Changes ahead for lawyers who handle medical malpractice, insurers' study says.

The shift from traditional fee-for-service health care to managed care will generate big changes for lawyers who handle medical malpractice claims, according to an insurance industry study.

The study, conducted by industry analysts Conning & Co. of Hartford, Connecticut, shows that more physicians are joining group practices and managed care organizations, which means individual doctors will no longer be the primary targets of malpractice suits.

Even the nomenclature surrounding these suits is undergoing a transformation. Conning refers to this area of law as managed care liability rather than the catch-all category of medical malpractice.

Individual doctors who make medical mistakes will continue to face liability, but the study notes that the trend toward managed health care is shaking up the way doctors, insurers, and lawyers conduct their business.

Conning's 154-page study, "From Medical Malpractice to Managed Care Liability," is aimed at the health insurance industry, but health care consumers may benefit from the company's analysis.

For example, the study noted that the "continued erosion of ERISA"--the Employee Retirement Income Security Act--leaves managed care organizations subject to greater accountability.

The 1974 federal law, which effectively shields managed care companies from liability, has been the bane of consumers injured by managed care organization physicians. Laws passed recently in Texas and Missouri are trying to dismantle managed care's once-impervious status as a protected entity. These laws essentially affirm that health maintenance organizations (HMOs) are considered health care providers, subject to the same level of malpractice scrutiny as doctors. (States call for HMO accountability, TRIAL, Sept.1997, at 12.)

The study also found that managed care companies are acquiring hospitals and private medical practices regionally and nationally. "Instead of one doctor with one policy," the study said, "it may be 1,000 doctors with one policy, which means a vastly increased risk of exposure" for individual doctors in the group.

The study said this consolidation and corporatization of physician practices is creating a competitive arena for insurers who are "chasing too few points of sale." Essentially, insurers may have weakened financial reserves that are used to pay claims.

It also means that consumers will have fewer options for coverage as the largest and strongest insurance companies dominate the industry.

"We found that because HMOs dominate the health care scene, there has been a shift in consumer attitudes about health care delivery," said Nancy Carini, Conning & Co. assistant vice president. "And, because providers are integrating at a record pace, the consumer no longer views the physician as the ultimate health care decision maker. Now consumers are going after managed care companies."

Copies of the insurance industry study are available for $495 each by contacting Conning & Co. at [phone]. C: