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SSB 5801

Risk of Harm. IIMAC's role: Sec 1. 2 (d) The industrial insurance medical advisory committee shall develop criteria for removal of a provider from the network?completed 9/22/11 by unanimous approval. 2. Risk of Harm. ?to be presented to the department and advisory group for consideration in the de

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SSB 5801

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    1. SSB 5801 Risk of Harm Dianna Chamblin, MD Provider Network Advisory Committee 10/13/11

    2. Risk of Harm IIMAC’s role: Sec 1. 2 (d) The industrial insurance medical advisory committee shall develop criteria for removal of a provider from the network…completed 9/22/11 by unanimous approval

    3. Risk of Harm …to be presented to the department and advisory group for consideration in the development of contract terms…

    4. Risk of Harm (7) the department may permanently remove a provider from the network or take other appropriate action when the provider exhibits a pattern of conduct of low quality care that exposes patients to risk of physical or psychiatric harm or death. Patterns that qualify as risk of harm include, but are not limited to, poor health care outcomes evidenced by increased, chronic, or prolonged pain or decreased function due to treatments that have not been shown to be curative, safe, or effective or for which it has been shown that the risks of harm exceed the benefits that can be reasonable expected based on peer-reviewed opinion.

    7. Current Process for Department Actions

    8. Process Time Line Length of Time 30 days 4-6 months 30 days 60 days Action ONC to select sample and prepare files for transfer to Permedion Permedion to conduct peer review ONC review and L&I Medical Director decision Provider able to protest

    9. Process Time Line Continued Length of Time 2-4 months 60 days Action If provider asks for reconsideration If original order and notice is affirmed and provider decides to appeal to BIIA.

    10. 1 6 1 2 4 2 12 _________??_________ =28 plus months

    11. Risk of Harm

    12. Medical harm refers to any systemic failure in the health care system that results in a negative psychological or physical consequence. Medical harm is not limited to iatrogenic illness. The Institute for Healthcare Improvement (IHI) defines medical harm as the “[u]nintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment), that requires additional monitoring, treatment or hospitalization, or that results in death. Such injury is considered harm whether or not it is considered preventable, whether or not it resulted from a medical error, and whether or not it occurred within a hospital.”[2] With this definition, IHI estimates that “15 million instances of medical harm occur each year”[2] in the United States. The term medical harm does not imply intent or negligence nor indicate the severity of the damage.

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