Program Value Malpractice Premium Savings

1
Program ValueMalpractice Premium Savings

• Studies conducted for Triton Group by Princeton
  Insurance Company and Huggins Actuarial Services.
• Premiums calculated for 2002, 2005, 2006
• Used Uniform Data System (UDS) data for deemed
  Health Centers

2
Program ValueMalpractice Premium Savings Study
Methodology

• Used Occurrence Premiums with 1m/3m limits.
• Premiums include 25 for taxes, profits,
  commissions, etc.
• Each deemed Health Center rated by its specific
  territory.
• Rates based on Full Time Equivalents by
  specialty.
• Premium increased by 10 to cover corporation and
  allied personnel.

3
Program ValueMalpractice Premium Savings Study
Results

• 2002 Savings for deemed centers - 164,000,000
• 2005 Savings for deemed centers - 180,000,000
• 2006 Savings for deemed centers -
  184,000,000
• 2007 Savings for deemed centers -
  192,000,000
• Extrapolating from the studies total savings
  since 1993
• 1.6 billion

4
History of the FSHCAA(Federally Supported Health
Centers Assistance Act)

• Late 1980s medical malpractice crisis similar
  to current situation.
• Health centers in certain geographic areas having
  difficulty finding adequate coverage.
• Studies commissioned showed health centers were
  lower risk for insurers.
• Congress passes FSHCAA of 1992 permitting
  Secretary to deem health centers as federal
  employees.

5
History of the FSHCAA(Federally Supported Health
Centers Assistance Act)

• As Federal employees health centers are
  protected by the Federal Tort Claims Act (FTCA).
• 92 Act unclear in many areas.
• 92 Act set to expire in 1995.
• Congress amends FSHCAA in 1995 to eliminate gaps
  and make program permanent.

6
Deeming Applications

• PAL 2008-05.
• Applications due July 11, 2008 but will be
  accepted sooner.
• Application process similar to prior years but
  enhanced.
• More emphasis on Quality Improvement and Risk
  Management activities in application.
• Application questions call FTCA Helpline at
  866-382-2435 (866-FTCA-HELP)

7
Deeming Applications

• Application requires information on the following
  health center activities
• Risk Management Systems.
• Credentialing Systems.
• Professional Liability History.
• Services to Non-Health Center Patients.

8
Credentialing and Privileging

• PIN 2002-22
• Credentialing and privileging required of all
  licensed or certified health care practitioners.
• Process for Licensed Independent Practitioners
  (LIPs) generally mimics JCAHO.
• Non-LIPs requires primary source verification of
  only license or certification.
• Volunteers included.

9
Non-Health Center Patients

• Federal Register Notice September 25, 1995
  (Volume 60 Number 185) page 49417 49418.
• Hospital On-Call Requirements.
• Cross Coverage Arrangements.
• Community Activities.
• Other situations require a Particularized
  Determination See 99-08.

Triton Group, LLC
10
Particularized Determinations

• Prior approval required for care to non-health
  center patients beyond what is already approved
  in Federal Register.
• May be submitted at any time.

11
Particularized DeterminationCriteria

• The services to the non-health center patient
  must benefit patients and those who could be
  served through community wide interventions, or,
• Care to non-health center patients facilitates
  care to patients of the center, or,
• Care to non-health center patients is required to
  be provided to such individuals under providers
  employment agreement with health center.