Friday, October 31, 2008

Pennsylvania Is Driving Its Doctors Away

Blame Gov. Rendell if you can't find a physician

Gov. Ed Rendell is holding the legislature, physicians and patients of Pennsylvania hostage. His ransom is a universal health-care program that he wants to create and force doctors to pay for.

Health-care reform debates often center on how to make insurance affordable for patients. But in Pennsylvania we've had to confront how to make malpractice insurance affordable enough to keep doctors in the state.

Six years ago, prior to Gov. Rendell assuming office, Pennsylvania addressed that issue by passing tort reform. It also created M-Care (Medical Care Availability and Reduction of Error), a supplemental malpractice insurance program that every doctor in the state must pay into, but which pays malpractice claims that exceed the required basic liability coverage. M-Care replaced a state fund designed to pay judgments in excess of physicians' liability coverage.

The tort reforms have reduced the number of suits filed by preventing venue shopping, and by requiring an expert to certify the legitimacy of a malpractice suit. But they have not significantly reduced malpractice premiums. M-Care has helped lower the total burden only because the legislature has abated the supplemental premium in its entirety for high-risk specialists (neurosurgeons, orthopedic surgeons, obstetricians and general surgeons), and by half for all other physicians. Premiums for some specialties had risen to as high as 55% of a doctor's annual income. The reformed system came with a public benefit -- before receiving the subsidy a doctor had to promise not to move to another state within the next year.

M-Care was able to abate its premiums because there is a surplus of more than $500 million in reserves in a separate retention account (funded by a tax on cigarettes and fees on some traffic violations) that is growing by about $15 million a month. Money in the retention account is used if and as needed to abate physician premiums in M-Care.

Enter Mr. Rendell. He was a supporter of M-Care abatements in 2003. But now he's desperate to punch his health-care reform ticket by creating a universal health-care program, in hopes of landing a cabinet post if Barack Obama is elected president. He wants a program that would provide health insurance to individuals whose income is less than 300% above the poverty level, and to fund it he proposes raiding the surplus in M-Care's retention fund. The governor calls his program "Cover All Pennsylvanians." It will increase the cost of practicing medicine, make health care more expensive, and drive doctors out of the state.

And that will only continue a trend that M-Care may have slowed down, but hasn't stopped. The state Department of Health reported earlier this year that the number of practicing physicians in Pennsylvania is down 6% from a few years ago. Younger doctors just are not as willing to settle down in a state where liability payouts are twice the national average and physician income is 44th out of the 50 states. Today, about 7%-9% of our doctors are under 35. A few years ago, the number was 15% and in some specialties more than 40% of the practicing physicians are more than 50 years old. And less than 80% of physicians with active licenses are engaged in patient care.

Newly minted doctors educated here are setting up their practices elsewhere. In 1992, 60% of residents stayed in Pennsylvania when they finished their training. Now only 20% do so.

These trends will be exacerbated if M-Care funds are siphoned off. M-Care is not an inexhaustible source of revenue. It was created to help doctors afford the skyrocketing price of insurance, something it will not be able to do as effectively as it has in the past if it must also subsidize a new health-insurance program. I can say that because doctors are already paying more thanks to Mr. Rendell -- even though his health-care plan is still on the drawing board.

Why? Because Mr. Rendell wants his health-care program to be funded by the premiums doctors paid into M-Care, and he has threatened to veto any legislation that would block him from doing so. That's put M-Care in limbo. It can't offer doctors the same abatement it gave them the past four years without first getting authorization from the legislature. But the legislature doesn't have the votes to pass such an authorization over Mr. Rendell's veto threat.

The Republican-controlled State Senate passed legislation authorizing the subsidies for this year three times, but so far the Democratically controlled House hasn't. What's more, House leaders are planning to return after Election Day and may vote to give Mr. Rendell his health-care program. The end result is that this year my total liability premiums increased 40% over what I paid last year, when the M-Care portion was abated.

Pennsylvania's physicians are willing to provide health care for those who can't afford it. More than 90% of us accept Medicaid despite reimbursements that are obscenely low and have not been raised since 1989. But what I, and other doctors, object to is being extorted to fund the governor's sociopolitical agenda.

I hope the legislature resolves this unseemly debacle appropriately by directing M-Care to start spending its funds on the program's stated purpose (cutting the cost of liability insurance) before year's end. But in the meantime, if you are a woman with a high-risk pregnancy who is unable to find an obstetrician in the rural areas between Philadelphia and Pittsburgh, or if you can't find a neurosurgeon on trauma call in the two-hour drive from Pittsburgh to Erie, call Mr. Rendell. He can tell you about his plans to "cover all Pennsylvanians."


Australia: "Targets" followed by government cancer screener set to kill woman

Breastscreen patients who get letters stating their mammograms show "no visible evidence of breast cancer" cannot be sure they are risk-free until they see a GP or have an ultrasound, a court has found. In a "controversial and far-reaching" case, Christine Ann O'Gorman, 57, was awarded almost $406,000 damages in the Supreme Court in Sydney yesterday after she sued BreastScreen NSW - an arm of the Sydney South West Area Health Service - for failing to diagnose a cancerous tumour that spread to her lungs and brain.

Ms O'Gorman, who is terminally ill, had mammograms every two years from 1994 at BreastScreen but radiologists failed to detect that a lump in her left breast had almost doubled in size between her 2004 and 2006 scans, Justice Clifton Hoeben found. After each scan, the single mother from Moorebank was issued with a letter stating her results showed "no visible evidence of breast cancer".

In his judgment, Justice Hoeben said a letter from BreastScreen was not enough for women to rely on. "I am sure that many women who participate in the BreastScreen program believe that when they receive the pro-forma letter, the presence of cancer is excluded," he said. "That is clearly not the case. The documents which those women sign before undergoing a mammogram and the pamphlets available make it clear that there are significant qualifications applicable when a 'no visible evidence of cancer' result is communicated to them."

Justice Hoeben found that, had radiologists compared O'Gorman's 2004 and 2006 scans, the change in appearance of the lump would have been detected and would have prompted further tests. Instead, Ms O'Gorman felt the cancerous tumour herself in January last year. After seeing her GP and undergoing further tests, she was diagnosed with breast cancer and after chemotherapy her left breast was removed in August last year. The cancer has subsequently spread to her lungs and brain.

Supported in court yesterday by her partner Glen and daughter Kristy, Ms O'Gorman wept when Justice Hoeben awarded her $405,990.15. Outside court, she said she did not want her negative experience with BreastScreen to discourage women from having their breasts checked regularly through the service. But she said compliance standards that urge clinics to "keep down" the numbers of women recalled to less than 5 per cent should be abolished to allow "case by case assessments". "The system has to be changed because even if they miss just one person it's wrong," she said.

In a statement, the SSWAHS said they would be "considering the judgment very carefully".


No comments: