Portal de Periódicos da CAPES

Republicans Push for Malpractice Reform

2009; Elsevier BV; Volume: 10; Issue: 5 Linguagem: Inglês

10.1016/s1526-4114(09)60112-8

2377-066X

Susan M. Pettey,

Legal Systems and Judicial Processes

SUSAN M. PETTEY has directed health policy and advocacy programs for long-term care physicians, administrators, and other professionals, including AMDA and the American Association of Homes and Services for the Aging. Her experience includes work with the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services) and the National Association for Home Care. She currently is a health policy consultant. As health care reform discussions intensify, Republicans in Congress are making a concerted push to include medical liability reform in any health care package. The loyal opposition is linking liability reform to health care access in a series of Congressional hearings on health reform as initiated by Democrats in the House and Senate. At a March hearing, of the Health Subcommittee of the House Energy and Commerce Committee, Rep. Joe Barton (R-Tex.), the ranking Republican on Energy and Commerce, noted that it is “well documented that doctors are scaling back on the care they provide or abandoning their practices altogether to avoid getting sued.” Working with other members of the Health Coalition on Liability and Access, AMDA solicited supporters of medical liability reform to write letters to subcommittee members. A comprehensive medical liability bill may be introduced in Congress this year or included as part of health care reform, although incremental reforms, such as demonstrations of health courts and medical-screening panels, are more likely. Meanwhile, the Senate Special Committee on Aging focused attention on Alzheimer's disease at a recent hearing at which retired Supreme Court Justice Sandra Day O'Connor outlined the dimensions of the problem: “Our study shows that in the next 20 years the number of people with Alzheimer's will increase by more than 50%. Without urgent action, ultimately one out of every two Americans over 80 will have Alzheimer's.” The study referred to was done for the Alzheimer's Study Group, of which Justice O'Connor has been a member. The researchers estimated that Alzheimer's and other dementias could cost Medicare and Medicaid more than $1 trillion annually by 2050. Justice O'Connor's husband, John, has Alzheimer's disease. At the same hearing, former Speaker of the House Newt Gingrich, cochair of the Alzheimer's Study Group with former Sen. Bob Kerrey, called for a public-private partnership to generate additional funding for Alzheimer's research and support for caregivers. The group said that government should provide financial incentives for pharmaceutical research on interventions to prevent and treat Alzheimer's. Mr. Gingrich asserted, “The current Medicare fee-for-service system actually discourages doctors from testing to see if their patient has Alzheimer's. Treatment, care management, and care coordination are so underfunded that doctors find themselves burdened with liabilities without compensation. The result of the current system is consistent underdiagnosis and under-reporting of Alzheimer's, and the neglect of treatments and support that could immediately result in significantly improving the quality of life for those with Alzheimer's and their families.” Mr. Gingrich recommended new models of payment for providers based on value, rather than on services rendered. Also, several bills related to long-term care that did not pass during the last Congress have been introduced again. The Nursing Home Transparency and Improvement Act is one of them. The bill would provide greater transparency in identifying persons or entities with a significant ownership or management interest in nursing homes. It would also require facilities and chains to develop compliance and ethics plans, report real-time nurse staffing information, and do separate financial reporting on expenditures for nurse staffing. The Centers for Medicare & Medicaid Services' Nursing Home Compare Web site would be expanded to include links to data from recent health and safety inspections. The bill would also strengthen enforcement and provide the CMS with tools to address corporate-level quality and safety problems in chains. In addition, the proposed legislation would improve staff training. Legislation to prohibit mandatory arbitration clauses in contracts between long-term care facilities and their residents has also been reintroduced in the House and Senate. The Fairness in Nursing Home Arbitration Act would not prohibit arbitration but would allow nursing home residents to have the choice whether to arbitrate a dispute after it has arisen. Turning to the administrative side of health policy, the CMS has announced a new, four-state demonstration to test whether the financial incentives of value-based purchasing will improve the quality of care in nursing homes. Nursing homes in Arizona, Mississippi, New York, and Wisconsin will be invited to participate. Facilities joining the Nursing Home Value-Based Purchasing demonstration will be awarded points for performance on quality measures in four areas: nurse staffing, avoidable hospitalizations, resident outcomes, and the scope and severity of deficiency citations that the home has received during inspections. Nursing homes with the highest scores or the greatest improvement in their score will be eligible for a performance payment. Nursing homes wishing to participate will be randomly assigned to a demonstration group or a comparison group. Medicare officials anticipate that at least 100 nursing facilities in each state will apply to be part of this demonstration. The project is expected to run from July 2009 through June 2012.