Defensive Medicine Driving Up Healthcare Costs

Posted on: November 16, 2009  |   Author: Jamie
Filed Under: Access to Care, Fraud & Abuse, Health Information, Liability & Litigation, Other   |   Leave a Comment

There is a heated debate currently ensuing between doctors and lawyers about defensive medicine and its effect on the rising costs of healthcare in the U.S.  Doctors attribute the high costs of healthcare to the payments of malpractice insurance and malpractice lawsuit awards.  Trial attorneys, however, are blaming the rising costs on the practice of “bad medicine.”

Of the $2.5 trillion dollars spent each year on healthcare, doctors say that 10 percent of this amount is attributable to practicing defensive medicine and paying for malpractice insurance, while lawyers attribute less than .5 percent of this spending on payments for medical malpractice settlement costs.  Around 720 doctors who responded to a 2008 survey by the Massachusetts Medical Society reported practicing defensive medicine in fear of facing a malpractice lawsuit, estimating the cost of extra tests to be around $281 million and unnecessary hospital admissions around $1.1 billion.  A study by researchers at the Harvard School of Public Health and Columbia Law School performed in 2005 found 93 percent of the 824 doctors who participated reported practicing defensive medicine. Lawyers attribute the rising costs of healthcare to “bad medicine,” insisting that medical malpractice suits protect patients from the devastating effects of medical errors. Lawyers also feel that the extra tests involved in the so-called practice of defensive medicine are really fueled by the self-interest of the doctor, arguing that many doctors have a financial interest in laboratories that conduct extra tests or procedures creating a conflict of interest which could add to the level of unnecessary tests.

Congress is currently deciding how to curb the rising costs of healthcare. A 2009 Congressional Budget Office analysis estimates that government health care programs could save $41 billion over 10 years if national limits on jury awards for pain and suffering in malpractice suits were enacted, along with similar restraints.  Along with this approach, there has also been a drive for less adversarial approaches to limiting rising malpractice costs. The University of Michigan Health System uses a system in which doctors acknowledge mistakes and then offer compensation, causing malpractice claims to fall from 121 in 2001 to 61 in 2006.  Another movement, which has found less support with lawyers, is a campaign enacted in part by the Sorry Works! Coalition urging doctors to apologize for their wrongdoing and provide prompt compensation when appropriate.

Commentary: In the article, Dr. James Wang points out that he makes an effort to tell his patients when the treatments they may be considering are not necessary in order to keep the cost of providing care to a minimum. If the patients insist that they have the unnecessary test done though, Wang admits to ordering or performing the procedure in order to protect himself from a medical malpractice lawsuit later. Wang is among many doctors who admittedly perform defensive medicine in order to protect themselves from suits of medical malpractice. The catch here is that in many cases, doctors are not practicing “bad medicine” and are actually attempting to inform patients that the treatments they seek are not required for their health. In these, the majority of situations, if the choice comes down to protecting themselves from a lawsuit even though they practiced sound medical judgment or ordering tests even though they incur further unnecessary costs, how can society fault doctors for choosing to protect themselves?

msnbc.com, Nov. 4, 2009.

Organized crime’s new target: Medicare and Medicaid

Posted on: October 23, 2009  |   Author: Ali
Filed Under: Fraud & Abuse, Medicaid, Medicare, Other   |   Leave a Comment

Organized crime groups are learning that it is profitable to file fraudulent claims with the federal Medicare program and state-run Medicaid plans. Timothy Menke, head of the investigations for the Officer of the Inspector General (OIG) at the Department of Health and Human Services said “[t]hey’re hitting us and hitting us hard.”

Because governmental health programs largely operate on the honors system, it is relatively easy for organized crime rings to steal money at the tax payers’ expense. In order to defraud the government the criminals steal either the identity of doctors, who bill for services, and patients, whose beneficiary numbers entitle them to Medicare services.

OIG believes that they are on-track to recover $4 billion this year by breaking up health care fraud schemes commitede by all types of criminals including organized rings and corrupt doctors. However, according to the National Health Care Anti-Fraud Association, this amount is only about 5% of the estimated health care fraud costs.

CNN, October 22, 2009

Open Market for Organs?

Posted on: August 7, 2009  |   Author: Daniel
Filed Under: Access to Care, Bioethics, Fraud & Abuse, Health Information, Hospitals & Health Systems, Liability & Litigation, Public Health Policy, Technology   |   Leave a Comment

In New York, the average waiting period for a kidney transplant is nine years. The only legal option for those who choose not to or cannot survive this extended period of time is to find someone willing to voluntarily donate an organ. The options are limited based on the fact that, currently in the United States, it is illegal to buy and sell organs. Despite similar bans in most developed countries, there remains a worldwide market for transplantable organs. As such, the World Health Organization estimates that 10% of the 63,000 kidneys transplanted worldwide each year from living donors have been bought illegally.

In 2008, authorities in India broke up an illegal ring involving doctors, nurses, paramedics, and hospitals that had performed 500 illegal transplants of organs to wealthy Indians and foreigners. Among the donors, most were poor laborers who were paid as much as $2,500 for a kidney, while some were forced to surrender their organs at gunpoint.

Recently, a Brooklyn businessman and self-proclaimed “matchmaker,” was arrested in New Jersey for trying to broker the purchase of a kidney for $160,000. Levy-Izhak Rosenbaum told an undercover investigator that he had been successfully brokering the sale of organs for 10 years. Rosenbaum would concoct a fake relationship between the donor, usually from a poor community, and the recipient, so that the donor could pass the hospital’s psychological screening interviews prior to surgery.

Dr. Michael Shapiro, the chief surgeon at Hackensack University Medical Center’s transplant unit, said he suspects that many would-be live donors are looking to be paid for their body parts, but fear getting caught. According to Dr. Shapiro, sometimes it is necessary to sit down with the donor and receive assurances that he or she knows that it is illegal to sell organs. However, as doctors are becoming more aware of the practice of selling organs, many feel powerless in deciphering the true motive of the donors. He notes that doctors are not educated in interrogating donors to prevent schemes like Rosenbaum’s.

Living organ transplantation has opened up a Pandora’s Box of questions that no government has been able to answer. For years, the World Health Organization has been weighing the possibility of legalizing organ sales, but the issue continually sparks intense debate.

Commentary: The average person waits five years for a new kidney, which is an amount of time that many cannot afford. An estimated 10-20 people die every day waiting in vain for their new organ. If voluntary organ donations were sufficient to satisfy the donation list, the supply of organs would be large enough to satisfy demand, and there would be no need to change the present system. However, with the demand for organs far outnumbering the number of donors, many economists and health care professionals are taking a controversial stance by urging the adoption of market-based innovations. It is the opinion of this blogger that, in the United States, there are already markets for blood, semen, human eggs, and surrogate wombs. Merely extending markets to include other organs, which can be obtained with reasonable safety, could be beneficial. An open American market in organs would sharply curtail the present black market and ensure the highest-quality medical care. However, there must be a systematic approach to eliminate coercion and establish a fair market price. This would protect those who are currently most vulnerable and ensure that all parties involved would receive the intended benefit.

N.Y. Times , July 29, 2009

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