There are, to be sure, opponents of malpractice reforms, specifically those that cap punitive and non-economic damage awards. And their arguments are certainly to be considered. But when patients have a greater right to sue than their right to see a physician in the first place then the system is out of balance. Areas where torts are epidemic often see the flight of physicians to friendlier locales. Texas was one of those states, but three years after malpractice reforms were initiated the exodus has become an influx, as Newt Gingrich and orthopaedic surgeon John Gill show today in the Wall Street Journal.
DALLAS--The Senate is once again taking up the issue of medical justice reform. If senators want to expand access to health care by increasing the number of physicians and lowering costs, they need to look at Texas.
In the summer of 2003 the Texas Legislature enacted important medical litigation reform. A voter-approved constitutional amendment, Proposition 12, followed later that year to solidify the changes. As a result, physicians are returning to the state, particularly in underserved specialties and counties. Insurance premiums to protect against frivolous lawsuits have declined dramatically, with the state's largest carrier reporting declines up to 22% and other carriers reducing premiums by an average of 13%. The number of lawsuits filed against doctors has been cut almost in half.
Prior to the successful reform effort, personal injury lawyers had put Texas doctors on the run. According to the Texas Department of Insurance, the frequency of claims was increasing at a rate of 4.6% annually--between 1996 and 2000 alone, one out of four doctors was sued.
These surging legal and insurance bills reduced patient access to health care. Texas fell to 48th out of 50 in physician manpower. There were 152 medical doctors per 100,000 citizens, well below the U.S. average of 196. Some 158 counties had no obstetrician. Good, competent doctors were closing their doors, unable to afford the cost of insurance.
Have the limits worked, at least as far as the health care system? Take a look.
So what has happened since September of 2003, when the new law went into effect? After years of losing doctors, Texas has added nearly 4,000 since passage of Proposition 12, including 127 orthopedic surgeons, almost 300 anesthesiologists, over 200 emergency room physicians, 146 new obstetricians, 58 neurologists and 24 neurosurgeons. The Texas Medical Board is anticipating some 4,000 applicants for new physician licenses this year alone--double last year's numbers, and 30% more than the greatest growth year ever.
California's very similar law has been on the books since 1975, and I don't know that medical care in that state is worse because of it. Other states without such limits should take note, including Massachusetts. One of those new physicians in Texas formerly worked in a general surgery practice in my office building, and was one of the top surgeons in our area. We'll miss him here, but I certainly understand.
5/4/06 1645: Related - The Boston Globe is reporting that an increasing percentage of physicians are declining to participate with managed care plans.
NEW YORK --The proportion of physicians who don't participate in managed care plans is rising in a development that may signal a trend toward higher patient costs and less access to doctors, a study to be released on Thursday said.
The proportion of U.S. doctors without managed care contracts rose to 11.5 percent in 2004-05, up from 9.2 percent in 2000-01 and 8.6 percent in 1998-99, according to the Center for Studying Health System Change, a nonpartisan research group in Washington, D.C.
Dr. Ann S. O'Malley, a senior researcher at the Center and an author of the study, said doctors often choose to opt out of networks because of low payment and paperwork hassles.
In my experience it's the low payments. If your office is busy, then the business-smart thing to do is decline the lowest paying managed care plan if you can still fill your office. You don't "negotiate" with managed care plans so much as you accept the terms they've dictated to you. So you're only choice is, do you accept them or not. "You've got a nice little practice there, Doctor. It'd be a shame if anything was to happen to it."
These MCP's are essentially middlemen, creating paperwork hassles for the office, taking a cut of the fees in order to process that paperwork, and dictating lower fees for providers, all in the guise of "cost containment." And they're often deceptive. There is one local rather large HMO with whom my practice declined to participate about 3 years ago. We tried to take another look at them this year, thinking that perhaps they'd straightened out some of the problems, and upon contacting them we were told that we couldn't see the fee schedule until we'd enrolled with them. That is, we can't find out how much they'd pay for various procedures until we had already agreed to accept said fees. We passed.