Crossing the Quality Chasm: Autonomous Physician Extenders Will Necessitate a Shift to Enterprise Liability Coverage for Health Care Delivery

International audienc

The Schizophrenia of Physician Extender Utilization

The Patient Protection and Affordable Care Act of 2010 provides incentives for healthcare to be delivered by Affordable Care Organizations (ACOs). The public face of many, if not most, ACOs is likely to be the Patient Centered Medical Home (PCMHs), a business structure that evolved from Retail Medical Clinics, which made greater use of physician extenders (PAs). Accordingly, this paper examines the evolution and structure of PCMHs as well as how the PCMH is regulated. As neither legal or market regulatory mechanisms are ideal for policing business structures that employ PAs, this paper concludes that the tort reform most appropriate for PCMHs is the introduction of either no-fault or enterprise liability coverage

Application of Administrative Law to Health Care Reform: The Real Politik of Crossing the Quality Chasm

Real Politik, a term in vogue at the height of the Cold War, contemplates that in practice, governmental bodies attempt to expand their spheres of influence and control by the application of economic leverage. The federal government is clearly interested in expanding its influence into health care because of its cost. Americans spend over one trillion dollars - forty-four percent of which is paid for by the federal government - on health care each year. To control the cost of health care, governmental reformers proposed the Health Securities Act of 1993 as a frontal assault on the American health care system. But, to the reformers\u27 chagrin, the Health Securities Act was dead on arrival, as much from the message as the messenger. Undeterred by having the front door of reform barred by a plurality of interests, the reformers shifted gears to use a side entrance to legislative reform - administrative agency law. Presently, health care reformers are using administrative law to institute many of the core concepts of the Health Securities Act