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PROFESSIONAL ISSUES

News in brief - Aug. 11, 2008

Mass., New York join trend on no pay for "never events" - S.C. medical society launches liability insurance company - Surgery checklist yields results in pilot studies - Ariz. appeals court voids expert witness requirements - Joint Commission delays standard

Mass., New York join trend on no pay for "never events"

Officials in Massachusetts and New York in June became the latest to announce plans to end payment to hospitals for the National Quality Forum's 28 "never events," incidents that kill or seriously injure patients.

The Massachusetts policy applies to the 1.6 million patients covered by the state Medicaid program, Group Insurance Commission, Dept. of Correction and Commonwealth Health Insurance Connector Authority. In January, 61 hospitals said they would stop billing payers for these events.

New York's Medicaid program, meanwhile, in October will stop paying for 14 of the 28 NQF-designated events, including air embolism, blood incompatibility and patient disability from use of contaminated drugs.

Pennsylvania's Medicaid program also adopted a no-pay policy in February, and many private health insurers have announced similar plans.

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S.C. medical society launches liability insurance company

South Carolina physicians now have another option for liability coverage after the state medical association launched a medical liability insurance company.

South Carolina Physician Assurance Co., a doctor-run subsidiary of the South Carolina Medical Assn., began offering policies June 1.

Company officials said they intend to reduce medical liability claims and keep premiums stable by requiring members to participate in a risk management program. Coverage is available to qualified members of the state medical association.

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Surgery checklist yields results in pilot studies

The World Health Organization is testing a surgical checklist aimed at reducing complications. The effort is designed to help surgeons and other operating-room professionals improve adherence to safety standards.

At the eight test locations, adherence to 24 must-do safety items has improved from 36% to 68%, with some hospitals nearing the 100% mark. The checklist, part of WHO's new Safe Surgery Saves Lives initiative, was released in June and will be finalized at the end of the year when the pilot studies are completed.

The list divides surgery into three phases: before anesthesia, before incision, and before the patient is wheeled from the OR. A nurse who does not scrub in is charged with ensuring list items are completed.

More information is available online (www.who.int/patientsafety/safesurgery/en).

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Ariz. appeals court voids expert witness requirements

Arizona doctors fear that a recent appeals court ruling could open the door to frivolous lawsuits and reverse improvements in the medical liability environment.

The Arizona Court of Appeals in June unanimously struck down as unconstitutional a statute regulating the qualifications of expert witnesses in medical liability cases. The 2005 law required physicians testifying as expert witnesses to be actively practicing or teaching in the same specialty as the defendant.

At least 25 states have passed similar laws, according to American Medical Association data.

But judges concluded that the Arizona statute violated the separation of powers between the Legislature and the judiciary. Judges said the law imposed stricter limits on expert witnesses than existing court regulations. An appeal to the state Supreme Court is expected.

"It's just common sense that with medicine being as specialized as it is now, expert witnesses at least practice in the same area that is under litigation," said David Landrith, vice president of policy and political affairs for the Arizona Medical Assn. The organization plans to file a friend-of-the-court brief in the high court.

Landrith said that since it passed, the statute has contributed to a 25% drop in medical liability claims.

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Joint Commission delays standard

The Joint Commission in June postponed implementation of a revised medical staff standard.

The policy -- originally scheduled to take effect July 1, 2009 -- is intended to outline what governance standards must be included in organized medical staff bylaws and voted on by physicians, versus what can be addressed in hospital board administrative regulations. A final implementation date has not been scheduled.

A task force charged with revising Joint Commission Standard MS.1.20 is expected to continue deliberations throughout the summer and early fall. The task force includes representatives from the AMA's Organized Medical Staff Section.

The Joint Commission said the delay will allow time to analyze the impact of the revisions and provide hospitals with at least 12 months notice before executing the policy. The commission approved revisions to Standard MS.1.20 in June 2007.

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