HealthBiz: Malpractice reform cuts cases

MALPRACTICE REFORM A SUCCESS IN PENNSYLVANIA

The political and policy arguments over medical malpractice insurance rates may drone on in Washington, but in nearby Pennsylvania reforms enacted last year have shown encouraging results.

The Pennsylvania Supreme Court reports a 30 percent decrease in the number of malpractice suits filed in that state in 2003.

Surprising, but Amy Kelchner, of the state's Office of Healthcare Reform, told UPI's HealthBiz the reforms had nothing to do with capping jury awards -- the main focus of the debate in Washington. Caps are prohibited by Pennsylvania law.

She said the state's high court instituted a rule change that governed venues. It required cases to be filed in the county where the alleged malpractice occurred. Kelchner said attorneys had been going out of their way to file all the cases they could in Philadelphia -- where jury awards were more generous.

The reforms also included requiring cases to obtain a certificate of merit before they go to court.

Attorneys argued against the malpractice reforms, on the grounds the state lacked statistical evidence to back them up, so the Supreme Court ordered all 67 counties in Pennsylvania to track three years' worth of malpractice cases -- 2000 to 2002 -- and then compare them to 2003, the first year the reforms took effect.

"Only now are we starting to have some numbers," Kelchner said, "so we can look at making some very good policy decisions."

Gov. Edward Rendell this week also proposed adding to the reforms through new legislation. He wants to extend for three years a two-year program that helps physicians pay malpractice insurance premiums. The $220-million-a-year abatement program gives high risk physicians -- such as obstetricians -- a 100 percent break on premiums for Mcare, the state-run insurance program. Other physicians got a 50 percent break on Mcare premiums.

Physicians in Pennsylvania buy half their insurance from the private market and half from Mcare, which is funded by a 25-cent-per-pack cigarette tax.

Rendell also proposed limiting attorney and referral fees in medical malpractice cases, creating a defense-initiated mediation program that would be mandatory for hospitals and health systems, giving judges more power to limit huge jury awards and giving the state's insurance commissioner more power to set malpractice rates.

EMERGENCY IN THE ER

An emergency is brewing in the ER these days: not enough resources and space combined with more patients who are staying longer.

"We're getting squeezed from both ends," Dr. George Molzen, an emergency room physician at Presbyterian Healthcare Services in Albuquerque, N.M., told HealthBiz

"Most emergency departments are operating at full capacity on a daily basis and most of us actually don't have enough capacity to see the patients that we need to see," Molzen, immediate past president of the American College of Emergency Physicians.

Emergency department patients also get squeezed -- fewer inpatient beds mean longer stays in the ER before hospital admission -- which in turns fills ERs to capacity.

A report by the Centers for Disease Control and Prevention in Atlanta counted more than 110 million ER visits in the United States in 2002, an increase of more than 3 million over 2001. That trend is expected to continue as the baby boom generation enters retirement.

A full house in the ER could spell trouble if a major disaster or terrorist attack occurs that sends scores or hundreds of people to the hospital.

Hospitals have tried to match capacity with patient volume for greatest efficiency and a better financial bottom line, but Molzen said additional space and beds are needed in emergency departments to ensure a state of preparedness.

"We don't have any give in our system," he said.

A General Accounting Office report last year found "boarding" -- keeping patients in emergency beds because there are no regular inpatient beds available -- was a key reason for the overcrowding problem.

SURGEON SHORTAGE ON THE WAY

The "Help Wanted" sign is out on the operating room door as the United States soon will face a shortage of surgeons and other physicians.

"It's across the board -- there's going to be an across the board shortage of physicians across America," said Dr. Rod Rohrich, president of the American Society of Plastic Surgeons.

The society's report looked specifically at plastic surgeons and Rohrich told HealthBiz that just considering the growing demand for gastric bypass surgery for weight loss, there will not be enough surgeons to handle the number of patients who opt for that procedure.

He said the medical associations and medical colleges need to acknowledge the upcoming shortage. Then, he added, "We are going to need to accelerate the number of individuals going to medical school."

Rohrich said though being a physician still is a "wonderful profession," medical school enrollments are down as fewer students are interested in a field that has undergone dramatic changes in the past decade with managed care and regulatory pressures.

The retiring baby boomers in the coming years will increase the need for physicians and Rohrich said, "If we started fixing it today, we might only miss the mark by five years."

He added even a 10 percent increase in class sizes at medical schools would help.

Another needed fix, he said, is Medicare's payment formula for the nation's teaching hospitals. To that end the college has an ally in the Senate -- Majority Leader Bill Frist, R-Tenn., is a physician and surgeon.

"He understands the ramifications," Rohrich said.

The ACEP study is published in its March issue of Plastic and Reconstructive Surgery, its official journal.

ADA: MEDICAID UNDERFUNDS CHILDREN'S DENTAL CARE

Most children covered by Medicaid do not receive basic dental treatment, but seven states offer models for change, the American Dental Association said Wednesday.

About 24 million U.S. children are enrolled in state Medicaid programs, but only one-quarter see a dentist each year, ADA President Eugene Sekiguchi told reporters in Washington.

Dentists often volunteer services for low-income children, but most Medicaid programs do not reimburse at the minimum cost needed for basic dental care, Sekiguchi said. As a result, it often is not cost-effective to accept Medicaid patients.

Medicaid has been plagued by policy problems at the state level for a long time, said James Crall, a pediatric dentistry professor from the University of California, Los Angeles. "Band-Aid solutions simply aren't going to make a difference."

Rep. Mike Simpson, R-Idaho, himself a dentist, said dental disease is almost 100 percent preventable and almost 100 percent curable. Voluntary programs are not enough, he said, and added Medicaid long has ignored dental care while favoring medicine.

Medicaid plans often base reimbursement rates on fees from the previous fiscal year, which may not reflect changing costs, and many providers are unsure whether to deduct Medicare adjustments before or after submitting claims, the ADA said.

Seven states have revamped their Medicare programs to offer more education for patients and better reimbursement for dentists. The combination has improved prevention and care, Crall said.

An Alabama task force negotiated reimbursement rates, while Delaware state officials and dentists joined to boost reimbursement and attract participants. Indiana, South Carolina and Georgia formed panels to recruit providers, while Tennessee and part of Michigan partnered with private dental groups.

Crall told HealthBiz the Michigan's Healthy Kids program -- which tripled dentist participation in Medicaid -- was successful largely because it used the "robust provider network" and market knowledge Delta Dental already had in place.

States that lack funding to boost their own Medicaid programs could "replicate the Michigan approach" by partnering with private contractors and increasing prevention programs with community help, Crall said.

GROWTH FACTOR INHIBITORS HAVE BIG MARKET

Kalorama Information predicts the global market for drugs that inhibit growth factors and angiogenesis will increase from about $4 billion to more than $13 billion in the next five years.

Growth factor inhibitors are used in oncology, rheumatology, ophthalmology and dermatology. The Kalorama study, "Growth Factor Inhibitors: Market Opportunities for a Growing Pipeline," said the rheumatology sector will be the hottest market, where Enbrel and Remicade already are very popular medications. The study said Iressa and Herceptin are gaining in popularity for cancer.

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Thanks to UPI's science intern David Kent in Washington for contributing to this column

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E-mail ebeck@upi.com