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Peer Group's Claims
Step 2. Peer Group's Claims:

The Peer Group’s Claims page lets you refine your peer group to include only those claims that match the criteria you specify. Your final peer group will include all claims that match these criteria and those you selected on the previous page, Entity’s Peer Group.

A.

Claim Costs – The dropdown menus in this section let you specify the cost criteria a claim must meet to be included in the peer group. For both Indemnity (insurance actually paid) and Expenses (funds spent on lawyers, court fees, etc.) there are two columns of options.

  • In the “Payment Made?” column, you can select whether or not to include claims where an indemnity or expenses payment has been made.
  • In the “Has a Reserve?” column, you can select whether or not to include claims that have an indemnity or expenses reserve.

In each dropdown you can select Yes, No, or Either. (The default setting is Either)

Selecting the Either option essentially means that this criterion is irrelevant to the filtering for your benchmark.

To be included in the peer group, a claim must meet ALL the criteria.

Fig.15, “Claim Costs Menu.” Enhance your peer group to include only claims that mach the criteria you specify.

B.

Status – Select claims that are Open or Closed (or both). When a malpractice claim is made, the plaintiff (or patient) takes legal action against a healthcare provider. A Closed claim would be one that has already been paid or dismissed. An open claim is one that is still being disputed.

Fig. 16, “Status Menu.”

C.

Claim Dates – Here you can filter claims either by Accident Year or Report Year. Keep in mind that the two are mutually exclusive – only 1 can be selected. Next, pick up to 5 years for your benchmark from the list below.

The Valuation Year is the year that the claim was first reviewed by the policy maker. Again, select up to 5 years from the list for your benchmark.

The years on these lists should include all Accident/Report Years and all Valuation Years for which Advisen has data in its database.

Fig. 17, “Claims Dates Menu.” Select Accident /Report years and Valuation years for your peer group.

D.

Departments – You can further focus the results of your benchmark by comparing specific medical departments.

For example, you could see how a hospital compares to its peer group in terms of claims made against its Nursing department.

You may select 1 of the following 7 departments:

  • Emergency Department
    		•
  • Medicine or Pharmacy
  • Nursing
    		•
  • Obstetrics
    		•
  • Surgery – Inpatient
  • Surgery – Outpatient
  • Other
    		•  

     

    Alternatively, you may keep the default selection (All) if individual departments are irrelevant to your benchmark.

     

    Also, you can select Other if the department you desire is not listed.

    Fig.18, “Departments Menu.” Compare specific medical departments in your benchmark.

    E.

    Cause – Same as above but with causes of the claim rather than medical departments. There are 10 causes to choose from:

  • Assault Issues
    		•
  • Diagnostic Issues
    		•
  • Equipment Issues
    		•
  • General Liability
    		•
  • Legal Issues
    		•
  • Medication Issues
    		•
  • Obstetric Issues
    		•
  • Patient Slip and Falls
    		•
  • Treatment Issues
    		•
  • Other Issues
    		•

    Again, you may keep the default selection (All) if individual causes are irrelevant to your benchmark, or select Other Issues for an unlisted cause.

    Fig.19, “Cause Menu.” Compare specific claim causes in your benchmark.

    F.

    Number of Claims Matching All Criteria – This count reflects the number of claims that meet all of your specified criteria and thus will be used for your benchmark comparison.

    Fig. 20, “Number of Claims Matching ALL Criteria Menu.” The count at the bottom of the page tells you how many claims match the combination of all your criteria.