Seven hospitals will participate in pilot
program
Contacts: Richard P. Gulla, MMS, 781-434-7101 rgulla@mms.org
Jerry Berger, BIDMC, 617-667-7308 jberger@bidmc.harvard.edu
Waltham/Boston -- April 18, 2012 -- Led by the Massachusetts
Medical Society, six health care organizations today announced the
start of a major initiative to improve the medical liability system
in the Commonwealth.
The new alliance has launched its effort with the release of
a Roadmap to Reform, an alternative approach to medical
liability intended to improve patient safety, increase
transparency, reduce litigation, and cut costs to the health care
system, and with the announcement that seven hospitals will
participate in a pilot program this year to implement the
reforms.
The alliance contains some of the most notable healthcare groups
in the Commonwealth, with major teaching hospitals, statewide
provider organizations, and patient advocacy groups participating.
Beth Israel Deaconess Medical Center, which along with
Massachusetts Medical Society (MMS), had a principal role in the
research effort to create the Roadmap document, is joined by
Baystate Health in Springfield, the largest health care provider in
Western Massachusetts; Massachusetts Coalition for the Prevention
of Medical Errors; Massachusetts Hospital Association; and
Medically Induced Trauma Support Services (MITSS), a nonprofit
whose mission is to support patients, families, and clinicians who
have been affected by adverse medical events.
The Roadmap to Reform proposes a process of Disclosure, Apology,
and Offer (DA&O), an alternative to the current tort system,
which many health professionals say is inefficient, drives health
costs higher, and is unduly burdensome to patients, physicians, and
the health care system. The DA&O approach will be instituted,
beginning this year, in seven hospitals in the state to test its
feasibility in different practice environments with different
insurance arrangements.
"The current approach to medical liability is onerous for both
patients and physicians," said Alan Woodward, M.D., Chair of the
MMS Committee on Professional Liability and a past president of the
organization. "It discourages transparency, inhibits communication
between caregivers and patients, burdens physicians with excessive
premiums, leads to unwarranted lawsuits, and motivates physicians
to practice defensive medicine. We can make the approach to medical
liability much better for both patients and physicians and stop
driving unnecessary costs with a new model that promotes honesty
and transparency."
Kenneth Sands, M.D., M.P.H., Senior Vice President for Health
Care Quality at BIDMC, said "We are proposing to create a
centralized resource to support this new model. By conducting
programs in seven hospitals, specifically chosen to allow
demonstration in various hospital settings and within different
malpractice insurance models, we can assess impact on patient
safety, malpractice claims, and overall liability costs. At the
same time, we will be educating the public and the broader health
care community, and thus building a foundation for medical
liability reform in the Commonwealth."
DA&O programs have been implemented in several settings
outside of Massachusetts and have demonstrated success as an
alternative to the current tort system. Both physicians believe
that patients and clinicians will regard the DA&O model as
fairer, timelier, and more supportive than the traditional response
to adverse events, which is adversarial, stifles the exchange of
information, and thwarts efforts to improve patient safety. They
also say the model will lead to faster resolution of cases and
enhanced reporting of medical errors.
How the DA&O Model Works
Under the DA&O model, healthcare professionals and
institutions and their insurers disclose to patient and families
when unanticipated adverse outcomes occur; investigate and explain
what happened; establish systems to improve patient safety and
prevent the recurrence of such incidents; and, where appropriate,
apologize and offer fair financial compensation without the patient
resorting to legal action. Such a system will not deny patients the
right to bring legal action, but would make tort claims a last
resort. Adverse events in which the provider or institution is
deemed to have met the standard of care would be firmly
defended.
The DA&O model, which has been highly successful at the
University of Michigan Health Care System for a decade, is gaining
broad support across the nation and is regarded as a successful
approach to medical liability reform and patient safety by such
groups as The Joint Commission, an independent, not-for-profit
organization that accredits and certifies more than 19,000 health
care organizations and programs in the U.S.
Seven Hospitals Will Participate in Program
The seven hospitals participating in the initiative
include three from the BIDMC health system (Beth Israel Deaconess
Medical Center in Boston, Beth Israel Deaconess Hospital-Needham,
and Beth Israel Deaconess Hospital-Milton); three from Baystate
Health system in Springfield (Baystate Medical Center in
Springfield, Baystate Franklin Medical Center in Greenfield, and
Baystate Mary Lane Hospital in Ware); and Massachusetts General
Hospital.
Effort Begun in 2010
This new effort is the result of a BIDMC/MMS collaboration
begun two years ago and led by Drs. Sands and Woodward. In 2010,
the two organizations received a planning grant from the Agency for
Healthcare Research and Quality, part of the president's Patient
Safety and Medical Liability Initiative, to create a roadmap to
advance an alternative medical liability model in the
Commonwealth.
Over the next year, four physicians, Drs. Sands and Woodward,
along with Drs. Peter Smulowitz and Sigall Bell, also from BIDMC,
interviewed key stakeholder groups -- physicians, attorneys,
legislators, public officials, patient safety experts and patient
advocates. They asked them to identify obstacles in implementing
such a model as well as to suggest strategies to overcome those
obstacles. From that investigation, a roadmap for implementing the
DA&O model in Massachusetts was developed.
Implementation of the roadmap in the Commonwealth is being
supported in part by grants from the state's three largest health
insurers: Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim
Health Care, and Tufts Associated Health Plan, along with the
Reliant Medical Group.
Complete List of Alliance Members
Massachusetts Medical Society, the statewide association
of physicians with nearly 24,000 members;
Beth Israel Deaconess Medical Center, a patient
care, teaching and research affiliate of Harvard Medical School,
currently ranking third in National Institutes of Health funding
among independent hospitals nationwide;
Baystate Health, the largest health provider in
Western Massachusetts, a Thomson Reuters top 15 healthcare system,
and the Western campus of Tufts University School of
Medicine;
Massachusetts Coalition for the Prevention of Medical
Errors, a public-private partnership whose mission is to
improve patient safety and eliminate medical errors;
Massachusetts Hospital Association, the voluntary,
not-for-profit association of hospitals and health systems in the
state;
Medically Induced Trauma Support Services (MITSS),
a nonprofit whose mission is to support patients, families, and
clinicians who have been affected by adverse medical
events.
Project Consultants
Consultants to the project are Dr. Woodward of the MMS;
Allen Kachalia, M.D., J.D., Associate Chief Quality Officer,
Brigham and Women's Hospital; Gregg Meyer, M.D., Senior Vice
President for Quality and Patient Safety, Massachusetts General
Hospital; Rick Boothman, J.D., Chief Risk Officer, University of
Michigan Health System; and Michelle Mello, J.D., Ph.D., Professor
of Law and Public Health, Harvard School of Public
Health.
Download executive summary. (.pdf, 2 pages)
