Employing Physicians can be a financial success

January 20, 2012

The Doctors’ Insurance Agency proudly represents The Doctors’ Company for Medical Malpractice Insurance in California and in other States. Over the years, our physician insurance agency has focused on other ‘complementary products’ so that our physicians have the coverage they need to manage the risk of their professional and personal investments.

I say professional investment because, of course, a medical malpractice lawsuit, no matter how non-meritorious it may be, can bring about the effect of a ‘shut down’ in business; There are companies now just specializing in keeping physicians good name clear on yelp, or other internet services which invite consumer comment online. So, The Doctors’ Company has responded with not only the first Administrative Medical Expense Insurance Protection (to cover the billing and med board inquiries), but now, we respond with Cyber guard, a $ 50,000 medical defense insurance addition to the medical malpractice insurance policy. This extra protection is free to the policyholder. We feel that with so much attention is given now to the HIPAA requirements of protecting patient information, we have to come to our physicians defense in the allegations of data breach. The innocent leak of data to someone other than a ‘protected, or covered entity’ (protected by HIpaa guidelines), can result in first party liability (meaning that the physician must pay to mitigate the damage due to the leak) and it, can result in the damage to the physician or physician’s group’s good name.

Similarly, employing or associating with another physician can result in ongoing liability. One bad partnership is like having a lasting lawsuit with a persistently crazy patient who has really had no harm done, but persists on presenting a law suit. The employee who claims hostile work environment, sexual harassment, discrimination, ‘wage and hour’ failure to pay, wrongful termination, failure to promote: all of these situations, all of these allegations can create lasting harm to the hiring physician’s reputation and energy. In these tough economic times, physicians need to maintain their energy, their offices need to be educated and focused and profitable.

The Doctors’ Insurance Agency works with medical practice consultants, billing experts, risk managers and specialized risk transfer solutions (insurance) to solve all of the business needs of our physician.

Recently, we worked with a Pediatrician who was contracting with a large medical organization (an institution really); and, for the first time in this physicians 30 year career, he has been noticed of a claim against him for creating a hostile working environment to females in the hospital. This new ‘institutional’ medical environment creates less familiar and hyper accountable practice conditions. This physician is now in the process of meeting with superiors and independent review panels and, fortunately for him, we have him covered through our TDC/NAS Employment Practices Liability Insurance Program.

Affordable insurance premium to protect physician employers and board of directors, serving to make decisions and carry themselves as superiors, as ‘bosses’ in a difficult medical economic climate.

The covered perils by our program are so comprehensive:

  • Wrongful Employment Practices
  • Actual Termination
  • Constructive Termination
  • Promissory Estoppel
  • Intentional Interference with Contract
  • Failure to Hire
  • Failure to Promote
  • Wrongful Discipline
  • Negligent Evaluation
  • Retaliation-Employment Related
  • Breach of Good Faith/Fair Dealing
  • Breach of implied contract
  • Failure to Grant Tenure
  • Defamation
  • Infliction of Emotional Distress or Mental Anguish
  • Invasion of Privacy
  • Misrepresentation
  • Harassment
  • Sexual Harassment
  • Non-Sexual Harassment
  • Discrimination
  • Discrimination based upon Genetic Makeup

In addition to insurance, we have risk management resources, articles and consultants all ready and designed to help you succeed and manage this risk of being sued by an unhappy or opportunistic employee. You may find yourself in the position of director of a hospital committee of employing physicians.

Faced with healthcare reform and economic challenges, increasing numbers of hospitals and physicians are seeking the safety of employment relationships. Yet, the hospitals that employ these physicians often suffer losses of $75,000 to more than $100,000 per employed physician per year. Searching with the power of google, I found this article published in the HFMA newsletter: "Physician Employment: How to Avoid Excessive Losses" Robert F. Hill and Craig E. Holm show strategies and tools to create financially sustainable employment arrangements.

The article advises employment contracts consider the following to protect the employing entity or physicians:

  • Structure employment contracts with limited terms such as one to three
  • Provide regular feedback and data to employed physicians on productivity, and other practice performance measures
  • Centralize billing and collections to achieve economies of scale
  • Establish metrics for the per-physician operating loss or subsidy that will be tolerated by the network
  • Conduct ongoing evaluations of employment relationships to consider alterations.

A number of evaluation tools can help employing physicians make effective decisions about performance and avoid financial peril.

Define what needs to be measured and establish metrics.. Specific indicators should be developed and agreed on for productivity, expense levels, quality and patient satisfaction, and overall performance.

Assess practice performance versus benchmarks and highlight areas of concern that may benefit from a more thorough operations review. Typical areas of concern may relate to revenue generation, employee turnover, outcomes measures, and/or overall performance.

Build on results of the desktop audit and conduct interviews with physicians and staff to identify operational and system impediments to productivity.

Based on these, develop strategies and initiatives for the respective practice to improve performance. These may include a modified compensation structure or practice promotion, and may also include recruitment of new physicians, changes in staffing, and/or upgrades to information systems.

Successful networks focus on high-impact performance improvement initiatives and/or avoidable practice expenses. A reasonable performance improvement target for an employed network is often $10,000 per FTE over one year, and $25,000 per FTE over three years. Keeping your physicians on track, staying in touch with them and the agreed metrics; as well as insuring yourself and your board properly will set you and your physicians (and employees) up for success.