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President-elect Trump: Part 6

Stanley Feld M.D.FACP, MACE

There has been no mention of the importance of tort reform in your proposal to replace Obamacare. President Obama made no mention of tort reform either.

Without medical malpractice reform your administration will not be able to reduce the cost of healthcare and increase the quality of medical care.

It is very difficult to institute malpractice reform. It is in direct opposition to the vested interest of plaintiffs’ malpractice attorneys and malpractice insurance companies. These two group have very powerful lobbies.

I have estimated that there is at least one trillion dollars of waste in our healthcare system because of over-testing, over-treating and over diagnosing as a result of the threat of malpractice lawsuits.

Malpractice insurance and the time and money spent in litigation has to be include in the one trillion dollar estimate. Ezekiel Emanual M.D., Obamacare architect, proposed an artificial threshold of significant cost savings in order to form a policy.

“ A useful threshold for savings is 1 percent of costs of healthcare, which comes to $26 billion a year. Anything less is simply not meaningful.”

One percent is arbitrary. It permits Dr. Emanuel to dismiss problems that cost the healthcare system less than $26 billion a year.

The validity of the data collection is of no concern to Dr. Emanuel. He says only $1.3 billion results in malpractice costs. He ignores over testing, and lawsuit costs.

He said,

“Health care spending in the United States typically increases by about $100 billion per year. Cutting a billion here or there from something that large is undetectable and meaningless.

 In health care, you have to be talking about tens of billions of dollars before you are talking about real money.

Dr. Emanuel has no difficulty in producing fake data to make his point to the unknowing.

 A study, closer to truth than just an opinion, disclosed:

The truth is a full accounting reveals that more than 10 percent of America’s health expenditures per year are spend on tort liability and defensive medicine.

This study concludes that $242 billion a year extra is spent because of the lack of tort reform.

The $242 billion is well above Dr. Emanuel’s fictitious threshold.

“Much of this waste is generated or justified by the fear of legal consequences that infects almost every health care encounter. The legal system terrorizes doctors. Fear of possible claims leads medical professionals to squander billions in unnecessary tests and procedures.

Physicians and nurses are afraid to speak candidly to patients about errors. They try to explain the risk reward ratio of treatments for fear of assuming legal liability. The result is the practice of defensive medicine and over testing to cover every possible contingency.

This legal anxiety is also corrosive to the therapeutic magic of the physician patient relationship.

It would be relatively easy to create new rules that would provide a reliable system of justice for patients harmed by medical treatments and procedures without encouraging costly litigation.

A new and effective tort reform system would decrease the costs of defensive medicine significantly. It would encourage physicians to use of clinical judgment rather than expensive tests. It would improve physician/patient relationships.

“ The good news is that it would be relatively easy to create a new system of reliable justice, one that could support broader reforms to contain costs.”

Everyone makes mistakes in every walk of life. The medical legal liability threat could result in further unnecessary errors. Physicians, nurses and hospitals are advised not to offer explanations about mistakes. Sometimes errors are concealed to avoid a legal ordeal. The hidden error could be compounded by additional mistakes.

“Even in ordinary daily encounters, an invisible wall separates doctors from their patients. As one pediatrician told me, “You wouldn’t want to say something off the cuff that might be used against you.”

There are cost multipliers created as mistrust accelerates between the patients and physicians. You would like physicians to adopt electronic medical records. Some physicians avoid using EMRs because the information could be misinterpreted and used against them.

The Electronic Medical Record available through hospitals systems or standalone physician practices is used by the government and the insurance industry to verify the treatment in order to guarantee treatment is best practice treatment.

Physicians are producing cut and paste reports to cover best practice observation by a third party rather than the actual encounter with the patient in order to avoid reimbursement penalty or possible liability.

There is an increasing use of second opinions. Every medical problem is requiring multiple unnecessary laboratory tests to rule out something that might have been missed in the evaluation of patients in order to avoid malpractice suits.

An example is a CAT scan done in Emergency Rooms for the slightest head trauma.

“Medical cases are now decided jury by jury, without consistent application of medical standards.

 According to a 2006 study in the New England Journal of Medicine, around 25 percent of cases where there was no identifiable error resulted in malpractice payments.

 The malpractice insurance companies want to settle the malpractice claims before the court charges mount.

“Nor is the system effective for injured patients — according to the same studies, 54 cents of every dollar paid in malpractice cases goes to administrative expenses like lawyers, experts and courts.”

These are some of the major tort reform issues that must be addressed in effectively.

They must be addressed to decrease wasteful expenditures in the healthcare system.

Malpractice lawsuits have been a growth industry for defense attorneys. The malpractice suits have also been a tremendous psychological and economic burden for physicians who have to defend themselves.

Politically is has been a tremendous economical burden to the healthcare system. In the past politicians have refused to acknowledge the economic burden to the healthcare system.

Malpractice reform is a threat to the vested interests of the defense attorneys and malpractice insurance companies.

Malpractice reform is essential to any meaningful healthcare reform.

President-elect Trump the big question is.

“Do you have the will and the courage to take on the plaintiff attorneys and the malpractice insurance industry in order to correct the medical tort reform system?”

 Effective Malpractice reform must treat both injured patients and physicians fairly.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

 All Rights Reserved © 2006 – 2015 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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