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In March of 2010, President Barack Obama passed The Affordable Care Act (ACA). This federal statute represents the largest overhaul within the U.S. healthcare system since the development of Medicare and Medicaid programs in the 1960s. The ACA faced legal challenges after its passage. However, in June of 2012, the U.S. Supreme Court upheld the constitutionality of most of the ACA’s provisions.

ACA will implement performance measures to create incentives for improving healthcare outcomes.

One of the goals of ACA is to institute reforms that will improve healthcare outcomes as well as, streamline the delivery of healthcare. To this end, ACA includes provisions that change how Medicare reimbursements are handled. Currently, Medicare operates a fee for service reimbursement model. This means that when a procedure, such as a hip replacement, is performed Medicare provides individual payments to each service provider involved in completing the procedure. However, under ACA, Medicare will shift to a pay for performance model whereby a single payment is issued to the hospital or physician group. The pay for performance model will also provide hospitals, physicians, and other healthcare providers with financial incentives for improving outcomes.

Medical professionals are concerned that performance measures will be used prove legal liability in medical malpractice cases.

The use of performance measures as part of ACA’s pay for performance model has many individuals wondering whether capturing such data will open up healthcare practitioners to legal liability. For instance, can poor scores on an ACA performance measure relating to a physician’s care of a patient provide grounds for the patient to sue the doctor for malpractice? Or, can an attorney introduce poor performance scores as evidence of medical negligence?

Georgia is the first state to pass a bill preventing ACA driven performance scores from being used as a basis for legal liability.

The American Medical Association (AMA) is trying to prevent performance data from opening up healthcare providers to legal liability. As such, AMA has developed model legislation to this effect for lawmakers across the country. Georgia is the first state to respond to AMA’s efforts. Last month, the State’s legislator passed a bill that would prohibit any medical guideline or reimbursement criteria that is developed under federal law from being used to established the standard of care in a negligence case for medical malpractice. The bill also bans using compliance with such guidelines or criteria as favorable evidence for a physician facing a negligence claim. The bill is currently awaiting signature by Governor Nathan Deal.

AMA also supports the Standard of Care Protection Act, a bipartisan bill that was recently introduced at the federal level by Rep. Phil Gingrey, MD (R-GA) and Rep. Henry Cuellar (D-TX). This legislation would prevent individual who bring a medical malpractice case from using guidelines established by ACA, or Medicare and Medicaid statutes to establish the standard of care that their physician had a duty to maintain. In addition, the legislation would not allow any federal laws to trump state laws related to medical liability.

Contact an attorney immediately if you have been injured during the course of your medical care as a result of negligence on the part of your physician or other healthcare professional. An attorney can help protect your legal rights and ensure that you receive the compensation you deserve.

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