Clip files / Local news from the states

This column features selected short items about state health care policy.

Insuring controversy: Malpractice surcharges

WASHINGTON, DC—Kenneth M. Greene wasn’t sure how his 1,500 patients would react when he asked them for a $10 contribution to help pay his $11,000 malpractice insurance bill. "The medical malpractice insurance crisis has come full force to Maryland," the 47-year-old Towson internist declared in a letter he sent last December. A "small donation . . . is necessary if we are to continue to keep our doors open." Nine hundred miles away in North Palm Beach, Fla., family physician Ira G. Warshaw launched a similar plan. Warshaw asked his 3,000 patients to send him a check for $125 ($25 if they were younger than 25) to help defray his $30,000 insurance bill, which has quadrupled since 2002. If patients didn’t help, Warshaw warned in an earlier letter, he might be forced to stop participating in Medicare and some health plans. "I felt like I was drowning, really," said Warshaw, a solo practitioner who said he felt some guilt about his request but was grappling with a $100,000 debt from a failed venture in group practice.

Greene and Warshaw are among the pioneers of a new, controversial tactic that is being viewed with keen interest by medical groups around the country: the malpractice surcharge. Both doctors say their letters were so successful, they plan to send another appeal before next year’s insurance bills are due. Rising expenses and static reimbursements have led a growing number of physicians, most of them in the less lucrative primary care specialties of pediatrics, family practice, and internal medicine, to begin charging so-called access fees for services they once provided for free. These include filling out camp and disability forms, taking after-hours phone calls, and answering e-mail questions. Some also are dunning patients for canceled appointments. A malpractice surcharge, some doctors say, is simply one more access fee, although it usually is presented as voluntary to avoid running afoul of Medicare rules that prohibit such mandatory charges.

Its appeal is enhanced by the anger many doctors feel about rising insurance rates, which has touched off a fierce political battle in Maryland and other states. "Physicians are getting crushed by the combination of malpractice cost shocks and declining reimbursement," said T. Michael Preston, executive director of MedChi, the Maryland state medical society. "As a result, there is great interest in surcharges or access fees."

Washington Post, Sept. 24, 2004