Compromise key to malpractice reform success

Malpractice reform could be just what the U.S. healthcare system needs if physicians are willing to accept other reforms as well, according to an essay published in Health Affairs.

To implement reform, doctors and the federal government should establish a compromise, according to William M. Sage, M.D., of the University of Texas Law School in Austin and David A. Hyman of the University of Illinois in Champaign. They say that in exchange for tort reform at the federal level, physicians should in return accept several other reforms that would require their cooperation or leadership, including:

Payment reform: Invoking the pending repeal of the sustainable growth rate (SGR), Sage and Hyman suggested that "through the SGR or independently, Congress might exchange malpractice reform for physicians' acceptance of oversight and participation in new payment and delivery systems." Continuing to rely on fee-for-service, they wrote, "facilitates the practice of defensive medicine," and keeps physicians in thrall to unpredictable conventional physicians' malpractice insurance.

Transparency: Fear of liability has long hindered physicians from being properly forthcoming about quality of care they provide, Sage and Hyman wrote. Malpractice reform could make them more comfortable disclosing errors and making apologies, as well as offering compensation without litigation. "Over the past decade, a movement favoring prompt disclosure and honest discussion of medical errors with patients and families has helped physicians appreciate the ethical implications of malpractice policy," they wrote.

Interdisciplinary/nonphysician practice: In exchange for malpractice reform, the authors wrote, groups like the American Medical Association could budge on their opposition to other healthcare workers providing clinical services. "These services would be provided both in interdisciplinary, community-based settings, such as patient-centered medical homes," they wrote, "which are specifically endorsed by the ACA [Affordable Care Act], and by advanced-practice nurses, pharmacists, and other nonphysician professionals in independent practice." Indeed, a July study found that easing scope-of-practice laws could help temper the physician shortage, FierceHealthcare previously reported.

"If you're not depressed about the possibility for constructive change, I don't think this is particularly difficult," Sage told PBS Newshour. "I actually think that if people can recognize that one can get cooperation and leadership from physicians as a group by offering them this deal, then it could happen."

To learn more:
- read the essay (subscription required)
- read the PBS Newshour article

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