Malpractice Insurance

[meuge]

Newsday is reporting that recent hikes in malpractice insurance in New York State will amount to a 25% increase in premiums, in addition to a $50'000 surcharge.

With insurance rates peaking at $100k/year, this will mean that many doctors will have to shell out nearly $175'000 in insurance premiums this year alone. Considering that average physician in private practice makes under $200'000 in NYS, it is leaving a significant percentage of doctors with no choice but to leave the state this year.

Given that health insurance companies have no intention of paying 25% more for doctor's time we're left with a situation where rising healthcare costs are being blamed on overpaid doctors, while liability claims go through the roof... malpractice insurance threatens to reduce the physician to a minimum-wage job... after 8 years of higher education and an average debt load topping $400'000.

 

[chmsam]

Nothing excuses negligence, but the solution many good NYS MD's are finding is to move to another state. Other states are finding similar problems. I've had several MD's who were just plain arrogant and rude, and had no common sense either. Those are the ones I'd want to move. Guess which ones hang around...

 

[Mike Painter]

Nothing excuses negligence, ...

Nice if it were true in the medical world. The single biggest reason for a lawsuit in emergency medicine is the case where a person comes in by ambulance with a "heart attack". Every test known to the hospital is run and *nothing* is found.
The patient is released, goes home and dies of heart failure.
The solution is simple, a 12 lead EKG done at the scene while the event is happening. Most partamedic units are switching to that but the event may well be over before they get there.
If you break your arm it will still be broken when you get to the hospital. If you have a heart attack, it may be over leaving (almost) no traces when you get there.

I say almost because today only the autopsy will provide clues.

Still they get sued and loose.

 

[swampgator]

If you have a heart attack, it may be over leaving (almost) no traces when you get there.

CPK, Troponin and MB levels should be elevated post MI. There's no good excuse for not checking lab values upon arrival to the ED.

 

[Mike Painter]

CPK, Troponin and MB levels should be elevated post MI. There's no good excuse for not checking lab values upon arrival to the ED.

The three hour lecture I sat through on the subject last year about this time is where most of this information comes from.
As I said, they run all ther tests and still send people home to die. As you said, they should be elevated.

 

[chmsam]

Yet another reason to be your own best medical advocate. And to despise most HMO's.

Having been misdiagnosed for even minor things several times over the past 30 years, I no longer trust any MD. I always ask questions and double check anything when dealing with "the medical industry" around here. HMO's have ruined the bedside manner and changed the attitude of most all of the medical staff for the worse. The rush to get patients through the system has really hurt medical care and promoted an attitude similar to that found in the service department at a car dealership.

The corporate attitude of "treat, don't cure" to make a buck has not helped either. Much of the areas' medical community has shifted to an industry mentality and the emphasis on profit making has soured staff and patients alike around here. That's bad mojo for everybody but that is nothing new, is it?

 

[swampgator]

HMO's have ruined the bedside manner and changed the attitude of most all of the medical staff for the worse. The rush to get patients through the system has really hurt medical care and promoted an attitude similar to that found in the service department at a car dealership.

The corporate attitude of "treat, don't cure" to make a buck has not helped either. Much of the areas' medical community has shifted to an industry mentality and the emphasis on profit making has soured staff and patients alike around here. That's bad mojo for everybody but that is nothing new, is it?

If anything the physicians and hospital that I'm associated with are different. Working in cardiology I've seen first hand patients treated far better than they could afford. I've seen many thousands of dollars written off for loss. I've also seen physicians fight corporate to have the tools to do the job.

I've seen homeless people come into the ED actively infarcting (having a heart attack). We go in, perform a cath and stent the patient. Patient spends at least one night in the ICU, then downgraded to the telemetry floor for cardiac monitoring. They stay on the floor at least two days. They are seen by cardiac rehab for post procedure education. After the physician feels they've recovered, then they're discharged. And the company rights off all the treatment.

 

[meuge]

Guess which ones hang around...

The ones who do enough creative accounting to be able to afford the insurance?

Listen... modern medicine has pretty much doubled the average lifespan in the U.S. in about a century. Since you can't stop people from making mistakes... would you rather have all the doctors sued into oblivion?

All people make mistakes... sometimes because they're careless... and sometimes simply because they're human. Doctors deal with people's lives... and hence they are held to a higher standard... but expecting them to not make any mistakes is ridiculous. Almost as ridiculous as expecting cheap/free healthcare, then complaining that doctors are overpaid... and then demanding millions in compensation for any mistake.

The thing is, most medical mistakes are not reported. If you take the average settlement, and extrapolate it to ALL the cases of malpractice, you wind up with an average of over $1 million per year per physician in settlement costs. Considering that an average doctor in the U.S. makes about $140 thousand... what is it that people actually want?

 

[chmsam]

This problem can be helped somewhat by moving away from an industry mentality. Doing so might provide better care and more responsibility, and that ought to mean better rates. I mean the system is more at fault and not just the individual doctor. Not to be misunderstood, I know some great doctors and have seen some examples of great care. I have a few relatives who are RN's and one who was an administrator. I also know of two families who have had loved ones dies needlessly -- both at the same hospital (a teaching hospital by the way), one from a simple staph infection that went unnoticed and untreated when staph infections were known to be frequent in that hospital. I have heard it before and since then, not enough staff to take care of the staph. That is the sort of problem that is still prevalent and it should not happen.

Let's see less of a corporate attitude and training toward it from the days of med school onward, and going back to more emphasis on patient care and getting the right test and procedure even if it means less profit for the HMO. Also, without things like limits on the number of hours on intern shifts and on the number of patients for which a nurse is responsible I do not see things getting better. These are simple and obviously needed changes. Most patients are not aware of that until there are problems and then come the malpractice suits. By then it's the MD who has to bear the brunt of the suit and every other MD sees the rates go up. Maybe the insurance industry is not a friend of the medical community.

Patients in this country receive different levels of care depending upon whether they have insurance at all and quality of the insurance they might have. Sometimes just dependent on the company that carries them. If the system works so well, why does the US rank so high among developed nations in the number of preventable patient deaths? That burden doesn't fall on the HMO's as much as on the individual MD's and their premiums. Good doctors can no longer afford to stay in states with high premiums, they have to move, and everyone loses because of it.

No, I am not going to hold my breath waiting for any of these changes, or for the premiums to drop in this state.

 

[jtr1962]

Listen... modern medicine has pretty much doubled the average lifespan in the U.S. in about a century.

Improved sanitary conditions account for most of that. Remember that people lived into their 60s and 70s regularly in Rome in those places with good sanitary conditions. The main thing medicine did was vaccinate against diseases which used to claim many young lives. A good thing to be sure, but you give modern medicine way too much credit. IMHO lifespans are about 20 to 30 years less than they should be given what we know about how the human body works, and how we can treat unavoidable conditions caused by advanced age. We're basically using drugs to compensate for poor lifestyle choices which cause large numbers of people to get ill well before they should. Sure, these drugs get lots of people to make it to their 60s or 70s who might not make it past 45, but with a poor quality of life for the last 20 or 30 years. Of course, it's a less contentious and time consuming route for a physician to prescribe Lipitor than to give an obese patient a choice of eating better, losing weight, and exercising, or dropping dead of a massive heart attack in the next few years. However, the later route could get the patient to live past 100, with most of those years in good health, rather than to 75, and with most of those years in misery. The insurance companies I'm sure are happier to have physicians just prescribe drugs assembly-line style, rather than deal with each patient on an individual basis.

I agree that pricing doctors out of the market for the mistakes of a few is a bad idea. However, we have the insurance system to blame for many of those mistakes as doctors are overworked, tired, and prone to making mistakes. In medicine more than in any other industry I've never understood the concept of forcing staff to work ridiculous hours. The consequences of a mistake can be deadly. If I see a doctor, I want that doctor to have gotten adequate rest the night before. And point of fact, medicine shouldn't be a for profit enterprise at all. The staff should be fairly paid of course, but the goal should be keep people healthy, not make money off them when they get sick. As chmsam said, the emphasis on treat, don't cure, is the main problem. Maybe the payment system needs to be changed. People pay x dollars per year of good health, and nothing when they get ill, with the caveat of course that they don't smoke, exercise, maintain proper weight. People who abuse their bodies should pay for treatment, but that's another story.

Regarding malpractice, the only real way to fix it is to get rid of contigency cases and percentage-based lawyer fees. Lawyers taking a case should be paid per hour like any other profession, win or lose. This will encourage clients to only pursue non-frivolous cases where they stand a good chance of winning since they have to pay their lawyer regardless. And loser pays is a good concept as well. The current legal fee structure is absolutely ridiculous. It's like me making an electronics project for a client, and if they do well with it they pay me more, but if it doesn't sell I make nothing. I'm sure I would be swamped with more work than I could handle if I offered terms like that, but most of it would end up being a gamble on my part. Unlike the lawyers, however, I wouldn't have an opportunity to sway gullible people into seeing things my way.

Honestly, it amazes me that anyone at all would even consider going into medicine. Between the years of school, cost of tuition, hazing-like internship, the attitude of insurance providers, big pharma, and malpractice it seems like you would do better working as a day laborer. I wonder if things for doctors are this bad outside the US? I think most people go into medicine with purely noble intentions (why else would anyone endure all that hardship?). It's the system which really needs to be changed so that doctors can be healers once again as most want to be.

 

[jtr1962]

Patients in this country receive different levels of care depending upon whether they have insurance at all and quality of the insurance they might have.

Actually, thanks to insurance increasing the general cost of medical care, most people without insurance are effectively priced out of the system. Last time I saw a doctor for a medical checkup was when I started college in 1980. Last time I saw a doctor for any reason at all was when I got stitches in my head following an auto accident in 1988 (the driver's no fault paid for that as I couldn't have afforded it on my own). In a way I'm glad I can't afford access to medical care. Given what I saw my mom go through all these years it appears the insurance companies postone treatment until the last possible minute. My mom developed severe carpal tunnel syndrome in her mid-40s. By the time the insurance company finally sprang for the operation most of the nerves in her hands were dead. Besides that, it took something like 5 years to even get a proper diagnosis. Doctors kept saying it was arthritis, prescribing pain killers, gold salts, etc. As for my dad, as far as I'm concerned the insurance company helped kill him. Although he abused his body, no excuse not to give a 70+ year old obese patient with a prior heart attack (and one blocked plus one partially blocked coronary artery) an echocardiogram every six months. Had they done so, they probably would have caught the impending blockage which gave him his final, fatal heart attack (he lasted four days in the hospital on life support, but they couldn't do anything). All they did was prescribe Lipitor and give him an EKG once a year. Oh, and I'm sure the Lipitor helped kill him too. He had just about all the indicated side effects, including extreme lethargy, muscle weakness, and constipation.

If it sounds like I'm disgusted with the state of medicine it's because I am.

 

[swampgator]

As for my dad, as far as I'm concerned the insurance company helped kill him. Although he abused his body, no excuse not to give a 70+ year old obese patient with a prior heart attack (and one blocked plus one partially blocked coronary artery) an echocardiogram every six months. Had they done so, they probably would have caught the impending blockage which gave him his final, fatal heart attack (he lasted four days in the hospital on life support, but they couldn't do anything).

Sorry for the loss of your father, but, an Echo want diagnose a coronary artery blockage. The only way to positively identify a blockage, until recently, is angiography. Now CTA (CT angio) can do it also. However you still have to have an invasive catherization or surgery to repair.

Depending on the size and location of the blockage sometimes medical management is a better option than either balloon angioplasty or stent placement. I worked on a patient today who had two minor blockages in the most distal portions of two arteries. The area of muscle these arteries profused was very minor. The physician in this case debated whether or not to place stents. Intra-coronary nitroglycerin was admistered and the arteries perked up enough to allow adequate profusion. Instead of proceeding with a $50K procedure, the physician opted to change the patient's medications and put him on a long lasting nitroglycerin medication.

The talk of "treat don't cure" is, in my opinion, nonsense. Certain diseases can be cured, we know that. However certain conditions can only be treated. Heart diease is a prime example. Once a patient is diagnosed they're looking at long term treatment. Depending on the severity is can be as simple as stent placement followed by yearly stress tests or as complicated as multi-vessel Coronary artery bypass grafting, which requires much more follow up. You can't just declare them cured and send them on their way. The human body doesn't work that way.

Here's an example: A patient came into our lab after hours on a Tuesday night actively having a heart attack. She was stented and stabilized and remained an in-patient. She returned to the lab for follow up stenting of several other vessels on Thursday. She was followed by her cardiologist and finally released home on Saturday. Her coronary artery diease should be cured, right?

She returned acutely again Sunday afternoon. 36 hours after being released. Her coronary was occluding in a portion of the vessel distal to the previously stented segment. Why? Because certain diseases are progressive and continue regardless of intervention.

Not all healthcare companies are evil. I work for a for profit corporation and I know first hand how much we write off. Even charges Medicare (who really set pricing for healthcare not private insurance) allows, we routinely discount.