News in brief - Oct. 23/30, 2006

Joint Commission looks to revise governance standards - Diagnostic errors big part of medical liability claims - Arizona board addressing office-based surgery - Texas doctors to see more insurance premium decreases - ACGME names new board of directors

Joint Commission looks to revise governance standards

A proposed Joint Commission on Accreditation of Healthcare Organizations' standard revision threatens to undercut medical staff self-governance, according to the American Medical Association. The debate between doctors and hospitals about proposed revisions to JCAHO Standard MS.1.20 centers on what components of governance must be included in medical staff bylaws -- and therefore voted on and approved by physicians -- and what can be addressed in administrative rules, regulations and policies decided by hospital boards and medical executive committees.

Paul M. Schyve, MD, JCAHO's senior vice president, said the revised standard is aimed at ensuring "the self-governing organized medical staff and the hospital governing body work together to enhance the quality and safety of care, treatment and services provided to patients."

But the AMA's Organized Medical Staff Section worries that issues such as credentialing, privileging, medical staff structure and the duties and privileges of different categories of medical staff could, if taken out of their hands, be more easily manipulated by hospitals. JCAHO will accept comments until Oct. 27 via its Web site (www.jointcommission.org).

At press time, the AMA was set to issue a letter to the commission outlining its concerns about Standard MS.1.20. The Association also planned to file a response with suggested changes addressing physician objections. The AMA is urging its members and all medical staff to file their own comments with JCAHO.

More detailed information on the OMSS position, including suggested comments on JCAHO's proposed standard, is available at its Web site (www.ama-assn.org/go/omss).

Diagnostic errors big part of medical liability claims

Diagnostic errors played a role in 59% of medical liability claims in which patients alleged they were harmed by missed or late diagnoses, according to a study in the Oct. 3 Annals of Internal Medicine.

Cancer was the most commonly missed diagnosis in the study, which reviewed 307 closed claims between 1984 and 2004 from four medical liability insurance companies.

Researchers identified the most common "breakdowns" in the diagnosis process and discovered that 55%of errors were associated with a failure to order an appropriate test. In more than 40% of cases, doctors did not follow up on test results or did not get adequate information from the patient, while 37% of cases involved incorrectly interpreted test results.

Patients contributed to medical errors in 46% of cases.

Arizona board addressing office-based surgery

The Arizona Medical Board has begun making rules for office-based surgery in a physician's office or other outpatient setting that is not part of a licensed hospital or licensed outpatient surgical center.

Board officials said most licensed physicians who perform office-based surgery using sedation already follow provisions in the draft regulations.

The board may not vote on the matter until later this year, a board official said. A draft of the rules is available online (www.azmdboard.org).

Texas doctors to see more insurance premium decreases

Texas' largest medical liability insurer in September announced that a 7.5% rate reduction across all specialties will take effect Jan. 1, 2007. It's the fourth time that Texas Medical Liability Trust has reduced rates since tort reform passed in 2003.

TMLT, which insures nearly 14,000 physicians in the state, also will credit doctors' premiums with a 20% overall dividend when their policies renew next year. That equates to about $35 million.

The doctor-owned insurer attributed the savings and the drop in premiums to the state's liability reforms that established a $250,000 limit on noneconomic damages in medical liability cases. Voters also approved a constitutional amendment to adopt the cap, making it difficult for a court to overturn.

TMLT said the tort reforms have helped decrease frivolous claims, something the company expects to continue as long as the tort measures remain in effect.

Meanwhile, physicians say the reforms have helped them provide patients with better access to care, according to a report the Texas Medical Assn. released in September. In an online survey of 1,154 TMA doctors, 45% said their insurance premiums had declined by up to 20% since September 2003; 25% said their rates had dropped by more than 20%.

More than 80% of respondents said that the improved liability environment was an important factor in their decision to begin accepting high-risk cases or to provide new services to patients; 23% said they had started offering new services to their patients since September 2003. About 16% of physicians said they now accepted complex or high-risk cases that they previously referred or declined to take.

ACGME names new board of directors

The Accreditation Council for Graduate Medical Education board of directors elected William H. Hartmann, MD, chair, during its September meeting in Rosemont, Ill.

Dr. Hartmann, a retired pathologist, was a clinical professor of pathology at the University of South Florida from 1993 to 2002 and has been on the ACGME board of directors since 2001. The board elected Susan H. Day, MD, as vice chair. Dr. Day is an ophthalmologist at the California Pacific Medical Center in San Francisco and has been an ACGME board member since 2004.

The board also endorsed seven new physicians to replace outgoing board members. The new members who will serve three-year terms are: Baretta R. Casey, MD; Anton N. Hasso, MD; Mahendr Kochar, MD; Carl Patow, MD; Sadeq A. Quraishi, MD, resident member; Carol Rumack, MD; and Ajit Sachdeva, MD.