Pennsylvania physicians are experiencing a silent crisis, but one that is no less serious because of its relative lack of visibility.
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| | | Gerald W. Pifer, M.D., is president of the Allegheny County Medical Society. | |
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The malpractice crisis that has sent physicians' insurance premiums skyrocketing as much as 40 percent this year is not something that typically grabs headlines or makes for good soundbites on the evening news. In fact, the crisis is not something most patients even think about. Yet it could have a profound affect on the quality of health care in Pennsylvania if the situation is not eradicated.
Patients seeking medical care from practitioners in some specialties have already experienced a taste of what could be a larger problem. Obstetric/gynecology patients in some parts of the state, such as Philadelphia, already have to wait weeks, if not months, to get appointments to see their physicians. Many physicians are eliminating high-risk surgical procedures such as those performed by obstetricians, neonatalogists and others. This curtailing of services comes at a cost to patients, as these procedures could be very beneficial. Other physicians are opting to retire early or relocating to other states where conditions are better.
Young physicians aren't coming here to practice, either, even those with local ties. Many of our medical school graduates are seeking residency programs in other states, and are starting practices in those states after completing their residencies. Our practicing physicians here often bemoan the difficulty they have finding partners to join their practices, saying it takes months, if not years, depending on their specialty.
Because the practice climate in Pennsylvania involves capitated fees from many of our managed care companies, physicians are feeling pressured on both ends of their practices and are under increasing pressure to leave the practice of medicine or curtail their services. Most physicians have not seen increases in reimbursement from insurers in over five years, and have, in fact, experienced cuts in reimbursement. They have no ability to raise fees to reflect their costs.
While the climate is unfavorable toward physicians today, problems may only be exacerbated if the climate does not change in Pennsylvania. Just last week, a major insurer, Princeton Insurance Co., announced that it was pulling out of Pennsylvania. Another carrier, MIIX, was downgraded by A.M. Best in their rating. A third company, Medical Protective, filed for a 45 percent rate increase with the Pennsylvania Insurance Department. When a true physician shortage does occur locally, it will take eight to 10 years to fill those vacancies.
There is help on the horizon, however, in the form of legislation passed by the state House of Representatives and awaiting Senate consideration when it reconvenes tomorrow.
The bill, House Bill 1802 -- the Medical Care Availability and Error Reduction Act -- would be greatly beneficial to physicians and patients and would indeed invoke real reform.
The bill calls for the phasing out of the commonwealth's Medical Professional Liability Catastrophic Loss (CAT) Fund and placing this responsibility in a private market. Immediate financial relief from the bill would result in discounts at the CAT Fund level of 5 percent this year and 10 percent each of the next two years. A reduction in mandatory coverage from the current requirement of $1.2 million per year to $1 million would also be a first step toward lowering premiums for professional liability insurance for physicians.
A Venue Commission would also study the problem of "venue shopping" in which attorneys try to get their cases moved to a county, or courtroom, that would most likely be favorable toward their client -- in Pennsylvania, that's Philadelphia.
Perhaps the most important provisions are the gains in patient safety, however.
The bill calls for the appointment of an independent authority to analyze medical errors and suggest remedies to improve patient safety and makes the reporting of serious events mandatory, including penalties for noncompliance. The reporting of serious events would also be publicly available, although there are provisions to protect the confidentiality of the committee. Further protections include prohibitions on discovery and testimony in legal actions. Another provision requires all medical facilities to have a patient safety plan, including a patient safety office and committee.
Other provisions require experts testifying in court to have proper credentialing in the specialty about which they are testifying. Another stipulation calls for the opportunity to make periodic payments in an award so those patients can have a steady stream of income to cover their ongoing medical expenses. The amended bill no longer contains a cap on noneconomic, or "pain and suffering" awards, leaving Pennsylvania in the minority of states in the nation with no ceiling on awards. Even without the cap that had been included in the first House version, the bill would stand to reduce administrative and legal costs and give more money to the injured parties.
The bill would also modify the collateral source rule, meaning that injured patients generally will be prohibited from recovering damages that were already paid for by collateral sources such as private health and disability insurance. Currently in Pennsylvania, the defense is not allowed to tell a jury about this. Patients will still be able to tell the jury about their expenses, however, even if they cannot recover for the expense.
Still another provision says that future noneconomic damages will be paid in periodic payments over up to a 20-year period, unless the claimant opts to have those damages reduced to present worth, using a payment methodology similar to that available to lottery winners. A guaranteed steady stream of income to cover ongoing medical expenses would benefit some patients who are sometimes ill-equipped to invest that large sum of money wisely to ensure that their future needs are met.
The medical malpractice problem in Pennsylvania isn't just a "physician income" problem, as personal injury lawyers like to characterize it. Lengthy trials are a major expense for every hospital, nursing home and short and long-term care facility in our community. Seven out of 10 cases filed are discontinued or found in favor of hospitals and physicians.
But the costs of defending those cases are high. And those costs are passed on indirectly to each of us through our health insurance costs. As we all know, the cost of health insurance is a critical factor in establishing a climate that keeps businesses and attracts new businesses. Many other states have changed their systems to control legal costs.
Physicians don't want special treatment. We are responsible for our actions. But we do want a system of justice that is fair and addresses patients' best interest. Physicians have come to the conclusion that the legal system today serves only the best interest of personal injury lawyers. Surely, we can do better than this.
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