Rates and Characteristics of Medical Malpractice Claims Against Hospitalists

Abstract

BACKGROUND: Hospitalists practice in high-stakes and litigious settings. However, little data exist about the malpractice claims risk faced by hospitalists. OBJECTIVE: To characterize the rates and characteristics of malpractice claims against hospitalists. DESIGN, SETTING, AND PARTICIPANTS: An analysis was performed of malpractice claims against hospitalists, as well as against select other specialties, using data from a malpractice claims database that includes approximately 31% of US malpractice claims. MAIN OUTCOMES AND MEASURES: For malpractice claims against hospitalists (n = 1,216) and comparator specialties (n = 18,644): claims rates (using a data subset), percentage of claims paid, median indemnity payment amounts, allegation types, and injury severity. RESULTS: Hospitalists had an annual malpractice claims rate of 1.95 claims per 100 physician-years, similar to that of nonhospitalist general internal medicine physicians (1.92 claims per 100 physician-years), and significantly greater than that of internal medicine subspecialists (1.30 claims per 100 physician-years) (P < .001). Claims rates for hospitalists nonsignificantly increased during the study period (2009-2018), whereas claims rates for four of the five other specialties examined significantly decreased over this period. The median indemnity payment for hospitalist claims was $231,454 (interquartile range, $100,000-$503,015), significantly higher than the amounts for all the other specialties except neurosurgery. The greatest predictor of a hospitalist case closing with payment (compared with no payment) was an error in clinical judgment as a contributing factor, with an adjusted odds ratio of 5.01 (95% CI, 3.37-7.45). CONCLUSION: During the study period, hospitalist claims rates did not drop, whereas they fell for other specialties. Hospitalists’ claims had relatively high injury severity and median indemnity payment amounts. The malpractice environment for hospitalists is becoming less favorable.

Methodologic Progress Note: A Clinician's Guide to Logistic Regression

“…Often, the outcome in a study is not a continuous variable but a simple success/failure variable (ie, dichotomous variable that can be one of two possible values). Schaffer et al 4 examined the binary outcome of whether a malpractice claim case would end in an indemnity payment or no payment. Linear regression models are not equipped to handle dichotomous outcomes.…”

“…Another common approach is to look at the data and identify the variables that vary significantly between the two outcome groups. Schaffer et al 4 used an a priori approach to define variables in their multivariable model (ie, "variables for inclusion into the multivariable model were determined a priori").…”

“…In logistic regression for categorical independent variables, all categories are compared with a reference group within that variable, with the reference group serving as the denominator of the OR. The authors 4 did not incorporate continuous independent variables in their multivariable logistic regression model. However, if the authors examined length of hospitalization as a contributing factor in indemnity payments, for example, the OR would represent a 1-unit increase in this variable (eg, 1-day increase in length of stay).…”

“…In the article "Rates and Characteristics of Medical Malpractice Claims Against Hospitalists" published in the July 2021 issue of the Journal of Hospital Medicine, Schaffer et al 4 used the Comparative Benchmarking System database, which is maintained by a malpractice insurer, to characterize malpractice claims against hospitalists. The authors used multiple logistic regression models to understand the relationship among clinical factors and indemnity payments.…”

The Medical Liability Environment: Is It Really Any Worse for Hospitalists?

“…The researchers examine the liability risk of hospitalists compared to that of other specialties by utilizing a large database of malpractice claims compiled from multiple insurers across a decade. 3 In a field of research plagued by inadequate data, the Comparative Benchmarking System (CBS) built by CRICO/RMF is a treasure. Unlike the primary national database of malpractice claims, the NPDB, the CBS contains information on claims that did not result in a payment, as well as physicians' specialty and detailed information on the allegations, injuries, and their causes.…”