In spite of a small jump last year, medical malpractice payments seem to be trending downward, although medical errors remain a major problem, according to a report from the consumer group Public Citizen.

But the American Medical Association, a longtime critic of the consumer group and its methods, questioned the validity of the report.

While noting a small increase in malpractice payments, the first in a decade, Public Citizen said it is troubled by the overall decline in the volume and value of such claims over the last 15 years, because it found no sign that the actual incidence of medical errors is falling. If anything, the group said, "the actual crisis over avoidable medical errors is worse than we ever knew."

Public Citizen attributed the drop in payments to medical practitioners who have been "feverishly advocating" for caps on damages since the early 2000s.

"Despite rhetoric about 'frivolous lawsuits,' the vast majority of medical malpractice payments compensate for injuries that no one would deem frivolous," the report noted.

Inflation-Adjusted Payments Tumble

Three-fifths of all payments in 2013 were associated with negligence that led to "significant permanent injury, major permanent injury, quadriplegia, brain damage, the need for lifelong care, or death."

The number of malpractice payments grew from 9,370 in 2012 to 9,677 in 2013, according to the group's analysis of data from the federal government's National Practitioner Data Bank (NPDB). These figures look paltry compared with the 16,565 payments reported in 2001.

Public Citizen noted in its report that the percentage of medical malpractice payments made on behalf of hospitals, instead of physicians, was not included in the NPDB data.

The value of payments also rose from $3.1 billion in 2012 to $3.3 billion in 2013. However, this 3.7% increase is negated when the figures are converted to actual and inflation-adjusted dollars, according to Public Citizen's analysis. For comparison, in 1991, the total value of medical malpractice payments on behalf of doctors in inflation-adjusted dollars was $3.6 billion, while in 2001 it was $5.8 billion.

Errors a Huge Problem

The consumer group contrasted these waning payments with large numbers of "avoidable adverse events" in hospitals, drawing on a variety of data sources.

These included the following:

A 2010 Department of Health and Human Services (HHS) report containing figures that, "if extrapolated nationally," add up to about 80,000 Medicare patients dying annually following preventable adverse events

A study of North Carolina hospitals -- also from 2010 -- which found that about 20% of patients suffered adverse events, 60% of which were avoidable

A 2011 Health Affairs study that documented errors or adverse events in roughly one-third of hospital admissions

A 2013 report from the Journal of Patient Safety which, using all three of the previous sources, estimated the number of patients dying prematurely from a preventable nosocomial harm to be more than 400,000 each year

Medical errors weren't the group's only issue. Public Citizen also highlighted a decrease in medical liability insurance rates, which undermine physicians' complaints about the burden of malpractice insurance.

"[C]ombined liability premiums paid by physicians and medical institutions fell from $10 billion in 2012 to $9.8 billion in 2013," the group reported, citing data from A.M. Best, an insurance rating agency.

Rates vary according to the region and provider, noted the report, which provided a few examples including the Doctors Company, where rates fell 35% between 2005 and 2013, according to SNL Insurance Daily, an industry news site.

AMA Fires Back

A representative of the American Medical Association told MedPage Today via email that any study using data from the National Practitioner Data Bank (NPDB) was "inherently flawed." The spokesperson added, "The Government Accountability Office has determined that the NPDB is riddled with duplicate entries, inaccurate data, and incomplete and inappropriate information."

The Public Citizen report and NPDB data also excluded the 65% of medical liability claims that have been "dropped, withdrawn, or dismissed," according to the AMA spokesperson. The expense of dropped claims accounts for 38% of total defense costs, the AMA said, citing data from the Physicians Insurers Association of America (PIAA).

"Less than 10% of medical liability claims were decided by a trial verdict, and the vast majority of them -- 89% -- were won by the physician defendant in the case," the spokesperson added.

Douglas Merrill, MD, of Dartmouth College in Hanover, N.H., said the report was an overly simplistic interpretation of complex data.

For example, Merrill suggested, a higher number of medical errors might simply mean more errors were reported.

"As an industry, healthcare has been striving for over a decade to create a climate of self-disclosure in the certainty that this would help discover trends in risk and safety that can be addressed at a systems level and preventive changes made earlier," said Merrill, who is also director of the Center for Perioperative Services at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. "Thus, a greater number of errors reported is potentially good news."

"No credible caregiver would say that healthcare can't be improved, whether regarding access or quality, or error rates. However, no credible healthcare analyst would use insurance data as an accurate descriptor of the need for or the intensity of those efforts."