We just went through our Joint Commission site survey and I have a few thoughts after doing this as a medical director. The Joint Commission for the Accreditation of Healthcare...
There are a lot of variables that go into the cost of medical malpractice premiums. One variable that is often overlooked is geography. The cost of premiums can vary tremendously from one part of the country to another and can even vary from one part of a state to another. For hospital medical directors seeking to recruit physicians, it is important to be aware of these differences since it will impact your hospital’s competitiveness for recruitment.
75% of physicians in low risk specialties and 99% of physicians in high risk specialties are named in a malpractice case by age 65. Even though most cases never go to trial and those that do go to trial are more often won by the defense, malpractice is very expensive with an estimate that the overall cost of $31/American per year and if the cost of defensive medicine is factored in, it is $174/American per year. In obstetrics alone, 1 out of every 3,711 births results in a malpractice claim resulting in the cost per delivery just to cover malpractice liability being $296.
Let’s take a look at the spectrum of annual costs for malpractice premiums across the United States:
Even within a state, there can be huge differences in premiums. In Ohio, for example, malpractice premiums are significantly higher in Northeastern Ohio (Cleveland area) than in Central Ohio (Columbus area):
So why the differences? Different states have different tort laws making it easier or harder for malpractice lawsuits to be filed. There are also state-specific monetary limits on damages that can vary considerably. As a general rule, states that have passed tort reform laws have fewer malpractice claims filed and lower overall pay-outs to the plaintiffs. Primarily for this reason, malpractice claims have been dropping over the past 20 years.
The penetration of hospital employment models also affects the vulnerability of physicians to malpractice suits and the overall cost of a given malpractice case. For example, in a community where physicians are mostly in private practices, if several physicians plus the hospital are all named in a suit, then each has to have their own attorney and expert witnesses, increasing the overall cost to defend the suit. Additionally, there can be finger pointing among the different physician named which makes the plaintiff attorney’s job easier. Where most physicians are hospital-employed, the physicians and hospital can mount a common defense and there is no finger-pointing.
In some states, certain physicians can claim “immunity” and thus not be personally named in a suit. This primarily happens with government-employed physicians, including those of us employed through the Ohio State University. In this case, the hospital is named but the individual physicians may not be. Additionally, in Ohio (for example), there are two court systems that hear malpractice cases: the Court of Common Pleas (cases decided by jury) and the Court of Claims (cases decided by a judge without a jury). Malpractice cases involving teaching physicians and government-employed physicians go to the Court of Claims where large payouts based on emotionally sensitive juries are avoided. In states without these provisions, malpractice cases are more common and more expensive.
Lastly, there can be regional cultural differences in patients’ willingness to sue physicians and in the community’s (and thus the juries’) likelihood of deciding in favor of the plaintiff. This plays out in Ohio where 50% of all malpractice cases in the state arise from the Cleveland area and as a consequence, malpractice premiums are higher there.
The regional variation in malpractice does result in regional variation in medical costs to the consumer. For example, let’s look at the difference in obstetrics in Long Island, NY versus Central California. The table below is what Medicare pays for obstetric services in the two regions; most commercial insurance companies will base their reimbursement for obstetric care off of what Medicare will pay. Obstetric costs are considerably higher in Long Island than in California (in keeping with the differences in malpractice premiums as mentioned earlier).
However, since the cost of malpractice premiums is nearly $200,000 more per year in Long Island, an obstetrician in Long Island would have to do 400 more deliveries per year than an obstetrician in California and that is just not humanly possible.
So if your hospital is looking to hire a physician, know what your state-specific and region-specific malpractice insurance will cost that physician because it will affect how that physician will look at a job at your hospital. To hear more about medical malpractice, check out our OSU MedNet webcast on malpractice.
August 2, 2016