Overview:
This webinar will discuss the Health Care Quality Improvement Act (HCQIA) in detail, including the standards that must be met to achieve immunity under the act.
The HCQIA itself will be reviewed, including a detailed look at the
Congressional purpose for the act. The legislative history of the act
will be reviewed to gain an understanding of the intent of Congress in
passing the act.
Next will be a review of the standards under the act. We will conduct a
detailed review of each of the standards and the actions that are
required to meet the intent of the standards. Specifically, there are
four standards under the act that must be met. We will review each of
these with an eye toward court interpretation of what actions an
organization must take to achieve the protections granted by the act.
First, the action must be taken “in the reasonable belief that the
action was in the furtherance of quality health care." We will examine
what this means and what is required for the entity taking the action to
have a "reasonable belief."
Second, the action must be taken "after a reasonable effort to obtain
the facts of the matter." The webinar will discuss in some depth what is
required to conduct an adequate investigation. Before any definitive
action is taken, there must be an adequate investigation to determine
the facts of the matter. This seems like simple common sense, but one
would be surprised at how often the investigation is found to be less
than what is expected. The focus of this portion of the webinar is to
review what constitutes an adequate investigation, particularly one that
will withstand the scrutiny of the court when the hospital or other
professional review body is asking for immunity under the Health Care
Quality Improvement Act (HCQIA).
Third, the action must be taken, "after adequate notice and hearing
procedures are afforded to the physician involved or after such other
procedures as are fair to the physician under the circumstances." The
act sets forth the "safe harbor" conditions that a health care entity
must meet regarding adequate notice and hearing procedures. We will
examine these safe harbor conditions and discuss in detail what must be
done to achieve immunity under this standard. In addition, we will
discuss what actions must be taken when a practitioner asks for a
hearing but it is not possible to provide one.
Fourth, the action must be taken, "in the reasonable belief that the
action was warranted by the facts known after such reasonable effort to
obtain facts and after meeting the [notice and hearing] requirement."
While the analysis of this standard generally tracts the analysis of the
first standard, "in the reasonable belief," there is considerable
interpretation by the courts of exactly what this standard means and
what must be done to accomplish it. We will review that court review and
analyze the actions required to meet it.
We will also review cases that discuss the situation where the peer
review committee reached incorrect conclusions, and the implications
that such a conclusion has for immunity under the act.
Why you should Attend:
You should attend this webinar to gain an understanding of how the HCQIA
protects your organization and those who participate in the peer review
process in your organization, as well as gain an appreciation of the
actions that are required to perfect the HCQIA immunity. Failure to take
the appropriate actions and to follow the correct protocol can result
in a disastrous situation.
You will learn how to facilitate the frank exchange of information among
professionals conducting peer review inquiries without the fear of
reprisals in civil lawsuits. The statute attempts to balance the
chilling effect of litigation on peer review with concerns for
protecting physicians improperly subjected to disciplinary action;
accordingly, Congress granted immunity from monetary damages to
participants in properly conducted peer review proceedings while
preserving causes of action for injunctive or declaratory relief for
aggrieved physicians. Not only will you gain an understanding of the
immunity provisions, you will gain an appreciation of the standards that
professional review actions must satisfy to entitle the participants to
such protection.
We will discuss what is required to provide a "fair" hearing, including
the actions that must be taken before and during the hearing process.
You will gain an understanding of how to conduct an investigation of the
allegations that form the basis of the professional review action and
the standards that the courts review to ensure that the investigation
was adequate.
You will learn how the courts interpret the mandate in the HCQIA that
the action was taken "in the reasonable belief that the action was in
the furtherance of quality health care." You will also gain an
understanding of what is required to meet the standard, "after adequate
notice and hearing procedures are afforded to the physician involved or
after such other procedures as are fair to the physician under the
circumstances."
Areas Covered in the Session:
- The Health Care Quality Improvement Act
- Legislative history of the Health Care Quality Improvement Act and the intent of Congress
- Immunity under the Health Care Quality Improvement Act
- Standards required to achieve immunity under the Health Care Quality Improvement Act
- Review of the Health Care Quality Improvement Act by the courts
Who Will Benefit:
- Hospital executives, particularly those involved with medical staff activities
- Medical staff officers
- Physicians who serve on peer review committees
- Medical staff support staff
- Attorneys representing medical staffs