MGMA executive director William Jessee points to a March letter from the office of the Department of Health and Human Services inspector general warning doctors that if they charge extra fees for covered services, they might face legal action. Because Medicare reimbursement includes an allocation for malpractice insurance, MedChi's Preston said, a mandatory malpractice fee would violate federal rules. A voluntary donation would not.
Whether surcharges are permissible or not, medical ethicist Art Caplan warns that doctors who ask their patients for extra dollars to help pay their bills risk "galvanizing patients into complete hostility."
Towson internist Kenneth M. Greene asked his patients to make a $10 contribution to cover a 28 percent increase in his premiums.
(By Craig Herndon - The Washington Post)
|
|
"It seems to me unethical to charge somebody for something that has nothing to do with services," said Caplan, director of the Center for Bioethics at the University of Pennsylvania. "The patient population is well aware of the malpractice problem, but perceives it rightly as a special interest battle" involving doctors, lawyers and lawmakers.
"I think it's disgraceful -- a cynical attempt to get patients [angry]" in the hope that they will pressure legislators to limit damage awards, said Arthur Levin, director of the Center for Medical Consumers, a New York-based advocacy group.
"Here we have a privileged group of professionals making more money than most Americans ever dream of, saying, 'When the going gets tough, I'll take it out of the hide of my patients,' " added Levin. The solution to malpractice rate hikes, he said, "is not to pass onto patients the cost of doing business."
Health insurers are not enthusiastic about the idea, either. Walt Cherniak, a spokesman for Aetna, one of the nation's largest health insurers, said that while the company "understands the pressures physicians are under and supports the need for meaningful malpractice reform, we don't think it's appropriate for our members to be caught in the middle." He said Aetna would not pay such a surcharge and would take action against a doctor who levied a mandatory fee of this sort.
While the costs of running a practice, including insurance premiums, have risen in recent years, physicians incomes do not appear to have dropped.
Data released by the MGMA found that between 1999 and 2003, the average reportable compensation of primary care physicians rose nearly 9 percent, to $156,902. Specialists fared better; their incomes rose more than 20 percent in the past four years from an average of nearly $246,000 to $296,000.
Greene, the Towson internist, isn't doing nearly that well. Last year, he said, he earned about $100,000. "My practice on the business side has always been kind of borderline," said the solo practitioner, who sees about two patients per hour -- about half the national average.
"Part of it is my personality, the way I feel I should practice medicine," said Greene, who said that many of the patients he treats have cerebral palsy or mental retardation. In his 13 years of practice, he said, he has never faced a malpractice suit or disciplinary action.
After his premium increased from $8,000 to $11,000 last year, Greene said, he was alarmed. He knew he couldn't raise his rates: 95 percent of his patients are covered by the five or six insurance plans with which he has contracts. Family responsibilities prohibit him from working longer hours, he said.
"I sat down and thought, 'How am I going to get out of this bind?' " he recalled. Then he drafted a letter and spent about $1,000 to print and mail it.
About 75 percent of his patients sent him money, said Greene, who received $5,000 -- more than he needed to offset the malpractice increase.
One couple told him they were leaving the practice, fearing that if they didn't send him a donation he might hold it against them, "which I wouldn't have. I don't bring that issue into the examination room with me."
Greene said he has heard a few expressions of disapproval from other doctors. He attributes such criticism to the culture of medicine "that says as a doctor you're supposed to suck up adversity."
But to family physician John Egerton, the issue is a matter of equity.
"Patients pay an enormous premium for their health insurance," said Egerton, who practices in Friendswood, Tex., and has seen his malpractice premium triple in the past three years, from $4,000 to $13,000.
"To say to a patient, 'Give me some money because I'm not as rich as I was last year' isn't the answer," Egerton said. "Everyone has problems."•
