2013-2014 National Health Law Moot Court Competition Best Brief.

This document was judged Best Brief submitted to the 2013­2014 National Health Law Moot Court Competition. The brief was submitted by students Jessica Robinson DeShon, Brandon Jackson, and Matthew Ward on behalf of Faulkner University School of Law in Montgomery, Alabama. Address correspondence to Professor Joe Lester at Jlester@Faulkner.edu.

The quality of medical care.

This article classifies the major approaches to the assessment of the process and outcomes of medical care. The apparent need to safeguard and enhance the quality of care has led to the institution of mechanisms that subject care to constant review so that deficiencies may be found and corrected. The article reviews the developments that led to the involvement of the federal government in this activity through its sponsorship of professional standards review organizations (PSRO's). The major features of the PSRO's are described and their possible effects discussed. It is too early to say how the PSRO's will fare, but should they fail to accomplish their objectives the pressure for more radical solutions will be difficult to resist.

As inconstitucionalidades da Resolução CFM nº 2294/2021 sobre a utilização das técnicas de reprodução assistida / The unconstitutionalities of Resolution CFM nº 2294/2021 on the use of assisted reproduction techniques

O Conselho Federal de Medicina acaba de editar a Resolução nº 2.294/2021, publicada em 15 de junho de 2021, que aponta normas para a utilização das técnicas de reprodução assistida. Apesar de o propósito ser o aperfeiçoamento das práticas e a observância aos princípios éticos e bioéticos para trazer maior segurança e eficácia a tratamentos e procedimentos médicos, repete inconstitucionalidades das normatizações pretéritas e impõe mais restrições ao sonho das pessoas de ter filhos. Desse modo, mais do que avanços, o novo regramento provoca um retrocesso que não se coaduna com a garantia constitucional e legal que assegura o livre planejamento familiar.(AU)

The Brazilian Federal Council of Medicine has just edited the Resolution nº 2.294/2021, published on June 15, 2021, which sets out rules for the use of assisted reproduction techniques. Although the purpose is to improve practices and observe ethical and bioethical principles to bring greater safety and efficacy to medical treatments and procedures, it repeats the unconstitutionalities of past regulations and imposes more restrictions on people's dreams of having children. In this way, more than advances, the new regulation provokes a setback that is not consistent with the constitutional and legal guarantees of free family planning.(AU)

Effectiveness research and assessment of clinical outcome: a review of Federal Government and medical community involvement.

Because of their concern about the increasing costs of health care, industry and government contractors for health care will attempt to control health-care costs for the foreseeable future. New proposals for cost containment include those that are focused on cost alone--for example, expenditure limits--and those that propose to control costs by limiting medical interventions to those of known efficacy. This latter attempt has come to be known as "effectiveness research." Herein, we briefly review the history of quality assurance and cost-containment efforts in the United States, giving special attention to the current initiative based on effectiveness research. Although the effectiveness research initiative has shortcomings (for example, it will not provide guidance when data are not available), it seems to be superior to the current peer review system because it encourages the development of a knowledge base and deemphasizes punitive measures as a way to ensure quality and control costs. The Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239) establishes a federal agency, the Agency for Health Care Policy and Research, within the Public Health Service to focus on effectiveness research.

Malpractice in psychotherapy. An overview.

A generation ago, psychotherapy was rarely the subject of a malpractice suit. Most litigation involving psychiatrists resulted from physical harm, rather than emotional harm, to the patient. During the last twenty-five years, the situation has changed with juries returning verdicts in a large number of cases awarding damages totaling millions of dollars. More recently, restrictions on bringing medical malpractice claim generally have multiplied, but now the role of managed care is affecting the standard of care and choice of treatment.

The impact of hospital regulatory programs on per capita costs, utilization, and capital investment.

Regulatory programs are widely used to exert disciplinary force on rising health care costs. This study assessed the impact of three widely used regulatory schemes in the hospital sector between 1971 and 1977: prospective rate setting, certificate of need, and professional standards review organizations. Strong evidence was found that neither voluntary rate setting nor CON review exerted any constraining effect on costs per capita, utilization, and capital investment. A negative but statistically insignificant influence on costs was documented for mandatory rate setting. A substantial cost moderating effect was, however, documented for PSROs. Utilization review may thus be a useful mechanism to counterbalance the incentive of per case rate setting to increase admissions.

Professional self-regulation: peer review.

Dentistry, in fulfilling its responsibility for self-regulation, has established a highly specific and formalized method of peer review. Its primary purpose is to mediate problems between patients, dentists, and third parties relative to the quality of treatment and appropriateness of care. It is a confidential service provided to the public and profession at no cost and accomplished with the voluntary cooperation of all parties involved. Decisions of peer review committees are advisory in nature but offer an alternative to legal resolution of misunderstandings and problems in patient care. The profession, by continually refining peer review and by educating its members and the public to its function, is providing a unique and valuable service to patients, dentists, and third parties. The objective and consistent application of this self-monitoring process is but one mechanism by which dentistry seeks to serve the public and perpetuate its high standard of care.

The historical precedents for quality assurance in health care.

The evolution of quality assurance as an essential component of a scientific, objective approach to health care delivery, and its implications for the profession of occupational therapy are presented. A review is made of the economic, ethical, psychological, and legislative forces that have influenced the development of quality assurance over the past century, a development that has seen times of strong emphasis on quality assurance functions, as well as periods of minimal support and, even, obstacles to any activity. Quality assurance standards established by both The American Occupational Therapy Association and the Joint Commission on Accreditation of Hospitals (JCAH) are discussed. Results of commitment to these standards include improved effectiveness and efficiency of health care, better coverage and reimbursement from third-party payors, and greater professional growth. The need for commitment by occupational therapists to the most effective forms of quality assurance is recommended.

Professional standards review; Professional Standards Review Organization (PSRO)--Health Care Financing Administration. Interim final regulation with a comment period.

This interim final rule is required to conform current regulations to certain provisions of the Omnibus Reconciliation Act of 1980 (Pub. L. 96-499) and the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35). To conform with current statutory authority, this rule makes technical changes to Parts 431, 432, 433, 456, 462, 463, 466, 473, 478, and 480 of Chapter 42 of the Code of Federal REgulations. The Omnibus Reconciliation Act of 1980 (Pub. L. 96-499) made several adjustments to the PSRO program. In conformance with that Act, this rule changes PSRO membership and advisory group requirements. The Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35) has further modified the PSRO program. In conformance with that Act, this rule changes the agreement requirements between HCFA and each PSRO. Accordingly, such agreements may be for any period not to exceed 12 months (42 CFR 462.11(a)(2)), and the procedures for termination or non-renewal of the agreement are modified.

Medicare program; utilization and quality control Peer Review Organization (PRO) area designations and definitions of eligible organizations--HCFA. Final rule.

This final rule implements a portion of the Peer Review Improvement Act of 1982 (Title I, Subtitle C of the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248) requiring the Secretary to establish geographic areas throughout the United States for contracts under the PRO program and defining organizations eligible to become PROs. A final notice published elsewhere in this edition of Federal Register establishes these area designations and will enable the Secretary to begin the process of contracting with PROs by setting the boundaries for each new organization. This final rule implements that portion of the law which defines organizations eligible to become PROs.

Medicare program; utilization and quality control Peer Review Organization (PRO) area designations--HCFA. Final notice.

A final rule published elsewhere in this issue of the Federal Register implements portions of the Peer Review Improvement Act of 1982 (Title I, Subtitle C of the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248) (PRO Act) requiring the Secretary to establish geographic areas throughout the United States for contracts under the PRO program and defining organizations eligible to become PROs. This notice sets forth the geographic areas (area designations) required for contracting under the PRO program.

Utilization and quality control Peer Review Program; solicitation of comments on proposed scope of work for waivered and exempt PRO areas--HCFA. Notice.

This notice does not constitute a request for proposal (RFP). The purpose of this notice is to solicit comments on the Scopes of Work prepared as part of the RFPs for Utilization and Quality Control Peer Review Organizations (PROs) for PRO areas waivered or exempted from the Medicare prospective payment system. These areas include Maryland, Massachusetts, New Jersey, New York, Guam, Puerto Rico, and the Virgin Islands.

Medicare programs; utilization and quality control peer reviews organization (PRO) area designations and definitions of eligible organizations--HCFA. Proposed rule.

This proposal would implement a portion of the Peer Review Improvement Act of 1982 (Title I, Subtitle C of the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248) requiring the Secretary to establish geographic areas throughout the United States for contracts under the PRO program. The establishment of these area designations will allow the Secretary to begin the process of contracting with PROs by setting the boundaries for each new organization. These regulations will also implement that portion of the law which defines organizations eligible to become PROs.

Medicare program; utilization and quality control peer review organization (PRO) area designations--HCFA. Notice.

This document would implement a portion of the Peer Review Improvement Act of 1982 (Title I, Subtitle C of the Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-248) that requires the establishment of geographic areas throughout the United States for the purpose of entering into contracts under the PRO program.

Utilization and Quality Control Peer Review Program; solicitation of comments on proposed PRO program scope of work--HCFA. Notice.

This notice does not constitute a request for proposal (RFP). The purpose of this notice is to solicit comments on the Scope of Work prepared as part of the RFP for Utilization and Quality Control Peer Review Organization (PRO) beginning in the third quarter of fiscal year 1984.

Medicare program; utilization and quality control peer review program; third Scope of Work for peer review organizations--HCFA. Notice.

This notice describes new requirements for the third Scope of Work for Utilization and Quality Control Peer Review Organizations (PROs) for fiscal year 1989, beginning October 1, 1988. This notice implements section 4091(b)(1) of the Omnibus Budget Reconciliation Act of 1987 (Pub. L. 100-203), which requires us to publish a new policy or procedure adopted by the Secretary that affects substantially the performance of contract obligations at least 30 days before the date the policy or procedure is to be used. It also implements other provisions of Pub. L. 100-203, as well as requirements of the Omnibus Budget Reconciliation Act of 1986.