Liability Reform IS Healthcare Reform

And now a word from your humble blogmeister:

Letter: Doctors harmed by liability costs

To the editor

Published 3:18 pm, Tuesday, July 9, 2013

The Times Union recently published an Associated Press report on an impending need for primary care doctors ("Provider gap predicted," June 23). But to those practicing medicine in New York, physician shortages are hardly news. For years, doctors have been driven from the state, in large part because of enormously high medical liability insurance premiums.

New York has the highest medical insurance payouts and premiums in the country by an astounding margin. Physicians in parts of the state pay nearly $200,000 per year for insurance. Yet, this is hardly an indictment of our doctors and hospitals. Indeed, New York physicians are among the safest and most skilled in the nation. The reason for this disconnect is our legal system, which incentivizes a steady stream of lawsuits. In fact, a series of studies (http://bit.ly/WaG8sT) of closed claims by the Harvard School of Public Health found that more than half of medical malpractice claims were either "frivolous" or of "uncertain merit."

It's so bad the state has been forced to intervene. Last year alone, New York taxpayers' paid $127.4 million (http://bit.ly/19I1qTF) to subsidize medical-malpractice insurance. But this is treating the symptom, not curing the disease.

The fact is our doctors are leaving (http://bit.ly/qooT4l) for states where measures have been passed to curb litigation. Those who remain must wonder every day whether the next time they see a patient it will be in the courtroom. New York doctors should be allowed to focus on saving lives, not fighting lawsuits.

Arthur C. Fougner, MD

Having health insurance is not the same as having access to a doctor. Once more time - Liability Reform IS Healthcare Reform.

Behind The Veil

Today's NY Times highlights an important issue for patients - finding the price hospitals charge for inpatient admissions. Most will use some variation of what Medicare pays per diagnosis or DRG. The kicker is that the Medicare payment system is arcane bordering on unfathomable. In the NY Times illustration, the DRG for uncomplicated vaginal delivery is 775. Some states, NY included, use Medicare payments - yes, Medicare in some instances of disability pays for childbirth - as the model from which all other payments are calculated. But try consulting Dr. Google for this one - you come up empty. I know I did. Here's a thought for the AMA - garner some karma points by compiling all Part A payments per locale per DRG and link this to the AMA website. Perhaps State Medical Societies and Specialty Societies should compile similar lists as well. A little good will would go a long way. Remember, it's not a free market when nobody knows the price.

CMV Alzheimers Link?

Alzheimer's could be triggered by by common CMV virus.

Contracting a common virus may play a role in the development of Alzheimer’s disease, a new study has found.

The study of the brains of older adults found an association between patients’ immune responses to cytomegalovirus (CMV) and signs of Alzheimer’s disease. “More studies are still needed to understand how an active CMV infection might be related to this most common form of dementia,” said study researcher Dr Julie Schneider, of the Rush University Alzheimer’s Disease Center in Chicago.

A cure? Faster Please.

The Soul Killer

Cytomegalovirus (CMV) is the most common viral infection of newborns in the US. About 30,000 infants are born with CMV infection annually. About 5000 infants are born with or develop serious disability.

Since most infected with the virus don't know they carry it, it's important to identify carriers during pregnancy. It's also more important to minimize exposure to infection. The CDC suggests the following:

• Wash your hands often with soap and water for 15-20 seconds, especially after
  • changing diapers
  • feeding a young child
  • wiping a young child’s nose or drool
  • handling children’s toys
• Do not share food, drinks, or eating utensils used by young children
• Do not put a child’s pacifier in your mouth
• Do not share a toothbrush with a young child
• Avoid contact with saliva when kissing a child
• Clean toys, countertops, and other surfaces that come into contact with children’s urine or saliva

For more information,do  discuss this infection with your Obstetrician - sooner rather than later.

America's Founding Doctors

Jacob Goldstein from the WSJ Health Blog:

Who knows better than a doctor — witness to birth, sickness and death — that all men are created equal? So it is fitting to recall, this Fourth of July, that the signatures of five physicians are scattered among the 56 names at the bottom of the Declaration of Independence.

Here are the basics on the Founding Doctors. Facts not otherwise attributed come from the book Physician Signers of the Declaration of Independence(Yes, there’s really a book with that title, and we were able to get our hands on a copy.)

Benjamin Rush was a Pennsylvania doc who served as a high-ranking surgeon in the Continental Army and was later treasurer of the U.S. Mint in Philadelphia. He is known as the Father of American Psychiatry, and his book Medical Inquiries and Observations upon Diseases of the Mind was the standard psychiatry textbook for much of the 19th century, the NIH says.

Matthew Thornton practiced for years in rural New Hampshire. When he went to Philadelphia for the Continental Congress, he had himself innoculated against smallpox and wrote of the ensuing ordeal. His satire described a Dr. Cash (“we saw no more of him, till I paid his bill of 18 dollars”); Dr. Critical Observer (“told me he would critically observe every stage … came once in two or three days, and stayed about a minute”); and Dr. Experience (“a merchant, who had the Small Pox, visited us every day, and gave a much truer account of the Small Pox, than all the doctors.”)

Josiah Bartlett was a practicing physician who became governor of New Hampshire and was one of the framers of the Constitution. But the practice of medicine remained important to him. In 1793, two years before he died, he wrote a letter to the New Hampshire state medical society (which he helped charter) expressing his hope that the group would crack down on quackery by “discouraging ignorant & bold pretenders from practizing [sic] an Art which they have no knowledge.”

Lyman Hall worked as a minister until, for reasons unknown to history, he was charged with “immoral conduct” and dismissed. He became a doctor, left his native Connecticut and ultimately landed in Georgia, where things seemed to improve for him — in 1783, he became governor of the state.

Oliver Wolcott was the son of a Connecticut governor who trained as a physician and may have practiced briefly, but spent most of his life in public office. For a while, he held the appealing sounding title of “high sheriff” in Litchfield County.

“And for the support of this Declaration, with a firm reliance on the protection of divine Providence, we mutually pledge to each other our Lives, our Fortunes and our sacred Honor.”

They didn't worry about third party payors, trial lawyers or SGR. They stood up for America against the tyranny of the crown. 

There are presently 20 physicians in Congress. It'd be a good idea for the Doctors Caucus of the House of Medicine to unite with the Doctors Caucus of the Houses of Congress. We'd all be better off.

Turning Point: A Sesquicentennial

One hundred fifty years ago, the Army of Northern Virginia stumbled upon the Army of the Potomac at Gettysburg, Pennsylvania. George Will shares some thoughts:

... Studying history serves democracy by highlighting contingencies: Things did not need to turn out the way they did; choices matter. Since Hegel, Marx and other 19th-century philosophers decided that history is History — a proper noun, an autonomous force unfolding an inner logic — humanity has been told that vast, impersonal forces dictate events, nullifying human agency.

But they don’t. Choices matter. They certainly did during the first three days of July 1863 at the town of 2,390 people seven miles north of the Mason-Dixon line. In “Intruder in the Dust,” William Faulkner famously invoked the tantalizing power of possibility:

“For every Southern boy fourteen years old, not once but whenever he wants it, there is the instant when it’s still not yet two o’clock on that July afternoon in 1863, the brigades are in position behind the rail fence. . . . That moment doesn’t need even a fourteen-year-old boy to think This time. Maybe this time with all this much to lose and all this much to gain: Pennsylvania, Maryland, the world, the golden dome of Washington itself.”

But Lee's gamble failed at the decisive moment and, inexorably, the South's fate was sealed. Without those three days in July of 1863, slavery might still exist and Lincoln would never had the opportunity to utter those few words that now, as Stanton put it, "belong to the ages." As in the Rubayat, "the moving finger writes and having writ, moves on." 

Now They Come For The Obstetricians

First they came for the Orthopedists. Today, the NY Times slams the cost of Maternity Care.

...  Despite its lavish spending, the United States has one of the highest rates of both infant and maternal death among industrialized nations, although the fact that poor and uninsured women and those whose insurance does not cover childbirth have trouble getting or paying for prenatal care contributes to those figures.

Some social factors drive up the expenses. Mothers are now older than ever before, and therefore more likely to require or request more expensive prenatal testing. And obstetricians face the highest malpractice risks among physicians and pay hundreds of thousands of dollars a year for insurance, fostering a “more is safer” attitude.

But less than 25 percent of America’s high payments for pregnancy typically go to obstetricians, and they often charge a flat fee for their nine months of care, no matter how many visits are needed, said Dr. Robert Palmer, the chairman of the committee for health economics and coding at the American College of Obstetricians and Gynecologists. That fee can range from a high of more than $8,000 for a vaginal delivery in Manhattan to under $4,000 in Denver, according to Fair Health, which collects health care data. 

According to the NY Times, the main issue is "a la carte" billing and payment. The solution is predictably bundled payments.

There are two problems with the NY Times analysis. The first issue gets barely a mention and, of course, is buried. That is cost of medical liability. While the US leads the world in healthcare costs, it also leads the developed world in liability costs as well.

Moreover, medical liability costs have risen faster than all other tort costs and healthcare inflation.

While the article mentions the high rate of liability insurance for obstetricians, it conveniently neglects the mention of the costs of liability insurance for what often is the deepest pocket - the hospital. Moreover, the article does not examine defensive medicine at all.

Finally, the article neglects to mention another, more troubling issue - the financing of graduate medical education. With the present emphasis on healthcare belt tightening, the costs of the training of our future doctors always seems to get the short shrift. This needs to be addressed asap and cannot be seen as an afterthought.

I look forward to future NY Times articles focusing on these two issues: graduate medical education and medical liability reform. Our lives may depend on it.