REUTERS: 1% of U.S. Docs Responsible for 1/3 of Malpractice Payments

In an article released on January 27, Gene Emery of Reuters writes that a large portion of the malpractice claims that result in payments to patients are caused by a small fraction of doctors in the United States.

Key Facts:

• "Almost one third of the cases were sparked by a patient's death. About 1 percent of physicians had at least two paid claims against them and those doctors accounted for 32 percent of paid claims."
• "One hundred twenty six doctors had more than five paid claims against them."
• "The median payment among all claims was nearly $205,000."
• "Doctors who accumulated two lawsuits where money was paid out were twice as likely to be successfully sued for malpractice a third time compared to doctors who only had one paid claim against them. Doctors with more than five paid claims were 12 times more likely to face a subsequent claim."
• "Compared to general practitioners, recurrence rates were roughly two times higher in the fields of obstetrics and gynecology, orthopedic surgery, plastic surgery and general surgery. The recurrence rate was highest for neurosurgeons, at 2.3 times that of GPs."
• "They found that physicians under age 35 were two thirds less likely to have to pay on a malpractice claim after an initial payment." 
• "The odds of paying out on a subsequent claim were 38 percent higher among male doctors than female physicians." 
• "Doctors trained outside the United States were 12 percent more likely to have to pay out on more than one claim."

Mr. Emery derived these statistics from an article published by Dr. David Studdert et al. in The New England Journal of Medicine, titled "Prevalence and Characteristics of Physicians Prone to Malpractice Claims."

New CMS Regulations Target Health Insurer Provider Directory Inaccuracies

As reported by Melinda Beck of the Wall Street Journal, health insurers may now face significant penalties under new regulations from the Centers for Medicare and Medicaid Services (CMS) for inaccuracies in their provider directories.

With the advent of these new regulations, health insurers may face fines “up to $25,000 per beneficiary for errors in Medicare Advantage plan directories and up to $100 per beneficiary for errors in plans sold on the federally run exchanges in 37 states,” writes Beck.

These new regulations are in response to the problem of patients being unable to identify in-network providers due to directory inaccuracies. This can result in unforeseen high out-of-pocket costs for patients.

Directory inaccuracies arise, and have become so widespread, because of frequent changes in provider information. As Beck writes, “Keeping directories up-to-date is difficult in part because relationships between doctors and hospitals are complex and frequently changing. Many physicians see patients in multiple locations and may be in different insurance networks at each one. According to LexisNexis Risk Solutions data, 30% of U.S. doctors change affiliations every year.”

CMS’ new regulations call for insurers to update their directories by contacting providers on a quarterly basis to verify information.

For more information, access the full WSJ article here.