Acadia Professional Acquires Toro Risk Consulting Group
October 4, 2019
Acadia Professional, a medical professional liability insurance agency, announced the acquisition of Toro Risk Consulting Group, a healthcare consulting firm that primarily works with emerging companies to support providers in value-based care programs.
“Traditional medical malpractice risk can no longer be viewed in a silo. Toro brings a deeper understanding of value-based care and new market access that allows us to better position our clients from a risk perspective,” said Scott Parker, Acadia president.
“Toro is both a business and a cultural fit for Acadia,” said Henry Kane, Acadia co-founder. “The synergies position Acadia to deliver more expertise and resources to our clients who want to be ahead of value-based reimbursement programs.”
“We have long understood the need to align the risk providers take in value-based care programs with professional liability risk. With the acquisition of Toro, Acadia is now able to expand its portfolio to help clients leverage the transition to a value-based care system," said Brian Kern, who was the founder and managing member of Toro Risk, now a partner at Acadia.
Effective immediately, Toro Risk Consulting Group will move its office to Acadia's Headquarters in Morristown, N.J.
Medical Liability Monitor’s 2019 Annual Rate Survey Indicates a Medical Professional Liability (Medical Malpractice) Insurance Market Firming, But Are We Headed for a Real Hard Market?
October 2, 2019
According to just-released data from the 2019 Medical Liability Monitor Annual Rate Survey, for the first time since 2006, more than 25 percent of medical professional liability (MPL) premium rates increased, while for a second consecutive year, only 5 percent of rates decreased. These firming rates indicate a turn from the market’s decade-plus period of soft pricing, but is it headed for a real hard market — with annual rate increases averaging between 10 and 30 percent — similar to the last one, which started as a low simmer in 1998, heated up in 1999 and boiled from 2000 to 2006?
To answer this question, Annual Rate Survey guest editors Bill Burns and Alyssa Gittleman from the Insurance Research Department of the global investment management firm Conning compare current market conditions to those which preceded the last hard market. They note similarities between the two in the MPL industry’s operating ratio, return on equity, declining loss reserve margins, use of schedule credits and declining competition, but also observe significant differences in policyholder surplus, exposures and ceded reinsurance.
What do the Rates Say?
From 2007 to 2018, the results of the Annual Rate Survey had a certain familiarity — companies held most rates flat, decreased some rates and increased even fewer rates. In 2019, things look different — with more than 25 percent of the rates reported in the Survey increasing, while only 5 percent of rates decreased.
Based on the information gathered in this year’s Survey, the overall rate increase from 2018 to 2019 was approximately 0.8 percent. Drilling down, we see that rates in states without patient compensation funds (PCFs) increased by 1.1 percent, while rates in states with PCFs decreased by 1.1 percent (excluding one company’s exceptional rate decreases in two PCF states, that number would be an increase of 1.9 percent).
Several MPL insurers adopted rate increases for general surgery that were higher than those of the other specialties. A review of several rate filings suggests that the rate relativity for general surgery is increasing. It appears average costs for general surgery are increasing by more than average costs for the companies’ base class (hence the rising relativity). Consequently, rate increases for general surgery are greater than the average increases.
Excluding one company’s exceptional rate decreases in two PCF states, the average rate increase in the Midwest was 2 percent, 1.4 percent in the Northeast, 1.1 percent in the South and 0.3 percent in the West.
What Else Did We Learn from the Annual Rate Survey?
In addition to information on rates, respondents to the Survey provided color on other facets of the market, including underwriting, coverage, whether they are expanding or contracting the states in which they write business and their general view of the MPL market.
One conspicuous theme that jumped off the page came from responses to the question, “What do you view as the biggest threat to your market share?” The answers to this question indicate companies are concerned about a continued shrinkage of the exposure base of insurable physicians, brought about by hospitals acquiring physician practices and/or employing physicians as well as venture capital creating large physician groups that move to self-insurance.
To purchase the 2019 Annual Rate Survey, click here or call 312-944-7900.
A.M. Best Revises Outlooks to Negative for ProAssurance Corporation and Certain Subsidiaries
September 26, 2019
AM Best has revised the outlooks to negative from stable and affirmed the Financial Strength Rating (FSR) of A+ (Superior) and the Long-Term Issuer Credit Ratings (Long-Term ICR) of “aa-” of certain members of the ProAssurance Group. Concurrently, AM Best has upgraded the FSR to A+ (Superior) from A (Excellent) and the Long-Term ICR to “aa-” from “a+” of Eastern Alliance Insurance Company (Lancaster, PA) and its affiliates that are now a part of ProAssurance Group. The outlook of these Credit Ratings (ratings) have been revised to negative from stable. Additionally, AM Best has affirmed the FSR of A- (Excellent) and the Long-Term ICR of “a-” of PACO Assurance Company, Inc. (PACO) (Springfield, IL). The outlook of these ratings remain stable. (See below for a detailed listing of the companies ratings.)
All companies are indirect subsidiaries of ProAssurance Corporation (PRA).
Along with these rating actions, AM Best has revised the outlooks to negative from stable and affirmed the Long-Term ICR of “a-” of PRA and the Long-Term Issue Credit Rating (Long-Term IR) of “a-” on PRA’s $250.0 million 5.30% 10-year senior unsecured notes, due 2023. AM Best also has affirmed the indicative Long-Term IRs under the shelf registration of “a-” on the senior unsecured debt, “bbb+” on the senior subordinated debt and “bbb” on the preferred stock of PRA.
The ratings of ProAssurance Group reflect its balance sheet strength, which AM Best categorizes as strongest, as well as its strong operating performance, favorable business profile and appropriate enterprise risk management (ERM).
The negative outlooks reflect the negative trend in the ProAssurance Group’s operating performance in recent years, which has resulted in underwriting and operating metrics falling to a level that, although still solid, is more in-line with its peers in the medical professional liability (MPL) industry, instead of out-performing them. While the group continues to report favorable prior period reserve development, the magnitude of favorable development has declined in recent years and AM Best expects this trend to continue, especially given concerns with regard to rising loss costs in the MPL industry.
The group’s balance sheet strength assessment continues to reflect its strongest level of risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio (BCAR), as well as the strength of its reserves and the quality of its investments. The ratings also consider the ProAssurance Group’s market position as one of the leading MPL insurers in the United States, as well as its diversification across multiple disciplines, geographic areas and in its other lines of business. These ratings also acknowledge the depth and breadth of the group’s ERM programs and policies. In addressing challenges in a prolonged soft MPL market, management has leveraged its talent, knowledge base and market position to introduce innovative alternatives.
The upgrade of the Eastern Alliance Insurance Company and its affiliates reflect their status as members of the ProAssurance Group due to their strategic importance as successful specialty workers compensation writers, common management and significant earnings contributions.
The ratings of PACO reflects its balance sheet strength, which AM Best categorizes as very strong, as well as its adequate operating performance, limited business profile and appropriate ERM. The ratings also reflect lift from the lead rating unit, ProAssurance Group, based on implicit support.
PACO’s ratings reflect its strongest risk-adjusted capital position and generally improved operating performance since being acquired by PRA in 2009. The company’s underwriting has been modestly profitable, benefiting from favorable industry trends in claims and losses in a lower-risk line of business during a softening market. PACO broadens PRA’s MPL lines of business to include chiropractors and acupuncturists, another niche medical specialty with favorable loss parameters.
Each of the rating units discussed above also benefits from the financial flexibility provided by PRA, the ultimate parent. PRA’s financial leverage is conservative, its interest coverage is solid and it holds cash and short-term investments outside of the insurance operating companies that are available for use without regulatory approval. At the same time, surplus growth at most rating units has been limited over the past five years by the payment of significant dividends to PRA, which they have utilized to pay shareholders’ dividends and repurchase company stock. Nonetheless, management remains committed to maintaining capital at the rated entities at levels commensurate with their ratings.
The outlooks have been revised to negative from stable and the FSR of A+ (Superior) and the Long-Term ICR of “aa-” have been affirmed for the following members of the ProAssurance Group:
• ProAssurance Casualty Company
• ProAssurance Indemnity Company, Inc.
• ProAssurance Specialty Insurance Company, Inc.
• Medmarc Casualty Insurance Company
• Noetic Specialty Insurance Company
• Podiatry Insurance Company of America
• ProAssurance American Mutual, A Risk Retention Group
The FSR has been upgraded to A+ (Superior) from A (Excellent) and the Long-Term ICRs to “aa-” from “a+” with the outlooks revised to negative from stable for Eastern Alliance Insurance Company and its affiliates:
• Allied Eastern Indemnity Company
• Eastern Advantage Assurance Company
AMA Inaugurates Recognition Program in Fight Against Physician Burnout
September 24, 2019
The American Medical Association (AMA) recognized 22 healthcare organizations as the first recipients of the inaugural Joy in Medicine Recognition. The new distinction offered by the AMA recognizes healthcare organizations that have committed to efforts that improve physician satisfaction and reduce burnout.
“It is a great honor to recognize the outstanding achievements of the organizations selected for the Joy in Medicine Recognition,” said AMA Board Chair Jesse M. Ehrenfeld, MD, MPH. “These organizations are true leaders in promoting physician well-being and continue to make a difference in the lives of our nation’s health are workforce.”
Candidates and their achievements to reduce physician burnout were evaluated against criteria demonstrating competencies in commitment, assessment, leadership, efficiency of practice environment, teamwork and support.
The recipients of the inaugural Joy in Medicine Recognition are:
Ascension Medical Group, St. Louis, Mo.
Beth Israel Deaconess Medical Center, Boston, Mass.
Boston Medical Center, Boston, Mass.
Cleveland Clinic, Cleveland, Ohio
Geisinger Health System, Danville, Pa.
Gould Medical Group, Modesto, Calif.
Heartland Health Centers, Chicago, Ill.
Icahn School of Medicine Mount Sinai, New York, N.Y.
Mayo Clinic, Rochester, Minn.
National Capital Region Military Health System, Bethesda, Md.
Northwestern Medicine, Chicago, Ill.
Oak Street Health, Chicago, Ill.
Ochsner Health System, New Orleans, La.
Southern California Permanente Group, Calif.
St. Vincent Medical Group, Ind.
Stanford Health Care, Palo Alto, Calif.
University of Colorado School of Medicine, Aurora. Colo.
UNC Health Care, Chapel Hill, N.C.
UPMC, Pittsburgh, Pa.
University of Rochester Medical Center, Rochester, N.Y.
Virginia Mason Medical Center, Seattle, Wash.
Wake Forest School of Medicine, Winston-Salem, N.C.
The Joy in Medicine Recognition Program is a component of the AMA’s Practice Transformation Initiative, an ambitious new course of action to advance evidence-based solutions that fill the knowledge gap in effective solutions to the physician burnout crisis.
“The Joy in Medicine Recognition Program is designed by the AMA to serve as a guide and catalyst for organizations who are interested, engaged and committed in efforts to fight the root causes of physician burnout,” said Ehrenfeld said. “The AMA is optimistic that the program will serve as a roadmap to reduce burnout within organizations and unite the health care community around systematic changes that will energize physicians in their life’s work of caring for patients.”
The founding of the Joy in Medicine Recognition Program was influenced by three timely and prominent sources — a call-to-action blog post in Health Affairs titled Physician Burnout is a Public Health Crisis: A Message to our Fellow CEOs, a research article published in JAMA Internal Medicine titled The Business Case for Investing in Physician Well-being and the multi-stakeholder effort resulting in the Charter on Physician Well-being.
The AMA continues to work on every front to address the physician burnout crisis. Through its research, collaborations, advocacy and leadership, the AMA is working to make the patient‐physician relationship more valued than paperwork, preventive care the focus of the future, technology an asset and not a burden, and physician burnout a thing of the past.
Michael G. Roque Joins CMIC Group as Chief Operating Officer
September 11, 2019
CMIC Group announced that Michael G. Roque has joined the CMIC Group team as the new Chief Operating Officer.
Roque has more than 20 years of experience in medical professional liability, working on both the broker and carrier sides. Most recently, he served as vice president of Business Development at NORCAL Mutual Insurance Co. Roque holds a BBA in Risk Management & Insurance from Temple University.
“We are very pleased to have Michael join our Team,” said Stephen J. Gallant, chief executive officer of CMIC Group. “His knowledge and experience within the MPL industry will be a tremendous asset for the company. We look forward to his leadership and insight as we continue to grow the company.”
ProAssurance Declares Quarterly Dividend
September 5, 2019
The Board of Directors of ProAssurance Corp. has declared a cash dividend of $0.31 per common share, payable on Oct. 11, 2019, to shareholders who own our stock as of Sept. 27, 2019.
The company's dividend policy anticipates a total annual dividend of $1.24 per share, to be paid in equal quarterly installments. However, any decision to pay future cash dividends will be subject to the Board’s final determination after a comprehensive review of the ProAssurance's financial performance, future expectations and other factors deemed relevant by the Board.
Kansas Insurance Department Places Physicians Standard Insurance Co. in Rehabilitation
August 29, 2019
The Kansas Department of Insurance has issued the following news release:
On Aug. 20, 2019, the Shawnee County District Court in Topeka, Kan., signed an order placing Physicians Standard Insurance Co. (PSIC) in rehabilitation under the supervision of the Kansas Insurance Department. The Order of Rehabilitation (Order) was entered with consent of the Board of Directors of PSIC. Pursuant to the Order, Kansas Insurance Commissioner Vicki Schmidt will serve as Rehabilitator.
“A primary responsibility of the Kansas Insurance Department is protecting consumers by ensuring companies are financially solvent and capable of paying claims,” Commissioner Schmidt said. “The Department determined PSIC’s financial condition had deteriorated to the point it was necessary to take the extraordinary step of obtaining a court order to give the Department the authority needed to protect the consumers and policy holders of PSIC. I remain fully committed to rehabilitating PSIC and continuing our responsibility of protecting consumers.”
A letter from the Commissioner to policyholders on Aug. 23, 2019, states, in part, “[t]he Order allows the Commissioner, as Rehabilitator, to reform and revitalize PSIC to protect policyholders.” Under the Order, PSIC continues to operate and current policies remain in effect.
As of the date of the Order, PSIC provided medical malpractice insurance for approximately 484 medical professionals in Kansas and Missouri. Most of the policyholders are in Missouri with just a few in Kansas.
For further information, including the full Order for Rehabilitation, Frequently Asked Questions, and an Open Letter to Policyholders, please visit https://www.ksinsurance.org/department/LegalIssues/PSIC-Rehabilitation.php. Non-media questions can be sent to the Department at KID.PSIC@ks.gov.
ProAssurance to Report Results, Longterm Strategy at Keefe, Bruyette & Woods 2019 Insurance Conference
August 27, 2019
ProAssurance Corp. president and chief executive officer Edward L. Rand, Jr., will discuss the medical professional liability insurance company’s recently reported results, current market trends and long-term strategy during a question and answer session with investors at the Keefe, Bruyette & Woods 2019 Insurance Conference on Thursday, Sept. 5, 2019, at approximately 10:10 a.m. ET.
The presentation will be streamed live over the internet. The webcast will be available through the ProAssurance investor home page: http://investor.proassurance.com. The presentation will also be available directly from: http://wsw.com/webcast/kbw49/pra. Replays will be available from both websites for at least 90 days after the event.
The Doctors Company Appoints New Chief Medical Officer
August 21, 2019
The Doctors Company announced the appointment of David L. Feldman, MD, MBA, CPE, FAAPL, FACS, as chief medical officer (CMO) of The Doctors Company Group. In this new role, Feldman will lead the group’s education efforts in — and be the primary spokesperson for — trends and issues on patient safety and risk management.
Feldman succeeds David Troxel, MD, who retired after more than 13 years as CMO.
Feldman will continue to serve as senior vice president and CMO at Healthcare Risk Advisors (HRA), formerly Hospitals Insurance Co. and FOJP Service Corp., which was recently acquired by The Doctors Company Group. Under his leadership, HRA provides resources and a collaborative environment designed to minimize claims and lower premiums for HRA clients by preventing patient harm, enhancing teamwork and communication, and improving documentation.
Prior to HRA, Feldman was vice president for patient safety, vice president of perioperative services and vice chairman of the department of surgery at Maimonides Medical Center (Maimonides) in Brooklyn, N.Y. He implemented numerous patient safety initiatives, including the use of the World Health Organization Surgical Safety Checklist. As past president of the Maimonides medical staff, Feldman was instrumental in the creation and implementation of a hospital-wide Code of Mutual Respect and physician peer review committee.
“We are pleased to welcome David to The Doctors Company Group,” said Richard E. Anderson, MD, FACP, chairman and CEO of The Doctors Company. “His leadership, depth of medical experience and commitment to optimal clinical performance and patient outcomes make him the ideal candidate to represent our clinical perspective.”
Feldman serves on the steering committee of the American College of Surgeons (ACS) for retraining and retooling of practicing surgeons. He has served on the ACS committee on perioperative care and as vice chairman of the ACS collaborative task force for the development of high-performance teams in surgery. He also served as the ACS liaison to the Association of periOperative Registered Nurses recommended practices committee.
Feldman is a master TeamSTEPPS trainer and a certified trainer in Crucial Conversations and Crucial Confrontations. He received a Bachelor of Arts degree and Doctor of Medicine degree from Duke University, completed training in general surgery at The Roosevelt Hospital (now Mount Sinai West) and plastic surgery at Duke University Medical Center. He earned a Master of Business Administration degree from New York University.
“I am excited to join The Doctors Company Group and to serve as an ambassador to the medical profession on patient safety issues,” Feldman said. “I am honored to contribute to the future-looking vision for The Doctors Company’s patient safety organization that supports the needs of the business and the mission of advancing the practice of good medicine.”
The Doctors Company Group includes The Doctors Company and three wholly owned strategic business units: TDC Specialty Underwriters, which provides liability solutions for a variety of healthcare organizations and medical facilities; Medical Advantage Group, an innovator in maximizing health plan and physician clinical and financial performance in value-based contracting; and HRA, a premier provider of medical malpractice insurance and risk management advisory services to physicians and hospitals in New York.
Ken Hawkins Joins Pinnacle Actuarial Resources as Consulting Actuary
August 20, 2019
Pinnacle Actuarial Resources announced that Ken Hawkins, ACAS, MAAA, has joined Pinnacle as a consulting actuary in the firm’s Bloomington, Ill., home office.
Hawkins returns to Pinnacle after three years of leading pricing and rate implementation for a regional property/casualty insurer’s commercial lines products.
“We are very pleased to welcome Ken back to Pinnacle,” managing principal Joe Herbers said. “Ken has tremendous breadth and depth of experience and will bring a highly relevant, customer-focused approach to the work he does for our clients.”
Hawkins has more than 13 years of experience in the property/casualty practice area. His expertise includes loss reserving, funding studies, cost-allocation mechanisms, loss-cost projections, captive-feasibility studies, commercial-lines ratemaking, financial analysis of insurance companies, deductible analysis and simulation methods. He has extensive experience developing simulations that utilize company-specific data to calculate risk margins.
Hawkins holds Associate of the Casualty Actuarial Society (ACAS) and Member of the American Academy of Actuaries (MAAA) credentials and received his Bachelor of Science degree in actuarial science from the University of Illinois, Urbana-Champaign.