Middleton says legislature needs to tackle thorny health reform issues next year

By Barbara Pash

For MarylandReporter.com

Medical malpractice and the scope of practice allowed health providers who are not physicians are thorny issues the next General Assembly needs to tackle as Maryland moves to implement federal health care reform, a key Senate leader said Thursday.

“They are controversial, but I’m willing to look at medical malpractice and the scope of practice,” Sen. Thomas “Mac” Middleton, chair of the Senate Finance Committee, told a conference of health industry professionals looking at the new federal law on Thursday. The Charles County Democrat  is a member of the governor’s Health Care Reform Coordinating Council, and if he wins re-election, will be an influential player in implementing the new law.

Middleton expected that changing how much doctors are held legally at risk and how much health professionals who are not doctors can do will figure prominently in the next legislative session.

Middleton appeared on a panel with Health Department Secretary John Colmers — co-chair of the coordinating council — Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, and Rodger Bayne, vice president of marketing and product development for Group Benefit Services, which sells insurance to smaller businesses and sponsored the event.

CareFirst’s Burrell said fear of lawsuits continues to play into the costs of care. He said a primary care physician typically sees 35 patients per day. If anything unusual appears, the patient is referred to a specialist because “the doctor doesn’t have time and there’s a fear of malpractice suits.” This results in a specialty-oriented medical system, he said .

Middleton said, “We will look at the cost of medical malpractice insurance” and its influence on people’s decisions about entering the medical field, and if so, in what areas they choose to practice. A special session of the legislature in 2004 took up the ballooning costs of malpractice insurance and changed some aspects of Maryland law. 

“Whether the legislature has the will to make [more] changes, I don’t know,” Middleton said.

Middleton referred to a 2008 study by the Maryland Hospital Association and MedChi, the state medical association, which found a severe shortage of primary care physicians, especially in the more rural areas of the state. Maryland is not alone in this situation and, he predicted, states will compete for such physicians.

“What is the responsibility of a medical school in providing primary care doctors?” Middleton asked rhetorically about the state’s two medical schools, Johns Hopkins University and University of Maryland.

In this context, Middleton said he wanted to examine the scope of practice, looking at the role of physician’s assistants, dental hygienists and other auxiliary health care professionals as they impact costs.

CORRECTION: Burrell said that 5% of the 3.5 million people CareFirst covers in Maryland, Washington, D.C. and northern Virginia, “consume more than 50% of all the medical dollars,” due primarily to chronic diseases and lack of coordination among health care professionals.

Burrell applauded the health care reform legislation but said the underlying cause, the rise in health care costs needs to be addressed. In each of the last three years, CareFirst has raised its premiums 10 to 14%.

In this context, Colmers said that Maryland is among states that are looking for ways to pay primary care physicians more to handle chronic illnesses.

Middleton opposes creation of a separate state agency to administer the federal health reform measures. “We have to be careful with costs and how much cost we put administratively into reform,” he said.

He also noted that some of the federal changes preempt Maryland action but the state has flexibility to encourage certain initiatives. One such initiative deals with healthy young adults who some believe will choose to pay a federal penalty rather than pay for presumably higher-cost insurance coverage.

Middleton said that the state is working on a plan to make the cost of purchasing insurance equal to the cost of the penalty. This would encourage more of the uninsured to buy into health care.

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