How likely are you to be sued for malpractice? According to information published in the New England Journal of Medicine. Americans file more than 17.000 medical malpractice lawsuits a year. That doesn't really seem like a big number or problem unless you are the one being sued. Regardless of the number of doctors sued, the reality is that you don't earn malpractice because every doctor is sued. You earn it in case you are sued. Why? You know the risks and the potential devastation that can occur personally and financially, even if you arc found not guilty. Medical journals run articles routinely on the devastation doctors feel after a law suit. They go to great lengths to point out simple things a provider can do to minimize the risk of a suit. Unfortunately, win or lose, malpractice cases take a toll on the doctor, the staff, and the practice. Sometimes, it changes them forever. What is more common and more traumatic than being sued for malpractice? Some would answer that question by saying audits and investigations by boards, insurance carriers, and the fed- cral government. I would say that, for the average doctor, these events outweigh the stress and trauma of a malpractice case. At least with a malpractice case, you hopefulh have malpractice coverage and a chance of being found "not guilty." Some current malpractice polices also earn a rider for "investigations or board defense." While that may provide some sense of relief, it really doesn't do much to ease the personal angst of an audit or investigation. How many doctors are being audited? The rule today is. "It's not a matter of if you will be audited, but when'' I think most of us know more than one colleague who lias undergone an audit or investigation of some type. The press makes it clear even more audits and investigations will occur in 2014. Why? It's simple. Follow the dollar. For every dollar put into healthcare fraud investigations, more than $7.90 is recovered. That's a 790% return! It's called recoupment, and it's big money for the government and insurance companies. And. by the way. that number docs not include what private insurance companies recoup. Suggestion: Now that you know the risk of being audited is higher than being sued, shouldn't you look at ways to minimize your risk of an audit or investigation? Moreover, if there were well-known reasons that trigger audits and investigations, wouldn't it be wise to look at how to reduce those specific risks? Of course you should. So what is one of the most common things that triggers investigations or audits for doctors of chiropractic? Guess what? It"s not malpractice. Follow the dollar again. It's the dollars and cents your patients want back when they file a complaint to your insurance company or states board of chiropractic examiners. Let me give you a real life example. Several months ago. I spent more than 13 hours of my "day off" observing a grueling day in the life of some of my colleagues who sit as members of our board of examiners. (God bless them.) Also in attendance was another colleague and his patient: other treating doctors, former partners, and their legal counsel: counsel for the state attorney general: legal representatives from the state medical association; and a host of other "interested parties." It was quite a gathering. (Because this was an open hearing, no protected, private, or privileged information will be shared here. The sad truth is that this type of meeting occurs in every state almost any time a board of examiners meets to address complaints.) So why were we there? Was someone killed? No. Was someone paralyzed? No. Was someone disfigured for life or rendered incapacitated as the result of some gross negligence? No. Was someone's life unalterably changed? Yes! I think so! This doctor, his patient, and others involved will probabh never feel the same toward one another, regardless of the outcome. I saw a well-educated, well-respected man insist on his right to be right. I saw what appeared to be a very nice woman. Ms patient, insist on her right to be right, as well as her right to a refund. There was no complaint of malpractice, paralysis, death, or negligence. There was a genuine disagreement on the outcome of care, his credentials, and a request for a refund. There is a lot more to this story, which relates more to the professional designations and certifications we are pennitted to use here in our state, but that issue will be decided down the road. From my perspective, at least in the short term, it came down to dollars and cents and what happens when a patient feels shortchanged, ignored, disrespected, or a combination thereof. Did that actually occur? I am not the judge of that. I don"t care to take sides, but there is a lot to learn about "risk management" from this real-life story. The bottom line is. in my opinion, that a stroke of a pen could have eliminated this tragedy. This patient was upset, and from what I recall, it had to do with money, ultimately. Was the doctor "right" to demand payment? Yes. if he performed the services. Was the patient "right" to demand a refund? Yes. in her mind. She was adamant enough that she was willing to file a formal complaint and spend a day out of her life to prove her point. The doctor also was right is his mind. He was willing to spend a day out of his life and office to incur the expense of hiring legal counsel to guide him through the process to make his case. What lesson did I learn that day? Interestingly, it was one I had heard my preacher teach some time back when talking about the relationship between a husband and wife. He said. "You can be right, or you can be happy, but you can"! always be both."" What wisdom! Who was right in this doctor's case? I don"t know that answer. However, unless I am willing to go through the trauma, expense, and cross examination by my board and the state attorney general's legal counsel, the next time I hear a patient insist upon a refund, the first question I will ask is. "And how do you spell that last name?" Then, you will hear the stroke of my pen writing a refund. Some may say. "You arc crazy." The doctor delivered the sen ices, the patient wasn't guaranteed a cure, and there are a hundred other great reasons to defend that position. And I would reply. "You are crazy." If you can make a problem go away for something as replaceable as money, don't waste your dollars—use your sense! Docs it mean they arc right and you are wrong? No. It means in most cases you arc smart and understand "risk management." You understand the nature of people who may feel wronged and who are determined to be right at any cost. Don't get me wrong. I expect my fees to be paid. I don't encourage any doctor to be railroaded by a disgruntled patient who may sec you as an easy mark. However, here's another favorite saying. "If money will fix it. it ain't a problem." From what I understand of this case, the doctor did most even thing right. He had all the right forms, agreements, and the correct intent to handle refunds when they were requested. The patient, on the other hand, thought she was entitled to a refund and reported feeling ignored and brushed off. It was undoubtedly a bad situation for all in the end. The worst part was that I saw an unnecessary tragedy that day. In retrospect, hurt people, hurt feelings, and hurt colleagues had to make tough calls. It simply didn't have to be that way. Yes, hindsight is always 20/20. It's easy to be an armchair quarterback, but I'll bet if those involved had to do it all over again, they may have chosen to spend their day a different way. I could be wrong. While there arc key issues surrounding this case that can and will affect our profession, this was not the place for this doctor to have to fight for the ability to list his hard-earned credentials. In retrospect, for me at least, the major part of this case could have been easily resolved with the stroke of a pen. My hope for you in reading this story is quite simple. Doctors, we have enough to worn about with properbilling, coding, and documentation. Don't let youroffice's financial policies put you at greater risk than a malpractice case. Make sure you avoid one of the most common problems we see in offices across the nation: faulty financial policies. These include: Avoiding dual-fee schedules. Don't charge more to insur ance than cash; it invites problems in most cases. Avoiding improper timc-of-senice discounts. Make sure any discounts you offer are "reasonable and defensible." Most experts say between 5 to 15% is reasonable, but make sure you arc not discounting deductibles or copayments because that may violate your provider agreements. Don't trigger inducement violations by failing to charge for senices that should be charged. Be careful about of fering discounts if you don't know the rules—all the rules. Far too often, we forget tliat a health care "system" regulates us, and we must comply with all layers of the system. Respect the rules and regulations from your board of examiners, provider agreements, state department of insurance, and attorney general's office, as well as CMS and the Office of Inspector General (OIG). It sounds like a daunting task, but it is possible with the proper office financial policy. More importantly, despite having the best, most legal, most enforceable financial policy known to man. always stop and ask yourself. "Do I want to be right, or do I want to be happy"? Is this fight worth a day out of your life and practice? Will it serve your best interest in the long run? If it will, fight the good fight, and much success. If it won't, choose to be happy. Learn from the experience and focus on serving the next patient you see to the best of your ability. If you would like a copy of a one-page simple financial policy that can be used to set the stage for a simple, compliant financial system in your office, send an email to Mod chirohealthusa.com and put POLICY in the subject line. Remember. "You can be right, or you can be happy, but you can"t always be both." So choose wisely! Dr. Foxworth is a certified Medical Compliance Specialist and Pivsident ofChimllealthUSA. A practicing Chiropractor, he remains "in the trenches" facing challenges with billing, coding, documentation and compliance. He has served as president of the A7/.W liiropractic Association, former Staff'Chiropractor at the < i ><nmy Montgomery IA Medical Center and is a Fellow of the International College of Chiropractic. He founded Conser-vaCarvCorp, the first chiropractic network selected by the State of Mississippi to serve over 195K covered lives in the State Health Plan. You can contact Dr. Foxworth at 1-888-719-9990, info% chimhealthusa.com or visit the ChiroHealthUSA website at www. chimhealthusa. com
