Comments on: For Doc Liability

By: Josh

Josh — Sat, 03 Oct 2009 22:37:52 +0000

It’s actually a good signaling subject.

Malpractice insurance itself is not a large expense for most doctors (OB/GYN and neurosurgeons being the most serious exceptions).

In my conversations with doctors, they have admitted to me that defensive medicine is primarily practiced not to avoid money costs, but because doctors don’t like being sued. It’s a reputational and personal embarrassment.

As a practical matter, if true, that suggests that tort reform which handles suits quietly and discreetly, with a minimum of aspersions cast upon the doctor and a minimum amount of time required from the doctor to defend himself, would be far more effective at reducing the cost of defensive medicine than tort reform that reduces malpractice awards, even if they reduce them very substantially.

By: retired urologist

retired urologist — Fri, 02 Oct 2009 14:21:57 +0000

@ Bill: “There may be differences in outcomes, but not on a risk adjusted basis. You see, if it is really risky, and where you have a systemic risk, the docs do it in the hospital.”

Not in our community. The figures *are* risk adjusted. Our docs purposely take the risky cases to our hospital because it has the best post-op care and the best chance of patient survival. In reality, the results have caused one of the local non-profits to shut down their heart program, and to buy a percentage of our facility. It is *the hospital*.

True enough about the Medicare compensation when we started, but there have been *huge* cutbacks, and our margin in quite small. It’s nor nearly as good an investment as say my wife’s Merle Norman cosmetic franchise.

By: Bill

Bill — Fri, 02 Oct 2009 12:59:31 +0000

Responding to retired urologist on heart hospital results:

1. Medicare and other payment systems have overcompensated heart procedures as a way to funnel money to tertiary hospitals for their uncompensated care. Heart docs figured this out, and had the incentive to build their own hospitals. Now, there are some efficiency benefits from this–scheduling, etc.and having dedicated staff.

2. There may be differences in outcomes, but not on a risk adjusted basis. You see, if it is really risky, and where you have a systemic risk, the docs do it in the hospital. They also like to do the no-pays in the hospital as well. What a surprise.

By: adam

adam — Thu, 01 Oct 2009 15:37:31 +0000

I agree with retired urologist. I have practiced in Europe and am now practicing in the US. In addition to the costs for extra tests mentioned by him/her, I am simply less productive here in terms of patients examined and treated per hour. Causes include 1) increased documentation requirements (needed for liability protection), 2) ordering and interpreting extra tests (needed for liability protection), 3) extensive consenting patients for even simple procedures (needed for liability protection), 4) exhaustive repeats of training on prodecural matters (the institution needs for liability protection), for example HIPAA.
Physicians are used to base most of what they do on scientific evidence. However, there is surprisingly little or no evidence, across the board, for these ‘legal’ requirements. Nevertheless there is ever more of this.
[I am making exceptions for specific measures such as presurgical time-ouits, which have been shown to work.]
In my opinion, physicians in the US are markedly better trained, but less productive, for the reasons cited above. Though small in number, there should be enough physicians who have practiced on both sides to allow comparisons to be made.

By: Tony

Tony — Thu, 01 Oct 2009 13:31:30 +0000

We limited malpractice damages in Ohio in 2003, and it hasn’t done anything to slow health care costs.

I think the big cost driver is the sheer number of uninsured people. Hospitals know they’ll be hit with a certain percentage of charity care, so they pass on costs to insurers. Insurers usually have a few middlemen, who all pass on costs (plus a bit extra for safety).

Then they have to jack up the price further, because a lot of people will go bankrupt and won’t be able to pay. You gotta save some room for the collections agency.

By: retired urologist

retired urologist — Thu, 01 Oct 2009 13:04:19 +0000

The Heart Hospital of Lafayette, a for-profit facility, was conceived and built by doctors, who own the facility, all its equipment, and the laboratories, as well as providing all the services. It’s results are superior to the three non-profits in town in all areas: mortality, complications, length of stay, and cost per diagnosis treated. Patients and their families vote it tops for service. It gets the best results for the lowest price. It is in the Top 100 Heart Hospitals in the US. Go figure.

By: Robert Speirs

Robert Speirs — Thu, 01 Oct 2009 12:52:35 +0000

When exactly did Obama “talk to enough doctors”? I do not believe him. How many is “enough”, anyway? This is a fellow who got the reimbursement for an amputation wrong by at least an order of magnitude. Why does nobody hold his feet to the fire on such statements? Oh, and calling people “teabaggers” is hardly reasoned debate. In fact, it’s offensive and utterly undercuts any other arguments the offender may make.

By: CannibalSmith

CannibalSmith — Thu, 01 Oct 2009 10:44:31 +0000

MM is two thousand just like XX is twenty and not hundred.

By: scott clark

scott clark — Thu, 01 Oct 2009 03:20:51 +0000

don’t let M be a typo, it’s the roman numeral for a thousand, so you you were dead on accurate. a million would be MM, a thousand thousand.

By: Bill

Bill — Wed, 30 Sep 2009 22:11:32 +0000

I think you have to disaggregate the cost of medical malpractice insurance from the cost of the alleged defensive practice of medicine. States with high insurance malpractice costs may have low medical costs and states with low medical malpractice costs may have high medical costs.

What I see in the real world are costs unrelated to medical malpractice costs.

1. Doctors doing tests because, guess what, they make money for doing tests and procedures. Texas has low malpractice costs, and its doctors make oodles of money running tests. Obama has singled out one such enclave in Texas, but you can also find them in Fla, Ga, and elsewhere…would be an interesting research study looking at med mal rates and frequency of testing procedures associated with certain diagnostic related groups. Also, if med mal rates are uniform across the state, there would not be such a money making disparity of “defensive” but well paying medicine across a state.

2. There is probably a bigger correlation between defensive practices and whether the doctor owns an interest in the equipment or lab, whether the doctor is an employee of the hospital which owns the equipment, or whether he practices on his own and uses the hospitals facilities.

3. Here are some examples of where you pay
a. Hospitals generally provide for “free” autopsies if requested–rolled up into your hospital bill–they claim for quality assurance.
b. JCAH may mandate tests for a hospital to be certified, even though those tests are useless…Case in point: test is required by JCAH if patient presents himself with certain symptoms; tests are returned in 3 days from the lab; in three days the doctor or nurse (ande even well instructed patient) would have been able to see the symptoms without the test.
4. When doctors own equipment, and get paid for using it, they use it even though there is marginal utility. Case in point: medical device and disposable reduce symptom and discomfort for 6 months; at the end of 6 months, patient receives surgury, or is better. In Europe, this device and disposable is not used because doctors go directly to surgery. So why is it used in the US…because there is a drg code for it and docs make money twice–one treatment with the device, and then the surgery. Go figure.