The American Medical Association's board of trustees has endorsed a policy that allows physicians to charge patients an extra fee to help offset the rising costs of malpractice insurance premiums.
With more doctors levying these annual and per-visit fees on their patients, the AMA's board has given its blessing to a new policy that supports the right of doctors to "institute a liability surcharge" as long as such payments are not prohibited by insurance contracts or state and federal regulations.
The proposal, which will be debated and voted upon next week during the AMA's midyear conference in Atlanta, could transform a relatively uncommon practice into a routine part of the cost of seeing a doctor.
Physicians say the extra fees, usually about the same as the average copayment for an office visit, represent an important way to defray steadily rising malpractice premiums that have forced some doctors to close their offices, relocate or restrict the types of services they offer, according to the AMA.
"I think if it's reasonable, patients are going to be very accepting of this," said Peter Lavine, an orthopedic surgeon in Washington who called six months ago for the AMA to study the issue of liability surcharges. "I don't know if there would be a groundswell of opposition to having to pay another $10 or $20. It's not going to be a particular burden to patients, and it will provide some relief to physicians."
But opponents of the surcharges, some of them physicians, question whether patients will agree without complaint to another charge at a time when employers and insurance companies are already passing along increased costs in the form of higher deductibles and copayments.
Sheldon Gross, a pediatric neurologist from San Antonio, said his state delegation to the AMA meeting will back a resolution calling for physicians to "have the right" to impose the fees. Yet he is strongly opposed to the liability surcharges. "I think it's just a bad idea," he said. "I think it'll be misinterpreted. I think patients will see it as an attempt to simply get more money from them. I think it might backfire on us."
In a five-page report to be presented to the AMA's 545-member House of Delegates, the board addresses concerns that a liability surcharge could "alienate patients and harm the physician-patient relationship."
"There is also risk," the report added, "that critics will point to surcharges as evidence physicians care predominantly about personal pocketbook issues rather than patient concerns."
Earlier this year, officials at Physicians for Women's Health, a 160-member OB/GYN group in Avon, Conn., said they would charge an extra $500 per pregnancy because of increased liability insurance costs. After warnings about the legality of such high fees by state Attorney General Richard Blumenthal, the medical group backed off and wound up negotiating increased fees with the majority of its payers, a spokeswoman said.
Ira Warshaw, a family physician in North Palm Beach, Fla., wrote a letter to his patients in January, asking for a voluntary annual donation of $125 because his practice was being threatened by a combination of "higher malpractice fees and lower reimbursements." He said about one-third of his patients agreed to the extra charge, making enough of a difference that "I didn't have to close."
"I had a very supportive response," Warshaw said. "Patients understood the motivation and appreciated the care they've been receiving. I think (the voluntary donation) is reasonable, given what's happening in our community. Other physicians are moving out of state, going to work for the VA or going to a full-blown boutique practice that charges $1,500 a year or so."
Aside from potential resistance by patients, doctors seeking to impose such a surcharge face several other hurdles from private insurers, as well as state and federal governments. Medicare does not allow extra charges for services already covered by the federal healthcare program, and most physician contracts with insurance companies also prohibit additional fees for covered services. Some companies allow the fees if a patient signs a waiver.