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Insurer focuses on OB, cuts rates for excellence
Hundreds of obstetrical nurses, midwives, residents, and doctors completing an intensive continuing education program focused on risk management are helping their hospitals lower professional liability costs through an obstetrics-intensive patient safety program. The program was launched by BETA Healthcare Group (BETA), the largest writer of hospital malpractice coverage in California.
The program has proven popular with hospitals, says Annie Herlik, RN, JD, CPHRM, vice president of risk management at BETA. With obstetrics (OB) posing some of the highest liability risks for hospitals, risk managers are eager for more training in best practices, she says.
BETA, on the other hand, is happy to provide the additional training and reduce the potential costs from malpractice cases, Herlik says. "BETA understands that patient safety drives sound risk management, which in turn leads to reduced claims frequency and severity," she says. "The program is a win-win for our member hospitals, physicians, and medical teams and, most of all, for their patients."
BETA covers about 50,000 births per year at 35 facilities, says BETA CEO Tom Wander. There has been a significant increase in recent years in the cost to settle OB claims, he says. A birth-injury baby claim commonly cost the insurer about $2 million to $3 million five years ago, but now that same claim will result in a payout of closer to $10 million, he says. "We'd rather spend that money on care and training rather than giving it to plaintiffs," he says. "When we look at the proximate cause of those claims, there tends to be a small number of problems that continue to occur, many of which are preventable with good operating practice by the nursing staff and the [obstetricians]."
Wander notes that, while risk managers and nurses have embraced the program, obstetricians are not as enthusiastic. The reason? They are not covered by BETA and therefore not motivated by the premium credit, and also they can be resistant to thinking they have anything to learn, Wander says. BETA is making headway with obstetricians by encouraging them to see the program as a way to improve teamwork, he says.
Insurer subsidizes training
To assist hospitals in delivering the training to its OB teams through a program called "Quest for Zero: Excellence in OB."
BETA covers 50% of the costs of a perinatal safety training system, which includes up to 24 hours of eLearning and training focused on electronic fetal monitoring and analysis, team communications strategies, and emergency management in labor and delivery. The benefits of improved risk management, better patient care, and clearer, more consistent communications among staff emerge as OB nurses and doctors progress through the program and continue to grow as teams work together, Herlik says.
BETA's OB risk assessment and training program is available to all of its member hospitals, which includes over 10,000 licensed beds in more than 100 city, county, district and nonprofit hospitals and health care facilities in California. (Much of the training material, including the OB best practices of six hospitals, is available to non-members at http://www.betahg.com/services/rm_ob_initiative.asp. Members also can participate in free online webinars at the same site.)
The BETA program requires all members of the participating hospital's perinatal team to meet specific quality-of-care criteria, including proof of competency in reading and interpreting a fetal heart monitor, a common language in all communication, and multidisciplinary fetal monitor strip reviews. These reviews include OB physicians, labor and delivery unit nurses, residents, and midwives jointly reading and interpreting the monitor strip, which is a safety training measure that helps build teamwork and stimulates rich discussion while reinforcing a common language for describing fetal heart tracings. When a survey by BETA representatives shows that the hospital is 100% compliance with all elements of the program, a 5% rate credit is provided by BETA to reduce the hospital's health care professional liability coverage costs, Herlik says.
"That premium credit is the carrot, but this isn't just about the money either for BETA or for the clinicians involved. We're creating a strong focus on patient safety because this is an area in which quality can matter the most," Herlik says. "Our CEO is tremendously invested in never seeing another birth-injured baby at BETA. We have great support from him to make the system safer so that nobody has to go home with a birth-injured baby. That's our goal."
The effects on claims is not evident yet, mostly because there can be a delay in the filing of birth injury cases and the program has been in place only three years, Wander says.
"We are taking a little leap of faith that this is good not only for the clinicians but also for the moms and babies and that the end result will be lower claim costs," he says. "But we know that improving care and addressing these specific areas of improvement shown in our claims can only yield positive results in the end."
Annie Herlik, RN, JD, CPHRM, Vice President, Risk Management, BETA Healthcare Group, San Diego, CA. Telephone: (858) 521-3690. E-mail: firstname.lastname@example.org.
Tom Wander, Chief Executive Officer, BETA Healthcare Group, Alamo, CA. Telephone: (925) 838-6070. E-mail: email@example.com.