claims they expect to pay out, even if not for several years.

References:

IRMI – International Risk Management Institute, Inc. (IRMI) http://www.irmi.com

The Risk Retention Reporter, January 2004