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Mark A Hall

Publications and source records attributed to Mark A Hall.

65 records · Page 4Linked to original sources
PubMedDate not supplied

Liability implications of physician-directed care coordination.

PURPOSE: Various public and private initiatives encourage physicians to coordinate care for patients who have multiple chronic conditions, but physicians may resist doing so for fear of liability. This article assesses the extent of liability risk. METHODS: This qualitative study combines legal research with key informant interviews. Relevant legal authorities were identified through literature searches in legal databases. In-depth interviews were conducted with a purposive sample of 16 key informants who have relevant expertise in malpractice insurance, risk management, or liability law. Additionally, 19 other participants with relevant experience in case management or managed care were briefly queried about their liability experience relating to care management. RESULTS: Some aspects of care coordination for patients with multiple chronic conditions hold potential for higher liability. Physicians coordinating care have a broader responsibility for patients with complex conditions who have a greater chance of poor outcomes. Care coordinators may be held to a higher standard of care by adopting best practices guidelines or by making medical decisions on issues that require specialized expertise. Other aspects, however, lower liability risk: elderly patients are less likely to sue, care coordination should improve outcomes, and the information systems that support enhanced care coordination target the major sources of medical error in primary care. On balance, the liability risks of care coordination are commensurate with other risks in primary care practice. Liability insurers indicated no reluctance to insure physicians who coordinate care for patients with multiple chronic conditions and no strong tendency to attribute higher risk to this role. Physicians who currently perform these or similar functions have not encountered demonstrably higher liability. CONCLUSIONS: Physicians' perceptions about the liability risks of coordinating care for patients with multiple chronic conditions do not match evidence about the factors actually driving liability. It appears from many informed sources that there is no strong basis for physicians who perform these functions to have serious concerns about liability; instead, care coordination done well may lower liability risks.

Liability, Legal↗
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How disclosing HMO physician incentives affects trust.

Opinions are deeply divided over whether rewarding physicians for lowering costs decreases trust in physicians or insurers. To explore the effects of disclosing physician payment methods in HMOs, members of two similar HMO plans were randomized to intervention and control groups, and the experimental arm was told how the HMO paid their primary care physician. Separate disclosures were developed for each plan, one describing primarily capitation payment, and the other (mixed-incentive plan) describing fee-for-service payment with a bonus that rewards cost savings, satisfaction, and preventive services. The disclosures pointed out more of the positive than the negative features of these incentives. We found that the disclosures doubled the number of subjects with substantial knowledge of the physician incentives and halved the number with no knowledge. Nevertheless, the disclosures had no negative effects on trust of either physicians or insurers. The capitated plan disclosure had a small positive effect on trust of physicians. Disclosing the positive and negative features of incentives and increasing knowledge of these incentives does not, in the short term, reduce trust in physicians or insurers and may have a mild positive impact on physician trust, perhaps as a consequence of displaying candor and increasing understanding of positive features.

Adult↗
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The impact of state managed care liability statutes.

Since the mid-1990s ten states have enacted statutes that have created tort liability for patient harm caused by managed care organizations, and similar liability has been considered in Congress. This study is the first attempt to evaluate the impact of these state statutes on liability exposure and litigation activity. These statutes have resulted in little or no litigation and are not seen as creating any fundamentally new type of liability exposure. This muted effect is not attributable primarily to ERISA preemption but, rather, to the costs and complexities of suing a health plan, which deter lawyers from including this additional defendant in medical malpractice cases. The main drivers of increased liability concerns are the large class-action lawsuits that are pending under federal law and the few state cases with massive punitive-damage verdicts prior to these statutes. This suggests that a federal liability statute is not likely to greatly increase liability exposure unless it allows such suits.

Employee Retirement Income Security Act↗
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Measuring patients' trust in physicians when assessing quality of care.

Trust is a fundamentally important aspect of medical treatment relationships. Studies have established that patient trust predicts instrumental variables such as use of preventive services, adherence, and continued enrollment at least as well as satisfaction does, and is more salient for measuring the quality of ongoing relationships. Measuring trust would help to inform public policy deliberations and balance market forces that threaten the doctor-patient relationship. Several validated measures could be easily included in surveys. While further studies to evaluate the cost-effectiveness of measuring trust and test interventions to improve trust are desirable, the action merits serious consideration.

Humans↗
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The impact of Blue Cross conversions on health spending and the uninsured.

Using statewide data on health spending and uninsurance rates, we investigate the impact of Blue Cross conversions on health care costs and coverage. We find mixed results, with some conversion states improving their performance on either or both measures relative to the national average and others experiencing a decline. A multivariate analysis suggests that overall, the impact of Blue Cross conversion may be to reduce hospital and total spending, but whether this effect endures depends in part on how "conversion" is defined. State policymakers and regulators might find these results useful in considering future Blue Cross conversions.

Blue Cross Blue Shield Insurance Plans↗
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Reviving managed care with health savings accounts.

Although health savings accounts (HSAs) and managed care are often seen as antithetical, they can be integrated in fruitful ways. Moreover, combining these approaches would serve policy objectives by clarifying the payment responsibilities of patients, health plans, and premium payers, thus altering important perceptions about health care decision making. The availability in HSAs of funds that patients can use to pay for services not covered under insurance contracts should help to relegitimize the predetermination of benefits and enable the public and the legal system to take a more benign view of corporate health plans as agents of their subscribers.

Community Participation↗
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Of magic wands and kaleidoscopes: fixing problems in the individual market.

Policy analysts sometimes imagine that problems in the individual market can be fixed by waving a magic wand that makes the individual market function more like the group market. However, prior studies reveal that purchasing cooperatives fail to achieve substantial economies of scale; market reforms that reduce the impact of medical underwriting are difficult to implement in the individual market; and it may not be as easy as imagined to induce people to purchase over the Internet or from new or smaller companies that are at higher risk for exiting the market. The best solution is to limit the use of subsidies to certain purchasing options, such as with purchasing cooperatives that abide by rating, issuance, and renewability rules. What is not acceptable is to hand people subsidies and send them to the unstructured and relatively unregulated individual market, nor will it work to give people unhindered choice between two basically different market segments.

Economic Competition↗
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Organ donations.

Explore the source record for details and available documents.

Altruism↗
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Effect of language immersion on communication with Latino patients.

BACKGROUND: In the US, the fastest growing segment of the general pediatric population is Latino children. Language barriers may impede optimal care for these patients. Programs are needed to enhance communication effectiveness with Latino patients. We examined the effect of language immersion training for pediatric faculty on their communication with Latino patients. METHODS: Five general pediatric faculty physicians were sent to Guatemala for a two-week language immersion course and then had monthly one-hour Spanish language meetings for one year. Before and after immersion, six, and twelve months later, their Spanish skills were assessed. Before and after faculty training, Latino parents of pediatric patients were surveyed to assess their trust in and communication with the attending pediatricians. Spanish survey instruments were pilot tested and revised (trust scale alpha = 0.79; communication scale alpha = 0.80). RESULTS: Language proficiency increased for all the faculty participants, from a baseline score of 28% to a post-intervention score of 55%, p < 0.001. This increase in proficiency was sustained six and twelve months after the intervention. General linear modeling with repeated measures was used to examine associations between physician, parent, and clinic variables and the doctor-patient communication and patient trust scores. Even though baseline communication and trust scores were high, both improved after the intervention, p < 0.01. CONCLUSION: A two-week faculty language-training program can improve physician' language skills, communication, and trust between non-Latino doctor and Latino patient. Other measures of cultural competence should be measured and cost-benefit analyses conducted to assess the impact of immersion versus classroom experience.

Adult↗
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Malpractice litigation reform: empirical approaches to establishing the legal standard of care.

This article proposes that the legal standard of care in malpractice cases should be established through empirical methods rather than only with experts'subjective opinions. The authors outline and critique two approaches for doing so and explain the legal advantages and barriers to implementing these legal reforms. Basing the legal standard of care on evidence of actual physician behaviors and views would help to improve medical practice by reducing the need to engage in defensive medicine and by making it safer to institute quality improvement measures.

Data Collection↗