Manage Risk

Quture products give actionable insight for proactive and clinical risk management, both methodical and anticipatory. Their legal counsel, risk managers, consultants, and boards of directors and leadership must become fully aware of the new risks and the compelling opportunities to balance risk with revolutionary insight from opportunities to improve and prevent adverse events. And with reporting performance for payment and other governmental initiatives comes the new demand for transparency. This will require public disclosure of what has historically been not only guarded but secret negative information – sometimes even from boards of trustees.

Standards and requirements that are now used to accredit hospitals mandate performance measurement of each individual doctor and clinical practitioner and for specific clinical privileges. These privileges are the permission, granted by the board of trustees, to diagnose and treat patients using specific clinical interventions. At the same time, the American Medical Association (AMA), the Physician Consortium for Performance Improvement (PCPI), and many medical societies are developing and publishing performance measures for hospitals and physicians. This is an international movement, with extensive reports in the international medical literature evaluating performance measures for validity and use to improve care and reduce costs. The American government and, even more so, single payer countries, are adopting performance measures from organized medicine and collaboratives. The imperative to improve quality and cut costs has led the federal government to initiate public reporting with Hospital Compare and to incentivize physician and hospital performance using pay-for-performance and value based purchasing payment systems. Soon, publicly available performance information specific down to individual physicians and their clinical privileges will be used by patients to select their providers and by insurers to select providers in their networks.

Compliance with these new standards and financial incentive will drive hospitals and physicians to measure performance. But products other than those of Quture will expose these providers to liability from allegations of negligent credentialing. These allegations and claims will foreseeably be against not only institutions and practitioners but against boards down to the personal level. And at the time when states and medical societies have become very proactive and achieved capitation on tort claims in many states, the lure of class action litigation for negligent credentialing should be anticipated.

On the positive side, the exponential improvement in patient care and reduction of adverse events will reduce liability exposure. And risks from claims for fraud and abuse in billing will be substantially mitigated and managed. Scientifically understanding what works best will literally transform health care – how it is delivered and how it is paid for – internationally.