As physicians and hospitals seek to align clinically, strategically and administratively in this era of consolidation and cooperation, assistance originates from a number of places ranging from national associations to internal committees and contract consultants. Hospitals and physicians in the Southeast might also add their malpractice insurer to that list.
MagMutual, a medical mutual company founded by physicians in 1982 to provide medical liability insurance, now serves more than 19,000 physicians and two dozen hospitals in 10 Southeastern states. Considering MagMutual’s vested interest in the delivery of evidence-based, high-quality care by the professionals the company covers, perhaps it shouldn’t be surprising that an insurer has taken a proactive stance in patient safety. Calling on more than three decades of risk management expertise and data analysis, the company is turning that knowledge into actionable tools that can be used by physicians and hospitals to improve communication and care coordination.
MagMutual Patient Safety Institute
In late October 2013, the company announced a $50 million investment in the formation of the MagMutual Patient Safety Institute. Mary Gregg, MD, FACS, MHA, who serves as both CMO for MagMutual and president of the Patient Safety Institute, was brought on board last spring to launch the initiative.
“I was hired by MagMutual to create the Patient Safety Institute to focus on how to begin to look at risk and begin to improve safety across all kinds of physician practices,” explained the retired cardiothoracic surgeon who has previously worked in both an independent practice setting and as an employed physician in a large health system.
“Risk in the past was often very reactive,” Gregg continued. “What we’re trying to do is get data, analyze closed claims, and assess practices in-hospital and out-of-hospital and then identify where there are opportunities to improve.”
Johnathan Brutlag, president of the wholly owned MagMutual subsidiary Professional Security Insurance Company, added, “There are a host of risk issues in the practice setting. There are a host of risk issues in the hospital setting. What we’re doing is trying to eliminate that gray area in between.”
Gregg noted, “We are working together side-by-side to ensure there is coordination of care and that there are no gaps in care between these two entities. We feel there are certain practices that if they are implemented every day … either by checklist or integrated in the EMR … then these processes will improve the quality, improve the safety, and improve the outcome of care.”
In addition to the inherent expertise within the company, the Patient Safety Institute relies on a number of outside sources for evidence-based standards of care. Gregg, the former medical director of Quality and Patient Safety at Swedish Health Services in Seattle, pointed to the Institute of Healthcare Improvement as an excellent resource. The IHI, she noted, created a bundled checklist to address central line safety. “If you follow this bundle 100 percent of the time, you can and will decrease the incidence of central line infections down to zero,” she stated, adding that she wouldn’t have believed that was possible early in her career.
Brutlag added achieving optimal outcomes doesn’t just happen in the hospital but requires coordination from the minute a patient steps into a physician’s office through the inpatient stay and then back into the community setting.
In Defense of Good Medicine
Despite best efforts and following protocols, physicians and hospitals do find themselves named in malpractice suits. “Do we think liability is increasing? Certainly it is,” Brutlag noted of practicing in a progressively more litigious society.
However, he sees this as another opportunity for physician-hospital alignment as MagMutual takes a coordinated defense approach. Rather than pointing fingers or putting the hospital and physician in an adversarial position, he prefers to address the claim as a team that works together.
“We really think it’s important to focus on a coordinated defense. If the standard of care was not breached, then we need to defend the medicine,” he said, adding, “If the medicine is good, it should be defensible.”
Turning Errors into Education
“Our idea is not only defending good medicine, but if there was an error or near miss, we need to guarantee that it doesn’t happen again,” said Gregg. “We need to help the two systems focus on the processes and increase reliability and accountability on both sides of the system.” She continued, “We need to learn from our mistakes. We need to learn from our near misses, and the culture really doesn’t support that right now.”
However, Brutlag said they are working to change that culture. The Patient Safety Institute is in the process of becoming a Patient Safety Organization (PSO), which can collect protected data. In addition to compiling a database of information from physician policyholders, the Patient Safety Institute has the ability to compare those findings across other national databases. Brutlag stressed the data provided by members for research and analysis to improve processes is not shared with MagMutual, which determines premiums.
However, the information is used to create tools and help members instantly access resources to improve their practice. “A really important component is we’re not only providing the tools to help them make a change or implement a process, but we’re also providing tools to help measure the outcome,” said Brutlag. “If we measure and there’s not improvement, we know we have to reevaluate and make change.”
Gregg concluded, “We’re using quality improvement tools to improve safety and decrease risk … so that’s closing the loop.”
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