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Medical liability defense attorney Michael J. Sacopulos often hears physicians speak in hindsight about signs they overlooked in patients that foreshadowed a coming claim.

In one such case, a plastic surgeon recalled a patient who wanted an unnecessary skin treatment. She complained about nearly every doctor she had seen previously.

Online consultations are spreading fast now that payers have figured out how to use them to save money. Last week, Health Affairs published a paper by researchers at HealthPartners -- a Minnesota-based health plan and physician group -- showing that online consultations with nurse practitioners for minor ailments saved the insurer $88 per episode of care.

Value-based purchasing will begin to take hold in 2013, with federal incentives for lower-cost care and best performance and disincentives for unnecessary care. Many of the VBP metrics will be a tall order for healthcare systems, especially 30-day readmissions and HCAHPS.

According to a report from the East Valley Tribune, "A state legislator wants to impose some new requirements on judges and attorneys in his bid to cut down on medical malpractice lawsuits.

The proposal by Rep. Bob Thorpe, R-Flagstaff, would bar lawyers from filing a medical malpractice lawsuit unless they were certified by the state Supreme Court as a "medical malpractice attorney.'' Thorpe's bill does not define what it would take to be certified, leaving the details up to the state's high court.