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 For claims that were dropped or withdrawn, it cost an average of just over $22k to defend; cases that go to trial average more than $100k to defend.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.

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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.

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No one is suggesting that generics don’t have a place in the health care system. But especially when it comes to cardiology and neurology, doctors are becoming more skeptical that generics can automatically be assumed to be a perfect equivalent for name brand drugs — or even other generics for the same drug.

Blood levels and bioequivalence

While all generics must have the same active ingredients at the same strength, they are only required to provide very close blood levels. Some practitioners think slight variations in how dosages metabolize could cause side effects or other difficulties — particularly in cardiology and neurology where patients tend to be sensitive to even very slight changes in dosages.

To test the theory, one consumer group ran tests on Wellbutrin XL and its generic version, Budeprion XL 300. According to the tests, the two drugs did have different diffusion rates for the active ingredient, which could cause decreased effectiveness of the generic in some patients who switched to it from the brand name.

At particular risk of side effects or complications are patients who start taking one brand name or generic drug, and then switch to another. That’s especially true since patients on generics may not be informed when their pharmacist substitutes one generic for another.

Regardless, the FDA and the AMA both stand by generic medications and say the varying diffusion rates are still well within the standards set to maintain effectiveness of the drugs.

One thing is clear: More research is needed to figure out exactly how varying diffusion rates could effect a patient’s treatment. In the meantime, it’s probably worth it to explain to patients that while generics work and are safe, they shouldn’t ignore it if they do start to have side effects when switching prescriptions (or even after starting a new refill.)

If you’ve had experiences with patients having bad reactions to generics, share them in the comments.

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Hospitals and practices are likely to see Medicare reimbursements shaved by 3% starting in 2012. And there’s not much you can do about it.  

The reduction is due to implementation of an IRS rule from 2005 that’s scheduled to be implemented Jan. 1, 2012. The rule requires an additional 3% withholding of payments to contractors working for local, state and federal governments. Payments under Medicaid would be exempt, but Medicare falls squarely under the umbrella.

The withheld money won’t be gone forever — it’s applied to the payee’s tax obligations for that year. Any money due to be refunded after that would be available once a practice or hospital submits its annual tax forms.

The real problem is that for many health care organizations with thin margins, especially small practices and sole proprietors, even a temporary loss of access to that 3% could have a devastating effect on their cash flow.

What’s ahead

The good news is, as with all things from the federal government, the “final” rule may not be completely final. There are two good reasons to hope that the feds will cut health care providers some slack:

1. The real targets of the IRS rule were defense contractors and similar large companies who were less-than-compliant with their taxes. Health care providers just got caught up in the broadly written rule. Many organizations are calling for Congress to amend the rule so it exempts health professionals, but with the economy still shaky, there’s no telling if Congress will be open to cutting its own cash flow to help health care providers.
2. One part of the rule stipulates that only payments over $10k are subject to the withholding. However, it’s not clear if a physician’s total bill to Medicare would count as one payment (and most likely be subject to withholding), or if each individual claim for each patient would be treated separately (avoiding withholding on the vast majority of payments). The American Medical Association has asked IRS for clarification of the rule.

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Physicians and other health care providers are being forced to rethink how they talk about patient costs when suggesting treatments.

It’s no secret patients are getting squeezed, and increasing health care costs are only part of the problem: More people have lost insurance following lay-offs. And many of those who still have insurance are finding that their coverage is significantly reduced and/or the portion of the bill they’re expected to pay has increased.

According to the American Medical Association, the evidence shows that most doctors are aware of the issue, but frank discussions of expenses just aren’t happening during most patient visits.

No doubt part of the problem is that the conversation is awkward for everyone involved. But once the issue is addressed, physicians report that most patients are relieved.

More importantly, having a realistic idea of the patient’s resources lets a health care provider provide the best possible treatment plan. After all, the most effective drug in the world won’t do patients any good if they can’t afford to get the prescriptions filled.

Dollars and sense

The AMA offered some advice and even suggested language for doctors and other clinicians to use when discussing options and costs with patients:

• Look for cues such as body language that indicate costs may be of particular concern to a patient. For example, if a patient looks away, shrugs or crosses her arms when you mention a specialist visit or expensive treatment, that’s a red flag that cost is an issue.
• Don’t assign blame. Denouncing a less-than-stellar insurance plan doesn’t solve anything and may make the patient feel even less in control of the situation.
• Follow up when prescriptions are unfilled or other care, like physical therapy, is ignored. It could be a signal the co-pays are too expensive for the patient.
• Stay up to date on the rough costs of treatments. You can’t — and patients don’t expect you to — know the precise cost of every drug or treatment. But being able to put a rough price tag on the cost of a suggested treatment gives the patient more information on which to make a decision — and they’ll be less likely to assume a particular treatment is out of their reach.
• Remember anyone can have trouble paying health costs. Even some people with insurance or “good” jobs are finding themselves struggling right now. Just because finances were never a problem before doesn’t mean a seemingly well-off patient isn’t pinching pennies now.

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