March 7, 2011 by matray

side note: With all the cost-cutting that is proposed at both federal and state levels, this is an especially prescient report. As the healthcare industry, employers and government officials seek to control the growth of health spending, new efforts are needed to develop and refine quality-of-care and other performance measures that can assure changes will improve medical care and do not harm patients, according to a new study by RAND Health, the nation's largest independent health policy research program. While some current quality measurement tools may be useful to new performance-based payment models, significant work is needed to design and test methods which can be applied to measuring the quality of care provided under innovative payment reforms, according to the report. “Insurers and purchasers of healthcare in the United States are on the verge of potentially revolutionary changes in the approaches used to pay for healthcare," said Eric Schneider, MD, the study’s lead author and a senior natural scientist at RAND. “A significant investment is needed to develop new performance measures that can assure high quality care as the United States experiments with these new payment models.” The RAND report studied 90 payment reform programs and identified 11 general payment reform models that reward providers for delivering better-quality, cost-conscious care or pay healthcare providers a fixed amount to coordinate treatment of an illness such as diabetes. Since at least the 1980s, the traditional fee-for-service model of healthcare payment has been challenged by reforms that alter payment methods in order to limit costs. Critics say that the persistent use of fee-for-service—where health providers are rewarded only when they provide more care—encourages unnecessary health care spending without enhancing quality or efficiency. The Patient Protection and Affordable Care Act of 2010 has given new impetus to payment reforms that can achieve both cost containment and improvements in healthcare quality. Most of the new approaches are expected to tame costs by reversing incentives to deliver more care. Instead they create incentives to providers and patients to weigh the costs of their medical choices. But some worry that if providers are at financial risk, these payment models may have mixed consequences for quality. Quality measurement should be used to assure that the financial incentives produce high quality cost-conscious care. The study, "Payment Reform: Analysis of Models & Performance Measurement Implications," is available at www.rand.org.

March 3, 2011 by matray

On Feb. 10, Representatives Bob Good-latte and Dan Boren announced the creation of a bipartisan legal reform caucus, the Congressional Civil Justice Caucus. Goodlatte and Boren will serve as co-chairs of the newly formed caucus. According to the congressmen, the Congressional Civil Justice Caucus will serve as a forum for discussing and debating the many legal reform issues affecting the civil justice system, including medical malpractice reform, venue reform, patent reform and federal pleading standards. “Our nation’s civil justice system has a direct impact on America’s competitiveness in the global marketplace,” said Goodlatte. “Excessive and frivolous litigation and inefficient rules and procedures drain U.S. companies of desperately needed resources and hinder job growth and innovation.” The congressmen claim that recent estimates indicate that the cost of the U.S. tort liability system, as a percentage of gross domestic product, is more than double the average cost of any other industrialized nation and that America’s businesses and citizens alike need a well-functioning civil justice system that provides for the efficient and timely redress of legitimate disputes without allowing opportunistic parties to game the system. The goals of the Congressional Civil Justice Caucus include strengthening our civil justice system and advancing the United States’ leadership in innovation, job creation and economic growth; advancing the public’s understanding of how civil justice issues affect the free enterprise system as well as America’s global competitiveness; and providing a bipartisan forum for discussion and debate of policy issues related to our nation’s civil justice system. “I look forward to working with my colleague, Congressman Goodlatte, to promote a civil justice system that respects the rule of law while allowing for the type of innovation, economic growth, and free enterprise that makes the United States a leader in global competitiveness,” said Boren. “By providing a bipartisan forum for the discussion, we hope to help educate Members of Congress, staff and the public on policy issues related to our nation’s civil justice system.” The U.S. Chamber of Commerce has wholeheartedly endorsed the caucus, offering its aid in making “our nation’s overall civil legal system simpler, fairer and faster for all participants.” “According to the respected actuarial firm of Towers Watson, the costs associated with our tort system alone were $248.1 billion in 2009, which translates into a cost of $808 per person,” said Lisa A. Rickard, president of the U.S. Chamber Institute for Legal Reform, an affiliate of the U.S. Chamber of Commerce. “The system encourages gamesmanship, is incredibly inefficient and often results in inadequate compensation to those truly injured due to the transaction costs associated with litigation.” The Civil Justice Caucus also received the endorsement of the Law & Economics Center at George Mason University School of Law, which formed the Congressional Civil Justice Caucus Academy to provide education programs on civil justice issues. Of course, less optimistic observers noted that reform would be a difficult political venture. “Anything Congress passes not only has to go through the gauntlet of Senate Majority Leader Harry Reid, but must be signed by President Obama, who has shown no stomach for meaningful liability reform, and whose administration has taken several anti-jobs positions to benefit trial lawyers," said Ted Frank, founder of the Center for Class Action Fairness as well as a writer at Overlawyered.com and the Manhattan Institute's PointofLaw.com. In addition to co-chairs Goodlatte and Boren, Representatives Lamar Smith, Trent Franks, Jim Matheson and Collin Peterson serve as founding members of the Congressional Civil Justice Caucus.

March 2, 2011 by matray

side note: If this isn't a strong argument that New York's medical liability climate threatens access to care, I do not know what would be. A malpractice insurance company has threatened not to renew coverage for eight Bronx obstetricians who treat poor, high-risk patients. The New York Times reports that Medical Liability Mutual Insurance Company issued the warning in a letter last month. It went out to eight of 13 obstetricians at Bronx-Lebanon Hospital Center. The hospital delivers about 2,700 babies a year. Many of the patients are teenagers or have diabetes, high blood pressure or other medical problems. The letter cited a “method of practice” among the doctors that made them “an unreasonable burden” to other policyholders. It did not specify how many times each doctor had been sued. The hospital said its services compare favorably with other hospitals. continue reading

March 1, 2011 by matray

side note: Here's an unusual piece of politics. The Democratic Governor of New York, Andrew Cuomo, is proposing malpractice damage caps to heal the state's economic woes. With the intention of re-structuring New York’s Medicaid system, Governor Cuomo is urging various changes to how medical malpractice suits are resolved. Primarily, he wishes to limit awards at $250,000 per case, explaining this change alone may save upwards of $200 million in the following year. However, Sheldon Silver, Assembly Speaker, believes this change to be unnecessary and is working to block it from occurring. Officials believe it will be resolved, but the methods and the duration at which it may take are yet to be known. side note: Here is an unusual turn in politics. Democratic NY Gov. Cuomo is proposing a cap on damages to help the state's budget woe Many advocates of the new change explain that often times, lawsuits are extremely out of control and award much more money than could be justified by the damages. The proposed change by Cuomo looks to benefit the overall financial situation of the state, potentially resolving the severe budget issues that currently exist. continue reading

February 22, 2011 by matray

side note: Uh-oh! Is the Commissioner cracking the whip on out-of-control medical professional liability insurance rates? Or is he off-base, and rates are where they should be in California? Insurance Commissioner Dave Jones today contacted several medical malpractice insurers raising concerns about excessive rates and asking that they make a rate filing with the California Department of Insurance (CDI) to reduce their rates. "Unlike health insurance, where I do not have the authority to reject excessive rates, the Insurance Commissioner does have the authority to regulate the rates of medical malpractice insurance paid for by doctors, surgeons, clinics and other health providers," Commissioner Jones said. "We have found that recent loss ratios - the percentage of every premium dollar the insurer spends on claims - of many medical malpractice insurers are low, and that's why I have directed my staff to carefully examine the rates of medical malpractice insurers. Low loss ratios are one indication that premiums may be too high." The authority to regulate medical malpractice insurance rates comes from provisions of law put into place by Proposition 103 in 1988. The Proposition 103 provisions include a mandate that insurers apply to the Insurance Commissioner for prior approval of rates and prohibit the use of excessive rates. Historically, this authority has been used to reduce medical malpractice rate increases and in some cases to require additional decreases in medical malpractice rates. The success CDI has had with regulating medical malpractice rates is another example of the benefits of strict rate regulation requirements. The provisions of Proposition 103 apply to most property-casualty coverages including personal auto and homeowners but do not apply to health insurance rates. For those medical malpractice insurers where CDI has reason to believe the rates are excessive, the insurer will be required to make a rate filing with the Department, after which, the Department will conduct a review to evaluate the filing and approve a rate level that complies with the law.

February 17, 2011 by matray

side note: On the heels of Wisconsin, here's another new republican majority working to further the tortreform agenda. Should be an interesting process to watch. North Carolina lawmakers have begun what promises to be a long fight over medical malpractice laws as insurance and medical services companies square off against law firms. A Senate committee opened discussions Tuesday on legislation that includes limiting damages for pain and suffering to $250,000. Courts in other states have found such limits to be illegal. Georgia’s Supreme Court ruled unanimously last year that a $350,000 cap on non-economic damages was unconstitutional. A bill signed into law in 2007 capped monetary damages in negligence cases at $1 million, but only for those who agreed to go to binding arbitration. Few people have taken advantage of the option. continue reading

February 16, 2011 by matray

side note: No shocker here. None of the $250 million can be used for implementing damage caps (like the Republican HEALTH Act seeks), but the President is in favor of states implementing ideas like health courts. WASHINGTON (AP) - Putting his own stamp on a long-standing Republican priority, President Barack Obama is launching a drive to overhaul state medical malpractice laws and cut down on wasteful tests doctors perform because they fear lawsuits. Obama's budget calls for $250 million in Justice Department grants to help states rewrite their malpractice laws in line with recommendations that his bipartisan debt reduction commission issued last year. "I think the president is very serious about following up on this," Health and Human Services Secretary Kathleen Sebelius told the Senate Finance Committee on Tuesday. Her agency would advise the Justice Department on awarding the grants. Specific reforms the money could be used for exclude caps on jury awards that the American Medical Association and GOP lawmakers have pursued for years without success. But they do include measures unacceptable to trial lawyers, an interest group that contributes heavily to Democratic candidates. Topping the list of ideas in an Obama administration summary of the proposal are health courts. Specially trained judges — not juries — would decide malpractice cases, awarding compensation from a set schedule. Plaintiffs' lawyers say that would undermine the constitutional right to trial by jury. But proponents say it would bring predictability, resulting in lower malpractice insurance rates for doctors. "Health courts offer much more protection for fearful physicians than caps because you are unlikely to get a crazy verdict when you have an expert judge," said lawyer Philip Howard, founder of Common Good, a nonprofit group that advocates for changes in the legal system. The money Obama seeks could go far, he added, estimating it would cost $5 million to $7 million for a midsize state to set up health courts. Speaking for trial lawyers, Gibson Vance, president of the American Association for Justice, called the idea "bad policy and bad for patients." Obama's proposal also got a cool reception Tuesday from congressional Republicans, who feel he has a record of promising more on malpractice than he delivers. Obama first indicated an interest in the issue during the marathon debate over his health care law. But all that actually wound up in the law was $25 million in grants to study the problem and potential solutions. It's different this time, administration officials said. The new proposal calls for ten times more money, and the grants would be used to change laws, not conduct more studies. Nonetheless, House Republicans are moving ahead with legislation to impose caps on jury awards. The cost of defensive medicine is difficult to estimate, but conservative estimates start at around $50 billion a year. Obama's debt commission estimated its recommendations could save government programs $17 billion through 2020, calling for an aggressive effort to rewrite malpractice laws. Obama's budget, however, does not claim any savings from the new proposal. Other malpractice reforms that could be funded under Obama's grant proposal include: — Creating a legal defense for doctors, hospitals and other providers who follow guidelines for best clinical practices and use electronic medical records. So-called "safe harbor" laws establish the presumption that by adhering to high standards, doctors are not behaving in a negligent manner. — Programs that require hospitals and doctors to disclose mistakes early, offer an apology and compensation, and also agree to make changes to protect other patients from being harmed in the same way. If the patient's family still wants to go to court, the provider's apology could not be used as evidence of liability. Such programs have been shown to reduce litigation. continue reading

February 10, 2011 by matray

side note: Wow! Here is an interesting case where the Tea Party philosophy clashes with the Republican agenda. The HEALTH Act (proposed federal tort reform) was set to be "marked up" yesterday by the House Judicial Committee, but had to be postponed because Rep. Ted Poe (R-Texas), a member of the Tea Party Caucus, said that it did not pass Constitutional muster. From The Hill's Healthwatch blog: Tea Party divide sidetracks tort reform: Rep. Ted Poe (R-Texas), a member of the Tea Party Caucus, said a Republican member's bill that would impose a cap on medical malpractice damages violates the Constitution. The House Judiciary Committee delayed markup of the tort reform bill until next week to consider whether the legislation would clash with state constitutions that forbid medical malpractice caps. see The Hill's Healthwatch blog

February 7, 2011 by matray

side note: Here is the lead story in the February 2011 issue of Medical Liability Monitor. MLM is a must-read for those in the medical professional liability insurance industry. Wisconsin could be the best barometer of a reshaped political landscape following the Nov. 2, 2010, elections—the only state in the union where both legislative houses and the governor’s office flipped from Democratic to Republican control. Think of it as a petri dish of reclaimed conservative influence upon government. The day after his inauguration, newly minted Gov. Scott Walker convened the Wisconsin Legislature in a special session to discuss five bills intended to create a more business-friendly environment, one of which—the Health Care Quality Improvement Act (HCQI)—contains medical liability tort reforms. With a 19-14 majority in the Wisconsin Senate and a 60-38-1 edge in the Assembly, the state’s Republican legislators were able to quickly usher Gov. Walker’s agenda through with minimal difficulty. According to Walker, the liability reforms will discourage plaintiffs from filing frivolous claims, cap non-economic damages for medical malpractice, improve rules of evidence, protect best practices peer review information from being subpoenaed and raise the standards for qualifying expert testimony. “Improving our state’s legal climate is important to creating an environment that allows the private sector to create jobs,” Walker said. “The lawsuit reform package passed by the legislature will bring much needed reforms to our legal system, so we are no longer known as the ‘Alabama of the North.’” Much of the recently passed legislation is identical to reforms drafted in 2005 and ultimately vetoed by then-Gov. Jim Doyle, a Democrat. Those in Wisconsin’s Democratic Party and its usual allies contend that liability reform will not create a single job and will ultimately harm the state’s patients in the long run. Specific to their argument that the new legislation will actually harm Wisconsin patients is the section of the law that would prevent reports from state regulators that find problems at healthcare facilities as well as statements from employees of a healthcare provider from being admissable in court. “The people in our communities who make up the courtroom juries are the same people our elected officials entrust to elect them,” said Mike End, president of the Wisconsin Association for Justice, the largest voluntary statewide plaintiff bar in Wisconsin. “With this bill our elected officials are saying that they know best—not the people and the judge in the courtroom—when it comes to determining who is at fault and who can testify.” Proponents of the bill argue that the legislation will improve patient safety because one of the greatest challenges hospitals face is persuading doctors, nurses and other healthcare professionals to report errors. They assert that if these professionals know that an incident report will not be subpoenaed, they will be much more likely to report a medical error and provide information that could prevent future errors. “The Health Care Quality Improvement Act will put Wisconsin at the forefront of the patient safety and quality improvement movement, leading to better outcomes for patients and better healthcare value,” said Stephen F. Brenton, president and CEO of the Wisconsin Hospital Association. “Under the proposal, healthcare providers will be able to study and improve practices, and importantly, share what they learn with others without fear of those findings being used against them in a lawsuit. These changes will bolster the work of organizations, including the state’s regulatory agencies, that work to improve patient safety and healthcare quality.”

January 27, 2011 by matray

In his recent, Jan. 25, State of the Union address, President Barack Obama indicated that he is “willing to look at other ideas to bring down [healthcare] costs, including one that Republicans suggested last year: medical malpractice reform to rein in frivolous lawsuits.” Shortly after the State of the Union, the White House Office of the Press Secretary released further clarification on its website: “Building on the deficit reduction already passed through the Patient Protection & Affordable Care Act, the President said his budget will include further efforts to reduce the cost of healthcare,” according to the online statement. “As part of these efforts, the President pledged to work with Republicans to support state reforms of medical malpractice systems to bring down costs and improve care—building on Administration efforts already underway to assess what works in medical malpractice reform.” The Office of the Press Secretary’s indication that the President’s support of medical liability tort reform ends at “state reforms of medical malpractice systems” indicates he is unwilling to champion any measures at the federal level, placing him at odds with the HEALTH Act, tort reform legislation introduced a day prior in the House that carries a $250,000 federal cap on non-economic damages. Those in the know understand that any tort reform efforts ultimately supported by the executive branch are likely to be similar to those pilot programs funded in the Patient Protection & Affordable Care Act. As part of the Act, the Department of Health & Human Services distributed $25 million in grants to encourage states to experiment with ways to deter medical malpractice lawsuits. These demonstration projects, already underway in 21 states, have built on hospital programs in which doctors who make a mistake apologize early and try to negotiate a payment as well as screening systems in which states have formed panels of medical experts who must rule that patients’ complaints have merit before they may sue. The President has never supported caps on non-economic damages.