Medical Malpractice Crisis

Is a new crisis looming in medical malpractice insurance? An AMA analysis finds that medical liability premiums are skyrocketing again – and radiologists may be among the physicians most affected due to their higher exposure to malpractice suits.

The proportion of medical liability premiums that increased year-to-year for OB/GYN, general surgery, and internal medicine doctors (radiologists weren’t surveyed) doubled from 2018 to 2019 (13.7% to 26.5%), and went up 30% year-to-year from 2020 to 2022. The last time rates rose this fast was during the medical liability crisis of the early 2000s, according to the AMA paper.

Insurers are raising premiums due to deteriorating underwriting results, lower loss reserve margins, and lower returns on investment, per the report. These trends are echoed in a new analysis of the medical malpractice segment by credit agency AM Best, which describes a “difficult environment” for medical liability insurers. The medical professional liability segment has seen eight straight years of underwriting losses.

Why should radiologists care? Well, radiologists are more likely to have experienced medical liability claims during their career than most other physicians. Another AMA survey of over 6k doctors found

  • Radiologists were more likely to say they had been sued in their career than all physician types (40.2% vs. 32.1%)
  • More radiologists have experienced a lawsuit in the past year than all physicians (4.2% vs. 2.0%)
  • The only other medical specialists more likely to be sued than radiologists were surgeons (48.9%) and emergency medicine physicians (46.8%) 

The first AMA report closes by saying that a medical liability insurance “hard” market – a market characterized by rapid price increases – already exists in a number of states, and is “slowly spreading” across the rest of the US. 

Further, there is “striking” geographic variation in premiums. OB/GYNs in Los Angeles County, California see average manual premiums of $49,804 a year, while those in Miami-Dade County, Florida are staring at a $226,224 liability insurance bill.

The Takeaway 

The AMA said the growing medical malpractice crisis could have multiple ramifications. Physicians in states with difficult liability environments could relocate or even drop some clinical services that raise their risk. Will the worsening environment draw the attention of state and federal regulators? Only time will tell. 

ACR Grants NPPs’ Contrast Supervision

The American College of Radiology (ACR) rolled out a significant change to its imaging contrast guidelines, allowing non-radiologists and non-physician practitioners (NPPs) to supervise intravenous CT and MRI contrast administration at accredited imaging centers.

A range of NPPs (NPs, PAs, RNs) and qualifying non-radiologist physicians will be able to directly supervise contrast administration under the “general supervision” of on-site radiologists, as long as it’s supported by state scope of practice laws. 

  • Superving radiologists must be available for “assistance or direction” and trained to handle acute contrast reactions/situations, but they won’t have to be in the same room as the patient.

These guidelines mirror the ACR’s new practice parameters for contrast supervision (adopted in May), and follow CMS’ recent efforts to expand more diagnostic tasks to non-physicians.

  • CMS granted radiology assistants the ability perform a range of imaging tasks in 2020 and permitted NPPs to directly supervise Level 2 tests in 2021 (like contrast-enhanced CT and MRI), in both cases requiring “general” radiologist supervision (on-site, but not in room… and virtual during the pandemic).

Although NPPs’ radiology expansion has historically sparked heated debates, the new ACR contrast supervision guidelines hasn’t faced many public objections so far. 

  • That’s potentially because some (busy) radiologists don’t view directly supervising contrast administration as a practical or efficient use of their time (even if they still have to drive to the imaging center), especially considering that technologists often spot adverse reactions before anyone else.
  • However, there’s surely plenty of radiologists who are concerned about whether these new guidelines might exacerbate scope creep, cut their earning potential (especially trainees), reduce radiologists’ patient-facing opportunities, and undermine patient care.

The Takeaway

The ACR’s decision to grant NPPs greater contrast supervision rights and loosen radiologists’ contrast supervision requirements might not be surprising to folks paying attention to recent ACR and CMS policies. That said, it’s still a notable step (and potential contributor) in the NPPs’ expanding role within radiology – and opinions might differ regarding whether that’s a good thing.

The MARCA Divide

The American College of Radiology might have a neutral stance on the Medicare Access to Radiology Care Act (MARCA), but a new survey confirmed that most ACR members are far from neutral about non-physicians’ role in radiology. 

MARCA Madness – MARCA would require Medicare to reimburse supervising radiologists for imaging services performed by radiologist assistants, as long as RAs work within physician-led teams. The ACR revealed its neutral position on MARCA in August, enraging some members who are concerned that MARCA will undermine radiologists’ role, and accused the ACR of selling out to PE. 

The Opinion Divide – The ACR survey (n = 4,207, or 16% of members) revealed overwhelming opposition to MARCA, but more balanced views on working with non-physician radiology providers (NPRPs). By NPRPs, they mean radiology assistants, advanced practice registered nurses, and physician assistants.

  • 60% are against MARCA (vs. 19% in favor, 21% neutral)
  • 86% are concerned about NPRP scope creep
  • 55% view NPRPs as a threat to patient care
  • However, just 43% are against using NPRPs in their practice
  • And 62% believe it’s up to practices whether they employ NPRPs

Behind the Divide – A deeper look into the ACR’s (very detailed) survey results revealed that members’ MARCA and NPRP opinions seem largely influenced by their professional situation. 

Career Stage

  • 80% of residents/fellows and 65% of early-career rads view NPRPs as a threat to patient care 
  • 51% of mid-career rads and 41% of late-career rads view NPRPs as a threat to patient care

Practice Type

  • 61% of respondents from academic settings view NPRPs as a threat to patient care
  • 69% of respondents from national and private practices think NPRP use is a practice decision 

Practice Role

  • 61% of non-leaders view NPRPs as a threat to patient care
  • 65% of practices leaders view NPRPs use as a practice decision

NPRP Experience

  • 69% of respondents who do not work with NPRPs view them as a threat to patient care
  • 57% of respondents who work with NPRPs believe they play an important role
  • 84% of respondents who support MARCA currently work with NPRPs

The Takeaway – We now have data confirming what most of you already knew: the majority of radiologists are firmly against MARCA and a small minority support it. However, the data also shows that plenty of radiologists see value in NPRPs, especially if they already work with non-physicians and if their careers are less threatened by them. What’s still unclear is what it will take for the ACR to break its neutrality on MARCA (in either direction).

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-- The Imaging Wire team

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