the amazing race
DESCRIPTION
The Amazing Race. Emerging Trends in Hospital Liability. Healthcare Facilities: The Amazing Race??. MODERATOR : Pamela K. Haughawout , CPCU , ARM, RPLU, Senior Vice President, Hilb Rogal & Hobbs Paul F. McKeon , MBA, Senior Vice President , Transatlantic Reinsurance Company - PowerPoint PPT PresentationTRANSCRIPT
2008 Medical Professional 2008 Medical Professional Liability SymposiumLiability Symposium
Chicago, Illinois ~ March 11 & 12, 2008
The Amazing RaceThe Amazing Race
Emerging Trends in Hospital LiabilityEmerging Trends in Hospital Liability
Healthcare Facilities: The Healthcare Facilities: The Amazing Race?? Amazing Race??
• MODERATOR: Pamela K. Haughawout, CPCU, ARM, RPLU, Senior Vice President,
Hilb Rogal & Hobbs
• Paul F. McKeon, MBA, Senior Vice President, Transatlantic Reinsurance Company
• Donna Modestine, Esq., Shareholder, Marshall Dennehey, Warner, Coleman & Goggin
• Joe P. Sullivan, Senior Vice President, Healthcare Group Executive, Zurich
4 Trends to Discuss
• The Condition of the Insurance Market
• Batch Issues
• Never Events
• Privacy Liability
Market Conditions
Riding the Roller Coaster
Again!
We all know the market is soft . . . But Why?
• Declining Frequency of Claims Tort Reform
• Claims Severity
Loss Ratios for Medical Malpractice Industry
Source: Bests Aggregates & Averages – Property/Casualty
0%
20%
40%
60%
80%
100%
120%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
CY LR AY LR(SchP)
1
National Practitioners Data BaseNationwide
Frequency AnalysisSource: National Practitioners Data Bank public use file, June 30, 2006
2.93.1 3 2.9
2.6 2.62.4 2.3 2.4 2.4 2.5
2.2 2.22 1.9 1.8
1.6
0
0.5
1
1.5
2
2.5
3
3.5
Cla
ims
Per
100
Phy
sici
ans
The Soft MarketMore than Just Price
• Coverage Enhancements Multi Year Deals Coverage for Punitive Damages
• Bariatrics – What Happened to this Issue?
• Risk Management Credits – Promotional Hype or Legitimate Underwriting Criterion?
Batch Issues
Batch/ Systemic Events
• Real or Imaginary?
• Brokers Pushing or UWs Offering?
• Excess layers are softest part of market
Systemic Events
• Over 30 cases in our inventory with some consistency: Surgical Techniques Sterilization (Hepatitis, Others) Credentialing Products Laboratory techniques
…various others
Underwriting Approaches
• Price, Attachment, Wording, or Luck?
• Wording - Policy period(s) Sole Judge Split Retentions …various others
Never Events
What are Never Events
• Payment reform enacted by Medicare
• No reimbursement for a condition that never should have occurred during an in-patient stay
8 Conditions
• object left in surgery• air embolism• blood incompatibility• catheter associated UTI's• decubitus ulcers• vascular cath associated infections• surgical site infections• falls and trauma
3 More Conditions
• ventilator associated pneumonia
• staph. aureus septicemia
• deep vein thrombosis / pulmonary embolism
3 criteria for deciding what a Never Event Is
• High cost/high volume or both
• Assignment of a case to a diagnostic related group with higher payment because of secondary diagnosis
• Preventable through evidenced based guidelines
NEVER EVENTS – NEW STANDARD OF CARE???
• Will "never events" payment rules impact Medical Malpractice Litigation
• Some Issues to Think About- Whether CMS regulatory violations constitute
negligence per se Whether payments to a hospital under 5001(c)
would be admissible evidence to support allegations of negligence
Do we still need medical experts now that CMS has specified preventable error and blessed specific preventable guideline?
• Private Insurers are following suit
DOES THIS CONSTITUTE STRICT LIABILITY
In the news…
Staph infection threatens lives
Drug-resistant skin infections spreading fast
Over half of ER cases caused by potentially fatal
superbug, researchers say
CDC seeks to calm schools over ‘superbug’Best way to fight the bacteria is simply to
washyour hands, officials say
Emergence of MRSA
• First recognized in 1968
• Early 1990’s accounted for 20-25% of Staph Aureus isolates
• 1999 - accounted for > 50% of Staph Aureus isolates
• 2003 – accounted for 59.5% of Staph Aureus isolates
Clostridium Difficile
Most common cause of hospital acquired bacterial diarrhea
Often triggered by antibiotics
Common in hospitals and long-term care facilities
Yearly Clostridium difficile-related mortality rates per million population, United States, 1999–2004.
Source: Centers for Disease Control and Prevention Emerging Infectious Diseases [online] 2007 Sep [cited 2007 Aug 17]. Available from Internet: http://www.cdc.gov/eid/content/13/9/1417.htm
Norovirus
“Cruise ship” virus - New strains have caused increased hospital and LTC outbreaks
ED visits for acute gastroenteritis increasing (especially since October 2006)
Probably under-reported since testing is inadequate
Norovirus
Estimated total cost for a 3 month Norovirus outbreak
clean-up expenses $96,000 staff sick leave and overtime $89,000 lost revenue from closing units and echo lab
$418,000.
Total: $650,000
Sources of Superbugs
• Patient gowns
• The floor
• Bed linens
• Blood pressure cuffs
• Over-the-bed tables
• Stethoscopes
• Door handles
• TV remote control
• Patient bed controls
#1 Healthcare Workers
Great Britain
• No long-sleeve white coats
• No ties• No fake nails• No jewelry
• No watches
Mandatory public reportingPremier. Reducing the cost and impact of infectious disease. June 2007
Privacy Liability
HIPAA – HOW FAR HAVE WE COME
• HIPAA AND HOW IT IS BEING ENFORCED, IF AT ALL Office of Civil Rights 24,000 HIPAA privacy complaints First HIPAA violation trial – Fernando Ferrer, Jr.
• HIPAA COMPLIANCE IS NOT SIMPLY A FEDERAL REGULATORY MATTER State Courts Look to HIPAA as Standard Acosta v. Byrum 638 S.E.2d. 246 (N.C. Ct. App. 2006) Bagent v. Blessing Care Corporation, 244 Ill.2d 154 (2007)
• HOW HOSPITAL'S ARE PROTECTING THEMSELVES
• IS HIPAA HERE TO STAY? (HIPSA) Kennedy/Leahy Bill - S. 1814
Discussion Points
• The issues surrounding interoperable electronic health records is the biggest privacy and security policy issue on the horizon
• Is it possible to balance the desire for electronic medical records/personal health records with appropriate privacy and security issues identified by HIPAA?
• The debate on EMRs/PHRs likely will drive a new evaluation of HIPAA
• Will the drive of Health Information Exchanges in Hospitals and Health Systems open the door to increased HIPAA based private litigation and what hospitals can do to protect themselves?
Thanks for Inviting US