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Chapter 24Tort Reform and Risk Reduction                                 2
Need for Tort Reform – I• Tort system inadequate in prevention of  medical malpractice.• Damage awards as deterrent have f...
Need for Tort Reform – II• State legislatures responding to calls for  medical liability reform.• Chapter reviews selected...
Defensive Medicine• Undertreatment  – avoiding high-risk tests & procedures• Overtreatment  – excessive use of diagnostic ...
Forms of Tort Reform – I•   Arbitration & Mediation•   Structured Awards•   Pre-trail Screening Panels•   Collateral Sourc...
Forms of Tort Reform – II•   Countersuits & Frivolous Claims•   Joint & Several Liability•   Malpractice CAPS•   No-Fault ...
Forms of Tort Reform – III•   Peer Review•   Professional Misconduct•   Regulations of Insurance Practices•   Require Impl...
Risk Management• Elements of risk management program• Risk Management committee                                        9
CQI•   Paradigm Shift•   Selecting a CQI Process•   CQI Implementation•   Steering Committee•   Training•   Facilitators• ...
CQI Data Collection         Indicators & Screens – I• Volume indicators  – indicators provide data that demonstrate scope ...
CQI Data Collection         Indicators & Screens – II• Occurrence screens  – predetermined indicators used to signal need ...
CQI Data Collection        Indicators & Screens – III• Clinical Pertinence Reviews  – process that monitors & evaluates cl...
Successful CQI Programs• Improving response time for thrombolytic  therapy• Improving safety• Improving pain management• I...
Failure Mode Effects Analysis• Method of identifying & preventing product &  process problems before they occur.          ...
Sentinel Events• Unexpected occurrence involving death or  serious injury or risk thereof in the health care  setting.• Ro...
Root Cause Analyses• Chronological review of an event to identify  what, how, why, when, & where an unwanted  event occurr...
National Health Reform• Key to improving quality & controlling costs  is cooperation, not alienation.• Policymakers have f...
REVIEW QUESTIONS1. Should there be limits placed on malpracticeawards? Support your opinion.2. How does a structured award...
REVIEW QUESTIONS, cont.4. Describe how risk management process can behelpful in reducing number of malpractice claims.5. D...
5530: Chapter 24
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5530: Chapter 24

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5530: Chapter 24

  1. 1. Chapter 24Tort Reform and Risk Reduction 2
  2. 2. Need for Tort Reform – I• Tort system inadequate in prevention of medical malpractice.• Damage awards as deterrent have failed to hold number of claims to reasonable level.• Exorbitant jury awards & malpractice insurance premiums, costing billions of dollars annually. 3
  3. 3. Need for Tort Reform – II• State legislatures responding to calls for medical liability reform.• Chapter reviews selected schemes for – tort reform – suggested programs for coping with the malpractice crisis 4
  4. 4. Defensive Medicine• Undertreatment – avoiding high-risk tests & procedures• Overtreatment – excessive use of diagnostic tests 5
  5. 5. Forms of Tort Reform – I• Arbitration & Mediation• Structured Awards• Pre-trail Screening Panels• Collateral Source Rule• Contingency Fee Limitations 6
  6. 6. Forms of Tort Reform – II• Countersuits & Frivolous Claims• Joint & Several Liability• Malpractice CAPS• No-Fault System 7
  7. 7. Forms of Tort Reform – III• Peer Review• Professional Misconduct• Regulations of Insurance Practices• Require Implementation of Best Practices 8
  8. 8. Risk Management• Elements of risk management program• Risk Management committee 9
  9. 9. CQI• Paradigm Shift• Selecting a CQI Process• CQI Implementation• Steering Committee• Training• Facilitators• CQI teams 10
  10. 10. CQI Data Collection Indicators & Screens – I• Volume indicators – indicators provide data that demonstrate scope & frequency of services provided over time.• Clinical indicators – used to screen the care provided to patients by clinical specialty. 11
  11. 11. CQI Data Collection Indicators & Screens – II• Occurrence screens – predetermined indicators used to signal need for evaluation of some aspect of patient care.• Focused reviews – are concentrated reviews of key areas in a department or clinical specialty determined by their high risk, high volume, or history of identified problems. 12
  12. 12. CQI Data Collection Indicators & Screens – III• Clinical Pertinence Reviews – process that monitors & evaluates clinical pertinence, completeness, accuracy, timeliness, & legibility of documentation as reflected in the medical record. 13
  13. 13. Successful CQI Programs• Improving response time for thrombolytic therapy• Improving safety• Improving pain management• Improving education programs 14
  14. 14. Failure Mode Effects Analysis• Method of identifying & preventing product & process problems before they occur. 15
  15. 15. Sentinel Events• Unexpected occurrence involving death or serious injury or risk thereof in the health care setting.• Root cause analysis conducted as a way to help prevent future occurrences of the event. 16
  16. 16. Root Cause Analyses• Chronological review of an event to identify what, how, why, when, & where an unwanted event occurred in order to prevent reoccurrence of an event.• RCAs focus on systems & processes, not individual performance. 17
  17. 17. National Health Reform• Key to improving quality & controlling costs is cooperation, not alienation.• Policymakers have failed & must return to a commonsense approach to policy development by including those providers who are on the front lines of medicine. 18
  18. 18. REVIEW QUESTIONS1. Should there be limits placed on malpracticeawards? Support your opinion.2. How does a structured award work?3. Which of the schemes for tort reform discussedpreviously do you consider most helpful inaddressing the malpractice insurance crisis? 19
  19. 19. REVIEW QUESTIONS, cont.4. Describe how risk management process can behelpful in reducing number of malpractice claims.5. Describe continuous quality improvement processas it applies to health care organizations. 20

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