Healthcare Risk Management Week


NQF endorses four new Never Events (June, 2011):

HHS imposes first HIPAA fine:

The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has issued a Notice of Final Determination finding that Cignet Health of Prince George’s County, Md., (Cignet) violated the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HHS has imposed a civil money penalty (CMP) of $4.3 million for the violations, representing the first CMP issued by the Department for a covered entity’s violations of the HIPAA Privacy Rule.

-submitted by Jim Bream, Querrey & Harrow


State of the Union:  Tort Reform?

Wednesday, January 26, 2011

The Washington Post

"I'm willing to look at other ideas to bring down [health-care] costs, including one that Republicans suggested last year: medical malpractice reform to rein in frivolous lawsuits."

Since his time in the Senate, President Obama has favored certain ways of trying to lower costs related to malpractice.

Essentially, he has been a proponent of reducing the number of such cases that reach the courts. In September 2009, he announced that the Department of Health and Human Services would start to give out $25 million in grants to encourage states to experiment with ways to deter such lawsuits. These demonstration projects, underway in 21 states, have built on hospital programs in which doctors who make a mistake apologize early and try to negotiate a payment. They also include screening systems in which states have formed panels of medical experts who must rule that patients' complaints have merit before they may sue.

But Obama does not like all ideas for changing the medical malpractice system. Even though the president said in his speech that he wants to work with Republicans, he has never supported one step that the GOP has long said would control malpractice costs: creating federal limits on the size of damage awards.

So both Obama and the GOP favor lowering medical malpractice costs. They just disagree sharply over how to do it.

            -The Washington Post 1-25-11



11 Hot Healthcare Buzzwords for 2011 

From HealthLeadersMedia, January 6, 2011

With rapid changes to the healthcare industry come terms and phrases every provider should know.   HealthLeaders Media rounded up 11 buzzwords for 2011 related to health information technology, healthcare marketing, and health system administration.



Top 10 Quality Issues for 2011

From HealthLeadersMedia, January 3, 2011

Here are the top quality challenges healthcare providers will face in 2011-many, such as imaging exposure effects, central line infections, and medical data breaches dominated headlines in 2010.


Joint Commission Sentinel Event Alert: Issue 46, November 17, 2010




Read more about risk assessment, risk reduction strategies, and references at: 



In 1998, The Joint Commission issued a Sentinel Event Alert on preventing inpatient suicides; this Alert updates the prevention strategies presented in that Alert with a focus on general hospitals and prevention of suicide in medical/surgical units and the emergency department. The goal of this Alert is to assure that patients outside of psychiatric units are appropriately screened and cared for. In addition to non-psychiatric settings, the Sentinel Event Database includes reports of suicide in psychiatric hospitals, behavioral health units of general hospitals, and residential treatment facilities. While psychiatric settings are designed to be safe for suicidal individuals and have staff with specialized training, typically, medical/surgical units and emergency departments are not designed or assessed for suicide risk and do not have staff with specialized training to deal with suicidal individuals. Not surprisingly, suicidal individuals often are admitted to general hospitals immediately following suicide attempts, or they seek help in hospital emergency departments - often at the urging of families or friends - when they are most desperate.(1) These patients are "known at risk" for suicide.


CMS launches center for innovation

November 16, 2010

The CMS has officially established the Center for Medicare and Medicaid Innovation, which is intended to study ways of delivering care and paying providers that can save money for the Medicare and Medicaid programs and improve quality.

Created in this year's Patient Protection and Affordable Care Act, the center will consult healthcare stakeholders nationwide-including hospitals, physicians, consumers, payers, employers, states and federal agencies-to create partnerships and also receive feedback on its operations.

"The center will identify and test care models that provide beneficiaries with a seamless care experience, better health and lower costs," physician Richard Gilfillan, the acting director for the new center, said in a news release. "By working together with innovative and committed providers, we can create a system that works better for everyone," he added. "We want to identify, validate and scale models that have been effective in achieving better outcomes and improving quality of care, but may be relatively unknown."

The agency also announced several programs to improve primary care in the U.S. The agency named eight states to participate in a demonstration project that will evaluate the effectiveness of physicians and other healthcare professionals working in a more integrated way and receiving coordinated payment from Medicare, Medicaid and private health plans. Maine, Michigan, Minnesota, New York, North Carolina, Pennsylvania, Rhode Island and Vermont will participate in the program, which the CMS is calling the Multi-Payer Advanced Primary Care Practice Demonstration. It will include about 1,200 medical homes that treat up to 1 million Medicare beneficiaries.

In addition, the agency announced the Federally Qualified Health Center Advanced Primary Care Practice Demonstration to evaluate physicians and other health professionals working in teams to treat low-income patients at community health centers. The demonstration will be conducted in up to 500 federally qualified health centers and provide care for up to 195,000 with Medicare. And the new Medicaid Health Home State Plan option will allow Medicaid enrollees with at least two chronic conditions to designate a provider as a "health home" to coordinate treatments. States that implement this option will receive more federal support to promote these "health homes" in their Medicaid programs, according to the CMS.

The CMS also said there will soon be demonstration projects that examine programs that integrate care for individuals who receive both Medicare and Medicaid, or "dual eligibles." The CMS said it will award up to $1 million each to 15 state programs, and states can begin applying for resources in December.


HHS' OIG report on Adverse Events 


November 16, 2010



Hospital care associated with adverse and temporary-harm events cost the Medicare program about $324 million in October 2008, according to the report.

While the findings showed that about 13.5% of hospitalized Medicare beneficiaries experienced adverse events during their hospital stays-and the same percentage experienced events that resulted in temporary harm-physician reviewers found that 44% of these events were "clearly or likely preventable."

The inspector general's office recommended that the CMS should use Present on Admission Indicators in billing data to calculate the frequency of adverse events occurring at hospitals and should look for opportunities to hold hospitals accountable for adoption of evidence-based practice guidelines. Meanwhile, the office suggested that HHS' Agency for Healthcare Research and Quality should sponsor periodic, ongoing measurement of the incidence of adverse events.
To read the full report,

Chicago Daily Law Bulletin (September 8, 2010):

Caps or not, physicians fear med-mal suits

Regardless of whether they work in a state that limits how much pain-and-suffering damages a patient can recover in a malpractice suit, physicians fear being sued, according to a study released today.

As a result, malpractice caps on noneconomic damages don't have a significant impact on stopping doctors from practicing defensive medicine that subjects patients to unneeded tests that can drive up health-care costs, the study states.

Researchers at the Center for Studying Health System Change report that tort reforms such as capping noneconomic damages "are only modestly associated with the level of physicians' malpractice concern and their practice of defensive medicine."

"The results raise the possibility that physicians' level of concern reflects a common tendency to overestimate the likelihood of 'dread risks' - rare but devastating outcomes - not an accurate assessment of actual risk," the study stated.

As a result, the study authors suggest that malpractice claims could be better addressed by alternatives to litigation that emphasize early disclosure of physician fault and provide a way to settle claims in a less adversarial process.

The conclusions are based on a 2008 survey that includes responses from 4,720 physicians who provide at least 20 hours of direct patient care each week.

To measure their subjective perception about liability concerns, the physicians were asked to indicate how strongly they agreed with the following statements:

  •  "I am concerned that I will be involved in a malpractice case sometime in the next 10 years."
  • "I feel pressured in my day-to-day practice by the threat of malpractice litigation."
  • "I order some tests or consultations simply to avoid the appearance of malpractice."
  • "Sometimes I ask for consultant opinions primarily to reduce my risk of getting sued."
  • "Relying on clinical judgment rather than on technology to make a diagnosis is becoming risky because of the threat of malpractice suits."

That yielded response rates of between 60 percent and 78 percent of physicians who either agreed or strongly agreed with each statement.

The last statement got the highest response of those who strongly agreed, with 78 percent saying that it's becoming increasingly risky to rely on clinical judgment rather than diagnostic testing.

"It is likely that physicians' assessment of their risk is driven less by the true risk of malpractice claims or the cost of malpractice insurance, and more by the perceived arbitrary, unfair and adversarial aspects of the malpractice tort process - which most traditional state reforms do not address," the study stated.

The study did find that physicians who work in states that have caps on total damages had modestly lower levels of malpractice concern.

But the study found that the type of reform that was adopted in Illinois in 2005 - a cap on pain-and-suffering damages only - did not significantly reduce the levels of physician concern when compared to states that do not have that sort of law in place.

Earlier this year, the Illinois Supreme Court struck down the state law that limited the amount of noneconomic damages that plaintiffs could recover. The caps had established ceilings of $1 million for hospitals and $500,000 for doctors and other health-care professionals.

Todd A. Smith, president of the Illinois Trial Lawyers Association, said he doesn't have any problem with the study's conclusion that hospitals should address medical errors with patients and families and settle claims at an early stage.

"It's possible that it means less work for lawyers, but I don't think that offends the trial lawyer community," said Smith, who practices at Power, Rogers & Smith P.C. "So be it, as long as people are being fairly compensated."

But plaintiff lawyers don't want to see medical negligence cases being completely removed from the court system, Smith said.

The study notes that its findings are at odds with other research that demonstrates that damage caps are associated with reduced defensive medicine practices.

And as for why a doctor's fear of getting sued doesn't change whether they live in a state that has caps or not, a defense attorney offered a response about the legal reality.

"Just because you have caps, it's not going to eliminate the fear of being sued because you still have lawsuits," said Linda J. Hay of Alholm, Monahan, Klauke, Hay & Oldenburg LLC. She serves on the Board of Directors of the Illinois Association of Defense Trial Counsel.

The study, which appears in this month's issue of Health Affairs magazine, is titled "Physicians' Fears of Malpractice Lawsuits Are Not Assuaged By Tort Reform."

Based in Washington, D.C., the Center for Studying Health System Change calls itself a nonpartisan policy research organization that provides objective research on the nation's changing health system to contribute to better health-care policy.


Medical Tourism and Superbugs:

Medical tourism to India and Pakistan has been linked to a new superbug in England for medical tourists.


Hospitals reporting CT scan radiation overdoses:,0,4205773.story


Article on physician over-testing;



House Bill 5483 would amend the current Open Meetings Act and require "a public body to make proposed minutes of an open meeting available for public inspection within 8 business days after the meeting to which the minutes relate and make approved minutes of an open meeting available for public inspection within 5 business days after approval (now, make available within 7 business days after approval)."


From the American Association for Justice (AAJ):

 One of AAJ's priority legislative initiatives now enjoys the full support of the U.S. Chamber of Commerce. HR 4796, the Medicare Secondary Payment Enhancement Act would create an efficient Medicare Secondary Payer system with speedy reimbursement to Medicare by establishing a timeline for the Centers for Medicare and Medicaid Services (CMS) to report reimbursement amounts to injured seniors who may be required to reimburse CMS under the Medicare Secondary Payer Act. The bill requires Medicare to respond to requests for final demand for reimbursement within 60 days or lose the ability to collect the amount owed.


HS for patient safety, medical liability reform.

The Providence Business News (6/25, Davis) reported the Agency for Healthcare Research and Quality has awarded $25 million in grants, including $2.9 million to the Massachusetts Department of Public Health for a project "to engage clinicians, patients, malpractice insurers and state officials to expedite the resolution of medical errors in outpatient practices and improve communication in all aspects of care." The grants will support "efforts by states and health systems" to implement and evaluate approaches to "patient safety and medical liability reform," the paper added.