Liability Reforms Bring More Care, More Doctors To Texans; TMA Physician Survey Confirms: Prop 12 Was Good For Texas

Main Category: Primary Care / General Practice
Article Date: 11 Sep 2008 - 0:00 PDT

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Whether it's in the emergency room, the examination room, or the operating room, sick and injured Texans now have more physicians offering more care, thanks to the state's landmark 2003 health care liability reforms, according to the results of a new survey the Texas Medical Association (TMA) released recently.

"This week marks the fifth anniversary of the liability reforms and Proposition 12," said TMA President Josie R. Williams, MD, a gastroenterologist from Paris. "This is great news for Texas patients and for Texas. It proves once again that the reforms have worked. Texans now have more doctors available to take care of them, especially the sickest and most badly injured patients."

The online survey of 1,391 physician members of TMA found that since September 2003, and primarily thanks to the liability reforms:

- Texas physicians are providing more services and caring for more patients with complex or high-risk problems.
- Physicians find it much easier to recruit new physicians to their communities, even among high-risk specialties.

These and many other positive findings stem from TMA's biennial Liability and Access to Care Survey, which measured Texas physicians' actions and attitudes on the fifth anniversary of the Texas reforms and Proposition 12.

Almost 90 percent of the survey respondents "strongly agree" or "agree" that compared with 2003, they now feel more comfortable practicing medicine in Texas in the manner in which they were trained. "That is very good for patient care in so many ways," Dr. Williams said.

The survey uncovered numerous instances of how the liability reforms have transformed what was an extremely troubled health care landscape across Texas. These examples illustrate the findings:

-- A family physician from Joshua says his community was able to establish a free health clinic in Cleburne and have enough volunteers to staff it four days a week. The clinic has provided needed care to care to more than 2,500 uninsured patients. "We would never have been able to provide a free clinic in the medical climate of 2003."

-- A 37-year-old emergency physician in Lubbock now can provide care more quickly to children who are in accidents and have severe fractures. "My emergency room now has two pediatric orthopedic physicians."

-- A family physician in Tyler said the medical liability reforms helped that community recruit a pediatric orthopedic surgeon, which was unheard of before the reforms.

-- According to a 41-year-old emergency physician, children in North Texas now have much greater access to pediatric subspecialists since 2003. "We now have a dedicated pediatric neurosurgeon on call 24/7, plus increased access to pediatric gastroenterologists, endocrinologists, neurologists, orthopedic surgeons, and general surgeons, improving the medical care children can receive."

-- Young doctors like a Central Texas cardiologist moved to set up practice in Texas specifically because of the improved medical liability climate. The 35-year-old physician provides potentially life-saving heart care to LaGrange and south Austin patients with urgent needs on the day they arrive. Prior to his arrival, many patients had long waits for care.

-- An internist in Dallas says with lower liability insurance premiums, he is able to spend more time participating in free health care clinics, like Project Access Dallas, which provide medical care to those who need it but don't have resources to pay for it.

-- A 57-year-old Austin geriatrician said, "Physicians are interested and willing to practice in the care of the frailest of the frail. Now, since the reforms, medicine feels much more open, more collaborative."

-- A 48-year-old El Paso obstetrician-gynecologist is able to take care of his patients with high-risk and complex pregnancies again. "I simply could not accept the risk before. My patients with complicated pregnancies had to wait a month or so to see a maternal-fetal specialist. Now I am able to care for these patients myself. My patients are receiving complex, special care much more quickly.

-- An obstetrician-gynecologist practicing for 41 years in Weslaco completely quit her obstetric practice in 2000 due to the high cost of liability insurance. In 2006, post-reform, she was able to allow obstetric patients back into her practice, including high-risk patients and the most complex cases.

-- A 58-year-old Irving and Grapevine pediatrician's patients used to have to wait months for urgently-needed pediatric endocrinology, psychiatric, and neurology care, but now can receive timely care. "What a relief to the children, their parents, and me as their primary care provider [to be able to provide that timely care]!"

-- A 51-year-old surgeon from Pennsylvania relocated to El Paso three years ago specifically because of Texas' improved medical liability climate. "Of all my 20 years' in medical practice, the best three years have been here in Texas - because of the medical liability climate that has evolved."

Since the 2003 liability reforms and the passage of Proposition 12, Texas physicians are much more likely to accept high-risk patients and offer new services or procedures.

Prior to the passage of the 2003 reforms, Texas physicians reported massive cutbacks in services they offered to their patients. Many physicians refused to accept patients with complex or high-risk problems, referring them to an increasingly shrinking pool of specialists in tertiary-care centers. TMA's 2008 survey found a continued reversal of that trend.

-- More than 18 percent of respondents say they now accept complex or high-risk cases they previously referred or denied. That is more than four and a half times greater than the 4-percent figure reported in the 2004 survey.

- Respondents told TMA they no longer refer patients with chronic pain and they are much more willing to treat patients with multiple complications - including cardiac, neurological, and immune deficiency problems - whom they previously would have referred to others.

- Eighty-five percent said the improved liability climate played a "very important" role in their decision to begin accepting complex or high-risk cases. That compares with 73 percent in the 2004 survey.

- Only 6 percent of respondents say that they have begun denying or referring high-risk cases since 2003. That compares with 20 percent in the 2004 survey. In TMA's prereform survey of March 2003, 62 percent said they had begun denying or referring complex or high-risk cases in the previous two years.

-- Twenty-two percent of respondents say they have started providing new services to their patients since Sept. 1, 2003. That compares with only 9 percent who reported offering new services in 2004.

- The improved liability climate is largely responsible for the new services. Eighty-four percent of respondents this year - vs. 77 percent in 2004 - say the perceived or expected change in the liability climate was a "very important" or "somewhat important" factor in their decision to offer new services.

- Many physicians reported they are now providing more charity care, participating in volunteer programs, and accepting more Medicaid and Medicare patients because of the liability reforms. They also are adding new in-office procedures and testing, nursing home coverage, and after-hours services.

- Only 5 percent of respondents say they have stopped providing certain services to their patients since Sept. 1, 2003. That compares with 13 percent in the 2004 survey. In TMA's prereform survey of March 2003, 51 percent said they had stopped providing certain services to their patients in the previous two years.

- More than 50 percent of the respondents said that the new liability climate was very important in their decision to add new in-office procedures and testing, nursing home coverage, and after-hours services.

More Physicians, Especially "High-Risk" Specialists, Coming to Texas

The liability reforms of 2003 have dramatically reversed Texas physicians' ability to recruit new colleagues to the state. And, the trend continues to grow more pronounced. Since 2003, the TMA survey found, efforts to recruit those "high-risk" specialists have been overwhelmingly successful.

-- More than 90 percent of the physicians who have successfully recruited new physicians to their practice, hospital, or community say the new liability climate was "very" or "somewhat" important in that success since 2004.

-- The new recruits - those who came to Texas to practice since 2003 - hold nearly identical opinions. Of the 127 respondents who were not practicing in Texas in September 2003, only 18 percent say they would have chosen to practice in Texas if the state had not reformed its health care liability laws. And 87 percent say the current liability climate for physicians in Texas is "much better" or "better" than the state from which they came.

-- Respondents who tried to recruit certain high-risk specialists were extremely successful:

- Emergency medicine specialists - 98 percent successful,
- Obstetricians - 90 percent successful,
- Orthopedic surgeons - 88 percent successful,
- Pediatric subspecialists - 88 percent successful,
- Neurosurgeons - 88 percent successful, and
- Trauma surgeons - 88 percent successful.

A Brief History of the 2003 Liability Reforms

In 2003, the Texas Legislature responded to the state's health care liability crisis by enacting new laws intended to reduce the number of meritless lawsuits filed against physicians and hospitals. The lawsuits and jackpot-sized judgments had led physicians' professional liability insurance premiums to skyrocket. As a result, many doctors reported they were drastically reducing their services, especially for the most severely sick or injured Texans, or were planning early retirement.

The centerpiece of the reforms was a $750,000 cap ($250,000 for physicians, $250,000 for the first hospital or health care facility, and $250,000 for any additional facilities) on judgments for noneconomic damages, such as pain and suffering, in health care liability cases. There is no cap on actual damages such as medical bills or lost income. The new law took effect Sept. 1, 2003. On Sept. 13, 2003, Texas voters approved Proposition 12 in a statewide constitutional election, ratifying the legislature's authority to adopt the caps.

Gov. Rick Perry, the Texas Legislature, and the voters reined in the epidemic of health care lawsuit abuse. "We now have a much healthier and robust system that is much better able to give Texans the medical care they need," said Dr. Williams.

Survey Technical Details

The online survey measuring physicians' attitudes and practice habits was conducted from Aug. 14 to Sept. 1, 2008, and 1,391 completed responses were received.

Invitations to participate in the online survey were sent via e-mail to 10,000 randomly selected physician members of TMA. Of those e-mails, 8,973 were delivered to the potential respondent's e-mail address. The response rate was 15.5 percent. The survey results accurately reflect the opinions of Texas physicians in general, with an overall margin of error for questions answered by all respondents of plus-or-minus 2.6 percent.

TMA is the largest state medical society in the nation, representing more than 43,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA's key objective since 1853 is to improve the health of all Texans.

Texas Medical Association