Category Archives: National

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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Physicians Say Up to 30% of Treatment Unnecessary

Despite years of emphasis on curbing costly and potentially harmful unnecessary care, physicians believe that overtreatment remains an ongoing problem, according to research from Johns Hopkins University published this week in the journal PLOS ONE. The findings, based on a survey of 2,106 physicians, revealed that most of those surveyed (64.7%) believe that at least 15% to 30% of medical care is unnecessary. Participants were from a subgroup of the American Medical Association’s Physician Masterfile. The top three “culprits” cited were: Tests (24.9%) Prescription medications (22%) Procedures (11.1%) “Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American,” said the study’s senior author, Martin Makary, MD, MPH, professor of surgery and health policy Johns Hopkins. Makary and colleagues also collected physicians’ opinions as to why overtreatment occurs, and found the following perceived reasons: Fear of malpractice (84.7%) Patient pressure/request (59%) Difficulty accessing medical records (38.2%) In addition, most respondents (70.8%) said they believed that physicians are more likely to perform unnecessary procedures when they profit from them. And most respondents believed that de-emphasizing fee-for-service physician compensation would reduce healthcare utilization and costs. The top three potential solutions for eliminating unnecessary services were: Training medical…

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Advances in Patient Safety and Medical Liability

Research in patient safety and medical liability in recent years has widened our definition of these terms. Patient Safety improvement is no longer a preventive strategy to protect medical facilities from lawsuits—it is a serious and wide-reaching effort to measurably improve the safety culture among staff in medical institutions, to find lasting and systemic prevention strategies for adverse events, and to work with patients—and with their families and caregivers—as equals to both address their care needs and to earnestly reconcile when their care does not go as planned. Working with patients as partners has become increasingly important in our rapidly changing medical landscape. Patients are experts in their own care and their own needs. Too often, we medical professionals ignore their expertise and opinion. In addition, caregivers and family members have knowledge and perspectives about the patient and his or her condition that can contribute to better care and improved patient safety. Transparency between and among medical colleagues and a supportive just culture are also central aspects to improving safety and creating a climate less prone to medical liability in health care facilities. The articles included in this publication demonstrate a wide variety of studies that investigate the importance of openness and…

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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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Congressman Steve King defends his medical malpractice tort reform bill

Healthcare Matters announced today that its video interview of United States Congressman Steve King — sponsor of the Protecting Access to Care Act of 2017— is available on Cunningham Group’s website. The Healthcare Matters interview of Rep. Steve King focused on the medical professional liability tort reforms contained in his Protecting Access to Care Act. The congressmen’s legislation would create a $250,000 cap on noneconomic damages, among other provisions that would preempt state laws governing medical malpractice lawsuits in the areas of statutes of limitation, joint and several liability, product liability and attorney contingency fees. In the interview, Rep. King also defended his Protecting Access to Care Act against claims by some of his more conservative colleagues that it violates the concept of states’ rights as well as argued why his medical liability reforms could and should pass independent of whether Congress succeeds in “repealing and replacing” the Affordable Care Act (Obamacare). About Healthcare Matters Healthcare Matters is an internet television program that explores the intersection of healthcare practice, the business of medicine and the law. Hosted by Michael Matray – editor of Medical Liability Monitor, the medical professional liability industry’s publication of record – Healthcare Matters investigates pertinent issues facing…

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Tort reforms facing legal challenges in three states

In contrast with the federal government—where a House-passed medical liability reform bill languishes in the Senate—many states have found success enacting tort reforms that better serve patients and physicians. But court cases are challenging reforms in place in at least three states. In Maryland and Michigan, plaintiffs’ attorneys are using what is described as “artful pleading” to skirt pre-trial measures that assess the merits of a complaint and its worthiness for going to court. And in Kentucky, a suit has challenged the constitutionality of its new law authorizing medical review boards to assess the merits of a complaint. The Litigation Center of the American Medical Association has filed amicus briefs in the Maryland and Michigan cases in which patients sued for injuries incurred after falling. By claiming ordinary negligence instead of medical malpractice, the plaintiffs bypassed review processes. The cases have gone through the trial and appellate courts and are now before the high court in both states. Dispute-resolution office bypassed in Maryland In Davis v. Frostberg Facility Operations, patient Sheila Davis was admitted to a nursing facility following back surgery. At one point, her mattress came loose and she fell on the floor. A nurse placed her on a mechanical lift to help her…

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Rural America’s Childbirth Crisis: The Fight to Save Whitney Brown

Whitney Brown was in labor with her first baby when suddenly she couldn’t breathe. Convulsions shook her body. Ms. Brown’s blood pressure and oxygen levels dropped, and the baby’s heart rate plunged. Nurses at Saint Thomas River Park Hospital called obstetrician Dawnmarie Riley, who minutes later burst into the operating room in such a rush her hospital scrubs were inside out. Dr. Riley delivered the baby girl in an emergency caesarean section, and Ms. Brown was taken to intensive care. Doctors at River Park, the only hospital in a central Tennessee county of 40,000 people, didn’t know what had caused Ms. Brown’s seizure. But they knew one thing: The 28-year-old woman needed more than they could provide. What followed was a race to save Ms. Brown, a high-risk medical challenge that would involve frantic requests for transportation, an hour-and-a-half ambulance ride through mountains and the rain, and last-minute medical interventions as she tore through the hospital’s blood supplies. Since the start of the century, it has become more dangerous to have a baby in rural America. Pregnancy-related complications are rising across the U.S., and many require specialized care. For some women, the time and distance from hospitals with the resources…

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This was our government working as it should

The Aug. 2 news article “Lobbyists taking credit for writing bill to overhaul medical malpractice laws” claimed that lobbyists boasted about writing new legislation blindly passed by Congress without review. The bill was a modestly revised version of legislation that has been debated for about 20 years.  In that time, nearly identical legislation was the subject of repeated congressional hearings and debate. Lobbyists’ role in “drafting” the bill was merely to provide proposed fixes meant to address concerns raised by reform opponents — hardly an effort to “protect their industry.”  The overwhelming majority of the bill remained unchanged from what had been debated. When interested parties acknowledge that they were consulted about legislation, they should be applauded for their transparency rather than falsely accused of “boasting” or attempting to undermine our legislative system. Passage of the medical liability reform bill is an example of our government working as it should — legislators consulting with their constituencies, stakeholders providing feedback and those concerns being appropriately considered. To imply otherwise is disingenuous.

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A doctor’s place is in the exam room

An orthopedic surgeon and a neurosurgeon walk into a room … Unfortunately, this is not the start of a joke. While we would prefer to be sharing best practices and treating patients in our exam rooms, the fact is we’re spending more time than we’d like in a courtroom. Because our medical liability system is broken, orthopedic surgeons, neurosurgeons, OB-GYNs and other specialty physicians continue to find themselves on the receiving end of meritless lawsuits. As a pediatric orthopedic surgeon practicing for more than 40 years in Iowa City, I’ve seen countless colleagues forced to defend their treatment decisions and reputations — leaving less time for patients — only for the lawsuits to be dropped, dismissed or withdrawn for lack of merit. Our medical liability system costs too much, takes too long, undermines the doctor-patient relationship and does not serve the needs of patients or physicians. Too often, the cost of defensive medicine — the tests and procedures above and beyond what is medically necessary to limit exposure to litigation — is tacked on to health care bills, leading to steep increases in costs year after year. When applied to 2015 health care spending, defensive medicine adds anywhere from $160…

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Commentary: Florida Supreme Court crowns itself fact-finder and policymaker on malpractice

On June 8, in North Broward Hospital District v. Kalitan, the Florida Supreme Court ruled that caps on noneconomic damages (pain and suffering) in medical malpractice lawsuits violated the equal protection clause. Mostly, the court said that the caps did not pass the “rational basis test,” where a challenged law must be rationally related to a legitimate government interest. By deciding the Legislature had no rational basis for imposing the caps, the court crowned itself fact-finder and policymaker, rejecting all of the Legislature’s work and its role under our system of government. Under the rational basis test, the court is supposed to defer to the Legislature if there is any “rational basis” in the record. Here, the court found there was no conceivable rational basis for the Legislature’s action. Let’s take a look at the record. In 2002, the Governor’s Select Task Force on Healthcare Professional Liability Insurance spent months traveling around the state, listening to all interested parties, gathering relevant data, and analyzing trends. What they observed and documented was alarming: In 2002, the average liability premium per doctor in Florida was 55 percent higher than the national average. For the period from 1996 to 2002, average insurance premiums in Florida…

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