Dataset Information

Medical malpractice reform: noneconomic damages caps reduced payments 15 percent, with varied effects by specialty.

ABSTRACT: The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of malpractice claims for the period 1985-2010, merged with information on state liability reforms, to estimate the impact of state noneconomic damages caps on average malpractice payment size for physicians overall and for ten different specialty categories. We then compared how the effects differed according to the restrictiveness of the cap ($250,000 versus $500,000). We found that, overall, noneconomic damages caps reduced average payments by $42,980 (15 percent), compared to having no cap at all. A more restrictive $250,000 cap reduced average payments by $59,331 (20 percent), and a less restrictive $500,000 cap had no significant effect, compared to no cap at all. The effect of the caps overall varied according to specialty, with the largest impact being on claims involving pediatricians and the smallest on claims involving surgical subspecialties and ophthalmologists.

SUBMITTER: Seabury SA

PROVIDER: S-EPMC4278571 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Medical malpractice reform: noneconomic damages caps reduced payments 15 percent, with varied effects by specialty.

Seabury Seth A SA Helland Eric E Jena Anupam B AB

Health affairs (Project Hope) 20141022 11

The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of malpractice claims for the period 1985-2010, merged with information on state liability reforms, to estimate the impact of state noneconomic damages caps on average malpractice payment size for physicians overall and for ten different specialty categories. We then compared how the effects differed according to t ...[more]

PMID: 25339633

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Project description:Although physician concerns about medical malpractice are substantial, national data are lacking on the rate of claims paid on behalf of US physicians by specialty.To characterize paid malpractice claims by specialty.A comprehensive analysis was conducted of all paid malpractice claims, with linkage to physician specialty, from the National Practitioner Data Bank from January 1, 1992, to December 31, 2014, a period including an estimated 19.9 million physician-years. All dollar amounts were inflation adjusted to 2014 dollars using the Consumer Price Index. The dates on which this analysis was performed were from May 1, 2015, to February 20, 2016, and from October 25 to December 16, 2016.For malpractice claims (n?=?280?368) paid on behalf of physicians (in aggregate and by specialty): rates per physician-year, mean compensation amounts, the concentration of paid claims among a limited number of physicians, the proportion of paid claims that were greater than $1 million, severity of injury, and type of malpractice alleged.From 1992-1996 to 2009-2014, the rate of paid claims decreased by 55.7% (from 20.1 to 8.9 per 1000 physician-years; P?<?.001), ranging from a 13.5% decrease in cardiology (from 15.6 to 13.5 per 1000 physician-years; P?=?.15) to a 75.8% decrease in pediatrics (from 9.9 to 2.4 per 1000 physician-years; P?<?.001). The mean compensation payment was $329?565. The mean payment increased by 23.3%, from $286?751 in 1992-1996 to $353?473 in 2009-2014 (P?<?.001). The increases ranged from $17?431 in general practice (from $218?350 in 1992-1996 to $235?781 in 2009-2014; P?=?.36) to $114?410 in gastroenterology (from $276?128 in 1992-1996 to $390?538 in 2009-2014; P?<?.001) and $138?708 in pathology (from $335?249 in 1992-1996 to $473?957 in 2009-2014; P?=?.005). Of 280?368 paid claims, 21?271 (7.6%) exceeded $1 million (4304 of 69?617 [6.2%] in 1992-1996 and 4322 of 54?081 [8.0%] in 2009-2014), and 32.1% (35?293 of 109?865) involved a patient death. Diagnostic error was the most common type of allegation, present in 31.8% (35?349 of 111?066) of paid claims, ranging from 3.5% in anesthesiology (153 of 4317) to 87.0% in pathology (915 of 1052).Between 1992 and 2014, the rate of malpractice claims paid on behalf of physicians in the United States declined substantially. Mean compensation amounts and the percentage of paid claims exceeding $1 million increased, with wide differences in rates and characteristics across specialties. A better understanding of the causes of variation among specialties in paid malpractice claims may help reduce both patient injury and physicians' risk of liability.

Project description:ObjectiveTo describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors.Data sources/study settingSecondary data collected from The University of Texas System, which self-insures approximately 6,000 physicians at six health campuses across the state. We obtained internal case management data for all medical malpractice claims closed during 1 year before and 6 recent years following the enactment of state tort reform legislation.Study designWe retrospectively reviewed information about malpractice claimants, malpractice claims, and the process and outcome of dispute resolution.Data collection/extraction methodsWe accessed an internal case management database, supplemented by both electronic and paper records compiled by the university's Office of General Counsel.Principal findingsClosed claims dropped from 244 in 2001-2002 to an annual mean of 96 in 2009-2015, closures following lawsuits from 136 in 2001-2002 to an annual mean of 28 in 2009-2015, and paid claims from 60 in 2001 to an annual mean of 20 in 2009-2015. Patterns of resolution suggest efforts by the university to provide some compensation to injured patients in cases that were no longer economically viable for plaintiffs' lawyers to litigate. The percentage of payments relating to cases in which lawsuits had been filed decreased from 82 percent in 2001-2002 to 47 percent in 2009-2012 and again to 29 percent in 2012-2015, although most paid claimants were represented by attorneys. Unrepresented patients received payment in 13 cases closed in 2009-2012 (22 percent of payments; mean amount $60,566) and in 24 cases closed in 2012-2015 (41 percent of payments; mean amount $109,410). Even after tort reform, however, claims that resulted in payment remained slow to resolve, which was worsened for claimants subject to Medicare secondary payer rules. Strict confidentiality became a more common condition of settlement, although restrictions were subsequently relaxed in order to further transparency and improve patient safety.ConclusionsMalpractice litigation risk diminished substantially for a public university health system in Texas following legal changes that reduced rights to sue and available damages. Health systems operating in a low-tort environment should work with policy makers, plaintiffs' attorneys, and patient groups to assist unrepresented patients, facilitate early mediation, limit nondisclosure obligations following settlement, and expedite the resolution of Medicare liens.

Project description:BackgroundLittle is known about how U.S. physicians’ political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation.ObjectiveTo assess U.S. physicians’ impressions about the direction of U.S. health care under the Affordable Care Act (ACA), whether that legislation will make reimbursement more or less fair, and examine how those judgments relate to political affiliation and perceived social responsibility.DesignA cross-sectional, mailed, self-reported survey.ParticipantsSimple random sample of 3,897 U.S.physicians.Main measuresViews on the ACA in general, reimbursement under the ACA in particular, and perceived social responsibility.Key resultsAmong 2,556 physicians who responded (RR2: 65 %), approximately two out of five (41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA (OR 33.0 [95 % CI, 23.6–46.2]; OR 5.0 [95 % CI, 3.7–6.8], respectively), as were physicians reporting a salary (OR 1.7 [95 % CI, 1.2–2.5])or salary plus bonus (OR 1.4 [95 % CI, 1.1–1.9)compensation type. In the same multivariate models, those who agreed that addressing societal health policy issues are within the scope of their professional obligations (OR 1.5 [95 % CI, 1.0–2.0]), who believe physicians are professionally obligated to care for the uninsured / under-insured (OR 1.7 [95 % CI,1.3–2.4]), and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage (OR 2.3 [95 % CI, 1.8–3.0]), were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it (OR 0.5 [95 % CI, 0.4–0.7], OR 0.6 [95 %CI, 0.5–0.9], respectively).ConclusionsSignificant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation,type of medical specialty, as well as perceived social responsibility.

Dataset Information

Medical malpractice reform: noneconomic damages caps reduced payments 15 percent, with varied effects by specialty.

Publications

Medical malpractice reform: noneconomic damages caps reduced payments 15 percent, with varied effects by specialty.

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