Pennsylvania's Crisis Is Not Over

By: Lewis S. Sharps, M.D., For The Bulletin
http://www.thebulletin.us

My dual experience as an orthopedic spine surgeon and president of Pennsylvania’s only physician-driven medical malpractice insurance company has provided me with a unique insight into this state’s medical malpractice environment.

Many states are threatened by an escalating medical liability crisis. They can learn a great deal from the Commonwealth of Pennsylvania, which has done an excellent job of reversing its medical malpractice meltdown.

Gov. Edward Rendell can take a great deal of credit for Pennsylvania’s successful medical liability turnaround. The combination of the Mcare Abatement policy, accompanied by common-sense legislative reforms, such as Certificate of Merit and anti-Venue Shopping laws, have led to a drop in the frequency of liability cases being filed and the cost of malpractice payouts, resulting in a decrease in the cost of liability (malpractice) insurance.

Mcare is the second layer of medical malpractice insurance coverage that the state’s physicians, and many other health care providers, must purchase.

However, this is a success story that is still in its infancy, and it is one that has yet to pass the test of time, actuarial scrutiny and political change. It is not time for either patients or the medical community to unfurl a “Mission Accomplished” banner.

The challenges posed by the yearly renewal of Mcare Abatement, the future plans for Mcare Phase-out and the potential for the trial bar to circumvent reforms still pose dramatic threats to the stability of affordable access to medical liability insurance.

The recent inability of the General Assembly to provide an acceptable bill for renewal of Mcare Abatement demonstrated that the present situation is fragile. In response to this new crisis, Gov. Rendell provided a 90-day suspension of the Mcare surcharge in order to allow time for adoption of a bipartisan bill. The clock is ticking.

We have come a long way since 2002 when rising costs stemming from increased frequency and severity of liability claims created a dangerous ripple effect across Pennsylvania. Several major medical liability insurers went out of business, limiting the options for doctors. Access to medical care was threatened by prohibitive malpractice premiums that forced many specialty doctors and practices to close or relocate to different states, leaving trauma centers struggling and jeopardizing patient care.

The outlook today is more positive, but it is imperative that new legislation be passed that strengthens reforms and perpetuates Mcare Abatement, thereby maintaining access to the highest quality of heath care for our citizens.

As founder and president of Positive Physicians Insurance Exchange (PPIX), the only physician driven medical liability carrier in Pennsylvania, I have experienced this transition from the total turmoil and panic in 2002 to the relative calm of the present time. I personally do not want to live through another liability insurance meltdown and recommend against declaring premature victory.

The commonwealth faces many critical issues going forward. A “Gray Hair crisis” lurks on the horizon because physicians in Pennsylvania are aging and there are far too few coming here to take their place. The commonwealth retains only 8 percent of the residents that it trains.

Additionally, Pennsylvania remains one of the country’s most litigious states. Medical communities in states that have incorporated caps on awards for non-economic damages, such as Texas, are thriving and are inundated by medical practice applications – and many of those applications are from Pennsylvania. “Defensive” medicine is still rampant and drives medical costs. Plaintiffs continue to receive only a mere $0.28 from every settlement dollar with the majority of awards going to high contingency legal fees and court costs.

Positive Physicians Insurance Exchange is contributing to reform by providing physicians with an integrated risk-management model designed to identify risks and head off potential problems. Physicians and their office staff are trained to recognize potential risks or adverse events early in a patient’s care and take the appropriate action to manage these risks. This is done by the insurer building a corporate culture that encourages communication between physicians, the patient and the risk coordinators. This philosophy is the keystone of our company and is designed for private practice physicians.

By providing layers of support for physicians that enhance patient satisfaction, we reduce the risk of litigation. This is accomplished with an aggressive team approach to managing risk that involves giving physicians direct access to experienced insurance professionals, experts in risk management, and a medical review board made up of peers.

This type of physician-driven risk management program can result in improving quality of care by improving patient satisfaction and by rewarding early intervention when risks are identified.

By involving the right people – those who are on the front lines and who live and practice with the outcomes of their policies – we can help bring greater stability to the system and maintain patient access to high risk specialties.

Remember, no one wins a malpractice claim. It’s only a matter of how much it costs. It is cheaper to prevent a claim than defend and win one.

Dr. Lewis S. Sharps is president of Positive Physicians Insurance Exchange (www.positivephysicians.com). Headquartered in Paoli. PPIX is the first physician-driven medical liability company in Pennsylvania.
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