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.