Healthcare Quality Improvement Act of 1986

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DEFINITION:


HCQIA was introduced in 1986 due to the rising number of malpractice lawsuits filed during the 1970s and 1980s. More medical malpractice suits were filed in the decade ending in 1987 than in the entire previous history of American tort law. “Claims per frequency per 100 physicians rose at least 10% each year during this period, from 13.5 claims in 1982 to 17.2 in 1986.” Congressman Ron Wyden from Oregon introduced the Healthcare Quality Improvement Act of 1986 as an effort to this malpractice crisis. This act addressed two issues that aroused during this period. One problem was the reluctance on the part of practitioners to engage in honest peer reviews of the errant few among their ranks and the second problem was the ability of incompetent practitioners to move from state to state without any record or previous negligence. HCQIA resolved this issue by granting limited immunity from damages to physicians and dentist engaging in peer review, and prohibited incompetent physician and dentist from moving across state boundaries without disclosing information about previous negligent performance.

Also, the act “would help protect hospitals and individual’s participating on medical peer review committees from potential liability in the form of money damages after the revocation of a physician’s hospital privileges. The Act has established standards for the hospital peer review committees, provides immunity for those involved in peer review, and has created the National Practitioner Data Bank, a system for reporting physicians whose competency has been questioned or when the physician has been sanctioned.” The Department of Health and Human Services would be in charge of carrying out the provisions of the National Practitioner Data Bank. The data bank was necessary because it would eliminate the chances of physicians suing hospital peer review members over a poor peer review and entering into a contract that would keep the hospital quiet about the departure of the physician. The data bank was a tool for assuring the information used by peer review boards would be accurate, complete, and uniformly available.

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There is a huge issue concerning the other effects that stemmed from HCQIA. They fear that physicians who have power are maliciously destroying the careers of other physicians by allegations through the peer review system. Another concern is the practitioner’s privacy against public access to the data bank’s reviews. While some people say that the pubic has a right to know about physician’s professional reviews, other argue that a rising number of false reports would jeopardize their career.

All states have their own safeguards with the standards of confidentiality. As of right now, the bank is exempt from the pubic access mandates of the Freedom of Information Act. Support for eliminating this exemption is growing.

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APPLICATIONS:

The HCQIA of 1986 attempted to improve the quality of care for patients. It also brings up questions dealing with confidentiality and privacy. While the controversy over practitioner privacy versus public access to the bank remains, we should question if the quality patient care has priority over physician’s privacy.

WEB RESOURCES:


http://www.usd.edu/elderlaw/student_papers_f2003/health_care_quality_improvement_act.htm
http://www.peerreview.org/seattle/1%20%20Health%20Care%20Quality.pdf
http://en.wikipedia.org/wiki/Healthcare_Quality_Improvement_Act
http://www.npdb-hipdb.hrsa.gov
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=299426&blobtype=pdf

RELATED TERMINOLOGY:


National Practitioner Data Bank
Freedom of Information Act
Ron Wyden
Healthcare Research and Quality Act of 1999
Wired for Healthcare Quality Act


CITATIONS/REFERENCES


Hall, Bryan. (Unknown) The Health Care Quality Improvement Act of 1986 and Physician Peer Reviews: Success or Failure. Retieved on March 11, 2008 from
http://www.usd.edu/elderlaw/student_papers_f2003/health_care_quality_improvement_act.htm

Heffernan, Margot. (1996) The Health Care Quality Improvement Act of 1986 and the National Practitioner Data Bank: the controversy over practitioner privacy versus public access. Retrieved on March 11, 2008 from
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=299426&blobtype=pdf