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.