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MPL Liability Insurance Sector Report: 2023 Financial Results Analysis and 2024 Financial Outlook

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Hear analysis and commentary on 2023 industry results and learn what to watch for in the sector in 2024, including an analysis of the key industry financial drivers.

MPL Association’s National Advocacy Initiative in Full Swing

The MPL Association is shifting its focus toward state policy makers with a new program—the National Advocacy Initiative. This comes at an important time for the MPL community as the deteriorating policy environment in the states is resulting in increasing attacks on established reforms.

 

FEATURE

Inform Safer Medical Oncology Practice with Lessons from Medical Malpractice Claims


By James Doolin, MD, MHQS, and Hannah Tremont, MPH



Evaluating malpractice claims has become a valuable tool to inform safer care by highlighting points of care at high risk for medical error during the past several decades. Individual cases can pinpoint the most vulnerable moments in clinical subspecialty practice. In medical oncology, the case of Betsy Lehman in 1994 was one event that crystallized the importance of patient safety in cancer care.

While undergoing breast cancer treatment at Dana-Farber Cancer Institute, a documentation error caused Lehman to receive four times the intended dose of chemotherapy, ultimately resulting in her death. The Commonwealth of Massachusetts went on to name their patient safety agency in honor of the late Boston Globe reporter and mother. Even though a medical oncology case was such a large catalyst in advancing patient safety, the literature contains few analyses of medical oncology malpractice cases.

To address the dearth of research, a team of clinicians performed and published a medical oncology malpractice case analysis in the Journal of Healthcare Risk Management. Their primary goal was to identify the association between safety incidents in medical oncology practice and systems failures to inform potential redesign solutions rather than individual provider remediation.

Medical Oncology Malpractice Case Data

The team compared the circumstances surrounding malpractice claims asserted against medical oncologists versus those asserted against other internal medicine subspecialties, such as cardiology, immunology, endocrinology, etc.

The analysis used a national database of medical professional liability (MPL) claims known as Candello, which contains one-third of malpractice claims in the United States. Looking at claims closed between 2008-2019, the team compared 456 medical oncology claims to 5,771 other internal medicine subspecialty claims.

Key Findings

  • Indemnity Payment: The rate of a case closing with an indemnity payment was roughly 30% for both medical oncology and other internal medicine subspecialties. This finding is consistent with a previous claims analysis of all physician specialties, which put oncology between pulmonology and cardiology. The median payment amount was also not significantly different between medical oncology ($190,591) and other subspecialties ($233,432).

When controlling for other factors present in a case, three contributing factors significantly increased the odds of a case closing with payment by more than 100%:

  • Patient assessment issues.
  • Communication among providers.
  • Safety and security allegations, which refers predominantly to patient falls.

Compared to other internal medicine subspecialties, medical oncology cases exhibited the following trends:

  • The allegation was more likely to be related to medication than other subspecialties.
  • The location was more likely to be in the ambulatory setting than other subspecialties.
  • The injury severity was more likely to be higher than other subspecialties.


Safety Incidents and Implications for Potential Systems Redesign

After detailed coding of safety incidents within a subset of 99 claims, the research team identified the most commonly occurring safety incidents were related to:

  • Provider cognitive processes--a grouping that includes evaluation, therapeutic decision-making, and follow-up.
  • Drug side effects.
  • Care coordination among team members.

The team also identified the top five system fixes based on the subset analysis:

  • Carry out a tumor board review before beginning treatment to ensure the patient receives the best treatment plan based on all current information.
  • Integrate a pharmacist into medication administration to conduct real-time safety checks.
  • Communicate results through a patient portal.
  • Use patient navigators for high-risk patients.
  • Establish a closed-loop system for following up on abnormal radiology results.

Interestingly, the distribution of cancer types seen in medical oncology claims did not match the overall incidence or prevalence of cancers in the United States. Hematologic malignancies and sarcomas were overrepresented in both randomly sampled claims and the top 5% of claims when ranked by indemnity payments, possibly due to factors such as younger patient age and the urgency and duration of treatment.

Recommendations for Safer Oncological Care

The findings highlighted the prevalence of known patient safety concerns in medical oncology, prompting several recommendations:


It is likely that analyzing malpractice claims will continue to shine a light on the most vulnerable points in healthcare delivery systems and clinical specialty practice. This study indicated no major differences between medical oncology and other internal medicine subspecialties within the malpractice environment; however, learning the specific details of medical oncology cases paves the way for further reducing the risk of medical error in cancer care.


 
James Doolin, MD, MHQS is a medical oncologist and the assistant director of quality and patient safety for Hematology/Oncology at Lahey Hospital & Medical Center.

 
Hannah Tremont, MPH is a Writer & Editor at CRICO
It is likely that analyzing malpractice claims will continue to shine a light on the most vulnerable points in healthcare delivery systems and clinical specialty practice.