Conventional wisdom is wrong: Primary care doctors who coordinate the care of their patients by specialists may actually have lower liability risk than primary care doctors who do not attempt care coordination. That is the advice from Mark Hall, JD, professor of law and public health sciences at Wake Forest University in Winston-Salem, NC. But many doctors believe otherwise, he says.
A representative national sample of 1,238 practicing physicians found that 49% listed legal liability as one of the two main barriers to care coordination, Hall reports. In fact, he and his colleagues found that care coordination by physicians does not increase the threat of lawsuits or result in higher malpractice insurance premiums.
Care coordination involves establishing and monitoring a comprehensive treatment plan encompassing the recommendations of all specialists and resolving conflicts among specialists regarding medication, treatment, or patient behaviors, Hall explains.
These primary care doctors review the overall management of the patient’s multiple conditions, encouraging compliance with recommendations of the specialists and taking steps to prevent future problems. But many primary care doctors don’t try to coordinate care beyond recommending that their patients see specialists, Hall says. "Persons with multiple chronic conditions often encounter a complex and inefficient system of care as a result of inadequate care coordination," Hall says. "Care coordination currently isn’t being done very well."
These patients account for more than half of all medical spending, he notes. "They endure higher rates of avoidable complications and hospitalizations," Hall says. "Improving care coordination can substantially improve health outcomes and lower costs."
Weighing the liability of care
Coordinating care also can reduce medical errors, so Hall says it is important to remove any perceived barriers to better care coordination by physicians. Physicians worry about liability because coordinating care creates a broader responsibility for patients with complex conditions who have a greater chance of poor outcomes, he explains.
"Based on the collective experience and judgment of experts in medical liability, however, there does not appear to be any basis for physicians who perform care coordination to have serious concerns about liability," Hall says. Patients with chronic illness are not more likely to sue. Also, courts will not hold primary care physicians automatically responsible for mistakes made by specialists just because the primary care physician is coordinating the patient’s care.
"Courts hold doctors responsible only for what the doctor does, and not what other doctors might do wrong," he says.
Conventional wisdom is wrong: Primary care doctors who coordinate the care of their patients by specialists may actually have lower liability risk than primary care doctors who do not attempt care coordination.
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