In order to survive (and God willing, even possibly succeed) in today’s medicine, every physician must come to accept certain key insights and recognize certain hard realities.
First insight: The number of agencies, entities and authorities who earn their living every day (and all day) regulating, auditing, monitoring disciplining, prosecuting and punishing physicians continues to grow every day.
Hard Reality: Any action, by any of these entities, will certainly be costly to defend, may well be career ending and may even place the physician’s liberty at stake.
Risk Management: Every physician must:
- 1Obtain the “ground rules” for every entity/agency under which they exist, operate and/or practice,
- 2Review and analyze the “ground rules”,
- 3Decide if they can comply with these “ground rules”, and
- 4If they cannot comply with the “ground rules”, every physician should immediately end any role or responsibilities they hold under that entity/agency.
Second Insight: All of the entities adverse to physicians have the ready ability, and in some cases the legal obligation, to communicate and coordinate with each other as to the action they are taking against a physician or practice.
Hard Reality: As a result, any investigation or action seemingly limited to one arena may well result in actions and/or investigations being brought against the physician from a number of other adverse entities. One of the tools in cross-referring physicians for corollary actions is the monitoring of the National Practitioner Data Bank (“NPDB”). The NPDB is a permanent depository of all professional data pertinent to a physician. Medical malpractice payers, State licensing boards, hospitals, other health care entities, and professional societies are responsible for reporting to the NPDB any medical malpractice payments made and/or adverse actions taken against a physician.
Risk Management: No inquiry or investigation (of any type, any nature or any mechanism) should be treated as “casual”, educational”, “collegial” or “informal”. Any physician under review, of any nature or degree, must be properly and thoroughly prepared for any meeting, review or conference. The physician under review must obtain the medical record at question, thoroughly review the record and be properly prepared prior to any such meeting, review or conference.
The National Practitioner Data Bank
Third Insight: Medical records are being reviewed, audited, analyzed and scrutinized at an ever increasing rate and in exponentially increasing numbers.
Hard Reality: Most of the complaints generated to entities adverse to a physician, and the resulting actions and/or investigations undertaken by those entities, are initiated by and predicated upon the negative conclusions derived from a review of medical records – without any direct discussion with, or defense by, the physician.
Risk Management: Every physician should design and prepare each and every medical record under the presumption that their patient, their department chairperson, and their “worst enemy” will be reviewing that very same medical record.
Medical Records Scrutiny
Fourth Insight: Almost every complaint to an entity adverse to a physician results in an eventual reporting or referral to the physician’s state licensing authority (“BOM”) and any adverse action by that state licensing authority far outweigh the practical impact of a medica