Top Pennsylvania malpractice carrier freezes rates

'Tis the holiday season as PMSLIC Insurance Co. has begun writing new policies after three years of restricting sales and six years of double-digit rate hikes. Pennsylvania actually has an innovative approach to dealing with the medical liability crisis and the stream of doctors fleeing the state.  PMSLIC provides coverage for claims totaling $500,000. MCARE Fund, a state program created in 2002, pays claims ranging between $500,000 and $1 million, and most of the state's 34,000 doctors are required to contribute to the fund. Hospitals generally provide additional coverage for doctors practicing in medical facilities, where claims exceeding $1 million most often occur. It's all a step in the right direction. But don't break out the champagne just yet. There's still the issues of a history of wildly fluctuating malpractice rates and the lack of a medical error reporting system. Read [Pittsburgh Business Times]

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[Donna]

"PMSLIC provides coverage for claims totaling $500,000. MCARE Fund, a state program created in 2002, pays claims ranging between $500,000 and $1 million, and most of the state's 34,000 doctors are required to contribute to the fund"

Don't hang a Nobel Prize on the person who invented PA's MCARE Fund yet, please - there are a couple of factual inaccuracies in this story.

Here's how it actually works:
PA doctors are required by law to buy TWO levels of malpractice insurance (since 1975)totalling one million dollars in coverage - although prior to 2003, it was 1.2 million in coverage.

The CAT Fund, which is now called the MCARE Fund, was created to entice commercial insurers into the state by lowering their exposure. COmmercial carriers sold only the first $200,000 in coverage, while doctors paid a surcharge each year to participate in the second one million dollar layer of coverage. Participation in both is a licensure requirement in PA.

Unfortunately, the CAT Fund gave away money like candy, and doctors' surcharges, assessed each year AFTER the number of awards was totalled up, skyrocketed, causing serious problems in the physician community back in the mid-90s. Sometimes, there was an emergency surcharge, which could equal a physician's commercial coverage or several hundred percent more...

Legislation passed in 1995 mandated the gradual reduction in the portion of the $1.2 million that the CAT Fund would be resopnsible for, with a commensurate increase in the portion covered by the doctor's commercial insurer. The reason for this was that physicians couldn't afford the surcharges and a serious deficit was building in the Fund. Levels shifted from 1 million CAT Fund/$200,000 commercial coverage in 1996 to $900,000 CAT Fund/$300,000 commercial in 1997 and 98, to $800,000 CAT Fund/$400,000 commercial in 1999 and 2000, and then to $700,000 CAT Fund/$500,000 commercial in 2001 and 2002. In 2002, the PA legislature reduced the mandated amount of insurance from a total of $1.2 million to $1 million and changed the name from the CAT Fund to the MCARE Fund, bringing the MCARE level and the commercial level to $500,000 each, where it is today.

Over the years when the Fund was covering million dollar levels of exposure, it built up an impressive deficit, or unfunded liability, which Pennsylvania's doctors are SOMEDAY going to be forced to pay. Right now, that "unfunded liability" sits at about $3.5 BILLION - that's billion not million. Eventually, the MCARE FUnd will be phased out entirely and docs will have to purchase the whole million in coverage from commercial carriers.

The only GOOD thing about the MCARE Fund is that the PA Legislature assessed cigarette taxes four years ago to help physicians with skyrocketing premiums, and the four highest risk specialties receive a 100% abatement of the MCARE surcharge, which can average around $25,000 a year for a surgeon. Other doctors receive a 50% abatement...

The CAT/MCARE Fund may have served a purpose in its day, but it was poorly administered and far too eager to give away physicians' hard earned money - leaving the next generation of PA physicians holding the bill. It wasn't a grand success....ask any doctor in Pennsylvania...

Oh, one or two more little things - PMSLIC is PA's largest commercial insurer, but not the only one, handling about 12% of PA's doctors....and there are not 34,000 doctors in Pennsylvania - the MCARE application process requires more than one application for any physician who works in more than one location (like residents who "moonlight"), docs who practice out of state, academic docs who don't see patients, etc....

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