| understanding-contribution-claims-in-medical-practice | Understanding Contribution Claims in Medical Practice | Partners in Medicine | Shared_Content/News/Latest_News/2025/understanding-contribution-claims-in-medical-practice | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2025/march-april/cover-wsma-marapr-2025-final-645x425px.jpg" class="pull-right" alt="March/April 2025 cover of WSMA Reports" /></div>
<h5>March 19, 2025</h5>
<h2>Understanding Contribution Claims in Medical Practice</h2>
<p>
By Melissa Cunningham, JD
</p>
<p>
Health care is a high-stakes world and medical malpractice claims are a cost of practice. Adding to existing liabilities is a growing but not well-understood risk for medical practitioners: contribution claims.
</p>
<p>
Unlike usual malpractice claims, which are the result of disagreements between patients and health professionals, contribution claims come into play after a settlement or verdict against a hospital or other facility that uses contracted physicians, such as an ambulatory surgical center. They occur when a hospital seeks financial contributions to help pay their settlement or courtroom loss- with that money often coming from physicians. Physicians, especially those in contracted roles, need an understanding of contribution claims to protect their practice and finances.
</p>
<h3>What is a contribution claim?</h3>
<p>
Think of a contribution claim as a claim triangle. It's a legal action in which a party pays a legal settlement, then seeks to have its costs entirely or partially covered by the party that played a role in the underlying incident. In health care, these claims arise when a hospital facing a malpractice lawsuit pays a settlement or is ordered to compensate the patient and then seeks to have other parties-such as physicians-share in the financial pain.
</p>
<p>
In typical malpractice cases, the patient/plaintiff must prove three things to prevail: that a duty of care existed, that this duty was not met, and that the breach caused injury to the plaintiff. This direct approach focuses on whether a physician or hospital acted negligently or carelessly, harming the plaintiff.
</p>
<p>
In contribution claims, that dynamic changes. In these cases, a plaintiff may sue only the hospital without the physician's knowledge. If the hospital chooses to settle or loses a case in court, it may then decide to seek a financial contribution from the physician or physicians involved, claiming that because the physicians provided part of the care that led to the settlement, they should share the economic burden.
</p>
<h3>How contribution claims unfold in medical malpractice</h3>
<p>
Picture a case in which a heart patient suffers post- surgery complications. The patient sues the hospital, alleging negligence, but does not specifically sue the physician who performed the actual surgery. After settling the claim against it, the hospital then goes to the contracted physician and demands that they pay a share of the settlement payout. This may occur even though the physician has not had a chance to defend themselves in court with capable legal counsel.
</p>
<p>
This scenario does indeed occur, and in most cases comes as a surprise to physicians who assume that they won't face financial liability unless they're sued directly. In contribution actions, however, a hospital will argue that it should not carry the financial burden alone, especially if it was sued based on the principle of "vicarious liability." Under this principle, the hospital is held accountable for the actions of contracted agents-such as physicians-who deliver care within it.
</p>
<h3>Legal standards and the shift in focus</h3>
<p>
Legal standards for contribution cases differ from those in conventional malpractice suits. In malpractice claims, plaintiffs must establish that a health professional's breach of the standard of care caused a patient's injuries. In contribution claims, the focus shifts to whether the hospital's settlement was "reasonable" under the circumstances. Determining this involves a distinct set of factors, including:
</p>
<ul>
<li>The hospital's defense, including how strong or weak it may have been.</li>
<li>The relative fault of each party involved in the patient's care.</li>
<li>The hospital's risk if the case goes to trial.</li>
<li>The financial ability of each party to pay.</li>
<li>The extent of harm to the patient.</li>
</ul>
<p>
This "reasonableness standard" emphasizes the financial and practical implications of the settlement, rather than the clinical details. This focus shift can frustrate physicians, as the hospital's decision to settle and then file a contribution claim may occur without any assessment of the physician's direct role or the quality of care provided.
</p>
<h3>Why are physicians at risk?</h3>
<p>
Contribution claims pose special risks to physicians due to two factors. The first derives from the complexity of modern health care settings and the financial pressures hospitals face. In scenarios in which multiple physicians and health professionals are involved, such as in obstetrics or emergency medicine, hospitals may decide to settle quickly and then decide to see if they can spread the financial burden.
</p>
<p>
The second factor to be considered is that contribution claims occur without giving the physician a chance to defend his or her actions. Once a hospital settles, the physician's ability to protect their reputation or contest their involvement is limited. To make matters worse, these settlements-even if they're related to contribution claims-are recorded in the National Practitioner Data Bank, which means they can follow a physician's career indefinitely, potentially affecting their credentialing, hiring, and malpractice insurance rates.
</p>
<h3>The practical implications of contribution claims</h3>
<p>
Contribution claims are most common in specialties involving risky medical conditions and multiple health professionals in the hospital setting, such as obstetrics, emergency medicine, anesthesiology, and radiology. Meanwhile, the financial pressures that hospitals face, plus the growing number of "nuclear verdicts"-jury awards that greatly exceed typical settlements-have driven hospitals to seek shared monetary responsibility.
</p>
<p>
These trends are exacerbated by "social inflation," which drives up verdict amounts in keeping with factors such as distrust of institutions and sympathy toward patients. When hospital settlements reach $10 million or even $20 million, the pressure to find ways to share these crushing amounts increases.
</p>
<h3>How to protect yourself and your practice</h3>
<p>
Contribution claims in health care can be particularly tricky to defend due to several factors, including the potential complexity of liability and statutory or regulatory nuances. Still, there are practical steps that physicians can take to protect themselves:
</p>
<ol>
<li>Engage in contract negotiation. When physicians sign agreements with hospitals or health care systems, these contracts often define the level of liability they may assume. Physicians should look for provisions that limit liability to their insurance-policy limits and negotiate for language that gives them control over settlement decisions affecting their cases. Hospitals may resist these efforts, but they're an effective way to forestall financial shocks.</li>
<li>Conduct legal and insurance review. Working with legal and insurance experts to ensure proper insurance coverage is critical. Malpractice insurance policies differ in their approach to contribution claims, so physicians should work with an insurance expert to confirm adequate protection.</li>
<li>Stay informed. Laws governing contribution claims vary by state, with Washington, for instance, having specific guidelines on "joint and several liability." This principle allows a plaintiff to seek full recovery from one party even if multiple parties share responsibility, thereby heightening the risk of contribution claims. Physicians should be aware of any changes to these laws and work proactively with legal and insurance professionals to keep ahead of them.</li>
</ol>
<p>
Though it is important to note that not all hospitals employ this strategy, it is equally important for physicians to understand how these claims work and take steps to address potential liability to safeguard their practice and reputation. Physicians Insurance also believes in coordinated defenses that uphold the standard of care, protecting the assets of hospitals and physicians alike.
</p>
<p>
Although the legal landscape surrounding contribution claims may continue to evolve, being proactive regarding contract negotiation, insurance coverage, and legal awareness can help physicians better manage these challenges with confidence.
</p>
<p>
<em>Melissa Cunningham, JD is a senior vice president and general counsel with Physicians Insurance.</em>
</p>
<p>
<em>This article was featured in the March/April 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 3/19/2025 12:00:00 AM | 1/1/0001 12:00:00 AM |
| negotiating-contracts-ask-the-right-questions | Negotiating Contracts: Ask the Right Questions | Partners in Medicine | Shared_Content/News/Membership_Memo/2025/march-14/negotiating-contracts-ask-the-right-questions | <div class="col-md-12">
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<h5>March 14, 2025</h5>
<h2>Negotiating Contracts: Ask the Right Questions </h2>
<p><strong><em>Sponsored content</em></strong> </p>
<p>Evaluating a potential job and employer is all about asking the right questions. The more answers you can find, the better equipped you will be to negotiate a contract and make the final decision to sign or not. You obviously want to know your salary, benefits package, or paid time off. However, there are other inconspicuous terms of employment that you'll want to know about sooner rather than later. Here are a few questions to ask your future employer. </p>
<p><strong>What are the other physicians like, and how do you fit in?</strong> </p>
<p>Getting to know who you would be working alongside will absolutely give you a better idea of how the practice functions. If you're able to speak with physicians and other current employees directly, you could also gain some insight into what they do or don't like about their workplace. </p>
<p>Most importantly, you want to understand where you fit with the other physicians from a scheduling standpoint. The way they are scheduled will affect when you work, and vice versa. Find out how many other physicians are working and how you share call time with them. Ideally, call time should be equal and rotating between all physicians involved. Whether or not this is the case, also investigate capping your call time to avoid taking an unnecessary amount. </p>
<p>Finally, know what happens when another physician must be absent. Will there be a backup, or will you have to pick up the slack? Similarly, what happens if someone leaves the practice entirely? Find out how the employer plans to handle these situations, and ensure your contract protects you from taking on any excess workload. </p>
<p><strong>What patient volumes can be expected?</strong> </p>
<p>Production bonuses are great, but only if you can meet the threshold. When your earnings are dependent on the number of patients you see, you must either see more patients or lower the expectations defined by your employer. While the former is mostly out of your control, the latter can be changed in your employment contract. </p>
<p>Inquire about patient volumes early in your talks with an employer. If you get the chance, ask other employees as well, so you get a more neutral view of the situation. Once you receive a contract, if you know what volumes to expect, you can determine whether the proposed bonus rate and threshold are reasonable. You don't want to sign a contract with a bonus threshold you will never realistically reach. </p>
<p><strong>What happens in the event of a buyout?</strong> </p>
<p>Questioning these more unassuming contract details helps you prepare for the "what-ifs," and a buyout is a big what-if to plan for. Even if it seems unlikely, do not write off the possibility of a buyout or acquisition taking place. </p>
<p>Your contract should include specific language designed to protect you in such situations. For example, if your contract includes a non-compete, that clause should be written in a way that it is waived in the event of a buyout. When you sign the contract, you agree to non-compete terms relative to your employer's current location(s). You don't want the clause applied to additional locations owned by an acquiring company, and you may want to leave the practice altogether if you don't like the new direction. Being unrestricted by a non-compete allows you the freedom to change jobs without changing location. </p>
<p>Malpractice tail coverage also becomes a topic of concern when ownership changes. It's ideal that your employer is responsible for 100% of your tail coverage costs if a buyout happens, provided they aren't already. Like waiving the non-compete, this gives you additional flexibility if you decide to leave the practice, since you won't have to worry about paying for tail coverage. </p>
<p>Additionally, ensure your path to partnership is uninterrupted, and preferably accelerated as well. You don't want to put a lot of time into a practice, get close to obtaining partnership, and then have a buyout postpone or even negate everything. The effects of a buyout on your partnership should also be specified in your contract. </p>
<p><strong>It's all in the details</strong> </p>
<p>When searching for a new job, you can save a lot of time and avoid trouble down the road by ironing out the small details early. Don't be afraid to ask questions, even if they regard situations that seem insignificant or unlikely to happen. Some employers may downplay the possibility of a buyout or staffing changes. Even so, after you've found sufficient answers to your questions, ensure that you have protection written into your contract. Although you may be able to renegotiate later, it's always best to fully understand your employment terms and negotiate them before you sign. </p>
<p><em>--This article is brought to you by WSMA's preferred partner, </em><a href="[@]wsma/membership/why_join_the_wsma_/partners-in-medicine/resolve.aspx"><em>Resolve</em></a><em>, providing WSMA members discounts on employment contract review services and salary data. </em> </p>
<p><em>You may also find WSMA's Career Center of interest in your job search. Find out more </em><a href="https://jobs.wsma.org/"><em>here</em></a><em>. </em> </p>
</div> | 3/14/2025 12:00:00 AM | 1/1/0001 12:00:00 AM |
| communication-and-the-use-of-interpreter-services | Communication and the Use of Interpreter Services | Partners in Medicine | Shared_Content/News/Latest_News/2025/communication-and-the-use-of-interpreter-services | <div class="col-md-12">
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<h5>Jan. 16, 2025</h5>
<h2>Risk Management Considerations With Today's Telemedicine </h2>
<p>
By Jessica Sofie
</p>
<p>
Telemedicine is one of the fastest growing means<strong> </strong>
of delivering patient care, and its technologies and policies are evolving rapidly. Physicians Insurance, WSMA's exclusively endorsed professional liability carrier, last provided risk-management telemedicine guidance to <em> WSMA Reports</em> readers in 2020. We thought the time was ripe to bring our guidance up to date—and to answer some of your frequently asked questions. As this area of health care is evolving rapidly, we advise you to continue to stay current on federal and state regulatory changes.</p>
<p>
<strong>What organizational policies should be in place before providing telemedicine services to patients? </strong></p>
<p>
The standard of care for telemedicine is the same standard as for in-person visits, so the same policies for patient care will apply. In addition, your policies and procedures should address common topics impacted by telemedicine. These could include the following: </p>
<ul>
<li>Provisions for obtaining informed consent for telemedicine services. </li>
<li>Which patient visits are eligible for telemedicine. </li>
<li>How the physician will verify and authenticate the patient's identity and location at each virtual encounter. </li>
<li>How the physician will determine patient readiness in a private environment. </li>
<li>How preventive maintenance for equipment will be handled. </li>
<li>Which quality data will be monitored and how improvement will be implemented. </li>
<li>How to handle a patient medical emergency that develops during a telemedicine visit. </li>
<li>Any documentation differences. </li>
<li>Changes to billing procedures. </li>
<li>Backup plans or downtime procedures for telemedicine interruption. </li>
</ul>
<p>
<strong>Are there license or geographic restrictions to providing patient care via telemedicine? </strong>
</p>
<p>
Each state regulates the scope of practice and requirements for licensure regarding the provision of telemedicine in their jurisdiction. Most require licensure in the state where the patient is located. For instance, if a Washington state-licensed physician is seeing a patient in Oregon, that professional is obligated to be licensed in Oregon, as well, and adhere to its scope of practice. There are exceptions where a rare appointment may be provided, such as if a patient is temporarily traveling out of state and has a follow-up question post procedure or needs a medication refill. Check with your professional regulating bodies, state regulations, and federal agencies for up-to-date practice acts and licensure laws including those that pertain to telemedicine.
</p>
<p>
<strong>Should I notify my professional liability carrier about new or expanded telemedicine services? </strong>
</p>
<p>
You are required to notify your professional liability carrier of changes in services to ensure you have adequate insurance coverage.
</p>
<p>
<strong>What are the credentialing considerations for providing telemedicine services? </strong>
</p>
<p>
All physicians and practitioners should be credentialed through their organization to include telemedicine privileges, if indicated. In addition, organizations should also check with their accreditation agencies for any telemedicine credentialing requirements. If telemedicine services are provided from a distant-site hospital, an agreement should state that the distant-site hospital is responsible for credentialing requirements.
</p>
<p>
<strong>Is written informed consent necessary when holding telemedicine visits? </strong>
</p>
<p>
Since state requirements vary, it is important to know the regulatory requirements for your state(s) of practice as well as for the patient's state of residency. While it is standard practice to obtain written patient consent for medical care, informed consent for telemedicine should include patient education about telemedicine and how it differs from an in-person visit.
</p>
<p>
A single consent form may be used for multiple visits as long as the same physician is treating the patient. When that changes, the patient should sign a new form. Even when the same physician continues to treat the same patient, it is recommended that a new form be signed annually.
</p>
<p>
Patient communication should include information on the unique characteristics of telemedicine services, such as:
</p>
<ul>
<li>Technologies used, capabilities and limitations of each. </li>
<li>Potential technical problems that may occur and what to do if an issue arises. </li>
<li>Agreement that telemedicine is appropriate for care. </li>
<li>Available alternatives to telemedicine. </li>
<li>Credentials of the physicians or practitioners involved. </li>
</ul>
<p>
Be sure to set realistic expectations with the patient regarding the scope of service, who will be present during the appointment, billing, prescribing policies, and follow-up communications.
</p>
<p>
<strong>How can I obtain written informed consent for telemedicine? </strong>
</p>
<p>
Prior to the telemedicine visit—and if indicated, the informed-consent document translated into commonly used languages—forms may be exchanged through the patient portal, electronically (either secure email or facsimile), or by standard USPS mail. Ensure receipt of the signed form. The completed documentation should be included in the patient's medical record. If a patient is unable to return electronic confirmation of signed informed consent, then document the following: consent has been reviewed with the patient, the patient is unable to respond electronically, and verbal consent has been obtained. If possible, a second staff member should listen in and attest as a witness.
</p>
<p>
<strong>Is international telemedicine allowed? </strong>
</p>
<p>
Many state medical boards have dictated that medical licenses are for the practice of health care within their specifc state or within U.S. borders. Since telemedicine rules apply where the patient is located, if a patient is a permanent resident of a foreign country, a physician would typically need to be licensed in that country for international care. An additional factor involves privacy rules and HIPAA compliance for telemedicine platforms.
</p>
<p>
Physicians traveling internationally who wish to deliver telemedicine services while abroad to U.S. residents may do so, provided the physician is licensed in the state where the patient receiving care is located and the platform used for telemedicine is HIPAA compliant (see the question after next).
</p>
<p>
<strong>If an established patient has left the state to attend college, can I continue treatment by using telemedicine visits? </strong>
</p>
<p>
Our recommendation is to check your licensing state's rules, as most states require the physician to be licensed where the patient is physically located.
</p>
<p>
<strong>Can I provide telemedicine services from my home or other location that is not my office? </strong>
</p>
<p>
The physician's obligation for patient privacy extends to any setting where care is provided. With proper privacy safeguards and consideration given to a professional presentation, it is possible to use the home setting. Keep in mind that public-facing communication resources, such as Facebook, Instagram, and others, are not appropriate for electronic health visits because the software or platform used for telemedicine must be HIPAA compliant.
</p>
<p>
<strong>Am I required to provide interpretation services on a telemedicine visit? </strong>
</p>
<p>
During a telemedicine visit, patients in need of interpretation services should have access to a certified health care interpreter. Physicians or their staff should be competent concerning how to bring the certified interpreter into the conference, and they should document this service. Check with Physicians Insurance or your professional liability carrier for more guidance on the use of certified health care interpreters.
</p>
<p>
<strong>Am I allowed to prescribe medications via telemedicine visits? </strong>
</p>
<p>
When deemed appropriate for the patient, a telemedicine physician may prescribe, as long as it is done within the scope of their licensure. Special caution must be used hen prescribing controlled substances. Currently, the DEA mandates how to prescribe for controlled substances via telemedicine. Please review their website and reach out to your pharmacy and medical board to verify state rules.
</p>
<p>
If you are a Physicians Insurance-insured member and have questions that are not covered here, visit <a href="https://phyins.com/resources">phyins.com/resources</a> or reach out to our risk management or underwriting departments. We also encourage you to seek input from your general counsel or attorney to maintain regulatory and legal compliance.
</p>
<p> <em>Jessica Sofe, CPHRM,<strong> </strong> is a senior risk consultant with Physicians Insurance.</em> </p>
<p>
<em>This article was featured in the January/February 2025 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 1/16/2025 12:00:00 AM | 1/1/0001 12:00:00 AM |