Defensive Medicine Becomes Part of Transformation Bill

Consultants will be hired by the Oregon Health Authority to analyze the cost and impact of defensive medicine
The Lund Report

July 14, 2011 -- Before Republicans signed off on major legislation transforming Oregon’s healthcare system – House Bill 3650 -- they insisted that the cost and impact of defensive medicine be looked into.

The Oregon Health Authority has been charged with hiring consultants to conduct such a study. The Legislature set aside $295,000, with half of those dollars coming from federal matching funds.

Felicia Hagins, political director for SEIU Local 49, isn’t convinced that’s money well spent. “A lot of resources have gone into this in the past, and the Legislature has been either unable to act or voters have turned this down on the ballot,” she told her colleagues on the Oregon Health Policy Board on July 12. 

Those dollars should have gone toward bringing more people onto the Oregon Health Plan or studying issues such as global budgeting, or outcomes and metrics, she said.  

But the impact of defensive medicine is a critical element to maintain an adequate work force in Oregon, countered Dr. Joe Robertson, president of Oregon Health & Science University.

“We’re competing with other states to see who can have an adequate work force,” he said, and evidence from other states indicates that the cost of defensive medicine definitely plays a role in whether physicians choose to work in certain areas. It’s not just training and loan forgiveness that makes a difference.

The Health Authority doesn’t intend to organize a work group on defensive medicine, said Dr. Bruce Goldberg, administrator. Once the consultants have finished their work, they’ll present their findings to the Health Policy Board, with recommendations readied for the February Legislature.

“We’ve had a number of work groups on this in the past,” he told the board. “Our goal is to carry out some analysis and work with expert consultants.” And, there’ll be sufficient time for stakeholders to share their expertise and opinions before those recommendations are finalized, he said.

The consultants are expected to look into the impact of malpractice caps on medical liability premiums; the benefits of binding and non-binding panels to examine malpractice claims; examine the exceptions and exemptions of the Stark laws, and placing a cap on damages to providers who participate in the Oregon Health Plan and other state-run programs.

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Comments

Tort reform is oversold. How about studying marketing costs for heath care? We would find that those wasteful expenditures oversell the very services that get around the impotent Stark laws and are the biggest driver for health care costs. The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) sets the reimbursements for procedure-oriented fee-for-service care and (along with most medical societies) is opposed to restraints on these reimbursements. These reimbursements will undoubtedly explode in 2013 when America implements the ICD-10, the long awaited update of our international coding system. Reimbursement for primary care relegates the PCP as the hamster-on-the-wheel without time to touch and talk. Ordering the test is much easier! Ironic since patient-centered primary care is promulgated. Devalue the PCP and we get what we pay for--that is... what we don't pay for. Funny how supply/demand economics don't work when health care is sold as a commodity in our unfettered "free" market. We have to replace the RUC and enforce Stark laws--or good primary care doctors will be extinct. Kris Alman MD replacetheruc.org

Supply and demand don't work unless the customer (patient) is informed and involved in the choices as well as paying, at least, a portion of the costs. We have insulated patients from the costs and many times from the options for care. We need transparency for medical costs including lab fees and diagonstic options. Regular office fees for standard services should be posted in the office and on the internet. The patient gets a written estimate for car repairs and an hourly charge before they commit to the repair and additional costs or work has to be disclosed. It doesn't need to be very complicated but if I know I can get an MRI in a town 20 miles away for less than half of what I pay in Corvallis I will choose that option if I am paying a percentage of the bill. If I don't know what the costs are and my doctor orders the test locally I end up paying the higher fees. Ultimately my insurance rates go up faster than if a lot of customers choose the lower cost option. Doctors need to help communicate costs and options with their patients. Many times they aren't aware of the actual costs themselves and market forces are unable to work. Doctors need to discuss coding options with their patients.