You can read the entire story including the video coverage here.

I started this article with this story because it typifies where most hospitals, insurers, and caregivers are with disclosure. Almost everyone knows disclosure is the “right thing to do” ethically as well as financially, but the trick is how to do it and when to do it? Disclosure is getting easier with more physicians become employed or covered by hospital RRGs, but as the story above shows even with employed physicians, disclosure can be challenging and sometimes too slow.

At its heart, disclosure is all about relationships. Keeping relationships alive and parties communicating even under the worst circumstances.  Keeping relationships alive so problems can be fixed without litigation. The old risk management style of “deny and defend” destroyed relationships, killed communication, fed suspicions, and made people angry – very angry – which led to lawsuits. Disclosure is a better way for all stakeholders.

The whole “relationship and communication thing” sounds good, but it’s difficult to conceptualize in a busy, crazy chaotic healthcare environment. How do you make disclosure operational with doctors and nurses who have historically been told to “shut up” after something goes wrong? Who talks post-event, what do they say, what do they not say, and a thousand other questions that can often slow and stall the process, which angers families and invites litigation.

At Sorry Works!, we work with hospitals and insurers all across the country on the issue of disclosure. In this brief article, I want to provide a few thoughts on what we consider best practices for disclosure.

1. Develop a disclosure program

It is critical to develop a true program that is operated by trained people who can guide staff through difficult post-event discussions. Moreover, the program allows the organization to move quickly – but not too quickly! – post-event and be responsive to the needs of the patient and family but also the caregivers. Moving quickly and being pro-active means showing empathy and concern in the immediate aftermath of an event, quickly reviewing the situation while staying connected with the patient/family, and, when necessary, having capacity to address financial and emotional needs upfront without the dance to the courthouse (i.e, your disclosure program needs to be synced with your claims and insurance coverage). The disclosure program also needs to be a known entity within your organization, complete with visible hot-line numbers and team members recognized by doctors and nurses. We fully recognize that developing a disclosure program will require a financial investment and dollars are tight in healthcare, but if you stop just one lawsuit the investment will be paid back with interest. If your CEO or CFO continues to resist, show him/her the story about the St. Louis hospital above. Your hospital is just one phone call, e-mail, or text message away from being in a similar situation unless you have a disclosure program as part of your neurosurgery medical malpractice insurance!

2. Train your staff how to empathize and stay connected post-event

The disclosure program needs to raise awareness among staff, including training them on how to empathize and stay connected with patients and families post-event without prematurely admitting fault. To be frank, this is where a lot of hospitals and insurers who practice disclosure fall-down. The c-suite or leadership understands and embraces disclosure, but no one has trained the front-line docs and nurses on their role in the process. Consequently, when something bad happens the docs and nurses resort to the “deny and defend” principles drilled into their heads, leadership doesn’t learn about the situation, and the family finds a lawyer  — and then you are like the St. Louis hospital getting slammed by litigation and horrible media coverage. The staff needs to be taught how to empathize – say “sorry” – without admitting fault, provide immediate assistance to the patient/family, stay connected with them — and call the disclosure program for help going forward.

3. Keep your culture alive!

Disclosure can’t be the “flavor of the month” or you and your patients & families will never receive the full benefit. Like anything else, you have to keep working at it. A good program will a) keep disclosure in front of your people, b) make sure new hires are properly trained, c) share success stories and also failures throughout the organization, and d) continue to be a visible presence and resource throughout the organization.

Disclosure is not easy, but the good news is many hospitals and malpractice insurers­ across the country in all sorts of venues are developing successful disclosure programs.

This blog is a guest post by Sorry Works! Learn more about their organization by visiting sorryworks.net. Sorry Works! specializes in making disclosure a reality for healthcare organizations. Sorry Works! educates and trains healthcare employees and insurance providers on the best practices for disclosure. Give us a call at 618-559-8168 or email doug@sorryworks.net.

Practice administrators are constantly managing the costs related to day-to-day operations.  Some of those costs are variable, based on the volume of patients, such as office supplies, equipment, medical supplies, and pharmaceuticals.  Many of these items are consumable, so when patient loads are high the costs in this area obviously rise.  These are costs that can be controlled to some degree by choosing the most cost-effective suppliers.  Saving a little here and there can make a difference to the bottom line.

However, the largest costs in a medical practice are the major fixed costs that must be budgeted for each year.  These costs may change from year-to-year, but remain stable monthly and quarterly.  Typically, personnel costs are a major fixed expense along with the various costs associated with occupying office space – rent, maintenance, etc.  Short of moving or letting staff go, there is little that can be done to control these expenses throughout the year.  The other major fixed expense is in the area of insurance: Health insurance for the group, Property and General Liability insurance, and Professional Liability insurance or medical malpractice insurance, which is usually the largest of the insurance related expenses.  Practice managers can save money in this area by doing some homework and taking a few simple steps.

Here are 3 ways to save: In order to maximize savings on malpractice insurance, before renewing, managers need to look at all available options, check for additional discounts, and consider alternate payment methods.

1. Check out all the options available

In today’s medical malpractice insurance market there are more options than there have been in decades.  Of course price should not be the only consideration when choosing a malpractice insurance company, but rates are extremely competitive and shopping around can usually result in finding lower premiums.  There are several types of malpractice insurance companies available: Stock, mutual, exchange, and risk retention groups.  Some of the previously higher priced “A” rated companies are now offering rates that compete with smaller alternative type companies.  Making a decision on the type of company means knowing the differences in the options available.  Some practice managers and physicians are willing to take on a little risk to save money, and some would rather pay a higher rate for security and stability.

What’s the difference?

• Stock Insurance Company – This is an entity organized as a for-profit corporation, with shareholders. Any profits of this type of company may be distributed as dividends to the shareholders or reinvested into the company or other investment vehicles.

• Mutual Insurance Company – The policyholders own this type of company, so earnings are distributed back to the insureds as dividends.  These are often set up as associations with policyholders being members.  The members have a vote in major decisions of the company.  Losses are not usually charged back to policyholders unless the company is Assessable – some states allow for this.

• Insurance Exchange – This type of company is an entity that provides insurance coverage generally unavailable elsewhere, for unusual or non-standard risks. Unlike insurance companies, however, insurance exchanges do not underwrite insurance coverage.  They are nonprofit organizations that oversee its underwriting members or “syndicates.”  Exchanges receive premiums, issue policies, handle claims, supervise underwriters, and monitor their solvency.  Like a mutual, an insurance exchange is owned by the policyholders who sometimes have a vote and a share in the surplus.  Exchanges will often pay dividends to policyholders if there is excess beyond expenses.

• Risk Retention Group – This is a form of self-insurance.  Individuals join together to pool their money to protect against potential shared risks.  RRGs are not subject to the individual state laws that would otherwise prohibit the formation of group captives or make it difficult to form or operate them.  Purchasing coverage from an RRG may require a capital investment in addition to premiums.

In states where the malpractice insurance market is stable and competitive most physicians and groups choose the stock companies and large mutuals because the rates are typically no higher than the alternative companies.  However, in states where the market is volatile and rates are high, it’s often difficult to get affordable coverage, especially for higher risk specialties.  That’s where the exchanges, and RRG’s can help save significant dollars.

2. Find out about discounts offered

In an environment where medical malpractice claims are steady and the rates are low, competition among insurance carriers can be fierce.  This creates a positive result for physicians.  Most malpractice insurance companies offer significant discounts to help set themselves apart from the competition.  Physicians and practice managers need to be diligent about asking for any and all discounts that apply.

The most typical discounts available are for:

• New-to-practice physicians
• Large groups
• Members of medical associations, such as the AMA and others
• Individuals and groups with no claims or few claims
• Physicians who have completed risk management courses – online or at seminars
• Insureds that have stayed with the insurance company for a number of years

Working with a broker that has experience and long-term relationships with the insurance companies is a great way to get all the discounts available.  Many times the carriers will not offer every discount unless they are requested.

3. Choose the best payment option

Most malpractice insurance companies will allow annual, quarterly, or monthly payments but be sure to find out if there are finance charges involved in the monthly or quarterly payment plans.  While spreading payments out can greatly improve cash flow for a practice, it sometimes comes at a cost.  Because of the cost, good budget planning can help avoid any surprises.  Many practice managers and administrators choose to pay malpractice premiums annually to avoid the additional charges and set aside funds throughout the year so they are prepared to pay the lump sum at policy renewal time.  This is especially important when the premium is one of the higher fixed costs for the practice.  Depending on the malpractice market and competition, there may be companies offering quarterly or monthly installments with no finance charge.  This is another way carriers are able to compete in a stable market where there are a lot of options.  Other practices use a line of credit at a bank to pay malpractice insurance premiums.  With interest rates being at all-time lows, this is another option worth considering.

These 3 simple steps can help practices maximize savings on one of the largest fixed expenses.  The experts at eQuoteMD are constantly working to find the best coverage at the best rate, and we’ve partnered with many different types of companies all over the country that offer competitive discounts and help with financing premiums.

As an online service providing quotes for medical malpractice insurance to physicians, eQuoteMD has achieved a milestone in both the number of physicians served and total premium volume sold.

The website, launched only two years ago, has helped thousands of physicians with quotes, policy comparisons, and insurance coverage for malpractice risks. Company executives credit the success to the combination of the ease of use for the customer, collaboration with industry experts, and the compilation of the best information available all in one place.

Since its establishment in January 2011, eQuoteMD has helped over 4,500 physicians from all 50 states find solutions to their medical malpractice and professional liability insurance needs. From those interactions brokers have sold insurance products totaling over $10,000,000 in policy premiums.

“We are very proud of the success of eQuoteMD because it means we are providing a needed service for physicians and other healthcare providers,” commented eQuote’s COO, Brian Dames.

“A few years ago we recognized that doctors, like most consumers, were starting to become more comfortable shopping for insurance on the Internet. So we built our website with the idea of becoming a resource for the healthcare community. We are more than just a place to get a quote – we provide solid, accurate information to help physicians make an educated decision about this important insurance coverage,” Dames said.

Making the website easy for any kind of user was one of the top priorities when it was being designed. Whether a physician just wants a quote the quickest and easiest way possible, or to gather information about medical malpractice insurance in another state, or to speak to a licensed broker over the phone who can answer technical questions about coverage, eQuoteMD provides quality service for any type of customer.

One physician recently remarked: “Malpractice insurance premiums have always been a struggle for me as a surgeon. After finding eQuoteMD and using their service I was amazed at their ability to find me lower rates in the state of Florida without me having to do the searching.”

Many physicians are not experts in malpractice insurance. That’s why eQuoteMD takes the work out of it. eQuoteMD has professional brokers with years of experience that help physicians find the right policy at the best rate.

About eQuoteMD

A group of medical malpractice insurance specialists created and developed eQuoteMD.com, an independent, web-based referral service for healthcare providers. With over 100 years of combined experience in the medical professional liability insurance industry, the professionals at eQuoteMD have put together one of the largest collections of medical malpractice insurance information and the largest network of malpractice insurance carriers in the nation.

Does your malpractice insurance policy cover the following exposures?

• Acts as a medical director
• Nurse practitioners working under your supervision
• Cyber liability
• Billing errors or Medicare/Medicaid fraud
• HIPAA violations
• RAC Audits

Typically there is no coverage for these risks in a malpractice policy.  That’s because med mal coverage is simple liability insurance.  It covers a physician for direct patient care and there are usually no bells or whistles.  So unless you have seen policy language that specifically includes coverage for additional risks, you probably don’t have it.

So where do you go to find coverage for these risks?  If, for example, you are a medical director at a hospital or nursing home, the first place you should look is the contract you’ve signed for that position.  Many hospitals and nursing homes provide coverage for their medical directors.  If they don’t you could be at risk if you are named in a malpractice lawsuit.  There are policies available at a reasonable cost for medical directors.  If the entity doesn’t cover you, make sure you talk to your broker about getting a separate policy.

Increasingly, physicians are employing or contracting with nurse practitioners to help handle the volume of patients and to bring in additional revenue.  Experts predict this trend will continue to grow as more and more previously uninsured consumers enter the healthcare system.  The additional help from a nurse practitioner, physician assistant, or other ancillary provider can take some of the stress out of the day-to-day life in a busy practice.  But malpractice insurance policies often don’t include coverage for these employees or independent contractors.  And it’s never automatic.

Many insurance companies will add coverage for ancillary providers if they are included by name in the original application and only if they are employees – not independent contractors – of the physician or group.  It’s a good idea to discuss this coverage with your broker because each insurance carrier handles these situations differently.  During the course of the year, if a nurse practitioner is added or leaves your practice you should notify your broker of the change.  Some carriers will add coverage for free and some will charge an extra premium.  Others will not cover such exposure at all and may specifically exclude coverage for any licensed non-physician healthcare provider.

If your policy doesn’t cover this type of risk, you can buy a separate policy.  Many physicians require the nurse practitioner to purchase the coverage as a condition of employment.  When hiring an independent contractor you need to make sure they have their own policy and require proof of coverage before they see patients.  This can also create an exposure of vicarious liability for the corporation which needs to be addressed.

News stories of “Cyber Liability” are popping up every day in most industries.  Healthcare is no exception.  You have electronic files that include legal name, date of birth, social security numbers and more on all patients.  Because of the amount of important personal information that healthcare providers have from their patients, medical practices are even more vulnerable to cyber liability than other businesses.  Are you covered if a hacker breaks in to your computer system and steals vital information?  When a physician or employee loses a laptop they’ve taken out of the office does your malpractice insurance cover you?  Even if the information doesn’t get into the wrong hands there are rules and guidelines that must be followed to protect patients’ information if there has been a compromise.  Notifying patients of the problem is just one of many steps that can cost thousands of dollars and man-hours.  Talk to your malpractice insurance broker to find out if your policy includes any coverage for this risk.  Some carriers are beginning to add coverage up to a certain limit for cyber liability but the limits are often too low.  You can increase the limit up to $1,000,000 for additional premium.  If your policy doesn’t include this coverage you should buy a separate policy.

With the U.S. healthcare reform and implementation of the Affordable Care Act the federal government is focused more than ever on finding Medicare and Medicaid billing errors and HIPAA violations.  Physicians, medical groups, and hospitals have been the targets of Recovery Audit Contractors (RAC) working for the Centers for Medicare and Medicaid Services (CMS).  These contractors have recovered billions of dollars from billing errors and overpayments.  Even if the errors are unintentional practices are faced with repayment of funds and severe fines and penalties.  Would your practice be adequately covered by a malpractice insurance policy for this type of exposure?  Probably not.  Again, some companies are starting to include coverage for RAC audits, HIPAA violations and the resulting fines or penalties, but at a low limit.  You need to talk to your broker about increasing the limits or purchasing a separate policy if you don’t have this coverage.

There are several national insurance carriers that offer coverage as a package policy for cyber liability, RAC audits, HIPAA violations, and loss of data.  The liability limits are usually $1,000,000.  The cost for these packages is usually very reasonable and the coverage is an important part of managing the risks of a medical practice.  You cannot purchase this type of coverage directly on your own.  Ask your broker to get you a quote and help you apply.

The experts at eQuoteMD are qualified to discuss the details of these risks and to help you find the best way to protect yourself and your practice.  We provide doctors with insurance solutions for every specialty and every state.  We have access to many “A” rated companies providing medical malpractice insurance and other professional liability insurance for exposures not covered in a malpractice policy.  Give us a call or submit your information online to learn more.

1. What type of policy are you buying and what are the long term implications of each?

What type of policy do you need? Occurrence or claims made? If you are starting a private practice for the first time, which type of coverage is best for you? While both will keep you equally protected, each type has its advantages and disadvantages and will affect your cash flow at different times throughout your practice. Make sure you think about things like the cost of the tail coverage, the portability of coverage and premium comparison for cash flow in the first 5 years.

 2. Underwriters are people too!

Underwriters work at every insurance company and their job is to do two things: first, to decide whether or not to insure you and second, to determine your premium. When you turn in an application, make sure it is as complete as possible and written legibly. Also make sure to attach all the documents requested on the back of the application. Most importantly, be straight forward, especially when it comes to your loss history. In most cases, official loss history from your previous carriers is required by the underwriters anyway. The underwriters’ will look at dozens of applications every day and ultimately they determine your premium. They must determine the risk a practice presents to the insurance company based on just a few documents and the more information they have, the better they can do their job. A more happy and informed underwriter is a more flexible underwriter.

 3. Your broker is your friend.

Think of your broker as your advocate who works on your behalf to secure the lowest premium and who can help get you what you need for your practice. Brokers do not work for a specific insurance company; rather they work on your behalf to find you the best rates possible. It is important that your broker knows as much about your practice, procedures and prior as possible in order to navigate the market and find the carrier that will serve your needs the best.

4. You aren’t the only one who needs coverage!

Don’t forget about your Nurse Practioners, Physician Assistants or your corporation. All of these can be sued if something happens in your practice. If you have NP’s, PA’s or other ancillary providers, make sure they are getting covered too! Corporations can also be sued, so make sure your corporation is covered too! The next decision you will have to make is whether or not these entities will have separate or shared limits of liability. This means will both you and your NP share $1,000,000 worth of coverage in a claim, or will you each have $1,000,000 individually when a claim comes in?

5. Use a reputable insurance company!

Make sure the medical malpractice insurance company is financially strong with the probability of being around if you have a claim. Contrary to popular belief, you do not need to be an accountant to have an understanding of your carrier’s finances. Most carriers release an annual report and the NAIC provides financials for most carriers online. Your broker can help you understand the different financial strengths and weaknesses between carriers. Be sure to ask if your carrier has reinsurance, which is in essence insurance for the insurance company to protect against unexpectedly high losses. Does the insurance company, or the reinsurance company have an AM Best or Demotech rating? But it isn’t ALL about finances. It is also important to work with carriers (and brokers) with a long track record of doing the right things for the physicians they insure. At the end of the day, honesty and integrity on the part of both your broker and the carriers he or she represents, should be one of your biggest factors when making a decision before you purchase your next medical malpractice insurance policy.

Now add 32 million previously uninsured patients looking for healthcare to that scenario – how will doctors keep up with the demand?  And where will patients find care if doctors can’t keep up?

Where is this demand coming from?
Since the implementation of the Patient Protection and Affordable Care Act signed into law in 2010, many healthcare experts have been warning of an impending physician shortage in the U.S.  In fact, due to the increasing number of baby boomers reaching Medicare age, the shortage was predicted before Obamacare ever came along.

Medicare officials expect enrollment to grow by 40% or more by 2025 because of the aging U.S. population.

According to a census performed by the Federation of State Medical Boards in 2010, there are 850,000 physicians licensed to practice medicine in the U.S.  A percentage of those are no longer practicing but still have an active license.

The Association of American Medical Colleges (AAMC) reports that we will have a shortage of 90,000 physicians by 2020 growing to 150,000 by 2025. About half of the void will be in primary care physicians.  Just as the number of patients is increasing, fewer and fewer young people are choosing the medical profession – especially primary care.  Those that do choose to go to medical school are specializing.

Where have all the general medical practitioners gone?
There are several reasons for this shift, but it’s mostly financial.  Med students typically graduate with the burden of a great deal of debt.  Student loans take years to pay off, and so, students want to maximize their earning power by going into the higher paying specialties.  According to a 2010 Medical Group Management Association (MGMA) study, primary care physicians make about half of what their colleagues make practicing in a higher risk specialty.

For many, lower incomes + higher volume of patients + rising cost of medical liability insurance + the stress of managing a private medical practice = a lesser quality of life for the primary care physician and that fact is working against any significant growth in this area.

Besides a heavier patient load for physicians, what’s the big deal?
The overall quality of healthcare is at risk.  More patients and fewer doctors means people will have to wait a lot longer to see their physicians – if they get to see them at all.  A shortage of doctors could mean a lower quality of care due to the pressures on physicians to see more patients and spend less time with each one.

Primary care physicians are already calling on Nurse Practitioners to help, but in the next decade we will see an increased amount of responsibility given to ancillary providers such as Nurse Practitioners, Physician Assistants, and Medical Assistants – responsibilities for which they are often not trained.  This has physician and consumer groups worried.

How does Affordable Care Act (ACA) address the problem of physician shortage?
Reimbursements – The ACA has includes increases in reimbursements to primary care physicians for Medicare and Medicaid patients in 2013 and 2014. It is designed to help better compensate current physicians and encourage med students to reconsider their career path although many physicians believe it’s only a temporary fix.

Repayment Assistance – Student loan repayment assistance is another way the ACA is addressing the physician shortage.  Newly trained doctors that agree to practice in medically “underserved” areas will be able to get funds to help pay back as much as half of their med school loans.  The underserved areas are usually inner cities and rural communities that have a difficult time attracting new doctors. The hope is that this assistance will increase the number of students entering into med schools.

Ancillary Providers – Although not part of the ACA, many see the expanding role of Nurse Practitioners, Physician Assistants, and Medical Assistants as a significant part of the solution.  There is currently a push to train these providers to do more than they are traditionally allowed.  With increased education and training, ancillaries can help a busy physician treat more patients.

How will the Affordable Care Act affect my medical malpractice insurance?
The challenges of the impending physician shortage will have an impact on physicians’ medical malpractice exposure.  Medical Malpractice insurance carriers are always concerned with the number of patients that physicians and hospitals see because the risk for a malpractice suit is increased by the volume of patients.

Less time spent with individual patients can lead to more mistakes or undiscovered problems, especially for family practice physicians.  Health professionals need to make sure they have a quality physician malpractice insurance that will cover the risks involved in the continuously changing practice of medicine.

Contact the consultants at eQuoteMD to compare medical malpractice insurance rates from multiple carriers.

• Physicians and other healthcare providers seem to fear each and every new provision as it’s unveiled and are anxious about how to implement the requirements placed upon them.
• Hospitals are trying to stay ahead of the game (and their competitors) by forming Integrated Health Systems and Accountable Care Organizations, and purchasing physicians’ private practices.
• Consumers are attempting to navigate the system to take advantage of improved health insurance coverage or to obtain it for the first time.
• Businesses of all sizes are looking for interpretations of what the law says about employee benefits.
• Health insurance companies are evaluating in what ways they will participate and what that participation (or lack of) will mean to them in the future.
• States are trying to decide if they will accept federal money to expand Medicaid and Medicare coverage within their borders.

No matter who you are or what you think of healthcare reform, the changes in the ACA are going to affect you and there are more on the way.

Protecting Consumers
Most people aren’t aware that since President Obama signed the ACA into law in March of 2010, over 30 provisions have been implemented. The initial items were put into place throughout 2010 and were focused heavily on protecting healthcare consumers. These protections put the greatest amount of pressure on health insurance companies by limiting rate increases, restricting pre-existing condition clauses for children, regulating annual and lifetime payout limits, and mandating an appeals process for denied claims. Business owners are feeling that pressure too as they see increases in health insurance costs for employees. Along with consumer protections, the ACA also includes provisions for improving the quality of healthcare and lowering the cost.

Improving Quality
While many wonder how some of these quality improvements will be funded long-term, there is no doubt that consumers will benefit from them. Providing tax credits for small businesses, free preventive care such as mammograms and colonoscopies, prescription drug discounts of 50% for seniors, and physician and hospital incentives for their use of electronic health records systems are all costly pieces of the overall plan. In fact, the federal government has promised billions of dollars in federal funds to help rollout and enforce the guidelines of the ACA. In addition to new consumer protections, improved quality, and reduced costs, the act allows for more access to affordable care, which is geared mainly toward uninsured consumers.

Increasing Access
People who have had trouble getting health insurance and access to affordable treatment in the past include young adults forced off of their parents’ insurance, individuals denied coverage due to a pre-existing condition, and early retirees compelled to spend retirement savings before meeting the age requirement for Medicare. The ACA addresses each of these issues through state and federal programs designed to ensure that virtually no one is unable to receive care. It is estimated that more than 30 million previously uninsured Americans will enter the U.S. healthcare system by 2015. Already facing a physician shortage, this increase in healthcare consumers will definitely put a strain on physicians, medical groups, and hospitals all across the country.

One way the ACA attempts to address the physician shortage is by giving incentives to increase the number of physician assistants, nurse practitioners, and primary care doctors. Incentives include scholarships to encourage medical students to consider primary care as a specialty and to practice in underserved areas.

What Comes Next?
Obviously a great deal of the ACA has been implemented over the last several years, but there are more changes on the way. In 2013 we will see expanded funding for free preventive care for those who qualify for Medicaid as well as increased coverage for children who do not qualify. In physician offices, probably one of the most talked-about provisions is “Payment Bundling.” This is a program designed to encourage primary care doctors and specialists, hospitals, surgery centers, and other providers to work together to charge a flat rate for an “episode of care,” rather than the fragmented billing in place now. Bundling is supposed to control costs for Medicare and Medicaid while improving the quality of care for the patient. Many physicians and administrators see this as a challenge because traditionally these groups have not worked well together. Communication among the different entities has not been easy, and often they are in competition, making it difficult to trust one another.

In 2014 and 2015 Consumer protections again will focus on health insurance companies by prohibiting denial of coverage or the charging of higher premiums based on sex or any pre-existing condition and also completely eliminating annual payout limits. The provisions will make it impossible for insurers to individually underwrite policies, making carriers nervous.

The establishment of the “Health Insurance Marketplace” will make it possible for individuals and small businesses to have more choices for affordable insurance than ever before. The “transparent” nature of the Marketplace along with price regulations promises coverage when an employer doesn’t offer any. The details of exactly what the Marketplace will look like are not clear. In addition, the ACA timeline provides tax credits for consumers, increased tax credits for small businesses, and more funding for Medicaid. And don’t forget the requirement for every American to obtain health insurance.

Also on the subject of transparency, the ACA “Sunshine Rule” was recently announced by the Centers for Medicare and Medicaid (CMS), which requires manufacturers of drugs and medical devices or supplies to report payments to healthcare providers. This rule is intended to avoid conflicts of interest that may occur in these relationships and will begin on August 1, 2013.

One physician-focused topic is the provision coming in 2015 that will tie payments to quality of care. The emphasis will be on higher quality care rather than on volume of patients. While no one would argue with the logic, many providers are concerned about the method of measuring “high quality care” vs. “lower quality care.” The language in the ACA seems vague at this point. You can keep up with the ACA changes on the timeline found on the government’s healthcare website.

How are Physicians Affected?
Doctors are concerned about the changes that have taken place and anxious about changes ahead. They are worried about increasing patient loads, decreasing revenue, and expanding government involvement in their practices. As providers face changes in the healthcare system, they often experience changes in exposure to risks associated with medical malpractice and as a result have questions about their medical malpractice insurance. There is certainly a higher possibility of a medical malpractice claim when seeing a higher volume of patients. But what new risks are involved when a physician joins an Accountable Care Organization? Who will purchase Tail Coverage when a physician becomes employed by a hospital? We see doctors adding new procedures and opening new locations to help increase their incomes; will a malpractice insurance policy cover any of these changes? Or is a separate policy necessary?

These questions and many others can be answered by the experts at eQuoteMD. Please contact us for solutions to your ever-changing insurance needs.

Here are 4 easy steps to help physicians along the process of applying for malpractice insurance.

Step 1: Gathering Your Information

Whether you are attempting to obtain medical malpractice insurance for the first time or looking to switch to a different company, the first detail needed is to pull out some basic information.  You can get a rate indication with very little information, but if you want a formal quote you’ll need to be prepared.

In most cases a broker can use your CAQH profile to get quotes from several companies, but if you haven’t completed that yet, you will need to provide the information that an insurance underwriter will want.

The insurance company is looking for:

• Declarations Page (face sheet) of your current policy
• Loss Run (claims history from current carrier)
• Copy of your CV
• Copy of your medical license
• Copy of your DEA license

If you don’t have all of these items handy, don’t sweat it, just acquire what you can for now.

Step 2: Exploring Your Options

Options, options, and more options. There are many options for medical malpractice insurance, which is a good situation for health care providers.  Though, all the options can also be confusing.  How do you know the best solution for your practice, specialty, and state?  Your decision should be based on more than just price, so this is where you have to do a little homework.

Depending on your state, there are anywhere from 4 to 10 or more medical malpractice insurance companies available.  Some of these companies specialize in specific medical specialties, some have better rates than others in certain geographic areas, some are risk retention groups, or mutual, or stock insurance companies.  Consulting with an independent insurance broker can help you sift through and find the type of company that meets your needs.

A good broker won’t pressure you but will help you narrow your search to a manageable number, make a recommendation, and then let you make the choice.  It’s a good idea to purchase your coverage through a broker rather than directly with the insurance company because he or she will be able to offer you choices again at renewal time and provide quality service throughout the year.

Step 3: Filling Out Applications

Physicians are often intimidated (or irritated) by the length and depth of a malpractice insurance application.  This can typically be avoided if your CAQH profile is complete and up-to-date.  Simply ask the broker to use that instead of the company application.  But if your broker doesn’t have the ability to use the CAQH, you will need to fill out the app., and sometimes more than one.

It doesn’t have to be a chore.  If you have an application that you’ve filled out previously, use it to help you complete the new one.  Most applications ask for the same information but it might be in a different order.  The easy questions are name, address, birthdate, social security number, medical license number, DEA license number, phone numbers, and email address – most of that you should have at your fingertips.

The more difficult information is the detail about practice plans, practice history, claims history (including dates, summary, and status of claims), current and previous malpractice insurance, education and training, and continuing education credits.  The insurance company wants to see the complete picture of the risk they are underwriting.

There are 2 very important points to consider when applying for malpractice insurance:

First, be completely honest.  Do not leave anything out or alter the truth in any way.  The underwriter will check the information, and if it is not accurate, coverage will usually be denied.  It could also come back to haunt you if you have a claim.  If there is anything false in the application the company can deny the claim and you are on your own.

The second significant point to remember is that the application is a snapshot of you, given to the insurance company underwriter.  The underwriters don’t normally meet physicians nor do they have the time to discuss background or ask questions about past history or future plans.

Make sure your applications are:

• Neatly written or typed
• Thorough and complete
• Concise providing explanations of any situation out of the ordinary

If you are unsure about anything on the application, ask your broker for help.  The broker is on your side, representing you.

Step 4: Choosing the Best Coverage

After you submit your applications along with the required documents, the broker will be able to get you the official quotes within a few days.  It could take longer, depending on the situation.  At this point, use the broker’s knowledge to help you make a decision.

Be sure to:

• Compare the policies, limits of liability, and coverage
• Consider the financial strength and type of company
• Look at the payment options
• Then choose the one that best fits your practice.

To put the coverage into effect, most companies will have you sign a “binder” and submit payment prior to the start date.  You can pay the entire premium in full or sometimes choose to pay monthly or quarterly with a 10 – 15% down payment.  The broker will have all the details and provide you with a Certificate of Insurance for proof of coverage.

While the application process may seem a bit daunting, it truly is imperative for physicians to be as thorough as they can. eQuoteMD helps eliminate part of this process by shopping the market for you and/or your practice. We make sure to tailor your coverage to your unique practice while saving money.

If you are interested in saving 20%, 30%, or even 40% on your medical malpractice insurance, request a quote online or call us today at (855) 857-8746.

Yes, this important coverage can be confusing, but your qualified insurance specialist is always there to help.  Organization is the key – making sure all necessary documents are kept in one place for easy reference.

In order to obtain medical malpractice coverage, the insurance carrier will ask you to complete a detailed application.  Historical and current information will be required, which includes:

• A current Curriculum Vitae (CV)
• A copy of your current medical malpractice insurance policy declarations page (if coverage is already in place)
• Copies of your licenses
• Detailed information regarding any claims or settlements you may have had
• Addresses of current and previous practice locations
• Information regarding your corporation (if you have one)
• Medical education and training specifics – medical schools, internships, residencies, fellowships, continuing education, etc.
• All of your previous medical malpractice insurance carriers, including policy numbers, effective and expiration dates, your retroactive date and type of coverage (claims-made or occurrence)

For your records, it is recommended that you keep copies of all of this, as well as your applications, certificates of insurance, policies, and any endorsements (including extended reporting, or tail coverage, if applicable).

All of this may seem quite daunting, but remember, if you keep all this information handy from year to year, and work with a qualified medical malpractice insurance specialist it will be easy – and you can keep your focus on medicine, where it belongs!

• What is tail coverage?
• How many years can a tail policy cover?
• When is tail coverage necessary?
• How much does tail coverage cost?

What is tail coverage?

The technical name for a tail is, Extended Reporting Period (ERP). It is actually an endorsement that is added to a medical malpractice insurance policy at the time of cancellation.  Tail coverage only applies to claims-made policies, not occurrence policies.  Since most policies written nationwide are now claims-made, it is important that physicians understand when a tail is necessary and the terms under which tails can be acquired (which is discussed in more detail below).

How many years can a tail policy cover?

This endorsement allows for claims to be covered for a specific period of time even though the original policy is no longer in force.  The period of time can be limited to 2, 3, or 5 years, up to as long as 10 years.  Or a tail can be indefinite or “Perpetual,” meaning there is no limit on the number of years claims can be covered.

When is tail coverage necessary?

Almost all claims-made policies include a provision for malpractice tail coverage.  When a claims-made policy is cancelled, or not renewed by a physician or group, the insurance carrier will offer a tail quote. These quotes for tail coverage must be accepted and paid for, or declined within a limited period of time, such as 20 – 30 days (or more) from the cancellation date.  The coverage is optional and can be expensive, but it is highly recommended that physicians choose to purchase the endorsement to protect themselves from potential claims that may arise as a result of prior acts.

It should be noted that most policies provide a free tail for retirement, death, or disability.  It is imperative that you know what the requirements are for these free tails.  You should not assume that it is automatically included in every policy.  Speak to your broker about the specifics and read your policy.

Another caveat to be aware of is that the medical malpractice insurance companies usually do not offer tail coverage if a policy is cancelled for non-payment.  So if you are making a change, notify your insurance company in writing so that you do not lose this option.  If you let it lapse and find out you need to purchase a tail, it might just be too late.

How much does tail coverage cost?

A good rule of thumb for estimating the cost of tail coverage is to double the amount of the premium at the time of cancellation.  The typical price ranges from 150-300% of the underlying premium, not including discounts.  Some companies charge a higher rate if the losses have been severe.  The formula used by each medical malpractice insurance company is unique and will be clearly stated in the policy language.  If it isn’t spelled out completely, contact a broker or insurance company representative to get the details.

When looking for a new medical malpractice insurance policy, make sure you know what the provisions for tail coverage are and what the cost will be.  eQuoteMD representatives are able to assist and educate physicians as well as save money on tail coverage.   Start by contacting eQuoteMD today and requesting a free, no-obligation quote.