NCPA - National Center for Policy Analysis


September 24, 2004

Rising expenses and static reimbursements have led a growing number of physicians to begin charging so-called access fees for services they once provided for free. Most of them are in the less lucrative primary care specialties of pediatrics, family practice and internal medicine. These services include filling out workers compensation and disability forms, taking after-hours phone calls, and answering e-mail questions. Some are also dunning patients for canceled appointments.

  • A malpractice surcharge, some doctors say, is simply one more access fee, although it is usually presented as voluntary to avoid running afoul of Medicare rules that prohibit such mandatory charges.
  • Its appeal is enhanced by the anger many doctors feel about rising insurance rates, which has touched off a fierce political battle in Maryland and other states.

As a result, there is great interest in surcharges or access fees:

  • Two-thirds of Maryland physicians are insured by Medical Mutual Liability Insurance Society of Maryland, which increased rates an average of 28 percent this year.
  • Last week the state insurance commissioner approved an average rate increase of 33 percent for 2005.

The Bush administration, backed by the American Medical Association (AMA) and other medical groups, is pushing legislation to limit liability costs, and reduce what the president last week called "junk lawsuits" that are driving "good docs" from practice. They advocate capping the amount of money patients harmed by medical negligence could collect from doctors and hospitals.

Source: Sandra G. Boodman, "Insuring Controversy." Washington Post, September 21, 2004.

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