Hospitalists? What Are Those?

In 2002, The Doctors Insurance Agency wrote our first hospitalist professional liability policy. This was a group of four internal medicine doctors working in the central Valley. What drove them to look for a separate policy is that they did not want their hospitalist work to impact their current medical practice, they wanted their claims history to be recorded and kept separate from their clinical practice. In part they did this out of caution, they were not sure this idea was going to work; and like many insurance carriers at the time, they were fearing that this concept might actually invite litigation and complaints.

This was an entrepreneurial group that signed contracts with two area hospitals. They (ideally) wanted a policy would cover them each at a limited part-time rates and still allow for a separate 1 million 3 million limit. We (The Doctors Insurance Agency working with The Doctors Company to find a policy that included tail insurance and part time (actually limited part time rates) worked hard to get it right . and, then once we figured this out, we had to bring this concept of measuring, underwriting and rating these physician’s policies to other groups and states.

As that group grew from 4 to 26 doctors and from two hospitals to more than 10 throughout the central part of California, the concept of hospitalist medicine was gradually growing. The Doctors Company, working with The Doctors Insurance Agency was hard at work, watching as the medical profession accepted more and more as mainstream this concept of dedicated, credentialed and board-certified primary care doctors exclusively performing this service of admitting (and the careful work that goes into a proper admission) And the many visits the inpatient visits that are inherent in the specialty, And eventually discharging the patient.

This care required careful study, repetition, expertise and practice in the careful risk communication between doctors, nurses and many technicians and other medical staff.

But How to rate these growing Medical Malpractice Insurance Policies for Hospitalists:

Over the years it became obvious that the best way to rate these policies was to use a premium measure that is connected to the actual time spent providing service…whether that was an RVU (relative value units), by the number of patients (patient consultations (similar to the patient visits in urgent care rating) or by the revenue. These are all pure reflections of the service provided by the group. And, therefore a much more fair and affordable method of developing the premium.

This method allows the group to bring in the number of doctors required to provide the staff necessary to fill 7 days and 24 hours per day.
Whether the group was made up of 10 or 150 doctors, the premium would be a function of the hospitalist service provided. In addition, The Doctors Company and with its national exposure and coverage and resources became central to bringing research and understanding and eventually proliferating information about patient safety and risk management to the many physicians now practicing within the specialty of hospitalist medicine.

As a result, the Society of Hospitalist Medicine gives The Doctors Company an endorsement!

What Is a Hospitalist?
The Hospitalist. 2006 February;2006(2)
Steve Pantilat, MD

According to an article years ago society newsletter hospitalist
A hospitalist is “a doctor who is an expert in taking care of people in the hospital.” though not too sophisticated, this definition usually does the job in simply explaining the work.

Dr. Pantilat goes on to say that “specialists in inpatient medicine ... who will be responsible for managing the care of hospitalized patients..
in the same way that primary care physicians are responsible for managing the care of outpatients.”

I like this definition.

This definition also explains why it is important when you are administering the group hospitalists have a malpractice insurance broker like The Doctors Insurance Agency that understands that quick on-boarding and flexible policies that provide tail, so when the doctors cancel, they are covered. These are the most important elements of a malpractice policy.

Actually becoming even a secondary concern (but still paramount) are affordability, financial strength and an accurate measure of premium.

A Hospitalist Medical Malpractice Insurance policy must accommodate staffing it is as demanding as emergency medical groups. When you sign a contract with a hospital you agree to provide the care usually 24 hours a day seven days a week in the malpractice insurance premiums can make it prohibitive policy must be rated by only counting the revenue relative value units generated or the number of consultations.

Additionally malpractice insurance policy should be in a position show proof of adequate coverage so that hospitals may credentialed the doctors quickly. This generally means a 1 million/ 3 million policy is available and the insurance underwriter can approve quickly …so that care is not delayed.
A hospitalist policy is as technical as telemedicine, urgent care and interstate practice of medicine.

In one year, it might make more sense to rate by counting the consultations in another year relative value units ; it is important to have the relationships with specialty carriers which understand and have an appetite for this kind of risk.


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