It was hard to know whether to laugh or cry at the recent op-ed from Neil Ferstand, executive director of the Connecticut Trial Lawyers Association.
At a time when Connecticut physicians are working diligently to provide the highest quality of patient care, and actively seeking to partner with policy makers and other stakeholders (trial bar included) for a closer look at our broken liability system, Mr. Ferstand’s piece seems to come out of out of left field.
Here in Connecticut, the liability system serves only a small percentage of patients, and diverts a tremendous amount of resources away from our healthcare system to the legal system. A significant portion of every settlement or court verdict goes directly to trial attorneys. How does that help improve quality or control costs?
According to the Connecticut Insurance Department, more than $797 million was transferred from the health care system to the legal system on 1,389 claims between 2010 and 2014. During that same four-year period, 1,702 claims were closed without a finding of indemnity. Yet it cost approximately $52 million to defend those cases, with an average defense cost of over $50,000 per claim.
According to the American Association of Medical Colleges, Connecticut ranks 4th nationally when it comes to training residents and fellows, but we drop to 45th when it comes to keeping those new physicians in the state. Liability costs are a major part of this retention problem: Connecticut primary care physicians, general surgeons and obstetrician-gynecologists have been found to have some of the highest medical liability rates in the country (Medical Professional Liability Insurance Premiums: An Overview of Data from 2005 to 2014). At a time when we desperately need more physicians to provide patients with access to quality care, it’s hard to see how Mr. Ferstand’s inflammatory statements will help improve the situation.
“Talk to your doctor.” It’s good advice, and Mr. Ferstand should give it a try. His doctor (any doctor, in fact) could tell him in great detail about the mind-numbing level of audits, reviews, pre-authorizations that must be obtained before providing medically-necessary services for patients, and restrictive drug formularies that allow only specified medications, even when a different drug might be better suited to a patient’s needs.
Both public and private insurers specify standards of quality care, and they are increasingly adjusting reimbursements based on those standards. Medicare has already started reducing payments to physicians who don’t participate in national quality reporting programs; those reductions will only get steeper over time. Insurance companies are making information on physician quality and cost available to the public. Patients with high-deductible plans are increasingly required to “shop around,” knowing that they will have to pay out-of-pocket for charges that are above the norm.
Bottom line? The reality of medical practice today bears no relation to Mr. Ferstand’s fantasy of unfettered, cash-driven physicians.
Connecticut physicians have been up front and consistent in asking our elected officials to step back and consider the entire liability system (including tort law and alternative dispute mechanisms, such as health courts). Much has changed since the last review in 2005, so it is simply common sense to ask for another systemic look at our state’s liability system. Picking away at a system piecemeal, or accusing an entire profession of fraudulent behavior, won’t help solve the problem.
In a rapidly-changing healthcare environment, Connecticut physicians are taking the lead in healthcare quality and safety programs. You can find CSMS members actively engaged in patient-centered medical home models, volunteering their time and expertise with the Connecticut State Innovation Model (SIM), working to address racial and ethnic disparities in patient care, and serving on national quality committees.
We invite elected officials, regulators, and the trial lawyers to join with us in a good faith effort to improve our liability system. This would help to improve healthcare quality, patient safety, and access to care for everyone.
Matthew C. Katz has been the EVP/CEO of the Connecticut State Medical Society, the state’s largest physician organization, since 2006.
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