VALLEY SURVEY Insurance expenses sicken physicians

Some doctors are contemplating early retirement or leaving Ohio.
By WILLIAM K. ALCORN
VINDICATOR HEALTH WRITER
BOARDMAN -- "A union. No kidding!! Stay tuned!!!"
That was the reaction of one Mahoning County physician when asked what could be done to ease the financial squeeze caused by low reimbursements for treatments and rising medical malpractice rates and overhead costs.
Other responses were:
"Kill all lawyers."
"Cap [court] awards. Punish frivolous claims."
"Tort reform at the federal level."
"Force the issue on legislators by closing offices and practices."
"Freeze the medical malpractice insurance rate and lower the [insurance] coverage required to join a hospital staff."
And until recent times, the almost unheard of opinion from an American doctor -- "Socialize medicine. Strike."
Another said: "A national health insurance system would simplify the administration and delivery of health care ... but that will be a long time coming."
These comments were among many made by some 100 physicians, the vast majority from Mahoning County and a few from Trumbull County, who anonymously answered a Mahoning County Medical Society survey on the current climate for practicing medicine, and what could or should be done to improve it.
The recent survey went to about 500 physicians, said Karyn Frederick, MCMS executive director. The results were given to the Ohio Department of Insurance in the hopes of convincing its director, Ann Womer Benjamin, that quick state action is needed before Ohio loses too many of its physicians to retirement or to medical-friendly states where malpractice insurance rates are more under control.
Encouraging change
The medical malpractice insurance problem was exacerbated by a recent change in ranking for Mahoning County by Medical Protective, one of the major medical liability insurance underwriters in Ohio.
The county was changed from Territory 2 to Territory 1, which means that on top of the recent across-the-board rate increases, county physicians insured by Medical Protective face additional rate increases from about 25 to 100 percent, depending on their type of practice and on the number of claims against them, said James Lang, president of Insurance Buyers Service in Boardman.
Mahoning County joined Cuyahoga County in the high-priced Territory 1 category, which Lang said is based on the numbers of claims and verdicts rendered. Trumbull and Columbiana counties remain in Territory 2.
Ohio's other major medical malpractice provider, ProAssurance, did not change Mahoning County's territory designation. ProAssurance is more costly in general than Medical Protective, however, Lang said.
The financial stability of a third medical liability insurance firm, Ohio Hospital Insurance Co., has been downgraded from A to B over the past few weeks, he added.
As a result, Lang said, University Hospitals in Cleveland and Cleveland Clinic will not accept OHIC as insurer for doctors who want to practice at the hospitals.
Though the medical liability insurance costs are going up significantly, particularly in Mahoning County, the news could be worse, Lang said.
"I don't want to give the impression that I'm happy the rates went up. But, at least Medical Protective and ProAssurance are still doing business in Ohio," he said.
Insurance premiums
The survey also asked doctors about the increase of their liability insurance premiums; how the climate in Ohio of low reimbursements, rising medical malpractice rates and overhead is affecting their practices; and what they plan to do to keep their practices afloat.
One primary care physician said his medical malpractice insurance premium increased from $6,000 to $25,000 over the past four years, and is projected to rise to $32,000 in the next year or two.
"Please realize that at this time of increasing premiums, I have not had any suits filed against me. I hope you can appreciate the sense of frustration that this causes," the doctor said.
Specialists who perform high-risk procedures, such as surgeons and obstetricians, have proportionately higher premiums. Also, doctors are practicing more "defensive" medicine by ordering more tests and referring out the more complicated, high-risk procedures, the survey answers say.
"I am considering early retirement for the first time," one doctor said. "I do dozens of tests I would not do on my own family members with the same problems. I lose sleep worrying about a ... lawsuit that will destroy me financially. I tell my kids not to go into medicine."
Considering retirement
Dr. Marc Saunders, president of MCMS, said he is somewhat buffered from malpractice premium increases because he closed his private general surgery practice and became hospital-based about six years ago because of decreasing reimbursement and increasing expenses.
He said, however, that most of the area's general surgeons are experiencing one-year increases from $30,000 to $40,000 last year to $80,000 to $100,000 in the upcoming year.
"Many of these surgeons are already planning on retiring or moving out of state. Our area could lose from one-third to one-half of our general surgeons," Dr. Saunders said.
One neurosurgeon is paying $250,000 a year and will probably retire early because of it. "Our eight-physician radiology group's malpractice premiums increased from $80,000 last year to $400,000 a year," Dr. Saunders said.
Another particularly at-risk area is obstetrics. Because of the cost of malpractice insurance for obstetrics, many have stopped delivering babies and practice only gynecology.
The bottom line, said Dr. Saunders, who initiated the survey, is that Ohio is absolutely in crisis because of the cost of medical malpractice insurance costs and controlled reimbursements.
"It's going to affect patients who are going to wake up and not be able to get an appointment to see a doctor," he said.
alcorn@vindy.com