- Joined
- Feb 24, 2005
- Messages
- 5
- Reaction score
- 0
Anesthesiologists Now Offer Model of How to Improve Safety, Lower Premiums
By JOSEPH T. HALLINAN
Staff Reporter of THE WALL STREET JOURNAL
June 21, 2005
The rising cost of medical-malpractice insurance has hit many doctors, especially surgeons and obstetricians. But one specialty has largely shielded itself:
Anesthesiologists pay less for malpractice insurance today, in constant dollars, than they did 20 years ago. That's mainly because some anesthesiologists chose a path many doctors in other specialties did not. Rather than pushing for laws that would protect them against patient lawsuits, these anesthesiologists focused on improving patient safety. Their theory: Less harm to patients would mean fewer lawsuits.
Over the past two decades, anesthesiologists have advocated the use of devices that alert doctors to potentially fatal problems in the operating room. They have helped develop computerized mannequins that simulate real-life surgical crises. And they have pressed for procedures that protect unconscious patients from potential carbon-monoxide poisoning.
All this has helped save lives. Over the past two decades, patient deaths due to anesthesia have declined to one death per 200,000 to 300,000 cases from one for every 5,000 cases, according to studies compiled by the Institute of Medicine, an arm of the National Academies, a leading scientific advisory body.
Malpractice payments involving the nation's 30,000 anesthesiologists are down, too, and anesthesiologists typically pay some of the smallest malpractice premiums around. That's a huge change from when they were considered among the riskiest doctors to insure. Nationwide, the average annual premium for anesthesiologists is less than $21,000, according to a survey by the American Society of Anesthesiologists. An obstetrician might pay 10 times that amount, Medical Liability Monitor, an industry newsletter, reports.
In some areas, anesthesiologists can now buy malpractice insurance for as little as $4,300 a year, although premiums ranged as high as more than $56,000, according to the ASA. The ASA survey gave no general explanation for the disparity but did note that premiums were higher for anesthesiologists who had been sued before and for those who perform higher-risk procedures.
A 1999 report by the Institute of Medicine noted that "few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety." It identified one exception: anesthesiologists.
"If there were any specialty where you said, 'Show me who has done anything right,' I would point to the anesthesiologists," says Neil Kochenour, medical director at the University of Utah Hospitals and Clinics. "They have really made some inroads and some impact."
Medical errors are a leading cause of death in the U.S., killing between 44,000 and 98,000 Americans each year, according to various studies.
Medical-malpractice insurance rates for some specialties, such as obstetrics and general surgery, have risen in some areas, especially in the past few years, as insurers have reported higher paid losses. The insurance industry and many doctors groups have blamed greedy plaintiffs lawyers and capricious juries for those losses. As a remedy, insurers and many medical organizations have pushed for legislation that caps damage awards and lawyers' fees. Most states have enacted some form of tort reform.
Many anesthesiologists also support legislative moves to rein in malpractice suits. "Even though we've controlled costs, it's still a big issue for our membership," says Karen B. Domino, chair of the ASA's committee on professional liability.
But overall, anesthesiologists have put more emphasis on improving safety. And now, some doctors in other fields are praising them for choosing a different response. Noting the success achieved by anesthesiologists, other doctors -- notably surgeons -- have aimed more at improving treatment methods. "There's a lot of room for us to do a better job and decrease liability, not just for patient safety but to reduce liability [premiums]," says F. Dean Griffen, a surgeon in Shreveport, La., who heads the patient-safety and professional-liability committee for the American College of Surgeons. That professional group recently launched a study of cases modeled on one that helped anesthesiologists recognize some of their shortcomings years ago.
For most of its 160-year history, anesthesiology, the practice of rendering a patient unconscious or insensitive to pain, has been fraught with danger. As recently as 30 years ago, doctors in the U.S. still made patients unconscious by administering ether and other flammable gasses. On rare occasions, static electricity sparked explosions. Less rarely, patients asphyxiated during surgery because their breathing tubes mistakenly became disconnected.
In 1982, the ABC news program "20/20" aired a piece on anesthesia-related deaths. "It was a devastating indictment of anesthesia," recalls Ellison C. Pierce Jr., a retired professor of anesthesiology at Harvard Medical School who is considered by many to be the father of the modern anesthesia-safety movement.
Around the same time, anesthesiologists were getting hit by their second wave of big malpractice-insurance premium increases in a decade. The specialty was then considered among the riskiest to insure, and premiums were often two to three times as high as those other doctors paid. Casey Blitt, a 63-year-old Tucson, Ariz., anesthesiologist who has long been active on patient-safety issues, says his insurance soared to $50,000 a year from $20,000 or less. Dr. Pierce says anesthesiologists were "terrified," and anxious to do something.
Dr. Pierce at the time was president of the American Society of Anesthesiologists. In 1985, that group provided $100,000 to launch the Anesthesia Patient Safety Foundation. The new foundation was unusual in medicine: a stand-alone organization solely devoted to patient safety. Working closely with the larger ASA, from which it still receives about $400,000 a year, the foundation galvanized safety research and improvement.
Unlike most other medical groups, the foundation admitted as members not only doctors but nurses, insurers and even companies that make products used by anesthesiologists. Industry's participation initially caused angst over whether the foundation was designed merely to sell machines. But over the years, that concern dissipated, Dr. Pierce says, as company money helped the organization fund important research.
One advance was the development of high-tech mannequins that allow anesthesiologists to practice responses to allergic reactions and other life-threatening situations. Anesthesiologists say the mannequins have also allowed them to become more proficient at performing an emergency procedure akin to a tracheotomy that involves slitting open a clogged airway -- something a doctor can't practice on live patients.
Twenty years ago, little was known about people injured or killed during anesthesia. No U.S. database existed, so anesthesiologists set out to create one. They decided to collect information from insurers on closed malpractice claims, those in which insurers had made a payment or otherwise disposed of the complaint.
Most insurers hesitated to cooperate at first, saying they were worried about patient privacy. One company finally agreed: St. Paul Fire & Marine Insurance Co. in Minnesota said it was concerned about heavy losses it had suffered from anesthesia-related injuries and was eager for anesthesiologists to review claims. Soon, other insurers followed suit.
Anesthesiologists left their practices for days at a time to pore over closed insurance claims. The information they collected was fed into a computer at the University of Washington to create an overall picture of how anesthesia accidents tend to occur. It "was a humbling experience," recalls Russell T. Wall, an anesthesiology professor at Georgetown University School of Medicine in Washington, D.C. To date, more than 6,400 claims have been analyzed.
In part by analyzing claims, the anesthesiologists were able to document the extent to which patients were dying because of a simple mistake: Anesthesiologists were inserting the patient's breathing tube down the wrong pipe. Rather than putting it down the trachea, which leads to the lungs, they were accidentally inserting it down the esophagus, which leads to the stomach. The problem was, there was no way to determine quickly whether the tube was in the right pipe. Patients often simply turned blue or their blood turned dark. By then, it was usually too late to save them.
The research contributed to two innovations that between them would all but eliminate death and injury from "intubation" errors. One, known as pulse oximetry, measures the oxygen level in the patient's blood stream by means of a device that clips onto the patient's finger. The other, capnography, measures carbon dioxide in a patient's expelled breath, which helps doctors determine at a glance that a patient is breathing properly.
At the time, though, the new technologies had a drawback, Dr. Pierce says: "It was very hard to get hospitals to buy pulse oximeters and capnographs," he says. When they were introduced in the 1980s, the two devices together cost about $10,000, according to several anesthesiologists.
That's where the safety foundation came in. In 1986, at the urging of the foundation, anesthesiologists made the use of pulse oximetry part of the ASA's basic standards for anesthesia care. A bit later, they added capnography.
By JOSEPH T. HALLINAN
Staff Reporter of THE WALL STREET JOURNAL
June 21, 2005
The rising cost of medical-malpractice insurance has hit many doctors, especially surgeons and obstetricians. But one specialty has largely shielded itself:
Anesthesiologists pay less for malpractice insurance today, in constant dollars, than they did 20 years ago. That's mainly because some anesthesiologists chose a path many doctors in other specialties did not. Rather than pushing for laws that would protect them against patient lawsuits, these anesthesiologists focused on improving patient safety. Their theory: Less harm to patients would mean fewer lawsuits.
Over the past two decades, anesthesiologists have advocated the use of devices that alert doctors to potentially fatal problems in the operating room. They have helped develop computerized mannequins that simulate real-life surgical crises. And they have pressed for procedures that protect unconscious patients from potential carbon-monoxide poisoning.
All this has helped save lives. Over the past two decades, patient deaths due to anesthesia have declined to one death per 200,000 to 300,000 cases from one for every 5,000 cases, according to studies compiled by the Institute of Medicine, an arm of the National Academies, a leading scientific advisory body.
Malpractice payments involving the nation's 30,000 anesthesiologists are down, too, and anesthesiologists typically pay some of the smallest malpractice premiums around. That's a huge change from when they were considered among the riskiest doctors to insure. Nationwide, the average annual premium for anesthesiologists is less than $21,000, according to a survey by the American Society of Anesthesiologists. An obstetrician might pay 10 times that amount, Medical Liability Monitor, an industry newsletter, reports.
In some areas, anesthesiologists can now buy malpractice insurance for as little as $4,300 a year, although premiums ranged as high as more than $56,000, according to the ASA. The ASA survey gave no general explanation for the disparity but did note that premiums were higher for anesthesiologists who had been sued before and for those who perform higher-risk procedures.
A 1999 report by the Institute of Medicine noted that "few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety." It identified one exception: anesthesiologists.
"If there were any specialty where you said, 'Show me who has done anything right,' I would point to the anesthesiologists," says Neil Kochenour, medical director at the University of Utah Hospitals and Clinics. "They have really made some inroads and some impact."
Medical errors are a leading cause of death in the U.S., killing between 44,000 and 98,000 Americans each year, according to various studies.
Medical-malpractice insurance rates for some specialties, such as obstetrics and general surgery, have risen in some areas, especially in the past few years, as insurers have reported higher paid losses. The insurance industry and many doctors groups have blamed greedy plaintiffs lawyers and capricious juries for those losses. As a remedy, insurers and many medical organizations have pushed for legislation that caps damage awards and lawyers' fees. Most states have enacted some form of tort reform.
Many anesthesiologists also support legislative moves to rein in malpractice suits. "Even though we've controlled costs, it's still a big issue for our membership," says Karen B. Domino, chair of the ASA's committee on professional liability.
But overall, anesthesiologists have put more emphasis on improving safety. And now, some doctors in other fields are praising them for choosing a different response. Noting the success achieved by anesthesiologists, other doctors -- notably surgeons -- have aimed more at improving treatment methods. "There's a lot of room for us to do a better job and decrease liability, not just for patient safety but to reduce liability [premiums]," says F. Dean Griffen, a surgeon in Shreveport, La., who heads the patient-safety and professional-liability committee for the American College of Surgeons. That professional group recently launched a study of cases modeled on one that helped anesthesiologists recognize some of their shortcomings years ago.
For most of its 160-year history, anesthesiology, the practice of rendering a patient unconscious or insensitive to pain, has been fraught with danger. As recently as 30 years ago, doctors in the U.S. still made patients unconscious by administering ether and other flammable gasses. On rare occasions, static electricity sparked explosions. Less rarely, patients asphyxiated during surgery because their breathing tubes mistakenly became disconnected.
In 1982, the ABC news program "20/20" aired a piece on anesthesia-related deaths. "It was a devastating indictment of anesthesia," recalls Ellison C. Pierce Jr., a retired professor of anesthesiology at Harvard Medical School who is considered by many to be the father of the modern anesthesia-safety movement.
Around the same time, anesthesiologists were getting hit by their second wave of big malpractice-insurance premium increases in a decade. The specialty was then considered among the riskiest to insure, and premiums were often two to three times as high as those other doctors paid. Casey Blitt, a 63-year-old Tucson, Ariz., anesthesiologist who has long been active on patient-safety issues, says his insurance soared to $50,000 a year from $20,000 or less. Dr. Pierce says anesthesiologists were "terrified," and anxious to do something.
Dr. Pierce at the time was president of the American Society of Anesthesiologists. In 1985, that group provided $100,000 to launch the Anesthesia Patient Safety Foundation. The new foundation was unusual in medicine: a stand-alone organization solely devoted to patient safety. Working closely with the larger ASA, from which it still receives about $400,000 a year, the foundation galvanized safety research and improvement.
Unlike most other medical groups, the foundation admitted as members not only doctors but nurses, insurers and even companies that make products used by anesthesiologists. Industry's participation initially caused angst over whether the foundation was designed merely to sell machines. But over the years, that concern dissipated, Dr. Pierce says, as company money helped the organization fund important research.
One advance was the development of high-tech mannequins that allow anesthesiologists to practice responses to allergic reactions and other life-threatening situations. Anesthesiologists say the mannequins have also allowed them to become more proficient at performing an emergency procedure akin to a tracheotomy that involves slitting open a clogged airway -- something a doctor can't practice on live patients.
Twenty years ago, little was known about people injured or killed during anesthesia. No U.S. database existed, so anesthesiologists set out to create one. They decided to collect information from insurers on closed malpractice claims, those in which insurers had made a payment or otherwise disposed of the complaint.
Most insurers hesitated to cooperate at first, saying they were worried about patient privacy. One company finally agreed: St. Paul Fire & Marine Insurance Co. in Minnesota said it was concerned about heavy losses it had suffered from anesthesia-related injuries and was eager for anesthesiologists to review claims. Soon, other insurers followed suit.
Anesthesiologists left their practices for days at a time to pore over closed insurance claims. The information they collected was fed into a computer at the University of Washington to create an overall picture of how anesthesia accidents tend to occur. It "was a humbling experience," recalls Russell T. Wall, an anesthesiology professor at Georgetown University School of Medicine in Washington, D.C. To date, more than 6,400 claims have been analyzed.
In part by analyzing claims, the anesthesiologists were able to document the extent to which patients were dying because of a simple mistake: Anesthesiologists were inserting the patient's breathing tube down the wrong pipe. Rather than putting it down the trachea, which leads to the lungs, they were accidentally inserting it down the esophagus, which leads to the stomach. The problem was, there was no way to determine quickly whether the tube was in the right pipe. Patients often simply turned blue or their blood turned dark. By then, it was usually too late to save them.
The research contributed to two innovations that between them would all but eliminate death and injury from "intubation" errors. One, known as pulse oximetry, measures the oxygen level in the patient's blood stream by means of a device that clips onto the patient's finger. The other, capnography, measures carbon dioxide in a patient's expelled breath, which helps doctors determine at a glance that a patient is breathing properly.
At the time, though, the new technologies had a drawback, Dr. Pierce says: "It was very hard to get hospitals to buy pulse oximeters and capnographs," he says. When they were introduced in the 1980s, the two devices together cost about $10,000, according to several anesthesiologists.
That's where the safety foundation came in. In 1986, at the urging of the foundation, anesthesiologists made the use of pulse oximetry part of the ASA's basic standards for anesthesia care. A bit later, they added capnography.