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October 2013 Archives

Health Care Costs Driven By Self-Dealing

As long as the physician deciding on the treatment for a patient's condition is also the one being paid to provide it, medicine will have an inherent conflict of interest that prevents patients from receiving the best care at an efficient price often increasing health care costs. While the self-interest of a car salesman is obvious to a potential buyer, the conflicting self-interests of the physician when recommending a course of treatment are not. The result is that treatment plan options are often presented based on the training and financial interests of the physician. As a result, patients often undergo treatments that fit the physician more than the patient. This has clinical and financial consequences. More efficient and patient centric care would result if the physician who provides the medical treatment advice not be the one paid for providing the recommended treatment. The question as to what treatment is best for the patient is a different question from what is the best treatment that this physician can provide for a patient.

Medical Malpractice Insurance Crisis Is Over

Medical malpractice insurance premiums have declined for the 6th straight year in a row for obstetrician-gynecologists, internists and general surgeons. Collective premium rates for these three medical specialties have fallen by about 2% each year. There is no current medical malpractice insurance crisis and continued efforts to further limit injured patients' access to the courts are not needed. There has been a 50% drop in malpractice claims since the supposed "liability crisis" in the early 2000s. The decrease in claims has resulted from tort reform that has been instituted in many states, but claims have also decreased in states that have not implemented such reforms.

Surgical Complications Rate Correlates with Peer Rating of Skill

Surgical complications correlate with a surgeon's skills as rated by his or her surgical peers. A study in the New England Journal of Medicine showed that the complication rates for bariatric surgeons were 3 to 5 times higher for surgeons rated in the lowest quartile (the lowest rated 25% of surgeons evaluated) compared with the highest quartile (the top rated 25% of surgeons evaluated). Twenty bariatric surgeons in Michigan sent in a representative videotape of a laparoscopic gastric bypass they performed and had their surgical skills evaluated by a panel of surgeons who did not know the identity of the surgeons on the videotape. Peer rating of surgical skills was accurate in so far as those surgeons who rated high had surgical complications of 5% compared with surgeons who rated low with complication rates of 15%. The increased surgical complications included leak, obstruction, infection and hemorrhage.

Primary Care Malpractice Claims Lead to Most Payments

Primary Care Malpractice claims against primary care physicians are more difficult to defend and lead to a higher percentage of paid claims. A recent study in the Journal of the American Medical Association (JAMA) reported a study of 7224 malpractice claims over a 5 year period in Massachusetts, with 551 arising from primary outpatient care. The study found that although primary care claims accounted for only 7.7% of claims, they were significantly more likely to be settled (35% vs. 20%) and/or result in a plaintiff's verdict (1.6% vs. 0.9%).

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