March 2016

MARCH | 2016
A Newsletter of Mutual Interests
SVMIC Issues $7 Million Dividend,
Announces No 2016 Rate Increases
SVMIC is proud to announce a $7 million dividend for policyholders, amounting to
just over 5% of annual premium. SVMIC has issued dividends in 32 of its 40 years
of insuring physicians.
The SVMIC Board of Directors has decided to keep premiums stable for 2016 in all
states. This means no rate increases for SVMIC-insured physicians this year.
Risk Pearls
by Julie Loomis, RN, JD
2016 SVMIC
Risk Education
Seminar Schedule
Maintaining privacy helps patients feel cared for
in your practice. The doctor-patient relationship
depends on a high level of trust and confidentiality
and achieving optimal care presumes a mutual
respect between the doctor and patient. Establish
an environment conducive to an open and honest
conversation about health concerns, which are
always personal and often sensitive in nature.
Protect the confidentiality of health information
to build trust in the doctor-patient relationship.
Federal HIPAA laws set a minimum standard for
protecting health information with steep fines and
even criminal charges for egregious violations.
April 5 & 6
Chattanooga, TN
April 14
Knoxville, TN
April 20
Springdale, AR
April 21
Fort Smith, AR
April 22
Morrilton, AR
May 5
Cookeville, TN
May 10
Nashville, TN
May 11
Bowling Green, KY
May 12
Paducah, KY
May 17
Decatur, AL
May 24
Memphis, TN
June 7
Florence, AL
June 23
Little Rock, AR
June 28
Chattanooga, TN
June 29
Cleveland, TN
For future dates,
please see www.svmic.com
Closed Claim Review:
Leave No Stone Unturned
by Tim Rector, JD, MBA
The
wise old saying
“leave
no stone unturned” is said to mean that one should
do everything possible to find something or to solve a problem.
see in the following claim that is very wise advice.
Well,
we will
This case involved a 45-year-old male who underwent routine treatment for a left ureteral stone. The
patient presented to the urologist on May 10 with a chief complaint of kidney stone. His past history
was noteworthy for a well-documented episode of ureterolithiasis four years prior, high blood pressure,
and asthma. In any event, the patient had an abnormal urinalysis so an Intravenous Pyelogram (IVP)
was performed. This revealed a left ureteral calculus with obstruction. The urologist planned to
perform cystoscopy with stent placement and Extracorporeal Shock Wave Lithotripsy (ESWL) on the
following day (May 11). However, the procedure was rescheduled for May 12 because the patient was
not NPO, and the plan called for use of general anesthesia. At this juncture, no antibiotics had been
prescribed.
During the evening of May 11, EMS was called because of the patient’s seizure activity, nausea,
vomiting, and left lower quadrant abdominal and back pain. The Emergency Department physician
diagnosed pyelonephritis, left ureteral calculus and hypertension. The supportive laboratory data
revealed that the urinalysis was markedly abnormal with pyuria, proteinuria, and cultured positive
for E. coli. The patient was discharged home after receiving fluid resuscitation, several injections of
Dilaudid, Zofran, and IV Levaquin.
The following morning, on May 12, the patient then presented to the Outpatient Surgery Center. Upon
arrival, his vital signs indicated a blood pressure of 118/81, pulse 95, respirations 18, temperature
97.6, and 02 sats of 96%. He was given Cipro 500 mg p.o. The anesthesiologist performed a preanesthetic evaluation, noting a normal heart and lung examination, and the patient was classified ASA
1. He then underwent cystoscopy, left ureteroscopy, dilation of the mid-urethral stricture, laser stone
ablation and extraction, and stent placement without complication. Post-operatively, the patient
began to have difficulty at 09:50. He was given Narcan repeatedly in an attempt to arouse him. Upon
2
arousal, his respiratory rate was elevated at 40 breaths per minute, and he was coughing up pink frothy
mucus. At 10:15, his oxygen saturation was low at 82, and the patient stated, “I can’t breathe. I’m
working too hard.” The anesthesiologist was paged to the Recovery Room where it was noted that the
patient’s lips were blue. Lasix 40 mg IV was administered along with Albuterol. By 11:00, the patient
stated he was breathing better. However, the 02 sats still remained low at 90% with a respiratory rate
as high as 30 for the next two hours. At 14:00, a chest x-ray showed the presence of pulmonary edema.
The urologist made the decision to transfer the patient to a higher level of care hospital at 14:10. This
was accomplished at 16:10.
Upon arrival at the hospital, the patient’s vital signs indicated blood pressure of 84/50, pulse 107,
respiratory rate 24, 02 sats 83%, WBC of 13,300, and D-dimer was elevated at greater than 5,000.
Arterial gases revealed hypoxemia and acidosis. The patient was clearly in shock.
He was admitted to the Intensive Care Unit for treatment of pulmonary edema, sepsis, and renal
failure. A CT scan revealed the ureteral stent had perforated the proximal ureter. At 18:40, the patient
coded, and he never recovered neurologic function. He expired 3 days later. An autopsy revealed no
MI, no PE, no pneumonia, left pyelonephritis, and the ureteral stent perforation of the left ureter at
the ureteropelvic junction, with abscess in the perirenal fat.
A lawsuit ensued naming the treating urologist and the anesthesiologist as defendants. The surgery
center nurses had reportedly begged for the patient to be transferred to a higher level of care as the
patient’s situation continued to decline. The chief obstacle in defending the urologist was her absence
of an abdominal examination at any time during the post-operative period. The urologist relied
entirely on the anesthesiologist to manage the patient’s obvious post-operative difficulty, and never
did she consider an operative complication. Experts criticized the urologist for her lack of insight into
this possibility. A low index of suspicion probably prevented her from obtaining a simple CBC with
differential while the patient was in the Recovery Room. Had this been done, it would have indicated
the presence of infection and sepsis. Consequently, this omission prevented the urologist from
recognizing the need to transfer the patient to
the hospital at an earlier time.
This case seems to exemplify a situation in
which continuing to seek any conceivable
explanation for the situation (or turning
over more stones) would have been wise.
Unfortunately for both the patient and the
urologist, her false assumption that the
patient’s decline had to be anesthesia-related
rather than a surgical complication resulted
in the missed opportunity to reverse the
outcome.
3
Reconsider Reappointments
by Elizabeth Woodcock, MBA, FACMPE, CPC
When searching for the reasons
that patients fail to keep their
appointments, one eye-opening
pattern will probably jump
out: appointments made a year
in advance are the ones most
likely to end up as no shows or
cancels. There are good reasons
to schedule follow-ups several
months out, but many practices
do not have a successful strategy
to make sure these long-range
appointments are kept. Most
simply hand the patient a small
card at check out that lists a date
and time to return – 365 days
later. Those little business-sized
cards don’t have magic embedded
in them. They certainly do not
guarantee that the patient will
remember the appointment, or
even keep the documentation
of the appointment. And the
common appointment-reminder
tactics, such as a call to the
patient the night before the
appointment, just don’t seem to
work either.
Scheduling visits far in advance,
which I will define it as any
time period greater than 12
weeks (though it may be longer
or shorter depending on your
patient population), is a recipe
for disaster. Not so long ago,
when physician appointments
were hand-written on home
4
calendars and served as the focal
point of the patient’s energies,
this protocol worked just fine.
But, today’s busy families have
work meetings, soccer games,
conference calls, book clubs,
science fairs, and charity events
in a typical week – and we haven’t
even made it to the weekend!
They are much more likely to lose
those little appointment cards
(or the information, regardless
of the paper you print it on).
And then there are the changes
that can occur in providers’ lives
and schedules that can make
“bumping” patients from longscheduled appointments an even
bigger nightmare than no shows.
Either way, the result is a negative
impact on your bottom line.
It’s an opportune time to
reconsider
your
practice’s
reappointment strategy. First,
decide what time frame you really
need to have on your calendar for
planning purposes; it may be 3
months out, just 30 days or some
other time period. Next, ensure
that your scheduling templates
are built out to that date. Then,
make sure that staff are trained
to use your practice management
system’s appointment recall
function. This function of your
scheduling module allows you to
retain a list of patients, organized
by date, to contact at a later
time to schedule the actual date
and time of the appointment.
(Historically, practices filed index
cards by date for this purpose.)
The next important step is to
script instructions for your staff
to use when patients check out
after their visits. For example,
“Ms. Jones, your physician has
asked that you revisit us in 12
months. We’ll be reaching out to
you next June for your annual
appointment next July. We’ll call
you at this number in early June,
so you can choose the best time
in July for your appointment.
This will allow you to know your
schedule a bit better, and ours
too.” Adjust the interval between
that future recall contact and
the approximate appointment
date so that it is not less than
your average time to next
appointment.
As for patients who have already
been scheduled for appointments
more than 12 weeks out (or
whatever time period you select),
group them into general time
slots, such as by month, and plan
to place “reminder/reschedule”
calls to them a month or two in
advance. (Alternatively, transmit
a secure electronic message or
mail the notification.) Use a
similar script to the one used at
check out to both remind them
of the appointment that was set
and also to offer the option of
making a new appointment –
odds are that they have forgotten
about the originally scheduled
appointment and have made
other plans for that date. Then,
follow your usual protocol for
placing a reminder call shortly
before the appointment.
After several months, most of
your follow-up appointments will
be shifted to the new protocol.
Keep the process manageable by
designating a member of your staff
each week to “work” the recall list.
Place the calls approximately four
to six weeks before the patient
was “scheduled” for the followup appointment. Never schedule
the appointment for the patient;
simply telling the patient the date
and time they are expected is a
profoundly non-patient-centered
behavior that, unfortunately,
continues in many practices.
Engage patients by asking them
what date and time works best for
them within the parameters of the
provider’s follow-up instructions.
Decide how many scheduling
attempts to make – consider
two phone calls, followed by a
written communication through
your patient portal (if applicable)
or by letter. Document all of
these attempts in the patient’s
record. Continue to follow the
practice’s current protocols with
appointment reminders for these
patients, too.
Assess rates for no-shows,
cancels, and provider bumps
before and after you make the
change. Chances are there will be
improved results for the practice
and its patients.
Physician Leadership Institute Held in March
SVMIC’s Physcian Leadership Institute was held at the Nashville Airport Marriott on March 4 and 5, 2016. Physicians
spent two full days discussing a wide variety of topics from practice finances to handling conflict and distruptive
behavior. Forty physician attendees representing Tennessee, Arkansas, Mississippi, and Kentucky participated,
representing a variety of medical specialties. Each doctor earned 14.5 hours of CME credit for their participation.
Faculty for the Institute consist of a variety of physician executives, attorneys, marketing professionals, and experts
from SVMIC’s Medical Practice Services department who bring a wealth of knowledge and experience in consulting
and managing medical practices.
The event is held annually in the early Spring. If you would like more information about Physician Leadership Insititute
or our Medical Practice Services, please email us at [email protected] or call 800.342.2239.
“I always find SVMIC seminars to be a
great use of my time. Thank you!”
-2016 PLI Attendee
“Outstanding faculty and presentations!
Highly recommend! Well-organized
and presented.”
-2016 PLI Attendee
5
Every Complaint is a Gift
by Elizabeth Woodcock, MBA, FACMPE, CPC
I recently contacted a medical practice
to explain my frustration about
experiencing a significant delay in
wait time. Alas, I was the victim of
the “checked-in-but-never-arrived”
syndrome, left to sit in the waiting
room unaware that my signing in
had never been transferred to the
computer. After sitting for nearly
an hour, I worked to get someone’s
attention (yes, it was one of those
closed-window practices). I finally
got the attention of a staff member
after lightly tapping on the window.
Despite being crossed off of the signin list, no one even knew I was there.
Apologies were issued, and I was told
that I could be roomed “right after the
next patient.” Already late for another
appointment — and incredibly
frustrated — I walked out.
The following day, I called to report
my complaint. I took a few deep
breaths before I picked up the
telephone. Certain that my call would
be met with silence, if not blatant
defensiveness, I needed to muster up
confidence. I asked to speak with the
practice administrator, and within
seconds, I was introducing myself,
and explaining the situation.
6
She let me finish talking and then
politely apologized. Although I wasn’t
surprised by that, I was shocked with
her subsequent words: “Thank you
for bringing this to my attention, Ms.
Woodcock. Every complaint is a gift.”
It stopped me cold in my tracks. I
could feel my heart skip a beat. I had
been so worked up about how I had
been treated and was ready to defend
myself but now, this? I had given her
a gift? With her words, my frustration
turned to satisfaction.
Her words — so powerful in their
meaning — have lingered with
me ever since. Not only did she
turn a customer service glitch into
something positive, I learned that
listening to complaints is exactly what
we need in order to improve. As I visit
practices all over the country, I realize
that we never view ourselves as doing
anything wrong. It seems that we can
explain away everything — from the
forgotten patient, to lengthy delays,
to computer glitches. Indeed, we give
our best every day. Yet, our “best” —
whether it’s the innovative processes
we’ve designed, the advanced
technology we’ve deployed or the
talented people we’ve just hired — may
not be good enough.
Quite simply, our systems — including
how we receive and communicate with
patients — need help. The solution may
be as basic as paying closer attention to
the voices of our patients, even when
what they say makes us uncomfortable.
Seek — and use — feedback from
surveys. The results can open our eyes,
raise new but legitimate questions
about our current approaches and,
ultimately, improve our practices.
Take the time to conduct “rounds” in
your reception area by sitting with
patients and requesting feedback, call
your referral sources, and always follow
up with patients who transfer their
care to another provider (of the same
specialty) in your community. Surf the
Web to read what patients are saying
about you, and keep a “murmur”
log to record patients’ frustrations
(documenting the issues that typically
don’t turn into formal complaints).
Don’t just let criticism go in one ear
and out the other; listen carefully, and
you will find that every complaint truly
is a gift to your practice.
Benchmarking and Financial Analysis
by Jackie Boswell, FACMPE
True Story: When my husband and I built our home in Waverly, Tennessee, there was no city water on our
property or in our subdivision, so we were forced to dig a well. The “well digger” we contacted promptly dug
270 feet before he reached “good water” (and yes, he charged us by the foot.) After 6 months of washing
clothes and taking showers in cloudy or even muddy water, I had enough! I began asking around and hearing
of other wells in the area that were not so deep. I decided to contact the division of the state that regulated
“well digging” (yes, there is one) to find out about the median and average depth of other wells in the area.
Just as I suspected, most wells in the area were approximately 75 feet deep and delivered crystal clear
water. If only I had thought to survey or “benchmark” other wells in the area BEFORE digging began, I could
have saved myself a lot of money and frustration!
Benchmarking and financial analysis are powerful techniques that can help a medical practice pinpoint when
specific processes, operations, or costs are out of line. The outcome of this analysis may even indicate that
processes could further improve if a little more money was spent on resources, such as staff. Typically, better
performing medical groups have slightly higher staff costs.
Once a medical practice has collected the appropriate financial and operational information on it and other
comparable organizations, it can benchmark and compare the practice’s current situation to a potentially
more desirable one. Practice leadership must embrace the direction in which the benchmarking is going and
also set the tone for all others in the practice. Once there is acceptance, the practice can set specific goals and
develop an action plan for implementation.
SVMIC Medical Practice Services was recently invited into a large medical practice to conduct a high-level
financial assessment. The assessment included benchmarking several financial key performance indicators
(KPI). Days in Accounts Receivable (AR) is a critical KPI that all practices should monitor. It measures the
number of days between providing services to a patient and collecting amounts owed by the patients and their
insurance company. It is one measure of how efficient a practice is in collecting money owed to the practice.
Typically, better performing practices have Days in AR of 35-38 days.
The large practice (let’s call them Getwell Medical Group or GMG) had patient Days in AR that had consistently
fluctuated between 65 and 67. After an extended process review and interviews with key collections staff,
SVMIC medical practice consultants made eight recommendations to streamline and automate current
processes using tools already available to the staff. GMG’s revenue cycle manager worked with the staff to
implement the recommendations.
Two months later, GMG proudly reported that patient Days in AR had been reduced from 67 to 53, improving
overall collections and cash flow. GMG recognized the collections staff for their accomplishment at the
business office’s monthly staff meeting, and the entire business office was rewarded with pizza!
Just remember, benchmarks are not the gospel. Benchmarks are simply techniques and tools used to measure
performance. The goal of achieving a benchmark should NEVER compromise or undermine the goals, integrity,
or mission of the practice, physicians, or employees.
7
Understanding Underwriting
The Problems with Indemnification Provisions
by James E. Smith, CPCU
It is fairly customary for the drafters of Professional
Services Agreements between physicians and
healthcare entities (hospitals, pharmaceutical
companies, skilled nursing facilities, etc.) to include
some form of a hold harmless and indemnification
provision in the agreement. The problem is that
many, if not most, indemnification provisions are
not clearly defined, not specific enough in intent, and
are broader than the physician’s medical professional
liability insurance (“MPL”) coverage. Physicians and/
or physician groups who agree to such indemnification
provisions could unknowingly assume some financial
risk.
In such agreements, the physician and/or physician
group (the “indemnitor”) essentially agrees to pay
losses and legal expenses on behalf of the other party
to the agreement (the “indemnitee” or “indemnified
party”) under certain circumstances—most likely
when the indemnified party is included in a lawsuit
that arises out of the professional services rendered
under the agreement.
those ordinarily contemplated by the underwriters
of the MPL policy and beyond those that would have
already existed under common law. The exception,
however, is that most MPL insurance companies,
including SVMIC, provide coverage for contractual
liability assumed under a professional services
agreement as long as the liability results from the
alleged sole negligence of the insured (where there
are no allegations of wrongdoing on the part of
anyone else—especially the indemnified party). In
other words, in order to be covered, the liability of
the indemnified party would need to be limited to
allegations of apparent agency or vicarious liability—
for which the remedy is typically already allowed
under common law.
While it is rare for SVMIC claims attorneys to
encounter a significant problem during the defense
of a medical professional liability claim in which an
uninsured demand for indemnification was asserted,
the potential certainly exists. Therefore, SVMIC
always recommends that indemnification provisions
not be ignored. They should be carefully reviewed by a
In general, liability assumed under a contract corporate attorney in conjunction with the physician’s
(“contractual liability”) is not covered by MPL policies insurance coverage and modified as needed before
because it creates additional legal obligations beyond signing.
Meaningful Use Hardship Exception
Recently, the Centers for Medicare & Medicaid Services (CMS) announced a clarification for the hardship exception application, as well as
a revision to the deadline. According to CMS, the application will be ignored in the event that you attest to Meaningful Use successfully
for the 2015 reporting year. This is in contrast to the instructions posted on the application, which was the basis of my recommendation
in the February SVMIC Sentinel to avoid completing the application if you chose to attest in 2015. With this clarification, please apply
for the hardship exception application. It consumes only minutes, and can be done for your entire practice on a single application.
Plus, the federal government passed a law in late December that guarantees applications will be automatically accepted. Unless another
category applies, choose option 2.2.d – Extreme and Uncontrollable Circumstances. What’s at stake? 3% of your Medicare revenue in 2017.
Since there’s no longer any downside to the application, consider completing yours today. You now have until July 1, 2016 to submit your
application.
8
SVMIC’s 2016 Proxy Voting is now open.
All policyholders will receive a Proxy in the mail in
the next few weeks.
Please be on the lookout for an SVMIC envelope
with “Your Proxy Enclosed” on the front.
If you don’t receive your Proxy by the 15th of April,
please call us at 800.342.2239 to request a duplicate.
All votes must be received in our office by Tuesday, May 3,
2016, at 5.00pm CDT.
You’re Invited to Join Us.
Open House and
Annual Meeting of Policyholders
When
Tuesday, May 3
Where
SVMIC’s Brentwood Office
101 Westpark Drive
2nd Floor
Brentwood, TN 37027
What
4.00-5.30 CDT Open House & Reception
5.30-6.15 CDT Annual Meeting
Contact
800.342.2239
[email protected]
RSVP
Not necessary
Please join us as we celebrate 40 years of serving physicians.
9
Specialty
Spotlight
General Surgery
by Rochelle “Shelly” Weatherly, JD
A
General Surgery closed claims
2010 – 2015 where a loss was paid on
review of
from
Systems
8%
behalf of an insured reveals that there were
3
basic areas
(excluding
errors in medical
Communication
36%
judgment) that contributed to the determined
indefensibility of the claims.
These
reasons
SYSTEMS
ISSUES
COMMUNICATION
ISSUES
DOCUMENTATION
ISSUES
are illustrated in the graph at the right.
10
Documentation
52%
Maintaining a well-documented medical record is crucial from both a patient care and a risk management standpoint.
As the graph above illustrates, documentation issues were a factor in 52% of claims paid in general surgery. Of those,
80% were found to have inadequate documentation which can negatively impact the ability to defend the care
provided to a patient. The majority of the cases in this category involved the failure to clearly document the consent
process. Either a generic hospital form was used to establish consent, or the record notes simply reflected “risks and
benefits discussed” without any documentation of the procedure-specific risks and benefits and no further indication
that alternatives and expected outcomes were likewise discussed. When a known complication occurred, the failure
of the record to reflect that the procedure-specific risks, benefits, and alternatives were thoroughly reviewed, opened
the door for the plaintiffs to contend that they had indeed not received such information, and further, if they had,
they would have sought more conservative treatment or a second opinion.
A significant number of cases also involved untimely documentation – i.e., operative reports being dictated
weeks or even months after the procedure and subsequent complication. Untimely documentation is often viewed
as self-serving by a jury and erodes a physician’s credibility. Plaintiffs may allege that the failure to timely complete
records further suggests a disregard on the part of the physician for patient safety as it can deprive other members
of the care team of vital information needed to manage a patient’s course of treatment.
Effective communication is essential in establishing trust and building rapport with patients, which in turn plays
a role in a patient’s perception of his/her quality of care. Of the claims reviewed, 36% involved communication
breakdowns. Physician-to-patient breakdowns were noted in the failure of the physician to discuss material
and significant risks associated with the procedure (e.g., esophageal tear during endoscopy, common bile duct
injury during a laparoscopic cholecystectomy) and in the failure to discuss the possibility of additional procedures
(e.g., laparoscopic procedure converted to open, oophorectomy converted to TAH). Physician-to-physician
breakdowns were likewise noted in a number of claims where the surgeon failed to provide relevant information
about a patient’s pending lab studies to the covering physician or where the surgeon failed to communicate urgent
or unexpected findings promptly and directly to the referring physician. Both situations resulted in a delay in
treatment.
Effective systems and processes help reduce adverse events. Of the claims analyzed, 8% involved a systems
breakdown. Of those, 58% involved either wrong site surgery or a retained foreign body. Although not
reflected in the analysis of this particular group of cases, it is worth noting that SVMIC continues to see newly
reported claims involving routine pre-operative tests, such as chest x-rays, that were not reviewed prior to the
procedure. If such a test ultimately reveals a potentially serious problem, the patient may later claim that he/she
would have declined to move forward with the surgery if the test results had been known, and may also have a claim
for delay in diagnosis.
LESSONS LEARNED
×× Document timely and completely –
including history, instructions, and telephone
calls as well as the rationale for actions that
may not be self-evident. Such documentation
not only enhances patient care, but bolsters
credibility if called upon to defend such care.
problems. At a minimum, information about
patients with specialized needs or fragile
medical conditions should be communicated.
Restrictions or prohibitions on prescribing
or refilling medications should be made
clear to the covering physician as well.
×× Personally review images that directly
pertain to the surgical procedure.
×× Use the Joint Commission’s protocol designed
to prevent wrong patient/site/procedure surgeries
by verifying patient identification, marking the
surgical site appropriately with the patient/
representative prior to surgery, and perform
a timeout to review relevant aspects of the
procedure with the surgical team and complete
the verification process. The American College of
Surgeons further suggests a briefing before the site
is marked to verify the plan for the procedure and
a debriefing to enhance patient flow and ensure
accurate documentation between providers.
×× Engage in a full and clear discussion with
patients about the nature of their medical
condition, the recommended treatment plan
and the risks/benefits/expected outcome,
possibility of an additional or different procedure
if indicated (e.g., need to convert a laparoscopic
to open procedure), and alternatives. Doing so
not only discharges legal and ethical obligations
to provide patients with sufficient information
with which to make an educated election about
the course of their medical care, but may help
create realistic expectations on the patient’s
part as to the outcome of treatment. Be careful
not to educate above a patient’s comprehension
level. Be sure the details of all discussions
with patients are documented in office records
rather than relying on hospital consent forms
which are not procedure-specific and may
not capture all details of a conversation.
×× Provide clear, detailed, understandable,
procedure-specific written postoperative
instructions to patients. Patients who have
a clear understanding of what signs and
symptoms to watch for, how medication should
be administered, and when to make follow-up
appointments are less likely to be readmitted
or visit the emergency department.
×× Follow the actions recommended in the
Joint Commission’s Sentinel Event Alert to
reduce the chances of a retained foreign object
after surgery. These actions should include
developing a highly reliable and standardized
counting system to ensure all surgical items are
identified and accounted for; following established
procedures for counting of items, wound opening
and closure and when intraoperative radiographs
should be obtained; instituting team briefings
and debriefings as a standard part of the surgical
procedure where team members are encouraged
to express any concerns about patient safety;
documenting the results of counts of surgical
items, including those items that were intentionally
left in the surgical site and actions taken if there
are discrepancies; and tracking discrepant counts
in order to better understand practical problems.
×× Communicate all relevant clinical
information to covering physicians, especially
information regarding patients with anticipated
×× Review results for all tests ordered preoperatively to ensure that any abnormalities
receive proper attention and follow-up.
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About Our Authors
Jackie Boswell is a Senior Medical Practice Consultant with the Medical Practice Services Department at SVMIC. Her background includes
over 25 years as a medical management executive including hospital
and physician practice administration. She obtained a Bachelor’s degree
in Computer Information Systems from Murray State University and a
Masters Degree in Business Administration from Belmont University.
She is a Fellow in the American College of Medical Practice Executives
and has served as Finance Chair for MGMA’s Financial Management
Society and as the ACMPE Forum Rep for the Tennessee MGMA. Jackie
is a member of the Board of Directors and Finance Committee at Three
Rivers Hospital in Waverly, TN. She also serves on the United Way Allocations Committee in Humphreys County.
Jim Smith is Senior Vice President of SVMIC. He received a Bachelor of
Science degree from Jacksonville State University in 1975 and earned the
CPCU designation from the Society of Chartered Property and Casualty
Underwriters in 1989.
Jim’s career began as a claims adjuster with Liberty Mutual Insurance
Company. In 1991, Jim was recruited by SVMIC as Vice President of
Underwriting, where he has been since. He was promoted to Senior Vice
President in 2012.
Mr. Smith served as a member of the Underwriting Section of the Physician Insurers Association of America (PIAA) from 1990 to 2009, and
was its chairman from 1993 to 2001. He is a member of the Professional
Liability Underwriting Society (PLUS), and briefly served on its Industry
Review Panel.
Julie Loomis is Assistant Vice President of Risk Education for SVMIC
where she develops educational programs and assists policyholders and
staff with risk management issues. Ms. Loomis is a member of the Tennessee Bar Association, Medical Group Management Association, and
American Society of Healthcare Risk Managers (ASHRM). She recently
contributed to ASHRM’s Medication Safety Pearls. She serves on the
Risk Management Committee of the Physician Insurers Association of
America. Ms. Loomis is a speaker on risk management and professional
liability topics at medical professional association meetings, medical
schools and residency programs, and industry seminars.
Shelly Weatherly is Vice President, Risk Education and Evaluation
Services for SVMIC. Ms. Weatherly graduated from the University of Tennessee School of Law, is a member of the Nashville and Tennessee Bar Associations, and has been with SVMIC for 26 years. Prior to joining SVMIC,
Ms. Weatherly served as Law Clerk on the Tennessee Court of Appeals for
the Honorable William C. Koch, as well as on the U.S. District Court for the
Middle District of Tennessee under the Honorable Charles Neese.
Ms. Weatherly leads SVMIC’s Risk Education and Evaluation Services. Prior
to 2015, she developed and administered the company’s Risk Evaluation
Services and earlier served as a Claims Attorney.
Ms. Weatherly is a frequent speaker on risk management, liability assessment, and professional liability topics at medical professional association
meetings, medical schools and residency programs, and industry seminars.
Tim Rector is a Senior Claims Attorney in SVMIC’s Claims
Department; he has been with the Company since 2004. Tim received
a Bachelor of Science Degree in Economics from Austin Peay State
University in 1982 and was a Distinguished Military Graduate in the
Army ROTC Program. Tim served as an active duty commissioned
officer in the U.S. Army for 21 years, primarily in Cavalry commands.
He earned a Master of Business Administration degree with honors from
Embry Riddle Aeronautical University in 1990. He graduated from the
Nashville School of Law with honors in 1996 earning a Juris Doctorate
degree. Tim has held legal positions with Phillips and Ingrum as well as
owning his own private practice primarily focused on the defense-side
of construction and trucking civil litigation and business formations.
Tim has also worked as an adjunct faculty member at Volunteer State
Community College and at Draughons Junior College.
Elizabeth Woodcock is the founder and principal of Woodcock &
Associates. She has focused on medical group operations and revenue
cycle management for more than 20 years and has led educational
sessions for the Medical Group Management Association, the American
Congress of Obstetricians & Gynecologists, and the American Medical
Association. She has authored and co-authored many books. She is
frequently published and quoted in national publications including The
Wall Street Journal, Family Practice Management, MGMA Connexion,
and American Medical News.
Elizabeth is a Fellow in the American College of Medical Practice
Executives and a Certified Professional Coder. In addition to a Bachelor
of Arts from Duke University, she completed a Master of Business
Administration in healthcare management from The Wharton School of
Business of the University of Pennsylvania.
GET IN TOUCH
SVMIC.com
By Phone
800.342.2239
By Email
[email protected]
By Fax
615.370.1343
By Mail
101 Westpark Drive, Suite 300
Brentwood, TN 37027