So, you want your FQHC to get FTCA?

Here are Five Things You Need to Know!

The Federal Tort Claims Act (FTCA) affords Federally Qualified Health Centers (FQHC) a significant benefit, substantially eliminating medical malpractice insurance expenses to cover their providers. FTCA coverage, in turn, improves health centers’ ability to attract and retain medical providers. Under the act, health center employees and eligible contractors are considered Federal employees and are thus protected from lawsuits for medical malpractice. A patient who alleges acts of medical malpractice by a deemed health center cannot sue the health center or the provider(s) directly, but must file the claim against the United States Government. The Federal government assumes responsibility for costs related to a claim resulting from the performance of a medical, surgical, dental, or related function. There is no cost to a participating health center or its providers, although prior to receiving FTCA, a health center must demonstrate that it adheres to quality standards. Claims against health centers are reviewed and/or litigated by the U.S. Department of Health and Human Services, Office of the General Counsel and the Department of Justice according to FTCA requirements.

To participate in the FTCA program, you must be a FQHC grantee (FQHC Look-Alikes are ineligible), and here are five things you need to know:

1. It is all about “compliance.” Those of you who have read our eight things you need to know about becoming and FQHC Look-Alike (here) will understand this. It is a recurring theme among all of our articles about attaining and retaining FQHC designation. Simply stated, you must do what HRSA requires of you! Since you reapply for FTCA each year, you must ensure that you are constantly reviewing and updating, as necessary, policies and procedures which may be verified at an Operational Site Visit (OSV). Delays in timely review and updating of policies and procedures could result in a gap in coverage.

2. You must have a robust QI/QA program. In order to cover your medical malpractice insurance, the Federal government wants to know that you are engaged in processes that document the provision of quality health care for your patients. This is generally referred to as a Quality Improvement/Quality Assurance (QI/QA) program. There are several things you need in place for a compliant program, including board-approved policies that establish the program, a board committee overseeing the program, a staff person responsible for implementation, formal processes for assessment of patient safety and adverse outcomes, quarterly assessments of the policy, and more. Since the process is intended to inform patient care, your medical director or Chief Medical Officer will play a critical role.

3. You must have an active risk assessment program. The Federal government wants to limit its liability as much as you do. Therefore, to cover you for malpractice, you are required to implement an ongoing health care risk management program to reduce the risk of adverse outcomes that could result in health-related litigation. Your risk assessment program must be authorized by and report to the board on an annual basis.. The report should include reviews of highest-risk clinical (e.g., obstetric care or infection control) and non-clinical (e.g., the Health Information Portability and Accountability Act or HIPAA) procedures, patient referral tracking, and a designated staff member responsible for implementing it all.

4. You must ensure your providers are qualified to provide the services you hired them to provide. All licensed or certified health care providers, including volunteers and locum tenens providers who work or volunteer in the health center, must undergo a formal credentialing and privileging process. This can be managed internally or through and independent credentials verification organization (CVO), although someone on staff must be charged with ensuring providers’ credentials and privileges are verified. Furthermore, credentialing must be verified periodically (e.g., every two years, although no time interval is mandated). The Federal government will not cover malpractice for a provider whose credentials and privileges have not been verified by the health center.

5. You must have a claims management process. This is to address potential or actual health-related claims, including medical malpractice claims, which may be eligible for FTCA coverage. There must be a staff member who is responsible for the management and processing of claims-related activities and serves as the claims point of contact for the organization. This person must document cooperation with the Federal government or other legal party involved, document deficiencies in procedures or non-compliance that resulted in the incident related to the claim, and use that information to implement steps that mitigate the risk of such claims in the future.

Keep in mind that if the Federal government acts as your medical malpractice insurer, and that it will enact all available policies to reduce its own risk, just like any other insurance provider should do. Federal staff take seriously their responsibility to protect taxpayers’ liability. If you want your health care workers to have malpractice insurance as a protection for them and your health center, you too will need to take this seriously as well. It is an opportunity with significant financial benefits that all FQHCs should explore. If you have questions, we have answers! Please don’t hesitate to contact us at 530-877-3426 or info@garybess.com.