The Health Care Quality Improvement Act - a brief understanding

The Health Care Quality Improvement Act (HCQIA) is a major antitrust legislation passed by the US Congress in 1986. This Act was passed to check the high degree and number of medical malpractices that had been taking place for about a decade prior to this legislation.

The HCQIA sought to blacklist physicians and surgeons that were found guilty of malpractices as described in this legislation. One of the main methods of medical malpractice that surgeons and other medical practitioners used to resort to was to simply move from the State in which he or she committed misdemeanors to another in which the law was less punitive. This made it impossible for the authorities to repatriate the erring practitioner to the original State for prosecution, because a federal law that applied to all States was absent till then.

As a result, for close to two decades prior to the promulgation of the Health Care Quality Improvement Act; there was a steady decline in the number of disciplinary actions against physicians, although their actual numbers were rising significantly.

Blocking the escape route

This lacuna was filled by the US Congress through the passage of The Health Care Quality Improvement Act. The fundamental intention of this Act was to put in place a federal legal mechanism by which interstate reporting of such cases could become possible. The Health Care Quality Improvement Act was passed to protect patient safety in case of a misdemeanor from a medical practitioner.

What all did the Health Care Quality Improvement Act seek to introduce?

Firstly, the Health Care Quality Improvement Act required medical practitioners who crossed from one State to another to report the same. Whenever a medical practitioner sought to do this, the HCQIA required that practitioner to report to the authorities, who would report these cases in the National Practitioner Data Bank.

The second important element of the Health Care Quality Improvement Act was that it sought to put in place a mechanism of peer review to correct the deficiency arising out of incompetent practitioners escaping the law and to improve patient safety. Exempting a peer reviewed practitioner from prosecution under this Act; the HCQIA seeks to provide immunity to such peer-reviewed practitioners from damage suits in case the practitioner moved from one State to another.

Effects of the Health Care Quality Improvement Act

The Health Care Quality Improvement Act, while being good in in its intention of curbing a major type of medical malpractice, in effect ended up replacing one kind of corrupted practice with another. While the action taken for escaping prosecution, namely moving from one State to another was somewhat halted, the system of peer review it put in place gave rise to more misdemeanors. A peer reviewed practitioner could influence the peer review board to grant a favorable review and become immune from legal action. This resulted in a new kind of malpractice, which many legal firms have openly admitted to exploiting for the advantage of their physician client.

Another drawback of the Health Care Quality Improvement Act

Another shortcoming of the Health Care Quality Improvement Act was that the National Practitioner Data Bank soon became a battleground for settling personal scores, as even the smallest and flimsiest of misdemeanors could be reported. This happened mainly because the Health Care Quality Improvement Act did not specify the exact nature of a malpractice or misdemeanor.