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Malpractice Caps Won’t Protect Harmed Patients

Medical-malpractice reform bills currently moving forward in both the Iowa House and Senate (SF 465) attempt to place a $250,000 cap on non-economic damages, such as “pain, suffering, inconvenience, physical impairment or mental anguish.” The push to limit non-economic damages comes from the provider community, which includes doctors and hospitals.

Both sides of malpractice reform offer persuasive arguments on the merits of these reforms. Injured individuals and their lawyers argue against malpractice reform, saying patients won’t be protected against negligent providers. Because of errors, healthcare costs are higher.  Botched care requiring fixes often happens without patient knowledge and involves additional patient and insurance payments. The social and economic costs of medical errors are also enormous.

Doctors and hospitals, on the other hand, usually push for reform, saying it will protect patients from having to pay the high costs of malpractice insurance and help curtail defensive medicine practices – presumably through lower health insurance premiums – and perhaps increase accessibility to some healthcare services.

Interestingly, a recent report from personal finance website, WalletHub, indicated that Iowa is the best state for doctors to practice medicine, when comparing 14 different relevant metrics, and Iowa is the fifth least-expensive state for annual malpractice liability insurance.

But here’s the fundamental question that gets lost: Will capping non-economic damages provide the necessary incentives for providers to alter their practices enough to eliminate avoidable medical errors? This should be the most critical question regarding malpractice reform being debated in Iowa and elsewhere. Unfortunately, the Iowa bills fail to address this issue.

Patients expect to be safe when they receive healthcare from the providers they trust. Yet, solid evidence suggests this trust is routinely violated. We’ve made relatively little progress in reducing preventable medical errors since 1999, the year the Institute of Medicine released their book, ‘To Err is Human.’ In the last year, using national estimates on preventable medical errors, my organization extrapolated that a mid-range estimate that 85,000 patients are harmed in Iowa hospitals yearly due to preventable medical errors. This number does not include harm occurring in physician clinics, outpatient surgery centers, nursing homes and other care locations.

I don’t represent trial lawyers nor healthcare providers and I have become rather apostate regarding political parties. In my opinion, tort reform should be about reducing medical errors – the root cause of why we have malpractice issues in the first place. By working toward the elimination of the root cause – medical errors – malpractice and its negative side effects will also disappear. This more logical approach will benefit patients, providers and our overall healthcare system. Adopting safe care practices would substantially reduce the costs of botched-care fixes and defensive medicine – in addition to enhancing the quality of life for patients and their caregivers.

As the Iowa bills demonstrate, we continue to seek ‘quick fixes’ that gnaw at the edges of the problem. But these laws seldom address the core reasons of why many medical errors happen.  Medical errors are, unfortunately, a fact of life.  But many are avoidable. In our healthcare world, we have well-meaning and very capable caregivers. Too often, however, we also have broken organizational cultures that inadequately address patient safety protocols and burned-out physicians and staff who are required to “produce” at unsustainable levels. Any meaningful reform must begin at the healthcare organization level, ensuring we all receive appropriate and safe care. Organizations providing impactful interventions to help promote safe cultures of care can greatly improve safe care practices.

Misguided malpractice reform can actually exacerbate rather than eliminate medical errors. Placing caps on damages, economic or otherwise, insulates the medical community from high monetary awards, yet offers little, if any, incentives for healthcare organizations to establish clear and genuine protocols to ensure a culture of safety. The right incentives matter, especially when it comes to the safe care we trust we’ll receive.

Isn’t it time for provider organizations to adopt a culture of safety, rather than seek malpractice caps that do nothing to protect us as patients?

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Volunteering = Positive Health Outcomes

The resolutions we make to change undesired personal traits or behaviors usually begin at the dawn of the new calendar year – an attempt to ‘start over’ and refresh our hopes and desires to make us more productive, perhaps improve our health (and appearance), and move us to a happier state.

Perhaps you have joined a fitness club, initiated a new dietary program, developed a budget to save more and spend less, or carved out more time to read rather than watch television shows. There are a host of other new beginnings that may meet your personal goals.

So, after just a few days into 2017, how are you doing?

Have you thought about volunteering your time within your community to benefit another person, group or organization? Perhaps serve on a committee at your church, spend time assisting an individual to shop for groceries or attend a doctor or dentist appointment, or participate with a non-profit organization to take care of our underserved vulnerable populations (e.g. homeless, disabled, elderly, etc). This isn’t necessarily about altruism, though having an unselfish regard for helping others is certainly important and admirable for the health of any community.

Volunteering actually invites a new sense of purpose to our lives that consequently impacts our OWN mental well-being. Sounds somewhat self-serving doesn’t it? But promulgating our own well-being by volunteering our time and resources to help others actually makes a great deal of sense. Such activities positively impact the social determinants of health for our communities.

Recent studies indicate a positive relationship between volunteering and healthy outcomes, such as  self-rated health, and risk factors for cardiovascular disease, disability, mental well-being and life satisfaction. Some studies report that volunteering activities can reduce the risk of mortality. A person who volunteers will have a larger social network of connections and a personal sense of accomplishment that comes from helping others.

Listen up to those age 40-plus

A 2016 study in The BMJ suggests that there is “no clear evidence that volunteering was positively associated with mental health during early adulthood to mid-adulthood.” However, a positive association with mental health became more apparent after around 40 years of age and “continued up to old age.” This same study reveals that even for those of us who participate minimally in volunteering activities appear to have better mental well-being compared to those who don’t volunteer at all. Those who never volunteered had “lower levels of mental well-being starting around midlife and continuing in old age compared to those involved in volunteering.”

As with any life-changing resolution we embark in this new year, taking small, incremental steps to achieve our personal objectives is often underestimated. Yes, making massive changes sounds great for many of us, but this can also cause most of us to give up before we ever start.

It’s never too late to amend your 2017 resolutions. Volunteering your time will have a positive impact on your neighbors, community – and yes, even your own health!

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Employers Role in Patient Safety

Uncomfortable-ShoesHealth premiums paid by employers and their employees are profoundly impacted by health costs, especially when the care was inappropriately delivered.

Since the release of Heartland Health Research Institute’s Silently Harmed white papers, a number of employers have inquired about how they can influence patient safety practices in the hospitals that serve their communities.

To be clear, there are no easy answers. Employers are deservedly frustrated with the perceived leverage they have to influence necessary progress on this issue that dually impacts costs, and most importantly, lives. When it comes to patient safety, there appears to be just enough self-interest group regulation that precludes the public from igniting a patient revolution.

It has been said that revolutions never happen in comfortable shoes – and so it goes with healthcare.

Healthy organizations require healthy employees. From the employer perspective, ‘patient safety’ should be equally balanced with two other initiatives: affordability and high-quality outcomes. This ‘holy trinity’ of value – cost, quality and safety – serve as the cohesive bond for all payers – government, carriers and employers. Armed with the right information, employers can play a proactive role in changing the healthcare delivery landscape that is currently going through a seismic evolution (if not a revolution). In fact, now is the time for employers to inject their influence to a mammoth industry that requires major disruption.

Employers, assisted by carriers, can begin to craft health plans that reward safety practices and discourage (or penalize) non-compliance, urging hospital boards to make patient safety a priority. This can be done by insisting that providers implement safety measures that demonstrate adherence to patient safety cultures. By leveraging this new role, employers can educate their employees on how they can engage more effectively with their healthcare partners to receive better care. Distributing patient safety literature to employees and family members can serve as important reminders for patients to proactively seek care from providers who have proven to give the right care at the right time. Visiting the National Patient Safety Foundation website can be a great first step to increase awareness about patient safety issues. There are many other organizations promoting quality and safety measures, such as The Leapfrog Group, which cleverly includes a ‘hidden surcharge calculator‘ for Leapfrog members to calculate their average annual hidden hospital surcharge resulting from medical errors.

Iowa is served by very capable and well-intentioned providers. But the question is not as much about the people who care for us, rather, the ‘systems’ in which they operate. Due largely to self-interest concerns, medicine is unable to regulate itself voluntarily – it needs a push from those who have much at stake – employers and other purchasers.

Employers can and must promote patient safety measures when purchasing health coverage. There is no better time than now for this to happen.

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