Frances Correa

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services department announced. The projected premium drop is based on bids submitted by Part D plans for 2012.

“No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don't have that terrible choice,” HHS Secretary Kathleen Sebelius said at the briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said.

“There [are] still critical gaps in coverage, especially for prescription drugs,” she said. She added that 25% of seniors have reported that high costs have lead them to skip dosages of medicine, cut pills in half, or simply not fill their prescriptions.

Although lawmakers have finally passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts. Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services department announced. The projected premium drop is based on bids submitted by Part D plans for 2012.

“No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don't have that terrible choice,” HHS Secretary Kathleen Sebelius said at the briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said.

“There [are] still critical gaps in coverage, especially for prescription drugs,” she said. She added that 25% of seniors have reported that high costs have lead them to skip dosages of medicine, cut pills in half, or simply not fill their prescriptions.

Although lawmakers have finally passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts. Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services department announced. The projected premium drop is based on bids submitted by Part D plans for 2012.

“No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don't have that terrible choice,” HHS Secretary Kathleen Sebelius said at the briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said.

“There [are] still critical gaps in coverage, especially for prescription drugs,” she said. She added that 25% of seniors have reported that high costs have lead them to skip dosages of medicine, cut pills in half, or simply not fill their prescriptions.

Although lawmakers have finally passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts. Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

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 years, 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. 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, 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.

“There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don't have that same merit. And those are the claims that we really should try to identify and limit early.”

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 years, 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. 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, 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.

“There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don't have that same merit. And those are the claims that we really should try to identify and limit early.”

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 years, 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. 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, 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.

“There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don't have that same merit. And those are the claims that we really should try to identify and limit early.”

Major Finding: 25% of Americans said they skipped going to the doctor when they were sick or injured. Among that 25%, 49% said they skipped going to the doctor because of costs.

Data Source: Deloitte Center for Health Solutions 2011 Survey of Health Care Consumers.

Disclosures: Researchers had no relevant financial disclosures.

The high costs of health care in the current uncertain economic environment are leading more consumers to delay medical care. That's according to the Deloitte Center for Health Solutions' 2011 Survey of Health Care Consumers, which included 15,000 health care consumers from 12 countries.

Among American respondents, 25% said they have skipped seeing a doctor when they were sick or injured. Among that 25%, 49% said they skipped going to a doctor because of costs. That's compared with 39% in Belgium, 35% in China, 34% in Mexico, 5% in Canada, and 7% in the United Kingdom and Luxembourg.

An additional 63% of Americans said their monthly health care costs make it harder for them to fund their housing, groceries, fuel, and education. Executive director Paul H. Keckley, Ph.D., said this year's results indicate a global concern.

“Regardless of the type of health care system – government-run or private – consumers around the world are feeling the pinch,” Dr. Keckley said in a statement.

While Americans might be skipping doctor's visits, it's not because they don't need care. In times of economic downturn and high unemployment, the need for psychiatric care is highest, according to Dr. Lee H. Beecher, a psychiatrist who practices in St. Louis Park, Minn.

He added that high premium rates for private insurance plans and low reimbursement rates for Medicare and Medicaid payments are decreasing patient access to care. Without a fix to the reimbursement systems and higher pay for outpatient services, Dr. Beecher said, more psychiatrists will be forced to work within a hospital system or the public sector. This, he said, will mean a more assembly-line approach to care, and less time to dedicate to patients.

“You might be able to see a psychiatrist every 3 to 6 months … you don't have a doctor-patient relationship with the psychiatrist as a patient in these public programs,” Dr. Beecher said in an interview.

As of January 2013, physicians will face a 30% cut in reimbursement rates under Medicare. In addition, the bill to raise the national debt ceiling included a committee tasked with assessing additional cuts down the line. Unless Congress takes action, physicians face an additional 2% cut by January 2014 and possible further cuts by the committee.

Deloitte has been measuring consumer trends in the health care system since 2008.

Major Finding: 25% of Americans said they skipped going to the doctor when they were sick or injured. Among that 25%, 49% said they skipped going to the doctor because of costs.

Data Source: Deloitte Center for Health Solutions 2011 Survey of Health Care Consumers.

Disclosures: Researchers had no relevant financial disclosures.

The high costs of health care in the current uncertain economic environment are leading more consumers to delay medical care. That's according to the Deloitte Center for Health Solutions' 2011 Survey of Health Care Consumers, which included 15,000 health care consumers from 12 countries.

Among American respondents, 25% said they have skipped seeing a doctor when they were sick or injured. Among that 25%, 49% said they skipped going to a doctor because of costs. That's compared with 39% in Belgium, 35% in China, 34% in Mexico, 5% in Canada, and 7% in the United Kingdom and Luxembourg.

An additional 63% of Americans said their monthly health care costs make it harder for them to fund their housing, groceries, fuel, and education. Executive director Paul H. Keckley, Ph.D., said this year's results indicate a global concern.

“Regardless of the type of health care system – government-run or private – consumers around the world are feeling the pinch,” Dr. Keckley said in a statement.

While Americans might be skipping doctor's visits, it's not because they don't need care. In times of economic downturn and high unemployment, the need for psychiatric care is highest, according to Dr. Lee H. Beecher, a psychiatrist who practices in St. Louis Park, Minn.

He added that high premium rates for private insurance plans and low reimbursement rates for Medicare and Medicaid payments are decreasing patient access to care. Without a fix to the reimbursement systems and higher pay for outpatient services, Dr. Beecher said, more psychiatrists will be forced to work within a hospital system or the public sector. This, he said, will mean a more assembly-line approach to care, and less time to dedicate to patients.

“You might be able to see a psychiatrist every 3 to 6 months … you don't have a doctor-patient relationship with the psychiatrist as a patient in these public programs,” Dr. Beecher said in an interview.

As of January 2013, physicians will face a 30% cut in reimbursement rates under Medicare. In addition, the bill to raise the national debt ceiling included a committee tasked with assessing additional cuts down the line. Unless Congress takes action, physicians face an additional 2% cut by January 2014 and possible further cuts by the committee.

Deloitte has been measuring consumer trends in the health care system since 2008.

Major Finding: 25% of Americans said they skipped going to the doctor when they were sick or injured. Among that 25%, 49% said they skipped going to the doctor because of costs.

Data Source: Deloitte Center for Health Solutions 2011 Survey of Health Care Consumers.

Disclosures: Researchers had no relevant financial disclosures.

The high costs of health care in the current uncertain economic environment are leading more consumers to delay medical care. That's according to the Deloitte Center for Health Solutions' 2011 Survey of Health Care Consumers, which included 15,000 health care consumers from 12 countries.

Among American respondents, 25% said they have skipped seeing a doctor when they were sick or injured. Among that 25%, 49% said they skipped going to a doctor because of costs. That's compared with 39% in Belgium, 35% in China, 34% in Mexico, 5% in Canada, and 7% in the United Kingdom and Luxembourg.

An additional 63% of Americans said their monthly health care costs make it harder for them to fund their housing, groceries, fuel, and education. Executive director Paul H. Keckley, Ph.D., said this year's results indicate a global concern.

“Regardless of the type of health care system – government-run or private – consumers around the world are feeling the pinch,” Dr. Keckley said in a statement.

While Americans might be skipping doctor's visits, it's not because they don't need care. In times of economic downturn and high unemployment, the need for psychiatric care is highest, according to Dr. Lee H. Beecher, a psychiatrist who practices in St. Louis Park, Minn.

He added that high premium rates for private insurance plans and low reimbursement rates for Medicare and Medicaid payments are decreasing patient access to care. Without a fix to the reimbursement systems and higher pay for outpatient services, Dr. Beecher said, more psychiatrists will be forced to work within a hospital system or the public sector. This, he said, will mean a more assembly-line approach to care, and less time to dedicate to patients.

“You might be able to see a psychiatrist every 3 to 6 months … you don't have a doctor-patient relationship with the psychiatrist as a patient in these public programs,” Dr. Beecher said in an interview.

As of January 2013, physicians will face a 30% cut in reimbursement rates under Medicare. In addition, the bill to raise the national debt ceiling included a committee tasked with assessing additional cuts down the line. Unless Congress takes action, physicians face an additional 2% cut by January 2014 and possible further cuts by the committee.

Deloitte has been measuring consumer trends in the health care system since 2008.

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 a physicians' facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier that insures 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 those physicians.

Overall, 7.4% of physicians were sued for malpractice in 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 in which indemnity payments were most prevalent.

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

Although 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 physicians have “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 on 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.

“There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don't have that same merit. And those are the claims that we really should try to identify and limit early.”

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.

View on the News

Liability 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. 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. Trial lawyers seeking a large payoff can no longer afford to litigate cases with few damages, so nuisance cases are reduced to complaints before the Texas Medical Board.

Texas hospitals can now redirect liability funds to improving care, like funding electronic health records. Physicians can invest in their practices, and 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 and a practicing orthopedic surgeon at the Austin Bone and Joint Clinic in Austin.

Vitals

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 a physicians' facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier that insures 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 those physicians.

Overall, 7.4% of physicians were sued for malpractice in 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 in which indemnity payments were most prevalent.

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

Although 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 physicians have “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 on 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.

“There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don't have that same merit. And those are the claims that we really should try to identify and limit early.”

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.

View on the News

Liability 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. 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. Trial lawyers seeking a large payoff can no longer afford to litigate cases with few damages, so nuisance cases are reduced to complaints before the Texas Medical Board.

Texas hospitals can now redirect liability funds to improving care, like funding electronic health records. Physicians can invest in their practices, and 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 and a practicing orthopedic surgeon at the Austin Bone and Joint Clinic in Austin.

Vitals

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 a physicians' facing a malpractice claim increases with length of time in practice, based on data from 1991 through 2005 from a large national malpractice carrier that insures 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 those physicians.

Overall, 7.4% of physicians were sued for malpractice in 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 in which indemnity payments were most prevalent.

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

Although 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 physicians have “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 on 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.

“There are some claims which have merit and should be fully investigated and should be brought before a jury or settled, and there are also claims that don't have that same merit. And those are the claims that we really should try to identify and limit early.”

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.

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Liability 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. 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. Trial lawyers seeking a large payoff can no longer afford to litigate cases with few damages, so nuisance cases are reduced to complaints before the Texas Medical Board.

Texas hospitals can now redirect liability funds to improving care, like funding electronic health records. Physicians can invest in their practices, and 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 and a practicing orthopedic surgeon at the Austin Bone and Joint Clinic in Austin.

Vitals

Insurers would be required to provide consumers with simple, standardized information regarding health policies under proposed regulations announced by the federal departments of Health and Human Services, Labor, and Treasury.

Under the regulations, insurers would be required to provide an outline of benefits, expenses, premiums, and other coverage details on no more than four double-sided pages. The document – called a Summary of Benefits and Coverage – must include examples of how coverage would apply in real-life situations, such as labor and delivery and diabetes management. Any changes in coverage will require 60-day notice.

“Instead of trying to decipher dozens of pages of just dense text, to just guess how a plan will cover your care, now it will be clearly stated in plain English,” said Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services.

Officials said the standardized process would make it easier for consumers as well as companies looking to provide insurance for employees to compare plans, making way for a more competitive market. “If an insurer's plan offers a subpar coverage in some area, they won't be able to hide that in dozens of pages of text. They'll have to come right out and say it,” Dr. Berwick said.

The standardized forms underwent months of testing through the Consumers Union, which showed that the forms helped purchasers compare their insurance options, said Lynn Quincy, senior policy analyst for Consumers Union. “Seeing the total amount they had to pay made it much easier to understand how much coverage they were getting from the health plan,” she said.

The proposed regulations include recommendations from the National Association of Insurance Commissioners. Comments can be made at www.regulations.gov

A plan with 'subpar coverage in some area … won't be able to hide that in dozens of pages of text.'

Source DR. BERWICK

Insurers would be required to provide consumers with simple, standardized information regarding health policies under proposed regulations announced by the federal departments of Health and Human Services, Labor, and Treasury.

Under the regulations, insurers would be required to provide an outline of benefits, expenses, premiums, and other coverage details on no more than four double-sided pages. The document – called a Summary of Benefits and Coverage – must include examples of how coverage would apply in real-life situations, such as labor and delivery and diabetes management. Any changes in coverage will require 60-day notice.

“Instead of trying to decipher dozens of pages of just dense text, to just guess how a plan will cover your care, now it will be clearly stated in plain English,” said Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services.

Officials said the standardized process would make it easier for consumers as well as companies looking to provide insurance for employees to compare plans, making way for a more competitive market. “If an insurer's plan offers a subpar coverage in some area, they won't be able to hide that in dozens of pages of text. They'll have to come right out and say it,” Dr. Berwick said.

The standardized forms underwent months of testing through the Consumers Union, which showed that the forms helped purchasers compare their insurance options, said Lynn Quincy, senior policy analyst for Consumers Union. “Seeing the total amount they had to pay made it much easier to understand how much coverage they were getting from the health plan,” she said.

The proposed regulations include recommendations from the National Association of Insurance Commissioners. Comments can be made at www.regulations.gov

A plan with 'subpar coverage in some area … won't be able to hide that in dozens of pages of text.'

Source DR. BERWICK

Insurers would be required to provide consumers with simple, standardized information regarding health policies under proposed regulations announced by the federal departments of Health and Human Services, Labor, and Treasury.

Under the regulations, insurers would be required to provide an outline of benefits, expenses, premiums, and other coverage details on no more than four double-sided pages. The document – called a Summary of Benefits and Coverage – must include examples of how coverage would apply in real-life situations, such as labor and delivery and diabetes management. Any changes in coverage will require 60-day notice.

“Instead of trying to decipher dozens of pages of just dense text, to just guess how a plan will cover your care, now it will be clearly stated in plain English,” said Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services.

Officials said the standardized process would make it easier for consumers as well as companies looking to provide insurance for employees to compare plans, making way for a more competitive market. “If an insurer's plan offers a subpar coverage in some area, they won't be able to hide that in dozens of pages of text. They'll have to come right out and say it,” Dr. Berwick said.

The standardized forms underwent months of testing through the Consumers Union, which showed that the forms helped purchasers compare their insurance options, said Lynn Quincy, senior policy analyst for Consumers Union. “Seeing the total amount they had to pay made it much easier to understand how much coverage they were getting from the health plan,” she said.

The proposed regulations include recommendations from the National Association of Insurance Commissioners. Comments can be made at www.regulations.gov

A plan with 'subpar coverage in some area … won't be able to hide that in dozens of pages of text.'

Source DR. BERWICK

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, according to the Health and Human Services Department. The projected premium drop is based on bids submitted by Part D plans for 2012.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, HHS Secretary Kathleen Sebelius said at a press briefing. Under ACA, the administration aims to close the doughnut hole by 2020.

“There [are] still critical gaps in coverage, especially for prescription drugs,” Ms. Sebelius said, adding that 25% of seniors report skipping medicines orsnot filling trescriptions because of high costs.

Although lawmakers have passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts. HHS officials would not comment on how beneficiaries could be affected.

The Joint Select Committee on Deficit Reduction, has until Nov. 23 to decide where to trim more than $1 trillion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, according to the Health and Human Services Department. The projected premium drop is based on bids submitted by Part D plans for 2012.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, HHS Secretary Kathleen Sebelius said at a press briefing. Under ACA, the administration aims to close the doughnut hole by 2020.

“There [are] still critical gaps in coverage, especially for prescription drugs,” Ms. Sebelius said, adding that 25% of seniors report skipping medicines orsnot filling trescriptions because of high costs.

Although lawmakers have passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts. HHS officials would not comment on how beneficiaries could be affected.

The Joint Select Committee on Deficit Reduction, has until Nov. 23 to decide where to trim more than $1 trillion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, according to the Health and Human Services Department. The projected premium drop is based on bids submitted by Part D plans for 2012.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, HHS Secretary Kathleen Sebelius said at a press briefing. Under ACA, the administration aims to close the doughnut hole by 2020.

“There [are] still critical gaps in coverage, especially for prescription drugs,” Ms. Sebelius said, adding that 25% of seniors report skipping medicines orsnot filling trescriptions because of high costs.

Although lawmakers have passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts. HHS officials would not comment on how beneficiaries could be affected.

The Joint Select Committee on Deficit Reduction, has until Nov. 23 to decide where to trim more than $1 trillion.

Three out of five adults who lost a job with health benefits in the past 2 years became uninsured, and many of those people and their families went without basic medical care, according to survey assessing the recession's impact.

Conducted by the Commonwealth Foundation, the analysis found that 72% of the 43 million adults who lost jobs during 2008-2010 have failed to fill a prescription or they skipped a recommended test, treatment, or follow-up. The same group also said that, due to high costs, they did not go see a doctor when they had a medical issue.

Many reported that medical bills forced them to spend all their savings (32%), go without paying for necessities like food, heat, or rent (27%), take on credit card debt (14%), or take out a loan or home mortgage (9%). The findings were based on the Commonwealth Fund 2010 Biennial Health Insurance Survey of 4,005 adults aged 19-64 years.

Dr. Yul Ejnes, a general internist at Coastal Medical in Cranston, R.I., said that the findings are consistent with what he has witnessed in own practice. Dr. Ejnes said he often reduces his fees and sometimes even waives fees for regular patients who lose their jobs.

Although the Consolidated Omnibus Budget Reconciliation Act, or COBRA, allows laid-off workers to keep their coverage for up to 18 months, few people enrolled during 2008-2010 because of high premium costs. “Once you are unemployed and uninsured, it's nearly impossible to afford COBRA or buy an individual policy,” noted Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund and coauthor of the report. She added that provisions of the Affordable Care Act will transform access to care.

“When it is fully implemented in 2014, the Affordable Care Act will usher in a new era for the unemployed, who will have a variety of options for comprehensive and affordable health insurance,” Dr. Collins said. Until then, the report recommended extending jobless benefits and reestablishing COBRA subsidies to help uninsured Americans keep their coverage.

Three out of five adults who lost a job with health benefits in the past 2 years became uninsured, and many of those people and their families went without basic medical care, according to survey assessing the recession's impact.

Conducted by the Commonwealth Foundation, the analysis found that 72% of the 43 million adults who lost jobs during 2008-2010 have failed to fill a prescription or they skipped a recommended test, treatment, or follow-up. The same group also said that, due to high costs, they did not go see a doctor when they had a medical issue.

Many reported that medical bills forced them to spend all their savings (32%), go without paying for necessities like food, heat, or rent (27%), take on credit card debt (14%), or take out a loan or home mortgage (9%). The findings were based on the Commonwealth Fund 2010 Biennial Health Insurance Survey of 4,005 adults aged 19-64 years.

Dr. Yul Ejnes, a general internist at Coastal Medical in Cranston, R.I., said that the findings are consistent with what he has witnessed in own practice. Dr. Ejnes said he often reduces his fees and sometimes even waives fees for regular patients who lose their jobs.

Although the Consolidated Omnibus Budget Reconciliation Act, or COBRA, allows laid-off workers to keep their coverage for up to 18 months, few people enrolled during 2008-2010 because of high premium costs. “Once you are unemployed and uninsured, it's nearly impossible to afford COBRA or buy an individual policy,” noted Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund and coauthor of the report. She added that provisions of the Affordable Care Act will transform access to care.

“When it is fully implemented in 2014, the Affordable Care Act will usher in a new era for the unemployed, who will have a variety of options for comprehensive and affordable health insurance,” Dr. Collins said. Until then, the report recommended extending jobless benefits and reestablishing COBRA subsidies to help uninsured Americans keep their coverage.

Three out of five adults who lost a job with health benefits in the past 2 years became uninsured, and many of those people and their families went without basic medical care, according to survey assessing the recession's impact.

Conducted by the Commonwealth Foundation, the analysis found that 72% of the 43 million adults who lost jobs during 2008-2010 have failed to fill a prescription or they skipped a recommended test, treatment, or follow-up. The same group also said that, due to high costs, they did not go see a doctor when they had a medical issue.

Many reported that medical bills forced them to spend all their savings (32%), go without paying for necessities like food, heat, or rent (27%), take on credit card debt (14%), or take out a loan or home mortgage (9%). The findings were based on the Commonwealth Fund 2010 Biennial Health Insurance Survey of 4,005 adults aged 19-64 years.

Dr. Yul Ejnes, a general internist at Coastal Medical in Cranston, R.I., said that the findings are consistent with what he has witnessed in own practice. Dr. Ejnes said he often reduces his fees and sometimes even waives fees for regular patients who lose their jobs.

Although the Consolidated Omnibus Budget Reconciliation Act, or COBRA, allows laid-off workers to keep their coverage for up to 18 months, few people enrolled during 2008-2010 because of high premium costs. “Once you are unemployed and uninsured, it's nearly impossible to afford COBRA or buy an individual policy,” noted Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund and coauthor of the report. She added that provisions of the Affordable Care Act will transform access to care.

“When it is fully implemented in 2014, the Affordable Care Act will usher in a new era for the unemployed, who will have a variety of options for comprehensive and affordable health insurance,” Dr. Collins said. Until then, the report recommended extending jobless benefits and reestablishing COBRA subsidies to help uninsured Americans keep their coverage.

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. 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.

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%). Cardiologists' risk fell in between the two categories, at about 9%. 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 on 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. 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.

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%). Cardiologists' risk fell in between the two categories, at about 9%. 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 on 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. 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.

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%). Cardiologists' risk fell in between the two categories, at about 9%. 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 on 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.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services Department announced. The projected premium drop is based on bids submitted by Part D plans for 2012.

“No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don't have that terrible choice,” HHS Secretary Kathleen Sebelius said during a press briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said. Under ACA, the administration aims to close the doughnut hole by 2020.

“There [are] still critical gaps in coverage, especially for prescription drugs,” Ms. Sebelius said.

Although lawmakers have finally passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts.

Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services Department announced. The projected premium drop is based on bids submitted by Part D plans for 2012.

“No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don't have that terrible choice,” HHS Secretary Kathleen Sebelius said during a press briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said. Under ACA, the administration aims to close the doughnut hole by 2020.

“There [are] still critical gaps in coverage, especially for prescription drugs,” Ms. Sebelius said.

Although lawmakers have finally passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts.

Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

Medicare beneficiaries with prescription drug coverage under Part D will pay about $1 less in monthly premiums next year for a basic plan, the Health and Human Services Department announced. The projected premium drop is based on bids submitted by Part D plans for 2012.

“No seniors should ever have to choose between medication they need to be healthy and putting food on their table, and the health care law is helping to make sure they don't have that terrible choice,” HHS Secretary Kathleen Sebelius said during a press briefing.

Further, about 900,000 beneficiaries have hit the Part D coverage gap or “doughnut hole” this year and have become eligible for a 50% discount on covered brand-name drugs. As of June, that discount – a provision of the Affordable Care Act – has saved Medicare beneficiaries about $462 million, Ms. Sebelius said. Under ACA, the administration aims to close the doughnut hole by 2020.

“There [are] still critical gaps in coverage, especially for prescription drugs,” Ms. Sebelius said.

Although lawmakers have finally passed an agreement to raise the nation's debt limit, Medicare remains vulnerable to cuts.

Under the Budget Control Act of 2011, the bipartisan 12-member Joint Select Committee on Deficit Reduction, also known as the Super Committee, will have until Nov. 23 to decide where to trim out an additional more than $1 trillion.

Three out of five adults who lost a job with health benefits in the past 2 years became uninsured and many of those people and their families went without basic medical care, according to survey aimed at assessing the impact of the recession.

Conducted by the Commonwealth Foundation, the analysis found that 72% of the 43 million adults who lost jobs during 2008-2010 have failed to fill a prescription or they skipped a recommended test, treatment, or follow-up. The same group also said that, due to high costs, they did not go see a doctor when they had a medical issue.

Many reported that medical bills forced them to spend all their savings (32%), go without paying for necessities like food, heat, or rent (27%), take on credit card debt (14%), or take out a loan or home mortgage (9%). The findings were based on the Commonwealth Fund 2010 Biennial Health Insurance Survey of 4,005 adults aged 19-64 years.

Dr. Yul Ejnes, a general internist at Coastal Medical in Cranston, R.I., said that the findings are consistent with what he has witnessed in own practice. Over the past few years, more of his patients have cancelled appointments or requested generic medications after being laid off. Dr. Ejnes said he often reduces his fees and sometimes even waives fees for regular patients who lose their jobs. While he has been able to adjust his own fees for those who need it, Dr. Ejnes noted that not all practices have that option. And, even if his patients do get in to see him, often they are unable to afford high-cost items such as MRIs or medical procedures.

"Depending on how many [uninsured] patients there are and what the practice demographics are, it can cause some strains on [a] practice ... it’s a burden I’ve been able to absorb," Dr. Ejnes added in an interview.

Although the Consolidated Omnibus Budget Reconciliation Act, or COBRA, allows laid-off workers to keep their coverage for up to 18 months, few people enrolled during 2008-2010 because of high premium costs. "Once you are unemployed and uninsured, it’s nearly impossible to afford COBRA or buy an individual policy," noted Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund and coauthor of the report. She added that provisions of the Affordable Care Act will transform access to care.

"When it is fully implemented in 2014, the Affordable Care Act will usher in a new era for the unemployed, who will have a variety of options for comprehensive and affordable health insurance," Dr. Collins said. Until then, the report recommended extending jobless benefits and reestablishing COBRA subsidies to help uninsured Americans keep their coverage.

The Commonwealth Fund is a nonpartisan foundation supporting research on health policy.

Three out of five adults who lost a job with health benefits in the past 2 years became uninsured and many of those people and their families went without basic medical care, according to survey aimed at assessing the impact of the recession.

Conducted by the Commonwealth Foundation, the analysis found that 72% of the 43 million adults who lost jobs during 2008-2010 have failed to fill a prescription or they skipped a recommended test, treatment, or follow-up. The same group also said that, due to high costs, they did not go see a doctor when they had a medical issue.

Many reported that medical bills forced them to spend all their savings (32%), go without paying for necessities like food, heat, or rent (27%), take on credit card debt (14%), or take out a loan or home mortgage (9%). The findings were based on the Commonwealth Fund 2010 Biennial Health Insurance Survey of 4,005 adults aged 19-64 years.

Dr. Yul Ejnes, a general internist at Coastal Medical in Cranston, R.I., said that the findings are consistent with what he has witnessed in own practice. Over the past few years, more of his patients have cancelled appointments or requested generic medications after being laid off. Dr. Ejnes said he often reduces his fees and sometimes even waives fees for regular patients who lose their jobs. While he has been able to adjust his own fees for those who need it, Dr. Ejnes noted that not all practices have that option. And, even if his patients do get in to see him, often they are unable to afford high-cost items such as MRIs or medical procedures.

"Depending on how many [uninsured] patients there are and what the practice demographics are, it can cause some strains on [a] practice ... it’s a burden I’ve been able to absorb," Dr. Ejnes added in an interview.

Although the Consolidated Omnibus Budget Reconciliation Act, or COBRA, allows laid-off workers to keep their coverage for up to 18 months, few people enrolled during 2008-2010 because of high premium costs. "Once you are unemployed and uninsured, it’s nearly impossible to afford COBRA or buy an individual policy," noted Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund and coauthor of the report. She added that provisions of the Affordable Care Act will transform access to care.

"When it is fully implemented in 2014, the Affordable Care Act will usher in a new era for the unemployed, who will have a variety of options for comprehensive and affordable health insurance," Dr. Collins said. Until then, the report recommended extending jobless benefits and reestablishing COBRA subsidies to help uninsured Americans keep their coverage.

The Commonwealth Fund is a nonpartisan foundation supporting research on health policy.

Three out of five adults who lost a job with health benefits in the past 2 years became uninsured and many of those people and their families went without basic medical care, according to survey aimed at assessing the impact of the recession.

Conducted by the Commonwealth Foundation, the analysis found that 72% of the 43 million adults who lost jobs during 2008-2010 have failed to fill a prescription or they skipped a recommended test, treatment, or follow-up. The same group also said that, due to high costs, they did not go see a doctor when they had a medical issue.

Many reported that medical bills forced them to spend all their savings (32%), go without paying for necessities like food, heat, or rent (27%), take on credit card debt (14%), or take out a loan or home mortgage (9%). The findings were based on the Commonwealth Fund 2010 Biennial Health Insurance Survey of 4,005 adults aged 19-64 years.

Dr. Yul Ejnes, a general internist at Coastal Medical in Cranston, R.I., said that the findings are consistent with what he has witnessed in own practice. Over the past few years, more of his patients have cancelled appointments or requested generic medications after being laid off. Dr. Ejnes said he often reduces his fees and sometimes even waives fees for regular patients who lose their jobs. While he has been able to adjust his own fees for those who need it, Dr. Ejnes noted that not all practices have that option. And, even if his patients do get in to see him, often they are unable to afford high-cost items such as MRIs or medical procedures.

"Depending on how many [uninsured] patients there are and what the practice demographics are, it can cause some strains on [a] practice ... it’s a burden I’ve been able to absorb," Dr. Ejnes added in an interview.

Although the Consolidated Omnibus Budget Reconciliation Act, or COBRA, allows laid-off workers to keep their coverage for up to 18 months, few people enrolled during 2008-2010 because of high premium costs. "Once you are unemployed and uninsured, it’s nearly impossible to afford COBRA or buy an individual policy," noted Sara R. Collins, Ph.D., vice president for Affordable Health Insurance at the Commonwealth Fund and coauthor of the report. She added that provisions of the Affordable Care Act will transform access to care.

"When it is fully implemented in 2014, the Affordable Care Act will usher in a new era for the unemployed, who will have a variety of options for comprehensive and affordable health insurance," Dr. Collins said. Until then, the report recommended extending jobless benefits and reestablishing COBRA subsidies to help uninsured Americans keep their coverage.

The Commonwealth Fund is a nonpartisan foundation supporting research on health policy.