Physicians need reforms that will help

Dr. Samuel W. Cullison, M.D. and Dr. Robert Jeffers, M.D.

One of the hallmarks of our nation’s health care delivery system is that our doctors are only a phone call away. Unfortunately, for many patients in our state, the phone on the other end of the line is either disconnected or a long-distance call.

That’s because many physicians in Washington state are being forced to close their doors or move out of state due to low reimbursement rates for Medicare and Medicaid, increased paperwork hassles and, now, skyrocketing medical malpractice insurance rates. Many others are retiring or even changing careers because they simply cannot afford to treat their patients.

For people who dedicate their lives to helping others through their pain and difficult times, these outside challenges have become overwhelming at best and unbearable at worst.

The ability of the health care delivery system — our physicians and hospitals — to remain economically viable is in jeopardy. And the real losers are the families and patients who rely on their physicians to provide care.

Each time a physician leaves, about 2,000 patients must find a new caregiver. When clinics close, patients then go to emergency rooms that are already overburdened. Such action is a costly alternative that cannot be sustained.

If we don’t take steps now to address this growing problem, we’ll continue to hear stories like the closing of Everett Family Practice and the Edmonds Family Medicine Clinic’s decision to no longer take new Medicare patients.

There are many factors contributing to the problem.

We have a state Medicaid program that pays at one-half the rate of private insurers for the same services. At the same time, we’ve doubled the number of people eligible for Medicaid over the past 10 years, while not funding the program adequately.

Overhead costs are escalating. Today, more than 60 cents on every dollar received by medical practices goes toward overhead and dealing with insurance plan requirements, not toward patient care. Where it used to take three support people per physician, now the number is five.

And now skyrocketing medical malpractice insurance premiums threaten to unravel the whole system. Late in 2001, Washington Casualty Company notified 1,900 physicians in Washington that it would no longer provide malpractice insurance. That was followed closely by St. Paul, the nation’s second largest malpractice insurer, announcing that it was leaving the medical malpractice market entirely.

Premiums charged by the remaining companies have increased dramatically. In the past five years the average malpractice premium for a family physician has increased a staggering 74 percent. For obstetricians, the increase has been more alarming — 79 percent since 1997.

Doctors know they need to be accountable for quality care — and injured patients who experience a bad outcome, even if no one was at fault, must be fairly compensated. However, at the same time, outsized jury awards are bankrupting the system, forcing insurance rates up and forcing doctors to make difficult decisions about their practices.

The trend is not moving in the right direction. And this needs to change. And the change needs to be made at the national level.

Representative James Greenwood, R-Pa., is soon expected to introduce a bill, tentatively named "The Help Efficient, Accessible, Low Cost Health Care Act of 2002." HEALTH 2002 seeks to improve patient access to health care services and reduce the excessive burden the liability system places on the health care delivery system.

The HEALTH Act of 2002 is based on successful reforms in California, which return more compensation directly to patients. Such reform will help stabilize medical liability premiums at a level that allows physicians to continue providing care to people who need it.

Every member of the Washington state congressional delegation should support this legislation. Please contact your representative to ask them to support this bill.

As physicians, our diagnosis for our health care delivery system in Washington state is not good. The patient is in decline. Changes need to occur. We can’t continue down this path without meaningful liability reform, higher reimbursement for Medicare and Medicaid and overhead costs being brought down. Otherwise, we’ll continue to see physicians closing their doors.

In the end, we want to make sure that when patients pick up the phone, there is someone on the other end of the line to help them with their health care needs.

Dr. Samuel Cullison is a family physician in Seattle and current president of the Washington State Medical Association. Dr. Robert Jeffers is an obstetrician/gynecologist in Edmonds and current chairman of the board of Physicians Insurance, A Mutual Company.

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