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    States are battlegrounds for pivotal legislative issues

    Urologists are urged to keep a close eye on liability reform, 'rental PPOs'

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    UT Figure Medical liability caps by state
    Washington—Lawmakers in many states across the nation are considering legislation that could directly affect the practices of urologists and other physicians, urologists who attended a Washington legislative conference in March were told.

    Richard Memo, MD, program director for the State Society Network at the American Association of Clinical Urologists, outlined developments in several state legislatures where lawmakers are seeking to make medical liability insurance more affordable, restrict their ability to provide diagnostic imaging services, and prevent "rental PPO" schemes that could cut physician reimbursement levels unfairly.

    Dr. Memo made his presentation here during the recent Joint Advocacy Conference sponsored by AACU and AUA.


    Richard Memo, MD
    "There is a lot going on at the state level, and it's just as important to urologists as what goes on in Washington," Dr. Memo told Urology Times during the conference.

    Key issues on which states are moving to act include medical liability, diagnostic imaging, and so-called rental PPOs.

    Medical liability


    Raichawn Flynn
    "Many in Congress are battling to place reasonable caps on non-economic damages in cases of medical liability," pointed out Raichawn Flynn, AACU state affairs manager. "Certain state legislatures have laws already in place. California and its Medical Injury Compensation Reform Act (MICRA) have taught physicians that to stabilize malpractice premium rates, a cap on non-economic damages of $250,000 works best."

    In 2005, caps on non-economic damage awards were approved in Alaska, Missouri, Georgia, South Carolina, South Dakota, and Illinois. Flynn said AACU is currently tracking 71 liability-related bills across the country.

    He pointed out that in 1995, Wisconsin enacted a $350,000 cap on liability awards, which, adjusted for inflation, stood at $445,775 in 2005. After 10 years of a "stable" malpractice environment, the state supreme court ruled the caps unconstitutional. The legislature approved a new cap law, but it was vetoed by the governor.

    In 20 states without caps, AACU is encouraging state societies to work with medical societies and specialties "for a unified voice" and to support appropriate legislation.

    "State societies and others must educate urologists in order for them to lobby state legislators," Flynn said.

    Dr. Memo said that other important provisions are also included in some of the state proposals, including "I'm Sorry" laws that allow open communication of sympathy to a patient's family by the physician without fear of those statements being used in court. Nine states enacted such measures last year, and Wisconsin and Vermont currently are considering them.

    In addition, certification and expert regulation bills have passed in nine states, ranging from those setting standards for expert witnesses to creating panels to throw out frivolous cases.

    Flynn said an AACU survey of its members showed that 89% of respondents own prostatic, abdominal, and/or genital ultrasound equipment and 29% own magnetic resonance imaging, positron-emission tomography, and/or other computed tomo-graphy equipment. However, if some lawmakers have their way, only radiologists would be able to perform procedures with or read the results of that equipment.

    "The battle is to define who can perform and read imaging procedures," Flynn said, noting that last year, organized radiology spent more than $1 million in a campaign aimed at changing current definitions, and 55 different state legislative proposals that could limit a trained physician's right to perform diagnostic imaging procedures were pending.

    "2006 could prove to be difficult," he said, "with 51 bills being tracked affecting imaging."

    Dr. Memo cautioned that patients' access to health services would suffer if restrictions are imposed on physicians' ability to provide in-office imaging.

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    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.

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