Study says Massachusetts medical malpractice insurance premiums aren't as bad as we think

Marc Rodwin, in his Health Affairs piece on Massachusetts malpractice premiums out this week, says the supposed malpractice crisis just isn’t there.

Inflation-adjusted premiums are about where they were 30 years ago; they’ve gone up — and down, in cycles — over the past three decades.  Furthermore, Massachusetts compares well to other states on premiums, even though we’re near the top of the range for recoveries.  See the Boston Globe article on this piece, too. 

However, not all is rosy.  Newly-installed Mass. Medical Society President Bruce Auerbach noted in the Globe article that there are issues beyond malpractice insurance premiums that make practice in Massachusetts challenging. 

In a conversation yesterday with the HealthBlawger, Dr. Auerbach said that Rodwin’s conclusions need to be examined in a broader context:  declining inflation-adjusted physician income and increased cost of living and practice costs (beyond malpractice insurance expense).  He also identified the need for tort reform as a key issue. See MMS’s reports on these subjects and more here. 

While Rodwin’s analysis looked at size of malpractice recoveries (relative to other states and over time), there are some other aspects of tort reform that Auerbach says warrant further attention (the MMS has sponsored state legislation to address many of these issues as well as some others): (1) elimination of joint and several liability in med-mal cases (which socks docs with more liability thanks to the Massachusetts limitation of liability law for nonprofits, including most hospitals here); (2) promoting apologies; (3) requiring large payouts to be made over time; (4) requiring reports of recoveries to the Betsy Lehman Center in order to help improve safety through evidence-based medicine.

Rodwin’s article contains a wealth of information and analysis — more than I can do justice to here.  From the perspective of the practicing doc, though, insurance premiums are just one piece of the puzzle, and all of the pieces need to be moved around — just as in the case of the Massachusetts universal health insurance law we talk about coverage, access and quality: one piece of that puzzle has been addressed, and now the others need to be tackled.      

— David Harlow