STATE LEGISLATIVE UPDATE

I am back writing these monthly updates for the rest of the year. I have decided to combine the months of September and October as they tend to be slow legislative news months. As of the first of the year there will be a new Legislative Analyst at the AAOS. I hope that you have found these Updates useful. Jay Fisher.

For a toolkit on medical liability reform visit www.pactproject.org.

As of the end of October, the following state legislatures were in regular session or in recess: MA, MI, NJ, NY, OH and PA.

Some of the bills the Department of Socioeconomic & State Society Affairs is tracking are outlined below. If you have any questions please give Susan Koshy a call at 800-346-2267.

TORT REFORM

A study published in Texas found that the medical liability reforms have resulted in a decrease of lawsuits by 80% in most of the major counties in Texas. Premiums have also already decreased for hospitals and large groups that self-insure.

According to published reports physicians in Connecticut expect to see premium increases of at least 25% in 2005. Connecticut's Attorney General is calling on the state's insurance commissioner to hold public hearings on medical liability rate increases and to support legislation that would allow stricter review of rates. The state's three major insurers have filed for rate increases ranging from 14.6 percent to 89.6 percent. The insurance commissioner has already ordered independent actuarial reviews of all three filings. Two hospitals in Connecticut announced layoffs of 34 people and the elimination of 60 vacant positions in response to rising liability premiums.

One of only three neurosurgery emergency rooms in Idaho closed due to liability concerns. The number of medical liability lawsuits filed in Oklahoma has dropped more than 60 percent since the state passed tort reform legislation last year.

An article in the Cincinnati Enquirer concluded that rates have not yet dropped after passage of reform legislation due to the uncertainty by the insurance companies that the Ohio Supreme Court would uphold the reform laws. Caps are under legal challenge in Ohio, Florida and West Virginia.

Maryland voters are aware of the rising cost of medical liability premiums and more than 9 out of 10 are concerned that these increases will affect their access to health care and increase the amount they pay for health care, according to the Maryland Hospital Association. The statistics are based on a poll of registered voters conducted by Gonzales Research, Oct. 1-5. The poll also indicates that 84 percent of voters favor a special legislative session this fall to deal with the issue. Recruiting doctors in high-risk medical specialties in Maryland has become difficult because of the state's high medical insurance premiums, according to an article in the Baltimore Business Journal. A survey taken by the state medical society found that nearly 40 percent of 774 physicians surveyed are considering closing their practice, retiring or relocating due to malpractice premiums. About 25 percent said they are limiting their emergency room coverage.

Kentucky lost about a third of its obstetricians and gynecologists in the past five years due to the increasing cost of medical liability insurance, according to a survey by the American College of Obstetricians and Gynecologists. At least 70 counties are without obstetricians and two hospitals have closed their maternity wards.

A study by the Wyoming Health Care Commission found that a cap of $250,000 on non-economic damages would decrease doctors' overall cost of medical liability claims, including payments to plaintiffs, legal fees and other defense costs, by about 15 percent.

OSTEOPOROSIS

The United State Surgeon General released a report on bone diseases concluding that by 2020 half of all Americans older than 50 will be at risk for fractures due to osteoporosis and low bone mass. Currently, 10 million Americans over the age of 50 have osteoporosis, and another 34 million are at risk for developing it. Around 20 percent of patients with a hip fracture end up in a nursing home within a year and hip fractures account for 300,000 hospitalizations a year. Information on osteoporosis is available on the AAOS web site.

MEDICAID

A report by the National Association of State Budget Officers found that Medicaid spending accounted for 21.4 percent of states' budgets in 2003, nearly matching spending on elementary and secondary education (21.7 percent). Total state Medicaid spending reached $243.6 billion, an 8 percent increase from 2002. Nearly half of all states experienced Medicaid budget shortfalls in 2003, and 18 states anticipate shortfalls this year.

View the report.

PHYSICIAN OWNERSHIP OF HEALTH CARE FACILITIES

Physician-owned specialty hospitals treat more patients that need expensive heart, orthopedic or surgical services than the average community hospital, according to preliminary results of a study by the Medicare Payment Advisory Commission.

In California Gov. Schwarzenneger signed the legislation discussed last month that arose after a hospital tried to reject the medical staff officer (an orthopaedist) who had a financial interest in a competing facility.