Tuesday, May 24, 2011
QD: News Every Day--Emergency doctors seek tort reform
The American College of Emergency Physicians (ACEP) is calling for malpractice reform in the emergency department to protect physicians and lower health care costs.
In the organization's recent poll, 44% of emergency physicians said the biggest challenge to cutting emergency department costs is the fear of lawsuits, and 53% said they conduct so many tests for fear of being sued. Also, 68% of respondents said there has been no improvement in the number of medical specialists willing to take call in the emergency department since health care reform legislation passed last year.
When the emergency physicians were asked what they believe is the biggest challenge to cutting emergency department costs, they responded:
When they were asked why emergency physicians conduct the number of tests that they do, they responded:Estimates on the costs of defensive medicine range from $60 billion to $151 billion per year, the organization wrote in a press release, while the total costs of emergency care were $47.3 billion in 2008, or 2% of all health care spending.
The organization, based in Dallas, cited its home state's tort reform as a model to follow. ACEP stated that since Texas passed liability reform in 2003:
--33 rural counties have added at least one emergency physician, including 24 counties that previously had none, the organization said,
--Texas saw the second biggest improvement for emergency department wait times among all states, according to a 2010 report from Press Ganey, and
--Texas improved access to medical care despite the highest uninsured population in the nation.
Whether tort reform in Texas succeeded or did not is up for discussion.
Yet, ACEP supports legislation proposed in the U.S. House of Representatives, H.R. 5 and H.R. 157, which are both aimed at liability reform. H.R. 5 would. among other things, cap noneconomic damages in lawsuits at $250,000, while H.R. 157 would extend to all emergency physicians the same legal protection that physicians in the Public Health Service have.
ACEP president, Sandra Schneider, MD, also raised the specter of quality measures for medical care, which are designed to discourage the overuse of testing but might open physicians to litigation, said Dr. Schneider. "For example, under new CMS guidelines, the use of head CTs is being discouraged. Fewer head CTs will mean that physicians miss maybe 1% of serious head bleeds. So a small percentage of people with head bleeds will be missed, and there are no liability protections for those physicians who may be sued as a result."
ACEP conducted the poll in March by e-mail to 20,687 emergency physicians, and 1,768 responded. The survey has a theoretical sampling error range of plus/minus 2.23.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
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One of the most popular anonymous blogs written by an emergency room physician.