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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

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Miscellaneous Healthcare FacilitiesRisk Mixing and Matching

Chicago, Illinois ~ March 14 & 15, 2006


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 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 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 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 FacilitiesRisk Mixing and Matching

Rob JurgelProduct Line OfficerAIG Healthcare

Chicago, Illinois ~ March 14 & 15, 2006


Miscellaneous Facilities – Industry Anatomy

  • $750M Insurance Marketplace

  • 50+ Diverse Classes

  • 50,000+ Prospects

  • 20+ Insurance Carriers

  • 5,000+ Brokers


Distribution – 5 Channels

  • National Brokers

  • Retailers – 2nd & 3rd Tier

  • Wholesalers

  • MGAs

  • Associations


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

  • 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

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)…

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?

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 FacilitiesRisk Mixing and Matching

Fran O’Connell

Vice President

Shand Morahan & Company

Chicago, Illinois ~ March 14 & 15, 2006


Healthcare Facilities Risk Mixing and Matching

  • What else Is influencing the Healthcare Marketplace?


Nip & Tuck, don’t break a sweat results

A Pill to improve your lifestyle

Advertising/Media


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?

  • They’re scary

  • They’re coming and here to stay

  • Alternative delivery system for drug and/or medical services


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

  • “Investigational” Drug Therapies

  • IT Exposures

    • Record, transmit and interpret data

  • Multiple State or Country Operations

  • Life Sciences

    • Molecular medicine

    • Implantable

  • Privacy Issues


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

  • Yes, we get CLAIMS


Surgicenter Claims

  • Surgicenter becomes deep pocket

  • Eye Surgeries

    • Failure to screen (optometrist)

    • Failure to calibrate (technician)

  • Emergency Procedures


Medi-Spa Claims

  • Laser Hair removal Burns

  • Micro-pigmentation Infections

  • No Informed Consent

  • Allergic Reactions


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

  • Ancillary Healthcare

  • Spec (specified) Med

  • Miscellaneous Medical


Defined By What It Is Not

  • NOT a provider

  • NOT a hospital

  • NOT long term care


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?

  • 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


Markets


Surgery Center

Surgery Center located in Midwest

  • Performs bariatrics

  • Performs plastic

  • $1M / $3M limits

  • Prior acts


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 located in Florida

  • Child Welfare Services

  • Package PL/GL

  • $1M / $3M

  • Claims Made Year 3


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

  • Class of business

  • Venue

  • Minimum premium requirements

  • Glamour do’s and don’ts by carrier


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


Pick Two


Healthcare FacilitiesRisk Mixing and Matching

Bruce Balck

Director – Risk Management

Arch Insurance Group

Chicago, Illinois ~ March 14 & 15, 2006


Risk Exposures

  • Mail-Order Pharmacy

  • Ambulatory Surgery

  • Dialysis

  • Ambulance Services

  • Home Health/Hospice


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

  • Patient Selection (Risk Factors)

  • Staffing competency

  • Procedure Appropriate for setting

  • Standards of Care

    • Infection Control

    • Monitoring modalities

    • Anesthesia*


Propofol – New Frontier?

  • It’s an anesthetic

  • Short acting sedative effect

  • Dangers;

    • Loss of airway reflexes

    • Oxygenation

    • Aspiration

    • Bradycardia

    • Hypoxia


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


Replaces normal kidney filtration

Causes:

Acute: Trauma, Surgical Complications, blockage to blood vessel

Chronic: Hypertension, Diabetes

Hemodialysis


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


The Issue: Dislodging the ‘ET’ during transport!

Primary and Secondary Verifications

Document placement (ET) during and after transfer.

Skill set – Practice

Ambulance – Airway Management


Grip-ET

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

Cost: $3.69

Dislodged Airway


Provides a breath-by-breath indication of exhaled CO2.

No airway = No CO2

CO2 Sensor


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

  • 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

9 Month Old ‘Vent Dependent’ with Trach

  • Panic when trach plugged

  • Failed to follow procedure

  • 19 minute delay


$2.5M Award

  • The Outcome:

  • Brain Damage – Died 28 Days later

  • $2.5M (with an annuity)

  • Key Elements:

  • Training/Experience

  • Lack of supervision


Paul GreveWillis Healthcare Practice

Greve_pa@willis.com

615 872 3320

Rob JurgelAIG/Lexington

Robert.jurgel@aig.com

617 772 4534

Fran O’ConnellShand Morahan

foconnell@markelcorp.com

847 572 6118

Leslie MillerNational Specialty Underwriters

lmiller@nsui.com

312 924 2819

Bruce BalckArch Insurance Group

bbalck@archinsurance.com

651 855 7127

Miscellaneous Healthcare Facilities


Miscellaneous Healthcare FacilitiesRisk Mixing and Matching

Chicago, Illinois ~ March 14 & 15, 2006


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