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Regulation of Medical Professionals: Innovations in Regulation, Healthcare Quality and Patient SafetyFebruary 27, 2007
Location: Denver, CO
Presented by the University of Denver Sturm College of Law and Common Good Colorado
Co-Sponsored by the Colorado Association of Health Plans, Colorado Hospital Association, Colorado Coalition for Patient Safety, Colorado Medical Society, and the COPIC Insurance Company
 VIEW THE WEBCAST
SUMMARY OF PROCEEDINGS:
The day began with remarks by Professor Ed Dauer, Dean Emeritus of the University of Denver Sturm College of Law. Professor Dauer welcomed attendees to the gathering, and introduced Dr. Rick May, Past President of the Colorado Medical Society, as the event’s master of ceremonies. Dr. May then outlined a number of challenges and opportunities facing Colorado health care, stressing that all stakeholders are involved with the same “ship of health care” – and that problems in the health care system affect us all. He also discussed the role that regulation should play in promoting quality of care, and invited attendees to keep this broad issue in mind during the day’s presentations and discussions.
Dr. James Dreisbach, a radiologist and member of the COPIC Insurance Company’s Board of Directors, and Dr. Bruce Baird, an anesthesiologist and past president of the Swedish Medical Center, then provided a medical perspective on the intersection between law, regulation, and the medical profession’s efforts to promote quality of care. Dr. Baird provided an overview of the interaction of hospital peer review programs with various oversight and regulatory mechanisms. He discussed the value and need for sharing of information about patient care and errors, but noted that this is not always easy to do. He made clear that reducing punitive sanctions in connection with reporting is key to promoting the sharing of information. Dr. Dreisbach added to the discussion by suggesting ways in which the regulatory process could be improved to enhance sharing of information. He discussed the lack of data sharing between regulatory systems and health care facilities, and the ways in which this constrains safety activities. There is, he noted, a significant evidence-based gap between technological innovation and improvements in patient care. Moreover, the regulatory process, particularly certification, can only ensure that physicians are adequate; robust quality assurance and improvement programs are also needed to work in tandem with certification and regulatory programs. The legal system does have some unintended consequences for robust quality assurance and improvement efforts, but legal system changes (like broadened peer review protection for data sharing) could help promote the flow of information. In essence, the law needs to be changed so that information can be shared without triggering mandatory reporting requirements.
» The Medical Perspective: Law, Regulation, and Medicine's Efforts to Achieve Quality of Care
» How Quality Assurance, Quality Improvement, and the Regulatory Process Can Improve Health Care
Randall R. Bovbjerg, Principal Research Associate at the Health Policy Center within the Urban Institute, then gave a presentation summarizing results of his research assessing the functioning of a number of state medical boards. State medical boards, he said, do serve a number of important functions, but they could do substantially more. However, the boards can face a number of barriers that prevent them from doing so, including organizational limitations, funding constraints, and issues of regulatory capture. He stated that his research had indicated that the discipline meted out by state medical boards tends to be largely driven by consumer complaints, that quality of care is a common factor in complaints, and that complaint volume varies by state. Ultimately, the disciplinary process is adversarial; it also can take a long time, is expensive, and it is difficult for boards to establish a physician’s incompetence. Partly this is because there is no meaningful measure as to the rate of “incompetence” in the medical profession. Also, there is reason to think that there is less tolerance for mistakes made by doctors than by other professionals. For example, the estimated rates of “incompetence” in the medical profession are higher than the corresponding rates for brokers.
» State Medical Boards: Assessing the Past and Planning for the Future
Mr. David Swankin, President of the Citizen Advocacy Center, then gave an overview of flaws in the current system, emphasizing the failure of legislatures to require state medical boards to have any continuing competency requirements, the “silo-ed” approach to competency, and its reactive rather than proactive approach. He then described several ways in which the medical boards might become more proactive, including by enhanced legislative authorization (as has happened in Massachusetts) or by board initiative under current laws. He concluded by outlining elements of the Citizen Advocacy Center’s “PreP for Patient Safety” program (PreP stands for “Practitioner Remediation and Enhancement Program”). The goal of the PreP program – as an early intervention – is to identify, remediate, monitor, and enhance the practice skills of physicians and nurses whose skill deficiencies cause concerns but do not rise to the level of requiring disciplinary action.
» Moving From REACTIVE to PROACTIVE Regulation of Physicians
» Presentation packet
Dr. James Thompson, President and Chief Executive Officer of the Federation of State Medical Boards, then gave a presentation about the evolving role of the state medical boards in driving enhancements in patient safety. He described a number of shifting priorities that the state medical boards face, including the need for providing enhanced consumer information as well as education for licensees, and he outlined a number of ways in which state medical boards could be more proactive in promoting safety enhancements. He also described several ways in which the Federation is promoting such steps.
» Patient Safety: The Evolving Role of State Medical Boards
Dr. Marie Bismark, a lawyer and physician from New Zealand and former legal advisor to the New Zealand Health and Disability Commissioner (that country’s physician regulatory body) next gave a presentation about New Zealand’s approach to physician discipline, patient compensation, and patient safety. The New Zealand system, she noted, is non-adversarial and safety-focused. She then provided several cross-cultural comparisons between the U.S. and New Zealand health systems, noting in particular that New Zealand spends less per capita (about $2,000 USD/year) to provide universal health care coverage than the U.S. spends to provide health coverage through its public health programs alone (about $2,700 USD/year, which is roughly 45 percent of total U.S. health expenses per capita of $6,000). She described a number of the benefits of New Zealand’s administrative compensation system for medical injuries, particularly in terms of efficiencies, lack of adversarialism, and expedited compensation. She then outlined further details about the functioning of New Zealand’s disciplinary process, and the interplay of this process with patient compensation and patient safety.
» Balancing the Three-Legged Stool: Compensation, Accountability, and Patient Safety in New Zealand
In the final session of the day, Professor Dauer led a discussion with a panel comprised of the following individuals: Paul Barringer, General Counsel of Common Good; George Dikeou, Legislative Consultant to (and former Executive Vice President of) COPIC Insurance Company; Alfred Gilchrist, the Executive Director of the Colorado Medical Society; Susan Miller of the Colorado Board of Medical Examiners; and Gerald P. McDermott, an attorney with McDermott Hansen & McLaughlin. Professor Dauer and members of the audience asked questions of the panelists to stimulate discussion about ways to reform the dialogue about medico-legal reform.
» George Dikeou's presentation on COPIC
» Webcast
» Agenda
» Background Materials
» Executive Summary and Conclusion of prior case study of state Boards
» Speaker Bios
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