Medical Risk Management Presented by:  Ronald E. Cline, MBA
Medical Risk Management <ul><li>What would America be like without Doctors, Nurses, or Hospital Emergency Rooms? </li></ul...
Medical Risk Management <ul><li>These sound like ridiculous scenarios but the reality is that they are already possibiliti...
Medical Risk Management <ul><li>Malpractice Insurance and Claims are the single, greatest threat to healthcare today. </li...
Medical Risk Management <ul><li>Legislators truly don’t understand the driving forces here. </li></ul><ul><ul><li>Tort Ref...
Medical Risk Management <ul><li>Why do Doctors have to pay “Tails” when they change carriers or retire? </li></ul><ul><ul>...
Medical Risk Management <ul><li>How would you feel if you were told you have no choice in defending yourself. An Attorney ...
Medical Risk Management <ul><li>Speaking of Spin </li></ul><ul><li>The Government Accounting Office (GAO) says it isn’t ev...
Medical Risk Management <ul><li>Insurance companies want caps on the amount of money that can be awarded but they spend mi...
Medical Risk Management <ul><li>Hospitals are so desperate, they are creating their own insurance companies. </li></ul><ul...
Medical Risk Management <ul><li>Judges, attorneys, expert witnesses, and juries are all responsible for shutting down the ...
Medical Risk Management <ul><li>Doctors are forming Risk Retention Groups (RRGs) to combat premium increases. </li></ul><u...
Medical Risk Management <ul><li>The only way this will ever be fixed is by enacting legislation that provides for a fair a...
Medical Risk Management <ul><li>Thank you for your time </li></ul><ul><li>http://www.linkedin.com/in/ronaldcline </li></ul...
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Medical Risk Management

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Malpractice Carrier Practices Issues

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Medical Risk Management

  1. 1. Medical Risk Management Presented by: Ronald E. Cline, MBA
  2. 2. Medical Risk Management <ul><li>What would America be like without Doctors, Nurses, or Hospital Emergency Rooms? </li></ul><ul><li>Can you imagine an ambulance driven by attorneys? </li></ul><ul><li>How about your doctor saying, “We can save the leg or give you $50,000 right now. which will it be?” </li></ul>
  3. 3. Medical Risk Management <ul><li>These sound like ridiculous scenarios but the reality is that they are already possibilities and with a few bad decisions by our government; they will become reality. </li></ul>
  4. 4. Medical Risk Management <ul><li>Malpractice Insurance and Claims are the single, greatest threat to healthcare today. </li></ul><ul><ul><li>It’s the threat of suits and the premiums paid to insurance companies with astronomical annual increases . </li></ul></ul><ul><ul><li>Many practices pay 20 to 30% of their gross revenues . </li></ul></ul><ul><ul><li>Well-established specialty practices are closing or severely restricting services. </li></ul></ul>
  5. 5. Medical Risk Management <ul><li>Legislators truly don’t understand the driving forces here. </li></ul><ul><ul><li>Tort Reforms only limit economic damages (lost wages) not pain and suffering awards. </li></ul></ul><ul><ul><li>An entire industry of Risk Management professionals was created simply because of the threat posed by litigious patients and a flawed legal process. </li></ul></ul><ul><ul><li>The legal system does not fairly represent doctors. Juries are not filled with peers with a clear understanding of the medical terminology or even basic principles. </li></ul></ul>
  6. 6. Medical Risk Management <ul><li>Why do Doctors have to pay “Tails” when they change carriers or retire? </li></ul><ul><ul><li>A Tail is a fee paid for continued coverage for any new claims filed for two years after you terminate/chamge carriers. </li></ul></ul><ul><li>Tail coverage is a fee charged for covering new claims filed during the period a doctor was already covered for. Essentially, you have to pay for the same coverage twice! The fee is typically two years worth of premiums. </li></ul><ul><ul><li>Imagine that you decided to change jobs and shortly after starting your new job you receive a bill for two years premium from your previous healthcare insurance. Your spouse was hospitalized for 30 days recently for a serious illness costing at least 100 thousand dollars and the bill wasn’t sent before you changed coverage. Now your old medical insurance can refuse payment unless you pay the additional two years premium. Sounds horrible doesn’t it? </li></ul></ul>
  7. 7. Medical Risk Management <ul><li>How would you feel if you were told you have no choice in defending yourself. An Attorney can decide to settle any case without your input possibly ending your professional career and you never had a choice. </li></ul><ul><li>Malpractice carriers have the right in most cases to settle cases over your objection. </li></ul>
  8. 8. Medical Risk Management <ul><li>Speaking of Spin </li></ul><ul><li>The Government Accounting Office (GAO) says it isn’t even a problem! </li></ul><ul><ul><li>Everyone else says it is. What numbers are they using? </li></ul></ul><ul><ul><li>Guess who they asked if there was a problem? </li></ul></ul>
  9. 9. Medical Risk Management <ul><li>Insurance companies want caps on the amount of money that can be awarded but they spend millions to avoid limits on premium increases. </li></ul><ul><ul><li>Increases of annual premiums are based on claims* made regardless of the dollar amount and the vast majority of claims are very small. </li></ul></ul><ul><ul><li>A 30% increase has become the norm for each claim made! Valid or not. </li></ul></ul><ul><ul><li>*Claims can also include the threat of a claim, even if never pursued. </li></ul></ul>
  10. 10. Medical Risk Management <ul><li>Hospitals are so desperate, they are creating their own insurance companies. </li></ul><ul><ul><li>Doctors are investing their own money to develop their own malpractice company so they can fight claims and retain some of the money they lose to malpractice carriers. </li></ul></ul><ul><ul><li>Mega-claims will literally close health systems down claiming thousands of jobs and leaving vast rural areas devoid of any services at all! </li></ul></ul><ul><ul><li>How would you like to live in one of these areas? </li></ul></ul>
  11. 11. Medical Risk Management <ul><li>Judges, attorneys, expert witnesses, and juries are all responsible for shutting down the world’s best healthcare system. </li></ul><ul><ul><li>Do you feel qualified to act as a peer of a highly-trained physician? Attorneys do. Juries are asked to. </li></ul></ul><ul><ul><li>Everyday, an attorney somewhere is explaining what a doctor did wrong. Which medical school did they go to? Which medical school did the jury go to? </li></ul></ul><ul><ul><li>“ Expert witnesses” testify on cases they have never reviewed, on procedures they have never done, about patients they have never met using terms that only medical professionals understand. </li></ul></ul>
  12. 12. Medical Risk Management <ul><li>Doctors are forming Risk Retention Groups (RRGs) to combat premium increases. </li></ul><ul><ul><li>RRGs allow Doctors to have some control over the increases arbitrarily exercised. </li></ul></ul><ul><ul><li>RRG’s do not protect them from massive damage awards. </li></ul></ul><ul><ul><li>Once a doctor has a “mega claim” against them, they face significant challenges in future medical practice. </li></ul></ul><ul><ul><li>Doctors can do everything right in a case by all medical standards and still lose in court! </li></ul></ul>
  13. 13. Medical Risk Management <ul><li>The only way this will ever be fixed is by enacting legislation that provides for a fair and just award for claimants and eliminates mega-dollar payouts to attorneys. Strangely enough, in States where Tort Reform has been enacted, attorneys lose interest in these cases and premiums for insurance are manageable. </li></ul>
  14. 14. Medical Risk Management <ul><li>Thank you for your time </li></ul><ul><li>http://www.linkedin.com/in/ronaldcline </li></ul><ul><li>[email_address] </li></ul>

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