2006 medical professional liability symposium chicago, illinois ~ march 14 & 15, 2006...
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Chicago, Illinois ~ March 14 & 15, 2006
2006 Medical Professional 2006 Medical Professional Liability SymposiumLiability Symposium
Miscellaneous Healthcare Miscellaneous Healthcare FacilitiesFacilities
Risk Mixing and MatchingRisk Mixing and Matching
Miscellaneous Healthcare Miscellaneous Healthcare FacilitiesFacilities
Moderator: Paul GreveWillis Healthcare
Practice
Panelists: Rob JurgelAIG/Lexington
Fran O’ConnellShand Morahan
Leslie MillerNational Specialty
UnderwritersBruce Balck
Arch Insurance Group
Miscellaneous Healthcare Miscellaneous Healthcare FacilitiesFacilities
Defined
• By exception: a broad range of healthcare entities that are not hospitals or LTC facilities
• New types of miscellaneous healthcare facility entities are created every year
Miscellaneous Healthcare Miscellaneous Healthcare FacilitiesFacilities
Examples• Alcohol and Drug Rehab
Ctrs• Ambulatory Surgery Ctrs• Ambulance Services• Blood Banks• Clinical Testing Labs• Diagnostic Imaging Ctrs• Dialysis Ctrs• Drug Testing Services• Home Health Care• Home Infusion Therapy• Hospices
• Lithotripsy Facility• MedSpas• Mobile Radiology Units• Nurse Registries• Outpatient Clinics• Pain Management Ctrs• Pharmacy• Public Health Clinics• Public Health
Departments• Urgent Care Ctrs• Visiting Nurse Assoc
Miscellaneous Healthcare Miscellaneous Healthcare FacilitiesFacilities
Why the Move to MHFs?• Aging Population• Utilization Increasing• Increase in Chronic Illness
By 2010, 70M will have 2 or more chronic illnesses• For Certain MHFs, e.g. ASCs, Physicians Can Achieve:
More Volume Better Reimbursement Convenience Lower Costs
• Competition Between Hospitals and Physician-Owned Specialty Services Will Continue
• Growth in Alternative Therapies Will Continue MedSpas Biofeedback Acupuncture
Chicago, Illinois ~ March 14 & 15, 2006
2006 Medical Professional 2006 Medical Professional Liability SymposiumLiability Symposium
Healthcare FacilitiesHealthcare FacilitiesRisk Mixing and MatchingRisk Mixing and Matching
Rob JurgelProduct Line Officer
AIG Healthcare
Miscellaneous Facilities – Miscellaneous Facilities – Industry AnatomyIndustry Anatomy
• $750M Insurance Marketplace
• 50+ Diverse Classes
• 50,000+ Prospects
• 20+ Insurance Carriers
• 5,000+ Brokers
Distribution – 5 ChannelsDistribution – 5 Channels
• National Brokers
• Retailers – 2nd & 3rd Tier
• Wholesalers
• MGAs
• Associations
Product / Coverage IssuesProduct / Coverage Issues
• Basic Forms – 3 Types• Limit Structure – Dual or Single Aggregates• Coverage Trigger – Incident Sensitive vs.
Demand• Sexual / Physical Abuse Coverage• Practitioner Coverage – Drs & CRNAs• Value Added Features – RM, Claims, Crisis
Management
Key Underwriting IssuesKey Underwriting Issues
• Know the Class• Understand the Exposure
Differences between Classes Differences within Classes (Risk Modifiers) Practitioner Coverage (Drs & CRNAs) Venue Differences Loss Experience Quality of Risk Management (Assessments)
Perception: Everybody Makes Perception: Everybody Makes Money in MF?Money in MF?True / FalseTrue / False
PBM Losses $42M – Changed Formulary to Increase Financial Incentives $23M – Rebating Issues $12M – Resold Returned Drugs
Pharmacy Losses $21M – Adult Version of Drug – Brain Injury$ 4M – Detained Shoplifter – Death$ 3M – Wrong Medication
EMT Losses $10M – Asthma Attack - Driver Lost Key to Drug Box$ 5M – Delayed Response, Cardiac Arrest$ 4M – Improper movement, spinal cord injury
Surgi-Center Losses$20M – Loss of Vision (Highly Paid Professional)$ 4M – Anesthesia - Coma$ 3M – Cardiac Arrest
Everybody makes money Everybody makes money (continued)…(continued)…
Hospice Losses $8M – Negligent Care in Nursing Home$3M – Negligent Care$3M – Hired and Non-owned Auto (accident)
Medical Lab $6M – Failure to Detect Cervical Cancer$3M – Failure to Detect Down Syndrome (4 claims)$2M – Failure to Detect Cancer (8 claims)
Behavioral Health$5M – Improper Restraint - death$5M - Failure to Monitor resident – elopement – murder$3M - Failure to monitor – suicide
Dialysis Losses $8M – Exsanguinations (bleed out)$2M - Exsanguinations (bleed out)$1M - Fall / injury
The Big Secret of Underwriting The Big Secret of Underwriting MF Business Successfully?MF Business Successfully?
Charge 25% less than the expiring carrier?
Offer a low premium but make it up on volume?
Charge the Correct Rate for the Exposure!
Chicago, Illinois ~ March 14 & 15, 2006
2006 Medical Professional 2006 Medical Professional Liability SymposiumLiability Symposium
Healthcare FacilitiesHealthcare FacilitiesRisk Mixing and MatchingRisk Mixing and Matching
Fran O’Connell
Vice President
Shand Morahan & Company
Healthcare Facilities Risk Healthcare Facilities Risk Mixing and MatchingMixing and Matching
• What else Is influencing the Healthcare Marketplace?
Advertising/MediaAdvertising/Media
• Nip & Tuck, don’t break a sweat results
• A Pill to improve your lifestyle
Who is being treated?Who is being treated?
• Consumer as Patient
• Consumer’s Concerns Cost Quality Time/Choice Service
What do What do www.getdrugs.comwww.getdrugs.com, , Telemedicine, Matchmakers Telemedicine, Matchmakers
have in common?have in common?
1. They’re scary
2. They’re coming and here to stay
3. Alternative delivery system for drug and/or medical services
New Medical RisksNew Medical Risks
• Telemedicine/e-Health
• Anti-Aging
• Bariatric Surgery
• Pain Management
• New Specialties/Expansion of roles
• Providers who are “bare”
Other Exposures “Creeping” Other Exposures “Creeping” into MPL Risksinto MPL Risks
• “Investigational” Drug Therapies• IT Exposures
Record, transmit and interpret data
• Multiple State or Country Operations• Life Sciences
Molecular medicine Implantable
• Privacy Issues
Coverage ConsiderationsCoverage Considerations
• Claims Made Professional Liability
• Claims Made Professional and General Liability
• Claims Made Professional and Occurrence General Liability
• Deductibles/SIRs• Defense
Inside Limit Outside Limits
• Prior Acts• Coverage trigger
options• Consent to Settle• Territory
ClaimsClaims
• Yes, we get CLAIMS
Surgicenter ClaimsSurgicenter Claims
• Surgicenter becomes deep pocket
• Eye Surgeries Failure to screen (optometrist) Failure to calibrate (technician)
• Emergency Procedures
Medi-Spa ClaimsMedi-Spa Claims
• Laser Hair removal Burns
• Micro-pigmentation Infections
• No Informed Consent
• Allergic Reactions
Chicago, Illinois ~ March 14 & 15, 2006
2006 Medical Professional 2006 Medical Professional Liability SymposiumLiability Symposium
Healthcare FacilitiesHealthcare FacilitiesRisk Mixing and MatchingRisk Mixing and Matching
Leslie Miller
Senior Vice President
National Specialty Underwriters
A Rose By Any Other NameA Rose By Any Other Name
• Ancillary Healthcare
• Spec (specified) Med
• Miscellaneous Medical
Defined By What Defined By What It Is NotIt Is Not
• NOT a provider
• NOT a hospital
• NOT long term care
Miscellaneous HealthcareMiscellaneous Healthcare
• Adult Day Care Centers• Ambulance Companies
(excludes auto liability)• Banks• Cancer Centers (Radiation
Oncology)• Clinics• Community Health Centers• Correctional Medicine• Dialysis Centers• Family Planning• Home Health Agencies• Hospice Care• Imaging Centers• Labs• Lithotripsy• Long-Term Care
• Medical Spas• Mental Health• Nurse Staffing• Perfusion/Auto transfusion• Pharmacies• Product Liability (medical
products only)• Public Health Dept.• Schools• Social Services• Sleep Centers (Apnea)• Social Services• Staffing• Surgery Centers• Therapy• Trauma Rehab
Why All of the Fuss?Why All of the Fuss?
• Surgical Centers – more than 5,500 ASC’s
• Imaging Centers – more than 2,800 facilities
• Home Health Care – more than 11,000 agencies
• Medical Labs – more than 5,000 laboratories
MarketsMarkets
Ace Admiral AIG
Arch CNA Colony
Darwin Evanston GenStar
Hudson Interstate James River
Lloyd’s of London
NAS One Beacon
RSUIUnited
NationalZurich
Surgery CenterSurgery Center
Surgery Center located in Midwest
• Performs bariatrics
• Performs plastic
• $1M / $3M limits
• Prior acts
A Rated Market QuotesA Rated Market Quotes
• Carrier A: $184,000Carrier A: $184,000 $20,000 deductible$20,000 deductible
• Carrier B: $210,000Carrier B: $210,000 $25,000 deductible$25,000 deductible
• Carrier C: $514,867Carrier C: $514,867 $25,000 deductible$25,000 deductible
Social ServicesSocial Services
Social Services located in Florida
• Child Welfare Services
• Package PL/GL
• $1M / $3M
• Claims Made Year 3
A Rated Market QuotesA Rated Market Quotes
• Carrier A: $26,500Carrier A: $26,500 $10,000 deductible$10,000 deductible
• Carrier B: $125,000Carrier B: $125,000 $10,000 deductible$10,000 deductible
• Carrier C: $200,000Carrier C: $200,000 $10,000 deductible$10,000 deductible
Market Selection Market Selection
• Class of business
• Venue
• Minimum premium requirements
• Glamour do’s and don’ts by carrier
Improving YourImproving Your Success Rate Success Rate
• A complete application, with a supplement to be certain that you have all of the information
• Understand what really goes on inside the box
• Know your client’s growth strategy
Pick TwoPick Two
Lowest Premium
Broadest Form
SpeediestUnderwriting
Chicago, Illinois ~ March 14 & 15, 2006
2006 Medical Professional 2006 Medical Professional Liability SymposiumLiability Symposium
Healthcare FacilitiesHealthcare FacilitiesRisk Mixing and MatchingRisk Mixing and Matching
Bruce Balck
Director – Risk Management
Arch Insurance Group
Risk ExposuresRisk Exposures
• Mail-Order Pharmacy
• Ambulatory Surgery
• Dialysis
• Ambulance Services
• Home Health/Hospice
Mail-Order Pharmacy Mail-Order Pharmacy
• Operations: Pharmacist involvement Bar coding Process of clarifying orders Computer Screens/Verification/Photograph Systems to track errors
• The Patient: 24/7 Pharmacy Support Patient Instructions (easy to read)
Ambulatory SurgeryAmbulatory Surgery
• Patient Selection (Risk Factors)
• Staffing competency
• Procedure Appropriate for setting
• Standards of Care Infection Control Monitoring modalities Anesthesia*
Propofol – New Frontier?Propofol – New Frontier?
• It’s an anesthetic• Short acting
sedative effect • Dangers;
Loss of airway reflexes
Oxygenation Aspiration Bradycardia Hypoxia
The Issue/Debate?The Issue/Debate?
• RN’s administering in: Diagnostic Centers Surgical Centers Doctor’s Offices Emergency Rooms
• Patient lose their respiratorydrive without warning
• Supporting airway until the medication “wears off”• No antidote – “Tincture of Time”• Airway management
Must be able to intubate
HemodialysisHemodialysis
• Replaces normal kidney filtration• Causes:
Acute: Trauma, Surgical Complications, blockage to blood vessel
Chronic: Hypertension, Diabetes
Risks of DialysisRisks of Dialysis
The ‘typical’ side effects: Infection, anemia, nausea, headaches, hypotension, etc.
• Electrolyte imbalance• Cardiac arrhythmia• Air embolism• “Bleed-outs”:
Pressure Alarms ‘off’ Lack of vigilance
• Failure to flush Dialyzer (filter) of cleaner (re-use) properly.
• Re-use; Infection/Verification • Falls
Ambulance – Airway Ambulance – Airway Management Management
The Issue: Dislodging the ‘ET’ during transport!
• Primary and Secondary Verifications
• Document placement (ET) during and after transfer.
• Skill set – Practice
Dislodged AirwayDislodged Airway
• Grip-ET • Prevents ET dislodgment for patients who must be moved and transported while intubated.
• Cost: $3.69
CO2 SensorCO2 Sensor
Provides a breath-by-breath indication of exhaled CO2.
No airway = No CO2
Esophageal/Tracheal AirwayEsophageal/Tracheal Airway‘Combitube’‘Combitube’
• Inserted “blindly” and ‘seals’ the oral and nasal pharyngeal cavities.
• Functions in either the trachea or esophagus.
• Normal and abnormal airways
• ‘Trapped’ patients
Home Health/HospiceHome Health/Hospice
• Background Checks• Supervision• Chain of Command/Communication• Job performance evaluations• Skill set that matches job function*
(*Trend towards using more non-licensed personnel)
Home Health Nurse Negligent Home Health Nurse Negligent in Airway Managementin Airway Management
9 Month Old ‘Vent Dependent’ with Trach
• Panic when trach plugged• Failed to follow procedure• 19 minute delay
$2.5M Award$2.5M Award
The Outcome:
• Brain Damage – Died 28 Days later• $2.5M (with an annuity)
Key Elements:
•Training/Experience• Lack of supervision
Miscellaneous Healthcare Miscellaneous Healthcare FacilitiesFacilities
Paul GreveWillis Healthcare [email protected] 872 3320
Rob JurgelAIG/[email protected] 772 4534
Fran O’ConnellShand [email protected] 572 6118
Leslie MillerNational Specialty [email protected] 924 2819
Bruce BalckArch Insurance [email protected] 855 7127
Chicago, Illinois ~ March 14 & 15, 2006
2006 Medical Professional 2006 Medical Professional Liability SymposiumLiability Symposium
Miscellaneous Healthcare Miscellaneous Healthcare FacilitiesFacilities
Risk Mixing and MatchingRisk Mixing and Matching