Washington is hyperactive these days over healthcare and medical malpractice reforms. Just several days ago Health Caucus Chair Rep. Burgess prescribed a medical liability reform that would cap damages to injured patients. But such a proposal misses the main point: healthcare costs continue to rise because current medical liability policy fails to encourage compliance with evidence-based medicine. It can take up to 17 years for physicians to implement cutting edge procedures.
These are serious problems. Health care costs are estimate at $2.4 trillion dollars which is about 17-18 percent of the GDP, a percentage which is twice as much as any other country in the World. Medical errors are estimated to be associated with up to 98,000 deaths every year, about twice as many as from car accidents. Anyone who cares must ask whether there is any way Congress can be helpful.
A step in the right direction was taken last month when President Obama hinted that he favored making medical liability reform part of broader healthcare reform which will encourage evidence-based medicine. Also encouraging, the American Medical Association's incoming president proposed that doctors should be exempt from liability for following medical guidelines.
The problem -- and it's significant -- is that current guidelines by and large do not work, because they are not produced under the appropriate incentives. Without appropriate incentives, costs savings will not be achieved and immunity for doctors from medical malpractice cannot be justified.
Instead, private firms which create evidence-based guidelines offering liability protection to complying doctors could decrease malpractice lawsuits.
Currently, various professional medical organizations -- such as the American Heart Association -- create guidelines for medical practice. But a recent study found that only half of all cardiac guidelines are based on scientific evidence.
Unfortunately, these organizations often struggle to provide guidelines that optimize care while minimizing unnecessary costs because they have neither the resources nor the financial incentive to invest in the continual improvement that is necessary to keep up with quickly evolving medical fields.
In 2001, a study examined the validity of clinical guidelines developed in 1990 through 1996 by the U.S. Agency for Health care Policy and Research and found that about two-thirds were out of date with current research.
A related problem is that many professional organizations and the clinical practice studies which they rely on have strong ties to drug or medical device companies -- businesses that would benefit greatly from guidelines recommending use of their products. A 2002 study involving 192 guidelines found that 58 percent of authors surveyed had received financial support to perform clinical research. About a fifth of respondents believe their coauthors' recommendations were influenced by their relationships with these companies.
Compounding the problem, these organizations are not subject to financial liability for their recommendations. Not surprisingly, many doctors suspect the guidelines do not reflect untainted, evidence-based advice. A recent study found that more than 50 percent of doctors say they pay no attention to the guidelines.
A market of private firms could set the gold standard of patient care by developing guidelines and competing for hospitals and doctors. The firms could offer doctors a safe harbor by bearing the costs of medical malpractice lawsuits provided doctors comply with their prescribed guidelines. The private firms, unlike current organizations that create guidelines, would be held liable for promulgating suboptimal guidelines. They would benefit by producing cost saving procedures to attract customers while also maximizing patient safety to avoid liability.
Granting doctors who follow such guidelines immunity from malpractice would go a long way toward meeting the nation's goals of minimizing healthcare costs while maximizing patient safety.
The private firms would have a strong interest in funding objective scientific research to create evidence-based medicine. Imagine the peace of mind that would follow for doctors who could trust guideline standards and no longer fear patients will sue them. Imagine a health care system in which doctors could focus on healing their patients instead of preparing for their day in court.
However, it did not make to the front page here; it is not considered in Washington either.
In the middle of the 16th century, Poland (to be precise, the Polish – Lithuanian Republic) was one of the wealthiest and most powerful European states. However, by the end of 16th century the first signs of decay started showing up. Two hundred years later, the country ceased to exist.
Overwhelming self-confidence and faith that God would always save Poland, paved the road to self-destruction. Similarly as now in America, many people had good ideas but none of them made into the mainstream. Ironically, most of the members Polish ruling class were obese as well as most of Americans are now.
World is running much faster now; one may only wonder, whether it will take two hundred years this time as well.
Please check my open letter to President Obama, http://www.huffingtonpost.com/henryk-a-kowalczyk/the-health-care-bill-wher_b_242496.html .
Allow smaller companies to pool to get better rates. This kills profits and lobbied against. There are many good ideas that get trashed because of profit goals. Lets not shuffle the same deck of cards and end up with garbage. That wont happen, I have seen this movie before. Lets have pizza from your favorite place and not end up with Dominoes thin crust for everybody.
The Permanente/ Nixon HMO idea was a brilliant bu$iness idea but a lousy system for the consumer. It was new in 1973. We need something new again that has price appropriate, cost effective, competetive top notch healthcare. Allow competition - like access to Canada's pharmacy. Remove the protectionism and have health as the goal. Ask yourself why all the good pharmacy treat symptoms and not the cure? If I cure you, they lose a customer. Restless leg syndrome and dry eye syndrome is a good example. lets make a drug and then see what it is good for ( see viagra )
Jim O'Hare VP of med mal claims PIC
This is about our choice. Do we want to stick to the concepts that made America strong and rich? Or, do we want abandon them, and experiment with new political concepts?
We can expect that doctors and insurance companies should be made from different clay than most of us and have no greed. Or, we can notice that they are in similar service business as car insurance companies and car mechanics.
Car mechanics do not fix cars for the love of automobiles. They are driven by greed. Some will take advantage of their customers. However, due to open competition most of them can make the best profit by eating with a teaspoon; by making a small profit everyday from the returning customers.
Similarly, some doctors can take advantage of their position and milk the patient and/or his or her health insurance provider. However, in the open society, those things reach the public eye earlier or later, destroying a career of such person. There is no government regulation that can impose personal integrity into the doctor-patient relationship. What it can only do, it can provide and alibi for questionable decisions, which basing on their conscience, doctors and insurance providers would never make.
Modify tort, corporate, and criminal laws to accomplish the following:
Step 1: to permit individual officers, directors, scientists, and other employees of any pharmaceutical, medical device, or other organization in the health care field to be held personally liable, under criminal and civil law, if their company falsifies data to the FDA, ghostwrites research, fails to report conflicts of interest, hides incriminating evidence, creates misleading ads, bribes doctors or government officials or agencies, or recommends off-label use.
Step 2: to permit any government official or employee, including those working for the FDA, EPA, USDA, and the NIH, to be held personally liable, under criminal and civil law, if they falsify data, accept bribes or any compensation from the industry they are charged with regulating, hide incriminating evidence, or fail to report conflicts of interest.
Step 3: to permit individual officers, directors, scientists, and other employees of any food company to be held personally liable, under criminal and civil law, if their company falsifies data to the FDA or USDA or the consumer, ghostwrites research, hides incriminating evidence, creates misleading ads, or bribes doctors or government officials or agencies.
The solution is based on a simple principle: personal accountability.
Roy Mankovitz, Director
http://www.MontecitoWellness.com
The bigger problem in our medical system that nobody talks about, except privately, is that approximately 70,000 Americans are killed by doctors yearly, through errors.
And of course the AMA and the insurance companies and so on and so forth want to limit liability or do away with it. There's damn little accountability as there is. Look at the celebrity doctors who are no more than drug dealers to their patients. And then there are the practitioners, who are legion, who are not competent to perform most invasive procedures, but do it anyway because insurance companies will pay them. That's how about half those 70,000 died.
So what good are standards and guidelines that are largely winked at? Who reports this stuff? Other doctors sign off on the death certificates. This is what health care for profit ends up in - patients as commodities. We see how well consumer guidelines and standards are going in other areas than medicine...