California's noneconomic damages cap upheld, -and- Aetna, Humana, Kaiser, UnitedHealthcare team up to trend claims data

Mon Oct 3 22:22:37 PDT 2011

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September 26, 2011

California's noneconomic damages cap upheld

amednews.com <http://www.ama-assn.org/amednews/2011/09/26/prsb0926.htm>  

by Alicia Gallegos

The Court of Appeal of the State of California, 5th Appellate District, has
upheld the state's $250,000 noneconomic damages cap, reaffirming what
physicians nationwide consider the gold standard among tort reforms.

In its Sept. 1 opinion, the court said the cap was enacted on valid
rationale and does not compromise citizens' rights.

"Our Supreme Court ... has already determined the constitutionality of [the
Medical Injury Compensation Reform Act], in which it concluded the statute
does not violate equal protection rights because the Legislature rationally
could conclude a medical malpractice crisis existed that required
legislative intervention to reduce medical malpractice insurance costs, and
that [MICRA] is rationally related to the cost-reduction goal," the court
said.

The legal challenge stemmed from a lawsuit filed by Holly Stinnett against
Modesto Surgical Associates and surgeon Tony Tam, MD, that alleged Dr. Tam's
negligence led to Stanley Stinnett's death.

Stanley Stinnett was admitted to Memorial Medical Center of Modesto in
January 2006 after he was injured in a motorcycle crash. After several days
there, he went into respiratory arrest and his stomach filled with fluid,
according to court documents. He later died.

California has had comprehensive tort reform since 1975.

Holly Stinnett, his wife, claimed that her husband died of aspiration of
stomach contents resulting from Dr. Tam's failure to drain his stomach
fluid. An autopsy report concluded that he died of heart failure.

Dr. Tam maintained no wrongdoing, saying his treatment of Stinnett was
within the standard of care, court records show.

A jury found Dr. Tam and Modesto Surgical Associates negligent in Stinnett's
care, awarding Holly Stinnett more than $1 million in economic damages and
$6 million in noneconomic damages. The trial court approved Dr. Tam's
request to reduce the award pursuant to California law. Holly Stinnett
appealed. Memorial Medical Center of Modesto settled with her before trial.

At this article's deadline, attorneys for the plaintiff had not returned
calls seeking comment.

Decision reaffirms law

The appeals court decision revalidates the tort reform measures in the state
and provides firm objections to arguments against its legitimacy, said
Alicia Wagnon, legal counsel for the California Medical Assn.

"I think this case ties in nicely the importance of the cap and of MICRA in
general," she said. MICRA has focused on "reducing and stabilizing medical
malpractice insurance costs so we can retain our doctors in California and
... provide the necessary care to citizens in California."

The $250,000 damages cap was part of the state's 1975 enactment of MICRA, a
comprehensive tort reform package aimed at easing California's then-medical
liability crisis. The law has faced numerous court challenges, including a
2009 lawsuit that went to the appellate level. In that case, judges found
the cap constitutional, but the opinion was unpublished. That means it was
binding for the plaintiff and defendants, but it could not be cited as case
law in future cases.

The Stinnett case opinion is published, which Wagnon said provides a
stronger shield for doctors against future challenges.

September 21, 2011

Aetna, Humana, Kaiser, UnitedHealthcare team up to trend claims data

FierceHealthPayer
<http://www.fiercehealthpayer.com/story/aetna-humana-kaiser-unitedhealthcare
-team-trend-claims-data/2011-09-21>  

by Karen M Cheung

The heavy hitters of health insurers yesterday launched the Health Care Cost
Institute (HCCI), in which Aetna, Humana, Kaiser Permanente, and
UnitedHealth Group will regularly supply information on more than 5 billion
claims to academic researchers, reports the New York Times. The Institute
represents a move to cut pricing variations between Medicare and private
health plans.

The Institute builds on Medicare's existing data that offers limited
information, according to the NYT article. In a move toward transparency,
according to UnitedHealth's Executive Vice President Simon Stevens, the
Institute will provide claims data to qualified researchers about healthcare
prices and use of services.  

"This is the first time that the claims data paid by carriers will be
available to produce public reports and for researchers to be able to use
the data," said Roy Goldman, a vice president and chief actuary for Humana.
The HCCI calls the Institute a first of its kind, according to its website.

The decade's worth of claims represent more than $1 trillion in healthcare
activity and more than 5,000 hospitals and 1 million other service
providers, according to The Hill.

The data, starting from 2000, will not include identifying information, such
as individual providers' or patients' information. The public will have
access to summary data twice a year.

The goal of the joint data is to draw trends about which programs and types
of care are the most expensive or least expensive. Based on that aggregated
information, the Institute will issue scorecards of healthcare costs and
utilization, but it isn't intended to be a consumer tool for researching
pricing or quality results, according to Dr. Martin Gaynor, a health
economist at Carnegie Mellon University, in a Wall Street Journal article.

Marcus Williams &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

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