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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

Miscellaneous Healthcare FacilitiesRisk Mixing and Matching

Chicago, Illinois ~ March 14 & 15, 2006


Miscellaneous healthcare facilities
Miscellaneous Healthcare Facilities

Moderator: Paul GreveWillis Healthcare Practice

Panelists: Rob JurgelAIG/LexingtonFran O’ConnellShand Morahan

Leslie MillerNational Specialty Underwriters

Bruce BalckArch Insurance Group


Miscellaneous healthcare facilities1
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


Miscellaneous healthcare facilities2
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


Miscellaneous healthcare facilities3
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


Healthcare facilities risk mixing and matching

Healthcare FacilitiesRisk Mixing and Matching

Rob JurgelProduct Line OfficerAIG Healthcare

Chicago, Illinois ~ March 14 & 15, 2006


Miscellaneous facilities industry anatomy
Miscellaneous Facilities – Industry Anatomy

  • $750M Insurance Marketplace

  • 50+ Diverse Classes

  • 50,000+ Prospects

  • 20+ Insurance Carriers

  • 5,000+ Brokers


Distribution 5 channels
Distribution – 5 Channels

  • National Brokers

  • Retailers – 2nd & 3rd Tier

  • Wholesalers

  • MGAs

  • Associations


Product coverage issues
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


Key underwriting issues
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)


Perception everybody makes money in mf true false
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


Everybody makes money continued
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


The big secret of underwriting mf business successfully
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!


Healthcare facilities risk mixing and matching1

Healthcare FacilitiesRisk Mixing and Matching

Fran O’Connell

Vice President

Shand Morahan & Company

Chicago, Illinois ~ March 14 & 15, 2006


Healthcare facilities risk mixing and matching2
Healthcare Facilities Risk Mixing and Matching

  • What else Is influencing the Healthcare Marketplace?


Advertising media

Nip & Tuck, don’t break a sweat results

A Pill to improve your lifestyle

Advertising/Media


Who is being treated
Who is being treated?

  • Consumer as Patient

  • Consumer’s Concerns

    • Cost

    • Quality

    • Time/Choice

    • Service


What do www getdrugs com telemedicine matchmakers have in common
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


New medical risks
New Medical Risks

  • Telemedicine/e-Health

  • Anti-Aging

  • Bariatric Surgery

  • Pain Management

  • New Specialties/Expansion of roles

  • Providers who are “bare”


Other exposures creeping into mpl risks
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


Coverage considerations

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


Claims
Claims

  • Yes, we get CLAIMS


Surgicenter claims
Surgicenter Claims

  • Surgicenter becomes deep pocket

  • Eye Surgeries

    • Failure to screen (optometrist)

    • Failure to calibrate (technician)

  • Emergency Procedures


Medi spa claims
Medi-Spa Claims

  • Laser Hair removal Burns

  • Micro-pigmentation Infections

  • No Informed Consent

  • Allergic Reactions


Healthcare facilities risk mixing and matching3

Healthcare FacilitiesRisk Mixing and Matching

Leslie Miller

Senior Vice President

National Specialty Underwriters

Chicago, Illinois ~ March 14 & 15, 2006


A rose by any other name
A Rose By Any Other Name

  • Ancillary Healthcare

  • Spec (specified) Med

  • Miscellaneous Medical


Defined by what it is not
Defined By What It Is Not

  • NOT a provider

  • NOT a hospital

  • NOT long term care


Miscellaneous healthcare
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


Why all of the fuss
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



Surgery center
Surgery Center

Surgery Center located in Midwest

  • Performs bariatrics

  • Performs plastic

  • $1M / $3M limits

  • Prior acts


A rated market quotes
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


Social services
Social Services

Social Services located in Florida

  • Child Welfare Services

  • Package PL/GL

  • $1M / $3M

  • Claims Made Year 3


A rated market quotes1
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


Market selection
Market Selection

  • Class of business

  • Venue

  • Minimum premium requirements

  • Glamour do’s and don’ts by carrier


Improving your success rate
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



Healthcare facilities risk mixing and matching4

Healthcare FacilitiesRisk Mixing and Matching

Bruce Balck

Director – Risk Management

Arch Insurance Group

Chicago, Illinois ~ March 14 & 15, 2006


Risk exposures
Risk Exposures

  • Mail-Order Pharmacy

  • Ambulatory Surgery

  • Dialysis

  • Ambulance Services

  • Home Health/Hospice


Mail order pharmacy
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)


Ambulatory surgery
Ambulatory Surgery

  • Patient Selection (Risk Factors)

  • Staffing competency

  • Procedure Appropriate for setting

  • Standards of Care

    • Infection Control

    • Monitoring modalities

    • Anesthesia*


Propofol new frontier
Propofol – New Frontier?

  • It’s an anesthetic

  • Short acting sedative effect

  • Dangers;

    • Loss of airway reflexes

    • Oxygenation

    • Aspiration

    • Bradycardia

    • Hypoxia


The issue debate
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


Hemodialysis

Replaces normal kidney filtration

Causes:

Acute: Trauma, Surgical Complications, blockage to blood vessel

Chronic: Hypertension, Diabetes

Hemodialysis


Risks of dialysis

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


Ambulance airway management

The Issue: Dislodging the ‘ET’ during transport! headaches, hypotension, etc.

Primary and Secondary Verifications

Document placement (ET) during and after transfer.

Skill set – Practice

Ambulance – Airway Management


Dislodged airway

Grip-ET headaches, hypotension, etc.

Prevents ET dislodgment for patients who must be moved and transported while intubated.

Cost: $3.69

Dislodged Airway


Co2 sensor

Provides a breath-by-breath indication of exhaled CO2. headaches, hypotension, etc.

No airway = No CO2

CO2 Sensor


Esophageal tracheal airway combitube

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’


Home health hospice
Home Health/Hospice pharyngeal cavities.

  • Background Checks

  • Supervision

  • Chain of Command/Communication

  • Job performance evaluations

  • Skill set that matches job function*

    (*Trend towards using more non-licensed personnel)


Home health nurse negligent in airway management
Home Health Nurse Negligent pharyngeal cavities.in Airway Management

9 Month Old ‘Vent Dependent’ with Trach

  • Panic when trach plugged

  • Failed to follow procedure

  • 19 minute delay


2 5m award
$2.5M Award pharyngeal cavities.

  • The Outcome:

  • Brain Damage – Died 28 Days later

  • $2.5M (with an annuity)

  • Key Elements:

  • Training/Experience

  • Lack of supervision


Miscellaneous healthcare facilities4

Paul Greve pharyngeal cavities.Willis Healthcare Practice

[email protected]

615 872 3320

Rob JurgelAIG/Lexington

[email protected]

617 772 4534

Fran O’ConnellShand Morahan

[email protected]

847 572 6118

Leslie MillerNational Specialty Underwriters

[email protected]

312 924 2819

Bruce BalckArch Insurance Group

[email protected]

651 855 7127

Miscellaneous Healthcare Facilities


Miscellaneous healthcare facilities risk mixing and matching1

Miscellaneous Healthcare Facilities pharyngeal cavities.Risk Mixing and Matching

Chicago, Illinois ~ March 14 & 15, 2006


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