TABLE 4.
Barriers to Implementing DA&O Model
| Barrier Cited | % (n) | Illustrative Quotations |
|---|---|---|
| Charitable immunity | 81 (22/27) | “You don't necessarily need to take charitable immunity away to make a program like this fly. What you need to do is convince the institutions to waive their charitable immunity and take systems-level responsibility.”—A hospital representative |
| Physicians' discomfort with disclosure | 78 (21/27) | “Disclosure is not amateur hour. It requires a certain level of expertise.”—A physician |
| Attorneys' interest in maintaining the status quo | 74 (20/27) | “They believe they are doing God's work in protecting patients, and they get paid handsomely for that. This is going to affect their pocketbook, and it's going to affect their livelihood.”—A health insurer representative |
| Coordination across insurers | 74 (20/27) | “We might not have enough time to get everybody together, to get everybody to assess what's going on and then make a determination. In the meantime, the patient is still sitting there.”—A health insurer representative |
| Physicians' name–based reporting | 70 (19/27) | “The systems issues are bigger than the doctor issues in most cases, so it's hard to say, ‘Doctor, you’re the one who's going to get the ding,’ when we know it wasn't [his/her fault].”—A physician representative of a community/teaching hospital |
| Concern about increased liability | 59 (16/27) | “I think that there are concerns on the part of the physician that even with a well-vetted model like this, that it may still expose them to greater malpractice liability. I think there are many who feel that if they just don't come forward, maybe the patient won't notice or won't do anything or take any further actions.”—A health insurer representative |
| Forces of inertia | 48 (13/27) | “Well, it's change! It's big change. All the traditional impediments to any change would certainly be in force here.”—A hospital representative |
| Fairness to patients | 44 (12/27) | “I think that some patient advocates might see it as a way to convince people indirectly or maybe even more directly not to sue when may be they should.”—A public official |
| May not work in other settings | 41 (11/27) | “We don't employ our physicians. We have to convince them to come to the table in a disclosure conversation if we were to go to a financial compensation model.”—A hospital representative |
| Insufficient evidence | 30 (8/27) | “I think what would be very, very useful is the availability of other empirical data from other locations across the country to confirm the observations in Michigan.”—A hospital representative |
| Supporting legislation needed | 30 (8/27) | “In states where it's been successful, the courts are overturning a lot of the legislative changes, so it's really an uphill battle.”—A malpractice insurance representative |
| Accountability for the process | 19 (5/27) | “I could imagine there could be groups out there that feel like, ‘Oh, yeah, well, it's going to be run by the hospital. This is like the fox in the chicken coop! The hospitals and the doctors, the people who screwed up to begin with, are going to execute this very nice, just system!’ … [They] may want to regulate the process in some way.”—A physicians’ group representative |