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Miscellaneous Healthcare Facilities Risk Mixing and Matching

Miscellaneous Healthcare Facilities Risk Mixing and Matching. Miscellaneous Healthcare Facilities. Moderator: Paul Greve Willis Healthcare Practice Panelists: Rob Jurgel AIG/Lexington Fran O’Connell Shand Morahan Leslie Miller National Specialty Underwriters Bruce Balck Arch Insurance Group.

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Miscellaneous Healthcare Facilities Risk Mixing and Matching

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  1. Miscellaneous Healthcare FacilitiesRisk Mixing and Matching Chicago, Illinois ~ March 14 & 15, 2006

  2. Miscellaneous Healthcare Facilities Moderator: Paul GreveWillis Healthcare Practice Panelists: Rob JurgelAIG/LexingtonFran O’ConnellShand Morahan Leslie MillerNational Specialty Underwriters Bruce BalckArch Insurance Group

  3. Miscellaneous Healthcare Facilities Defined • By exception: a broad range of healthcare entities that are not hospitals or LTC facilities • New types of miscellaneous healthcare facility entities are created every year

  4. Miscellaneous Healthcare Facilities Examples • Alcohol and Drug Rehab Ctrs • Ambulatory Surgery Ctrs • Ambulance Services • Blood Banks • Clinical Testing Labs • Diagnostic Imaging Ctrs • Dialysis Ctrs • Drug Testing Services • Home Health Care • Home Infusion Therapy • Hospices • Lithotripsy Facility • MedSpas • Mobile Radiology Units • Nurse Registries • Outpatient Clinics • Pain Management Ctrs • Pharmacy • Public Health Clinics • Public Health Departments • Urgent Care Ctrs • Visiting Nurse Assoc

  5. Miscellaneous Healthcare Facilities Why the Move to MHFs? • Aging Population • Utilization Increasing • Increase in Chronic Illness • By 2010, 70M will have 2 or more chronic illnesses • For Certain MHFs, e.g. ASCs, Physicians Can Achieve: • More Volume • Better Reimbursement • Convenience • Lower Costs • Competition Between Hospitals and Physician-Owned Specialty Services Will Continue • Growth in Alternative Therapies Will Continue • MedSpas • Biofeedback • Acupuncture

  6. Healthcare FacilitiesRisk Mixing and Matching Rob JurgelProduct Line OfficerAIG Healthcare Chicago, Illinois ~ March 14 & 15, 2006

  7. Miscellaneous Facilities – Industry Anatomy • $750M Insurance Marketplace • 50+ Diverse Classes • 50,000+ Prospects • 20+ Insurance Carriers • 5,000+ Brokers

  8. Distribution – 5 Channels • National Brokers • Retailers – 2nd & 3rd Tier • Wholesalers • MGAs • Associations

  9. Product / Coverage Issues • Basic Forms – 3 Types • Limit Structure – Dual or Single Aggregates • Coverage Trigger – Incident Sensitive vs. Demand • Sexual / Physical Abuse Coverage • Practitioner Coverage – Drs & CRNAs • Value Added Features – RM, Claims, Crisis Management

  10. Key Underwriting Issues • Know the Class • Understand the Exposure • Differences between Classes • Differences within Classes (Risk Modifiers) • Practitioner Coverage (Drs & CRNAs) • Venue Differences • Loss Experience • Quality of Risk Management (Assessments)

  11. Perception: Everybody Makes Money in MF?True / False PBM Losses $42M – Changed Formulary to Increase Financial Incentives $23M – Rebating Issues $12M – Resold Returned Drugs Pharmacy Losses $21M – Adult Version of Drug – Brain Injury $ 4M – Detained Shoplifter – Death $ 3M – Wrong Medication EMT Losses $10M – Asthma Attack - Driver Lost Key to Drug Box $ 5M – Delayed Response, Cardiac Arrest $ 4M – Improper movement, spinal cord injury Surgi-Center Losses $20M – Loss of Vision (Highly Paid Professional) $ 4M – Anesthesia - Coma $ 3M – Cardiac Arrest

  12. Everybody makes money (continued)… Hospice Losses $8M – Negligent Care in Nursing Home $3M – Negligent Care $3M – Hired and Non-owned Auto (accident) Medical Lab $6M – Failure to Detect Cervical Cancer $3M – Failure to Detect Down Syndrome (4 claims) $2M – Failure to Detect Cancer (8 claims) Behavioral Health $5M – Improper Restraint - death $5M - Failure to Monitor resident – elopement – murder $3M - Failure to monitor – suicide Dialysis Losses $8M – Exsanguinations (bleed out) $2M - Exsanguinations (bleed out) $1M - Fall / injury

  13. The Big Secret of Underwriting MF Business Successfully? Charge 25% less than the expiring carrier? Offer a low premium but make it up on volume? Charge the Correct Rate for the Exposure!

  14. Healthcare FacilitiesRisk Mixing and Matching Fran O’Connell Vice President Shand Morahan & Company Chicago, Illinois ~ March 14 & 15, 2006

  15. Healthcare Facilities Risk Mixing and Matching • What else Is influencing the Healthcare Marketplace?

  16. Nip & Tuck, don’t break a sweat results A Pill to improve your lifestyle Advertising/Media

  17. Who is being treated? • Consumer as Patient • Consumer’s Concerns • Cost • Quality • Time/Choice • Service

  18. What do www.getdrugs.com, Telemedicine, Matchmakers have in common? • They’re scary • They’re coming and here to stay • Alternative delivery system for drug and/or medical services

  19. New Medical Risks • Telemedicine/e-Health • Anti-Aging • Bariatric Surgery • Pain Management • New Specialties/Expansion of roles • Providers who are “bare”

  20. Other Exposures “Creeping” into MPL Risks • “Investigational” Drug Therapies • IT Exposures • Record, transmit and interpret data • Multiple State or Country Operations • Life Sciences • Molecular medicine • Implantable • Privacy Issues

  21. Claims Made Professional Liability Claims Made Professional and General Liability Claims Made Professional and Occurrence General Liability Deductibles/SIRs Defense Inside Limit Outside Limits Prior Acts Coverage trigger options Consent to Settle Territory Coverage Considerations

  22. Claims • Yes, we get CLAIMS

  23. Surgicenter Claims • Surgicenter becomes deep pocket • Eye Surgeries • Failure to screen (optometrist) • Failure to calibrate (technician) • Emergency Procedures

  24. Medi-Spa Claims • Laser Hair removal Burns • Micro-pigmentation Infections • No Informed Consent • Allergic Reactions

  25. Healthcare FacilitiesRisk Mixing and Matching Leslie Miller Senior Vice President National Specialty Underwriters Chicago, Illinois ~ March 14 & 15, 2006

  26. A Rose By Any Other Name • Ancillary Healthcare • Spec (specified) Med • Miscellaneous Medical

  27. Defined By What It Is Not • NOT a provider • NOT a hospital • NOT long term care

  28. Miscellaneous Healthcare • Adult Day Care Centers • Ambulance Companies (excludes auto liability) • Banks • Cancer Centers (Radiation Oncology) • Clinics • Community Health Centers • Correctional Medicine • Dialysis Centers • Family Planning • Home Health Agencies • Hospice Care • Imaging Centers • Labs • Lithotripsy • Long-Term Care • Medical Spas • Mental Health • Nurse Staffing • Perfusion/Auto transfusion • Pharmacies • Product Liability (medical products only) • Public Health Dept. • Schools • Social Services • Sleep Centers (Apnea) • Social Services • Staffing • Surgery Centers • Therapy • Trauma Rehab

  29. Why All of the Fuss? • Surgical Centers – more than 5,500 ASC’s • Imaging Centers – more than 2,800 facilities • Home Health Care – more than 11,000 agencies • Medical Labs – more than 5,000 laboratories

  30. Markets

  31. Surgery Center Surgery Center located in Midwest • Performs bariatrics • Performs plastic • $1M / $3M limits • Prior acts

  32. A Rated Market Quotes • Carrier A: $184,000 $20,000 deductible • Carrier B: $210,000 $25,000 deductible • Carrier C: $514,867 $25,000 deductible

  33. Social Services Social Services located in Florida • Child Welfare Services • Package PL/GL • $1M / $3M • Claims Made Year 3

  34. A Rated Market Quotes • Carrier A: $26,500 $10,000 deductible • Carrier B: $125,000 $10,000 deductible • Carrier C: $200,000 $10,000 deductible

  35. Market Selection • Class of business • Venue • Minimum premium requirements • Glamour do’s and don’ts by carrier

  36. Improving Your Success Rate • A complete application, with asupplement to be certain that you have all of the information • Understand what really goes on inside the box • Know your client’s growth strategy

  37. Pick Two

  38. Healthcare FacilitiesRisk Mixing and Matching Bruce Balck Director – Risk Management Arch Insurance Group Chicago, Illinois ~ March 14 & 15, 2006

  39. Risk Exposures • Mail-Order Pharmacy • Ambulatory Surgery • Dialysis • Ambulance Services • Home Health/Hospice

  40. Mail-Order Pharmacy • Operations: • Pharmacist involvement • Bar coding • Process of clarifying orders • Computer Screens/Verification/Photograph • Systems to track errors • The Patient: • 24/7 Pharmacy Support • Patient Instructions (easy to read)

  41. Ambulatory Surgery • Patient Selection (Risk Factors) • Staffing competency • Procedure Appropriate for setting • Standards of Care • Infection Control • Monitoring modalities • Anesthesia*

  42. Propofol – New Frontier? • It’s an anesthetic • Short acting sedative effect • Dangers; • Loss of airway reflexes • Oxygenation • Aspiration • Bradycardia • Hypoxia

  43. The Issue/Debate? • RN’s administering in: • Diagnostic Centers • Surgical Centers • Doctor’s Offices • Emergency Rooms • Patient lose their respiratorydrive without warning • Supporting airway until the medication “wears off” • No antidote – “Tincture of Time” • Airway management • Must be able to intubate

  44. Replaces normal kidney filtration Causes: Acute: Trauma, Surgical Complications, blockage to blood vessel Chronic: Hypertension, Diabetes Hemodialysis

  45. The ‘typical’ side effects: Infection, anemia, nausea, headaches, hypotension, etc. Electrolyte imbalance Cardiac arrhythmia Air embolism “Bleed-outs”: Pressure Alarms ‘off’ Lack of vigilance Failure to flush Dialyzer (filter) of cleaner (re-use) properly. Re-use; Infection/Verification Falls Risks of Dialysis

  46. The Issue: Dislodging the ‘ET’ during transport! Primary and Secondary Verifications Document placement (ET) during and after transfer. Skill set – Practice Ambulance – Airway Management

  47. Grip-ET Prevents ET dislodgment for patients who must be moved and transported while intubated. Cost: $3.69 Dislodged Airway

  48. Provides a breath-by-breath indication of exhaled CO2. No airway = No CO2 CO2 Sensor

  49. Inserted “blindly” and ‘seals’ the oral and nasal pharyngeal cavities. Functions in either the trachea or esophagus. Normal and abnormal airways ‘Trapped’ patients Esophageal/Tracheal Airway‘Combitube’

  50. Home Health/Hospice • Background Checks • Supervision • Chain of Command/Communication • Job performance evaluations • Skill set that matches job function* (*Trend towards using more non-licensed personnel)

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