SHIFTING THE FOCUS TO PATIENT SAFETY
SHIFTING THE FOCUS TO PATIENT SAFETY IS THE KEY TO MEDICAL LIABILITY MARKET REFORM:
According to Stephen C. Schoenbaum, MD, of the Commonwealth Fund, in New York, and Randall R. Bovbjerg, JD, of the Urban Institute, in Washington, DC, “physicians hold the key to malpractice reform in the United States.” (1)
They note that large numbers of Americans are the victims of preventable medical injury, which in some specialties and locations have doubled within the past 1or 2 years.
Nationwide, in 2002, malpractice premiums increased on average by 23.2%. “Caps” on jury awards and settlements do exist in 24 states and are the only malpractice reform effort that has affected physicians’ premiums, reducing them 17.1 % in these states. (2) According to the Schoenbaum and Bovbjerg, however, such caps ignore the fundamental problem by neglecting to address patient safety as an issue that needs reform.
The authors believe that reducing medical errors and improving patient safety must be an important part of any medical liability reform and that more active work to reduce harm and improve care is clearly in the best interest of the public. Ultimately, they believe, it is also in the best interest of American physicians.
They added, “Simply capping awards applies a Band-Aid to the increases in premiums bleeding many physicians, while leaving patient wounds unattended.”
A COLLECTIVE PHYSICIAN EFFORT IN RHODE ISLAND TO REDUCE PATIENT HARM:
What has never been tried in any state with or without caps on awards is to combine Rhode Island malpractice market reform with a physician-led, consumer, malpractice insurer and regulator-supported effort to “quarantine” or eliminate from practice the small minority of physicians with the worst records of repeated incidents of unequivocal patient harm.
This is entirely feasible because only a small minority of American physicians are responsible for the majority of the patient injuries and malpractice payment dollars paid.
Since the National Practitioner Data Bank inception in 1990, the one percent of physicians with the largest total payments in the NPDB were responsible for about 12 percent of all the money paid for physicians in reported malpractice judgments or settlements. The five percent of physicians with the largest total payments in the NPDB were responsible for just under a third of the total dollars paid for physicians over the 13-year period. Eleven percent of U.S. physicians were responsible for half of all malpractice dollars awarded by jury verdicts or settlements from September 1, 1990 through March 31, 2003.
(See: http://www.npdb-hipdb.com ).
Legislation producing meaningful long-term reform of the medical liability market in Rhode Island is impossible this year since the 2004 legislative activities of the Rhode Island General Assembly will most likely be completed before the July 4th holiday.
However, this is clearly an important and costly bi-partisan issue that must be confronted and solved as soon as possible. This will be possible only by creating a consensus among all its stakeholders on specific easy-to-understand reform measures and by adequately educating members of the medical and legal professions, legislators, the public and the media.
The proposed solution is straightforward and should be easily understood by all:
In exchange for an unprecedented effort by the majority of Rhode Island physicians to help enhance health care consumer safety and cut overall medical malpractice costs by stopping repeat offenders, the Democratic Rhode Island General Assembly and Republican Governor Carcieri would work together in the 2005 legislature to create a legislative pro-consumer, pro-business solution to the serious medical malpractice insurance cost and availability crisis in this state.
Subsequent postings on this topic using publicly-accessible information contained in the National Practitioner and Healthcare Integrity and Protection Databanks will provide a complete description of the scope of the medical malpractice and physician discipline problems in Rhode Island since September, 1990.
Viewing and understanding this historical data is crucial to implementing the critical first component of the triad that is necessary for meaningful long-term reform (as outlined in my first posting on June 13th).
(1)Annals of Internal Medicine (2004; 140: 51-53).
(2) Physicians Financial News March 15, 2004 (page 26) See: http://www.healthaffairs.org/press/janfe0403.htm .
June 15, 2004:
According to Stephen C. Schoenbaum, MD, of the Commonwealth Fund, in New York, and Randall R. Bovbjerg, JD, of the Urban Institute, in Washington, DC, “physicians hold the key to malpractice reform in the United States.” (1)
They note that large numbers of Americans are the victims of preventable medical injury, which in some specialties and locations have doubled within the past 1or 2 years.
Nationwide, in 2002, malpractice premiums increased on average by 23.2%. “Caps” on jury awards and settlements do exist in 24 states and are the only malpractice reform effort that has affected physicians’ premiums, reducing them 17.1 % in these states. (2) According to the Schoenbaum and Bovbjerg, however, such caps ignore the fundamental problem by neglecting to address patient safety as an issue that needs reform.
The authors believe that reducing medical errors and improving patient safety must be an important part of any medical liability reform and that more active work to reduce harm and improve care is clearly in the best interest of the public. Ultimately, they believe, it is also in the best interest of American physicians.
They added, “Simply capping awards applies a Band-Aid to the increases in premiums bleeding many physicians, while leaving patient wounds unattended.”
A COLLECTIVE PHYSICIAN EFFORT IN RHODE ISLAND TO REDUCE PATIENT HARM:
What has never been tried in any state with or without caps on awards is to combine Rhode Island malpractice market reform with a physician-led, consumer, malpractice insurer and regulator-supported effort to “quarantine” or eliminate from practice the small minority of physicians with the worst records of repeated incidents of unequivocal patient harm.
This is entirely feasible because only a small minority of American physicians are responsible for the majority of the patient injuries and malpractice payment dollars paid.
Since the National Practitioner Data Bank inception in 1990, the one percent of physicians with the largest total payments in the NPDB were responsible for about 12 percent of all the money paid for physicians in reported malpractice judgments or settlements. The five percent of physicians with the largest total payments in the NPDB were responsible for just under a third of the total dollars paid for physicians over the 13-year period. Eleven percent of U.S. physicians were responsible for half of all malpractice dollars awarded by jury verdicts or settlements from September 1, 1990 through March 31, 2003.
(See: http://www.npdb-hipdb.com ).
Legislation producing meaningful long-term reform of the medical liability market in Rhode Island is impossible this year since the 2004 legislative activities of the Rhode Island General Assembly will most likely be completed before the July 4th holiday.
However, this is clearly an important and costly bi-partisan issue that must be confronted and solved as soon as possible. This will be possible only by creating a consensus among all its stakeholders on specific easy-to-understand reform measures and by adequately educating members of the medical and legal professions, legislators, the public and the media.
The proposed solution is straightforward and should be easily understood by all:
In exchange for an unprecedented effort by the majority of Rhode Island physicians to help enhance health care consumer safety and cut overall medical malpractice costs by stopping repeat offenders, the Democratic Rhode Island General Assembly and Republican Governor Carcieri would work together in the 2005 legislature to create a legislative pro-consumer, pro-business solution to the serious medical malpractice insurance cost and availability crisis in this state.
Subsequent postings on this topic using publicly-accessible information contained in the National Practitioner and Healthcare Integrity and Protection Databanks will provide a complete description of the scope of the medical malpractice and physician discipline problems in Rhode Island since September, 1990.
Viewing and understanding this historical data is crucial to implementing the critical first component of the triad that is necessary for meaningful long-term reform (as outlined in my first posting on June 13th).
(1)Annals of Internal Medicine (2004; 140: 51-53).
(2) Physicians Financial News March 15, 2004 (page 26) See: http://www.healthaffairs.org/press/janfe0403.htm .
June 15, 2004:
posted by Bob Coli, MD at 10:54 AM
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