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Missouri Medical Tort Reform

The Missouri House of Representatives passed medical tort reform Wednesday that would cap “pain and suffering” damages recovered in court at $350,000. The vote was 94-61.

Medical tort reform is an important issue to medical professionals, who aren’t always successful in providing services, said Ravi Johar, a doctor of obstetrics and gynecology at Mercy Clinic Women’s Health in Hazelwood near St. Louis.

He also disagreed with legal pain and suffering claims because the jury can sometimes be swayed by emotion.

Medical liability insurance is used to compensate doctors who are sued for malpractice and maloccurrence. But if their insurance policy reaches its coverage limit during a legal battle, doctors are stuck with the bill.

Malpractice is when a doctor does something incorrectly. Maloccurrence is when something goes wrong unexpectedly.

In 2005, Missouri capped medical damages at $350,000, but the Missouri Supreme Court overturned the law in 2012, according to the Associated Press. The court ruled that the law violated a person’s right to a jury trial, which was how medical malpractice cases were determined.

House Bill 1173, sponsored by Rep. Eric Burlison, R-Springfield, would take medical malpractice and maloccurrence out of the courts by putting a statutory cap on recoverable damages.

Most suits are thrown out of court, Johar said. However, it still costs money to evaluate the validity of those claims.

In 2005, providers spent $80 million defending more than 3,000 claims, according to Show-Me Tort Reform, a group lobbying on behalf of the doctors.

Rep. Stephen Webber, D-Columbia, however, worried about unintended consequences of the bill, particularly for senior citizens.

The bill doesn’t change economic damages, which is calculated based on, among other things, medical bills and lost earnings from work.

To this extent, Webber wondered how seniors would be able to recoup economic damages if they were retired.

Lawyers’ fees from malpractice suits also stuck in doctors’ craws. Several doctors felt that lawyers were inflating noneconomic damages because they received a fairly large cut of the money.

Webber, who is a lawyer, disagreed, saying that “at least two-thirds” of money from suits and settlements ended up in their clients’ hands.

Webber also expressed concern that Burlison’s legislation would let insurance companies get between doctors and their patients. If doctors could only be sued a certain amount of money, he said, then insurance companies might discourage doctors from recommending medical tests.

In general, representatives in favor of the bill said on the House floor Wednesday that malpractice claims were driving doctors from the state. Drawing attention to medical tort reform, they said that, though having insurance is important to seeking treatment, having a doctor is even more so.

Having talked to around 20 doctors, Webber said two of the doctors thought tort reform was the most pressing medical issue today. The other 18 said it was Medicaid expansion.

Although the bill passed the House, it has yet to pass the Senate.

 

Hospitals Push to Clear RAC Appeals Backlog

The two-year backlog of Recovery Audit Contractor (RAC) appeals is unacceptable and the Centers for Medicare & Medicaid must come up with a long-term plan to clear it up, according to the American Hospital Association.

The AHA this week urged CMS to collaborate with the Office of Medicare Hearings and Appeals (OMHA) to fix the problems that led to the backlog of appeals of Recovery Audit Contractor (RAC) inappropriate denials.

“Without fundamental reform, the RAC program will continue to improperly harm Medicare beneficiaries and hospitals,” AHA Executive Vice President Rick Pollack said in an open letter to the 177 members of Congress who are co-sponsoring the Medicare Audit Improvement Act.

“Delays of at least two years in granting an ALJ [Administrative Law Judge] hearing for an appealed claim are not only unacceptable, they are a direct violation of Medicare statute that requires ALJs to issue a decision within 90 days of receiving the request for hearing,” Pollack wrote in a separate open letter to CMS Administrator Marilyn Tavenner. “Further, this is not a new problem; prior to OMHA’s suspension of appeals assignments, ALJs were not adhering to their statutory deadline.”

Until the CMS can develop a lasting solution, Pollack made several recommendations as to how it can temper the negative effects of RAC denials, including:

  • Suspending RAC audits until all levels of the determination and appeals process clear their backlogs;
  • Enforcing timeframes for appeals decisions by entering default judgments in favor of the provider if an appeal is not made by the deadline;
  • Addressing the underlying structural issues with RACs that result in avoidable claim denials; and
  • Lowering the additional documentation request (ADR) limit to minimize the number of claims that end up in the appeals system (similar to the ADR adjustment made last year).

The AHA endorses the bipartisan Medicare Audit Improvement Act, but RACs have sharply criticized it, saying it will “send Medicare crashing to the ground” .