Mello, Boothman, McDonald et al’s report in the January 2014 issue of Health Affairs (http://content.healthaffairs.org/content/) on “Communication-And-Resolution (CRP) Programs: The Challenges and Lessons Learned from Six Early Adopters.” (www.nlbi.nlm.nih.gov/pubmed; PMID # 243959310) reviews two models of such programs as well as the lessons learned after 6 years of operation. The first, an early settlement model utilized by self-insured hospital programs, investigates unanticipated outcomes that may merit damages, provides an apology and requires the patient to sign a release from making further claims if compensation is accepted. The second, a limited-reimbursement model that is utilized by non-captive medical malpractice insurers, offers patients with less severe injuries, and who have not sued, modest payments for out-of-pocket and other loss expenses to a limit of $30,000. Patients who accept payments are not required to forgo litigation. The theory is that if doctors and health care institutions admit to errors and apologize, patients are more likely to accept a reasonable payment which, in turn, would forestall litigation.
The authors describe factors within both models that contribute to success, especially the degree of physician participation, and to each model’s ongoing challenges. The cooperation of physicians was most evident in CRP programs where the physicians were both employed and insured by the self-insured entity. The authors note that: 1) the implementation of CRP’s signals a “transformative culture change” within medicine; 2)“program leaders had little evidence they could use to assure clinicians that the fear of liability exposure was unfounded” despite presence of the program, and 3) the effect of CRP programs on claims and indemnity costs may not be evident for some years.