Growth in the physician market.

Where can a physician look to make money?

Obviously, reimbursements are cut from private payers to government agencies, from managed care organizations to medicare, physicians are being asked to work harder and provide more services for less dollars.

Consequently, physicians are taking work in other areas to enhance their net pay. There are, of course, medical malpractice insurance ramifications in this area.

The five common areas we see physicians taking on extra work in order to retain a challenging practice with the chance to increase their net pay are the following:

  • Concierge Medical  Practices
  • Utilization Review for State’s Workers Compensation
  • Medical Director for Nursing homes, Medical Homes, Surgery Centers and Medispas
  • Investing in Surgery Centers
  • Independent Contractor work for Hospitalist groups
  • Telemedicine Consultations.

According to Crittenden, Physicians are moving to the concierge model very quickly in anticipation of many patients gravitating to this model in response to the changes in health care looming.

Many  concierge practices expect an increase in patient membership with the estimated newly insured to hit  the market with the health care act taking place in 2014.

This growth and trend into concierge medicine could make this one of the main sources of primary care in this country. And, accordingly, the malpractice insurance carriers are going to have to study how best to rate and defend these practices.

Physicians are already working for state compensation fund payers to help them fight the fraudulent lingering of claims.  We are insuring independent management companies which contract with physicians and nurses to provide the important review services for these payers: Nurses and physicians guide payers and patients through the medical care process.   Utilization Review (UR) services deliver appropriate, treatment recommendations that result in: more rapid recoveries, faster workplace returns and cost effective outcomes.

  • Evidenced-based national guidelines or state specific are applied to both approvals and modifications / denials
  • There is a panel of credentialed, board-certified physicians
  • Peer reviews conducted by physicians of the same specialty
  • UR-Bill Review system integration, with adjuster treatment alerts
  • Cost savings reports on denied / modified services – hard savings only

Medical Directors are common in many hospital departments, aesthetic spas and nursing homes.

As the society ages and more and more people are going to want to continue a high quality of life, the population of elderly in nursing homes (and the level of activity and medical care in these homes will continue its upward trajectory:

The Medical Director plays a pivotal role in assuring that these facilities function like high quality hospitals.

Government Agencies will continue to implement high standards and increasing oversight.

And, the medical director opportunities will expand.  The 2001 Institute of Medicine report Improving the Quality of Long Term Care urges facilities to give medical directors greater authority and hold them more accountable for medical services. The report  states, nursing homes should develop structures and processes that enable and require a more focused and dedicated medical staff, bringing the care, the level of communication, compassion and management of outcomes more accountable.  ..the institute of medicine is putting the responsibility for the improved patient care on to the medical directors.   These organizational structures should include credentialing, peer review, and accountability to the medical director.

The medical Directors will have to obtain their own, Medical Directors Professional Liability Insurance policies, in order to keep the loss experience of the facility separate from the administrative experience of the Medical Director.

The Doctors’ Insurance Agency can assist in this important placement of insurance.  We have access to the most cost effective professional liability providers of Medical Director Only Liability Policies.

Physicians also find themselves as Directors and Officers or Owners of Surgery Centers.

Again, this can be a very positive move, and there are important insurance considerations.The Facility needs to be independently insured, separate from the insurance of the physicians using it.

And, the facility must credential its staff of physicians carefully, checking claims and education and practice history against representations made.  They do not always ‘square’.

Physicians can make these investments, but they should also be thorough in their due diligence. They cannot  underestimate the upside, but be realistic about the risks. Obviously, patients come first, and the surgery center must choose which procedures, which physicians and staff will give it the best chance for financial gain.

Surgery Center Professional Liability and  a quality Directors and Officers policy can provide the risk management necessary to make this business decision a strong win!

Physicians practicing with Hospitalists need to ask one important question:

How will my tail be provided if I sign this contract?  The answer is :  it almost always is included in the roster type of malpractice insurance policy.  The Doctors’ Insurance Agency can help you analyze whether you have that type of policy, which includes tail  embedded in the premium.

According to Today’s Hospitalist online newsletter:

Physicians are now expected to provide clear instruction to patients and families about what they should do post-discharge. They’re also increasingly expected to make sure that follow-up and referral issues are handled proactively and documented not only in patient charts, but in physician- and patient-focused discharge summaries.

The fact that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has also called for standardized, person-to-person patient hand-offs in its 2006 patient safety guidelines means that the failure to do so could increase malpractice exposure in the future, Dr. Siegal predicted.

This is why we recommend the nations’ leader for Hospitalists, The Doctors’ Company, endorsed by the Society for Hospital Medicine.

Finally, a rapidly growing area in healthcare services today is Telemedicine.  The Doctors’ Insurance Agency provides telemedicine medical malpractice insurance for the medical entity, providing the services, directing the care to the various specialties and following up with the diagnosis.  The entity carries much vicarious medical malpractice risk engaged in the chain of medical services.

And, in addition to the business responsibility, vicariously to  the care provided, the treatment rendered by the physicians who have been approved to work in contract or employed by the telemedicine company,

It is important to insure the physicians directly for just that treatment.   They may have their own medical malpractice insurance policies, and, it is likely that those policies are tied to the locations which they’ve been approved for, and, in spite of the low percentage of time overall which the hospitalist may be spending at this new location, there is no coverage unless picked up by the hospitalist group.

The definition of telemedicine varies based on the source and purpose of the definition, but it generally refers to the use of technology for the delivery of health care services when the health care practitioner and patient are not in the same physical location. Telehealth services are defined more broadly to include any type of health related services, medications or other information that is transmitted electronically.

This electronic communication, transmission is the reason that The Doctors’ Insurance Agency works with NAS and Beazley and the specialty underwriters and brokers across the country to find the most competitive, comprehensive data breach, Cyber Liability Insurance Policy.

Telemedicine inherently involves moving personal health information over electronic infrastructure, the laws and regulations of HIPAA require that your medical organization have the proper protocol in place to avoid the breach.

And, it is important to work  with an agency that understands how to offload this risk of lost data, and the associated fines and penalties and first party costs to the right insurance company.



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