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New Medicare & Medicaid Reimbursement Guidelines May Increase Rates Of Malpractice

The Centers for Medicare & Medicaid Services (CMS) has revised and will be implementing some new guidelines relating to patient evaluation and management. The majority of the changes will take effect in 2021, a delay that has largely been attributed to negative reactions from physicians. These modifications to documentation, coding, and payments are being presented as ways to increase efficiency and reduce redundancy and costs. Many physician groups who oppose these changes feel it will compromise patient care and potentially increase risks associated with medical malpractice.

Documentation Changes

The CMS feels that these changes will reduce the amount of time that practitioners spend making notes about information that already exists in the patient’s medical records. Physicians would save time by limiting their notes exclusively to current changes. Existing patient data would still need to be reviewed and verified.

Shorter Patient Visits

David J. Rothman, a medical historian at Columbia University, says increasingly that doctors have “one eye on the patient and one eye on the clock”. The CMS claims the upcoming changes will allow for a reduction in paperwork that should amount to approximately 1.6 minutes of time per patient visit.

Many physicians explain that today there are more patients suffering from multiple serious conditions such as heart disease, diabetes, cancer etc. In these cases, the physician is likely to need time to review multiple lab and test results, make changes to the care plan and ask questions regarding behavioral issues. They feel that the result will be an “increased volume of low-value visits” and greatly increase the chance for mishaps and oversights that can lead to claims of malpractice.

“Hand-Offs” & Fragmented Patient Care

Today’s healthcare system is increasingly fragmented. Patients are less likely to have the same physician for decades at a time and are more likely to have several different specialists. Patients themselves are often not a reliable source for the specific details of their medical history. Across the continuum of medical care a patient might see their primary care physician, psychiatrist, physical therapist and have an emergency room visit in one-year.

This can obviously lead to a lack of continuity in treatment. In a hospital setting the process of transitioning a patient to another provider is often referred to as a “hand-off”. The Joint Commission has identified errors in “hand-offs” as being one of the leading causes of claims of medical negligence.

Communication-Related Errors

  • Many electronic medical record systems are incompatible (lacking interoperability)
  • Communication failures are estimated to cause almost 2,000 fatalities and $1.7 billion in costs relating to medical malpractice annually
  • Failures in communication exist in roughly 30% of malpractice claims
  • Failures in communication exist at even higher rates in claims of medical malpractice involving severe injuries or death

The upcoming CMS changes are designed to lower costs and boost efficiency. Meanwhile, physicians are seeing larger volumes of patients in efforts to offset declining reimbursements for healthcare services. Critical medical information about patients is often not communicated between different healthcare practitioners that see the same patient. The combination of these factors creates a host of potential problems, including a likely increase in the number of allegations of medical malpractice.

About the Author

Briggs Bedigian
Briggs Bedigian

H. Briggs Bedigian (“Briggs”) is a founding partner of Gilman & Bedigian, LLC.  Prior to forming Gilman & Bedigian, LLC, Briggs was a partner at Wais, Vogelstein and Bedigian, LLC, where he was the head of the firm’s litigation practice.  Briggs’ legal practice is focused on representing clients involved in medical malpractice and catastrophic personal injury cases. 


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