Advanced Practice Providers’ (APPs) Increased Practice Means Increased Risk

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By Daniel Casciato

Healthcare professionals want to prevent any potential legal actions as it relates to the excellent care they provide to their patients. This includes advanced practice providers (APPs), such as Nurse Practitioners who now face similar legal issues to those experienced by physicians and other medical providers.

According to Tom Murphy, a Med Mal and Workers Comp Specialist with Danna-Gracey, one of the largest independent brokers of insurance coverages for the healthcare sector, the most common causes for a malpractice claim involving APPs are as follows:
  • Failure to follow the standard of care;
  • Improper use of medical equipment;
  • Failure to document;
  • Failure to monitor and properly assess the patient care, and;
  • Failure to communicate.
One area of concern that has increased rapidly over the past few years, Murphy notes, is related to the opioid crisis and the improper prescription and monitoring of these controlled substances.
“Primary care and behavioral health account for over 80% of all NP claims but the top claim payouts for nurse practitioners is in the area of neonatal and obstetrics care where the average payment as of 2016 was $630,000,” he says. “This number has increased as have all claim payments and claims expenses related to nurse practitioners.”
CNA/NSO completed a claims study in October 2017 with some of the following details: Nurse practitioner average claim indemnity payments rose 12% from 2012 to 2017. The total number of NP claims rose 27% in that same time period and the average claim expense and legal payment rose almost 30%.
The following are strategies all Advanced Practice Providers should follow to prevent claims:
  1. Practice within the requirements of your state NP guidelines and laws.
  2. Document all conversations and treatments objectively, timely, accurately, and legibly.
  3. Never alter any portion of the medical record, unless it is critical to the patient care and treatment. If this is necessary, be sure to properly document and date the delayed entry.
When faced with the knowledge of an incident or actual claim, do not speak with anyone regarding the issue until you have spoken to your insurance professional or legal counsel. Do not change the medical record in any way and never agree to a conversation or deposition until you have spoken to your insurance specialist or legal counsel.
In Florida, advanced practice providers are required to carry a minimum of $250,000 per claim and $750,000 aggregate limits of liability. “We recommend that all APP’s carry a minimum of $1 million per claim and $3 million aggregate limits while these limits are still affordable,” says Murphy.
Advanced practice providers, like all medical providers, should have a trusted healthcare insurance specialist to provide guidance with navigating the complexities of the medical professional liability insurance world.
“They should also have a trusted healthcare legal expert for constructing and reviewing all healthcare contracts,” adds Murphy. “The medical profession has become more complex over the past ten years with increased regulation such as HIPAA and HITECH, and consolidation. APP’s, like all medical professionals, need experienced and trustworthy assistance to avoid the pitfalls of the rapidly changing landscape.”