Selected Podcast
Medical Professional Liability Risk Management: The Difference is in the Data
Health care risk management is a very diverse field and when you meet one risk manager, you meet one risk manager. One size does not fit all. This podcast series will look to discuss risks inherent to a variety of areas in health care. If you have ever wondered what working for a professional liability insurance carrier is like, this podcast, the second of the series, is the podcast for you. Medical professional liability carrier risk managers use traditional sources of data as well as real world data to help covered insureds improve patient safety and manage risk. Listen in if you want to know more.
Featuring:
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM
Sue Boisvert is Patient Safety Risk Manager for The Doctors Company’s Southeast Region. She has extensive clinical, leadership and medical professional liability risk management experience in hospitals, physician practices and long-term care facilities. Sue earned a bachelor’s degree in Nursing from The University of Connecticut and a Master of Health Services Administration from St. Joseph’s College. She is active in the American Society for Healthcare Risk management, currently serving as editor for the Journal of Healthcare Risk Management in addition to committee roles and participating in member education. Sue is a frequent speaker at local, state and national conferences and contributes to risk management and patient safety journals and publications. Transcription:
Prakash Chandran: Welcome to the ASHRM Podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org, that is ashrm.org/membership to learn more and to become an ASHRM member. I am Prakash Chandran.
Healthcare providers want what's best for their patients, but sometimes there are factors human or otherwise that pose a risk for malpractice. Through analyzing these risks, it's possible to enhance the success of care. Here to dig into the data with us is Susan Boisvert, patient safety risk manager for The Doctors Company.
Sue, thank you so much for joining us today. I really appreciate it. I was hoping that you could get started by briefly describing medical professional liability or MPL and what goes into analyzing liability risks.
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: Thank you for that question. Medical professional liability is basically malpractice insurance. And the company that I work for insures doctors, dentists, ambulatory surgery centers and some hospitals. One really good source of data on patient safety, it's retrospective, is claims data. Closed claims are reviewed by experts who apply coding taxonomy and then we can aggregate that data and look for causal factors that we can address with our doctors and dentists and ambulatory surgery centers.
Prakash Chandran: Okay, understood. And what made you specifically choose to work for an MPL carrier?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: When I first started, I'm a nurse by background. Of course, I worked in a hospital and I enjoyed it and I moved into risk management and quality. And then eventually up into hospital leadership. And as I was working, I started thinking there's got to be something that's a little bit less intense. I was looking for Monday through Friday, and I really wanted to work with providers who really need help. Hospitals are complex systems, and there are a lot of support staff of all different varieties available.
During my time in the hospital, I always worked at facilities that had physician practices and I really enjoyed working with the doctors and staff and the practices. So when I started looking for other opportunities, I found medical professional liability. And now, I work directly with physicians and dental providers and their practice managers and it's really much closer to patient safety and it's easier to make an impact in a setting like that than it was for me at the hospital system level.
Prakash Chandran: Yeah, that sounds amazing. I guess another question is are these physicians or dentists approaching you as good regulatory hygiene on a proactive basis or are they engaging with you when there is a concern that they need addressed or audited?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: That is a really great question. And so the business model of the company I work for is that there's general levels of service that all providers have available to them and one of those is telephone consultation, which I'll get back to. And then the larger the practice, the more services they can have. So we may do onsite risk assessments. We may provide them education. We may do record reviews, that sort of thing. And for the really large practices, we'll develop a service plan together that we work on for the year.
The phone call part is how I know what's going on with the members. And it really gives us a bird's eye view of what's going on in physician practices -- I work for a national company -- across the United States. So when I was talking about claims data being retrospective, it takes three to five years for a claim to wind its way through the process. Those calls are real-time data. So we can tell by looking at the number of calls we're receiving, what kind of provider they're from and what the topic is, what is really going on, what are the pain points for the doctors and dentists in the United States and the states that I'm assigned to at any point. Very interesting.
Prakash Chandran: Yeah, absolutely. So, you know, you talked about the telephone consultation and claims data. It just seems like a lot of data to parse through. So how do you actually go about doing it and how do you figure out what to look for and essentially put together the pieces of the story?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: It's such a great idea. Well, of course, we have an analytics department and we have a wonderful IT department. So we have all sorts of tools to assist with data management. I personally liked the Excel pivot sheet. So I will tell our analytics department exactly what I want in terms of phone calls in claims and they will pull that into a spreadsheet that I can play with to my heart's content.
From a claims perspective, we look particularly for causal factors, contributing factors to the claim. So if that claim was not there, the error would not have reached the patient. And when we figure out what those are and we can do it based on whatever the provider specialty is and whatever the main categories are. So I know what the common communication contributing factors are. I know documentation, I know decision-making, clinical decision-making, which really gets at diagnostic error. And then we can personalize our education and discussion based on our data and what the practice's needs are.
And physicians are data-driven. You know, they don't want us to come in and say, "This is what you need to do." They want to see, "This is the data. This is your data. This is what the literature says, and this is how we think we can help you address the problem." So it's very interactive and collaborative, and I really enjoy that approach.
Prakash Chandran: Yeah, absolutely. And, you know, you touched on this earlier, but I'd love for you to maybe talk a little bit more about what's unique about your specific role.
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: So as a nurse, when I started, I was taking care of patients and what I found was as I moved up the ladder in leadership that I really liked taking care of providers the best. If the providers have the tools and resources that they need, and when I say provider, I mean, doctors, dentists, advanced practice professionals, direct, you know, medical caregivers. If they have the tools that they need, their job is more interesting. It's more satisfying for them. They feel more confident. And of course, the secondary gain of that is patient satisfaction and patient safety. And that's kind of what risk managers want to do. We want to identify the risks. We want to address the risks so that everything goes more smoothly. And I just enjoy doing that directly with physicians and dentists in their practices. They don't have their own risk managers. Many of them don't have quality improvement programs other than what's required for payment. So they need us and I really enjoy that.
Prakash Chandran: Yeah. And just to expand on that, I was going to ask what your favorite part of the job is. And is it being that resource for them or is there something else that you'd like to share?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: I do enjoy being a resource for the providers. My absolute favorite part of the job is the phone. You just never know what's going to come in. And of course, there are a lot of questions that are routine that I receive all the time. But then there will be that one question, and when you use, you know, behavioral interviewing techniques and our critical thinking skills to draw out what the problem really is, you know, we're helping them improve patient care in real time and I absolutely love that. And you never know where a call is going to come from. It could come from Florida, California, Colorado. So, it's interesting for me as a risk manager, because not only do I need to help them address their issue, but there will be state and local regulations and contributing factors. So, there's never a dull moment.
Prakash Chandran: Yeah, it definitely sounds like it. So Sue, just before we start to close here, is there anything else that you wanted to share with our audience here today?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: I think that everybody is going to find their place in risk management. And the great part about being a risk manager is no matter what you like, if you like the hospital, if you want fast action, trauma, that sort of thing, there's a place for you. If you are looking for more personal approach that's very data-driven with a broad bunch of peers to work with, medical professional liability is it is a great choice. You just sort of have to find your way, but there's plenty of opportunity for risk management in healthcare.
Prakash Chandran: Well, Sue, thank you so much for that. And I think that's the perfect place to end. Thanks for your time.
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: Thank you.
Prakash Chandran: That was Sue Boivert, Patient Safety Risk Manager for The Doctors Company. This podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org/membership to learn more and to become an ASHRM member. I'm Prakash Chandran. Thanks so much for listening.
Prakash Chandran: Welcome to the ASHRM Podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org, that is ashrm.org/membership to learn more and to become an ASHRM member. I am Prakash Chandran.
Healthcare providers want what's best for their patients, but sometimes there are factors human or otherwise that pose a risk for malpractice. Through analyzing these risks, it's possible to enhance the success of care. Here to dig into the data with us is Susan Boisvert, patient safety risk manager for The Doctors Company.
Sue, thank you so much for joining us today. I really appreciate it. I was hoping that you could get started by briefly describing medical professional liability or MPL and what goes into analyzing liability risks.
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: Thank you for that question. Medical professional liability is basically malpractice insurance. And the company that I work for insures doctors, dentists, ambulatory surgery centers and some hospitals. One really good source of data on patient safety, it's retrospective, is claims data. Closed claims are reviewed by experts who apply coding taxonomy and then we can aggregate that data and look for causal factors that we can address with our doctors and dentists and ambulatory surgery centers.
Prakash Chandran: Okay, understood. And what made you specifically choose to work for an MPL carrier?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: When I first started, I'm a nurse by background. Of course, I worked in a hospital and I enjoyed it and I moved into risk management and quality. And then eventually up into hospital leadership. And as I was working, I started thinking there's got to be something that's a little bit less intense. I was looking for Monday through Friday, and I really wanted to work with providers who really need help. Hospitals are complex systems, and there are a lot of support staff of all different varieties available.
During my time in the hospital, I always worked at facilities that had physician practices and I really enjoyed working with the doctors and staff and the practices. So when I started looking for other opportunities, I found medical professional liability. And now, I work directly with physicians and dental providers and their practice managers and it's really much closer to patient safety and it's easier to make an impact in a setting like that than it was for me at the hospital system level.
Prakash Chandran: Yeah, that sounds amazing. I guess another question is are these physicians or dentists approaching you as good regulatory hygiene on a proactive basis or are they engaging with you when there is a concern that they need addressed or audited?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: That is a really great question. And so the business model of the company I work for is that there's general levels of service that all providers have available to them and one of those is telephone consultation, which I'll get back to. And then the larger the practice, the more services they can have. So we may do onsite risk assessments. We may provide them education. We may do record reviews, that sort of thing. And for the really large practices, we'll develop a service plan together that we work on for the year.
The phone call part is how I know what's going on with the members. And it really gives us a bird's eye view of what's going on in physician practices -- I work for a national company -- across the United States. So when I was talking about claims data being retrospective, it takes three to five years for a claim to wind its way through the process. Those calls are real-time data. So we can tell by looking at the number of calls we're receiving, what kind of provider they're from and what the topic is, what is really going on, what are the pain points for the doctors and dentists in the United States and the states that I'm assigned to at any point. Very interesting.
Prakash Chandran: Yeah, absolutely. So, you know, you talked about the telephone consultation and claims data. It just seems like a lot of data to parse through. So how do you actually go about doing it and how do you figure out what to look for and essentially put together the pieces of the story?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: It's such a great idea. Well, of course, we have an analytics department and we have a wonderful IT department. So we have all sorts of tools to assist with data management. I personally liked the Excel pivot sheet. So I will tell our analytics department exactly what I want in terms of phone calls in claims and they will pull that into a spreadsheet that I can play with to my heart's content.
From a claims perspective, we look particularly for causal factors, contributing factors to the claim. So if that claim was not there, the error would not have reached the patient. And when we figure out what those are and we can do it based on whatever the provider specialty is and whatever the main categories are. So I know what the common communication contributing factors are. I know documentation, I know decision-making, clinical decision-making, which really gets at diagnostic error. And then we can personalize our education and discussion based on our data and what the practice's needs are.
And physicians are data-driven. You know, they don't want us to come in and say, "This is what you need to do." They want to see, "This is the data. This is your data. This is what the literature says, and this is how we think we can help you address the problem." So it's very interactive and collaborative, and I really enjoy that approach.
Prakash Chandran: Yeah, absolutely. And, you know, you touched on this earlier, but I'd love for you to maybe talk a little bit more about what's unique about your specific role.
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: So as a nurse, when I started, I was taking care of patients and what I found was as I moved up the ladder in leadership that I really liked taking care of providers the best. If the providers have the tools and resources that they need, and when I say provider, I mean, doctors, dentists, advanced practice professionals, direct, you know, medical caregivers. If they have the tools that they need, their job is more interesting. It's more satisfying for them. They feel more confident. And of course, the secondary gain of that is patient satisfaction and patient safety. And that's kind of what risk managers want to do. We want to identify the risks. We want to address the risks so that everything goes more smoothly. And I just enjoy doing that directly with physicians and dentists in their practices. They don't have their own risk managers. Many of them don't have quality improvement programs other than what's required for payment. So they need us and I really enjoy that.
Prakash Chandran: Yeah. And just to expand on that, I was going to ask what your favorite part of the job is. And is it being that resource for them or is there something else that you'd like to share?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: I do enjoy being a resource for the providers. My absolute favorite part of the job is the phone. You just never know what's going to come in. And of course, there are a lot of questions that are routine that I receive all the time. But then there will be that one question, and when you use, you know, behavioral interviewing techniques and our critical thinking skills to draw out what the problem really is, you know, we're helping them improve patient care in real time and I absolutely love that. And you never know where a call is going to come from. It could come from Florida, California, Colorado. So, it's interesting for me as a risk manager, because not only do I need to help them address their issue, but there will be state and local regulations and contributing factors. So, there's never a dull moment.
Prakash Chandran: Yeah, it definitely sounds like it. So Sue, just before we start to close here, is there anything else that you wanted to share with our audience here today?
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: I think that everybody is going to find their place in risk management. And the great part about being a risk manager is no matter what you like, if you like the hospital, if you want fast action, trauma, that sort of thing, there's a place for you. If you are looking for more personal approach that's very data-driven with a broad bunch of peers to work with, medical professional liability is it is a great choice. You just sort of have to find your way, but there's plenty of opportunity for risk management in healthcare.
Prakash Chandran: Well, Sue, thank you so much for that. And I think that's the perfect place to end. Thanks for your time.
Susan Boisvert, BSN, MHSA, CPPS, CPHRM, DFASHRM: Thank you.
Prakash Chandran: That was Sue Boivert, Patient Safety Risk Manager for The Doctors Company. This podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashrm.org/membership to learn more and to become an ASHRM member. I'm Prakash Chandran. Thanks so much for listening.