July 7, 2016 by matray

Healthcare providers face rising medical professional liability exposures given the recent increase in healthcare-system utilization under the Affordable Care Act (Obamacare), shifting trends in hiring and employment patterns as well as healthcare delivery models, increased use of electronic platforms and portals, decreasing reimbursements and greater regulatory scrutiny. As such, all those along the medical liability continuum are looking for answers on assessing and mitigating risk, managing litigation, defending claims and altering underwriting processes to address the changing medical liability landscape. That is why you cannot afford to miss American Conference Institute's 2nd National Advanced Forum on Medical Liability - Claims, Coverage and Risk Management on October 27-28, 2016 in New York City. This conference will bring together an impressive faculty of government officials, medical experts, risk managers, insurance professionals and leading plaintiffs' and defense attorneys, who will provide the most up-to-date information on complex medical issues and litigation hurdles, including: • ELECTRONIC MEDICAL RECORDS, METADATA, AUDIT TRAILS: Tackling the Unique Malpractice Risks and E-Discovery Challenges • The Latest CYBER THREATS to the Healthcare Industry: PHI Data Breaches, the Recent Alarming Wave of "RANSOMWARE ATTACKS," Growing Cybersecurity Threats to Medical Devices and Beyond • Mitigating Exposure to Rising Healthcare BATCH CLAIMS, and Defending Against Batch Claims Once They Are Brought • CALCULATING DAMAGES in Med Mal Cases, Catastrophic Injury & Life Planning Considerations and USING THE ACA TO MITIGATE FUTURE DAMAGES • HOSPITAL BORNE ILLNESSES & INFECTIOUS DISEASES: What Hospitals Can Do to Mitigate Risks and Avoid Legal Implications • HOSPITAL WORKER MISCLASSIFICATION ISSUES AND OSTENSIBLE AGENCY in Medical Malpractice - What Are the Risks? • Does Saying Sorry Work?: An Industry Discussion of DISCLOSURE AND APOLOGY LAWS and Their Impact on Medical Malpractice • TELEMEDICINE, 3D PRINTING, ROBOTIC SURGERY & OTHER MEDICAL DEVICE DEVELOPMENTS - Mitigating Emerging Exposures & Assess These Technologies from an Enterprise Risk Management Perspective • OBSTETRICS: Looking at 2016's Biggest Claims Trends, New & Emerging Risks and What to Expect in the Year Ahead • New Claims Trends Related to the U.S. Pain Crisis: Taking a Look at the Recent PRESCRIPTION OPIOID ABUSE EPIDEMIC and Its Impact on a New Wave of Med Mal Insurance Claims • A to Z of LITIGATING YOUR MEDICAL MALPRACTICE CASE: An Examination of Each Stage Including Trial Techniques, Lining Up the Right Experts, Using Technology in Trial Presentations, and Beyond Register now by calling: 1-888-224-2480 Or by faxing your registration form to: 1-877-927-1563. You can also register online at www.AmericanConference.com/MedLiability Be sure to also book for the Brain Injury Master Class: Oct. 28; 2-5 p.m.  

July 2, 2015 by matray

On June 25, the U.S. Supreme Court endorsed consumer subsidies to purchase healthcare insurance in the 36 states that have not established their own exchange under the Patient Protection & Affordable Care Act. The decisive 6 - 3 decision in King v. Burwell further cemented the reforms from President Barack Obama’s signature legislation into the American healthcare delivery system. “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” wrote Chief Justice John Roberts, explaining the Court’s rationale in the majority opinion. “If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.” With King v. Burwell decided, and the Affordable Care Act the law of the land, the question that remains to be answered is how the healthcare law will affect the medical professional liability industry. Since its passage in 2010, many medical malpractice professionals have worried that the influx of 10 to 30 million newly insured individuals carries the potential to create a spike in claims frequency. The reasoning is that individuals who have health insurance are more likely to engage the healthcare system, which creates more opportunity for unintended medical outcomes. Alarmists also point to coordinated care as a depersonalization of medicine because patients will no longer just see one doctor for their healthcare needs, and studies show that patients are less likely to sue a physician they have a personal relationship with. A contrary theory is that greater access to healthcare will equate to better preventive care, which will lead to fewer bad medical outcomes, which will lead to fewer claims of medical malpractice. An emerging legal theory expected to be tested is whether the Affordable Care Act could have a deflating effect on medical liability indemnity payments in those states that limit awards based on reimbursement from collateral sources—e.g., healthcare insurance. In a Rand Corp. white paper titled How Will the Patient Protection & Affordable Care Act Affect Liability Insurance Costs?, David Auerbach, Paul Heaton and Ian Brantley argue that the court systems that limit the collateral source rule could actually see a reduction in medical liability damage awards. Payments to victims of medical malpractice could be reduced once the injured party obtains coverage under the Affordable Care Act and payments for care made on their behalf by health insurers deducted from their award. “What we’re going to be litigating in the near future is whether covering the out-of-pocket expenses related to buying healthcare insurance can substitute for the high-dollar cost of care. That’s an interesting issue that’s going to play out throughout all the states,” said Craig Brodsky,  Esq., a partner in the law firm Goodell Devries, who specializes in professional liability defense. “The defense will argue that the plaintiff’s future medical costs should be measured by the out of pocket expenses for a health insurance policy and co-pays that will provide care at no cost for the rest of the plaintiff’s life. That’s a lot less than paying for the actual care. The question is whether states will allow healthcare providers to make this argument.” The Supreme Court decision in King v. Burwell turns the page on what might be the last significant legal challenge to the Patient Protection & Affordable Care Act of 2010. What remains to be seen is exactly how it will affect medical professional liability claims frequency and severity. This article appears in the July 2015 issue of Medical Liability Monitor.

May 19, 2015 by matray

The following is an unabridged version of Medical Liability Monitor's review of the 2015 PLUS Medical PL Symposium. An abridged version of this article appears in the May issue of Medical Liability Monitor. With the U.S. healthcare delivery system negotiating its way through unprecedented reforms, the Professional Liability Underwriting Society (PLUS) focused its 2015 Medical PL Symposium on innovation and its implications for medical liability. This year’s symposium took place April 28-29 at the Marriott Marquis in downtown Atlanta. The two-day event’s focus was highlighted by the keynote address given by “innovation activist” John Kao. A graduate of Yale College, Yale Medical School and Harvard Business School as well as a celebrated author, Tony-nominated producer/musician who apprenticed under composer/arranger/guitarist/bandleader/iconoclast Frank Zappa, serial entrepreneur and consultant, Kao’s keynote shared his provoking perspectives on the “how” of innovation—where it is defined not only as a brainstorm-to-blueprint, but by results based on discipline and practice. In keeping with the keynote’s theme, the PLUS Medical PL Symposium content drilled down on the many innovations being implemented in today’s healthcare environment and the resulting liability issues. The opening session, What Is the Impact of PPACA on MedPL Exposures, compared the most up-to-date available data with some of the past predictions made about how the Patient Protection & Affordable Care Act (PPACA) of 2010 was going to impact medical professional liability. While the session’s panelists agreed that the pace of change has been, at times, overwhelming, the prediction that an influx of newly insured patients would overwhelm the healthcare system and expand claims frequency has not proven true. Panelist Michael Reynolds, claims director and director of government relations for ProAssurance, pointed to how a state-level trend toward giving advanced mid-level clinicians (such as nurse practitioners and physician assistants) full-practice authority and the rise of retail medical clinics have blunted the impact of the nation’s physician shortage. During the session Technology in Healthcare: EHRs & PHI, panelists addressed the myriad of technological advances in healthcare as well as heightened exposures due to the increased collection of personal health information (PHI) and their impact on risk management and underwriting approaches being utilized. Panelist Brenda Osborne, executive vice president of the Healthcare Division at Lexington Insurance, referenced data from CRICO, the Harvard-affiliated risk management group, that indicated the greatest challenges in implementing and executing electronic health record (EHRs) in a hospital setting is the inability of different EHR models to communicate cross-platform, system errors that cause the EHR to crash and the inherent dangers when humans are tasked with entering data into EHRs. Fellow panelist Joshua Rozovsky, a technology consultant, emphasized that a data breach can be expensive, but the real danger is in an unknown hacking the system and altering patient records or shutting down the entire system for ransom. The session Batch Claims: What Are the “Three P’s”? addressed the potential for batch/multi-claimant situations in the context of medical professional liability claims. These claims are high-profile, big-dollar claims, such as the $190 million Johns Hopkins Health System had to pay for its OB/Gyn who secretly recorded pelvic exams of his patients, the cardiologist indicted for performing dozens of unnecessary heart stent placements or the Las Vegas physician who exposed hundreds of patients to Hepatitis C by reusing endoscopy equipment. Panelist Scott Crockett, an attorney, noted that batch claims became more prominent in medical liability five years ago, and that in the last 24 months, he had seen two medical malpractice batch claims that totaled more than $290 million. Now, he said, batch coverage is common in hospital professional liability policies, and when a plaintiff attorney gets a case, he or she almost always goes on a phishing expedition for similar cases in hopes of creating a batch claim. Fellow panelist Brad Ash, senior vice president of Insurance Services at The Doctors Company, stressed that there are really “no pricing guidelines for batch coverage” and “batch claims are unpredictable and often catastrophic.” The session titled The Changing and Expanding Role of Emergency Medicine dealt with the growing demands on the nation’s emergency departments as they have become gatekeepers on readmissions in a healthcare reimbursement model that punishes readmissions. According to panelist Tom Syzek, vice president of Online Learning at The Sullivan Group, there is both spoken and unspoken pressure coming from hospital administrations not to readmit patients. The moderator, Robert Blasio of Western Litigation Inc., noted an expected physician deficit of 95,000 emergency physicians within the next five years, which requires the increased use of advanced practice clinicians and no one is certain of the medical liability implications of having these mid-levels take a greater role in the emergency department. The session Coming to You: Medical Marijuana MedPL Exposures explored how malpractice carriers underwrite this relatively new exposure. While the exposure is greater for general liability, the panelists emphasized how extremely specific the policy language is for insurers who cover the medical liability side. Panelist Deb Goldberg, managing director at Markel Corp., noted that while the policy language can be very explicit, the insureds have a “strong interest in meeting all the requirements of the policy and state law.” The second day of the symposium began with Healthcare Access in Your Big Box Store. This very new phenomena has been wildly popular with consumers because its one-stop shopping makes services accessible for the time challenged, while the low-cost of primary care in retail medical clinics for those seeking value. With almost 2,000 retail clinics currently operating in stores like Wal-Mart, Target and Walgreens, and another 1,000 expected to open in the next year, panelist Alice Epstein, allied healthcare facilities risk control liaison for CNA Financial, said that this model is perfect for younger consumers who “value immediate attention over a physician/patient relationship.” Panelist Kevin O’Brien, senior vice president at Arch Insurance Group, added that while convenience care is not yet regulated, these clinics practice protocol-based medicine, and if they follow their protocols, there is low-risk involved. Ending the two-days of educational sessions was Mo’ Money, Mo’ Problems: Do Limits Increase Claims Values where panelists tackled the question of whether being overinsured invites higher-value losses or being underinsured can actually lower ones exposure. Panelist Michael Barrett, a plaintiff attorney, acknowledged that the amount of insurance is first and foremost in a lawyer’s mind when considering a case. Panelist Paul Marshall, senior vice president of the Healthcare Liability Practice Group at the Marsh & McLennan Agency, argued that being underinsured could generate anger in a jury and invite bad faith punitive damages, while William McDonough, managing principal at Integro Insurance Brokers, said that he has never subscribed to the idea that you can be overinsured because he believes “a claim is worth what a claim is worth.”

October 10, 2014 by matray

Medical Liability Monitor’s 2014 Annual Rate Survey Indicates the Medical Professional Liability Insurance Industry’s Decade-Long Premium Decline Continues with No Indication of a Course Correction in Sight

June 4, 2014 by matray

With the healthcare delivery system navigating a sea of reform, PIAA members convened from May 14 - 16 to share ideas for success and gain insight from experts at the medical professional liability insurance trade association’s annual Medical Liability Conference. This year’s confabulation took place at Toronto’s Fairmont Royal York Hotel and tackled topics such as enterprise risk management, electronic health records, hospital employment of physicians, new systemic risks, alternative business models and more. Following is a review of the educational sessions and panel discussions that took place: After welcoming remarks and industry awards, the Medical Liability Conference kicked off with a special keynote session by Reed Tuckson, MD, titled Sustaining Cost-Effective, Patient-Centered Care in an Era of Transformation. As a former vice president for professional standards at the American Medical Association, a previous commissioner of public health for the District of Columbia and former president of the Charles R. Drew University of Medicine & Science, he was uniquely qualified to offer fresh perspectives on recent developments in U.S. healthcare as well as insights into the successes and challenges experienced as the Affordable Care Act continues to roll out. Prowling the crowd with his wireless microphone, Dr. Tuckson shared volumes of data on what healthcare reform might really mean to medical professionals, their patients and the medical liability insurance industry. He shared his belief that PIAA companies have an important role to play in the future of healthcare delivery and praised the association’s Data Sharing Project as a potentially invaluable resource moving forward. In conclusion, Dr. Tuckson encouraged PIAA members to be “more public with your contributions to the industry.” With the Affordable Care Act ushering physicians into a healthcare delivery model that emphasizes accountable care organizations and coordinated care, Gregg Hansen, chief executive and president of Coverys, moderated a widely attended panel discussion on Hospital Employment: The Physicians Changing Role, during which Hayes Whiteside, MD, chief medical officer and senior vice president of risk management at ProAssurance Corp., compared the exodus of physicians from private practice to hospital employment to a sort of schizophrenia, “where everything about the trend of hospitals employing physicians is consistently inconsistent.” While noting a statistically significant increase in the number of physicians employed by hospitals, Dr. Whiteside pointed to a number of factors that signal the era of private practice is far from dead. Graham Billingham, MD, chief medical officer at Princeton Insurance Co., and Luke Sato, MD, senior vice president and chief medical officer at CRICO, focused their attention on the opportunities for PIAA companies in an era of physician hospital employment. Specifically, hospitals are not educated in physician exposures and physician risk management in the same way the medical professional liability insurance industry is. This spells opportunity for PIAA companies. Joan Winters Burmaster, RN, JD, general counsel at LAMMICO, moderated a panel discussion about Attacks on Civil Justice Reform. With an initiative that would retroactively index the MICRA cap on noneconomic damages to inflation qualifying for this November’s ballot in California making headlines, panelists examined the latest information on what is being done to defend important reforms, including what has and has not been successful so far and why. With physicians and attorneys often holding divergent opinions on the merits and risks involved in using clinical decision support tools, the session titled Information Technology-Based Decision Support: the Good, the Bad & the Unknown provided a valuable update on the rapidly advancing science of health information-based decision support. Moderated by Jaan Sidorov, MD, chairman of the board of directors at NORCAL Mutual Insurance Co., panelists Domenic Crolla, Esq., partner at Gowling Lafleur Henderson LLP, and Martin Kohn, MD, chief medical scientist at Jointly Health, examined a range of potential liability risks associated with the use of this emerging technology in both diagnosis and treatment. Of particular concern to both panelists was how constantly evolving technologies affect standard of care issues. In a session titled From Obstacles to Opportunities: Using ERM as a Platform for Business Success, Catherine Walberg, JD, senior vice president of legal and government relations at Physicians Insurance A Mutual Co., moderated a discussion on how medical professional liability insurance companies can employ enterprise risk management (ERM) metrics to identify and evaluate new business opportunities. Panelists Gerry Glombicki, CPA, director at Fitch Ratings, David Ingram, executive vice president at Willis Re, and Mark Stephens, managing director of corporate risk advisory services for Milliman Inc., discussed how a disciplined approach to risk management and strategic planning may prove helpful to medical liability insurers in preserving capital and reducing market volatility. Stephen Underdal, JD, managing director and head of global healthcare for Guy Carpenter, moderated a session on Alternative Business Models for MPL Insurers. With an increasing number of physicians choosing hospital employment over private practice, smart medical professional liability insurance companies are founding risk retention groups, creating captives, entering into contractual partnerships with hospital systems or unbundling their services to sell them as individual products. Panelists Susan Forray, principal and consulting actuary at Milliman Inc., Michael Maglaras, principal at Michael Maglaras & Co, and Neil E.S. Morrell, president of MagMutual Insurance Co., discussed how this trend has been impacting the traditional medical professional liability insurer as well as the pros and cons of each alternative business model. In the session New Systemic Risks in Medical Indemnity: Prediction, Mitigation & Management, moderator Gerry Lewis-Jenkins, executive vice president at COPIC, as well as panelists Paul McKeon, senior vice president and chief underwriting officer at Transatlantic Reinsurance North America, and Thom Petty, senior medical claims handler and clinical risk manager for MDU Services Ltd., walked attendees through the extent of risk inherent in serial claims, class-action litigation and systemic risk. After breakfast and the Annual Meeting of Members hosted on the second day of the PIAA Medical Liability Conference, educational sessions resumed with the universally attended MPL Financial Update: What Exactly Is the “New Normal?” Presented by James Hurley, consulting actuary at Towers Watson, attendees were treated to a detailed look at the critical elements and trends observed in a composite of PIAA companies’ loss experience, premium, balance sheets and income statements during the past 10 years. While aggregate financial results have been favorable for the last several years, Hurley drew attention to a combined ratio that has been creeping upward since 2010, declining investment income as a percentage of premiums, loss reserves that have been deteriorating since 2007 and a small, but steady, increase in the underwriting expense ratio during the last decade. The PIAA Medical Liability Conference closed out with a presentation by Daniel Friedland, MD, president and CEO of SuperSmartHealth, titled A Framework for Cultivating Resiliency in Healthcare, in which he introduced attendees to tools for enhancing healthcare professional wellbeing, patient satisfaction and mitigate malpractice risk. * this article appears in the June 2014 issue of Medical Liability Monitor.

May 5, 2014 by matray

With the Patient Protection & Affordable Care Act headlong into its implementation, the Professional Liability Underwriting Society (PLUS) focused its 2014 Medical PL Symposium on addressing the new and emerging risks resulting from the healthcare delivery system’s move toward a clinically integrated and accountable care approach. This year’s symposium took place April 23-24 in Atlanta. The first day of the two-day symposium began with a session titled Healthcare Insurance Exchanges: the Rubber Hits the Road, which addressed how changes in healthcare and attitudes towards the healthcare profession will likely result in significant changes for the medical professional liability industry. The session’s panelists noted that the industry has enjoyed an unprecedented period of stability in the low frequency of claims and a steady, predictable severity trend, coupled with record levels of financial capacity during the last decade. No one really knows how long that will last because of the Affordable Care Act’s requirements that are driving many specialties toward hospital employment and an anticipated additional 25-27 million new patients stressing a healthcare system already suffering from a physician shortage. Panelists warned of higher patient expectations in an environment of high premiums and deductibles, narrow networks and constant chaos. Paul Greve, Jr., executive vice president of Willis Healthcare Practice, moderated a panel dedicated to examining Strategies to Successfully Integrate Hospitals & Physician Practices. Key to the Affordable Care Act’s downward pressure on healthcare costs is the integration of hospitals and physician practices, and between 2008 and 2012, the number of independent practices decreased by almost eight percent. This decline in practice ownership is even greater among younger physicians and women. Emerging risks resulting from increased hospital employment include an adversarial claim relationship, lack of risk-management and quality-improvement coordination as well as limited shared clinical/business goals and objectives. Panelists agreed on the need for improved patient engagement, stressing the collaborative relationship between physician and patient in the modern healthcare system. This will require teaching patients how to be engaged, and teaching providers how to engage. In the session titled Tackling the Top Claims Trends, moderator Jayme Vaccaro, Esq., director of professional liability claims at Sedgwick Inc., steered panelists through issues affecting the medical professional liability industry such as aging claims professionals readying for retirement, the relatively new phenomena of medical outsourcing and telehealth, the challenges inherent in the increased reliance on allied health providers, the potential impact of the Affordable Care Act as well as changes in claim severity and frequency. Panelists noted that claims frequency remains flat, but severity is climbing. Some panelists attributed increased severity to the new challenges inherent in electronic medical records and e-discovery. In the session titled Ahead of the Curve: Identifying & Mitigating New Exposures, panelists identified new exposures evolving within the healthcare arena and shared their views on how best to mitigate risks in the rapidly evolving medical professional liability marketplace. Stephan Christiansen, managing director at Conning, shared his investment management company’s data that forecasts weakening profitability for medical professional liability insurance companies—with combined ratios exceeding 100 percent by 2016. He also noted the stresses the healthcare delivery system will experience as more patients are added and that accountable care organizations will spread exposure among many new players. Christiansen recommended an increased focus on risk management and paying close attention to developing claims frequency and severity patterns. Barbara Sinclair, senior vice president and product manager at One Beacon Professional Insurance, shared her insights as to the proactive role medical professional liability insurers should take in order to mitigate emerging exposures related to electronic health records, regulatory requirements, fraud and abuse as well as new transparency rules. She also noted that physician integration, mergers and acquisitions as well as new organizational structures are going to require the blending of exposures—such as D&O, managed care E&O, cyber and medical professional liability. Registration for this year’s Medical PL Symposium included the ability to attend the organization’s Cyber Liability Symposium, which overlapped many of the medical liability sessions. These sessions varied between new ways the plaintiff bar is exploiting HIPAA, how electronic medical records and e-discovery are affecting claim severity as well as the dangers of social media and new technologies such as Google Glass. * This article appears in the May 2014 issue of Medical Liability Monitor.

May 5, 2014 by matray

American Conference Institute, organizers of the 13th Annual Obstetric Malpractice Claims Conference taking place June 25-26, 2014, at the Union League in Philadelphia, today announced key highlights from this year’s program agenda: NEW THIS YEAR! Obtain insight as to the perspectives from the Bench - Learn from EIGHT JUDGES. They will tell you what works and what doesn’t in their courtrooms, why parties succeed and don’t succeed in med mal cases, novel trial and case management strategies, examples of bad lawyering and more. View the complete list of distinguished speakers here: www.AmericanConference.com/ObMal/speakers • New trends in shoulder dystocia cases and the expulsion defense as well as hypothermia treatment for newborns suffering from acute hypoxic encephalopathy. • The use and limitations of placental pathology in untoward pregnancy outcome. • “The New Tort Reform”: Early recognition of injury, disclosure, investigation, settlement negotiations and ADR. • The use of Oxytocin, hyperstimulation and oxygen deprivation. • Determining when an injury occurred: Infections, metabolic disorders, labor & delivery, genetic defects and beyond. • Affordable Care Act nuances and the collateral source rule. • Electronic records and audit trails as well as preparing and presenting your witness for deposition. • Proven jury selection and communication methods as well as harnessing social media when gearing up for trial. Full agenda can be found at www.AmericanConference.com/ObMal/agenda For more information on the forum, visit American Conference Institute online at AmericanConference.com/ObMal or call 888-224-2480    

June 24, 2013 by matray

editor's note: A version of this interview -- edited for length -- appears in the July 2013 edition of the Medical Liability Monitor. When Brian Atchinson assumed the chief executive position at PIAA, the trade association representing domestic and international medical professional liability insurance companies, risk retention groups, captives, trusts and other entities, the American healthcare delivery system was headlong into a period of unprecedented change. The Patient Protection & Affordable Care Act had been signed into law less than 18 months earlier, and its systemic reforms were compelling PIAA members to reevaluate their role in the healthcare market of tomorrow. At the conclusion of the first day of the 2013 PIAA Medical Liability Conference, which was hosted in Palm Desert, Calif., May 15-17, Atchinson sat down with Medical Liability Monitor to discuss the state of the medical professional liability industry and what challenges lay ahead as well as PIAA’s just announced rebranding effort and how its services will help shepherd member companies through this period of change. Following is a transcript of that conversation. Medical Liability Monitor: This is your second Medical Liability Conference as PIAA president. How has your understanding of the medical professional liability industry and the challenges it faces evolved? Brian Atchinson: There is a lot of change going on within the medical professional liability industry and marketplace, just as there is throughout the entire healthcare delivery system. I was fortunate to have a fairly good grounding in what used to be referred to as medical malpractice and is now more appropriately called medical professional liability. Early in my career, I worked for a hospital system company that ultimately became Tenet Healthcare. When I moved to Maine in 1988, I started working as an attorney representing hospitals and physician practices, mostly on business and practice issues. Soon after that I went to work for the state, for Commissioner Susan Collins, who oversaw the department of professional financial regulation and also chaired the governor’s health policy council. I was her legal counsel and functionally served as her deputy. Early on, I was assigned to tort reform and medical liability issues in the Maine state legislature and public policy domain. In 1992, when I became the insurance superintendent for the state of Maine, my very first week on the job, I had to preside over rate hearings for medical professional liability insurance. So, my familiarity with MPL issues comes from a few different perspectives. It provided me with a good foundation. Working in the Maine state government, I had the opportunity to learn from Medical Mutual Insurance Company of Maine, one of the mutuals set up many years ago. The essence of the PIAA companies is well represented by the Medical Mutual Insurance Company of Maine, and I learned a great deal from them. When there was a workers compensation crisis in Maine, and there were no companies willing to write workers compensation insurance, I took a page out of the medical liability industry playbook. We created an employer’s mutual, which was a great solution that still serves as the primary writer of workers compensation insurance in the state to this day. So, when I came back into the medical professional liability line of business, it felt very comfortable. I had to get up to speed on some of the current players and how the market has evolved, but it was interesting. In my prior work, when I was working with the Geneva Association, which is a think tank, and I was participating in meetings with the International Association of Insurance Supervisors debating with the global insurance regulators about systemic risk and whether or not there are elements of the insurance industry that could constitute systemic risk, there was a discussion about market disruption and what would happen if a dominant carrier left at a critical point. The example given by then NAIC president Dr. Terese Vaughan was the medical liability insurance marketplace and the successful response when the St. Paul companies exited the line suddenly, creating what was initially thought to be a tremendous, potentially disruptive void in the marketplace that could have had significant ramifications for the U.S. healthcare system. PIAA member companies met that challenge. There were a few other players in the market, but that is a great example of how PIAA member companies and the medical professional liability industry have a great sense of market needs. Returning to this industry after being away from it for a while has been very gratifying. This industry is so unique and so special. It really understands the role it serves for its insureds and others. I love the expression that someone said distinguishes PIAA member companies from most other lines of insurance – whether its health insurance or others – and it’s what my government relations team uses when they try to help people on capitol hill understand our industry – “our insureds actually like us”, which is not the case with some other lines of insurance. MLM: In your remarks opening the Medical Liability Conference this morning, you said that there is no greater place to address the current challenges facing the medical professional liability industry than here. What do you feel are the greatest challenges facing the industry today? BA: As a number of our speakers noted, there’s significant change going on, and we see many companies in the medical professional liability line of business adjusting to the change. They are expanding the scope of their products to include other professions within healthcare – such as nurse practitioners, nurse midwives, physician assistants and others – that are playing a more prominent role in care delivery, as well as institutions, hospitals and health systems. Many companies are expanding the scope of the providers they insure...  They are also looking at new areas of risk that are emerging now and determining how they can continue to contribute to the evolution of patient safety.  Because, ultimately, promoting quality healthcare distinguishes PIAA companies from other MPL insurers. Along those lines, I think it’s going to be very important how we evaluate the changing risks in the delivery of medicine in this country. We’ve had a number of great panels today that have touched on this theme. To borrow an expression from Wayne Gretsky, you don’t want to go to where the puck is, you want to go to where the puck is going to be. That is our goal when we put together our programs—whether it be this yearly conference, one of our educational workshops, or a webinar.  We strive to help people assess where the puck is going to be in the next few years, so to speak. Laura Jacobs, our luncheon speaker, captured it well when she was talking about people who are saying, “Oh well, you saw this migration towards acquiring or employing physicians 10 or 15 years ago and then it undid itself.” Some people say that may happen again and others say there is no way that is going to happen again. It was refreshing to hear her say, “You know, no one really knows.” We are in such different, changing times. As our keynote speaker Leonard Schaffer said this morning, the economics and the financials are much different now than ever before, and those factors will drive much of our healthcare system in the future. The sessions we’ve been putting on will stimulate a lot of good discussions and provide people with some insights into where these changes are taking us. MLM: That’s interesting. Last year’s keynote speaker at the PIAA Medical Liability Conference, Ian Morrison, had said that the healthcare reforms have left the station and we’re definitely not turning back. Here, Laura Jacobs is saying that nobody really knows what is and isn’t definite. BA: Absolutely. We know that things will never be exactly the same as they were before, but what we don’t exactly know is where things are going. People need to embrace change. That can mean different things to different individuals, but at a minimum, people need to build-in versatility and flexibility into their business models because healthcare will be delivered differently in the future. For example, there have been many articles written and some of the economic modeling conducted showing there simply will not be enough doctors in the future. However, when you speak to people in the nurse practitioner community, they point out there are not going to be enough nurse practitioners to meet projected needs, either. We know that in the future nurse practitioners, certified nurse anesthetists, nurse midwives and others are going to have greater authority and responsibility in terms of ordering tests or writing prescriptions, and we have no doubt that that will translate into greater liability. It’s a natural sort of evolution, and people need to be prepared for that. MLM: The healthcare delivery system is changing and the medical professional liability industry will change in response to those changes. How is the PIAA and its function going to change? BA: That’s a really good question. As you know, we announced the results of our rebranding efforts today. In many respects, what we’ve really done is updated our brand to better reflect what we have already become over the last 10 to 20 years. It surprises people when we tell them that our members already insure close to 3,000 hospitals, about 2,000 of those in the United States and the others around the world. Our members are not just mutuals anymore. They are reciprocals, exchanges, trusts, risk retention groups, captives, privately held stock companies, publicly held stock companies. There is no one type of PIAA member. What we have started to do in this past year, and we plan to do even more of in the future, is to ensure that our programs – whether they be in-person workshops, the yearly Medical Liability Conference, the many   webinars we are hosting or educational sessions that are available to be played back from our website – provide education, training, and tools for all of our members. That includes self-insured health systems and hospitals. We have health systems whose captives are members; we have risk retention groups that represent groups of hospitals or health systems. Many of their needs and their goals are the same as a mutual or a reciprocal or a cooperative. We are working to ensure that our programs encompass issues and topics that are just as valuable and relevant for them as they are for the traditional member company. We have the unique capability to bring together the greatest expertise in the medical professional liability community, regardless of the shape or size of the organization, the type of healthcare providers, or institutions they are insuring. Implementing our strategic plan over the last year and a half has provided us with a good opportunity to step back and look at the organization in a different light.  To use a familiar analogy, much like an automobile, we put the organization up on the lift to give it a tune-up. That applies to our programs as well. The strategic plan development was a collaborative undertaking between the board of directors and PIAA staff. It was the perfect opportunity for us to analyze the organization and truly assess our position within the MPL industry and also determine how well we are meeting the needs of our members. Every organization, big or small, should do this sort of thing every few years; it helps you become proactive as opposed to reactive. As the new guy in the organization, I found it fascinating to work with the board of directors to collectively step back, go offsite – we did it with our staff for a couple of days, then we did it with the board – and acknowledge that people sometimes – all of us –don’t see the trees through the forest. It’s been a long time since this organization was just “physicians insuring physicians,” and yet when I was talking with people about potentially joining this organization, if I talked to eight or nine friends, colleagues about the organization, by and large it was viewed as the physician mutuals insuring physicians. It had not been that organization in a long time. We had some fascinating discussions among the board of directors, really the best and brightest in this industry, about who we are, who we think we are, and who we want to be. It was really surprising to many of us that who we wanted to be – to some extent – was who we already were. We just hadn’t updated our brand; we hadn’t updated how we described ourselves. So this was a significant undertaking. [PIAA director of public relations and marketing] Eric Anderson and his team did a fantastic job of carrying out the rebranding effort, but it was made simpler because we were just trying to better articulate who the organization already was. As we framed it, certain things became apparent. At a time of dramatic change, it was also a good thing to provide the perception of a bigger tent for those who still think of us in the old vernacular of just physicians insuring physicians. What does PIAA stand for? Everyone on our staff, everyone on our board is now ready and able to collectively say that we are the insurance trade association that represents the entire MPL community who support the quality delivery of healthcare and the practice of medicine. That’s who we are. Probably 50 percent of the time, when we ask others that question, someone is going to say, “You mean you are the group whose members insure physicians.” Old perceptions die-hard. So, we understand the perception is not going to change right away. This is a situation where the brand is catching up with the reality of the organization. We are really excited to have this opportunity to convey our message a little more clearly and have a name and a brand that we can speak to. Of course, we are never going to forget our roots and the founders of this association. The physician component will always be a bedrock element of our organization as we take on a broader role in the evolving healthcare industry. As we addressed the question of whether or not to keep the name, use the acronym or come up with a whole new name, it was interesting how many of the organizations that are in our membership have already gone down this road. There are a lot of companies that have rebranded over the last 10 or 20 years. It takes a little while before the whole world starts referring to you by the new brand, but we’re sure that they will. We’re excited about that. MLM: Your answer reminds me of a conversation I had three weeks ago with Neil Morrell, the president of MagMutual in Atlanta. He said that when he came onboard in April of 2012, the first thing he did was sit down with his team to clearly define what they stand for and what drives what they do. BA: It’s oftentimes just a question of taking the time to step back, turn off the telephones and get your people together to ask, “Who are we?” That was one of the best parts about doing this rebranding. Our staff is about 20 people, and they were all involved in the process.   And I must say that taking this approach  reaffirmed my belief that sometimes it is the most junior people in your organization that have the clearest perception of who you are and what you do. The first day we spent a lot of time asking, “Who are our members? And who do we serve?” We settled on the wording, “We promote. We protect. We educate.” We thought we had it, but at the five o’clock hour, after a late afternoon break, the consultant we worked with came over and told me, “The new junior IT guy, Justin, made an observation that resonated with me. I’d like him to run it by you and the group.” Justin joined the organization only eight weeks earlier. He said, “It seems like a big part of what this organization does – from what I’ve learned so far – is you connect this industry.” We all sat there and realized, “Bing!” So now in everything promotional, you will see, “We promote, protect, educate and connect.” It is a big part of what PIAA has always done. Going back to the early days of PIAA, the purpose was exactly to connect the people who were providing medical professional liability insurance. Before the internet and all the technology that now links everyone together, PIAA literally brought people together to connect. And we still do.

June 29, 2012 by matray

The Supreme Court decision on the constitutionality of the Patient Protection & Affordable Care Act—or as its detractors call it, ObamaCare—was a victory for the President, judicial precedent and the estimated 32 to 50 million Americans who will soon have access to healthcare. As Americans, we care about the health of our brothers and sisters. Today is a good day, but regardless as to which way the Supreme Court had ruled, the United States’ healthcare delivery system was going to continue down the path of change it has been trudging for the last several years. Those involved in healthcare would have to be blind not to notice our system is broken. The United States spends the largest percentage of its gross domestic product of any nation on healthcare expenses, but the World Health Organization ranks its healthcare system at No. 37 when compared to other countries. By contrast, France spends the second largest percentage of its gross domestic product on healthcare, and its healthcare system ranks No. 1 in in the world. I write about healthcare from the standpoint of medical professional liability, and in May, I attended the Physician Insurers Association of America’s Annual Medical Liability Conference in Washington, D.C. During his keynote speech, healthcare futurist Ian Morrison, PhD, emphasized how regardless of the Supreme Court’s ruling, the transformation of our healthcare delivery system would continue unabated. “We are in the midst of a healthcare delivery transformation, which will be unaffected even if the Supreme Court—or the upcoming presidential election—overturns the Affordable Care Act,” Morrison said. “The momentum behind the transformation of the delivery system is immense. It’s very safe to say the train has left the station, and it’s very unlikely to ever go back to the way it was. “The Affordable Care Act stimulated this conversation at the national level, but what is driving this transformation is a relentless pressure from purchasers of healthcare who are dissatisfied with both the quality and performance of American healthcare. We, as Americans, pay more for a system that underperforms in so many metrics.” Earlier this year, I had the opportunity to interview Wayne Lipton, founder and CEO of Concierge Choice Physicians, a New York-based company that helps primary care physicians implement a hybrid model of concierge healthcare. He seemed mildly surprised that people feel the Affordable Care Act has been the driving factor behind the changes occurring in healthcare. “Yes, healthcare delivery is changing, but it’s been changing as long as I’ve been in the industry,” Lipton remarked. “Future change is going to be built around a continued downward pressure on cost and establishing a greater universality to care.” Many in the healthcare industry view the Affordable Care Act and its reliance on accountable care organizations to curb costs as another attempt at managed care, an idea that failed in the 1990s. So why are we returning to it now? First, accountable care organizations are built around healthcare providers rather than healthcare insurers, and accountable care organizations payment approaches will include improvements in quality of care measurement that take into account the continuum of service delivery they are designed to provide. Second, we now have the technology to do managed care right. HIPAA-compliant information technology, specifically electronic health records, will ultimately save the healthcare system billions of dollars by helping doctors reduce the number of redundant or inappropriate tests they order. Each new physician a patient visits will have access to the notes of the patient’s previous physicians or the one that referred the patient to them. Back in March, when the Supreme Court was first hearing oral arguments on the constitutionality of the Affordable Care Act, I had a great conversation with Barry Couch, founder and chief executive of HealthSure, a company that works with hospital boards, physician groups and healthcare management teams to create competitive advantages, control costs as well as put together insurance packages to cover and reduce risks in the healthcare industry. A longtime hospital trustee and licensed risk manager, Couch remarked how regardless as to whether the Affordable Care Act is deemed constitutional, the healthcare reimbursement model moving forward would necessitate physicians participate in some form of managed, or integrated, care. “Whether you are a physician or a hospital, if you are not participating in an integrated model, you simply will not have the patient flow needed to stay in business,” Couch explained. “The health insurance companies, Medicare, Medicaid are all going to contract with large integrated networks and bundle their payments for the defined population in an area. It will be a challenge for the independent, small hospital or independent practitioner not in some sort of direct ownership integration or quasi-collaborative-type of arrangement. There is going to have to be some contractual arrangement to be guaranteed a patient flow.” It’s great news that the Supreme Court recognized the constitutionality of the Affordable Care Act today. Millions of previously uninsured Americans will now have access to healthcare, those with preexisting conditions will no longer be excluded and our healthcare system takes a proud step in the humane direction. That said, the United States’ healthcare delivery system is just continuing down the path of change it has been trudging for the last several years.

July 26, 2011 by matray

I was contacted this morning by the Executive Office of the President and the Library of Congress this morning. Both offices were requesting the Medical Liability Monitor's Annual Rate Survey data. Being the morning after the President and Speaker of the House made televised speeches on how they were at an impasse on the debt ceiling negotiations, and both emphasized a need for compromise, my intuition tells me medical malpractice reform will be part of that compromise. Stay tuned for the latest developments.