Dropped Medical Malpractice Claims: Their Surprising Frequency, Apparent Causes, and Potential Remedies by Dwight Golann :: SSRN

July 28, 2011

Most medical malpractice claims are not won or lost in court, or settled. Instead, they disappear, abandoned by the plaintiffs who bring them.

A study of 3,605 malpractice claims closed in Massachusetts between 2006 and 2010 showed that in 45.4 percent of malpractice cases and 56.8 percent of claims against individual doctors, plaintiffs eventually dropped the case or claim without a decision or recovery. This did not occur, however, until defendants had incurred defense costs of more than $25,000 per claim and $44,000 per case; there was also significant stress and other non-monetary costs for both patients and doctors. Defense costs escalated rapidly between the second and fourth year a claim was pending; abandoned claims in the study were pending for an average of 2.7 years before being closed.

Most of the abandoned malpractice claims in the study were not frivolous. Sixty percent of abandoned claims had gone through the state’s medical malpractice tribunal, and of those 27 percent were rejected as inadequately supported.

The study included interviews of plaintiff lawyers, which show numerous reasons for plaintiffs’ decisions to abandon a claim. The most common is that malpractice cases are complex and their validity is therefore difficult to ascertain before discovery processes occur. Unfortunately the legal system is adversarial and inefficient, with both plaintiffs and defendants commonly withholding information and avoiding serious discussion about settlement, often for years.

The article argues that patients and doctors have a joint interest in finding a better process, and notes that there are models for how this could be done. One is the Toro Company, maker of power tools, which reformed its claims process and realized large savings as a result. The University of Michigan hospital system has taken a similar approach to allegations of medical malpractice. It investigates adverse outcomes, explains its findings to patients and their lawyers, commits to using what it has learned to improve patient care and, when appropriate, offers fair compensation.

Traditionally insurers have expressed concern that if the litigation process is streamlined plaintiffs will assert more weak claims. In fact after the University of Michigan changed its approach its malpractice cases declined by 36 percent, and the average cost of resolving a case dropped 44 percent, from $410,000 to $228,000. Some of this improvement was likely due to the fact that the Michigan program improved its quality of care as well as changing how it handled claims.

The article suggests that plaintiff malpractice specialists, who accounted for a large proportion of the abandoned claims in the study, work with insurers and hospitals to develop ways to exchange information and discuss settlement efficiently. Such reforms would substantially reduce the frequency and duration of dropped claims and substantially reduce the cost of medical malpractice litigation.

More at Dropped Medical Malpractice Claims: Their Surprising Frequency, Apparent Causes, and Potential Remedies by Dwight Golann :: SSRN.


Implementation of Medicare Part D and Nondrug Medical Spending for Elderly Adults With Limited Prior Drug Coverage, July 27, 2011, McWilliams et al. 306 (4): 402 — JAMA

July 27, 2011

Implementation of Part D was associated with significant differential reductions in nondrug medical spending for Medicare beneficiaries with limited prior drug coverage.

More at Implementation of Medicare Part D and Nondrug Medical Spending for Elderly Adults With Limited Prior Drug Coverage, July 27, 2011, McWilliams et al. 306 (4): 402 — JAMA.


The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes – The Commonwealth Fund

July 27, 2011

In this Commonwealth Fund–supported study, researchers found that an increase in nurse staffing hours was associated with lower deficiency scores—and thus improved quality of care—in Florida nursing homes. Such findings, when reported on public Web sites, can help families make informed decisions when shopping for long-term care.

More at The Influence of Nurse Staffing Levels on Quality of Care in Nursing Homes – The Commonwealth Fund.


Promising Payment Reform: Risk-Sharing with Accountable Care Organizations – The Commonwealth Fund

July 27, 2011

The Medicare Shared Savings Program, a component of the Patient Protection and Affordable Care Act, has accelerated the creation of accountable care organizations (ACOs), payer–provider alliances meant to deliver lower-cost but still high-quality health care via new payment models, particularly ones that reward efficiency. This paper describes and reports on the implementation of eight private ACOs that use, or are planning to deploy, a shared payer–provider risk payment model. Still in an early developmental phase, these payment models vary not only in their design and in how they define shared risk. The authors note that providers currently lack the infrastructure required to take on and manage risk successfully, though some payers are providing such support. Providers will need more data and analytic capabilities to manage the patient populations for which they take on financial risk and to negotiate appropriate risk-sharing arrangements with payers.

More at Promising Payment Reform: Risk-Sharing with Accountable Care Organizations – The Commonwealth Fund.


Boldrin and Swamidass: A New Bargain for Drug Approvals – WSJ.com

July 27, 2011

In the first half of this year, the Food and Drug Administration approved 20 new drugs, putting it on track to double the number approved last year. But in an industry that annually invests nearly $70 billion in drug development, there’s no reason we can’t approve 10 times more new drugs each year. Driven by genomic sequencing and other new technologies, the coming revolution in precision medicine requires a new system capable of delivering new drugs at this scale as soon as possible.

More at Boldrin and Swamidass: A New Bargain for Drug Approvals – WSJ.com.


Medicare To Examine Quality Of Care At Outpatient Surgery Centers – Capsules – The KHN Blog

July 27, 2011

The quality of care at outpatient surgical centers has remained a mystery even as their number has swelled to more than 5,000. But as Medicare moves toward taking quality into account in setting payments, it’s going to start looking at the rates of problems at these facilities, formally known as ambulatory surgery centers, or ASCs.

Starting in October 2013, Medicare’s ASCs payments would be affected by how they score on these measures.

More at Medicare To Examine Quality Of Care At Outpatient Surgery Centers – Capsules – The KHN Blog.


Rural Americans face greater lack of healthcare access | Reuters

July 27, 2011

A panel of health experts on Wednesday emphasized technological innovations as a way to improve healthcare in rural areas, after a study showed problems in those regions could be aggravated by new laws.

The study showed rural Americans already are more likely to suffer from chronic health conditions and face greater difficulty accessing quality healthcare than urban counterparts.

Patients in rural communities face greater rates of diabetes, heart problems and cancer but receive lower quality healthcare, the Wednesday report by the UnitedHealth Center for Health & Reform Modernization found.

More at Rural Americans face greater lack of healthcare access | Reuters.


Access to Health Care Benefits for Gay Partners Is Gauged – NYTimes.com

July 27, 2011

In the first comprehensive count of domestic partner benefits by a federal government agency, the Bureau of Labor Statistics found that about one-third of all workers had access to health care benefits for same-sex partners.

More at Access to Health Care Benefits for Gay Partners Is Gauged – NYTimes.com.


AARP backs bill to extend new rules on insurers’ spending – The Hill’s Healthwatch

July 27, 2011

AARP endorsed a bill Tuesday that would impose tighter limits on supplemental health plans that are often sold under the AARP brand.

The seniors’ lobby backed a bill that would extend the healthcare law’s medical loss ratio (MLR) provisions to Medigap plans. The new law requires traditional plans to spend 80 to 85 percent of their premiums on medical care. Medigap policies are subject to a lower limit.

More at AARP backs bill to extend new rules on insurers’ spending – The Hill’s Healthwatch.


The Labor Market Impact of Employer Health Benefit Mandates: Evidence from San Francisco’s Health Care Security Ordinance by Carrie Colla, William Dow, Arindrajit Dube :: SSRN

July 27, 2011

A key issue surrounding employer benefit mandates is the incidence on workers through wages and employment. In this paper, we address this question using a pay-or-play policy implemented in San Francisco in 2008 that requires employers to either provide health benefits or contribute to a public option health plan. We estimate the impact on employment and earnings for the private sector overall, as well as for high impact sectors: retail and accommodation and food services. We develop a novel approach for individual case studies by combining both spatial discontinuity in policies and permutation-type inference using other MSAs. We find that, compared to control counties, employment and earnings patterns in San Francisco did not change appreciably following the policy. This was true for industries most affected by the mandate, as well as for overall private sector employment. The results are generally robust to inclusion of different control groups, county-specific time trends, and varying pre-periods. In contrast to the small effects on the labor market, we do find that about 25% of surveyed restaurants imposed customer surcharges, with the median surcharge being 4% of the bill. These results indicate that while little of the burden of the mandate fell on San Francisco workers, approximately half of the incidence of the mandate fell on consumers.

More at The Labor Market Impact of Employer Health Benefit Mandates: Evidence from San Francisco’s Health Care Security Ordinance by Carrie Colla, William Dow, Arindrajit Dube :: SSRN.