Going To Sleep Is Free, But

Pennsylvania's Ed Rendell Playing Games With Mcare Abatement

• Categories: Medical Malpractice, Policy, Politics
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The Governor of my state, Ed Rendell, has decided he wants to spend any surplus from the catastrophic malpractice insurance fund (which pays awards and settlements over $500,000) on providing insurance for uninsured adults in Pennsylvania. He wants this so much that that he's threatened not to renew the Mcare program unless he gets what he wants. Thought he State Senate has voted to extend the abatement, the House adjourned before voting.

Here's an interesting quote from Rendell:

What about the pain of the physicians who will have to figure out how to get the money to pay the full amount in January rather than April? Does the Governor think it's harder for the State to issue a refund than it is for doctors to get their hands on that kinds of money?

There should be no linkage between renewal of Mcare abatement and funding of the Cover All Pennsylvanians insurance program. Mcare funds should be used to cover the program's unfunded liability and make it easier to privatize later. The Governor's Cover All Pennsylvanians should get funding in a way that does not impact Mcare's ability to retire unfunded liability and he should stop playing political games to fund it otherwise.

Pennsylvania Doctor Trap Number Two Proposed

• Categories: Medical Malpractice, News, Tort Reform
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Pennsylvania has chosen an interesting strategy to keep doctors from leaving the state. Rather than fix the current jackpot medical malpractice system they've decided to try to trap doctors that are already here.

The first example of this was something called the MCARE abatement program. The Medical Care Availability and Reduction of Error (MCARE) Act replaced an existing catastrophic coverage fund with a new fund to cover awards which exceeded the primary coverage provided by professional liability policies. Each physician must pay into the fund a percentage of their primary premium to sustain the fund.

The MCARE abatement program (or Health Care Provider Retention Program) provides some financial relief from paying premiums to the fund. How much relief a physician gets depends on the practitioners specialty. And here we come to trap number one. If you accept the abatement, you agree to practice in the state for the year in which you receive the abatement AND the next year. If you leave early, you have to pay back the full amount of the abatement.

The legislature is now working on trap number two--a physician loan forgiveness program. For a period of ten years, for every year a physician practices in Pennsylvania after completing training the state will pay off ten percent of their student loan debt. If they leave early (say, after five years), they have to pay the state back ALL of the money the state paid toward their loans.

Pennsylvania's Lawmakers Could Learn From Texas

• Categories: Medical Malpractice, Tort Reform
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Texas enacted tort reform in 2003, capping damage awards at $250,000. In an article titled "Insurance companies, doctors flock to Texas" David Hendricks passes along some facts I hope Pennsylvania legislators take to heart:

• Malpractice insurance rates have fallen an average of 21%
• The number of companies offering malpractice insurance in the state has risen from four to thirty
• Malpractice lawsuits have fallen 50%
• Doctors are coming to Texas, as evidenced by 2,250 pending applications for medical licensure

[Kevin, MD]

Another Obstetrics Ward in Philadelphia Plans To Close

• Categories: Medical Malpractice
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Lots of other good data in that article, too, such as the time-line for closure of other OB units in the greater Philadelphia area:

• Medical College of Pennsylvania (1997)
• Nazareth (1998)
• Germantown (1999)
• City Avenue (1999)
• Roxborough (1999)
• Warminster (2000)
• Elkins Park (2001)
• Episcopal (2001)
• Mercy Philadelphia (2002)
• Methodist (2002)
• Mercy Fitzgerald (2003)
• Parkview (2003)
• Frankford-Torresdale (2006)
• Jeanes (2007)

Pennsylvania Physician Supply Back In The News

• Categories: Medical Malpractice
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A recent Health Affairs article titled Changes In Physician Supply And Scope of Practice During A Malpractice Crisis: Evidence From Pennsylvania has gotten a great deal of national media attention. It's conclusion was as follows:

I've been thinking about this article for a while now. I've written to the lead author asking about the inclusion of medical residents-in-training in their statistics but have yet to hear back. Including residents may hide important trends. For example, new residency programs may have opened during the study period. Trading doctors who are fresh out of internship for experienced specialists is not a good deal, but the numbers as used wouldn't show this.

Another question I have is 'compared to what?' What has happened in other states during this time? According to the Dauphin County Medical Society, among the twenty most populous states, only Pennsylvania and California saw their physician supply drop during the study period. All others saw an increase of 10-20% in physician supply.

Pennsylvania Malpractice Numbers Ignored?

• Categories: Medical Malpractice
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Was it published? Nope. Oh, well.

PA Ranks Second in Total Dollars Paid in Malpractice Claims

• Categories: Data, Medical Malpractice
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At the same website mentioned in the preceding post one can find information on total dollars paid in malpractice cases in 2006. Pennsylvania ranked second with $308,781,000 paid (second only to New York). See for yourself.

Vermont looks pretty good to me right now...

PA Ranks Third in Paid Malpractice Claims

• Categories: Medical Malpractice, Data
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The Kaiser Family Foundation maintains StateHealthFacts.org, a site "designed to provide free, up-to-date, and easy-to-use health data on all 50 states". The site just published Number of Paid Medical Malpractice Claims, 2006. Pennsylvania ranks third among all states in number of malpractice claims paid per thousand physicians. See for yourself.

New Study on Malpractice Costs

• Categories: Medical Malpractice, Data
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Pacific Research Institute:

JACKPOT JUSTICE: The True Cost of America's Tort System

Processing....

Why Are C-Section Rates Still Going Up?

• Categories: Medical Articles, Medical Malpractice, Politics
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As an anesthesiologist I provide anesthesia for cesarean sections quite often. In fact, when I'm on overnight call it's what I spend most of my time doing. Usually, anesthesia for c-section consists of a spinal anesthetic, or using a pre-existing epidural catheter, or (more rarely and usually only in emergencies) a general anesthetic. I am therefore quite interested in the subject of cesarean section rates and what effects how often they are done. I learned some things from this article [free full text]:

Cesarean Delivery and The Risk-Benefit Calculus

1. Parturients are different--they are heavier and older.
2. The number of premature and low birth-weight babies has grown.
3. Vaginal breech deliveries are no longer recommended.
4. Operative deliveries (forceps or vacuum) are less common due to better data describing their risks.
5. More labors are induced (20% in 2003 vs 9.5% in 1990) and induced labors are more likely to result in C-section.
6. Changes in provider behavior

Look at John Edwards' list of law cases (thank you, Google). Notice the medical malpractice cases:

Despite the increase in c-section rates nationwide, we have seen no reduction in the cerebral palsy rate...

Even Malpractice Lawyers Need Doctors, Sometimes

• Categories: Medical Malpractice
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In An Eye For An Eye, Charity Doc describes a close encounter with a malpractice attorney who once sued him. I'm not sure I would have been as, um, gracious....

Pennsylvania's Health Care Crisis has NOT 'turned the corner'

• Categories: Medical Malpractice
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Our Governor is quoted as saying that Pennsylvania's health care crisis has turned a corner. It has not and as evidence I point you to the following article about a Cardiology group in Philadelphia that will no longer provide coverage at one health center there:

Imagine you're, say, a plastic surgeon. There used to be fifteen of you on staff at a hospital so you took ER call only two days per months (as a precondition for maintaining staff privileges). Well, because of a malpractice crisis that has NOT turned the corner there are only three of you now. That's ten days of ER call each month. Kinda forces you to ponder whether maintaining staff privileges is worth is, doesn't it? And if you decide it's not, then patients loose access to yet another specialist at the hospital. See where this goes?