PHYSICIAN ASSISTANT LIABILITY: NATIONAL...
Transcript of PHYSICIAN ASSISTANT LIABILITY: NATIONAL...
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PHYSICIAN ASSISTANT LIABILITY: NATIONAL PRACTITIONER DATA BANK ANALYSISDouglas Brock, PhD Jeff Nicholson, PhD, PA-C Roderick Hooker, PhD, PA
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Study Objectives
• Describe trends in Physician Assistant, Physician, and Nurse Practitioner liability from 2005-2014.
• List types of practice allegations resulting in successful malpractice actions.
• Describe liability actions as baseline estimates of Physician Assistant medical error.
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National Practitioner Data Bank (NPDB) • Established under Title IV of Public Law 99-660 of the Health
Care Quality Improvement Act of 1986.
• A national registry of recorded actions—required reports of malpractice payments and adverse actions.
• Malpractice refers to misconduct, unprofessional conduct, mismanagement, or negligence.
• Liability refers to legal responsibility, accountability responsibility, or charge.
• Adverse actions can involve licensure, clinical privileges, professional society membership, and exclusions from Medicare and Medicaid participation.
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Adverse Actions and Malpractice Counts (2005-2014)
License Total
Physician!Assistant 3,621 71.9% 1,415 28.1% 5,036 3,061 2.9%
Physician! 63,634 37.1% 108,038 62.9% 171,672 99,877 94.9%
Nurse!Practitioner 1,440 50.0% 1,442 50.0% 2,882 2,258 2.1%
Total 68,695 38.3% 110,895 61.7% 179,590 105,196 99.9%
* !0.1%!(n=93)!of!unique!providers!had!actions!under!multiple!licenses!!(e.g.,!PA!and!Physician)
Adverse!Action Malpractice Unique!Providers
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PA and Physician Rates of Malpractice and Adverse Actions Per 1000 Providers
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PA and Nurse Practitioner Rates of Malpractice and Adverse Actions Per 1000 Providers
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Median Malpractice Payments
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MD / PA, MD / NP, and PA / NP Malpractice Risk Ratios
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Most Common Malpractice Allegations
Malpractice!Allegation PA Physician! NP AllDiagnosis!Related 52.8% 31.8% 40.6% 32.2%Treatment!Related 26.6% 19.6% 32.2% 19.8%Medication!Related 9.3% 5.2% 12.8% 5.3%Surgery!Related 4.0% 26.6% 1.8% 26.0%Monitoring!Related 2.5% 3.1% 4.8% 3.1%Obstetrics!Related 0.7% 7.6% 3.7% 7.4%Equipment/Product!Related 0.5% 0.6% 0.3% 0.6%Anesthesia!Related 0.4% 2.7% 1.1% 2.7%Behavioral!Health!Related 0.2% 0.4% 1.1% 0.4%IV!&!Blood!Products!Related 0.1% 0.2% 0.1% 0.2%Other!Miscellaneous 2.8% 2.3% 1.5% 2.3%
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Allegations: Severity of Event
34%! 32%!38%!
26%! 31%!27%!
12%!12%! 10%!
12%!11%! 8%!
16%! 13%! 16%!
0%!
20%!
40%!
60%!
80%!
100%!
PA! Physician!! NP!
Minor!Temporary!Injury!
Major!Temporary!Injury!
Minor!Permanent!Injury!
Significant!Permanent!Injury!
Death!
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Medical Error
(1) Failure of a planned action to be completed as intended or use of a wrong plan to achieve an aim; the accumulation of errors results in accidents.
(2) Failure to complete a planned action as intended, or the use of an incorrect plan of action to achieve a given aim.
(3) The failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.
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Medical Error ….• Has been established as common
• Institute of Medicine “To Err is Human” (2000) • Estimated 44,000-98,000 annual deaths
• Resistant to large scale improvement • James (2013)
• Recent estimates of 210,000-440,000 annual deaths
• Serious harm estimated as 10-20 times more common than death
• Increasing focus on diagnosis • National Academies of Sciences, Engineering and Medicine (2015)
• Leading cause of paid malpractice claims
• Estimates 10% of patient deaths attributable to diagnostic error
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Questions?