We believe health care financing and delivery are two sides of the same coin. Health insurers and physicians are interdependent upon one another when it comes to taking care of upstate New Yorkers. Recently, working with the Medical Society of the State of New York, Univera Healthcare committed to make $53 million in improvements to reduce administrative burdens on physicians in order to create more time for patient care, increase the accuracy of claims payments and reduce uncertainties regarding covered services and procedures.

Up to $5 million has been committed to in-kind benefits for physicians in active practice, $500,000 for physicians who have retired and $1.25 million to fund community health initiatives jointly agreed upon by MSSNY and Univera Healthcare.

A long-standing shared goal exists to improve the legal environment in which medicine is practiced. We have an historic record of supporting medical malpractice tort reforms “backed by partner physicians and hospitals” to prevent the escalation of physician malpractice premium rates due to runaway jury verdicts and settlements. Most recently, we committed dollars to that effort as well by providing MSSNY with $250,000 to support their quest for reform.

Our state’s current tort system, which covers a person’s right to seek legal redress from the individual who negligently caused harm, has made it too common for juries to award millions of dollars for “pain and suffering” on top of appropriate awards for lost wages and medical bills.

Pain and suffering awards have resulted in an increase in the practice of “defensive medicine,” the term used to describe when physicians order tests, the results of which will neither change the diagnosis or treatment of a patient, in order to protect against malpractice claims. A report issued in January by PricewaterhouseCoopers estimates that 10 percent of overall health care premium costs are attributed to defensive medicine.

Our tort system is an impediment to recruiting physicians to New York state and retaining those who are already here, particularly in high-risk fields such as neurosurgery and obstetrics/gynecology. As a result, some areas of our state are underserved by these specialties because physicians are not willing to accept the risks.

Many doctors and Univera Healthcare believe physician actions that result in patient harm should be judged on the basis of accepted standards of care by non-biased expert witnesses using clinical evidence and evidence-based medicine, rather than jurors’ emotions.

We have so many challenges in finding a proper balance between the costs of medical care and our collective ability to pay for it. Our tort system should be reformed in a manner that recognizes that challenge for the good of patients, hardworking physicians and the consumers and taxpayers who struggle to financially support the entire health care system that takes care of us all.

Dr. Jay I. Pomerantz is vice president and chief medical officer of Univera Healthcare.

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