Deadline near for patient safety/liability reform proposals

Experts discuss viable projects and challenges in preparing proposals to qualify for some of the $25 million available in federal grants.

By Amy Lynn Sorrel — Posted Jan. 4, 2010

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The Jan. 20 deadline is approaching for states and health systems looking to grab federal grant money dedicated to testing new approaches to improving patient safety and reducing medical liability pressures on physicians. In an effort to put applicants on the right track, Common Good, a proponent of health courts, hosted a forum on Dec. 10, 2009, in which participants looked at promising ideas and potential pitfalls.

In September 2009, President Obama authorized the Dept. of Health and Human Services to set aside $25 million for the pilot projects. States and health systems may qualify for grants of up to three years and $3 million each. The Agency for Healthcare Research and Quality began accepting proposals Dec. 20, 2009.

Experts in the policy, legal and medical fields emphasized that projects must link both the patient safety and medical liability components.

"The common thread in all these discussions is there is something terribly wrong with the culture of health care delivery that people are so self-protective and bureaucratic, and it's just not a good system," said Philip K. Howard, founder and chair of Common Good.

"If you have a trusted system of justice, you can manage health care delivery with broader goals in mind," he said.

Getting down to the details with a scientific approach in pursuing those goals will be critical in drafting a successful proposal, said Michelle Mello, PhD, a professor at the Harvard School of Public Health in Boston.

"It's time to get very, very specific: What is your intervention and how does this new approach work, step-by-step, like a scientific protocol," she told participants. "The people who are going to be reviewing these grants are scientists, and they are going to look at things in this way."

Some panelists shared their plans to test proposals.

Martin J. Hatlie, CEO of the Coalition for Quality and Patient Safety of Chicagoland, said his organization plans to partner with the University of Illinois at Chicago to expand the institution's early-offer and disclosure program to 80% of the state's hospitals within five years.

The Massachusetts Medical Society is considering joining in on a comprehensive study of defensive medicine, including ways to address such practices while measuring patient and physician satisfaction.

The goal is "a fundamental transformation of a system from one that is reactive to one that is proactive ... and from one that motivates defensive medicine to one that promotes evidence-based medicine," said emergency physician Alan C. Woodward, MD, a past MMS president.

The American Medical Association, while still favoring traditional tort reforms such as damage caps, also supports the testing of alternatives and is working with state medical societies that are considering participating in the grant projects.

In New Mexico, state officials, the American College of Obstetricians and Gynecologists, and nurse-midwife organizations are developing a health court model.

The effort will build on a state task force recently convened to restructure the state's legal system for obstetric patient injury compensation after high liability insurance costs caused a shortage of ob-gyns.

"Patient safety is a driving force, and [the proposal] will involve training in all of our hospitals. And that information captured in the process of the health court system will be essential in what we are planning," said Elaine Brightwater, RN, senior project coordinator at the University of New Mexico's Center for Development and Disability.

Anticipating obstacles

Forum participants also tried to anticipate roadblocks to success.

The Maine Medical Assn. has been asked to partner in a proposal by some health systems to institute practice guidelines for advanced imaging, with the goal of reducing unnecessary exposure for patients, lowering costs and protecting physicians from liability when they adhere to the guidelines. But the final piece may not be feasible without legislative action, MMA Executive Vice President Gordon H. Smith said.

"The greatest challenge is how to provide that assurance to physicians ... and there's a reluctance to put something in a proposal that would rely on a change in legislation," which is difficult to predict, he said.

On the other hand, projects using arbitration as an alternative dispute mechanism may already have favorable federal laws on their side, said David J. Oakley, a New York health care lawyer with Manatt, Phelps & Phillips, LLP. As a practical matter, however, applicants would need to secure the administrative resources to explain the process to patients and obtain their consent.

Collecting and sharing patient information and claims data, if not properly protected, could create legal issues, Oakley warned.

Paying attention to how new patient safety oversight initiatives interact with existing mechanisms -- such as peer review and state licensing bodies -- will help facilitate open communication and avoid unnecessary regulatory hurdles, said Nancy Foster, American Hospital Assn. vice president for quality and patient safety policy. "You don't want to be bumping into that furniture."

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Building winning proposals

Experts say strong proposals are critical to winning grants to test new patient safety and medical liability reform pilots. Harvard School of Public Health professor Michelle Mello, PhD, offers these tips:

  • Include both the patient safety and medical liability components and describe the link between the two.
  • Be specific in describing implementation and goals.
  • Include any data demonstrating the project has promise.
  • Provide details about plans to measure outcomes.
  • Make sure the primary grantee meets the eligibility criteria and secure commitments from other key partnerships.
  • Avoid promising results that may be out of the planners' control, for example, something that may require the passage of legislation.

Source: "Fulfilling the Promise: Advancing Patient Safety and Medical Liability Reform Innovations," Common Good forum, Dec. 10, 2009 (link)

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External links

Agency for Healthcare Research and Quality on medical liability reform and patient safety initiative (link)

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