Senator offers plan to keep doctors

Tuesday, Nov. 26, 2002 | 11:05 a.m.

CARSON CITY -- To stem the tide of departures and retirements by Southern Nevada doctors, Sen. Valerie Wiener, D-Las Vegas, wants to let physicians charge patients more to help cover rising medical malpractice insurance costs.

Wiener has asked that a bill be drafted for the 2003 Legislature to allow doctors to impose a surcharge of $5 or $10 for each office visit to offset higher malpractice insurance premiums.

Since January, when the state's largest malpractice insurance provider got out of the business, doctors have seen premiums double or triple. OB/GYNs, surgeons and emergency doctors have been hardest hit, and many have decided to move their practices out of Nevada or retire early instead of paying.

"We're hemorrhaging at the loss of doctors," Wiener said.

The bill would be a stopgap measure until it is determined whether the medical malpractice reform bill passed by the special legislative session works, she said.

The bill, should it pass, could have only a limited effect, however.

Doctors who treat Medicare and Medicaid patients, for example, may not be able to impose the fee because the government programs put limits on what can be charged.

In addition, some doctors may not be able to levy the surcharge because of their contracts with HMOs and insurance companies, Wiener said. Marie Soldo, spokeswoman for Sierra Health & Life Insurance Co., said the company's contracts with physicians do not allow them to charge patients the difference between their bills and the HMO reimbursement.

"I know they (doctors) can't balance bill the patient. They can't seek additional fees," she said.

Patients can be billed only for the deductible or the co-payment for the services, Soldo said. The company, which has several associated firms including the HMO Health Plan of Nevada, has 5,000 to 10,000 contracts with doctors, she said.

But Soldo emphasized she has not seen the draft of the Wiener bill and can't say exactly how it would affect the contracts between the company and the doctors. Four states allow added payments, Soldo said, and Sierra Health is trying to get copies of those laws to determine how they work.

Wiener said the details would have to be worked out, but she does not want to interfere with contracts between doctors and their insurance companies.

Meanwhile, Larry Matheis, executive director of the Nevada State Medical Association, said he expects physicians will react favorably to Wiener's bill.

"For some it might be an important break they could take advantage of," he said.

Matheis said about 170 physicians in Clark County have either left Nevada, retired or are thinking about leaving or retiring because of the higher rates in medical malpractice.

"Almost half have already left," he said.

"We want to keep good doctors," Wiener said. "This would allow doctors to recoup some of the high increases."

The surcharge would be optional, and the law would expire in four years unless renewed, she said.

The Legislature, in a July special session, passed a bill limiting the amount of money awarded for pain and suffering to $350,000, except in special cases. It also decided that a doctor would not have to pay the full court award to an injured patient if there were others who were found liable but were unable to pay.

Wiener and Matheis both said it was too soon to tell if the bill is working. There are still a lot of potential claims to be paid that date back several years before the new law was passed.

"So far we've been disappointed we have not seen any positive response from the insurance industry," Matheis said. Some insurance companies have even raised their malpractice rates.

Insurance officials said when the bill passed that it would be several years before the results become apparent.

Matheis said the bill would allow many physicians "to do what they did in the past by passing on large increases for service." Doctors' ability now to pass along these higher costs is limited, he said.