Healthcare Quality Improvement Act of 1986

adversely affecting

reducing, restricting, suspending, revoking, denying, or failing to renew clinical privileges or membership in s health care entity

secretary

the secretary of health and human services

hospital

the term licensed health care practitioner and practitioner mean with respect to a state an individual who is licensed or otherwise authorized by the state to provide health care services.

state licensing board

with respect to a physician or health care provider in a state, the agency of the state which is primarily responsible for the licensing of the physician or provider to furnish health care services.

professional review action

an action/recommendation of a professional review body which is taken or made in the conduct of professional review activity, which is based on the competence or professional conduct of an individual physician

the increasing occurrence of medical malpractice and the need to improve the quality of medical care have become nationwide problems that warrant greater efforts than those that cant be undertaken by

any individual state

professional review "body"

health care entity and the governing body or any committee of a health care entity which conduct professional review activity and includes any committee of the medical staff of such an entity when assisting the governing body in a professional review activity

Board of Medical Examiners

includes a body comparable to such a Board (as determined by the state) with responsibility for the licensing of physicians and also includes a subdivision of such a board/body

Clinical privileges

includes privileges , membership on medical staff, and the other circumstances pertaining to the furnishing of medical care under which a physician or other licensed health care practioner is permitted to furnish such care by a health care entity.

there is a national need to restrict the ability of incompetent physicians t move from state to state without disclosure or discovery of the physicians previous damaging or

incompetent performance

HCQIA

is provided for two reasons. 1. because of its importance to understanding the related discussion in the body of the chapter 2. because the acts complex definitions and overall structure make for a good exercise in statutory interpretation.

physician

a doctor of medicine or osteopathy, dental medicine, dental surgery, podiatric medicine, optometry, or chiropactic medicine legally authorized to practice by the state in which he/she performs

a health care entity including

a health maintenance organization or group medical practice) that provide health care services and that follows a formal peer reciew process for the purpose of furthering quality health care, and a professional society of physicians or other licensed health care practitioners that follows a formal peer review process for the purpose of furthering quality health care

health care entity

a hospital that is licensed to provide health care services by the state in which it is located.

medical malpractice action or claim

a written claim or demand for payment based on a health care providers furnishing health care services, and includes the filling of a cause of action, based on the law of tort, brought in any court of ant state or the united states seeking monetary damages

professional review activity

activity of a health care entity with respect to an individual physician - to determine if the physician has clinical privileges with respect to membership - or to change/modify such privileges/membership

the nationwide problem can be remedied through

effective professional peer review.