The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.

1. Medical Malpractice Reform:
Don’t Believe the Hype
Laura Medford-Davis, MD
Robert Wood Johnson Clinical Scholar
University of Pennsylvania

2. Malpractice

3. Overview
1. Definition: What is Malpractice Reform?
2. Map: Status of Reform in the US
3. Outcomes of Malpractice Reform

4. Malpractice (Tort) Reform
• Tort = Compensation for injury
• Reform = Rules regarding Tort Claims

5. Mechanisms of Reform
• Damage Caps
–Economic damages
–Non-economic damages
• Pain and suffering, anguish
• Punitive and exemplary

6. Mechanisms of Reform
• Attorney Fees
–Fee limits
–Loser pays fees
• Qualifications for expert testimony
• Statute of limitations
• Pre-trial screening
• Burden of proof

7. Alternative Models
• No-Fault Compensation
– New Zealand
– Sweden
– Denmark
• Federal Tort Claims Act
– Veterans Affairs
– Federally Qualified Health Centers
– Indian Health Services
– Public Health Service

8. Malpractice: What’s at stake?
• $3.6 billion paid in 2012 on 12,142
claims ($296,000/claim)
–93% settled out of court
–31% of claims for wrongful death
–33% of claims for misdiagnosis

9. Malpractice: What’s at stake?
• Additional $4.1 billion litigation fees
• Liability Insurance Premiums:
$3,375-$215,000/year
• Defensive Medicine $46 billion/year
–28% of orders
• Access to Care

10. Defensive Medicine - Physician Concern
• More referrals to ER and orders for
advanced imaging
• No correlation with tort reform

11. Defensive Medicine: Liability Premiums
• Increased costs when treated by a
physician with a higher liability
premium

12. Annual Risk of Claim by Specialty
Source: NEJM 2011. 365(7):629-36.

13. Cumulative Lifetime Risk by Specialty
Source: NEJM 2011. 365(7):629-36.

14. Overview
1. Definition: What is Malpractice Reform?
2. Map: Status of Reform in the US
3. Outcomes of Malpractice Reform

15. Top Malpractice Payouts (2013)
1. New York $763 M
2. Pennsylvania $316 M
3. California $223 M
4. New Jersey $207 M
5. Florida $204 M

16. Top Malpractice Payouts (2013)
Per Capita
1. New York (#4) $38
2. Pennsylvania (#6) $25
3. California (#1) $6
4. New Jersey (#11) $23
5. Florida (#3) $10

17. Top Malpractice Payouts (2013)
Per Capita
1. New York (#4) $38
2. Pennsylvania (#6) $25
3. California (#1) $6
4. New Jersey (#11) $23
5. Florida (#3) $10
Texas (#2) $3

18. Damage Caps in the United States
Legend
<$500,000
$500K-$1M
>$1M
Sliding Scale

19. Pre-Trial Screening

20. Patient Compensation Funds

21. Overview
1. Definition: What is Malpractice Reform?
2. Map: Status of Reform in the US
3. Outcomes of Malpractice Reform

22. Reform Outcomes: Damage Caps
• Reduce liability premiums by 17%
–Only when $500,000 or less
• Do not decrease health insurance
premiums

23. Reform Outcomes: Other Limits
• Nothing besides damage caps makes
a difference
• Gross Negligence => No Change in
Defensive Medicine
–CT/MRI utilization
–ER charges (3.6% in Georgia only)
–Admission rates

24. Physician Availability
• Surgeons more likely to start practice in
areas with damage caps and lower
malpractice premiums
• Texas reform in 2003
–Physicians have increased by 8% more than
population
–46+ counties in Texas have added a
specialist physician

25. Summary
• Malpractice reforms limit patients’ ability to
bring claims for injury
• Malpractice risk and reform vary depending
on location and specialty
• Surgeons are at more risk than primary care
• Damage Caps decrease malpractice insurance
premiums
• Reform does not decrease healthcare costs or
defensive medicine
• Unknown impact on patient safety

26. Discussion
• Available studies are limited
• Laws are constantly changing
• Who does reform benefit?

27. Questions/Comments