METHOD AND SYSTEM FOR REDUCING THE INCIDENCE OF DEFENSIVE MEDICINE

Abstract

Methods and systems are described that implement evidence-based schemata in a health care system that embody practice guidelines and/or a standard of care. Physicians in the health care system agree to adhere to the practice guidelines. An insured patient assigns/subrogates the right to sue a physician malpractice to the health insurance carrier and receives medical care in compliance with the practice guidelines. The insured patient may be subject to incentives and disincentives to encourage compliance with the assignment/subrogation agreement. Shielding the physician from lawsuits will give the physician an incentive to abandon the practice of “defensive medicine.” This will significantly reduce the number of diagnostic tests and procedures and associated risks and expenses. Such a system can promote cost-efficiency, increase safety and provide fair remedies to patients who are injured, regardless of the cause.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other objects and advantages of the invention will be apparent from the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout and in which:

FIG. 1 is a schematic diagram showing a closed health care system according to an embodiment of the invention;

FIG. 2 is a flow diagram of a method according to an embodiment of the invention;

FIG. 3 is a graphical representation of benefits derived when medical tests are administered according to accepted practice guidelines;

FIG. 4 is a schematic diagram of an “open” health care system in accordance with another embodiment of the invention; and

FIG. 5 is a schematic view of a preferred embodiment of a hardware system for implementing the present invention.

Claims

1. A method for deterring practice of defensive medicine by health care providers, said method comprising: a health insurance carrier defining and disseminating practice guidelines for rendering medical care;said health insurance carrier issuing to a patient a plan of health insurance, including securing from said patient subrogation/assignment to said health care insurance carrier of any professional liability claim that arises against any health care provider; andsaid health insurance carrier refraining from asserting any professional liability claim against any health care provider that adheres to said practice guidelines.

2. The method of claim 1 wherein said subrogation/assignment prevents the patient from suing the physician directly.

3. The method of claim 1 wherein the subrogation/assignment allows the health insurance carrier to sue the health care provider in the event of negligence on the part of the health care provider.

4. The method of claim 3 wherein the health insurance carrier recovers from the health care provider at least a defined limit of damages suffered by a patient and sustained due to negligence by the health care provider.

5. The method of claim 3 wherein the health insurance carrier is allowed to recover damages from the health care provider only if a predetermined threshold level of negligence has occurred.

6. The method of claim 3 wherein at least a portion of damages recovered by said health insurance carrier is transferred to one of (a) said patient, (b) said patient's family, and (c) said patient's designee.

7. The method of claim 6 wherein said portion of damages is inversely proportional to incentives received by said patient for said subrogation/assignment.

8. The method of claim 5 wherein said threshold level of negligence is ordinary negligence.

9. The method of claim 5 wherein said threshold level of negligence is gross negligence.

10. The method of claim 1 wherein said health care provider receives from said health care insurance carrier an incentive to adhere to said practice guidelines.

11. The method of claim 10 wherein said incentive is selected from the group consisting of bonuses, additional compensation, and combinations thereof.

12. The method of claim 10 wherein said adherence is determined based on audit.

13. The method of claim 1 wherein said patient receives from said health care insurance carrier an incentive in exchange for said subrogation/assignment.

14. The method of claim 13, wherein said incentive includes a reduced health insurance premium.

15. The method of claim 13 wherein said incentive includes at least one of (a) a disability insurance policy, (b) a life insurance policy, and (c) a long-term care insurance policy.

16. The method of claim 13 wherein said incentive includes a subsidy for premium for one of (a) a disability insurance policy, (b) a life insurance policy, and (c) a long-term care insurance policy.

17. The method of claim 13 wherein said incentive comprises paid up health insurance premium for a predefined period of time when said patient suffers a covered injury by a health care provider.

18. The method of claim 13 wherein said incentive comprises paid up medical care for a predefined period of time when said patient suffers a covered injury by a health care provider.

19. The method of claim 13 wherein said incentive comprises a level of health insurance premium commensurate with said one of said defined levels.

20. The method of claim 1 wherein said patient is subject to a disincentive if said patient ignores terms of said subrogation/assignment.

21. The method of claim 20 wherein said disincentive is selected from the group consisting of liquidated damages, attorneys fees, denial of continued medical insurance coverage, and combinations thereof.

22. The method of claim 1 wherein said practice guidelines specify tests, therapies and recommendations for referrals established to maintain a standard of care to maintain at least one of a defined goal of patient safety, a defined level of diagnostic sensitivity, and a therapeutic goal for a specific medical condition.

23. The method of claim 22 wherein there is a gradation of defined levels of said practice guidelines.

24. The method of claim 23 further comprising offering to an insured an incentive for choosing one of said defined levels of said practice guidelines.

25. The method of claim 24 wherein said incentive comprises a level of health insurance premium commensurate with said one of said defined levels.

26. The method of claim 24 wherein said incentive comprises a level of subsidy, commensurate with said one of said defined levels, for a premium for one of (a) life insurance, (b) disability insurance, and (c) long-term care insurance.

27. The method of claim 24 wherein said incentive comprises paid up health insurance premium for a predefined period of time whose length is commensurate with said one of said defined levels.

28. The method of claim 24 wherein said incentive comprises paid up medical care for a predefined period of time whose length is commensurate with said one of said defined levels.

29. The method of claim 24 wherein said incentive comprises a guarantee of implementation of patient safety systems.

30. The method of claim 1 further comprising said health care provider agreeing to adhere to said practice guidelines.

31. Apparatus for deterring practice of defensive medicine by health care providers, said apparatus comprising: a practice guideline unit for defining and disseminating practice guidelines for rendering medical care;an issuing unit adapted to issue to a patient a plan of health insurance, including securing from said patient subrogation/assignment to said health care insurance carrier of any professional liability claim that arises against any health care provider;a claims unit adapted to accept a report, from a covered patient, of a claim of injury resulting from alleged violation of said practice guidelines by a health care provider;a claims review unit comprising an output and an input device, wherein:for each report received of a professional liability claim from a covered patient:said output device flags said report for review for making a determination of whether said health care provider adhered by said practice guidelines, andon completion of said review, said determination is entered into said input device, said claims review unit further comprising:a lawsuit authorization unit adapted to authorize a lawsuit against said health care provider when review of said claim results in a conclusion that said health care provider failed to adhere to said practice guidelines.

32. The apparatus of claim 31 wherein said issuing unit requires said health care professional to agree to adhere to said practice guidelines.

33. The apparatus of claim 31 further comprising a printer adapted to print a certificate evidencing coverage for each patient accepted for coverage under said plan of insurance.

34. The apparatus of claim 31 further comprising a disbursement unit adapted to disburse funds to said patient on the occasion of an award or settlement in said lawsuit.

35. The apparatus of claim 34 wherein said disbursement unit disburses funds a portion of said award or settlement according to a level of coverage purchased by said patient.