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Reform Update: Calif. ballot issue heats up discussion over med-mal caps


By Andis Robeznieks
Posted: May 19, 2014 - 4:15 pm ET
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The debate in California over raising the cap on noneconomic damage awards in medical malpractice suits to account for inflation reminds many physicians of one of their biggest complaints about Obamacare—that it did not include damage caps or other limits on medical liability suits.

The arguments for and against caps are guaranteed to be the topic of renewed discussion now that California Secretary of State Debra Bowen has certified a ballot initiative to raise the state's cap on pain and suffering damages from $250,000 to about $1.1 million to account for inflation. The measure will appear on the Nov. 4 ballot. The cap has not changed in the nearly 40 years since the law was passed.

If California voters approve the Troy and Alana Pack Patient Safety Act, doctors would be required to undergo drug and alcohol testing and providers would have to check a patient's drug history before prescribing certain controlled substances.

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Physicians pushed hard in 2009 to include malpractice damage caps in the Patient Protection and Affordable Care Act like those in place in California and Texas—even though debate continues in those states over whether the caps have lowered costs related to defensive medicine or increased access to care. President Barack Obama reportedly offered congressional Republican leaders a deal in 2009 to include malpractice damage caps if they supported his healthcare reform legislation, but they did not respond.

But the Affordable Care Act did authorize up to $50 million in funding for tort reform demonstration projects. While that money was never appropriated by Congress, 20 grants totaling $23.2 million were awarded in June 2010 using an appropriation that had been approved earlier.

The AHRQ says that extensions had been granted to all but one demonstration project. The only project completed within the original time frame was one looking at ways to eliminate variation in obstetrics practice at the Ascension Health System in St. Louis. An early progress report on the almost $3 million effort noted that birth traumas had “reduced significantly” at five participating hospitals compared with 32 control institutions.

A multi-hospital initiative in Massachusetts started with AHRQ funding is still going strong in the form of a coalition known as the Massachusetts Alliance for Communication and Resolution following Medical Injury. The coalition of state healthcare organization promotes non-litigious methods for settling malpractice claims known as Communication, Apology, and Resolution, also known as CARe. The group is holding its second annual CARe Forum on May 22. Preliminary data from the initiative is expected to be released then.

Using a similar approach at the University of Illinois Hospital and Health Science System, grant recipient Dr. Timothy McDonald reported that medical malpractice premiums declined by $22 million between fiscal 2010 and fiscal 2013.

In 2012, the Congressional Budget Office estimated that a package of federal tort law changes—including a $250,000 cap on noneconomic damages, a cap on punitive damages, a tighter time frame for bringing cases and certain other reforms—would reduce the federal budget deficit by about $57 billion from 2012 to 2021.

PCORI paying up to $90 million for comparative-effectiveness studies

Up to $90 million is being made available for “game-changing” comparative-effectiveness studies by the Patient-Centered Outcomes Research Institute, an independent not-for profit organization created by the Patient Protection and Affordable Care Act.

PCORI announced that it will pay up to $10 million in direct costs for nine different “large pragmatic” studies that can take up to five years and are intended to fill knowledge gaps on health problems facing patients and their families.

“The ambitious goal of our Large Pragmatic Studies Initiative is to establish a portfolio of game-changing studies that will significantly improve our understanding of clinical decisions made every day by patients and those who care for them,” Dr. Joe Selby, PCORI executive director, said in a news release.

ACA long way from cutting errors through patient safety, study says

One aspect of how the Patient Protection and Affordable Care Act sought to address malpractice concerns was by improving patient safety to reduce errors that could lead to lawsuits, but it appears that there may still be a long way to go to accomplish this aim.

Individuals on hospital staffs generally have a positive view of their institution's patient-safety culture, but are still concerned about patient handoffs and whether their organization truly has a nonpunative approach to error reporting, according to a new survey by the HHS' Agency for Healthcare Research and Quality.

For this year's edition of its annual Hospital Survey on Patient Safety Culture, AHRQ received responses from 405,281 staffers at 653 hospitals. Of these, 81% reported that their hospitals exhibit good teamwork with mutual staff support and respect, 76% said their supervisors consider staff suggestions for improving patient safety and do not overlook safety concerns, and 73% said their hospital is on a continuous improvement cycle and that mistakes have led to positive changes.

Only 44%, however, reported that they felt their mistakes or event reports won't be used against them, just 47% thought important patient information is transferred across all hospital units during shift changes, and only 55% felt their hospital had adequate staff to provide the best care for patients.

Follow Andis Robeznieks on Twitter: @MHARobeznieks


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