This column was originally published in AMA eVoice on Jan. 17, 2008. Dr. Davis is president of the American Medical Association.
Last month, Medical Liability Monitor released results of its annual rate survey, which reports the medical insurance rates of the nation's major insurers of physicians. The results are a bit of a mixed bag.
First, some positive news: Medical liability rates appear to be stabilizing for the second consecutive year. According to the survey, nearly 84 percent of company—reported rates held steady or dropped in 2007. Of that 84 percent, 31 percent of rates decreased—almost triple the number of rate reductions in 2005.
Now for the bad news: Premiums in many areas of the country still are at or near all-time highs. For example, premiums in Connecticut, New Jersey, and Pennsylvania have nearly tripled since 2000. And in New York, after a 14 percent increase in rates last July, most physicians are paying as much as 80 percent more for their liability insurance than they were in 2002, bringing annual premiums for many specialists to levels in the hundreds of thousands of dollars.
Clearly, there's much to be done on this front. That's why the AMA is aggressively working to solve this ongoing problem and protect patients' access to care. One way we're doing that is through efforts with state medical associations to enact and defend strong medical liability reform laws.
Last year, the AMA provided support to the Illinois State Medical Society (ISMS) in anticipation of a legal challenge to medical liability reforms enacted there in 2005. In November, the possibility of a challenge became reality when a Cook County Circuit Court judge ruled those reforms to be unconstitutional. An appeal has moved to the state Supreme Court, and the AMA and ISMS have collaborated on these ads (PDF, 321KB) as part of the fight to retain these reforms.
The AMA also has helped the Hawaii Medical Association, the Medical Society of the State of New York, and the Tennessee Medical Association in the past year in their efforts to pass medical liability reforms in their respective states.
A number of states have enjoyed great success in getting reforms passed—and they're reaping the benefits. Since 1999, 16 states have capped noneconomic damages or improved existing caps, and close to 30 states now have some form of a cap in place.
Among them is Texas, where a series of reforms took effect in 2003. Since then, Texas physicians have seen their rates cut by an average of 21.3 percent, and the state has experienced a statewide increase in the number of physicians, particularly specialists. Another is Ohio, where, also in 2003, lawmakers passed two dozen sweeping medical liability reforms. That year, the state only had five medical liability insurance carriers; today, because of the stability of the marketplace and an improved liability climate, that figure is up to 15.
These accomplishments, as well as recent changes in other states that have enacted significant reforms, are supported by a growing body of economic research (PDF, 72KB) that links medical liability reforms to slower growth in indemnity payments and premiums.
Because some states have had difficulty securing effective reforms, the AMA is advocating for a federal solution based on proven state laws, such as California's Medical Injury Compensation Reform Act (MICRA). Enacted in 1975, MICRA—considered the "gold standard" of medical liability reform#151;limits noneconomic damages in medical liability cases to $250,000 and has stabilized rates in California for more than three decades.
Last year, the AMA initiated a sign-on letter in support of medical liability reform legislation that would have established a cap of $250,000 for noneconomic damages, prohibited arbitrary awarding of punitive damages, and promoted swift dispute resolution. That bill was introduced in and passed by the U.S. House of Representatives but failed to garner enough support in the Senate. Despite that outcome, the AMA remains committed to advancing federal legislation on this issue.
The AMA also continues to research alternative reforms, such as affidavits of merit, statutes of limitations/repose, and apology inadmissibility. In addition, the AMA recently adopted policy on health courts to serve as legislative guidelines in the development of a fair and expeditious system for the resolution of medical liability claims.
Only through a collective effort to spur reform can we help more states make the types of gains seen in California, Texas, Ohio, and others, and also bring about a federal solution to the nation's medical liability problem. So please learn more about what the AMA is doing to reform the system. By working together, we'll be able to present a unified front to advocate for reforms that promote access to quality care while protecting against attempts to overturn existing laws that are helping physicians and their patients.
The lighter side
In a study published in JAMA in 1997, researchers reported that primary care physicians who have had no medical liability claims against them are more likely than those who have had two or more claims against them to use certain communication behaviors in their patient interactions, including laughter and humor. Interestingly, the investigators found no difference in communication behaviors between claims and no-claims surgeons.
An article in American Medical News gave examples of the use of humor by physicians. For example, during a routine Pap test, Douglas Farrago, MD, a Maine family physician and editor-in-chief of Placebo Journal, may turn to his nurse and say: "Did you mistakenly switch the Crazy Glue with the Vaseline again?" The article pointed out that while humor can strengthen the bond between physician and patient (and thus might reduce the likelihood of the patient filing a lawsuit in the event of a bad clinical outcome), it can also harm their relationship if used inappropriately.
Do you use humor or other special communication techniques to strengthen the bond with your patients and/or reduce the chance of lawsuits? Would you be willing to share any stories of when these techniques worked well, or did not work so well?
Please send comments, questions, and replies to amaprez@ama-assn.org.
Content provided by: Ronald M. Davis MD