Governor Edward Rendell can take a great deal of credit for Pennsylvania’s successful medical liability turnaround. The combination of Mcare Abatement and common-sense legislative reforms, such as certificate of merit and anti-venue-shopping laws, has led to a drop in the frequency of liability cases being filed and the cost of malpractice payouts, resulting in a decrease in the cost of liability insurance.
However, this is a success story that is still in its infancy, and it is one that has yet to pass the test of time, actuarial scrutiny, and political change. It is not time for either patients or the medical community to unfurl a “Mission Accomplished” banner.
The challenges posed by the yearly renewal of Mcare Abatement, the future plans for an Mcare phaseout, and the potential for the trial bar to circumvent reform still pose dramatic threats to the stability of affordable access to medical liability insurance.
This instability and uncertainty was reinforced by the General Assembly’s recent inability to provide a suitable bill for renewal of Mcare Abatement. The clock is ticking in that the Rendell administration provided a ninety-day suspension of the Mcare surcharge to allow for an acceptable bipartisan bill.
We have come a long way since 2002. Rising costs stemming from the increase of liability claims had created a dangerous ripple effect across Pennsylvania. Several major medical liability insurers went out of business, limiting the options for doctors. Access to medical care was threatened by prohibitive malpractice premiums that forced many specialty doctors and practices to close or relocate to different states, leaving trauma centers struggling and jeopardizing patient care.
The outlook today is more positive, but it is imperative that new legislation be passed that perpetuates Mcare Abatement, thereby maintaining access to the highest quality of health care for our citizens.
As founder and president of Positive Physicians Insurance Exchange (PPIX), the only physician-driven medical liability carrier in Pennsylvania, I have personally experienced the transition from the total turmoil and panic in 2002 to the relative calm of the present time. I personally do not want to live through another liability insurance meltdown and recommend against declaring premature victory.
The Commonwealth faces many critical issues going forward. A “gray hair crisis” lurks on the horizon because physicians in Pennsylvania are aging, and there are far too few coming here to take their place. The Commonwealth retains only 8% of the residents that it trains.
Additionally, Pennsylvania remains one of the country’s most litigious states and has not incorporated awards caps for non-economic damages. Medical communities in states that have, such as Texas, are thriving and are inundated by medical practice applications — and many of those applications are from Pennsylvania.
The Commonwealth’s reputation as a litigious state means defensive medicine is still rampant. Physicians order tests, procedures, and visits, or avoid high-risk patients or procedures, primarily to reduce their exposure to malpractice liability, rather than to benefit patients. Defensive medicine is one of the least desirable effects of the rise in medical litigation because it increases the cost of health care and exposes patients to unnecessary risks.
Positive Physicians Insurance Exchange is contributing to reform by providing physicians with an integrated risk-management model designed to identify risks and head off potential problems. Physicians and their office staff are trained to recognize potential risks or adverse events early in a patient’s care and take the appropriate action to manage these risks. This is done by the insurer building a corporate culture that encourages communication between physicians, the patient, and the risk coordinators. This philosophy is the keystone of our company and is designed for private practice physicians.
By providing layers of support for physicians that enhance patient satisfaction, we reduce the risk of litigation. This is accomplished with an aggressive team approach to managing risks that involves giving physicians direct access to experienced insurance professionals, experts in risk management, and a medical review board made up of peers.
This type of physician-driven risk-management program can result in improving quality of care by improving patient satisfaction and by rewarding early intervention when risks are identified.
By involving the right people — those who are on the front lines and who live and practice with the outcomes of their policies — we can continue to bring stability to the system and maintain patient access to high-risk specialties.
Remember, no one wins a malpractice claim. It’s only a matter of how much it costs. It is cheaper to prevent a claim than defend and win one.
About the Author
Dr. Lewis S. Sharps is president of Positive Physicians Insurance Exchange (www.positivephysicians.com). Headquartered in Paoli, Pennsylvania, PPIX is the first physician-driven medical liability company in Pennsylvania. PPIX is a domiciled reciprocal insurance exchange whose mission is to provide a stable, long-term, physician-driven resource to control medical liability insurance.
