Claims Data SnapshotNeurology

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This publication contains an analysis of the aggregated data from MedPro Group’s Neurology claims closed between 2007 and 2016. All claims included in this analysis identify a neurologist as the primary responsible service. Claims in which another specialty is identified as the primary responsible service are not included, unless otherwise noted.

This analysis is designed to provide MedPro Group insured doctors, healthcare professionals, hospitals, health systems, and associated risk management staff with detailed claims data to assist them in purposefully focusing their risk management and patient safety efforts.

Data are based on claim counts, not on dollars paid (unless otherwise noted). The type of claims and the details associated with them should not be interpreted as an actuarial study or financial statement of dollars paid; however, the information may be referenced for issues of relativity.

Introduction

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Allegations & financial severity

NOTE: The “other” category includes allegations for which no significant claim volume exists. Any totals not equal to 100% are the result of rounding. Total dollars paid = indemnity + expense.

Top allegation sub-categories/diagnoses/medications:

Diagnosis-related:• Primarily delays in diagnosing strokes, infections &

cancers; aneurysms & spinal fractures are noted as well

Medical treatment:• Management of a course of treatment (63%)• Performance of procedures (22%), including

arteriography & EEGs

Medication-related:• Medication regimen management (68%)

• Most frequent - anticonvulsants, anticoagulants, sedatives

• Ordering errors (14%)• Most frequent - anticonvulsants

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Allegation trending over time & clinical severity

NOTE: Any totals not equal to 100% are the result of rounding.

High clinical severity patient injuries include death and permanent disability.

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Top risk factors in diagnostic, medical treatment & medication-related allegations

Clinical judgment

Communication

Clinical systems

Documentation

Behavior-related

Inadequate patient assessments, failure to appreciate relevant patient symptoms/testresults, narrow diagnostic focus, failures/delays in ordering diagnostic tests

Patient non-compliance with treatment/medication regimen and follow up appointments, dissatisfaction with care

Delay in reporting test results – including patients who do not receive the results of tests; failures/delays in scheduling/performing diagnostic tests

Lack of access to other providers’ medical records, failure to read medical record; also patient/family education about medication & treatment regimen & follow-up instructions for ongoing care, inadequate informed consent

93%

43%

17%

17%

17% Insufficient documentation related to clinical findings and the rationale for specific treatment plans

Risk factors are broad areas of concern that may have contributed to allegations, injuries, or initiation of claims.

NOTE: Top factors within each risk category are identified. Totals exceed 100% because generally more than one factor is associated with each claim.

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Important risk mitigation strategies

Clinical judgmentBe aware that inadequate patient assessment might be a result of cognitive biases, inadequate medical and family history taking, or inadequate sharing of information among providers.

Recognize that delays in obtaining consults/referrals are one of the top driving factors behind diagnostic claims.

CommunicationFocus on patient education related to follow-up expectations and risks of medications with an incorporated ‘teach-back’ methodology.

Ensure efficiencies in the sharing and discussing of test results and consultative reports among other providers.

Behavior-relatedRecognize patterns of patient non-compliance, and focus on documentation of efforts made to encourage compliance and follow up with treatment.

Clinical systemsFocus on ‘closing the loop’ with regards to receiving, reporting and acting on test results, including incidental findings

DocumentationVerify that documentation supports the clinical rationale for the method of treatment.

Describe the rationale for inclusion/exclusion of differential diagnoses.

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Key points

Diagnostic claims are the most prevalent of all allegations against neurologists. Failure to diagnose strokes, infections and cancers are most often noted. Diagnostic claims are also the most expensive in terms of total dollars paid – accounting for almost three-fourths of the dollars.

More than two-thirds of neurology claims are linked to a high severity patient outcome. Those clinically severe outcomes are distributed across all allegations.

A narrow diagnostic focus, inadequate clinical assessments, the failure to timely share test results and clinical updates across specialties, and lack of robust informed consent discussions and explanations of treatment regimen expectations, are among the top risk factors for neurologists.

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MedPro Group has entered into a partnership with CRICO Strategies,

a division of the Risk Management Foundation of the Harvard Medical

Institutions. Using CRICO’s sophisticated coding taxonomy to code

claims data, MedPro Group is better able to identify clinical areas of

risk vulnerability. All data in this report represent a snapshot of MedPro

Group’s experience with specialty-specific claims, including an analysis

of risk factors that drive these claims.

Disclaimer

This document should not be construed as medical or legal advice. Because the facts applicable to your situation may vary, or the laws applicable in your

jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or

rights, state or federal laws, contract interpretation, or other legal questions.

MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO,

Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates,

including National Fire & Marine Insurance Company. Product availability is based upon business and regulatory approval and may differ between

companies.

© 2018 MedPro Group Inc. All rights reserved.

A note About MedPro Group data