TorteDeForm

Justinian Lane

A way to help doctors that doesn’t require punishing patients

I remember reading that the AMA was going to grade health insurers.  Well, the report is out and there are some sad results:

The American Medical Association issued its first health insurance report card at the group's annual meeting Monday. The primary focus is on how quickly and accurately doctors get paid.

"Physicians are spending 14 percent of their total revenue to simply obtain what they've earned," said Dr. William Dolan, an AMA board member.  (Emphasis added.)

The report card is an effort to reduce the cost of claims processing to doctors and help them as they negotiate contracts with insurance companies, he said. The report card will help patients if it reduces wasteful administrative costs, Dolan added.

The report card compares Medicare and seven national commercial health insurers on the timeliness and accuracy of claims processing. It is based on a random sample drawn from 3 million claims.

There are no grades like A, B and C, and many of the technical measures may not mean much to most patients. But business leaders and health policy makers are interested in cutting an estimated annual $210 billion in wasted administrative claims processing costs, AMA leaders said.  (Emphasis added.) Source: AMA issues first report card on health insurers - Yahoo! News

Wouldn't everyone be better off if we cut that 14% figure down to 4%?  Or cut that $210 billion down to $10 billion?  Focusing on eliminating these transaction costs doesn't hurt anyone, unlike enacting immoral policies like damage caps. 

Justinian Lane: Author Bio | Other Posts
Posted at 11:58 AM, Jun 17, 2008 in Medical Malpractice
Permalink | Email to Friend


Comments

None of it is by accident nor incompetence. Every obstruction is a lawyer devised ruse to control clinical care, and its huge budget. Every bill is an opportunity for a lawyer gotcha for violation of inscrutable rules. Most of the costs stem from government obstruction. And government is a 99% wholly owned subsidiary of the criminal cult enterprise that is the lawyer profession.

Then the cult criminal has given government and itself total, absolute immunity from any accountability. Everyone else gets parsed for the slightest deviation from mysterious rules. The lawyer remains absolutely immune.

This immunity fulls justifies, morally and intellectually, the total self-help response by patients, doctors, and all productive entities. Start by shunning the lawyer and its running dog, the government functionary. Shun them into the Stone Age.

Posted by: Supremacy Claus | June 17, 2008 1:25 PM

Um... and now for a comment that is relevant to the actual post:

This is a great point--one specific example of the many ways in which energy, time, and money are wasted which could instead be used to prevent malpractice and to reduce health care costs.

Another example: many med students are fed propaganda about tort "reform" through panels and lectures. The time spent paying these speakers is time that could be spent training med students and working with hospitals on addressing the challenges of implementing more effective patient safety systems. Med students could be educated about the benefits of disclosure of medical errors to patients, which is the fair and right thing to do, allows for more open examination of how to prevent medical errors in the future, and informs patients therefore reducing the chance that the patient will decide to sue (since they often sue because they know important information is being kept from them).

Anyway, great post. Now let me predict what the tort "reform" supporters will say: "But those trial lawyers!"

Posted by: Kia | June 17, 2008 3:54 PM

"Another example: many med students are fed propaganda about tort "reform" through panels and lectures."

My wife just graduated from med school and I can assure you for every panel and lecture about tort "reform" there is a panel and lecture about the outragous claims made by patients and their lawyers, and another panel and lecture about why practicing extremely defensive medicine could help you avoid lawsuits. There's always another side you folks seem to be missing. You lawyers make it sound like everyone who walks into a hospital should walk out perfectly fine anything else is malpractice.

I do agree with open disclosure of medical error and malpractice. I think that would be beneficial and probably create a better trust between patient and doctor.

Also, I actually thought this post was quite interesting, although the last statement about enacting damaging caps not hurting anyone is a complete lie.

Posted by: Adam | June 17, 2008 4:31 PM

Adam, just to be clear, my point is that reducing transaction costs doesn't hurt anyone. But enacting damage caps does hurt the seriously injured; $250k is not enough to compensate for some serious injuries.

I'd be very interested in hearing more about these panels - I get the impression that med students are getting indoctrinated with "reform" rhetoric.

I wonder if a law firm could put on a panel and explain what it is that they look for in a medmal suit. You know, kind of get it from the horse's mouth/

Posted by: Justinian Lane | June 17, 2008 4:42 PM

I understand the overall point of the post as well as the fact that 250K may not be enough to compensate for some serious injuries, but tens and sometimes millions of dollars is almost always way too much compensation for some people who aren't even seriously injured.

I can also assure that most doctors coming out of med school aren't interested in neither tort reform “rhetoric” nor the propaganda you folks preach.

Ironic? My verification words were: Angry Doctor

Posted by: Adam | June 17, 2008 4:52 PM

That is ironic.

I would suggest that very, very few cases end up with people who weren't seriously injured getting millions of dollars. I'll use the famous McDonald's coffee case: The woman was served coffee at a temperature close to the water in your car radiator, and she suffered third degree burns to her thighs and genitals. Regardless of whether you think McDonald's was liable, the $2 million award (reduced to $600kish) isn't a ton of money for those sorts of injuries.

The truth of the matter is that most people wouldn't want to endure the kind of pain necessary to get a seven figure award.

Posted by: Justinian Lane | June 17, 2008 4:57 PM

Ahhhh McDonald's, Do I think 3rd degree burns to the thighs and genitals are worth 2M? no way. 600K is still to high. I don't fault her though. She did offer a fair settlement to McD's which McD's refused. Basically (in my opinion) she was awarded 600K because of McD's stubborness and her own stupidity which brings me up to point 2. Would I ever put a cup of hot cup coffee between my legs? Would you?

Posted by: Adam | June 17, 2008 5:27 PM

I can assure you for every panel and lecture about tort "reform" there is a panel and lecture about the outrageous claims made by patients and their lawyers, and another panel and lecture about why practicing extremely defensive medicine could help you avoid lawsuits.

Adam, you and I are referring to precisely the same type of panels. Those all fall under the umbrella of tort "reform" lectures. From personal experience, I can say I don't expect there to be no mistakes, I don't expect doctors to be perfect. But there are standards of care, and of disclosure, that are most often met, but when breached patients deserve both a) to know about it, and b) to have access to adequate recourse for unacceptable and costly harms the breach causes.

And all I'm saying is that med students deserve to know about other ways to reduce health care costs and improve the quality of care. Some of these ways provide the other side to the tort "reform" perspective. Give them the information, they're smart--for goodness sake, they're doctors. And let them decide for themselves.

While we're at it, the entire general public should have access to such information.

Posted by: Kia | June 17, 2008 5:31 PM

Both Justinian and Cyrus have posted excellent blogs about the McD case, the details, and why the elderly woman in that case was well within her rights to sue. Here and here, for example.

But it's not about whether "3rd degree burns to the thighs and genitals are" worth $600K, it's about how much the company has been unfairly profiting off of harmful activity, and what does it take to punish them (that's essentially what punitive damages are) for ignoring their legal obligations in order to get them to think twice about doing it next time? Believe me, a court ordered "I'm sorry" doesn't cut it.

At any rate, it's always fun to call the plaintiff stupid, and say they should have been more careful. It's easy to feel miles apart from a plaintiff--who thinks they'll ever find themselves in a courtroom as a plaintiff? But the fact remains that we have to look at what is fair and reasonable and how the legal system helps enforce that by making the victim whole and by requiring actors (corporations, doctors, or otherwise) to take seriously their duty of care to others.

Capping damages in malpractice suits places a blind limit on compensation to victims. And besides some extreme exceptions to the rule, damage caps are rigid and arbitrary and don't take into account what the victim actually deserves.

Posted by: Kia | June 17, 2008 5:57 PM

Kia: Give us a figure for the harm of the intentional infliction of emotional distress suffered by the 75% of medmal defendants found not liable. You should include time spent, lost income opportunity, post-traumatic stress disorder, including a changed relationship with subsequent patients, now seen as adversaries, a PTSD symptom.

Give us your figure for when tort reform gets reversed.

Also, shouldn't judges paid to churn litigation by both plaintiff and defense bars be made to pay out of personal assets, for their corrupt but traumatic rent seeking? Why can't judging improve from a good dose of restorative torts?

Posted by: Supremacy Claus | June 17, 2008 7:05 PM

Kia, if you do all the work Supremeacy Claus asks, make sure you bill him.

Posted by: Adam | June 17, 2008 9:27 PM

Kia is a gone left wing ideologue. She hates money. For her skill and intelligence, her salary is ridiculous. Because of her blinding indoctrination, she takes the economic abuse of her awful masters. She will not even look up the salary of her male predecessor to see if he got paid more. She just refuses.

Posted by: Supremacy Claus | June 17, 2008 9:32 PM

Adam: I will! Haha.

SC: I'm not going to disclose my personal information on the web. How much money do you make? I wish we could move past that. Please feel free, however, to send donations to the "Kia's salary is too low" fund to the Drum Major Institute, attention to me. Thanks.

Wait, weren't we talking about health care costs and medical malpractice? Yes, I think so. Let's stick to that discussion.

Posted by: Kia | June 18, 2008 11:43 AM

Interesting blog! The 14% of gross income paid by healthcare providers to "collect" from health insurers pales in comparison to the 1 - 2% of costs attributable to medical malpractice claims. Maybe doctors should focus their rath on the health insurers and not the trial bar which represents the victims of medical negligence!

Posted by: Dan Frith | June 19, 2008 10:36 AM

Interesting blog! The 14% of gross income paid by healthcare providers to "collect" from health insurers pales in comparison to the 1 - 2% of costs attributable to medical malpractice claims. Maybe doctors should focus their rath on the health insurers and not the trial bar which represents the victims of medical negligence!

Posted by: Dan Frith | June 19, 2008 10:36 AM