The HHS Patient Safety and Medical Liability Initiative

On September 9, 2009, President Obama addressed a joint session of Congress to announce his proposals for health insurance reform. In his speech, the President highlighted the need to invest in new ways to address medical liability claims. The President stated:

I don't believe malpractice reform is a silver bullet, but I've talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I'm proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush administration considered authorizing demonstration projects in individual states to test these ideas. I think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today.

Implementing President Obama’s Vision

In October 2009, the Secretary of Health and Human Services (HHS) launched a Patient Safety and Medical Liability initiative and announced the availability of $25 million in funding to address four goals:

Put patient safety first and work to reduce preventable injuries;
Foster better communication between doctors and their patients;
Ensure that patients are compensated in a fair and timely manner for medical injuries, while also reducing the incidence of frivolous lawsuits; and
Reduce liability premiums.

Overview of HHS Patient Safety and Medical Liability Initiative

This initiative includes the following components:

Grants to jump-start and evaluate efforts. Three-year grants of up to $3 million to States and health systems for implementation and evaluation of patient safety and medical liability demonstrations.
Planning grants. One year grants of up to $300,000 to States and health systems in order to plan to implement and evaluate patient safety and medical liability demonstrations.
Review of existing initiatives. In December 2009, AHRQ issued a review of reforms to the medical liability system and their impact on health care quality, patient safety, and medical liability claims.

Projects Funded by the Patient Safety and Medical Liability Initiative

HHS’s Agency for Healthcare Research and Quality (AHRQ), which is administering the initiative, issued two funding announcements requesting applications for planning and demonstration grants in October 2009. All proposals submitted under this initiative by the January 2010 deadline underwent rigorous peer review by independent, scientific experts.

The awards announced on June 11, 2010 will support 20 projects designed to plan, implement, and evaluate reforms that address limitations of the current medical liability system, such as costs, patient safety, and administrative burden.

Planning Grants

The planning grants give States and health systems the opportunity to create detailed plans for patient safety and medical liability reform. AHRQ funded 13 planning grants for a total amount of $3.5 million.

These 13 grants represent a variety of models that meet one or more of the patient safety and medical liability reform goals, including 11 that are intended to reduce preventable medical injuries in a variety of ways. The planning grants include:

Supporting the development of a “safe harbor” for physicians who can prove they followed state-endorsed evidence-based care guidelines (1);
Promoting shared decision making (1);
Supporting early disclosure and offer models, which inform injured patients and families promptly, and make efforts to provide prompt compensation (3); and
Promoting transparency and enhanced communication between providers and patients when avoidable injuries occur (4).

For details on each funded planning grant, go to: http://www.ahrq.gov.

Demonstration Projects

The demonstration grants support the implementation and evaluation of evidence-based patient safety and medical liability projects. AHRQ funded seven demonstration grants for a total amount of $19.7 million.

These seven grants include a variety of models that meet one or more of the patient safety and medical liability reform initiative goals, including:

Reducing preventable harms (6);
Informing injured patients promptly, and making efforts to provide prompt compensation (5); and
Promoting early disclosures and settlement, through a court-directed alternative dispute resolution model (1).

For details on each funded demonstration project, go to: http://www.ahrq.gov.

Overall Evaluation

The Patient Safety and Medical Liability initiative includes a competitively awarded evaluation contract, awarded to JBA/RAND for $2 million dollars, focusing on improvements in both patient safety and medical liability systems. The evaluation is designed to allow long-term assessment of findings from multiple grants across the entire initiative.

Background Facts on Patient Safety and Medical Liability

Too many patients experience significant challenges with health care quality and patient safety, and many injured patients are not well-served by the current medical liability system.

According to the Institute of Medicine (IOM) report To Err is Human, between 44,000 and 98,000 patients die each year from medical errors.
Patients who are seriously harmed from medical errors often wait too long for compensation.
Many experts believe fear of liability is a substantial barrier to the development of transparent and effective patient safety initiatives in hospitals and other settings.

The medical community reports serious problems with the medical liability system.

Many doctors believe that medical liability concerns lead to “defensive medicine,” which in turn may contribute to higher costs.
Many physicians continue to struggle to pay their medical malpractice premiums, which vary tremendously by specialty and by state. The cost of insurance continues to be one of the highest practice expenses for some specialties.
Fears of medical malpractice claims may lead to altered practices, restricted emergency coverage, and limited or discontinued high-risk procedures.

The evidence regarding the impact of prior efforts to reduce the occurrence of lawsuits and improve patient safety is mixed. In particular, evidence regarding the impact of specific medical liability reforms on health care quality and patient safety is almost nonexistent; these grants will address that essential gap.