• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Proposal Would Raise Doctors' Fees; Full Funding, Participation Sought for State Birth-Injury Program Critic Calls 'Failure'

Posted on: Thursday, 15 December 2005, 06:00 CST

By Bill McKelway

Six years after finding itself sinking into debt, the state's birth-injury program is asking for broad new fees from every doctor and hospital in Virginia. More than 14,000 physicians would be affected.

If approved by the General Assembly next year, the proposed schedule of fees, surcharges and mandatory participation requirements would erase a $117 million deficit over 12 years.

Obstetricians, the primary beneficiaries of the state's 18-year- old birth-injury program, would see the biggest increases on a percentage basis; their annual fees, which would no longer be voluntary, would go from about $5,400 a year to more than $7,600.

The legislative effort, which is the most aggressive in the program's history, would especially affect the Richmond-area medical community, where participation by hospitals and obstetricians has been inconsistent since the program's earliest days.

VCU Health Center, St. Mary's and St. Francis Hospitals, which have not participated in recent years, would be required to pay tens of thousands of dollars in new costs annually; the money goes toward lifelong medical care -- about $2 million per child -- of infants whose injuries at birth leave them severely disabled for life.

Spokespeople for the affected entities declined to comment last night, saying they have not seen the proposals and studies leading to them, which cover more than 100 pages.

But Dr. John Seeds, who is chairman of VCU Health Center's obstetrical department, has been a sharp critic of program operations, telling the board in July that court rulings, outside experts and administrative decisions have pushed the program beyond its original intent.

"It's a failure," he said.

Seeds has said the program is too narrowly defined to offer an economic incentive to VCU, whose doctors are self-insured.

Program board members yesterday, including chairman Melina Dee Perdue, a Roanoke hospital executive, said they fully expect the proposals to raise a storm of protest, especially given rising malpractice premiums and low Medicaid reimbursement rates for doctors.

"I know obstetricians are working more and making less" because of their costs, she said.

"This is what it will take to get ourselves out of debt. All we can do is present our recommendations to the General Assembly and hope for the best," said C. Gary Burke, a consultant hired by the program to assess strategies for reducing the program's financial problems.

The debt stems largely from legal requirements that the program have sufficient funds at any time to care for any eligible child born within the previous decade. Under its current fee structure, the program is not expected to actually begin failing for another 15 years. It takes in almost three times more than it spends annually, about $18 million compared with $7 million, but without higher fees, costs of operation and the increased claimant load soon will begin eating into assets.

About 14,200 doctors would be affected. About 600 obstetricians who do not currently participate, more than half the state total, would be required to join the program; 13,115 non-obstetricians also would see new fees and a $76 annual surcharge. It was not clear how many more hospitals beyond the current 31 participants would be required to join because not all hospitals offer obstetrical services.

Created in 1987 in the midst of a malpractice-insurance crisis, the program was intended to remove from potential litigation a narrowly defined class of infants injured at birth from oxygen loss.

The program is formally called the Virginia Birth-related Neurological Injury Compensation Program; only Florida has copied the Virginia model.

Injuries must be so severe that a child will never reach independence; most program children have the severest form of cerebral palsy and have difficulty talking, can't walk, and often can't speak. Many must be fed through stomach tubes and some require ventilators. Few of the children are expected to live into adulthood.

Originally envisioned as caring for up to 40 children a year, the program has accepted barely over 100 since it began. Actuarial adjustments to long-term program costs erased a $45 million surplus in the late 1990s; that deficit has grown to more than $110 million despite safeguards in the law imposing fees against liability insurers and doctors who are not obstetricians.

Liability insurers, who already contribute some $11 million annually, would pay almost $5 million a year in new surcharges. Those costs are passed on to policyholders.

The program has about $150 million in assets, but lost nearly $100 million in potential income during the 1990s after the legislature, actuarial firms, the State Corporation Commission and board members agreed to reduce fees even as the claimant load and costs of lifetime care were mounting.

In addition to new surcharges and participation requirements, legislation being sought by the program would vastly alter the admissions process by placing new emphasis on medical panel findings and a form incorporating medical evidence of certain markers of oxygen loss at birth.

Infants whose injuries may be associated with maternal infections and diseases, as well as premature infants not showing evidence of global oxygen loss, would be excluded; other proposals would sharply reduce the involvement of lawyers assisting families in the filing of petitions for care.

Ann Jones, a Northern Virginia lawyer who has helped some 20 infants get program help, said yesterday the changes could free up many infants and their families to bring malpractice suits.

"I don't think we'll hear many objections from the trial lawyers," Jones said. "You have to wonder what protections the doctors will really be paying for if all this goes through."

The program has helped moderate malpractice-insurance premiums and helped to keep insurers in Virginia but some national experts argue that the injuries the program addresses are largely unpreventable.

That has undercut the program's allure as a positive alternative to medical malpractice suits; but some board members noted yesterday that any doctor who delivers a brain-injured child whose development had not previously shown complications is an easy target.

"That doctor is going to get sued," said board member McLain T. O'Ferrall Jr.

Source: Richmond Times - Dispatch

More News in this Category