Category Archives: California

September 2017 Newsletter

Liability concerns drive up defensive medicine, cost of care Providing treatment above what is medically necessary to fend off the threat of a lawsuit continues to be a trend – and a major driver of health care cost increases. A study of over 2100 physicians conducted by Johns Hopkins University found that more than two-thirds of respondents believe that 15-30% of tests, procedures, and prescriptions were unnecessarily recommended. The reason? Liability concerns. Over 80% of the physicians surveyed cited the fear of medical liability lawsuits as the justification for practicing defensive medicine. “Addressing overtreatment can have a major impact on rising healthcare costs in the U.S.,” the authors wrote. “Using the Institute of Medicine’s estimate of excess costs arising from overtreatment, a 50% reduction in ‘unnecessary services’ would result in $105 billion in savings each year, or about 4% of total national healthcare spending.” With a patchwork of laws leaving uncertainty about the liability climate from state to state, physicians surveyed recommended a series of changes that could help in the interim, including improved training on appropriate criteria for care, more accessible medical records, and evidence-based practice guidelines. To read more about the Johns Hopkins study on defensive medicine, click…

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Brace Yourself for an Ob/Gyn Shortage by 2020

Depending on where you live in the United States, it could already be tough to find an obstetrician/gynecologist—almost half of U.S. counties lack one, according to the U.S. Bureau of Labor Statistics. But recent studies show that the problem is only going to get worse, with some cities at risk for a severe shortage in the coming years. In July, Doximity, a social networking site for health care providers, released a study identifying 10 metropolitan areas that are most at risk for an ob/gyn shortage. After surveying 30,000 ob/gyns across the country and considering their age and workload, they found that the top five cities deemed most “at risk” are Las Vegas; Orlando, Florida; Los Angeles; Miami; and Riverside, California. Doximity’s study is hardly the only research on the shortage. The American College of Obstetrics and Gynecologists (ACOG) recently estimated that by 2020, there will be up to 8,000 fewer ob/gyns than needed across the country. “One of the reasons we put this report together was because of anecdotal stuff we were hearing,” Joel Davis, vice president of strategic analytics and growth at Doximity, tells SELF. “We wanted to bring transparency to the trend, because through that, policy decisions can be made. It can take…

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June 2016 Newsletter

Republican Health Care Task Force Offers Medical Liability Solutions for Patients, Physicians New health care reforms, including medical liability proposals, were introduced last week by the Republican Health Care Task Force and formally kicked off initiatives that will guide the legislative activities in a new Congress, with a new administration. Led by House Speaker Paul Ryan, the health care reform framework and proposal offered by Republicans aims to empower patients, make the health system more accessible and affordable, and spur medical innovation. “We know that comprehensive medical liability reform that includes caps on non-economic damages will improve patients’ access to quality care while reducing the overall cost of health care in America,” the report states. “Our plan will include liability reform that includes caps on non-economic damage awards, ensuring plaintiffs can recover full economic damages and that patients will not have their damages taken away by excessive lawyer contingency fees.” These reforms have proven effective in states like California and Texas, where patients have greater access to critical care, and health care costs and liability premiums remain affordable. “The HCLA will work with Members of Congress on both sides of the aisle, as well as the new administration, to bring…

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Medical Liability Reform

The nation’s medical liability system is broken, and it has imperiled patient access and imposed tremendous costs on our nation. The current system has forced doctors out of practicing in certain specialties; it has caused trauma centers to close; and it has forced pregnant women to drive hours to find an obstetrician.42 The current system also has imposed a tremendous burden in unnecessary costs on our national health care system and federal government. Estimates are that the failure to enact meaningful medical liability reform costs our nation’s health care system as much as $300 billion each year.43 In states without liability reform, the system does not serve anyone except trial lawyers. Injured patients are not compensated in a timely or equitable way. They are forced to wade through several years of litigation and receive, on average, only 46 cents of every dollar awarded while the remaining 54 cents goes to their lawyers and other administrative fees.44 President Obama has repeatedly promised to address the issue of medical liability reform but has failed to do so. The time for experiments is over. California and Texas, as well as numerous other states, already have taken the difficult steps to enact comprehensive liability…

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Malpractice premiums flat in 2015, but changes could be ahead

Physicians paid about the same in liability insurance premiums in 2015 as in 2014, and analysts don’t see costs changing anytime soon. A nationwide survey of insurers by the Medical Liability Monitor shows that 71% of insurance premiums did not change this year, while 17% of rates rose and 12% fell. Internists experienced an average premium increase of 0.6% in 2015, while general surgeons saw a 0.2% average rate decrease, and ob.gyns experienced an average 0.5% rate increase. The static premium market is being largely driven by the low number of lawsuits filed by patients and family members in recent years, said survey coauthor Paul Greve Jr., executive vice president/senior consultant for the Willis Health Care Practice, a global risk management consultant firm. “It’s amazing to see the continuing stability in claim frequency,” Mr. Greve said in an interview. “The claims counts are just not rising. Its great for the industry, and it’s great for physicians, but it is puzzling because you wonder what has caused what amounts to a sea change in the attitudes of the general public toward malpractice litigation such that the claim counts were drop off.” Premiums continue to vary geographically. Southern Florida internists for example,…

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Medical liability damages cap upheld

The nation’s leading medical liability reform law has been upheld yet again in a California court of appeal, with the court finding that the state’s cap on noneconomic damages is constitutional. It’s another victory to ensure physicians can afford to stay in practice and continue to provide care to the patients in their communities. In Chan v. Curran, the plaintiff attempted to prove that the non-economic damages cap under Medical Injury Compensation Reform Act (MICRA), California’s historic tort reform law, should be struck down. The cap is set at $250,000. The plaintiff claimed the MICRA cap was unconstitutional for a few reasons: MICRA was put in place to tamp down California’s medical liability insurance crisis in the 1970s, but times have changed and the crisis no longer exists. The court rejected this argument, noting that the Supreme Court of the United States rejected a similar argument. The noneconomic damages cap discourages attorneys from taking cases on contingency, so it limits access to the courts. The court held that parties in civil cases are not guaranteed the right to counsel. MICRA interferes with the right to jury trial. The court rejected this argument based on previous cases that held the same….

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Offer SGR Solutions Not Complaints

The American Medical Association (AMA) is doing a disservice by not weighing in on how to pay for repealing the sustainable growth rate (SGR) formula for physician reimbursement under Medicare, a member of Congress said Thursday. During the second day of a hearing on repealing and replacing the SGR, Rep. Larry Bucshon, MD (R-Ind.), a cardiac surgeon and member of the House Energy and Commerce Health Subcommittee, asked Barbara McAneny, MD, chair of the AMA’s board of trustees, if the AMA could offer “substantial possible pay-fors” to cover the cost of the repeal. The Congressional Budget Office last year put the cost at about $140 billion over 10 years. But McAneny, an oncologist in Albuquerque, N.M. who testified on the AMA’s behalf, declined to do so. “Within the healthcare sector, so many are struggling now to keep the doors open, so for us to come up with specific pay-fors may not be as useful until there are some guidelines set up by Congress,” she said. “The AMA stands ready to assist and help by weighing in on any specific suggestions; we don’t really have the ability to give you specific pay-fors, because the devil is in the details.” Bucshon expressed…

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Congressman to AMA: Offer SGR Solutions Not Complaints

The American Medical Association (AMA) is doing a disservice by not weighing in on how to pay for repealing the sustainable growth rate (SGR) formula for physician reimbursement under Medicare, a member of Congress said Thursday. During the second day of a hearing on repealing and replacing the SGR, Rep. Larry Bucshon, MD (R-Ind.), a cardiac surgeon and member of the House Energy and Commerce Health Subcommittee, asked Barbara McAneny, MD, chair of the AMA's board of trustees, if the AMA could offer "substantial possible pay-fors" to cover the cost of the repeal. The Congressional Budget Office last year put the cost at about $140 billion over 10 years. But McAneny, an oncologist in Albuquerque, N.M. who testified on the AMA's behalf, declined to do so. "Within the healthcare sector, so many are struggling now to keep the doors open, so for us to come up with specific pay-fors may not be as useful until there are some guidelines set up by Congress," she said. "The AMA stands ready to assist and help by weighing in on any specific suggestions; we don't really have the ability to give you specific pay-fors, because the devil is in the details." Bucshon expressed...
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California’s Proposition 46 and the Uncertain Future of Medical Malpractice Liability Reform

On November 4, 2014, Californians voted against Proposition 46, an unprecedented statewide ballot initiative that would have, among other things, raised the $250,000 cap on noneconomic damages to $1.1 million and indexed it to the rate of inflation in future years. The margin was significant — 67 percent voted against it. For nearly 40 years, noneconomic damages, which entail payments to patients for pain and suffering resulting from medical malpractice (as opposed to economic damages such as lost wages and medical costs), have been at the forefront of debates over the U.S. medical liability system. Currently, 22 states have caps on noneconomic damages of varying sizes in place. If it had passed, the ballot initiative would have raised the cap on noneconomic damages in California from among the most restrictive to the least restrictive among all states with caps. Opponents of Proposition 46, and supporters of malpractice reform more generally, argued that raising the noneconomic damages cap would have increased malpractice awards and subsequently malpractice premiums, which would be passed on to patients and insurers as higher costs. Proponents countered that the $250,000 cap is outdated and that liability is necessary to compensate patients and provide physicians with incentives to…

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Malpractice Insurance Premiums Nudge Down Again

For the seventh straight year, malpractice insurance premiums have decreased for three bellwether specialties, and even for sticker-shocked obstetrician-gynecologists on Long Island in New York, according to an annual premium survey released this week by Medical Liability Monitor (MLM). Rates quoted by a malpractice carrier called Physicians’ Reciprocal Insurers for obstetrician/gynecologists in the New York counties of Nassau and Suffolk, east of Queens, went from $227,899 in 2013 to $214,999 in 2014, a decrease of almost 6%. However, this rate continues to be the highest quoted by any carrier in any state for this specialty. Overall, malpractice premiums decreased on average by 1.5% in 2014 for obstetrician/gynecologists, internists, and general surgeons, which is slightly less than the 1.9% decrease in 2013. By specialty, rates fell 1.6% for internists, 1.3% for general surgeons, and 1.7% for obstetrician/gynecologists. Since 2008, overall rates for the three specialties have fallen by 13%, MLM said. To many physicians, this slow decline represents little comfort because it was preceded by an era of rate spikes: Premiums increased more than 20% in both 2003 and 2004, and about 9% in 2005 (rate increases in 2006 and 2007 were less than 1%). “We haven’t come down as far…

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