Coordinating care of chronically ill patients does not increase liability

Conventional wisdom is wrong: primary care doctors who coordinate the care of their patients by specialists may actually have lower liability risk than primary care doctors who do not attempt care coordination.

That is one finding from a study by Mark Hall, J.D., of Wake Forest University Baptist Medical Center. But many doctors believe otherwise. "A representative national sample of 1,238 practicing physicians found that 49 percent listed legal liability as one of the two main barriers to care coordination," he said, writing in the March/April issue of Annals of Family Medicine.

In fact, Hall and his colleagues found that care coordination by physicians does not increase the threat of lawsuits or result in higher malpractice insurance premiums.

Care coordination involves establishing and monitoring a comprehensive treatment plan encompassing the recommendations of all specialists "and resolving conflicts among specialists regarding medication, treatment or patient behaviors," he said.

These primary care doctors review the overall management of the patient's multiple conditions, encouraging compliance with recommendations of the specialists and taking steps to prevent future problems. But many primary care doctors don't try to coordinate care beyond recommending that their patients see specialists.

"Persons with multiple chronic conditions often encounter a complex and inefficient system of care as a result of inadequate care coordination," said Hall, professor of law and public health sciences. "Care coordination currently isn't being done very well."

These patients account for more than half of all medical spending. "They endure higher rates of avoidable complications and hospitalizations," Hall said. "Improving care coordination can substantially improve health outcomes and lower costs."

Coordinating care can also reduce medial errors. "So it is important to remove any perceived barriers to better care coordination by physicians," he said.

Physicians worry about liability because "coordinating care creates a broader responsibility for patients with complex conditions who have a greater chance of poor outcomes."

"Based on the collective experience and judgment of experts in medical liability, however, there does not appear to be any basis for physicians who perform care coordination to have serious concerns about liability," Hall and his colleagues concluded. Patients with chronic illness are not more likely to sue. Also, courts will not hold primary care physicians automatically responsible for mistakes made by specialists just because the primary care physician is coordinating the patient's care.

"Courts hold doctors responsible only for what the doctor does, and not what other doctors might do wrong," Hall explained.

Instead of increasing liability, care coordination may lower liability risks. "Every medical function carries some liability risk and care coordination is no exception, but the extent of these risks appears to be broadly commensurate with other risks to primary care practice," the authors write.

Hall's coauthors were Ralph A. Peebles, J.D., professor of law, and Richard W. Lord Jr., M.D., assistant professor of family and community medicine, both at Wake Forest Baptist.