The Value of Claims ‘Signal’ Data in Orthopaedic Surgery

The Value of Claims ‘Signal’ Data in Orthopaedic Surgery
AAOSNow – January 2019 
by Michael Marks, MD, MBA

In last month’s article, “Scientific Analysis for Medical Liability Claims,” Coverys’ Robert Hanscom, vice president of business analytics, and Lisa Simm, manager of risk management, presented the methodology the insurer utilizes to analyze medical professional liability (MPL) claims. This article features an analysis of Coverys’ review of 474 closed orthopaedic claims from 2013–2017.

The analysis revealed that the top allegation category for claims is surgery/procedure-related (62 percent of the claims, 64 percent of the indemnity dollars) (Fig. 1). This is not surprising, as orthopaedics is a highly technical area of medicine, requiring sharp skills by surgeons who perform complex procedures. However, what is startling is that nearly 90 percent of the procedure-related MPL claims allege negligent performance. In other words, the plaintiffs are claiming that the skill level of the surgeons—as manifested by their role in the procedure—was insufficient, inadequate, or below standard. Are our skills really that poor? The perception of inferior skills is probably the result of ineffective physician-patient communication and the physicians’ inability to ensure appropriate patient expectations.

Given the extensive media coverage of health issues, patient expectations may be higher than ever. In 2015, Danny Lee, MD, a surgeon in Hong Kong, wrote: “Technological advancements and media coverage of successful cases invariably contribute to higher expectations among patients. When these expectations—realistic or unrealistic—are not met, patients may feel let down.”

So, what is behind the high levels of performance-related allegations in orthopaedics? Are surgeons now being sued for what used to pass for normal risks associated with any complex surgical procedure, or is the answer more complex?

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