by Nora Edinger
CLARKSBURG -- Area doctors closely involved in the state's sweeping medical-reform efforts say things have improved significantly since earlier this year, when the state Legislature averted a health-care crisis that had reached the point of physician walkouts.
"I think we had the best (legislative year) that any state medical association has had in 25 years," said Dr. Doug McKinney, a Harrison County urologist who is president of the West Virginia Medical Association.
After heavy lobbying by that physicians' professional group, the Legislature passed a reform package in March that included both restrictions on how courts handle malpractice cases and how much money they can award victims, and the establishment of a physician-operated insurance company. Both efforts were ultimately aimed at containing skyrocketing premium rates for medical malpractice insurance, which doctors claimed were forcing them to leave the state or quit practicing.
"We're already seeing the fruits of it," McKinney said.
McKinney, who has springboarded from lobbying into a Republican gubernatorial campaign, said that is particularly true in terms of doctor recruitment. He said the Kanawha Valley region was able to recruit more doctors in April, May and June -- the first three months after the state Legislature passed the reform package -- than it did in all of 2002.
He said that trend is also holding true inside Harrison County, which has recruited a number of doctors, including two pediatricians and a nephrologist (kidney/dialysis specialist) recently.
The latter, whom a United Hospital Center official confirmed will arrive later this year, is a victory on two counts. The incoming doctor will fill a position that has been vacant for more than two years. That specialty is also a high-need one, serving West Virginia's large diabetic community.
Such specialty positions as nephrology and neurology had become increasingly difficult to fill in recent years as in-state premiums for malpractice insurance had increased to as high as $200,000 a year for the most high-risk specialties, hospital officials have said.
McKinney said the legislative reform has also stopped talk of early retirement among area doctors who were frustrated by high premiums and what they perceived as an increasingly adversarial relationship with state government. He said some of the younger doctors who were planning to leave West Virginia in search of greener pastures have also reversed their decisions.
"It's all directly attributable to the passage of that bill," he said. "Doctors are happier."
Two area doctors also embroiled in the reform effort agreed with McKinney's assessment, albeit from a slightly different point of view.
Dr. Robert D'Alessandri, dean of the West Virginia University School of Medicine in Morgantown, and Dr. Michael Stewart, a radiation oncologist who serves a variety of North Central hospitals, are both board officers for the new self-insurance plan. It's called the West Virginia Physicians' Mutual Insurance Co. and is expected to break from state oversight and become independent early in 2004.
D'Alessandri believes the mutual will bring the kind of financial stability to the state that many doctors have been craving. The mutual stemmed from an emergency insurance program called BRIM II that the state created and initially intended to cover doctors whose high-risk specialties had priced them out of the private market or who had been left without malpractice coverage after all but one of the major malpractice carriers pulled out of the state. The independent mutual will be open to compete for any physician's business.
"When physicians begin to look at this as an option ... they don't have to worry that is will disappear tomorrow," board Vice Chair D'Alessandri said.
While he believes competition from private carriers is important to the mix, he anticipates that participation in the mutual will grow. He predicted it could serve as many as 70-80 percent of in-state doctors in the next five to six years.
Stewart also believes the combination of the mutual and the tort reform is electric.
"Particularly now that there's tort reform, we have every element to succeed," said Stewart, board treasurer. "So, cynics beware."
Stewart said he gets an occasional comment of reform distrust from doctors he believes have soured on the overall profession, but said the general feeling is now one of optimism.
"This is a way that malpractice (premiums) will be stabilized," said Stewart, who is among about 1,200 state physicians already insured through the new program. "We don't have a motive to make a profit. If anyone can do this right, it's us."
He believes an initial funding assist from the state has been key as well.
The mutual is being set up with a $24 million loan from the state's tobacco lawsuit settlement, a one-time $2,500 fee from each of the nearly 1,300 companies selling any kind of insurance in the state and a $1,000 one-time fee from each physician.
"We have $30 million in the bank walking in," said Stewart.
More or less
Recent reports on slow collection of the physician-generated part of the fee left some people, including legislators, wondering just how healthy the post-reform temperature is in the medical community, however.
The Associated Press reported last week that fewer than half of physicians who had been sent invoices by the state's two medical boards had paid the fee, which applies to all licensed physicians regardless of what their source of malpractice insurance is.
During a recent interim session, some legislators expressed displeasure in the slow response. When they discovered the reform bill did not include any deadline for physician payment of the fee or penalties for non-payment, they began discussing ways to tighten the legislation so that it would require payment for future medical-license renewals.
According to the state Board of Medicine, one of two boards charged with assessing the fees beginning July 1, about 2,160 doctors had paid as of Friday. Another 825 had claimed exemptions, such as full-time service in the military or as medical faculty. That board sent out invoices to more than 5,700 physicians with inactive or active licenses.
An official with the state Board of Osteopathy, said about 200 of the 780 doctors it invoiced had paid by week's end.
In contrast, Tamara Lively, a BRIM II official helping with the mutual's establishment, said all but 21 of the 1,292 insurance companies that body assessed had paid their $2,500 shares.
But McKinney, Stewart and D'Alessandri each said they were undisturbed by the non-payments. They believe they are related to physician attrition that is finally being accounted for on paper rather than lingering doctor angst.
McKinney, in particular, said that the non-payments may finally settle the question as to how many doctors there are in West Virginia. The state claims there are about 6,000. The Medical Association believes the number is more like 3,100, with other licenses being held by retirees or younger doctors who are practicing in other states but are keeping their option open to return to West Virginia for a quieter retirement practice.
Based on phone calls he's gotten from physicians in those situations, he believes much of the non-payment indicates they are opting out of their inactive state licenses, which they had been able to retain with only a $100 payment every other year.
"The point is, there are a lot of people who have West Virginia licenses who don't practice in West Virginia," D'Alessandri said. "I'm not sure that we need to be concerned, at all, about this at this point. If we're getting the people in the state who are practicing, that's the most important thing."
McKinney said doctors he has been talking to are grudgingly accepting of the fee, even those, like he, who remain privately insured.
"This is a part of the law we had to agree to in order to get the tort reform," McKinney said. "Most people didn't like it, but they're going to pay it."
The three regional doctors said there are two other things they and colleagues are keeping a wary eye on, however, as the reform policies continue to be sorted out.
D'Alessandri believes it is still possible to meet a Jan. 1 target date for taking the mutual independent. Stewart is more skeptical and pointed out BRIM II does not officially sunset until June 30. McKinney said he is confident the doctors on the board will fight for an independence schedule that is reasonable without being rushed.
The three are also anxious to see how the state Supreme Court of Appeals will react to the tort reform side of the legislative package. They fear the high court could make rulings on malpractice related cases that would effectively dismantle the reform.
Regional Editor Nora Edinger can be reached at 626-1447 or by e-mail, at firstname.lastname@example.org