Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Wednesday, August 7, 2013

My Counter-Argument

I read this on Pharma Gossip, and it made me angry. According to a new report by Public Citizen, the

"Continued Decline [in medical malpractice payments] Debunks Theory That Litigation Is to Blame for Soaring Health Care Costs."

Some key points:

 -The number of malpractice payments on behalf of doctors (9,379) was the lowest on record, falling for the ninth consecutive year;

- The value of payments made on behalf of doctors ($3.1 billion) was the lowest on record if adjusted for inflation. In unadjusted dollars, payments fell for the ninth straight year and were at their lowest level since 1998;

- More than four-fifths of medical malpractice awards compensated for death, catastrophic harm or serious permanent injuries – countering the claim that medical malpractice litigation is “frivolous”;

- Medical malpractice payments’ share of the nation’s health care bill was the lowest on record, falling to about one-tenth of 1 percent (0.11 percent) of national health care costs;

- Medical liability insurance premiums, a broad measure that takes into account defense litigation costs and other factors as well as actual payments, fell to 0.36 of 1 percent of health care costs, the lowest level in the past decade.

Now, I suspect that no one cause is to blame for soaring health care costs. But when I read this:

“The facts clearly and obviously refute the contentions that...malpractice litigation significantly influences health care costs. Medical malpractice payments continue to fall and health care costs continue to rise. It doesn’t take a math whiz to determine that they are not correlated,” said Lisa Gilbert, director of Public Citizen’s Congress Watch division.

I got seriously mad. I thought, "If physicians are practicing more defensive medicine, then it follows that there will be fewer malpractice suits, fewer malpractice payments, and the cost of liability insurance will go down. But more defensive medicine means more tests, means more expense, so the cost of healthcare will increase." Which is what they found.

They're claiming that, "More than four-fifths of medical malpractice awards compensated for death, catastrophic harm or serious permanent injuries – countering the claim that medical malpractice litigation is 'frivolous'."

This does not imply that "frivolous" suits were not brought, wasting valuable time and money, merely that they weren't successful.

I decided to be level-headed about it, and read the report. Well, it's too damn long.

But there's nothing in the report about the number of malpractice suits brought, frivolous or otherwise  (at least not to my perusal).  Just a lot of figures about malpractice payments.

And I did find the section that discussed the issue of defensive medicine:

In a given snapshot of time, the defensive medicine theory defies conclusive evaluation because it ultimately rests on divining the private thoughts underlying doctors’ decisions. But broad trends over time provide convincing evidence that the defensive medicine theory is essentially bogus. If litigation fears truly prompt unnecessary tests and procedures, then the volume of care rendered should be declining in sync with diminished litigation risk. This thinking is at the heart of the argument for imposing caps on malpractice awards. But, as illustrated above, costs have marched upward while litigation risk has declined. Increased volume of care, including testing, is almost certainly a key reason for the increased costs.

This idea that the volume of care would decrease has to do with the fact that Texas enacted restricted litigation laws in 2003, and that while malpractice payments fell between 2003 and 2010, health care costs increased faster than the national average, especially for medicare diagnostic tests.

Well, maybe. But Texas is not solely responsible for soaring health costs.

So what DOES the report think may be the cause of rising costs?

Those truly looking to stem health care costs should look elsewhere. This report reviews the 2003 and 2013 pay for physicians in six specialties (Anesthesiology, Cardiology (noninvasive), General Surgery, Internal Medicine, Ob-Gyn and Radiology) as chronicled by Modern Healthcare in its annual doctors’ compensation survey. Practitioners of these specialties have seen their pay rise from 24.3 percent (ob-gyn) to 82 percent (radiology) over this time period. For all specialties but one, pay raises have exceeded inflation. Likewise, Modern Healthcare reports that compensation for health care system CEOs rose at more than twice the rate of inflation from 2003 to 2012 (to over $1.1 million annually, on average). Pay increases for chief medical officers and chief financial officers also far outpaced inflation. These figures suggest that financial incentives, not litigation or the fear of it, provide a far more plausible explanation for soaring costs.

You got me. I'm a greedy doctor, more interested in being out on my expensive yacht than taking care of patients.

Here's another set of figures:

WASHINGTON, D.C. Aug. 11, 2010 - Health Care for America Now (HCAN), the 1,000-member coalition that led the successful fight for health reform, released a report today showing that in 2009, ...chief executives of the 10 largest for-profit health insurance companies collected total pay of $228.1 million, up from $85.5 million the year before. The CEOs of UnitedHealth Group, WellPoint, Aetna, CIGNA, Humana, Coventry Health Care, Health Net, Amerigroup, Centene and Universal American took $944.1 million in compensation from 2000 through 2009, according to the report, entitled "Breaking the Bank." 

The boldface is mine. But 228 MILLION! That's 3 orders of magnitude greater than the average physician's income. That's the kind of number that would go a long way towards defraying health care costs.

And who is "Public Citizen"? The Board of Directors includes a bunch of lawyers, a couple activists, and one stand-up comic.

I really hope they asked at least one doctor's opinion about medical malpractice.

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