Koshnick a passionate advocate for patients, other doctors
In almost 40 years as a family practitioner — most of those spent working with patients in the Detroit Lakes area — Dr. Robert Koshnick has been a tireless advocate for medical malpractice reform, physician-led health care, and daily exercise.
“I’m a strong believer in physical exercise,” says the Fargo native, who rides his bike from Detroit Lakes to Frazee and back twice a week — a distance of 13 miles — since expanding his family practice from Essentia Health-St. Mary’s in Detroit Lakes to the new EHSM clinic in Frazee earlier this year.
He is also a regular participant in triathlons, marathons — he’s run the Boston Marathon five times — and the Birkebeiner, a tradition-soaked form of long distance cross-country skiing competition.
“I’ve done 28 American Birkebeiners,” Koshnick says, referring to the grueling ski race from Cable to Hayward, Wis., held every February. “I’m kind of an exercise nut.”
Staying physically active is just one part of Koshnick’s personal philosophy, to “live NIMBLY,” according to these six basic concepts:
· Nourish relationships;
· Ingest wisely, whether it be food, liquid or air;
· Maintain fitness;
· Be respectful, in all areas of life;
· Live intentionally, with clear goals and a strong moral code;
· You’re responsible for your own decisions, personally and professionally.
As part of this philosophy, Koshnick is very involved in state medical politics, as a member of both the Minnesota Medical Association’s (MAA) Board of Trustees (where he was recently appointed to his third three-year term); and the Board of Directors of the Minnesota Academy of Family Physicians (MAFP), where he was elected to three different six-year terms.
“I represent the northwest district (of MAFP), with about 350 physicians,” Koshnick said. “I’ve also been both on, and chairman of, the Practice Enhancement and Patient Advocate Committee of MFAP.”
In his work with MMA, Koshnick has been a part of reshaping state, and even national policy involving medical malpractice insurance — but his passion for malpractice reform has a much more local tie.
“My interest really started in the 1970s, when we had two local malpractice suits filed by one family,” Koshnick says.
One of those lawsuits caused a fellow Detroit Lakes physician — someone Koshnick knew well — to eventually commit suicide via a prescription overdose.
“At that time, the St. Paul insurance companies had 80 percent of the market.”
In other words, he added, the insurance companies “had complete control” of which malpractice suits were settled out of court, and which they would choose to fight.
“When they (the insurance companies) thought it was cost beneficial to settle a suit (out of court), they’d settle it, whether there was any merit to the case or not, and regardless of what the physician thought,” Koshnick said.
The net result was that many frivolous lawsuits were settled out of court by the insurance companies, rather than going to the expense of bringing in a legal team to fight the case in court.
“The biggest problem with this was that lawyers saw it (malpractice suits) as easy money,” said Koshnick — which meant that more and more cases were filed, for increasingly frivolous reasons.
This, in turn, created a culture of “defensive medicine,” where health care professionals “would end up doing a lot of (precautionary) things that don’t make cost effective sense.”
Koshnick and his partner in the Detroit Lakes practice at that time, Dr. Jim Knapp — who by this time had become president of the MMA — began working toward the concept of a physician-owned insurance carrier to handle cases of what Koshnick refers to as “medical error” rather than “malpractice.”
“The thrust of his (Knapp’s) interest was to start a new physician-owned malpractice insurance carrier,” Koshnick said. “He was successful in that.”
In fact, “Detroit Lakes had policy number one” issued by the Minnesota Malpractice Insurance Exchange, now known as MMIC, Koshnick said.
This company eventually grew to encompass 22 states, becoming one of the largest insurance companies of its type in the nation.
The idea behind the formation of MMIC “was twofold,” Koshnick said. “The first part was that all lawsuits which did not have merit would be defended to the end. The second concept was that the physician (who was targeted by the suit) had to be involved in how the lawsuit was resolved, and would have a say in whether it was settled or not.
“The insurance company could no longer ignore the plaintiffs and settle meritless cases without their consent,” said Koshnick.
This helped reduce the number of frivolous lawsuits that were filed, as did subsequent changes in state law that made it a requirement for all malpractice lawsuits filed with the state to include an outside physician’s certification of merit.
Koshnick is also a strong proponent of a concept known as collaborative law, first created by Minnesota family lawyer Stu Webb.
Collaborative law is a method of practicing law where all parties in a legal case agree to sit down and work toward a settlement, making that the priority rather than going to trial. If the parties are unable to settle and trial proceedings move forward, the legal counsel on both sides must step down and new attorneys must be obtained for trial.
“In the last 18 years since he (Webb) developed that concept, it’s done quite well in Canada, England and Australia, but the trial lawyers in America have been very organized in opposing this sort of change in the law.”
So far, only seven of the United States have passed legislation in favor of collaborative law.
“We’ve passed resolution in the MMA and also MAFP to expand the confidentiality protections needed for collaborative law reform to take place in our state, but we have not been able to move forward with it up to this point.”
It’s something he hopes to eventually change, however.
“It’s such a reasonable, logical solution to get people involved in medical error cases together to discuss it,” he said. “In many cases it’s just a matter of miscommunication, and can be resolved quickly and easily.”
Under the current system, however, the process of filing medical malpractice claims often “leads to psychological injury on both sides,” he added, noting that it’s part of the reason why medical practitioners have such a high rate of alcoholism and drug abuse.
“I’m very committed to changing the medical error resolution system in our state, and in our country,” Koshnick said.
His work with MAFP has also involved helping to develop the concept of patient centered medical home healthcare.
“One of the original concepts was that it was to be a physician-led medical home (system), but that seems to be getting diluted — it’s evolving toward institution-centered medical homes,” Koshnick said.
It’s one evolution he does not necessarily see as a positive change.
“Physician-led medical homes emphasize continuous and comprehensive care over time,” he said. “In that paradigm, the idea is to get everyone in the population identified with a (set) health care team.”
In an institution-based medical home model, however, the members of the health care team are set on a rotational basis, which might cost the institution less, but not necessarily the patient.
“I think we’re moving away from physician-led healthcare toward administration-led, hospital-based, big system care,” Koshnick said. “It’s much less personalized — that’s the net result. You lose that continuity of contact with the healthcare team members, because of the rotation of responsibilities. It’s less efficient and less satisfying to the patient, yet more costly (to them).”
When he’s not involved in championing the causes of malpractice reform and patient-focused, physician-led healthcare, or pursuing various physical fitness activities, Koshnick is also an active member — and past president — of the Detroit Lakes Morning Rotary.
He is also devoted to his family, which includes wife Loxley — whom he met while interning at Hennepin County Medical Center in Minneapolis — and father to two grown children, daughter Becky and son Nick, who have given them three grandchildren.
Follow Detroit Lakes Newspapers reporter Vicki Gerdes on Twitter at @VickiLGerdes.