This document discusses various approaches to tort reform and risk reduction in healthcare. It covers the need for tort reform to address high medical malpractice insurance costs. Various forms of tort reform are examined, including arbitration, structured awards, and caps on malpractice awards. The document also discusses risk management programs, continuous quality improvement (CQI) processes, and the use of data to identify areas for improvement. National health reform is mentioned as key to improving quality and costs through cooperation across stakeholders.

2. Chapter 24
Tort Reform and Risk Reduction
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3. 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.
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4. 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
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5. Defensive Medicine
• Undertreatment
– avoiding high-risk tests & procedures
• Overtreatment
– excessive use of diagnostic tests
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6. Forms of Tort Reform – I
• Arbitration & Mediation
• Structured Awards
• Pre-trail Screening Panels
• Collateral Source Rule
• Contingency Fee Limitations
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7. Forms of Tort Reform – II
• Countersuits & Frivolous Claims
• Joint & Several Liability
• Malpractice CAPS
• No-Fault System
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8. Forms of Tort Reform – III
• Peer Review
• Professional Misconduct
• Regulations of Insurance Practices
• Require Implementation of Best Practices
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9. Risk Management
• Elements of risk management program
• Risk Management committee
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10. CQI
• Paradigm Shift
• Selecting a CQI Process
• CQI Implementation
• Steering Committee
• Training
• Facilitators
• CQI teams
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11. 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.
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12. 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.
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13. 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.
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14. Successful CQI Programs
• Improving response time for thrombolytic
therapy
• Improving safety
• Improving pain management
• Improving education programs
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15. Failure Mode Effects Analysis
• Method of identifying & preventing product &
process problems before they occur.
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16. 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.
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17. 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.
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18. 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.
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19. REVIEW QUESTIONS
1. Should there be limits placed on malpractice
awards? Support your opinion.
2. How does a structured award work?
3. Which of the schemes for tort reform discussed
previously do you consider most helpful in
addressing the malpractice insurance crisis?
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20. REVIEW QUESTIONS, cont.
4. Describe how risk management process can be
helpful in reducing number of malpractice claims.
5. Describe continuous quality improvement process
as it applies to health care organizations.
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