Data Help Control Malpractice Outbreak

Boston Herald

October 2, 2012

To help doctors and other clinical staff make fewer mistakes that risk lawsuits, more hospitals are learning lessons from years of malpractice data that have been gathered and interpreted.

“Analytics is becoming increasingly important in medicine, and it’s crucial that we use physician experts to communicate what we learn from crunching data,” said Luke Sato, M.D., chief medical officer at Controlled Risk Insurance Co. (CRICO), a Cambridge, MA-based nonprofit malpractice insurer and legal defender for 12,000 doctors at 25 Harvard-affiliated hospitals that uses data mining to identify vulnerable spots in patient care.

CRICO Strategies, the firm’s consulting arm, uses its malpractice data expertise to cut risks at 520 hospitals and medical practices around the country, and it plows profits back into research initiatives and efforts to promote best practices for all the hospitals it serves.

The 140-person firm has found a unique niche: assembling the largest national database of malpractice claims—more than 200,000 in all—and crunching numbers to identify the most common mistakes. CRICO Strategies employs frontline doctors as medical directors, such as Carrie Tibbles, M.D., of Beth Israel Deaconess Medical Center.

“Physicians have misconceptions about malpractice,” said Tibbles, an emergency room physician. “They think it’s rare, a product of angry patients, and caused by a perfect storm of bad luck. But by tracking malpractice case trends, we help doctors understand why things go wrong. But you have to present it to them in the right way.”

Tibbles led a recent CRICO study of emergency rooms in more than 90 hospitals that found missed or delayed diagnoses accounted for more than 47% of the 1,304 malpractice cases it analyzed. Tibbles said there were communication breakdowns between doctors and nurses in one of every three encounters that led to lawsuits. Almost half the malpractice cases resulted in permanent injury or death, with an average lawsuit judgment of $508,000.

“CRICO’s malpractice data-crunching is the gold standard in the world,” said Jeffrey Driver, chief risk officer at Stanford University Medical Center, a CRICO client for eight years. Using CRICO’s data and addressing the risk areas it identified, Driver says, Stanford has reduced its malpractice claims 25% over the past five years and is saving $3.2 million a year in insurance costs.

CRICO Strategies works in five areas: emergency room services, surgery, ambulatory care, electronic medical records and obstetrics. “We partner together with physicians to change behavior,” Sato said.

Tibbles has developed a “Triggers” protocol at Beth Israel Deaconess Medical Center and other hospital emergency rooms that puts a doctor, nurse and technician immediately at the bedside of any patient who shows signs of clinical instability.

CRICO’s data mining is paying off. Where U.S. hospitals average 12 malpractice claims per 100 physicians covered every year, doctors represented by CRICO average just 2.3 claims. Malpractice premiums also are much cheaper for CRICO-insured doctors.

Obstetrics doctors in Massachusetts can pay up to $200,000 a year for malpractice coverage, but CRICO-insured doctors pay only $65,000 per year. “The number of malpractice claims are going down,” Sato said.