Protests by physicians over rising malpractice insurance premiums may be signaling a political shift that could make doctors see Republicans as their allies, a public-advocacy official thinks.

On April 27, when about 2,000 doctors marched in suburban Philadelphia to protest the rates, Frank Clemente, an official of the advocacy group Public Citizen, recalled what White House strategist Karl Rove said last year. Rove had commented that the debate over a Patients' Bill of Rights had divided doctors from the GOP.

"He said that was the wrong playing field and the Republicans had to get them back," Clemente told the Washington Post.

That's just what seems to be happening in the GOP's embrace of malpractice as an issue that threatens to bury the Democratic-led coalition of patients and doctors seeking broader legal liability for HMOs.

"To have these white-coated doctors marching around state capitols is a tremendous public relations win," Clemente added.

The rally in Pennsylvania was just the latest display of physician outrage and frustration with malpractice insurance premium hikes. Most of the barbs were aimed at trial lawyers, as reflected in one sign: "Doctors Take Oaths, Lawyers Take Money" (but see the Compensation Monitor for some contradictory information).

While managed care organizations, for the moment, seem to have found some shelter through all this, the issue has more than just public relations and long-term public policy implications. Access to doctors may become a chronic problem for health plans.

As the Philadelphia Inquirer noted, "Speaker after speaker warned that young doctors were leaving Pennsylvania and that patients would lose access to health care if mushrooming malpractice premiums were not curbed." Pennsylvania is 1 of 12 states identified by the American Medical Association as being in crisis, with Florida, Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Texas, Washington, and West Virginia.

Physicians, state medical societies, the AMA, and the American Association of Health Plans are among those who have been petitioning state and federal legislatures to resolve issues that contribute to the problem.

Without definitive action, several scenarios promise to play out in the crisis states. Many doctors will retire early, others will move to states where they can develop more lucrative practices, while still others will leave the profession altogether.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.