I'm a doctor. So sue me. No, really

The doctors' lobby says capping malpractice suits will make healthcare cheaper.
I'm an M.D. and I don't believe it
Salon.com
By Rahul K. Parikh, M.D.
Oct. 27, 2009

Flu season has come early and I'm writing far too many prescriptions for Tamiflu. I'm trying my best to adhere to the guidelines set by the Centers for Disease Control for who should get the drug (kids under 5 years of age, or kids who have a chronic illness like asthma or diabetes). But in more than a few instances, I've ignored the guidelines and given Tamiflu to perfectly healthy kids with no risk factors for influenza-related complications.

Part of the reason I'm writing so many extra prescriptions stems from stories about healthy people getting sick with H1N1 and ending up critically ill or dead. One of those stories aired recently on "60 Minutes" -- a healthy high school football player in Arkansas developed a fever after a game. He went to his doctor, who thought he had a garden variety flu and sent him home. Two days later, the boy collapsed and was airlifted to the nearest pediatric intensive care unit. He developed a bacterial pneumonia on top of his H1N1 flu, which led to severe damage to his lungs. He couldn't breathe on his own, so he remains in the ICU on a ventilator.

The H1N1 strain of influenza is no more lethal than any other strain of flu. Mortality is less than 1 percent. Nevertheless, by over-prescribing an expensive drug that has only marginal benefits, I'm unequivocally practicing what is known as defensive medicine. As in, the kind of medicine that protects doctors as much as patients.

Mine isn't an extreme example of defensive medicine. I'm a pediatrician. Obstetricians and emergency room doctors are sued at far higher rates, and would have more dramatic stories to share. But my motivations are the same as theirs: I'm afraid that if I don't do something, one of my patients may get sick or die, and I'll end up in court being asked why I didn't do everything I could have.

Defensive medicine is just one of the supposed systemic ills that doctors, doctors' lobbies and doctors' insurers invoke when they shill for what they call malpractice reform. Proponents of reform say that defensive medicine, frivolous lawsuits and high premiums are behind the surge in healthcare expenses. They insist that malpractice costs are forcing doctors to close their doors and depriving patients of care. Recently, three past presidents of the American Medical Association coauthored an opinion piece for the Wall Street Journal that bundled all of these arguments into an attack on the public option. Their piece attempted to shift the blame for America's healthcare crisis away from private insurers and onto a supposed scourge of ambulance chasers. "The nation needs comprehensive medical malpractice reform," they wrote. "It is the surest and quickest way to slow down the rising cost of healthcare."

Their refrain is familiar to anybody following the healthcare reform debate. The only problem is that it's not true. There's nothing "sure or quick" about changing medical liability laws that will improve healthcare or its costs. Defensive medicine adds very little to healthcare's price tag, and rising malpractice premiums have had very little impact on access to care.

Let's look at the numbers. First, based on the current rhetoric, it's easy to assume we have an epidemic of malpractice suits in America. We don't.

There are many statistics out there, and it's not always possible to make an apples to apples comparison between one study and another. Some surveys cover the nation, some cover one group of states, some cover another cluster, and results vary. But according to the Congressional Budget Office, nationally, between the mid-1990s to the mid-2000s, the frequency of malpractice suits per capita remained stable at about 15 claims per 100 physicians per year. Another report, from the National Center for State Courts, actually shows that the number of cases between 1996 and 2006 dropped 8 percent.
Quantcast

Although the payout per claim has increased, the Justice Department, in a 2007 report about medical malpractice -- in fact, the same report cited by the authors of the Wall Street Journal piece mentioned above -- provided an explanation quite different from an epidemic of lawsuits. "Growing healthcare costs and an increasing effort by many attorneys to litigate only those medical malpractice claims involving severe injuries or wrongful death claims may explain some of these increases," they wrote. Still, even with the rise in payouts, the Congressional Budget Office, using statistics from the government's Centers for Medicare and Medicaid Services, estimates that malpractice costs account for less than 2 percent of healthcare spending. Saving 2 percent of the over $2 trillion we spend on healthcare isn’t going to bend the cost curve.

Next is the question of frivolous lawsuits. Tort reformers push the notion that junk lawsuits dominate the legal system. The Wall Street Journal article cited above refers to studies that show that 80 percent of claims are settled without payment to the patient and that when a case does make it to trial, doctors win 89 percent of the cases.

But the private studies cited often involve small numbers of claims, or focus on a single hospital, insurer, specialty or type of injury, or were commissioned by interested parties, aka the malpractice insurers themselves. The 2007 Department of Justice study cited by the Journal trio covers only seven states, and nowhere does it mention the numbers 80 percent and 89 percent. Repeated attempts to contact and ask one of the authors of the WSJ story about the specific source of their data were unsuccessful. The DOJ report shows that in one state, Illinois, 88 percent of claims were closed without a payout. But for the other states it examined, the number was between 62 percent and 69 percent. Regarding the percentages of cases doctors win, a 2001 analysis by the Bureau of Justice Statistics, examining malpractice trends in the 75 most populous counties in the U.S., put that number closer to 70 percent.

In 2006, researchers from Harvard published a study in the New England Journal of Medicine that was designed to avoid the limits, and the biases, of prior research. What they found kills the notion of frivolous lawsuits. It suggests that most people who sue are suing for good reason.

Next page: Tort reformers neglect the fact that malpractice reform won't save one extra life

Healthcare system wastes up to $800 billion a year

Healthcare system wastes up to $800 billion a year
Mon Oct 26, 2009
By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.

The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters, found.

"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.

The CIO 50 West winners include David Hudson, VP IT, Keenan & Associate

Everything Channel Announces the CIO 50 West Winners
press release
Sept. 21, 2009

--New Recognition Honors IT Executives for Influence, Innovation and Ability to Collaborate with Integrators and Vendors

FRAMINGHAM, Mass., Sept 21, 2009 /PRNewswire-FirstCall via COMTEX/ -- Everything Channel, a division of United Business Media, today announced the CIO 50 West winners, a new recognition that honors IT executives for their influence, innovation and ability to collaborate with integrators and vendors. The awards were presented at Everything Channel's Midsize Enterprise Summit West 2009, which took place at the Hyatt Regency Century Plaza in Los Angeles, CA.

The CIO 50 West winners include:

1. Mohinder Chopra, SVP & CIO, OSI Systems
2. David Hudson, VP IT, Keenan & Associates
3. Tracy Cleeton, Director of IT, Saga Communications
4. Keenan Lersch, Technology Manager, American Railcar Industries
5. Thomas Smith, CTO, PSRS/PEERS of Missouri
6. Brad Cackler, IT Director, Micro Power Electronics
7. Dave McDowell, Director of IT, West Liberty Foods
8. Greg McLean, Director of Technical Services, Green Bay Packaging
9. Christopher Holda, Director, IT, Integrated Health Associates
10. Randy Nye, IT Manager, Oak Harbor Freight Lines, Inc.
11. Rita Lazar-Tippe, IS Manager, Edmonton Journal
12. Michael Gauthier, CIO, IMTT
13. Michelle George, First VP - Application Development, Securities America
14. Nathan Church, VP & IT Manager, Columbia River Bank
15. Dave Ploch, CIO/Director, IT, Novus International
16. Greg Katers, Director of IT, Green Bay Packaging
17. David Chin, Director of IT, Stanford Hotels Corporation
18. David Price, IT Director, Resource Management, Inc.
19. Michael Brown, VP of IS, Peter Piper Pizza
20. Neil Stewart, Director Technical Operations, QuikTrip Corp
21. Dirk Anderson, VP Technology, C R England
22. Paul Dupree, CIO, Assistant VP of I.S., Asbury College
23. Bruce Hagen, VP Corporate IS, Bemis Manufacturing Co
24. Robert Bence, VP, Technology, Southwest Credit Systems
25. Larry Freed, Vice President & CIO, Atrium Companies, Inc.
26. Seth Hansen, VP - IT, Daktronics, Inc
27. David Cresswell, Director, IT Planning & Strategy, British Columbia
Institute of Technology
28. Lawrence Frederick, CIO, University of the Pacific
29. Raman Krishnaswami, Director, IT, Healthcare Benefit Trust
30. John DeLuca, Director of Information Technology, Hydranautics
31. Craig Crosby, Director, Information Services, Procopio, Cory, Hargreaves
& Savitch LLP
32. Adam Farkas, VP IT, Crown Media
33. Leonardo Imana, Director of Technology, Adelman Travel Group
34. Sergey Bushlyar, CIO, IT Director, Paul Capital Partners
35. Neil Ferguson, Technology Director, Orrick, Herrington, & Sutclife
LLP
36. Peter Mills, Executive Director, Information Technology, Canadian
Tourism Commission
37. David Cropper, CIO, Mamiye Brothers
38. Susan Faulkner, Director, Information Systems and Technology, Bluewave
Energy
39. Eric Vlam, Director of Information Systems, Equipment Depot
40. Michael Gibbons, Director, Northeastern State University
41. Aaron Bukhari, CIO & CSO, SNC Lavalin Nuclear Inc.
42. Chris Daly, Director, Infrastructure & Application Support,
Corporation Service Company
43. Niel Nickolaisen, CIO, Headwaters, Inc.
44. Lawrence Frederick, CIO, University of the Pacific
45. Carl Gammon, Director, Information Systems, Minntech Corporation
46. James Fielder, Vice President Information Technology, Farm Credit
Services of Illinois
47. Matthew Sharp, Director of I.T., David and Lucile Packard Foundation
48. Brian Mackay, Associate VP and CIO, Thompson Rivers University
49. Nick Barakat, IT Manager, Clean Energy Fuels Corp

50. Gary Allen, Chief Technology Officer, Amarillo Independent School
District





The professionals comprising the CIO 50 West were chosen for their leadership in utilizing technology to help increase corporate efficiencies, drive revenue and achieve other key business goals within their midsize company or organization. In particular,

Obama attacks insurance companies for capping coverage and charging "outrageous fees"

http://www.reuters.com/article/healthNews/idUSTRE57D47P20090816?feedType=nl&feedName=ushealth1100
Sat Aug 15, 2009
By Jeff Mason and Matt Spetalnick

GRAND JUNCTION, Colorado (Reuters) - U.S. President Barack Obama reignited his criticism of health insurance companies on Saturday, promising reforms that would prevent firms from capping coverage or charging "outrageous" fees.

Traveling to a conservative area of Colorado, a western state that supported Obama in the 2008 election, the president continued his assault on companies that the White House has painted as being at the root of the country's healthcare woes while defending his proposals to fix the system.

"Insurance companies will no longer be able to ... place an arbitrary cap on the amount of coverage you can receive or charge outrageous out-of-pocket expenses on top of your premiums," Obama told the crowd of roughly 1,500 people.

"No one in America should go broke because they get sick," he said to loud applause.

The "death panels" are already here

Is our current system "downright evil"?

The "death panels" are already here

Sorry, Sarah Palin -- rationing of care? Private companies are already doing it, with sometimes fatal results
Salon.com
By Mike Madden
Aug. 11, 2009

The future of healthcare in America, according to Sarah Palin, might look something like this: A sick 17-year-old girl needs a liver transplant. Doctors find an available organ, and they're ready to operate, but the bureaucracy -- or as Palin would put it, the "death panel" -- steps in and says it won't pay for the surgery. Despite protests from the girl's family and her doctors, the heartless hacks hold their ground for a critical 10 days. Eventually, under massive public pressure, they relent -- but the patient dies before the operation can proceed.

It certainly sounds scary enough to make you want to go show up at a town hall meeting and yell about how misguided President Obama's healthcare reform plans are. Except that's not the future of healthcare -- it's the present. Long before anyone started talking about government "death panels" or warning that Obama would have the government ration care, 17-year-old Nataline Sarkisyan, a leukemia patient from Glendale, Calif., died in December 2007, after her parents battled their insurance company, Cigna, over the surgery. Cigna initially refused to pay for it because the company's analysis showed Sarkisyan was already too sick from her leukemia; the liver transplant wouldn't have saved her life.

That kind of utilitarian rationing, of course, is exactly what Palin and other opponents of the healthcare reform proposals pending before Congress say they want to protect the country from. "Such a system is downright evil," Palin wrote, in the same message posted on Facebook where she raised the "death panel" specter. "Health care by definition involves life and death decisions."

Coverage of Palin's remarks, and former House Speaker Newt Gingrich's defense of them, over the weekend did point out that the idea that the reform plans would encourage government-sponsored euthanasia is one of a handful of deliberate falsehoods being peddled by opponents of the legislation. But the idea that only if reform passes would the government start setting up rationing and interfering with care goes beyond just the bogus euthanasia claim.

Opponents of reform often seem to skip right past any problems with the current system -- but it's rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren't immune to difficulty...

SEC: Ex-AIG CEO Greenberg settles fraud charges
AP

By STEPHEN BERNARD, AP Business Writer Stephen Bernard, Ap Business Writer

August 6, 2009

NEW YORK – The Securities and Exchange Commission said Thursday that former American International Group Inc. CEO Maurice "Hank" Greenberg agreed to pay a $15 million fine to settle fraud charges.

The charges are tied to an accounting scandal earlier this decade at AIG that led to Greenberg's ouster in 2005. The following year, AIG paid more than $1.6 billion to settle charges of improper accounting.

The case is unrelated to the government bailout of AIG, which is in the process of trying to sell off assets to pay off the $182.5 billion in loans it has received since last September.

A spokesman for Greenberg was not immediately available to comment. An AIG spokesman declined to comment.

The SEC said AIG's former chief financial officer, Howard Smith, will pay a $1.5 million fine tied to the investigation.

In complaints against Greenberg and Smith, the SEC said the pair were responsible for making misstatements that falsely showed AIG met or exceeded earnings and growth targets between 2000 and 2005. The pair did not admit or deny any wrongdoing as part of the settlement.

Greenberg was forced out of AIG after charges that the company had engaged in deceptive accounting practices surfaced.

Greenberg, who built AIG over his 35-year career from a small company into the world's largest insurer, have been fighting in court in an unrelated case over who controls an employee retirement fund. AIG had accused Greenberg of plundering the AIG retirement program composed of $4.3 billion in stock through a company called Starr International Co. that Greenberg controls. A jury last month sided with Greenberg in the civil case saying he did not have to reimburse AIG for the stock, but the decision was only an advisory recommendation.

The judge hearing the case will make a final ruling on who controls the fund, and its purpose, by the end of the month. This case is also unrelated to the insurer's bailout by the government.

AIG is currently in the middle of a major overhaul as it looks to repay the government for the loans it received to avoid collapsing last fall at the peak of the credit crisis. In return for the loan package, which is worth up to $182.5 billion, the government received about an 80 percent stake in the insurance giant.

Vicki Forman's twins weighed only a pound at birth. She thought they should be allowed to die. Doctors disagreed

Born too soon
By Katharine Mieszkowski
Salon.com
July 25, 2009

After years of trying to conceive, writer Vicki Forman's twins were finally coming. Way too early.

Evan and Ellie were only 23 weeks gestation when Forman went into labor. They were so premature Forman thought she was having a miscarriage. At birth, each baby weighed only about a pound.

"One of life's great illusions is the notion that we can want -- and get -- things on our own terms, no matter what. It's human nature to seek pleasure and avoid suffering, but what happens when suffering finds you?" Forman writes in her harrowing new book "This Lovely Life: A Memoir of Premature Motherhood." "My husband and I had tried for two long years to conceive these twins, had lived through miscarriages and fertility treatments to bear them. When I learned they were coming so early and so fragile, I had only one wish: to let them go."

While Forman thought the twins should be allowed to die, their doctors struggled to save them. While Ellie lived for only four days, Evan, who endured severe disabilities including the inability to speak or see, died just shy of his eighth birthday...