Is the Medical-Malpractice Crisis Being Solved?
In a JAMA article published last month, Michelle Mello and colleagues review trends in medical-malpractice claims and med-mail insurance costs.
Data show a decline in the rate of paid claims against physicians: 6.3% annually for MDs and 5.3% for doctors of Osteopathy, from 1994 to 2013. Further, the average amount paid per claim has been unchanged in real (inflation-adjusted) terms for the past seven years.
Source: The Medical Liability Climate and Prospects for Reform from JAMA
Medical Liability Monitor’s Annual Rate Survey also shows that premiums charged to physicians have been relatively stable the past decade.
Organized medicine has cited state-level tort reform as a factor in stabilizing rates. However, Mello and her colleagues are skeptical, claiming that the reforms neither address adequately compensating patients who are negligently injured, nor ensure deterrence against poor care.
The Obama administration has awarded grants in support of so-called nontraditional reforms that purport to address barriers to filing claims, protracted litigation, and costly adversarial processes between competing experts. The Agency for Health Research and Quality has underwritten a nation-wide scale-up of a communication-and-resolution program.
However, Mello has also identified regular cycles in liability insurance during the past four decades, which indicate another increase in premiums within the next few years. Time will tell whether traditional or nontraditional tort reforms will temper the next cyclical hike.
It’s interesting that DOs and MDs have very similar rates of paid claims. However, DOs are higher is some years but not in other years. I also wonder why MDs and DOs have nearly identical rates in 2011 (~10.25%), but the rate of paid claims for DOs spikes up in 2012 and in 2013 (estimated)?
Devon,
The authors’ state the following methodology used to arrive at Figure 1: “Claims counts were extracted from the NPDB, then divided by the estimated total number of active physicians recorded in the Masterfile to calculate rates.”
With that said, Mello adds “Our analysis has limitations. First, generalizations about national
trends in medical liability claims and costs are difficult to make because there is substantial variation in liability environments across clinical specialties and geographic locations. Second, the AMA Master file may not accurately report the number of physicians in active practice, although there is no reason to suspect that the degree of any such bias varies over time. Finally, we report national trends in claim frequency only for claims that resulted in a payment on behalf of a physician because there is no centralized collection of data on all claims filed in the United States. The NPDB is considered the best source of national data on trends in claims but only
includes an estimated 30% of all claims filed.”
It doesn’t seem to be having any effect on the cost and extent of defensive medicine and the cya mentality that pervades physicians’ practice patterns at least in my area.
Has your state enacted traditional tort reform?
The prob with this analysis is that it measures judgments PAID malpractice claims against practitioners involved that have self reported to the National Practitioner Data Bank and to State licensing boards where substandard care was alleged. It doesn’t include strategically settled cases that are settled out of court, like those wherein a plaintiff tries to essentially extort the MD and his insurance and it costs less to settle. Could the reduction in malpractice claims be from more successful defenses of more claims simply settled before trial? Just my contrarian .02.