Malpractice Threats in Well-Intended Patient Handoffs

Mark Crane

Disclosures

October 04, 2012

In This Article

Why Don't Electronic Health Records Help?

Will the increased adoption of electronic health records help? In theory, they should. But not all doctors have access to the electronic charts, and many information systems do not talk to other systems.

"Electronic records work best with the primary care doctors who can access the hospital's system," said Dr. Fitzgibbons. "They are a huge help in letting us complete summaries, check test results, and read consultants' recommendations from home."

Still, electronic records are no panacea. They work best in integrated systems where everyone is familiar with the system. "In most of medicine, that isn't the case," said Dr. Lembitz. "Electronic charts will be a great repository of information. But they don't solve the problem of who takes ownership and accountability for the patient."

Insurers and medical leaders urge hospitals to adopt automated discharge summaries. "The problem is that vital information is buried in boilerplate. The critical piece of information often isn't highlighted," he said. "With automation, we produce volumes of information instead of levels of what the key priority is. Can you write a template for a discharge summary that answers this? With so many different systems, it isn't easy."

Unfortunately, there's no unified system for relaying vital information. "What is the preference of the primary care doctor who is following a patient after a heart attack?" asks Dr. Lembitz. "Some just want to see the report. Which ones want to be called? Hospitalists and specialists try to tailor their communication to the referring doctor's desires."

Proposed New Codes Could Help

Doctors on both sides of the handoff are at legal risk when mishaps occur. If a lawsuit occurs, the plaintiff's attorney will initially sue everyone involved in the patient's care and then sort out accountability later. Years after the event, a jury may decide who is really liable for fumbling the patient handoff, he said. "Trial lawyers don't care who writes the check," said Dr. Lembitz. "All they have to prove is that the team was dysfunctional and not communicating with each other."

"There may soon be another strong reason for physicians to take more care in the patient handoff," says Elizabeth Woodcock, MBA, Principal, Woodcock & Associates, Atlanta, Georgia. “The proposed 2013 Medicare Physician Fee Schedule (PFS), which was published in the July 30, 2012, Federal Register, offers a new code -- and corresponding payment -- for post-discharge care coordination.

Believing that physicians' efforts have a positive influence on reducing hospital readmissions rates -- a key area of focus for the Centers for Medicare & Medicaid Services (CMS) -- the government intends to reimburse physicians nearly $100 for each assist provided to patients in their transition from a hospital, nursing home, or other facility back home, Woodcock notes.

The newly proposed procedure code -- temporarily listed as GXXX1 -- would compensate physicians for a range of non-face-to-face care coordination services they provide to help patients in their transition back to the community after a stay in a hospital or nursing home.

"The proposed code would be payable once in the 30 days following a discharge -- per patient, per discharge -- to a single community physician or a qualified advanced practice provider who assumes responsibility for the patient's post-discharge care coordination," Woodcock said. "The services would include those provided by the clinical staff or an office-based case manager supervised by the physician or provider."

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