There is little good news for hospitals and physicians from any quarter the-se days. However, premium costs for anesthesiologists are easing at the two major insurance companies in Massachusetts and nationally at the St. Paul Fire & Marine Insurance Company. In recent years, the relative rate factor (classification) for anesthesiologists at St. Paul has declined from 5.0 to 3.5, at the Massachusetts Joint Underwriting Association UUA) from 5.0 to 3.5 (soon to go to 3.0), and at Harvard’s insurer, CRICO from 5.0 to 3.0. This classification is one indication of relativity, or the multiplication factor applied to the lowest malpractice premium (usually family practitioners who do no surgery) to determine the premium for each class of specialists.
Relative rate changes are not necessarily accompanied by equal changes in the premium cost because the base may change However, in the case of CRICO, the actual premium costs have declined by 33% for 1989 compared to 1988. Furthermore, in the JUA, whereas there were 27 major hypoxic claim in the I 8 months prior to December 31, 1986, during the calendar year 1988 not a single one was reported. Similarly among the CRICO insureds, there has not been a single major intraoperative catastrophic anesthesia mishap in some 280,000 anesthetics since August, 1985.
In the NAIC study during the 1970’s of malpractice claims, anesthesia accounted for about 3.5% of the total number of malpractice claims; the associated cost of anesthesia-induced claim VMS about 11% of the total cost. Today at St. Paul, the number of claims remains at 3.5% but the total cost has fallen to 3.6% suggesting that the average type of claim now is due to problems and injuries that are less severe.
In this issue of the Newsletter, James F. Holzer, J.D., Vice President for Risk Management at CRICO gives his viewpoint. Earlier, Mr. William A. Cass, Risk Manager at the JUA, commented “They’ve made the practice of anesthesia a low risk procedures”
Across the country, and indeed around the world, the causes for such changes are hotly debated. We may never know the precise reasons. However, I personally agree with Holzer and Cass in believing that the setting of standards and the utilization of specific fail safe backup monitoring devices is responsible to a considerable extent. Not all people examining the phenomenon concur. Other factors should be considered: improved training and education, recognition of human error, more qualified and better practitioners, more advanced departmental organization, and markedly increased interest in all aspects of risk management. Perhaps in time it will be sorted out. In any case, the markedly improved claims experience is here now and is good news for all involved.
E.C. Pierce, Jr. M.D. President, APSF
- McGinn, PR: Practice standards leading to premium reductions. American Medical News, December 2, 1988;22.