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Details about the latest relief package

The latest iteration of the COVID-19 relief package from Congress has taken many turns, and it hasn’t even been finalized yet. Some points of contention include:

  • Hospital bailout money
  • Medicaid protection funds
  • Liability protections for health care professionals

Hospital funding is tricky, as well as a moving target. While elective procedures all but stopped in the spring, some hospitals have reported larger than expected earnings during the first half of the year. The current proposed bailout amount is floating somewhere around $25 billion, and while that may seem like a huge infusion to keep hospitals afloat, the industry’s original request was $100 billion.

Medicaid is also tricky, in that it’s supposed to be largely funded by individual states. But when certain states are on the verge of bankruptcy (and it’s a matter of opinion as to whether those reasons are entirely COVID-related), who but the federal government can provide a large enough bailout? The current bill is requesting roughly 12 – 14% in matching federal dollars. One main caveat in this federal bailout is that states cannot cut enrollment numbers while they are taking in the money from the federal government.

On the liability side for hospitals and health care professionals, the bill seeks to provide protections against COVID-related lawsuits. Further, the bill also proposes capping allowable damages if in fact those protections aren’t enough. But neither immunity nor a cap can literally prevent someone from filing suit. And fighting a suit, even if it is eventually dismissed, is costly. Not only in dollars, but in time, morale, and reputation. No one wants this burden when trying to triage patients, but it’s a sad reality for most in the health care industry.

Not all of the potential liability is related to COVID-19, though. Elective procedures that were canceled might have long-term effects on patients, even if they never had the virus. Other potential risk areas include employee protections (ranging from lack of PPE to burnout to overtime pay), misdiagnoses, ratio of personnel to patients, and equipment shortages, to name a few.

As with any legislation, this is largely a waiting game. If you haven’t already, educate yourself about the relief bill. And call your representative so that your voice is heard. Then call your medical liability carrier to see how all of this affects you.

Contact us today. We can review your professional liability policy to ensure your coverage aligns with current mandates and guidelines.

Footnotes

  1. https://www.politico.com/news/2020/07/27/senate-coronavirus-package-hospitals-medicaid-383375
  2. https://www.jdsupra.com/legalnews/minimizing-medical-malpractice-90844/
  3. https://thehill.com/policy/finance/509438-stocks-close-down-as-congress-clashes-over-covid-19-relief-bill
  4. https://care-ins.com/

From Triage to Trial

Healthcare professionals working the front lines are faced with difficult decisions every day. Compound that with the COVID-19 pandemic, working around the clock, and worrying about their own health and safety. Basic triage decisions have evolved into heartbreaking shifts, with hardly any respite for those facing the onslaught day after day.

As is the norm in our litigious culture, what will follow is a wave of potential malpractice suits(1), some due to the triage decisioning process, and others because healthcare facilities lack basic supplies, such as face masks and ventilators. While it seems unthinkable to accuse a medical professional of making the wrong decision when they are putting themselves at great personal risk to treat so many others, it will happen.

The key to triaging patients during a global pandemic is consistency. It is paramount to determine – and stick with – clear, concise, specific policies that do not discriminate based on subjective criteria. A healthcare professional cannot simply decide if a patient is too old or too sick (based on other comorbid conditions) every time they triage a new patient. The clearer the guidance, the more objective employees can be. Follow up these decisions with proper documentation to ensure that guidelines were followed, and the documentation can serve as the collective memory, even once this pandemic has past.

There’s also the question of how to determine what a pandemic triage policy should be, when (hopefully), each of us will only go through something so impactful once in our lifetimes. For example, the next outbreak might not require such a large demand for ventilators, so how do we determine (and who decides) what is normal or expected?

In terms of prevention, healthcare facilities can support their personnel by addressing the anxiety and confidence dips that are normal during a global health crisis. Health care workers cannot calm and reassure the public when they aren’t being reassured themselves. The concerns of health care professionals can be summed up in five categories: hear me, protect me, prepare me, support me, and care for me(2).  

There is no clear way to end an article about an ever-evolving situation. So much is unknown and uncertain. The most important thing we as professionals in the healthcare industry can do right now is protect ourselves. And each other.

Footnotes

You’re a Specialist? You Need Specialized Coverage.

While a general practitioner is usually comfortable with basic medical liability coverage, specialty providers have specific needs and circumstances that merit special consideration. If you are a specialist, consider seeking malpractice coverage from a company that knows the specifics of your industry.

CARE Professional Liability Association, LLC offers the following types of specialty coverage:

  • Dental
  • Chiropractic
  • Pain Management
  • Medical Directorship
  • Bariatric Surgery

A CARE policy offers solid, affordable coverage to physicians from coast to coast. Our goals are to offer the lowest premium possible and tailored flexibility to meet a specialty practice’s needs. Some features of a CARE policy include:

  • Claims-made coverage
  • Limits available that meet or exceed state requirements
  • Death, disability, and retirement (DD&R) available
  • Coverage for multi-specialty groups
  • Ancillary personnel can be covered on a shared limit basis (subject to certain restrictions)
  • Special pricing for part-time, low-volume visits, low reads, deliveries, and surgery
  • Multiple deductible options available
  • Policy can be tailored to meet the specialty physician’s needs
  • Proactive risk management program included with policy
  • Installment financing available

According to a 2019 Medscape survey, approximately 59% of physicians who responded said they have been named in a malpractice suit(1). Given that statistic, providers need to carefully consider their liability coverage options. A robust policy is a substantial investment, but it can also save your practice from bankruptcy should you ever be involved in a malpractice claim. Policy costs vary greatly, depending on the type of medical professionals covered in the policy(2). This is one reason why you should partner with a risk retention group that understands the nuances of specialty practices. It’s an art and a science balancing coverage and cost, and experienced underwriters can develop a policy that provides you with the best solution.

Contact us today. Our underwriters understand the challenges of specialty practices. Put our years of experience to work for you.

Footnotes

Preparing Your Practice for Telemedicine Care

The COVID-19 pandemic has healthcare providers evolving their practices daily as protocols for diagnosing and treating the virus change so quickly. Telemedicine has become an effective means of triaging patients while limiting exposure for both patients and office staff.

The AMA(1) has issued a guide to quickly establishing a telemedicine offering at your practice. Some suggestions include:

  • Establish an implementation team
  • Review malpractice insurance policy
  • Evaluate payment guidelines   
  • Select third-party vendor to provide services
  • Ensure HIPAA compliance
  • Train clinicians, care team members, and schedulers
  • Set up telehealth space at your location
  • Determine documentation protocols
  • Ensure you receive advanced consent from patients for telemedicine interactions
  • Conduct proactive patient outreach to spread awareness of telemedicine offering

The Department of Health and Human Services(2) has issued guidance to health care providers who are new to providing telemedicine options to their patients. They have confirmed that covered health care providers will not be subject to penalties for violations of the HIPAA Privacy, Security, and Breach Notification Rules that occur during the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This notification does not affect the application of the HIPAA Rules to other areas of health care outside of telehealth during the emergency.

CMS (Center for Medicare & Medicaid Services)(3) has issued guidelines for Medicare and Medicaid patients. For private insurers, several healthcare companies have announced that they will make telehealth more widely available. Some are offering telehealth services for free for a certain period of time.

Contact us today. We can review your professional liability policy to ensure your coverage aligns with current telemedicine mandates and guidelines.

Please Note: Any communications relating to the impact of coronavirus/COVID-19 on insurance policies or healthcare protocols are not legal opinions, warranties, or guarantees, and should not be relied upon as such. We do not render legal advice or make coverage decisions regarding COVID-19 claims. Given the ongoing and constantly evolving pandemic situation, this communication does not necessarily reflect the latest information regarding recently enacted, pending, or proposed legislation or mandates that could override, alter, or affect existing insurance coverage. Please consult with an attorney for specific legal advice in this regard.

Footnotes

Important CDC Resources During the Pandemic

The CDC urges healthcare facilities and provider practices to assess their protocols to help prevent the spread of COVID-19. The CDC has provided the following resources to aid healthcare providers in these efforts:

Also be sure to keep the CDC Emergency Operations Center number readily available for emergency or urgent patient care assistance (not intended for use by general public): 770-488-7100. It is staffed 24 hours a day, seven days a week.

Contact us today. We can review your professional liability policy to ensure your coverage aligns with current mandates and guidelines.

Please Note: Any communications relating to the impact of coronavirus/COVID-19 on insurance policies or healthcare protocols are not legal opinions, warranties, or guarantees, and should not be relied upon as such. We do not render legal advice or make coverage decisions regarding COVID-19 claims. Given the ongoing and constantly evolving pandemic situation, this communication does not necessarily reflect the latest information regarding recently enacted, pending, or proposed legislation or mandates that could override, alter, or affect existing insurance coverage. Please consult with an attorney for specific legal advice in this regard.

Are You Prepared if the Coronavirus Knocks on Your Door?

With the coronavirus making landfall in the continental United States, is your staff prepared to handle potentially infected patients? All medical offices, no matter their size or specialty, should have an infection control and emergency preparedness plan in place. A solid plan, coupled with thorough screenings, can aid the healthcare community as a whole better manage this outbreak(1).

If you and your staff are not already familiar with the CDC’s educational site, now is the time to circulate that information, which can be found here: https://www.cdc.gov/coronavirus/2019-ncov/index.html(2). While a global epidemic can seem frightening, especially to healthcare workers, education is one of the best weapons you can provide your staff. Media reports, while helpful in disseminating information quickly, can also cause undue stress and panic among uninformed populations.

Proper resource management is essential for a healthcare practice during potential pandemics. For example, non-healthcare venues affect absenteeism at your practice. Consider how schools, childcare centers, and other business closings affect your staff. Be sure to work these contingencies into your emergency preparedness plan. Also give thought to how other local infrastructure, such as law enforcement and the transportation industry, affect your practice.

The World Health Organization (WHO) has released an online training program that may prove beneficial to you and your staff. It can be accessed via this link: https://openwho.org/courses/introduction-to-ncov(3). The course, which was published on January 26, 2020, has already seen a large volume of registered users – almost 3,000 daily. It is free to enroll, and is currently being produced in many languages across the globe. The World Health Organization believes that dispersing this type of knowledge into the hands of first responders (such as you and your staff) is paramount in controlling the outbreak of the coronavirus.

Contact us today. We can provide additional resources and training ideas to create an emergency preparedness plan that your practice can put into place immediately.

Footnotes

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