Contenu connexe Similaire à Senator Brandon Beach & Wayne Oliver's 2013 SLC Presentation (20) Plus de American Academy of Family Physicians (20) Senator Brandon Beach & Wayne Oliver's 2013 SLC Presentation1. PATIENTS’ COMPENSATION SYSTEM
A PROPOSAL THAT WORKS FOR PHYSICIANS AND THEIR PATIENTS
Presentation to:
AAFP State Legislative Conference
Senator Brandon Beach
District 21, North Atlanta
Wayne W. Oliver
Executive Director, Patients for Fair Compensation
November 1, 2013
2. ADDRESSING A SIGNIFICANT PROBLEM
SB141 represents a bold, new, innovative approach
to healthcare …
• Thousands of hours of engagement by national and
international thought leaders
• Investment into clinical research, original thought leadership,
data and analytics, actuarial reports, and peer-review studies
• Gaining nationwide attention as policy makers look for an
answer to out-of-control healthcare costs
• PCS solution saves lives, advances patient safety, decreases the
cost of healthcare, saves taxpayers, physicians and families
money and fairly and appropriate compensates legitimately
injured patients
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3. THOUGHTFUL APPROACH
SB141 represents a bold, new, innovative approach
to healthcare …
• Based on scientific research, data analysis, medical experts and
actuarial studies
• Working with specialty and professional societies to create the
best bill
• Will work with state and national societies to replicate and pass
on lessons learned …
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4. WE’RE SOUTHERNS …
We like our college football …
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5. 2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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6. CURRENT TORT SYSTEM BROKEN
Promotes Defensive Medicine
• GALLUP - 26% of overall healthcare costs
• Cost up to $650 Billion to US citizens
•
$14 billion annually to Citizens of Georgia
Prevents Access to Justice
• Less than 20% of injured patients receive compensation
• Less than 1% receive Jury Award
Hurdle for Patient Safety
• Unable to significantly improve under a “Blame & Shame” system…
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7. REDUCES BOTH LITIGATION COSTS AND
COST OF DEFENSIVE MEDICINE
Traditional tort
reform only
reduces the cost
of litigation
Patients’
Compensation
System
COST OF
LITIGATION
$31 Billion **
per year
Physicians in states with
traditional tort reform
practice same amount of
defensive medicine as
other states…
Source:
“A Costly Defense” published
by Jackson Healthcare
September 21, 2011
02/25/13
COST OF
DEFENSIVE MEDICINE
$650 Billion
per year
** Source: BioScience Valuations report
July 19, 2012
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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8. PHYSICIANS PRACTICING DEFENSIVE MEDICINE (%)
82%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
0%
U.S.
Canada
0%
U.K.
0%
0%
Sweden
New
Zealand
U.S. physicians are only ones personally
financially liable for malpractice; and the
only ones practicing defensive medicine.
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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Source:
Pacific Research Survey
June 24, 2011
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9. WHY DO PHYSICIANS PRACTICE DEFENSIVE MEDICINE?
Avoid personal financial exposure
from “jackpot justice” awards from
non-peers
Physicians abhor defending against
lawsuits
Source:
“A Costly Defense”
published by Jackson Healthcare
September 21, 2011
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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10. WHAT HAVE GEORGIA PHYSICIANS TOLD US?
82% of Georgia physicians practice defensive medicine
74% of Georgia physicians believe that defensive
medicine negatively impacts patient care
95% of Georgia physicians support PCS Proposal
96% Georgia physicians agree that a PCS solution would
reduce healthcare costs
Source:
“The Practice of Defensive Medicine”
Oppenheim Research
January 12, 2012
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11. DEFENSIVE MEDICINE IS REAL
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12. DEFENSIVE MEDICINE IS COSTLY
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13. DEFENSIVE MEDICINE IS PERVASIVE
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14. DEFENSIVE MEDICINE HURTS EVERYONE
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15. DEFENSIVE MEDICINE IS REAL
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16. BUSINESS LEADERS ENGAGED
Atlanta Business Chronicle, 10/21/2013
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17. WHY DEFENSIVE MEDICINE HARMS PATIENTS?
Unnecessary tests & procedures
“High risk” patients denied care
• Sometimes referred to as reverse defensive medicine
Physicians cannot afford to admit mistakes
Increased overall cost of healthcare
• Both health plan and out-of-pocket expenses …
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18. PATIENTS LOSE IN CURRENT LITIGATION SYSTEM
› Drives wedge between patient / physician
› Denies access to justice
› <5% of filed cases go to jury
› Patients receive <50% of awards
on legal & administrative costs
› 5 – 7 year process
› Stress of litigation…
Source:
PIAA, 2011 Report
Towers Watson Study, 2011
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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19. CURRENT SYSTEM IN CRISIS :: ACCESS TO JUSTICE
Summary of Findings:
Attorneys require $500,000 of economic damages to
take case
Denies any “Access” to anyone that is on
Medicaid, Medicare, Out of Job, elderly, poor, young
people
80% of all legitimate medical injuries fall UNDER
$500,000
Source:
JUSTICE IN CRISIS: Victim Access to
American Medical Liability System, 2013
Professor Joanna Shepherd Bailey, Ph.D.
Emory University School of Law
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20. THE SOLUTION
Replace Tort System with an
Administrative Compensation System:
Patients’ Compensation System
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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21. PATIENTS’ COMPENSATION SYSTEM
HOW DOES IT WORK?
Patient Advocate
1
2
6
Quality
Improvement
Department
Medical Review
Department
3
5
Independent
Medical
Review Panel
Administrative
Law Judge
4
Compensation Department
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22. PATIENTS’ COMPENSATION SYSTEM
PATIENT ADVOCATE
1
1. Patient Advocate
› Helps patient navigate
through the system…
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23. PATIENTS’ COMPENSATION SYSTEM
MEDICAL REVIEW DEPARTMENT
2
2. Medical Review
Department
› Headed by CMO – Physician
› Gathers all pertinent medical
records
› Interviews all relevant parties
› Makes prima facie determination
of medical injury
› Appoints expert panel…
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24. PATIENTS’ COMPENSATION SYSTEM
INDEPENDENT MEDICAL REVIEW PANEL
3. Independent Medical
Review Panel
› Pre-approved physicians and
other medical experts
› 3 physicians – if only a physician
3
is involved
› 3 physicians plus 2 other experts
if system is involved
› All identifiers of patient and
providers are redacted
› RESULT: Rules claim as a
“Medical Injury” – “Yes” vs. “No”
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25. PATIENTS’ COMPENSATION SYSTEM
COMPENSATION DEPARTMENT
4. Compensation
Department
› Total compensation may not
exceed total malpractice costs
for 2013
› Creates compensation
schedule for each type of
injury & severity
› Awards compensation if panel
says medical injury has
occurred…
4
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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26. PATIENTS’ COMPENSATION SYSTEM
ADMINISTRATIVE LAW JUDGE
5. Administrative
Law Judge
› Ensures process is
applied in accordance to
the law
5
› Limited appeal of
process only…
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27. PATIENTS’ COMPENSATION SYSTEM
QUALITY IMPROVEMENT DEPARTMENT
6. Quality Improvement
Department
6
› Records all claims data
confidentially
› Shares lessons learned with
providers…
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28. SOURCE OF FUNDS
Funded through money in system today
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29. MORE EFFICIENT USE OF EXISTING FUNDS
Current System
20%
Injured Patients
17.5%
3-5 years
Malpractice
Costs
Patient Compensation System
100%
Injured
Patients
180 days
80%
Malpractice
Costs
Source: PIAA, 2011 Report
Towers Watson Study, 2011
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30. PATIENT BENEFITS
All complaints are reviewed
Faster payment of claims – months vs. years
Reduces exposure to unnecessary tests
Guaranteed funds for avoidable medical injury
Increased patient safety
Increases Access to Justice
Injured patients are fairly compensated …
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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31. PHYSICIAN BENEFITS
Physicians will never be sued again … Ever
No personal financial risk
Does NOT assign blame
Safe to admit mistakes
Medical malpractice premiums will decrease …
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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32. WHO IS THE OPPOSITION?
Those who profit from the current system where
doctors, healthcare professionals and hospitals are sued
…
• Trial Attorneys
• Medical Malpractice Insurance Companies
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33. IMPACT ON MALPRACTICE COST
Average GA
Medical
Malpractice
Carrier –
Current Tort
Liability
Patient
Compensation
System
Alternative
Percentage
Change
Collected Premium
1.00
0.92
-8.1%
Paid to Patients
0.23
0.51
119.8%
Paid to Defense Attorneys
0.30
0.09
-68.9%
Administration Costs
0.17
0.17
0.0%
Insurance Company Profit
0.30
0.15
-50.0%
Patient Claims
2880
4796
66%
Patient Awards
864
1918
122%
Categories (Cents per Dollar)
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34. NO INCREASED COSTS
Awards may not exceed the fiscal year 2013 aggregate
costs of medical malpractice as determined by an
independent actuary
Significantly decreases defensive medicine
saving billions annually for Georgia families
Medical malpractice rates decrease under
predictable PCS model
Georgia taxpayers reap savings which is currently
being wasted on defensive medicine and med-mal
defensive attorneys
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35. NO INCREASED REPORTING
The bill specifically limits the power of the medical
review panel to determining avoidable harm.
No Negligence / No Lawsuit
No blame / No increased reporting
Bill specifically prohibits reporting
Shall provide Medical Board with information
upon request
Public Safety Issue: May notify Medical Board of
“risk of harm to the public”
2655 Northwinds Parkway • Alpharetta, GA 30009 • 877 248 1689 • www.patientsforfaircompensation.org
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36. IMPACT ON GEORGIA
Two Actuarial Studies :: AON and BioScience
Valuation
Peer review by David Frisvold (Assistant
Professor, Department of Economics, Emory
University) determined the following
Significant decrease in medical malpractice
insurance rates & healthcare expenses
Savings to State of Georgia
› $3.1 Billion
› $3.8 Billion
$6.9 Billion
Medicaid
State Employee Healthcare Costs
Total Savings in First 10 years
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37. SUMMARY…
PCS is a Solution to Completely Replace the Current Tort System
•
•
•
•
•
•
•
•
•
No more medical malpractice lawsuits
Strong legal precedent
Slashes defensive medicine costs
Eliminates bad press
Increases access to justice
Enhances patient safety
More efficient use of existing funds
More patients receive more compensation
No Cost to Georgia Taxpayers …
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