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Healthcare: News and Commentary: MedWatch

Doctors cannot rely on the law to protect sensible decisions. Legal fear is eroding the quality and availability of healthcare in America. Common Good's MedWatch collects recent news and commentary reflecting on this trend.

**If an article is publicly available online, a link to it is provided following the article summary. If no link is provided, please visit the primary source’s archives to access the article.

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All Most Recent News

Obama Open to Reining in Medical Suits
Sheryl Gay Stolberg and Robert Pear, New York Times, June 15, 2009

In closed-door talks, President Obama has been making the case that reducing malpractice lawsuits can help drive down health care costs, and should be considered as part of any health care overhaul. Medical liability is an important component of the debate, but a controversial issue. Mr. Obama has not endorsed capping malpractice jury awards. But as a senator, he proposed legislation aimed at reducing both medical errors and lawsuits. Dr. J. James Rohack, the incoming president of the medical association, said the American Medical Association’s legislative experts are drafting a bill that would set out a way to protect doctors who are sued if they have followed professional practice guidelines. “We are supportive of anything that may reduce liability,” Dr. Rohack said, adding that he was heartened by Mr. Obama’s “recognition that defensive medicine contributes to unnecessary health costs.” » article

The Role of Medical Liability Reform in Federal Health Care Reform
Michelle M. Mello and Troyen A. Brennan, New England Journal of Medicine, June 15, 2009

The health care reform package should include reforms to the medial liability system, which is often blamed for contributing to rising health care costs. Michelle Mello and Troyen Brennan suggest three paths for reform. The first calls for state experimentation with programs where health care providers disclose unanticipated outcomes of care to patients and, in some cases, make prompt offers of compensation. The second approach shifts adjudication of claims to a tribunal—either an administrative panel that would award damages on the basis of judgments by neutral experts about the avoidability of the injury or specialized health courts presided over by judges with medical experts. A third approach creates a federal “safe harbor,” retaining the current process of adjudication but insulating physicians from liability if they adhered to evidence-based medical practices. If liability reform is included in a reform proposal, it could reduce costs, appease physicians and attract support from congressional republicans for a health care reform package. » article

Eliminate Inefficiencies to Cut Health Care Costs
Richard Keller, Salt Lake Tribune, June 12, 2009

What is most important when discussing economic methods to finance medical reform is the removal of the inefficiencies in the delivery of health care and the elimination of the profit motive that promotes unnecessary care. There is a myth that more care equates to better care. This myth, combined with defensive medicine, results in expensive and unnecessary medical procedures. The goal should be "what is best for the patient" is best for the health care system. This means efficient, effective care is the best care. A coordinated, team effort produces the best results at the lowest prices -- a win-win situation. » article

Reform Health Care Now: The Malpractice Liability Crisis Persists
Dr. Russell Turk, Daily Finance, June 12, 2009

Dr. Russell Turk discusses how medical liability fears have changed the practice of medicine and driven up costs. Medical malpractice reform should be part of the larger health care reform debate as lawmakers consider ways to control costs and improve quality. Turk describes the experience of transitioning from a managed care organization to a private practice, where evidence-based guidelines were left behind and physicians ordered up tests and procedures in part to satisfy patient demands, and in part to protect themselves from future lawsuits. Rising premiums - nearly $200,000 for Ob-Gyns in Florida - have forced one in seven obstetricians to stop delivering babies. Turk writes, "the best hope for resolving the medical liability crisis appears to be convincing the public that we would all be better served by the formation of so-called health courts, where compensation judgments would be made outside the regular tort system." » article

Fixing Health Care Starts With the Doctors
Steve Pearlstein, Washington Post, June 10, 2009

Recent articles have catalogued the many failings of today's medical system, but perhaps no group has more control over the delivery and provision of care than physicians themselves. Author Steven Pearlstein describes how, if the country is going to contain health care costs, reform must begin with the doctors. All parties have a role in rising cots, but the wasteful tests and procedures originate with the providers. Recent evidence has made it clear that part of this waste is colored by a drive for profits, but in the majority of cases variation in care - and excess - most often occurs where there is scant evidence on best practices. Certain health systems have already recognized this pattern and have worked to provide specific steps and guidelines for a wide array of treatments. The results are remarkable - when providers possess good research in tandem with evidence-based guidelines, care is more efficient, effective and less costly. » article

Is Hospital Peer Review a Sham? Well, Mostly Yes
Dr. Bob Wachter, Health Care Blog, June 3, 2009

Dr. Bob Wachter has written extensively on patient safety, and finds a recent report on hospital peer review to be revealing. The report describes hospitals' and providers' inability to hold one another accountable in instances of wrongdoing, so much so that the National Practioner Data Bank - established in 1986 to collect data on problem physicians - has been woefully underused. Nearly half of the country's hospitals have failed to report a single problem to the NPDB. Wachter discusses numerous reasons why peer review has floundered: physicians may be reluctant to chastize a colleague due to a sense of comraderie and respect for their training; providers may simply be unprepared for such delicate situations; physicians may simply want to help without turning the problem into a reportable event. Wachter also notes that the issue of liability looms large for providers. Though NPDB reports are intended to have protections from lawsuits, physicians lack confidence in these guarantees. "The specter of baseless, time-consuming and expensive litigation serves as a powerful disincentive to effective peer review," wrote the American Hospital Association. » article

Doctors Duty to a Third Part the Exception, Not Rule
Amy Sorrel, AMNews, June 1, 2009

The California Court of Appeals recently decided to keep limits on physicians' liability for harm their patients cause to a third party. The court ruled that a psychiatrist, Dr. Laurence Greenberg, owed no duty of care to Denise Smith, whose husband and daughter were shot by the doctor’s patient. Doctors owing a duty to a third party should be the exception, rather than the rule, said Joel B. Douglas, Dr. Greenberg’s attorney, “You don't want to invite everybody to second-guess these private, contractual relationships. And here you have a third party trying to adjudicate what a doctor should do with a patient." Expanding physician liability to an infinite third party poses potential risks, "you’re really opening up the physician-patient relationship to external pressures that do not support quality medical care," said Dean P. Nicastro, a health care lawyer with Pierce & Mandell PC in Boston. » article

Defensive Medicine

Is There a Cure for Miami's Soaring Health-Care Costs?
Tim Padgett, Time, May 20, 2009

The latest installment of the Milliman Medical Cost Index indicates that Miami has the nation's highest medical costs, just over $20,000 for a family of four. Author Tim Padgett explores some of the drivers behind these rising costs, particularly describing the detrimental effects of the medical liability system in the state. Florida does not require its doctors to carry malpractice insurance, and many forgoe the coverage because it has become unsustainable. Costing tens of thousands or more for some, they elect simply to set aside $100,000 in personal assets as the law requires and then engage in defensive medicine to protect themselves from being sued. "As a result, those doctors are often more concerned with covering their rear-ends against malpractice, by ordering excessive tests and treatment, than with providing the most efficient care. 'We've seen too large an increase in defensive medicine here,' says [Linda] Quick, [president of the South Florida Hospital and Healthcare Association]." » article

ACOG 2009: Liability Fears May Be Linked to Rise in Cesarean Rates
Richard Hyer, Medscape, May 12, 2009

A study performed by Dr. Elizabeth A. Platz found that state-specific cesarean delivery rates differed by medical liability climate. Platz found that states classified as having a medical liability crisis or crisis brewing by ACOG [the American College of Obstetricians and Gynecologists] had significantly higher rates of cesarean delivery, and this may reflect a pattern of defensive medicine in response to the liability climate. Her research affirmed what many obstetricians believe to be true—legal fear is causing more obstetricians to perform C-sections. Dr. Kurt L. Barnhart, director of women's health research at the University of Pennsylvania in Bryn Mawr, was optimistic that these findings would result in wider reforms, “with objective evidence that fear of liability is causing C-sections, we can address the problem by reducing liability, thereby reducing C-sections.” » article

Aiding our Health, Economy
Bert Marshall, The Oklahoman, April 27, 2009

Bert Marshall, president of Blue Cross and Blue Shield of Oklahoma, explains how medical malpractice reform will benefit patients and physicians. Legal fear causes physicians to perform more tests and refer patients to expensive specialists, which in turn leads to higher health costs. Physicians should not be forced to make treatment decisions based on fear of litigation rather than what is in the best interest of the patient and the health care system. By enacting malpractice reform, Oklahoma can hope to see an increase in practicing physicians. This expansion in the availability of quality physicians also creates competition, helping to reduce costs and improve service. » article

Birth by Appointment
Karen Goldberg Goff, Washington Times, April 15, 2009

The rising Caesarean rate in the United States from 20 percent in 1996 to 31.8 percent in 2008 is due in part to the growing trend of elective C-sections. A decade ago, surgical delivery mainly was reserved for emergency situations. Today, changing attitudes toward childbirth, the convenience of a scheduled birth, and malpractice concerns by doctors and insurance companies are leading to the rapid rise in C-sections. Even though the procedure is more expensive and requires a longer recovery time than vaginal delivery, it can lessen the chance of legal recourse. Dr. Bruce L. Flamm, an obstetrician in California, attributes rising C-sections to legal fear. He says that "medical-legal issues have contributed to the rise in the number…obviously, if labor goes wrong, the doctor is open to a lawsuit. With a planned C-section, at least the perception of risk is eliminated." Dr. Flamm says he expects to see the C-section rate continue to rise. » article

Birth by Surgery: The Skyrocketing Cesarean Rate
Mary Beth Pfeiffer, Poughkeepsie Journal, March 29, 2009

Cesarean-section birth is soaring to its highest levels ever, and many are blaming this fact on legal fear. To be sure, every obstetrician knows of or has experienced a vaginal birth gone bad; some said that they and other colleagues had been sued more than once. "If anything goes wrong, the first question you're asked is, 'Why wasn't a C-section done?'" said Dr. Scott Hayworth, chairman of the New York district of the American College of Obstetricians and Gynecologists, who calls lawsuit fear "the leading cause" of rising cesareans. Although C-sections might quell a physician’s legal fears, they are physically taxing for the patient and more expensive than vaginal deliveries. C-sections demand a longer recovery time and cost 49 percent more than a vaginal delivery. "Physicians are less risk-tolerant," said Dr. Michael Rosenberg, president of the Medical Society of the State of New York, "when a physician is forced to make clinical decisions influenced by the threat of lawsuits, they are not rendering the best medical care to their patients." » article

Fear of Lawsuits Drives up Testing, Costs
Trisha Torrety, Syracuse Post-Standard, February 3, 2009

Patients today rarely question their doctors decisions to order expensive tests or procedures. CTs, MRIs and other tests seem like routine measures to patients, but frequently they are unnecessary and extremely costly. Surveys have found that upwards of 90 percent of physicians admit to ordering extra tests to protect themselves from liability. "Yes, it seems that an eventual malpractice lawsuit is the impetus for ordering so many tests. The fear of lawyers and large settlements has created 'defensive medicine.'" Physicians pay tens of thousands of dollars each year in medical liability premiums even if they have never been sued. Those that are sued face huge sums in legal fees and reward amounts, thus they order extra tests to prove they took ever precaution in their diagnosis. The costs add up and eventually hurt patients, "either in next year's premium or in next year's taxes for Medicare or other government insurance programs. One estimate tells us that these unneeded tests are costing payers almost $130 billion per year. That is money coming out of our pockets." » article

Our Health-Care System is Broken
Dr. Jeff Hersh, Taunton Daily Gazette, January 19, 2009

The U.S. faces rising health care costs and mounting inefficiency while millions go without any health insurance at all. The system must be fixed. Dr. Hersh describes how the health care system wastes billions on administrative costs, overhead and expensive testing. Yet the quality of care is worse than in many countries. Medical liability is in part to blame for encouraging defensive medicine which is both extremely costly and potentially dangerous. "We have an opportunity to fix our health-care system. We need to completely redesign it, increasing efficiency and emphasizing data-driven ways to improve the health of our population," writes Dr. Hersh. » article

Primary Care Shortage Exists
Michael MacAuliffe, The Republican, January 4, 2009

In a pair of reports, the Massachusetts Medical Society (MMS) concluded the shortage of primary-care physicians is now at a "critical" level, several specialties are woefully undermanned and doctors are costing the health-care system more than a billion dollars a year as they seek to avoid being dragged into what the society calls a "dysfunctional" medical liability system. These MMS reports found that 85 percent of the nearly 850 doctors surveyed reported practicing defensive medicine—unnecessary imaging and lab tests, referrals, unnecessary hospital visits used to avoid liability exposure. The cost of defensive medicine amounted to $1.4 billion. Primary care physicians, who receive less compensation than specialists, are leaving the profession to make more money and avoid the paperwork. To bring new primary care physicians to the field, lower costs, and remove legal fear, requires reforming the expensive and unpredictable liability system. Dr. Alan C. Woodward, a past MMS president, calls the existing liability system “slow, inefficient, inequitable,” and must be replaced by a system that offers “fair and timely economic compensation” in the case of avoidable injury and that disputes be resolved through medication or arbitration. » article

Doctors Fear of Lawsuits Tied to Added Costs of $1.4b
Kay Lazar, Boston Globe, November 18, 2008

The Massachusetts Medical Society released a study which outlines the total costs related the fear of medical liability in Massachusetts. Doctors afraid of being sued frequently order unnecessary tests and procedures to protect themselves from liability - a practice that can become very costly. Eighty-three percent of physicians surveyed reported that they had practiced defensive medicine and an average of 18 to 28 percent of tests, procedures, referrals, and consultations, and 13 percent of hospitalizations, were ordered to avoid lawsuits. All told the extraneous costs add up to $1.4 billion in the state alone. "The current liability system is toxic to patient safety," says Mass. Med. Society President, Alan Woodward. Patients who undergo unneeded imaging tests, for example, may be exposed to extra risk from radiation and allergic reaction to contrast dyes, Woodward said. Moreover, 38 percent of physicians surveyed said they had reduced high risk procedures or stopped doing them altogether. Physicians are asking legislators to respond by creating early offer programs of compensation and other reforms to reduce defensive medicine. » article

Often, Preventative Medicine Means Warding Off Suits
Rachel K. Sobel, Philidelphia Inquirer, September 29, 2008

Dr. Rachel K. Sobel explains how treating patients while attempting to avoid litigation often results in diminished quality of care. As a medical student, Dr. Sobel learned to keep extensive notation of her meetings with patients, not to provide greater care, but to avoid lawsuits. Doctors must keep meticulous documentation for the possibility of future legal action. Dr. Sobel links these fears to a fact ingrained in medical school: “It’s not a matter of if you get sued but when.” In fact, only 3 percent of physicians will retire from a 35-year career without a claim. Medical mistakes, however, are not the main reason patients file malpractice suits. The majority of patients file suits because of poor communication with their physician. Dr. Sobel, therefore, encourages physicians to spend more time worrying about their patients and fostering a relationship of trust, as opposed to being preoccupied by the fear of litigation.

Defensive Medicine Gets Offensive
Benjamin Brewer, M.D., The Wall Street Journal, September 18, 2008

“Defensive medicine is part of the cost of doing business, and also, unfortunately, a large part of the unnecessary expense of health care,” explains New York physician Benjamin Brewer. Doctors “play defense” to protect themselves against malpractice lawsuits. Although ordering extra tests and consults put physicians at ease, they also expose patients to radiation and unnecessary procedures. Dr. Brewer conservatively estimates defensive medicine accounts for 10% of the waste in his practice. Beyond economic pain, malpractice fears dictate how physicians practice medicine. Many doctors turn away the sickest patients to avoid a potential lawsuit. » article

Not What the Doctor Ordered: Lawsuit Fears Drive Doctors to Play it Safe
Steve Eder, Toledo Blade, August 24, 2008

Both The American Medical Association and the Ohio Malpractice Commission believe Ohio is facing a malpractice crisis. Surveys have shown that over 90 percent of physicians admit to practicing defensive medicine—ordering unnecessary tests and procedures—in an effort to prevent lawsuits. Avoiding liability risk can mean extraneous medical tests and higher costs for patients. The costs of defensive medicine are difficult to gauge, but some estimates argue that it could be as much as $200 billion annually. Despite recent reforms, including capping damages, some Ohio doctors have relocated to states where their actions will not be dictated by fear of litigation and they can “just practice medicine.” Comprehensive liability reforms are needed such that injured patients are compensated, quality of care is improved, and physicians are able to maintain their practices. Health courts would offer just such a solution. » article

Massachusetts Doctors Challenge Liability Insurance Analysis
Amy Lynn Sorrel, AMNews, July 28, 2008

A recent study claims that Massachusetts physicians have seen a drop in liability insurance premiums since 1990, when prices are adjusted for inflation. Physicians believe the study considered limited criteria and that doctors in the state are dealing with some of the worst conditions in years. A recent article in Health Affairs found that malpractice awards in Massachusetts were fourth highest in the nation and the American Medical Association has said the state is in a crisis. The Massachusetts Medical Society believes the recent study did not account for a number of factors, including the affects of the threat of lawsuits, defensive medicine and the increased cost of living. The study did find that premiums had increased for certain high-risk specialists at a rate out of proportion with other physicians. The study authors recommended a series of reforms including programs to reduce errors and a no-fault compensation program. » article

Decrease Costs to Increase Care
Dwight K. Bartlett, Baltimore Sun, June 24, 2008

In a recent editorial, Dwight Bartlett describes how the problems facing health care today cannot be solved by simply covering every citizen. Bartlett points out that health care costs are staggering, and growing faster than the economy itself, and thus most people do not have insurance because it is simply too expensive. America currently spends 16 percent of its gross domestic product on health care, and yet 30 to 40 percent of that care is wasteful, unnecessary and potentially dangerous. Moreover, the threat of medical malpractice claims encourages doctors to practice "defensive medicine," spurring them to order costly tests and procedures that may not be medically necessary.

Malpractice Premiums, Rate of C-Sections Rise Together
Kathleen Doheny, Washington Post, May 5, 2008

The rate of Caesarean sections and medical malpractice premiums have risen concurrently, according to new research findings. The study, based on data from the University of Connecticut, provides a glimpse of the association between litigation and obstetrics care. “I can’t say one led to the other or vice-versa,” said Dr. Jeffrey Spencer, author of the study. But he speculates that the cost of malpractice insurance is driving up C-section rates. “The theory is, doctors are practicing more defensive medicine. Maybe doctors are fearful of litigation,” he added, perhaps likely to perform a C-section at the first indication of any potential problems. C-sections accounted for a record 30 percent of all deliveries in 2005, according to the U.S. Centers for Disease Control and Prevention. “These two papers do nothing more than substantiate what we already know,” said Dr. Marsden Wagner, a former director at the World Health Organization. One of the driving factors behind what Wagner refers to as the “scandalous” rate of C-sections is that “doctors are afraid of litigation.” » article

Price is High for Preventing Medical Lawsuits
Alexander Strasser, Democrat and Chronicle, March 21, 2008

In this editorial, Dr. Alexander Strasser, a New York internist, describes one of the negative effects the current legal system has had on health care. The omnipresent threat of a lawsuit has forced doctors to practice “defensive medicine” – the ordering of unnecessary tests and procedures out of legal fear. In particular, radiologists have become vague in their reports out of fear of being sued. This often leads to overuse of diagnostic procedures such as CT scans, which are “not medically indicated, but legally necessary.” When medically necessary, further testing should be done. “But who decides what is medically indicated?” asks the author. “Is it the insurance company, the malpractice attorney or the attending physician?” Because of the current system, doctors have left New York or are refusing to settle there in the first place. Legal reform is necessary, because the “price for this [current system] is too high and one that society cannot afford.”

Many Doctors, Many Tests, No Rhyme or Reason
Dr. Sandeep Jundahar, New York Times, March 11, 2008

“I recently took care of a 50-year-old man who had been admitted to the hospital short of breath. During his month long stay he was seen by a hematologist, an endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a nutritionist, a general surgeon, a thoracic surgeon and a pain specialist.” So begins an article by a New York cardiologist about the problems associated with over testing. The 50-year-old patient underwent a total of 12 procedures, including a pacemaker implantation and a bone-marrow biopsy, and when he was discharged, follow-up appointments were scheduled with seven specialists. This case is not atypical in America’s health care system, “where doctors are paid piecework for their services, [and] if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur.” Overutilization is caused by many factors such as doctors trying to avoid lawsuits (i.e., “defensive medicine”). While precise data is lacking, the overuse of medical services likely cost hundreds of billions of dollars last year – a huge portion of the approximately $2 trillion that Americans spent on health care. And “[a]re we getting our money’s worth?” asks Dr. Jauhar. “Not according to the usual measures of public health. The United States ranks 45th in life expectancy, behind Bosnia and Jordan; near last, compared with other developed countries, in infant mortality; and in last place...among major industrialized countries in health care quality, access and efficiency.” » article

Broken Legal System Chasing Doctors Away
Carlos Muhletaler, South Florida Sun-Sentinel, February 26, 2008

A representative from Florida Stop Lawsuit Abuse describes how the current medical malpractice system is ineffective and expensive for all patients, not just those who have experienced medical injury. Physicians, fearful of liability, practice costly defensive medicine and those costs are passed on to the consumers. In Florida, the "three strikes" law - in which physicians' licenses are revoked after three malpractice verdicts - has discouraged doctors from practicing in the state or entering high risk specialty fields. The medical society predicts a 65% shortage of on-call neurosurgeons by 2011. In one doctor's words, "This [law] opened the door to every bogus lawsuit possible. With the sense that we all had bulls-eyes on our back, we left." The author urges common sense liability reform that encourages and protects patient safety, while attracting physicians. Health courts would have significant linkages to patient safety mechanisms and would encourage consistent and fair liability decisions.

Besieged by Scourge of Medical 'Malpractice'
John Maxfield, Naples Daily News, February 16, 2008

In this editorial, an emergency physician in Ohio describes the current affliction of defensive medicine (unnecessary medical tests stemming from legal fear). “Why not obtain a CT scan on every patient with back pain or, for that matter, perform every test known to medical science on every patient who is ill? After all, peoples’ lives are at stake,” questions the doctor. There are two main reasons, he explains. First, many medical tests are inaccurate to at least some degree. Furthermore, a test that comes back positive often leads to additional testing. These tests and procedures are sometimes invasive and many carry the potential for dangerous complications or side effects. Because of this, “the search for extremely unlikely diagnoses would kill more patients than would missing those diagnoses,” writes the author. Dartmouth University researchers have shown that “more care is often worse care.” The second major reason is the sheer cost of defensive medicine. We must choose where to spend our money, and if we spend it on frivolous tests, we will need to decrease spending in other areas (e.g., national defense and public education). “[S]ome of my younger colleagues, paralyzed by the fear of being sued, regularly spend $2,000 to diagnose a cold,” notes the writer. Our nation has to make a choice when it comes to our medical malpractice system, “[a] chance for good and efficient medical care for the many or a stacked lottery for the few.” » article

Medical Testing, Dealing with Uncertainty
Joe Pellicer, The Olympian, January 28, 2008

One physician describes how the fear of liability is affecting the way doctors practice medicine. Many patients believe more testing leads to better care, and physicians have responded by ordering up expensive tests to satisfy patients and protect themselves from liability claims. Medicine is not always an exact science and there is always the possibility that a diagnosis is wrong, despite all the symptoms or tests. Physicians now rely heavily on testing and defensive medicine has become a costly and ubiquitous feature in the field.

Health Courts

The Role of Medical Liability Reform in Federal Health Care Reform
Michelle M. Mello and Troyen A. Brennan, New England Journal of Medicine, June 15, 2009

Reform Health Care Now: The Malpractice Liability Crisis Persists
Dr. Russell Turk, Daily Finance, June 12, 2009

Malpractice Laws Should Focus on Patients
Edward Dauer and Judith Ham, Denver Post, May 26, 2009

Common Good Colorado board members Edward Dauer and Judith Ham write in the Denver Post that the “perennial sport” of debating the size of malpractice award caps – which recently took place in Colorado’s General Assembly – “is a waste of time, words and political energy.” “More importantly,” they continue, “it is a lost opportunity to accomplish something meaningful for the people whose interests ought to count the most: the patients.” What patients need, they argue, is a medical liability system that not only fairly and efficiently compensates them for injuries and losses, but one that improves patient safety as well – things our current fault-based tort system doesn’t do, nor higher award caps would improve. On the issue of patient safety in particular, Dauer and Ham explain: “Increasing doctors' liability does not produce safer health care. In fact, it impedes in numerous ways health care's own efforts to make itself better. A fault-based, punitive environment causes error to be denied rather than addressed; drives hospitals and physicians to argue only that they were right, rather than to examine openly how they might have done better; and inhibits information about ‘near misses’ from being collected, analyzed, and turned into useful lessons.” They call for demonstration projects to test alternative liability systems. » article

The Great Health Care Reform Debate
Jake Tapper, ABC News, May 15, 2009

The president-elect of the American Medical Association, Dr. James Rohack, spoke with ABC's Jake Tapper about the need for medical liability protection as part of broad health care reform efforts. President Obama's administration has been clear in its intentions to reduce waste and excess spending in the health care system, particularly by realigning incentives amongst physicians and insurers to encourage savings and value. One way to achieve efficiency is through offering physicians liability protection to discourage them from practicing defensive medicine. "What we asked the president is that if we as physicians are willing to tackle the issue of looking at variation of care and reducing unnecessary tests, we also have to have protection in the courtroom," Rohack said, that "if we didn't order a test, that we subsequently aren't going to get sued because we didn't order that test that shouldn't have been done in the first place." Rohack went on to note that patients who are injured through medical care should not be prevented from seeking compensation. "So this is not a prevention of being in the court system. This is also looking at again alternatives to the liability system, perhaps there is a dispute resolution, there is a health court, there are expert witness guidelines." » article

Obama Plan May Give Doctors Leverage to Press for Liability Protection
Dave Michaels, Dallas Morning News, May 12, 2009

Dave Michaels of the Dallas Morning News reports that renewed efforts in Washington and among industry leaders to reduce the cost of health care – which is estimated to rise at more than three times the rate of inflation over the next ten years – could provide doctors with leverage to press for liability reform. He writes: “With the Obama administration needing cooperation from doctors to drive down health costs, the physicians’ lobby may have leverage to secure enhanced liability protection. Physicians say they must often carry out duplicative tests and unnecessary procedures because they worry about lawsuits over their decisions.” Michaels quotes Dr. J. James Rohack, president-elect of the American Medical Association, who states: “‘If we can have additional liability protection in the courtroom against not doing something that we feel doesn’t need to be done, then we can achieve even more bending of the curve ….’” Dr. Rohack goes on to cite special health courts as a possible reform solution. » article

AMA Letter Backs Obama’s Broad Principles for Health System Reform
Chris Silva, AMNews, April 27, 2009

In a letter to the White House earlier this month, the American Medical Association further fleshed out eight guiding principles it will push for in this year's landmark health system reform debate. The AMA’s suggested reforms are widespread, ranging from premium subsidies for low-income individuals to medical liability reform. The AMA suggests easing the effect of liability pressure on the practice of defensive medicine through innovative approaches, such as health courts, early disclosure and compensation programs, and expert witness qualification standards. AMA President Dr. Nancy Nielsen said she is encouraged by the progress already made in talks about Medicare physician payment reform, and is confident that these eight principles will receive thoughtful consideration by lawmakers. » article

Now is the Time for Medical Malpractice Reform
Alan Miller, CNBC, April 22, 2009

Alan Miller discusses the need for meaningful national medical liability reform that will reduce costs and improve access for patients. Long seen as a partisan issue, Miller notes that a few influential Democratic Senators - Wyden and Baucus - have signaled the need for reform. Miller particularly discusses how states that enacted reforms are seeing lower costs and an influx of physicians while their numbers continue to struggle to maintain adequate numbers of doctors. The new administration has made clear its intentions to overhaul the health care system, and have further suggested that medical liability reform will need to be part of the package. Both Senators Wyden and Baucus agree - with Senator Baucus proposing health court pilot projects. "I think it's essential for there to be enduring reform, reform that will stick and will get a significant bipartisan vote in the United States Senate," Wyden said. » article

Health Courts, and How They Can Save Our Health Care System
Dr. Kevin Pho, KevinMD Weblog, April 9, 2009

Dr. Kevin Pho, a primary care doctor concerned with reforming America’s health care system, believes health courts could save the country’s ailing health care system. He references Common Good Chair Philip K. Howard’s recent op-ed in the New York Times to convey the inefficiencies in the current medical liability system. Howard cites the landmark study by the New England Journal of Medicine finding that in 25 percent of medical malpractice payments there was no identifiable error. The study also found that 54 cents of every dollar paid in malpractice cases goes to administrative expenses (lawyers, experts, and courts). Dr. Pho is confident that health courts would bring down litigation costs and provide proper compensation. Alternative forms of dispute resolution, including health courts, as well as no-fault malpractice insurance and mediation, are better than the inefficient system currently in place, says Pho. » article

Health Debate Could Spur Malpractice Changes
Erica Werner, Associated Press, March 17, 2009

The Obama administration and key congressional Democrats say something must be done to curb medical malpractice costs to help pay for revamping the nation's $2.4 trillion health system. John McDonough, a top health adviser to Sen. Edward Kennedy, D-Mass., told a conference of urologists this week that tort reform will not solve the problem: "The solution in terms of medical malpractice is not putting arbitrary caps on pain and suffering that discriminate against lower-income folks.” Other reforms must be considered, such as Common Good’s health court proposal, endorsed by Senate Finance Committee Chairman Max Baucus, and alternative dispute resolution, which would allow patients to learn of medical errors and establish negotiated compensation with the offer of an apology. Whatever shape reform takes, Rep. Rob Andrews, D-N.J., who chairs an Education and Labor health subcommittee, is confident that liability issues will be considered "It's hard for me to imagine a result that gets to the president's desk that doesn't deal with the medical malpractice issue in some way." » article

Docs Need Malpractice Relief
The Threat of Lawsuits is Crushing New York Hospitals
Dr. Lee Goldman & Dr. Herbert Pardes, New York Daily News, February 28, 2009

Two physicians in New York argue that medical liability reform is crucial step in controlling costs and maintaining access to care for patients in and around Manhattan. Ob-gyns in particular face staggering premiums, forcing them to retire, cut obstetrics services or leave the state. One Brooklyn hospital has already announced it can no longer afford to provide maternity care. With Medicaid cuts almost certain, easing the financial pressure for doctors and hospitals through liability reform is essential. The authors argue that there are numerous ways to improve the current system, including switching to a no-fault model or implementing health courts. Moreover, allowing for apologies, early offers of compensation and improving the informed consent process could reduce lawsuits and improve doctor-patient relationships. "Whichever model we move to, we need to start a serious debate right now. The status quo is terrible for doctors - and increasingly dangerous to patients." » article

Obama Has Good Idea: A Bipartisan Health Summit
Mort Kondracke, Real Clear Politics, February 27, 2009

The stimulus package included money for both electronic medical records and comparative effectiveness research, setting off a wave of arguments and accusations amongst politicians on both sides of the aisle. Obama has made health care reform a priority and will host a bi-partisan summit that will allow both sides to air their views and hopefully encourage lawmakers and lobbyists to work together rather than point fingers. David Kendall, of the Progressive Policy Institute, argues that health care reform is essential and can be financed in large part by combating the waste rampant in our current system. He proposes creating a body to review and approve medical standards, coordinating care and establishing health courts to review medical liability claims. "The scale of waste is shocking," says Kendall. » article

After Wall St.: Radical RX for New York
John Faso, NY Post, February 13, 2009

In 2007, New York’s financial-services industry produced 20 percent of state revenue. With Wall Street currently in decline, New York State is facing a major economic downturn. The only rational response, says John Faso, the New York GOP candidate for governor in 2006, is to cut costs in other sectors. He cites eight cost-cutting measures, including lowering health care costs for doctors, hospitals and consumers. Among his suggestions for the health sector, Faso supports eliminating hidden state taxes on health insurance, letting publicly held for-profit companies run hospitals, providing patients with more information about their health care providers, and allowing for more competition among insurers. When addressing the expensive medical liability system, Faso cites Common Good’s health courts initiative to settle malpractice disputes. Health courts would not only provide more consistent rulings, they would also lead to lower legal costs. Delaying needed reform, says Faso, “will inevitably bring further decay and the exodus of our most productive citizens. The time to act is now.” » article

The Doctor is Out
Paul Howard, Forbes, January 2, 2009

Manhattan Institute fellow Paul Howard discusses the nation's health care dilemma. Primary care physicians are leaving the field while health care reformers make plans to expand the demands on the already strained population of primary care doctors. With the prospect of universal coverage, more primary care physicians will be needed to address the needs of a new influx of patients requiring regular care and chronic disease treatment. Yet a recent survey found that 50 percent of primary care doctors plan to reduce the number of patients they see or leave the field within the next three years. Moreover, only 2 percent of medical school graduates plan to pursue the field. Howard offers numerous solutions for improving the state of primary care including: changing the reimbursement structure to reward quality and time spent with patients; offering tax incentives for individual insurance; and expanding the use of retail clinics. Howard also notes the need for medical liability reform as part of the broad policy efforts to help reduce legal fears and limit the practice of defensive medicine. "Reducing litigation--through special medical courts or arbitration--would lower malpractice insurance premiums, increase doctors' take-home pay and improve their ability to offer quality health care to their patients." » article

Lawyers' Bills Pile High, Driving up Health Care Costs
Editorial, USA Today, December 29, 2008

This editorial from the USA Today notes the pervasive and growing trend of physicians practicing defensive medicine to protect themselves from being sued. A recent study in Massachusetts found that more than 80% of physicians admit to practicing defensive medicine. The practice points to a larger problem where physicians are altering their practices, cutting services or leaving the profession to avoid medical liability troubles. "These defensive actions carry a cost beyond money. Many small communities end up with little or no access to top-level care. Patients exposed to unnecessary imaging tests face the risk of radiation exposure and allergic reactions. Many surgical procedures, such as caesarean sections and breast biopsies, have increased because of the fear of being sued, the study found....Change obviously is needed..." The editorial discusses several alternatives, particularly creating pilot projects to test specialized health courts or expanded use of arbitration and mediation in resolving claims. Health courts in particular could reduce both legal fear and medical errors through improved linkages to patient safety. » article

Malpractice Reform Needed in State
Edward J. Volpintesta, M.D., The New-Times, November 18, 2008

Dr. Edward J. Volpintesta, a family practitioner from Connecticut, expresses his frustration with the medical liability system and calls for a system of health courts. Medical malpractice cases often worsen the pain and confusion of victims and result in a loss of confidence in the health system. Health courts, however, Dr. Volpintesta explains, “compensate families rapidly and reasonably, minimize finger-pointing, and promote humane and sympathetic communication.” He stresses that health courts are not meant to lessen accountability, but rather they prevent turning “a lamentable situation into a legal battleground.”

Durbin, Doctor Vie for U.S. Senate
Associated Press, Lake County News-Sun, October 27, 2008

Dr. Steve Sauerberg is offering a new agenda to voters in Chicago, asking them to elect him over two-term incumbent Senator Dick Durbin. Sauerberg is the Republican candidate who believes he offers an outsider's perspective on Washington that would help bring about needed change. Sauerberg is a family practice physician who sees health care as a major challenge facing the country. He believes government will need to control costs, in part by creating separate health courts to handle medical liability cases. Health courts would help to provide quick and consistent remedies to medical malpractice cases while lowering overall systems costs.

Advancing Health Care
R. Bruce Josten, Politico, October 20, 2008

R. Bruce Josten, executive vice president for Government Affairs at the U.S. Chamber of Commerce, believes the health care system is inefficient, too expensive, and places too much focus on treatment as opposed to prevention. Although these faults are daunting, a systematic approach can remedy American health care. In addition to wellness and prevention programs, and health information technology, Josten cites Common Good’s health courts as a way to provide higher quality care. Josten and Common Good support implementing health courts as a way to combat the wasteful spending caused by defensive medicine and eradicate legal fear from the practice of medicine. According to Josten, specialized health courts would “remove medical malpractice claims from the tort system.” » article

Safer Care Means Fewer Lawsuits
PPI Health Policy Wire, October 16, 2008

The Progressive Policy Institute believes that medical mistakes in hospitals represent the faults of the health care system. “The problem,” PPI states, “is that providers see lawsuits as random acts of violence against them rather than as a symptom of a broken safety system.” Because only 2 percent of injured patients actually file malpractice suits, doctors and hospitals find it hard to determine how to prevent injuries and provide better care. PPI believes health courts, which “deliver fair and reliable justice,” will transform American heath care. Similar to workers compensation, health courts would handle routine cases administratively with only non-routine cases going to full trial. Health Courts would introduce a predictable legal system for both patients and providers. Predictability will allow providers to assess their actions and detect errors, which will result in better patient care. » article

Colorado Senate Debate
Denver Post, October 8, 2008

At a recent debate between candidates for Colorado’s open U.S. Senate seat, Bob Schaffer made a case for health courts. As part of his affirmative response to the question of “whether the nation’s health care system needs comprehensive reform,” Schaffer argued: “We ought to establish around the country specialized health courts so that we could expedite legitimate claims against health providers and others in a way that maintains consistency and predictability throughout the country.”

AMA President Says N.Y. Needs More Primary Care Physicians
E.B. Solomont, New York Sun, July 14, 2008

Physicians across the country are struggling to maintain their practices. Dr. Nancy Nielsen, the president of the American Medical Association, describes how major changes are needed in health care from the way health insurance is structured to the way physicians are compensated. A practicing physician in Buffalo, Nielsen points to the need for more primary care physicians in New York, and around the country. She discusses how New York physicians are headed for a serious conflict as liability rates are set to increase unless Governor Patterson commits to making reform a priority. "We've had a medical liability crisis in New York for a long, long time, and when I say crisis, it has led people to leave their practice before they otherwise would have," says Nielsen. "There are many alternative approaches that have been suggested, such as medical courts, because people who are injured deserve to be compensated." » article

Make Health Courts Central to Medical Reform
William Reider, South Florida Sun-Sentinel, April 7, 2008

“[ Florida] will continue to drive away the best and brightest [doctors] from considering practicing,” quotes this editorial addressing the state’s critical medical malpractice situation. Physicians are leaving Florida at an “alarming rate,” due much in part to skyrocketing malpractice insurance premiums. Further complicating the situation is the practice of defensive medicine, which is the over utilization of tests out of a fear of lawsuits. Health courts could be the solution, and the proposal has been supported by experts at the Harvard School of Public Health, the Robert Wood Johnson Foundation, and the Progressive Policy Institute. Moreover, AARP has called for health court pilot projects. Such a system could utilize special judges with health care expertise and neutral medical experts to achieve more reliable verdicts. “The health courts concept has been around for many years,” writes the author. “The time has come for our legislators to consider this reform.”

Conference Looks at Ways to Reduce Medical Errors, Boost Openness
Allison Rupp, Billings Gazette, April 4, 2008

This recent article highlights a conference in Laramie, Wyoming cosponsored by Common Good and the University of Wyoming. The keynote speaker, past president of the Joint Commission Dr. Dennis O’Leary, described how medical errors continue to be a serious challenge facing providers and administrators. Speakers from across the country, in many fields of expertise, discussed ways to improve patient safety and reduce errors through both medical and legal programs. While some advocates noted the need for transparency and disclosure, others noted that the current legal system discourages those very practices. Moreover, the legal system links compensation with provider accountability, according to Ed Dauer of Common Good Colorado. "A patient can't get compensation if the doctor doesn't lose," said Dauer, who is currently president of the Colorado branch of Common Good, a bipartisan legal and health care reform coalition. "It creates an adversarial posture." Common Good General Counsel, Paul Barringer, suggested voluntary compensation pilot projects which would take medical malpractice claims out of the court system for faster, more equitable resolution with robust linkages to patient safety. » article » more coverage of the Wyoming event

New Zealand's Approach Points the Way on Medical Liability
Senator Bob Hagedorn, Rocky Mountain News, March 22, 2008

In this article, Senator Hagedorn, chairman of the Colorado Senate Health and Human Services Committee, outlines some of the failings of the current legal system and suggests an alternative that warrants attention – New Zealand’s health court system. The current “lawsuit-based status quo” has a number of critical shortcomings: it does a poor job of preventing future medical errors; it is terribly inefficient – it “wastes huge amounts of money,” which could be used to meet the “medical needs of uninsured working families”; it undermines the physician-patient relationship; and it limits access to care, as doctors avoid high-risk services like obstetrics. There is a better way to run the U.S. medical liability system, and one needs only to look at New Zealand to find a promising approach. In New Zealand, patient compensation is accomplished via a system very similar to health courts. Injured patients are compensated without being forced to show that their doctor was at fault, and physicians are still held accountable through a range of disciplinary mechanisms. Importantly, “emphasis is made...on learning from mistakes and improving the system so errors won’t be repeated.” Colorado “should aspire to move beyond the current medical liability dynamic,” writes Senator Hagedorn, “[and] toward a system that protects and compensates patients, targets the reduction of mistakes and accidents, restrains costs and doesn’t declare open season on physicians.” » article

Doctors Rally for a Remedy
James Odato and Cathleen Crowley, Albany Times-Union, March 5, 2008

Around 1,500 doctors recently went to Albany to call for a fix to New York’s exorbitant medical liability insurance rates. The members of the Medical Society of the State of New York applauded the Governor and Senate leader for their commitment to find solutions to the crisis. "We will alleviate the pain; that is the pledge I make to you," announced Governor Spitzer. Among proposals recommended by the Medical Society to remedy the current liability climate are the creation of a "no-fault compensation fund for babies who suffer neurological injuries at birth" and the formation of "medical courts." » article

New York Must Fix Malpractice Insurance Problem
Editorial, Newsday, March 4, 2008

New York’s medical liability climate needs immediate attention. Physicians are currently marching on Albany in an attempt to seek relief from sky-rocketing malpractice insurance premiums, which can reach as high as $177,880 per year for a Long Island obstetrician. According to this editorialist, however, the common proposal to fix the crisis (caps on non-economic damages in lawsuits) is probably not the best solution. “With a 14 percent jump in premiums this year and the specter of more to come, officials must move past the stalemate over caps. What’s the alternative?” questions the author. Among the “ideas worth exploring” are proposals to establish “specialized medical malpractice courts” (or health courts) and a no-fault system, especially for cases involving injured infants. Governor Spitzer’s malpractice task force should look to alternative ideas when it issues its report next month. “Clearly, something’s got to give,” the writer states. “Otherwise physicians will leave the state and patients will have a hard time finding doctors - and not just for one day.”

Malpractice Crisis Looms for Area MDs
George Wallace, Suffolk Life, February 20, 2008

Despite recent hikes in liability costs this year, doctors in Suffolk County fear that they may suffer another financial blow this year. Physicians could be struck with a $50,000 surcharge, and another 10% to 15% increase in medical liability premiums this year and in succeeding years. According to Dr. Erika Jurasits, of Mather Hospital, this is causing a disaster: “Thirty primary care physicians have already left this community, either leaving medicine all together or retiring early.” Dr. David Kirshy, president of the Suffolk County Medical Society noted, “OB-GYNs in this area have stated that they can’t afford any more increases. They’ll just have to stop delivering babies altogether. That’s not a threat; they’re just stating facts.” Among the reform proposals being considered to fix this crisis are plans for “medical courts” and an “impaired newborn compensation program.” Medical courts would utilize specialized judges and experts to review cases and increase overall efficiency. A compensation program for babies with birth injuries would pay claims for perinatal neurological impairment issues. According to Senator Flanagan, “[a] long-term solution needs to be vetted and implemented sometime this year. We are definitely in a crisis right now, and I don’t think we have a choice. This resembles a pressure cooker – it’s been building up over time and when it blows, it’s not going to be pretty.”

The Elusive Prescription for Health Care we can Afford
Dr. Sidney Goldfarb, Wall Street Journal, February 4, 2008

There are many factors driving the high cost of national health care, and this letter to the editor discusses how defensive medicine and expensive malpractice lawsuits are contributing to the national problem. Some estimates say defensive medicine is responsible for 20-25% of the nation’s health care spending. In addition, high-priced expert witnesses in malpractice trials add enormous cost to the litigation process. This author supports the creation of health courts to keep costs down, while improving efficiency and patient safety. » article

Why Health Courts Could Pick Up Steam
Leslie Kane, Medical Economics, January 4, 2008

An editorial in Medical Economics discusses how health courts offer a promising solution to the medical liability problem. Though health courts provide benefits for consumers and physicians, legislation has been unable to move beyond the initial stages. Yet health courts offer real solutions to improving patient safety, improving error reporting and catalyzing quality improvement measures - changes which would benefit every health care consumer. Common Good's Paul Barringer notes that public interest is growing through the organization's advocacy efforts. » article

Health Care Costs and Malpractice Reform
David Kendall, American Interest, January 1, 2008

David Kendall's memorandum to the 2008 presidential candidates describes the need for dramatic medical liability reform. Kendall discusses how the use of specialized health courts dedicated to resolving medical injury disputes can lower liability costs and create consistency. Such a system would motivate medical professionals to back more sweeping health care reforms for the insurance system. » article

Health Court Benefits Discussed by Experts
Sharon Fain, Wyoming Tribune-Eagle, October 16, 2007

Over 100 health care providers, academics, attorneys, patient safety experts and policymakers met in Cheyenne, WY last week to discuss alternatives to the medical liability system. Common Good, in coordination with the Wyoming Healthcare Commission, hosted the event which focused on emphasizing patient safety in medical malpractice. Several presenters discussed new approaches and recent research. Panelists from the Wyoming area discussed the proposal in terms of local needs. "Our current medical litigation system is broken. It doesn't work well for patients and doesn't work well for doctors,” said Wyoming Senator Mike Enzi in a statement. “What we need is a system that delivers quick and fair compensation to injured patients while providing consistent and reliable results so doctors can eliminate the practice of defensive medicine and learn from medical errors." » article, » Read more about the Wyoming forum

Give Health Courts a Fair Shake
Mark Crane, The American, August 20, 2007

Health courts “might be the cure to alleviate the pain suffered by all sides in our present highly dysfunctional system,” advises Mike Crane of the American. In malpractice cases, jurors hear testimony from “dueling expert witnesses” – hired professionals who favor one party’s version of events and can have tremendous influence over a jury. The author writes that “too much compensation is awarded to some injured patients and little or none to others.” Patient safety is at risk too: pervasive legal fear quiets doctors from reporting and discussing errors. Fixing the medical legal system could reduce defensive medicine, thereby lowering costs while improving patient safety by discouraging risky and unnecessary procedures. Health courts could provide the opportunity for faster and more just compensation for deserving patients. » article

Congress to Weigh Health Courts
Olga Pierce, United Press International, May 24, 2007

Citing the introduction of the Fair and Reliable Medical Justice Act by Sens. Michael Enzi (R-WY) and Max Baucus (D-MT) and Reps. Jim Cooper (D-TN) and Mac Thorberry (R-TX), United Press International reports that “[t]he medical tort reform debate has not been fertile ground for compromise, but the sponsors of a bipartisan bill introduced today say they may have found a way out of the impasse.” The bill would award grants to 10 states to develop special health court pilot projects. According to the sponsors, the bills’ limited scope and the fact that it encourages state experimentation should make it easier to build a consensus behind this new alternative to traditional tort reforms. “Health courts are also an idea that creates a lot of consensus,” said Sen. Enzi, ranking member of the Senate Health, Education, Labor and Pensions Committee. “The idea was chosen for state grants ‘because it hasn't been politicized by Congress,’ Enzi said.” » article

More media coverage

End the Blame and Shame Game
Paul Barringer and Edward Dauer, Modern Healthcare, May 21, 2007

In a recent Modern Healthcare opinion piece, Common Good General Counsel Paul Barringer and Common Good Colorado President Ed Dauer discuss how the current medical liability system undermines patient safety. Notably “the ‘blame and shame’ approach of litigation inhibits learning and the collection of information about errors that would be most useful to avoiding harm in the future.” “Physicians’ justifiable fear of the legal system inhibits open communication about errors, reinforcing a culture of nondisclosure and noncollaboration in efforts at improvement. In all of this, what should be the principal objectives of the law are lost: fair and effective compensation, predictable standards for medical practitioners, accountability for hurtful incompetence, and the wise use of today’s mishap in order to prevent tomorrow’s.” Barringer and Dauer underscore the need for fundamental change, not simply tort reform of the usual kind. The administrative health court model developed by Common Good and researchers at the Harvard School of Public Health is one novel alternative that would be eligible for federal grants under a new bipartisan bill before the U.S. Senate.

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Health Courts – Promoting Reliable Medical Justice
Paul Barringer III and Sarah Samis, Health Insurance Underwriter, October 2006

In the latest issue of Health Insurance Underwriter, Common Good makes the case that health courts are the right prescription for America’s ailing medical liability system. As Paul Barringer and Sarah Samis relate, the current system “works poorly for consumers and health care providers.” It is slow, costly, and inefficient, and does a poor “job of distinguishing between negligent and non-negligent care.” Moreover, its “unreliable and inconsistent verdicts,” in addition to undermining patient safety and health care quality by “sending [providers] unclear signals about the appropriate standard of care,” promote “a culture of silence in medicine, in which providers are afraid to share information about mistakes and near misses.” Health courts, on the other hand – with their administrative approach, trained judges, neutral experts, “avoidability standard of liability,” compensation schedules, and “strong linkages to patient-safety structures” – are designed to “efficiently compensate[ ] injured patients, clarif[y] the standard of care for providers, and support[ ] quality-of-care enhancements.” Support for health courts, Barringer and Samis conclude, is both growing and broadening across party lines and among health care policymakers. They write: “Transformative system changes do not happen overnight. However, the chances are strong that a pilot project can be enacted to begin to test the feasibility of the health court concept. With public support and legislative leadership, health courts – a promising approach to medical justice – can become a reality.”

Interview: An 'Awful' Tort System, AMA
Laura Gilcrest, United Press International, September 1, 2006

In a recent interview, American Medical Association President William Plested, III underscored the need for comprehensive reform of our current medical justice system and endorsed health courts as “a very attractive alternative.” Our current system, Dr. Plested argues, is “not a system of justice,” but rather a “contest” between lawyers. While he believes that damage award caps can help stabilize malpractice insurance rates, he acknowledges that “the system’s fundamental flaw” is that it “focuses on poor outcomes, [and] not how those outcomes happened.” He explains: “A bad outcome is not necessarily negligence. You can do the very best you can and have the very best training and still have a bad outcome, the system puts you at risk for that. Are we trying to give away money to people who have things happen to them, or are we trying to weed out negligence in care?”

Health Courts: The Debate Continues
Progressive Policy Institute, PPI Health Policy Wire, August 10, 2006

In its most recent Health Policy Wire, the Progressive Policy Institute again endorses health courts as a one way “to make medical justice less bureaucratic and more responsive to injured patients.” In response to Duke law professor Neil Vidmar’s defense of the current system, whose large contingency fees, he argues, are based “on the need for lawyers to deal with the slow, intensive nature of malpractice cases,” PPI writes: “The resulting acrimony and lengthy legal wrangling are exactly what's wrong with the current medical justice system. In contrast, a health court would authorize an investigation by a neutral third party. Patients would get answers and compensation more quickly. Responsiveness to patients is also important in helping send clear signals back to doctors about preventing injuries.” article »

DLC Designates Health Courts A Model Initiative
July 21, 2006

The Democratic Leadership Council has designated health courts one of its model initiatives in its 2006 Playbook of innovative policy proposals. Recommending health courts as “a true cure: fair and reliable compensation for patients injured by medical mistakes and clear legal signals for doctors and hospitals to help them prevent mistakes,” the DLC outlines several steps states can take to implement the key elements of the health court concept within their current systems.

Another Way on MedMal?
Mary Agnes Carey, CQ HealthBeat, July 13, 2006

Witnesses at a recent hearing held before the U.S. House Committee on Energy and Commerce “said the current medical malpractice system helps few of the patients it is intended to serve, does little to encourage providers to disclose medical errors and has created an environment of ‘defensive medicine’ where physicians and other health care providers order extra tests and procedures, which in turn drive up health care costs,” reports Congressional Quarterly’s HealthBeat. Harvard School of Public Health Associate Professor Michelle M. Mello testified that “‘[her] work has led [her] to conclude that our medical liability system is in need of significant reform and that the conventional array of tort reform options will not get us where we need to be. Farther-reaching changes are required.’” One such non-conventional option discussed at the hearing was Common Good’s proposal for special health courts. Testifying before the committee, Common Good General Counsel Paul Barringer related that “such courts would rely on the standard of ‘avoidability,’” a standard which is broader – i.e., would compensate more people – than the current negligence standard.

Beyond Medical Tort Caps
Laura Gilcrest, UPI, July 13, 2006

Reporting on the hearing before the U.S. House Committee on Energy and Commerce on proposed reforms to our medical malpractice system, Laura Gilcrest of United Press International notes that “lawmakers agreed Thursday [July 13th] that the status quo isn’t working and the ultimate losers are the patients.” One of the proposals garnering the most attention at the hearing was Common Good’s health court proposal. Michelle Mello, a professor of health policy and law at Harvard University, told the committee that “[h]ealth courts would shift the medical liability system from one based on negligence – which breeds fear and stigma – to one focused on preventability.” She added that health courts, which would seek to compensate more injured people, more efficiently, “could be tested at the state level – and backed by federal dollars – through a series of pilot projects ‘at low cost and low risk.’”

Hospitals Press for Solutions to Rising Liability Costs
Lucy Ament, AHA News Now, July 10, 2006

AHA News reports that the “Reliable Medical Justice Act” (S. 1337), sponsored by Senators Enzi (R-WY) and Baucus (D-MT), which could lead to funding of health court pilot projects, incorporates a number of concepts being explored by the American Hospital Association’s Task Force on Liability Reform. Notably, the task force is currently examining the merits of an administrative compensation system, according to Steven Summer, president and CEO of the West Virginia Hospital Association and chair of the AHA task force. “‘The idea would be to take the case out of the current judicial system and move it through some administrative process with a history of dealing with the health care field,’” Summer told AHA News. Of Johns Hopkins Medicine’s support for the health court concept, AHA News quotes Joanne Pollak, vice president and general counsel for the hospital, as saying: “‘The severity of cases is going up, and we’re concerned that a good chunk of what is being spent on malpractice recoveries goes into lawyers’ fees … . A health court would cap legal fees at a certain percentage, and would also quickly try to compensate people fairly for the injuries they’ve sustained.’” Johns Hopkins is one of six hospitals and academic medical centers that have expressed interest in participating in health court pilot projects.

Analysis: See You in Health Court?
Olga Pierce, UPI, July 7, 2006

In keeping with the creation of specialized courts to handle other types of complicated disputes, such as bankruptcy and labor disputes, “a growing chorus of voices is calling for the establishment of a health court with jurisdiction over medical malpractice cases,” reports United Press International. Focusing on Common Good’s efforts in developing and promoting the health court concept, UPI Health Business Correspondent Olga Pierce relates Common Good Chair Philip K. Howard’s view that “‘[h]ealthcare is suffering a kind of nervous breakdown’” and that was is needed to fix it is “‘a system of justice reliable enough to uphold choices about what’s good care.’” Pierce goes on to quote Common Good General Counsel Paul Barringer as saying that, while one goal of health courts is “‘to make justice more reliable,’” their “‘goal is to improve the practice of medicine’” as well.

It's Time for Special Health Courts in New York
Richard M. Peer, Buffalo News, June 26, 2006

In an opinion piece in the Buffalo News, Dr. Richard M. Peer, president of the Medical Society of the State of New York, writes that “[i]t's time to give health courts a chance” because “[t]he current medical justice system is not working for doctors or for patients.” According to Dr. Peer, a vascular surgeon himself, some doctors,“[f]aced with increased liability and skyrocketing malpractice premiums, … are giving up the practice of medicine, especially those in high-risk specialties such as obstetrics, neuro and general surgery and emergency care.” He continues: “At the same time, the current system doesn't provide appropriate or timely compensation to patients who truly experience negligent adverse events. Instead, studies show that it rewards only a small fraction of plaintiffs with legitimate claims and those eventually compensated will have suffered an average of more than four years of litigation.” By streamlining proceedings and lowering the costs of adjudicating a claim, Dr. Peer argues that health courts would help solve these problems.

Trial Lawyers, Inc., Is an Economic Disease
Deroy Murdock, National Review Online, May 30, 2006

In his National Review column, contributing editor Deroy Murdock recommends Common Good’s proposal for special health courts as a solution to the ills of the current medical malpractice system, which drives up health care costs and restricts access to care. A key benefit of special medical courts, according to Murdock, would be "specialized judges, often in non-jury trials, that would consult their own objective expert witnesses and also weigh the validity of scientific evidence, which sometimes baffles jurors." For example, in the recent Vioxx trial in Texas, one uncomprehending juror remarked to the Wall Street Journal: “Whenever Merck was up there, it was like wah, wah, wah. We didn’t know what the heck they were talking about.” article »

Whither Malpractice Reform?
PPI Health Policy Wire Vol 4, No 9, May 11, 2006

In a recent PPI Health Policy Wire, the Progressive Policy Institute calls for health courts as a solution to our broken medical justice system. Highlighting the recent failure to pass damage award caps in Congress, and noting that “[t]he raging feud between doctors and trial lawyers [over such caps], with partisans playing to their favored constituency, is unproductive,” PPI recommends that “what congressional Democrats should offer as an alternative, is a new system of health courts.” “Civil courts are not appropriate for malpractice cases." Instead, “[h]ealth courts, which would have expert judges and professional witnesses as well as limits on non-economic damages determined by an independent commission based on the severity of a patient's injury, would be able to distinguish real cases from bogus ones and process claims expeditiously.” article »

Michigan Needs Special Health Courts
Edward A. Loniewski, DO, Michagan Forward, May 2006

In a piece for the Michigan Forward, Edward A. Loniewski, DO, past president of the American Osteopathic Association and the Michigan Osteopathic Association, argues that “Michigan needs special health courts” to remedy the flaws of the current medical justice system. He notes that, despite the fact that the state “has led the nation in enacting tort reforms” to address medical justice issues, “[t]he number of malpractice claims per 1,000 doctors in Michigan is among the highest in the nation, and Wayne County physicians pay the second highest medical liability insurance premiums in the country.” “With its plan for health courts,” he continues, “Common Good has offered a solution to this problem that is just the prescription Michigan needs. … The plan is generating bi-partisan support because it would bring much needed reliability to our system of justice without treading on the rights of injured patients.”

Examining America's Healthcare System
Mehmet Oz, M.D., Saturday Evening Post, March 6, 2006

In a piece for the Saturday Evening Post, Dr. Mehmet Oz identifies “a disintegration of trust” as “the root cause” of America’s healthcare system woes. These woes are evident, he relates, in our “erratic” and inadequate system of health insurance, in our inability to adequately share health information, and in our poor system of “malpractice protection.” On the malpractice issue in particular, he writes, “[O]ur medical malpractice adjudication procedures result in a form of ‘jackpot justice’ that neither helps many of the harmed nor drives doctors and hospitals to improve the quality of care they provide. The costs to the system, including defensive medicine, are estimated at $50-100 billion a year.” One way we “could build trust in a 21st century intelligent healthcare system,” he suggests, drawing from a survey of health professionals and laypeople conducted by the Institute for Medicine as a Profession and the Center for Health Transformation, would be to create health courts. He writes, “Progressive health justice programs should build trust by prompting doctors to more readily share the truth about unexpected outcomes with patients and colleagues. How else can we learn from the mistakes that humans taking care of humans are destined to make? … Many solutions have been offered, including creation of health courts (resembling tax courts) where expert panels could streamline payment of money to injured patients and families with less delay and overhead.”

Special Health Courts Could Heal State's Liability Costs
Alan M. Mindlin, M.D., Detroit News, March 2, 2006

In an opinion piece for the Detroit News, Dr. Alan M. Mindlin, president of the Michigan State Medical Society, touts Common Good’s proposal for special health courts as “an intelligent proposal that is just the prescription we need to cure the medical liability crisis.” Evidencing the wide variation in jury awards, he writes that “[t]he overriding problem with our system of medical justice is that it is unpredictable.” It is also costly, inefficient, serves too few deserving victims, and harms too many good doctors. Health courts, he argues, would not only “ensure that injured patients are compensated,” but “also would help increase candor among health professionals.” He concludes by saying that “it's time for our elected leaders to act."

Washington State Looking Towards Health Courts
"States tackle issue from all angles" and "Losing the patient"
Brad Shannon; Nina Shapiro, Olympain; Seattle Weekly, March 1, 2006

After the failure of two malpractice reform initiatives, one supported by lawyers and the other by doctors, and despite a compromise malpractice bill recently brokered by the state’s governor, Christine Gregoire, Washingtonians are increasingly looking towards health courts as a more complete solution to the state’s broken medical malpractice system – one that will benefit both providers and patients alike. In a piece for the Olympian, Brad Shannon describes health courts as a reform idea that “[has] gained traction.” He writes that health courts were recently discussed by Mary-Lou Misrahy, an executive with Seattle’s Physicians Insurance, “as one of several possible solutions to consider.” “She noted that most victims of malpractice never get their cases into court under the fee-driven system that prevails today.” And in a piece for the Seattle Weekly, Nina Shapiro writes that Randy Revelle, a senior vice president for the Washington State Hospital Association, shows “no inclination” to again fight for caps in future reform debates. “‘I personally became convinced over the last six months that trying to fix the current system isn't going to solve the problem,’” she quotes him as saying. “‘We need to go to a new system.’” Shapiro writes that Revelle is “working on a proposal for dramatic reform that would increase patient safety and compensate greater numbers of malpractice victims without them entering the tort system.” He is studying the work of Michelle Mello, a Harvard School of Public Health professor who, along with her colleagues, is working with Common Good to design a system of health courts. Seattle Weekly article »

ABA Rejection of Special Health Courts Sparks Clash
Lenard Post, National Law Journal, February 27, 2006

In a piece for the National Law Journal, Paul Barringer of Common Good and David Studdert of Harvard University comment on the ABA’s decision to oppose health court pilot projects. Barringer, Common Good’s general counsel, sees health courts as “‘an approach that will expedite compensation and dispute resolution for injured patients,’ and also establish a more reliable system for health care providers.” Studdert, a professor at the Harvard School of Public Health, which is working with Common Good to develop a health court system, suggests that we try health courts “‘in a few places … for a few years.’” “‘If it's not a better system,’” he says, “‘then we can go back to the dysfunctional tort system.’" In addition to bills that have been introduced in both houses of Congress to “facilitate” health court pilot projects, bills have recently been introduced in both the Virginia and Maryland legislatures to study the issue.

A State Health Court Would Be In Order
Robert A. O’Leary and Richard T. Moore, Boston Herald, February 15, 2006

In a recent opinion piece for the Boston Herald, Massachusetts State Senators Richard T. Moore and Robert A. O’Leary “advocat[e] the creation of a health court system that would benefit patients and doctors alike.” In addition to detailing how such a system should work, they write, “Caps on damages or other avenues of tort reform have often been suggested as a means of addressing the liability crisis. Caps may slow the growth of insurance rates, but they do not address the underlying problems with our adversarial tort system and do nothing to improve patient safety. We must find a better option for reform.” The senators argue that it is past the time for their colleagues to merely study the issue and “actually time for a specific plan to be considered on Beacon Hill.” “In the coming months,” they write, “we will be submitting legislation to implement a pilot project at some area hospitals to help determine the feasibility of a health court. With our medical malpractice environment near crisis, we must look beyond incremental reform to the current system to a more promising alternative."

Code Blue: The Case for Serious State Medical Liability Reform
Randolph W. Pate and Derek Hunter, The Heritage Foundation, January 17, 2006

A report by the Heritage Foundation declares health courts an “innovative solution” to our current broken tort system that would “enhance consumers’ rights while increasing access to quality and affordable medical care.” As the report relates, our current system is inadequate for resolving medical malpractice cases for several reasons: it has high administrative costs; too few injured patients are compensated; juries often cannot easily interpret complex medical information; and jury awards are inconsistent and unreliable.

Health courts can help solve these problems. In a health court system, judges with specialized training in medicine would adjudicate cases assisted by court-appointed expert witnesses and write decisions clarifying what constitutes an appropriate standard of care. “Medically trained judges will be better able to wade through difficult evidence to get to the real facts,” and their opinions become “part of a consistently applied body of law to which physicians can look with more certainty.” report »

IN DEPTH: The Economist Calls Health Courts a Sensible Idea
Scalpel, Scissors, Lawyer
Economist, December 14, 2005

In a recent article, the Economist recommends Common Good’s proposal for special health courts as a solution to the deficiencies of our current system of medical justice. Upon detailing the problems of our current system, they write, “A more sensible idea would be specialist medical courts, as proposed by Philip Howard of Common Good …. The idea is partly modelled on the specialist courts that deal with other complex technical issues” and “ought to make the system less capricious.”

Malpractice Makes Perfect
Robert A. Berenson, M.D., New Republic, October 10, 2005

In a recent piece for the New Republic, Robert A. Berenson, M.D., a senior fellow at the Urban Institute, urges political support for testing health courts as a solution to the medical malpractice crisis in this country. Of the current malpractice system, Berenson writes that “it is not surprising that no evidence shows that patient safety has been substantially improved by the threat of suit, despite the billions spent on lawyers, expert witnesses, and the courts. The tort system and the slowly developing patient-safety movement simply function in separate worlds.” Health courts, he argues, are a promising proposal to “join those worlds.” The greatest benefit to operating under a system of “avoidability,” as opposed to negligence, Berenson surmises, might be that “errors would no longer be kept hidden, and providers could be held accountable for their performance in protecting patient safety.”

Special Courts for Medical Lawsuits Could Ease the Malpractice Crisis
Dan F. Kopen, M.D., Citizens' Voice (Wilkes-Barre, PA), August 8, 2005

An state-commissioned Advisory Committee on Medical Professional Liability in Pennsylvania recently produced a report detailing "several significant deficiencies" of the current tort system, including "excessive cost, undue delay, disproportionate compensation, unqualified juries, biased and unqualified expert witnesses, emotional stress, and impediments to patient safety." Focusing on patient safety, Dan F. Kopen, M.D., argues in the Citizens' Voice for pilot projects to create special health courts. He writes, "Our tort system, grounded in an adversarial ethic, is still geared toward seeking and placing blame on individuals for errors in complex situations, even though quality experts clearly demonstrated over a half century ago that roughly 85 percent of the responsibility for human error lies in system failure and not individual mistake."

Health Courts
Editorial Board, South Florida Sun-Sentinel, July 10, 2005

Special health courts might be the "best solution yet proposed for [Florida's] medical malpractice crisis," argues the editorial board of the South Florida Sun-Sentinel. The Sun-Sentinel calls on Floridians to support legislation in the U.S. Senate that would authorize funding for states to create special health courts on a pilot project basis. The Sun-Sentinel concludes, "Courts with true, unbiased medical experts serving as judges and witnesses, and establishing precedents for similar cases, would add predictability and reasonableness to a system that is now out of control. Floridians should support the bill, then lobby hard to be among the states awarded grants."

Special health courts, the centerpiece of Common Good's work to restore reliability to medical justice, are endorsed by over 80 national leaders in healthcare and law. USA Today has recently joined the New York Times in calling for pilot projects.

Medical Malpractice Panel Suggests Patient-Safety Center, Special Courts
T.C. Brown, Cleveland Plain Dealer, April 29, 2005

Special health courts were among the final recommendations of Ohio's Medical Malpractice Commission, which started investigating the state's malpractice crisis two years ago. Common Good is working to create special health courts to make medical justice reliable for doctors and patients.

Too Many Suits, Too Little Cure
Editorial, USA Today, January 9, 2005

USA Today calls for "real reform" of the medical justice system aimed at bringing "more consistency to the lawsuit industry, where awards vary wildly from one jurisdiction to the next," and at improving "patient-safety efforts." Specific ideas "worth considering" according to the paper include: (1) heightened "scrutiny of doctors"; (2) allowing doctors to discuss errors without the fear of being sued; and (3) having court-appointed expert panels, as opposed to "hired guns," testify in malpractice cases about whether a doctor "violated the accepted standard of care."

Common Good applauds USA Today for recognizing that unreliable justice is infecting our healthcare system with distrust, contributing not only to increased insurance premiums, but also to costly defensive medicine and to a culture of secrecy that impedes efforts to improve patient-safety. The special health court system proposed by Common Good would more effectively identify bad physicians, would restore trust to encourage professional interaction and improve patient safety, and would employ court-appointed experts rather than "hired guns"--all ideas recommended by USA Today. The New York Times recently called on Congress to enact demonstration projects for special health courts. article »

Insurance Premiums and Access to Care

Columnist with Parkinson’s Urges Keeping Ban on Device Suits
Alicia Mundy, Wall Street Journal, May 12, 2009

Columnist Michael Kinsley, a former star with the New Republic, CrossFire and Slate, announced a few years back that he had developed Parkinson’s disease. In a bittersweet moment, Kinsley testified before the House Energy and Commerce Committee about what he considers the wonders of a device implanted in him — Medtronic’s Activa brain stimulator. Kinsley’s testimony warned that lawsuits would prevent patients from getting access to life-altering devices, such as his brain stimulator, which has enabled him to walk. Kinsley is adamant that lawsuits harm more patients than they help and that the FDA, despite a recent raft of recalls, shouldn’t be second-guessed. » article

Malpractice Lawsuit Costs Still a Huge Issue for Pennsylvania
Gerald O’Malley, PennLive, May 2, 2009

Gerald O’Malley, a Philadelphia-based emergency physician, objects to Governor Rendell’s claim that Pennsylvania’s malpractice crisis is over. Hospitals are limiting their services due to rising malpractice premiums and frivolous lawsuits continue to make their way into the courtroom. Rendell's announcement is based on the Pennsylvania Supreme Court's annual Malpractice Filings Report, but the court's numbers tell only a part of the story. The Court’s numbers do not take into account the number of litigants within those cases or the out-of-court settlement. Multiple litigants contribute to larger payouts, which is a major factor behind the state's astronomical medical liability insurance rates and overall health care costs. Despite the Court’s promising numbers, the predatory practice of filing frivolous lawsuits continues in the state, and the crisis is far from over. » article

High Risk of Lawsuits is bad for the Patients, Too
Michael Warren, Galveston Daily News, April 28, 2009

In his editorial in the Galveston Daily News, Dr. Michael M. Warren, a professor of surgery at University of Texas Medical Branch Division of Urology, calls for malpractice reform. Physicians are often blamed for anything less than complete recovery or a fairy-tale ending to illness. Malpractice suits have become so threatening that many young doctors are turning their backs on some areas of medicine, rather than risk ruin by a lawsuit. Even legislators have recognized this major problem, and some states are introducing limits to the amount for which a doctor can be sued for malpractice. While Dr. Warren acknowledges that physicians do make mistakes and patients do deserve compensation, he stresses that risk is an inherent aspect of practicing medicine. The economic effects of malpractice lawsuits extend beyond the patient and the physician. The high malpractice premiums physicians pay are passed onto the consumer. A restructuring of the malpractice system must acknowledge that oftentimes physicians do all they can and accidents still occur; a lawsuit is not always the answer. » article

Area Physicians Join Forces
Jennifer Boen, Fort Wayne News-Sentinel, April 21, 2009

As health care costs grow, physicians are finding that forming practice groups provides them with something of an advantage. Larger groups can work to negotiate better reimbursement rates with insurers, they can lower overhead and adaministrative costs, and they can get better rates on liability insurance. The majority of physicians have traditionally worked in solo practices, or sometimes small groups. But with increasing costs and growing economic uncertainty, practice groups are becoming more appealing. In particular, the cost of providing health care for employees has become burdensome, and larger practices can receive better rates. “We are not wanting to get bigger clinically,” Rumsey said, noting both practices will continue operating in their current locations. "This is a merger from a business point. In the economies of scale, if I have to buy health care for my employees, I can buy it more competitively if there are 40 docs, not 15. This is about merging the back-office stuff, so I can offer my employees outstanding benefit packages," said one physician. » article

MMS Annual Analysis Shows Deteriorating Physician Practice Environment
Massachusetts Medical Society, April 15, 2009

The annual Massachusetts Medical Society Physican Practice Environment Index found that the state faces serious problems as practicing physicians age and new recruits prove ever more difficult to attract. The annual survey has seen the practice environment in the state decline steadily in recent years even as Massachusetts has served as something of a model for health care reform. Primary care physicians are becoming scarce, creating access problems for the growing influx of insured patients. Meanwhile, the existing physician population is aging as patient demand increases. The factors influencing the decline in the practice environment include the increasing costs of maintaining a practice, increased demand for physicians, and ever-rising liability premiums. The state struggles to recruit new physicians, in part due to these high costs, and as the aging physician population begins to retire, the face will face a real crisis. » article

Doctor Shortages Hit Maryland
Ashley Andyshak, Frederick News Post, April 5, 2009

According to a study performed by the Maryland Hospital Association, the state is experiencing physician shortages in almost every specialty. The study found Maryland has the equivalent of 178 active physicians per 100,000 residents. The U.S. average is 212 per 100,000. Southern Maryland, in particular, is struggling: Charles, Calvert and St. Mary's counties will have a shortage in primary care and 27 specialties by 2015. Low Medicare reimbursement, high malpractice insurance premiums and lack of damage caps on malpractice lawsuits, are contributing to the doctor shortage. Maryland's average malpractice award payment is nearly $320,000, about $35,000 more than the national average. The average specialist in the state pays $100,625 in medical liability premiums, compared with the national average of about $65,000. Doctors said they know the situation won't improve until serious legislative changes are made. » article

‘Sick’ Economy Forces Layoffs at New York Hospital
Laura Batchelor, CNN, March 16, 2009

Economic problems are forcing Brookdale University Hospital and Medical Center in New York City to lay off 240 employees, including doctors, nurses and management positions. Among the reasons for the layoffs, the hospital cited budget deficiencies, reduced Medicaid reimbursements, and malpractice costs. The 1199 SEIU United Healthcare Workers East, the largest local union in the world, said in a statement that the situation is dire and "hospitals are hanging on by a thread." The hospital has nearly 4,000 employees and serves more than one million New York residents.

Medical Lawsuits Get New Window?
Rick Karlin, Times Union, March 3, 2009

The New York State Medical Society recently participated in its annual lobby day to open dialogue between health care providers and lawmakers. This year’s discussions are especially pertinent due to a legislative push to change the state’s medical malpractice laws. Physicians fear that a Democratic controlled Senate could lead to measures that would make it easier for patients to sue. The proposal causing the most worry among doctors would ease the statue of limitations for malpractice suits. Currently, people can sue for medical malpractice two and half years after the malpractice occurred. The new legislation, known as the "data discovery" law, would set that clock forward to begin whenever the effects of the alleged malpractice are discovered. Gerard Conway, vice president of the state Medical Society, is one of many physicians voicing his concern to New York lawmakers. Estimates by insurers reinforce physicians’ claims that the proposal could raise malpractice insurance premiums by $100 million. “We're very concerned,” said Conway, "there should come a point in time when the threat of litigation is ended.” » article

Doctors in Short Supply in Rural Maryland
Stephanie Desmon, Baltimore Sun, March 1, 2009

Patients in rural Maryland are finding it increasingly difficult to receive medical care. The number of physicians in certain parts of Southern and Western Maryland is shrinking and the state medical society, MedChi, expects the problem to get worse in coming years. Legislators and physician groups are working on a series of proposals to attract more doctors to rural areas, including a loan forgiveness programs. Maryland physicians face high medical liability rates in tandem with low reimbursement rates, meaning new doctors saddled with $200,000 in debt find the state very unattractive. As physician numbers decrease, patients will find it more difficult to receive adequate and timely care where they live. Primary care shortages are particularly worrying as patients may not get necessary tests or checkups, and serious medical problems could go undiagnosed. "We should have done something yesterday," noted one lawmaker. » article

The Birth of a Notion: Hospitals Turning to Laborists to Deliver Babies
Liz Kowalcyzk, Boston Globe, February 22, 2009

Laborists or OB hospitalists, a new breed of hospital-based physicians who deliver babies for other doctors’ patients, are becoming more prevalent. They are helping to fill the void created by the growing number of obstetrician-gynecologists who have stopped delivering babies because of grueling on-call schedules and high malpractice insurance costs. The Boston-based ProMutual Group, the largest malpractice insurer in the Massachusetts, said about 65 of the 120 OB-GYNs it insures have quit delivering babies. The growing popularity of laborists is part of what some doctors say is an unavoidable shift in medicine: fewer doctors have time to care for their patients when they are in the hospital. Laborists pay lower insurance premiums than obstetricians and therefore benefit hospitals; however, they also spend less time with patients, meaning many expecting mothers do not meet the doctor attending their birth until they arrive at the hospital. » article

Giving Away Medical Care Isn't Easy
Peter Applebome, New York Times, February 18, 2009

One family physician has taken it upon himself to establsih a free clinic for patients, but unfortunately it's proved more difficult than he imagined. Dr. Lloyd Hamilton, 81, is a retired Harvard Medical School graduate who has been trying to find a local clinic where he can practice, free of charge. He began working at a local clinic in 1991 for minimal pay, but it recently lost funding and he sought to open his own free clinic. Yet local chartities and churches were uninterested, noting that it would take at least $10,000 for insurance just to begin operation. "He figured he could do it without malpractice insurance — his clients over all are probably the least litigious demographic in America — but was strongly advised against that. 'It only takes one avaricious nephew,” he said. “The risk is small, but it’s not zero.'" Dr. Hamilton has since found funding by establishing his own charity, Doctors Within Borders, and is looking for a location as well as other physicians who would be willing to pitch in. » article

Doctor Shortage Troubling
Editorial, Erie Times-News, February 10, 2009

A new report from the Pennsylvania Medical Society and the Hospital and Healthsystem Association of Pennsylvania finds that primary care physicians are leaving the state at a rapid rate. Between 2004 and 2006, the number of primary care doctors dropped by 8 percent. There are a number of factors contributing to the decline, particularly high medical malpractice insurance premiums. Additionally, it has become increasingly difficult to recruit new doctors to the primary care field. There are programs in the Erie County area which help new doctors pay off their loans but the financial incentives to choose a specialty over primary care remain significant. » article

Doctor Shortage Troubling
Editorial, Erie Times-News, February 10, 2009

Hawaii’s Medical Malpractice Controversy
Lisa Kubota, KGMB9, February 10, 2009

Hawaii’s House health committee approved a bill aimed to keep physicians in the state by reforming the malpractice environment. Physicians are leaving Hawaii due to high malpractice premiums and low reimbursement rates. Dr. Linda Rasmussen, an orthopedic surgeon, is increasingly taking on patients outside of her specialty to combat the physician shortage; "Every day there are people that are suffering due to lack of access to care. I'm writing for high blood pressure medications because we do not have internists in Kailua." Supporters of the medical malpractice bill claim it will lower the cost of malpractice insurance, which can run tens of thousands of dollars a year. The measure would limit the compensation for non-economic damages like pain and suffering. The cap would be $250,000 per physician and $3 million in severe cases. » article

Doctor Shortage Takes Toll on Mammogram Center
Heather Knight, San Francisco Chronicle, February 8, 2009

San Francisco General Hospital opened a state-of-the-art breast cancer center five years ago with great success, yet today they are having difficulty recruiting radiologists to staff the center. The shortage has created a 10-month wait for area women needing mammograms. The center originally served 10,000 women each year, but with the departure of two radiologists, the wait list to be seen has grown and the number of women has fallen to 5,000. Though other options exist for women to be treated locally, the breast cancer center's troubles are notable. Mammographers are particularly difficult to recruit because they are prone to lawsuits and many physicians shy away from the field. "There's a lot of risk involved, and the compensation isn't as great as it is for some specialties," said Susan Brown, director of health education for Susan G. Komen for the Cure. » article

Florida Projects a Worsening Doctor Shortage
Tanya Albert Henry, AMNews, January 22, 2009

A survey of 50,000 physicians by the Florida Department of Health found that 13% of Florida doctors plan to significantly reduce their scope of practice or leave medicine in the next five years. Liability and reimbursement were the top two reasons doctors cited for changing their practice outlooks. In radiology and obstetrics, two of the most litigious specialties, physicians are choosing to abandon risky procedures. More than 14% of physicians who provide obstetric care said they would discontinue it in the next two years, and nearly 18% of radiologists who read mammograms or other breast imaging exams said they would decrease or discontinue that part of their practice. The Florida Medical Association (FMA) said several factors have led to the physician shortage, including poor Medicare and Medicaid reimbursement rates, exorbitant professional liability insurance costs, burdensome bureaucracy, a growing number of elderly patients, and a shortage of residency slots. The FMA believes policy changes will influence how physicians practice: "It is our hope that the state Legislature will work with us…creating an environment that will attract and keep physicians in our state is sound policy and an important step in ensuring Floridians have access to care." » article

Keep Doctors From Disappearing
Gary S. Mirkin, MD, Newsday, January 8, 2009

According to a study released by the Physicians' Foundation in November, nearly half of the nation's primary care physicians, including pediatricians, plan to stop practicing or reduce the number of patients they see over the next three years. Their reasons include "increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations." With rising overhead costs and skyrocketing medical liability premiums, the income of primary care physicians, adjusted for inflation, dropped by 10.2 percent from 1995-2003, while the amount of work increased and reimbursement rates remained stagnant. More medical students are selecting higher paying specialties over primary care. Dr. Mirkin, a pediatrician in Long Island, stresses that reform is required to ensure that primary care physicians continue to play a central role in improving the overall health of patients.

State's Malpractice Crisis Continues
MIchael Tremoglie, Philadelphia Bulletin, December 30, 2008

The Hospital and Health System Association of Pennslvania (HAP) has filed suits against the state of Pennsylvania in an effort to block state officials from deploying hundreds of millions of dollars intended for a doctor's medical liability fund for other purposes. HAP believes the state owes them between $446 and $616 million in reimbursement for fees paid into the liability fund over the last several years. The fund was established to supplement skyrocketing medical liability premiums for physicians who were threatening to leave the state and provide financial incentives to bring in new physicians. The state medical association and HAP have worked with the Governor and the legislature to phase out the liability fund, but lawmakers are interested in using the remaining dollars to help fill budget gaps . “If the [medical liability fund] is diverted, this has great potential to be yet another set-back for Pennsylvania’s physician recruitment efforts,” said Dr. Daniel Glunk, president of the state medical association. » article

Hospital Would Leave OB Patients in the Lurch
Barbara Benson, Crain's New York Business, November 25, 2008

Continuum Health Partners recently announced plans to close obstetric and delivery services at Brooklyn's Long Island College Hospital. The effect could be disastrous for nearby hospitals who would be expected to absorb LICH's 2300 annual deliveries. Due to these concerns, the New York Department of Health has so far prevented Continuum from closing the maternity service at LICH. Citing rising liability costs, Continuum maintains that the practice is unsustainable saying that for every birth, Brooklyn hospitals lose as much as $4,000. In 2007, LICH’s OB/GYN cases accounted for 12% of the hospital’s discharges, a measure of patient volume, but 33%, or $11 million, of the hospital's total losses. And OB malpractice accounted for $8.8 million, or 40%, of LICH’s $22 million in malpractice insurance costs. Medical liability reform has been long overdue in the state as Gov. Patterson and the legislature signed a bill this Summer which put off raising rates for another year, hoping that stakeholders might be able to reach some agreement about reform by then. But no hospitals surrounding LICH want the extra deliveries as they add more liability and diminsh profits. “We are facing an obstetrical Armageddon,” says Mark Mundy, president and chief executive of New York Methodist Hospital in Park Slope. » article

Half of Primary-care Doctors in Survey Would Leave Medicine
Val Willingham, CNN, November 18, 2008

A recent survey from the Physician's Foundation reveals that doctors are extremely unsatisfied with the state of medicine today. Nearly half of all primary care doctors claim they would seriously consider leaving medicine within the next three years if they had other options. Physicians noted that red tape and the administrative burden of practicing medicine have become overwhelming, such that most doctors feel more like businessmen than physicians. Moreover, shrinking reimbursement payments and rising medical liability costs have made the profession less and less attractive. Recent studies have already warned of a coming physician shortage, particularly amongst primary care doctors. Should more physicians choose to leave the profession, patients may not have access to the care they need. Moreover, primary care physicians are often considered the first line of defense in preventing illnesses and managing chronic diseases. "People who have insurance can't find a doctor, so suddenly we are going to give insurance to a whole bunch of people who haven't had it, without increasing the number of physicians?" says one doctor. "It's going to be a problem." » article

Pennsylvania is Driving its Doctors Away
Frederic Jarrett, Wall Street Journal, October 25, 2008

Dr. Jarrett, a Pennsylvania physician, discusses Gov. Rendell's plan to cover uninsured citizens. Gov. Rendell intends to fund a universal insurance program in the state by siphoning off funds from the M-Care program, which provides an abatement for physicians' medical liability payments. The M-Care program, which is funded by a tax on cigarettes, provides doctors some relief for their liability premiums in a state where jury awards are abnormally high. High insurance payments and lower physician salaries have left Pennsylvania struggling to recruit and retain newly minted doctors. The M-Care abatement provides some incentive, but Dr. Jarrett argues that it is merely offering temporary relief while the underlying problem remains. If Gov. Rendell is successful in tapping the M-Care funds, Dr. Jarrett worries that fewer doctors will choose to practice in Pennsylvania, practicing physicians will leave and patients will struggle to get the care they need. "But in the meantime, if you are a woman with a high-risk pregnancy who is unable to find an obstetrician in the rural areas between Philadelphia and Pittsburgh, or if you can't find a neurosurgeon on trauma call in the two-hour drive from Pittsburgh to Erie, call Mr. Rendell" » article

Doctor Retires after 54 Years of Service
Anthony Gottschlich, Dayton Daily News, October 20, 2008

After 54 years in medicine, Dr. Kent Scholl, a family doctor in Dayton, Ohio, is retiring. Scholl is tired of fighting with insurers who want to dictate how he treats his patients. His retirement comes at a time when fewer medical school graduates are entering family medicine and primary care, preferring specialties that carry shorter hours and higher salaries. Dr. Scholl’s method of practice is a dying breed. Dixon, a cancer survivor, knows how rare Dr. Scholl’s practice is, “this is a lost art in the medical industry. How many places do you go where you take a number? You come in when you’re sick and you don’t have to worry about him not seeing you.” » article

Study Sees Doctor Shortage
Christine McConville, Boston Herald, October 6, 2008

The most recent Physician Workforce Study in Massachusetts shows critical areas for improvement. Twelve specialty fields have an inadequate number of physicians across the state. Massachusetts has successfully established a statewide insurance program that has added hundreds of thousands of people to the numbers of insured. However, without adequate numbers of physicians to provide care, people will face longer wait times to see their doctors and may not be able to get the care they need when they need it. In an effort to attract more physicians to the state, the state medical society says they will focus on enacting much needed liability reform and student loan forgiveness for young doctors. » article

Big Island Dealing with Doctor Shortage
Associated Press, October 3, 2008

The trend of doctors fleeing their practices due to rising malpractice premiums has reached Hawaii. The Big Island will soon lose three orthopedic surgeons who cite the rising cost of malpractice insurance, low reimbursements and huge workloads as reasons for state. This exodus leaves only one full-time orthopedic surgeon on the island of Hawaii. With only one overworked bone surgeon, many patients will be forced to travel to Honolulu to receive orthopedic care. » article

Crisis of Care on the Front Line of Health
Jane Brody, New York Times, September 29, 2008

Recent studies have found that fewer numbers of graduating medical students are opting to practice primary care, and it is the patients who may suffer. Primary care doctors are the first lines of defense in treating patients with chronic diseases, and yet the increasing costs and decreasing reimbursements have fundamentally altered the way most primary care physicians practice medicine. Higher overhead and smaller payments means doctors must squeeze more patients in, focus on only the immediate problems and rush through their appointments. For patients, this means their doctors may not be able to address all their needs and often go with problems untreated or undiagnosed. Many feel the problem will only get worse if the country opts for universal coverage, as patient numbers will increase and payments will likely remain stagnant or decrease. Some primary care doctors have reacted by opting out of managed care or insurance plans altogether, electing to provide better care to fewer patients who are willing to pay out of pocket. “If you have only six to eight minutes per patient, which is the average under managed care, you’re forced to concentrate on the acute problem and ignore all the rest,” said one physician. » article

Survey: Doctors Dissatisfied With Practice Environment in State
Hillary Waldman, Hartford Courant, September 24, 2008

A recent survey of 1,077 practicing physicians commissioned by the Connecticut State Medical Society conveys how difficult it has become for doctors to provide quality care and maintain their livelihood. Many survey responders complained that despite working longer hours, new patients still endure long waiting periods to see a physician. Due to high malpractice insurance costs and restrictions imposed by managed care, 19.3 percent of physicians said they were contemplating a career change and 10.8 percent planned on leaving the state’s inhospitable medical environment. The Connecticut State Medical Society supports cutting malpractice insurance premiums to prevent practicing physicians from leaving and attract more physicians to the state.

State Aid for Malpractice Insurance Up in Air
Bill Toland, Pittsburgh Post-Gazette, September 16, 2008

For years, Pennsylvania doctors have relied on abatements to help them pay for expensive malpractice insurance coverage through the state’s Medical Care Availability and Reduction of Error fund. These abatements allowed doctors in high-risk specialties to continue practicing medicine. Unfortunately, fund abatements for this year have not been renewed as the Pennsylvania Senate discusses how to provide insurance coverage to uninsured residents. Pennsylvania doctors fear that the program may expire for good, “permanently increasing med-mal rates for doctors across the state by tens of thousands of dollars.” Doctors fear if the stalemate continues they will have no choice but to leave Pennsylvania and practice medicine in a state with less expensive med-mal insurance rates. » article

It's Not Our Fault
Dr. Rob, MedPage Today, September 10, 2008

A physician blogger describes the challenges facing physicians today and how they effect patients. Financial and legal stresses are forcing doctors to change the way they practice medicine and it is frequently the patients who suffer most. Dr. Rob describes why patient visits often seem unnecessary, brief and impersonal. Physicians must see their patients for every medication or symptom and cannot offer advice or prescriptions over the phone due to liability and cost. Moreover, liability risks and insurance companies require that physicians chart every note and comment in order for them to be reimbursed. The unfortunate effect is that patients often feel frustrated and rushed. "The practice of medicine has turned into the business of medicine. We didn’t do that, nor do we like it. But we have to stay in business, so we do what we must." » article

Fewer Med Students Choosing Primary Care
Carla Johnson, Associated Press, September 9, 2008

Fewer medical students are choosing to pursue a career in primary medicine. A recent survey found that only 2 percent of graduates planned to go into primary care, down from 9 percent in 1990. Primary care physicians are the first line of defense in managing patients with chronic or complex diseases and can be essential in controlling health care spending. The field has become less attractive to students coming out of school saddled with $140,000 in debt, on average. Primary or family care is typically one of the lowest paying medical fields and students facing school loans and shrinking insurance reimbursement payments are opting for more lucrative specialties. Many cite the impersonal nature of speeding through a dozen patients to cover costs as a significant deterrent. Though foreign medical school graduates seem to be filling in the gaps in primary care, the overall numbers remain stagnant despite a growing population.

Maternity Care Quality in PA at Crisis Point
Tom Killion, DelcoTimes, September 1, 2008

In his guest column, Pennsylvania representative Tom Killion describes how low medical insurance, Medicaid reimbursements and astronomical insurance rates are forcing maternity wards to close. In the past 10 years one-third of the maternity wards in southeastern Pennsylvania have closed due to economic constraints. Without changing the current health care climate, obstetricians will continue to leave Pennsylvania. Killion explains that due to “opponents of reform there are far too few elected officials and Pennsylvanians aware of this issue.” He believes that comprehensive liability reforms will lessen the economic burden on physicians and hospitals, and increase patient access to care.

Legislative Malpractice
Editorial, New York Post, August 25, 2008

The New York Legislature attempted to solve the malpractice crisis with a “band-aid” this week by placing a year-long moratorium on medical malpractice premiums. The plan intends to aid doctors, particularly obstetricians, who are leaving the state to escape high insurance costs. Although this moratorium may “slow the doctor hemorrhage,” it will “plunge [insurance companies] into the red.” The true cause of malpractice crisis, according to this op-ed contributor, is New York’s status as a “tort-crazy state.” As long as influential Democrats, such as Assembly Speaker Sheldon Silver who is “of counsel” to a tort-law firm, benefit from malpractice cases, there is no incentive to cure this “sick system.” » article

State’s Medical Crisis is For Real
George H. Limpert, Chester Daily, August 22, 2008

George H. Limpert, a Pennsylvania physician, describes the dire situation of health care in his state. Both doctors and patients are suffering due to escalating malpractice costs. Doctors are finding it more and more difficult to practice in their state and patients have less access to medical care. Limpert is so disillusioned by his state’s health care crisis that he encourages his medical students to leave Pennsylvania and practice in states with lower malpractice premiums. The flight of skilled physicians to other states is most visible in the recent closing of the trauma center at Brandywine Hospital in Chester County.

Albany Has Fix For Doctors’ Insurance Ills
E.B. Solomont, The New York Sun, August 21, 2008

In an attempt to alleviate the malpractice crisis New York lawmakers are freezing liability premiums for a year and prohibiting a surcharge on premiums. New York physicians and hospitals, which pay the highest malpractice rates in the country, welcomed the moratorium and hoped it would stimulate discussion of the state’s malpractice insurance costs. However, most in the health care field do not view this temporary freeze on premiums as a solution. Dr. Michael Rosenberg, president of the New York State Medical Society, believes New York’s health care crisis will not abate until the entire system is reexamined. According to Rosenberg, “The Legislature has postponed the day of reckoning.....This issue has not been resolved.” Common Good has proposed a bill in the state legislature that would help to create an administrative compensation system for children with certain neurological birth-injuries. Such a system would provide lifetime benefits for injured children, regardless of whether there was physician negligence, and provide some savings for obstetricians as well. » article

A Baby-Free New York
Editorial, New York Post, August 1, 2008

Brooklyn's Long Island College Hospital has been forced to shutter its obstetrics ward due to skyrocketing medical liability premiums. The hospital has delivered over 5,000 babies in the last two years yet the obstetrics department is responsible for a third of the hospital's $170 million debt. This editorial warns that Insurance Superintendent Eric Dinallo will likely be forced to raise malpractice rates in the future, though an increase has been averted for this year. Former Gov. Eliot Spitzer's task force to address the medical liability problem has been dormant for months and few proposals for reform have made it out of the starting gate. "Let's face it: Absent legislative action, future hikes are inevitable. And that will fuel the exodus of high-quality medical talent and easily available obstetric care. Brooklyn residents are already beginning to suffer. Other New Yorkers should worry, too," notes the paper. » article

Rural Maryland Faces Shortage of Doctors
Associated Press, Baltimore Sun, July 28, 2008

Maryland physicians continue to press for much needed reform in the wake of the Physician Workforce Study released earlier this year stating that Maryland would face critical physician shortages by 2015. Two panels are preparing recommendations for both the Governor and the 2009 Legislature. The report, released by the Maryland Hospital Association and MedChi, recommended a series of reforms, including loan forgiveness, medical liability reform and higher reimbursement rates to attract doctors to the area. The two professional associations are now hosting a series of events across the state to bring the issues directly to local physicians and health care workers. According to the report, rural areas will be affected most directly and emergency rooms especially may have gaps in coverage as the number of specialists shrinks. "When you look at the physician supply, the people who are the most affected are those who are most in need," said Dr. Thomas Chappell, a Cumberland internal medicine physician and past president of the Allegany County Medical Society.

Uninsured Doctors on the Rise in South Florida
Bob LaMendola, Florida Sun-Sentinel, July 27, 2008

Florida physicians are forgoing medical liability insurance at an alarming rate - a quarter of physicians in Palm Beach and Broward counties are uninsured, a third in the Miami area and one-eighth statewide are opting out. As medical liability rates have increased, the crisis has become a state policy issue and lawmakers responded in 2003 by allowing physicians to opt out of medical liability coverage as long as they posted signs in their offices and were willing to pay up to $250,000 per award. As a result, many attorneys and patients fear that doctors may not be able to cover medical expenses for injured patients. Physicians counter that they feel the change allows them to continue practicing and avoid frivolous claims. One physician described dropping his coverage after his liability insurer paid over $1 million on two claims which he felt were unfounded. Florida liability premiums are some of the highest in the country - specialists can pay $200,000 for coverage. Marc Singer, a partner at a wealth management firm, said he advises doctors to drop coverage and, if sued, offer the patient a choice: a small settlement or get nothing when the doctor goes bankrupt. "The idea here is not to beat the patient, the idea is to lower the expectations of the plaintiff's attorney," Singer said. » article

Is There a Doctor in the House?
Jill Armentrout, Saginaw News, July 2, 2008

Hospitals in Saginaw, Michigan are finding it increasingly difficult to get specialists to maintain continuous on-call coverage in the their emergency rooms. Hospitals are required by federal law to keep a roster of on-call physicians, and doctors typically take call in order to obtain hospital privileges. Yet an increasing doctor shortage and general reluctance to take call is causing problems for local hospitals. Physicians are less inclined to cover emergency rooms because patients there are frequently uninsured and there is added liability potential with unfamiliar, emergent patients. Moreover, specialists covering an emergency room often end up taking on numerous new patients as a result, many of whom are uninsured. A recent study in the state found that numerous specialties are already experiencing shortages and the problem will only get worse over time, expanding to primary care by 2020. Indeed, the physician population is aging with few new doctors ready to take their place. In a recent survey, four in every ten Michigan doctors said they plan to retire within the next ten years. "You can't survive on emergency room cases alone. There is a doctor shortage coming to Michigan. There is no easy solution,'' said one local specialist.

Where the Money Isn't
Tricia Bishop, Baltimore Sun, June 29, 2008

Physicians are feeling the pinch as costs increase while Congress considers cutting Medicare reimbursement rates an additional 10.6 percent. Even without the additional cuts, many Maryland doctors say they may not be able to keep their practices open. With growing overhead costs and ever-increasing medical liability premiums, doctors are opting for earlier retirements. Baltimore's reimbursement rates, and Maryland's overall, are some of the lowest in the country. Insurers offer incentives for physicians who take extra steps to improve quality, such as implementing electronic health records. "This is about a very complicated set of issues in health care. Whether it's access to quality or cost containment, there are ways in which they all interact with one another, and physician reimbursement is not different. And so solutions have to be done in a fair and balanced way," John Colmers, the state's secretary of health and mental hygiene said. "Right now, the system is such that the more you do, the more you get paid, not necessarily the better you do, the better you get paid, and I think physicians are frustrated, many of them particularly in primary care." A recent study showed growing doctor shortages in the region due to a combination of economic factors, including liability premiums. Fewer young professionals are opting to practice medicine, and even fewer are electing to practice in Maryland.

5 Investigates Statewide Doctor Shortage
CBS 5, May 13, 2008

A doctor shortage in Arizona is leaving patients with less physicians to choose from, longer drives to reach a doctor and, too often, patients not receiving the medical treatment they need. When Nereyda Teran went into labor, she had to drive 100 miles from her home to a hospital in Sierra Vista because there were no obstetricians in her area. “On our turn to Sierra Vista, I was just like, ‘Mom, I just can’t hold it anymore. He’s coming!’” recollected Teran. She delivered her baby on the side of a rural road. “And I pushed the second time and he completely came out, and that’s when my husband pulled over, ran around the car and took off his shirt and just wrapped him up there,” Teran said. She and her child were fortunate there were no complications. For other women in southeastern Arizona, however, giving birth is a gamble. Copper Queen Community Hospital used to deliver around 300 infants per year, but when five obstetricians couldn’t afford skyrocketing malpractice premiums, the hospital closed its delivery room. In other areas, there are doctors, but they are so overwhelmed that they cannot take new patients. Fred Tenca is one patient who has felt the squeeze in access to health care. He needed a follow-up after a recent hospital visit but couldn’t find a physician. “I have called other doctors in Prescott and they’ve all said that they’re not taking new patients,” Tenca said. “ Arizona has some of the highest malpractice premiums in the country,” reports CBS. And combined with other problems such as patients without insurance, “these factors make a perfect storm for physicians and specialists who have a hard time making enough money to cover their costs.” » article

High Liability Rates Forcing OB/GYNs to Leave Florida
Carlos Muhletaler, Palm Beach Post, May 10, 2008

In this editorial, the author notes how Florida’s medical liability environment is pushing doctors out of the state and causing many OB/GYNs to give up delivering babies. Expectant mothers should be most concerned with the current situation, as more physicians opt to practice solely gynecology. With some of the highest medical malpractice premiums in the nation, OB/GYNs are leaving Florida and 86% of medical students are choosing not to remain in state upon graduation. Moreover, those that do remain are forced to practice defensive medicine, ordering unnecessary tests and procedures in order to protect themselves from potential liability claims. “We are privileged in this state to be surrounded by some of the best doctors in the world. But we are making it difficult for them to care for us and our mothers,” notes the author.

Aggressive Malpractice Environments Dictate How, Not Where, Neurosurgeons Practi
Caroline Cassels, Medscape Today, May 1, 2008

A recent study presented at the annual conference of the American Association of Neurological Surgeons revealed that many neurosurgeons are limiting their practices to reduce potential liability. Neurosurgeons typically have some of the highest malpractice premiums, and awards against them rank the highest of any specialty. According to a survey in 2002, some 43% of neurosurgeons were considering limiting the scope of their practice, 30% were planning early retirement, and 20% were planning to relocate to another state with a better liability climate. As a follow-up to the survey, researchers have found that numbers of neurosurgeons between 2005-2007 were actually greater in states with less favorable liability laws. "We think neurosurgeons have done exactly what they said they were going to do — they've limited their practice in order to limit their liability," said Dr. Zachary Litvack, one of the researchers. As a result, fewer neurosurgeons are covering emergency rooms, creating gaps in coverage for people in the greatest need. "Unfortunately, in the United States, probably more than anywhere else, there is an expectation that you will have the perfect outcome every single time, and it is those expectations that have gotten us to where we are now," said Dr. Litvack. » article

More South Florida Obstetricians Stop Delivering Babies, Cut Services
Patty Pensa, South Florida Sun-Sentinel, April 14, 2008

In South Florida, pregnant women have fewer options for medical care as more physicians cease delivering babies and avoid taking high-risk patients. As more patients head to fewer doctors, two corollaries are longer waits to see a physician and a break in doctor-patient relationships. Projections show that in three years there will be 30 percent fewer obstetrician-gynecologists in Palm Beach County, despite an estimated 7 percent growth in the demand for such doctors. Part of the problem is the medical liability system. Ob-gyns and others like neurosurgeons and family practitioners are caught between exorbitantly high malpractice insurance premiums and low reimbursement for their services. “Obstetrics is a very important part of medicine,” said Dr. Jay Trabin, head of Florida’s chapter of the American College of Obstetrics and Gynecology. “But it’s not what it used to be. I love delivering babies but I can’t do it anymore.” In addition to losing established doctors, it is very difficult to recruit new physicians because of the high cost of malpractice insurance – around $100,000 per year, according to Dr. Anne Honebrink. And the situation especially affects patients. “To go to your gynecologist is one of the most personal things a person does,” said Stephanie Tomasini, 33, of Delray Beach. “It’s a shame if the doctors aren’t there. I don’t know how you would get the care you need.”

Lawyers, Insurance Industry, Doctors and Officials Need to Work Together
Arnold Ghitis, South Florida Sun-Sentinel, April 8, 2008

Beginning in the last five years, Florida physicians started opting out of ER call as medical malpractice insurance rates climbed higher and higher. High-risk fields such as neurosurgery were particularly affected. Now, new doctors have little interest in relocating to Florida because of the infamous liability environment. And as baby boomers continue to age, more people will need medical attention, and the health care system will face mounting pressure – especially worsened if the liability trends continue. “Only a collaborative effort between the medical community, legal entities, the insurance industry and our officials can bring a fair solution to cure our health system,” writes Dr. Arnold Ghitis.

Medical Liability Worries End Free School Physicals
Carolyn Casey, Rocky Mount Telegram, April 6, 2008

An increase in medical liability will end a more than 30 year old program in some North Carolina schools. Administrators at Nash-Rocky Mount public schools have eliminated school site physicals for student athletes because of legal concerns. Physicians who volunteer each year at the schools thought it wise to move the physicals off site because of an increase in malpractice lawsuits, said Wayne Doll, the system-wide athletics director. “We just can’t put ourselves at that liability anymore,” said Dr. Nicholas Patrone, head of the Boice-Willis Clinic. Off site physicals can allow for more exam time, and the school-based exams were a “potentially huge legal liability for us if anything does happen to that child,” commented Dr. Patrone. And this problem is not exclusive to North Carolina; school districts across the nation are encountering similar medical liability troubles.

An Unhealthy Situation for Patients
Cathleen Crowley, Albany Times Union, March 30, 2008

Dr. Joseph Sellers works as a primary care physician at Bassett Healthcare Cobleskill. He lives in Cobleskill, New York, where his son is mayor. Nineteen years ago, Sellers was lured to the county because New York State promised to repay part of his medical school loans if he practiced in an underserved area. However, the area is still suffering from a health care shortage. According to the Annual Physician Workforce Profile, the county has only 68 physicians per 100,000 residents – in stark contrast with Albany County’s 406 per 100,000 – and the number is falling. A new loan forgiveness program has been proposed, but many in the medical community say that it will not be enough. “Exorbitant malpractice insurance premiums [and] flat Medicare reimbursement rates” are among the central issues affecting access to health care in the region. Over one-quarter of New Yorkers live in underserved areas, according to the state Department of Health. And eight counties have no practicing obstetrician. “If I want to refer someone to a dermatologist or child neurologist, there is nobody available for miles and miles and months and months,” Sellers said. » article

Thousands of Michigan Doctors Likely to Hang Up Their Stethoscopes
Diane Ivey, MLive, March 28, 2008

More than 6,000 Michigan doctors will be retiring or quitting in the next 10 to 12 years. Among them is John Dircks, a doctor of pulmonary medicine. Dircks, 65, founded his pulmonary care group in 1976, and says he looks forward to a diminished workload. “It’s really just not feasible to keep doing what I'm doing,” Dircks said, referring to increased overhead and reduced reimbursements. Many primary care, family, and internal medicine physicians will also be retiring – approximately 38 percent by 2020. The growing exodus of physicians is due to several factors, according to David Fox of the Michigan State Medical Society. Between problems such as declining income, high medical malpractice insurance rates, and greater exposure to lawsuits, doctors are inclined to quit sooner. Political and other governmental leaders need to address this problem. “People will need doctors, and who’s going to take care of them?” asked Fox.

Obstetricians May Avoid Births Due to Lawsuits
Frank Donnelly, Times-Picayune, March 27, 2008

Several years from now, many infants could be delivered by physicians who are total strangers to their mothers. Medical malpractice insurance could become so costly that only hospitals could afford birth coverage. This would mean that ob-gyns would have to transfer the care of expectant mothers to hospital staff doctors, who would likely be unknown to the mothers. Obstetricians say exceedingly high medical liability premiums – around $200,000 per year – have resulted in many of their colleagues ceasing baby delivery or quitting the field altogether. “All too often, doctors are held liable for less-than-perfect outcomes,” said Dr. Ralph W. Hale of the American College of Obstetricians and Gynecologists. Yet a number of of those injuries – cerebral palsy, brain damage, or other problems – can be a result of circumstances beyond the physician’s control, such as congenital or genetic abnormalities, or intrauterine strokes. “I think [the medical malpractice crisis is] going to compromise the care," said Dr. David Herzog, an attending physician at Richmond University Medical Center. A baby's birth will become “a sterile procedure instead of a beautiful experience; it’s inevitable if the current system continues as is.” » article

Primary Care Needs Fixing Before Universal Care Can Work
Benjamin Brewer, Wall Street Journal, March 26, 2008

In a recent editorial, Dr. Benjamin Brewer describes how the promise of universal healthcare hinges upon the availability of a large group of well-trained primary care physicians able to provide continued care. Yet recent numbers from the American Academy of Family Physicians show that 40,000 new primary care physicians will have to join the workforce in the next 12 years to meet the nation’s demand. Primary care physicians face many challenges with high overhead costs and lower reimbursement payments than other specialists. These crunches have put some seasoned doctors out of practice and are deterring new students from entering the field. With fewer physicians and more patients, liability costs will rise and the chances will increase that a physician makes an mistake. “We won't see better health outcomes or any cost savings from improvements in quality unless there are broadly trained primary care doctors available and willing to practice where they're needed…Medical insurance coverage without a doctor to see is another big health problem -- not a solution.” » article

Frivolous Lawsuits Hurt Patient and Doctor
Augusto Lopez-Torres, South Florida Sun-Sentinel, March 24, 2008

One Florida physician describes how the state's medical liability laws are forcing doctors out of the state or out of practice. Despite a growing population, the number of Florida physicians is shrinking. As liability costs increase, physicians are unable to maintain their practices, especially in particularly high risk fields such as obstetrics or neurosurgery. This author points out that part of the problem is the poor regulation of expert witness testimony in liability cases. Witnesses are often experts-for-hire who come from out of the state to provide testimony. This practice ensures that experts providing fraudulent testimony cannot be sanctioned by the Florida Medical Board, as they don't practice within the state. Moreover, Florida's "three strikes" rule, which revokes the license of any physician with three malpractice judgments, makes the state particularly unfriendly for physicians. As the author notes, "This is no longer about simply protecting doctors from frivolous lawsuits; this is about protecting all Floridians."

Cost of Malpractice Insurance Forcing Doctors to Leave High-Risk Specialties
Dr. Michael Lynch, Concord Monitor, March 13, 2008

In this editorial, Dr. Michael Lynch, a New Hampshire emergency physician, laments the state of affairs of the medical liability system and warns of dangers to come. Extrapolating present trends, there will be far fewer doctors to care for New Hampshire residents in 10 years. And the culprit behind this mess? The flawed medical liability system. Already there is a long list of doctors who have removed themselves from emergency call or who are likely to do so. Furthermore, many physicians are departing the state as malpractice insurance expenses soar. Certain specialists have experienced a 50 percent increase in premiums from five years ago, with average premiums reaching as high as $100,000 for obstetricians and neurosurgeons. “Our medical system is going through significant difficulties, including increasing health insurance costs, a growing uninsured population, rising medical costs and loss of specialists and primary care physicians,” bemoans the author. And the cost of the medical liability system contributes to these problems, making less money available to care for the uninsured. In fact, medical liability costs add $60-108 billion to the cost of health care each year, according to an estimate by the Department of Health and Human Services. These costs will take a dire toll on patients – “...when future calls are made from the emergency department seeking help, [physicians] may not be there.” » article

Shortage of Primary Care Threatens Health Care System
Dr. Kevin Pho, USA Today, March 13, 2008

In this editorial, Dr. Kevin Pho argues that solutions to our nation’s health care system need to include greater numbers of primary care physicians and a bigger emphasis on continued primary care. More than other nations, the US healthcare system pushes patients towards specialist physicians and increasingly fragmented care. Studies have shown that this fragmentation increases medical errors and costs. Dr. Pho describes how the current “fee-for-service” payment method by insurers places a premium on procedures, and offers little for doctors who devote time to discussion and physical examination. Young doctors, facing huge student loans and ever-increasing liability insurance payments, see that primary care offers a comparatively lower salary and often elect to specialize. Solutions to health care need to include incentives for primary care physicians – such incentives woudl allow primary-care doctors to remain in practice given the low reimbursement rate and high liability costs. “Universal coverage is useless without primary care access,” notes Dr. Pho. » article

State's Pool of Doctors is Shrinking
Bradley Vasoli, The Philadelphia Bulletin, March 11, 2008

The number of direct patient care doctors working in Pennsylvania has dropped by over 1,600 since 2004, according to the Pennsylvania Medical Society. And a primary factor involved with the low population of Pennsylvania physicians is retirement. Speaking to a committee of the state House of Representatives, former Governor Thornburgh referenced an estimate that 10,000 doctors will retire by 2010. According to Ken Kilpatrick, spokesperson for the Patients and Physicians Alliance, the state’s shortage of physicians can be principally addressed by enacting reforms to the legal system.

Doctor Shortage: Trauma Center Closure Spotlights Crisis
Editorial, Bradenton Herald, March 11, 2008

Shortly after the president of the Florida Medical Association grimly warned about the “critical” doctor deficit, Bayfront Medical Center in St. Petersburg was forced to cease receiving trauma patients due to a lack of neurosurgeons on emergency call. As a result, those patients were diverted to Tampa hospitals. Such shortages of trauma and other specialists endanger public health. Dr. K. M. Altenburger, head of the Florida Medical Association, has cited several reasons for the doctor shortage, including Medicare and Medicaid budget cuts and the high cost of medical liability insurance. Florida doctors pay more for medical malpractice insurance than their counterparts in most states, and the lack of meaningful legal reform has not helped the current climate.

'Hospitalists' Save Doctors a Trip
Cliff Peale, Cincinnati Enquirer, March 9, 2008

"Hospitalists" are part of a growing trend in healthcare. These physicians are hired by hospitals to do rounds and look after patients during their hospital stay, allowing the patients’ primary-care doctors to spend more time in their own practices. Many patients and physicians see this as an unavoidable trend in medicine, as hospitalists are salaried doctors who do not need to worry about overhead costs, such as liability insurance, and can take their time with patients. Yet physicians fear that this system will erode the patient-doctor relationship where a physician tracks and cares for a patient over many years. Studies have shown that hospitalists can help to reduce costs and shorten hospital stays by providing around-the-clock care when primary physicians can’t afford to do so. High liability costs and low reimbursement rates means primary care doctors must squeeze in more patients to cover their costs, and doing hospital rounds has become a luxury they can rarely afford.

Group Predicts Doctor Shortage
Daniel Axelrod, Times-Tribune, March 7, 2008

According to “The State of Medicine in Pennsylvania,” a recently released study by the Pennsylvania Medical Society, Pennsylvania is currently lacking a variety of types of doctors and falling short of recruiting objectives. What’s more, the state will become “critically short,” unless more is done to “attract, train, compensate and provide affordable malpractice insurance to doctors.” In less than a decade, Pennsylvania could lack 10,000 doctors based on supply and demand calculations. Presently, however, the shortage is still quite severe. The state’s doctors to elderly patients ratio ranks 37^th nationwide. Furthermore, many Pennsylvania physicians are closing in on retirement – half of doctors are over 50. And recruiting new doctors is difficult as fewer young physicians are choosing to continue practicing in Pennsylvania, instead opting for states with more favorable conditions such as mellower medical liability climates. The shortage has the potential to have widespread consequences, even outside the realm of health care. “Health care is the largest employer and economic engine in Pennsylvania,” said Roger F. Mecum, CEO of the Medical Society. “If health care as an industry really starts to struggle badly, it’ll have a double whammy effect on the economy as well.” » article

Malpractice Costs Cause a Ripple Effect
Alison Snyder, Long Island Business News, March 7, 2008

The medical liability crisis in New York isn’t just affecting doctors – midwives are being especially hard hit as well. In the New York City area, midwives – who provide prenatal health care and help deliver babies – have seen their medical malpractice insurance rates increase from an annual payment of $11,000 in 2002 to $27,000 in 2007. These extraordinarily high rates are discouraging potential midwives from entering the profession. Nicole Rouhana, director of Stony Brook University School of Nursing’s midwifery program, says that the problem is hurting the entire profession. Furthermore, the high cost of medical malpractice insurance is discouraging some students from entering Stony Brook’s program; enrollment has plummeted from 40 new students each year to between 10 and 20. “We recognize that it is a real issue that is affecting our profession in many different ways,” said Kristen Walsh, president of New York State Association of Licensed Midwives.

Staten Island Doctors Join Rally Against Insurance Rates
Frank Donnelly, Staten Island Live, March 4, 2008

Physicians in Staten Island have joined fellow doctors from across New York to march on the state’s capitol and seek solutions to the growing medical malpractice crisis; last year, medical liability insurance premiums increased by the largest amount in fourteen years. Typical obstetricians in Long Island pay $160,000 to $225,000 for their premiums annually. During the march, many doctors left their white lab coats on the Capitol’s steps as a gesture to show that the liability rates are causing many physicians to shut down their practices. "New doctors are choosing not to practice here," stated Dr. Ralph Messo. "Many areas across the state are facing a shortage of doctors, especially for specialists." Several proposals are being considered as possible solutions to the doctor shortages and rising liability insurance rates, including specialized "medical courts" that would utilize judges with special training and independent expert witnesses. » article

Docs on the Rocks
Robert Goldberg, New York Post, March 4, 2008

Physicians in New York are looking at a 15 to 25 percent hike to their medical malpractice premiums this year, on top of a record increase last year. Many doctors now pay up to 80 percent more than they did five years ago. As a result, 1,500 doctors have traveled to Albany to seek a solution to the problem, which is likened to an "ever-tightening vise." The situation is so bad that some doctors are quitting the profession, or leaving New York, writes Dr. Robert Goldberg, the president of the Medical Society of the State of New York. Young doctors completing their residency programs in New York are leaving for states not suffering from these problems. However, it is vital to keep the "right to sue when something goes terribly wrong." What can be done then? One solution is the establishment of pilot tests for "medical courts," which are likely better suited for producing equitable results. Reform is urgently required, the author states. "[A]fter all, this emerging crisis is ultimately about the patients – and who will be there to heal them." » article

North Country Mothers Are in Desperate Need of More Doctors
Judd Gregg, Union Leader, March 4, 2008

In this editorial, Senator Judd Gregg describes the deficit of obstetricians currently plaguing New Hampshire. This coming April, Weeks Medical Center’s maternity ward will close. This will leave residents of northern New Hampshire with only one hospital for maternity care in the entire 1,830 square miles of Coos County. Moreover, women in the northernmost town will be forced to drive over 60 miles for urgent medical care. The result of this closing “will be compromised care for women when they are expecting a baby and increased risk of complications for mothers and babies when moms are forced to travel such long distances to give birth.” New Hampshire’s situation is not unique; in fact, it is reflective of the significant lack of obstetricians in many parts of the country, which is due in large part to the nationwide medical liability crisis. This is “one of the most pressing issues facing the health care community today,” and in order to fix it, the country must enact “comprehensive medical liability reform.” » article

Lawsuits are Behind Surgeon Shortage in USA
Lewis Sharps, USA Today, March 3, 2008

In this editorial, Dr. Lewis Sharps comments on the "effect medical malpractice has on a region’s ability to retain surgeons." In 2002, the increasing costs of medical liability insurance caused a major crisis in Pennsylvania. When several liability insurance carriers went out of business because of deficiencies in the legal system, many doctors were severely limited in their ability to find medical malpractice coverage and practice medicine. Sky-high malpractice insurance forced many physicians to retire or move to other states. "[T]here is a perfect storm forming as a result of the shortage of physicians," the author writes. And “…it has been brewing on the horizon for a decade. » article

Who'll Patch Us Up?
Suzanne Hoholik, Columbus Dispatch, March 3, 2008

In Ohio, if you "cut off your finger, get stabbed or are hurt in a car crash," you will be rushed to a hospital best prepared to treat such severe trauma. However, local trauma physicians are troubled that, in five to ten years, a deficit of doctors will make it very hard to keep four adult trauma centers. Each level-one trauma center needs roughly 200 doctors devoted to trauma injuries. But only 15 doctors are at each such facility or on-call to respond to such cases at any given time. Exacerbating this shortage is the fact that fewer young physicians are specializing in trauma care. In fact, approximately 40 percent of trauma residency and fellowship programs go unfilled. Major reasons include increased difficulties stemming from the legal system (medical liability issues) and uninsured patients. "It’s an absolute freight train hitting the American health care system square in the eye," said Dr. J. Wayne Meredith, trauma director at the American College of Surgeons. » article

Specialist Shortage Creating ER 'Crisis'
Kate Eckman, NBC 2, March 3, 2008

Southwest Florida is suffering a dearth of specialist doctors as many are now leaving the state. Of particular scarcity are emergency room specialists, and some experts say that this "is the number one health care problem we are facing today." Lawsuits and money are cited as the prime forces causing the shortage, which has especially affected patients. "[There are many] stories within the state of quite a few patients dying in the ER while waiting to find a place to transfer that patient to," said Dr. Larry Hobbs, an ER physician. » article

Shortage of Surgeons Pinches U.S. Hospitals
Robert Davis, USA Today, February 26, 2008

Physicians and experts are predicting severe shortages in practicing doctors in the near future. In the 1970s and 1980s, national advisory groups put a cap on medical school admissions in expectation of an upcoming glut of new physicians. As the population expanded, these groups realized their error and removed the caps, but many feel shortages will only worsen as baby-boomer doctors begin to retire. The American Association of Medical Colleges is predicting that 250,000 doctors will retire by 2020. Yet it is unlikely that new student enrollment will close the gap in demand for physicians because it takes years to educate and train new physicians and surgeons. Especially hard hit are rural areas, where only a handful of doctors are responsible for whole communities. New students look to more profitable specialties and locations to help pay off loans and cover high liability costs. One rural surgeon notes that "access to surgery in the periphery is in jeopardy...nobody will want to sign up for this job anymore." The American College of Emergency Physicians is calling for medical liability reform and changes in the way physicians are reimbursed. Such changes would encourage more students to serve rural areas and more doctors to choose less lucrative specialties. » article

Emergency Care in Crisis with Few Specialists On Call
Marsha Sills, Daily Advertiser, February 24, 2008

Hospitals in Lafayette, Louisiana are finding it more difficult to recruit and retain specialists to take emergency call. The combination of declining reimbursement rates and increasing liability costs are deterring physicians from taking unknown patients in the ER, while taking time away from their own practices. The staffing shortages mean patients often have to travel farther or be transferred to another facility in order to receive treatment.

North Country Doctor Shortage
Katie Morse, News 10 Now, February 20, 2008

The number of primary care physicians in Northern New York is on the decline. Medicaid reimbursement rates in New York are extremely low, while medical liability costs continue to grow. Recent increases in premiums, and the threat of a $50,000 surcharge, is pushing doctors out of the profession and the state. Medical students trained in New York are electing to start their practices elsewhere due to the economic squeeze on physicians. Physicians say the onus is on the state to improve the situation, and help attract and retain more doctors. Without change, access to care will be severely compromised in the rural northern region. "From talking to other hospital administrators across the North Country, we're all facing the challenge. The people that are especially affected are the poor, the uninsured, the Medicaid population," said one local administrator. » article

County Facing a Shortage of Doctors
Lisa Carolin, Livingston Community News, February 15, 2008

Many patients in Livingston County, Michigan are already travelling outside the area to receive medical care. The growth in population has far outpaced the physician supply, and in a few years, the area will be in a legitimate crisis. The competition for medical students is fierce, and enrollment in medical school is dropping. "There are fewer people going to medical school because it's become such a litigious environment," says one local physician. "The relationship between doctors and patients has changed." There are plans to expand services in the area, but many fear the physician shortage will eventually affect the whole state. » article

Primary Care Physicians Caught in Squeeze
Sylvia Booth Hubbard, Newsmax, February 14, 2008

Primary-care doctors are often a patient’s front line of defense for fighting disease. However, these physicians are encountering a wide variety of difficulties such as problems with insurance companies and lawyers. Primary-care income has suffered as Medicare payments have changed little in the past eight years. The way that Medicare pays these doctors often encourages them to see a high volume of patients instead of focusing on the quality of care. Further complicating matters is the issue of medical injury. Doctors fall prey to less than scrupulous lawyers, and patients often remain unaware of an incompetent physician’s history until it is too late. As a consequence of these and other problems, interest in becoming a primary-care doctor has declined substantially, with the number of primary-care residency positions dropping by more than half in the past decade. » article

Crisis in Care: The Doctor is Out
The Republican, February 11, 2008

Physicians specializing in women’s health care are “avoiding Western Massachusetts like the plague,” laments this editorial. Recently, the Department of Public Health disclosed that almost two-thirds of the four western counties in Massachusetts are “medically underserved.” Despite the region’s world class teaching hospitals and natural beauty, the area has great difficulty recruiting and retaining doctors. High malpractice insurance rates are a bane that keeps doctors away. “Patients in need of the most basic medical care often must wait weeks for an appointment, or travel increasingly greater distances for treatment,” the author notes. “It’s time to stop the bleeding.”

Lawmakers try to Lure Doctors to Wyoming
Michelle Dynes, Wyoming Tribune-Eagle, February 10, 2008

Wyoming is struggling to attract physicians, but lawmakers are crafting an incentive package that includes moving expenses, two years of insurance premiums, and a signing bonus. “We realized we were losing physicians to other states,” said Representative Lori Millin. “All of Wyoming is medically underserved.” Senator Bob Fecht said that one problem is that Wyoming has one of the highest malpractice insurance rates. In other states, doctors only pay a fraction of what they would in Wyoming. “There is a tremendous shortage of physicians, both specialist and primary care, and it is statewide,” added Senator Fecht. » article

Doctor Deficit Plagues Shore
Greg Latshaw, Daily Times, February 3, 2008

There is a growing dearth of physicians in Maryland, especially in rural areas. The Eastern Shore needs more doctors in 60 percent of medical specialties, and the gap is expected to increase to more than 83 percent by 2015. “Quite honestly, it’s being felt across the board in the hospital,” said Dr. Tom Lawrence. “If you just walked out to the mall and asked folks, ‘Are you having trouble seeing doctors?’ Most would say, ‘Yeah.’” A main cause of the shortage is the fact that Maryland doctors receive more than 20 percent less in insurance reimbursements than the national average and malpractice premiums are high. As a result, patient access to care is impacted. “Your health care card isn’t any good when there is no doctor at the other end,” commented the head of the state medical society.

Neurosurgeons Scarce in Palm Beach County Due to Legal Climate
Patty Pensa, South Florida Sun-Sentinel, February 1, 2008

Around much of Florida, there is a shortage of specialty health care due to the increasing rarity of neurosurgeons. Working on call in an urgent care setting is considered risky, and patients could suffer as the number of neurosurgeons in emergency departments drops. One major reason for the shortage is the sky-high amount that doctors are forced to pay for liability insurance. Proposals to alleviate the problem are being advanced, but an immediate turnaround is not expected. “There’s a reason for real concern in our community,” said Tenna Wiles of the Palm Beach County Medical Society. “This is a highly complex level of medicine, and there’s a higher concern about liability.” However, this problem has already affected many people. Mary Stone had a stroke several years ago, and eleven hours after she was diagnosed at Jupiter Medical Center she was sent to a hospital nearly 260 miles away. Ms. Stone died 10 days later at age 52, a result that might not have occurred if there was no shortage. The answer, according to the medical community, is to decrease the number of frivolous lawsuits.

Emergency Rooms' Growing Problems Affect Us All
Renie Schapiro, Milwaukee Journal-Sentinel, January 27, 2008

Recent studies have found wait times in ERs getting longer, yet the causes and effects of these findings have not been fully discussed. High liability costs coupled with large numbers of uninsured patients has forced many hospitals to close their emergency departments. For remaining ERs, this means overcrowding, which forces ambulances and patients to be diverted at critical times. Additionally, staffing shortages mean treatment times are longer and hospitals are more selective about patients they admit, sometimes turning walk-in patients away to make room for physician referrals who are more likely to have insurance. Finally, specialists are in short supply as they do not want to take the time and expense away from their own practices to treat high-risk, anonymous patients who are more likely to sue if something goes wrong. All of these issues contribute to a growing national problem that will affect all patients, with or without insurance. » article

Malpractice Costs Have Docs Seeking Shelter Elsewhere
Alison Snyder, Long Island Business News, January 25, 2008

In New York, the towering cost of medical malpractice insurance has forced some obstetrician/gynecologists to limit the types of care they provide, while others are leaving the state altogether. This has prompted concerns about decreased health care access for pregnant women and lower-income patients. Last year’s massive rate hike resulted in New York OB-GYNs paying the fourth-highest medical liability premiums in the nation. Most OBs in Suffolk and Nassau counties pay a starting rate of over $175,000 per year for this insurance. Dr. Matalon, an obstetrician in Bay Shore, decided to cut back his practice after the rate increase – he no longer performs major surgeries and stops seeing patients past a certain stage in their pregnancies. A recent survey indicated that half of physicians had trouble paying for their medical malpractice insurance and half were strongly contemplating leaving the state. “I’m scared that we’re just going to have people simply stop practicing,” said Senator Hannon, the chair of the Senate Standing Committee on Health. “It has been noticeable that the physician community has been quiet – it hasn’t spoken up, and I tend to think there’s too many people planning, saying ‘you know, four more years and my kids are out of high school, and I’m going to move.’” Dr. Quirk, the head of the obstetrics department at Stony Brook Medical Center, observed that patients will suffer the most – particularly “the medically underserved.”

Doctors Fear Impact of Insurance Surcharge
Frank Donnelly, Staten Island Advance, January 20, 2008

A potential $50,000 surcharge to be levied on New York doctors has frightened physicians in Staten Island. Not only will this hurt the doctors, they say, but patients will be adversely affected as well. “There's going to be practices going out of business and the higher-tech specialties [such as obstetricians, neurosurgeons and orthopedists] are going to be harder to find. Everybody’s nervous about what’s going to happen,” cautioned Dr. Ralph Messo, president of the Richmond County Medical Society. “It’s going to affect patient care.” The surcharge was just one of the proposals brought up when Governor Spitzer created a task force to examine the state’s escalating medical malpractice costs. Dr. John Maese, a past president of the medical society, says that such a solution is infeasible. “There's no way you have a spare $50,000 to cover that on top of your regular $30,000 [in annual medical malpractice insurance a Staten Island general practitioner typically pays]. Primary care practices run on a very tight [profit] margin.” An ordinary local obstetrician-gynecologist pays an astonishing $160,000 to $225,000 in annual malpractice premiums and a neurosurgeon may have to pay more than $300,000 a year, according to physicians. The doctors advocate reforming the legal system – and perhaps even establishing medical malpractice courts (or health courts). Finding an equitable solution is critical, and everyone from politicians to insurance companies must collaborate. “Right now, it’s the physicians’ problem,” said Dr. Messo. “Tomorrow it will be the public’s problem.” » article

Small Clinics Feel Cuts by OHSU
Joe Rojas-Burke and Ted Sickinger, The Oregonian, January 19, 2008

A recent ruling by the Oregon Supreme Court effectively ended a $200,000 cap on non-economic damages that had shielded Oregon Health & Science University (OHSU) from high liability costs. As a result OHSU is going to have to cut $30 million in programs to pay additional increasing malpractice premiums. Several hundred job cuts, double-digit tuition increases for students, and the restructuring of about a dozen facilities will be the result of the ruling. The closing of small, rural clinics will have the most dramatic impact, as they are the only source of care for their communities. OHSU will have to cut programs and reduce the size of the incoming medical school class, leaving local patients with fewer options across the state.

ER Wait Times Getting Longer
Forbes.com, January 15, 2008

A recent study found that wait times in hospital emergency departments have gone up significantly, with an average increase of 30 minutes per patient. For people in need of medical attention, 30 minutes can be a crucial time lapse. With higher liability premiums and a large number of uninsured patients, hospitals are finding it increasingly difficult to keep their emergency rooms open. Yet patient numbers in emergency rooms have only increased while available beds have decreased. The study’s leader noted that, “increasing wait times are the result of a ‘perfect storm’ that has occurred as emergency room visits are on the rise while many ERs are closing their doors.” » article

Lack of Doctors is Real Health-Care Crisis
Van Allen, Arizona Daily Star, January 13, 2008

The U.S. health care crisis is not simply due to a lack of insurance, according to this op-ed in an Arizona newspaper. The main issue is a shortage of physicians. “What good will universal health care be if there aren’t enough doctors to satisfy patient demand?” asks the writer. This lack of doctors is felt most severely in rural and poor urban areas. The average time it takes to see a specialist is increasing because “more patients seek appointments with fewer doctors.” Exacerbating this shortage is the fact that many doctors are considering leaving the field because of factors such as the constant threat of lawsuits and the rising cost of malpractice insurance. However, an emphasis on preventative medicine and improved public health education could decrease the need for health care, and legal reforms could encourage doctors to remain in the profession. “...[T]hese are the issues that the candidates should consider and debate in order to make the right prescription for health care in America,” writes the author. » article

Patients Call for Medical Liability Reform
Leland Kim, NBC 8 KHNL, January 11, 2008

Hawaiian patients have joined local physicians in calling for reform of the state’s medical malpractice system. For months, doctors have been warning legislators of the dangers of a health care shortage caused by high liability insurance premiums. The supply of primary care and trauma doctors has been particularly impacted by this matter, a problem that one young man was unfortunately forced to experience first hand. Brock Raymond was riding his motorcycle in Maui when he was involved in an accident. His bike skid and slammed into a guardrail, severing his leg. He was rushed to a nearby hospital, but there were no surgeons available to reattach it. Brock was flown to an Oahu hospital, which caused treatment to be delayed for over six and a half hours. “Those hours are very critical,” said Dr. Linda Rasmussen, an orthopedic surgeon. “Once you hit six hours, there’s no chance of re-vascularizing and saving the tissue. It’s dead beyond that point.” Brock lost his leg, and while his family is frustrated, their disappointment is not aimed at the health care community. “It’s not a reason of bad personnel. They’re good people. They’re good doctors. They’re good nurses. There’s just not enough of them to cover,” said Brock’s father. Patients and doctors are calling upon lawmakers to assume leadership and fix Hawaii’s medical crisis. “You may get along for five, ten years without being in a major car accident, but when you are, it could be your leg that is lost,” stated Dr. Rasmussen. » article

'Wrongful Death' Legislation Passes in the End
Susan Livio, Newark Star-Ledger, January 8, 2008

The New Jersey Senate recently passed a controversial measure which will allow families to sue for emotional distress in cases of wrongful death. The bill passed by only a narrow margin due to some concerns that it will drive up medical liability premiums and force some physicians out of practice. One Senator feared that OB-GYNs will be especially hard-hit, as they often find themselves the subject of wrongful death litigation. The bill finally passed on a promise from leaders that they would work together to control medical malpractice costs for state doctors.

Severe Dearth of Doctors Forecast for Maryland
Susan Levine, Washington Post, January 8, 2008

The Maryland Hospital Association’s recent report on physician supply has grave implications for state-wide medical care in the coming years. By 2015, many areas of the state will face a severe physician shortage, meaning longer wait times for appointments and crowded emergency rooms. The physician population in the state is aging and residency programs are retaining few of their trainees. As a result, primary care and specialist physician numbers are shrinking, with effects that reach beyond the Maryland borders to the nearby District of Columbia and Northern Virginia capital region. The Hospital Association recommends several actions that will increase physician ranks and retention rates, including monetary incentives. The major causes for the shortage, the report says, are shrinking insurance reimbursement rates coupled with high liability costs for physicians. » article

Disappearing Doctors
Scott Maizel, Baltimore Sun, January 4, 2008

A recent study presented at the University of Maryland Medical School demonstrated critical problems in Maryland's ability to attract and retain physicians. The study found that over 30 percent of the state’s general and thoracic surgeons are expected to retire in the next seven years. Moreover, the state has substantially fewer practicing physicians per 100,000 citizens than the nationwide average. This shortage is projected to reach crisis levels in many areas of Maryland. Part of the reason for this problem is that insurers pay Maryland physicians up to 20 percent less than what is normal in other states. This predicament is compounded when coupled with the state’s “skyrocketing malpractice insurance rates.” Although rates have recently been kept steady by a state subsidy program, albeit at remarkably high levels, premiums will climb again if the government does not make changes. “The consequences of our shrinking physician work force are increasingly obvious,” writes Dr. Maizel, the president of the Maryland State Surgical Association. “[There will be] longer waits in our emergency rooms, greater difficulty finding a doctor who accepts new patients, fragmented care with more tests, and more expensive health care.”

Primary Care Among His Primary Concerns
Judy Benson, Connecticut Day, January 1, 2008

The story of one primary care physician speaks to a growing national problem. Dr. Robert Linden is retiring after 30 years as a primary care doctor, serving about 2,200 patients in his community. Linden prided himself on serving his friends and family – providing continued close care for his patients. Yet he fears that he is part of a trend, older doctors retiring with few new primary care physicians available to take his place. With high malpractice costs and shrinking reimbursement rates, doctors are forced to see dozens of patients each day to cover their costs – meaning less time and attention for each patient and fewer physicians who choose to go into the field. “A lot of doctors have become so aloof and are scared to get close to their patients because of medical malpractice, or they're getting so caught up in all the insurance codes they forget about treating the patient,” says Linden.

Other Reform Proposals

Obama Open to Reining in Medical Suits
Sheryl Gay Stolberg and Robert Pear, New York Times, June 15, 2009

Doctors Duty to a Third Part the Exception, Not Rule
Amy Sorrel, AMNews, June 1, 2009

Bringing Sky-High Malpractice Premiums Down to Earth
Nancy Terry, Medscape, May 21, 2009

In the face of health care reforms, doctors are crying for liability relief. After years of rallying for change to current system of handling medical liability claims, physicians have found little relief as their premiums continue to climb. In New York, doctors have seen their premiums go up 55% to 80% in the last five years. There is near universal agreement that the current system fails to achieve its goals - slow and inefficient, few patients are compensated, patient safety problems persist, and 54 cents of every award dollar goes towards paying attorney and court fees. Reforms are needed, and this article describes several options. Medical review panels have been tried in several states to help sort through claims at the earliest stages, but there have been mixed results. No-fault systems have found some support amongst physicians who feel it would compensate patients and improve the doctor-patient relationship. "I come home literally every night afraid to open the mail," reports a psychiatrist. "Cut my income to the bone and I'll still try to carry on. But, keep holding me responsible for every unfortunate event within arms reach, and I'm out of here." » article (registration required)

NC Malpractice Arbitration Going Unused
Jordan Schrader, Citizen-Times, March 29, 2009

North Carolina’s arbitration program, a new method of resolving lawsuits against doctors that requires both sides to consent and caps damages at $1 million, is going unused. When the final version of the law passed unanimously in 2007, it was pitched as a way to lower insurance fees by bringing notoriously large jury awards under control. Doctors throughout the state claim their patients have refused the offer to arbitrate, preferring to try their chances in a courtroom for the potential of a large payout. Lawyers also prefer not to arbitrate, believing they are better off trying their cases before a 12 member jury as opposed to a single expert. While lawyers and doctors blame each other for the unused law, many attribute lack of arbitration to ignorance—the law has not received enough publicity. Despite the fact that no one has used the bill, its supporters remain optimistic. One of its chief supporters in the House, Rep. Bob England, is confident that the law has had a positive impact, “at the very least, the law was useful for showing that doctors and lawyers can agree on something. It opened up many doors of discussion.” » article

At the Same Table: Alternative Liability Resolution
Amy Lynn Sorrell, AMNews, February 2, 2009

Physicians, lawyers and hospitals around the country are experimenting with alternative approaches to resolving medical liability claims. At Abington Memorial Hospital in Pennsylvania, a new mediation pilot program has begun which brings parties together voluntarily to meet in a non-adversarial setting. Mediation allows both parties to reach a mutually acceptable agreement, but the mediators resolution is not final and either party can still elect to go to trial. The process can save time and money, encourage communication and avoid protracted and emotional court battles. Several hopsitals have found this model to be effective at reducing costs while making sure patients and physicians receive fair treatment. Some states have experimented with mandatory mediation with little success. The mandate becomes just another step in the process and another cost. "Doctors are interested in anything that improves the current court-based system," said a Board member of the American Medical Association. But despite anecdotal evidence of the benefits of mediation and other approaches, "it is not conclusive, and what we need to have is clear evidence." » article

Making Access to Quality and Affordable Care a Reality for Every American
John McCain, Journal of the American Medical Association, October 29, 2008

Presidential hopeful John McCain provides an in-depth explanation of his health care plan which he hopes will “put patients and doctors back in control of health care decisions.” McCain’s plan will consist of four components: affordability, portability and security, access and choice, and quality. Senator McCain addresses the issue of quality, and how medical liability reform will benefit doctors and patients. He notes that the current tort system has fostered inefficiency, as doctors practice defensive medicine and drive up costs. Moreover, high liability payments and the adversarial litigation process can push doctors to leave the field, making it more difficult for patients to find the physicians they need. He rejects tort reform because it leads to defensive medicine, unnecessary medical procedures, and limits the availability of many specialists. » article

CMS Pay-for-Performance Pilot has Improved Quality of Care and Lowered Costs
Medical News Today, August 18, 2008

The Centers for Medicare and Medicaid Services recently announced that pilot program aimed at improving quality and lowering costs has been extremely successful. The program, involving 10 practices, changes the reimbursement structure for physicians, rewarding them for quality and effiecient care. CMS found that all 10 groups improved the quality of care for patients with heart disease and diabetes and 4 of the groups reduced spending, saving a combined $17.4 million. "The Medicare Payment Advisory Commission and other analysts have said it is important to reward doctors for quality and efficiency and to encourage hospitals and physicians to coordinate on more high-quality, efficient care as a strategy to improve the value of Medicare spending." The pilot project has implications for physcian reimbursement structures as well as the clinical and cost effectiveness of certain treatments. As CMS and others look for ways to contain costs, evaluating different therapies and treatments will be critical in determining how to improve quality and efficiency. » article

In U.S., Expert Witnesses Are Partisan
Adam Liptak, New York Times, August 11, 2008

The American legal system is set apart from the rest of the world in numerous ways, but one area which has frustrated many is the appointment of expert witnesses. In many parts of the world, neutral experts are appointed by the judge to offer an unbiased opinion of the case. In the U.S., experts testifying can offer valuable testimony that often completely contradicts the opposing expert. One judge noted, “The two sides have canceled each other out,” refusing to accept the testimony of either expert and complaining that “no funding mechanism” existed for him to appoint a neutral. A new Australian technique, termed "hot tubbing," asks the experts to testify concurrently, asking each other questions and responding to the evidence in an effort to work out where the common ground lies. Other countries have eliminated competing experts altogether, opting for court-appointed neutrals who pledge their duty to the court itself. More than 40% of expert testimony in the U.S. is medical, and it is thriving business for some. Medical courts would employ neutral experts appointed by the court in an effort to create a less adversarial environment and reduce administrative costs. » article

NICE Job. Cost-effectiveness in the UK
Matthew Holt, The Health Care Blog, August 5, 2008

Author Matthew Holt describes a presentation from Britain's head of the National Institute for Clinical Excellence (NICE). NICE is devoted to assessing new treatments, drugs and therapies for both their clinical effectiveness and cost-effectiveness in comparison with exsiting technologies. NICE's head, Andrew Dillon, explained that the agency does not have a specific cutoff point for rejecting any new drug or therapy, but rather considers each individually. The probability of rejection appears as an S curve, going up steeply once the cost of a treatment per Quality Adjusted Life Year (QALY) reaches 40,000 GBP. Dillon also stressed that part of NICE's role, in the beginning, was to incorporate more new technologies and therapies into British medicine, which is notoriously conservative. Now that is has effectively brought the level of care of to speed, NICE has received some negative publicity for limiting the use of certain drugs or technologies. However, Dillon points out that the agency approves most treatments - 72% are positive, 3% are negative and 25% are both positive and negative, meaning they are approved only for specific uses. Dillon noted that NICE was specifically designed for the British system and works closely with the primary care trusts (similar to HMOs) and doctors to ensure compliance and get doctors to alter their practices in accordance with the guidelines. Moreover, there is broad popular and political support for the agency in Britain and it is poised to expand in effort to improve care and maintain cost-effectiveness. » article

Med School for Judges: A Crash Course in Medical Litigation
Amy Lynn Sorrel, AMNews, July 28, 2008

A judicial education program is helping to train judges to better understand the nuances and complexities of medical malpractice trials. The Advanced Science and Technology Adjudication Resource, ASTAR, has been training judges in complex litigation issues that involve more than just an understanding of the law. A recent course at the Indiana University School of Law featured mock trials, case histories, and simulated clinical discussions. Participating judges must first go through a 120 hour "boot camp" to get up to speed on basic terminology and core concepts in medicine. This training gives judges a major advantage when hearing adversarial testimony from expert witnesses - they know which questions to ask to see if the testimony is based on sound evidence. These training sessions demonstrate that medicine is an imperfect science and one that is always shifting. But with certain significant Supreme Court rulings, judges have been given more influence in scrutinizing expert testimony and potentially making groundbreaking rulings. The several hundred ASTAR judges are from around the country and it is up to individual states to deploy them. Ohio Chief Justice Moyer hopes the medical profession "will find comfort in the fact that there is a developing group of judges who understand enough about the science of medicine to be better gatekeepers. ... Because at the end of the day, what we all want is for the judgment to be based on the very best information available." » article

Hospitals Learn to Say Sorry
Maura Lerner, Minneapolis Star Tribune, March 29, 2008

Minnesota hospitals have quietly been changing the way they approach medical errors. For years hospitals and providers have been encouraged not to reveal any information about a mistake or acknowledge that something had gone wrong. Yet research shows that malpractice claims can often be deterred if the patient and their family are offered an apology and an explanation. Beginning in 1999, two Minnesota children’s hospitals revised their policies to require the immediate disclosure of adverse events and near-misses. Without this kind of openness, patients often feel abandoned and betrayed by trusted caregivers. Moreover, the silence surrounding errors means physicians and hospitals do not discuss what went wrong and take steps to prevent the same incident from recurring. "As a whole state, I think the culture has shifted," said Dr. Phil Kibort, vice president and chief medical officer at Children's Hospitals. "In the last five, six years, we've been telling the truth." » article

Abington Hospital Starts Mediation Effort
Sandra Moyer, The Intelligencer, March 28, 2008

A new mediation program at Abington Memorial Hospital in Pennsylvania hopes to bring quick, fair resolution to patients injured in the course of treatment, as well as encourage patient safety improvements. The program, run by the Hospital, the Montgomery County Medical Association and the Montgomery County Hospital Association, will attempt to resolve malpractice claims without the lengthy and exhausting process of going to trial. The program was first promoted by the State Supreme Court in 2002 as one of a series of reform measures that could lower liability costs and keep hospitals in business. Three years in the making, the program hopes to bring patients and doctors to the table before moving to trial in order to resolve claims amicably, fairly and quickly. Patients retain the ability to go to trial, but often patients want to hear an apology and see that the providers are taking steps to make sure the same error is not repeated. “But the process gives patients and doctors a chance to communicate with each other before each side has a chance to harden their positions,” noted the chair of the mediation program. “There is healing through mediation.” » article

Malpractice and Apologies
Editorial, Brockton Enterprise, March 13, 2008

A recent bill introduced in the Massachusetts legislature would allow physicians to make a simple, but important, gesture to patients who have been injured in the course of receiving treatment. The bill will make doctors’ apologies inadmissible in medical malpractice cases. Patient advocates say that simple apologies can go a long way in easing the effects of a medical injury. Many victims often want an apology more than anything and have sued as a result of their frustration. Mistakes, and their ensuing litigation, come at a high cost in medicine – driving up liability costs and increasing defensive medicine. “Saying "I'm sorry" won't fix the malpractice insurance crisis, but legalizing apologies may help. Let's at least give doctors and patients the chance to come together over their shared tragedies in the hospital room instead of the courtroom.” » article

Free Care for Life, If Money Holds Out
Anita Kumar, Washington Post, March 6, 2008

The Virginia Birth-Related Neurological Injury Program has been given a much-needed infusion of funds with the passage of a recent bill. The program provides lifetime medical care for some children with specific birth-injuries, without the difficulty or expense of a lengthy trial. The program currently has 109 children enrolled who receive at home nursing therapies, medical equipment, and other benefits. Yet in 2000 the program was declared actuarially unsound and is carrying a large deficit. With average expenses for a child’s lifetime care being $2.2 million, the program is expected to last another 20 years, but parents fear that the program will not be able to provide the much needed lifetime care it promised. "We can't abandon them," said Del. Harvey B. Morgan (R-Gloucester), who introduced one of this year's bills. "They are far better off being in this program." The program is financed by fees from participating physicians and insurers, but those fees were slashed after few children enrolled at the program’s inception. As the program ages, more children are living longer and administrators say those fees are long overdue for an increase. A recent bill approved by the Virginia Legislature will raise fees paid by doctors and insurers in order to help the program continue.

Doctor-lawyer Project Tackles Malpractice
Stacey Burling, Philadelphia Inquirer, March 3, 2008

Physicians and attorneys in Pennsylvania are launching a pilot project they hope will keep more malpractice disputes out of the traditional court system. Lawyers and doctors will collaborate to mediate conflicts between patients and health care providers (not unlike several proposals for health courts). Proponents anticipate that the “new approach will resolve problems more quickly and humanely,” and without the brutal adversarialism evident in many malpractice fights. Dr. John Kelly, chief of staff at Abington Memorial Hospital, said he wanted to steer clear of the “harshness” of litigation. “At the end of the day, I think everybody walks away feeling like it's a much more productive process, and it’s a healing process.” The project began three years ago when the state Supreme Court encouraged counties to look at alternatives to traditional court battles since physicians had threatened to leave Pennsylvania because of astronomical malpractice insurance rates. The project was pursued by doctors and lawyers because “there’s got to be a better way to do things than the way we’ve been doing them,” said Dr. Mark Lopatin, who led the medical society’s part of the effort. Supporters of the program say it is frequently less expensive than court because there are fewer exhibits and costly hired experts. Advocates of the experiment also say it is “more likely to give patients what they really want: early action, an apology, and information.”

Insurance Panel Eyes No-Fault Malpractice Plan
Gale Scott, Crain's New York, February 15, 2008

Recent spikes in New York malpractice liability premiums have spurred legislators to begin discussing ways to lower costs and stave off a crisis. A task force created to assess reform alternatives is expected to recommend the creation of a no-fault birth injury program. Establishing such a program would remove specific cases from the lititgation process and offer continued financial assistance to individuals who qualify through a much faster and cheaper administrative process - similar to a health court. The New York State Medical Society has been pushing for such a program, which would lower obstetrical liability premiums. "Dr. Steven Safyer, president of Montefiore Medical Center, hopes that such a reform is in the works. The center’s medical malpractice coverage has more than doubled since 2005, to $91 million, and obstetrics coverage drove about half of that increase, he says." » article

Senator Pushing for Bill to let Retired Doctors Practice
Bobby Shuttleworth, NBC 48 WAFF, January 25, 2008

Alabama Senator Arthur Orr is pushing for a bill that would allow retired doctors to practice in free clinics while the state covers their malpractice insurance. Many retired physicians would readily devote their time and skill to such a cause, but cannot afford to pay hefty liability premiums. Dentists and pharmacists have expressed interest in similar proposals, allowing them to offer free services to low income patients. » article

Should I Sue My Doctor?
Elizabeth Cohen, CNN, January 9, 2008

There are no simple answers for many patients who suffer from complications. One woman, Christine, had a hysterectomy last autumn, but something went wrong. What was supposed to be a week-long recovery grew to a four month ordeal as she underwent three extra surgeries to correct the problems. Her family was concerned. “The first question everyone I know asks is, ‘Are you suing?’” recalled Christine. However, she did not want a black mark against her physician. “He’s such a nice guy. He delivered my children,” she said. Despite her initial reluctance, Christine, also a physician, eventually visited a medical malpractice attorney. But he would not accept the case. Another malpractice attorney, Wayne Grant, provided a rationale, “My expenses would likely be more than the recovery. She's out of luck.” Furthermore, explained Grant, the complication that caused Christine’s problems would likely be considered a typical complication of the surgery, not negligence. “Just because you have a bad outcome doesn’t mean you can sue,” he said. This information does not, however, bring much relief to an expensive and painful ordeal. According to Lucian Leape, a professor at the Harvard School of Public Health, if Christine lived in New Zealand or Sweden the outcome could have been quite different. In those countries the national health program pays patients (via a health court system), even if there was no negligence. “You can slice this any way you want, but something obviously did go wrong. Who caused it is irrelevant,” commented Dr. Michael Woods, a surgeon and CEO of a group that attempts to reduce misunderstandings between doctors and patients. » article

Patient Safety, Quality of Care, and Doctor Discipline

Is Hospital Peer Review a Sham? Well, Mostly Yes
Dr. Bob Wachter, Health Care Blog, June 3, 2009

Hospitals find Confession Good for the Bottom Line
Jay Greene, Crain’s Detroit Business Journal, May 11, 2009

Over the past several years, a small yet growing number of hospitals in Michigan have been developing “I am sorry” teams to tell patients and their families when medical mistakes have been made. Through these teams, hospitals hope to increase transparency, correct broken medical processes, improve individual performance and quality, and reduce costs related to medical malpractice lawsuits, liability premiums and attorney fees. Hospitals across Michigan have seen success: millions of dollars in reductions of malpractice expenses and fewer open claims. With less money put aside for litigation costs, hospitals can invest in patient safety initiatives to further improve quality. » article

Power for Patients
Ruth Faden and Jonathan D. Moreno, Baltimore Sun, May 1, 2009

Comparative effectiveness research could have a profound, positive effect on how medical decisions are made. Currently, there are three main drivers in medical decision-making: advertising and promotion by drug and device companies; coverage decisions by insurance companies; and medical science and experience. Comparative effectiveness, on the other hand, would allow patients and doctors to make decisions together based on the best possible scientific evidence, giving patients real choices based on solid information. It would also improve the quality of the medical care that patients receive, not only by identifying what works best but also by identifying what doesn't work at all - and even more importantly, what causes more harm than good. Choosing blindly is an empty right; choosing with evidence respects patients' rights and enhances quality. » article

Health Care in Bits
Ed Sperling, Forbes, April 13, 2009

Discussing innovations in health care with the CIO of Inova Health Care, Forbes finds that electronic health records and computerized systems have the potential to improve quality, streamline efficiency and reduce errors. By making medical records standardized and readily available across practices, patients can receive more coordinated and targeted care. Moreover, safeguards can be built in to reduce drug interactions and create standardized protocols for the treatment of particular illnesses or injuries. » article

Success from Surgical Checklists Breeds Idea for Ethical Checks
Kevin B. O’Reilly, AMNews, April 13, 2009

The intensive care unit at the Washington Hospital Center in Washington, D.C. is hoping to expand the benefits found in surgical and infection control checklists by adding an ethical component. The eight-item ethics checklist-- actually an ID-sized badge that residents wear on lanyards -- covers ethical issues that commonly arise in the hospital setting. Is the patient able to make medical decisions? Is there a do-not-resuscitate order? Is there a disagreement among family members about how care should proceed? Supporters find many benefits to the practice, including the standardization of care, outward thinking on the part of the physician. Checklists could also prevent ugly squabbles with families and prevent lawsuits. Many remain skeptical of the checklist hype. Dr. Peter J. Pronovost, principal investigator of a patient-safety initiative, said "checklists are a way to summarize what to do, but it's naive to think that will change behavior.” Rather, checklists must be part of a broader approach to changing medical practice. » article

Hidden Malpractice Dangers in EMRs
Steven I. Kern, Medscape Business of Medicine, April 9, 2009

With the current administration avidly promoting healthcare information technology, and tens of thousands of dollars at stake in incentives and future penalties for doctors, more physicians will be implementing electronic medical records (EMRs) in the coming years. One of their highly-touted benefits is the potential to help prevent malpractice incidents and medical errors. However, many of their appealing characteristics also pose potential malpractice risks. In particular, repetitive documentation could obscure critical patient information; use of the wrong template could produce a faulty patient profile; physician attention could switch from the patient to technology; and failure to adopt this new technology could lead to malpractice claims. As with all other aspects of their practice, doctors need to be careful and vigilant when using an EMR. Although it's inviting to let templates do much of the heavy lifting, physicians need to be cognizant of the information contained within them, and not blindly follow templates. » article

Why Are Healthcare Information Manufacturers Free of Liability?
PRNewswire, March 24, 2009

Even when their products are implicated in harm to patients, manufacturers of healthcare information technology (HIT) currently enjoy wide contractual and legal protection that renders them virtually "liability-free.” HIT vendors claim that, because they cannot practice medicine, clinicians should be accountable for identifying errors resulting from faulty software or hardware. However, errors or lack of clarity in HIT software can create serious, even deadly, risks to patients that clinicians cannot foresee." Provisions in most HIT contracts also prohibit healthcare organizations from openly disclosing any problems caused by vendor software, thereby defeating patient safety efforts. Ross Koppel, Ph.D., of the University of Pennsylvania School of Medicine, states that "we must achieve a better balance among patient safety concerns, fairness to clinicians, vendor responsiveness, and vendor marketing." He suggests moving the HIT industry toward this balance may require several changes to the status quo, including altering legal standards to facilitate rather than frustrate disclosure of HIT product shortcomings that have patient safety implications. » article

Hospitals Offer a New Take on Medical Mistakes
Mary Jo Layton, Richmond Times Dispatch, March 21, 2009

Eager to resolve medical mistakes more efficiently and amicably, some New Jersey hospitals and physicians are openly admitting errors to patients and sometimes even offering compensation. Hospitals hope saying "we're sorry" will cut down on lawsuits. Hospitals across the country have proven the efficacy of such programs. After adopting such a program at the University of Michigan Health System, for example, lawsuits were cut in half and litigation expenses dropped by two-thirds, or $2 million. It's a radical change from the "deny and defend" culture of medicine, which leaves patients angry and litigious. Larry Downs, general counsel for the Medical Society of New Jersey is confident apologizing is a better way to confront errors than “blood and guts litigation.” While the conversation disclosing an error can be unpleasant, program advocates believe patients appreciate hearing the truth. » article

Reporting of Mistakes by Hospitals Is Faulted
Anemona Hartocollis, New York Times, March 9, 2009

New York City hospitals are the least reliable in the state at reporting preventable mistakes and adverse incidents for patients like heart attacks, blood clots, hospital infections and medication errors, according to a new report by the office of City Comptroller. Though city hospitals accounted for almost half the patients statewide in 2006, they reported about 39 adverse incidents per 10,000 patient discharges, compared with nearly 70 per 10,000 in the northern suburbs and upstate, and nearly 64 per 10,000 on Long Island. The report stresses that since similar institutions are being compared, a higher number of incidents does not mean that a hospital provides worse treatment, only that it is more diligent about reporting problems. Lack of reporting makes it impossible for consumers to accurately judge the quality of a hospital. The City Comptroller states that unreliable reporting will hurt patients in the form of longer hospital stays and higher health care costs; “without the fullest possible reporting, hospitals cannot identify areas where systematic improvement may be needed.” » article

Surgeons should know the legal liability of consenting to patient-demanded treat
Dr. Sonny Bal and Lawrence Brenner, Orthopedics Today, March 9, 2009

The nature of the patient-doctor relationship has shifted in recent years. With the information available to patients on the internet, as well as direct advertising by physicians and pharmaceutical companies, patients receive more information from a wide array of sources. A more informed patient certainly has its advantages, but it can lead to problems. If patients demand a drug or procedure, despite a physician's warnings or inclinations, is the physician liable if something goes wrong? The authors list a series of steps physicians can take to protect themselves in this new environment, including ensuring that the patient is fully informed of all the risks and obtaining their consent. Moreover, physicians are equally able to refuse to perform surgeries that are contraindicated and may need to work more to control the conversation regarding treatment options. "Such skills are all the more important today, when patients often come to the first visit already equipped with medical knowledge, and biases toward or against specific surgical procedures." » article

Finding a Way to Ask Doctors Tough Questions
Laura Landro, Wall Street Journal, March 4, 2009

Despite efforts by advocacy groups and others to empower patients, challenging a doctor or nurse on whether they are correctly doing their job remains intimidating. More and more institutions are making the effort to help patients take an active role in caring for their own health. There is evidence suggesting that greater patient involvement can improve medical outcomes. The Robert Wood Johnson Foundation surveyed 600 patients with chronic illnesses in the Seattle area and found a link between how patients feel about their encounters with doctors and how well they adhere to their regimens. For example, among patients in treatment for depression who felt their medical providers treated them fairly, 90% took their medications regularly. But adherence to a regimen was just 60% among patients who said they felt they had not been communicated with or were treated poorly. Although some doctors may be unreceptive to a patient challenging their course of care, being vocal holds benefits for patients and doctors. » article

Finding a Way to Ask Doctors Tough Questions
Laura Landro, Wall Street Journal, March 4, 2009

Does Oversight Threaten the Doctor-Patient Bond?
Pauline W. Chen, M.D., New York Times, February 26, 2009

The $1.1 billion set aside in the economic stimulus bill for comparative-effectiveness research is causing worry among physicians and patients that an outside third party lacking medical experience will be defining what is “appropriate” care. Although oversight can put doctors and third parties at odds over treatment, organized and consistent oversight has proven successful in the area of organ donation. During the transplantation process the doctor-patient relationship is both intensely monitored and successful. The United Network of Organ Sharing is a nonprofit organization which reviews every donor case and every transplant case in the country. UNOS is in charge of clinical oversight and develops policies using evidence-based studies and consensus among representatives of its many constituent groups. The transparency, consistency, and evidence-based research on which UNOS prides itself, ensures that all transplant doctors and patients know where their third party stands. » article

Why Hotels Resist Having Defibrillators
Scott McCartney, Wall Street Journal, February 24, 2009

Automated external defibrillators (AEDs) -- laptop-sized devices that can automatically restart a heart after sudden cardiac arrest -- have saved lives at airports, casinos, health clubs and many public buildings. But hotels have resisted installing them, citing potential liability issues. Hotels worry that if they have the devices, which cost about $1,200 to $2,000 each, they could be sued for failing to have enough units, failing to put them in the right places, failing to replace batteries or maintain them properly, or failing to properly train hotel workers to use the device. Hotels across the country are using similar legal reasoning for not purchasing AEDS, demonstrating how liability fears often preempt common sense and threaten the common good. A 2004 study published in the New England Journal of Medicine found that public access to AEDs doubled the chances of survival in cardiac-arrest cases. Hotels that have installed AEDs have seen dramatic results. At the Sheraton San Diego Hotel, for example, six of seven people who suffered sudden cardiac arrest in the past five years have been saved with AEDs. Michael Caspino, an attorney specializing in lodging issues, says many hotels worry that Good Samaritan laws, which provide legal protection for people making a good faith effort to render assistance, aren't adequate. Further, they don't want to incur the costs to defend a lawsuit -- even if the case ultimately gets thrown out. » article

A Skeptic Becomes A True Believer
Manoj Jain, Washington Post, February 10, 2009

Dr. Manoj Jain was skeptical when her hospital joined 4,000 other health care facilities in the quality improvement initiative led by the Institute for Healthcare Improvement. The program claimed to reduce and even eliminate hospital-acquired infections by implementing thorough and consistent checklists. Prior to engaging in the initiative, Dr. Jain viewed hospital-acquired infections as anticipated outcomes of a hospital stay. For years, says Dr. Jain, “I thought that hospital-acquired infections were the price we had to pay for intensive care. You stay two weeks in the ICU and you get an infection -- that's not unusual.” The quality improvement initiative, however, changed her mentality. The checklist system forced physicians to look at the process, measure the results, provide feedback, and develop strategies to improve patient care. The initiative transformed the hospital’s culture of patient safety and quality, leading to a 50 percent decline in ICU infection rates with a 21 percent reduction in cost per ICU discharge. » article

When Doctors and Nurses Can't Do the Right Thing
Dr. Pauline Chen, New York Times, February 5, 2009

Dr. Pauline Chen describes the many competing influences which doctors and nurses face today when providing care. Nurses in particular feel that their concerns are often trumped by physician hubris or demands from insurers or families. Physicians too feel that their decisions are scrutinized and second-guessed by insurers and risk managers. Chen calls this growing trend "moral distress," meaning that providers find that what they may feel is best for the patient is comprimised by the dictates of others. “A lot of the reasons for moral distress come from the environments where we work. Are we working as respectful partners or are we afraid? Doctors feel that the risk managers or the lawyers are telling them what they can and cannot do for patients, and that affects physicians," said one researcher and nurse, Ann Hamric. » article

America's Safest Hospitals
Rebecca Ruiz and David Whelan, Forbes, January 27, 2009

In its seventh annual study of "quality and clinical excellence," HealthGrades identified 270 hospitals out of 5,000 that collectively had a 28% lower mortality rate and 8% lower complication rate than the national average. The list reflects the top 5% of hospitals nationwide. If all facilities performed at this level, the authors argue, 152,600 lives might have been saved and 11,700 hospital complications might have been prevented between 2005 and 2007. Improved safety rates clearly benefit patients, but they may also help lower health care spending. Better outcomes and fewer errors may also persuade underwriters to view the hospital as low-risk. They may also decrease the number of medical malpractice claims, which cost insurers $7.1 billion in 2007. Dr. Gregg Meyer, vice president of quality and safety at Massachusetts General Hospital, says accountability and transparency also contribute to a hospital’s success: "What you want is an organization that has a high rate of reported safety events and does something about them." » article

Get Hospital Infection? It Will Cost
Josh Goldstein, Philadelphia Inquirer, January 22, 2009

The Pennsylvania Health Care Cost Containment Council study of hospital-acquired infections found that the average bill for patients that contracted an infection during their hospital care in Pennsylvania was nearly five-and-a-half times the bill for those who did not get an infection. In 2007, 27,949 patients acquired infections during their hospital stays, an 8% drop from the previous year. Pennsylvania’s Health Care Cost Containment Council is an independent state agency that addresses the problems of escalating health costs, and access and quality of care. Due to the Council’s efforts, Pennsylvania was the first state to require hospitals to publicly disclose infection rates and data on individual hospitals; both of which improve patient safety. » article

Surgeon Shortage Pushes Hospitals to Hire Temps
Vanessa Fuhrmans, Wall Street Journal, January 13, 2009

Due to increasingly grueling schedules, shrinking payments, and the temptation of more profitable surgical specialties, the traditional way of practicing general surgery is fading in many parts of the country. General surgery is now among the fastest-growing areas of a temporary-medical-staffing industry that is expected to double to $2.1 billion in 2009. Staffing agencies estimate that at least 1 in 20 of America's 17,000 general surgeons now work on a temporary basis some or all of the time. Even though temporary surgeons do not worry about overhead costs, they place more of a financial burden on hospitals than a permanent surgeon. A temporary surgeon who performs scheduled procedures and emergency operations can cost a hospital about $1,500 a day. Beyond price, critics worry that temporary surgeons pose a risk because they do not remain with their patient throughout the course of their treatment. » article

Pregnant Women: Just Say 'No' to Early C-Section
Deborah Kotz, U.S. News & World Report, January 8, 2009

A recent study in the New England Journal of Medicine found that babies delivered via C-section before 39 weeks are at significantly increased risk for respiratory problems and other complications. The rates of C-sections have risen steeply in recent years to nearly a third of all births. While few mothers actually request C-section deliveries, doctors have increasingly turned to them because they are more predictable, and often less risky, than vaginal deliveries. Doctors choose C-section deliveries because they are often less likely to lead to costly liability claims. » article

Health Care that Puts a Computer on the Team
Steve Lohr, New York Times, December 27, 2008

The Marshfield Clinic in Wisconsin demonstrates how computerized medical records improve the quality and efficiency of medicine. Marshfield’s technology has helped keep their patients out of the hospital by providing better monitoring of chronic diseases. Electronic records, currently used by only 17 percent of the nation’s physicians, include up-to-date histories, medications, lab tests, treatment guidelines and doctors’ and nurses’ notes. This technology helps to reduce unnecessary tests and medical errors and encourage the provision of better overall care. Widespread use of electronic records, especially among smaller health care facilities that cannot afford the pricey equipment, depends upon incentives. Policy experts say government matching grants or other subsidies should be provided for practices with fewer than 10 doctors. “People ask about return on investment, but that’s the wrong question,” said Dr. John W. Melski, the medical director of clinical informatics at Marshfield. “This requires the usual leap of faith that knowledge will yield good things — better care, doing things smarter and, yes, saving money in the long run.” » article

Physicians Who Use EHRs Pay Fewer Malpractice Claims
Sheri Porter, AAFP News Now, December 23, 2008

A new study finds a correlation between the use of electronic health records (EHR) and a reduction in paid malpractice claims. The study found that, among physicians responding to a survey, 6.1 percent of those using EHR had record of a paid claim and 10.8 percent of those not using EHR had record of a paid claim. The study's author noted that the study's findings were consistent across all specialties and said that it provided some of the first clear evidence that EHRs have a direct link to reducing errors. Researchers hope the findings will encourage doctors to adopt electronic health records more quickly and potentially provide incentives for malpractice insurers to offer discounts. » article

Doctor-Patient Communication Is Key To Good Health
Joan Robinson, Medical News Today, December 22, 2008

The patient consent form has become a ubiquitous necessity in modern medicine, but researchers feel it has become as much of a liability as the procedure it precedes. Consent forms are viewed merely as necessary legal release forms, missing a crucial opportunity to convey important information about medical procedures to the patients. Detailed information offered in a mutual exchange would provide educational information, give the patient options and result in the patient having more realistic expectations for recovery. The complex legal nature of the forms is often difficult to understand and sets the doctor-patient relationship off with an adversarial tone . A clear exchange of information could reduce a patient's worries and improve the relationship between patient and physician. » article

Weak Oversight Lets Bad Hospitals Stay Open
Alex Berenson, New York Times, December 8, 2008

In late 2006, a New York State commission recommended that University Hospital be scaled back and merged with another hospital due to its substandard care. Despite these facts, University Hospital remains open. The state’s inability to follow through on that plan for University demonstrates how hard it can be to close or shrink hospitals, even when there is evidence they are providing costly and below-average care. Unlike some other nations, including France, the United States has no federal agency charged with hospital oversight. Any effort to maintain national standards is left largely to Medicare and the Joint Commission, a nonprofit group. University Hospital was not closed and did not suffer financial penalties because of its ties to the community. The hospital’s unions paid for television ads, lobbied lawmakers, and filed a lawsuit to overturn the recommendations. Dr. Berwick, the president of the Institute for Healthcare Improvement, a national nonprofit group trying to reduce hospital mistakes stressed that “we need to act with more speed and diligence to stop practice where it’s actively harmful…let the needs of patients come first, not the needs of a hospital.” » article

As Hospital Infections Spread, So Do Medical-Malpractice Lawsuits
Sylvia Hsieh, Maryland Daily Record, November 30, 2008

As the rates of deadly hospital infections have been on the rise in recent years, lawsuits charging hospitals with negligence have become more common. Recently, there have been several large awards to individuals or families of individuals who have suffered from hospital-acquired infections. Such infections used to be considered a risk that hospitals could do little to prevent, yet recent studies have shown that strict hand-washing and safety protocols can reduce the risk of infections to near zero. The Joint Commission recently released a compendium of strategies for avoiding infections, detailing specific actions and protocols which hospitals can implement. Implementing these best practices can help to reduce both lawsuits and infections. As with health courts, using the information gained from frequent lawsuit claims can help to stem future injuries. » article

Next President Must Put Health in Health Care
Sheldon Whitehouse and Newt Gingrich, Washington Times, October 28, 2008

Senator Sheldon Whitehouse (D-RI) and former Speaker of the House, Newt Gingrich, cross party lines to discuss the ills facing America’s health care system. Health care, which accounts for one-sixth of our nation’s spending, must be a priority for the next president. Although they acknowledge the issue of the uninsured, their three components of reform include: investment in health information technology, promotion of evidence-based medicine, and restructuring of the medical payment system. Embracing technology and utilizing medicine that is proven by science will decrease health care spending. A reformed payment system would stop rewarding physicians for the amount of procedures they perform, and instead reward prevention and treatment. By making quality, not quantity, the priority, physicians will not feel pressured to perform extraneous medical tests and work towards preventing costly chronic diseases. » article

The Blame Game - No Winners
Deane Waldman, Huffington Post, October 20, 2008

According to Deane Waldman, “everyone loses when playing the Blame Game.” Fear of medical liability hurts patients by preventing error reduction and suppressing quality improvement. Legal fear continues to force many physicians out of medicine, decreasing the amount of available health care providers. Fixing the system requires systematic overhaul, not “casting stones” in the form of lawsuits. Waldman encourages patients to accept responsibility for their own health decisions to ensure that the health care system provides what we all desire: quality care. » article

Doctors More Likely to Tell Patients About Obvious Errors
Jacob Goldstein, Wall Street Journal, October 6, 2008

Medical error reporting has long been a priority of patient safety and hospital accreditation boards, but the physician community is only slowly changing its practices. Recent studies have found that doctors are more likely to report a blatant error, such as an overdose of insulin that could hospitalize a patient, but a relative minority would tell the patient about an overlooked lab result or more discrete error. Though some states protect physicians from liability if they apologize to a patient for making a mistake, doctors are still fearful of liability and this has traditionally engendered a culture of silence regarding medical errors. The Joint Commission requires the reporting of errors and sees this newest study as a slow step in the right direction. Doctors are slowly coming around to the idea of reporting mistakes and improving patient safety. With health courts, medical error reporting, malpractice cases and patient safety would be linked, such that physicians and administrators could readily learn from their errors and implement standard best practices that better serve patients. » article

Medicare Won't Pay for Medical Errors
Kevin Sack, New York Times, September 30, 2008

Medicare, along with many of the country’s largest commercial insurers, will stop paying hospitals for the added cost of treating patients who are injured in their care. Medicare generated a list of 10 “reasonably preventable” conditions it refuses to cover, including incompatible blood transfusions, serious bedsores, and post-op infections. The mandate, which will only save $21 million annually, is a symbolic effort to reorient the medical payment system towards greater focus on prevention, chronic disease management, while discouraging unnecessary procedures. Diane C. Rydrych, the state health department official in charge of reporting, says Medicare’s new policy does not seek to chastise hospitals, but to ensure that hospitals and physicians learn from their mistakes, avoid harm, and provide better quality of care. » article

Hospital Clash Puts Patients in the Middle
Manoj Jain, Washington Post, September 16, 2008

Manoj Jain, a consulting physician in a Tennessee hospital, discusses the conflict that often erupts between doctors and hospital administrators and its negative impact on patients. Many sources underlie doctor-hospital disputes from salary inequities to challenges regarding autonomy. These disputes do not only prove difficult for physicians and administrators, they are also potentially dangerous. Dr. David Nash, Chairman of the Department of Health Policy at Thomas Jefferson University Hospital in Philadelphia, believes that “cultural strife leads to errors, and the number of errors shows the size of the cultural rift.” According to the Institute of Health, medical errors result in 98,000 deaths in hospitals a year. These conflicts must be resolved ,whether through outside mediation or internal restructuring, to ensure that patients’ care is not compromised. » article

Shorter Hours Mean Fewer Surgical Mistakes: Study
Julie Steenhuysen, Reuters, September 15, 2008

A U.S. based study found that surgical residents who worked shorter shifts were less likely to make mistakes during gallbladder surgery. This study supports 2003 guidelines that called for maximum shifts of 30 hours, and a maximum 80-hour work week. Fewer hours translates to more alert physicians and fewer technical errors. Although this research demonstrates the benefits of shorter work weeks, many doctors are skeptical about further cuts. The head of the study, Dr. Virgilio believes hospitals cannot institute any future limits on work weeks because they could “result in poorly prepared physicians.” » article

Untangling Health Care
E. Michael Foster, The News & Observer, September 14, 2008

E. Michael Foster, a professor at the University of North Carolina School of Public Health, discusses six issues that are contributing to the nation’s failing health care system. These issues are deep-seeded and require a “health care overhaul” of system fundamentals. America’s health care system is economically unsustainable, plagued by errors, and lacking the level quality patients deserve. According to Foster, the U.S. must ask "whether something fundamental needs to change about how health care is organized, delivered and regulated." » article

Small Patients, Big Consequences in Medical Errors
Laurie Tarkan, New York Times, September 14, 2008

Medical errors are a serious hazard for all patients and are far more prevalent than most people realize. However, children are sometimes at greatest risk of being the victims of medical errors, particularly when receiving medication. Adult prescriptions come in readily made dosages, but dosages for children are usually made from a distillation of the adult prescription. If a doctor misplaces a decimal or makes a slight mistake, the effects can be ten or one hundred times as powerful. Additionally, it can be more difficult to tell if something is wrong with children and parents must be particularly vigilant for strange or erratic behavior. Technology can help to reduce medication errors in particular, but small miscalculations can have enormous repercussions. » article

Survey Reveals That Doctors Feel Pressured By Health Insurers To Alter Treatment
Medical News Today, September 10, 2008

A survey of more than 1,200 New York physicians revealed that health insurer rules often force doctors to alter their treatment plans not necessarily for the benefit of the patient. Ninety percent of respondents expressed feeling pressured to prescribe certain medications, perform certain tests, or avoid referrals because of insurance company incentives and disincentives. While 95% of physicians surveyed agreed that “decisions on what medications are right for a patient should be made by the patient’s own doctor and not by the health plan or the insurance carrier,” monetary issues often prevent such practice. This survey conveys how system failures translate to poorer quality of care for patients. » article

Medical Errors Prompt Work Restrictions for Doctors
Ally Donnelly, NECN.com, September 9, 2008

Five years ago, the board which oversees medical residency training placed restrictions on the number of hours residents could work. Longer hours and fewer breaks can frequently mean young doctors are more easily distracted and prone to making errors. Now Congress is asking if the restrictions went far enough as medical errors continue to plague hospitals. Residents will readily admit that they have difficulty focusing after long shifts with little sleep. Physicians in charge of training say that preventing errors is foremost amongst their concerns, but young residents can miss important procedures and lessons if they are forced to end their shift. One physician expert noted, "We know that 24 consecutive hours leads to a 36% increase in serious medical errors, more than 400% increase in serious diagnostic errors that residents make, they crash their cars twice as often when they're driving home from work and suffer 61% more needle stick injuries." Unfortunately, cuts in hours mean more residents will be required to provide continuous coverage, a cost hospitals may not be able to sustain. » article

Rise in C-Sections Stirs Health Worry
Phil Galewitz, Palm Beach Post, August 23, 2008

In the past 10 years the rate of caesarian sections in Palm Beach County has nearly doubled to 40 percent, significantly higher than the national average of 31 percent. Rates continue to increase despite widespread research showing that C-sections are more dangerous than vaginal births. Many Florida obstetricians, such as Dr. Allan Dinnerstein, attribute this increase to legal pressures: “Every doctor knows you can’t get sued for doing a C-section, but you can get sued for not doing one.” Doctors and hospitals frequently perform C-sections in order to shield themselves from potential lawsuits even though caesarians are more costly and may pose risks to the mother. » article

Health Care’s New Entrepreneurs
Paul Howard, City Journal, Summer 2008

Paul Howard, director of the Manhattan Institute’s Center for Medical Progress, examines the work of health care entrepreneurs, individuals who refuse to wait for legislation to fix America’s health care system. Howard explains how these progressive doctors and scientists are spurring a “revolution from below that promises to improve quality, lower costs, and empower people to control their own health care.” Health care is currently unlike any other business because consumers have little incentive to compare costs and effectiveness when insurance covers their care. Moreover, the field is complex and it can be hard for patients to navigate their way through specialists and tests, trying to understand which treatment is most effective. In this setting, primary care doctors are more important than ever, yet they are being pushed out by high liability premiums and low reimbursement payments. Some companies and physicians are developing alternative models in an effort to cut costs and provide regular quality care to those who need it. By simplifying medical decisions, increasing access to affordable health care through convenient-care clinics, and utilizing innovations in genetic technologies, physicians hope to make the health care system more understandable, affordable, and personal. » article

Eyes Bloodshot, Doctors Vent Their Discontent
Dr. Sandeep Jauhar, New York Times, June 17, 2008

One doctor describes how physician satisfaction is indicative of many of the ills facing American health care. Recent surveys show that over 90 percent of physicians are dissatisfied with nonclinical aspects of medicine. More and more, doctors are required to be both business managers and physicians, and many are fed up. As managed care has grown, physicians find their decisions being scrutinized and second-guessed by claim adjusters with no medical experience. Lower reimbursements mean doctors must fight for every penny, and yet insurance companies routinely deny coverage. Moreover, liability concerns have only grown in recent years and premiums have followed suit, pushing many doctors towards early retirement. Patients trust their doctors less, armed with information gleaned from the internet, they second guess diagnoses and demand drugs. “I was naïve,” Saeed Siddiqui said. “When I was a resident I thought it was enough to take good care of patients. But the real world is totally different.” » article

Study Links Caesareans with Births Before Term
Denise Grady, New York Times, May 28, 2008

A recent study indicates that physicians are performing more Casesarean sections and that they are often done before the babies reach full term. Researchers looked at single births from 1996-2004 and found and increase from 9.7% to 10.7% in that period of late preterm deliveries. Of those deliveries, 92% were C-sections. It is hard to pinpoint whether the increase in late preterm deliveries is solely due to unnecessary Caesareans, as it is typically difficult to tell whether the C-section was medically indicated from a patient's medical records. Many physicians have noted an increase in the rate of C-sections in recent years. “Perhaps for convenience, perhaps out of fear of litigation, perhaps in response to a maternal request, they are scheduling their deliveries rather than allowing labor to begin,” said one physician. “And this comes when there is an epidemic in America of prematurity.” » article

A Doctor's Apology Can Heal
Connie Schultz, Capital Times, May 23, 2008

One author relates her own experience as a good indicator of how openness and physician apologies can soothe patients' frustration and prevent ill will. Many physicians are told not to reveal anything when a mistake has been made and patients are often angry and confused, left trying to cope and understand what went wrong. Studies have shown that apologies and expressions of regret can preserve the physician-patient relationship, prevent malpractice claims, and encourage the healing process for both patient and provider. What's more, such openness and communication serve a learning function, helping physicians to better understand what went wrong and prevent such harms from recurring. "We're doing a lot of things to emphasize better communication with patients, including those times when you have to deliver bad news, even when the bad news isn't your fault," said one physician. "Apologizing for mistakes may reduce the anger and litigation, but it's also just the right thing to do."

Doctors Who Say They're Sorry
Editorial, New York Times, May 22, 2008

The New York Times points out that the current medical liability system prevents physicians from communicating openly with patients when something goes wrong. Furthermore, the current system is an inefficient way to deter future harms as thousands of patients are injured each year due to negligence, but few ever take their claim to court. Moreover, many patients frustrated by the lack of knowledge or communication may pursue action in court, even if their injury was simply a bad outcome. "What is needed, many specialists agree, is a system that quickly brings an error to light so that further errors can be headed off and that compensates victims promptly and fairly. Many doctors, unfortunately, have been afraid that admitting and describing their errors would only invite a costly lawsuit." As a result, many prominent institutions are encouraging the disclosure of errors and expressions of regret. Indeed more than 30 states have passed legislation that makes doctor's apologies or admissions of sympathy inadmissable in court. "Admitting errors is only the first step toward reforming the health care system so that far fewer mistakes are made. But reforms can be more effective if doctors are candid about how they went astray." » article

Debunking the Bad Apple
Deane Waldman, Huffington Post, May 13, 2008

One author describes how the current medical liability system is failing patients and providers in a number of respects. “Our medical malpractice system works against us. We cannot just tweak it. We must reject it and create a whole new one,” Waldman notes. The perception of the physician has shifted over the years, from being infallible to criminal, as patients expect perfect outcomes when such expectations are unrealistic. Waldman describes many of the current misconceptions, namely that medicine is not a perfect science and physicians cannot always predict how every patient will react to a given treatment. Moreover, Waldman describes how many errors are due to systems failures and miscommunication, and eliminating the so-called “bad apple” doctors will not solve the problem. “I think (I hope) we can agree that what we really want are two things: 1) Help, and if appropriate compensation, whenever we are injured (regardless of whether a provider is proven negligent); and 2) Learning, so that the bad outcome may be avoided in the future,” says Waldman. “Our current system cannot do either. We need a new system.” » article

Reasons Not to Become a Doctor
Tara Weiss, Forbes, May 5, 2008

“No one ever said being a doctor was easy,” begins this Forbes article. “School and training go on seemingly forever; once graduation arrives, doctors work long hours and are faced with life-and-death decisions daily.” According to projections in the recently published Will the Last Physician in America Please Turn Off the Lights, the U.S. will lack 90,000 to 200,000 doctors within the next 15 years. The American Medical Association recognizes that there are shortages in certain regions and specialties. Primary reasons include lower insurance reimbursements and the rising costs of medical malpractice coverage. “If you think there’s a long wait for an appointment now, it could be nothing compared with 15 years down the road,” writes the author. Indeed, the wait for a non-emergency routine doctor’s visit could jump to three or four months and cost two to three times what it does now. Evidencing the negative pressures on the profession, 57 percent of physicians questioned in a 2007 survey would not recommend the medical field to their children. “Doctors have to practice defensive medicine [ordering unnecessary tests due to fear of lawsuits], and their insurance rates are so high,” says Mike Matray, editor of the Medical Liability Monitor. “... A lot of doctors right now are not encouraging their kids to be doctors.” » article

South Florida medical malpractice cases difficult for both sides
Patty Pensa, South Florida Sun-Sentinel, April 20, 2008

Nine years ago, Rita Wax’s son died during surgery, yet the lawsuit alleging malpractice continues. “I was devastated,” said Rita Wax, 72, of Boca Raton. “I really still haven’t recovered. It’s something that will never go away.” Medical liability cases can last for years, taxing emotionally both plaintiffs and defendants. Regardless of the outcome, lawyers say, “neither side really feels like the winner.” The average length of a malpractice case is three to five years. Furthermore, adverse outcomes, deaths, or injuries do not automatically equate with wrongdoing by a physician. Many families file lawsuits simply because they want to know what happened, according to Lindsey Chepke, a researcher at Duke University. Several years ago, in response to the escalating costs of the system, the Florida Legislature enacted caps on damages for pain and suffering. Chepke says, however, that “reforms often are a tug of war among trial lawyers, medical groups, and insurers. They ignore patient safety, which should be the focus.” The current system fails both doctors and patients. Even when a case ends, physicians see their reputations tarnished, their decisions questioned, and they practice medicine defensively, seeing patients as potential plaintiffs. Patients are ill-served as well. “I’ve had $300 million in settlements over my career,” said Gary Cohen, a veteran trial lawyer, “but I never see anyone walk out happy. They feel they’ve stood up and gotten justice but they’re very rarely happy. If they lose, they’re no more devastated than when they win.”

Health Care Reform II
Senator Robert O'Leary, Barnstable Patriot, April 17, 2008

The Massachusetts Senate is considering health care reform legislation, specifically to reduce costs, to increase access to primary care, and to improve transparency and efficiency. Among other things, the bill addresses issues surrounding medical education and primary care. However, writes Senator O’Leary, “we must do more work to control the growing cost of health care for our first-in-the-nation approach to work. . . . I think that we can do more, especially in the area of malpractice reform.” The current process for handling medical injury cases “takes a long time, is very inefficient, and does little to promote system-wide enhancements in patient safety.” Physicians can no longer afford exorbitant premiums for malpractice insurance; many are abandoning certain specialties, such as obstetrics, or are leaving Massachusetts altogether. Further inflating medical costs is the practice of defensive medicine – in which doctors order unnecessary tests out of legal fear. Moreover, the legal environment inhibits patient safety and learning because doctors are afraid to talk about mistakes. In addition, the present court system fails patients – studies suggest that less than 5 percent of injured patients seek compensation. Reforms like caps on damages have been suggested, but they do not address fundamental problems with the current tort system and do nothing to enhance patient safety. “We must find a better option for reform,” mandates Senator O’Leary. “An alternative approach could help to correct these failings, while also potentially reducing adversarialism in the system – benefiting both patients and health care providers.” » article

Study Finds Many Patients Dissatisfied with Hospitals
Robert Pear, New York Times, March 29, 2008

Recent data on patient satisfaction with hospital care shows that patients are often unhappy with some aspect of their care. Many patients described a lack of courtesy and respect, feeling that they had not received adequate pain medication, and many said they received unclear instructions from their caregivers. Nationwide, an average of 67% of patients would recommend a hospital to a friend or family member. But the results provide cause for concern, said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, a unit of the Public Health Service. “Poor communication is a major source of medical errors,” Dr. Clancy said. “If doctors are not listening carefully, patients may not bring up important information. Patients who do not understand discharge instructions are more likely to be readmitted to the hospital or end up in the emergency room.” » article

Health Insurers Limit Advanced Scans
Linda Johnson, Forbes, March 23, 2008

Citing concerns about increasing costs and patient safety, many insurers are putting programs in place to regulate the use of medical imaging techniques, such at CT or PET scans. Recent studies have shown that doctors are using these scans at increasingly high rates, potentially exposing patients to radiation and driving up costs. Physicians often use the scans to make diagnoses, but there are concerns that many are also practicing defensive medicine or using in-house machines to provide added income. In an efforts to control costs, insurers are beginning to require pre-authorization for these tests. Yet physicians argue that pre-authorizations will put patients at greater risk and jeopardize patient care. Physicians may prefer to use a CT scan, but rather than wait for approval, may elect to do a much riskier procedure to reach the same conclusion. "There is substantial evidence that these types of techniques, when used appropriately - and I want to emphasize the word 'appropriately' - can keep the lid on expenses and improve outcomes," such as by catching cardiac problems early enough to prevent a heart attack, one expert said. Physicians are hoping that insurers will respond to their concerns, but the companies feel their efforts to control the use of these scans have been effective.

Rules Aim for Better Patient Safety Through Confidential Error Reports
Dave Hansen, AMN News, March 10, 2008

Medical organizations and providers are cheering the recent publication of new error reporting and patient safety rules. The Agency for Healthcare Research and Quality has laid out a set of rules which responds to the Patient Safety and Quality Improvement Act of 2005. That legislation enabled the creation of patient safety organizations, which would spearhead error reporting efforts and suggest quality improvment measures. The legislation also established protections for physicians participating in quality reviews. Physicians are often reluctant to report errors or engage in peer review studies of quality measures for fear that the information they disclose could be used against them in a medical liability case. The new rules prevent information which physicians disclose to patient safety organizations from being subpoenaed or entered as evidence in court. In this manner, patient safety organizations could encourage learning and track errors in order to suggest changes in the standard of care. A trustee from the American Medical Association said, "The proposed rule is the first step toward implementing this important legislation, which will allow health care professionals to report errors voluntarily without fear of legal prosecution and transform the current culture of blame and punishment into one of open communication and prevention. When health care errors can be reported in a voluntary and confidential manner, future errors can be avoided." » article

Patient Safety is the Real Issue
Tim Riley, Erie Times-News, March 9, 2008

In this letter to the editor, the President of the Erie Association for Justice discusses how medical errors are a main driver of unnecessary medical costs. In Pennsylvania, Governor Ed Rendell has said the medical malpractice crisis is over, yet the crisis is not limited to controlling costs and stopping the physician exodus. Failures in patient safety cause thousands of unnecessary errors and cost billions of dollars, by some estimates. Medical liability should have strong ties to patient safety to prevent errors and improve the quality of care. Health courts would provide such a solution, by connecting malpractice claims with error reporting and quality analyses. » article

Has Medical Malpractice Changed Medicine?
St. Louis Post-Dispatch, February 20, 2008

A series of editorials describes the many views of medical malpractice reform. For practitioners and researchers, medical malpractice has catalyzed a patient safety movement which aims to reduce systemic errors through simple procedures. Medical boards have stopped issuing lifetime certification in favor of licenses that must be renewed. Despite these efforts, patient safety remains a concern. Indeed, attorneys feel that capping non-economic damages prevents many deserving individuals from receiving compensation for injuries. The lengthy and expensive litigation process means many attorneys will only take certain cases that promise big payouts in order to cover expenses. Some physicians see the reduction in malpractice cases as essential to keeping good doctors in business. Without reforms, liability costs were pushing some doctors out of the field. Traditional liability reforms curb costs, but health courts could address all of these issues, emphasizing patient safety, creating access for a broader pool of injuries with less focus on individual blame, while still lowering costs and streamlining the process.

Consent Forms that Patients Can Understand
Laura Landro, Wall Street Journal, February 6, 2008

Hospitals are experimenting with new ways of obtaining informed consent and notifying patients of potential complications with their care. Informed consent procedures have long been neglected as administrative nuisances by physicians and administrators, but experts say better communication and understanding can help prevent errors. Administrators are using new methods to help patients fully understand procedures and are working with physicians to ensure that they accurately explain themselves and obtain consent. By automating the process, providers can better track outcomes and compare results for individual patients. » article

Two Studies Describe Approaches Shown to Reduce Obstetrical Errors
Laura Beil, Medscape, February 4, 2008

Two new studies found substantial patient safety improvements in hospitals which implemented some basic strategies for managing obstetric care. Researchers at Yale–New Haven hospital found that using a dedicated patient safety nurse, standardizing common procedures and terminology, and improved training for providers significantly reduced error rates. The error rate was reduced by half, and accordingly medical malpractice premiums went down significantly. The hospital encouraged all staff to use the 2-challenge rule, a policy taken from the aviation industry, in which team members are asked to speak up if something doesn’t follow procedure and to speak up again if the practice doesn’t change. "We all practice better medicine when non-physician staff [members are] empowered to speak up," said one researcher. Another hospital, only emphasizing crew management to improve safety, also found reduced error rates due to better communication. » article

Birth, the American Way
Jennie Yabroff, Newsweek, January 28, 2008

A new documentary notes how recent increases in the number of Caesarean section deliveries have some physicians and researchers worried. Though the risk of death during childbirth is exceptionally small under any circumstances, C-Sections do have increased risk and carry added complications for babies as well. Many women are opting for C-sections over natural child birth, at greater cost and risk. Many believe hospitals prefer to do C-section deliveries, as natural child birth costs hospitals money and resources. Additionally, should even minor complications appear, physicians feel obligated to perform C-sections in order to protect themselves from liability. “If something does go wrong, in the eyes of the courts a normal birth is a risk. The courts reward action," says one researcher. » article

'It's Never Just One Thing' That Leads to Serious Medical Error
Susan Brink, Los Angeles Times, January 28, 2008

A technician misreads one letter in a drug name. A physician misplaces a decimal in a prescription. A nurse grabs a vial in a cabinet, except that the lights are dim, and she does not see that the powder-blue label is actually sky blue. Such mistakes are often simple, and they have all happened in American hospitals. Each error is supposed to be remedied by a backup system – say a second pair of eyes – that is in place to reduce human mistakes. Many things must be overlooked in the deluge of mistakes that result in acute patient harm. “It’s never just one thing that goes wrong when a serious event happens,” says Michael Cohen, president of the Institute for Safe Medication Practices. However, few hospitals learn from mistakes. If patient safety is to improve, hospitals need to study errors. But one major problem is that mistakes must be admitted first, and there is a substantial fear that doing so will lead to lawsuits. » article

Insurers Stop Paying For Care Linked to Errors
Vanessa Fuhrmans, Wall Street Journal, January 15, 2008

Some of the country’s largest private insurers are following in the steps of Medicare and designating certain preventable errors for which they will no longer reimburse hospitals. These “never-events” include leaving an instrument in a patient after surgery or developing bed sores. Aetna and Well-Point insurance are the two companies exploring programs that would refuse payments for medical errors. Medicare recently announced they would not compensate hospitals for medical expenses resulting from common preventable errors, such as hospital-acquired infections. The insurers hope these programs will give hospitals greater incentive to improve patient safety, report errors, and implement broad quality improvement standards. » article

Explain a Medical Error? Sure. Apologize Too?
Sandeep Juahar, M.D., New York Times, January 1, 2008

One physician discusses his experience with medical malpractice and describes how important an apology can be. For the best doctors, there are times when they don’t read the signs correctly and a proper diagnosis may be missed or delayed. Researchers say that many malpractice claims could be avoided if physicians would communicate openly with their patients and apologize for mistakes. » article

No. 1 Book, and it Offers Solutions
David Leonhardt, New York Times, December 19, 2007

“Overtreated,” by Shannon Brownlee, has been dubbed the economics book of the year. In large part, this book chronicles the work of Dr. Wennberg, which began in Vermont in the late 1960s. Despite having one of the most homogenous populations in the country (including similar levels of poverty and education statewide), the health care Vermont residents received varied drastically by region. For example, in one region only 7 percent of children had their tonsils removed, while in another region the figure was 70 percent. The key discovery was that residents of areas with more health care were not necessarily healthier. Dr. Wennberg went on, over the last 30 years, to repeat this work nationwide, with similar results. The United States spends 16 percent of its gross domestic product on health care, while countries such as Canada and France, where people live longer, spend approximately 10 percent. “We spend between one fifth and one third of our health care dollars,” writes Ms. Brownlee, a former writer for U.S. News & World Report, “on care that does nothing to improve our health.” One critical cause of this problem is that doctors often overtreat because they “worry about being sued if they do too little.” However, this is a difficult political issue since Americans often believe it is “the other guy” who is receiving the unnecessary treatment. “Since the 1950s, doctors have made incredible progress against diseases that were once inevitably fatal. That progress is probably the finest human achievement of the last half century,” writes the New York Times’ David Leonhardt. “If we weren’t wasting so much money on overtreatment, it would be a lot easier to repeat the achievement over the next half century.” » article

Recent Cases and Miscellaneous

A Shortage of Primary Care Doctors is Predicted
Natasha Lee, Stamford Advocate, February 24, 2008

A recent verdict in a Connecticut medical malpractice trial could spark a new debate about the medical liability system in the state. The jury awarded the parent of a child with cerebral palsy $34.5 million, saying that the OB-Gyn failed to act quickly enough in performing a Caesarean section. Local physicians feel that such verdicts are symptoms of a broken system, when there is little evidence that the doctor acted negligently or that her actions caused the child's illness. Harvard School of Public Health Professor, Michelle Mello, believes that testing liability alternatives, such as health courts, could stabilize insurance rates and offer more consistent verdicts.

'Expert' Witness is Heart of Med-Mal Problem
Jay Grossman, Miami Herald, January 21, 2008

In this editorial, Dr. Jay Grossman, a professor at the University of Miami Medical School and a director at the University of Miami Hospital, responds to the opinions of an attorney and details his thoughts on a central problem of the current medical injury legal system – expert witnesses. Florida’s high rates of litigation have had adverse effects on the practice of medicine in the Sunshine State. Several years ago, many doctors found it nigh impossible to obtain malpractice insurance at affordable levels. One cause of this problem is the prevalence of bogus lawsuits enabled by suspicious expert testimony. “I have personally seen many cases where the same ‘expert’ is a professional witness testifying all over the state,” writes Dr. Grossman. “Where do you find these people?” he asks. “It’s easy; they’re all over the Internet, just like the escort services – but more lucrative.” What is needed, according to Dr. Grossman, is a radical change in the functioning of medical malpractice lawsuits.

Waste, Costs, and Inefficiency

Eliminate Inefficiencies to Cut Health Care Costs
Richard Keller, Salt Lake Tribune, June 12, 2009

Fixing Health Care Starts With the Doctors
Steve Pearlstein, Washington Post, June 10, 2009

One Doctor’s Quest to Cut Unneeded Treatments
Nortin Hadler, ABC News, May 18, 2009

Dr. Nortin Hadler explains how unnecessary procedures, which he refers to as Type II Medical Malpractice, are a scourge in American health care. Type II Medical Malpractice is when a physician or surgeon does the unnecessary, even if it is done well. The unnecessary includes extraneous tests and procedures that often produce little to no improvement in the patient’s health. Although many studies comparing the efficacy of treatments are available, some procedures considered common practice do not lead to vast improvements in care. Physicians continue to perform high-priced and counterintuitive test and procedures with no benefit to the patient. Cutting these unneeded and inefficient treatments will results in cost savings and improved quality of care. » article

An Insider’s View on Health Care Reform
Blaine Peterson, Denver Post, May 15, 2009

In order to fix the health care system, we must address the fundamental flaw in the system—cost. Health care is over utilized, in part due to defensive medicine. Legal fears not only lead to unnecessary testing of patients, but they also increase costs for physicians. The cost of malpractice insurance is pricing many physicians out of the business. Administrative costs are also rising in part to malpractice issues. Hospitals and physicians are bound by bureaucracy, and often hire extra staff to protect themselves from lawsuits. For hospitals, labor costs are generally around 50% of the total cost. Reforming the health care system without reducing the cost of the system first will never produce reform that works at a cost we can afford. » article

How to Fix Health Care: Four Weeds to Remove
Dr. Scott Haig, Time, April 30, 2009

Fixing the inefficient and unsustainable health care system requires that four problems be addressed. First, the system is overregulated, redundant and takes up too much of physicians’ time. Second, the rules of the medical-billing industry are so complex hospitals must hire staff just to handle administrative tasks, thereby detracting funds from patient care. Third, the federal mandate to computerize medical records has little chance of saving money for anyone except the lucky insiders who sell the computers, software and support. Aside from the cost of medical technology, electronic records are time-consuming — a constant distraction from patient care. Finally, the malpractice system is unreliable and inefficient, instilling fear in physicians that manifests in defensive medicine. If these four “weeds” are removed, doctors will find some relief from economic and legal constraints, and deliver better quality care. » article

Federal Agencies Begin to Prioritize Comparative Effectiveness Research Dollars
Doug Trapp, AMNews, April 27, 2009

The $1.1 billion the American Recovery and Reinvestment Act designates for comparative effectiveness research will be divided three ways: $400 million for the Office of the Secretary of Health and Human Services, $400 million for the National Institutes of Health and $300 million for the Agency for Healthcare Research and Quality. All three major funding recipients are working together to make sure they are not duplicating each other's efforts. Dividing the funding will ensure that various aspects of comparative effectiveness are realized, including researching various procedures, devices and methods, disseminating results, and using those results to implement the best and most cost-effective care. Discussing the breakdown of funds will hopefully clarify the main goal of comparative-effectiveness research, which is not cost-containment, but better quality and more efficient care. » article

Discussing End-of-Life Care Lowers Cost: U.S. Study
Andrew Stern, Reuters, March 9, 2009

In the quest for cost-saving initiatives in the US health care system, researchers say end-of-life care merits a closer look. A study in the Archives of Internal Medicine found that terminally ill patients who talk over end-of-life treatments with their doctors spend less money and do not die any sooner but die more peacefully than those receiving aggressive care. Patients who have the discussion tend to opt for cheaper palliative care in a hospice or at home rather than costly treatments like emergency resuscitation, ventilators, and movement to a hospital's intensive care unit. According to the study, if half of the estimated 566,000 American adult cancer patients who died in 2008 had the end-of-life discussion, the projected savings would conservatively be $77 million. Of the 603 terminally ill cancer patients interviewed, those who spoke with their doctors about end-of-life care incurred $1,876 in medical costs in their final week of life, compared to $2,917 for those who did not. » article

Good or Useless, Medical Scans Cost the Same
Gina Kolata, New York Times, March 1, 2009

Medical scans have become a prime of example of where medicine can be both at its best and its worst. Technology in the area has advanced at a rapid clip, meaning doctors can see and diagnose things much more easily than they could have ten years ago. Yet patients are frequently sent for a costly scan that is worthless to their physician, and may undergo subsequent surgeries or procedures that can be painful, costly and sometimes unnecessary. The quality of scans, scanners, and physicians reading the scans varies widely, yet insurers pay the same regardless. Researchers estimate that of 95 million scans done each year, at a cost of over $100 billion, 20 to 50 percent should never have been ordered. A law which goes into effect in 2012 will require scanning centers to receive accreditation in order to be covered by Medicare, yet many feel this is only part of the fix. Physicians have added scanners to their offices, and often order substantially more medical images in an effort to boost profits. Moreover, older scanners or poorly trained technicians can influence results dramatically. “The system is just totally, totally broken,” said Dr. Vijay Rao, the chairwoman of the radiology department at Thomas Jefferson University Hospital, in Philadelphia. » article

Good or Useless, Medical Scans Cost the Same
Gina Kolata, New York Times, March 1, 2009

Drugs Can Save Hearts and Cash
Sarah Avery, News & Observer, February 19, 2009

Research conducted by scientists at Duke University found that it is cheaper and just as effective to treat some heart attacks with drugs instead of inserting stents. Stenting, which opens clogged arteries to restore blood flow, costs $700 million for the estimated 100,000 U.S. heart attack patients each year. Forgoing stents for less expensive drug treatments could save an average of $7,000 per patient. This study demonstrates how research can lead to cost-saving measures. Spending on health care in the United States tops $2 trillion a year and has risen nearly 10 percent annually since 1970. If the health care system does not uncover cheaper yet effective treatments, these costs will continue to rise. Joel Miller, senior vice president for operations at the National Coalition on Health Care, a Washington health advocacy group, states that this research demonstrates the potential cost savings found in comparative-effectiveness research: "we need to put more resources into research to know what works and doesn't work for same medical conditions. Physicians and patients need better data, and this is a case in point."

Getting Off the Patient Treadmill
Pauline W. Chen, M.D., New York Times, February 19, 2009

Many are critical of the traditional fee-for-service reimbursement system which pays doctors a set price for each visit, test or procedure they do. This system provides no incentives for doctors to promote healthy living or strong doctor-patient relationships. To promote cost-cutting and better quality of care, some health care providers are switching to a pay-for-performance system that links financial incentives to quality, not quantity. Questions remain, however, as to the system’s efficacy. Certain hospitals and physicians have found ways to “work” the system, by avoiding patients who require more costly care, and exaggerating the severity of patient status in order to document the kind of dramatic improvement that might result in a bonus. Dr. Petersen, chief of the section of health services research at Baylor College of Medicine in Houston, acknowledges imperfections in the pay-for-performance model, but still believes it provides the best medical care; “Even in the best hospitals, you find that things happen that shouldn’t. And it is not that people are bad or dumb, but that the system is not ensuring the best care. I’m interested in those enforcing functions that make it almost impossible to do the wrong thing. I am pretty optimistic right now. I think our current crisis of payment is going to stimulate action.” » article

In Health Care, New not Necessarily Better
Michael C. Brannigan, Albany Times-Union, January 25, 2009

Medical technologies, which often produce little benefit at high cost, are contributing to the nation’s rising health care expenses. According to the Congressional Budget Office, health care spending is currently 15 percent of our GNP and projected to reach 18.4 percent in five years. The article notes, “We waste nearly $700 billion annually on ineffective and redundant treatments and tests." Assessing new medical technologies, therefore, is a key strategy to contain costs and improve quality. The culprit is not technology, but rather the inappropriate use of medical technologies. Both President Obama and Tom Daschle, head of the Department of Health and Human Services, support a rigorous and objective assessment of new medical technologies that is immune from political and marketing enticements. Carefully monitoring new medical technology can prevent waste, defensive medicine, and climbing health care costs to produce the most cost-effective and beneficial results. » article

Health-Care Costs Need Radical Surgery
Dr. Deborah Greer, Auburn Citizen, January 19, 2009

One physician discusses her own troubles with obtaining medical insurance for her employees and how the health care crisis in America has many facets. Health care costs in the U.S. are some of the highest in the world, yet the system is plagued with waste and inefficiency. An abundance of technology has not translated into better care, but more care. Doctors facing declining reimbursement rates are not encouraged to treat with efficiency and care but rather speed through patients and order expensive tests using the latest technology. Dr. Greer notes that much of medicine today lacks careful analysis of which practices are most effective and efficient. Moreover, physicians facing staggering liability premiums will seek ways to pass the costs off and remain profitable. "The system needs a total overhaul. Correcting just one part of the problem is not going to be the answer. There needs to be a view from “outside the box,” a new look, a new system, to solve the many facets of the problems with which we are now faced." » article

Blue Cross Sets Sights on Lower Health Care Costs
Jeffrey Krasner, Boston Globe, January 14, 2009

Blue Cross Blue Shield of Massachusetts, the state's largest health insurer, has signed the Alternative Quality Contract, an innovative contract with a hospital and two physician groups that will slow the rate of medical cost increases and reward top-performing doctors with bigger paychecks. Most doctors and hospitals are paid under the fee-for-service system: a doctor provides treatment, and the insurance company pays for it. The system has come under scrutiny because it creates incentives to perform expensive and often unnecessary procedures. Blue Cross's new program gives providers a flat payment based on the number of patients they treat. By restricting treatments and thereby cutting costs, physicians can earn more over time. As part of the new system, doctors who do not meet strict quality standards will receive less money. Stuart Altman, a professor of healthcare economics at Brandeis University, praised the insurance company’s efforts, but remained realistic as to its long-term effects: "they are moving in the right direction. Where they're going to run into trouble is that as long as this is voluntary. This will only really work if it becomes the dominant way of paying for healthcare." Moreover, as long as doctors continue to face liability fears, it is likely that some measure of unnecessary testing will continue. » article

Nation's Health Spending Rising, But Not so Much
Kevin Freking, Washington Post, January 6, 2009

In 2007, the nation’s health care spending increased 6.1 percent to $2.2 trillion, the smallest increase since 1998. Overall, this translates to $7,421 per person for the year. Prescription drugs spending provided a bit of optimism as they experienced the smallest increase in spending. The small increase in prescription drug spending is attributed to the expanding use of generics, which can cost as little as one-third of the price of name-brands. Yet the expanded use of generics only makes a small dent in the overall cost of healthcare as prescriptions only account of 10 percent of all health spending. Richard Foster, chief actuary for the Centers for Medicare and Medicaid Services remains pessimistic about America’s health care burden: "I wouldn't expect the good news to continue…all other major health sectors—such as hospitals, physicians, nursing homes and home health—grew at the same rate or slightly faster than the previous year.” » article

More Isn't Always Better in Coronary Care
Jane Brody, New York Times, January 5, 2009

Angioplasty and stents are being used with greater frequency, often for patients who do not require such procedures. For these moderately healthy patients, stents offer no more protection than following a heart-healthy lifestyle and taking medication. However, medication and lifestyle changes, unlike pricey procedures, are not reimbursed by insurance. Dr. Michael Ozner, a Miami cardiologist, says that doctors have “extended the indications for surgical angioplasty and stent placement without any data to support the procedures in the vast majority of patients — stable patients with blockages in their arteries.” Patients, often afraid of not following their doctor’s advice, undergo these unnecessary procedures, which cost $60 billion a year in the United States. “Interventional cardiology is doing cosmetic surgery on the coronary arteries, making them look pretty, but it’s not treating the underlying biology of these arteries,” said Dr. Ozner; “if some of the billions spent on intervention were put into prevention, we’d have a much healthier America at a lower cost.” » article

Reigning in Doctors who Cost Too Much
Uwe E. Reinhardt, New York Times, January 2, 2009

In the seventh installment of his series on why America pays so much for health care, economist Uwe E. Reinhardt discusses how the nation’s fee-for-service payment system drives up costs. For example, physicians who have a direct financial interest in using imaging technology, such as CAT scans and M.R.I. scans, will recommend imaging tests more often than physicians who lack such financial incentives. Evidence-based case reimbursement, however, would combat this conflict of interest by covering supplies, services and evidence-based practices with one single payment. In addition to payment reform, Reinhardt supports implementing electronic health-information techniques through medical profiles to provide better care and lower costs. These cost-effectiveness profiles would pool information from many physicians regarding the risk and effectiveness of certain procedures. “Payment reform and more widespread use of electronic information systems,” Reinhardt states, “could drive even our existing system toward greater cost-effectiveness of care and, most likely, more moderate growth in health spending.” » article

British Balance Gain against the Cost of the Latest Drugs
Gardiner Harris, New York Times, December 3, 2008

How much is life worth saving? The British government created the National Institute for Health and Clinical Excellence, NICE, a decade ago to ensure that every pound spent buys as many years of good-quality life as possible. Many argue, however, that the institute is frequently rejecting expensive treatments and preventing patients from accessing the best care. With U.S. medical costs expected to reach 25 percent of the nation’s gross domestic product in 2025 from 16 percent, some wonder if NICE’s cost saving methods should be applied in America. The institute, which includes 270 doctors, economists and pharmacists, researches various medical techniques and determines which ones are the most effective and cost efficient. Their research creates guidelines and consistency, but denying costly treatment also raises moral questions regarding patient care. » article

New Report Shows Slower Premium Growth, But Increasing Pressure to Address Waste
Market Watch, December 3, 2008

In its third report on America’s health care system, Pricewaterhouse Coopers (PwC) on behalf of America's Health Insurance Plans (AHIP), examines the causes of rising health care costs and analyzes how health insurance premium dollars are being spent. The report, "The Factors Fueling Rising Healthcare Costs 2008," finds that higher costs, increased utilization and waste in the health care system continue to fuel underlying health cost increases. Karen Ignagni, President and CEO of AHIP, views these findings as catalysts for improvement: "Once again PwC's report demonstrates that we have made strides in lowering costs, but more must be done to make health care more affordable and eliminate waste in the system.” The report found that 87 cents out of every premium dollar go directly towards paying for medical services. Embedded within the 87 cents are the costs of medical liability and defensive medicine, which are estimated to be ten cents of the premium dollar. The report outlines efforts to reduce waste such as increasing standardization and transparency; improving research on comparative effectiveness of treatments; reforming the medical liability system; promoting value based reimbursement; and enhancing health information technologies.

Pushing Past the Placebo: Legislating for a New Kind of Clinical Trials
Geri Aston, AMNews, December 1, 2008

Physicians, insurers and consumer groups widely agree that not enough comparative effectiveness data exist on pharmaceuticals, medical devices and procedures. The Food and Drug Administration’s approval process primarily tests new drugs against placebos and not against other treatments. Proponents of comparative effectiveness claim that comparing the effects of similar drugs and treatments will help to improve quality and lower costs. Doctors searching for the best treatment for their patient face many obstacles: an overwhelming amount of data, insufficient time to research new treatments, and persuasive drug reps with a conflict of interest. A comparative effectiveness institute would provide independent and consolidated research. » article

U.S. Not Getting What We Pay For
Ceci Connolly, Washington Post, November 30, 2008

The outlook for health care in the U.S. is grim. Leaders and experts in the field widely agree that the country spends far too much for substandard care which is frequently wasteful and even dangerous. "There is more than enough money in the system," said former House speaker Newt Gingrich. "We just are not spending it well." It appears that Congress need only to consult with the field's experts and researchers - they generally agree on the broad outline of system reforms. A high-performance 21st-century health system, they say, must revolve around the central goal of paying for results. That will entail managing chronic illnesses better, adopting electronic medical records, coordinating care, researching what treatments work best, realigning financial incentives to reward success, encouraging prevention strategies and saying no to expensive, unproven therapies. Ideally, doctors and patients armed with comparative-effectiveness data could make more rational decisions -- such as whether to choose a more expensive, but therapeutically equivalent, medication. » article

The Minimal Impact of a Big Hypertension Study
Andrew Pollack, New York Times, November 28, 2008

In one of the biggest clinical trials ever organized by the federal government, a committee nicknamed Allhat found that when treating high blood pressure, generic pills that cost only pennies a day and work better than newer drugs up to 20 times as expensive. Yet the study, completed six years ago, has done little to increase the use of generic pills for hypertension. A confluence of factors blunted the study’s impact. One was the simple difficulty of persuading doctors to change their habits. Another was the response from pharmaceutical companies, who began heavily marketing their own expensive hypertension drugs and releasing their own clinical trials proving their treatments were paramount. Dr. Carolyn M. Clancy, director of the federal Agency for Healthcare Research and Quality, said providing doctors information is “necessary, but not sufficient” to urge them to change their practices. The Allhat experience conveys the need for comparative effectiveness research that is independent and consistent. » article

The Wrong Place to Be Chronically Ill
The New York Times, November 17, 2008

A study released by the Commonwealth Fund found that chronically ill Americans suffer far worse than their counterparts in seven other industrial nations. The study is a harsh wake-up call to those who still believe the American health care system is the best in the world. The study surveyed 7,500 patients in the US, Australia, France, Germany, the Netherlands, New Zealand and Britain suffering from one of seven chronic conditions: hypertension, heart disease, diabetes, arthritis, lung problems, cancer or depression. Among the American participants, more than half did not receive care because of high out-of-pocket costs. Americans also reported their care was unorganized citing unavailable medical records and late lab results. Although the US faltered on many levels, redeeming the failing system can be tied to a few simple changes, such as supporting a strong primary care system and using electronic medical records. » article

The Other $700 Billion Question
Jennifer Robison, Gallup Management Journal, November 13, 2008

Jennifer Robison of the Gallup Management Journal examines wasteful spending in America’s health care system. Health care spending accounts for 16% of the GDP, and 5% of that, or $700 billion, goes to spending that cannot be shown to improve health outcomes. Princeton University's Angus Deaton says "a tremendous amount of what we pay is spent on things that don't actually do any good.” To combat this wasteful spending, the Congressional Budget Office (CBO) recommends evidence-based medicine mandates that come from medical associations. Determining the best and most cost-efficient mode of care will benefit both patients and physicians. » article

Use of Imaging Technology Skyrockets
U.S. News & World Report, November 10, 2008

A study by researchers at Stanford and Harvard universities found that although the use of MRI and CT scans in the US has more than doubled since 1995, it has not resulted in better health care or fewer deaths. Laurence Baker, an author of the study from Stanford University, explains how health care providers must place more emphasis on studying the cost-effectiveness of imaging tests and the effect on patient care. Policy makers, payers and providers can only determine how best to use available testing methods when they have access to all the information. » article

Insurers Hire Radiology Police to Vet Scanning
Anna Wilde Matthews, Wall Street Journal, November 6, 2008

In an attempt to rein in the skyrocketing costs of imagining scans, health insurers are hiring radiology benefits managers, or RBMs, to determine if a costly test is necessary. The recommendations of RBMs, which are based on scientific evidence and medical groups’ recommendations, often clash with doctors. Physicians fear these middle men can cause delays or rejections of treatment that pose risks for patients. In addition, physicians are angry that they have to justify their course of treatment to reviewers who have not seen their patients. Dr. Agura, an oncologist at Baylor University Medical Center, said RBMs got in the way of his treatment plan of his patient: “Every time we scanned him, we had to go through a lengthy approval process…Delays in approval lead to cancers coming back and not being detected.” Insurance companies, however, claim RBMs lead to cost savings by preventing doctors from ordering unnecessary tests. Although RBMS claim they often approve tests after in-depth discussions with physicians, this is precious time doctors could be spending with patients. » article

NQF Endorses Consensus Standards to Reduce Waste and Promote Safe and Effective
Wall Street Journal Market Watch, October 30, 2008

The National Quality Forum has endorsed eight national voluntary consensus standards to encourage the appropriate and efficient use of imaging procedures in outpatient settings. Outpatient imaging -- such as CT scans and MRIs -- has an annual cost of $14 billion for Medicare beneficiaries. Yet there are few national standards to measure the safety, quality, efficiency, and appropriate use of outpatient imaging services. Janet Corrigan, NQF president and CEO, said “there are opportunities within many areas of our health care system to eliminate waste by providing effective services” and these standards will “reduce unnecessary and redundant services that expose patients to more potential harm than good." When measured and publicly reported, the standards endorsed by NQF can help health care systems pinpoint inefficiencies, waste, and overuse within outpatient imaging services by tracking patient radiation exposure, documenting the use of imaging services, and tracking the use of results.

Cost of Diabetes Care Has Doubled
Steven Reinberg, Washington Post, October 27, 2008

A recent study finds that the cost of treating patients with type 2 diabetes has skyrocketed, and yet it is unclear whether the added cost will have any positive impact on outcomes. Between 2001 and 2007, total spending doubled to $12.5 billion. The major driver of cost increases was the use of newer prescription drugs over generic or older brands. The study's author notes, "All too often, physicians and patients may tend to adopt newer therapies without sufficient evidence of their superiority or benefits over older, less expensive, more time-tested alternatives," he said." In addition, the number of Americans being diagnosed with type 2 diabetes has grown considerably in the last several years. For many of these chronic conditions, drugs and expensive therapies provide tangible, easy solutions when prevention and hard work are in fact most effective. Notes one physician, "Spending money is bad, and diet and exercise is the best thing we can do for our diabetic patients, but they are not very comfortable accepting diet and exercise as the treatment for diabetes." » article

How to Take American Health Care From Worst to First
Billy Beane, John Kerry and Newt Gingrich, New York Times, October 24, 2008

Former Speaker of the House, Newt Gingrich, and Senator John Kerry team up with former baseball player Billy Beane to discuss challenges in today's health care system. The authors note how fundamental information on the quality and effectiveness of treatments and prescriptions is severely lacking - driving inefficiency and failing to promote quality. "Remarkably, a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures. Studies have shown that most health care is not based on clinical studies of what works best and what does not — be it a test, treatment, drug or technology. Instead, most care is based on informed opinion, personal observation or tradition." Health care costs in the United States outpace any other industrialized nation with little added benefit. This financial drag effects businesses big and small as insurance costs continue to outpace the GDP. The authors discuss how baseball managers and owners have begun to focus on statistics to build better all-around teams with less money. Health care providers would do well to follow suit - a focus on evidenced-based care would reduce overall costs while improving quality. » article

Slowing the Growth of Health Care Costs - Learning from International Experience
Karen Davis, New England Journal of Medicine, October 23, 2008

Karen Davis, president of the Commonwealth Fund, discusses how international comparisons could yield important lessons for legislators and policymakers trying to reform the U.S. health care system. Davis notes that there are a number of available prescriptions under discussion amongst health care experts and researchers and that no one solution will fix the system. However many of the options under consideration draw on ideas already in place in other countries, particularly the use of cost-effectiveness analysis, employing electronic health records, altering the reimbursement structure for physicians to reward quality, and promoting the use of primary care physicians as a first line of defense. Many nations, such as Britain, Denmark, New Zealand and others, already use many of these tools to keep costs under control while simultaneously providing coverage to the majority of their citizens. Recent research has shown that while the United States spends twice per capita on health care what other countries spend, yet patients here get little or no added value or quality from the health care services they receive. Cost-effectiveness in particular could save $368 billion over a 10 year period. » article

A Plan to Improve Health Care and Limit Costs
Elizabeth Olson, New York Times, October 17, 2008

Scott Serota, president and chief executive of the insurer Blue Cross Blue Shield, explains his company’s initiative to contain health costs and improve care. While he does not think health care costs can come down, Serota believes insurers can work to make sure they stop rising. By cutting health care waste in the form of unnecessary, redundant, and sometimes harmful testing, the US can save $700 billion. Serota, therefore, supports current legislation pending in Congress regarding the creation of a comparative effectiveness institute to determine what treatments work best for a given condition. In addition, focusing on preventive care targeted at expensive diseases like diabetes will save the country billions of dollars. Sweeping systematic reforms are necessary, and by conversing with others in the insurance and health care industry, Serota believes the American health care system can be healed. » article

The Big Squeeze
Editorial, St. Louis Post-Dispatch, September 29, 2008

Two recent national studies show that health care costs continue to grow, putting serious strain on individuals and employers nationwide struggling to meet their bills. Though the rate of growth of health care premiums slowed to just 5 percent this year, many more businesses are asking their employees to cover a greater share of their medical expenses. The average cost of insurance for a family is $12,680 to an employer and $4,704 for an individual worker. Another study found that one in five families had difficulty paying their medical bills. Experts say the country's health care system is in need of fundamental reform. "It's becoming increasingly clear that the American health care system as currently organized — wasteful, inefficient and poorly designed — is unsustainable. The solution isn't more money; it's a completely redesigned system." As part of the potential solutions, policy makers will need to consider how to control costs, increase efficiency and deter errors.

Former Surgeon General Urges Companies to Help Prevent Chronic Disease
Kendall Anderson, Finance and Commerce, September 17, 2008

Last week, former U.S. Surgeon General Dr. Richard Carmona told a crowd at General Mills that the country must address a crucial issue of national security: chronic diseases. By perpetuating unhealthy lifestyles, America is “endangering itself and could bankrupt future generations.” Chronic disease such as obesity, diabetes, heart disease, and cancer are the leading causes of death and disability in the United States and comprise around three-quarters of total health care spending. We are currently spending $1.5 trillion on chronic diseases; a fact which Carmona believes will cause the US “to lose its corporate and military edge.” Carmona believes health care costs will drop as more businesses incentivize healthy behavior and cause chronic diseases to decline. » article

Utah Doctors Say Industry Must Share Blame
James Thalman, Deseret News, September 7, 2008

In an annual roundtable discussion this week Utah physicians discussed the detriments of wasteful spending in the national health care system. They opposed finger-pointing and a market-driven approach, and instead discussed the need for long-lasting solutions to alleviate unsustainable spending, rising costs of premiums, and limited access to quality care. The nation's “perverse” health care system rewards quantity as opposed to quality, which manifests in extraneous and costly medical procedures. Cost containment, physicians believe, will provide needed relief to a wasteful system that cannot sustain itself. In the end, however, the greatest beneficiary of health care reforms are patients, who deserve, above all else, quality care. » article

Remedy for Uninsured Reduced Numbers but not Necessary Costs
The News Journal, September 2, 2008

In this editorial, the writers assert that the Census Bureau report for 2008 will show that there are more Americans without health insurance. Despite this year’s gains of a reduction in the uninsured population of over a million, the current economic downturn will likely send those numbers back up. The census showed that while more people have insurance, most are receiving it from the government and the number of people receiving employer-sponsored health care has actually declined. As more and more people turn to the government for health care assistance, the uninsured will continue to stress an already weak economic system. They will require support from already burdened state budgets, which will in turn demand more from taxpayers and those with health insurance. However, simply expanding health care coverage will “push up the cost of the system and not help the people who need it.” To remedy the failing health care system, states must advocate for cost containment and quality improvement.

Drug Makers' Push Leads to Cancer Vaccines' Rise
Elizabeth Rosenthal, New York Times, August 20, 2008

Critics of new cervical cancer vaccines, such as Merck’s Gardisil, claim skillful marketing has turned an “obscure killer confined mostly to poor nations to the West’s disease of the moment.” Targeted advertisements have created an urgency to get vaccinated while questions remain concerning the drug’s side effects and long-term effectiveness. The vaccines are approved for universal use which translates to a potential cost to the US government of more than $1 billion. Many are critical of the government’s spending on these vaccines because cervical cancer is preventable through regular Pap smears. In particular it is unclear that the vaccine is worth the added costs, nearly $400 for the series of shots. Cervical cancer killed 400 in Britain last year because the disease can be easily caught and prevented with regular pap smears and early treatment. Though cervical cancer is a leading cause of death among women, 90% of the cases are in developing countries. The vaccine does not fully prevent all causes of cervical cancer, and it unclear how long the vaccine will last or if a booster will be required. The cost to society of requiring the vaccine is estimated at between $30,000 and $70,000 for each added year of life - a cost that is on par with treating existing cases of cancer. » article

Study Finds Settling is Better than Going to Trial
Jonathan Glater, New York Times, August 7, 2008

A recent study suggests that, in civil suits, it is in the client's best interest to settle. The comprehensive study looked at over 2,000 cases that went to trial and found that plaintiff's who rejected settlement offers got, on average, $43,000 less by proceeding to trail. For defendants, the cost was much greater, averaging $1.1 million more for those who made the decision to go to trial. Only 24% of defendants proceeded to trial while 61% of plaintiffs made the same choice, and 15% of cases were correctly sent to trial - meaning the verdict was less than what the plaintiff wanted, but more than the settlement offer. Between 80 and 92% of cases settle, but for those that do not, it is difficult to gauge where the mistake was made. The study found that plaintiffs mistakenly proceeded to trial more often when the lawyer was paid a share of the award amount. The study included an analysis of trial outcomes over a 40-year period and found that the false inclination to forgoe settlement has actually increased over the years. In trying to account for how mistakes were made, experience of the attorney, practice size and a number of variables were considered. The most common predictor of whether a case went to trial, however, was the type of case. Poor decisions by plaintiffs to go to trial “are associated with cases in which contingency fee arrangements are common,” according to the report. “On the defense side, high error rates are noted in cases where insurance coverage is generally unavailable.” » article

A Call for a Warning System on Artificial Joints
Barry Meier, New York Times, July 29, 2008

As joint replacements have increased over the last several years, so too has the potential for such artificial devices to fail and need replacement. Dr. Lawrence Dorr, an expert orthopedic surgeon, began noticing that several of his patients with a particular model of artificial hip were experiencing severe pain and needed costly replacements. Dr. Dorr did his own research and came to find that thousands of patients had complained of complications and required replacements. In the time it took him to complete his research some 1,300 new patients received that hip. The company that makes the hip that was used with Dr. Dorr's patients has since withdrawn the product and now estimates that replacements will be required for 13,000 patients. In many nations there are national registries for artificial joints which allow physicians to track the success of particular devices. Joint replacement procedures cost between $30,000 and $40,000 and secondary corrective surgeries can take a tremendous toll on the cost of health care. Currently the FDA is responsible for monitoring joint devices, yet the agency is already heavily overburdened with regulating pharmaceutical products. Many doctors support the creation of a national registry yet fear that physicians will only fully comply with reporting if there is a national mandate from Medicare. Such a registry could save physicians, insurers and Medicare both time and money, as the need for costly replacement surgeries could be significantly reduced. » article

Making Health Care More Efficient
Center for American Progress, July 18, 2008

A recent hearing in the House Budget Committee featured testimony from several experts on how to increase quality and efficiency in health care while controlling costs. The current US system spends far more than other nations, yet those who get the most care don't necessarily receive better care. Experts discussed creating incentives for higher quality care and the use of comparative effectiveness research to create more transparency in cost and efficiency. » article

While the US Spends Heavily on Health Care, a Study Faults the Quality
Reed Abelson, New York Times, July 17, 2008

A recent report from the Commonwealth Fund shows a U.S. health care system in need of serious reform. The report showed that while the U.S. outspends most other nations for health care, quality is in fact much lower than other industrialized countries. Indeed the U.S. has fallen to last place amongst industrialized nations in preventing deaths through the use of timely and effective treatment. The report also describes serious access problems, as the number of uninsured and underinsured has grown. Experts agree that, despite isolated successes, the report reflects the need for system-wide change to increase efficiency, lower costs and improve quality. “We need to generate better value in this country,” said Dr. Denis A. Cortese, the chief executive of the Mayo Clinic. Experts note that other countries have taken similar reports and used them to target individual hospitals for specific quality improvements. “It proves once again if you have quantitative information and metrics and make people pay attention, they change,” says Helen Darling, president of the National Business Group on Health. » article

Comparative What? Translating Policy Lingo into Something Meaningful
Sarah Arnquist, The Health Care Blog, July 11, 2008

Sarah Arnquist delves into the complex and often controversial issue of comparative effectiveness research. Arnquist argues that the use of comparative effectiveness to limit health care spending will likely be central to future reforms. Given that Americans are so adverse to limiting technology or putting a price cap on health care, research that can determine whether new drugs or therapies are better than existing options will be crucial in controlling costs. Yet Arnquist notes that the public will need to fully understand the dialogue if they are to get involved in the debate and back the idea. Using oblique terms such as "comparative effectiveness" and discussing evidenced-based medicine, researchers and policy makers are limiting their audience and dooming their cause. Many other nations already have comparative effectiveness centers established to study the value of various drugs and procedures in comparison with existing technologies. Arnquist notes that many, including both presidential candidates, believe that the use of comparative effectiveness will be critical in the future of health care. Author Shannon Brownlee goes further to describe how journalists need to take the issue head on and get the public fully involved. Changing the system will be "so difficult short of some crisis environment" unless there is substantial research and data to support the changes, says Gail Wilensky, former head of Medicare and Medicaid Services. "If there is good clinical evidence you have a chance of getting people to change behavior." » article

Weighing the Costs of a CT Scan's Look Inside the Heart
Alex Berenson and Reed Alebson, New York Times, June 29, 2008

The growing use of CT heart scans is indicative of many of the challenges and hard questions facing American health care. The number of CT heart scans, or CT angiograms, has significantly risen in the last few years with the invention of the 64 slice CT scanner which enables physicians to view images of a beating heart. Yet the new, and costly, technology has not been proven to be more effective than older technologies. Cardiologists in private practice see the scans as both a better way to diagnose their patients and as an added source of revenue. The American penchant for wanting the latest in treatments and technology has only spurred widespread use of the CT angiogram. Yet many physicians contend that traditional heart tests, such as a nuclear stress test, are more effective at diagnosing heart disease. CT angiograms allow doctors to view plaque buildup in the arteries, but plaque is common in middle-aged patients and is only problematic when it breaks loose and causes a blockage - something the CT scans cannot predict. In light of their growing use and the lack of evidence that the extra cost is justified, Medicare considered refusing to cover the scans until a major study was done to prove their effectiveness. Both physicians and device makers lobbied hard and the agency backed off. Many physicians argue that it takes years for new technologies, such as mammograms, to prove their value and that doctors should embrace the scans without waiting for evidence-based medicine to follow suit. Opponents say such studies and trials are critical to providing quality care and not exposing patients to the added radiation risk - nearly 1,000 times more than a chest x-ray. “We have too many situations where we thought we knew what the answer was and it didn’t turn out like everyone thought,” said Dr. Mark Hlatky, a cardiologist and professor of health research and policy at Stanford University. » article

A Menu Without Prices
Dr. Alan Garber, Annals of Internal Medicine, June 17, 2008

In this recent editorial, Dr. Alan Garber discusses how receiving health care in the United States is an overwhelmingly blind process, with patients largely unaware of the cost or quality of services they receive. Indeed, few hospitals or providers are even able to provide some indication of the cost of a procedure or treatment at the outset. Dr. Garber suggests that comparative effectiveness research could fill the void of information, providing physicians and administrators with the most current research on the quality and effectiveness of a particular treatment as compared with similar procedures at different price points. To date, cost effectiveness research has been criticized and largely avoided because of seeming inconsistency in measuring the data and the suggestion that such endeavors place a dollar value on human life. On the contrary, cost-effectiveness research attempts to establish which treatments and procedures offer the greatest value per health care dollar. The American College of Physicians has argued that quality cost-effectiveness research needs to become an integral part of a physician's decision-making. Health care costs in the United States are growing at a rapid pace and care decisions focus solely on effectiveness without any consideration of value, meaning new technology often adds to, but does not replace, diagnostic or therapeutic techniques. "In health care, affordablechoices are scarce, compelling many Americans to go withouttimely and appropriate care. We won't have an efficient healthcare system until we learn the value of individual health interventionsand use the knowledge effectively," notes Dr. Garber. » article

Fed Chief Fans Flames on Health Care Reforms
Maurna Desmond, Forbes, June 16, 2008

Federal Reserve Chief Ben Bernanke recently made a speech decrying the state of America's health care and called for broad reforms that would reduce spending and cut costs. At its current growth rate, with Medicare and Medicaid consuming 23 percent of government spending, our health care model is simply unsustainable and will have dire consequences for the economy. With the federal government spending so much to keep its citizens healthy, other programs will suffer, taxes will increase or budget deficits will grow. Bernanke suggested a Congressional panel could offer recommendations or an independent body could be dedicated to making tough decisions on cost and care. Some lauded the Fed Chief for creating a sense of urgency on the issue while others criticized him for merely pointing to problems while failing to offer any solutions. Professor Peter Morici discussed how Bernanke needs to reconcile the European health care systems, which have meaningful price controls and rationing, with America's economic and health care needs. » article

Health Decisions with an Eye to the Bottom Line
Ricardo Alonso-Zaldivar, Los Angeles Times, June 9, 2008

As health care costs continue to grow, policy makers, researchers and physicians are looking for ways to effectively cut costs while still providing quality care. Comparative effectiveness research is gaining popularity as a way to measure the relative quality and cost of various therapies and procedures. Both presidential candidates have expressed interest in using the technique to help rein in health care costs. Other policy analysts have pointed to such methods as essential to controlling costs as the population ages. Some estimate that health care costs will account for 20% of the nation's gross domestic product within a decade. As technology advanceds and brings new forms of treatment, little has been done to measure the relative gain in quality relative to the added expense. One recent study compared two techniques for treating prostate cancer and found that the newer, more expensive technique, did not provide a measurable advantage over the older method. The cost difference for the two treatments is slightly over $30,000. "People have pointed out that a lot of the care in our system is inefficient, wasteful or inappropriate -- maybe 20% or 30%. The problem is, it doesn't come tagged," said Sean Tunis, Medicare's former chief physician.

Debate Ignores Reality of Dividing up Health Care Resources
Mary Jo Feldstein, St. Louis Post-Dispatch, May 21, 2008

One columnist describes how the health care discussion in this country is going to take a dramatic turn if universal health care becomes a reality. With more people eligible to receive care, physicians and researchers will need to be able to understand which treatments and procedures offer the best care at the most efficient cost. People on both sides of the debate recognize that health care in this country faces serious ills, with many uninsured and undersinsured patients receiving essential care and diagnoses too late or not at all. Moreover, physicians and hospitals are not paid according the quality or efficiency of care they deliver, but are reimbursed simply for the most expensive procedure deemed medically necessary. Yet more care does not equal better care, and if we truly hope to offer quality care to all we will need to establish the best practices and procedures for treatment.

Wasted Medical Dollars
Kevin Pho, USA Today, April 23, 2008

More than half the dollars in America’s $2.2 trillion health care system are wasted each year, according to a recent PricewaterhouseCoopers analysis. Factors contributing to this waste include medical errors, poor use of information technology, and badly managed chronic diseases. Dwarfing these factors is a phenomenon called “defensive medicine,” in which physicians order unnecessary tests to avoid even the threat of lawsuits. This can result in wasteful spending such as unneeded CT scans, MRIs, and cardiac testing. More than nine in ten physicians, on average, reported practicing defensive medicine, according to a 2005 survey in the Journal of the American Medical Association. However, in the experience of Dr. Kevin Pho, “patients don’t seem to mind the extra testing, and they often equate defensive medicine with ‘more thorough’ care. After all, if one test is good, wouldn’t more be better?” Not necessarily – every test can result in a “false positive,” which is a positive test despite the absence of disease. This can lead to yet more testing, such as advanced imaging scans or biopsies, which carry risks of serious complications. “How do we tackle this problem?” asks Dr. Pho. The malpractice system needs to be more reliable in its ability to differentiate between cases of negligence and those in which a patient simply suffered a bad outcome. “Until the system is perceived as being fairer, physicians will do all they can to avoid being sued,” writes Dr. Pho. “That involves ordering unnecessary tests, which is a shame, because those billions of dollars can be put to much better use.” » article

Report: US Wastes More Than Half of Health Spending
Anna Matthews, Wall Street Journal, April 10, 2008

Further chronicling the inefficiency of the U.S. health care system is a new report by the Health Research Institute at PricewaterhouseCoopers. The new analysis puts the price tag of waste in the health care system at a gigantic $1.2 trillion per year. This “wasteful spending” could account for over half the $2.2 trillion spent annually on health care in America. One of the biggest parts of the waste is “defensive medicine” – unnecessary medical tests driven by legal fear. Defensive medicine weighs in at $210 billion per year, dwarfing the waste in many other categories, such as the $22 billion tied to badly-managed diabetes. » article

Health Care Reform Comes Down to Cost Efficiency
Richard Lamb, News Journal, April 1, 2008

In this editorial, Dr. Richard Lamb, a hospital-based anesthesiologist since 1955, offers a prescription to the health care mess. To make the medical system more efficient and economical, America should try to control the outrageously expensive legal costs. Defensive medicine wastes billions of health care dollars annually. Because of the costs stemming from legal fear and other problems, “this country is bankrupt,” and “it’s time to come to our senses.”

Righting Healthcare Reform
Christopher Anderson, Boston Globe, March 31, 2008

In a 2005 letter to the state legislature, more than 20 Massachusetts business associations affirmed their support for measures that would rein in health care expenses. They wrote that “cost, after all, is the single biggest problem we face today in the delivery of health care.” Unfortunately, the price of health care is just as big an issue today, and “ Massachusetts has reached a crisis point,” according to Christopher Anderson, president of the Massachusetts High Technology Council. One idea is to reform the state’s medical malpractice laws. “Creating a system that minimizes frivolous lawsuits and provides protections to doctors,” writes Anderson, “would greatly stabilize skyrocketing malpractice premiums, which are driving many good doctors out of state.” Furthermore, a federal report showed that reforming the medical malpractice system would save the nation over $100 billion in annual health care costs. According to Charles Baker, head of Harvard Pilgrim Health Care, the Senate President is “doing us a big favor by throwing the gauntlet down” on cost reform. The stakeholders in the health care debate must work together to ensure it is done right. » article

Health Care Costs Trends Still Cause for Concern
Steve Sink, Rochester Democrat and Chronicle, March 30, 2008

The cost of health care is a pressing issue in Albany, Washington, and on the presidential campaign trail. Being especially hard hit are small businesses. “When your income is going up somewhere between 2 and 5 percent a year and your health care costs are rising 10 to 15 percent, that [gap] falls directly to the bottom line,” lamented Gerald Archibald, a small business leader in Rochester, New York. Archibald cited prescription drug prices and lawsuits as two of the primary problems. Among suggested solutions, Archibald addressed the tendency of Americans to file a lawsuit “every time things don’t go [their] way.” Malpractice insurance rates for physicians have skyrocketed due to “our litigious society.” Another effect is that doctors practice “defensive medicine,” meaning that they often order high-priced, unnecessary exams and procedures out of legal fear. Meanwhile, because of the high cost of health care, “it’s a safe bet that some of the 2.2 million non-elderly New Yorkers without health insurance are small business workers, maybe even owners.”

May I Say: Band-Aids Won't Fix Health Crisis
Debbie Griffin, River Falls Journal, February 15, 2008

This Wisconsin editorialist discusses the myriad reasons why healthcare in the US is reaching crisis level. Insurance companies and pharmaceutical industries dictate the care people receive more and more, and at ever greater cost. More individuals are forgoing regular checkups or insurance coverage altogether so that they pay off other expenses - like mortgages or groceries. Moreover, pharmaceutical companies send the message that there is a pill for everything - resulting in more medicating, more testing, and ultimately more spending. Physicians are paid for performing costly, and often unnecessary, procedures and are sued for failing to do so, and those costs are passed on to the consumer. "How much less could care cost without that overhead? If it came with a deep discount on care, patients would line up to sign a release waiver on their way in." » article

Health Insurance Costs Stymie Small Businesses
James Arvantes, AAFP News Now, January 29, 2008

The escalating cost of health insurance has made it hard for owners of small businesses to provide health benefits for themselves and their employees. “Between 2003 and 2008, the cost of a single policy has increased 80 percent, an average of 16 percent a year,” testified Dr. Stephen Eby in front of the House Committee on Small Business. “I suppose when these people become ill, they will have to go to the emergency room and pray the hospital bills don’t drive them into bankruptcy.” A ranking committee member asked if the U.S. legal system and frivolous lawsuits have played a role in driving up insurance costs. Dr. Eby commented that medical malpractice laws are a “significant problem” that increase both insurance premiums and medical costs in general. Emergency room doctors have to practice defensive medicine to avoid lawsuits. “From the ER doctor’s perspective, they don’t know the patient, and they cannot afford to miss anything,” he said. “If you walk into the ER with a headache, you are going to get a CT scan, almost guaranteed. If you walk in with a sore throat, you will probably get a blood test.” » article

Pennsylvania's Crisis is not Over
Lewis Sharps, The Bulletin, January 11, 2008

While Pennsylvania’s malpractice environment has improved recently, there is still much work to be done, according to Dr. Lewis Sharps, an orthopedic spine surgeon and president of Pennsylvania’s physician-driven malpractice insurance company. Several years ago, a deluge of lawsuits caused a surge in malpractice insurance costs that threatened the state’s supply of doctors. Access to medical care was endangered as prohibitive liability premiums coerced many specialists and practices to either close or move to other states. Trauma centers were left struggling, further jeopardizing patient care. However, legislation in the form of government subsidies (state-signed checks serving as a band-aid for larger system deficiencies) helped reverse the problematic situation. But more fundamental flaws in the medical malpractice system still exist. “Defensive medicine” – unnecessary treatment used out of legal fear – is an epidemic pushing general health care expenses even higher. Moreover, the injured patients are badly served by the current system: only $0.28 from every settlement dollar goes to a plaintiff (the rest goes towards administrative costs such as attorney fees). However, Dr. Sharps does have some advice: improve the quality of care and stem the flow of patients injured by medical treatment. “Remember, no one wins a malpractice claim,” writes Dr. Sharps. “It’s only a matter of how much it costs. It is cheaper to prevent a claim than defend and win one.”

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