Alicia Gallegos

Full implementation of the Affordable Care Act could result in as many as 500,000 more discretionary surgical procedures by 2017, based on health reform experiences in Massachusetts.

Dr. Chandy Ellimoottill of the University of Michigan, Ann Arbor, and associates analyzed the potential effect of the ACA on surgical procedures by examining the Massachusetts insurance expansion and the utilization of discretionary and nondiscretionary surgical treatment. They reviewed inpatient databases from Massachusetts and two control states – New Jersey and New York – to identity nonelderly patients who underwent discretionary procedures and nondiscretionary procedures from January 2003 to December 2010. Their findings were published July 2 in JAMA Surgery.

© XiXinXing/Thinkstock

The investigators defined discretionary surgery as procedures that were elective or preference-sensitive, such as joint replacement surgery or back surgery. Nondiscretionary surgeries were those that were life-saving or imperative, such as hip fracture repair.

Insurance expansion in Massachusetts was associated with a 9.3% increase in discretionary surgery and a 4.5% decrease in nondiscretionary surgery, Dr. Ellimoottil and colleagues found (JAMA Surg. 2014 July 2 [doi:10.1001/jamasurg.2014.857]).

Based on their findings, the ACA could yield an additional 465,934 discretionary surgical procedures by 2017. The researchers noted that their conclusions suggest insurance expansion results in greater utilization of discretionary inpatient procedures often performed to improve quality of life rather than to address immediate life-threatening conditions.

The study was supported primarily by federal grants (Agency for Healthcare Research and Quality, National Institute of Diabetes and Digestive and Kidney Diseases). The authors reported no relevant conflicts of interest.

Full implementation of the Affordable Care Act could result in as many as 500,000 more discretionary surgical procedures by 2017, based on health reform experiences in Massachusetts.

Dr. Chandy Ellimoottill of the University of Michigan, Ann Arbor, and associates analyzed the potential effect of the ACA on surgical procedures by examining the Massachusetts insurance expansion and the utilization of discretionary and nondiscretionary surgical treatment. They reviewed inpatient databases from Massachusetts and two control states – New Jersey and New York – to identity nonelderly patients who underwent discretionary procedures and nondiscretionary procedures from January 2003 to December 2010. Their findings were published July 2 in JAMA Surgery.

© XiXinXing/Thinkstock

The investigators defined discretionary surgery as procedures that were elective or preference-sensitive, such as joint replacement surgery or back surgery. Nondiscretionary surgeries were those that were life-saving or imperative, such as hip fracture repair.

Insurance expansion in Massachusetts was associated with a 9.3% increase in discretionary surgery and a 4.5% decrease in nondiscretionary surgery, Dr. Ellimoottil and colleagues found (JAMA Surg. 2014 July 2 [doi:10.1001/jamasurg.2014.857]).

Based on their findings, the ACA could yield an additional 465,934 discretionary surgical procedures by 2017. The researchers noted that their conclusions suggest insurance expansion results in greater utilization of discretionary inpatient procedures often performed to improve quality of life rather than to address immediate life-threatening conditions.

The study was supported primarily by federal grants (Agency for Healthcare Research and Quality, National Institute of Diabetes and Digestive and Kidney Diseases). The authors reported no relevant conflicts of interest.

Full implementation of the Affordable Care Act could result in as many as 500,000 more discretionary surgical procedures by 2017, based on health reform experiences in Massachusetts.

Dr. Chandy Ellimoottill of the University of Michigan, Ann Arbor, and associates analyzed the potential effect of the ACA on surgical procedures by examining the Massachusetts insurance expansion and the utilization of discretionary and nondiscretionary surgical treatment. They reviewed inpatient databases from Massachusetts and two control states – New Jersey and New York – to identity nonelderly patients who underwent discretionary procedures and nondiscretionary procedures from January 2003 to December 2010. Their findings were published July 2 in JAMA Surgery.

© XiXinXing/Thinkstock

The investigators defined discretionary surgery as procedures that were elective or preference-sensitive, such as joint replacement surgery or back surgery. Nondiscretionary surgeries were those that were life-saving or imperative, such as hip fracture repair.

Insurance expansion in Massachusetts was associated with a 9.3% increase in discretionary surgery and a 4.5% decrease in nondiscretionary surgery, Dr. Ellimoottil and colleagues found (JAMA Surg. 2014 July 2 [doi:10.1001/jamasurg.2014.857]).

Based on their findings, the ACA could yield an additional 465,934 discretionary surgical procedures by 2017. The researchers noted that their conclusions suggest insurance expansion results in greater utilization of discretionary inpatient procedures often performed to improve quality of life rather than to address immediate life-threatening conditions.

The study was supported primarily by federal grants (Agency for Healthcare Research and Quality, National Institute of Diabetes and Digestive and Kidney Diseases). The authors reported no relevant conflicts of interest.

CHICAGO – Despite more resources than in the past, physicians who are depressed, burned out, or stressed still find it difficult to reach out for help.

"Show me a physician, and I’ll show you a physician under stress," health law attorney Julian Rivera said at a physicians’ legal issues conference held by the American Bar Association. "Show me a physician, and I’ll show you a physician who is suffering. It is endemic."

One of the first steps to mitigating physicians’ feelings of depression and stress is recognizing the problem early and overcoming the stigma associated with getting help, Dr. Luis Sanchez said at the conference.

"In order to be a good physician, the physician must be a good patient," said Dr. Sanchez, director emeritus of Physician Health Services in Waltham, Mass., a referral program for physicians with substance abuse and behavioral health conditions. "That means we have to be able to take care of ourselves and have someone who is a doctor take care of us ... We need to have our illnesses diagnosed, we need to have them treated, and we need to have a support system."

Better self-awareness among physicians is essential, said Mr. Rivera, a partner in Husch Blackwell’s Healthcare, Life Sciences & Pharmaceuticals business unit in Austin, Tex.

"Suffering physicians generally have very low awareness of how they are functioning in their social, business, and clinical environments," he said in an interview. "Increasing self-awareness, developing coping mechanisms, and adoption of a strong social and professional support network are keys to reducing stress and avoiding burnout."

Frequently, a suffering, stressed physician becomes a disruptive physician, thus creating additional concerns for employers, peers, and patient care, Mr. Rivera added.

He recommends that physician leaders, administrators, and colleagues work together to identify when physicians are afflicted and schedule business meetings with the doctors to address the issue. Mr. Rivera emphasizes that the meetings should be "business like" and not adversarial or casual.

"Dealing with suffering physicians in a compassionate, business-like environment where physicians leaders and anyone else in the enterprise who can be helpful communicate openly with the physician in a plain, organized, and well-facilitated manner is invaluable to connecting with afflicted physicians," he said. "The goal of those meetings should be to hear everyone’s perspective, reach agreement about the challenges faced, and agree on action terms."

For their part, suffering physicians should make the most of available programs and resources such as physician health programs, forensic and clinical psychiatrists, treatment centers, and practice consultants, Mr. Rivera said. Fellow physicians, supervisors, and administrators should be vigilant in referring doctors to treatment, when necessary.

No longer will the physician culture accept and ignore physicians with unhealthy behaviors, Mr. Rivera said.

There has been a "revolution in the last 20 years," he said. "Now we have programs, we have thoughtful analysis, and we have conferences like this where we’re trying to approach [the issues] in a more conscientiousness way."

CHICAGO – Despite more resources than in the past, physicians who are depressed, burned out, or stressed still find it difficult to reach out for help.

"Show me a physician, and I’ll show you a physician under stress," health law attorney Julian Rivera said at a physicians’ legal issues conference held by the American Bar Association. "Show me a physician, and I’ll show you a physician who is suffering. It is endemic."

One of the first steps to mitigating physicians’ feelings of depression and stress is recognizing the problem early and overcoming the stigma associated with getting help, Dr. Luis Sanchez said at the conference.

"In order to be a good physician, the physician must be a good patient," said Dr. Sanchez, director emeritus of Physician Health Services in Waltham, Mass., a referral program for physicians with substance abuse and behavioral health conditions. "That means we have to be able to take care of ourselves and have someone who is a doctor take care of us ... We need to have our illnesses diagnosed, we need to have them treated, and we need to have a support system."

Better self-awareness among physicians is essential, said Mr. Rivera, a partner in Husch Blackwell’s Healthcare, Life Sciences & Pharmaceuticals business unit in Austin, Tex.

"Suffering physicians generally have very low awareness of how they are functioning in their social, business, and clinical environments," he said in an interview. "Increasing self-awareness, developing coping mechanisms, and adoption of a strong social and professional support network are keys to reducing stress and avoiding burnout."

Frequently, a suffering, stressed physician becomes a disruptive physician, thus creating additional concerns for employers, peers, and patient care, Mr. Rivera added.

He recommends that physician leaders, administrators, and colleagues work together to identify when physicians are afflicted and schedule business meetings with the doctors to address the issue. Mr. Rivera emphasizes that the meetings should be "business like" and not adversarial or casual.

"Dealing with suffering physicians in a compassionate, business-like environment where physicians leaders and anyone else in the enterprise who can be helpful communicate openly with the physician in a plain, organized, and well-facilitated manner is invaluable to connecting with afflicted physicians," he said. "The goal of those meetings should be to hear everyone’s perspective, reach agreement about the challenges faced, and agree on action terms."

For their part, suffering physicians should make the most of available programs and resources such as physician health programs, forensic and clinical psychiatrists, treatment centers, and practice consultants, Mr. Rivera said. Fellow physicians, supervisors, and administrators should be vigilant in referring doctors to treatment, when necessary.

No longer will the physician culture accept and ignore physicians with unhealthy behaviors, Mr. Rivera said.

There has been a "revolution in the last 20 years," he said. "Now we have programs, we have thoughtful analysis, and we have conferences like this where we’re trying to approach [the issues] in a more conscientiousness way."

CHICAGO – Despite more resources than in the past, physicians who are depressed, burned out, or stressed still find it difficult to reach out for help.

"Show me a physician, and I’ll show you a physician under stress," health law attorney Julian Rivera said at a physicians’ legal issues conference held by the American Bar Association. "Show me a physician, and I’ll show you a physician who is suffering. It is endemic."

One of the first steps to mitigating physicians’ feelings of depression and stress is recognizing the problem early and overcoming the stigma associated with getting help, Dr. Luis Sanchez said at the conference.

"In order to be a good physician, the physician must be a good patient," said Dr. Sanchez, director emeritus of Physician Health Services in Waltham, Mass., a referral program for physicians with substance abuse and behavioral health conditions. "That means we have to be able to take care of ourselves and have someone who is a doctor take care of us ... We need to have our illnesses diagnosed, we need to have them treated, and we need to have a support system."

Better self-awareness among physicians is essential, said Mr. Rivera, a partner in Husch Blackwell’s Healthcare, Life Sciences & Pharmaceuticals business unit in Austin, Tex.

"Suffering physicians generally have very low awareness of how they are functioning in their social, business, and clinical environments," he said in an interview. "Increasing self-awareness, developing coping mechanisms, and adoption of a strong social and professional support network are keys to reducing stress and avoiding burnout."

Frequently, a suffering, stressed physician becomes a disruptive physician, thus creating additional concerns for employers, peers, and patient care, Mr. Rivera added.

He recommends that physician leaders, administrators, and colleagues work together to identify when physicians are afflicted and schedule business meetings with the doctors to address the issue. Mr. Rivera emphasizes that the meetings should be "business like" and not adversarial or casual.

"Dealing with suffering physicians in a compassionate, business-like environment where physicians leaders and anyone else in the enterprise who can be helpful communicate openly with the physician in a plain, organized, and well-facilitated manner is invaluable to connecting with afflicted physicians," he said. "The goal of those meetings should be to hear everyone’s perspective, reach agreement about the challenges faced, and agree on action terms."

For their part, suffering physicians should make the most of available programs and resources such as physician health programs, forensic and clinical psychiatrists, treatment centers, and practice consultants, Mr. Rivera said. Fellow physicians, supervisors, and administrators should be vigilant in referring doctors to treatment, when necessary.

No longer will the physician culture accept and ignore physicians with unhealthy behaviors, Mr. Rivera said.

There has been a "revolution in the last 20 years," he said. "Now we have programs, we have thoughtful analysis, and we have conferences like this where we’re trying to approach [the issues] in a more conscientiousness way."

Receiving notice that a patient is suing can spark a range of emotions in physicians, including fear, anger, hurt, and helplessness. But litigation experts stress that after a filing, physicians must rein in their feelings and focus on immediate next steps – crucial actions that can significantly impact the suit and its outcome.

"Doctors have two reactions to getting sued – either they’re very sad or they’re very angry," said Steven Fitzer, a medical liability defense attorney at Fitzer, Leighton & Fitzer, P.S., in Tacoma, Wash., and former chair of the Washington State Bar Association Litigation Section. "Relaxing and composing yourself are important because a lawsuit is a marathon – not a sprint."

American Medical Association data show 60% of physicians will be sued by the time they reach 55 years of age. The average span of a medical malpractice claim from start to close is generally about 2.5 years, although many suits progress longer. While most medical liability claims do not end in trial, defense attorneys say knowing how to respond to a lawsuit can raise doctors’ chances of a quicker, more ideal resolution.

First and foremost, physicians should notify their malpractice insurance carrier as soon as possible after lawsuit papers are served, said Matt Mitcham, senior vice president of claims for MagMutual Insurance Company, a medical liability insurer that operates in the Southeast. Employed physicians should immediately alert their risk management department.

"All suits have a limited time for providing a response, and there are severe consequences for not meeting these deadlines," Mr. Mitcham said. "In addition, physicians need to provide their defense team with as much time as possible to prepare a response."

Doctors should resist the desire to contact patients or their families in an attempt to work out the situation themselves, adds Mr. Fitzer, who recently shared lawsuit preparation tips in two video playlists for The Doctors Company, a national medical malpractice insurer.

Another action to avoid after a lawsuit filing is making additions or changes to patient records, said Mr. Mitcham.

"The original records should never be altered under any circumstance," he said. "Today’s forensic specialists are experts in identifying changes, and by altering records, a physician can potentially turn a defensible case into one that is indefensible."

Securing an attorney that doctors trust and with whom they can aptly communicate is also essential, said Michael F. Ball, a medical liability defense attorney and partner at McCormick Barstow, LLP, in Fresno, Calif. Most doctors may not realize they can typically choose from a panel of attorneys used by their insurer, he said. Physicians can also ask to view the attorney panel and conduct their own research before requesting a specific lawyer.

Mr. Ball counsels his clients to focus only on the task at hand during each stage of a lawsuit, rather than worry about future phases or a possible trial. For example, during the deposition stage, physicians should prepare by understanding the deposition’s purpose, reading through the record, and being clear on what questions may be asked. A deposition is a witness’s sworn, out-of-court testimony used to gather information as part of the discovery process.

"Some [physicians] don’t review the record as closely as they should," he said. "There’s no substitute for real preparation."

Additionally, depositions are a stage in which a physician’s emotions may come bubbling to the surface, notes Angela Dodge, Ph.D., founding partner of Dodge Consulting & Publications, LLP, a litigation consulting firm in the Seattle-Tacoma area.

"A doctor may go into a deposition feeling very angry and resentful because a patient they believe they gave good care to is now suing," said Ms. Dodge, author of the book "When Good Doctors Get Sued: A Practical Guide for Physicians Involved in Malpractice Lawsuits, and Winning at Jury Selection." "We counsel them on the importance of setting that aside because it could interfere with" their success.

Negative emotions by doctors may be interpreted by plaintiffs’ attorneys as guilt or defensiveness and used to fuel their claims, she said. Doctors should also focus only on the questions being asked during a deposition and not offer up any further or additional information. For instance, in a recent case, a doctor was asked about a specific part of his education. In response, the physician provided unnecessary information about his entire medical education, including his experience operating on pigs, how pig anatomy is relevant to human medicine, and other needless details, Ms. Dodge said.

"He was so anxious to explain how he gained his expertise; he forgot that the question was [only] where and when he gained his expertise," she said.

Litigation counselors point to strong cooperation among physicians, insurers, and defense attorneys as one of the most vital components to the successful handling of a lawsuit.

"The legal system can be a very daunting place for physicians, but when the malpractice carrier and defense attorney work together as a team, they can help the physician navigate the process and hopefully win the case," Mr. Mitcham said.

Receiving notice that a patient is suing can spark a range of emotions in physicians, including fear, anger, hurt, and helplessness. But litigation experts stress that after a filing, physicians must rein in their feelings and focus on immediate next steps – crucial actions that can significantly impact the suit and its outcome.

"Doctors have two reactions to getting sued – either they’re very sad or they’re very angry," said Steven Fitzer, a medical liability defense attorney at Fitzer, Leighton & Fitzer, P.S., in Tacoma, Wash., and former chair of the Washington State Bar Association Litigation Section. "Relaxing and composing yourself are important because a lawsuit is a marathon – not a sprint."

American Medical Association data show 60% of physicians will be sued by the time they reach 55 years of age. The average span of a medical malpractice claim from start to close is generally about 2.5 years, although many suits progress longer. While most medical liability claims do not end in trial, defense attorneys say knowing how to respond to a lawsuit can raise doctors’ chances of a quicker, more ideal resolution.

First and foremost, physicians should notify their malpractice insurance carrier as soon as possible after lawsuit papers are served, said Matt Mitcham, senior vice president of claims for MagMutual Insurance Company, a medical liability insurer that operates in the Southeast. Employed physicians should immediately alert their risk management department.

"All suits have a limited time for providing a response, and there are severe consequences for not meeting these deadlines," Mr. Mitcham said. "In addition, physicians need to provide their defense team with as much time as possible to prepare a response."

Doctors should resist the desire to contact patients or their families in an attempt to work out the situation themselves, adds Mr. Fitzer, who recently shared lawsuit preparation tips in two video playlists for The Doctors Company, a national medical malpractice insurer.

Another action to avoid after a lawsuit filing is making additions or changes to patient records, said Mr. Mitcham.

"The original records should never be altered under any circumstance," he said. "Today’s forensic specialists are experts in identifying changes, and by altering records, a physician can potentially turn a defensible case into one that is indefensible."

Securing an attorney that doctors trust and with whom they can aptly communicate is also essential, said Michael F. Ball, a medical liability defense attorney and partner at McCormick Barstow, LLP, in Fresno, Calif. Most doctors may not realize they can typically choose from a panel of attorneys used by their insurer, he said. Physicians can also ask to view the attorney panel and conduct their own research before requesting a specific lawyer.

Mr. Ball counsels his clients to focus only on the task at hand during each stage of a lawsuit, rather than worry about future phases or a possible trial. For example, during the deposition stage, physicians should prepare by understanding the deposition’s purpose, reading through the record, and being clear on what questions may be asked. A deposition is a witness’s sworn, out-of-court testimony used to gather information as part of the discovery process.

"Some [physicians] don’t review the record as closely as they should," he said. "There’s no substitute for real preparation."

Additionally, depositions are a stage in which a physician’s emotions may come bubbling to the surface, notes Angela Dodge, Ph.D., founding partner of Dodge Consulting & Publications, LLP, a litigation consulting firm in the Seattle-Tacoma area.

"A doctor may go into a deposition feeling very angry and resentful because a patient they believe they gave good care to is now suing," said Ms. Dodge, author of the book "When Good Doctors Get Sued: A Practical Guide for Physicians Involved in Malpractice Lawsuits, and Winning at Jury Selection." "We counsel them on the importance of setting that aside because it could interfere with" their success.

Negative emotions by doctors may be interpreted by plaintiffs’ attorneys as guilt or defensiveness and used to fuel their claims, she said. Doctors should also focus only on the questions being asked during a deposition and not offer up any further or additional information. For instance, in a recent case, a doctor was asked about a specific part of his education. In response, the physician provided unnecessary information about his entire medical education, including his experience operating on pigs, how pig anatomy is relevant to human medicine, and other needless details, Ms. Dodge said.

"He was so anxious to explain how he gained his expertise; he forgot that the question was [only] where and when he gained his expertise," she said.

Litigation counselors point to strong cooperation among physicians, insurers, and defense attorneys as one of the most vital components to the successful handling of a lawsuit.

"The legal system can be a very daunting place for physicians, but when the malpractice carrier and defense attorney work together as a team, they can help the physician navigate the process and hopefully win the case," Mr. Mitcham said.

Receiving notice that a patient is suing can spark a range of emotions in physicians, including fear, anger, hurt, and helplessness. But litigation experts stress that after a filing, physicians must rein in their feelings and focus on immediate next steps – crucial actions that can significantly impact the suit and its outcome.

"Doctors have two reactions to getting sued – either they’re very sad or they’re very angry," said Steven Fitzer, a medical liability defense attorney at Fitzer, Leighton & Fitzer, P.S., in Tacoma, Wash., and former chair of the Washington State Bar Association Litigation Section. "Relaxing and composing yourself are important because a lawsuit is a marathon – not a sprint."

American Medical Association data show 60% of physicians will be sued by the time they reach 55 years of age. The average span of a medical malpractice claim from start to close is generally about 2.5 years, although many suits progress longer. While most medical liability claims do not end in trial, defense attorneys say knowing how to respond to a lawsuit can raise doctors’ chances of a quicker, more ideal resolution.

First and foremost, physicians should notify their malpractice insurance carrier as soon as possible after lawsuit papers are served, said Matt Mitcham, senior vice president of claims for MagMutual Insurance Company, a medical liability insurer that operates in the Southeast. Employed physicians should immediately alert their risk management department.

"All suits have a limited time for providing a response, and there are severe consequences for not meeting these deadlines," Mr. Mitcham said. "In addition, physicians need to provide their defense team with as much time as possible to prepare a response."

Doctors should resist the desire to contact patients or their families in an attempt to work out the situation themselves, adds Mr. Fitzer, who recently shared lawsuit preparation tips in two video playlists for The Doctors Company, a national medical malpractice insurer.

Another action to avoid after a lawsuit filing is making additions or changes to patient records, said Mr. Mitcham.

"The original records should never be altered under any circumstance," he said. "Today’s forensic specialists are experts in identifying changes, and by altering records, a physician can potentially turn a defensible case into one that is indefensible."

Securing an attorney that doctors trust and with whom they can aptly communicate is also essential, said Michael F. Ball, a medical liability defense attorney and partner at McCormick Barstow, LLP, in Fresno, Calif. Most doctors may not realize they can typically choose from a panel of attorneys used by their insurer, he said. Physicians can also ask to view the attorney panel and conduct their own research before requesting a specific lawyer.

Mr. Ball counsels his clients to focus only on the task at hand during each stage of a lawsuit, rather than worry about future phases or a possible trial. For example, during the deposition stage, physicians should prepare by understanding the deposition’s purpose, reading through the record, and being clear on what questions may be asked. A deposition is a witness’s sworn, out-of-court testimony used to gather information as part of the discovery process.

"Some [physicians] don’t review the record as closely as they should," he said. "There’s no substitute for real preparation."

Additionally, depositions are a stage in which a physician’s emotions may come bubbling to the surface, notes Angela Dodge, Ph.D., founding partner of Dodge Consulting & Publications, LLP, a litigation consulting firm in the Seattle-Tacoma area.

"A doctor may go into a deposition feeling very angry and resentful because a patient they believe they gave good care to is now suing," said Ms. Dodge, author of the book "When Good Doctors Get Sued: A Practical Guide for Physicians Involved in Malpractice Lawsuits, and Winning at Jury Selection." "We counsel them on the importance of setting that aside because it could interfere with" their success.

Negative emotions by doctors may be interpreted by plaintiffs’ attorneys as guilt or defensiveness and used to fuel their claims, she said. Doctors should also focus only on the questions being asked during a deposition and not offer up any further or additional information. For instance, in a recent case, a doctor was asked about a specific part of his education. In response, the physician provided unnecessary information about his entire medical education, including his experience operating on pigs, how pig anatomy is relevant to human medicine, and other needless details, Ms. Dodge said.

"He was so anxious to explain how he gained his expertise; he forgot that the question was [only] where and when he gained his expertise," she said.

Litigation counselors point to strong cooperation among physicians, insurers, and defense attorneys as one of the most vital components to the successful handling of a lawsuit.

"The legal system can be a very daunting place for physicians, but when the malpractice carrier and defense attorney work together as a team, they can help the physician navigate the process and hopefully win the case," Mr. Mitcham said.

When it comes to ID theft, "someone out there is going after doctors," according to Rafal Subernat, D.O.

"And we’ve done nothing wrong," added Dr. Subernat, an anesthesiologist in Bangor, Maine, who’s identity was stolen this year at tax time.

Dr. Subernat and his wife thought it was peculiar when earlier this year they attempted to file their taxes electronically and the return was inexplicably rejected.

They subsequently filed by paper. But 2 weeks later, a debit-like card that Dr. Subernat had never ordered arrived in the mail. When he called the issuer, an operator explained the prepaid tax refund card was opened in Dr. Subernat’s name, and that its original $10,000 balance was now at $10.

"It was already too late at that point, because the money was gone," said Dr. Subernat, who discovered his social security number had been used to file a fraudulent tax return. "Emotionally, now you’re worried, where is my information? Where is my social security number? Is it going to happen next year again?"

Dr. Subernat’s story is mirrored by hundreds of physicians across the country who have become victims of tax fraud this year. Medical providers in 49 states and the District of Columbia have reported identity theft in 2014, including at least 50 physicians in Maine, 135 in Indiana, 192 in New Hampshire, 100 in Connecticut, 34 in Vermont, and 100 in North Carolina, according to estimated numbers provided by state medical associations. The widespread physician ID theft has led to a collaborative investigation by the IRS, the Federal Bureau of Investigation, and the Secret Service. At this article’s deadline, the source of the multistate ID theft had not been identified.

"What is happening is very concerning," said Scott G. Colby, executive vice president for the New Hampshire Medical Society. "We had a handful of people report this happened to them last year, but this year, it’s a significant amount. We’ve never before heard about this" scope of physician ID theft.

Like Dr. Subernat, most physicians learn of the fraud when their tax returns are rejected. In some cases, debit cards are issued in the doctor’s name or bank accounts are fraudulently opened to obtain tax returns. One of the most troubling aspects of the theft is the potential for the stolen personal information to be used for further fraud such as medical identity theft, said Matthew Katz, CEO of the Connecticut State Medical Society.

"When you have a physician’s social security number, name and address, you could potentially do other damaging things related to their identity and their medical practice," Mr. Katz said. "Physicians have concerns that [their] information could be used in some way to falsify claim submissions to the government or even worse, trying to procure medications inappropriately."

Dr. Subernat recommended that all physicians check the IRS website and review their transcripts to learn if they have been a fraud victim (www.irs.gov/Individuals/Get-Transcript). Physicians should also keep their eye out for any unusual amount of credit card offers in the mail, Mr. Katz said. A higher frequency of bank card offers and mailings could be a sign that someone is using their identity, he said.

Physicians are also reporting calls from unknown individuals who purport to be from the IRS and want them to disclose personal information so they can "check" if they are a fraud victim. The callers are believed to be piggybacking on the initial fraud crime in an attempt to fool more victims.

"We’ve cautioned our physicians not to provide information to anyone they do not know," Mr. Katz said. "Physicians should remain vigilant and cautious."

If doctors believe their identity has been stolen, the IRS encourages them to immediately report the identity theft to the agency, along with local police and the Federal Trade Commission (www.irs.gov/uac/Newsroom/Tips-for-Taxpayers,-Victims-about-Identity-Theft-and-Tax-Returns). Physicians should also contact credit reporting companies and place a 90-day fraud alert on their credit report, Mr. Colby said. The hold makes it more difficult for thieves to open accounts in the victim’s name (www.consumer.ftc.gov/articles/0275-place-fraud-alert).

Dr. Subernat was provided a secure IRS PIN for future tax return filings. He noted that physicians who believe they are ID theft victims or those who want to prevent the occurrence can contact the IRS about receiving a PIN (www.irs.gov/uac/Get-An-Identity-Protection-PIN).

As for identifying and preventing medical identity theft, physicians should make an effort to review their insurance billings and enrollment records, said Dr. Shantanu Agrawal, deputy administrator and director for the Centers for Medicare & Medicaid Services Center for Program Integrity (CPI). Medical ID theft occurs when a doctor’s personal information is stolen to obtain medical care, buy drugs, or submit fake billings to Medicare (https://oig.hhs.gov/fraud/medical-id-theft/). Doctors can request a copy of their billings from insurers as well as review their Medicare enrollment information, Dr. Agrawal said.

"Ask for your billings and make sure nothing is in your name that you didn’t bill," he said. "With Medicare, we have a system that tracks all of the enrollment information. Physicians can access this information any time to make sure enrollment information is true."

Safeguarding all personal information and being cognizant of any inappropriate activity is critical to avoiding ID theft, Dr. Agrawal said.

"It’s very good for physicians to be focused on prevention and to be aware of these issues," he said.

When it comes to ID theft, "someone out there is going after doctors," according to Rafal Subernat, D.O.

"And we’ve done nothing wrong," added Dr. Subernat, an anesthesiologist in Bangor, Maine, who’s identity was stolen this year at tax time.

Dr. Subernat and his wife thought it was peculiar when earlier this year they attempted to file their taxes electronically and the return was inexplicably rejected.

They subsequently filed by paper. But 2 weeks later, a debit-like card that Dr. Subernat had never ordered arrived in the mail. When he called the issuer, an operator explained the prepaid tax refund card was opened in Dr. Subernat’s name, and that its original $10,000 balance was now at $10.

"It was already too late at that point, because the money was gone," said Dr. Subernat, who discovered his social security number had been used to file a fraudulent tax return. "Emotionally, now you’re worried, where is my information? Where is my social security number? Is it going to happen next year again?"

Dr. Subernat’s story is mirrored by hundreds of physicians across the country who have become victims of tax fraud this year. Medical providers in 49 states and the District of Columbia have reported identity theft in 2014, including at least 50 physicians in Maine, 135 in Indiana, 192 in New Hampshire, 100 in Connecticut, 34 in Vermont, and 100 in North Carolina, according to estimated numbers provided by state medical associations. The widespread physician ID theft has led to a collaborative investigation by the IRS, the Federal Bureau of Investigation, and the Secret Service. At this article’s deadline, the source of the multistate ID theft had not been identified.

"What is happening is very concerning," said Scott G. Colby, executive vice president for the New Hampshire Medical Society. "We had a handful of people report this happened to them last year, but this year, it’s a significant amount. We’ve never before heard about this" scope of physician ID theft.

Like Dr. Subernat, most physicians learn of the fraud when their tax returns are rejected. In some cases, debit cards are issued in the doctor’s name or bank accounts are fraudulently opened to obtain tax returns. One of the most troubling aspects of the theft is the potential for the stolen personal information to be used for further fraud such as medical identity theft, said Matthew Katz, CEO of the Connecticut State Medical Society.

"When you have a physician’s social security number, name and address, you could potentially do other damaging things related to their identity and their medical practice," Mr. Katz said. "Physicians have concerns that [their] information could be used in some way to falsify claim submissions to the government or even worse, trying to procure medications inappropriately."

Dr. Subernat recommended that all physicians check the IRS website and review their transcripts to learn if they have been a fraud victim (www.irs.gov/Individuals/Get-Transcript). Physicians should also keep their eye out for any unusual amount of credit card offers in the mail, Mr. Katz said. A higher frequency of bank card offers and mailings could be a sign that someone is using their identity, he said.

Physicians are also reporting calls from unknown individuals who purport to be from the IRS and want them to disclose personal information so they can "check" if they are a fraud victim. The callers are believed to be piggybacking on the initial fraud crime in an attempt to fool more victims.

"We’ve cautioned our physicians not to provide information to anyone they do not know," Mr. Katz said. "Physicians should remain vigilant and cautious."

If doctors believe their identity has been stolen, the IRS encourages them to immediately report the identity theft to the agency, along with local police and the Federal Trade Commission (www.irs.gov/uac/Newsroom/Tips-for-Taxpayers,-Victims-about-Identity-Theft-and-Tax-Returns). Physicians should also contact credit reporting companies and place a 90-day fraud alert on their credit report, Mr. Colby said. The hold makes it more difficult for thieves to open accounts in the victim’s name (www.consumer.ftc.gov/articles/0275-place-fraud-alert).

Dr. Subernat was provided a secure IRS PIN for future tax return filings. He noted that physicians who believe they are ID theft victims or those who want to prevent the occurrence can contact the IRS about receiving a PIN (www.irs.gov/uac/Get-An-Identity-Protection-PIN).

As for identifying and preventing medical identity theft, physicians should make an effort to review their insurance billings and enrollment records, said Dr. Shantanu Agrawal, deputy administrator and director for the Centers for Medicare & Medicaid Services Center for Program Integrity (CPI). Medical ID theft occurs when a doctor’s personal information is stolen to obtain medical care, buy drugs, or submit fake billings to Medicare (https://oig.hhs.gov/fraud/medical-id-theft/). Doctors can request a copy of their billings from insurers as well as review their Medicare enrollment information, Dr. Agrawal said.

"Ask for your billings and make sure nothing is in your name that you didn’t bill," he said. "With Medicare, we have a system that tracks all of the enrollment information. Physicians can access this information any time to make sure enrollment information is true."

Safeguarding all personal information and being cognizant of any inappropriate activity is critical to avoiding ID theft, Dr. Agrawal said.

"It’s very good for physicians to be focused on prevention and to be aware of these issues," he said.

When it comes to ID theft, "someone out there is going after doctors," according to Rafal Subernat, D.O.

"And we’ve done nothing wrong," added Dr. Subernat, an anesthesiologist in Bangor, Maine, who’s identity was stolen this year at tax time.

Dr. Subernat and his wife thought it was peculiar when earlier this year they attempted to file their taxes electronically and the return was inexplicably rejected.

They subsequently filed by paper. But 2 weeks later, a debit-like card that Dr. Subernat had never ordered arrived in the mail. When he called the issuer, an operator explained the prepaid tax refund card was opened in Dr. Subernat’s name, and that its original $10,000 balance was now at $10.

"It was already too late at that point, because the money was gone," said Dr. Subernat, who discovered his social security number had been used to file a fraudulent tax return. "Emotionally, now you’re worried, where is my information? Where is my social security number? Is it going to happen next year again?"

Dr. Subernat’s story is mirrored by hundreds of physicians across the country who have become victims of tax fraud this year. Medical providers in 49 states and the District of Columbia have reported identity theft in 2014, including at least 50 physicians in Maine, 135 in Indiana, 192 in New Hampshire, 100 in Connecticut, 34 in Vermont, and 100 in North Carolina, according to estimated numbers provided by state medical associations. The widespread physician ID theft has led to a collaborative investigation by the IRS, the Federal Bureau of Investigation, and the Secret Service. At this article’s deadline, the source of the multistate ID theft had not been identified.

"What is happening is very concerning," said Scott G. Colby, executive vice president for the New Hampshire Medical Society. "We had a handful of people report this happened to them last year, but this year, it’s a significant amount. We’ve never before heard about this" scope of physician ID theft.

Like Dr. Subernat, most physicians learn of the fraud when their tax returns are rejected. In some cases, debit cards are issued in the doctor’s name or bank accounts are fraudulently opened to obtain tax returns. One of the most troubling aspects of the theft is the potential for the stolen personal information to be used for further fraud such as medical identity theft, said Matthew Katz, CEO of the Connecticut State Medical Society.

"When you have a physician’s social security number, name and address, you could potentially do other damaging things related to their identity and their medical practice," Mr. Katz said. "Physicians have concerns that [their] information could be used in some way to falsify claim submissions to the government or even worse, trying to procure medications inappropriately."

Dr. Subernat recommended that all physicians check the IRS website and review their transcripts to learn if they have been a fraud victim (www.irs.gov/Individuals/Get-Transcript). Physicians should also keep their eye out for any unusual amount of credit card offers in the mail, Mr. Katz said. A higher frequency of bank card offers and mailings could be a sign that someone is using their identity, he said.

Physicians are also reporting calls from unknown individuals who purport to be from the IRS and want them to disclose personal information so they can "check" if they are a fraud victim. The callers are believed to be piggybacking on the initial fraud crime in an attempt to fool more victims.

"We’ve cautioned our physicians not to provide information to anyone they do not know," Mr. Katz said. "Physicians should remain vigilant and cautious."

If doctors believe their identity has been stolen, the IRS encourages them to immediately report the identity theft to the agency, along with local police and the Federal Trade Commission (www.irs.gov/uac/Newsroom/Tips-for-Taxpayers,-Victims-about-Identity-Theft-and-Tax-Returns). Physicians should also contact credit reporting companies and place a 90-day fraud alert on their credit report, Mr. Colby said. The hold makes it more difficult for thieves to open accounts in the victim’s name (www.consumer.ftc.gov/articles/0275-place-fraud-alert).

Dr. Subernat was provided a secure IRS PIN for future tax return filings. He noted that physicians who believe they are ID theft victims or those who want to prevent the occurrence can contact the IRS about receiving a PIN (www.irs.gov/uac/Get-An-Identity-Protection-PIN).

As for identifying and preventing medical identity theft, physicians should make an effort to review their insurance billings and enrollment records, said Dr. Shantanu Agrawal, deputy administrator and director for the Centers for Medicare & Medicaid Services Center for Program Integrity (CPI). Medical ID theft occurs when a doctor’s personal information is stolen to obtain medical care, buy drugs, or submit fake billings to Medicare (https://oig.hhs.gov/fraud/medical-id-theft/). Doctors can request a copy of their billings from insurers as well as review their Medicare enrollment information, Dr. Agrawal said.

"Ask for your billings and make sure nothing is in your name that you didn’t bill," he said. "With Medicare, we have a system that tracks all of the enrollment information. Physicians can access this information any time to make sure enrollment information is true."

Safeguarding all personal information and being cognizant of any inappropriate activity is critical to avoiding ID theft, Dr. Agrawal said.

"It’s very good for physicians to be focused on prevention and to be aware of these issues," he said.

The recent upsurge in medical and recreational marijuana laws is creating novel public health concerns for physicians, health advocates, and state regulators alike. Implications of the new laws include packaging risks, accessibility to children, dosage dangers, and the potential for greater drug-related traffic injuries.

Now "is really the time for public health [leaders] to engage on some of these issues" surrounding changes in state laws regarding marijuana use, Colorado Assistant Attorney General Eric Kuhn said during an American Society of Law, Medicine, and Ethics webinar on the expansion of medical marijuana laws. Twenty-one states and the District of Columbia have legalized medical marijuana, and eight other states are considering legislation in 2014. Two states – Colorado and Washington – have legalized recreational use of marijuana. Most recently, Florida legislators overwhelmingly voted in May to legalize a strain of marijuana for limited medicinal use. The bill is now in the hands of Florida Gov. Rick Scott.

Courtesy Wikimedia Commons/Coaster420/Creative Commons License

Health challenges include how best to regulate the drug and to ensure that accessibility does not lead to related harms. Purity and packaging of marijuana are already posing significant worries for states that allow use of the drug, said Mr. Kuhn, who is a National Attorneys General Training and Research Institute/Robert Wood Johnson Foundation public health fellow and the author of a paper about public health issues related to marijuana legalization.

Marijuana samples "have been found to be contaminated with pesticides, herbicides, mold, fungus, bacteria, viruses and other contaminants," he said. Further, "a public health department can’t certify that a product, inherently adulterated with a schedule I substance, is pure."

"The emerging hazards of edibles [are] just beginning to get recognition," Gordon Smith, professor of epidemiology and public health at the University of Maryland, Baltimore, said during the webinar. Of particular concern is the inability to regulate dose. "The standard dose might be an eighth of a brownie. ... Who on earth eats an eighth of a brownie?

Edibles also pose driving risks. "You may start driving and feel fine and then a half an hour later, once the edible starts to get absorbed and have an effect, you start to become very intoxicated," Mr. Smith said. "You really can’t control the dosage."

Some marijuana packages have been labeled to resemble candy and have names similar to those of candy bars. A 2013 analysis of a large Colorado children’s hospital showed that before Sept. 30, 2009, there were zero cases of marijuana ingestion by pediatric patients. After that time, there were 14 cases of marijuana ingestions by children at the hospital, according to a study published in JAMA Pediatrics (2013;167:630-3). The study was conducted before the state’s January recreational marijuana law went into effect but after medical marijuana was decriminalized.

Physicians and health centers are integral to research and safety analyses of medical and recreational marijuana use, health experts said. For instance, more marijuana testing of injured patients by emergency care providers is necessary to determine the role cannabis is playing in traffic crashes, Mr. Smith said.

The recent upsurge in medical and recreational marijuana laws is creating novel public health concerns for physicians, health advocates, and state regulators alike. Implications of the new laws include packaging risks, accessibility to children, dosage dangers, and the potential for greater drug-related traffic injuries.

Now "is really the time for public health [leaders] to engage on some of these issues" surrounding changes in state laws regarding marijuana use, Colorado Assistant Attorney General Eric Kuhn said during an American Society of Law, Medicine, and Ethics webinar on the expansion of medical marijuana laws. Twenty-one states and the District of Columbia have legalized medical marijuana, and eight other states are considering legislation in 2014. Two states – Colorado and Washington – have legalized recreational use of marijuana. Most recently, Florida legislators overwhelmingly voted in May to legalize a strain of marijuana for limited medicinal use. The bill is now in the hands of Florida Gov. Rick Scott.

Courtesy Wikimedia Commons/Coaster420/Creative Commons License

Health challenges include how best to regulate the drug and to ensure that accessibility does not lead to related harms. Purity and packaging of marijuana are already posing significant worries for states that allow use of the drug, said Mr. Kuhn, who is a National Attorneys General Training and Research Institute/Robert Wood Johnson Foundation public health fellow and the author of a paper about public health issues related to marijuana legalization.

Marijuana samples "have been found to be contaminated with pesticides, herbicides, mold, fungus, bacteria, viruses and other contaminants," he said. Further, "a public health department can’t certify that a product, inherently adulterated with a schedule I substance, is pure."

"The emerging hazards of edibles [are] just beginning to get recognition," Gordon Smith, professor of epidemiology and public health at the University of Maryland, Baltimore, said during the webinar. Of particular concern is the inability to regulate dose. "The standard dose might be an eighth of a brownie. ... Who on earth eats an eighth of a brownie?

Edibles also pose driving risks. "You may start driving and feel fine and then a half an hour later, once the edible starts to get absorbed and have an effect, you start to become very intoxicated," Mr. Smith said. "You really can’t control the dosage."

Some marijuana packages have been labeled to resemble candy and have names similar to those of candy bars. A 2013 analysis of a large Colorado children’s hospital showed that before Sept. 30, 2009, there were zero cases of marijuana ingestion by pediatric patients. After that time, there were 14 cases of marijuana ingestions by children at the hospital, according to a study published in JAMA Pediatrics (2013;167:630-3). The study was conducted before the state’s January recreational marijuana law went into effect but after medical marijuana was decriminalized.

Physicians and health centers are integral to research and safety analyses of medical and recreational marijuana use, health experts said. For instance, more marijuana testing of injured patients by emergency care providers is necessary to determine the role cannabis is playing in traffic crashes, Mr. Smith said.

The recent upsurge in medical and recreational marijuana laws is creating novel public health concerns for physicians, health advocates, and state regulators alike. Implications of the new laws include packaging risks, accessibility to children, dosage dangers, and the potential for greater drug-related traffic injuries.

Now "is really the time for public health [leaders] to engage on some of these issues" surrounding changes in state laws regarding marijuana use, Colorado Assistant Attorney General Eric Kuhn said during an American Society of Law, Medicine, and Ethics webinar on the expansion of medical marijuana laws. Twenty-one states and the District of Columbia have legalized medical marijuana, and eight other states are considering legislation in 2014. Two states – Colorado and Washington – have legalized recreational use of marijuana. Most recently, Florida legislators overwhelmingly voted in May to legalize a strain of marijuana for limited medicinal use. The bill is now in the hands of Florida Gov. Rick Scott.

Courtesy Wikimedia Commons/Coaster420/Creative Commons License

Health challenges include how best to regulate the drug and to ensure that accessibility does not lead to related harms. Purity and packaging of marijuana are already posing significant worries for states that allow use of the drug, said Mr. Kuhn, who is a National Attorneys General Training and Research Institute/Robert Wood Johnson Foundation public health fellow and the author of a paper about public health issues related to marijuana legalization.

Marijuana samples "have been found to be contaminated with pesticides, herbicides, mold, fungus, bacteria, viruses and other contaminants," he said. Further, "a public health department can’t certify that a product, inherently adulterated with a schedule I substance, is pure."

"The emerging hazards of edibles [are] just beginning to get recognition," Gordon Smith, professor of epidemiology and public health at the University of Maryland, Baltimore, said during the webinar. Of particular concern is the inability to regulate dose. "The standard dose might be an eighth of a brownie. ... Who on earth eats an eighth of a brownie?

Edibles also pose driving risks. "You may start driving and feel fine and then a half an hour later, once the edible starts to get absorbed and have an effect, you start to become very intoxicated," Mr. Smith said. "You really can’t control the dosage."

Some marijuana packages have been labeled to resemble candy and have names similar to those of candy bars. A 2013 analysis of a large Colorado children’s hospital showed that before Sept. 30, 2009, there were zero cases of marijuana ingestion by pediatric patients. After that time, there were 14 cases of marijuana ingestions by children at the hospital, according to a study published in JAMA Pediatrics (2013;167:630-3). The study was conducted before the state’s January recreational marijuana law went into effect but after medical marijuana was decriminalized.

Physicians and health centers are integral to research and safety analyses of medical and recreational marijuana use, health experts said. For instance, more marijuana testing of injured patients by emergency care providers is necessary to determine the role cannabis is playing in traffic crashes, Mr. Smith said.

CHICAGO – A new HIPAA rule means physicians face broader liability for protected health information breaches by their business associates.

The final omnibus rule on the Health Insurance Portability and Accountability Act broadens the definition of who and what is considered a business associate and places more responsibility on doctors for protected health information (PHI) acts or omissions by such associates.

About "28%-49% of breaches in the health care industry are associated with business associates and how they’re using data," health law attorney Clinton R. Mikel said at a physicians’ legal issues conference held by the American Bar Association.

"It’s important to know who your business associates are, how you’re [interacting] with them and what they’re doing with your data."

The final HIPAA omnibus rule went into effect in September 2013, but allowed covered entities and businesses to continue operating under some existing contracts for up to 1 year. Grandfathered business agreements must be revised to meet the new HIPAA requirements by Sept. 22, 2014.

Under the omnibus rule, a business associate is defined as any person or entity that creates, receives, maintains, or transmits PHI on behalf of a covered entity. The regulation means that business associates now include patient safety organizations, data transmission organizations, personal health record vendors, entities that transmit and need routine access to PHI, and data storage vendors – paper based and cloud based.

On physicians’ immediate checklist of things to be reviewed and updated is their existing business-associate agreement template, said Mr. Mikel, a partner at The Health Law Partners, PC, in Southfield, Mich. The revised agreement should ensure that associates comply with all measures of the Security Rule for electronic PHI and that business associates report any breach of unsecured PHI.

In addition, business associates should enter into contracts only with subcontractors that comply with such agreements and restrict subcontractors from disclosing PHI in an inappropriate manner.

Distribute the new template as soon as possible for all new contracts and evaluate outstanding business associate relationships, Mr. Mikel advised.

Proper data security from cloud-based vendors is especially important in light of the new HIPAA rule, said Hemant Pathak, assistant general counsel for Microsoft. Make certain they are told where and how their data is stored in "the cloud" and have clear data maps and geographic boundary information.

Vendors should be "transparent about what their operations are, have a breach procedure, and be willing to share" their policies, Mr. Pathak added. "It should not be something that is obtuse. It should be something that is clear and transparent."

Under the omnibus rule, both the doctor and vendor are on the hook if PHI is exposed.

"It’s important for both of us in protecting our reputations and understanding what the needs are from a compliance" standpoint, Mr. Pathak said.

CHICAGO – A new HIPAA rule means physicians face broader liability for protected health information breaches by their business associates.

The final omnibus rule on the Health Insurance Portability and Accountability Act broadens the definition of who and what is considered a business associate and places more responsibility on doctors for protected health information (PHI) acts or omissions by such associates.

About "28%-49% of breaches in the health care industry are associated with business associates and how they’re using data," health law attorney Clinton R. Mikel said at a physicians’ legal issues conference held by the American Bar Association.

"It’s important to know who your business associates are, how you’re [interacting] with them and what they’re doing with your data."

The final HIPAA omnibus rule went into effect in September 2013, but allowed covered entities and businesses to continue operating under some existing contracts for up to 1 year. Grandfathered business agreements must be revised to meet the new HIPAA requirements by Sept. 22, 2014.

Under the omnibus rule, a business associate is defined as any person or entity that creates, receives, maintains, or transmits PHI on behalf of a covered entity. The regulation means that business associates now include patient safety organizations, data transmission organizations, personal health record vendors, entities that transmit and need routine access to PHI, and data storage vendors – paper based and cloud based.

On physicians’ immediate checklist of things to be reviewed and updated is their existing business-associate agreement template, said Mr. Mikel, a partner at The Health Law Partners, PC, in Southfield, Mich. The revised agreement should ensure that associates comply with all measures of the Security Rule for electronic PHI and that business associates report any breach of unsecured PHI.

In addition, business associates should enter into contracts only with subcontractors that comply with such agreements and restrict subcontractors from disclosing PHI in an inappropriate manner.

Distribute the new template as soon as possible for all new contracts and evaluate outstanding business associate relationships, Mr. Mikel advised.

Proper data security from cloud-based vendors is especially important in light of the new HIPAA rule, said Hemant Pathak, assistant general counsel for Microsoft. Make certain they are told where and how their data is stored in "the cloud" and have clear data maps and geographic boundary information.

Vendors should be "transparent about what their operations are, have a breach procedure, and be willing to share" their policies, Mr. Pathak added. "It should not be something that is obtuse. It should be something that is clear and transparent."

Under the omnibus rule, both the doctor and vendor are on the hook if PHI is exposed.

"It’s important for both of us in protecting our reputations and understanding what the needs are from a compliance" standpoint, Mr. Pathak said.

CHICAGO – A new HIPAA rule means physicians face broader liability for protected health information breaches by their business associates.

The final omnibus rule on the Health Insurance Portability and Accountability Act broadens the definition of who and what is considered a business associate and places more responsibility on doctors for protected health information (PHI) acts or omissions by such associates.

About "28%-49% of breaches in the health care industry are associated with business associates and how they’re using data," health law attorney Clinton R. Mikel said at a physicians’ legal issues conference held by the American Bar Association.

"It’s important to know who your business associates are, how you’re [interacting] with them and what they’re doing with your data."

The final HIPAA omnibus rule went into effect in September 2013, but allowed covered entities and businesses to continue operating under some existing contracts for up to 1 year. Grandfathered business agreements must be revised to meet the new HIPAA requirements by Sept. 22, 2014.

Under the omnibus rule, a business associate is defined as any person or entity that creates, receives, maintains, or transmits PHI on behalf of a covered entity. The regulation means that business associates now include patient safety organizations, data transmission organizations, personal health record vendors, entities that transmit and need routine access to PHI, and data storage vendors – paper based and cloud based.

On physicians’ immediate checklist of things to be reviewed and updated is their existing business-associate agreement template, said Mr. Mikel, a partner at The Health Law Partners, PC, in Southfield, Mich. The revised agreement should ensure that associates comply with all measures of the Security Rule for electronic PHI and that business associates report any breach of unsecured PHI.

In addition, business associates should enter into contracts only with subcontractors that comply with such agreements and restrict subcontractors from disclosing PHI in an inappropriate manner.

Distribute the new template as soon as possible for all new contracts and evaluate outstanding business associate relationships, Mr. Mikel advised.

Proper data security from cloud-based vendors is especially important in light of the new HIPAA rule, said Hemant Pathak, assistant general counsel for Microsoft. Make certain they are told where and how their data is stored in "the cloud" and have clear data maps and geographic boundary information.

Vendors should be "transparent about what their operations are, have a breach procedure, and be willing to share" their policies, Mr. Pathak added. "It should not be something that is obtuse. It should be something that is clear and transparent."

Under the omnibus rule, both the doctor and vendor are on the hook if PHI is exposed.

"It’s important for both of us in protecting our reputations and understanding what the needs are from a compliance" standpoint, Mr. Pathak said.

Fifty-six percent of uninsured patients in the United States are now eligible for financial assistance with insurance coverage through Medicaid, the Children\'s Health Insurance Program, or subsidized private coverage under the Affordable Care Act, according to a report from the Robert Wood Johnson Foundation and the Urban Institute.

The analysis estimates the ACA ultimately will lead to more than 27 million previously uninsured patients gaining health insurance coverage by 2016.

In states that have expanded Medicaid eligibility under the ACA, 68% of the uninsured have become eligible for assistance, compared with 44% of newly eligible patients in states that have not expanded Medicaid.

Significant state variation remains in the number of uninsured newly eligible for financial assistance. West Virginia tops the list with a high of 83% of the formerly uninsured now covered, while Texas has the lowest number of newly insured at 40%.

"Financial assistance is a big factor in whether or not an individual obtains health insurance under the Affordable Care Act," said Katherine Hempstead, Robert Wood Johnson Foundation team director and senior program officer. "Early data suggest that the [uninsured] rate in states that expanded Medicaid has dropped more sharply than in states that decided against the expansion."

Fifty-six percent of uninsured patients in the United States are now eligible for financial assistance with insurance coverage through Medicaid, the Children\'s Health Insurance Program, or subsidized private coverage under the Affordable Care Act, according to a report from the Robert Wood Johnson Foundation and the Urban Institute.

The analysis estimates the ACA ultimately will lead to more than 27 million previously uninsured patients gaining health insurance coverage by 2016.

In states that have expanded Medicaid eligibility under the ACA, 68% of the uninsured have become eligible for assistance, compared with 44% of newly eligible patients in states that have not expanded Medicaid.

Significant state variation remains in the number of uninsured newly eligible for financial assistance. West Virginia tops the list with a high of 83% of the formerly uninsured now covered, while Texas has the lowest number of newly insured at 40%.

"Financial assistance is a big factor in whether or not an individual obtains health insurance under the Affordable Care Act," said Katherine Hempstead, Robert Wood Johnson Foundation team director and senior program officer. "Early data suggest that the [uninsured] rate in states that expanded Medicaid has dropped more sharply than in states that decided against the expansion."

Fifty-six percent of uninsured patients in the United States are now eligible for financial assistance with insurance coverage through Medicaid, the Children\'s Health Insurance Program, or subsidized private coverage under the Affordable Care Act, according to a report from the Robert Wood Johnson Foundation and the Urban Institute.

The analysis estimates the ACA ultimately will lead to more than 27 million previously uninsured patients gaining health insurance coverage by 2016.

In states that have expanded Medicaid eligibility under the ACA, 68% of the uninsured have become eligible for assistance, compared with 44% of newly eligible patients in states that have not expanded Medicaid.

Significant state variation remains in the number of uninsured newly eligible for financial assistance. West Virginia tops the list with a high of 83% of the formerly uninsured now covered, while Texas has the lowest number of newly insured at 40%.

"Financial assistance is a big factor in whether or not an individual obtains health insurance under the Affordable Care Act," said Katherine Hempstead, Robert Wood Johnson Foundation team director and senior program officer. "Early data suggest that the [uninsured] rate in states that expanded Medicaid has dropped more sharply than in states that decided against the expansion."

When it comes to ID theft, "someone out there is going after doctors," according to Rafal Subernat, D.O.

"And we’ve done nothing wrong," added Dr. Subernat, an anesthesiologist in Bangor, Maine, whose identity was stolen this year at tax time.

Dr. Subernat and his wife thought it was peculiar when earlier this year they attempted to file their taxes electronically and the return was inexplicably rejected.

© Brian Jackson/Thinkstock

They subsequently filed by paper. But 2 weeks later, a debit-like card that Dr. Subernat had never ordered arrived in the mail. When he called the issuer, an operator explained the prepaid tax refund card was opened in Dr. Subernat’s name, and that its original $10,000 balance was now at $10.

"It was already too late at that point, because the money was gone," said Dr. Subernat, who discovered his Social Security number had been used to file a fraudulent tax return. "Emotionally, now you’re worried, where is my information? Where is my Social Security number? Is it going to happen next year again?"

Dr. Subernat’s story is mirrored by hundreds of physicians across the country who have become victims of tax fraud this year. Medical providers in 49 states and the District of Columbia have reported identity theft in 2014, including at least 50 physicians in Maine, 135 in Indiana, 192 in New Hampshire, 100 in Connecticut, 34 in Vermont, and 100 in North Carolina, according to estimated numbers provided by state medical associations. The widespread physician ID theft has led to a collaborative investigation by the IRS, the Federal Bureau of Investigation, and the Secret Service. At this article’s deadline, the source of the multistate ID theft had not been identified.

"What is happening is very concerning," said Scott G. Colby, executive vice president for the New Hampshire Medical Society. "We had a handful of people report this happened to them last year, but this year, it’s a significant amount. We’ve never before heard about this" scope of physician ID theft.

Like Dr. Subernat, most physicians learn of the fraud when their tax returns are rejected. In some cases, debit cards are issued in the doctor’s name or bank accounts are fraudulently opened to obtain tax returns. One of the most troubling aspects of the theft is the potential for the stolen personal information to be used for further fraud such as medical identity theft, said Matthew Katz, CEO of the Connecticut State Medical Society.

"When you have a physician’s Social Security number, name and address, you could potentially do other damaging things related to their identity and their medical practice," Mr. Katz said. "Physicians have concerns that [their] information could be used in some way to falsify claim submissions to the government or even worse, trying to procure medications inappropriately."

Dr. Subernat recommended that all physicians check the IRS website and review their transcripts to learn if they have been a fraud victim (www.irs.gov/Individuals/Get-Transcript). Physicians should also keep their eye out for any unusual amount of credit card offers in the mail, Mr. Katz said. A higher frequency of bank card offers and mailings could be a sign that someone is using their identity, he said.

Physicians are also reporting calls from unknown individuals who purport to be from the IRS and want them to disclose personal information so they can "check" if they are a fraud victim. The callers are believed to be piggybacking on the initial fraud crime in an attempt to fool more victims.

"We’ve cautioned our physicians not to provide information to anyone they do not know," Mr. Katz said. "Physicians should remain vigilant and cautious."

If doctors believe their identity has been stolen, the IRS encourages them to immediately report the identity theft to the agency, along with local police and the Federal Trade Commission (www.irs.gov/uac/Newsroom/Tips-for-Taxpayers,-Victims-about-Identity-Theft-and-Tax-Returns). Physicians should also contact credit reporting companies and place a 90-day fraud alert on their credit report, Mr. Colby said. The hold makes it more difficult for thieves to open accounts in the victim’s name (www.consumer.ftc.gov/articles/0275-place-fraud-alert).

Dr. Subernat was provided a secure IRS PIN for future tax return filings. He noted that physicians who believe they are ID theft victims or those who want to prevent the occurrence can contact the IRS about receiving a PIN (www.irs.gov/uac/Get-An-Identity-Protection-PIN).

As for identifying and preventing medical identity theft, physicians should make an effort to review their insurance billings and enrollment records, said Dr. Shantanu Agrawal, deputy administrator and director for the Centers for Medicare & Medicaid Services Center for Program Integrity (CPI). Medical ID theft occurs when a doctor’s personal information is stolen to obtain medical care, buy drugs, or submit fake billings to Medicare (https://oig.hhs.gov/fraud/medical-id-theft/). Doctors can request a copy of their billings from insurers as well as review their Medicare enrollment information, Dr. Agrawal said.

"Ask for your billings and make sure nothing is in your name that you didn’t bill," he said. "With Medicare, we have a system that tracks all of the enrollment information. Physicians can access this information any time to make sure enrollment information is true."

Safeguarding all personal information and being cognizant of any inappropriate activity is critical to avoiding ID theft, Dr. Agrawal said.

"It’s very good for physicians to be focused on prevention and to be aware of these issues," he said.

When it comes to ID theft, "someone out there is going after doctors," according to Rafal Subernat, D.O.

"And we’ve done nothing wrong," added Dr. Subernat, an anesthesiologist in Bangor, Maine, whose identity was stolen this year at tax time.

Dr. Subernat and his wife thought it was peculiar when earlier this year they attempted to file their taxes electronically and the return was inexplicably rejected.

© Brian Jackson/Thinkstock

They subsequently filed by paper. But 2 weeks later, a debit-like card that Dr. Subernat had never ordered arrived in the mail. When he called the issuer, an operator explained the prepaid tax refund card was opened in Dr. Subernat’s name, and that its original $10,000 balance was now at $10.

"It was already too late at that point, because the money was gone," said Dr. Subernat, who discovered his Social Security number had been used to file a fraudulent tax return. "Emotionally, now you’re worried, where is my information? Where is my Social Security number? Is it going to happen next year again?"

Dr. Subernat’s story is mirrored by hundreds of physicians across the country who have become victims of tax fraud this year. Medical providers in 49 states and the District of Columbia have reported identity theft in 2014, including at least 50 physicians in Maine, 135 in Indiana, 192 in New Hampshire, 100 in Connecticut, 34 in Vermont, and 100 in North Carolina, according to estimated numbers provided by state medical associations. The widespread physician ID theft has led to a collaborative investigation by the IRS, the Federal Bureau of Investigation, and the Secret Service. At this article’s deadline, the source of the multistate ID theft had not been identified.

"What is happening is very concerning," said Scott G. Colby, executive vice president for the New Hampshire Medical Society. "We had a handful of people report this happened to them last year, but this year, it’s a significant amount. We’ve never before heard about this" scope of physician ID theft.

Like Dr. Subernat, most physicians learn of the fraud when their tax returns are rejected. In some cases, debit cards are issued in the doctor’s name or bank accounts are fraudulently opened to obtain tax returns. One of the most troubling aspects of the theft is the potential for the stolen personal information to be used for further fraud such as medical identity theft, said Matthew Katz, CEO of the Connecticut State Medical Society.

"When you have a physician’s Social Security number, name and address, you could potentially do other damaging things related to their identity and their medical practice," Mr. Katz said. "Physicians have concerns that [their] information could be used in some way to falsify claim submissions to the government or even worse, trying to procure medications inappropriately."

Dr. Subernat recommended that all physicians check the IRS website and review their transcripts to learn if they have been a fraud victim (www.irs.gov/Individuals/Get-Transcript). Physicians should also keep their eye out for any unusual amount of credit card offers in the mail, Mr. Katz said. A higher frequency of bank card offers and mailings could be a sign that someone is using their identity, he said.

Physicians are also reporting calls from unknown individuals who purport to be from the IRS and want them to disclose personal information so they can "check" if they are a fraud victim. The callers are believed to be piggybacking on the initial fraud crime in an attempt to fool more victims.

"We’ve cautioned our physicians not to provide information to anyone they do not know," Mr. Katz said. "Physicians should remain vigilant and cautious."

If doctors believe their identity has been stolen, the IRS encourages them to immediately report the identity theft to the agency, along with local police and the Federal Trade Commission (www.irs.gov/uac/Newsroom/Tips-for-Taxpayers,-Victims-about-Identity-Theft-and-Tax-Returns). Physicians should also contact credit reporting companies and place a 90-day fraud alert on their credit report, Mr. Colby said. The hold makes it more difficult for thieves to open accounts in the victim’s name (www.consumer.ftc.gov/articles/0275-place-fraud-alert).

Dr. Subernat was provided a secure IRS PIN for future tax return filings. He noted that physicians who believe they are ID theft victims or those who want to prevent the occurrence can contact the IRS about receiving a PIN (www.irs.gov/uac/Get-An-Identity-Protection-PIN).

As for identifying and preventing medical identity theft, physicians should make an effort to review their insurance billings and enrollment records, said Dr. Shantanu Agrawal, deputy administrator and director for the Centers for Medicare & Medicaid Services Center for Program Integrity (CPI). Medical ID theft occurs when a doctor’s personal information is stolen to obtain medical care, buy drugs, or submit fake billings to Medicare (https://oig.hhs.gov/fraud/medical-id-theft/). Doctors can request a copy of their billings from insurers as well as review their Medicare enrollment information, Dr. Agrawal said.

"Ask for your billings and make sure nothing is in your name that you didn’t bill," he said. "With Medicare, we have a system that tracks all of the enrollment information. Physicians can access this information any time to make sure enrollment information is true."

Safeguarding all personal information and being cognizant of any inappropriate activity is critical to avoiding ID theft, Dr. Agrawal said.

"It’s very good for physicians to be focused on prevention and to be aware of these issues," he said.

When it comes to ID theft, "someone out there is going after doctors," according to Rafal Subernat, D.O.

"And we’ve done nothing wrong," added Dr. Subernat, an anesthesiologist in Bangor, Maine, whose identity was stolen this year at tax time.

Dr. Subernat and his wife thought it was peculiar when earlier this year they attempted to file their taxes electronically and the return was inexplicably rejected.

© Brian Jackson/Thinkstock

They subsequently filed by paper. But 2 weeks later, a debit-like card that Dr. Subernat had never ordered arrived in the mail. When he called the issuer, an operator explained the prepaid tax refund card was opened in Dr. Subernat’s name, and that its original $10,000 balance was now at $10.

"It was already too late at that point, because the money was gone," said Dr. Subernat, who discovered his Social Security number had been used to file a fraudulent tax return. "Emotionally, now you’re worried, where is my information? Where is my Social Security number? Is it going to happen next year again?"

Dr. Subernat’s story is mirrored by hundreds of physicians across the country who have become victims of tax fraud this year. Medical providers in 49 states and the District of Columbia have reported identity theft in 2014, including at least 50 physicians in Maine, 135 in Indiana, 192 in New Hampshire, 100 in Connecticut, 34 in Vermont, and 100 in North Carolina, according to estimated numbers provided by state medical associations. The widespread physician ID theft has led to a collaborative investigation by the IRS, the Federal Bureau of Investigation, and the Secret Service. At this article’s deadline, the source of the multistate ID theft had not been identified.

"What is happening is very concerning," said Scott G. Colby, executive vice president for the New Hampshire Medical Society. "We had a handful of people report this happened to them last year, but this year, it’s a significant amount. We’ve never before heard about this" scope of physician ID theft.

Like Dr. Subernat, most physicians learn of the fraud when their tax returns are rejected. In some cases, debit cards are issued in the doctor’s name or bank accounts are fraudulently opened to obtain tax returns. One of the most troubling aspects of the theft is the potential for the stolen personal information to be used for further fraud such as medical identity theft, said Matthew Katz, CEO of the Connecticut State Medical Society.

"When you have a physician’s Social Security number, name and address, you could potentially do other damaging things related to their identity and their medical practice," Mr. Katz said. "Physicians have concerns that [their] information could be used in some way to falsify claim submissions to the government or even worse, trying to procure medications inappropriately."

Dr. Subernat recommended that all physicians check the IRS website and review their transcripts to learn if they have been a fraud victim (www.irs.gov/Individuals/Get-Transcript). Physicians should also keep their eye out for any unusual amount of credit card offers in the mail, Mr. Katz said. A higher frequency of bank card offers and mailings could be a sign that someone is using their identity, he said.

Physicians are also reporting calls from unknown individuals who purport to be from the IRS and want them to disclose personal information so they can "check" if they are a fraud victim. The callers are believed to be piggybacking on the initial fraud crime in an attempt to fool more victims.

"We’ve cautioned our physicians not to provide information to anyone they do not know," Mr. Katz said. "Physicians should remain vigilant and cautious."

If doctors believe their identity has been stolen, the IRS encourages them to immediately report the identity theft to the agency, along with local police and the Federal Trade Commission (www.irs.gov/uac/Newsroom/Tips-for-Taxpayers,-Victims-about-Identity-Theft-and-Tax-Returns). Physicians should also contact credit reporting companies and place a 90-day fraud alert on their credit report, Mr. Colby said. The hold makes it more difficult for thieves to open accounts in the victim’s name (www.consumer.ftc.gov/articles/0275-place-fraud-alert).

Dr. Subernat was provided a secure IRS PIN for future tax return filings. He noted that physicians who believe they are ID theft victims or those who want to prevent the occurrence can contact the IRS about receiving a PIN (www.irs.gov/uac/Get-An-Identity-Protection-PIN).

As for identifying and preventing medical identity theft, physicians should make an effort to review their insurance billings and enrollment records, said Dr. Shantanu Agrawal, deputy administrator and director for the Centers for Medicare & Medicaid Services Center for Program Integrity (CPI). Medical ID theft occurs when a doctor’s personal information is stolen to obtain medical care, buy drugs, or submit fake billings to Medicare (https://oig.hhs.gov/fraud/medical-id-theft/). Doctors can request a copy of their billings from insurers as well as review their Medicare enrollment information, Dr. Agrawal said.

"Ask for your billings and make sure nothing is in your name that you didn’t bill," he said. "With Medicare, we have a system that tracks all of the enrollment information. Physicians can access this information any time to make sure enrollment information is true."

Safeguarding all personal information and being cognizant of any inappropriate activity is critical to avoiding ID theft, Dr. Agrawal said.

"It’s very good for physicians to be focused on prevention and to be aware of these issues," he said.

Mindfulness could play a role in reducing physician burnout and, in turn, medical malpractice claims.

Burnout is "a massive problem," Dr. Daniel Friedland said at PIAA’s May medical liability conference in Toronto. "I don’t know of any other industry where burnout is so high. Here, we have physicians who are helping patients navigate their stress-related concerns and, in general, they tend to be more stressed out than their patients."

Several studies have linked burnout to medical errors. A survey of 7,905 surgeons found that each one-point increase in physicians’ emotional exhaustion was associated with a 5% increase in error reporting. Each one-point increase in depersonalization was associated with an 11% increase in reporting an error (Ann. Surg. 2010 June [doi:10.1097/SLA.ob013e3181bfdab3]).

In a study of patient performance ratings of 353 physicians at a large U.S. teaching hospital, researchers at the Harvard Risk Management Foundation found that patients were 26% more likely to sue doctors in the middle tier and 110% more likely to sue those in the bottom tier, compared with physicians in the top patient satisfaction level (Am. J. Med. 2005;118:1126-33).

Two primary components of burnout are emotional exhaustion and depersonalization, according to Dr. Colin P. West, professor of medicine, medical education, and biostatistics at the Mayo Clinic in Rochester, Minn.

"If you are depersonalized toward others and you’re not treating them as other human beings in the physician-patient relationship, it seems reasonable that that’s to be associated with poor communication skills and that could then lead to increased litigation risk," Dr. West said in an interview. "Certainly the literature suggests that [poor] physician communication is related to malpractice risk."

Gaining control of impending stress, anxiety, and tension is the first step to overcoming burnout, said Dr. Friedland, an internist and founder and CEO of SuperSmartHealth, a national consulting firm that provides health and wellness initiatives, physician resilience programs, and other management strategies to businesses and individuals.

He has developed a four-step program, "The 4 in 4 Framework to Cultivate Resiliency in Health Care," that centers on the mental practice of mindfulness. The program involves recognizing reactivity, reappraising stress and self-doubt, cultivating creativity, and focusing on what matters most.

Using the strategies builds physicians’ resiliency in the face of burnout, while also reducing their chances of making mistakes and being sued, Dr. Friedland said.

Mindfulness practices have been shown to markedly increase physician satisfaction, Dr. West said. In his study of 74 Mayo Clinic physicians enrolled in a stress intervention program, rates of high depersonalization decreased by 15.5% for physicians involved in the mindfulness program; physicians’ perceptions of meaningfulness in their work increased by 6% as well (JAMA Intern. Med. 2014;174:527-33).

"I think these [interventions] are important," Dr. West said. "But they are only part of what’s necessary. My view is that we need to come up with a toolkit of solutions. Some people are going to respond to mindfulness training, some are going to respond to yoga, some are going to respond to scheduling meetings with colleagues to maintain connectedness. [Research] suggests when you do such interventions, you can make pretty substantial differences" in physician burnout.

Mindfulness could play a role in reducing physician burnout and, in turn, medical malpractice claims.

Burnout is "a massive problem," Dr. Daniel Friedland said at PIAA’s May medical liability conference in Toronto. "I don’t know of any other industry where burnout is so high. Here, we have physicians who are helping patients navigate their stress-related concerns and, in general, they tend to be more stressed out than their patients."

Several studies have linked burnout to medical errors. A survey of 7,905 surgeons found that each one-point increase in physicians’ emotional exhaustion was associated with a 5% increase in error reporting. Each one-point increase in depersonalization was associated with an 11% increase in reporting an error (Ann. Surg. 2010 June [doi:10.1097/SLA.ob013e3181bfdab3]).

In a study of patient performance ratings of 353 physicians at a large U.S. teaching hospital, researchers at the Harvard Risk Management Foundation found that patients were 26% more likely to sue doctors in the middle tier and 110% more likely to sue those in the bottom tier, compared with physicians in the top patient satisfaction level (Am. J. Med. 2005;118:1126-33).

Two primary components of burnout are emotional exhaustion and depersonalization, according to Dr. Colin P. West, professor of medicine, medical education, and biostatistics at the Mayo Clinic in Rochester, Minn.

"If you are depersonalized toward others and you’re not treating them as other human beings in the physician-patient relationship, it seems reasonable that that’s to be associated with poor communication skills and that could then lead to increased litigation risk," Dr. West said in an interview. "Certainly the literature suggests that [poor] physician communication is related to malpractice risk."

Gaining control of impending stress, anxiety, and tension is the first step to overcoming burnout, said Dr. Friedland, an internist and founder and CEO of SuperSmartHealth, a national consulting firm that provides health and wellness initiatives, physician resilience programs, and other management strategies to businesses and individuals.

He has developed a four-step program, "The 4 in 4 Framework to Cultivate Resiliency in Health Care," that centers on the mental practice of mindfulness. The program involves recognizing reactivity, reappraising stress and self-doubt, cultivating creativity, and focusing on what matters most.

Using the strategies builds physicians’ resiliency in the face of burnout, while also reducing their chances of making mistakes and being sued, Dr. Friedland said.

Mindfulness practices have been shown to markedly increase physician satisfaction, Dr. West said. In his study of 74 Mayo Clinic physicians enrolled in a stress intervention program, rates of high depersonalization decreased by 15.5% for physicians involved in the mindfulness program; physicians’ perceptions of meaningfulness in their work increased by 6% as well (JAMA Intern. Med. 2014;174:527-33).

"I think these [interventions] are important," Dr. West said. "But they are only part of what’s necessary. My view is that we need to come up with a toolkit of solutions. Some people are going to respond to mindfulness training, some are going to respond to yoga, some are going to respond to scheduling meetings with colleagues to maintain connectedness. [Research] suggests when you do such interventions, you can make pretty substantial differences" in physician burnout.

Mindfulness could play a role in reducing physician burnout and, in turn, medical malpractice claims.

Burnout is "a massive problem," Dr. Daniel Friedland said at PIAA’s May medical liability conference in Toronto. "I don’t know of any other industry where burnout is so high. Here, we have physicians who are helping patients navigate their stress-related concerns and, in general, they tend to be more stressed out than their patients."

Several studies have linked burnout to medical errors. A survey of 7,905 surgeons found that each one-point increase in physicians’ emotional exhaustion was associated with a 5% increase in error reporting. Each one-point increase in depersonalization was associated with an 11% increase in reporting an error (Ann. Surg. 2010 June [doi:10.1097/SLA.ob013e3181bfdab3]).

In a study of patient performance ratings of 353 physicians at a large U.S. teaching hospital, researchers at the Harvard Risk Management Foundation found that patients were 26% more likely to sue doctors in the middle tier and 110% more likely to sue those in the bottom tier, compared with physicians in the top patient satisfaction level (Am. J. Med. 2005;118:1126-33).

Two primary components of burnout are emotional exhaustion and depersonalization, according to Dr. Colin P. West, professor of medicine, medical education, and biostatistics at the Mayo Clinic in Rochester, Minn.

"If you are depersonalized toward others and you’re not treating them as other human beings in the physician-patient relationship, it seems reasonable that that’s to be associated with poor communication skills and that could then lead to increased litigation risk," Dr. West said in an interview. "Certainly the literature suggests that [poor] physician communication is related to malpractice risk."

Gaining control of impending stress, anxiety, and tension is the first step to overcoming burnout, said Dr. Friedland, an internist and founder and CEO of SuperSmartHealth, a national consulting firm that provides health and wellness initiatives, physician resilience programs, and other management strategies to businesses and individuals.

He has developed a four-step program, "The 4 in 4 Framework to Cultivate Resiliency in Health Care," that centers on the mental practice of mindfulness. The program involves recognizing reactivity, reappraising stress and self-doubt, cultivating creativity, and focusing on what matters most.

Using the strategies builds physicians’ resiliency in the face of burnout, while also reducing their chances of making mistakes and being sued, Dr. Friedland said.

Mindfulness practices have been shown to markedly increase physician satisfaction, Dr. West said. In his study of 74 Mayo Clinic physicians enrolled in a stress intervention program, rates of high depersonalization decreased by 15.5% for physicians involved in the mindfulness program; physicians’ perceptions of meaningfulness in their work increased by 6% as well (JAMA Intern. Med. 2014;174:527-33).

"I think these [interventions] are important," Dr. West said. "But they are only part of what’s necessary. My view is that we need to come up with a toolkit of solutions. Some people are going to respond to mindfulness training, some are going to respond to yoga, some are going to respond to scheduling meetings with colleagues to maintain connectedness. [Research] suggests when you do such interventions, you can make pretty substantial differences" in physician burnout.

Receiving notice that a patient is suing can spark a range of emotions in physicians, including fear, anger, hurt, and helplessness. But litigation experts stress that after a filing, physicians must rein in their feelings and focus on immediate next steps – crucial actions that can significantly impact the suit and its outcome.

"Doctors have two reactions to getting sued – either they’re very sad or they’re very angry," said Steven Fitzer, a medical liability defense attorney at Fitzer, Leighton & Fitzer, P.S., in Tacoma, Wash., and former chair of the Washington State Bar Association Litigation Section. "Relaxing and composing yourself are important because a lawsuit is a marathon – not a sprint."

American Medical Association data show 60% of physicians will be sued by the time they reach 55 years of age. The average span of a medical malpractice claim from start to close is generally about 2.5 years, although many suits progress longer. While most medical liability claims do not end in trial, defense attorneys say knowing how to respond to a lawsuit can raise doctors’ chances of a quicker, more beneficial resolution.

First and foremost, physicians should notify their malpractice insurance carrier as soon as possible after lawsuit papers are served, said Matt Mitcham, senior vice president of claims for MagMutual Insurance Company, a medical liability insurer that operates in the Southeast. Employed physicians should immediately alert their risk management department.

"All suits have a limited time for providing a response, and there are severe consequences for not meeting these deadlines," Mr. Mitcham said. "In addition, physicians need to provide their defense team with as much time as possible to prepare a response."

Doctors should resist the desire to contact patients or their families in an attempt to work out the situation themselves, adds Mr. Fitzer, who recently shared lawsuit preparation tips in two video playlists for The Doctors Company, a national medical malpractice insurer.

"Particularly with family practice physicians, they tend to have a long and strong bond with their patients and their patients’ families, and they think, ‘If I just call and ask what’s going on, we can just fix this all right here,’ " he said. "That never works. The patient or their lawyer will take whatever you say in or out of context and use it against you."

Another action to avoid after a lawsuit filing is making additions or changes to patient records, said Mr. Mitcham.

"The original records should never be altered under any circumstance," he said. "Today’s forensic specialists are experts in identifying changes, and by altering records, a physician can potentially turn a defensible case into one that is indefensible."

Securing an attorney that doctors trust and with whom they can aptly communicate is also essential, said Michael F. Ball, a medical liability defense attorney and partner at McCormick Barstow, LLP, in Fresno, Calif. Most doctors may not realize they can typically choose from a panel of attorneys used by their insurer, he said. Physicians can also ask to view the attorney panel and conduct their own research before requesting a specific lawyer.

Mr. Ball counsels his clients to focus only on the task at hand during each stage of a lawsuit, rather than worry about future phases or a possible trial. For example, during the deposition stage, physicians should prepare by understanding the deposition’s purpose, reading through the record, and being clear on what questions may be asked. A deposition is a witness’s sworn, out-of-court testimony used to gather information as part of the discovery process.

"Some [physicians] don’t review the record as closely as they should," he said. "There’s no substitute for real preparation."

Additionally, depositions are a stage in which a physician’s emotions may come bubbling to the surface, notes Angela Dodge, Ph.D., founding partner of Dodge Consulting & Publications, LLP, a litigation consulting firm in the Seattle-Tacoma area.

"A doctor may go into a deposition feeling very angry and resentful because a patient they believe they gave good care to is now suing," said Ms. Dodge, author of the book "When Good Doctors Get Sued: A Practical Guide for Physicians Involved in Malpractice Lawsuits, and Winning at Jury Selection." "We counsel them on the importance of setting that aside because it could interfere with" their success.

Negative emotions by doctors may be interpreted by plaintiffs’ attorneys as guilt or defensiveness and used to fuel their claims, she said. Doctors should also focus only on the questions being asked during a deposition and not offer up any further or additional information. For instance, in a recent case, a doctor was asked about a specific part of his education. In response, the physician provided unnecessary information about his entire medical education, including his experience operating on pigs, she said.

Litigation counselors point to strong cooperation among physicians, insurers, and defense attorneys as one of the most vital components to the successful handling of a lawsuit.

"The legal system can be a very daunting place for physicians, but when the malpractice carrier and defense attorney work together as a team, they can help the physician navigate the process and hopefully win the case," Mr. Mitcham said.

Receiving notice that a patient is suing can spark a range of emotions in physicians, including fear, anger, hurt, and helplessness. But litigation experts stress that after a filing, physicians must rein in their feelings and focus on immediate next steps – crucial actions that can significantly impact the suit and its outcome.

"Doctors have two reactions to getting sued – either they’re very sad or they’re very angry," said Steven Fitzer, a medical liability defense attorney at Fitzer, Leighton & Fitzer, P.S., in Tacoma, Wash., and former chair of the Washington State Bar Association Litigation Section. "Relaxing and composing yourself are important because a lawsuit is a marathon – not a sprint."

American Medical Association data show 60% of physicians will be sued by the time they reach 55 years of age. The average span of a medical malpractice claim from start to close is generally about 2.5 years, although many suits progress longer. While most medical liability claims do not end in trial, defense attorneys say knowing how to respond to a lawsuit can raise doctors’ chances of a quicker, more beneficial resolution.

First and foremost, physicians should notify their malpractice insurance carrier as soon as possible after lawsuit papers are served, said Matt Mitcham, senior vice president of claims for MagMutual Insurance Company, a medical liability insurer that operates in the Southeast. Employed physicians should immediately alert their risk management department.

"All suits have a limited time for providing a response, and there are severe consequences for not meeting these deadlines," Mr. Mitcham said. "In addition, physicians need to provide their defense team with as much time as possible to prepare a response."

Doctors should resist the desire to contact patients or their families in an attempt to work out the situation themselves, adds Mr. Fitzer, who recently shared lawsuit preparation tips in two video playlists for The Doctors Company, a national medical malpractice insurer.

"Particularly with family practice physicians, they tend to have a long and strong bond with their patients and their patients’ families, and they think, ‘If I just call and ask what’s going on, we can just fix this all right here,’ " he said. "That never works. The patient or their lawyer will take whatever you say in or out of context and use it against you."

Another action to avoid after a lawsuit filing is making additions or changes to patient records, said Mr. Mitcham.

"The original records should never be altered under any circumstance," he said. "Today’s forensic specialists are experts in identifying changes, and by altering records, a physician can potentially turn a defensible case into one that is indefensible."

Securing an attorney that doctors trust and with whom they can aptly communicate is also essential, said Michael F. Ball, a medical liability defense attorney and partner at McCormick Barstow, LLP, in Fresno, Calif. Most doctors may not realize they can typically choose from a panel of attorneys used by their insurer, he said. Physicians can also ask to view the attorney panel and conduct their own research before requesting a specific lawyer.

Mr. Ball counsels his clients to focus only on the task at hand during each stage of a lawsuit, rather than worry about future phases or a possible trial. For example, during the deposition stage, physicians should prepare by understanding the deposition’s purpose, reading through the record, and being clear on what questions may be asked. A deposition is a witness’s sworn, out-of-court testimony used to gather information as part of the discovery process.

"Some [physicians] don’t review the record as closely as they should," he said. "There’s no substitute for real preparation."

Additionally, depositions are a stage in which a physician’s emotions may come bubbling to the surface, notes Angela Dodge, Ph.D., founding partner of Dodge Consulting & Publications, LLP, a litigation consulting firm in the Seattle-Tacoma area.

"A doctor may go into a deposition feeling very angry and resentful because a patient they believe they gave good care to is now suing," said Ms. Dodge, author of the book "When Good Doctors Get Sued: A Practical Guide for Physicians Involved in Malpractice Lawsuits, and Winning at Jury Selection." "We counsel them on the importance of setting that aside because it could interfere with" their success.

Negative emotions by doctors may be interpreted by plaintiffs’ attorneys as guilt or defensiveness and used to fuel their claims, she said. Doctors should also focus only on the questions being asked during a deposition and not offer up any further or additional information. For instance, in a recent case, a doctor was asked about a specific part of his education. In response, the physician provided unnecessary information about his entire medical education, including his experience operating on pigs, she said.

Litigation counselors point to strong cooperation among physicians, insurers, and defense attorneys as one of the most vital components to the successful handling of a lawsuit.

"The legal system can be a very daunting place for physicians, but when the malpractice carrier and defense attorney work together as a team, they can help the physician navigate the process and hopefully win the case," Mr. Mitcham said.

Receiving notice that a patient is suing can spark a range of emotions in physicians, including fear, anger, hurt, and helplessness. But litigation experts stress that after a filing, physicians must rein in their feelings and focus on immediate next steps – crucial actions that can significantly impact the suit and its outcome.

"Doctors have two reactions to getting sued – either they’re very sad or they’re very angry," said Steven Fitzer, a medical liability defense attorney at Fitzer, Leighton & Fitzer, P.S., in Tacoma, Wash., and former chair of the Washington State Bar Association Litigation Section. "Relaxing and composing yourself are important because a lawsuit is a marathon – not a sprint."

American Medical Association data show 60% of physicians will be sued by the time they reach 55 years of age. The average span of a medical malpractice claim from start to close is generally about 2.5 years, although many suits progress longer. While most medical liability claims do not end in trial, defense attorneys say knowing how to respond to a lawsuit can raise doctors’ chances of a quicker, more beneficial resolution.

First and foremost, physicians should notify their malpractice insurance carrier as soon as possible after lawsuit papers are served, said Matt Mitcham, senior vice president of claims for MagMutual Insurance Company, a medical liability insurer that operates in the Southeast. Employed physicians should immediately alert their risk management department.

"All suits have a limited time for providing a response, and there are severe consequences for not meeting these deadlines," Mr. Mitcham said. "In addition, physicians need to provide their defense team with as much time as possible to prepare a response."

Doctors should resist the desire to contact patients or their families in an attempt to work out the situation themselves, adds Mr. Fitzer, who recently shared lawsuit preparation tips in two video playlists for The Doctors Company, a national medical malpractice insurer.

"Particularly with family practice physicians, they tend to have a long and strong bond with their patients and their patients’ families, and they think, ‘If I just call and ask what’s going on, we can just fix this all right here,’ " he said. "That never works. The patient or their lawyer will take whatever you say in or out of context and use it against you."

Another action to avoid after a lawsuit filing is making additions or changes to patient records, said Mr. Mitcham.

"The original records should never be altered under any circumstance," he said. "Today’s forensic specialists are experts in identifying changes, and by altering records, a physician can potentially turn a defensible case into one that is indefensible."

Securing an attorney that doctors trust and with whom they can aptly communicate is also essential, said Michael F. Ball, a medical liability defense attorney and partner at McCormick Barstow, LLP, in Fresno, Calif. Most doctors may not realize they can typically choose from a panel of attorneys used by their insurer, he said. Physicians can also ask to view the attorney panel and conduct their own research before requesting a specific lawyer.

Mr. Ball counsels his clients to focus only on the task at hand during each stage of a lawsuit, rather than worry about future phases or a possible trial. For example, during the deposition stage, physicians should prepare by understanding the deposition’s purpose, reading through the record, and being clear on what questions may be asked. A deposition is a witness’s sworn, out-of-court testimony used to gather information as part of the discovery process.

"Some [physicians] don’t review the record as closely as they should," he said. "There’s no substitute for real preparation."

Additionally, depositions are a stage in which a physician’s emotions may come bubbling to the surface, notes Angela Dodge, Ph.D., founding partner of Dodge Consulting & Publications, LLP, a litigation consulting firm in the Seattle-Tacoma area.

"A doctor may go into a deposition feeling very angry and resentful because a patient they believe they gave good care to is now suing," said Ms. Dodge, author of the book "When Good Doctors Get Sued: A Practical Guide for Physicians Involved in Malpractice Lawsuits, and Winning at Jury Selection." "We counsel them on the importance of setting that aside because it could interfere with" their success.

Negative emotions by doctors may be interpreted by plaintiffs’ attorneys as guilt or defensiveness and used to fuel their claims, she said. Doctors should also focus only on the questions being asked during a deposition and not offer up any further or additional information. For instance, in a recent case, a doctor was asked about a specific part of his education. In response, the physician provided unnecessary information about his entire medical education, including his experience operating on pigs, she said.

Litigation counselors point to strong cooperation among physicians, insurers, and defense attorneys as one of the most vital components to the successful handling of a lawsuit.

"The legal system can be a very daunting place for physicians, but when the malpractice carrier and defense attorney work together as a team, they can help the physician navigate the process and hopefully win the case," Mr. Mitcham said.