Letters to the Editor - March 27, 2006

At this practice, HSAs a "disaster" - Workers comp-style system should replace current medical tort system

At this practice, HSAs a "disaster"

Regarding "Collecting patients' share up-front getting easier" (Article, Feb. 27): I enjoyed your article on health savings accounts, but let me tell you why they are a disaster for my solo primary care practice.

The patient comes in with their HSA high-deductible type insurance and is given appropriate treatment, goes to the check-out window with their claim ticket, pays their contracted co-pay and leaves.

Sometime later, instead of receiving our usual discounted payment amount in the mail, we receive no check and are notified that the patient has not yet met their deductible and we must instead collect from the patient.

Unfortunately, the patient is long gone and may have even forgotten they ever saw the doctor. Needless to say, the likelihood of this bill being paid promptly is approximately zero.

My accounts receivable are going up rapidly in parallel with the increasing HSAs in our area. Check deductible status at the time of service? Well, that capability seems to be a long way in the future and when it does get here, I wonder how much this extra checking will hold up the patients in the check-out line or tie up my multitasking receptionist when she has other tasks that need her attention.

Just another scam putting the squeeze on the lowly primary care doc. Not that anyone cares.

--Everest A. Whited, MD, PhD, Pflugerville, Texas

Workers comp-style system should replace current medical tort system

Regarding "Tort reform: The truth of the matter" (Editorial, Feb. 20):

There is a basic issue that the AMA needs to address before physicians will get real tort relief. The reason why we cannot get the public and their representatives in Congress to support tighter tort reform is because nobody is offering an alternative venue to civil litigation.

Most physicians will candidly admit that accidents and injuries occur to patients in the course of all kinds of medical care.

In the current American legal culture, the only way that an injured person can be compensated is to contact a lawyer and file a lawsuit.

Lawyers will say that the current tort reform proposals will only reduce the injured client access to the court system because low-value cases are not financially feasible to prosecute.

I believe they are absolutely correct. What trial lawyers don't want to see is an alternative way to settle medical malpractice claims, because to win a large case is the big payoff to their firms. Malpractice insurers don't want tort reform to change their ability to make profits from physicians who fear medical malpractice claims and loathe lawyers.

There is a way to settle malpractice claims that no one is talking about and makes a lot of sense. We need to have a compensation system similar to disability or workers compensation that will hear these cases before an administrative law judge who is experienced in medical issues. This would take the emotional pleas before a jury away from the decision process and would lead to more medically correct determinations of whether there was fault or malpractice and how much patients should be compensated.

I believe the reason physicians and the AMA don't get widespread public support for tighter tort reform in the present system is because the voting public can see only disadvantages for the patient and advantages to the doctor to avoid any litigation.

If we want fairness to doctors as well as patients, we need to accept responsibility and accountability for our mistakes.

--William V. Choisser, MD, Orange Park, Fla.