Professional liability insurance (PLI) premiums have been increasing at an alarming rate. As reported in the Fall 2001 issue of the Bulletin, the most obvious reason for increasing premiums is the increase in jury awards for medical malpractice claims. From 1996 to 1999 jury awards increased 76 percent, according to Jury Verdict Research. Between 1999 and 2000 the median medical malpractice award increased another 43 percent-reaching the $1 million mark in 2000, nearly doubling from the 1996 median award of $503,000.
The problem has continued to grow unabated, impacting not only physicians, but patient care. On June 12, 2002, the House Judiciary subcommittee on commercial and administrative law held a hearing to answer the question, “Does Limitless Litigation Restrict Access to Health Care?” Donald Palmisano, MD, president-elect of the American Medical Association, testified:
Emergency departments are losing staff and scaling back certain services such as trauma units. Many obstetrician-gynecologists and family physicians have stopped delivering babies, and some advanced and high-risk procedures (such as neurosurgery) are being postponed because surgeons cannot find or afford insurance.
How significantly has the PLI problem affected neurosurgery? The Council of State Neurosurgical Societies determined to explore the issue through a nationwide survey.
Survey Documents Significant 2000, 2001 PLI Problem
On Feb. 2, 2002, a single-page survey was faxed to U.S. neurosurgeons, with a total of 2,410 successfully sent. The survey requested data on annual premiums for 2000, 2001 and 2002 coverage information, PLI costs per operative case, insurer and insurance type, as well as general demographic information. Data was accrued over one month and was analyzed using the Kruskal-Wallis test, correlation analysis and ANOVA.
A total of 563 surveys were returned for a 23.3 percent response rate. There were respondents from 49 states and the overall number of respondents per state correlated with the population distribution in each state. Further validity of the survey’s representative nature was obtained by analysis of the respondents’ distribution in terms of practice type and location.
The results of the survey indicate that indeed there is a significant problem of increasing PLI premiums in neurosurgery. Although at the present time the PLI crisis is regionalized, affecting some states more than others, all of the states have been affected by significant increases in annual premiums.
Some important implications of the survey relate to the impact that PLI increases may have on the neurosurgical workforce. Almost 20 percent of the respondents indicated that they plan to retire as a result of PLI increases, and 6 percent are seriously considering doing so. Given the limited number of neurosurgeons entering the workforce, a retirement of 20 percent of practicing neurosurgeons will have a significant negative impact on the delivery of neurosurgical care.
The data also indicates that the median cost of PLI premiums per operative case rose by 21 percent from 2000 to 2001, to a median of $200 per case. However, for those in the 95th percentile the increases ranged from $553 in 2000 to $800 in 2001. Given the low reimbursement rate by some carriers (TriCare, Medicaid and Medicare), some neurosurgeons are at risk of actually losing money when performing certain procedures.
2002 PLI Data Needed
This survey is the first attempt at obtaining data on neurosurgical professional liability insurance problem. So far the data obtained was for 2000 and 2001. Given the fact that the survey was sent at the very beginning of 2002, the premium data for many neurosurgeons was not available. It is critical that we obtain further data as the problem appears to have worsened from 2001 to 2002. Therefore, neurosurgeons are requested to complete the survey at www.neurosurgery .org/csns with 2002 PPLI information, and fax it directly to CSNS. This is vital information as it will help organized neurosurgery develop a strategic plan in order to appropriately address this significant problem for practicing neurosurgeons.
David F. Jimenez, MD, is chair of the Council of State Neurosurgical Societies.