A new study from the American Medical Association looked into which doctors — by gender, age, specialty, etc. — are most likely to get sued or have other liability claims against them.

The report (downloadable) makes interesting — if sometimes maddening — gawking material. For example, a review of the records found that 65% of claims are dropped or dismissed, and another 30% are settled or decided via an alternate dispute method. Only 5% of claims actually go to court — of those, 90% are decided for the physician.

Even a win can be costly, however: Average costs to defend against a claim were just under $40,700. For claims that were dropped or withdrawn, it cost an average of just over $22k to defend; cases that go to trial average more than $100k to defend.

More frustrating: The rate of claims seems to have little correlation to actual malpractice. The AMA researchers found that among closed claims, 3% of patients hadn’t suffered any injury and in another 37%, there had been no error.

Worse: Many injured patients and wrongly accused doctors don’t get true justice. The researchers found that 27% of claims are paid despite the doctor not making an error. At the same time, 27% of patients who suffered from an error receive no compensation.

By the numbers

A doctor’s specialty, type of practice and even gender play a role in how likely he or she is to face liability claims.

Not surprisingly, the study found that the specialties with the highest rate of claims were general surgery and obstetrics/gynecology, with nearly 70% of physicians in those specialties facing suits during their careers.

Least likely to face claims: pediatricians and psychiatrists. Less than 30 percent of doctors in these specialties were sued during their careers.

The study also found that the type of practice can increase a doctor’s risk of being sued. Among physicians in solo practices or single specialty group practices, 45% faced lawsuits in their careers. The rate was only 40% for physicians working in hospitals, and 37% for doctors in multi-specialty group practices. Owners of practices are also more likely to be sued than employees.

Male doctors are twice as likely to be sued. In part, because they are concentrated in specialties with high rates of claims and are more likely to own their practices. The researchers noted that other studies indicate differences in interpersonal skills may contribute to some of the gender gap in lawsuits, but the data is difficult, at best, to quantify.

The breach was discovered by a photographer for The Boston Globe, who noticed a 20-foot by 20-foot pile of paper when he was dropping off his own trash. He checked out the cache of paper, curious why it wasn’t being recycled. Closer examination showed the paper was a mass of patient records from at least four Massachusetts medical centers and their associated pathology groups. The hospitals affected are Carney, Holyoke, Milford and Milton.

The investigation is ongoing, but so far it appears that the a billing vendor used by several of the pathology groups dumped the records. The billing company was sold at the beginning of this year — most of the records were from 2009.

A small sample of the records collected by The Globe contained sensitive data including patient names, addresses, insurance information, Social Security numbers, pathology reports and post-miscarriage lab work.

A few things are still unclear, including how many patients — at how many hospitals — may have been affected. The hospitals are trying to determine whose records may have been compromised so they can begin notification procedures.

Data breaches of this sort aren’t uncommon, but it appears in this case that the hospitals had no reason to believe the records weren’t being disposed of properly.

Unfortunately, even hospitals with strict adherence to privacy controls can fall victim to a data breach if one of it’s countless physicians, other associated health care providers, billing companies, insurance partners or other contractors who have access to patient data aren’t as careful.

The hospitals at the center of the investigation are University of Texas Southwestern Medical Center and Parkland Memorial Hospital.

One of the main allegations is that UT Southwestern didn’t supervise residents as they should have to meet the requirements for procedures billed to Medicare and Medicaid.

UT Southwestern in particular is known for giving second-year residents wide latitude to perform some procedures with minimal supervision. The feds are investigating whether procedures actually done by the residents were billed as though they had been performed by the hospitals’ physicians.

The residents were working at Parkland. It’s not clear to what extent the feds are investigating that hospital’s involvement.

The initiatives are designed to address a number of public health issues, ranging from smoking to increased exercise — with the ultimate goal being a reduction in the number of people who need additional treatment or hospitalization later.

For example, the FDA will get new authority to regulate tobacco products, restaurants will have to provide nutritional data, and new mothers are due “reasonable” breaks for breast-feeding by their employers. A new federal program will provide communities with funds for bike paths, hiking trails and playgrounds.

Some of the programs more directly affect health care providers: Medicare and Medicaid will provide expanded coverage for things like free physicals, smoking cessation programs for pregnant women, etc. And insurance companies won’t be able to charge co-payments or deductibles for vaccines, recommended screenings and similar preventative care.

On their own, the initiatives are far less controversial than the Patient Protection and Affordable Care Act, as a whole. But skeptics say the increased federal spending won’t save money in the long run.

The Patient Protection and Affordable Care Act (PPACA) offers additional funding for some programs and will provide access to insurance for many who don’t currently have it. But even those benefits won’t outweigh the hidden costs in some states.

States like Massachusetts and Wisconsin, which have relatively few uninsured residents due to expanded state programs, stand to gain significantly: Their additional outlay of funds will be minimal, and they’ll still be eligible for billions in federal funds.

Other states like Alabama and Texas, with many more uninsured residents and limited Medicaid coverage, face significant costs getting everyone covered — millions more are  now eligible.

For example, to help close a budget deficit, Arizona slashed insurance coverage for 350,000 residents just in the past month. Under PPACA, those people will be back on the insurance rolls — and the state has to foot the bill.

In 2004, Ohio passed lawsuit liability reform that limited jury verdicts to $250,000 for pain and suffering in non-catastrophic cases, limited punitive damages, and made it harder to go to trial.

That year, average premiums for employer-based family plans were $9,590, according to the Kaiser Family Foundation. Five years later, premiums were up 19%. That increase was slightly lower than the national average (22%) for the same time period — but higher than neighboring states, such as Kentucky, that didn’t have liability reforms in place.

Of course, the drivers behind medical costs are complex, and there’s no way to know how much expenses may have risen had liability reform not been in place — or if the reforms were part of the reason Ohio’s medical expenses lagged the national average.

What did work

One area that liability reform did seem to curb costs was in malpractice premiums and the number of cases brought to court.

Between 2005 and 2008, the number of malpractice cases in Ohio dropped 39%. Since 2006, malpractice premiums dropped 22%.

The health care reform bill finally passed, and while no one may be completely happy with it, it brings some definite good news for the industry.

Just how good the news is depends on the type of work you do. But the bill was generally praised by the American Medical Association, the American Nurses Association and the American Hospital Association.

Although the Patient Protection and Affordable Care Act (PPACA) still leaves plenty of room for improvement of the national health care system, it will help millions of currently uninsured get better access to care. Which should, in turn, allow health care providers to:

• encourage wellness and preventative medicine, and
• diagnose conditions earlier when they’re both easier and cheaper to treat.

Some of the provisions of the law don’t kick in for several years, so the full effects won’t be felt right away. But in general, expect to see the following changes at health care organizations.

• Primary care practices get a 10% Medicare bonus for the next five years. A similar 10% bonus will go to general surgeons working in under-served areas.
• Mental health services paid via Medicare will be increased 5% in 2010.
• Doctors (all specialties, but especially family practice) should see more patients coming in as the newly insured seek previously delayed care. (Some practices are already getting ready to hire additional staff.)
• Some of those new patients will have complicated cases due to lack of prior treatment.
• Hospitals should see a reduction in uninsured patients using emergency departments for basic care.
• Hospitals and practices are expected to enjoy a reduction in the amount of “charity care” they provide, as more patients will have insurance. (AMA estimated that in 2008 doctors provided $24 billion in unpaid care — mostly to the uninsured.)
• Pharmaceutical companies will make a combined $85 billion contribution to the government program via industry fees and lowered prices. They’re expected to quickly recoup that money thanks to innumerable new prescriptions from newly-insured patients.
• The PPACA also eventually closes the Medicare “doughnut hole,” making it easier for many seniors to fill prescriptions, or allowing them to use name-brand drugs in lieu of generics.
• Insurance companies face the least clear picture — In the short term, they can expect many more enrollees. In the long term, they’ll need to adapt to new ways of selling insurance and weighing risks.

Do you think PPACA is a overall win for the health care system? What else needs to be done? Share your thoughts in the comments.

The Center for Healthcare Research & Transformation (CHRT) surveyed more than 1,000 adults in Michigan about their views and decision-making regarding health care.

To no one’s surprise, 40% of those without insurance said they had delayed getting required care because it was too expensive. More surprising was that 17% of those with insurance said the same thing.

Besides worries over costs, many people expressed more difficulty accessing care. People living in smaller towns and rural areas were most likely to report this as an issue. High-income suburban residents and low-income residents of big cities were the least likely to report difficulty accessing care.

The terms of the agreement haven’t been released yet. But Health Alliance of Cincinnati and its former members, including Christ Hospital and St. Luke Hospital, faced a potential liability of more than $420 million.

The allegations? That between 1999 and 2004, time slots at Health Alliance’s “Heart Station” clinic were based solely on which cardiologists/practices had generated the most revenue for Health Alliance. The “Heart Station” clinic provided non-invasive cardiac tests and procedures — many of which were billed to federal health programs.

Dr. Harry Fry, a cardiologist, filed suit under the False Claims Act, claiming that scheduling system amounted to illegal kickbacks to physicians who referred clients to Health Alliance or otherwise generated business for the company. The feds intervened in the suit because federal law makes it illegal to exchange any financial incentive for patient referrals.

The government concedes that none of the patients received improper treatment, unnecessary services or was overbilled as part of the “scheme.”

While the terms of the agreement aren’t yet public, Fry is expected to see a hefty payday. Under the False Claims Act, the person who files the case can receive a portion of whatever funds are recovered.

Health care’s share of the economy increased 1.1% over 2008’s figures. That may not sound like much, but that’s the biggest increase since CMS started tracking the data in 1960.

Spending by governments (federal, state and local) was up 8.7% — compared to 3% growth for spending by employers, insurers and individuals.

2019 outlook

The report predicts that by 2019, health care spending will represent a whopping 19.3% of the country’s economy and will cost $2 trillion more than it did in 2009. Of that, 52% will be paid by the government.

The report did not take into account possible effects of current health care reform proposals.