Medical Liability Reform Position Statement Now Addresses Harmful Payer Policies, Telemedicine Authorization & Patient Compensation

Harmful payer policies, telemedicine authorization and patient compensation funds are now part of the ACR’s position statement on medical liability reform. On Aug. 16, the ACR Board of Directors approved the additions, which were put forth by the ACR Committee on Rheumatologic Care (CORC).

Dr. Phillips

“By putting these three new statement policies on paper, we are clearly asserting how we as a community of practitioners and as a College believe things should be,” says Chris Phillips, MD, CORC chair and community rheumatologist in Paducah, Ky. “So, when you as an ACR member are advocating for legislation with your state or federal representative, making a point in a dispute with a payer or perhaps dealing with a legal issue, you can refer to these position statements. Then you are not just expressing your personal views; you are stating the positions of the College.”

Harmful Payer Policies

Harmful payer policies are an increasingly prominent issue in rheumatology. “We are trying to practice evidence-based medicine and make personalized treatment decisions because each patient has unique needs, and yet we often run into step therapy, formulary restrictions and/or prior authorizations,” Dr. Phillips says. These practices, he contends, can delay or deny recommended treatments and potentially lead to adverse outcomes.

“The new statement addition says that we are advocating for legal protections that shield us from liability when our best-laid plans have been essentially waylaid by payer policies. It further states that in the event of an adverse outcome, the payer should be held to the same standard of liability as we are,” he says. “That is obviously ambitious, but it is the harmful payer policies that are tying our hands.”

Telemedicine Authorization

Telemedicine is convenient, but it has inherent limitations that carry the potential to miss some symptoms or diagnoses that a physical exam or office visit would more likely catch, Dr. Phillips says. By addressing liabilities that might arise as a result, the updated statement supports both patient education about those limitations and mechanisms for documenting patients’ consent to telemedicine.

Documentation is an especially important aspect, he notes. “For instance, some platforms have mechanisms to obtain written informed consent, but many don’t. So, healthcare professionals should not be held liable for lacking written consent when there aren’t mechanisms in place universally for obtaining and documenting it.”

Patient Compensation Funds 

This third new position lines up with a ACR Government Affairs Committee (GAC) health policy position that advocates for patient compensation funds. Such funds would offer cost-effective malpractice coverage for participating clinicians, in addition to standard liability insurance. “Here, we are advocating for state-run funds to which providers or physicians would contribute. If there is then a successful malpractice claim in an amount in excess of the malpractice coverage limits, these funds would act as ‘over-insurance’ and cover that excess,” Dr. Phillips explains. 

This would be advantageous to the provider and the patient, he remarks, “because the clinician would not be on the hook for those excess funds, and in the event of a large claim, the patient would have an increased likelihood of actually receiving the awarded funds.”

Relevant & Timely

CORC recommended these changes during its regular four-year review of the ACR policy statement on medical liability reform. “We wanted to address things that were directly relevant to and timely for our members and went through many iterations of edits to develop them,” Dr. Phillips says.

Beyond these additions, the section on arbitration and medical liability courts now includes expanded wording regarding state medical malpractice review panels, which Dr. Phillips notes is also in line with the GAC’s health policy statement that guides legislative advocacy. The added language advocates that all state medical malpractice review panels consist of physicians from the defendant’s specialty—in this case, rheumatology—and that those panels should be in place to review malpractice claims before they go to court, as a way to discourage frivolous litigation.

Dr. Phillips thanked the members of our committee for their hard work, while also encouraging others to consider participating in the College. “It’s rheumatology professionals in the real world who come together to volunteer in meetings and help put these positions together,” he says. “Anyone can be a part of doing this work. It makes a difference.”

Leslie Mertz, PhD, is a freelance science journalist based in northern Michigan.