Continuing Benefits of Comprehensive Medical Liability Reform In Texas
Influx of doctors overwhelms Texas board
Monday Jul 9, 2007: 5:18 PM ET
An influx of doctors lured to Texas by new limits on malpractice lawsuits has overwhelmed the state board that screens candidates for medical licenses, creating a backlog that forces many applicants to wait months before they can start seeing patients.
Officials said many of the relocating physicians are filling shortages in areas such as Beaumont, where trauma patients previously had to be flown other cities because there weren't enough surgeons to treat them. But Austin psychiatrist Dr. James E. Kreisle Jr. said he fears the Texas Medical Board's backlog could prompt some physicians to rethink their decision to move.
Kreisle and his colleagues have been waiting since the fall for two psychiatrists from South Carolina and Georgia to get licensed in Texas so they can join their practice. In the meantime, patients are being forced to wait three weeks for appointments.
The board received 4,000 applications for medical licenses in 2006, up from 2,992 the previous year. Spokeswoman Jill Wiggins said the board expects to approve 2,750 new licenses this year, 235 more than last year. There is a backlog of more than 2,398 applications.
Lawmakers approved $1.2 million to hire six more employees to process applications more quickly. The board has also hired temporary workers and is paying staffers overtime, but they still can't keep up, Wiggins said. "The pipeline is just clogged," she said.
Approving an application for a medical license involves verifying the doctor's medical education, doing a criminal background check and other steps. In 2003, it took 45 days to approve the most complex applications and 20 days to approve the simplest, Wiggins said.
Data provided by the board shows it is now taking the agency more than six months to process the most complicated applications, including those that come from out-of-state doctors or veteran doctors who have long histories to be checked. The simplest applications are taking about 41 days to approve. Wiggins estimated it will take "a little over a year" before the agency's new staffers can bring the applications backlog under control. "You're turning a battleship around," she said.
Several doctors who moved to Texas from other states said they were drawn by lower malpractice insurance rates.
The average malpractice insurance premiums in Texas have fallen by 21.3 percent since 2003, when lawmakers and voters implemented a $250,000 cap on non-economic damages such as pain and suffering in malpractice cases, according to Jon Opelt, who leads a group of doctors, hospitals and other health care providers that fought for the changes.
The changes are "a big factor why Texas has become a popular state to practice in," said Dr. Punit Chadha, an oncologist who moved from Chicago to Austin last year. He said his malpractice insurance premium is one-fourth of what it would have been in Chicago.
Dr. Kevin H. Brown, an obstetrician who opened a Round Rock practice with his wife in May, said they paid $130,000 a year for their malpractice insurance in Georgia. Now, they pay a combined annual premium of $82,000 a year.
"It was a $24,000 raise for each of us before we even got started," Brown said.
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Information from: Austin American-Statesman, http://www.statesman.com
David Hendricks: Insurance companies, doctors flock to Texas
Web Posted: 06/01/2007 09:01 PM CDT
When Texas voters in 2003 approved a state proposition capping lawsuit awards for medical malpractice cases, only four insurance companies even offered malpractice policies to Texas doctors.
Now, 30 insurance companies crowd the market, and premiums have fallen like so many San Antonio Spurs playoff opponents. The lower cost of being a doctor in Texas has helped trigger a stampede of applications for physician licenses, with the waiting line now up to 12 months.
Rates have fallen an average of 21.3 percent, and up to 41 percent at one insurance company, says former state Rep. Joe Nixon, a Houston trial lawyer who helped sponsor passage of Proposition 12.
An internal medicine doctor in Houston paid $18,507 for malpractice insurance in 2003 but only $13,272 in 2007, or $10,403 with a 20 percent renewal dividend, according to figures given to Nixon by the state's largest insurer, Texas Medical Liability Trust. An obstetrician paid $56,564 in 2003 but only $41,575 in 2007, or $32,585 at the renewal rate. A neurosurgeon paid $103,558 in 2003 but only $76,117 in 2007, or the renewal rate of $59,659.
Before Proposition 12, the state did not impose a cap on the amount of noneconomic damages in a malpractice lawsuit against doctors. Proposition 12 established a cap of $250,000. Malpractice lawsuits have fallen 50 percent, Nixon said, causing some malpractice lawyers to shift to other fields, such as commercial litigation.
Insurance companies are flocking to Texas because now they can put a numeric value on the risk of doing business in Texas, something that was not possible when the sky was the limit for juries. Assessing risks helps assure profits for insurance companies. As more insurance companies entered Texas, rates have dropped even further because of competition.
Probably no other profession could benefit so much from legislated lawsuit protection. As Nixon explained it, doctors have little control over their incomes. Their fees are determined by government programs such as Medicare and Medicaid and by insurance companies. On the expense side of doctors' balance sheets, however, are rising incomes for staff, higher rents for offices and, before 2003, outlandish malpractice insurance premiums. An unknown number of Texas doctors closed their practices or retired earlier than they would have liked.
Tennessee is considering a lawsuit cap similar to the one in Texas. In the meantime, 350 Tennessee doctors have applied to move their practices to Texas, 50 of those with license applications still pending, Nixon said.
Meanwhile, about 2,250 license applications await processing at the Texas Medical Board in Austin. The wait could be as long as a year for some of the more experienced doctors because it takes longer to review their records.
The fear is that some doctors will give up on Texas and go elsewhere instead of waiting. A $1.22 million emergency funding request was approved during the last days of Texas legislative session for the Texas Medical Board, which licenses physicians. That is on top of the $18.3 million regular biennial appropriation, said Jane McFarland, the board's chief of staff.
The board plans to add nine new employees to its 139-member staff, seven of which will help chop away at the backlog of license applications.
Six months to a year is a long time to make a doctor wait to start a practice in a new location. Texas needs as many doctors as possible because it ranks in the bottom half of states in doctors per capita. Even the new wave of applicants won't change that.
Alluding to popular restaurants with lines of patrons out the front door, Nixon said: "Some of these doctors will find a new place to eat."
Posted on Fri, Jun. 15, 2007
Perry signs Medicaid reform bill
By BILL HANNA
Star-Telegram staff writer
FORT WORTH -- Gov. Rick Perry signed the state's Medicaid reform bill Thursday, which is designed to bring increased healthcare coverage to as many as 200,000 of the state's working poor.
That is a small fraction of Texans without health insurance (4%), but Perry, who was speaking at John Peter Smith Hospital, touted the plan as an important first step.
"It will help encourage personal responsibility," Perry said. "It will promote consumer choice and will provide hundreds of millions of dollars to insure working Texans who are just one terrible illness away from an absolute catastrophe in their personal lives."
State Sen. Jane Nelson, R-Lewisville, the sponsor of Senate Bill 10, warned that Medicaid costs are spiraling out of control in Texas. Ten years ago, 14 percent of the state budget was spent on Medicaid. It is now close to 26 percent and was expected to reach 40 percent by 2017.
Medicaid is the federal program administered by states that pays for indigent healthcare. The costs are shared by state and federal governments. Texas is seeking a federal waiver that could bring in $1 billion to create a trust fund that would help the working poor obtain health insurance. Nearly 25 percent of Texans do not have health insurance.
Mike Leavitt, U.S. Health and Human Services secretary, traveled with Perry to endorse the legislation, leaving officials confident that the waiver will be approved.
"My hat is off to Texas today and Governor Perry. I do get it, and I get that it was an important day for Texas and an important day for America," Leavitt said.
Medicaid By the Numbers:
$17.9 billion: Amount Medicaid costs Texas annually.
5 million: Number of uninsured Texans.
200,000: Uninsured Texans who could get insurance under this plan.
Highlights of legislation
Creates a fund to cover some healthcare costs and provides money for premiums.
Provides assistance for private insurance enrollment and employer-sponsored plans.
Creates benefit packages for children with special healthcare needs.
Promotes consumer choice through health savings accounts.
Rewards healthy lifestyles with healthcare incentives.
SOURCE: Gov. Rick Perry's office and state Sen. Jane Nelson' office
posted by Bob Coli, MD at 8:48 PM
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