Shrager, Spivey & Sachs

The news in Philadelphia last night and this morning recounts another tragedy that took the lives of two teenagers, Robert Michael Melson and Casey John Russo. Both boys had just finished tenth grade last Thursday.

From the account in the Inquirer, it was almost a “perfect storm” of well-known risk factors for unsafe teen driving:

• male driver
• 16 year old, new driver who had just gotten his “junior” or restricted license
• driving with a peer in the car
• had just left a party
• was trying to get home ahead of 11:00 p.m. – the hour after which he couldn’t drive with that license
• crossed the double yellow line to pass a carload of fellow teenagers
• driver and passenger were not wearing seat belts

As lawyers whose cases often follow tragedies like this, we are all too familiar with the pain that the surviving families will bear for the rest of their lives.

I urge any parent of a teen driver to go to the website for the Center for Injury Research and Prevention at Philadelphia’s Children’s Hospital of Philadelphia ( http://stokes.chop.edu/programs/injury/) . This is a great resource with as much detailed information as any parent or new driver could ask for to help raise the awareness of the risks of teen driving.

Every time I speak on this subject, I repeat my mantra: if there were a disease killing over 5,000 young people a year, the efforts nationwide to fight that disease would be astounding, but we aren’t doing enough to find a “cure” for this problem. If it were a disease, nobody would rest until a cure or effective treatment had been identified. I just don’t understand why we don’t have a similar campaign to make the streets safe for our teen drivers.

Please, take a moment and have a conversation with your teen driver to begin the process of educating him or her about the risks. You’ll be glad you took the time.

Yes, you’re on the right page. This is a Philadelphia trial lawyer’s blog. But I am applauding organized medicine.

The American Medical Association has just started a new campaign called “the Cure for Claims” to make sure that doctors are paid fairly and quickly by health insurers. You know what? They deserve that.

The statistics about how much of our medical resources are wasted on getting doctors paid are truly staggering. The AMA says that as much as $210 billion is added to the health care system annually because of the inefficient and unpredictable system of processing medical claims. They estimate that 14% of physicians’ revenue is spent on staff and overhead just trying to navigate through cumbersome and arcane claims processing.

How do you know this is a big deal to doctors? Because in its annual report calling for medical liability reform, the AMA quotes a statistic that the practice of “defensive medicine” (cost incurred only because doctors are afraid of being sued) is between $70 billion and $126 billion per year. In other words, the claims practices of big health insurers are adding costs to the delivery of health care that are 2-3 times as significant as lawsuits.

This is no surprise to lawyers like me. We spend our lives fighting against insurers to get fair compensation for our clients. I’ve said before that the typical insurance reaction is the “3Ds”: deny, defend and delay. Deny the claims in the first instance, spend resources defending your decision, and delay the ultimate payout of what is properly owed. The battles I have with insurers are, by their nature, adversarial. So we expect to be confronted by this approach. There’s nothing about the practice of medicine that should have to face the same adversarial 3Ds. Not surprisingly, the first bullet point in the AMA’s press release identified “denials” as one of the key problems. Another bullet point was “payment timeliness” – isn’t that delay?

Clearly the insurance companies are up to their same old tricks to hold money that fairly and properly should be paid to the physicians. The longer they hold the money (and earn interest on it), the more they benefit.

In a climate where health care costs are escalating far faster than inflation, our doctors deserve fairness in their dealings with the large health insurers, and patients deserve a payment system that leads to the most efficient delivery of service possible.

I’m starting to think that the practice of medicine in Pennsylvania is happening in parallel, but unrelated, universes. In one universe,  are Pennsylvania’s hospitals. The majority have soundly managed their business and developed practice areas in growth markets and, according to this morning’s Philadelphia Inquirer, are averaging 4.8% profits in the last year. In the other universe, are Pennsylvania’s doctors. According to their professional/lobbying group,  the Pennsylvania Medical Society, we need tort reform because physicians are leaving Pennsylvania.

Consider these numbers: the Hospital of the University of Pennsylvania earned profits on patient care of 14.28%; Paoli Memorial of the Main Line Health System earned a 23.7% profit. One year ago when profits were reported, Ralph Muller, the CEO at Penn said it was  because patients were moving to facilities that do more procedures and have better outcomes (see my blog from last year, http://www.shragerlaw.com/blog/?p=371 ). This year, the Mullen quote is essentially the same: “[the higher profit] margins showed that patients were flocking to HUP for advanced cancer, heart treatment and organ transplants. The hospital is full most days, he said, and that is driving higher [profit] margins.”

The real insight in the Inquirer article came from a consultant to Main Line Health System who said that hospitals in Philadelphia have benefited from a shakeout in the market that has left many of the survivors flush with profits.

We all know what that means, some of the less competitive hospitals aren’t around any more. Main Line Health’s management consultant says that’s a benefit to other hospitals. The market had a “shakeout.” So in the hospitals’ universe a reduction in the number of hospitals has benefited the surviving hospitals.

But in that other universe the Pennsylvania Medical Society, which claims it is losing dues paying members, is blaming this shakeout on lawsuit abuse! In his comments to the Pennsylvnia Senate Republican Policy Committee, Ralph Mecum, the CEO of the Pennsylvania Medical Society said that Pennsylvania is losing several types of specialists, including cardiologists – doctors who provide heart care.

Now connect the dots with me here. PMS’ Mecum tells the Republican state senators that the number of cardiologists is going down. Ralph Muller says that one reason HUP is making double digit profits is the growth of “heart treatment” at Penn. Isn’t it clear that in specialties like cardiology, patients (read: heath care customers) are choosing to go to the centers with the most experience and the best ability to treat their conditions? Maybe, heart care should be focused in the big urban centers whose hospitals are typically associated with medical schools.

One thing is clear, the Pennsylvania Medical Society’s incessant calls for tort reform are misplaced and out of touch with the economic realities of why the delivery of health care in Pennsylvnia is changing.