I’ve been a critical care nurse for 12 years. I rarely find out about the costs my patients incur as they get care in my unit, though occasionally I hear figures. One gentleman, who had open heart surgery to fix one of his heart valves had to come back 3 months later for a re-do. His wife told me that they had just received the bills that added up to almost $200,000. That was about 8 years ago.

Not long ago I learned that the charge per day in intensive care units like mine was now $11,000. Not unrelated to that fact, just the other day, one of our patients who was a ’self pay’ (read ‘no insurance’) was quickly and quietly packed up and transferred to the county hospital for the remainder of her critical care stay which was going to be several days.

ludlow’s diary :: ::
Though I am not a health care economist I do believe that the true costs of care are incomprehensibly skewed as everyone in the system scrambles to make up for ’self pay’ patients who would most likely never in a million years have the astronomical amounts needed to cover care while the private insurers and Medicare and Medicaid negotiate greatly reduced prices from that ‘retail’ cost. And it is further skewed by plain old greed.

The whole system is such a many-headed hydra monster! And if you try to reform it bit by bit you end up with a 10,000-paged bill that still fails the American People. Just as with the many-headed hydra who immediately regrew one and sometimes more heads when one was lopped off, when you attempt to reform and regulate an aspect of the similarly poisonous insurance/pharmaceutical complex, one or more new problems spring up. The ‘hydra’ can’t be regulated or compromised with. It needs to be taken out in order to make the system safe for everyone. Once that is done, Problem. Solved.

Just today the Senate HELP Executive Committee discussed medical liability and ways to handle malpractice suits. Included in the discussion was an amendment from Senator Enzi (that he said he developed with Montana Max!) to have Medical Courts decide malpractice cases. These ‘courts’ would not be trial-by-jury but rather have some entity (who in my view would be in the insurance industry’s pocket, limiting the industry’s expenses) decide who was wronged and how much if anything they should be compensated. At least that crazy idea was rejected by the committee.

What would happen to medical malpractice costs under Single Payer? With no private insurance companies zealously trying to guard their bottom line? The Physicians for a National Health Program tell us this:
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On May 21, Oklahoma Gov. Brad Henry today signed into law historic tort reform legislation, saying House Bill 1603 by Rep. Dan Sullivan and Senate President Pro Tempore Glenn Coffee will help improve the legal process without impeding a citizen’s access to the courts. The measure would help curb frivolous lawsuits and reduce costs associated with the justice system, among other things.

“This legislation enacts reasonable and responsible reforms that improve the civil justice system without impairing a citizen’s constitutional right to have his or her legitimate grievances appropriately addressed in court,” Gov. Henry said.

“It is perhaps the most comprehensive tort reform measure in state history, and I want to thank all the parties who were involved in crafting this bipartisan legislation. Now it is time to put this issue behind us and give the new reforms an opportunity to work.”

The Legislature overwhelmingly approved the measure last week in a bipartisan vote. Today, legislative leaders applauded Gov. Henry’s action on the bill.

“This is a huge day for Oklahoma,” said Senate President Pro Tem Glenn Coffee. “Thanks to the good faith efforts on the part of health care and business interests, legislative leadership, the Trial Bar and Royalty
Owners, we can proudly proclaim that Oklahoma is open for business. We have made it possible for Oklahoma to keep our best and brightest physicians, and assure that those legitimately wronged will have their day in court.

“I thank the Governor for signing this legislation and helping move Oklahoma a giant step forward.”

“This law represents a truly bipartisan effort between legislative and executive leaders, doctors, trial attorneys, mineral owners, the business community and numerous other affected groups. As with most compromises, this isn’t a perfect bill by our standards, but we believe it is true reform that
will ensure access to quality, affordable health care while encouraging economic development and jobs creation in our state,” said House Speaker Chris Benge, R-Tulsa. “This is an historic day for our state and is one that should make the people of Oklahoma proud.”

HB 1603 will become effective on Nov. 1, 2009.

A message to all physicians from AMA President Nancy H. Nielsen, MD, PhD.

As our country hurtles toward health system reform, Medicine has been at the table during the discussions. The American Medical Association and the specialty and state society leaders have had access to and have been engaged with the White House and the key committees in Congress.

We have been working closely with top Obama administration officials and key staff members of both parties. We have given our best advice, and we have taken the time and effort to carefully consider all views. In truth, we’re not just at the table; we’re helping set the stage for our nation’s future.

But as Sen. Jay Rockefeller (D, W.V.) said recently, “There’s too much happy talk. It’s time to start thrashing out decisions on the tough issues.”

We couldn’t agree more, which is why we need to keep focused on precisely what the issues are that are driving the current debate.

The first is cost. Our nation spends more than $2 trillion per year on health care, and there is nothing in today’s health system to stop costs from increasing beyond our nation’s ability to pay for it.

In fact, everywhere you look you can see the cracks: 46 million uninsured; millions more underinsured; patients putting off preventive care and buying needed prescriptions to save money for things like rent and food. If we all don’t control costs, our nation is in deep trouble.

Physicians can’t and shouldn’t be held responsible for all medical costs, obviously. But we order and are involved in many of the costs, way beyond our own services. We deserve to be paid fairly for our services.

We also have a professional responsibility to be just stewards of finite resources. We have to be concerned about what works better than something else, about what costs more (for our individual patients and our country) than something else, and about honoring the wishes of our patients while giving them information on which to base informed choices.

We also have a right to point out the administrative costs we physicians have had to bear in this fragmented health care “system.”

The second issue driving debate is quality. We’ve taken a leadership role on quality throughout the history of this association, not just recently. But recent history is instructive.
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Physicians and surgeons in Oregon have seen a decline in medical professional liability insurance rates the past several years, according to a Department of Consumer and Business Services analysis of recent rate changes.

The DCBS Insurance Division found that physicians insured by Oregon’s two largest medical malpractice insurers have experienced an average 18 percent rate decrease since 2005 (see chart below). The two largest insurers—Continental Casualty Company (CNA) and Northwest Physicians Insurance Company (NPIC)—represent about 53 percent of the medical professional liability insurance market in Oregon.

“In the earlier part of this decade, rising malpractice insurance costs were a significant concern for specialty doctors, particularly in rural areas, forcing many to leave the state,” said Cory Streisinger, director of the Oregon Department of Consumer and Business Services. “The recent decline in rates should help Oregon continue to retain and attract highly skilled physicians.”

CNA, which provides malpractice insurance for the Oregon Medical Association, recently filed a 2.5 percent rate decrease with the Insurance Division. The decrease is effective May 1, 2009. NPIC has not filed a rate change this year as it transitions its business to its larger affiliate, The Doctors Company, An Interinsurance Exchange. This is the third straight year each company has dropped rates or left them unchanged.
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Last month, the Massachusetts Medical Society (MMS) testified before the legislature’s Joint Committee on Health Care Financing and urged adoption of major reforms in medical liability, saying that the current system to resolve medical liability claims doesn’t work for either patients or providers, takes too long, doesn’t appropriately compensate negligently injured patients in a timely manner and encourages the practice of costly defensive medicine.

Alan Woodward, MD, vice chair of the MMS’ Committee on Professional Liability and a past president of the organization, recently testified in support of Senate Bill 561, “An Act to Establish an Adverse Event Disclosure and Compensation Grant Program for Hospitals.”

The legislation would establish a program at the Betsy Lehman Center for Patient Safety and Medical Error Reduction to encourage the early disclosure of medical errors and appropriate apology as well as provide fair and prompt non-judicial resolution of claims for damages resulting from those errors. The measure would replicate to a large degree the successful approach used by the University of Michigan Health System, which allows for “timely notice” to investigate claims, open communication and apology to acknowledge medical errors as well as fair compensation to aggrieved patients.

The Medical Society also recommended that the legislation be extended beyond hospitals to include all healthcare facilities and licensed providers, as set forth in Senate Bill 574, “An Act Relative to Malpractice Reform,” which is awaiting a hearing before the Committee.

Woodward said that these bills would eliminate unnecessary litigation, decrease the cost of professional liability insurance, promote improvements in patient safety and reduce the incentives to practice defensive medicine. Based on a survey conducted in 2008, the Medical Society has estimated the cost of defensive medicine in the state to be at least $1.4 billion, including unnecessary hospital admissions, diagnostic and laboratory tests as well as other medical and pharmaceutical services.

The bills would allow patients to receive information to allow the parties to judge better the merits of a claim resulting from an adverse event. They would also provide a time period during which the parties may negotiate and arrive at a fair settlement prior to beginning legal action. And they would provide protection for statements of apology or sympathy, preventing them from being used as an admission of negligence in subsequent legal action.
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