Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Pro-actively improve quality, rather than reacting to liability concerns

Charles A. Pilcher, MD
Physician
June 16, 2011
Share
Tweet
Share

Over the past year I have been involved in many discussions with doctors, healthcare executives, elected officials, plaintiff and defense attorneys and others about healthcare reform. Bottom line: There is no consensus what the future holds.

There is no question that reform is necessary to avoid absolutely bankrupting the country. However, the recent legislation is a work in progress, not yet an achievement. A change in congressional leadership could derail, or improve, the entire process, depending on one’s point of view.

Though there is debate about the method, some say it goes too far, and others not far enough. Though there is a framework in place, most of the details are yet to be worked out. Though there is a great deal of focus on improving quality and lowering cost, the patient is a surprisingly insignificant part of the equation. Though “capitation” and “managed care” are not publicly being promoted as solutions, almost everyone involved privately admits we will soon be dancing with that elephant in the room.

I recently attended Swedish Hospital’s 100th Birthday Symposium on “Innovation in the Age of Reform.” With a grand array of speakers including government leaders like Representatives Jim McDermott and Jay Inslee, Microsoft executive Peter Neupert, and health industry CEO’s from around the country, it was time well spent – primarily because it became clear that the end game has yet to be played out. Were this a horse race, I would opt out of betting on anyone.

One of the interesting aspects of almost every discussion is the relative absence of talk about malpractice reform. Health leaders at their core know that things could be better, and are working hard to make it so.

Despite what doctors may feel, the overall plan emphasizes improving quality pro-actively, rather than reacting to liability concerns. Everyone recognizes that there are better and cheaper ways to provide care by applying best practices from “evidence-based medicine” and “comparative effectiveness research” to all areas of our health care.

Overuse of medical technology is rampant, but attorneys are not being openly blamed for that. In fact, it’s often acknowledged that it is the patient who is driving demand. This is a result of our current fee-for-service system in which neither the provider nor recipient of a service has any incentive to eliminate waste. In fact, the incentives are backward; the more doctors do the more they get paid. And it costs the patient nothing – at least until the next premium increase (or employer request for greater participation.)

Doctors are not paid for long discussions with patients about options. Any true reform must incentivize both doctors and patients “to do the right thing.” And that’s difficult to achieve in a profit driven insurance industry.

Should capitation and managed become a part of the healthcare scene, an entirely new aspect of medical litigation will arise: the accusation that a physician did not “do the right thing,” not because of negligence but because he/she had a profit motive. There is probably a fair amount of case law currently available – with existing HMO’s and managed care organizations – that could be pulled off the shelf and reviewed. It will come in handy if that is the direction we are heading.

Charles A. Pilcher is an emergency physician who has helped both plaintiff and defense attorneys with malpractice litigation for over 25 years. He can be reached at his self-titled site, Charles A. Pilcher, MD.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Physicians are not cogs: How we can be great in healthcare

June 16, 2011 Kevin 2
…
Next

How medicine can be like a scene in Jerry Maguire

June 17, 2011 Kevin 5
…

Tagged as: Malpractice, Primary Care, Specialist

Post navigation

< Previous Post
Physicians are not cogs: How we can be great in healthcare
Next Post >
How medicine can be like a scene in Jerry Maguire

ADVERTISEMENT

More by Charles A. Pilcher, MD

  • Teen dies when blood culture protocol botched: What can we learn from this tragedy?

    Charles A. Pilcher, MD
  • a desk with keyboard and ipad with the kevinmd logo

    tPA is the standard of care for stroke but with significant risks

    Charles A. Pilcher, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How a doctor reviews cases for both plaintiff and defense attorneys

    Charles A. Pilcher, MD

More in Physician

  • How tragedy shaped a medical career

    Ronald L. Lindsay, MD
  • A doctor’s guide to preparing for your death

    Joseph Pepe, MD
  • How policy and stigma block addiction treatment

    Mariana Ndrio, MD
  • Why don’t women in medicine support each other?

    Jessie Mahoney, MD
  • IMGs are the future of U.S. primary care

    Adam Brandon Bondoc, MD
  • The high cost of gender inequity in medicine

    Kolleen Dougherty, MD
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

      Adwait Chafale | Meds
    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

      Adwait Chafale | Meds
    • Healing from medical training by learning to trust your body again [PODCAST]

      The Podcast by KevinMD | Podcast
    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Pro-actively improve quality, rather than reacting to liability concerns
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...