How much are you spending on malpractice premiums? According to the Congressional Budget Office (CBO), you’re spending about $35 billion a year; or rather you and your fellow physicians are spending that much just on malpractice premiums.

So, with the healthcare debate going on, particularly about the costs, malpractice reform is a big part of it, right?

Wrong. There have been some attempts at amendments to the bills going through the Senate, but neither the Finance Committee’s or the Health, Education, Labor and Pensions Committee’s bill has anything specific on this aspect of reform.

Yet, according in a letter from CBO Director Douglas Elmendorf to Utah Senator Orrin Hatch, if there was a national policy on malpractice insurance reform (such as California’s MICRA), that reform could, in partnership with other reforms, reduce mandatory spending up to 41% while increasing revenue up to 13% by 2109.

Such reforms proposed often include, according to the CBO:

• A cap of $250,000 on awards for noneconomic damages;
• A cap on awards for punitive damages of $500,000 or two times the award for economic damages, whichever is greater;
• Modification of the “collateral source” rule to allow evidence of income from such sources as health and life insurance, workers’ compensation, and automobile insurance to be introduced at trials or to require that such income be subtracted from awards decided by juries;
• A statute of limitations—one year for adults and three years for children—from the date of discovery of an injury; and
• Replacement of joint-and-several liability with a fair-share rule, under which a defendant in a lawsuit would be liable only for the percentage of the final award that was equal to his or her share of responsibility for the injury.

Elmendorf said in the letter that many analysts surmise that the current medical liability system encourages providers to increase the volume or intensity of the health care services they provide to protect themselves against possible lawsuits.

“For example, [in a 2006 CBO paper, we] observed reductions in Medicare’s hospital spending in states that had enacted a cap on noneconomic damages; however, those studies also reported increases in Medicare’s spending for hospitals and for physicians’ services in states that had changed their joint-and-several liability rules to fair-share rules.”

While only one of the House bills mentions this reform, the CBO letter to Senator Hatch may help physicians push national tort reform through, although the trial lawyers will have a say before the debate is concluded.

Comments

Jerry Manoukian MD

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No discussion of healthcare reform is complete without mention of tort reform. That tort reform can be discussed without addressing the medical record process is, well, malpractice. Some of our colleagues are content to write chart notes that are illegible to two healthcare providers (that is the current working definition of 'illegible') with the expectation that that same scribble is going to defend them in a court of malpractice law. Good luck to those poor fools.
Until physicians learn to document in a readable communicative way, we are relying on our luck and good looks for a solution to out-of-control malpractice premiums and awards.

Tuesday 03 November 2009, 16:33

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