Malpractice for physician extenders and allied health professionals

Fiend

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We are all familiar with the studies that demonstrate equivocal patient safety outcomes between CRNA and physician delivered anesthesia and have read the articles in U.S. News (from 31 Jan 2005 issue) about the increased role of physician extenders and allied health professionals. NPs, CRNAs, AAs, and NPs all are here to stay (or have been here for a while and are not going anywhere). They are obtaining more practice rights everyday and in many cases can practice independent of physician supervision.

What I haven't seen is a MEANINGFUL discussion of the malpractice situation with these professionals. (no flames, please). Which insurance carriers cover these health care providers and what are their premiums like? Do they pay less than their physician counterparts? Do hospitals that employ them cover the malpractice? If there is an adverse outcome or a frivolous lawsuit, whom do the attorneys go after? Is there any money to be made suing a NP or CRNA - are they covered for multimillion dollar liability? Will they be affected by tort reform that we all hope is in the pipeline?

Once again, please no flames.

Thanks.
 

jwk

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Fiend said:
We are all familiar with the studies that demonstrate equivocal patient safety outcomes between CRNA and physician delivered anesthesia and have read the articles in U.S. News (from 31 Jan 2005 issue) about the increased role of physician extenders and allied health professionals. NPs, CRNAs, AAs, and NPs all are here to stay (or have been here for a while and are not going anywhere). They are obtaining more practice rights everyday and in many cases can practice independent of physician supervision.

What I haven't seen is a MEANINGFUL discussion of the malpractice situation with these professionals. (no flames, please). Which insurance carriers cover these health care providers and what are their premiums like? Do they pay less than their physician counterparts? Do hospitals that employ them cover the malpractice? If there is an adverse outcome or a frivolous lawsuit, whom do the attorneys go after? Is there any money to be made suing a NP or CRNA - are they covered for multimillion dollar liability? Will they be affected by tort reform that we all hope is in the pipeline?

Once again, please no flames.

Thanks.
I can only respond from a group practice standpoint. I practice in a large group of 36 anesthesiologists and 70 anesthetists using the ASA Anesthesia Care Team model. All are covered by the same malpractice carrier, in our case a physician-owned company. The anesthetists' portion of the premiums are in the neighborhood of $2,000-3,000 per year I believe. The anesthesiologists' are significantly higher ($30k or so). Malpractice insurance is paid for all providers by the group. Hospitals that employ anesthetists pay for their malpractice insurance. Hospitals that contract with CRNA's either provide coverage, or the contract CRNA (or their company or agency) provides their own coverage. I would like to know as well how fully independent CRNA's (in the opt-out states) premiums compare with those who still have a physician supervision requirement.

All of our anesthetists choose to work within this practice model. Obviously if any of our CRNA's sought independent practice they wouldn't work with our group. AA's always have been and always will be practicing in a care team practice with anesthesiologists.

The lawyers will happily sue everyone involved with a case - MD, AA, CRNA, RN, whoever else they think can contribute to their lifestyle. (One local personal injury attorney owns his own private island in the Caribbean). I'll defer to the CRNA's to comment about their own levels of coverage.
 

Tenesma

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Fiend can you list the studies that show "equivocal patient safety outcomes"... i only know of two very poor attempts (both very poor studies) 1) the Pine study and 2) the pennsylvania study.... so the US News report is barely scientific literature...

in general CRNAs and MDs are covered for the same amount of liability - however CRNAs pay far less in premiums.... there are a few reasons for this
1) insurance companies know they can squeeze more out of physicians 2) physicians are more often cited in lawsuits 3) physicians tend to provide care to a sicker and therefore more litigious population
 
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Fiend

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Tenesma,
I don't know the exact references for the studies you asked about. I just keep hearing about them again and again.
Aside from that, my question is geared towards what the actual costs (in real dollars and for the future) of malpractice coverage for allied health professionals and advanced practice nurses are.
If the physician is cut out of the supervision (be it in anesthesia or another field of medicine), then is the liability burden the same? If it is (i.e. you can still sue a CRNA or NP for millions of dollars) then why aren't the insurance premiums for them just as high?
If an OB/GYN in Illinois has to pay more than $200K/year for malpractice, how the heck could an independent nurse midwife afford that?
I just have not seen this issue really talked about and am dying to know what the mechanisms of funding are.
 

toughlife

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I would diligently seek out CNRA's who practice independently, who practice independently, especially in those 12 states where they are allowed to bill, and try to make some cash there.