Local Physicians Struggling

Under Managed Care, Malpractice Burdens

By John Voket

This is the first part of a two-part story on how local physicians are dealing with escalating malpractice costs and diminishing compensation from the managed care industry.

Newtown resident Dr David Kloth, an advocate and renowned authority on interventional pain management whose practice treats nearly 40,000 patients annually, is seriously considering a career change — to real estate development.

Another local physician, Dr Lionel Brown whose specialty involves intricate hand surgery, recently stopped treating Medicare patients, and is forced to deny what he feels is appropriate care to many others because insurance underwriters are refusing to endorse the recommended procedures.

These two medical specialists represent the growing number of doctors and other related practitioners across America feeling the squeeze from this unsettling health care trend. Tens of thousands of physicians, technicians, nurses, and others are constantly under the demands of malpractice insurance carriers to pay higher premiums or deny certain types of care, while the managed care industry on the other hand continues to whittle away at compensation for increasingly expensive treatments.

A recent poll of Fairfield County physicians by the Fairfield County Medical Association (FCMA) demonstrates that doctors are steadily changing the way they practice medicine due to skyrocketing medical liability insurance costs. According to FCMA members Drs Brown and Kloth, these changes directly affect patient care, health care costs, and the future of the profession.

“I’m working with patients who are experiencing chronic pain, as well as with primary care physicians, specialists, oncologists…” Dr Kloth told The Newtown Bee earlier this week. “We’re talking about people with back pain, muscle pain, cancer pain. Of course some of the pain intervention procedures are high risk. They come with occasional complications, and infrequently with bad outcomes. We always take the utmost care with these patients but occasionally bad things occur.”

Dr Brown equates rapidly escalating malpractice fees to being held captive by the insurance industry, and if he doesn’t pay up ultimately it is the patients who suffer.

“We keep paying hostage fees [for malpractice coverage] and nobody is being served, nobody is being disciplined, and few patients are not appropriately reimbursed,” Dr Brown said. “And if they get through the process it can take years.

“Malpractice only serves to aggrandize the lawyers. It is not achieving the lawyers’ goal of ensuring the safety of patients — to make sure we are doing a good job,” he said.

In his experience, Dr Brown said malpractice awards are typically decided on an emotional argument.

“Many times these outcomes are out of the control of mere mortals. And in the end, most of the money goes to the legal team with a portion to the victim,” he continued. “Malpractice suits predominantly occur because a business needs to maintain a cash flow. This means a number of off-the-record settlements which are made from malpractice underwriters [and paid] out of exorbitantly priced premiums.”

Situation Critical

The FCMC has conducted the same survey for the past five years, and each successive survey has shown that the situation is worsening. More and more physicians have stopped performing high-risk procedures, removed themselves from HMO panels, declined to accept patients with Medicaid and/or Medicare insurance, lowered the number of high-risk patients they treat, raised patient fees when possible, increased the number of medical tests ordered to defend against medical liability claims, and reduced the amount of free care given to patients.

“When I started we would admit people to a hospital to have them benefit from the expertise of the entire medical community,” Dr Brown said. “This system as it is today is not a careful caretaker of health care. Private health care — the ability for an American to choose a doctor — is extremely in danger.

Mark S. Thompson, executive director of the FCMA agreed, saying the landscape for physicians has changed radically.

“Skyrocketing insurance premiums are forcing doctors to limit care and curtail free medical care,” Mr Thompson said.

Dr Kloth said he is holding off on modifying the way he and doctors in his group are practicing, for now. He said, however, that in order for his practice to obtain malpractice protection for two extremely effective pain management procedures, his personal premium will increase from $30,000 to $70,000.

“I don’t make $70,000 annually to perform these procedures,” Dr Kloth said. “And while these specific procedures are classified as last resort, they are proven to be highly effective.”

Noting that insurance premiums for some doctors have topped $180,000, the association has urged the state legislature to enact comprehensive changes in the way medical liability cases are handled by the courts. FCMA supports the concept of special health courts as an alternative to handling medical liability disputes.

The administrative nature of the initial claim-filing process would allow easier access to compensation for a greater number of injured patients, including those who could not afford a good attorney. Those claims not easily resolved through the administrative process would be referred to a special health court, which would be overseen by specially trained judges.

Expert witnesses would be hired by the court, rather than by parties to the case, eliminating any bias that might exist.

“A meaningful solution must be implemented; otherwise, we will find ourselves with an even greater reduction of medical services, a shortage of specialists, and increasingly higher patient costs,” said Mr Thompson. “We need medical liability reform that will address patient safety and quality of care without compromising accountability — we believe special health courts may provide a real benefit.”

Dr Kloth said if changes do not happen quickly at the federal level, he may join the ranks of highly-qualified specialists abandoning his field.

“I’ve been described as one of the nation’s leading physicians in my field…at the top of my game, and I want to get out of it,” he said. “I see the writing on the wall. There is nothing compared to the feeling I get when a patient comes to me and says I helped stop his pain, but I’m seriously looking at a new career in real estate development as a fall back; what the insurance industry is doing to doctors today is criminal.”

(The second part of this story will focus more directly on how the managed care process is affecting the levels and quality of patient care.)