Research on Medical Malpractice Reform: Examples of What Foundations Have Funded
September 9th, 2010
by
Lee-Lee Prina
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The just-released September 2010 issue of Health Affairs contains a section on malpractice and medical errors. Today, the GrantWatch Blog looks at examples of foundation funding of research on malpractice reform and suggests related resources for further reading on this controversial topic.
New Issue Brief:
“Will the Patient Protection and Affordable Care Act Address the Problems Associated with Medical Malpractice?” Randall R. Bovbjerg, August 2010, Urban Institute paper. Funded by the Robert Wood Johnson Foundation. This document is one of a series of briefs that look at the question, “How will [health] reform affect health care costs?”
“Malpractice reforms could help curb health care spending and promote safety,” but the Patient Protection and Affordable Care Act “only offers small steps,” according to the paper’s pull-quote.
After mentioning the politics of malpractice reform, Bovbjerg comments, “Conventional tort reform is a zero-sum game, much as lawsuits are—every gain for one side is a loss for the other.” He adds that “the traditional liability regime” helps neither patients nor caregivers.
The Affordable Care Act, however, “did nothing to change this political dynamic or the underlying problems,” the author maintains. In fact, he explains that there are only “two small liability-related provisions” in the law. These provisions (1) authorize limited demonstration projects by states on the topic of malpractice and (2) extend “federal malpractice protections to free clinics’ nonmedical personnel.”
Bovbjerg indicates that, unfortunately, the savings that would accrue from reducing the practice of defensive medicine would be small. But he also says that “omitting defensive services almost by definition would not harm patients.” Defensive medicine is practiced “more for legal defense than for patient benefit,” he explains.
He then examines various promising liability and safety reforms (such as early disclosure of “adverse events” by physicians, with subsequent “reasonable compensation” to the patient “where mistakes have occurred”) to see whether they would qualify for the Affordable Care Act’s demonstration grants. He finds that it is unlikely that any of these approaches would get the thumbs-up from the federal government.
Bovbjerg recommends shifting “any available” funding for demonstrations under the Affordable Care Act to the Agency for Healthcare Research and Quality (AHRQ), which recently awarded grants through its Medical Liability Reform and Patient Safety Initiative. (The author notes that the money for medical liability reform demonstration grants in the Affordable Care Act has been authorized but not yet appropriated. This point was confirmed by an AHRQ spokesperson.)
Bovbjerg also suggests that a trade-off of sorts be made with physicians: medical liability reform could be extended to them so as “to promote [their] full participation in Medicaid or to reduce resistance to evidence-based medicine, case management, or other health insurance initiatives that reduce cost or enhance value.” That would be similar to the free-clinic liability provision in the Affordable Care Act.
In a summary of the paper, the author states, “Patients as a whole could benefit if conventional tort limits were traded for better-value care as health reform is implemented or if broader reforms of liability could be demonstrated [to be] successful.”
Grant Awarded:
The New York State Health (NYSHealth) Foundation awarded a $151,980 grant in August 2009 to the Common Good Institute, in Brooklyn, New York, to design “an arbitration-based medical injury dispute resolution system for New York health systems.” The aim of the nonpartisan, nonprofit Common Good is to develop a program based on arbitration (not litigation) that would “resolve medical liability cases openly, quickly, and at a significantly reduced cost for all parties involved.” The grantee planned to collaborate with health providers in New York. Read more about this interesting project here.
This grant is one of six grants awarded under NYSHealth’s Strategies to Contain Health Care Costs in New York State program. For background, read the (now-closed) request for proposals.
Related reading:
“A Philanthropy Tackles Growth in Health Costs at the State Level,” David Sandman of NYSHealth Foundation and Anthony Kovner of New York University’s Robert F. Wagner Graduate School of Public Service, Health Affairs, GrantWatch section, July 2010. The grant to Common Good is described there also.
The Robert Wood Johnson Foundation (RWJF) awarded several grants to Common Good over the years; all have now concluded. From the RWJF’s website, it appears that the most recent grant was for a forum that was held in December 2009 “on viable, state-based medical liability reform.” Read more here about the forum, held at the National Press Club, in Washington, D.C.
Related resources on medical malpractice reform:
Health Affairs, September 2010 issue, which has a section on Medical Malpractice and Errors. Articles include:
“Low Costs of Defensive Medicine, Small Savings from Tort Reform,” by J. William Thomas, Erika C. Ziller, and Deborah A. Thayer, all of the Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine. The RWJF’s Health Care Financing and Organization (HCFO) national program supported the research for this article.
“Physicians’ Fears of Malpractice Lawsuits Are Not Assuaged by Tort Reforms,” by Emily R. Carrier, James D. Reschovsky, Michelle M. Mello, Ralph C. Mayrell, and David Katz. Carrier, Reschovsky, and Mayrell are with the Center for Studying Health System Change; Mello is at the Harvard School of Public Health; and Katz is with the University of Iowa’s Department of Internal Medicine. The RWJF funded this work.
Common Good Institute’s website, http://www.commongood.org. This site has useful links to recent news articles on medical malpractice.
“Even with Malpractice Insurance, Doctors Opt for Expensive, Defensive Medicine,” Manoj Jain, Washington Post, Health Section, August 31, 2010. Jain writes about his own experience. He is an infectious-disease specialist in Memphis, Tennessee, and an adjunct assistant professor at Emory University’s Rollins School of Public Health.
Medical Liability Reform and Patient Safety Initiative, AHRQ (an agency of the US Department of Health and Human Services [HHS]), http://www.ahrq.gov/qual/liability. President Obama announced this initiative September 9, 2009. This web page has links to descriptions of the demonstration grants and planning grants that were awarded in June 2010. HHS allocated $25 million for this initiative, and all of the money has been awarded, according to the AHRQ spokesperson I contacted. Existing AHRQ funding will pay for a review of what works and for overall program evaluation, according to an initiative fact sheet.
Read more about the AHRQ demonstration grants in “Averting Medical Malpractice Lawsuits: Effective Medicine—or Inadequate Cure?” by Stephen Langel, September 2010, Health Affairs. Langel is a senior editor at the journal.
“Young Doctors Getting Defensive Medicine Lessons Early On: But Less Than a Third of Physicians Older Than Fifty-five Learned These Tactics When They Were in Medical School,” Amy Lynn Sorrel, American Medical News, May 19, 2010. Reporting on a survey that was conducted by Jackson Healthcare, Sorrel says, “eighty-seven percent of doctors who described themselves. . . as current residents or fellows reported being taught to practice defensive medicine while in medical school or residency.”
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