News What are the factors driving the rising costs of healthcare?

[adrenaline]

As someone who many times is forced to vote as a democrat, it was smart of Kerry to choose someone who can harvest some Southern votes. I also like Edward's position on the persistent racial problems that still simmer in our nation. However,if Edwards hopes to be Vice President someday then I would suggest that he learn three important lessons:

#1. Manipulating the system for the benefit of a hand picked few does not mean that you are a defender of the poor and downtrodden.

#2. Attacking and exploiting important sectors of our society such as health care and insurance for the benefit of a small subset of the population is bound to have bad, unintended consequences that will affect everyone.

#3. Being Vice President of the United States means that you are a leader to all Americans not just victims of Cerebral Palsey or the poor or the unemployed


There are exceptions to this generalization, however, but as a trial lawyer, He/her will often put the client’s interest above the greater good. That is the nature of the lawyer/client relationship and of trial law in this country.

I believe that lawyers like John Edwards undermine our legal system. They can ignore data, science and greater good, and they do regularly. They are doing their job - and Edwards does that job well.

I admire his skill, but I disdain what his cases do to our legal system. I do not blame him, but I do not want someone with his attitude about the law as my vice president and potentially, president. If I needed a good trial lawyer, I'd hire him.

We need tort reform, and not just in medicine. Our legal system in so many aspects of society bog down and hinder production. Small business owners can't even survive some insurance premiums and protection umbrella systems that is now necessary. With Edwards in second in command, any hopes of reform will probably vanish. The court system, as used in this country, does not protect the public good.

We need a change from Bush but since Edwards represents the current sorry state of affairs, he scares me




And to add a further rant, Edwards made his money suing doctors who 'didn't perform C-sections soon enough' and thus 'condemned the children to suffer cerebral palsy.' The argument makes the science surrounding global warming seem like Gospel Truth. As a result of such lawsuits, there are now more than four times as many Caesarean sections as there were in 1970. But curiously, there has been no change in the rate of babies born with cerebral palsy. As The New York Times reported: "Studies indicate that in most cases, the disorder is caused by fetal brain injury long before labor begins." All those Caesareans have, however, increased the mother's risk of death, hemorrhage, infection, pulmonary embolism and Mendelson's syndrome.

How charming that Edwards cares about cerebral palsy babies...look at his legislative record in North Carolina: Edwards was one of the leading opponents of a bill in the North Carolina Legislature that would have established a fund for all babies born with cerebral palsy. So instead of all disabled babies in North Carolina being compensated equitably, only a few will win the jury lottery -- one-third of which will go to trial lawyers like Edwards, who insists he doesn't care about the money.

 

[adrenaline]

Let me introduce facts regarding the general misconception of tort reform.

People have a misconception of the AMA. For instance, the AMA, is mainly for nationalized insurance or health care of some kind...something the general population does not realize.

Just to be clear, the AMA does not oppose compensating an injured patient for medical expenses and lost wages. If there's been a wrong, they want it made right.

And the AMA also want accountability for all -- for attorneys and physicians -- and that includes those who give false testimony using junk science to perpetuate a meritless claim that should not have been brought in the first place. They still want bad doctors to get out of practicing medicine.

Reform based on actuarial evidence and not political expediency. National reform that does not undermine the effective state reforms already in place.
Their quest is to maintain access for patients in their hour of need. The current system is destroying access.



Right now, the medical liability insurance companies are a convenient scapegoat, but they are required by law to make conservative investments. They typically place about 80% of their investments in the bond market -- not the stock market. According to A.M. Best Co., the investment yields of medical liability insurers have been stable and positive for the last five years.

Thus, the issue on focusing on them detracts from the larger issue.... Errors can involve nurses, pharmacists, health technicians, aides -- in short, anyone who is working in the complex system of health care delivery. This word -- " system" -- is key to understanding how medical errors happen and how we can prevent them.

If you think the AMA is a "pawn," you are mistaken. Visit the Litigation Center on the AMA's Web site (www.ama-assn.org/go/litigationcenter). There you will find ample evidence that the AMA takes on insurers when we document that they have done harm to patients and physicians.

The Institute of Medicine and the Health and Human Services Dept. say most medical errors are not failures of physicians, but failures of the system. Even when doctors do their jobs correctly, most errors would still occur.

A better approach to fixing the problem of system errors would be to dispel the fear of physicians, hospitals and nurses that open discussion on adverse events would be discoverable in lawsuits. To stop errors, we need to prevent them through improved systems of safety, just as it has been done in the nuclear and aviation industries. The fear of being sued obviously discourages health care professionals from reporting problems when they happen. It hampers efforts to determine what went wrong and how to prevent it.


To truly protect patients, the AMA supports the Patient Safety and Quality Improvement Act or HR 663 -- legislation recently passed by the House of Representatives -- that would help create a voluntary, confidential error reporting system that allows review by experts, who report back to those involved on how to fix the system. The fix is then shared with all.

That is how the aviation safety reporting system works. Similar legislation, S 720, has been approved by the Senate Health, Education, Labor and Pensions Committee -- unanimously. In both chambers, the AMA has been immersed in bipartisan negotiations.
That's why the AMA support the Patient Safety and Quality Improvement Act (S 720), a proposed federal law that would allow the voluntary, confidential reporting of errors to patient safety experts. The result would be advice on how to improve the system and therefore patient safety. This system fix would be shared with all in a de-identified manner. This model works for the Aviation Safety Reporting System. It would work in the health care field, too. Right now, the current system does not help with an open discussion of errors.

The AMA continue to challenge the Assn. of Trial Lawyers of America to match our donations to the National Patient Safety Foundation. To date, they haven't offered one thin dime. Is this a hint that the trial lawyers are more interested in suing physicians than in saving patients?


Regardless of whose views prevail as to how to change the system, there will, ultimately, be change -- because patients will lose access to care as doctors retire early, limit their practice such as no longer delivering babies, or move to one of the six states that have more stable liability climates. Athens, on the third largest city in georgia just lost almost all its obstetricians. They were not asking for a raise, but when malpractice premiums are 1 1/2 times your salary, you can't survive. I don't know who is going to deliver my daughter's baby when she grows up, it will probably be a nurse midwife whose insurance coverage offers less reward value for the jury. (By the way, Edwards has limmited cases for a botched delivery preformed by a midwife or nurse practioner for this very reason.)

I disagree with the AMA on some things but their idea that we have to move away from a culture of shame and blame and towards a culture of prevention and safety is right on.


And for the record, the best doctors are the ones being sued. The average academic physician has 5 lawsuits vs. one in private practice at any given time. The qualifications and dedication of academic physicians are generally regarded as above those in private practice. (Work for less money and are on the cutting edge of information and research). This is because of the volume and complexity of the patients seen. 88% of those that go to trial are won in defense of the doctor. (The jury sees that the doctor did not commit negligence, the others may or may not have been negligence and may have been won with jury sympathy, like the cerebral palsey cases...and anyone can do some literature research to see how c sections don't affect the rate of cerebal palsey as this is a scientific forum and all.)

 

[member 5645]

To truly protect patients, the AMA supports the Patient Safety and Quality Improvement Act or HR 663 -- legislation recently passed by the House of Representatives -- that would help create a voluntary, confidential error reporting system that allows review by experts, who report back to those involved on how to fix the system. The fix is then shared with all.

Im glad you brough this up. I couldn't find the bill. I can't say how much I support this! It's fantastic idea.

 

[Njorl]

How interesting, since New Jersey inacted malpractice tort reform laws, including a 78 million dollar pot to subsidize the doctors malpractice insurance costs.
Nice example...

Oooh

If you add in that 78 million, the percentage rises from 3.2% to 4%. Still very far from a problem.

Damage caps have been shown to have no statistically noticeable effect on insurance premiums in any state.

New Jersey enacted "reform" because their rates were higher than average. So 4% of income for malpractice insurance is higher than average. There is no problem.

Njorl

 

[adrenaline]

Oooh

If you add in that 78 million, the percentage rises from 3.2% to 4%. Still very far from a problem.

Damage caps have been shown to have no statistically noticeable effect on insurance premiums in any state.

New Jersey enacted "reform" because their rates were higher than average. So 4% of income for malpractice insurance is higher than average. There is no problem.

Njorl

You are right, tort reform is more than limiting jury awards, although that is what makes the news and evokes little sympathy.

(However, I will tell you when they did limit noneconomic damages to 250,000 in Texas, state wide premiums went down... so the article is not accurate in its assessment about it not affecting premiums.)


First of all, we all want grieviously injured patients to be reimbursed and adequetly treated. Tort reform is not going to take that away.

But let's look at numbers before we say the insurance companies are all to blame: 10 years ago Georgia had over 30 malpractice insurers. We are down to five. It ain't that profitable and most know it. St. Paul our largest Nation wide insurerer quit basically because of this.

It is estimated that malpractice insurers will pay out approximately $1.40 in claims losses and direct expenses for every dollar of premium collected in 2001 and 2002 Even with significant rate increases, it is projected that insurers will be forced to expend $1.35 in claims costs and expenses for each premium dollar received in 2003.3 These figures are independent of investment gains or losses.


Mutual or reciprocal insurance companies, companies that are owned by the physician policyholders themselves, not outside shareholders, insure more than 60% of America’s practicing physicians. The primary mission of these companies is to provide insurance protection for practicing physicians. nonetheless, no company can long sustain losses of this magnitude and remain solvent, so premium rates have been forced sharply upward. MAG mutual, my insurance carrier has lost 1.12 for every dollar invested and at this rate will probably pull out of the whole business in 5 years.


Since 2000, mean rates across the country have increased between 10% and 20% annually. So our overhead increases automatically by 20% on a yearly basis while other reimbursement sectors continue to cut their payment. For instance, after 2006, Medicare will start cutting back payments for a total of 11% cut over five years (not even enough to keep up with inflation) and more docs will be leaving private sector or not treating Medicare patients. (The latter is becoming a reality...can't treat someone for essentially free and still make enough to pay exploding overhead payments that include liability .)

These averages obscure increases of 100% or more in some venues with unlimited liability in contrast to average increases of 5% to 10% in states that have passed effective tort reform statues In the states most severely affected, which include Pennsylvania, Nevada, West Virginia, Mississippi, Texas, and Florida, some physicians have been unable to find coverage at any price, or have been forced into state-run plans.

Despite the trial lawyers trying to blame malpractice rate increases on investments, the data argue that the problem is a cost problem. Trial lawyers speak persuasively, regardless of the data. That is their job! But the data prove them just sophists.

Though frequency has changed little over the past few years, it has stabilized at extraordinarily high levels. On any given day, there are more than 120, 000 malpractice actions pending against the physicians of the United States. One sixth of America’s physicians report a claim every year (The Doctors Company, unpublished data, 2002). For high-risk specialties, the numbers are even larger. The average neurosurgeon reports a claim every other year (The Doctors Company, unpublished data, 2002). Expressed differently, 50% of America’s neurosurgeons are sued every year. More than 30% of orthopedists, obstetricians, trauma surgeons, emergency department physicians, and plastic and reconstructive surgeons are sued every year (The Doctors Company, unpublished data, 2002).

And the number of lawsuits has nothing to do with competance. To say he/she is less compentant because they have more lawsuits is fallacious.

Approximately 70% of all these claims are closed with no payment to the plaintiff, but each one costs an average of $22,967 to defend adding an enormous expense that must be calculated into the cost of insurance.

This last sentence is the one that most opponents of tort reform ignore. We cannot just look at settlements and judgements; we have huge costs even in frivolous claims.


Wrongful death is abhorent. No monetary settlement can really right that wrong. However, huge payments add a second injury to the first. Physicians do not pay the $5.7 million.

Society pays.

Society pays through decreased access to the benefits of medical care.

Society pays through increased defensive medicine. Society pays as the doctor patient relationship becomes eroded. Physicians feel under siege. Many view each patient as a potential litigant.

In this atmosphere, California has the best track record.


A $250,000 cap on non-economic, not economic damages. Thus, a person can win millions of dollars in economic damages, lost wages, potential earned income etc. and this is not included in the award decision. The non-economic damages are what drives most of the frivilous lawsuits. As for pain and suffering, no one can put a price of that.


2nd, initiate the collateral source rule. This prevents double collection for the same damages. For example, if an injured patient has already had lost wages or medical costs covered by disability or medical insurance, recovery is not duplicated in a malpractice award.

We also need a provision for periodic payments. This allows damage awards to be paid over the period they are intended to cover.


3rd... limit attorneys’ contingency fees. MICRA provides for a sliding scale; a plaintiff’s attorney keeps 40% of the first $50 000 of an award but “only” $221, 000 (plus expenses) of a $1 000 000 judgment. This allows more of an award to actually reach the injured patient. The difference is significant. A patient with a $1 000 000 award in a state with a contingency fee of 40% must give $400 000 (plus expenses) to his or her attorney.


88% of trials that go to jury in Georgia are won by the doctors. Any other profession (tort lawyers) with such an 88% failure rate would be out of business. What this shows is the lawyers are bringing to trial many cases that don't have much of a leg to stand on. Perhaps, an independant body of reviewers who can review the case for legitimicy would be a good start. It is these 88% that really tax the system! not the remaining 12% which are probably valid cases and the victims need to be reimbursed. I spent $50,000 extracting myself from a lawsuit just because I treated the person for asthma 2 weeks before she got a severe infection from her spinal implants from her spinal surgery. They just threw out a net and roped anyone and anything that had contact with her before her severe illness. However, there is no valid mechanism of such innocent bystanders throwing off the net without expensive and timely legal proceedings just to say...oh yeah, you didn't need to be named in the suit.

The problem is much larger than jury settlements.

The Pennsylvania example is fallacious. There exists almost no specialties in certain fields since they have fled the state (almost no gastroenterologists who were hit especially hard for some inexplicable reason) and an influx of primary care physicians skewed the numbers to show there are more doctors. West Virginia has almost no cardiologists. If you have a heart attack, pray for a good internist who can retevase (thrombolyse) you, stabilise you and transfer you out of state for life saving angioplasty or open heart. This can take days to find a hospital willing to accept you.

 

[russ_watters]

... Pennsylvania has increased its per capita physician level every year recently.

...Roughly one out of forty deaths is due to an avoidable medical error. That's well over double either drunk driving or homicide.

I'm not saying you're wrong, but I'd like to see a source for that information. Also, does the second one directly imply malpractice?

Is this a hint that the trial lawyers are more interested in suing physicians than in saving patients?

My best friend is a paralegal and an aspiring trial lawer. We had this discussion about a week ago. He concluded/conceded:

1. There is a crisis due to flaws in the insurance/malpractice system, which can largely be fixed with better regulations.
2. Lawyers will exploit (I think his word was just "use") the flaws for profit until they are fixed.
3. Lawyers will/do fight like hell to prevent passing of better regulations.
4. Most politicians are lawyers, which very much helps with #3.
5. There is nothing wrong (unethical) about #2, 3, or 4 or their relation to each other.

And so I asked him: now do you understand why I despise lawyers? He didn't.

 

[member 5645]

adrenaline - thanks for posting such complete and eliquent posts. Keep it up, I'm still reading, although it seems you are beating me to the punch on many subjects. I will sit it out for a little :)

 

[Njorl]

Nuts. I had posted a long response to Adreniline, and it didn't make it.

I'll be back.

Njorl

 

[member 5645]

Nuts. I had posted a long response to Adreniline, and it didn't make it.

I'll be back.

Njorl

That always sucks. Copy it before you post next time! :)

 

[Njorl]

Just to be clear, the AMA does not oppose compensating an injured patient for medical expenses and lost wages. If there's been a wrong, they want it made right.

The AMA is evidently generous with other people's money. Insurance companies are the ones who pay, and they do not have the generous attitude the AMA has. Corporations are required by law to act in the best interest of their shareholders. Insurance companies are no exception. If they can find a way to avoid paying an injured party, they will do it. Only lawsuits make refusal to pay just claims an economically poor proposition. By necessity, some lawsuits must result in disproportionately large judgements in order to deter stonewalling by the insurers. If insurance companies could fight every settlement with impunity, they would fight every settlement.

And the AMA also want accountability for all -- for attorneys and physicians -- and that includes those who give false testimony using junk science to perpetuate a meritless claim that should not have been brought in the first place. They still want bad doctors to get out of practicing medicine.

I see no reason to believe the AMA wants accountability for doctors. They do not perform actions that support that contention. Their actions indicate the opposite is true. The AMA seeks to protect doctors from accountability.

There are existing remedies for those who commit a fraud on the court. Scams invovlving personal injury in automobile accidents were very common. Lawyers would suborn purjury from a doctor to win large awards. Sting operations were enacted to catch these frauds. Such is not done in malpractice cases because it is simply not a widespread problem. I'm sure it does happen sometimes, but it is not widespread.

Reform based on actuarial evidence and not political expediency. National reform that does not undermine the effective state reforms already in place.
Their quest is to maintain access for patients in their hour of need. The current system is destroying access.

The GAO found no evidence to support the claim that malpractice premiums are having an effect on access to medical services.

Right now, the medical liability insurance companies are a convenient scapegoat, but they are required by law to make conservative investments. They typically place about 80% of their investments in the bond market -- not the stock market. According to A.M. Best Co., the investment yields of medical liability insurers have been stable and positive for the last five years.

Rate of return on bond-indexed funds has dropped to 4% annually. Combined with the stock market disaster, the extremely low malpractice rates due to the booming stock and bond markets of the 90's, rates have risen.

Thus, the issue on focusing on them detracts from the larger issue.... Errors can involve nurses, pharmacists, health technicians, aides -- in short, anyone who is working in the complex system of health care delivery. This word -- " system" -- is key to understanding how medical errors happen and how we can prevent them.

Doctors make the systems. Doctors protect the systems.

If you think the AMA is a "pawn," you are mistaken. Visit the Litigation Center on the AMA's Web site (www.ama-assn.org/go/litigationcenter). There you will find ample evidence that the AMA takes on insurers when we document that they have done harm to patients and physicians.

I don't doubt the AMA fights for doctors against insurers. They might even fight for patients against insurers. Doctors, however, are their real concern. If patients must suffer for a doctors benefit, so be it.

The Institute of Medicine and the Health and Human Services Dept. say most medical errors are not failures of physicians, but failures of the system. Even when doctors do their jobs correctly, most errors would still occur.

This is nothing new. Solutions to many problems are known. Doctors feel no need to adopt them. Every medical school in the country should teach, and every hospital should adopt exactly the same pre-operative system of checks to ensure that the operation performed is the operation the patient is supposed to receive. They don't. It is preferable to amputate the wrong limb or remove the wrong eye than to do this. Incompetance is acceptable.

A better approach to fixing the problem of system errors would be to dispel the fear of physicians, hospitals and nurses that open discussion on adverse events would be discoverable in lawsuits. To stop errors, we need to prevent them through improved systems of safety, just as it has been done in the nuclear and aviation industries. The fear of being sued obviously discourages health care professionals from reporting problems when they happen. It hampers efforts to determine what went wrong and how to prevent it.


To truly protect patients, the AMA supports the Patient Safety and Quality Improvement Act or HR 663 -- legislation recently passed by the House of Representatives -- that would help create a voluntary, confidential error reporting system that allows review by experts, who report back to those involved on how to fix the system. The fix is then shared with all.

That is how the aviation safety reporting system works. Similar legislation, S 720, has been approved by the Senate Health, Education, Labor and Pensions Committee -- unanimously. In both chambers, the AMA has been immersed in bipartisan negotiations.
That's why the AMA support the Patient Safety and Quality Improvement Act (S 720), a proposed federal law that would allow the voluntary, confidential reporting of errors to patient safety experts. The result would be advice on how to improve the system and therefore patient safety. This system fix would be shared with all in a de-identified manner. This model works for the Aviation Safety Reporting System. It would work in the health care field, too. Right now, the current system does not help with an open discussion of errors.

It would be very tricky to implement such a scheme. The board to which a doctor reported could not have any economic interest in the case with the error. If it did, such a board would have an economic interest in using the privaledge granted to develop systems to prevent lawsuits, not errors. If the institution for which the erring doctor worked were a corporation, they would be required to use the privaledge to conceal errors.

If the board has no administrative power, and was merely deliberative, I see no reason why doctors or hospital administrators would pay any attention to it.

Airlines lose a lot of money when a plane crashes. Pilots die when they make a bad mistake. When doctors and hospitals make mistakes, only the patient suffers, unless there is litigation.

The AMA continue to challenge the Assn. of Trial Lawyers of America to match our donations to the National Patient Safety Foundation. To date, they haven't offered one thin dime. Is this a hint that the trial lawyers are more interested in suing physicians than in saving patients?

That is ridiculous. The NPSF is an institution for the improvement of medical professionals. It only benefits doctors. How many doctors make charitable contributions to improve lawyers abilities?

Regardless of whose views prevail as to how to change the system, there will, ultimately, be change -- because patients will lose access to care as doctors retire early, limit their practice such as no longer delivering babies, or move to one of the six states that have more stable liability climates. Athens, on the third largest city in georgia just lost almost all its obstetricians. They were not asking for a raise, but when malpractice premiums are 1 1/2 times your salary, you can't survive. I don't know who is going to deliver my daughter's baby when she grows up, it will probably be a nurse midwife whose insurance coverage offers less reward value for the jury. (By the way, Edwards has limmited cases for a botched delivery preformed by a midwife or nurse practioner for this very reason.)

Malpractice premiums have had no significant impact on access to medical care, according to the GAO. I found 10 obstetricians in Athens yellow pages. Most OB's don't even list in the yellow pages. I also found that Athens has a special high-risk pregnency medical facility. I think you've been accepting AMA hype at face value.

I disagree with the AMA on some things but their idea that we have to move away from a culture of shame and blame and towards a culture of prevention and safety is right on.

Without blame, there will never be accountability. Without accountability there will never be improvement.


Numbers you will never see from the insurers or the AMA:

-Total malpractice premiums paid.
-Total payments from judgements and settlements.
-Total physician earnings.

I bet you would see two things. Premiums paid were much more than payments over tha last 3 years, and premiums are just a small fraction of physician earnings.

These numbers would make an unimpeachable case for them, if they were right. Instead they use anecdotes about physicians quitting, or lie about numbers of doctors decreasing in hard hit areas. They point to individual large judgements. They also like trends. They talk about average judgements doubling without bothering to point out that maybe they were too low before. There is no crisis. It is hype.

Njorl

 

[Njorl]

I'm not saying you're wrong, but I'd like to see a source for that information. Also, does the second one directly imply malpractice? My best friend is a paralegal and an aspiring trial lawer. We had this discussion about a week ago. He concluded/conceded:

"In Pennsylvania and West Virginia, for example, two of 19 states designated by the AMA as being in a "full-blown liability crisis," the number of doctors per capita has actually increased in the past six years, according to the GAO. "

From

http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&contentId=A15752-2003Sep15&notFound=true

I haven't found the GAO report to which the article refers though. They are hard to track down.

Njorl

 

[Njorl]

You are right, tort reform is more than limiting jury .

awards, although that is what makes the news and evokes little sympathy.

(However, I will tell you when they did limit noneconomic damages to 250,000 in Texas, state wide premiums went down... so the article is not accurate in its assessment about it not affecting premiums.)

Nothing happens in a vacuum. Maybe something else happened in Texas.

States with caps raised the premiums at a higher rate than states without caps.

http://www.weissratings.com/malpractice.asp

First of all, we all want grieviously injured patients to be reimbursed and adequetly treated.

Who is "we". Insurance companies are certainly not part of that "we", and they are the ones who cut the checks.

Tort reform is not going to take that away.

Anything that makes suing less profitable makes it more profitable for an insurer to knowingly refuse to make a just settlement. I never see any tort reform containing provisions to prevent knowingly defrauding victims. If they do actually exist, they need to be publicized.

But let's look at numbers before we say the insurance companies are all to blame: 10 years ago Georgia had over 30 malpractice insurers. We are down to five. It ain't that profitable and most know it. St. Paul our largest Nation wide insurerer quit basically because of this.

A boom-bust cycle always winnows insurance companies. The boom of the 90's made competition for premiums fierce. Companies overextended and died when the earnings of investments no longer covered operating costs.

It is estimated that malpractice insurers will pay out approximately $1.40 in claims losses and direct expenses for every dollar of premium collected in 2001 and 2002 Even with significant rate increases, it is projected that insurers will be forced to expend $1.35 in claims costs and expenses for each premium dollar received in 2003.3 These figures are independent of investment gains or losses.

I doubt those numbers are right. It might be what insurers are telling people, but they never let the raw data upon which those numbers are based see the light of day.

Mutual or reciprocal insurance companies, companies that are owned by the physician policyholders themselves, not outside shareholders, insure more than 60% of America’s practicing physicians. The primary mission of these companies is to provide insurance protection for practicing physicians. nonetheless, no company can long sustain losses of this magnitude and remain solvent, so premium rates have been forced sharply upward. MAG mutual, my insurance carrier has lost 1.12 for every dollar invested and at this rate will probably pull out of the whole business in 5 years.

The Dow Jones industrial average as a whole lost 32% of its value from January 2001 to October 2002. No company can sustain those losses indefinitely. Somehow, I believe most of them will continue to exist, or will be replaced by companies that do the job better.

Since 2000, mean rates across the country have increased between 10% and 20% annually.

From 1988 to 1998 malpractice insurance rates increased by a total of only 5.7% while medical costs increased by 74%. This was an enormous windfall for doctors. You can not expect to benefit from the effects of one side of a business cycle and be immune to the negative effects of the other.

So our overhead increases automatically by 20% on a yearly basis while other reimbursement sectors continue to cut their payment. For instance, after 2006, Medicare will start cutting back payments for a total of 11% cut over five years (not even enough to keep up with inflation) and more docs will be leaving private sector or not treating Medicare patients. (The latter is becoming a reality...can't treat someone for essentially free and still make enough to pay exploding overhead payments that include liability .)

There are a lot of real problems in medical care. I will not argue that. None of this is pertainent though. I would enjoy a thread that dealt with solutions to those problems. (continued)

 

[Njorl]

These ... plans.

I have seen nothing to support this. I have seen that judgements decrease with reform, but not premiums.

Despite the trial lawyers ..., regardless of the data. That is their job! But the data prove them just sophists.[/b]

The data is in the hands of insurers and doctors. They keep the persuasive data hidden.

Though frequency has changed little over the past few years, it has stabilized at extraordinarily high levels. On any given day, there are more than 120, 000 malpractice actions pending against the physicians of the United States.

That is a good example of the type of statistics the AMA loves. It is completely meaningless. How long does a case "pend"? A year? Two years? Ten years?

One sixth of America’s physicians report a claim every year (The Doctors Company, unpublished data, 2002). ...are sued every year (The Doctors Company, unpublished data, 2002).

These are all partial statistics. They don't mean a thing. A statistical analysis is not just a bunch of unrelated percentages.

And the number of lawsuits has nothing to do with competance. To say he/she is less compentant because they have more lawsuits is fallacious.

I would be very surprised if the number of lawsuits had no relationship to competence. I'm sure the relationship is not absolute, there are undoubtedly other factors. But when those factors are normallized, though there will be randomness, there will also be a positive correlation.

Approximately 70% of all these claims are closed with no payment to the plaintiff, but each one costs an average of $22,967 to defend adding an enormous expense that must be calculated into the cost of insurance.

When caregivers are more vigilant in preventing error, patients and lawyers will be less likely to assume that there was an error worth litigating about. Plaintiffs don't want go through that for nothing. Lawyers certainly don't want to waste their time on fruitless suits when they are being paid a contingency fee.

This last sentence is the one that most opponents of tort reform ignore. We cannot just look at settlements and judgements; we have huge costs even in frivolous claims.

The best way to reduce "frivolous" (not every failed suit is frivolous) claims is to reduce grounds for non-frivolous claims.

Wrongful death is abhorent. No monetary settlement can really right that wrong. However, huge payments add a second injury to the first. Physicians do not pay the $5.7 million.

Society pays.

Society pays through decreased access to the benefits of medical care.

Society pays through increased defensive medicine. Society pays as the doctor patient relationship becomes eroded. Physicians feel under siege. Many view each patient as a potential litigant.

It would be cheaper for society if we just killed the injured party and anyone who depended on them for economic support. Justice is not defined by what is cheapest for society.

Without the threat of punitive damages there is no incentive to pay justified damages. Without punitive damages there is no incentive to change dangerous but economical systems.

Consider by-pass surgery. The patients are generally old, with little future earnings, and often no dependents. Mistakes usually lead to death. Without significant punitive damages, there are no repurcussions for incompetence.

In this atmosphere, California has the best track record.


A $250,000 cap on non-economic, not economic damages. Thus, a person can win millions of dollars in economic damages, lost wages, potential earned income etc. and this is not included in the award decision. The non-economic damages are what drives most of the frivilous lawsuits. As for pain and suffering, no one can put a price of that.

So if you are blinded by incompetence, they pay for brail lessons, give you a lifetime supply of white canes and $250,000 of "fun money". That $250,000 makes up for those non-economic things like never seeing another movie, giving up all past-times that rely on sight, and never seeing your family again.

This is something special just for doctors though. If a cab driver does his job incompetently and blinds you, a jury or judge will decide what your sight is worth. Of course, a cab driver would also lose his license for such incompetence. A doctor would not.

2nd, initiate the collateral source rule. This prevents double collection for the same damages. For example, if an injured patient has already had lost wages or medical costs covered by disability or medical insurance, recovery is not duplicated in a malpractice award.

Good idea, though I would allow a judge or jury to decide which insurer should cover the judgement in part or in whole. My health insurer should not have to pay for damages due to malpractice. They should only cover what the malpractice insurer does not.

We also need a provision for periodic payments. This allows damage awards to be paid over the period they are intended to cover.

I agree. I think the best way is a principle that is owned but untouchable by the injured party. Their benefits are the interest from this sum. Upon the death of the injured party, or the coming of age of dependents, the principle would revert to the insurer. This way, the injured party gets paid even if the insurer goes bankrupt. The insurer can still list the sum as an asset usable in the future.

I am reminded of the Terry Schiavo case. The husband has received a settlement for treatment of his wife who is in a persistent vegetative state. He is petitioning to have her life support cut off. While he is entitled to whatever portion of the settlement was for the loss of his wife, he should not be entitled to that portion designated for her medical expenses.

3rd... limit attorneys’ contingency fees. MICRA provides for a sliding scale; a plaintiff’s attorney keeps 40% of the first $50 000 of an award but “only” $221, 000 (plus expenses) of a $1 000 000 judgment. This allows more of an award to actually reach the injured patient. The difference is significant. A patient with a $1 000 000 award in a state with a contingency fee of 40% must give $400 000 (plus expenses) to his or her attorney.

I agree with this in theory also. I don't know that I would stratify the percentages the same way. There are too many factors involved. I would not want to restrict contingency fees to the point where hospitals always have better lawyers. Such was the case until fairly recently.

88% of trials that go to jury in Georgia are won by the doctors. Any other profession (tort lawyers) with such an 88% failure rate would be out of business. What this shows is the lawyers are bringing to trial many cases that don't have much of a leg to stand on. Perhaps, an independant body of reviewers who can review the case for legitimicy would be a good start. It is these 88% that really tax the system! not the remaining 12% which are probably valid cases and the victims need to be reimbursed. I spent $50,000 extracting myself from a lawsuit just because I treated the person for asthma 2 weeks before she got a severe infection from her spinal implants from her spinal surgery. They just threw out a net and roped anyone and anything that had contact with her before her severe illness. However, there is no valid mechanism of such innocent bystanders throwing off the net without expensive and timely legal proceedings just to say...oh yeah, you didn't need to be named in the suit.

Setting more rigorous standards for whether a suit can proceed would be good. A step where the plaintiff must convince a judge that he has a legitimate suit would be reasonable. However, without an opposing counsel, any lawyer will usually win. You can't ask the state to provide a judge who will rigorously oppose the plaintiff's lawyer. That is essentially asking the state to fund the first round of the defendent's case.

The problem is much larger than jury settlements.

The Pennsylvania example is fallacious. There exists almost no specialties in certain fields since they have fled the state (almost no gastroenterologists who were hit especially hard for some inexplicable reason)

I have a hard time believing that. What is your source?

I found 61 Gastroenterology entries in the Philly yellow pages and 80 in the Pittsburgh yellow pages. I'm sure there are many that are multiple doctor practices, though some might also be multiple practice doctors. Those two cities were cited as having disproportionately high malpractice awards, even compared to the rest of the state.

and an influx of primary care physicians skewed the numbers to show there are more doctors. West Virginia has almost no cardiologists. If you have a heart attack, pray for a good internist who can retevase (thrombolyse) you, stabilise you and transfer you out of state for life saving angioplasty or open heart. This can take days to find a hospital willing to accept you

I checked the Charleston WV yellow pages for cardiologists, and got 60 entries. I can't say for sure they were cardiologists though, the format was poor.

Njorl

 

[JohnDubYa]

RE: "Medical malpractice kills almost 100,000 Americans a year. It injures many times that number. Injuries at birth require a lifetime of care, often costing tens of thousands of dollars per year."

This is no excuse for court-room shenanigans.

 

[selfAdjoint]

I served on one of those juries. We gave the victim 3.5 million dollars, because we thought she deserved it and would need it to pay for care in her expected 20-30 year future life of handicaps.

It wasn't the victim's lawyer who sold us, it was the corporation's lawyer who put on a show of mean spiritedness and character assassination that was not only repusive, but was easily shown by testimony to be false.

 

[member 5645]

I served on one of those juries. We gave the victim 3.5 million dollars, because we thought she deserved it and would need it to pay for care in her expected 20-30 year future life of handicaps.

And that wouldn't change with caps either.

 

[Njorl]

RE: "Medical malpractice kills almost 100,000 Americans a year. It injures many times that number. Injuries at birth require a lifetime of care, often costing tens of thousands of dollars per year."

This is no excuse for court-room shenanigans.

I agree. However, "court-room shenanigans" are no excuse for depriving Americans of the right to sue for redress of grievances. The proper response is proscecuting people for purjury, or suborning purjury. Nothing would please me more than seeing corrupt lawyers and lying "expert" witnesses rotting in jail.

I would also like to see judges with a modicum of scientific knowledge, so they can intelligently rule as to the admissibility of dubious medical facts. It is entirely within a judges power to deem so-called expert witness testimony inadmissible if he does not find it relevant to the case. He would not need to be an expert, as long as he could discern the reletive merits of an expert's case. A grasp of the fundamentals of statistics would be useful, which many judges certainly don't have. An understanding of the scientific process would help a judge determine whether something were an accepted theory, a promising hypothesis, unknown or hogwash.

Njorl

 

[Njorl]

And that wouldn't change with caps either.

Nope. Caps just make it safe for corporations to fight every justified case tooth-and-nail, so that people are intimidated into settling for less than they will need. It is only the fear of punitive damages that makes companies settle justified claims.

If the worst that can happen is that you will be forced to pay someone what they deserve, why would any corporation bother to pay an injured party what they deserve without a lawsuit?

Njorl

 

[JohnDubYa]

Why did you let the lawyer's mean-spiritidness factor into your decision? The merits of the plaintiff's case should have rested on its own merits, not the personality of the lawyers.

And no one is saying that every case that is settled for the plaintiff is fraudulent, so I am not sure what your anecdotal example proves.

 

[selfAdjoint]

The question was whether the victim was really handicapped. The victim's lawyer did not quite convince us (it was a brain damage-behavioral issue). But we reasoned that if the corporate lawyer had a real case, he wouldn't have resorted to such phoney tactics.

The point I was making is that all the animus is directed at lawyers, but juries are quite capable of making up their own minds.

 

[member 5645]

The point I was making is that all the animus is directed at lawyers, but juries are quite capable of making up their own minds.

I hoep you aren't really using this as your main defense here.
Do I need to show you a list of many times with 12 people were OBVIOUSLY wrong?

 

[adrenaline]

Nothing happens in a vacuum. Maybe something else happened in Texas.

States with caps raised the premiums at a higher rate than states without caps.

http://www.weissratings.com/malpractice.asp

It still affects rates. Here is an independant study :

Physicians in states with caps on medical malpractice awards enjoy premiums that are 17.1% lower than those in states without caps, according to a new study from the chair of the health policy and management department at Emory University Rollins School of Public Health in Atlanta.

Author Kenneth E. Thorpe said caps at the federal level ultimately would mean lower insurance premiums, but he questioned whether that would accomplish the liability system goals. "The results suggest that capping awards may improve the profitability of malpractice carriers and reduce premiums," Thorpe said in the study. "Whether this is socially desirable or improves the goals of deterrence and compensation remains an open question."

The report, "The Medical Malpractice 'Crisis': Recent Trends And The Impact Of State Tort Reforms," is available online (content.healthaffairs.org/cgi/content/full/hlthaff.w4.20v1/DC1).

I trust advocates of public health, many who are not physicians but scientists and are not susceptible to lawsuits.



Quote:
...we are quick to use other people'smoney

Since the only "we" are doctors paying insurance premiums than we bear the ultimate cost. Taxpayers don't unless we seguaey into a more socialized model which i would not mind, (you also can't sue in that model yet these medical systems still outdo us in providing quality medical care (WHO ranking put Canada, cuba, many european countries such as france and germany etc. above the US) So I am not using other people's money, I see it in my yearly increases despite an impeccable track record.

From 1988 to 1998 malpractice insurance rates increased by a total of only 5.7% while medical costs increased by 74%. This was an enormous windfall for doctors. You can not expect to benefit from the effects of one side of a business cycle and be immune to the negative effects of the other.

Doctor's salaries account for less than 2 percent of the health costs you are talking about. The 74 % increase is the overall cost of medicine in the system. My salary has gone down yearly in the past five years of practice despite being so full I have closed my practice to new patients for three years. I'm still doing well, but I sure did not increase my salary by 74%! (I have 12,000 active patients.)You make it sound like we all had a 74% increase in salaries! By the way, 90% of what I take in every month goes to overhead according to my accountant. (Workman's comp insurance, unemployment insurance, malpractice, 401k for my employees, medical and dental, yearly raises, uniform stipends, CMEs for all the nurses and insurance personell, (which now total above 25 for us measly 4 doctor practice, a $150,000 dollar electronic medical record system purchase Omni-Doc, Intergy, $7,000 a month telephone system to help handle insurance and patient calls ) a $30,000 dollar a month rental.etc etc.

http://medrants.com/archives/2003/0...lpractice-laws/

Here is a more reliable independant source about the premiums.

:
The Employment Policy Foundation (EPF) is a nonprofit, nonpartisan public policy research and educational foundation based in Washington, D.C. focused on workplace trends and policies. Its mission: to shape the direction and development of U.S. employment policies by providing policymakers, the media and the public with timely, high quality economic analysis and commentary. Federal and state executive branch officials and legislators, corporations, think tanks, universities, media and the public use EPF as a primary source of unbiased, reliable data, research and knowledge on employment and labor issues.


Rising Verdicts and Increasing Cost of Discovery Forces Rate Increases

Doctors, nurses and hospitals have been faced with skyrocketing malpractice insurance premiums in response to increasing claims. The rising litigation costs are reflected in malpractice insurance underwriting losses, which doubled from $4.1 billion in 1991 to $8.6 billion in 2001. This total includes amounts paid to plaintiffs and their attorneys, expenditures for processing and investigating claims, including the majority that are subsequently dropped or dismissed and expenditures to defend litigated claims. The study found that as the number of claims increased, so too have jury awards. Between 1995 and 2001, median jury awards in medical malpractice cases doubled from $500,000 to $1,000,000 for the typical case with the maximum annual claim award reported nationwide increasing from $5.3 to $20.7 million over the same period.

Malpractice insurers paid out $1.53 in claims settlements and claims adjustment and defense expenses for every dollar that they collected in premiums. In 2001, the gap between premiums collected and underwriting losses amounted to $4,033 per physician, assuming that all 744,000 full-time physicians in the U.S. were covered.

Most Litigation Costs Do Not Benefit Injured Patients

EPF’s analysis found that the malpractice litigation system is a highly inefficient method for identifying and correcting medical errors. Plaintiffs eventually receive only 38 percent of the total dollars that flow through the malpractice litigation system. The majority - 62 percent - compensates the plaintiff?s lawyers and expert witnesses and the insurer?s claims adjustment, cost of investigating claims and defending claims made against insured physicians and hospitals.


Caps on Non-Economic Damage Awards Are Effective

The study found that significant cost differences do exist between states with non-economic damage award caps and those states without limits. Between 1976 and 2000, malpractice insurance premiums nationwide increased 505 percent - equivalent to 7.8 percent annual premium growth compounded over 24 years. In California - which caps non-economic damage awards - malpractice premiums increased 167 percent?equivalent to a 4.2 percent annual growth rate. The resulting impact on premiums is very real. In 2001, the premium range for obstetricians was $143,000 to $203,000 per physician in Florida compared to $23,000 to $72,000 in California. The pattern was similar for surgeons - $63,000 to $159,000 in Florida compared to $14,000 to $42,000 in California.

Indirect Costs Result from ?Defensive? Medicine

Faced with the prospect of litigation, the study found many doctors and hospitals practiced “defensive” medicine. This practice artificially inflates EPF’s analysis found that controlling excesses in the malpractice litigation system could reduce current health care costs by 5 to 9 percent without sacraficing quality of care. The dollar impact on annual medical expenditures is large - up to $68.8 billion.

your source says a single digit malpractive premium percentage raise, the above source says 505% increase within almost the same time period except it starts in the late seventies. The obstetrician's premium in Florida which went up from $143,000 to over $200,000 three years ago would not call that an 7.4% increase.

:
That is a good example of the type of statistics the AMA loves. It is completely meaningless. How long does a case "pend"? A year? Two years? Ten years?

Because the lawyers drag it out that way. Victims are told to wait until the very last day of the statute of limitations ( which is two years) in hopes the memory of the incident will be a fog and this will cloud memory of critical events and puts doctors at great disadvantage. And the draggingit out, its the lawyers, not doctors. we are generally want things to get done and over with.

I would be very surprised if the number of lawsuits had no relationship to competence. I'm sure the relationship is not absolute, there are undoubtedly other factors. But when those factors are normallized, though there will be randomness, there will also be a positive correlation.

It's because this is what the lawyers want you to believe. Thus, more and more doctors are giving up treating risky patients so their "numbers" can look good both in outcomes and lawsuits.


Instead of listing to media rhetoric, this is what I have seen on the front lines. When we serve our 2 year tenures as chief of medicine, we are privey to every lawsuit out there since the Chief of Medicine and Surgery get dragged in indirectly as representatives of the hospital and doctor. (This is due to laws of statistical averaging , the most popular and sought after doctor have more patients due to their popularity and higher expectations of perfection which translates to more lawsuits.) Every, and I mean every professor of medicine, both associate and tenured, at both Emory and MCG, the two main teaching hospitals in Georgia, has been sued at least once. Most if not all, multiple times. Especially the ones I consider outstanding. I have a hard time believing the number of increased lawsuits suggest our medical training has diminished in quality over the last 20 years.

The best way to reduce "frivolous" (not every failed suit is frivolous) claims is to reduce grounds for non-frivolous claim.

Exactly why some believe capping emotional pain and suffering will do it. Cases are bought to court when no physical disability or injury has happened, the non economic damages is the lotto ticket. Case in point, a woman sues a dermatologist in Tampa because a shave biopsey that removed a stage II melanomaleft a small scar on her scapula. She sued him for 1.2 million becaue of emotional pain and suffering despite being forwarned about the possibility of scarring.

.

 

[adrenaline]

Without punitive damages there is no incentive to change dangerous but economical systems.

As previous chief of medicine I went to meetings after meeting about improving patient safety. Safety measures such as those implemented to reduce complications of infections and reduce hospital stay etc. meant more reimbursement to the hospital administrators due to DRGs or diagnostic related groups which provide fixed fee reimbursement for certain conditions. Study after study shows faster quick discharges if antibiotics are implemented within three hours of the patient arriving in the ER for pneumonia. Of course, as doctors, we care about how it affects mortatlity . Not lawsuits. In fact, that was rarely a topic of the underlying motivation for those on the hospital executive committees. Of course, doctors don't look at things from that end of the telescope and just hope administrative and doctor patient interests stay aligned as much as possible.

Consider by-pass surgery. The patients are generally old, with little future earnings, and often no dependents. Mistakes usually lead to death. Without significant punitive damages, there are no repurcussions for incompetence.

People who have oopen heart are in general old and sick and have multiple comorbidities such as diabetes, previous strokes, peripheral arterial disease,smoke etc. which increases their chance of developing complications and death. That's why open heart surgeons (the bestof the best)IN ACADEMIA have the WORSE LOOKING outcomes statistics because they operate on older, sicker, more medically complicated folks that some private surgeons will refuse to treat so as not to skew their statistiscs. They have greater numbers of bad outcomes and even death because it is the nature of human biology.


You have just hit on the most expensive part of our medical practice, doctors practicing defensive medicine. I even admit to ordering xrays, 1000 dollar MRI's etc. because my lawyer told me to , not because i felt it was clinically necessary. I spend just as much time charting into my electronic medical records (Which pro safety people love) as I do seeing my patients. It's not about practicing better medicine, you practice better defensive medicine and get saavy leaving a better paper trail.




.

Setting more rigorous standards for whether a suit can proceed would be good. A step where the plaintiff must convince a judge that he has a legitimate suit would be reasonable. However, without an opposing counsel, any lawyer will usually win. You can't ask the state to provide a judge who will rigorously oppose the plaintiff's lawyer. That is essentially asking the state to fund the first round of the defendent's case.

It would not be a judge. A panel of doctors, nurses, non doctor scientists, ethicists, pharmacist, epidimiologists, business men and lawyers who can view things from many differnt angles. A malpractice board surcharge fee so to speak could be implemented and most doctors are willing to pay. (Oregon had something similar during the days of Marcus Welby)

I found 61 Gastroenterology entries in the Philly yellow pages and 80 in the Pittsburgh yellow pages. I'm sure there are many that are multiple doctor practices, though some might also be multiple practice doctors. Those two cities were cited as having disproportionately high malpractice awards, even compared to the rest of the state.

There used to be twice that. Call and see how long it takes to make an appt.

. Since 2000:

870 physicians relocated to other states.
163 physicians retired earlier than planned.
213 physicians were laid off, forced to close their practices, gave up practicing medicine, or died and were not replaced.
379 physicians significantly altered their practices or curtailed high-risk services.
Source: Pennsylvania's Disappearing Doctors list, maintained by the Pennsylvania Medical Society Alliance

you'll probably find how many were in the specialties hit hard.

I checked the Charleston WV yellow pages for cardiologists, and got 60 entries. I can't say for sure they were cardiologists though, the format was poor.

Call any of them up and see if they are interventional cardiolgist.(The ones who actually do angioplasty, stent placement etc.) The majority remaining are general cardiologists who are glorified internists. (They only have one more year of training than I do, read echos, stress tests and administer clot blosters...all the things internists can do.)

As for the obgyns in a telephone listing in Athens. They are still board certified as obgyns so they are listed as obgyns,even many are now fully gyns only. They have not fled the Athen's area but no longer practice obstetrics, only gynecology. There are a few obstetritrians manning their high risk unit but now take call almost every night to provide for coverage. MCG's subsidiary hospital in Savannah has only one obstetrician taking medicaid and is now the sole medicaid ob provider and works 45 days on call night and day straight. She is independantly wealthy and pays her own premiums and garnishes her salary from savvy investments, not because of her revenue from medicaid (which don't even pay for overhead costs.) Guess what, she is going to be making mistakes.

Most of all, the tort reform is blind siding everyone but the doctors by distracting the public from the real issue of changing the whole system, of which, tort reform is a small part . The tort lawyers are not interested in changing a systme that benefits them, they have shown no support for any legislature , bills or studies seeking to improve overall safety valves in the system. These aren't antidotes, just look at the Assoc for Trial lawyers website and see how they support what I mentioned already the Patient Safety and Quality Improvement Act or HR 663 that would help create a voluntary, confidential error reporting system that allows review by experts, who report back to those involved on how to fix the system. The fix is then shared with all and Patient Safety and Quality Improvement Act (S 720), a proposed federal law that would allow the voluntary, confidential reporting of errors to patient safety experts. We want this to be an open system to all.

 

[adrenaline]

Without punitive damages there is no incentive to change dangerous but economical systems.

As previous chief of medicine I went to meetings after meeting about improving patient safety. Safety measures such as those implemented to reduce complications of infections and reduce hospital stay etc. meant more reimbursement to the hospital administrators due to DRGs or diagnostic related groups which provide fixed fee reimbursement for certain conditions. Study after study shows faster quick discharges if antibiotics are implemented within three hours of the patient arriving in the ER for pneumonia. Of course, as doctors, we care about how it affects mortatlity . Not lawsuits. In fact, that was rarely a topic of the underlying motivation for those on the hospital executive committees. Of course, doctors don't look at things from that end of the telescope and just hope administrative and doctor patient interests stay aligned as much as possible.

Consider by-pass surgery. The patients are generally old, with little future earnings, and often no dependents. Mistakes usually lead to death. Without significant punitive damages, there are no repurcussions for incompetence.

People who have oopen heart are in general old and sick and have multiple comorbidities such as diabetes, previous strokes, peripheral arterial disease,smoke etc. which increases their chance of developing complications and death. That's why open heart surgeons (the bestof the best)IN ACADEMIA have the WORSE LOOKING outcomes statistics because they operate on older, sicker, more medically complicated folks that some private surgeons will refuse to treat so as not to skew their statistiscs. They have greater numbers of bad outcomes and even death because it is the nature of human biology.


You have just hit on the most expensive part of our medical practice, doctors practicing defensive medicine. I even admit to ordering xrays, 1000 dollar MRI's etc. because my lawyer told me to , not because i felt it was clinically necessary. I spend just as much time charting into my electronic medical records (Which pro safety people love) as I do seeing my patients. It's not about practicing better medicine, you practice better defensive medicine and get saavy leaving a better paper trail.




.

Setting more rigorous standards for whether a suit can proceed would be good. A step where the plaintiff must convince a judge that he has a legitimate suit would be reasonable. However, without an opposing counsel, any lawyer will usually win. You can't ask the state to provide a judge who will rigorously oppose the plaintiff's lawyer. That is essentially asking the state to fund the first round of the defendent's case.

It would not be a judge. A panel of doctors, nurses, non doctor scientists, ethicists, pharmacist, epidimiologists, business men and lawyers who can view things from many differnt angles. A malpractice board surcharge fee so to speak could be implemented and most doctors are willing to pay. (Oregon had something similar during the days of Marcus Welby, the real one Thomas Stern Md)

I found 61 Gastroenterology entries in the Philly yellow pages and 80 in the Pittsburgh yellow pages. I'm sure there are many that are multiple doctor practices, though some might also be multiple practice doctors. Those two cities were cited as having disproportionately high malpractice awards, even compared to the rest of the state.

This represents a decrease. Such large cities need three times the amount. Call and see how long it takes to make an appt.

. Since 2000:

870 physicians relocated to other states.
163 physicians retired earlier than planned.
213 physicians were laid off, forced to close their practices, gave up practicing medicine, or died and were not replaced.
379 physicians significantly altered their practices or curtailed high-risk services.
Source: Pennsylvania's Disappearing Doctors list, maintained by the Pennsylvania Medical Society Alliance

you'll probably find how many were in the specialties hit hard.

I checked the Charleston WV yellow pages for cardiologists, and got 60 entries. I can't say for sure they were cardiologists though, the format was poor.

Call any of them up and see if they are interventional cardiolgist.(The ones who actually do angioplasty, stent placement etc.) The majority remaining are general cardiologists who are glorified internists. (They only have one more year of training than I do, read echos, stress tests and administer clot blosters...all the things internists can do.)

As for the obgyns in a telephone listing in Athens. . They have not fled the Athen's area but no longer practice obstetrics, only gynecology. There are a few obstetritrians manning their high risk unit but now take call night and day for ungodly amounts of time. MCG's subsidiary hospital in Savannah has only one obstetrician taking medicaid and is now the sole medicaid ob provider and works 45 days at a time. She pays her own premiums and garnishes her salary from savvy investments, not because of her revenue from medicaid (which don't even pay for overhead costs.) Guess what, she is going to be making mistakes.

Most of all, the tort reform is blind siding everyone but the doctors by distracting the public from the real issue of changing the whole system, of which, tort reform is a small part . The tort lawyers are not interested in changing a systme that benefits them, they have shown no support for any legislature , bills or studies seeking to improve overall safety valves in the system. These aren't antidotes, just look at the Assoc for Trial lawyers website and see how they support what I mentioned already the Patient Safety and Quality Improvement Act or HR 663 that would help create a voluntary, confidential error reporting system that allows review by experts, who report back to those involved on how to fix the system. The fix is then shared with all and Patient Safety and Quality Improvement Act (S 720), a proposed federal law that would allow the voluntary, confidential reporting of errors to patient safety experts. We want this to be an open system to all.

 

[adrenaline]

I see no reason to believe the AMA wants accountability for doctors. They do not perform actions that support that contention. Their actions indicate the opposite is true. The AMA seeks to protect doctors from accountability.

you need to back that up.

This is nothing new. Solutions to many problems are known. Doctors feel no need to adopt them. Every medical school in the country should teach, and every hospital should adopt exactly the same pre-operative system of checks to ensure that the operation performed is the operation the patient is supposed to receive. They don't. It is preferable to amputate the wrong limb or remove the wrong eye than to do this. Incompetance is acceptable

patently false. Every hospital has a QI committee staffed without pay by highly dedicated doctors, nurses, pharmacists, lawyers (usually one of the legally trained administrators) who rigorously try to establish better and safer standards. Such standards may not be the perview of the doctor to adopt. The problem is due to different state laws, civil laws, etc. (the state medicare guidelines, osha guidelines, differ from the federal ones and so on.). If we want to prevent falls in the elderly, demented by placing posies, in some states ,this is a violation of individual, civil rights. Yet, not every elderly has a family member willing to stay in the room to enusre they don't climb out of bed, while our understaffed nurses are starting ivs and treating other patients. )By the way, the warning systems don't work half the time, they have fallen out and broken a hip within seconds of setting off their alarms.) That is just one such example.

You are attacking the very constitutional and fundamental aspect of individual state's perogative in establishing their own guidelines, and not just in the medical sector. Don't point to doctors as the barrier to inertia. We can easily remedy this by making all the hospitals federal, (rather than county or public or funded by academic funds) and supported by our government tax dollars. It already exists, it's called the Veterans Administration hospitals.

 

[JohnDubYa]

RE: "I agree. However, "court-room shenanigans" are no excuse for depriving Americans of the right to sue for redress of grievances."

Actually, it is the perfect excuse. Rights are taken away because someone takes advantage of them for their own gain and, as a result, hurts society. In this situation, depriving the People of their rights is a necessary shield to protect American business from the likes of people like Edwards.

We limit freedom when it comes to business practices. Why? For the same reason.

So if Americans are denied their right, wouldn't Edwards be considered partly to blame? Couldn't someone say that Americans would have that right if it hadn't been for people like Edwards that prostituted the system for his own gain?

If you really want people to have the right to sue for as much as they wish, then you should be mad as Hell at people like Edwards who took advantage of the situation.

 

[Njorl]

It still affects rates. Here is an independant study :


I trust advocates of public health, many who are not physicians but scientists and are not susceptible to lawsuits.

.

That "17.1%" statistic is irrelevant. To demonstrate the effect of caps, it is necessary to compare the rate of change in premiums between capped and uncapped states, or the rate of change in a state before and after caps are placed. A simple comparison of a snapshot of rates in capped and uncapped states is worthless, and profoundly unscientific. The author writes like a policy analyst, not a scientist.

Quote:
...we are quick to use other people'smoney

Since the only "we" are doctors paying insurance premiums than we bear the ultimate cost.
.

I was refuting your point that the benevolance of the AMA somehow was meaningful in this discussion. Insurance companies control whether a check is cut.

Doctor's salaries account for less than 2 percent of the health costs you are talking about. The 74 % increase is the overall cost of medicine in the system. My salary has gone down yearly in the past five years of practice despite being so full I have closed my practice to new patients for three years. I'm still doing well, but I sure did not increase my salary by 74%! (I have 12,000 active patients.)You make it sound like we all had a 74% increase in salaries!
.

1988-1998 is not the last 5 years.

My point was not even about doctor's salaries, it was about the artificially low rates they paid. Insurance payouts are significantly impacted by the cost of future medical care. How could the puny premium increases possibly cover the increased medical care costs injured parties would receive? The ridiculously low rate of premium increase in this period was unrealistic. Doctors paid too little. Insurance companies felt the impact in 2000. Doctors have felt it since. Due to the nature of the insurance business, I'm sure insurers are overcompensating now.

By the way, 90% of what I take in every month goes to overhead according to my accountant. (Workman's comp insurance, unemployment insurance, malpractice, 401k for my employees, medical and dental, yearly raises, uniform stipends, CMEs for all the nurses and insurance personell, (which now total above 25 for us measly 4 doctor practice, a $150,000 dollar electronic medical record system purchase Omni-Doc, Intergy, $7,000 a month telephone system to help handle insurance and patient calls ) a $30,000 dollar a month rental.etc etc.
.

And none of this is slightly relevant to tort reform.

http://medrants.com/archives/2003/0...lpractice-laws/

Here is a more reliable independant source about the premiums.



your source says a single digit malpractive premium percentage raise, the above source says 505% increase within almost the same time period except it starts in the late seventies.

The link was not working.

Going back to the late seventies more than doubles the time period I was discussing. It is not remotely "almost the same". It also conveniently includes the last correction to premiums from boom bust cycles.

The obstetrician's premium in Florida which went up from $143,000 to over $200,000 three years ago would not call that an 7.4% increase.

Please. I quoted a 5.7% increase, not 7.4%. I talked about 1988-1998, not 3 years ago. And you resort to using selective anecdotes as data.

What were this doctors premiums doing in the 90's?

Consider an OB's likely damage payments. An injured child will have mostly medical expenses as the payout. It is entirely reasonable that an OB's insurance rates would parallel medical care inflation when compounded over an entire boom-bust cycle.

Compounding the 74% inflation from 1988-98, and the 52% inflation from 1999-2003 an OB's rates should be at least 2.65 times what they were in 1988.

Because the lawyers drag it out that way.

You missed the point entirely. The point was that the statistic is just hype. It has no educational value. It just sounds good. Everything I hear from the AMA and insurers is of this nature. If they have a good statistical case, they are not bothering to make it.

It's because this is what the lawyers want you to believe. Thus, more and more doctors are giving up treating risky patients so their "numbers" can look good both in outcomes and lawsuits.


Instead of listing to media rhetoric, this is what I have seen on the front lines. When we serve our 2 year tenures as chief of medicine, we are privey to every lawsuit out there since the Chief of Medicine and Surgery get dragged in indirectly as representatives of the hospital and doctor. (This is due to laws of statistical averaging , the most popular and sought after doctor have more patients due to their popularity and higher expectations of perfection which translates to more lawsuits.) Every, and I mean every professor of medicine, both associate and tenured, at both Emory and MCG, the two main teaching hospitals in Georgia, has been sued at least once. Most if not all, multiple times. Especially the ones I consider outstanding. I have a hard time believing the number of increased lawsuits suggest our medical training has diminished in quality over the last 20 years.

I will repeat. Those sorts of things can be statisticly accounted for. I never implied the notion of comparing general practitioners with research neurosurgeons.

Yes, there are factors that can explain a large number of lawsuits for a specific doctor. But sometimes those factors will not be there. Even then, the correlation will not be absolute, but there will be a correlation. To believe otherwise is naive. It is to believe that there is no relationship between lawsuits and malpractice. That is the fantasy the AMA would like people to accept.

Exactly why some believe capping emotional pain and suffering will do it. Cases are bought to court when no physical disability or injury has happened, the non economic damages is the lotto ticket. Case in point, a woman sues a dermatologist in Tampa because a shave biopsey that removed a stage II melanomaleft a small scar on her scapula. She sued him for 1.2 million becaue of emotional pain and suffering despite being forwarned about the possibility of scarring.

Just win the lawsuit or find another solution that doesn't deny people their rights.
Denying people their rights solves all sorts of problems.

Pain and suffering are real. Real people are genuinely injured by medical incompetence. They don't consider it winning the lottery. If I were blinded by a medical error no amount of money would make it right, but some money would make it more bearable. $250,000 would be an insult. I would use it to hire a hit man.

Njorl

 

[Njorl]

RE: "I agree. However, "court-room shenanigans" are no excuse for depriving Americans of the right to sue for redress of grievances."

Actually, it is the perfect excuse. Rights are taken away because someone takes advantage of them for their own gain and, as a result, hurts society.

That is for individuals. We call it criminal justice. When practiced against groups we call it civil rights violations.

In this situation, depriving the People of their rights is a necessary shield to protect American business from the likes of people like Edwards.
.

No, it is an expedient way to make money to overcome poor business practices of last decade.

We limit freedom when it comes to business practices. Why? For the same reason.
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Business practices are not constitutionally protected rights. Damage caps infringe upon the first and seventh amendment.

So if Americans are denied their right, wouldn't Edwards be considered partly to blame? Couldn't someone say that Americans would have that right if it hadn't been for people like Edwards that prostituted the system for his own gain?

If you really want people to have the right to sue for as much as they wish, then you should be mad as Hell at people like Edwards who took advantage of the situation.

Sometimes people elect bad presidents. The right to vote should be taken away.

Sometimes people say things I don't like. All people should lose the right to free speech.

Njorl

 

[member 5645]

This is a great thread :D!

 

[JohnDubYa]

RE: "Business practices are not constitutionally protected rights. Damage caps infringe upon the first and seventh amendment."

Here is the First Amendment: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.

Here is the Seventh Amendment: In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any court of the United States, than according to the rules of the common law.

Now kindly explain how damage caps, which are only applied to future litigation, violate either of these two amendments.

RE: "Sometimes people elect bad presidents. The right to vote should be taken away. Sometimes people say things I don't like. All people should lose the right to free speech."

These are not analagous to the situations I am describing. A better analogy would be to say:

Because some people in the past have abused the right to free speech by yelling "fire" in crowded theaters, my right to free speech has become limited.

All I am saying is, if you want the right to sue for mega-millions preserved, then you should condemn Edwards' legal activity, because it is the type of activity that ultimately produces lawsuit caps.