Frances Correa

WASHINGTON – To avoid a nearly 30% physician pay cut Jan. 1, Congress should instead adopt a 10-year plan that freezes primary care pay and cuts specialist pay by 5.9% three years in a row. That's according to a proposal presented by staffers.

While such a solution is expensive — with a $200 billion price tag — it reduces the estimated cost of replacing the current Sustainable Growth Rate (SGR) formula by $100 billion, according to the MedPAC staff presentation.

In formulating their proposal, MedPAC staffers sought to address four key concerns:

▸ To cut the link between Medicare fee schedule updates and cumulative spending called for by the SGR.

▸ To replace the SGR with a predictable 10-year system of fee updates.

▸ Halt the nearly 30% pay cut on Jan. 1.

▸ Balance the cost of reform with maintaining access to care.

The proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), post-acute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

While specialists bear more of the costs, they also rely on a higher percentage of Medicare patients and will likely benefit from the expected steady increase in beneficiaries in the market, according to the proposal.

Response to the proposal was swift and vehement.

Cuts to specialists will ultimately mean cutting access to gynecologists, who often serve a dual role providing both specialty and primary care, said Dr. Lisa Hollier, chair of the Texas district of the American Congress of Obstetricians and Gynecologists.

With further cuts, we could “see a decrease in the ability to provide care to an increasing population of elderly women,” Dr. Hollier said in an interview. She added that any physician pay reform proposal should emphasize new measures for rewarding quality and efficiency over volume. “I think we need to not look simply at cutting but rather a redesign of the entire system.”

Other specialty groups had similar arguments.

“This proposal simply devalues the expertise and critical care that specialists provide to Medicare patients and will further restrict access to care for them,” Dr. Alex Valadka said in a statement. Dr. Valadka is a neurosurgeon from Austin, Tex., and spokesperson for the Alliance of Specialty Medicine.

“There comes a point where if you keep cutting specialists' reimbursements, we can't maintain our practice, keep our doors open, and employ staff,” Dr. Valadka added. “The end result of that means we can't properly take care of our most vulnerable patients.”

The American Medical Association called the proposal “misguided.”

“The new cuts are inconsistent with MedPAC's previous recommendations to stop cuts to physicians who care for Medicare patients, because they threaten access to care for patients and would have severe consequences for the Medicare system,” AMA President Peter Carmel said in a statement.

“Drastic cuts pose a very real risk to physicians' ability to retain staff, care for Medicare patients, and make the investments needed to modernize their practices and participate in care delivery models intended to improve quality while reducing costs in the Medicare system,” Dr. Carmel said.

MedPAC commissioners will consider the report and finalize the commission's recommendations at its October meeting.

Regardless of whether Congress adopts this proposal, the current system must be addressed, MedPAC Chairman Glenn Hackbarth said at the meeting.

“If large Medicare savings are used for other purposes … and SGR is not addressed, we could end up with long-term destabilization,” Mr. Hackbarth said.

WASHINGTON – To avoid a nearly 30% physician pay cut Jan. 1, Congress should instead adopt a 10-year plan that freezes primary care pay and cuts specialist pay by 5.9% three years in a row. That's according to a proposal presented by staffers.

While such a solution is expensive — with a $200 billion price tag — it reduces the estimated cost of replacing the current Sustainable Growth Rate (SGR) formula by $100 billion, according to the MedPAC staff presentation.

In formulating their proposal, MedPAC staffers sought to address four key concerns:

▸ To cut the link between Medicare fee schedule updates and cumulative spending called for by the SGR.

▸ To replace the SGR with a predictable 10-year system of fee updates.

▸ Halt the nearly 30% pay cut on Jan. 1.

▸ Balance the cost of reform with maintaining access to care.

The proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), post-acute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

While specialists bear more of the costs, they also rely on a higher percentage of Medicare patients and will likely benefit from the expected steady increase in beneficiaries in the market, according to the proposal.

Response to the proposal was swift and vehement.

Cuts to specialists will ultimately mean cutting access to gynecologists, who often serve a dual role providing both specialty and primary care, said Dr. Lisa Hollier, chair of the Texas district of the American Congress of Obstetricians and Gynecologists.

With further cuts, we could “see a decrease in the ability to provide care to an increasing population of elderly women,” Dr. Hollier said in an interview. She added that any physician pay reform proposal should emphasize new measures for rewarding quality and efficiency over volume. “I think we need to not look simply at cutting but rather a redesign of the entire system.”

Other specialty groups had similar arguments.

“This proposal simply devalues the expertise and critical care that specialists provide to Medicare patients and will further restrict access to care for them,” Dr. Alex Valadka said in a statement. Dr. Valadka is a neurosurgeon from Austin, Tex., and spokesperson for the Alliance of Specialty Medicine.

“There comes a point where if you keep cutting specialists' reimbursements, we can't maintain our practice, keep our doors open, and employ staff,” Dr. Valadka added. “The end result of that means we can't properly take care of our most vulnerable patients.”

The American Medical Association called the proposal “misguided.”

“The new cuts are inconsistent with MedPAC's previous recommendations to stop cuts to physicians who care for Medicare patients, because they threaten access to care for patients and would have severe consequences for the Medicare system,” AMA President Peter Carmel said in a statement.

“Drastic cuts pose a very real risk to physicians' ability to retain staff, care for Medicare patients, and make the investments needed to modernize their practices and participate in care delivery models intended to improve quality while reducing costs in the Medicare system,” Dr. Carmel said.

MedPAC commissioners will consider the report and finalize the commission's recommendations at its October meeting.

Regardless of whether Congress adopts this proposal, the current system must be addressed, MedPAC Chairman Glenn Hackbarth said at the meeting.

“If large Medicare savings are used for other purposes … and SGR is not addressed, we could end up with long-term destabilization,” Mr. Hackbarth said.

WASHINGTON – To avoid a nearly 30% physician pay cut Jan. 1, Congress should instead adopt a 10-year plan that freezes primary care pay and cuts specialist pay by 5.9% three years in a row. That's according to a proposal presented by staffers.

While such a solution is expensive — with a $200 billion price tag — it reduces the estimated cost of replacing the current Sustainable Growth Rate (SGR) formula by $100 billion, according to the MedPAC staff presentation.

In formulating their proposal, MedPAC staffers sought to address four key concerns:

▸ To cut the link between Medicare fee schedule updates and cumulative spending called for by the SGR.

▸ To replace the SGR with a predictable 10-year system of fee updates.

▸ Halt the nearly 30% pay cut on Jan. 1.

▸ Balance the cost of reform with maintaining access to care.

The proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified.

For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), post-acute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

While specialists bear more of the costs, they also rely on a higher percentage of Medicare patients and will likely benefit from the expected steady increase in beneficiaries in the market, according to the proposal.

Response to the proposal was swift and vehement.

Cuts to specialists will ultimately mean cutting access to gynecologists, who often serve a dual role providing both specialty and primary care, said Dr. Lisa Hollier, chair of the Texas district of the American Congress of Obstetricians and Gynecologists.

With further cuts, we could “see a decrease in the ability to provide care to an increasing population of elderly women,” Dr. Hollier said in an interview. She added that any physician pay reform proposal should emphasize new measures for rewarding quality and efficiency over volume. “I think we need to not look simply at cutting but rather a redesign of the entire system.”

Other specialty groups had similar arguments.

“This proposal simply devalues the expertise and critical care that specialists provide to Medicare patients and will further restrict access to care for them,” Dr. Alex Valadka said in a statement. Dr. Valadka is a neurosurgeon from Austin, Tex., and spokesperson for the Alliance of Specialty Medicine.

“There comes a point where if you keep cutting specialists' reimbursements, we can't maintain our practice, keep our doors open, and employ staff,” Dr. Valadka added. “The end result of that means we can't properly take care of our most vulnerable patients.”

The American Medical Association called the proposal “misguided.”

“The new cuts are inconsistent with MedPAC's previous recommendations to stop cuts to physicians who care for Medicare patients, because they threaten access to care for patients and would have severe consequences for the Medicare system,” AMA President Peter Carmel said in a statement.

“Drastic cuts pose a very real risk to physicians' ability to retain staff, care for Medicare patients, and make the investments needed to modernize their practices and participate in care delivery models intended to improve quality while reducing costs in the Medicare system,” Dr. Carmel said.

MedPAC commissioners will consider the report and finalize the commission's recommendations at its October meeting.

Regardless of whether Congress adopts this proposal, the current system must be addressed, MedPAC Chairman Glenn Hackbarth said at the meeting.

“If large Medicare savings are used for other purposes … and SGR is not addressed, we could end up with long-term destabilization,” Mr. Hackbarth said.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released at the end of August are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

“[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, wrote in a blog post announcing the change. “With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors.” Under the Medicare Electronic Prescribing Incentive Program, heligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

Also, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

▸ registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

▸ an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

▸ very limited prescribing activity, or

▸ insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns.

The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

“We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty,” Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released at the end of August are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

“[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, wrote in a blog post announcing the change. “With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors.” Under the Medicare Electronic Prescribing Incentive Program, heligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

Also, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

▸ registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

▸ an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

▸ very limited prescribing activity, or

▸ insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns.

The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

“We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty,” Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released at the end of August are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

“[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, wrote in a blog post announcing the change. “With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors.” Under the Medicare Electronic Prescribing Incentive Program, heligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

Also, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

▸ registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

▸ an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

▸ very limited prescribing activity, or

▸ insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns.

The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

“We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty,” Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Although physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629–36).

“If you've hit 65 and you haven't had a claim, that's rare; that's almost impossible in our data,” Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4% of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year.

Dr. Jena and colleagues also found that specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent.

For example, although neurosurgeons had a higher yearly risk of being sued than did pediatricians (19.1% vs. 3.1%), the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians. Neurologists' yearly risk of being sued was about 8%, with an average indemnity payment of about $240,000.

Among all specialties, thoracic-cardiovascular surgery had the second highest yearly risk of being sued (18.9%), followed by general surgery (15.3%). Specialties with the lowest yearly risk of being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

“A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer,” Dr. Jena said. “The physician has loss of productivity because they're not able to see patients as they defend cases … and then there are all sorts of nonmonetary costs that we simply cannot measure,” Dr. Jena said in an interview.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there's little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

View on the News

Malpractice Caps: The Texas Experience

While the results of this study may not be surprising, Texas has found one solution to the issue. Since Texas instituted a $250,000 cap on noneconomic damages in 2003, nuisance suits have been significantly reduced. The wasteful process of a medical liability trial has also been reduced, as true cases of malpractice are typically resolved through a settlement. Also, legitimate cases of malpractice can still be awarded the compensation they deserve. In addition to the $250,000 maximum payment for pain and suffering (per physician, hospital, and/or third party, equaling up to $750,000), patients can also be compensated for past and future medical expenses. In addition, trial lawyers seeking a large payoff can no longer afford to litigate cases with very few damages. Therefore, nuisance cases are reduced to complaints before the Texas Medical Board where they can be handled responsibly in a more cost-effective manner.

Without the concerns of facing a nuisance suit, hospitals in Texas can now redirect those funds to improving care, like funding safety systems or electronic medical records. Physicians can invest in their practices too, improving patient care. They can provide more charity care as well. The change has also brought thousands of doctors to Texas and improved access to quality care. As family practitioners face high overhead costs and low reimbursement rates, just saving on medical liability has allowed some doctors to continue their work where otherwise they may not have been able to.

BRUCE MALONE, M.D., is the president of the Texas Medical Association. He is also a practicing orthopedic surgeon at the Austin Bone and Joint Clinic in Austin, Tex.

Although physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629–36).

“If you've hit 65 and you haven't had a claim, that's rare; that's almost impossible in our data,” Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4% of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year.

Dr. Jena and colleagues also found that specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent.

For example, although neurosurgeons had a higher yearly risk of being sued than did pediatricians (19.1% vs. 3.1%), the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians. Neurologists' yearly risk of being sued was about 8%, with an average indemnity payment of about $240,000.

Among all specialties, thoracic-cardiovascular surgery had the second highest yearly risk of being sued (18.9%), followed by general surgery (15.3%). Specialties with the lowest yearly risk of being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

“A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer,” Dr. Jena said. “The physician has loss of productivity because they're not able to see patients as they defend cases … and then there are all sorts of nonmonetary costs that we simply cannot measure,” Dr. Jena said in an interview.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there's little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

View on the News

Malpractice Caps: The Texas Experience

While the results of this study may not be surprising, Texas has found one solution to the issue. Since Texas instituted a $250,000 cap on noneconomic damages in 2003, nuisance suits have been significantly reduced. The wasteful process of a medical liability trial has also been reduced, as true cases of malpractice are typically resolved through a settlement. Also, legitimate cases of malpractice can still be awarded the compensation they deserve. In addition to the $250,000 maximum payment for pain and suffering (per physician, hospital, and/or third party, equaling up to $750,000), patients can also be compensated for past and future medical expenses. In addition, trial lawyers seeking a large payoff can no longer afford to litigate cases with very few damages. Therefore, nuisance cases are reduced to complaints before the Texas Medical Board where they can be handled responsibly in a more cost-effective manner.

Without the concerns of facing a nuisance suit, hospitals in Texas can now redirect those funds to improving care, like funding safety systems or electronic medical records. Physicians can invest in their practices too, improving patient care. They can provide more charity care as well. The change has also brought thousands of doctors to Texas and improved access to quality care. As family practitioners face high overhead costs and low reimbursement rates, just saving on medical liability has allowed some doctors to continue their work where otherwise they may not have been able to.

BRUCE MALONE, M.D., is the president of the Texas Medical Association. He is also a practicing orthopedic surgeon at the Austin Bone and Joint Clinic in Austin, Tex.

Although physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629–36).

“If you've hit 65 and you haven't had a claim, that's rare; that's almost impossible in our data,” Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4% of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year.

Dr. Jena and colleagues also found that specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent.

For example, although neurosurgeons had a higher yearly risk of being sued than did pediatricians (19.1% vs. 3.1%), the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians. Neurologists' yearly risk of being sued was about 8%, with an average indemnity payment of about $240,000.

Among all specialties, thoracic-cardiovascular surgery had the second highest yearly risk of being sued (18.9%), followed by general surgery (15.3%). Specialties with the lowest yearly risk of being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

“A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer,” Dr. Jena said. “The physician has loss of productivity because they're not able to see patients as they defend cases … and then there are all sorts of nonmonetary costs that we simply cannot measure,” Dr. Jena said in an interview.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there's little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

View on the News

Malpractice Caps: The Texas Experience

While the results of this study may not be surprising, Texas has found one solution to the issue. Since Texas instituted a $250,000 cap on noneconomic damages in 2003, nuisance suits have been significantly reduced. The wasteful process of a medical liability trial has also been reduced, as true cases of malpractice are typically resolved through a settlement. Also, legitimate cases of malpractice can still be awarded the compensation they deserve. In addition to the $250,000 maximum payment for pain and suffering (per physician, hospital, and/or third party, equaling up to $750,000), patients can also be compensated for past and future medical expenses. In addition, trial lawyers seeking a large payoff can no longer afford to litigate cases with very few damages. Therefore, nuisance cases are reduced to complaints before the Texas Medical Board where they can be handled responsibly in a more cost-effective manner.

Without the concerns of facing a nuisance suit, hospitals in Texas can now redirect those funds to improving care, like funding safety systems or electronic medical records. Physicians can invest in their practices too, improving patient care. They can provide more charity care as well. The change has also brought thousands of doctors to Texas and improved access to quality care. As family practitioners face high overhead costs and low reimbursement rates, just saving on medical liability has allowed some doctors to continue their work where otherwise they may not have been able to.

BRUCE MALONE, M.D., is the president of the Texas Medical Association. He is also a practicing orthopedic surgeon at the Austin Bone and Joint Clinic in Austin, Tex.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

“[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, wrote in a blog post announcing the change. “With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors.” Under the Medicare Electronic Prescribing Incentive Program, heligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions. The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

“[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, wrote in a blog post announcing the change. “With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors.” Under the Medicare Electronic Prescribing Incentive Program, heligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions. The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

“[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed,” Dr. Patrick Conway, chief medical officer at CMS and director of the agency's Office of Clinical Standards and Quality, wrote in a blog post announcing the change. “With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors.” Under the Medicare Electronic Prescribing Incentive Program, heligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a “qualified” e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions. The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

In a time when hospitals are looking for ways to optimize their performance, a recent study suggests an association between physician-led hospitals and high performance ratings.

Among 1,859 hospitals that were analyzed in the specialties of cancer, digestive disorders, and heart surgery, physician-led hospitals scored more than 25% higher than did those with nonphysicians managers, averaging 8-9 points more in their hospital quality ratings, according to Amanda Goodall, Ph.D., a senior research fellow at the Institute for the Study of Labor, Bonn, Germany. She analyzed data from performance ratings for the top 100 hospitals as ranked by U.S. News and World Report in 2009.

Hospital quality points were awarded based on quality measures including mortality rates, nurse staffing, physician decision making, the number of discharges, and availability of necessary technologies.

The fact that the number of physician-led hospitals has declined by 90% (from 35% in 1935 to 4% today) has contributed to the ailing U.S. health care system, according to Dr. Richard Gunderman of Indiana University, Indianapolis, who has written about physicians as hospital leaders (Acad. Med. 2009;84:1348-51). One of the reasons our health care system “is in such sorry shape” is the fact that many of the chief executives of our hospitals and health care corporations see the hospital primarily as a business whose product happens to be health care, Dr. Gunderman said.

He added that the qualities of a good doctor and a good manager are closely linked. “Studying structure and function and using it to improve coordination and performance is second nature to physicians. We need to provide physicians opportunities to better understand the structure and function of hospitals and [other health care organizations], so that they can use that understanding to help hospitals perform better.”

The change, Dr. Gunderman said, needs to come from within the medical school curriculum.

“The organizational dimension of medicine (as opposed to the molecular, cellular, and other dimensions) has been crowded out of the curricula of medical schools and residency programs,” he said.

In a time when hospitals are looking for ways to optimize their performance, a recent study suggests an association between physician-led hospitals and high performance ratings.

Among 1,859 hospitals that were analyzed in the specialties of cancer, digestive disorders, and heart surgery, physician-led hospitals scored more than 25% higher than did those with nonphysicians managers, averaging 8-9 points more in their hospital quality ratings, according to Amanda Goodall, Ph.D., a senior research fellow at the Institute for the Study of Labor, Bonn, Germany. She analyzed data from performance ratings for the top 100 hospitals as ranked by U.S. News and World Report in 2009.

Hospital quality points were awarded based on quality measures including mortality rates, nurse staffing, physician decision making, the number of discharges, and availability of necessary technologies.

The fact that the number of physician-led hospitals has declined by 90% (from 35% in 1935 to 4% today) has contributed to the ailing U.S. health care system, according to Dr. Richard Gunderman of Indiana University, Indianapolis, who has written about physicians as hospital leaders (Acad. Med. 2009;84:1348-51). One of the reasons our health care system “is in such sorry shape” is the fact that many of the chief executives of our hospitals and health care corporations see the hospital primarily as a business whose product happens to be health care, Dr. Gunderman said.

He added that the qualities of a good doctor and a good manager are closely linked. “Studying structure and function and using it to improve coordination and performance is second nature to physicians. We need to provide physicians opportunities to better understand the structure and function of hospitals and [other health care organizations], so that they can use that understanding to help hospitals perform better.”

The change, Dr. Gunderman said, needs to come from within the medical school curriculum.

“The organizational dimension of medicine (as opposed to the molecular, cellular, and other dimensions) has been crowded out of the curricula of medical schools and residency programs,” he said.

In a time when hospitals are looking for ways to optimize their performance, a recent study suggests an association between physician-led hospitals and high performance ratings.

Among 1,859 hospitals that were analyzed in the specialties of cancer, digestive disorders, and heart surgery, physician-led hospitals scored more than 25% higher than did those with nonphysicians managers, averaging 8-9 points more in their hospital quality ratings, according to Amanda Goodall, Ph.D., a senior research fellow at the Institute for the Study of Labor, Bonn, Germany. She analyzed data from performance ratings for the top 100 hospitals as ranked by U.S. News and World Report in 2009.

Hospital quality points were awarded based on quality measures including mortality rates, nurse staffing, physician decision making, the number of discharges, and availability of necessary technologies.

The fact that the number of physician-led hospitals has declined by 90% (from 35% in 1935 to 4% today) has contributed to the ailing U.S. health care system, according to Dr. Richard Gunderman of Indiana University, Indianapolis, who has written about physicians as hospital leaders (Acad. Med. 2009;84:1348-51). One of the reasons our health care system “is in such sorry shape” is the fact that many of the chief executives of our hospitals and health care corporations see the hospital primarily as a business whose product happens to be health care, Dr. Gunderman said.

He added that the qualities of a good doctor and a good manager are closely linked. “Studying structure and function and using it to improve coordination and performance is second nature to physicians. We need to provide physicians opportunities to better understand the structure and function of hospitals and [other health care organizations], so that they can use that understanding to help hospitals perform better.”

The change, Dr. Gunderman said, needs to come from within the medical school curriculum.

“The organizational dimension of medicine (as opposed to the molecular, cellular, and other dimensions) has been crowded out of the curricula of medical schools and residency programs,” he said.

In recent years, the United States has seen an increase of bedbug infestations, according to the Centers for Disease Control and Prevention. However, the chemicals used to eradicate the bugs are causing more harm than are the bugs themselves.

In all, 111 illnesses and one fatality caused by improper use of insecticides were reported in seven states in 2003-2010, according to the CDC’s Morbidity and Mortality Weekly Report. The report analyzed cases in California, Florida, Michigan, North Carolina, New York, Texas, and Washington.

Photo courtesy CDC/Piotr Naskrecki

The analysis showed that illnesses resulted most commonly from excessive insecticide application, lack of notification of pesticide application, and not washing or changing insecticide-treated bedding. In addition, 39% of pesticide applications were done by people living in the home who weren’t certified to apply the pesticides. Private homes were the site of 43% of the illnesses; 40% occurred in multiunit housing. Hotels were the source of only 3% of illnesses. A majority (67%) of illnesses occurred in people aged 25 years or older.

The most common symptoms of illness were headaches and dizziness (40% of cases), respiratory symptoms (40%), and gastrointestinal issues including nausea and vomiting (33%). New York City had the most cases of insecticide-related illness, representing 58% of cases (MMWR 2011;60:1269-74).

However, 81% of cases were considered low severity. The report also showed that 89% of the illness-causing insecticide exposures, including the fatality, were to pyrethroids, pyrethrins, or both, and were in toxicity category III.

Bedbugs themselves do not carry disease, and the CDC recommends using nonchemical methods for treating an infestation. For example, infested rooms can be heated to 118° F or cooled to 3° F for 1 hour. The CDC also recommends vacuuming, steaming, laundering, or disposing of infested items, and encasing mattresses and box springs in bedbug-proof covers.

In recent years, the United States has seen an increase of bedbug infestations, according to the Centers for Disease Control and Prevention. However, the chemicals used to eradicate the bugs are causing more harm than are the bugs themselves.

In all, 111 illnesses and one fatality caused by improper use of insecticides were reported in seven states in 2003-2010, according to the CDC’s Morbidity and Mortality Weekly Report. The report analyzed cases in California, Florida, Michigan, North Carolina, New York, Texas, and Washington.

Photo courtesy CDC/Piotr Naskrecki

The analysis showed that illnesses resulted most commonly from excessive insecticide application, lack of notification of pesticide application, and not washing or changing insecticide-treated bedding. In addition, 39% of pesticide applications were done by people living in the home who weren’t certified to apply the pesticides. Private homes were the site of 43% of the illnesses; 40% occurred in multiunit housing. Hotels were the source of only 3% of illnesses. A majority (67%) of illnesses occurred in people aged 25 years or older.

The most common symptoms of illness were headaches and dizziness (40% of cases), respiratory symptoms (40%), and gastrointestinal issues including nausea and vomiting (33%). New York City had the most cases of insecticide-related illness, representing 58% of cases (MMWR 2011;60:1269-74).

However, 81% of cases were considered low severity. The report also showed that 89% of the illness-causing insecticide exposures, including the fatality, were to pyrethroids, pyrethrins, or both, and were in toxicity category III.

Bedbugs themselves do not carry disease, and the CDC recommends using nonchemical methods for treating an infestation. For example, infested rooms can be heated to 118° F or cooled to 3° F for 1 hour. The CDC also recommends vacuuming, steaming, laundering, or disposing of infested items, and encasing mattresses and box springs in bedbug-proof covers.

In recent years, the United States has seen an increase of bedbug infestations, according to the Centers for Disease Control and Prevention. However, the chemicals used to eradicate the bugs are causing more harm than are the bugs themselves.

In all, 111 illnesses and one fatality caused by improper use of insecticides were reported in seven states in 2003-2010, according to the CDC’s Morbidity and Mortality Weekly Report. The report analyzed cases in California, Florida, Michigan, North Carolina, New York, Texas, and Washington.

Photo courtesy CDC/Piotr Naskrecki

The analysis showed that illnesses resulted most commonly from excessive insecticide application, lack of notification of pesticide application, and not washing or changing insecticide-treated bedding. In addition, 39% of pesticide applications were done by people living in the home who weren’t certified to apply the pesticides. Private homes were the site of 43% of the illnesses; 40% occurred in multiunit housing. Hotels were the source of only 3% of illnesses. A majority (67%) of illnesses occurred in people aged 25 years or older.

The most common symptoms of illness were headaches and dizziness (40% of cases), respiratory symptoms (40%), and gastrointestinal issues including nausea and vomiting (33%). New York City had the most cases of insecticide-related illness, representing 58% of cases (MMWR 2011;60:1269-74).

However, 81% of cases were considered low severity. The report also showed that 89% of the illness-causing insecticide exposures, including the fatality, were to pyrethroids, pyrethrins, or both, and were in toxicity category III.

Bedbugs themselves do not carry disease, and the CDC recommends using nonchemical methods for treating an infestation. For example, infested rooms can be heated to 118° F or cooled to 3° F for 1 hour. The CDC also recommends vacuuming, steaming, laundering, or disposing of infested items, and encasing mattresses and box springs in bedbug-proof covers.

WASHINGTON – To avoid a nearly 30% physician pay cut Jan. 1, Congress should instead adopt a 10-year plan that freezes primary care pay and cuts specialist pay by 5.9% three years in a row. That’s according to a proposal presented by staffers at a Sept. 15 meeting of the Medicare Payment Advisory Commission.

While such a solution is expensive – with a $200 billion price tag – it reduces the estimated cost of replacing the current Sustainable Growth Rate (SGR) formula by $100 billion, according to the MedPAC staff presentation.

In formulating their proposal, MedPAC staffers sought to address four key concerns:

• To cut the link between Medicare fee schedule updates and cumulative spending called for by the SGR.

• To replace the SGR with a predictable 10-year system of fee updates.

• Halt the nearly 30% pay cut on Jan. 1.

• Balance the cost of reform with maintaining access to care.

The proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified. For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), post-acute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

While specialists bear more of the costs, they also rely on a higher percentage of Medicare patients and will likely benefit from the expected steady increase in beneficiaries in the market, according to the proposal.

Response to the proposal was swift and vehement.

"This proposal simply devalues the expertise and critical care that specialists provide to Medicare patients and will further restrict access to care for them," Dr. Alex Valadka said in a statement. Dr. Valadka is a neurosurgeon from Austin, Tex., and spokesperson for the Alliance of Specialty Medicine.

"There comes a point where if you keep cutting specialists’ reimbursements, we can’t maintain our practice, keep our doors open, and employ staff," Dr. Valadka added. "The end result of that means we can’t properly take care of our most vulnerable patients."

The American Medical Association called the plan "misguided."

"The new cuts are inconsistent with MedPAC’s previous recommendations to stop cuts to physicians who care for Medicare patients, because they threaten access to care for patients and would have severe consequences for the Medicare system," said AMA president Dr. Peter Carmel in a statement. "Drastic cuts pose a very real risk to physicians’ ability to retain staff, care for Medicare patients, and make the investments needed to modernize their practices and participate in care delivery models intended to improve quality while reducing costs in the Medicare system."

MedPAC commissioners will consider the report and finalize the commission’s recommendations at its October meeting.

Regardless of whether Congress adopts this proposal, the current system must be addressed, MedPAC Chairman Glenn Hackbarth said at the meeting.

"If large Medicare savings are used for other purposes ... and SGR is not addressed, we could end up with long-term destabilization," Mr. Hackbarth said.

WASHINGTON – To avoid a nearly 30% physician pay cut Jan. 1, Congress should instead adopt a 10-year plan that freezes primary care pay and cuts specialist pay by 5.9% three years in a row. That’s according to a proposal presented by staffers at a Sept. 15 meeting of the Medicare Payment Advisory Commission.

While such a solution is expensive – with a $200 billion price tag – it reduces the estimated cost of replacing the current Sustainable Growth Rate (SGR) formula by $100 billion, according to the MedPAC staff presentation.

In formulating their proposal, MedPAC staffers sought to address four key concerns:

• To cut the link between Medicare fee schedule updates and cumulative spending called for by the SGR.

• To replace the SGR with a predictable 10-year system of fee updates.

• Halt the nearly 30% pay cut on Jan. 1.

• Balance the cost of reform with maintaining access to care.

The proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified. For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), post-acute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

While specialists bear more of the costs, they also rely on a higher percentage of Medicare patients and will likely benefit from the expected steady increase in beneficiaries in the market, according to the proposal.

Response to the proposal was swift and vehement.

"This proposal simply devalues the expertise and critical care that specialists provide to Medicare patients and will further restrict access to care for them," Dr. Alex Valadka said in a statement. Dr. Valadka is a neurosurgeon from Austin, Tex., and spokesperson for the Alliance of Specialty Medicine.

"There comes a point where if you keep cutting specialists’ reimbursements, we can’t maintain our practice, keep our doors open, and employ staff," Dr. Valadka added. "The end result of that means we can’t properly take care of our most vulnerable patients."

The American Medical Association called the plan "misguided."

"The new cuts are inconsistent with MedPAC’s previous recommendations to stop cuts to physicians who care for Medicare patients, because they threaten access to care for patients and would have severe consequences for the Medicare system," said AMA president Dr. Peter Carmel in a statement. "Drastic cuts pose a very real risk to physicians’ ability to retain staff, care for Medicare patients, and make the investments needed to modernize their practices and participate in care delivery models intended to improve quality while reducing costs in the Medicare system."

MedPAC commissioners will consider the report and finalize the commission’s recommendations at its October meeting.

Regardless of whether Congress adopts this proposal, the current system must be addressed, MedPAC Chairman Glenn Hackbarth said at the meeting.

"If large Medicare savings are used for other purposes ... and SGR is not addressed, we could end up with long-term destabilization," Mr. Hackbarth said.

WASHINGTON – To avoid a nearly 30% physician pay cut Jan. 1, Congress should instead adopt a 10-year plan that freezes primary care pay and cuts specialist pay by 5.9% three years in a row. That’s according to a proposal presented by staffers at a Sept. 15 meeting of the Medicare Payment Advisory Commission.

While such a solution is expensive – with a $200 billion price tag – it reduces the estimated cost of replacing the current Sustainable Growth Rate (SGR) formula by $100 billion, according to the MedPAC staff presentation.

In formulating their proposal, MedPAC staffers sought to address four key concerns:

• To cut the link between Medicare fee schedule updates and cumulative spending called for by the SGR.

• To replace the SGR with a predictable 10-year system of fee updates.

• Halt the nearly 30% pay cut on Jan. 1.

• Balance the cost of reform with maintaining access to care.

The proposal would result in a 2% annual increase in federal spending per Medicare beneficiary, but is budget neutral based on a number of possible savings identified. For example, the proposal outlines $235 billion in possible savings from pharmaceuticals ($75 billion), post-acute care ($49 billion), beneficiaries ($33 billion), hospitals ($26 billion), labs ($21 billion), Medicare Advantage ($12 billion), and durable medical equipment ($14 billion).

While specialists bear more of the costs, they also rely on a higher percentage of Medicare patients and will likely benefit from the expected steady increase in beneficiaries in the market, according to the proposal.

Response to the proposal was swift and vehement.

"This proposal simply devalues the expertise and critical care that specialists provide to Medicare patients and will further restrict access to care for them," Dr. Alex Valadka said in a statement. Dr. Valadka is a neurosurgeon from Austin, Tex., and spokesperson for the Alliance of Specialty Medicine.

"There comes a point where if you keep cutting specialists’ reimbursements, we can’t maintain our practice, keep our doors open, and employ staff," Dr. Valadka added. "The end result of that means we can’t properly take care of our most vulnerable patients."

The American Medical Association called the plan "misguided."

"The new cuts are inconsistent with MedPAC’s previous recommendations to stop cuts to physicians who care for Medicare patients, because they threaten access to care for patients and would have severe consequences for the Medicare system," said AMA president Dr. Peter Carmel in a statement. "Drastic cuts pose a very real risk to physicians’ ability to retain staff, care for Medicare patients, and make the investments needed to modernize their practices and participate in care delivery models intended to improve quality while reducing costs in the Medicare system."

MedPAC commissioners will consider the report and finalize the commission’s recommendations at its October meeting.

Regardless of whether Congress adopts this proposal, the current system must be addressed, MedPAC Chairman Glenn Hackbarth said at the meeting.

"If large Medicare savings are used for other purposes ... and SGR is not addressed, we could end up with long-term destabilization," Mr. Hackbarth said.

Adult smokers in the United States are smoking fewer cigarettes, according to a report released today by the Centers for Disease Control and Prevention.

The proportion of smokers who said they smoked 30 or more cigarettes daily decreased from 12.7% to 8.3%, according to CDC data for 2005-2010. Also, more smokers said they were smoking nine or fewer cigarettes daily, an increase from 16.4% to 21.8%. The number of adult smokers also declined from 20.9% to 19.3%, representing nearly 3 million fewer smokers.

©milosluz/iStockphoto.com

Even as smoking prevalence has decreased overall, the data varies according to race/ethnicity, age, level of education, region, and poverty status (MMWR 2011;60:1-6). Smoking prevalence was lowest among Hispanics (12.5%) and Asians (9.2%), seniors (9.5%), those with a graduate degree (6.3%), and residents of the West (15.9%). The highest prevalence was among American Indians/Alaska Natives (31.4%), adults aged 25-44 years (22%), General Education Development (GED) certificate recipients (45.2%), and residents of the Midwest (21.8%). Categorized by poverty status, 18.3% of those at or above the poverty level smoke, compared with 28.9% of those below the poverty level.

Although smoking appears to be decreasing nationwide, the CDC said the rates have decreased more slowly in the past 5 years. A lack of investment in antismoking campaigns is one of the biggest contributing factors to the slow decline, according to Dr. Tim McAfee, director of the CDC’s Office on Smoking and Health.

"If states were to dedicate more like the 10%-15% that is recommended of these revenues for tobacco control, they’d be fully funding these programs and we’d be seeing a much more rapid decline in tobacco use in our society," Dr. McAfee said during a press briefing. Currently, states are contributing about 2% of their tobacco-related revenues to antismoking efforts.

Dr. McAfee added that states that invest in antismoking programs reap significant health care savings. For example, California has invested about $2.8 billion in antismoking efforts since 1988. During that same period, the state has saved nearly $86 billion in related health care costs and saw adult smoking rates decrease by about 50%, Dr. McAfee said. Smoking costs the United States $193 million annually, nearly equally divided between medical costs and loss of productivity, according to the CDC.

In addition to increased financial support for antismoking initiatives, the CDC recommends that more states place higher taxes on tobacco products and increase smoke-free policies and clinical interventions. As of 2011, 26 states and the District of Columbia have comprehensive smoke-free laws, according to the CDC.

Another 18 states have smoking restrictions at work sites, in restaurants, or in bars. Also, 25 states have added clean air laws that make smoking in public more difficult, Dr. McAfee said.

The report is based on data from the CDC’s 2005-2010 National Health Interview Surveys and the 2010 Behavioral Risk Factor Surveillance System survey. The analysis does not include data for underage smokers.

Adult smokers in the United States are smoking fewer cigarettes, according to a report released today by the Centers for Disease Control and Prevention.

The proportion of smokers who said they smoked 30 or more cigarettes daily decreased from 12.7% to 8.3%, according to CDC data for 2005-2010. Also, more smokers said they were smoking nine or fewer cigarettes daily, an increase from 16.4% to 21.8%. The number of adult smokers also declined from 20.9% to 19.3%, representing nearly 3 million fewer smokers.

©milosluz/iStockphoto.com

Even as smoking prevalence has decreased overall, the data varies according to race/ethnicity, age, level of education, region, and poverty status (MMWR 2011;60:1-6). Smoking prevalence was lowest among Hispanics (12.5%) and Asians (9.2%), seniors (9.5%), those with a graduate degree (6.3%), and residents of the West (15.9%). The highest prevalence was among American Indians/Alaska Natives (31.4%), adults aged 25-44 years (22%), General Education Development (GED) certificate recipients (45.2%), and residents of the Midwest (21.8%). Categorized by poverty status, 18.3% of those at or above the poverty level smoke, compared with 28.9% of those below the poverty level.

Although smoking appears to be decreasing nationwide, the CDC said the rates have decreased more slowly in the past 5 years. A lack of investment in antismoking campaigns is one of the biggest contributing factors to the slow decline, according to Dr. Tim McAfee, director of the CDC’s Office on Smoking and Health.

"If states were to dedicate more like the 10%-15% that is recommended of these revenues for tobacco control, they’d be fully funding these programs and we’d be seeing a much more rapid decline in tobacco use in our society," Dr. McAfee said during a press briefing. Currently, states are contributing about 2% of their tobacco-related revenues to antismoking efforts.

Dr. McAfee added that states that invest in antismoking programs reap significant health care savings. For example, California has invested about $2.8 billion in antismoking efforts since 1988. During that same period, the state has saved nearly $86 billion in related health care costs and saw adult smoking rates decrease by about 50%, Dr. McAfee said. Smoking costs the United States $193 million annually, nearly equally divided between medical costs and loss of productivity, according to the CDC.

In addition to increased financial support for antismoking initiatives, the CDC recommends that more states place higher taxes on tobacco products and increase smoke-free policies and clinical interventions. As of 2011, 26 states and the District of Columbia have comprehensive smoke-free laws, according to the CDC.

Another 18 states have smoking restrictions at work sites, in restaurants, or in bars. Also, 25 states have added clean air laws that make smoking in public more difficult, Dr. McAfee said.

The report is based on data from the CDC’s 2005-2010 National Health Interview Surveys and the 2010 Behavioral Risk Factor Surveillance System survey. The analysis does not include data for underage smokers.

Adult smokers in the United States are smoking fewer cigarettes, according to a report released today by the Centers for Disease Control and Prevention.

The proportion of smokers who said they smoked 30 or more cigarettes daily decreased from 12.7% to 8.3%, according to CDC data for 2005-2010. Also, more smokers said they were smoking nine or fewer cigarettes daily, an increase from 16.4% to 21.8%. The number of adult smokers also declined from 20.9% to 19.3%, representing nearly 3 million fewer smokers.

©milosluz/iStockphoto.com

Even as smoking prevalence has decreased overall, the data varies according to race/ethnicity, age, level of education, region, and poverty status (MMWR 2011;60:1-6). Smoking prevalence was lowest among Hispanics (12.5%) and Asians (9.2%), seniors (9.5%), those with a graduate degree (6.3%), and residents of the West (15.9%). The highest prevalence was among American Indians/Alaska Natives (31.4%), adults aged 25-44 years (22%), General Education Development (GED) certificate recipients (45.2%), and residents of the Midwest (21.8%). Categorized by poverty status, 18.3% of those at or above the poverty level smoke, compared with 28.9% of those below the poverty level.

Although smoking appears to be decreasing nationwide, the CDC said the rates have decreased more slowly in the past 5 years. A lack of investment in antismoking campaigns is one of the biggest contributing factors to the slow decline, according to Dr. Tim McAfee, director of the CDC’s Office on Smoking and Health.

"If states were to dedicate more like the 10%-15% that is recommended of these revenues for tobacco control, they’d be fully funding these programs and we’d be seeing a much more rapid decline in tobacco use in our society," Dr. McAfee said during a press briefing. Currently, states are contributing about 2% of their tobacco-related revenues to antismoking efforts.

Dr. McAfee added that states that invest in antismoking programs reap significant health care savings. For example, California has invested about $2.8 billion in antismoking efforts since 1988. During that same period, the state has saved nearly $86 billion in related health care costs and saw adult smoking rates decrease by about 50%, Dr. McAfee said. Smoking costs the United States $193 million annually, nearly equally divided between medical costs and loss of productivity, according to the CDC.

In addition to increased financial support for antismoking initiatives, the CDC recommends that more states place higher taxes on tobacco products and increase smoke-free policies and clinical interventions. As of 2011, 26 states and the District of Columbia have comprehensive smoke-free laws, according to the CDC.

Another 18 states have smoking restrictions at work sites, in restaurants, or in bars. Also, 25 states have added clean air laws that make smoking in public more difficult, Dr. McAfee said.

The report is based on data from the CDC’s 2005-2010 National Health Interview Surveys and the 2010 Behavioral Risk Factor Surveillance System survey. The analysis does not include data for underage smokers.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."

Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."

Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Based on feedback from physicians and health care providers, the final federal e-prescribing regulations released Aug. 31 are more flexible and contain more exemptions, the Centers for Medicare and Medicaid Services announced.

The changes come after concern that the program criteria should be more aligned with the Medicaid incentive program for electronic health records, according to CMS officials.

"[The changes] will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, wrote in a blog post announcing the change. "With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors."

Under the Medicare Electronic Prescribing Incentive Program, eligible prescribers who meet the e-prescribing criteria will get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. Those who do not meet the criteria in 2012 will be penalized 1% of Medicare payments; the penalty will escalate in 2013 and 2014.

Under the final rule, prescribers who use certified electronic health records can claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records, CMS officials said.

The final rule, which goes into effect 30 days after its official publication in the Federal Register, contains hardship exemptions for those who live in a rural area without high-speed Internet access and those who work where there are not enough pharmacies that can take electronic prescriptions.

In addition, the final rule creates additional hardship exemption categories. Eligible professionals have to demonstrate that they have:

• registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology,

• an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics),

• very limited prescribing activity, or

• insufficient opportunities to report the e-prescribing measure.

The deadline to apply for a hardship exemption has been extended until Nov. 1, 2011, according to CMS officials.

Even with the changes, however, some physicians still have concerns. The American Medical Association said it is worried about the amount of time physicians will have to apply for the exemptions.

"We remain concerned that physicians will be hit with a penalty and are not being given enough time to comply with the e-prescribing program criteria to avoid this penalty," Dr. Cecil Wilson, AMA immediate past president, said in a statement.

Major Finding: Among the 7.4% of physicians who face medical malpractice claims every year, only 1.6% result in compensation paid to the plaintiff.

Data Source: An analysis of the malpractice claims of 40,916 physicians from 25 different specialties, from 1991 to 2005.

Disclosures: The study received funding from the National Institute on Aging and the RAND Institute for Civil Justice; one coauthor received grant support from the RAND Institute for Civil Justice.

Although physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65 years. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45 years, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629-36).

“If you've hit 65 and you haven't had a claim, that's rare; that's almost impossible in our data,” Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4% of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year. Specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent, Dr. Jena and his coauthors wrote.

For example, 19.1% of neurosurgeons faced a claim each year, according to the analysis, compared to 3.1% of pediatricians. However, the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

“A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer,” Dr. Jena said. “The physician has loss of productivity because they're not able to see patients as they defend cases … and then there are all sorts of nonmonetary costs that we simply cannot measure,” Dr. Jena said in an interview.

Among all specialties, neurosurgery had the yearly highest risk of being sued (19.1%), followed by thoracic-cardiovascular surgery (18.9%), and general surgery (15.3%). Specialties with the lowest yearly risk of facing being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there's little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

Major Finding: Among the 7.4% of physicians who face medical malpractice claims every year, only 1.6% result in compensation paid to the plaintiff.

Data Source: An analysis of the malpractice claims of 40,916 physicians from 25 different specialties, from 1991 to 2005.

Disclosures: The study received funding from the National Institute on Aging and the RAND Institute for Civil Justice; one coauthor received grant support from the RAND Institute for Civil Justice.

Although physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65 years. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45 years, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629-36).

“If you've hit 65 and you haven't had a claim, that's rare; that's almost impossible in our data,” Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4% of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year. Specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent, Dr. Jena and his coauthors wrote.

For example, 19.1% of neurosurgeons faced a claim each year, according to the analysis, compared to 3.1% of pediatricians. However, the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

“A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer,” Dr. Jena said. “The physician has loss of productivity because they're not able to see patients as they defend cases … and then there are all sorts of nonmonetary costs that we simply cannot measure,” Dr. Jena said in an interview.

Among all specialties, neurosurgery had the yearly highest risk of being sued (19.1%), followed by thoracic-cardiovascular surgery (18.9%), and general surgery (15.3%). Specialties with the lowest yearly risk of facing being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there's little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.

Major Finding: Among the 7.4% of physicians who face medical malpractice claims every year, only 1.6% result in compensation paid to the plaintiff.

Data Source: An analysis of the malpractice claims of 40,916 physicians from 25 different specialties, from 1991 to 2005.

Disclosures: The study received funding from the National Institute on Aging and the RAND Institute for Civil Justice; one coauthor received grant support from the RAND Institute for Civil Justice.

Although physicians in high-risk specialties face a near certainty of a malpractice claim at some point in their careers, only a small minority will end up making an indemnity payment to a patient.

The probability of facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier insuring more than 40,000 physicians in all 50 states and the District of Columbia.

Among physicians in high-risk specialties such as neurosurgery, general surgery, and obstetrics/gynecology, an estimated 88% were projected to face their first claim by age 45 and an estimated 99% by age 65. In low-risk specialties such as family medicine, pediatrics, and psychiatry, 36% of physicians were projected to face their first claim by age 45 years and 75% by age 65 years, Dr. Anupam Jena of Harvard Medical School and his colleagues wrote.

In contrast, the projected rates of indemnity claims paid to plaintiffs were lower. By age 45, 33% of physicians in high-risk specialties were projected to have had a claim paid, rising to 71% by age 65 years. For physicians in low-risk specialties, 5% were projected to have had a claim paid by age 45 years, rising to 19% by age 65 years (N. Engl. J. Med. 2011;365:629-36).

“If you've hit 65 and you haven't had a claim, that's rare; that's almost impossible in our data,” Dr. Jena said in an interview, adding that high-risk specialties often come with higher salaries, which could be what balances out the risk factor for physicians.

Overall, 7.4% of physicians were sued for malpractice each year of the study, with 1.6% having an indemnity payment made each year. Specialties in which physicians were more likely to face a malpractice claim were not the ones where indemnity payments were most prevalent, Dr. Jena and his coauthors wrote.

For example, 19.1% of neurosurgeons faced a claim each year, according to the analysis, compared to 3.1% of pediatricians. However, the average indemnity payment for neurosurgeons was $344,811, lower than the average of $520,924 for pediatricians.

While few claims resulted in payment, researchers said they were surprised by how many physicians face malpractice claims every year.

“A lot of those claims do not resolve in a payment to the patient, but they still involve significant monetary costs to both the physician and the insurer,” Dr. Jena said. “The physician has loss of productivity because they're not able to see patients as they defend cases … and then there are all sorts of nonmonetary costs that we simply cannot measure,” Dr. Jena said in an interview.

Among all specialties, neurosurgery had the yearly highest risk of being sued (19.1%), followed by thoracic-cardiovascular surgery (18.9%), and general surgery (15.3%). Specialties with the lowest yearly risk of facing being sued included psychiatry (2.6%), pediatrics (3.1%), and family medicine (5.2%). The average payment for all specialties was $273,887.

Some lawmakers and health care organizations have advocated for national medical malpractice reform, or tort reform, as a means of lowering health care costs; California and Texas already have $250,000 caps noneconomic damages. However, there's little evidence that proves these measures are lowering health care costs. Even without tort reform, Dr. Jena said that he believes the best solution is one that roots out frivolous claims.