WASHINGTON, Feb. 24 (UPI) -- Medical malpractice legislation appeared to be going nowhere -- again -- in the U.S. Senate Tuesday as Democrats opposed a narrowly scoped Republican bill to cap non-economic damages at $250,000 on lawsuits involving only obstetricians and gynecologists.
The House has passed comprehensive malpractice legislation including the cap for all physicians, which the Senate has rebuffed, and it appeared even a scaled back version would not meet with sufficient support.
"It's an exercise to come up with a roll call vote," said Sen. Dick Durbin, D-Ill., who added S. 2061 was introduced just days ago and came to the Senate without committee consideration. He said the Republican goal is to put senators on the spot for a quick vote so Republicans can vote in favor and tell constituents and special interests in an election year: "See, we moved on this as quick as we came back from recess" -- regardless of the outcome.
There is no political argument that a problem exists but there is over whether caps are an effective cure for skyrocketing malpractice premiums. The Congressional Budget Office has noted malpractice insurance premiums for obstetricians and gynecologists increased 22 percent between 2000 and 2002 -- but there is anecdotal evidence for some docs the increases have been far higher.
S. 2061 was based on a long-standing California law and the American Medical Association strongly supports its passage as a first step toward a more comprehensive effort. A number of other states have adopted similar legislation, including Texas.
The AMA cites data showing since 1976 malpractice premiums nationwide have increased three times faster than in California. AMA data show an ob-gyn in Los Angeles would pay about $69,000 a year for insurance that would cost a colleague in Miami -- Florida has no cap on damages -- about $249,000.
"We have 19 states in (medical malpractice) crisis -- 140 million people living in those states," Dr. Donald Palmisano, who also is an attorney, told HealthBiz. "This is an attempt to fix part of the problem."
"I believe capping damages has a good effect, Sen. Jeff Sessions, R-Ala., said during Senate debate. "Doctors cannot be the guarantor that every birth they preside over will be healthy."
Sen. Tom Daschle, D-S.D., called the legislation an industry bill that seeks to "close the door to the courthouse" under the guise of protecting women and infants. He said statistics from the Medical Liability Monitor show states with damage caps had a 54 percent increase in ob-gyn insurance premiums, compared to a 14 percent increase in states without a cap.
QUALITY CARE ALL OVER THE MAP
Many lawmakers feel bipartisan, comprehensive medical malpractice legislation should include improving quality of care, in turn, improving patient safety -- all reducing the need for malpractice suits.
"More than 70 studies have documented serious quality problems in medical treatment -- but this bill does absolutely nothing to address the underlying problem of patient safety," Sen. Dick Durbin, D-Ill., noted in the Senate Tuesday while arguing against S. 2061.
Many in healthcare are implementing quality care measures -- successfully so -- but not all are doing it the same way or to the same extent. It is all over the healthcare map. Many healthcare facilities and associations have programs to improve quality care but focus on any number of demographic groups, conditions or procedures. Accreditation organizations have guidelines for certain industry sectors and the government is implementing quality care indicators on three specific conditions as a condition of full Medicare payment to hospitals -- yet it would be difficult to translate all this into legislation language.
Take, for example, an analysis by the Center for Studying Health System Change in Washington on the Leapfrog Group's program to improve patient safety in hospitals. Leapfrog was formed in 2000 by the Business Roundtable and includes a long list of Fortune 500 companies that initiated a program to improve quality of care and reduce medical errors.
The HSC survey released this week found while hospitals are very interested in doing it -- few have fully implemented the Leapfrog program's standards for using computerized prescriptions, specially trained intensive care unit physicians and volume thresholds for selected high-risk procedures.
"What we did is look at the hospitals in the 12 markets and it is clear that Leapfrog has had a significant impact in raising hospital awareness of these safety practices .... however hospitals are not that far along in implementing any of these standards," HSC's Alwyn Cassil told UPI's HealthBiz.
Leapfrog provided a statement in response that said: "Leapfrog has always been clear that our safety standards are set high, they are 'big leaps' in patient safety and therefore not easily attainable. We did not expect hospitals to be able to implement them overnight. However, since Leapfrog began surveying hospitals in 2001, implementation and participation rates have risen. In our third yearly survey, which ends in March 2004, 1,136 hospitals have reported so far."
MORE ON HSAS...
Health Savings Accounts are gearing up -- insurers and companies are very interested in adding them as alternatives to more expensive comprehensive plans and the question arises whether the Federal Employee Health Benefits Program will have them as well. Greg Scandlen, director of the Galen Institute's Center for Consumer Driven Health Care, Tuesday issued an open letter to Congress in support.
The letter disputes critics that claim HSAs in the federal program -- which offers workers a variety of plans -- would increase premiums for federal workers who remain in traditional plans because HSAs would siphon off healthy enrollees from those more comprehensive options. Scandlen said the studies used to back up those claims are old and flawed.
He said looking at the seven years' experience with Medical Savings Accounts shows no evidence of adverse selection problems. "What we have seen is that MSAs appeal to a segment of the population that has declined any other kind of available coverage. The IRS reports that 73 percent of MSA buyers had been previously uninsured," he said in a statement.
He also said the two-year experience with Health Reimbursement Arrangements shows people who choose them tend to be older and sicker than those who do not.
He said HSAs will be even better than MSAs. "HSAs belong to the worker, and they allow both employer and employee to contribute. Balances roll-over from year to year and are fully portable when a worker changes jobs. There is no question that workers will see this money as their own," he said.
An Internal Revenue Service official told HealthBiz that any companies with questions on HRAs should contact the agency and the questions and answers will be put on the IRS Web site.
Ellen Beck's e-mail is email@example.com