Diagnostics & Imaging Week Washington Editor
WASHINGTON Take a hotel full of physicians. Throw in some politicians and healthcare lobbyists for good measure.
The result? Talk of medical liability reform, of course.
It was one of many healthcare topics being discussed including Medicaid reform and improvements in healthcare information technology during last week's American Medical Association (AMA; Chicago) National Advocacy Conference, but tort reform was certainly the most popular subject on the agenda.
The administration of President George Bush has made healthcare tort reform one of its most important goals in a second term. With Republican lawmakers, and some Democrats, also eager to pass liability reform, and more than 600 physicians in attendance at the AMA program, the meeting's message seemed loud and clear.
"Medical lawsuit abuse must stop," said Senate Majority Leader Bill Frist, MD (R-Tennessee), in his presentation to the physicians. As only on of two physicians in the Senate, Frist called himself "a pilgrim in an unholy land."
"There are 58 lawyers up there [in the Senate]," he added. "I may be outgunned, but I will not be undone."
He vowed to "continue fighting" for liability reform, saying that it was not a partisan issue but an American one. Frist said that the legislation should deal with much more than caps on liability awards and should be a "comprehensive" reform package.
"All I need is just a few Democrats three or four to come to the table and talk, and we can get it done," he said.
Frist said that legislation also could reduce money "wasted" on defensive medicine, which the majority leader estimated as costing roughly $100 billion a year.
The White House's plan would put a limit of $250,000 on non-economic damages, which also means the pain and suffering portions of malpractice awards. There would be no imposed limits on economic losses suffered as the result of what the Bush administration calls "legitimate medical error."
The president's proposal would allow malpractice awards to be paid out over time, instead of in a lump sum, in addition to limiting the time in which such suits could be filed after malpractice is claimed.
Opponents of the president's plan maintain that caps on malpractice claims serve only to shield doctors and companies that provide substandard healthcare or products. The real problem, according to lawyers who represent malpractice victims, is insurers who look to raise premiums, which affects the healthcare spending for individuals and companies.
Rep. Bart Gordon (D-Tennessee), who sits on the House Committee on Energy and Commerce and is ranking member of the Committee on Science, said it was unlikely Congress would act on permanent liability reform this year given the looming battle on Capitol Hill over the president's budget for fiscal year 2006, though a "temporary fix" could be reached.
"I have supported medical malpractice reform, and I'll fight until we finally get it passed," he said.
Gordon said that by 2014, according to the Congressional Budget Office, government will account for half of all healthcare spending in the U.S., and so lawmakers should be looking for "real solutions."
He said most members of Congress were "reasonably smart" a comment provoking considerable laughter from the audience and that physicians must be more involved in educating lawmakers, contacting their congressional representatives and educating them about challenges specific to the practice of medicine.
"Some people we have driving the malpractice bills in the House and Senate are more interested in their own agendas than they are in passing the bill," Gordon said, explaining that many of his Democratic colleagues would vote for medical liability reform if the legislation eliminated add-ons not specific to tort reform.
"The bills before us overreach, and they include matters dealing with the drug industry, the medical device industry, and that has been a real problem," he argued. "If we had something that was more narrow in its focus, and really dealt with doctors and medical malpractice, I think we could pass this thing in the morning."
He urged lawmakers to look to California as an example of a system of reform that is "on the right track." Currently, California, Colorado, Indiana, Louisiana, New Mexico and Wisconsin are the only states that have instituted some sort of medical liability caps.
Along with litigation reform, information technology has been a focus of many of Frist's recent healthcare speeches, and he included it here at AMA.
"We have underinvested in healthcare IT," he said. "We [the government] need to come up with interoperability and safety standards. But doctors need to step up and participate in the IT process."
He said it was up to the government and physicians to convince institutions that investment in electronic health records and information exchange is ultimately cost-saving.
Mark McClellan, MD, administrator of the Centers for Medicare & Medicaid Services (Baltimore), who also spoke at the AMA conference, said that though his agency is not directly investing in healthcare IT efforts, programs such as its pay-for-performance quality initiative foster technology innovation.
"Pay-for-performance programs and technologies lead to better healthcare and lower costs," McClellan told reporters after his presentation. "When you pay for results, healthcare organizations are more willing to adopt technology, invest more, leading to better medical outcomes."
Though not "a panacea" for the U.S. healthcare delivery system, advancing healthcare information technology and reforming medical liability would result in "substantial" cost savings, Frist said, affecting all cost centers in the sector.
Mike Leavitt, secretary of the Department of Health and Human Services (HHS), told the AMA members that working toward practical IT recommendations for healthcare is both a source of excitement and a primary mission for him.
He also said he was committed to reform for the Medicaid program.
"The current system is unresponsive to reality and rigidly inflexible," he said.
Over the next 10 years, according to Leavitt, states and the federal government will spend $5 trillion on Medicaid, more than a 7% jump from current spending.
The program, Leavitt said, must change to meet the needs of individuals and better meet the needs of different states' demographics.
According to HHS, 46 million Americans get their primary healthcare though Medicaid.
"If left unchanged, Medicaid in its current form will treat fewer people instead of more though costs keep rising," he said.
The secretary pointed to the new Medicare Part D prescription drug program for seniors as positive example of change at CMS.
Rep. Gordon said Medicaid and Medicare reform is essential, but that programs such as the prescription drug benefit have been ill-conceived.
"If we're going to get out of this hole we're in, we are going to have to deal with drug costs," Gordon said. "We should start by revisiting the Medicare drug program and making it more effective."
He called it "egregious" that the bill prohibits Medicare from negotiating better drug prices for seniors and tax payers, a comment to which the audience responded with applause. Gordon said the current program used by the Department of Veterans Affairs would be a good model to follow, since the program allows for negotiated pricing.
"We have a proven model that has saved us billions of dollars," he said. "We need to look into that."