Medical insurance company RANT

[PrincessPerky]

3 years ago, the Medical Association of Georgia used their money to bully the GA legislature into passing those laws aka "tort reform". They have to had admit that to date there has been no reduction in their malpractice insurance premiums. So that is not a solution.

And why should docs be shielded from being held civilly accountable for negligence or incompetence? I don't think there is anyone who doesn't agree that there are a multitude of frivolous lawsuits out there but you can't lump all lawsuits into the frivolous category.

K so insurance hasn't been reduced, but what about payouts and law suits that go to court? have they been reduced?

Though I have to say...folks assume to much is simple in an ER sometimes. Mistakes happen, and getting billions of dollars for it really isn't fair to the non messed up pts. suppose Johnny has a surgery and Doc messed up unless it was due to drunkenness or the like it was an accident. Paying Johnny a billion dollars because he cannot walk now leaves ALL the other pts of the Doc at risk of NOT receiving care. While I can sympathize with poor Johnny.... I do not feel a billion dollars (half of which goes to the lawyers anyway) will help that much. Not no money, just less. Maybe less lawyer speeches about 'how much Johnnys life is worth' would help?

Life is priceless, living life with all your abilities is priceless, you cannot pay someone back for messing that up.... payouts should be focused on paying for the extra care and expenses... not on "making it up to them". Because you can't.

[maat55]

3 years ago, the Medical Association of Georgia used their money to bully the GA legislature into passing those laws aka "tort reform". They have to had admit that to date there has been no reduction in their malpractice insurance premiums. So that is not a solution.

And why should docs be shielded from being held civilly accountable for negligence or incompetence? I don't think there is anyone who doesn't agree that there are a multitude of frivolous lawsuits out there but you can't lump all lawsuits into the frivolous category.

Something has to change. Doc's need to know their limits of abilities and work accordingly. Patients need to realize that we live in an imperfect world, mistakes happen. To through money into the punishment for doc's only hurts the patient. We are the ones the cost is passed on to. I think doc's being held to criminal and licence standards should be enough motivation to be thorough in their job.

[disneysteve]

3 years ago, the Medical Association of Georgia used their money to bully the GA legislature into passing those laws aka "tort reform". They have to had admit that to date there has been no reduction in their malpractice insurance premiums. So that is not a solution.

It isn't just about lowering malpractice premiums, though that would be nice.

It is more about lowering the cost of healthcare overall. Doctors order millions of tests and spend billions of dollars on unnecessary tests "just in case" to cover themselves in the event of a lawsuit.

Certainly, gross negligence and incompetence should be punished and patients should be compensated in a reasonable way for their losses. But that isn't the way the system is currently set up. Instead, it is set up to punish every doctor who may not have crossed every T and dotted every I in the records. And a great many cases punish doctors who did everything totally right and made no mistakes at all. Even when the doctor wins the case (which happens about 85% of the time), it still costs tens of thousands of dollars for a doctor to defend himself. That's what needs to change.

[disneysteve]

An APN can assess and order tests for strep throat and other acute conditions just as an MD. They also can follow their patient's medical history like a doctor

I totally agree that an APN can treat the acute conditons just fine. That isn't what this thread is about.

I disagree with the 2nd sentence, though. Yes, an APN can follow the history, but that won't be done at these walk-in clinics. They are set up to ONLY treat acute illnesses. They might know a patient has diabetes or hypertension, but they won't be doing anything about it other than reminding them to see their doctor. That's where I'm concerned that the continuity of care will be impacted.

If a patient wants to use a clinic instead of a private doctor, that is totally their choice. I just don't think the insurance company should be permitted to try and make that choice for them by giving the clinic an unfair competitive advantage by waiving the copay.

[maat55]

This is good for the consumer. Some doctors have the priestly attitude that only they can solve complex problems. An APN can assess and order tests for strep throat and other acute conditions just as an MD. They also can follow their patient's medical history like a doctor. Maybe this will encourage family doctors to start being more patient centered instead of running them through their clinics like cattle. IMHO

This may be true in most cases, but I went to a emergency center once and left there with no help at all. I was having pain move through my body, attacking joints and trouble with swallowing. I had never been sick like that in my life.

The next day I went to our family doctor who prescribed strep throat. He gave me shots and antibiotics and fixed me up.

[Cashguy]

This may be true in most cases, but I went to a emergency center once and left there with no help at all. I was having pain move through my body, attacking joints and trouble with swallowing. I had never been sick like that in my life.

The next day I went to our family doctor who prescribed strep throat. He gave me shots and antibiotics and fixed me up.

Don't mean to thread hijack:
I work in a ER for a group of highly respected peers and understand the frustration people have after sitting for hours in the waiting area in miserable severe pain and then finally getting less than two minutes to explain the problem to the doctor. ERs are understaffed with doctors as well RNs. I've seen many cases where the docs can't get a accurate diagnosis of the problem unless it's obvious and/or shows up on film or lab work. Then insurance is billed thousands for the visit.
Anyway, I will never leave my GP for a walk-in clinic unless absolutely necessary.

Glad to hear the injections and medicine cured you.

[Scanner]

I do think a $1000 co-pay is reasonable for all the drunks in the ER. I must spend 50% of my Friday nights overnight attending to drunks.

If you want to get drunk, pay for the ER care on your own dime IMO.

[sweeps]

I do think a $1000 co-pay is reasonable for all the drunks in the ER. I must spend 50% of my Friday nights overnight attending to drunks.

If you want to get drunk, pay for the ER care on your own dime IMO.

I can see it now:

Patient: "Help, I'm dying!"
Receptionist: "I need your insurance card, I need this 10-page questionnaire filled out, and I need you to blow hard into this Breathylzer test. Thank you, have a seat."

[Scanner]

No. . .not necessarily that. . .but after they are determined drunk and chewing up healthcare resources, they pony up a $1000 copay.

If they don't have it, then they can do time doing dishes in the cafeteria.

[disneysteve]

I do think a $1000 co-pay is reasonable for all the drunks in the ER. I must spend 50% of my Friday nights overnight attending to drunks.

If you want to get drunk, pay for the ER care on your own dime IMO.

Self-induced illness is a pet peeve of mine. Unfortunately, you can't limit it to just alcohol, though. Much of what I treat on a daily basis is self-induced in one way or another. Drugs and alcohol are the most obvious, but there are also all the morbidly obese patients who come in complaining of low back and knee pain, or the car accident victims who weren't wearing seatbelts or the smokers with chronic bronchitis or the type 2 diabetics who weigh 300+ pounds. I think people in general need to make their health and well being a much higher priority in their lives. If we all did this, health care costs would drop dramatically.

[asmom]

K so insurance hasn't been reduced, but what about payouts and law suits that go to court? have they been reduced?

Though I have to say...folks assume to much is simple in an ER sometimes. Mistakes happen, and getting billions of dollars for it really isn't fair to the non messed up pts. suppose Johnny has a surgery and Doc messed up unless it was due to drunkenness or the like it was an accident. Paying Johnny a billion dollars because he cannot walk now leaves ALL the other pts of the Doc at risk of NOT receiving care. While I can sympathize with poor Johnny.... I do not feel a billion dollars (half of which goes to the lawyers anyway) will help that much. Not no money, just less. Maybe less lawyer speeches about 'how much Johnnys life is worth' would help?

Life is priceless, living life with all your abilities is priceless, you cannot pay someone back for messing that up.... payouts should be focused on paying for the extra care and expenses... not on "making it up to them". Because you can't.

I mostly agree with you. A mistake does not = negligence and too often people think they should be guaranteed a good or perfect outcome. But is it really fair to say that in the case of negligence that people should only get extra care and expenses? That's a little harsh, don't you think? If you are disabled because of someone's malpractice your meds and medical supplies are paid for but nothing else? You don't think that if the ability to provide some of the niceties in life for yourself for example a vacation or a nice home is taken away from you, you should receive some compensation for that? No you can't make up for the loss of a limb or mobility or whatever else but I don't agree that you shouldn't even try. The award should try to be at least somewhat proportionate to the loss.

[PrincessPerky]

I mostly agree with you. A mistake does not = negligence and too often people think they should be guaranteed a good or perfect outcome. But is it really fair to say that in the case of negligence that people should only get extra care and expenses? That's a little harsh, don't you think? If you are disabled because of someone's malpractice your meds and medical supplies are paid for but nothing else? You don't think that if the ability to provide some of the niceties in life for yourself for example a vacation or a nice home is taken away from you, you should receive some compensation for that? No you can't make up for the loss of a limb or mobility or whatever else but I don't agree that you shouldn't even try. The award should try to be at least somewhat proportionate to the loss.

I forgot to add lost wages (and no claiming Johnny will be turning his 4 figure income into a 6 or 7 figure income if he wasn't ill!)...yeah a small bonus might be a bit of silver lining, but not a bazillion dollar lining!

[asmom]

It isn't just about lowering malpractice premiums, though that would be nice.

It is more about lowering the cost of healthcare overall. Doctors order millions of tests and spend billions of dollars on unnecessary tests "just in case" to cover themselves in the event of a lawsuit.

Certainly, gross negligence and incompetence should be punished and patients should be compensated in a reasonable way for their losses. But that isn't the way the system is currently set up. Instead, it is set up to punish every doctor who may not have crossed every T and dotted every I in the records. And a great many cases punish doctors who did everything totally right and made no mistakes at all. Even when the doctor wins the case (which happens about 85% of the time), it still costs tens of thousands of dollars for a doctor to defend himself. That's what needs to change.

I agree completely. I've had people threaten to sue because they didn't like their dinner or because they didn't get a blanket in a timely manner. They're usually willing to "settle" (naturally) and this sort of frivolous B.S. drives me nuts. It also costs the hospitals millions every year. But is the answer really so-called tort reform? I think it punishes those who have legitimate complaints.

This might sound wierd but I heard of a study in which physicians apologized in a matter of fact way for errors and percieved slights. Physicians who apologized were much less likely to be sued. I think that's worth exploring. In my own past I have on two occasions made medication errors. When I apologized and explained about what happened to the patient honestly and in an upfront manner and explained what steps were taken to insure that it wouldn't happen again, they were amazingly forgiving and most importantly....no legal action.