Participatory risk management: promoting physician compliance with practice guidelines

Claims that result from at-risk medical practices, especially those involving medical records and systems failure-related problems, cost significantly more than the average claim to resolve, primarily due to additional defense costs required for expert witnesses. An analysis of these claims areas has pinpointed specific problems that can be addressed and corrected.

A participatory risk management program requires all physicians applying for insurance to comply with established general and specialty-specific practice guidelines. Additionally, physicians and their staff receive premium-credit points by attending regularly scheduled continuing education programs on reducing liability risk. If a claim arises in which there is some question about whether the physician followed the guidelines, the circumstances are thoroughly reviewed with the physician after defense of the claim has been completed. Additionally, a medical records consultation program helps individual practices audit their records and identify and correct any at-risk problems.

Based on the success of the program, a new premium program has been instituted in which all physicians are placed in the lowest premium group, but they must participate regularly in risk management activities and avoid adverse actions to maintain the low premium rate.