Medical Malpractice: Don't Believe the Hype - 2015 Policy Prescriptions® Symposium
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Transcript of Medical Malpractice: Don't Believe the Hype - 2015 Policy Prescriptions® Symposium
Medical Malpractice Reform: Don’t Believe the Hype
Laura Medford-Davis, MDRobert Wood Johnson Clinical Scholar
University of Pennsylvania
Malpractice
Overview
1. Definition: What is Malpractice Reform? 2. Map: Status of Reform in the US3. Outcomes of Malpractice Reform
Malpractice (Tort) Reform• Tort = Compensation for injury• Reform = Rules regarding Tort Claims
Mechanisms of Reform• Damage Caps–Economic damages–Non-economic damages• Pain and suffering, anguish• Punitive and exemplary
Mechanisms of Reform• Attorney Fees– Fee limits– Loser pays fees
• Qualifications for expert testimony• Statute of limitations• Pre-trial screening• Burden of proof
Alternative Models• No-Fault Compensation– New Zealand– Sweden– Denmark
• Federal Tort Claims Act– Veterans Affairs– Federally Qualified Health Centers– Indian Health Services– Public Health Service
Malpractice: What’s at stake?
• $3.6 billion paid in 2012 on 12,142 claims ($296,000/claim)–93% settled out of court–31% of claims for wrongful death–33% of claims for misdiagnosis
Malpractice: What’s at stake?
• Additional $4.1 billion litigation fees• Liability Insurance Premiums:
$3,375-$215,000/year• Defensive Medicine $46 billion/year–28% of orders
• Access to Care
Defensive Medicine - Physician Concern• More referrals to ER and orders for
advanced imaging• No correlation with tort reform
Defensive Medicine: Liability Premiums• Increased costs when treated by a
physician with a higher liability premium
Annual Risk of Claim by Specialty
Source: NEJM 2011. 365(7):629-36.
Cumulative Lifetime Risk by Specialty
Source: NEJM 2011. 365(7):629-36.
Overview
1. Definition: What is Malpractice Reform? 2. Map: Status of Reform in the US3. Outcomes of Malpractice Reform
Top Malpractice Payouts (2013)
1. New York $763 M2. Pennsylvania $316 M3. California $223 M4. New Jersey $207 M5. Florida $204 M
Top Malpractice Payouts (2013) Per Capita1. New York (#4) $382. Pennsylvania (#6) $253. California (#1) $64. New Jersey (#11) $235. Florida (#3) $10
Top Malpractice Payouts (2013) Per Capita1. New York (#4) $382. Pennsylvania (#6) $253. California (#1) $64. New Jersey (#11) $235. Florida (#3) $10
Texas (#2) $3
Damage Caps in the United States
Legend<$500,000$500K-$1M>$1MSliding Scale
Pre-Trial Screening
Patient Compensation Funds
Overview
1. Definition: What is Malpractice Reform? 2. Map: Status of Reform in the US3. Outcomes of Malpractice Reform
Reform Outcomes: Damage Caps• Reduce liability premiums by 17%–Only when $500,000 or less
• Do not decrease health insurance premiums
Reform Outcomes: Other Limits• Nothing besides damage caps makes
a difference• Gross Negligence => No Change in
Defensive Medicine–CT/MRI utilization –ER charges (3.6% in Georgia only) –Admission rates
Physician Availability• Surgeons more likely to start practice in
areas with damage caps and lower malpractice premiums
• Texas reform in 2003–Physicians have increased by 8% more than
population –46+ counties in Texas have added a
specialist physician
Summary• Malpractice reforms limit patients’ ability to
bring claims for injury• Malpractice risk and reform vary depending
on location and specialty• Surgeons are at more risk than primary care• Damage Caps decrease malpractice insurance
premiums• Reform does not decrease healthcare costs or
defensive medicine• Unknown impact on patient safety
Discussion• Available studies are limited• Laws are constantly changing• Who does reform benefit?
Questions/Comments