A medical emergency

October 26, 2004|By Calvin M. Pierson

PHYSICIANS HAVE started receiving renewal bills for their medical liability insurance, and the "sticker shock" is forcing them into decisions that could severely damage the delivery of health care services in Maryland for years.

Surgeons and obstetricians are being asked to pay $100,000 or more for 12 months of liability insurance protection. As a result of these staggering insurance costs, physicians all over the state are prematurely ending their careers, restricting their practices to low-risk procedures or dismissing staff to make ends meet. Specialists such as orthopedists, neurosurgeons and cardiologists increasingly are not willing to provide coverage to hospital emergency departments.

A recent survey of the state's hospitals by the Maryland Hospital Association found that hospitals' liability insurance costs have increased $40 million since last year. Hospitals are spending nearly $150 million a year for this coverage, diverting precious dollars from patient care.

Compounding these costs is the impact that physicians' practice decisions are having on hospitals, forcing reductions in services and patient access to care in over 20 percent of Maryland's hospitals. That number is growing by the day.

One hospital has told me that half of its obstetricians are restricting their practices to gynecology or have stopped taking Medicaid or uninsured patients. Another said it was losing one-third of its heart surgeons to early retirement and relocation to other states.

Others report their vascular surgeons no longer will accept high-risk patients. Hospitals depend on radiologists to read images from X-rays and MRIs. These physicians are facing pressure from insurers to curtail their work with hospitals and in reading life-saving mammogram images because these activities present the highest risk for medical malpractice.

Replacing departing physicians is getting harder, too. New medical school graduates are not choosing high-risk specialties. Physicians are increasingly reluctant to come to Maryland to practice. Physicians who want to work part-time can't afford to because their liability costs are so high.

Poor and uninsured patients are particularly vulnerable. Because of the low physician reimbursement rates for treating the poor under Medicaid, many physicians no longer can afford to accept these patients.

Doctors cannot pay their liability insurance premiums by caring for individuals on Medicaid: The state's payment rates don't even cover their overhead. Obstetricians, for instance, say their liability insurance costs consume more than one-third of what they are paid on average to treat a pregnant woman and to deliver the baby. Medicaid payment rates are even lower.

Further, with medical liability coverage so expensive, fewer doctors feel they can participate in programs for the uninsured. Vital programs to care for the uninsured such as the Primary Care Coalition of Montgomery County are in jeopardy. This unfortunate chain of events threatens to unravel an already fragile health delivery network.

Based on a recent Gonzales Research & Marketing Strategies poll, the public wants legislative action. An astounding 91 percent of those surveyed were concerned that the crisis could have an impact on their access to health care, 95 percent worried it eventually will mean higher health care bills for their families, and 84 percent wanted a special session of the General Assembly to address the issue immediately - regardless of their party affiliation, gender and other demographics.

In recent months, Gov. Robert L. Ehrlich Jr., legislative leaders, and most members of the Assembly have expressed a willingness to adopt comprehensive reforms. It will require a truly bipartisan effort to come up with long-lasting remedies and short-term answers that allow Maryland health care providers to keep doing what they do best.

The reforms should include:

Implementing tort reforms that have a record of success, such as sensible limits on economic damages and payment of awards over time rather than in a lump sum.

Increasing payments to physician specialists by Medicaid and commercial insurers.

Expanding protections for emergency room staff and physicians.

Enhancing patient safety.

Creating a short-term stop-loss fund that would allow medical liability insurers' to freeze premiums at current levels.

We need reforms to provide fair compensation to patients who are harmed but also restore balance to Maryland's out-of-control liability climate.

There's not much time to act. Unless something is done by Annapolis policy-makers in the next month, we could experience a medical brain drain of frightening proportions as the deadline for physicians to pay their six-figure premiums approaches.

Maryland doctors are being forced to make career-altering decisions, and all of us, as future patients, could be the ultimate losers.

Calvin M. Pierson is president of the Maryland Hospital Association.

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