Oncology Expert Witness On Malpractice Insurance Part 1

In Malpractice Premiums Drop for 6th Straight Year, oncology expert witness Dr. Judy L. Schmidt writes:
Judging by 3 representative specialties, physicians in 2013 are once again experiencing relief on malpractice insurance premiums.

Collective rates for obstetrician-gynecologists, internists, and general surgeons fell on average for the sixth straight year in 2013, according to an annual premium survey released this week by Medical Liability Monitor (MLM).

The decrease is only 1.9%, a tad more than the 1.7% decline in 2012. However, one group views the ongoing premium shrinkage as more evidence that organized medicine’s push for tough medical-liability tort reform, such as limits to noneconomic damages, is much ado about very little.

“It makes sense that premiums are going down because malpractice litigation is going down,” said Taylor Lincoln, a research director for the consumer watchdog Public Citizen, in an interview with Medscape Medical News. Lincoln’s organization announced in August that the number of malpractice payments on behalf of physicians as reported to the National Practitioner Data Bank fell for the ninth consecutive year in 2012. Public Citizen maintains that malpractice litigation cannot be blamed for runaway healthcare costs.

Asked to comment on the numbers from MLM, the American Medical Association (AMA) issued a statement from its president, Ardis Dee Hoven, MD, to Medscape Medical News:

Although the 2013 Medical Liability Monitor [survey] suggests decreases in premiums have become more common than premium increases, they pale in comparison to the magnitude of the increases experienced during the most recent liability crisis,” said Dr. Hoven. “We are committed to testing alternative reforms, such as safe harbors for the practice of evidence-based medicine, to determine if these innovations can improve patient care and reduce costs.

The AMA, she said, “continues to work for proven reforms to rein in the broken medical liability system, reduce the growth of healthcare costs, and preserve patients’ access to medical care.”

Chad Karls, an actuary who summarized premium trends in an article for MLM, sees both sides of the argument. For proponents of tort reform, “the wind has been taken out of their sails a little bit,” said Karls, a principal and consulting actuary for Milliman. “Premium costs are lower than what they were a decade ago. However, it doesn’t necessarily mean that they shouldn’t be lower.”

Falling premiums, Karls told Medscape Medical News, reflect a roughly 50% drop in malpractice claims per physician since the liability crisis in the early 2000s that the AMA references. In both 2003 and 2004, premiums shot up roughly 20%, according to MLM. State-level tort reform accounts for some of the decrease in malpractice claims, Karls said. However, claims frequency also has declined in states that lack such laws.
The 1.7% drop in premium rates this year for the combined specialties of obstetrics-gynecology, general surgery, and internal medicine, Karls noted, applies more or less to each individual specialty as well. In other words, it isn’t as if decreases for 2 specialties erased an increase for the third.