AHRQ’s Patient Safety and Medical Liability Initiative James B. Battles, Ph.D. Agency for Healthcare Research and Quality Center for Quality Improvement and Patient Safety

2 Presidential Action On September 9, 2009, President Obama addressed a joint session of Congress to announce his proposals for health insurance reform. One component of such a plan includes investing in new ways to manage medical liability claims. The President stated: 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. 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 think it's a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today. 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.

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

4 Components of the Patient Safety and Medical Liability Initiative Review of what works Review of what works Grants awarded (June 2010) Grants awarded (June 2010) – Demonstration – Planning Evaluation contract Evaluation contract Open funding announcements (November 2010) Open funding announcements (November 2010)

5 Review of What Works Document published by AHRQ in December, 2009 Document published by AHRQ in December, 2009 “Review of Reforms to Our Medical Liability System” “Review of Reforms to Our Medical Liability System” Examined medical liability reforms Examined medical liability reforms – Full Disclosure/early offer programs – Certificate of merit programs – Caps on damage awards – Pre-trial screening panels – Health courts Studies conflict on impact of reforms on frequency or severity of claims Studies conflict on impact of reforms on frequency or severity of claims Little evidence on impact of reforms on patient safety Little evidence on impact of reforms on patient safety

6 Stakeholder Input AHRQ reached out to a wide range of stakeholders representing different views about the extent and nature of the medical liability problem AHRQ reached out to a wide range of stakeholders representing different views about the extent and nature of the medical liability problem – health care providers, patients, academicians, insurers, and lawyers Outreach included an October 26, 2009 all-day public meeting Outreach included an October 26, 2009 all-day public meeting Unanimous support for reforms that can measurably improve patient safety and help bring rationality and fairness to the medical liability system Unanimous support for reforms that can measurably improve patient safety and help bring rationality and fairness to the medical liability system Stakeholder input informed the development of the demonstration and planning grants review criteria Stakeholder input informed the development of the demonstration and planning grants review criteria

Grants 2010 Grants RFA published – October 20, 2009 RFA published – October 20, 2009 Awards announced – June 11, 2010 Awards announced – June 11, 2010 Address patient safety and medical liability Address patient safety and medical liability Four goals of the initiative (patient safety first, communication, compensation, reduce liability premiums) Four goals of the initiative (patient safety first, communication, compensation, reduce liability premiums) $23 million $23 million 20 grants awarded (7 demonstration, 13 planning) 20 grants awarded (7 demonstration, 13 planning) Largest government investment linking medical liability to quality Largest government investment linking medical liability to quality Variety of models Variety of models

8 Demonstration Grants States and/or health care systems States and/or health care systems 3 year grants 3 year grants Up to $3 million/grant Up to $3 million/grant 7 demonstration grants 7 demonstration grants Total $19.7 million Total $19.7 million

9 Planning Grants States and/or health care systems States and/or health care systems 1 year grants 1 year grants Up to $300,000 Up to $300, grants awarded 13 grants awarded Total $3.5 million Total $3.5 million

10 Evaluation Contract An independent program evaluation across all patient safety and medical liability grants An independent program evaluation across all patient safety and medical liability grants Awarded to JBA/RAND Awarded to JBA/RAND $2 million dollars/5 years $2 million dollars/5 years Assess the impact of the projects and activities Assess the impact of the projects and activities Measure and document how well the projects have contributed to addressing the patient safety and medical liability concern Measure and document how well the projects have contributed to addressing the patient safety and medical liability concern

11 Current Program Announcement AHRQ issued two program announcements (demonstration/planning) that will enable AHRQ to receive grant applications now and make grant awards, contingent on available funding resources (November 2010) AHRQ issued two program announcements (demonstration/planning) that will enable AHRQ to receive grant applications now and make grant awards, contingent on available funding resources (November 2010) Similar to previous funding announcement Similar to previous funding announcement – Eligibility was expanded beyond health systems and States to include non-profit organizations; – Consortiums (States, health systems and risk management organizations) – Next submission due date is May 25, 2011

12 Featured Projects Demonstration Grants Judy Kluger, J.D. Judy Kluger, J.D. New York State Unified Court System, New York, NY New York State Unified Court System, New York, NY Ann Hendrich, M.S., R.N., F.A.A.N. Ascension Health System, St. Louis, MO Ann Hendrich, M.S., R.N., F.A.A.N. Ascension Health System, St. Louis, MO Planning Grants Kenneth Sands, M.D., M.P.H. Kenneth Sands, M.D., M.P.H. Beth Israel Deaconess Medical Center, Boston, MA

13 Hold Your Questions? We will take questions at the end of the three presentations