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Marketplace.MD UpdatebobMattTom LeithpgbMD Recent comment authors
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bob
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bob

As far as cost of malpractice the average internal medicine doc in my area pays around 30 to 35k. The average internal medicine MD in my area makes around 175k. This percentage is similair for most specialties in my area which has one of the highest rates of claims in the country. Defensive medicine has been estimated around 10 percent of the total cost of medical care. I believe that estimate to be low. NO democracy is the world has a rate of lawsuits anywhere near the rate in the US. This also applies to all forms of civil suits… Read more »

Matt
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Matt

“Entire counties in Arizona do not have a single obsetrician.” Which ones? The same rural counties that have always had trouble retaining physicians of any kind? “While a far less than perfect piecemeal approach, at least it provides the opportunity to assess real world experience with respect to access to care, medical outcomes, and malpractice insurance premiums, especially for high risk specialties, in states that have enacted sensible malpractice litigation reform legislation vs those that have not.” Since malpractice is primarily a state level action, it only makes sense that the states would be the one to pass reforms, regardless… Read more »

Peter
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Peter

Thanks Barry and Tom for the feedback. Barry, I think Dentistry is not a good correlation as I would not think Veternary would be either. There the patient(well payer) has choices, althought not the best. In Dentistry it’s “pull it”, in Veterneary it’s kill it. Both cheap alternatives. And the Dentist schools do provide cheap care. Here in NC the Dentists have it pretty good. The school only admits a limited number and we have one of the lowest per pop. of any state. As for say a voucher/means test with fee for service, again I believe that can be… Read more »

Tom Leith
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Tom Leith

Peter asks: > So why aren’t docs lobbying against the insurers? > Too tough, so get the government to go after > malpractice? Or maybe it’s just an aggrevation > issue not an income issue? “I don’t want anyone > looking over my shoulder.” Its all of the above. And docs do lobby against the insurers. You have heard me say here that managed care is mostly illegal now, and its because docs protested and got their patients to help them. The malpractice thing resonates with our cultural rejection of “ill-gotten gains” or something like that. We do not want… Read more »

Barry Carol
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Barry Carol

Peter, a couple of things. First, Medicare and Medicaid are already, in effect, single payer systems for the large populations that they serve. While they have continually squeezed reimbursement rates for both doctors and hospitals over the last 15 years, their overall costs continue to grow far faster than general inflation. Why is this? I don’t know, but I’m sure there are numerous factors at work such as an aging population, new expensive technologies (including biotech cancer drugs), longer life expectancy, etc. I do find it interesting that an area like dentistry, including relatively expensive procedures like root canal and… Read more »

Peter
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Peter

The report does give where they got their figures from; National Association of Insurance Commissioners (NAIC) “According to the federal government’s Medicare program” So I guess we’d have to root through their data. Would be nice to agree on some numnbers. I don’t think Nader/Citzen is down on docs, just the medical lobby. The following statement is also in the report, · Reduced fees—not insurance rates—are the biggest financial burden on doctors. Doctors across the country have seen their fees slashed in recent years as managed care companies tried to increase profits, and government programs, such as Medicare and Medicaid,… Read more »

Tom Leith
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Tom Leith

Dr. Borboroglu asks: > Am I interpreting these numbers wrong? Well, not the numbers so much as the qualifiers. The average physician isn’t in a surgical specialty, and MedMal rates vary by about a factor of four among specialties and geographical regions. Averages aren’t very useful. I think I posted some figures on this a month or so ago. Surgical specialties spend more like 10% of the gross on MedMal insurance, and the ObGyns can spend more than that in some places. It is highly variable, but let’s use “10%” as an average for “surgeon, anywhere but Southern Illinois, USA”… Read more »

Marketplace.MD Update
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[LEVEL3] Rethinking MedMal

Malpractice insurance is cheaper.

pgbMD
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pgbMD

“Malpractice insurance costs comprise 3.9 percent of a physician’s practice income. Doctors allocate 13 times more of their practice income for their own salaries than they pay in malpractice premiums. According to the federal government’s Medicare program, doctors nationally spend an average of 52.5 percent of their practice incomes on their own Executive Summary pay, about 31 percent on such overhead expenses as office payroll and rent, and only 3.9 percent on malpractice insurance.” I may be interpreting this wrong, but if these numbers are correct then an OBGYN that spends $150k on malprac insurance should be also taking home… Read more »

Barry Carol
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Barry Carol

Peter, All good questions. Starting with the lawyers, the “stars” at the top of the field do only take the very strongest cases. I skimmed the Public Citizen study that you referenced in your last comment. As you can imagine, I am not a big Ralph Nader fan (founder of Public Citizen). The part of the study that referenced relatively subdued trends in malpractice payouts, did not really speak to the high costs that insurers spend defending (and generally winning) non-meritorious claims. Many of these might be cases of bad outcomes that were not due to malpractice. The defensive medicine… Read more »

Peter
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Peter

Barry, if the significant costs to healthcare of malpractice are the defensive medicine costs then how do we track that? Will docs admit to procedures as only defensive, not medical needs for the patient? Or are the so called defensive costs actually bill padding? If docs do defensive medicine how much of that adds to their incomes in order to offset the insurance costs? And if there is so much defensive medicine going on why are there so many stated malpractice lawsuits? If as you say the majority of claims that go to trial are in favor of the defendant… Read more »

Barry Carol
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Barry Carol

Peter, Wow, where to start. First, with respect to drug spending being 10% of healthcare costs, it was actually Tom that originally made that point a couple of times, and I just repeated it or referred to it. More to the point, regarding malpractice insurance premiums being only 1% or so of total healthcare costs, that does not include all of the defensive and CYA medicine that is routinely practiced systemwide to try to protect against lawsuits, at least to some extent. Perhaps Tom has some data on this, but it wouldn’t surprise me if defensive medicine, solely attributable to… Read more »

Peter
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Peter

Barry, every time someone complains about the high cost of drugs you counter by saying it’s only 10% of the overall healthcare bill; forget it, no big deal on a macro view. I found these two statements on http://www.citizen.org/documents/MedMalBriefingBook08-09-04.pdf The whole thing’s worth a read. 1. Medical malpractice expenditures comprise less than 1 percent of overall health costs. In 2002 health care expenditures rose 9.3 percent to $1.553 trillion. Yet expenditures on all malpractice premiums reported to the National Association of Insurance Commissioners (NAIC) that year were only $9.6 billion – making malpractice costs about .62 percent of national health… Read more »

Barry Carol
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Barry Carol

Abby, Your point about licensing boards not acting aggressively enough to weed out bad doctors by revoking their license could well be a significant part of the problem. It seems to me that an issue like this lends itself very nicely to representatives from the boards in each state getting together to share and spread best practices and/or develop common criteria under which medical licenses would be revoked. If, in fact, a fairly small percentage of doctors account for a disproportionate share of malpractice suits, the profession’s self-interest should be to weed them out and not protect them behind a… Read more »

Matt S.
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Matt S.

I’m also going to start posting under “Matt S.” from now on to avoid confusion.