Miscellaneous Healthcare Facilities Risk Mixing and Matching

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Miscellaneous Healthcare FacilitiesRisk Mixing
and Matching
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Miscellaneous Healthcare Facilities

• Moderator Paul Greve Willis Healthcare
  Practice
• Panelists Rob Jurgel AIG/Lexington Fran
  OConnell Shand Morahan
• Leslie Miller National Specialty Underwriters
• Bruce Balck Arch Insurance Group

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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

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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

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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

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Healthcare FacilitiesRisk Mixing and Matching

• Rob JurgelProduct Line OfficerAIG Healthcare

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Miscellaneous Facilities Industry Anatomy

• 750M Insurance Marketplace
• 50 Diverse Classes
• 50,000 Prospects
• 20 Insurance Carriers
• 5,000 Brokers

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Distribution 5 Channels

• National Brokers
• Retailers 2nd 3rd Tier
• Wholesalers
• MGAs
• Associations

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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

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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)

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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

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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

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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!

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Healthcare FacilitiesRisk Mixing and Matching

• Fran OConnell
• Vice President
• Shand Morahan Company

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Healthcare Facilities Risk Mixing and Matching

• What else Is influencing the Healthcare
  Marketplace?

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Advertising/Media

• Nip Tuck, dont break a sweat results
• A Pill to improve your lifestyle

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Who is being treated?

• Consumer as Patient
• Consumers Concerns
• Cost
• Quality
• Time/Choice
• Service

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What do www.getdrugs.com, Telemedicine,
Matchmakers have in common?

• Theyre scary
• Theyre coming and here to stay
• Alternative delivery system for drug and/or
  medical services

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New Medical Risks

• Telemedicine/e-Health
• Anti-Aging
• Bariatric Surgery
• Pain Management
• New Specialties/Expansion of roles
• Providers who are bare

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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

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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

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Claims

• Yes, we get CLAIMS

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Surgicenter Claims

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

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Medi-Spa Claims

• Laser Hair removal Burns
• Micro-pigmentation Infections
• No Informed Consent
• Allergic Reactions

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Healthcare FacilitiesRisk Mixing and Matching

• Leslie Miller
• Senior Vice President
• National Specialty Underwriters

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A Rose By Any Other Name

• Ancillary Healthcare
• Spec (specified) Med
• Miscellaneous Medical

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Defined By What It Is Not

• NOT a provider
• NOT a hospital
• NOT long term care

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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

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Why All of the Fuss?

• Surgical Centers more than 5,500 ASCs
• Imaging Centers more than 2,800 facilities
• Home Health Care more than 11,000 agencies
• Medical Labs more than 5,000 laboratories

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Markets
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Surgery Center

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

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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

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Social Services

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

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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

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Market Selection

• Class of business
• Venue
• Minimum premium requirements
• Glamour dos and donts by carrier

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Improving Your Success Rate

• A complete application, with a supplement to be
  certain that you have all of the information
• Understand what really goes on inside the box
• Know your clients growth strategy

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Pick Two
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Healthcare FacilitiesRisk Mixing and Matching

• Bruce Balck
• Director Risk Management
• Arch Insurance Group

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Risk Exposures

• Mail-Order Pharmacy
• Ambulatory Surgery
• Dialysis
• Ambulance Services
• Home Health/Hospice

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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)

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Ambulatory Surgery

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

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Propofol New Frontier?

• Its an anesthetic
• Short acting sedative effect
• Dangers
• Loss of airway reflexes
• Oxygenation
• Aspiration
• Bradycardia
• Hypoxia

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The Issue/Debate?

• RNs administering in
• Diagnostic Centers
• Surgical Centers
• Doctors 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

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Hemodialysis

• Replaces normal kidney filtration
• Causes
• Acute Trauma, Surgical Complications, blockage
  to blood vessel
• Chronic Hypertension, Diabetes

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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

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Ambulance Airway Management

• The Issue Dislodging the ET during transport!
• Primary and Secondary Verifications
• Document placement (ET) during and after
  transfer.
• Skill set Practice

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Dislodged Airway

• Grip-ET

• Prevents ET dislodgment for patients who must be
  moved and transported while intubated.
• Cost 3.69

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CO2 Sensor

• Provides a breath-by-breath indication of exhaled
  CO2.
• No airway No CO2

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Esophageal/Tracheal AirwayCombitube

• Inserted blindly and seals the oral and nasal
  pharyngeal cavities.
• Functions in either the trachea or esophagus.
• Normal and abnormal airways
• Trapped patients

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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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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

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2.5M Award

• The Outcome
• Brain Damage Died 28 Days later
• 2.5M (with an annuity)
• Key Elements
• Training/Experience
• Lack of supervision

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Miscellaneous Healthcare Facilities

• Paul GreveWillis Healthcare Practice
• Greve_pa_at_willis.com
• 615 872 3320
• Rob JurgelAIG/Lexington
• Robert.jurgel_at_aig.com
• 617 772 4534
• Fran OConnellShand Morahan
• foconnell_at_markelcorp.com
• 847 572 6118

• Leslie MillerNational Specialty Underwriters
• lmiller_at_nsui.com
• 312 924 2819
• Bruce BalckArch Insurance Group
• bbalck_at_archinsurance.com
• 651 855 7127

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Miscellaneous Healthcare FacilitiesRisk Mixing
and Matching