ACC: Docs discuss beef with healthcare reform bill
CHICAGO—The Patient Protection and Affordable Care Act has been debated and discussed ad  nauseam, but how will the guts of the bill actually impact doctors? This is the question Richard E. Anderson, MD, chairman and CEO of The Doctors Company, asked March 25 at an afternoon session at the 61st annual American College of Cardiology (ACC) scientific session. While the bill’s goal is to insure more Americans, Anderson said ultimately it will increase demand yet offer no break in terms of supply or professional liability.

“Full disclosure … I am an atheist, I don’t believe in either Republicans or Democrats,” Anderson said, garnering laughs from the audience.

“It’s harder to talk about the reform bill, particularly in the context of national healthcare,” he said. But he offered that a major hurdle will be the push to curb the practice of defensive medicine.

“What’s missing in the bill in terms of professional liability? Everything,” Anderson added.

“This is a 2,500-page bill and there is only one or two mentions of professional liability reform,” Anderson said. “The ones that are in the bill are exclusionary.”

However, he said that there is a section (Sec. 10608), which extends federal malpractice protection to “nonmedical persons at free clinics.” While Anderson said that this is great in terms of enhanced protection, “the real question is why aren't we all protected?”

He noted some major issues within the current legislation:
  • It provides new standards of care. “The legal system works backwards from the outcome and poor outcomes are subject to litigation, period";
  • It will increase demand, with no change in supply. "The supply of physicians is not going to change dramatically despite the fact that in 2014 we will have 32 million in new participants in the healthcare system"; and
  • The enormous complexity and unknown nature of the reform could hurt practice with “botched handoffs, disjunctions in care and unmet expectations.”
A major problem will be the fact that current bill language says, “nothing in this bill should be construed to establish new standards of care for medical malpractice litigation,” said Anderson. “This is very important language.”

In terms of the guidelines, Anderson noted that there are 2,700 practice guidelines today in practice; however, he said that these practice guidelines are not helpful in terms of defending physicians in court. He even went as far as to say that sometimes “practice guidelines are often wrong.” He referenced the Centers for Medicare & Medicaid Services (CMS) congestive heart disease (CHD) guidelines and others that were found to need an overhaul.

“If you can write it clearly down on paper [in the guidelines] it is not really an issue,” Anderson said, “but you are really damned if you do and damned if you don’t.” He said that if doctors follow practice guidelines they will not be litigated, but if they had adverse outcomes and are in court, it will be that they “negligently implemented the guidelines.”

Additionally, Anderson noted that the cost curve must be bent. “There is absolutely, positively no doubt that the cost of medical care is unsustainably expensive,” he said. The U.S. spends more on healthcare than the entire economies of France, Brazil and others, he said.

Another problem with the healthcare reform bill is the fact that providing health insurance to all Americans would cover only 60 percent of the cost of healthcare. In comparison, today, health insurance covers nearly 80 percent of all healthcare expenditures.

“It’s 100 percent clear that the cost of healthcare must come down,” Anderson said. “The cost of healthcare in the U.S. is not sustainable and we need to be part of that solution.”

However, controlling costs and continuing to deliver top-notch care will be the overarching challenge.

Anderson noted malpractice is still a huge issue that forces physicians to practice defensive medicine. “Ultimately when you get into any situation that limits healthcare in any way, you are forced to defend the negative.

“Either the test is indicated or it isn’t indicated,” he said. Today, nearly 100 percent of care in the U.S. is being practiced as defensive medicine. In fact, a recent survey showed that 91 percent of physicians believed that malpractice concerns resulted in defensive medicine.

He did offer an alternate view that was optimistic, saying that healthcare reform could lead to improved coordinated care, evidence-based medicine, improved medical records and a reduced need to sue for costs of care.

However he summed, “Nothing in the healthcare bill alters current political realities surrounding likelihood of national professional liability reform.”