‘Sorry Works’ Really Works

Since President Obama supported alternative malpractice reforms as a Senator, I expected health care reform to include something more robust than demonstration projects dedicated to exploring different initiatives for improving patient safety and reducing costs. After all, Obama co-sponsored Sorry Works legislation — an initiative built on the assumption that “disclosure and apology” encourages providers to “deal with medical mistakes: [r]ather than stonewalling patients and relatives.” The approach pushes hospitals and institutions to address their mistakes and has found some success in lowering costs.

Just yesterday, a new study in the Annals of Internal Medicine of the period in which such a program was implemented at the University of Michigan Health System found that “legal costs went down, as did the number of new claims for compensation, the number of claims compensated and the time it took to resolve a claim.”

But whether costs and the number of claims declined as a result of the new policy isn’t clear, since there was no control group — and claims in the state were generally on the decline. (The university system did have fewer claims than were predicted by historical trends and its own models, the study says.)

It’s also unclear whether the same results would apply to physicians in private practice or who purchase their own liability insurance; UMHS docs were covered by their institution. The authors say the results suggest that such a disclose-with-offer program can be implemented without exacerbating legal costs and that it can address some of the problems of the medical liability system, including long waits for compensation.

The accompanying editorial calls the study “promising” but notes a couple of other limitations, including the fact that “the authors could not distinguish disclosures initiated by the health system from those offered in response to a patient complaint.” (In other words, it’s hard to know how many of the voluntary disclosures were voluntary.)

Sorry Works may not be a silver bullet, but it’s at least part of the answer to controlling malpractice costs. And its success in this study only suggests that doctors and hospitals can implement solutions that are independent of Congressional action, with government funding. In June, HHS announced that it would be distributing $20 million in development grants and planning grants “to states and health care system” to develop and test successful models for reducing malpractice costs. The funding provides systems with an opportunity to test run some of these alternative models.