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The Affordable Care Act’s Quality Measures and What They Mean for Medical Malpractice

The Affordable Care Act (ACA), made many different changes to the healthcare system including some to established government programs such as Medicare. While the ACA does not directly address the issue of medical malpractice, the law makes several changes which may alter how courts handle medical malpractice cases. For instance, one of the changes in the law requires the Secretary of Health and Human Services to produce a core set of healthcare measures that the government can use to judge the quality of care that a patient receives. Although the government made this change to determine how much Medicare should pay a doctor, it may also have interesting implications for the way judges and juries examine the evidence in medical malpractice cases.

Medical malpractice cases, like many civil lawsuits, require proving that the defendant was in some way negligent or careless. This can pose a challenge in some cases, particularly in complex or technical areas like medical malpractice, because the jury can find it difficult to determine how much care was, or should have been taken. Fortunately, in many areas of the law, the government has set out standards of care that people should follow. A speed limit makes a great example of this. If someone gets into a car accident going over the speed limit, the judge or jury can take that as evidence that they were being careless, rather than going through the complicated process of trying to figure out exactly how fast the person should have been driving.

These sorts of short-cut standards exist throughout the law in many places where the government regulates an activity. Although, some of them carry less weight than others depending on exactly what the government is trying to accomplish with the law. For instance, a law requiring that people keep their yards free of litter exists more to keep a neighborhood looking nice as opposed to keeping people safe like a speed limit. Consequently, if someone trips over a piece of garbage in their neighbor’s yard the litter law would matter less than exceeding the speed limit does in a traffic accident.

The ACA’s quality standards mix these two types of laws together. On the one hand they look like the litter law, since they were created to figure out how much Medicare was going to pay doctors rather than being created to tell doctors what is or is not safe. On the other hand, as a matter of safety, they talk about exactly what qualifies as proper care that patients should receive. That would make them an excellent signpost for juries to use in malpractice cases. While judges have not yet decided how to handle these quality standards if they make an appearance as evidence, some legislatures, with the support of groups like the American Medical Association, have started introducing laws to prevent their use in medical malpractice trials. These laws have met with mixed reception, and Illinois currently has no such law. This seems to indicate that these new measures of quality may provide viable a way for judges and juries to better understand the complexities surrounding medical malpractice, and help our attorneys get victims the compensation that they are owed.

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