Looking For Answers On The Malpractice Crisis

By Brian McCurdy, Associate Editor

The scene has been played out at varying degrees throughout the country. Doctors are walking out of hospitals, practitioners are struggling to pay malpractice insurance premiums and juries are awarding millions of dollars to patients who have sued for malpractice. Many perceive a malpractice crisis is affecting the entire healthcare field and DPMs are among those who may feel the crunch. Across the United States, doctors of several disciplines have found themselves unable to practice due to malpractice costs, leaving patients unable to access healthcare. Last year, the University of Nevada Medical Center closed for 10 days because its surgeons’ premiums increased sharply. Indeed, some of these surgeons saw their premium increase from $40,000 to $200,000, according to a July 2002 report from the U.S. Department of Health and Human Services (HHS). In Pennsylvania, 44 doctors in one Philadelphia suburb left practice in 2001 due to high insurance costs. During that same year, premiums for many Ohio physicians tripled, according to the HHS report. Sixty-five percent of New Jersey hospitals reported physicians leaving due to higher premiums that had increased 250 percent over three years. Around the country, some doctors have walked out to protest higher malpractice insurance costs. Such walkouts have occurred in Florida, Mississippi and West Virginia. In New Jersey, 5,000 doctors left work and protested at a rally several months ago. “More and more doctors seem to be getting fed up with today’s medical environment and are leaving this career altogether or opting for early retirement,” says Anthony Poggio, DPM, who practices in California. “Many of the doctors I personally know who have chosen to leave medicine were all very dedicated and competent doctors. Their skills will be missed.” The Costs And Consequences Of Higher Premiums Practitioners who are staying in medicine find themselves paying escalating premiums. Doctors spent $6.3 billion in 2001 to acquire coverage and hospitals and nursing homes spend billions more, according to the HHS report. Michael Downey, DPM, Chief of the Division of Podiatric Surgery at Presbyterian Medical Center in Philadelphia, says he paid $7,000 in premiums five years ago, but paid $21,000 last year. “Doctors don’t really have that much recourse. They pay it. They have to,” says Janice Roven, JD, an attorney who has represented podiatrists. “It’ll get to a point in time where podiatrists or any doctors … will restrict what they’ll do because they’re afraid of being sued.” In addition to doctors leaving areas that are deemed to be cost-prohibitive for insurance, one DPM says the word about higher costs gets out quickly so new practitioners are reluctant to come to certain areas. In the long run, he says this could lead to a potential shortage. While some DPMs are relocating or retiring early, attorney Jeffrey Cohen notes many doctors are insuring themselves and protecting their assets. “The malpractice insurance industry is in crisis in Florida,” says Cohen, who works in Florida. “Premiums continue to soar and the number of insurers continues to diminish. The results are that clients are scrambling to find coverage.” When Rising Premiums Are Combined With Decreasing Reimbursement Several DPMs note that increased malpractice insurance costs may be passed onto consumers, but this can have a potentially damaging ripple effect as well. “Office fees may go up and for cash patients, this may put medical care out of their reach,” explains Dr. Poggio. He notes patients with limited incomes may be burdened if they are charged for previously complimentary services like filling out forms. However, when you consider the combination of escalating insurance premiums and declining Medicare reimbursements for services, physicians don’t seem to have a lot of options. “Increasing malpractice premiums in a climate of decreasing reimbursement have made it economically unfeasible to accept the lower fee schedule,” says Michael Hriljac, DPM, JD. “The provider can no longer agree to the discount that is hallmark of most PPO plans. The increased fee comes directly out of the patient’s pocket and the health care delivery systems suffer.” Dr. Poggio also notes that increasing insurance costs and decreasing reimbursements can result in limited pay raises, and reduced or eliminated benefits for staff. One can try to increase revenue by seeing more patients, but Dr.

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