Good Acronyms

In our experience, acronyms have often been associated with regulations, regulatory bodies, or health care delivery systems. Terms such as OSHA (Occupational Safety and Health Administration), DMFS (Dental Materials Fact Sheet), PPO (preferred provider organization), FFS (fee for service) and HMO (health maintenance organization) are among the most frequently utilized. Sometimes these acronyms have a negative connotation to dentists. Those applied to the delivery systems have additionally been referred to as "alphabet soup."

Our present purpose is to focus on a couple of acronyms that without any doubt have been extremely positive for dentistry in California, MICRA and TDIC. Let us explain. In a news release dated mid-June, the American Medical Association released the results of a 50-state analysis showing that "medical liability has reached crisis proportions in 12 states, with more than 30 others seeing problem signs." The AMA said medical liability insurance (premium), which insures doctors against malpractice lawsuits, could reach as much as $200,000 or more annually for some physicians, such as surgeons or obstetricians. The AMA president noted that as insurance becomes unavailable or unaffordable, physicians would either be forced to limit their services or to leave practice. The release further states that several firms have either failed or have stopped writing malpractice insurance.

Of particular interest is that in medicine, only 5 percent of malpractice cases are taken to trial. Physicians and hospitals apparently want to avoid the negative publicity or expense of lawsuits and trial preparation that they fear would occur if they take cases to trial.

That brings us back to dentistry, and dentistry in California to be specific. Are we likely to be faced with a similar danger to that faced by medicine? While we need to be extremely careful in assuming what the future may hold for fear of setting up a jinx, at the moment, it appears that California dentists are in a very fortunate position for two very important reasons. We must remember that in the 1970s and early 1980s California dentistry experienced its own crisis of rising malpractice costs. While we didn’t experience a crisis of the same magnitude as that currently faced by medicine, it brought forth some committed visionary minds to forge some solutions that we continue to benefit from today.

The first part of our solution was MICRA (Medical Injury Compensation Reform Act of 1975), which placed a cap on non-economic damages of $250,000. We have the hard work of our association to thank for being a major participant, along with TDIC, in the coalition (Californians Allied for Patient Protection -- CAPP), which continues to lobby to maintain the cap. The California MICRA law is currently being discussed by the AMA as a model, in their campaign to urge Congress to develop a Health Act of 2002 to resolve the current malpractice crisis.

MICRA’s limit on pain and suffering awards has kept malpractice premium costs down. As a result, it has obviously resulted in keeping all health care costs down, helped to maintain access to care, places a limit on attorney fees and contingency fees, and removed the trial lawyers financial incentive to take on nonmeritorious cases.

In our view however, the bigger story here has been The Dentists Insurance Company. In the first years after TDIC’s incorporation in 1980, no one could have imagined the impact and benefit it would eventually have for its dentist shareholders in California. The early years were difficult, but visionary leaders and supportive policyholders nursed the company through the difficult years. As the first dentist-owned professional liability carrier in the country, it helped eliminate the unfair premium practices that CDA members were being subjected to by commercial carriers at the time.

This summer, TDIC announced that it had retained an A.M.Best rating of "A" for 2002. Best cited the company for remaining "dedicated to its policyholders through claims and risk management." In addition to good company management, unquestionably, the many quality educational programs launched by TDIC for the profession and for students has been a major factor in managing risk and reducing liability claims.

Not only has the company provided a stable insurance product for policyholders, but it has provided financial benefit to policyholders, CDA, and the CDA Foundation, in the form of dividends and charitable contributions.

The most recent TDIC support is extremely impressive and worthy of mention. Policyholders have received $39 million in dividends since 1989. Policyholder dividends have been declared in each of the past five years, including the sum of $4.9 million this year alone.

The company made a recent charitable donation to the CDA Foundation, bringing its total contribution to the foundation to almost $1.4 million. These funds assist the foundation in raising awareness of dental disease, improving access to care, and providing scholarships to students seeking dental careers. These contributions to the public and to our future professionals are achievements of which all members of the California Dental Association should be extremely proud. It is a positive accomplishment that contributes to the image of the profession and should not go unnoticed.

The next time we engage in conversation about the negatives that we must endure in our professional world, we must at the same time remember the two acronyms that do so much to protect our liability interests here in California, TDIC and MICRA.

Pull quotes

MICRA’s limit on pain and suffering awards has kept malpractice premium costs down.

In the first years after TDIC’s incorporation in 1980, no one could have imagined the impact and benefit it would eventually have for its dentist shareholders in California.