Tort reform in Iowa is at a standstill. For years, the leadership of the Iowa Orthopaedic Society actively campaigned at the state level for tort reform, but there were never enough votes in the Senate for it to pass. For our efforts to be successful, we will need a state legislature that is more in tune with this agenda. Iowa has no caps on noneconomic damages or any other measures that would assist in lowering healthcare costs in the state. We are hopeful that the legislative climate will change and that effective tort reform legislation will be enacted in the future. But for now, we wait. Mary A. Bechler, FACMPE; Iowa Orthopaedic Society

AAOS Now

Published 12/1/2009

Executive director on the street

What’s the status of tort reform in your state? Are other issues related to healthcare reform significantly affecting your members?

Tort reform in Iowa is at a standstill. For years, the leadership of the Iowa Orthopaedic Society actively campaigned at the state level for tort reform, but there were never enough votes in the Senate for it to pass. For our efforts to be successful, we will need a state legislature that is more in tune with this agenda. Iowa has no caps on noneconomic damages or any other measures that would assist in lowering healthcare costs in the state. We are hopeful that the legislative climate will change and that effective tort reform legislation will be enacted in the future. But for now, we wait. Mary A. Bechler, FACMPE; Iowa Orthopaedic Society
Tort reform continues to be a big issue in Tennessee. It’s a political football right now between the federal and state governments. Some members of the Tennessee Congressional delegation have said it’s a state’s responsibility and some members of the Tennessee General Assembly have said it’s a federal issue.Some of the other big issues involve uncertainty about how the new healthcare reform legislation is going to affect Medicare and workers’ compensation payments. If serious limitations are placed on Medicare and workers’ compensation requirements, orthopaedic surgeons are going to bear the brunt of decreased compensation and will face more regulatory oversight. Given this scenario, access to care is going to become a major issue because many orthopaedic practices won’t be able to afford to take on workers’ compensation and Medicare patients. Paul J. Biggers, PhD; Tennessee Orthopaedic Society
In California, we’ve been fortunate to have the Medical Injury Compensation Reform Act (MICRA) since 1975, which has been instrumental in reining in medical malpractice premiums. The strength of California’s tort reform has been compared to the concept of the “three-legged stool.” The “three legs” in our state’s tort reform include payment for present and future medical costs, lost wages, and future earnings; a sliding scale for attorney contingency fees; and the cap on noneconomic damages at $250,000. All three legs have to be in place to have effective tort reform. The most important leg, I believe, has been the $250,000 cap on noneconomic damages. Having MICRA in place has increased patients’ access to health care, saved billions of dollars in the healthcare system, and resulted in some of the lowest malpractice premiums in the nation. Diane M. Przepiorski; California Orthopaedic Association
Payment reform is a big issue in Massachusetts. In July, the Governor’s Payment Reform Commission made its recommendations to the legislature. The overall premise is to put an end to fee-for-service, to the extent that they can, and replace it with what they call “medical home organizations.” This would mean that single specialty or multispecialty physicians would organize as groups and the hospital would pay them a global fee. Some people feel this is a capitation plan, but state officials deny that. A lot of us think this has the potential to effect a greater change in the way orthopaedists in our state practice medicine than what’s taking place in Washington, D.C. Paul J. Wetzel; Massachusetts Orthopaedic Association

State orthopaedic society executive directors recently attended the AAOS-sponsored Executive Directors’ Institute to discuss important issues affecting their members and ways to collaborate with the Academy. AAOS Now talked to executive directors from Massachusetts, Tennessee, California, and Iowa about issues in their states.