Also this issue: Take My Knife ... Please -Bruce Schimmel Dissent in the Ranks -Howard Altman Letters to the Editor

January 16-22, 2003

slant

Sick System

Patients need quality health care.

by Alan G. Rosenbloom

When President Bush appears today in Scranton to discuss the medical malpractice insurance crisis, every Pennsylvanian needs to understand the president is here because we are one of the "ground zero" states in terms of the scope and extent of the problem. While the president and his allies in Congress are now moving forward with legislation to address this matter at the federal level, it is the battles in states like Pennsylvania and West Virginia that are drawing attention.

As the medical malpractice insurance morass demands priority status in Washington, so too does it need immediate attention in Harrisburg. We desperately need a legislative solution that ensures patients of all ages and all walks of life retain access to quality health care. News reports of trauma centers closing and doctors compelled to walk off the job have served to crystallize the problem.

While the Schweiker administration created positive movement toward resolving this highly complex and contentious issue, Gov.-elect Rendell and the General Assembly now must bring the many disparate players together to craft a package that is politically achievable, constitutional and likely to stabilize the insurance marketplace so Pennsylvanians can be assured of continued access to high quality care and services. Fortunately, the governor-elect clearly intends to craft both stopgap relief and long-term solutions.

This is no easy task, and we undoubtedly have embarked upon a rocky road. Nevertheless, failure to reform our malpractice insurance laws is no longer an option -- the Commonwealth cannot afford it, patients in need of care don't deserve it and our citizens will not tolerate it.

Yet, while much of the public debate has focused on how this crisis affects physicians and hospitals, solutions must also provide relief to Pennsylvania's long-term care providers if we are to maintain access to essential care services for frail, vulnerable seniors throughout the Commonwealth. Our long-term care system -- which cares for approximately 90,000 of our state's most frail and vulnerable citizens residing in nursing homes and another 54,000 living in personal-care homes -- is faced by demographic realities that cannot be ignored: Pennsylvania is the second oldest state in the nation, following only Florida; our fastest growing age group -- those 85 and older -- will skyrocket 114 percent by the year 2010, to over 365,000; our 2 million citizens over 65 increasingly will require long-term care services. This is precisely the time we must strengthen our long-term care infrastructure in preparation for greater demand of services, not stand by and watch it incrementally weakened by the growing threats associated with litigation and the rapidly escalating cost of liability insurance.

Despite modest claims experience, Pennsylvania's long-term care providers -- both nursing homes and personal-care/assisted-living residences -- face a precipitous drop in availability of insurance options, and steep increases in the cost of liability insurance. From 1996 to 2000, liability insurance costs increased 250 percent for Pennsylvania nursing facilities. In each year since 2000, long-term care providers have faced annual premium increases in excess of 500 percent. Across the Commonwealth, moreover, nursing homes have seen their MCARE (Medical Care Availability and Reduction of Error) surcharges increase from 20 percent to 125 percent each year from 2000 through 2003 -- despite the fact that, in the 28-year history of the CAT Fund/MCARE Fund, nursing homes have paid nearly $50 million in surcharges and assessments, yet these funds have paid just $3 million or less in claims. Any reasonable cost-benefit assessment of the status quo will conclude this is neither workable nor fair.

Indeed, we have begun to see nursing homes close in significant part due to skyrocketing insurance costs, as demonstrated most recently by Temple University's announcement that it will soon close a major nursing facility. The unfortunate bottom line is that while seniors needing long-term care are threatened by the possibility of more limited access to quality care, we collectively face the troubling reality that an increasing amount of public resources are being directed toward rising insurance premiums, not toward improving patient care.

Like President Bush, our lawmakers in Harrisburg need to address the fact that, slowly but surely, the gnawing problems associated with the malpractice insurance crisis are beginning to extend beyond the physician and hospital community and into seniors' long-term care. If we are to protect our seniors and their continued access to quality health services, it is essential that President Bush and the U.S. Congress -- as well as Gov.-elect Rendell and the General Assembly -- assure that legislative reforms at both the federal and state levels address the needs of the long-term care provider community in addition to physicians and hospitals.

Alan G. Rosenbloom is the president and CEO of the Pennsylvania Health Care Association in Harrisburg, Pa. If you would like to respond to this Slant or have one of your own (850 words), contact Howard Altman, City Paper executive editor, 123 Chestnut St., third floor, Phila., Pa., 19106 or e-mail altman@citypaper.net.