medical liability reform

Medical Liability Reform Begins in Massachusetts

Posted in Defensive medicine, Health Reform, Malpractice, medical liability reform, professional liability reform, Uncategorized on February 14th, 2013 by MMS Communications – Comments Off

With a research initiative begun three years ago that created a roadmap to reform, medical liability reform has now begun to unfold in Massachusetts.

The Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI) this week announced the launch of its website detailing information on the reform efforts for Massachusetts patients and providers at www.macrmi.info.

MACRMI was formed as the result of the initiative begun in 2010 and led by Beth Israel Deaconess Medical Center and the Massachusetts Medical Society. Participants and supporters also include Baystate Health, Massachusetts Hospital Association, Massachusetts Coalition for the Prevention of Medical Errors, Medically Induced Trauma Support Services, as well as health insurers, provider organizations, and patient advocacy groups.

MACRMI has now started to implement the roadmap to reform, through a Communication, Apology, and Resolution (CARe) program (also known as disclosure, apology and offer, or DA&O), with pilot programs underway in six hospitals.

The six hospitals participating in the pilot initiative include three from the BIDMC health system (Beth Israel Deaconess Medical Center in Boston, Beth Israel Deaconess Hospital-Needham, and Beth Israel Deaconess Hospital-Milton); and three from Baystate Health system in Springfield (Baystate Medical Center in Springfield, Baystate Franklin Medical Center in Greenfield, and Baystate Mary Lane Hospital in Ware).

The research initiative by BIDMC and MMS was funded by a grant from the Federal Agency for Health Care Research and Quality as part of the President’s Patient Safety and Medical Liability Program.

A key step in the process was an unprecedented agreement on legislative language among the Massachusetts Medical Society, Massachusetts Bar Association, and Massachusetts Academy of Trial Lawyers. That agreement led to approval of the provisions enabling reform by the legislature and Governor and their subsequent inclusion into the payment reform bill that Governor Patrick signed last August. Among the provisions are a six-month, pre-litigation resolution period, sharing of all pertinent medical records, appropriate apology protections for providers, and full disclosure to patients.

Passage of the law made Massachusetts the first in the nation to have comprehensive legislation that will provide for the conduct of such a program in different practice environments with different insurance arrangements.

 

Key Similarities and Differences Between the House and Senate Payment Reform Bills

Posted in Accountable Care Organizations, Defensive medicine, Electronic health records, Electronic Medical Records, Health IT, Health Reform, Malpractice, Mass. Legislature, medical liability reform, Payment Reform on June 8th, 2012 by MMS – 1 Comment

After two years of discussion and debate, the Massachusetts Legislature must now deal with two huge pieces of payment reform and cost control legislation.

Earlier this week, the House passed its legislation by a wide margin, following eight hours of deciding which of 275 amendments it would accept. The Senate passed a separate bill on May 17.

During the House debate this week, the MMS sought to protect most small and medium physician groups from the House’s very rigorous reporting requirements. The original House bill exempted groups with fewer than 10 physicians. Due to MMS advocacy, the House agreed to increase the exemption to 25, which we will try to increase further during the conference committee’s deliberations.

When the members of the conference committee are appointed, they will have until adjournment on July 31 to agree on a single bill and get it passed by both chambers.

Despite their many similarities, reconciliation and consolidation of the bills is not expected to be an easy task.

Key Similarities

  • Cost containment: Each bill states that overall health care costs should rise in concert with the growth in the state’s economy. (Differences noted below.)
  • State oversight: Each creates a new state agency to certify provider groups, and collect volumes of information on quality measures and costs. The House agency is placed inside the executive branch, under the Executive Office of Health and Human Services. The Senate agency is an independent entity.
  • Market power: Both bills require payers to negotiate separate contracts for each hospital facility, with some exceptions.
  • Alternative payment models: The bills define ACOs and their requirements. They provide a 2 percent bonus in Medicaid payments to providers starting in July 2013, if they move to alternative payment methodologies.
  • Electronic Health Records: Each requires physicians to be proficient in the use of electronic medical records. (Differences noted below.)
  • Medical liability: Both mandate waiting periods for civil suits brought against health care providers. They require disclosure of case information to patients and providers; protect statements of apology from being admissible as evidence; provide for early payments to patients without prejudice. They reduce the prejudgment interest rate in malpractice cases from 4 percent to 2 percent. No contract may prohibit a physician from serving as an expert witness.
  • Determination of Need: They expand the Determination of Need process to include more new technologies, transfers of ownership and site expansions.
  • Administrative simplification: Both bills require standards forms for utilization review.
  • Peer review: Both bills expand the peer review statute. The House specifically provides ACOs with peer review protection; the Senate provides such protections to any provider group that conducts peer review activities.
  • Charitable immunity: They raise the charitable immunity cap from $20,000 to $100,000 (affects most hospitals in Massachusetts).
  • Physician assistants and nurse practitioners: Each bill provides more independence to physician assistants and nurse practitioners.
  • Limited service clinics: Both bills eliminate some existing regulations for the operation limited service clinics, such as those located in pharmacies; however their approaches differ.

Key Differences

Cost Containment

  • The House’s benchmark is 3.6 percent for 2012 and 2013. In 2014 and 2015, it would be equal to the growth rate projected in the Governor’s budget submissions. From 2016 to 2026, it would be equal to a half percentage point below the Gross State Product (GSP) from 2016 to 2026, and equal to one point above GSP after 2027.
  • The Senate’s cost benchmark is a half point above GSP through 2015, and equal to GSP from 2016 to 2026.
  • The House imposes a penalty on providers who costs are 20 percent higher than the benchmark. It establishes rate setting for governmental units. The House gives the state the ability to force providers to reopen contracts that it considers contributing to excessive spending. The House gives the attorney general to block unreasonable increases in rates, and block changes that adversely affect patient access and the quality of care. In the Senate bill, groups that exceed the benchmark must file improvement plans.

Market power

  • The House subjects provider groups of 10 or more physicians to a market impact review.
  •  The Senate gives the attorney general the power to prevent excess consolidation and collusion.

Certification

  • The House requires any physician group with 25 or more physicians to be certified by the Department of Public Health.
  • The Senate requires certification for all providers entering into alternative contracts. It exempts groups with less than $500,000 in annual net patient service revenue and fewer than five affiliated physicians, if the group does not accept risk.

Electronic Health Records

  • The House requires providers to adopt EHRs that are fully interoperable and connect to the statewide health information exchange.
  • The Senate updates existing the requirement for EHR proficiency by 2015 by requiring physicians must demonstrate the skills to comply with the federal government’s meaningful use requirements. It creates an institute to facilitate the implementation of interoperable records statewide, and promote the use of other health information technologies.

Physicians’ Fear of Being Sued is Pervasive

Posted in Malpractice, medical liability reform, workforce on October 5th, 2011 by MMS – Comments Off

Third in a series of five articles on the 2011 MMS Physician Workforce Study

Our 10th annual workforce study suggests that while medical malpractice insurance costs in Massachusetts tend to be higher than national averages, the fear of being sued has a much more dramatic impact on physicians than the actual cost of the insurance.

The survey found that 12.5 percent of physicians have limited the scope of their practice because of malpractice insurance costs. Specialists were only slightly more likely to respond yes, at 14.6 percent.

But when asked whether the fear of being sued has prompted them to alter or limit their scope of practice, that number jumps to 46 percent. There’s only a slight difference between primary care physicians and specialists (46 and 49 percent, respectively).

But within specific specialties we see some interesting numbers, especially when comparing their answers to the same question in the 2008 survey.

In 2008, about half of orthopedic surgeons, gastroenterologists and dermatologists said they had altered their practice for fear of being sued. In 2010, that numbers jumps to almost three in four.

Conversely, we see the reverse dynamic among neurosurgeons and urologists. In 2008, three quarters of these doctors said they had altered their practice. In this year’s survey the number was much closer to 50 percent.

The percentage of obstetrician-gynecologists (who have the highest premiums of any specialty) who responded yes to that question remained relatively steady at 56 percent, compared to 57 in 2008.

Why the differences over the years? It’s hard to say, and the study didn’t delve into the question. But as the survey notes, “the threat of a malpractice suit has an extraordinary pervasive impact on all specialties.”

Read the workforce study at www.massmed.org/workforce

Coming tomorrow: Physicians and Their Professional Satisfaction. Read the other posts in this series here.

Health Reform Principles Stress Balance Between Patient Choice and Economic Reality

Posted in Accountable Care Organizations, Annual Meeting 2011, Defensive medicine, Global Payments, Health Policy, Health Reform, Malpractice, medical liability reform, Payment Reform on May 22nd, 2011 by MMS – Comments Off

Spirited debate at the MMS House of Delegates Saturday led to the adoption of 18 principles on health care reform that the Society plans to share with local and national legislators.

The principle that dominated deliberations asserted that “health care reform must enable patient choice in access to physicians, hospitals, and other services while recognizing economic reality.”

Among the other principles adopted were the following:

  • Physicians must lead reform, keeping clinical decision-making in the hands of doctors and patients.
  • Reform must be flexible enough to account for different practice types and their variable readiness to change.
  • Fee-for-service payment should have a role in any system.
  • Physicians will need infrastructure support, especially for IT and hiring physician extenders.
  • Risk adjustment methods must incorporate physician input and account for illness burden and socioeconomic status of patients.
  • Transparency throughout the whole process is essential.
  • Patient education and accountability must be enhanced.
  • Professional liability and antitrust reform are crucial underpinnings to reform.

The complete principles are available at www.massmed.org/healthreformprinciples.

Complete Annual Meeting coverage is available at www.massmed.org/annual2011.

Boston Papers Call for Malpractice Reform

Posted in Defensive medicine, Malpractice, medical liability reform, Uncategorized on February 22nd, 2011 by MMS Communications – 1 Comment

The Boston Globe took a more national perspective, and the Boston Herald pointed to Governor Deval Patrick’s bill for health care cost containment, but the message from both Boston newspapers was the same:  the current system of medical liability needs to be reformed. Both papers stated their support for such reform in their lead editorials published today [February 22].

Among the comments, the editorials cited the needs that reform must satisfy: reducing the practice of defensive medicine, establishing measures for disclosure and apology, attempting to resolve differences before legal action begins, and examining the causes of errors to prevent them from happening in the future.

In its editorial, the Globe wrote that “Both [Obama and the GOP] should find common ground on innovative approaches that not only reduce jury awards, but also help doctors and hospitals correct underlying problems.”

The Herald said that “Gov. Deval Patrick shrewdly included medical malpractice reform in his new health care cost containment bill. No attempt to rein in the runaway costs in the health care system due in part to the practice of defensive medicine, would be complete without it….”

Read The Boston Globe, Obama, GOP should avoid a standoff on malpractice reform

Read Boston Herald, Reform sick system

Congress Tackles Medical Liability Reform: Our View

Posted in Malpractice, medical liability reform on January 26th, 2011 by MMS – 2 Comments

The new Congress is already making headlines, including the fact that several members have introduced comprehensive proposals to dramatically reform the nation’s medical liability system.

I’m pleased to see this development, because we have long argued that our toxic medical liability system is badly in need of reform. It turns patients and doctors into adversaries, and is actually counterproductive to the goal of promoting patient safety.

That’s why, for example, we have proposed legislation that protects physicians’ statements of apology, and provides for early compensation of patients who have suffered an adverse medical event. We also support a “cooling-off period” that allows time for a root-cause analysis of adverse events, which is  critical to improving quality and safety. Programs like these have been in place at the University of Michigan health care system, and have produced significant results.

I hope that these congressional proposals signal a new interest in medical liability reform. We’ll look carefully at all these proposals, and looks forward to working with the members of Congress, to finally make progress on this pressing issue.

Alice A. Tolbert Coombs, MD
President, Massachusetts Medical Society