WhiteCoat

Healthcare Update — 11-19-2010

Malpractice environment in Texas improves, doctors flock to state. In the three years after tort reform took place in Texas, 7000 doctors applied for Texas medical licenses. Malpractice environment in Illinois stays bad, doctors leave. According to a recent Northwestern University study (.pdf file, see story here), 70% of medical students who planned to leave Illinois after graduation cited Illinois’ “anti-doctor liability environment” as playing a role in their decision. The study predicts that rural communities in Illinois will remain underserved due to lack of physicians. So which is more important, perfect care or available care?

St. Joseph Hospital in Baltimore pays $22 million to settle claims that it was performing unnecessary cardiac stenting procedures in patients. Three cardiologists who blew the whistle on the hospital get a cut of the settlement. That leaves the hospital with only 101 more lawsuits to defend due to the allegations.

Can computers help curb “unnecessary tests”? According to the Institute for Clinical Systems Improvement, a computer program has reportedly saved Minnesota $28 million per year by “eliminating thousands of unnecessary tests.” The project in Minnesota discovered that physicians chose clinically unuseful testing approximately 10% of the time, so insurers agreed to forgo prior authorizations for testing if doctors used the program. Two problems with the system and the article mentions them: Defensive medicine and patient satisfaction. If doctors perceive that they are going to reduce liability by ordering the test, they’re going to order the test, and if doctors are getting graded by how happy they make patients, when patients want the test, doctors are going to order the test. Despite the shortcomings, the program has been so successful that the federal government is considering whether or not to implement it on a national basis.

New York woman wins $3.5 million in a jury trial after requiring lower leg amputation due to “emergency room delays” in treating a knee dislocation.

Team Health, one of several national emergency department staffing companies, had third-quarter profit that was up 30% due to recent acquisitions and improved contract volume.

University of Minnesota’s medical malpractice cases going down, but costs remain stable. The University spent $4.3 million to defend 42 claims filed against the University since 2005. It spent almost $740,000 to get 16 cases dismissed before trial and spent another $2.5 million settling and defending 15 other cases. Four cases went to trial and the University won all of them. The numbers in the article don’t add up, but do give at least an idea of what it costs to defend malpractice cases.

Good way for insurers to make lots of money: Collect premiums, insure patients, don’t pay (or underpay) claims for a few years, then go bankrupt. California insurer La Vida did just that, sticking many emergency medical providers with years of unpaid bills.

Some people go to the emergency department and get treatment for bedbug bites … some people go to the emergency department and get bedbug bites. Bedbug infestation found in two rooms at a Milwaukee emergency department. Ewwwwww. How many people started itching after reading this? I can only imagine what the Medical Marijuana Advocates are going say about that one.

Interesting factoid from across the pond. In Great Britain, 23% of all cancer cases, including up to 50% of leukemia and brain tumor patients, are initially diagnosed in the emergency department.

New Yorkers have drinking problems? Emergency department visits for alcohol-related issues in New York increase 250% from 2003 to 2009.

Identity theft ring hits Florida emergency departments. Employee accessed more than 1,500 files and printed patient information which was later sold to other criminals who used the data to obtain fraudulent credit cards and debit cards. With criminal charges that range from 10 to 20 years per count, these citizens can expect a permanent room at the Greybar Motel.
Reading through the archives, another man, Ruben Rodriguez, was sentenced to 11 years in prison for selling patient information this past October.

Ya think? Researchers discovered that “differences in hospital surveillance methods affect the quality of public reporting of bloodstream infections on hospital report cards.” In fact, in this study, the hospital that reported the lowest overall infection rates had the highest infection rates when surveillance methods were standardized. The researchers could have saved their troubles by looking at some real investigative blogging on the topic.

14 Responses to “Healthcare Update — 11-19-2010”

  1. Matt says:

    “Malpractice environment in Texas improves, doctors flock to state. ”

    Physicians per capita by state:

    http://www.statemaster.com/graph/hea_tot_non_phy_percap-total-nonfederal-physicians-per-capita

    Texas – tied for 40th

    Illinois – 14th.

    Good call, WC. Texas is kicking their butt!

    I also like this statement:

    “The numbers in the article don’t add up, but do give at least an idea of what it costs to defend malpractice cases.”

    Our math doesn’t work, but trust me! At what point do you care about your credibility WC? The insurers estimate to take one to verdict costs about $100K, btw.

  2. Matt says:

    You also forgot to mention where they were “flocking” from. I believe a significant amount of the flock are from states that already had your “reform”. Since you are a believer that correlation equals causation, I guess we can conclude tort reform in those states is a failure. Now those people don’t have available OR perfect care. Using your logic of course.

    Maybe we should get some “reform” that keeps physicians from suing health insurers for billions as they have lately on the theory it would reduce the health insurance premiums of us patients? You’d support that, right?

    Tell me, when you’re regurgitating insurer half truths, do you feel a little sick inside?

  3. Anonymous says:

    The first bit of this post is clearly fuzzy statistics. 7000 doctors applied, yet there’s no indication in the article what the number was BEFORE tort reform. So for all I know it originally was 10,000 and tort reform is bad.

    “70% of medical students who planned to leave Illinois after graduation”

    Yes now tell us what percent of total graduates said they plan to leave at all. If this is 70% of 5% then who care?

    • Andrew says:

      The Illinois story surveyed 561 students, 50% of whom were interested in leaving the state.

      The Texas number needs to be fleshed out. For the most part, the defense of tort reform will be anecdotal. When I entered my clinical rotation, defensive medicine literally became part of the curriculum, especially in the OB/GYN clerkship. We were explicitly told which tests had to be ordered to fend off law suits.

      • WhiteCoat says:

        In Texas, “licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before.”
        http://www.nytimes.com/2007/10/05/us/05doctors.html?pagewanted=1&_r=1

      • Matt says:

        That’s actually a 3 year old article. But you’re right, it does appear that for a few years at least, Texas’ physician growth kept up with its population growth. It also has a correlation/causation, issue, but even if you assume as you do that there is a cause, it’s not exactly a ringing endorsement since more patients is going to naturally mean more jobs.

      • Matt says:

        “50% of whom were interested in leaving the state.”

        This is the problem with surveys being cited as authoritative: “were interested in”. I’m “interested in” living on the beach in San Diego, but that doesn’t really tell you much about the reality of my situation.

      • Andrew says:

        To clarify: “Results of the 2010 New Physician Workforce Survey, along with documented demographics by the AAMC, indicate that approximately half of new physicians who complete their training in Illinois will leave the state to practice.”

        Interestingly, 4% are planning on moving to Texas.

        I don’t think anyone can argue that malpractice is the TOP reason for moving to a state, but its certainly factored in.

      • bk, MD says:

        as a very recent IL med school graduate, the missing piece of these statistics are what percentage of med school students are originally from out of state?

        At my school, my year the percentage was about 60%. the year before me was %70 percentage. the year after me was the first year in nearly 2 decades where in state students outnumbered out of state students. the biggest feeder state was by far california. take a wild guess how many of these out of state students planned on returned home.

        to my knowledge, all of the med schools, with the exception of UIC, had a majority of out of state students my year.

  4. SeaSpray says:

    Does anyone know why bedbug infestations are on the rise?

    It just seems that we should have the ability to prevent this from spreading.

    I never took the idea of bedbugs seriously. Anyone remember hearing “Sleep tight – don’t let the bedbugs bite!” when growing up. I thought that was just a joke.

    Why can’t they just eradicate them once and for all? They are showing up all over the place in NY. Why?

  5. ThorMD says:

    Just curious, did you guys know that a person with a normal pulse in their foot is showing “subtle signs of ischemia”? That’s what the plaintiff’s expert testified to during the trial cited above in which the plaintiff was awarded $3.5 million in the NY knee dislocation case.

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