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Got an extra $1.4 million to spend? You might need it if you don’t have cybersecurity liability coverage.

Did you know that it costs roughly $1.4 million to recover from a cyberattack? The cost of lost productivity, damage to your practice’s reputation, and service disruption, among other expenses, add up quickly(1). Responding to cyber incidents can be time-consuming too, depleting resources and taking your focus away from patient care.

Data transmission permeates the healthcare industry. While we assume the obvious data breach potential occurs when transmitting PHI (protected health information) data from one provider to another (physician to hospital, for example), even seemingly innocuous DME (durable medical equipment), such as insulin pumps, pacemakers, and infusion pumps, carry the threat of data theft and exposure(2).

CARE Professional Liability Association offers liability policies to protect policyholders against evolving cyber threats. A cyber liability policy covers many aspects of potential risk(3):

  • Privacy or security breach mitigation, including the cost to provide 12 months of credit monitoring and identity restoration services to affected individuals
  • Data restoration, recovery, or replacement costs when data is damaged, corrupted, or destroyed as a direct result of a network security incident
  • Income loss and business interruption expenses
  • Ransom payments to persons reasonably believed to be responsible for a cyber extortion threat
  • Brand loss: loss of net profit incurred as a direct result of a breach notification or adverse media report following a privacy/security breach
  • Claims alleging negligent acts or errors in electronic or print media that results in infringement of copyright, trademark, domain name, or plagiarism
  • Claims alleging liability for failure to prevent or hinder a privacy/security breach
  • Investigations and other civil proceedings brought by government agencies for the enforcement of privacy regulations
  • Written demands for assessments made by acquiring banks or credit card associations due to non-compliance

Contact us today. We are serious about data security and patient privacy. We can help you mitigate cyber security risks before they affect your practice.

Footnotes

  1. https://healthitsecurity.com/features/what-is-cyber-insurance-for-healthcare-organizations
  2. https://www.healthdatamanagement.com/opinion/how-cyber-risk-is-affecting-medical-professional-liability
  3. https://gallery.mailchimp.com/2e65dcb86f6030c0d5aba0903/files/5b57d519-55f8-4271-8ba6-215aa7ae0d6d/CARE_RRG_Agent_Cyber_Flyer_10.17.pdf

Professional Partnership Announcement: CARE and MGIS

We are excited to announce our newly formed professional partnership with Medical Group Insurance Services (MGIS). For more than 50 years, MGIS has specialized in creating a continuum of coverage that addresses the unique income replacement needs of physicians and dentists. Working with world-renowned underwriters at Lloyd’s of London, MGIS has added a layer of coverage for high-earning physicians and dentists: MGIS incomeprotect® | HIGH LIMITS maintains the integration of key provisions crucial to protecting high-income earners.

This new disability insurance program is available exclusively to our members.  As a physician’s income grows, finding disability insurance that adequately replaces income when a disability occurs is difficult and expensive. This insurance program solves this problem with features and pricing exclusive to association members. The coverage is provided by the prestigious Underwriters at Lloyd’s of London, through their U.S. partner, MGIS, who has delivered income protection solutions to doctors nationally for more than 50 years.

You can choose from these benefit options:

Lump Sum

  • $250,000 with a one-year elimination period
  • $500,000 with a one-year elimination period
  • $1,000,000 with a one-year elimination period

This program has other advantages that you won’t see on other offerings outside of this exclusive program:

  • Easy Enrollment. Simplified Issue (only three questions about missed work and recent medical needs; no exams are required).
  • Best Definition of Disability in the Industry. You are considered disabled if you cannot perform the actual procedures you have performed over the past 12 months. This is crucial to ensuring you qualify for benefits.

You may pre-enroll by clicking here for easy electronic enrollment. To make enrollment even simpler, you’ll want to have the following available when you log in:

  • Your NPI or SSN
  • Total earned income from all practice settings

Please send questions to HighLimitsFAQ@MGIS.com.

Contact us today if you have questions about this exciting new service offering with our latest professional partner.

Tools and Resources to Mitigate Provider Burnout

Any career that involves connecting with other people is prone to professional burnout. It is very difficult to maintain a sense of self while caring for and supporting others. Increased administrative and productivity-based demands placed on physicians has led to worsening effects of physician burnout.

Increases in burnout rates can lead to negative impacts on both healthcare organizations and providers, including(1):

  • Emotional exhaustion
  • Depersonalization/distancing behaviors
  • Feelings of ineffectiveness
  • Lack of personal accomplishment
  • Feeling overextended
  • Unwilling to sympathize/empathize with patients
  • Unable to meet workplace demands
  • Diminished quality of care
  • Poor patient satisfaction
  • Increased medical errors and patient safety events
  • Decreased retention/increased turnover
  • Substance abuse/suicide

Any one of these elements can expose organizations to potential medical liability claims. Whether the issue is a serious medical mistake, or simply a perceived wrongdoing by a patient, the risk is inherent in any medical practice. While it may seem unreasonable to completely eliminate career burnout, there are tools to help both providers and support personnel help mitigate the risk associated with these issues. With limited investment, organizations can make effective and impactful changes to address and prevent burnout.

One of our professional partners, SE Healthcare, developed a video series(2) about physician burnout. The videos take a look at the range of negative impacts to the healthcare industry for both providers and patients (including financial, clinical, resources, errors, etc.). More importantly, each video provides suggestions on negating the effects of physician burnout at your practice.

SE Healthcare also offers a comprehensive Physician Burnout Prevention Program(4). This program uses a three-pronged approach to address and minimize physician burnout within your organization. The three pillars of the program include:

  • The Assessment: A confidential, short survey focused on identifying causes of burnout; uncovers where your physicians are on the burnout continuum; identifies top causes of burnout
  • The Dashboard: Provides actionable data to address burnout; includes valuable organizational and work-unit-level data available to leadership; offers individualized reports for physicians
  • The Enrichment Center: Curriculum-based learning module; features a complete library of exclusive materials; also includes a video training curriculum

A healthcare provider typically operates in a team-based model, working closely with other clinical office staff. However, this still puts physicians in a silo of sorts, in that daily interaction with other physicians is minimal. This isolation, coupled with the fact that vocational burnout still carries a negative stigma, prevents those who could see the signs and symptoms be comfortable enough to have conversations about workplace stressors(3). The program provides individual training and education on recognition and management of burnout, both within yourself and your colleagues. The program even offers tips on how to approach a colleague in distress.

Uncertainty about whether anything can be done to impact burnout often creates a barrier to action. Despite this trend, there are a number of key actions organizations can take to reduce burnout. SE Healthcare’s program provides leadership with a communication tool to listen to physicians and help uncover underlying issues. The program equips providers with the tools and skills to relieve stress and reduce levels of burnout, thus leading to significant benefits for both the organization and the provider.

Contact us today. We can help you uncover your risk potential based on your current level of organizational burnout. We can also help you easily and immediately implement the Physician Burnout Prevention Program in your practice.

Footnotes

  1. https://www.apaservices.org/practice/update/2018/01-25/mental-health-providers
  2. https://www.youtube.com/watch?v=RsN7vShw7UA&list=PLcE1V4co1oBYmhL4nIrHFkOEVUXL41CN3
  3. https://www.sehealthcarequalityconsulting.com/2019/12/19/using-our-eyes-and-ears-how-leaders-can-listen-to-physicians-to-help-detect-burnout/
  4. https://www.sehealthcarequalityconsulting.com/physician-burnout-prevention-program/

Another Strong Partnership Development: CARE and HealthShare

We are excited to announce our partnership with HealthShare, an association with more than 40 years of experience in the healthcare industry. They provide a proven, non-insurance solution to the high cost of paying for healthcare.

HealthShare is managed by SHMI, Inc., which assists its clients in improving healthcare services and reducing costs. Their mission is to facilitate access to quality healthcare at affordable prices. The HealthShare model is centered on a commitment to healthy living and a cost-sharing model of medical care. Learn more about this model here.

The partnership between CARE and HealthShare serves to benefit our clients, agents, and brokers, as it provides a workable solution for you, your peers, and even your clients if they are looking for affordable, high-quality alternatives to traditional health insurance options.

To see more details about how this program works, please click here. Or complete this form to be contacted by a HealthShare professional.

Additionally, you can Contact us at CARE today. We can show you how this new partnership offers benefits to you and your clients.

Malpractice Prone: Do Providers Have Common Traits?

Is there a set of traits that identify malpractice claim-prone providers? Or at least that identify complaint-prone trends? A recent study(1) presented findings that may help industry experts identify and mitigate future risk based on historical data. For example, in that study, approximately 1% of all physicians accounted for 32% of paid claims. Additionally, the risk of recurrence increased with the number of previously paid claims. For example, providers who already had three paid claims had three times the risk of incurring another. In other words, they have a 24% chance of acquiring another paid claim within two years. 

Generally speaking, male physicians over age 35 were in the greatest risk category. Additionally, these specialties were at higher risk for litigation(2):

  • Neurosurgeons
  • Orthopedic Surgeons
  • General Surgeons
  • Plastic Surgeons
  • Obstetricians/Gynecologists

However, the issue isn’t simply a matter of being a male neurosurgeon who graduated from medical school at least five years ago. If other factors can be isolated, then providers and healthcare organizations need to develop programs to reduce the likelihood of adverse incidents that lead to malpractice litigation.

Algorithms and risk assessments are already in place for insurers, with underwriters and actuaries studying data and trends every day. Actuarial analysis for liability coverage creates specific, cost-aligned policies and programs. But data isn’t a person. And malpractice is not always a measurable action. A patient’s propensity to sue is based on many factors, not the least of which is their perceived relationship with their provider(3).

While an evidence-driven trend may exist, the real question is how to harness this data into actionable future risk mitigation. Does the defense of malpractice suits only play a reactive role in the healthcare industry? Certainly, more research is needed to determine whether statistics can be used for quality improvement efforts, including counseling, training, and supervision.

Contact us if you are interested in learning more about how actuarial analysis aids us in forecasting your practice’s litigation potential.

Footnotes

  • https://www.nejm.org/doi/full/10.1056/NEJMsa1506137
  • https://www.physiciansweekly.com/examining-proneness-to-malpractice-claims/
  • https://www.nytimes.com/2015/06/02/upshot/to-be-sued-less-doctors-should-talk-to-patients-more.html

Reimbursement Rates: Don’t Settle for Less

As with anything in the healthcare industry, reimbursement rates are constantly in flux. New providers are often caught between the urgency of signing contracts in order to expand their patient base and the time it takes to negotiate fees(1) that accurately reflect their experience and talent.

Lack of experience can definitely be a liability when it comes to negotiating power. Results are what providers need to prove their value to insurance networks. However, providers can’t get results without being part of a network. Lacking results, a provider’s next best asset is data. Do some homework on your available network options, also taking into consideration providers in both similar and parallel specialties. A strong medical network works just as a strong social network does: it’s who/what you know and who/what they know.

Reimbursement rates are influenced by more than a single physician’s skill. The entire office staff is a reflection of what the physician is worth, including any advance practice providers (APPs), such as PAs and APRNs(3), that support the registered physician. The office’s reputation, clinical quality, professionalism, and patient satisfaction are all measurable components that can help you make an argument for increasing your reimbursement rates every time your contract is up for renegotiation. Keep in mind that insurance companies have their own competition to ward off, and every provider that they can depend on in their provider counts is an asset in their marketing arsenal too.

Our partner, SE Healthcare, has published an insightful piece, titled “Positioning Your Practice to Negotiate the Reimbursement You Deserve from Payers.(2)” This ebook explains strategies to uncover missed opportunities and grow your revenue by maximizing reimbursement rates.

Contact us(4) today so you can take advantage of the benefits of your CARE membership to utilize the expertise of our partner, SE Healthcare. They will help you assess your current reimbursement rates and formulate a strategy to maximize your current reimbursement contracts.

Footnotes

  • https://blog.evisit.com/how-to-negotiate-higher-physician-reimbursement-rates
  • https://www.sehealthcarequalityconsulting.com/download-ebook-positioning-your-practice-to-negotiate-the-reimbursement-you-deserve-from-payers/
  • https://www.physicianspractice.com/article/pas-deserve-direct-reimbursement-their-services
  • https://care-ins.com/contact/

The Fine Line Between Supervision and Accountability

In an earlier blog, we discussed the Swiss cheese model as it relates to risk management in healthcare. Today’s article takes a deeper dive into the element of supervision in that model, especially as it relates to Advanced Practice Providers (APPs). These APPs are generally defined(1) as professionals with advanced training, such as Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs). A practice itself might employ APPs or managing physicians may simply have supervisory responsibilities due to contractual arrangements directly with APPs or with facilities that use APPs. In either case, APPs are able to practice independently of physicians(2).

As this video explains, APPs are essential to professional practices in that they assist with provider workload and help keep costs down. Any office that is inundated enough to outsource some of its workload to APPs runs the risk of miscommunication, inadequate care, adverse events, and subsequent litigation. This resulting litigation could potentially involve both the supervising physician and the APP. That is why it is immensely important to outline the scope of the APP’s responsibilities, taking in to account their experience and ability to make judgement calls in the absence of the supervising provider.

The RiskFit helpline, managed by OmniSure, serves as a vital resource to CARE Professional Liability Association members. The professionals that operate this helpline can answer questions about the following:

  • Developing a collaborative provider/APP agreement
  • State-specific laws regarding APP scope of responsibilities
  • Hiring protocols
  • Proper risk reduction audit procedures
  • Capturing patient satisfaction metrics

All of these aspects of APP employment need to be carefully planned and documented to avoid potential litigation issues. The partnership between CARE and OmniSure puts a wealth of expertise at your fingertips to help you fill the holes in your risk management plan so that it does not turn into a block of Swiss cheese.

Contact us today if you have questions about whether your plan provides coverage for the APPs in your practice. Laws vary based on the state where you practice(2), and are constantly changing. Put our expertise to work for you in designing a coverage plan that perfectly suits your business.

Footnotes

  1. https://www.forbes.com/sites/realspin/2017/03/16/advanced-practice-providers-are-key-to-americas-healthcare-future/#2c8596759985
  2. https://www.studergroup.com/resources/articles-and-industry-updates/insights/august-2016/optimizing-the-value-of-advanced-practice-provider
  3. https://www.healthleadersmedia.com/clinical-care/aprn-and-pa-scope-practice-rules-draw-fire

Risks of an AMA Discharge

The hospital term “AMA” usually refers to when a patient decides to leave the hospital and the care of the attending providers against their medical advice. The AMA designation is used so that future healthcare providers are aware of how the patient/provider relationship came to an end while the patient was hospitalized. This serves to legally shield the attending doctor and hospital from liability if a patient gets ill or dies as a result of the discharge(1).

Patients most often opt for an AMA discharge for the following reasons:

  • Cost
  • Lack of insurance
  • Disagreements over standard of care
  • Errors or mistakes in administering care
  • Previous bad experiences
  • Fear of contagion
  • Wait times are too long
  • Personal reasons

Patients who discharge with the AMA designation definitely pose a litigation risk(2). Without proper treatment and monitoring, these patients are left to make major medical decisions without the advice of a professional. And further, if a patient is in the hospital in the first place, it is likely that they cannot properly treat themselves at home for the same illness/injury. Should the patient’s case come to litigation, the outcome will hinge on what was said, done, and documented when the patient left the hospital, especially the conversation about the AMA designation(3).

Prevention is key when it comes to managing whether a patient even considers an AMA discharge in the first place. The best course of action for a hospital or provider is to diffuse any potential situations before they escalate into an AMA discharge request(4). This is best accomplished by utilizing patient advocates to mediate between the patient’s concerns and the hospital’s directives. This method ensures that both parties are heard and understood by an objective source. Plus, the likelihood of achieving a mutually agreed upon plan of care (and hence, the quality of the care itself) increases when all parties’ concerns are addressed.

Contact us today to determine if your liability coverage is sufficient if your practice incurs an AMA-related lawsuit.

Footnotes

  1. verywellhealth.com
  2. the-hospitalist.org
  3. thesullivangroup.com
  4. today.mims.com

Losing a Provider: Ensure Proper Recordkeeping

Providers change practices every day, so it’s important to have a policy in place to provide guidance for patient care and records retention. A formal policy could include the following elements(1):

  • Notify patients of provider’s departure (state laws vary as to whom the responsible party is for this notification, as do details of what to include in the notice; check with your legal counsel for specifics of your situs state)
  • Instructions for contacting departing physician (if still practicing medicine)
  • Contact information at existing practice for reassignment to another provider
  • Instructions for requesting medical records

Most importantly, the policy needs to be communicated to existing staff so that there is no disruption in continuity of care.

Managing the affected patients is only one aspect of provider departures. When it comes to medical records(2), a policy should specifically outline these elements:

  • Exact end date of departing provider
  • Specific party responsible for transferring and archiving records
  • Which party is responsible for contacting affected patients
  • Updating new provider with relevant medical history of patients

Don’t rely too heavily on electronic recordkeeping, though. Nothing beats the trained eye of a professional. Electronic health record (EHR) systems(3) are only as thorough as the data that a person has entered into the system. Mistakes and oversights are just as likely to happen on a computer screen as they are to happen on paper. While EHRs save time, space, and headaches, they might also be managed with great care upon a provider’s departure from one practice to another. Fastidious record keeping is even more important in the event of retirement or death.

If you would like additional guidance in developing these types of policies for your practice, look to other sources, such as HIPAA guidelines, payer contracts, and federal programs such as the Centers for Medicare & Medicaid Services (CMS) (4).

Contact us today. We can help you formulate these types of policies to ensure that they mitigate your risk from future litigation.

Footnotes

  1. ECRI.org
  2. ama-assn.org
  3. physicianspractice.com
  4. cms.gov

CARE Joins Forces with Digital Surgery

At CARE, we strive to partner with other industry leaders who can bring high-quality, meaningful contributions to our members. In the spirit of that goal, we have joined forces with Digital Surgery, a leader in simulation training, surgical video management and storage, and automated surgical analytics. Digital Surgery’s award-winning mobile application Touch Surgery houses more than 200 surgical simulations across 14 specialties, and its content library is continuously growing. The company’s latest offering, Touch Surgery Professional, offers secure video storage and management, automated analytics, annotation tools, and sharing capabilities for peer review and training purposes.

Together, CARE and Digital Surgery offer unique benefits to members that make coverage through CARE an even more invaluable investment. For example, qualified* Touch Surgery Professional (TS Pro) members can receive up to 10% off their CARE insurance policy. Another benefit of combined membership is knowledge exchange, which grows exponentially as members exchange ideas, solutions, and best practices via the TS Pro platform.

Digital Surgery’s goal is to utilize digital technology to empower surgeons and surgical teams all over the world to create safer, better outcomes. Like many of us in the healthcare field, Digital Surgery wants its tools to help increase knowledge and improve the delivery of surgical care across the globe. 

Contact us today. We can help you maximize your membership through our collaboration with Digital Surgery. Working together, we bring these industry-leading tools and resources to you to optimize your and your team’s training, shared learning, and performance in the operating room. 

*Qualified Digital Surgery members are those who have signed up for the Touch Surgery Professional offering, available for $999 for an annual subscription. This subscription provides access to (1) all of Digital Surgery’s publicly available CG and video-based simulations, (2) Digital Surgery’s video upload and storage platform, with automated analytics for selected procedures, (3) tools to annotate videos; add instruments, notes, and assessments; and to share with colleagues or trainees for peer review or training purposes. A minimum of 50 surgical videos are required to be uploaded annually to the Touch Surgery Professional video platform in order to remain eligible for the CARE insurance premium discount.