Category Archives: Uncategorized

A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

Back in 2010, Tom Price, then a congressman, said he knew the chief reason health care cost so much: “Defensive medicine” was costing the United States $650 billion per year — about 26 percent of every dollar spent. The widely dismissed estimate from Dr. Price, an orthopedic surgeon who went on to become President Trump’s health and human services secretary before resigning last fall, was memorable for its magnitude. But American doctors often rail against the country’s medical malpractice system, which they say forces them to order unnecessary tests and procedures to protect themselves if a patient sues them. Some prominent health economists, including those at the Congressional Budget Office, have tended to play down such costs, arguing that medical practice is not too warped by fear of lawsuits. But the question has proved difficult to study, since patients nearly everywhere can sue. Without a control group, it’s hard to know how differently doctors might act if they were less worried about liability. Researchers from Duke and M.I.T. have found a pocket of America that is different, and they now offer what is perhaps the most precise estimate of how much defensive medicine matters, at least for care in the…

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Malpractice Award Caps May Alter CAD Testing, Management

Physicians in states that limit the amount juries can award for noneconomic damage in medical malpractice suits conduct fewer invasive tests for suspected coronary artery disease (CAD) and referred fewer patients for revascularization than their counterparts in states with no caps on medical liability. Results of a study led by Steven A. Farmer, MD, from the Center for Healthcare Innovation and Policy Research at George Washington University, Washington, DC, show that physicians in nine “new-cap” states substantially changed their approach to CAD testing and management compared with physicians in 20 states with no caps. “To our knowledge, ours is the first paper to show changes in clinical behavior following up cap adoption in the particular setting of CAD testing and treatment,” the authors write. “Our study suggests that physicians who face lower malpractice risk may be less concerned with that risk, and thus more receptive to new care delivery strategies associated with alternate payment models,” they conclude. The difference-in-differences study, conducted jointly by researchers at George Washington and Northwestern universities, was published online June 6 in JAMA Cardiology. Defensive Medicine Physicians often report practicing “defensive” medicine to reduce malpractice risk, including performing expensive but marginally beneficial tests and procedures, the researchers write. Many…

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Managing physician risk in a costly world

Amid speculation that malpractice insurance rates will rise, maintaining an air-tight risk management plan should be on doctors’ agenda this year. Malpractice insurance rates declined over the last decade as tort reform and industry safety measures led to fewer claims, but the size of the largest claims is growing. This could lead to higher rates in the future, experts say.This article appears in the 4/10/18 issue of Medical Economics. “It’s not widespread, but we’re finally beginning to see some upward pressure on [malpractice insurance] rates,” says Chad Karls, FCAS, principal and consulting actuary for Milliman, a Brookfield, Wis.-based actuarial and consulting firm. The examples are spotty geographically, but primary care practices are among those at higher risk, he says. A 2017 study of hospital professional liability by consulting firm Aon and the American Society for Healthcare Risk Management projects no increase in the number of claims below $2 million for 2018, but a 2 percent rise in claim severity. The study also noted “early signs” of a rise in the number of claims above $5 million, but the data wasn’t conclusive enough to quantify the increase. Also on the rise, the report found, are so-called batch claims, or multiple claims…

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Proposed amendment to Arkansas Constitution sparks debate

A proposed amendment to the Arkansas Constitution has elicited strong opinions from both proponents and detractors. Annabelle Imber Tuck, a retired Arkansas Supreme Court justice who is chairman of the Defending Your Day in Court, or D-Day, Legislative Question Committee, spoke to the Sebastian County Bar Association in Fort Smith on Monday about Issue 1. Tuck said Issue 1, which will be on the ballot in the Nov. 6 general election, has several parts. The first part is limiting the percentage that attorneys can charge clients in contingency fee contracts. Tuck also discussed a provision that limits awards of non-economic damages in lawsuits for personal injury, property damage or wrongful death to $500,000 for each claimant, or $500,000 for all beneficiaries of an deceased person in a lawsuit for wrongful death. The last part of the proposed amendment, Tuck said, is shifting the authority of court rule-making from the Arkansas Supreme Court exclusively to the Legislature. An official statement from the D-Day Legislative Question Committee provided by Tuck states the shift would allow special interests and politics to directly interfere with due process, access to justice and the fair and impartial administration of justice. Issue 1 includes the following: “Providing…

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New Study Finds Patient Care Improved when Hospital Physicians Received Immunity from Malpractice Suits

MIAMI–(BUSINESS WIRE)–Adverse medical events declined when physicians received immunity from malpractice lawsuits at a large Miami teaching hospital, according to a study published in the latest issue of Health Management, Policy and Innovation (HMPI). The six-year study found no negative impact on patient safety when approximately 900 University of Miami Health System physicians received sovereign immunity from medical malpractice claims while working at Jackson Memorial Hospital, a public hospital that also serves as the University of Miami’s main teaching hospital. In fact, the incidence of harmful events decreased by 13 percent over a four-year period. “This study suggests that without the threat of malpractice lawsuits, physicians are still committed to delivering the safest, highest quality patient care possible,” said Dr. David A. Lubarsky, chief medical and systems integration officer at the University of Miami Health System and the study’s lead author. The change in sovereign immunity was led by Donna Shalala, former President of the University of Miami and former Secretary of the U.S. Department of Health and Human Services. Medical malpractice premiums have risen dramatically in parts of the United States, sometimes deterring physicians from practicing in specialties viewed as high risk, or leading to so-called defensive medicine. With…

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April 2018 Newsletter

Improving patient care by removing threat of lawsuits In an effort to better understand the impact that medical lawsuit abuse has on health care providers, a recent study granted immunity from liability lawsuits to practicing physicians – and studied the after affects. Over the course of six years, 900 clinically active employed physicians at Jackson Memorial Hospital, part of the University of Miami, could be deemed agents of JMH and received the protections of sovereign immunity when they were providing medical care at a JMH facility. Not only was there no negative impact on patient safety, but the number of harmful events decreased by 13 percent over a four-year period. “This study suggests that without the threat of malpractice lawsuits, physicians are still committed to delivering the safest, highest quality patient care possible,” said Dr. David A. Lubarsky, chief medical and systems integration officer at the University of Miami Health System and the study’s lead author. The immunity offered physicians an opportunity to treat patients without the threat of liability lawsuits, reducing the incentive to practice defensive medicine. “An effective liability system should offer incentives to institutions that adopt safer systems,” Dr. Lubarsky said, citing better patient data sharing, education,…

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AMA Studies Show Continued Cost Burden of Medical Liability System

The American Medical Association (AMA) today released a new series of trend reports in its Policy Research Perspective series illustrating the price Americans pay for the nation’s broken medical liability system. “Information in this new research paints a bleak picture of physicians’ experiences with medical liability claims and the associated cost burdens on the health system,” said AMA President David O. Barbe, M.D., M.H.A. “The reports validate the fact that preserving quality and access in medicine, while reducing cost, requires fairness in the civil justice system. Every dollar spent on the broken medical liability system is a dollar that cannot be used to improve patient care.” The first report analyzes medical liability claims frequency among patient care physicians in the U.S. and finds that getting sued is virtually a matter of when, not if, for physicians. Highlights in the report include: Getting sued is not an uncommon event for physicians. More than a third of physicians (34 percent) have had a claim filed against them at some point in their careers. Because older physicians have been in practice for a longer time and thus have had more exposure, the probability of getting sued increases with age. Nearly half (49.2 percent) of physicians…

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Top cases show physicians had a forceful ally in the courts

One thing physicians from Florida to Hawaii had in common in 2017 was that the Litigation Center of the American Medical Association and State Medical Societies had their backs. The Litigation Center was involved in legal battles that helped prevent an insurance mega-merger, protected physicians’ right to free speech, and fought back on multiple fronts against attempts to sidestep or peel back established state liability reforms. But it was a case involving the staff at a hospital in rural California that may have attracted the most attention. Case signaled threat to end medical staff independence in California. In Tulare Regional Medical Center Medical Staff v. Tulare Local Healthcare District et al, the Litigation Center provided significant legal and financial support after the hospital’s board of directors voted to terminate the medical staff organization, remove elected medical staff officers, install a slate of appointed officers and approve new medical staff bylaws and rules without staff input. “This case serves as an existential threat to independent hospital medical staffs,” said Long Do, California Medical Association (CMA) legal counsel and director of litigation. Just before closing arguments were scheduled in October, Tulare filed for Chapter 9 bankruptcy. As part the process, the hospital…

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August 2017 Newsletter

Liability litigation threatens access to care in three states As medical liability reform continues to await consideration by the US Senate, the successes of state-based reforms are threatened by legal challenges that could limit access to affordable care. In Maryland and Michigan, personal injury attorneys are attempting to advance cases by filing ordinary negligence claims, rather than medical negligence claims, to skirt pre-trial reviews intended to weed out meritless lawsuits. In Kentucky, the constitutionality of a law enacted earlier this year on using medical review boards to assess the merit of a case is being challenged. In the Maryland case, a number of lower courts ruled that the proper procedure of submitting a claim with the Maryland Healthcare Alternative Dispute Resolution (ADR) Office for pre-suit arbitration had not been followed prior to allowing a liability claim to move forward. The issue now awaits a ruling by the Maryland Court of Appeals, the highest court in the state, which could affect the efficiency in which deserving patients receive compensation. “We’re worried that, if this went through, it would be a significant roundabout of the system we’ve worked out over the last 20 years,” said Stephen Rockower, MD, President of MedChi (Maryland…

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A Doctor’s Place is in the Exam Room

An orthopaedic 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, orthopaedic surgeons, neurosurgeons, OB-GYNs and other specialty physicians continue to find themselves on the receiving end of meritless lawsuits. As a pediatric orthopaedic 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 billion…

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