High deductible insurance plans require patients to take on
more of the financial risk in exchange for lower monthly premiums. Patients are increasingly choosing plans
where they cover their own eligible expenses until costs reach a deductible
that can be well into the thousands of dollars.
These high deductible insurance plans can pose a malpractice risk to
doctors.
The number of patients with health insurance has increased
due to the Affordable Care Act, however, most of these patients choose high
deductible health plans. The number of
patients with these types of plans has increase to 17.4 million in January of
2014, up more than 12 percent from the previous year, according to Healthcare
Finance.
The issue that physicians are seeing with these high
deductible plans is that patients are making medical appointments less often
for chronic care, and are also skipping medication refills or declining to pay
their out-of-pocket costs for medical tests.
Patient choices to forgo aspects of their health care can
have disconcerting implications for physicians.
A case reported in Massachusetts Medical Law Report demonstrates these
potential consequences. A physician was sued
for malpractice by the family of a patient who died after a late stage cancer
diagnosis. The patient, a 65-year-old
man was a patient of the physician for four years; however the physician never
performed a complete physical exam during that time, including colon rectal
cancer screening.
The cancer was not diagnosed until the patient went to the
hospital with abdominal pain for several hours and no bowel movement for
several days. He underwent exploratory
surgery where stage IIIB colon cancer was discovered. The physician said he did not offer the
patient cancer screening because he was only seeing him for blood pressure
checks, not for full primary care. The private-pay
patient declined any further medical care beyond those blood pressure
checks. The case ultimately settled for
$1.5 million.
The risk stems from the fact that physicians could be held
responsible for patients who decline care and this risk is likely to increase
as patients put off or skip screenings that are not covered by insurance.
To protect themselves, physicians must explain the risks of
skipping tests and then follow through on whether they have been performed or
not. Physicians must also document
everything – the patient chart should reflect whether a patient declined
appropriate screening tests, as well as whether the patient understands the
possible consequences of that decision.
To learn more about the potential implications of
high-deductible insurance on medical malpractice, contact us today.
