EXECUTIVE SUMMARY
Healthcare organizations will face risk management challenges in the coming decade. Some of the challenges will involve cybersecurity and the increasing use of artificial intelligence.
- The surge in nuclear verdicts will continue.
- Consolidation may prompt further regulation.
- Patient trust in the healthcare system will continue diminishing.
By Greg Freeman
Key trends in the healthcare industry will continue in the coming decade and exacerbate risk management challenges, according to an assessment by The Doctors Company, part of TDC Group, a malpractice insurer based in Napa, CA. Nuclear verdicts will continue to be a threat to healthcare organizations, and risk managers will have to contend with multiple trends that will require time and resources. A recurring theme is how technology, such as artificial intelligence (AI), will be changing and how that may affect cybersecurity issues, says Julie Ritzman, MBA, CPHRM, vice president for patient safety and risk management with TDC. “Although AI tools will be helping in healthcare, they will also be hindering our cybersecurity,” she says. “So, it’s kind of a double-edged sword.”
The predictions include calls to action to address the coming challenges, but Ritzman says healthcare organizations may face some difficulty when strategizing. “From a financial standpoint, health systems are being paid less from the federal government for both health systems as well as practitioners,” she says. “In addition to that, they have less resources because of the shortage of the number of physicians who are currently being trained in medical schools to deal with the aging population.”
These are the top 10 risk management predictions for 2034 from the The Doctors Company analysts:
- Nuclear malpractice verdicts will continue to cause ripple effects that threaten physicians and patients, says Jacqueline Ross, RN, PhD, coding director, patient safety and risk management. To reduce the possibility of patient injury and a claim leading to a nuclear verdict, she advises reviewing policies and procedures in high-risk areas to ensure they reflect current best practices. Audit practitioner documentation to verify policies and procedures are being followed, she advises, and contact your insurer early for advice on incidents and potential claims to implement patient and family communication and risk mitigation strategies. Early interventions may lead to more positive outcomes, she says.
- Healthcare consolidation will continue, but concerns over how consolidation increases costs and cybersecurity risks will push policymakers into further regulation, says Robin L. Wessels, MBA, BSN, RN, CPHRM, vice president, patient safety and risk management.
“Develop a comprehensive cybersecurity response plan to follow if a breach or ransomware compromises patient records or business systems. Train staff on technology backup plans and equipment, such as paper records or offline computer systems,” Wessels says. “Run simulation drills with staff to identify communication and response gaps and ensure a coordinated effort. Create processes for patient safety in the event of a cybersecurity incident, such as contingencies for affected equipment, protocols for canceling elective procedures, diversion for emergency care, and patient transfer agreements with other healthcare organizations.” - Nurse practitioners, physician assistants, and alternative care models, such as hospital-at-home programs, will be key to alleviating the continuing primary care crisis, says Julie M. Brightwell, BSN, JD, RN, CPHRM, director, patient safety. Diagnosis-related errors (failure, delay, wrong) remain the most frequent allegations against nurse practitioners and physician assistants in malpractice claims and are the top causes of patient harm, she notes.
“To reduce diagnostic errors, perform thorough patient assessments, use clinical decision support tools, implement systems to track laboratory and diagnostic tests, and document patient and referral-practitioner communication,” Brightwell says. “Virtual patient assessments in the hospital-at-home environment may contribute to diagnosis-related errors. Implement best practices to conduct virtual assessments, integrate data from remote monitoring devices, convert a virtual visit into an in-person visit when necessary, and coordinate care for the patient at home.”
Brightwell also recommends educating patients on operating reliable telehealth equipment, using remote monitoring devices, and communicating signs and symptoms. - Healthcare will face a two-headed crisis, with patients increasingly mistrusting medical organizations and practitioners losing confidence in the systems meant to support them, says Robert D. Morton, MAS, CPPS, assistant vice president, Department of Patient Safety and Risk Management. Patient mistrust of healthcare organizations may result in screening and preventive care delays, he says.
“Use tracking and follow-up systems to reach patients who have missed preventive care opportunities. Open communication and shared decision-making may help patients regain trust,” Morton says. “Healthcare professionals will be attracted to healthcare organizations that institutionalize well-being as a long-term value and operationalize interventions to enhance care delivery and advance patient safety — in collaboration with clinicians.”
Organizations that take purposeful actions to improve work environments, staffing, and healthcare professional control over workloads can prevent burnout and increase confidence in systems, he says.
“Thoughtful application of AI may reduce practitioner time spent on documentation and other administrative burdens and may help restore trust in healthcare organizations,” he says. - Magnified obstetric safety risks post-Dobbs will continue to cause physical trauma to patients, inflict moral injury on practitioners, and create maternity care deserts, producing disastrous effects in healthcare for years to come, predicts Ginger Breedlove, PhD, CNM, FACNM, FAAN, founder and principal consultant of Grow Midwives and member of the TDC Group APC Advisory Board.
“Remain current on relevant state and federal laws involving patient access to care related to reproductive options, and create a list of resources and referrals for unmet needs,” she says. “Having readily available and meaningful resources for patients can impact individual lives. Guttmacher’s interactive map on state abortion policies and legislation tracker contains pertinent information about current laws and restrictions on access for both providers and patients.”
The Guttmacher map is available online at https://www.guttmacher.org/state-policy/explore/state-policies-abortion-bans. - AI clinical decision support tools will bring benefit and risk, but it will take advancements in legislation to clarify who is liable when an AI tool errs, Ritzman says.
“AI does not possess a medical license. Therefore, you must review the AI-provided information and determine the appropriate care for the patient,” she says. “Documenting AI results, along with your rationale at the time for agreement or disagreement, will be crucial for defending against liability.” - Ambient listening tools to record patient-clinician interactions will face implementation challenges, liability risks, and uncertain outcomes, Ritzman says.
“For both legal and ethical reasons, disclose the use of ambient listening, be prepared to answer patient inquiries, and provide patients with the option to decline,” she says. “An AI scribe is a tool, with the clinician ultimately responsible for its safe and effective application. Therefore, thoroughly reviewing the generated clinical note is imperative to ensure its accuracy and completeness.” - Cybersecurity and HIPAA risks will be heightened by the implementation of AI, says Richard Cahill, JD, vice president and associate general counsel.
“Require practitioners, employees, and contractors to undergo annual training on recognizing phishing attempts, conducting secondary validation of suspicious phone calls and voicemails, and the critical importance of safeguarding patient information throughout all levels of the organization,” Cahill says. “Evaluate whether the current policies and procedures governing protected health information collection (PHI), handling, distribution, and use sufficiently address the application of PHI in AI technology.” - Retail giants, facing serious setbacks with their healthcare clinics, will shift to partnerships and subscription models, predicts Paul Nagle, ARM, CPHRM, vice president, patient safety and risk management. Practitioners need to ensure follow-up as patients complete ordered laboratory tests, diagnostic studies, and consultations at different locations, he says.
“Review test results and consultation reports, communicate findings to the patient, and document the plan to close the loop. Access to care can become a liability issue when delayed treatment leads to complications or worsening of the patient’s condition,” Nagle says. “Healthcare services that can be provided in the same location with extended hours for care, offering telehealth services, or transportation assistance to access care can reduce potential delays.” - Life sciences companies’ entrance to the direct-to-patient space with medications, devices, and telehealth services will raise liability risks, Cahill says. Risk managers should ensure there is a thorough medication reconciliation process for all medications, vitamins, supplements, and over-the-counter drugs that patients are using, he says.
“Compare the medications reported by the patient with those prescribed to ensure accuracy in drug type, dose, frequency, and route,” Cahill says. “Consider social determinants of health when examining discrepancies between prescribed medication and what the patient is taking. These discrepancies may result from economic factors, cultural influences, or a lack of understanding.”
Sources
- Ginger Breedlove, PhD, CNM, FACNM, FAAN, Founder and Principal Consultant of Grow Midwives and Member, TDC Group APC Advisory Board, Napa, CA. Telephone: (800) 421-2368.
- Julie M. Brightwell, BSN, JD, RN, CPHRM, Director, Patient Safety, The Doctors Company, part of TDC Group.
- Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company, part of TDC Group.
- Robert D. Morton, MAS, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company, part of TDC Group.
- Paul Nagle, ARM, CPHRM, Vice President, Patient Safety and Risk Management, The Doctors Company, part of TDC Group.
- Julie Ritzman, MBA, CPHRM, Vice President Patient Safety and Risk Management, The Doctors Company, part of TDC Group.
- Jacqueline Ross, RN, PhD, Coding Director, Patient Safety and Risk Management, The Doctors Company, part of TDC Group.
- Robin L. Wessels, MBA, BSN, RN, CPHRM, Vice President, Patient Safety and Risk Management, The Doctors Company, part of TDC Group.
Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
Key trends in the healthcare industry will continue in the coming decade and exacerbate risk management challenges, according to an assessment by The Doctors Company, part of TDC Group, a malpractice insurer based in Napa, CA. Nuclear verdicts will continue to be a threat to healthcare organizations, and risk managers will have to contend with multiple trends that will require time and resources.
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