Docs admit malpractice fears lead to overly aggressive care, -and- UC-Davis Wins Emergency Services Lawsuit

Sun Oct 9 16:23:45 PDT 2011

Description: Description: Description: Description: CAL/AAEM: California
Chapter of the American Academy of Emergency Medicine

September 27, 2011

Docs admit malpractice fears lead to overly aggressive care

FierceHealthcare
<http://blogs.wsj.com/health/2011/09/26/many-physicians-feel-theyre-deliveri
ng-too-much-care/> 

Doctors admit to being part of the healthcare problem, fessing up that they
provide too much medical care in a nationwide survey published in the
Archives of Internal Medicine. They said malpractice concerns, current
reimbursement structure, and quality measurement systems drove them to
practice more aggressive healthcare.

Almost half (42 percent) of the 627 surveyed physicians said their patients
"were receiving too much medical care" and another 28 percent said they had
ordered more tests and made more referrals to specialists than they would
like, reports the Los Angeles Times.

The doctors said fear of malpractice lawsuits (76 percent) and clinical
performance measures (52 percent) were the most common drivers of their more
aggressive practices. Another 40 percent don't spend enough time with their
patients to figure out what's wrong, so they ordered tests and consultations
to provide answers.

Eighty-three percent of the physicians said they could be sued if they
didn't order a test that was indicated, whereas only 21 percent said they
could be sued for ordering a test that wasn't indicated, according to the
Wall Street Journal. The incentives, therefore, point toward "when in doubt,
do more," says Brenda Sirovich, an author of the study and a staff physician
and research associate in the Outcomes Group at the VA Medical Center in
White River Junction, Vt.

The study also found that 40 percent of doctors thought other primary care
physicians were driven by extra income that results from ordering more
tests, although only 3 percent said financial considerations influenced
their own practice style, Reuters reports.

"I'm not saying that physicians do tests in order to make money--there is a
potential to be a real cynic here--but I think that the reimbursement model
for most healthcare encourages utilization in a variety of ways," Sirovich
said. "It's a time for us to reflect about what incentives we have built
into our healthcare system, and what directions they are taking us in," she
added.

September 30, 2011

UC-Davis Wins Emergency Services Lawsuit

CaliforniaHealthline
<http://www.californiahealthline.org/capitol-desk/2011/9/judge-rules-county-
must-pay-ed-costs.aspx#ixzz1ZYtehKXE> 

by David Gorn 

The courts have sided with UC-Davis Medical Center, ruling this week that
Sacramento County must pay for emergency services for indigent patients.

Superior Court Judge Lloyd Connelly said the county has a responsibility to
pay for indigent care, whether the county contracts with a specific provider
of those emergency services or not.

"The judge rejected every defense the county had to not pay us," UC-Davis
attorney David Levine said. "He conclusively confirmed that they owe us
money, and they have to pay us."

Another hearing will determine how much the county owes UCD Med Center.
Levine estimates it "in the multiple tens of millions of dollars." Other
counties pay for indigents' emergency services, Levine said. He doesn't know
of any other county that has gone to court to try to halt those payments.

"This is good news for the university, for the community, for the
indigents," Levine said. "It's good news."

County officials said that they've always been willing to resolve issues
with UCD Med Center and that the ruling doesn't change that. And according
to Brad Hudson, a Sacramento County official, the county finds itself in an
unusual position -- pinched by state budget cuts, and now by a California
university's lawsuit. 

"It's unfortunate that an arm of the state chose to sue Sacramento County
over payment of indigent health care services at UC-Davis, when ironically
the state has grossly underfunded this program at the county level."

Sacramento County lost a similar court case last month. That case dealt with
a Sacramento County resident who became ill while visiting Monterey County
and went to a hospital emergency department in Monterey. The court ruled
that indigent care responsibility applied no matter where the care was
delivered and ordered Sacramento County to pay.

Read more:
http://www.californiahealthline.org/capitol-desk/2011/9/judge-rules-county-m
ust-pay-ed-costs.aspx#ixzz1ZYtehKXE

Marcus Williams &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

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