Tag: medical malpractice

AI As Malpractice Safety Net

Posted on by Brian Casey

One of the emerging use cases for AI in radiology is as a safety net that could help hospitals avoid malpractice cases by catching errors made by radiologists before they can cause patient harm. The topic was reviewed in a Sunday presentation at RSNA 2024. 

Clinical AI adoption has been held back by economic factors such as limited reimbursement and the lack of strong return on investment. 

  • Healthcare providers want to know that their AI investments will pay off, either through direct reimbursement from payors or improved operational efficiency.

At the same time, providers face rising malpractice risk, with a number of recent high-profile legal cases.

  • For example, a New York hospital was hit with a $120M verdict after a resident physician working the night shift missed a pulmonary embolism. 

Could AI limit risk by acting as a backstop to radiologists? 

  • At RSNA 2024, Benjamin Strong, MD, chief medical officer at vRad, described how they have deployed AI as a QA safety net. 

vRad mostly develops its own AI algorithms, with the first algorithm deployed in 2015. 

  • vRad is running AI algorithms as a backstop for 13 critical pathologies, from aortic dissection to superior mesenteric artery occlusion.

vRad’s QA workflow begins after the radiologist issues a final report (without using AI), and an algorithm then reviews the report automatically. 

  • If discrepancies are found the report is sent to a second radiologist, who can kick the study back to the original radiologist if they believe an error has occurred. The entire process takes 20 minutes. 

In a review of the program over one year, vRad found …

  • Corrections were made for about 1.5k diagnoses out of 6.7M exams.
  • The top five AI models accounted for over $8M in medical malpractice savings. 
  • Three pathologies – spinal epidural abscess, aortic dissection, and ischemic bowel due to SMA occlusion – would have amounted to $18M in payouts over four years.
  • Adding intracranial hemorrhage and pulmonary embolism creates what Strong called the “Big Five” of pathologies that are either the most frequently missed or the most expensive when missed.

The Takeaway

The findings offer an intriguing new use case for AI adoption. Avoiding just one malpractice verdict or settlement would more than pay for the cost of AI installation, in most cases many times over. How’s that for return on investment?

Did Malpractice Risk Kill V/Q Exams?

Posted on by Brian Casey

CT perfusion angiography exams have largely replaced nuclear medicine-based ventilation/perfusion (V/Q) studies for detecting pulmonary embolism. But a new article in Academic Radiology suggests that CT’s rise wasn’t entirely based on clinical efficacy – fears of malpractice risk may have played a role. 

V/Q studies can help diagnose PE by enabling clinicians to visualize lung perfusion, showing defects such as blockages in pulmonary vessels. The scans are typically performed in three phases … 

  1. An albumin injection to show pulmonary vasculature.
  2. A radiopharmaceutical that’s inhaled and imaged with a gamma camera.
  3. A chest radiograph to correlate findings. 

The scans dominated PE imaging in the 1980s, but the rise of CT saw radiology facilities begin to shift.

  • CTPA was seen as having higher spatial resolution and was easier to perform than nuclear medicine exams. 

But the new article suggests that there were other forces at work as well – in particular, fear of malpractice risk from PEs that weren’t adequately followed after inconclusive V/Q exams.

  • The problem originated with clinical guidelines for V/Q reporting that classified some 20% of V/Q studies as “low probability” for PE when they probably would have better been classified as “inconclusive” or “non-diagnostic.”

As a result, a number of “low probability” patients weren’t followed up adequately, with tragic results that later figured into medical malpractice cases …

  • A patient who was diagnosed with pneumonia after an inconclusive V/Q exam, sent home, and died one day later of a “massive” PE.
  • A patient with leg and chest pain who was given heparin after a negative V/Q scan and later suffered internal hemorrhage; fortunately she survived.
  • A patient with “vague symptoms” who had an inconclusive V/Q scan and later died of an undiagnosed PE that some claimed would have been detected on CTPA.

Indeed, the theme of PE malpractice cases began to shift over time, from failure to diagnose V/Q scans to failure to order CTPA exams – which were soon seen as the clinical gold standard.

The Takeaway

Given the fast pace of development in radiology, it’s inevitable that some technologies that were once clinical staples fall by the wayside. But the new article offers a fascinating look at how clinical language can lead to medico-legal concerns that influence physician behavior – often in ways that are impossible to detect as they happen.

Teleradiology Malpractice Risk

Posted on by Brian Casey

A new study in Radiology comes to an explosive conclusion: medical malpractice cases involving teleradiology interpretation of medical images more frequently involved patient death and had higher payment amounts. 

Perhaps no technology has wrought greater changes on the field of medical imaging than teleradiology. 

  • By leveraging radiology’s conversion to digital imaging and the rapid expansion of Internet bandwidth, teleradiology makes it possible for medical images to be interpreted independent of the radiologist’s location, with studies sometimes literally sent around the world. 

But teleradiology has had its share of unintended consequences, such as the emergence of nighthawk and specialty teleradiology firms that have seized hospital contracts from traditional radiology groups. 

But this week’s study in Radiology adds a new wrinkle, suggesting that teleradiology could actually have an additional malpractice risk. Researchers analyzed 3,609 malpractice claims, of which 135 involved teleradiology, finding that teleradiology cases…

  • Saw patient death occur more often (36% vs. 20%)
  • More frequently saw communication problems among providers (26% vs. 13%)
  • More often closed with indemnity payments (59% vs. 41%)
  • Had higher median indemnity payments ($339k vs. $214k) 

Why might problems be more frequent in teleradiology? The authors offered several reasons, including …

  • Teleradiologists may not have access to EMR and other patient data
  • Teleradiology interpretations are often provided at night and on weekends/holidays
  • Claims involving neurology and the emergency setting were more common, illustrating the challenges in these areas

Potential solutions could involve making sure that teleradiologists have access to EMR data, and by performing overreads of interpretations delivered on nights and weekends. 

The Takeaway
The findings have disturbing implications, not only for dedicated teleradiology providers but also for traditional radiology practices that use teleradiology as part of their service offerings. And as noted in an accompanying editorial, they could provide ammunition to teleradiology’s opponents, who continue to rail against the technology that has done so much to change radiology. 

Medical Malpractice Crisis

Posted on by Brian Casey

Is a new crisis looming in medical malpractice insurance? An AMA analysis finds that medical liability premiums are skyrocketing again – and radiologists may be among the physicians most affected due to their higher exposure to malpractice suits.

The proportion of medical liability premiums that increased year-to-year for OB/GYN, general surgery, and internal medicine doctors (radiologists weren’t surveyed) doubled from 2018 to 2019 (13.7% to 26.5%), and went up 30% year-to-year from 2020 to 2022. The last time rates rose this fast was during the medical liability crisis of the early 2000s, according to the AMA paper.

Insurers are raising premiums due to deteriorating underwriting results, lower loss reserve margins, and lower returns on investment, per the report. These trends are echoed in a new analysis of the medical malpractice segment by credit agency AM Best, which describes a “difficult environment” for medical liability insurers. The medical professional liability segment has seen eight straight years of underwriting losses.

Why should radiologists care? Well, radiologists are more likely to have experienced medical liability claims during their career than most other physicians. Another AMA survey of over 6k doctors found: 

  • Radiologists were more likely to say they had been sued in their career than all physician types (40.2% vs. 32.1%)
  • More radiologists have experienced a lawsuit in the past year than all physicians (4.2% vs. 2.0%)
  • The only other medical specialists more likely to be sued than radiologists were surgeons (48.9%) and emergency medicine physicians (46.8%) 

The first AMA report closes by saying that a medical liability insurance “hard” market – a market characterized by rapid price increases – already exists in a number of states, and is “slowly spreading” across the rest of the US. 

Further, there is “striking” geographic variation in premiums. OB/GYNs in Los Angeles County, California see average manual premiums of $49,804 a year, while those in Miami-Dade County, Florida are staring at a $226,224 liability insurance bill.

The Takeaway 

The AMA said the growing medical malpractice crisis could have multiple ramifications. Physicians in states with difficult liability environments could relocate or even drop some clinical services that raise their risk. Will the worsening environment draw the attention of state and federal regulators? Only time will tell. 

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