This is the time of the year when the word "resolution" makes some of us cringe. Wikipedia defines New Year’s resolution as “a promise to do something differently in the New Year”. Taking a fresh look at how you address and mitigate clinical risk could be that "something". Would you like to keep your patients and your medical practice even safer from risk this year?

Get in Shape with Risk Reduction this New Year

Mary Stoll, RN, BSN, Senior Risk Manager; Direct: 630.694.5377

This is the time of the year when the word ‘resolution’ makes some of us cringe. Wikipedia defines New Year’s resolution as “a promise to do something differently in the New Year”.  Taking a fresh look at how you address and mitigate clinical risk could be that ‘something’.  Would you like to keep your patients and your medical practice even safer from risk this year? Then commit to a more thorough focus on your current risk management systems and resolve to be proactive in reducing your risk.  

This is highly recommended, especially in light of industry reports that claims severity is continuing to uptick.  Recent research on hospitals and outpatient care clinicians attest to this trend.1  Interesting to note is that claims involving nurse practitioners and physician assistants showed higher severity. Communication breakdown and mishaps related to diagnosis is cited, along with increase in severity of claims involving children’s hospitals and teaching hospitals.2 

One report emphasized three approaching areas of risk in healthcare – medical marijuana, telemedicine and social media.  One issue with the first is the legal discord due to state and federal marijuana laws and how this will present medical and legal dilemmas for clinicians.1  Questions are looming such as “Should?” or “How will?” I integrate medical cannabis into my practice?   

Telemedicine services continue to grow and social media is here to stay.  Both come with issues of HIPAA privacy/security, documentation, EHR functionality and operability issues.  As an alternative to standard healthcare, telemedicine poses additional challenges such as guidelines for establishing the physician-patient relationship, credentialing and reimbursement.  In the social media realm, there is the added concern of patients recording office visits or surgical procedures and the surrounding legal ramifications.1   

Risk reduction shape-up plan for 2020:
RISKS-First, consider that medical liability risks often fall into the following categories:

  • Communication
  • Documentation
  • Lack of follow-up on tests and failed appointments
  • Medication errors 
  • Patient complaints  

Next, identify two or three principal risks in your organization (office based or non-office based) that need attention:

  • Is it the absence of an efficient process for tracking of tests which stands out as a risk issue, or is it the fact that communication-documentation of after-hours phone calls is lacking? 
  • Does your documentation reveal a complete, concise and accurate story of patient treatment and plan of care? 
  • Are your informed consent processes effective?
  • If you are involved in a hospital-based practice, do you see deficiencies in your processes with communication with other providers? 
  • Do you have back-up systems present for technical equipment?
Once you identify some risks, consider evaluating their significance and frequency.  Respond to the risk by implementing a system(s) to address the risk issue.  For example, you decide that your communication with patients could use some fine-tuning. 

Resolve to spend a bit of extra time with your patients at each encounter to make sure that they are adequately informed.  Patient education is time-consuming, but very beneficial, as studies show that poor communication can lead to claims.3

Improve efforts to communicate effectively with other team members, especially during handoffs.

Changes in current systems may be resisted by you or your staff, but remember, the goal is patient safety and reducing your liability exposure.

Exploration and Emerging Risks in Telehealth and Telemedicine

Gallagher National Risk Control Team

21st century healthcare has gone beyond just in person Doctor’s visits and long lines at the Pharmacy. Between needing to have a unique understanding of writing policies within this field, and also understanding the exposures in the Digital Health space, Gallagher has truly become one of the industry insurance leaders.

To dive into this industry, you will need a little understanding of the telehealth terminology. Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technology. Telehealth and telemedicine are usually used interchangeably in the industry. You might also hear digital health, mobile health, or health IT. However, telemedicine is actually a subset of telehealth. Telemedicine is specifically clinical services via telecommunications. 

Understanding the growth alone in this industry gives Gallagher an advantage. It is quoted by Mobile Health News that the telehealth industry will hit $130.5 billion dollars by 2025. It is currently valued at $38.3 billion dollar market. This report predicts that telehealth will be $64.1 billion dollars and tele-hospitals will reach a total value of $85.3 billion dollars. This is an increase of 19.2% annual growth.  Already we are seeing this growth within our own book of business.

The majority of the industry is located in San Francisco Bay area and New York City. The evolution of telehealth companies usually begin as small start-ups and develop very quickly even in the pre-earnings phase. The second year tends to be the licensing phase of their business, and ultimately the third year in growth. Growth includes reaching multiple states with their telehealth platform in both patients and also employees. Once growth starts to develop, these companies tend to double and triple in size. This is a strength and also a weakness if these companies are not prepared. The trend for the Digital Health space has been exponential growth within the first three years, which also opens opportunities to deliver Risk Control capabilities for their growing exposures. 

As we explore the risks, you will see multiple types of telehealth companies in existence today. Many of which Gallagher supports in their insurance needs. One great example is a large telehealth company who has developed a virtual platform for primary care physician needs for patients. By simply clicking an app and talking to a virtual physician you can be prescribed medicine and given a health plan over your phone. They have been very successful and raised $74 million dollars in funding at the end of 2018. Not only are their patient platforms growing, but more and more major healthcare organizations believe this is the future of rural healthcare, and telehealth continues to gain popularity. Other examples of telehealth organizations are third parties that hold patient information, and health and wellness apps that track your health information. The majority of these companies utilize multiple technologies. You will see mobile health, video and audio technologies, digital photography, remote patient monitoring, and store and forward technology. All of these show risk and weaknesses in cyber security by holding confidential patient information, and also a large risk from a Professional Liability standpoint. 

Overall, most of these telehealth companies have little to no insurance and risk management experience. Because they function initially as small technology startups the primary concern is their state medical platforms and cyber security initiatives.  Where Risk Control can become beneficial for digital health companies are in the Workers Compensation space, Auto/Fleet, Professional Liability, and most importantly cyber opportunities.  The challenge is getting ahead of the growth and helping our clients reach their Risk Management needs before their organization implodes internally. Areas of support that most clients from the telehealth industry need includes; written program development, orientation, mandatory/regulatory training requirements, work-from home risks, and hired-non owned auto risks. 

So what’s next in the telehealth world? Inevitably major growth. Soon we will start to see less patients in primary care facilities and more patients calling over the phone or using an app to call a doctor. Not only does this show unique risks by not physically going to an office, but more and more patient’s information will be readily available and stored on platforms. Being able to help prepare these companies for a catastrophic event of losing data whether by hacking or a major event is key. As well as convincing these start-ups that not only is their patient information and cyber information important, but their overall Risk Management procedures for their organization are of equal importance. 


Larry Hansard, Area Director – Gallagher Healthcare Practice, Washington DC