Obamacare forces physician salaries down while pitting doctors against administrators, and patients against both!

Obamacare pits doctor against doctor, and doctor against Healthcare administrator, and patient against all of them (and each other), and ...you get the point!

 

Doctors vs. Obamacare: Can your physician simply ‘opt-out’?

Photo: The Washington Times

Tuesday, January 17, 2012 - Medicine and Politics in America by Adam Frederic Dorin, M.D., MBA

Adam Frederic Dorin, M.D., MBA

SAN DIEGO, January 17, 2012 — The destruction of quality in the American medical system will not result from one isolated event. Neither the ‘Affordable Care Act’, its restricted pay to physicians, nor even rationed care will immediately tip the scales toward a subpar medical system. Rather, the turn for the worse will take effect as several pieces of the Obamacare puzzle are set into motion over the next few years.

One piece of this puzzle likely to work against the success of Obamacare will be the creation of local managed care ‘medical homes’ called ‘Accountable Care Organizations’ or ACOs. These little fifedoms controlled by local medical community powerbrokers will pit physician against physician, with only hospital administrators and local medical society ‘leaders’ profiting above the fray.

The other piece will be efforts by the government to force physicians to participate in Medicare and Obamacare plans. These Obamacare components raise serious questions as to whether doctors have any rights in the President’s vision for the future of American medicine.

As one astute physician noted to me recently, “doctors in practice need an ‘out’ to protect themselves against the upcoming tsunami.” What he was referring to are forces behind the scenes today attempting to eliminate any obstacles to Obamacare’s future success. Since the new law’s ability to deliver care to tens of millions of additional patients rests on its ability to cut costs, both Medicare and Obamacare reimbursement to doctors will be low.

A basic tenet of Obamacare is to force doctors to take untenable cuts in pay, all the while absorbing overbearing new regulations and mandates with little or no personal recourse. Proponents of the Obamacare law know that they can suffer concessions made in Washington, D.C. as long as the doctors delivering the majority of medical care in towns all across this land are made to heel to the new law’s demands in the end.

Some on the political left have conjured up schemes to tie physician state licensure to participation in Medicare and Obamacare. Others have taken solace in the notion that the regional ACOs themselves will be able to quash any doctor rebellions by simply using their control of the purse strings to withhold or limit how much local money each doctor will be paid for his services.

Unbeknownst to most people in or out of the healthcare arena, however, are the legal options available to physicians to either never enroll in Medicare or to voluntarily withdraw their participation in the government’s plan. The legal nuances of the doctor-Medicare relationship may shed light on options available to physicians to skirt inclusion in Obamacare if the law’s enforcers decide to use a heavy hand in mandating their participation.

Quoting a memorandum by the California Medical Association’s Solo/Small Group Practice Forum delegation on January 9, 2012, physicians became aware of a “bulletin circulated by the American Medical Association [referencing] an email authored by an unidentified Center for Medicare and Medicaid (CMS) employee who stated that a non-enrolled physician who treats Medicare beneficiaries must either involuntarily enroll in Medicare or else provide medical care free of charge. Apparently some embrace conscription of physicians and believe that the federal government can require physicians to work for free.”

The real challenge for physicians today is that they lack true representation by the American Medical Association (AMA). Since the AMA’s membership represents only about 15% of practicing community doctors in America, and since the AMA lost 12,000 member doctors in 2010 alone (and are expected to have lost at least that amount in the year 2011), the AMA has a real credibility problem with the nation’s physicians.

Furthermore, since the AMA publically signed on as a supporter of the Patient Protection and Affordable Care Act (PPACA) with only the implicit blessing of their limited membership, and many local and state AMA-affiliated medical societies remained eerily quiet during and after the contentious health care reform debates, the vast majority of doctors feel the organization betrayed them. America’s doctors need true representation to the public and to their elected representatives. Without proper representation, doctors are looking for ways to simply opt-out of all government health care plans.

Organizations like America’s Medical Society (AMS) have sprung up in the aftermath Obamacare’s passage to help physicians preserve and grow their independent practice of medicine. They believe that doctors have the right to privately contract with patients for their medical treatment.

Patients can seek reimbursement from Medicare by completing form CMS-1490S, which contains the following instructions: “Doctors, providers, and suppliers are required to submit claims to Medicare when providing covered services. You can reduce your out-of-pocket expense by seeing a doctor or supplier that is enrolled in Medicare and bills Medicare for the services provided.” See: https://www.cms.gov/cmsforms/downloads/cms1490s-english-instructions-DME.pdf

Such wording on an official Medicare form, promulgated by the Center for Medicare and Medicaid Services (CMS) would lead one to believe that a patient may seek treatment from a non-enrolled physician and may also pay ‘out-of-pocket’ for at least part of their medical care. This would seem to contradict the AMA email referenced above.

In the case Stewart v. Sullivan (816F.Supp. 281,282 283; D.N.J. 1992), Lois Copeland, M.D., a Medicare nonparticipating physician, filed a lawsuit challenging Medicare’s prohibition against charging Medicare beneficiaries more than the government’s stated limit. The court noted that penalties described in Social Security Act 1848(g)(4)(A) require proof of over-charges on a “repeated basis,” and in a “knowing and willful manner.” Although the court ruled that they did not find any infringement on private contracting, the case was dismissed.

Many physicians, feeling isolated and in fear of losing their practices due to severe cuts in reimbursement under Obamacare, are looking for remedies under the law to simply not participate, disenroll, or limit their involvement with the Medicare program. Many would like to continue to see patients by making private arrangements and/or by simply giving free care, but on their terms without unwieldy and unnecessary government regulations imposed by such participation.

Here are three potential approaches to understanding how physicians may resist Medicare and, by extension, Obamacare participation:

Physician enrollment in Medicare is voluntary. Sec.1866. [42 U.S.C. 1395cc] (a)(1) states a provider is “qualified to participate and eligible to receive payments from the government if s/he files with the Secretary” an agreement (i.e., voluntarily completes form CMS-855).

A non-enrolled physician has equal protections and due process rights under laws that prohibit the federal government from demanding a physician either serve (enroll in) Medicare or give free medical care to Medicare beneficiaries.

Some would say the US Constitution, Amendment Thirteen, protects every American from “conscription” in that:

“Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States …”

Section 1842(i)(2) does not restrict a physician to only two choices: “participating” or “non-participating.” Sec.1842. [42 U.S.C. 1395u] (i)(2) clearly states “The term … nonparticipating physician refers … to a physician who … is not a participating physician … (as defined in subsection (h)(1))” Sec. 1842(i)(2) is a conditional statement: if non-participating, then not participating.

But physicians obviously have more than two possible relationships with Medicare including “opted out,” never enrolled, voluntarily terminated, or employed by a Medicare Advantage IPA/HMO.

Section 1848(g)(4)(A) explains how a physician who is enrolled in Medicare should submit bills under Part B; it does not mandate every physician who is non-enrolled into enrollment, thus triggering mandatory claims submission. Section 1848(g)(4)(A) does not grant the federal government authority to press physicians into service (enrollment).

So what about patient reimbursement by Medicare? Can a patient pay his/her doctor and then seek reimbursement from Medicare? Most physicians will agree to bill the government, but if they don’t does this mean they must give free medical care to Medicare beneficiaries?

Healthcare attorney Andrew L. Schlafly wrote the following: “… even if the federal government attempted to assert control over payments by patients to disenrolled physicians, courts may well hold that it is unconstitutional for government to interfere with payments made by Medicare enrolled patients for services rendered by physicians who have disenrolled. We are unaware of a court case establishing or forbidding this option. Government may prefer not to test its authority over disenrolled physicians rather than risk a new precedent against its power.”

Later this year, the Supreme Court will decide on the merits of the Affordable Care Act’s individual mandate requiring all Americans to either participate in Obamacare or pay a penalty; then, the country will face challenges to other vexing issues associated with this legislation. Will a change in leadership at the White House and the Senate result in an outright repeal of the law? Will such a repeal automatically stop the regional, community-based ACOs dead in their tracks, as Obamacare foes hope? Will physicians be threatened and mandated to participate in Medicare and other government-sponsored health insurance plans regardless of the law’s fate?

Health insurance is an important and vital component of a free-market society. The question remains, should government mandate coverage? Obamacare mandates participation, additional fees, over a hundred new government agencies, and layers of additional bureaucracy, but fails to include rules to allow insurance entities to compete across state lines; it also lacks tort reform to lessen the costly and widely denounced practice of defensive medicine to ward off frivolous lawsuits.

It seems the question is not one of intent in criticizing the new health care law, but rather one of content. Obamacare gets it wrong at almost every turn. Instead of finding tax-credits and other incentives to help doctors care for the uninsured, it imposes paternalistic, over-bearing, and anti-competitive pressures to coerce providers of care to see more patients for less under unfavorable conditions.

Obamacare opponents are not against healthcare for all; nor are they against government-sponsored health insurance. What they find troubling is the notion that the government wants to control every minute detail of the medical care delivered between a doctor and a patient.

In the end, Americans will not abandon independent, physician-directed medical care centered around the core doctor-patient relationship. In the match up of Doctors vs. Obamacare, physicians have already opted-out—in due time, this reality will become more and more obvious.

Doctor Dorin is a Hopkins-trained, board-certified anesthesiologist, practicing in a large group in San Diego. He is a small business owner, a Commander in the US Navy Reserves, and the Founder/President of America’s Medical Society, Inc., (AMS) a non-profit corporation created to serve and educate physicians and the general public in matters of national health-care reform and medical politics.

Academia attacks physicians and physician salaries...What a joke!

What a joke of a study! Does this article even address the hours worked by a Physician? Does it take into account the $250K in student loans the average U.S. trained physician will be saddled with prior to seeing their first patient? Then there is the fact that many physicians will not be finished with their training until they are into their 30s.

Take an accounted that graduates college at 22, and becomes a CPA by 25. This accountant will make upwards of $750k before a doctor makes their first buck!

OK…Now check this out…Every quote in this story is from “Academia”! So you have these pointed head professors walking around campus with nothing to do except dump on the earnings of U.S.  motivated and driven physicians! Let’s all talk about the cost of a college education in the U.S. While we are it lets see about the workday of the tenured University professor. Don’t get me started on the cost of an education because of the way way way way over paid tenured professors!

 

Sky-high salaries, costly hips boost US health costs

Compared with five other countries, America is tops in docs' income, fees, study finds

By Linda Carroll

msnbc.com contributor

updated 9/8/2011 9:05:48 AM

High doctors’ salaries and climbing fees may be the major reasons that health care costs are so much steeper in the United States than in other developed countries, a new study concludes.

Don't miss these Health stories Columbia University researchers compared payments to primary care doctors and orthopedic surgeons from six developed countries: Australia, Canada, France, Germany, the United Kingdom — and the United States.  After scrutinizing the data, they found that both groups of US physicians were making much more money than their foreign counterparts.

In part that’s because procedures like hip replacements cost so much more in the US, said the study’s lead author Miriam J. Laugesen, an assistant professor of health policy and management at the Mailman School of Public Health at Columbia University.  In part it’s because physicians are just paid better here, she added.

On average, primary care physicians in the United States received $186,582 in pretax income a year, compared with $95,585 in France and $92,844 in Australia. When it came to orthopedic surgeons, there was a similar disparity, with US surgeons taking in an average of $442,450 a year, compared with $154,380 in France, $208,634 in Canada and $324,138 in the UK.

“With the recession we have right now, there are a lot of questions about whether physician fees can continue to go up at the pace they have,” Laugesen said. “We can’t say what is the right amount to pay. But we can certainly shed some light on what is going on.”

A similar trend was seen in specific procedures. Hip replacements, for instance, cost almost twice as much in the US as they do in foreign countries: When a private insurer paid, the US cost was $3,996. That’s compared to $1,943 in Australia and $2,160 in the UK, for example. The disparity wasn’t as sharp when there was a public payor, but the US still led the pack with an average payment of $1,634 vs. $652 in Canada, $1,046 in Australia and $1,181 in the UK.

Experts said the study contributed important data to the ongoing health-care debate.  “I think that it’s clear that something is broken in our health care system,” said Daniel Polsky, a professor of medicine and health care management at the Perelman School of Medicine and the Wharton School, both at the University of Pennsylvania. “A lot of people think that to fix it we need to do less care — that we’re just doing too much. What this study suggests is that it’s not about how much we’re doing, but about how much we’re paying for what we’re doing.”

The new data provide a window on something shown by earlier studies: as much as 70 percent of health care costs are due to salaries of health care workers, said Jonathan P. Weiner, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.

“This suggests we don’t have the right balance,” Weiner said. “This is a time when 40 to 50 million Americans are without health insurance.”

Beyond that, Weiner said, the study underscores the inequity between specialist salaries and those of primary care physicians.

So how did we get to where we are?

“In part it’s due to our cultural acceptance of paying a lot for health care,” said Meredith Rosenthal, a professor of health economics and policy at the Harvard School of Public Health. “Physicians incomes are way above the median. They’re in the top 5 percent.”

As for primary care physicians’ complaints about the disparity between their incomes and those of specialists, Rosenthal said, it’s all just a matter of perspective.

“On the one hand, primary care physicians make a lot more than the average American, but they make a lot less then dermatologists,” she explained. “So the primary care physicians see themselves as relatively impoverished because of their position relative to the dermatologist — not relative to the average working guy.”

But ultimately, Americans need to look at these numbers and think about what they mean, Rosenthal said.

“We’re willing to pay physicians so much because we value health care so much,” she explained. “But, physicians are making five times the median income. Is that what we really want?”

 

Obamacare will kill patients (Not kidding....if you can't see the doctor when you are sick...how can you recover?)

OK…Let me get this right…Longer wait for patients to see the doctor…Doctors will be paid less…Those of us who pay for their Health Insurance will pay higher premiums…Those on Medicaid will have to search for a physician that will accept Medicaid….So now all Floridians will be miserable…and The Government will try to tell us we’ll all be better for it! Thanks for nothing OBAMA!

Florida doesn't have enough doctors for Medicaid expansion, lobby group says

February 22, 2013|By Kathleen Haughney, Tallahassee Bureau

TALLAHASSEE Brace yourself for longer lines at the doctor's office.

Whether you're employed and insured, elderly and on Medicare, or poor and covered by Medicaid, the Florida Medical Association says there's a growing shortage of doctors — especially specialists — available to provide you with medical care.

And if the Florida Legislature goes along with Gov. Rick Scott's recommendation to offer Medicaid coverage to an additional 1 million Floridians — part of the Affordable Care Act that takes effect next January — the FMA says that shortage will only get worse

"Florida needs more doctors and it needs more nurses, and it needs them working together in teams," said Rebecca O'Hara, a lobbyist for the FMA.

About 15 million Floridians have health insurance today, and Obamacare, which requires most adults to have coverage by January, could add as many as 2.5 million more. One million would come through a potential expansion of the federal-state Medicaid program that Scott announced this week he was backing. The others would be the result of new mandates requiring employers and individuals to have insurance or be fined.

Currently, the state has 44,804 doctors, but about 5,600 of them are expected to retire in the next five years. And even though Florida has opened three new medical schools in the past dozen years, the state isn't producing as many doctors as it needs. Scott's budget this year has $80 million to fund programs to train 700 new residents a year, in hopes they'll remain in the state.

Of all patients, people covered by Medicaid may have the hardest time finding a doctor; only 59 percent of the state's physicians are taking new Medicaid patients, according to a Kaiser Health News study.

Committees in both the House and Senate have been meeting for the past two months to discuss implementation of the Affordable Care Act. On March 4, they expect to see two major studies by the Office of Economic and Demographic Research, one that looks at the overall economic impact of the health-care overhaul and another that simply examines Medicaid expansion.

Scott, however, has already made clear how he feels about that.

On Wednesday, he unexpectedly announced that he had reversed his earlier, adamant opposition and now wants a three-year expansion that would cover single adults and families earning up to 138 percent of the poverty line; the costs would be fully covered by the federal government. If the expansion is re-approved after three years, the federal government is committed to paying no less than 90 percent of the cost.

House and Senate leaders will begin their budget deliberations in the coming weeks, which will include the decision over new residency slots, along with the debate over whether to expand Medicaid. Many lawmakers have expressed opposition.

Sen. Joe Negron, R-Stuart, who chairs the Senate committee studying the AFA, said lawmakers have heard concerns about a potential physician shortage, but he said he did not believe that would be a "determining factor" in the committee's decision over whether to expand Medicaid.

One reason, he said, is the responsibility for coverage may soon be falling to private health insurance companies or physician groups.

The federal government this week gave Florida preliminary approval of a plan that would put most of Florida's current 3.3 million Medicaid recipients — and any added via expansion — in some form of managed care, either HMOs or doctor-run networks, by 2014. In order for HMOs or the provider service networks to get state-approved contracts, they must prove they can provide "adequate" care, which means patients must be able to see a doctor in a reasonable time.

"It's their responsibility to have network adequacy," Negron said of the private providers. "So, they'll be responsible for making sure people can get care with network physicians."

Negron also noted that the amount doctors will be paid for seeing Medicaid patients is rising, which may prompt more physicians to take them. As part of the health care law, primary-care doctors will be paid as much for a Medicaid patient as they are under Medicare, a 73 percent increase.

Health care advocates who back the expansion say they aren't worried either.

Greg Mellowe, policy director for health advocacy group Florida Chain, said the state needed to carefully watch the situation as it develops, but added, "We don't believe that there is a crisis brewing."

Mellowe noted that many uninsured already receive care — often in emergency rooms, which is more expensive — that hospitals aren't paid for. If many of these patients have insurance coverage, he said, hospitals may see an opportunity to shift resources to primary care settings.

Lawmakers are slated to return to Tallahassee the week of March 4 for the beginning of the 2013 legislative session. The studies from the state economists are also due at that time.

Negron said until the state can look at that information, it was impossible to say what direction the Legislature would take.

"It will be a judgment call to make on the right way to proceed for Florida's families and businesses," he said. "I just think it's too early to tell where either the House or Senate will come down on this."

khaughney@tribune.com or 850-224-6214

Doctor shortage

Number of doctors in Florida: 44,804

Number of people with health insurance coverage: 15 million

Number expected in 2014, including a Medicaid expansion: 17 million to 17.5 million

Percentage of physicians expected to retire in the next five years: 5,600

Concierge Medicine works for Physicians and Patients! Obamacare does Not!

Concierge medicine for the people! American patients seek concierge services from their physician at only $50 a month! Sounds Good!

Bruce Japsen, Contributor

Forbes

Pharma & Healthcare 1/30/2013 @ 9:30AM

1 In 10 Doctor Practices Flee Medicare To Concierge Medicine

As Medicare whacks away at what doctors are paid and health insurers move away from paying fees for service to bundled payments, more physicians who own their own practices will start direct pay or concierge medicine in the next one to three years.

New data from a national survey of nearly 14,000 physicians conducted by physician staffing firm Merritt Hawkins for The Physicians Foundation, analyzing 2012 practice patterns, found that 9.6 percent of “practice owners” were planning to convert to concierge practices in the next one to three years.

The movement is across all medical disciplines with 6.8 percent of all physicians planning to stop taking insurance in favor of concierge-style medicine or so-called “direct primary care.”

“Physicians have been running for cover for several years now,” said Mark Smith, president of Merritt Hawkins. “There is a lot of uncertainty in health care now and the only certainty is there is a lot of talk about cutting physicians fees. One way to get out of it is to go off the grid.”

The data release comes less than a month after Congress waited until the 11^th hour to avoid the fiscal cliff as well as the so-called “doc fix” on Medicare payments. Even though a cut of nearly 27 percent in Medicare payments to doctors was avoided, doctors remain upset at the lack of a permanent solution for dramatic cuts to doctor payments from the Medicare health insurance program for the elderly under the sustainable growth rate formula also known as “SGR.”

Already, one in five physicians is restricting the number of Medicare patients in their practice and one in three primary care doctors – the providers on the front lines of keeping the cost of seniors’ care low – are restricting Medicare patients, according to a 2010 AMA survey of more than 9,000 physicians who care for Medicare patients.

Under direct primary care, doctors contract directly with patients to provide all of their primary care needs free of insurance interference at a price generally between $50 and $60 a month per patient. It’s what the New York Times last spring called “concierge for the masses” because it was much cheaper than the historically high cost of concierge medicine some Congressional investigators found to be $5,000 to $15,000 a year or more.

“It’s not just for the rich and famous anymore,” Merritt Hawkins’ Smith said of concierge medicine and direct primary care practices. “If you can afford a gym membership, you can afford this kind of care.”

 

The direct primary care approach provides unlimited visits to a physician’s office plus 24-hour access to doctors through e-mail consultations. The primary care model has drawn insurance industry opposition in part because the health insurer middleman is cut out of the equation as doctors are no longer paid by the likes of Aetna (AET), Humana (HUM) or a UnitedHealth Group (UNH).

Under a proposal under consideration by Congress and Medicare officials, a pilot program  would provide “monthly fee-based payments for direct primary care medical homes” for certain Medicare beneficiaries, according to the legislation introduced by Rep.  Bill Cassidy, a Louisiana Republican and physician.

Supporters of the direct primary care approach see the pilots as a way to show Congress and an Obama administration eager to reign in Medicare spending that the concept can provide quality medical care and lower costs.

 

 

Obamacare...Patients wait for care....Just ask the Brits and the Canadians! Oh yeah...there goes our research and manufactoring industry...it was nice knowin' ya!

Here comes Obamacare....wait for it....wait for it....wait....wait.....wait...(that's what we will do when we need to see the doctor)

 

The take-away is that women (in Canada) face nearly double the mortality risk from breast cancer that American women face; British men face six times the mortality risk from prostate cancer than that faced by American men.

 

 

May/June 2009

Obamacare: Medical Malpractice

By

Edward H. Crane

Edward H. Crane is the founder and president of the Cato Institute.

The columnist Robert J. Samuelson had a perceptive piece in the Washington Post recently in which he stood back from the policy trees to look at the Barack Obama forest. What he saw was disturbing. He suggests that Obama is advancing a “post-material economy” designed to “achieve broad social goals” that will end up spending more to get less. The president proposes to radically restructure America’s energy industry through massive tax increases (“cap and trade”) in the name of fighting the problematic notion that mankind’s miniscule addition to greenhouse gases will create crippling global warming. But as the world-renowned scientist Freeman Dyson points out, “Most of the evolution of life occurred on a planet substantially warmer than it is now and substantially richer in carbon dioxide.”

Obama also proposes to make the failed public school model available to even younger children and make liberal arts college more accessible to hundreds of thousands of students who, as American Enterprise Institute scholar Charles Murray points out, would be much better off going to vocational schools or junior colleges. Obama would escalate George W. Bush’s efforts to essentially federalize education in America. Never mind that the word “education” in not to be found in the federal Constitution.

But perhaps most threatening to most Americans is Obama’s determination to nationalize health care in America. It’s a truly bad idea. But that is what the president has made clear he wants. Obama has publicly declared his preference for a single-payer system “managed like Canada.” His initial proposal, part of an ill-defined $634 billion “down payment” on health care reform, would create heavily subsidized federal insurance that would put private insurance at an unhealthy disadvantage. Some estimates suggest that private insurance would be reduced by more than 60 percent, leading ultimately to its collapse. Speaking of the Canadian system, Obama says of his approach that “it may be we end up transitioning to such a system.” Ya think?

That, of course, would be a tremendous mistake, a fundamental mistake. America is a land of free individuals. Socialized medicine is not what we as a nation are about—and with good reason, both philosophical and practical. Consider:

• Eight out of ten of the most recent major medical innovations, ranging from MRIs to hip replacement, have come from the United States.
• Americans have access, on a per capita basis, to three times as many CT scans as Canadians and four times as many as Britons. Had the actress Natasha Richardson had her skiing accident in upstate New York rather than in Canada, she might have had a chance of survival.
• According to Vancouver’s Fraser Institute, the average wait for treatment by a specialist in Canada is 18 weeks. As the Canadian Supreme Court ruled when eliminating the national health care monopoly in 2005: “The evidence shows that in the case of certain surgical procedures, the delays that are the necessary result of waiting lists increase the patient’s risk of mortality… The evidence also shows that many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life.”
• According to a Cato study British women face nearly double the mortality risk from breast cancer that American women face; British men face six times the mortality risk from prostate cancer than that faced by American men.

Really, does it make any sense whatsoever to change our health care system to a nationalized system? None of which should suggest that we can’t improve on our employer-based, third-party payer approach. And we seem to be moving away from that. Cato published the first book on Health Savings Accounts, which bring about a major improvement by individualizing and making portable health insurance. The next great innovation is from University of Chicago finance professor and newly minted Cato adjunct scholar John Cochrane. His Cato Policy Analysis (no.633), “Health-Status Insurance: How Markets Can Provide Health Security,” is a brilliant solution to high insurance costs and issues such as preexisting conditions.

While left-wing coalitions like Health Care for America Now gear up to do battle, and more traditional opponents of socialized medicine like the business community and the American Medical Association prepare to essentially capitulate, all parties should pay attention to a recent front page story in the New York Times, headlined “Doctor Shortage Proves Obstacle to Obama Goals.” You don’t suppose that shortage has anything to do with the prospect of nationalized health care, do you?

 

Nurse Practitioners and Physician Assistants are in the cross-hairs of the Malpractice Lawyers industry! America...Here comes the PAIN!!!

As more Nurse Practitioners and Physician Assistants are used to fill the void in the Physician shortage Malpractice Lawyers will begin a campaign to sue the Mid-Levels. It is just beginning, but an aggressive field of Malpractice lawyers will begin the process of setting high award cases. Trail lawyers will be happy, patients looking to hit the “Jackpot” (and you all know who you are) will be happy, and the America will again seeing rising costs of its Health Care take place. Everyone loses except the trail lawyers!

 On the Defensive

More patients are naming nurses in malpractice suits

From Nurseweek.com

By Todd Stein
May 15, 2000
Illustration: Margie Paschke/
William Jacoby/Photodisc

 Not so long ago, the distinction between nurses and physicians was pretty clear: Physicians took care of the medicine, nurses took care of the patient. Today, as nurses take on more of the physician’s medical duties, they are increasingly exposed to a physician’s greatest fear – the malpractice lawsuit.

"Clearly, there has been a marked increase" in malpractice suits naming nurses as defendants, said William McDonough, senior vice president for health care at Boston-based Marsh Inc., the world’s biggest insurance brokerage firm. McDonough estimates that the number of malpractice lawsuits naming nurses as defendants has risen 10 percent nationally since 1995.

That number may be low, especially where highly skilled nurses are concerned. A study of nurse-malpractice lawsuits in Harvard University medical institutions found that claims against nurse practitioners jumped 16 percent between 1984 and 1992.

Insurance experts mostly blame the increase on overzealous lawyers lured by substantial jury awards. Lawyers blame managed care for axing hospital staffs and increasing patient loads – leading to more mistakes. But all sides agree the primary reason more nurses are getting sued is, ironically, that they are more skilled than ever before.

"Patients expect more of nurses, so when something goes wrong there’s less hesitation to blame them," said Marc Mandell, a Norwich, Conn., lawyer who specializes in nursing risk management.

More vulnerable

As their professional roles expand, nurses are naturally becoming more vulnerable to the types of lawsuits that have plagued physicians for years. Malpractice is the legal term for negligence by any licensed professional. Case law began recognizing nurses as professionals in the mid-1970s, and has lately come to see registered nurses as "assertive, decisive healthcare providers," according to a 1985 New York appellate court opinion.

"Unlike a generation ago, jurors are more likely to agree that if something goes wrong, the nurse should have picked it up just like a doctor," Mandell said.

The financial cost of malpractice is covered by most employers’ insurance policies, and few experts suggest nurses need their own malpractice insurance. But if malpractice is claimed, the cost to a nurse’s career can be staggering. Even if the nurse is a so-called "tag-along" defendant and not the primary focus of the lawsuit, once money is exchanged through an out-of-court settlement or jury award, the nurse’s name is automatically reported to the state Board of Nurse Examiners, to insurers and to the federal government’s National Practitioners Databank.

State nursing boards are increasingly likely to suspend or discipline nurses who are found guilty in malpractice suits. Even if the board is lenient, employers may not be. Nurses are required to report their involvement in a malpractice suit to each of their employers for the rest of their professional careers.

"The patient isn’t the only victim in a malpractice case," said Tom Packer, a San Francisco lawyer who specializes in defending nurses in liability cases. "The emotional and professional effect on nurses can be devastating because it’s forever on their record that one of their patients was paid money after they alleged malpractice, even if they only got one dollar."

Guides for protection

Not all the news is bad, though. Thankfully, there are clear guidelines for protecting yourself from a malpractice suit.

Nursing malpractice occurs only under two conditions: You make a mistake that can be proved to have harmed a patient, and the mistake is one that a reasonably careful nurse wouldn’t have made in a similar situation. The law doesn’t require you to provide the best or safest care humanly possible – only to meet a reasonable standard.

In court, that standard is your state’s Nurse Practice Act. So it follows that the primary way to prevent a malpractice lawsuit from being filed is to know the law.

"A nurse absolutely has to be familiar with the Nurse Practice Act, so if she’s asked to do something out of bounds, she knows to refuse it," said Elizabeth Higginbotham, RN, an Austin plaintiff’s lawyer and president of The American Association of Nurse Attorneys (TAANA), Texas chapter, who leads workshops on avoiding malpractice suits for both nurses and hospital administrators.

Many times, Higginbotham said, employers will put nurses in a catch-22 situation where they must choose between compromising their license and keeping their job. A long-term care facility, for instance, may have a policy that requires RNs to let unlicensed personnel hang IVs, even if the state’s Nurse Practice Act requires an RN to do the job. If something goes wrong and a lawsuit is filed, it’s the nurse who will be held responsible.

Similarly, a nurse who notifies a physician that a patient is in trouble is legally responsible for that patient even if the physician makes no response.

"You can’t just drop the ball," Higginbotham said. "You’ve got to go over (the physician’s) head and find somebody who’s going to give you orders to take care of that patient. Otherwise, you might find yourself in my office."

Many state nursing boards make available guidelines that outline a step-by-step process for determining which duties are outside a nurse’s scope of practice. Most can be printed from the Internet free of charge.

Documentation is key

Another way to prevent malpractice suits is to scrupulously document everything from disagreements with the physician to a patient’s noncompliance with medications. "Nobody’s going to protect you but yourself," attorney Mandell said. "And the best way to protect yourself is to document everything and to do it contemporaneously, not after the fact."

Adding to the medical record after a lawsuit has been threatened is one of the most common and costly mistakes a nurse can make, added Monica Mooney, RN, a San Francisco defense lawyer and president of TAANA’s California chapter. "As a defense attorney, that is one of the last things you want to see. Any time you alter the medical record after the fact your liability is huge because it ruins your credibility and the jury’s not likely to believe anything else you say."

Ideally, chart entries should be made at the time of an assessment or intervention and no later than shortly afterward. If you make a mistake in the record, draw a line through it, write "mistaken entry," include the correct information, and initial the changes. Never erase or obscure the record. Document forensics experts are commonly employed by attorneys to uncover such glaring indicators of error.

While other prevention tactics are advisable, perhaps the best technique to prevent a malpractice suit from being filed is the one that comes most natural to nurses. Being kind.

"Politeness is the best cure against malpractice," Mandell said. "If the patient likes you and you’ve been kind to that patient you decrease your odds of being sued immensely."

Politicians and their Lawyer backers are seeking to raise Medical Malpractice premiums! Forget the 30% recover fees, politicians and lawyers want much more!

….And you thought lawmakers were elected to represent the people! Well...you got it wrong! Lawmakers (generally and more often these lawmakers are lawyers seeing they can’t find a real job, so they get elected to something) are legislating for themselves and their current and former law firms. The story below shows how these lawmakers are seeking to make more money off the backs of Doctors and Patients!

Lawyer pol bids for higher malpractice fees

• By CARL CAMPANILE
• NY Post
• Last Updated: 12:37 AM, March 21, 2011
• Posted: 12:37 AM, March 21, 2011

A powerful state senator who is a medical-malpractice attorney has sparked a furor by pushing a bill to boost trial lawyers' pay by eliminating 2-decade-old limits on legal fees in such cases.

Sen. John DeFrancisco (R-Syracuse), chairman of the Finance Committee, is "of counsel" to the Syracuse medical-malpractice law firm DeFrancisco & Falgiatano.

And watchdog groups say his advocacy for an end to limits on contingency fees is a blatant conflict of interest, while health-care-industry officials claim giving more money to attorneys could dramatically increase malpractice-insurance premiums for medical providers and reduce payouts to patients.

"It's a conflict of interest for a lawyer to champion a bill that benefits his profession and his law firm," said Citizens Union President Dick Dadey.

The bill also undercuts Gov. Cuomo's bid to slash malpractice costs.

In response to medical-industry complaints about high malpractice premiums, Cuomo proposed a $250,000 cap on non-economic "pain and suffering" awards, to slash $700 million in costs.

In exchange, health-care providers and unions backed Cuomo's plan to trim Medicaid.

Current law caps fees for attorneys who earn a percentage of what their clients win. They're now paid on a sliding scale.

For example, lawyers can collect up to 30 percent on judgments of less than $250,000 but no more than 10 percent of awards of more than 1.25 million. DeFrancisco's bill would abolish those limits.

"This bill would drastically worsen hospitals' already oppressive medical-malpractice costs and threaten access to care. To enact it would be shameless," said Brian Conway, spokesman for the Greater New York Hospital Association.

DeFrancisco declined comment.