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The following stories happened prior to this and may have been a factor in Gov. Jeb Bush calling the Legislature back into a third special session. There has been a breakthrough and compromise. The two sides have agreed to a $500,000 non-economic cap per physician or $750,000 per hospital sued or up to $1 million more if death, vegetative state or permanent or severe injury. This means any one physician is limited in the money they will lose but the patient will shotgun sue everyone to get more. The ED physicians would have their non-economic damages capped at $250,000. The attorneys are not satisfied. They want the old ways back. Get over it and move on. They will do a judicial challenge, hopefully spend alot of money and lose. If the trial lawyers win, the state will see a closure of medical offices and procedures that would be unprecedented except for the 1975 California strike. The insurance companies have a 210 day window to offer to settle a case with merit and not expose the physician to large losses. If they don't, they are open to bad faith charges. The law originally froze malpractice rates until the beginning of the year and then mandates a reduction. This was removed at the end as probably unconstitutional.
Since most Florida physicians only carry insurance of up to $250,000 there will be a flood of physicians incorporating to protect their personal assets.
In Florida a group of about 1000 physicians signed affidavits stating they were either moving, retiring or reducing the procedures they are doing. One of the physicians has already stopped taking new Medicaid and Medicare patients due to low payments. These affidavits will be presented to the Florida Senate when they return to "work".
A recent poll in Florida found that the majority of Floridians favor a cap on non-economic damages. The don't seem to care if the cap is $250,000 or $500,000, as long as there is a cap.
Tennessee physicians are attempting to make their case for malpractice reform. Their pleas are going to a subcommittee since the full legislature is not in session for the rest of the year.
The Tennessee Medical Association has been accused by the president of a county chamber of commerce of using untrue facts. The TMA had stated that the only doctor in the county to do OB and C-Sections was considering stopping the sections. The Chamber prexy states there are four GPs in the county who do OB and C-Sections. The TMA states that if they made a mistake, no harm intended and they will correct the data. The Trial Lawyers glommed on to this and are using it as a prime example of the lying TMA.
The Chair of the Tennessee panel on malpractice believes that other factors besides high payouts for non-economic damages are the cause of increasing malpractice premiums. He is a Democrat plus an attorney, a bad combo. The Democrats, who receive significant money from the trial lawyers, are questioning the use of caps.
The Ohio oncologist whose patients raised money for his malpractice premiums has stated thanks but no thanks for the coming year. Dr. Diaz of Westlake has decided to play golf instead of practicing medicine in Ohio. The Ohio insurers are forcing the issue by requiring a five year insurance contract. This will mean many physicians will quit now instead of later.
Pennsylvania's
Maryland has now become a new ground for malpractice reform. The physicians are faced with a 28% raise in premiums. The trial lawyers expert witness says that only a 3.7% raise is needed. The expert is a prior state insurance commissioner. This will go the legislature early next year. The average claim in Maryland has raised more than $100,000 in the past year.
The American Arbitration Association last year came out with a policy that they will no longer arbitrate medical malpractice claims. This information apparently did not get to Nevada physicians who continue to have patients sign agreements that the Association will arbitrate. The agreements are void. The physicians are now having the patient sign arbitration agreements without naming the arbitor. Nevada has a state law saying that arbitration can be done if ordered by a judge or agreed to by both parties. There is also a Federal Arbitration Act which is very pro arbitration. I don't understand , he says tongue in cheek, why the trial lawyers don't like them. I advise all physicians to ask their patients to sign these at a time when they enter the practice. I would advise OBs to have the patient sign at the first prenatal visit or not see the patient. At that time there probably has been no physician patient relationship and no duty to the patient. One may use the American Health Lawyers Association or any other neutral third party to arbitrate. Don't put any one organization in the arbitration agreement. Top
Wisconsin is attempting to copy the Bay Area, but too late. They have gotten many of the companies together to form a coalition to pay less for medical care. Their brilliant solution is to pay less for care. That may have worked several years ago but with the new activism I see in the medical ranks, I doubt they can pull it off now. They want to pay Medicare plus 50%, when the going rate is two times Medicare.
The CMS still want to reduce physician's fees by over 4% for the coming year. It will occur unless Congress acts as they did last year. If the fees are reduced there will be more physicians not taking new Medicare patients due to the 10% reduction over the last several years. Currently about 20% of the membership of the American Academy of Family Practitioners are not taking new patients. Watch for this to go over 50%.
Nevada is losing physicians due to decreased income. The decrease comes from high expenses when their malpractice premiums did not fall due to the poor laws passed by the legislature and no increase from insurers. In Clark County ( Los Vegas) the net increase in licenses were nine down from over 100 the year prior. The majority of those few physicians that did come to Nevada went away from Clark County where the malpractice rates are the highest. This is despite that the county has a large influx of seniors each year. There will be few to treat them.
Please see New Legislation for changes in Medicare payment for oncology drugs. Top
What area of what state has enough physicians? The survey says upstate New York. However, they don't happen to be the correct physicians. The numbers are correct but not the type of surgeons says the survey by Lifetime Health who is trying to sell insurance to the good people of the area. Top
One Medigap insurers of the People's Republic of Massachusetts are raising their rates. Blue Cross and Shield are raising their rates 12% for their basic coverage and 20% for the plans that cover some prescriptions. This means that the other plans should have a field day taking the business from the Blues. The only reason for the raise is the Blues are attempting to cost shift from all the required coverage in the state. All insurers must cover the exact same things in each of their 10 plans and are only differentiated by cost. Top
The United States has developed an Ebola vaccine. It seems to work on monkeys, thought to be a host vector. There has been no studies on humans as yet. Knowing the Pentagon, they will want all the troops to be vaccinated and then send them into the areas to see what happens or they will talk the CDC into immunizing all first responders. This is truly a major breakthrough for this horrific disease and may lead to other vaccines against viral agents. Top
Fresno California's St. Agnes Hospital is putting up multiple office building to attract new physicians to the area. The area is in the middle of the central valley and does not have an ideal climate. It does have a good university. The first building will also have outpatient surgery and endoscopy suites. This is a joint venture with the local physicians for succession planning. Top
While the Washington State Insurance Commissioner believes boutique medicine is illegal in the state, Texas and now the People's Republic of Massachusetts' Tufts University have embraced it. They will put a $1800 fee for patients that don't want the People's brand of medicine. The fees will be used to subsidize the money losing primary care practice. This is instead of the mockery of MGH and Brigham that spoke from both sides of their mouth. They bad mouthed boutique medicine but put in special floors in their hospital for high paying guests. This included better food, linens and private rooms. Top
Modern Physician just ran an article about on-call physicians. It describes a differentiation between having to come to the ED if you are the back-up list, which is required and not being on the list at all which is not required by EMTALA. The hospital may have their own requirements but they can be negotiated. It gave the example of a hospital in Roanoke, Virginia, that had problems with neurosurgical backup. It describes the quitting of the staff by one of the few remaining neurosurgeons on the staff. This pressured two pf the remaining three neurosurgeons to limit their practice to spinal surgery. This left only one to do the cranial stuff. The hospital attempted to to remove the two physicians from the staff but since it would not be for quality concerns, there would be no report to NPDB. The neurosurgeons sued the hospital anyway to stop their unilateral policy. The two sides reached a compromise. The two neurosurgeons regained their cranial work and the hospital lured back the one that left. The article didn't say how much this cost the hospital but I am sure it must be at least $1000 a day for them to take call. The growing trend is for hospitals to pay to take call. The article talks about San Francisco's Cal Pacific that pays physicians to take call. The two hospitals I belonged to pay all physicians to be on call. This will continue to grow in all hospitals where physicians are not owned and treated like fungible items.
A San Antonio hospital has paid a $15,000 fine for the actions of one of their ED physicians. He transferred a patient with a urinary tract infection, depression and a suicide attempt to another hospital by taxi and without proper notice to the other hospital. The hospital has also done a corrective action plan and assisted the OIG in their investigation. The fine could have been much higher ($50,000) Top
The previously employed oncologist at Good Samaritan Medical Center in Palm Beach, Florida, have left the hospital employ and gone into private practice. They have taken over the management of the prior hospital cancer institute. Most, but not all, of the former employees will be retained. The hospital states it is just part of the trend to no longer employ physicians since they can run their practices better and more efficiently than the hospital. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.