The government in recent years has implemented tort reforms in efforts to control costs and reduce frivolous claims. Malpractice insurance premiums have risen to excessive levels at times and driven some practitioners away from particular fields of medicine. Many doctors have resorted to practicing “defensive medicine,” which is believed to lead to approximately $50 billion in often unnecessary costs.
At the University of Miami's Jackson Memorial Hospital, researchers conducted a study that they say shows that if physicians are granted sovereign immunity, they are less prone to adverse events. Dr. David Lubarsky, the chief medical officer, says physicians showed a commitment to high-quality patient care without the fear of malpractice claims.
The study, initiated in part by University of Miami President Donna Shalala, involved 900 physicians at the hospital. After a period of six years, there was a 13% reduction in the volume of adverse events. Jackson Memorial is a 1,600-bed facility and employs many of the same doctors that work at the 500-bed University of Miami Hospital. This is believed to be only the second study of its kind where physicians were granted temporary immunity; the other was conducted by an organization with hospital locations in Texas and Louisiana.
The results at Miami reinforce beliefs that stricter laws regarding medical malpractice do not necessarily lead to a reduction in surgical errors. The findings of the study in Texas and Louisiana actually had similar results, suggesting that the quality of care remained somewhat constant regardless of whether limitations (caps) on the amount of recoverable damages were in place. One notable result of the Texas study was that after caps were implemented, there was a drop in the volume of claims. Those involved in the Miami study also have said that the dollar amount of claims has been declining.
Conducting before-and-after testing is subject to shifts in the patterns and evolution of medical care, as well as potential changes in how quality is evaluated and reported. The researchers determined that the performance and quality of care with and without immunity were fairly consistent. There was a definitive reduction in the number of events where patients experienced severe safety concerns.
The data in the study was gathered and compared using software produced by Quantros. The safety outcomes were compared to determine the number of reported harmful events. In addition, they reported on the claim volume, overall value of the claims, and average value of claims.
Dr. Lubarsky feels that the results of the test are positive; however, he contends that increases in safety are tied to other factors beyond simply immunity from liability. The keys that he has identified include the following.
- Improved communication of data with patients.
- Continual education.
- Systems established for safety management.
- Employment of electronic health record systems.
He explained that institutions must make a commitment to investing in safer systems and practices. Overall, malpractice insurance premiums have continued to rise; however, claim volume between 1992 and 2014 fell an estimated 55%.