The Academy of Medicine of Cleveland/Northern Ohio Medical Association (AMC/NOMA) proposes several initiatives to further the positive steps taken by tort reform and to combat the damaging effects on physicians and their patients by the destabilization of the professional liability insurance market. These initiatives include Mandatory Arbitration, Establishment of a Medical Review Panel, Creation of a Sliding Scale for Attorney Contingency Fees, Lowering Required Hospital Liability Limits and the Development of a Patient Compensation Fund (PCF).
Mandatory Arbitration - The recently enacted medical liability reform legislation (SB 281) included arbitration language that can be utilized in the State of Ohio. Ohio Revised Code § 2711.21-24 authorizes health care providers to enter into an agreement to resolve future medical malpractice claims through binding arbitration. Based on that arbitration language, The AMC/NOMA developed a model arbitration form. However, arbitration is not mandatory under SB 281. Therefore, the AMC/NOMA supports a proposal to change the law to substitute ORC § 2711.22-24 with language similar to what is contained in the California arbitration statute that enables the patient to agree to arbitration up front. If the patient agrees, the agreement is irrevocable and binds the patient to arbitration in case of a dispute.
Establishment of a Medical Review Panel - During the debate on SB 281, the AMC/NOMA testified in support of the establishment of a Medical Review Panel to provide for pre-litigation screening to eliminate frivolous claims. This medical liability system reform from MICRA was not enacted in SB 281. The benefit of a medical review board is that it removes lawsuits from the system before they occur by identifying whether the claim is valid or not. Other states have instituted this type of panel and it was been very successful. The recent Pinnacle Report provided to the Ohio Department of Insurance (ODI) provides for a medical review panel in Ohio. The AMC/NOMA supports this recommendation in the ODI report.
Creation of a Sliding Scale for Attorney Contingency Fees - During the debate on SB 281, the AMC/NOMA provided extensive testimony on the need to adopt attorney contingency fee limits similar to those enacted in California. The AMC/NOMA provided expert testimony and data to the State of Ohio House and Senate during testimony on SB 281 that clearly showed that a cap on attorney contingency fees results in an increase in patient compensation. The recent Pinnacle/ODI study (as well as other studies) confirmed that a California-type contingency law would yield a 12 percent increase in damage awards retained by the plaintiff. The AMC/NOMA continues to strongly support a sliding scale for attorney contingency fees and we will provide testimony on this topic to the legislature.
Lowering Required Hospital Liability Limits - All hospitals in Northeastern Ohio require physicians to carry liability insurance equal to $1 million per incident and $3million in the aggregate. In addition, the hospitals normally require that physicians carry insurance with an A minus rating or better. The AMC/NOMA supports reducing the amount of required limits in addition to acceptance of a lower rating for insurance carriers. To assist physicians in this region in this regard, the AMC/NOMA has sent out letters to all of the hospitals in Northeastern Ohio regarding this issue and we will continue to support these changes in hospital policy to provide relief to physicians in the region. We are also in discussions with the local hospital association in an attempt to find a solution to this issue.
Development of a Patient Compensation Fund (PCF) - The Pinnacle Report prepared for the ODI includes a provision for the establishment of a Patient Compensation Fund (PCF). The PCF is meant to enhance or increase market availability and affordability of professional liability coverage. The AMC/NOMA believes that the PCF concept may have merit, however, careful consideration must be given to the issues outlined in the Pinnacle Report prior to determining whether or not a PCF would be of assistance to the physicians in the state of Ohio.
The AMC/NOMA provides physician members with staff representatives that work with area insurance companies regarding reimbursements issues and problems. In addition, the AMC/NOMA has various committees that provide assistance to physician in regard to physician advocacy issues and managed care issues. As an example, just recently, the AMC/NOMA established policy on the charging of administrative fees by physicians.
The AMC/NOMA has worked diligently to introduce legislation that would provide physicians with the ability to jointly negotiate with managed care plans. The Association believes that tort reform legislation is only the beginning and that physicians must be given the right to negotiate with insurance companies. There are federal laws that exempt insurance companies from antitrust scrutiny. This means that these companies are allowed to share information including reimbursement schedules - but physicians cannot. This allows certain insurance companies to dominate markets and force one-sided "take it or leave it" contracts upon physicians. It also allows these companies to dictate to physicians how to run their practice. The only way to avoid this problem is to level the playing field for physicians and allow physicians to jointly negotiate with insurance companies on behalf of our patients. The AMC/NOMA continues to support legislation that will allow physicians to jointly negotiate with managed care plans. This is not a "union" bill and does not require that physicians' join a union in order to negotiate for their reimbursement.
A group of healthcare experts have come together under the leadership of Common Good - a coalition dedicated to restoring the ability to make common choices and promote legal reform. The group calls upon the United States Congress to immediately initiate hearings on the broad effects of litigation on healthcare (not just on the immediate litigation insurance crisis) and to consider recommendations on how to create new systems of medical justice that will promote better care.
A petition has been prepared and signed by a large number of health care groups and medical schools including the dean of Case Western Reserve University and referred on to Congress. The AMC/NOMA has joined in supporting the petition on behalf of the physicians in Northeastern Ohio. To view the petition go to the Common Good web site at www.ourcommongood.com.
"The AMC/NOMA is the only regional physician organization capable of representing physicians on these issues," said James Lane, M.D., president of the AMC/NOMA. "Our physician advocacy and legislative efforts are aggressive and we will continue to work to achieve solutions to the problems and issues facing physicians and their patients in Northeastern Ohio."
"The AMC/NOMA has several solutions to the issues confronting physicians' and hospitals in Northeastern Ohio," said John Bastulli, Vice President of Legislative Affairs. "We believe that these solutions can be accomplished without unions or physician work stoppages through a continued, sustained and aggressive stance by organized medicine in the region."