I wrote at some length yesterday about the prerequisites for a medical group to self-insure. What I didn’t go into in detail was the why — the benefits and the risks. I’m going to tackle that a bit today.
Potential Benefits to self-insurance
Those who have been around a few years can testify that the medical malpractice insurance market is highly cyclic. It seems that about once a decade a crisis hits. Whether this is a rational market is another question entirely. Some have attributed these crises to macroeconomic factors, like the market crash of 2002, after which insurers had to recoup investment losses, or hurricanes and natural disasters in which insurers cost shifted onto other product lines. Other obervers cite skyrocketing medical malpractice losses as the driver of these intermittent price spikes. I don’t pretend to know the reason, but it’s a reality that prices go up, and sometimes rapidly so, for no apparent reason. Additionally, during these times of market disruption, it’s common for carriers to drop clients, leave states they perceive as too risky, or leave the med mal market altogether.
One big advantage of self-insurance is that you can control your own destiny and insulate yourself from these market forces. You set your own premium and it only has to go up if you deem it necessary and prudent. You have a carrier that is guaranteed to issue a policy, and that will never leave the market. These are not small considerations.
I know a group that liquidated because their insurer dropped them and they could not find insurance; a contract management chain picked up the contract. I know several groups whose insurer stopped writing med mal and they were left high and dry. They had to purchase a group tail at an exorbitant mark-up and scramble on very short notice to find a new carrier, whcih was excruciatingly stressful. So to have carrier permanence, guaranteed issue, and premium stability is a huge benefit of self-insurance. Read more »
*This blog post was originally published at Movin' Meat*
In an earlier post, DrRich offered several potential strategies for doctors and patients to consider should healthcare reformers ultimately succeed in their efforts to make it illegal for Americans to seek medical care outside the auspices of Obamacare. To those readers who persist in thinking that DrRich is particularly paranoid in worrying about such a thing, he refers you to his prior work carefully documenting the efforts the Central Authority has already made in limiting the prerogatives of individual Americans within the healthcare system, and reminds you that in any society where social justice is the overriding concern, individual prerogatives such as these must be criminalized. Indeed, whether individuals will retain the right to spend their own money on their own healthcare is ultimately the real battle. The outcome of this battle will determine much more than merely what kind of healthcare system we will end up with.
DrRich, despite his paranoia on the matter, is a long-term optimist, and believes that the American spirit will ultimately prevail. So, to advance this happy result DrRich (in the previously mentioned post) graciously offered several creative options that could be employed to establish a useful Black Market in healthcare, which will allow individuals to exercise their healthcare-autonomy against the day when such autonomy again becomes legal. His suggestions included offshore, state-of-the-art medical centers on old aircraft carriers; combination Casino/Hospitals on the sovereign soil of Native American reservations; and cutting-edge medical centers just south of the border (which would have the the added benefit of encouraging our government to finally close the borders to illegal crossings once and for all).
As entertaining as it might be to imagine such solutions, a readily available, though much more mundane, option exists today, which is to say, medical tourism. Read more »
Cardiologists in Connecticut are standing up to the lack of liability protection in the state’s new low-income health plan called SustiNet:
The SustiNet program would create large pools of people, including those who can’t currently afford health insurance, that would theoretically drive down premium costs by competing with the plans of private insurers. Among other cost savings, it would designate a single doctor or practice for each patient, to reduce emergency care use, and create new “best-use” procedures for a variety of ailments to reduce the number of tests doctors order.
But a key provision of the plan was that doctors, in return for following the new procedures and ordering fewer tests, would be protected from malpractice suits if the outcome of a case was not favorable for the patient. However, with backing from the Connecticut Trial Lawyers Association, that provision was removed from the SustiNet bill two weeks ago.
Cardiologists are considered a particularly important group for the new best-use procedures because they tend to order a battery of expensive tests when patients show signs of heart trouble. If specialists like them failed to participate in the SustiNet program, cutting medical costs could be more difficult.
On Tuesday, the Connecticut chapter of the American College of Cardiology withdrew its support for the bill and said that it would circulate an open letter to House Speaker Christopher G. Donovan and Gov. Dannel P. Malloy saying that it could not support the bill without the malpractice protection.
As screws continue to get tightened on doctors’ ability to order tests thanks to third-party oversight bodies, look for more physicians to play hardball about liability limits at both the state AND national levels.
Doctors are being forced to do do their part to control health care costs as a result of our increasingly government-controlled health care initiatives. It’s high time for the trial lawyers’ to do the same. And there’s already precedent to doing so: just look to the legal protections military doctors enjoy when caring for their members. While legal recourse still exists in the military, the challenge of suing the government on behalf of their employees thwarts frivolous claims.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
I was very sad and quite angry after watching a powerful video this weekend entitled “The Faces of Medical Error: From Tears to Transparency.” It’s the story of Michael Skolnik. His mother, Patty, gave me the video when I met her recently. Michael had what may have been unnecessary brain surgery in 2001 and died three years later.
The Skolniks worked on this video as part of an educational campaign on medical error, and they created an organization now named Citizens for Patient Safety. Here’s a trailer to the video:
You can also watch a Today Show segment that profiled the Skolniks from a few years ago:
While much of the message is about medical errors and malpractice, the Skolniks also promote a message of the “critical need for shared decision-making.” In fact, I met Patty at a shared decision-making conference.
If you haven’t heard Michael Skolnik’s story, you should. And if you’re like me, you’ll need a tissue box close by for the sadness, and something else to help with the ensuing anger.
Thanks to Patty Skolnik for sharing the story and the video with me.
It’s happening more frequently: Requests for medical advice by email. The more I do, the more people I meet. The network grows and friends of friends learn about what I do.
So junior has a little pain and shows at the local ER where the requisite CT shows a little thickening of the ileum. Someone suggests that the family drop me a line. Here’s the problem: There’s more to this than digital correspondence will allow.
While the statistical reality of this child’s situation is that this finding represents a little edema from a virus, the differential is precarious: Crohn’s disease, lymphoma, tuberculous ileitis, eosinophilic enteropathy.
A case of this type requires the thorough exploration of a child’s story and a compulsive exam that takes into consideration the problems in the differential. Worrisome considerations need to be framed and discussed in the context of the child’s total presentation and real likelihood of occurrence. The sensitive dialog surrounding our diagnostic approach to this child requires a relationship. And the various approaches require an element of negotiation with the family. All of this takes time, emotional intelligence, and good clinical judgment.
Children are complicated creatures. Parents are more complicated. Loose, off-the-cuff advice based on shotty information shortchanges both parties.
Of course the easiest response to these regular queries is that my employer, malpractice carrier, and the Texas State Board preclude offering medical advice without an established relationship or the maintenance of a medical record available for peer review. Everybody understands legalese. Few, however, understand the complexity of a properly executed medical encounter.
*This blog post was originally published at 33 Charts*
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