Category Archives: National

August 2019 Newsletter

Liability reforms must be more than skin deep An analysis by University of Virginia (UVA) researchers on the prevalence of unnecessary medical tests highlighted the effect on health care costs and patient anxiety, leading a retired neurologist to reflect on how reforms must go beyond the superficial. The initiative followed a report by UVA researchers Andrew Parsons, a hospitalist and an assistant professor of medicine, and Joe Wiencek, a pathologist and an assistant professor of pathology, which found that diagnostic care that offered little value to patients is estimated to cost our health care system $800 billion annually. By offering technical solutions, such as a screen alert when a doctor orders a certain test and a weekly email that analyzes the amount of tests a doctor orders as compared with their peers, they seek to drive down unnecessary costs. Retired Virginia neurologist Dr. Justiniano F. Campa urged policymakers and patients to consider the root cause – a physician’s fear of being faced with a lawsuit. “I have to point out that the main reason for those tests lies in doctors’ fear of being sued, an event that can stop and destroy a hard-earned reputation and career,” Campa writes. While he…

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Opinion/Letter: Unnecessary tests need deep reform

SOURCE: The Daily Progress The July 28 issue of The Daily Progress relates the initiative from two young members of the University of Virginia faculty, Dr. Joseph Wiencek and Dr. Andrew Parsons, about reducing unnecessary medical tests. As a retired neurologist from 40 years of clinical practice, I have to point out that the main reason for those tests lies in doctors’ fear of being sued, an event that can stop and destroy a hard-earned reputation and career. One of my UVa mentors told us, “If you practice long enough, you will be sued.” This fear might lead doctors to: 1) order more tests, 2) refer patients to more expensive tertiary care hospitals and 3) contribute to the current flight to become hospital employees, where ordering more tests is easy and expected, instead of remaining in independent practice. Add these three contingencies, and guess what is the additional cost to our health care? A figure for this cost is not readily available and seldom mentioned, truly a political taboo. Yet I and my contemporary colleagues estimate it at 20% to 25%. When one compares this malpractice cost in the U.S. to the likely 3% in the European countries, it is…

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UVa researchers lead effort to reduce unnecessary medical tests

SOURCE: The Daily Progress Unnecessary medical tests can add to a patient’s costs, discomfort and anxiety as more and more tests cascade in an effort to chase the cause of a symptom. A doctor may order those tests out of a worthy desire to take care of a patient, according to University of Virginia researchers, but when the tests are not needed, they don’t add much value. Instead, according to Dr. Andrew Parsons, a hospitalist and an assistant professor of medicine, and Joe Wiencek, a pathologist and an assistant professor of pathology, hospitals and medical schools can do a better job educating doctors and patients about what tests are supposed to do and when they’re effective — and when to avoid them. The two have teamed up as part of a UVa effort to examine levels of testing and try out various methods to ensure that only useful tests are ordered. “Even in the beginning of medical school, they instill a culture that you should be quite thorough,” Parsons said. “And that makes sense, but we’re trying to switch that culture from thoroughness to appropriateness.” In a June report for the journal Clinical Lab Manager, the two researchers wrote that…

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July 2019 Newsletter

Opportunity for ACCESS: Liability reform introduced in Congress A new bill introduced in Congress offers the opportunity to limit the patchwork of medical liability laws and bring certainty to patients across the country seeking access to care. The Accessible Care by Curbing Excessive LawSuitS Act (ACCESS Act) is a comprehensive medical liability reform bill introduced by Representative Richard Hudson (R-NC) and modeled after proven reforms already in place in Texas, California, and many other states around the country. Rep. Hudson was joined in introducing the bill by Representatives Roger Marshall, MD (R-KS) and Larry Bucshon, MD (R-IN). The bill, H.R. 3656, ensures full and unlimited recovery of economic damages to deserving patients for expenses such as lost wages, past and future medical expenses, rehabilitation costs, and other out-of-pocket expenses. The legislation also permits the additional recovery of up to $250,000 for non-economic damages, such as damages awarded for pain and suffering, and the bill also protects states’ rights in the process. Recent estimates from the Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) estimate that the provisions included in the bill would reduce federal spending by about $14 billion over five years, and almost…

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Strong physician-patient relationships improve care, ward off malpractice suits

SOURCE: AAP News As experts in prevention, pediatricians need to know essential strategies to prevent medical liability claims. Ample research shows that communicating skillfully and fostering effective physician-patient relationships can help pediatricians avoid malpractice litigation. The literature also provides insights on how pediatricians can enhance communication skills. Communication differences between physicians and surgeons with malpractice histories and those with none are revealing. A sentinel study found that primary care physicians with no malpractice claims employed the following communication techniques: oriented patients about what the visit would entail, solicited opinions and concerns, verified patient understanding, and spent more time during office visits. No such differences were identified among surgeons with malpractice claims and those without (Levinson W, et al. JAMA.1997;277:553-559). A recent analysis of 24,000 medical liability claims from 2009-’13 by CRICO, a program that insures Harvard medical institutions and their affiliates, revealed that communication failures were factors in 30% of malpractice suits. More than half of those cases resulted from communication problems between providers and patients/families. Another study found that one-third of malpractice litigation was related to communication problems manifested by the physician appearing inattentive, discourteous or providing inadequate information (Roter D. J Health Care Law Policy. 2006;9:304-314). Research shows…

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A Missed Opportunity for the Malpractice System to Improve Health Care

SOURCE: The New York Times The American medical malpractice system is doing almost nothing to improve the quality of health care, research suggests. What may be more concerning is that there is very little discussion, much less action, on reform. Despite worries among doctors that they are at financial risk from large payouts to plaintiffs, it turns out that a small percentage are responsible for a huge number of claims. A new study, confirming earlier research, found that about 2 percent of doctors accounted for about 39 percent of all claims in the United States. The study contained other valuable information about a system that not only compensates patients who have been harmed, but is also supposed to identify physicians who may be performing poorly and need correction. First, these doctors quit at higher rates than other physicians. This is considered good news by the medical profession. These doctors also tend not to pick up and move somewhere else to start fresh (which many thought they’d do given that licenses and malpractice are regulated at the state level). But the overwhelming majority of doctors who had five or more paid claims kept on going. And they also moved to solo…

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June 2019 Newsletter

Lifting liability limits in New Mexico could take medical system from bad to worse Already ranking two spots from the bottom on access to health care when compared to all U.S. states, New Mexico patients now face another obstacle if personal injury attorneys have their way. Challenges stemming from a rural landscape, an aging population, and low physician pay influencing recruitment already make it difficult for patients to access affordable health care. Making things worse is an attempt to raise reasonable limits on non-economic damages to $2 million for individual physicians and $25 million for medical entities, which includes many small practices. Michael Kaufman, MD, of Taos Medical Group, who has practiced internal medicine in Taos for more than 40 years, expressed what many fellow practitioners were feeling: “If this goes through, we’re out of here.” Dr. Kaufman cited an impossible operating environment for a four-physician, three-nurse practitioner practice due to higher insurance premiums required to remain covered under an increased limit. While the measure was defeated – for now – due to overwhelming opposition by the healthcare community demonstrating their concern for their patients’ access to healthcare, it remains likely to be introduced again in the future. Click here…

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May 2019 Newsletter

Minnesota liability ruling trends towards dangerous precedent for patients Setting a troubling precedent that could limit collaborative patient care efforts, the Minnesota Supreme Court recently ruled in favor of expanding liability and opening the door for an increase in medical lawsuit abuse. In mid-April, the Court issued a ruling case of Warren v. Dinter, reversing precedent and stating that the existence of a physician-patient relationship was not a prerequisite for bringing forth a medical liability lawsuit. The Court declared that legal actions could proceed if the harm suffered by an individual — even if they were not considered a patient of the physician — was a “reasonably foreseeable consequence” of the physician’s actions. Supporting the defendant were the American Medical Association (AMA), Minnesota Medical Association (MMA), and the Minnesota Hospital Association (MHA), on the basis that this new precedent could expose physicians and other health professionals to expanded liability risks in situations that were previously protected, including unbilled consultations, and discourage collaboration. “The overall expansive language in the Court’s opinion does raise concerns,” said Mark Fogg, general counsel of COPIC, MMA’s endorsed medical professional liability insurance provider. “We respectfully believe that it is important that a physician-patient relationship be established…

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April 2019 Newsletter

Risky business: Lawsuit venue shopping harms access to care An overview of Pennsylvania’s recent proposed changes to lawsuit venue filing rules highlights the risk it adds to accessible and affordable care. Following a surge of liability lawsuits in locations that were seen as ruling favorably to plaintiffs, the Pennsylvania Supreme Court issued a rule that required a plaintiff to file the lawsuit in the county where the alleged medical error occurred. When recent discussions on changes to this rule to allow for “venue shopping” were made public, justices agreed to delay any changes until a legislative study could be done on the matter. A public hearing made the position of access to care advocates clear: “…Doctors and hospitals would be reluctant to partner with facilities located in a city where juries tend to favor plaintiffs over defendants, rewarding the former with sizable judgments,” a recent Medscape article reflected. Restrictions on venue shopping have reduced medical lawsuit abuse in the state of Pennsylvania, bringing the state’s medical liability compensation fund to a record surplus. The risks of venue shopping “will need to [be weighed] carefully before deciding whether the venue rule should stand as it is or be altered,” the article…

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Here’s how to bring down the rate of malpractice claims

SOURCE: Pittsburgh Post-Gazette More than a third of all physicians have had at least one malpractice suit filed against them, which helps explain why malpractice insurance can run into the six figures. And now, after decades of relative stability and even declines in premiums, the American Medical Association reports that they have been trending up for many specialties since 2015. These costs are ultimately borne by patients, of course, which means that health care may become even more expensive. The good news is that we have developed a far better understanding in recent years about why malpractice claims arise in the first place — it turns out that they often have more to do with poor communication than bad medicine. And reforms and new approaches are underway that are reducing malpractice claims and improving patient outcomes. Although large jury awards get the most attention, they account for a tiny fraction of cases. An AMA policy report for 2006 through 2015 found that only 7 percent of claims were resolved by a trial verdict, and defendants won 87 percent of those cases; 23 percent of claims were settled before trial. Significantly, a large majority of claims — 68.2 percent — were…

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