Massachusetts has adopted an approach that experts say may provide a model for other states. Without waiting for a complaint to be filed, the Massachusetts Board of Registration in Medicine conducts a clinical review of any doctor who has made three or more malpractice payments to patients, as a result of jury verdicts or settlements. Nancy Achin Audesse, executive director of the board, said: "Three is a magic number. Doctors who have to make three or more payments are also more likely to be named in consumer complaints and to be subject to discipline by hospitals and the medical board."

In Massachusetts during the last 10 years, Audesse said, "one-fourth of 1 percent of all the doctors — 98 of the 37,369 doctors — accounted for more than 13 percent of all the malpractice payments, $134 million of the $1 billion in total payments."