Insurance Costs Pack A Punch For DPMs
Paying malpractice insurance premiums is a necessary evil for doctors. Lately, however, both doctors and insurance companies have been feeling the crunch more than ever before. The entire country faces a “crisis” when it comes to medical malpractice coverage, although some states, like Pennsylvania and Texas, are hit particularly hard, according to PICA President and CEO Jerry Brant, DPM.
“I’m fortunately busy enough that I can afford to do surgery,” says Stephen A. Monaco, DPM, who practices in suburban Philadelphia, an area with high insurance and settlement costs. He acknowledges other practitioners are not so lucky. “A lot of people I know dropped surgical coverage because they couldn’t afford to do (surgery anymore).”
A consultant to the executive board of the Pennsylvania Podiatric Medical Association (PPMA) and a former president of PPMA, Dr. Monaco practices with another doctor and pays $40,000 a year in malpractice insurance premiums for himself and his partner.
What may even be more disturbing is the assertion that insurance companies may have actually held back on raising annual premiums in recent years.
“Professional liability has been underpriced for the last two to five years,” says Dr. Brant. “Everyone was afraid to raise premiums because they were afraid to raise the market share.”
As a result, several insurance companies have gone bankrupt or have withdrawn from professional liability insurance, according to Dr. Brant. The economic downturn is also to blame for some of the troubles, as Dr. Brant says it is not unusual for the medical profession to see more cases during tougher economic times and when investment portfolios have been earning less.
Is There Any Relief In Sight?
The Pennsylvania Malpractice Professional Liability Catastrophe (Cat) Fund pays for insurance across the state. Dr. Monaco says the PPMA successfully lobbied state legislature to pass an amendment letting DPMs opt out of paying into the Cat Fund in two years.
The Cat Fund pays settlements and judgments from the current year, covering settlements totaling more than regular insurance coverage. In 1995, doctors and hospitals paid $250 million into the Cat Fund. Settlements increased in 1999 and they paid $350 million in 2000.
Now the task ahead for PPMA is to create a fund to replace the Cat Fund and create a management company to handle the fund, which Dr. Monaco says will be maintained by a surcharge on DPMs.
Dr. Brant believes tort reform would help the insurance crisis but admits that reforms are easier said than done. The Pennsylvania legislature attempted tort reform in 1996 before the measure was declared unconstitutional. Due to its meaningful tort reform, he says California is “one of the better states to do business in.” The state’s MICRA program caps insurance costs.
Dr. Brant does not think the podiatric community will see a “wholesale uprooting” of DPMs who leave practice due to insurance costs but says he thinks prices in selected states may discourage people from practicing in those areas. Dr. Monaco concurs, noting that high malpractice rates are making new DPMs think twice about practicing in the Philadelphia area.
Dr. Monaco does not have numbers on how many DPMs have left practice in the Philadelphia suburbs due to high insurance rates but he does know of one DPM who left to teach in public schools.
“The malpractice crisis as we know it has made a lot of the doctors, who are eking out a living, think twice,” says Dr. Monaco.
Deciphering The Endless Coding Questions
“Can I bill the office visit as well as a procedure code at the same time?” “If I don’t know the exact diagnosis and I am awaiting a diagnostic test or pathology reports, how do I code the diagnosis and visit?” These are just a few of the common coding questions that Gary Dockery, DPM, has heard from fellow podiatrists.
There’s no doubt that some of these questions and other coding dilemmas may come up during the session, “Coding, Reimbursement and Practice Management: Infections,” which is scheduled for Friday, August 9 at the APMA’s 2002 Annual Scientific Meeting in Seattle.
Questions like this are typical among many physicians due to the constant coding changes. Dr. Dockery cites an example of CPT code 64640 being denied in some areas of the country or the insurance company telling the practitioner a certain procedure was experimental and not covered by insurance.
Dr. Dockery, who will be lecturing along with Warren Joseph, DPM, and Harry Goldsmith, DPM, at the aforementioned APMA session, recommends doing some “extra homework” when insurance companies deny claims or grossly underpay because they have recoded the original code. He recommends “getting advice and coding recommendations from the coding specialists and online services.”
In more severe cases, the carrier may tell you that you are not an authorized provider of the treatment as only MDs are authorized. If this occurs, Dr. Dockery suggests, “writing a letter of justification of the procedure with a direct contact with the insurance company’s medical director and/or sending in copies of relevant medical articles justifying the technique.”
While the lecture might not touch on changes that DPMs would like to see, Dr. Dockery has his own suggestion. “The biggest change that needs to be made is equal reimbursement for equal services, not dependency upon the practitioner’s degree … the procedure should be coded, billed and paid the same for DPM, DO and MD alike.”
For more information on the APMA’s 2002 Annual Scientific Meeting, check out www.apma.org.
– Gina DiGironimo
Production Editor
