The Healthcare Quality Improvement Act: The Quest for Immunity in Your Peer Review Process
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Date
Feb 11, 2022 -
Time
13:00 PM EST -
Duration
60 Min
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.
Session Highlight:
· 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
Why Should You 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."
Who Should Attend:
· 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
Ask your question directly from our expert during the Q&A session following the live event.
William Mack Copeland, MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC, where he is president and CEO. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics. He is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations. A former hospital chief executive officer, he is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007.
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