ppaca wk 2

Problem stream:

The problem is real - Malpractice issues in Illinois are particularly problematic. Illinois is ranked as having the fourth highest tort costs in the country and the fifth most draconian tort laws according to The Pacific Research Institute (Luke, Illinois, NY among Usual Tort Suspects in PRI Study, 2008). Illinois is also in the top five states in terms of malpractice insurance costs (Kiernan, 2016’s Best & Worst States for Doctors, 2016).

Politics Stream

Stakeholders:

1) Patients - the consumers of health care - Individuals who are scheduled for or are receiving healthcare services. There are a variety of associations and organizations that advocate for patients. For example, Propublica is committed to “expose abuses of power and betrayals of the public trust by government, business, and other institutions, using the moral force of investigative journalism to spur reform through the sustained spotlighting of wrongdoing” (Propublica, 2016). Their journalistic interest extends to healthcare including medical malpractice. They are particularly interested in changes in the malpractice environment that will decrease medical errors (Pierce & Allen, 2015)

2) Providers - physicians, nurses, allied health professionals and other personnel who deliver health care services to patients. The United States’ largest advocacy group for physicians is the American Medical Association. They advocate for noneconomic damages limitations, reduction of premiums, health courts and safe harbors (American Medical Association, 2016). The AMA is also dedicated to reducing medical errors (American Medical Association, 2003).

3) Legislators - individuals who make laws. In Illinois, the Committee of the Whole in the House considered tort reform last year (Levin &Perconti, 2015).

4) Government executives - individuals who work in the executive branch of government at various jurisdictional levels who enforce and execute laws. An example of an association that represents government executives is the National Governors Association (NGA). The NGA is the bipartisan association of U.S. state governors. They state that “through NGA, governors share best practices, speak with a collective voice on national policy and develop innovative solutions that improve state government and support the principles of federalism” (National Governors Association, 2016). The NGA is committed to containing medical malpractice costs by reforming tort law, decreasing premiums, ensuring physician tax credits, reducing medical errors, and improving reporting (National Governors Association, 2005).

5) Judges – an elected or appointed individual who considers and renders decisions about cases in a court of law. A representative of judges in Illinois is the Illinois Judges Association (IJA). The IJA “supports judicial excellence and professional development and judicial education, fosters public confidence in an independent judiciary, works to preserve the independence of the judiciary by educating the public and students, and promotes a diverse judiciary that administers justice in a fair and impartial court system” (Illinois Judges Association, 2016).

6) Trial Lawyers - a lawyer who tries cases in a court of law. The Illinois Trial Lawyers Association (ITLA) represents plaintiffs’ attorneys in Illinois. Their mission is “to ensure all citizens get equal footing in the courtroom, even when taking on the most powerful interests. We see to it that those who harm consumers, other individuals, or even their own employees, are held accountable” (Illinois Trial Lawyers Association, 2015). The ITLA takes a strong position against medical malpractice reform (Illinois Trial Lawyers Association, 2010).

7) Insurance Companies - companies that provide insurance to individuals and employers to pay for medical care expenses for those individuals and their families or employees respectively. America’s Health Insurance Plans (AHIP) organization is the leading trade association representing the health insurance community in the United States. “AHIP advocates for public policies that expand access to affordable health care coverage to all Americans through a competitive marketplace that fosters choice, quality, and innovation” (America’s Health Insurance Plans, 2016).

8) Government Payers - the Center for Medicare and Medicaid services and state-run Medicaid programs that pay for medical expenses for their constituents.

9) Hospitals -facilities that provide surgical and medical therapies to patients. As noted above the Illinois Health and Hospital Association (IHA) is an example of an association that represents the interests of hospitals.  The IHA seeks to “To advocate for and support hospitals and health systems as they serve their patients and communities” (Illinois Health and Hospital Association, 2016). The IHA has a keen interest in malpractice reform. They maintain a page on their website for medical liability (Illinois Health and Hospital Association, 2016).

10) Associations and organizations - various groups that advocate for their constituents points of view in the healthcare space.

The Illinois legislature has tried to address the problem but has been blocked by the courts. The IHA filed an amicus brief regarding the courts consideration of the 2005 cap (Nodzenski, Galland, Hatton, & Mudron, 2005).  Despite this, the court overturned the cap on constitutional grounds. In fact, the Illinois Supreme Court has struck down $500,000 noneconomic malpractice case award limitations passed by the Legislature on three different occasions. The Court has done this even after recognizing that eight states have sustained caps in the face of legal challenges, and 19 states have a successfully adopted damage caps. The courts principal argument is that caps are unconstitutional based on separation of power arguments (Clayton, Hansen, & Placher, 2010).

Policy Stream – Reaction to a crisis

1) Tort reform - mitigate awards with other fund sources such as health insurance, assign financial liability in proportion to fault rather than in proportion to capacity, eliminate or restrict punitive damages, end lump-sum payments, and cap noneconomic damages at $250,000. The impact of tort reform is controversial. Some authors maintain that, at least in some states, it has been highly successful. In other cases, it appears that tort reform initiatives like noneconomic damages caps have not worked in isolation. Amongst the stakeholder groups, trial attorneys and possibly injured patients would be financially disadvantaged. The predicted effect of tort reform, in particular, damage limitations, without provisions for premium limitation on the other stakeholders is variable. From a political feasibility point of view tort reform in Illinois seems to face a very steep hill to climb – i.e. a consistent and firm resistance of the Supreme Court to allow the legislature to pass noneconomic damage limitations.

2) Medical error reduction - incentivize quality improvement and quality assurance programs, facilitate device and medication error reduction strategies (for example, with barcoding), require algorithms of care utilization and evidence-based standards of practice, reward the penalty free reporting of medical errors, address provider impairment (substance abuse and sleep deprivation), and promote information transparency, accessibility, communication, and accuracy with information technology. Medical error reduction benefits all stakeholders except for trial attorneys. The only caveats have to do with concerns over “big brother” oversight and the sweat equity and financial costs of increased documentation

3) Develop expert medical panels and/or health courts. Instead of lay persons struggling with difficult to understand medical complexities malpractice cases would be adjudicated by expert panels or judges. Panels and health courts are considered alternative mechanisms for dispute resolution. Trial lawyers and some injured patients could expect less remuneration. The other stakeholders would benefit but only if such a system worked and if it was politically feasible. Both of these caveats are raised as substantial concerns by multiple authors.

4) Do not address the medical malpractice environment in Illinois – the medical malpractice situation in Illinois is very unfavorable. The current emphasis on quality and on saving money in the US healthcare environment, and the current Illinois Governor’s desire to overhaul the malpractice system make doing nothing politically inexpedient.

Window of opportunity:

A window of opportunity may now exist in Illinois for malpractice reform because of the new governor. Bruce Vincent Rauner is the new Governor of Illinois. Mr. Rauner is a wealthy self-made businessman who was elected governor of Illinois on November 4, 2014 (Sanguinetti, 2015). He has a strong pro-business platform that includes tort reform (Geiger & Hellmann, 2015). However, it should be noted that Mr.Rauner’s tort reform efforts, including those that have to do with malpractice, have faced considerable resistance from the Democrats in the Illinois House of Representatives (Hinz, 2016). Overall, the malpractice issues higher on the public agenda than it was prior to Mr. Rauner’selection.

Bibliography

America’s Health Insurance Plans. (2016). About. Retrieved June 14, 2016, from America’s Health Insurance Plans:https://www.ahip.org/about-us/

American Medical Association. (2003, December). Opinion 8.121 - Ethical Responsibility to Study and Prevent Error and Harm. Retrieved June 14, 2016, from American Medical Association: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8121.page

American Medical Association. (2016). Medical Liability Reform. Retrieved June 14, 2016, from American Medical Association:http://www.ama-assn.org/ama/pub/advocacy/topics/medical-liability-reform.page

Clayton, R. R., Hansen, M. D., & Placher, J. A. (2010). What Every Litigator Needs to Know About the Illinois Supreme Court’s Rejection of Damage Caps. IDC Quarterly, 20(4), 46 – 49.

Geiger, K., & Hellmann, J. (2015, May 12). Madigan sends Rauner message on tort reform. Retrieved June 14, 2016, from Chicago Tribune:http://www.chicagotribune.com/ct-illinois-madigan-rauner-tort-reform-met-0513-20150512-story.html

Hinz, G. (2016, January 27). State of the State - Rauner offers softer tone, but same hard line. Retrieved June 14, 2016, from Crain's Chicago business: http://www.chicagobusiness.com/article/20160127/BLOGS02/160129832/rauner-offers-softer-tone-but-same-hard-line

Illinois Health and Hospital Association. (2016). About IHA. Retrieved June 10, 2016, from IHA today: http://www.ihatoday.org/about-iha.aspx

Illinois Health and Hospital Association. (2016). Medical liability. Retrieved June 10, 2016, from IHA today:http://www.ihatoday.org/Health-Care-Issues/Medical-Liability.aspx

Illinois Judges Association. (2016). About. Retrieved June 14, 2016, from Illinois Judges Association: https://ija.org/about-ija.html

Illinois Trial Lawyers Association. (2010). The Whole Truth About Medical Malpractice and Insurance. Retrieved June 14, 2016, from Illinois Trial Lawyers Association: https://www.iltla.com/WebsiteDocs/TheWholeTruthAboutMedicalMalpractice_Feb2010.pdf

Illinois Trial Lawyers Association. (2015). Our Mission. Retrieved June 14, 2016, from Illinois Trial Lawyers Association:https://www.iltla.com/about-itla/our_mission/

Kiernan, J. S. (2016). 2016’s Best & Worst States for Doctors. Retrieved June 14, 2016, from Wallet Hub: https://wallethub.com/edu/best-and-worst-states-for-doctors/11376/

Kiernan, J. S. (2016). 2016’s Best & Worst States for Doctors. Retrieved May 28, 2016, from Wallet Hub: https://wallethub.com/edu/best-and-worst-states-for-doctors/11376/

Levin, & Perconti. (2015, June 23). Illinois Hearing Highlights Problems with Tort Reform. Retrieved June 14, 2016, from Illinois Medical Malpractice Blog: http://medicalmalpractice.levinperconti.com/2015/06/illinois_hearing_highlights_pr.html

Luke, R. (2008, March 11). Illinois, NY Among Usual Tort Suspects in PRI Study. Retrieved June 14, 2016, from Pacific Research Institute:http://www.pacificresearch.org/article/illinois-ny-among-usual-tort-suspects-in-pri-study/

Luke, R. (2008, March 11). ILLINOIS, NY AMONG USUAL TORT SUSPECTS IN PRI STUDY. Retrieved May 28, 2016, from Pacific Research Institute: http://www.pacificresearch.org/article/illinois-ny-among-usual-tort-suspects-in-pri-study/

National Governors Association. (2005, June 30). Containing Medical Malpractice Costs: Recent State Actions. Retrieved June 14, 2016, from National Governors Association: http://www.nga.org/cms/home/nga-center-for-best-practices/center-publications/page-health-publications/col2-content/main-content-list/containing-medical-malpractice-c.html

National Governors Association. (2016). About - Mission Statement. Retrieved June 14, 2016, from National Governors Association:http://www.nga.org/cms/about

Nodzenski, T. J., Galland, G. F., Hatton, M. R., & Mudron, M. D. (2005). Amicus Curiae Brief of the Illinois Hospital Association, American Hospital Association, Illinois Catholic Health Association and Illinois Rural Health Association in Support of Defendent – Appellant GottliebMemorial Hospital. Retrieved June 10, 2016, from IHA Today: http://www.ihatoday.org/uploadDocs/1/lebron.pdf

Pierce, O., & Allen, M. (2015, December 31). How Denmark Dumped Medical Malpractice and Improved Patient Safety. Retrieved June 14, 2016, from Propublica: https://www.propublica.org/article/how-denmark-dumped-medical-malpractice-and-improved-patient-safety

Propublica. (2016). About Us. Retrieved June 14, 2016, from Propublica: https://www.propublica.org/about/

Sanguinetti, E. (2015). About Bruce. Retrieved June 14, 2016, from Bruce Rauner: http://brucerauner.com/about/

Yee, M. (2014, March 31). Illinois's Cap for Medical Malpractice Damages. Retrieved June 14, 2016, from Legal Match:http://www.legalmatch.com/law-library/article/illinoiss-cap-for-medical-malpractice-damages.html

Bottom of Form