ACO Reinsurance is Available For Medicare Shared Savings Programs Track 2- Two Sided Model

The approach of spring signals new things; in the ACO world on April 1 those who have been selected to participate in track 2 Medicare Shared Savings Programs will be selected. Those who selected the Track 2 will be assigned a patient group. ACO’s can share in up to 60% of the savings, and conversely they can also share in the losses after a 2% minimum is achieved.

CMS will give a per year per member, or PYPM, factor which is based on past payment per member. This has been adjusted for trend, and there has been adjustment for the chronically ill hopefully assuring that the ACO does not get an inordinate amount of patients with known morbid diagnosis.

The math will look like this:

5000 ACO patients x $13,000 (cost that CMS feels it will pay this year per patient) = $65,000,000.

The $65 million will be the target budget, which the ACO will manage, and through coordination of care, EMR, preventative medicine, and other services the cost will be driven down and will improve patient morbidity. The ACO will share in the savings. If they blow the budget then they have to pay CMS a penalty based on a small percentage of the losses.

The ACO must post cash, bond, LOC, or reinsurance to assure there will be some security, so that if there are losses the ACO’s part is secured. ACO reinsurance presents some challenges since there are no off the shelf solutions. The ACO reinsurance company will have multiple risks to access. However it is not outside of the lexicon of provider stop loss; it is also called Managed Care Excess, provider stop loss reinsurance, or capitated stop loss.

Our company was an early pioneer of provider stop loss; over 20 years ago, we created many of its applications along with some bold reinsurance companies. Provider Stop Loss was designed to provide per patient protection for a capitated provider. There is a deductible per patient and once it is met, the reinsurer reimburses the provider. The ACO reinsurance policy will need this type of outlier protection so that if the patients that are assigned have significant shock loss there needs to be protection for the ACO. If they have a fair number, this could cause the ACO to exceed its budget and the reinsurance will be there as an outlier to reimburse the provider, who now owes its penalty for exceeding the budget. There is also an aggregate need, which would basically take the total budget and use this as the aggregate deductible and once it is exceeded by X% the ACO reinsurer pays the ACO the claim.

We at HCP National have been working with our reinsurance companies for some time to create an ACO reinsurance product which we have achieved. We also provide stop loss insurance, provider Stop loss, HMO reinsurance, ACO stop loss and malpractice insurance in CA, Malpractice insurance in Co, and Malpractice insurance in NY.

NORCAL Mutual has been approved by the California Department of Insurance for an overall 7.07 percent rate decrease in Medical Malpractice Insurance rates. I would like to elaborate on a few points for you.

•The full implementation of the new Med Mal rates will be completed by July 1, 2012. The new malpractice rates apply to all new and renewed policies effective January 1, 2012 and later. All adjustments will be made by July 1, 2012.

Two other changes were made as part of the rate filing:
• The entity premium increased from 11 percent to 12 percent.
• The claims-made step progression has been changed from six years to five years to achieve policy maturity.

Please note that the changes in the entity rate and the adjustment in the claims-made malpractice insurance step process will become effective for new and renewed business on July 1, 2012 or later, and will not be applied retroactively. Either of these two changes may, in some cases, increase an account’s overall premium or offset what otherwise might be a premium reduction.

For those clients eligible for NORCAL Mutual’s five percent risk management discount (solos and 2–4 groups), the rate filing may mean additional savings. If the client is an active member of one of NORCAL Mutual’s endorsing medical societies, they can receive an additional two percent discount by completing a minimum of three NORCAL Mutual CME credits. We have worked with the county medical societies to obtain their membership lists, to ensure that those eligible medical malpractice policyholders who earned three or more CME hours in 2011, will receive the new 7% discount beginning January 1, 2012.

Also, as a reminder, we have waived the age requirement for the med mal retirement tail waiver rule. All other provisions remain unchanged.

Nothing in this blog changes or alters coverage terms. Always check your policy and call your insurer if you have any questions.

HCP National is a national medical malpractice broker appointed by Norcal. HCP National’s Medical Malpractice Insurance brokerage is located in Orange County and Riverside CA and NY, NY. HCP does Colorado malpractice insurance, New York malpractice insurance, and California malpractice insurance.

Your medical malpractice insurance quotes and policies have their own terms, which you need to understand. By having a basic knowledge of the key terms of malpractice insurance you can be a more informed buyer and avoid costly errors.

• Retro Date – There is no coverage for any wrongful act that occurred prior to the retro date. For example, if you have a retro date of 01/01/2001, you can submit a covered claim to your current carrier for claim that happened anytime after 01/01/2001. If the act occurred prior to your policy retro date, your carrier will not respond. Always make sure your retro date is maintained before changing your insurance company; if the date changes you loseWeight Exercise insurance coverage.

• Renewal Date- This is the date that the insurer has the right under your policy to change the price or terms of your coverage. You should get your renewal ideally 30 day prior, but no later than 2 weeks prior. Call your broker or insurer if your renewal offer is late.

• Claims Made Policy- Most Med Mal insurance policies are written on a claims made basis. A claims made malpractice policy covers any eligible claims brought during the claims made policy period. There are two events for claims made medical malpractice coverage to apply. The incident must have occurred during the policy coverage period (from the retro date going forward) and it must be reported during the active policy year.

• Tail Coverage or Extended Reporting Period – This is purchased when your claims made malpractice policy is cancelled: for retirement, the insurer non- renews your coverage or you cancel your coverage for any reason.

• Full Prior Acts Coverage- This is term for malpractice insurance quotes that means the insurer is covering you back to your retro date. Always check the date on the insurance quote or policy.

• Retro Date Inception Coverage- This means that the insurer is not covering your prior acts or back to your retro. They are only covering for acts that happened after your coverage goes into effect. If you buy this type of coverage, you should always buy tail coverage from your expiring/non-renewing insurance carrier to cover your retro date.

• Step Up Rate Adjustments- When you have a claims made policy the rate will increase each year until your retro date is a full 5 years old. The reason is, each year the insurer adds one more year of coverage to the retro. If you have a retro date younger than 5 years you will receive an increase, as the insurer adds to its risk of a claim.

• At five years completed retro date the policy is called a Mature Claims Made Policy. A Mature policy usually means that you will not have any additional premium increases unless you have changes to your risk (i.e. claims, new procedures…) or if the insurer decides to raise their overall prices.

• Occurrence Medical Malpractice Insurance- An occurrence malpractice insurance policy covers any claims that occur during any policy years that you had the coverage. You do not have to buy tail insurance with this type of coverage, because it covers wrongful acts that occurred during the policy period, whether the policy is currently active or not. Occurrence Med Mal is more expensive because it has more coverage and eliminates the need for tail coverage.

• Declaration Page- This page is normally toward the beginning of your insurance policy. It lists who is covered, the deductible, the limits of coverage, your retro date, your specialty, the effective date of the coverage and the annual premium. Always review the declaration page when you receive your policy and report any discrepancies to your broker or insurance carrier immediately.

• Policy Exclusions- Always read this section in your med mal policy, especially if you have surgical malpractice or OB med mal coverage. If services or procedures that you provide are listed as excluded, call your insurer and/or broker to discuss this immediately. If something is excluded, you have no coverage for that item.

HCP is national medical malpractice company who specializes in group medical malpractice insurance and surgical malpractice insurance.

If you have ever read your medical malpractice insurance policy, you may find that you have little or no coverage for HIPAA violations. Under HIPAA you are to protect patient’s medical information (the patient’s name, social security number, and services provided).
Many surgeons and OB/GYN’s fail to realize that even “friending” a client on a social network can create a possible HIPAA claim which your medical malpractice insurance may or may not cover. If you are a General Surgeon, Cosmetic Surgeon or OB/GYN and are sued for medical malpractice for a HIPAA violation this can lead to an increase in your malpractice insurance premiums. General Surgeon malpractice insurance, as with Cosmetic Surgeon malpractice insurance and OB malpractice insurance, can be extremely expensive, even with a clean record. When claims are filed due to violations of HIPAA due to social networking, the malpractice rates can increase significantly.

General Surgeon Malpractice Insurance, Cosmetic Malpractice Insurance, and OB/GYN Malpractice Insurance loss ratios can be protected from HIPAA claims by doing some simple risk management when it comes to social media. First, do not “friend” any current or past patients. If they invite you to be a friend, politely turn them down and inform them of your patient confidentiality policy. Also ask your employees to sign a practice policy informing them that they are not to “friend”, or be “friended”, on any patient’s social networking site. Let the employee know that apart from putting the practice at risk, they themselves could be named in a suit. Do not list a patient’s name or image of their face on your website without consulting your attorney.

Lastly, consider buying HIPAA liability insurance that will protect you for claims for HIPAA violations. The coverage is affordable and worth the expense.

HCP National is a medical malpractice insurance broker in NY, Malpractice Broker in TX, Medical Malpractice Broker in CA, Malpractice Broker in AZ, and a Medical Malpractice Broker in CO. This blog is a brief description of some risk management ideas and is not meant to be legal advice.

Being a surgeon can be challenging enough by itself; but, there is always the possibility that you will be sued as well.

Sometimes your gender can contribute to whether you will be sued. Studies show that female doctors are sued much less than male doctors. Apart from purchasing Medical Malpractice Insurance from a Medical Malpractice Company, it is also important to keep in mind the following risk management techniques:

1. The first thing a surgeon should do to minimize their Malpractice Insurance loss ratio is to be a good communicator. Patients and their family members do not like to be left in the dark when it comes to what could go wrong prior to the procedure. After the procedure, call the patient or their family caregiver to see how they are doing. By doing this you are showing that you care and understand their feelings. People do not normally sue the caring surgeon who shows he or she cares.

2. Another risk management tool to protect the Cosmetic Surgeon’s malpractice loss ratio is keeping good medical records. Switch to an ERM and learn to type. Legible and clear records are what can make or break Malpractice Insurance.

3. Finally, buy malpractice insurance from a good Medical Malpractice Company and keep it up to date for the procedures you are actually doing.

If you have Cosmetic Insurance Malpractice Insurance, General Surgeon Malpractice Insurance, or OB Malpractice Insurance and you want to keep your premiums low, slow down, and try to have and show empathy for your patients. A nice doctor is seldom sued.

HCP National is a medical malpractice insurance broker in NY, Malpractice Broker in TX, Medical Malpractice Broker in CA, and Malpractice Broker in AZ. This blog is a brief description of some risk management ideas and is not meant to be legal advice.

(December 16, 2010, Aliso Viejo, CA)

William Dyer, President and Founder of HCP National, has announced their new reinsurance product for the proposed Medicare ACO’s. The final regulations have not been determined, but it appears that there will be downside risk and upside reward for providers and their facility partners. In response we have developed a reinsurance product to either insure the risk on a per patient or aggregate basis.

“We have reinsurance companies ready to issue quotes and bind coverage,” says William Dyer of HCP National. HCP National has been providing HMO reinsurance, Provider Stop Loss Reinsurance, and CMS demonstration project reinsurance for past seventeen years. If it is in healthcare and has downside risk, we can reinsure it, whether it is HMO Reinsurance, Provider Stop Loss, or ACO Stop loss.

As physicians align themselves with Hospitals, large groups or ACO’s they have to consider their Medical Malpractice Insurance. When you are solo you are the one in charge of your medical malpractice insurance. Now you may be considering relinquishing that control to the hospital, as you become their employee.

Remember, when there is a suit, they are suing you primarily and your employer is often secondary. It is you who will deal with the Medical Board, and the claims history, and the loss of reputation. So take a moment to ask some good questions:

1. Who is the hospital’s insurer, is it a self insured program. What if the Hospital has a financial crisis and I am in the middle of a claim? Who will pay for my defense?

2. If the hospital goes bankrupt what will happen to my prior acts coverage or current coverage?

3. Does the hospital cover Medical Board actions if so how much?

4. What are the limits of my malpractice coverage, will I have my own separate 1 million/3 million limit, or am I sharing this with other doctors. What will happen if the other doctors erode the policy limit, am I on my own?

5. Is the coverage occurrence or claims made; if the coverage is claims made medical malpractice will you buy my tail when I leave? How will you provide me proof that a tal was purchasedl? Also what will the limits be on my tail, and will the policy terms are the same?

6. What if I want to retire will you give me free tail?

7. Will you inform me when you make changes to the hospitals malpractice coverage, will I have a say if I do not like your planned changes?

8. Will Medicare/Medicaid billing fraud and abuse be covered?

9. Can I select my own attorney or do I have to use yours?

10. Can you force me to settle a case that I want to fight? Also what control do I have over allocation of settlement? Will payments be allocated against my record with the NPDB?

If any of the above makes you nervous. Negotiate with the hospital to have them reimburse you for your own medical malpractice insurance policy that you purchase on your own. This way you control your own insurance.

Then purchase an occurrence policy from an” A” (AM Best Category insurer) insurer. By buying occurrence medical malpractice insurance, when you leave the hospitals employ, you will have built in tail.

Parting thoughts, it appears great to leave the pressure of private practice and go work for a hospital, but remember the above before handing your medical malpractice protection over to your new employer.

HCP National is medical malpractice company broker. We provide medical malpractice in CA, NY, FL, TX and MI.

If an insurer is admitted in the state of New York their rates are regulated, and filed with the state. This gives the policyholder the security that the insurance companies cannot charge whatever they choose, since the state of New York must approve it.

Admitted New York Malpractice insurers are also part of the state guarantee fund. The purpose of this fund is to be a backstop. This means that if an admitted insurer goes under and leaves policyholder uncovered for claims, the state fund will provide coverage.

Further, admitted NY Medical Malpractice insurers, such as MLMIC and PRI must contribute to the states high risk pool which inflates the cost of malpractice premiums. This contribution is one of the reasons why NY malpractice premiums are so expensive.

HCP National is proud to provide an alternative to the high cost options that the admitted NY malpractice market offers. We have access to a national Risk Retention Group who can now provide medical malpractice insurance in NY, in many cases at lower cost. The RRG was started by MD’s who were tired of the high cost of insurance.

Here are some of the features of the RRG:
• Claims Made Policy
• 600 physicians insured and growing with coverage in 20 states
• It is reinsured by an “A” rated insurer on a ground up 80/20 quota share. Meaning the “A” rated reinsurer takes 80% of the risk and the RRG 20%
• Physician Owned and Managed
• Non- Assessable Policy
• Risk Management for all members
• Affordable Deductibles
• Premium Financing
Risk Retention Groups are usually not as expensive, as the traditional admitted insurers since they are not required to pay into NY State’s high risk pool. If you are a NY MD, let us show you how to lower your cost on your medical malpractice insurance in NY.

HCP National is medical malpractice insurance broker in NY, Malpractice Broker TX, Med Mal Broker CA and Malpractice Broker in FL. This blog is a brief description of a new lower cost NY malpractice insurer’s coverage. Do not rely on this blog for an explanation of the coverage. Only a complete policy can describe coverage.

A recent study by the AMA says that male doctors are sued more than females, and the most sued are general surgeons and OB’s. This is not a surprise to us, our firm has been providing general surgeon medical malpractice and OB medical malpractice insurance for 16 years.

Both can have similar characteristics. They perform lots of surgical procedures and have a limited relationship with the patient, when compared to the patient’s family physician (exception when the OB is also the patients Gyn).

Why males over females, male general surgeons or Ob’s can have more tunnel vision, and be seen as less caring to their patients. Meaning they concentrate so hard on doing the procedure, that they can forget there is a scared person they are working on.

It is simple, physicians who are likeable are less likely to be sued. We have found this in our experience; doctors who are always hurried and not personable often have the most claims , and those who are not had the least. Studies show those MD’s who are the most kind to their patients do not get sued as often. Tips for an amicable doctor-patient relationship:

Sit down for a minute and be eye level, or if the patient is on the exam table have
him/her above you.

Talk at a normal pace and look them in the eye.

Force yourself to listen and ask questions to show you are listening and you care.

Explain the procedure and ask if they have any concerns and listen to them.

If possible call the patient the night before the procedure if you’re a surgeon, and or go see them in the hospital one more time than necessary. Talk with the family answer their questions or concerns.

Think about the person, this may be their first time in a hospital; they and their families are scared. For you this is another of many procedures, but for them this is a big event.

Slow down and show you care, and if the procedure goes wrong at least the patient and the family have a favorable image of you. Otherwise you become the faceless nameless, or worse the rude cold doctor who harmed them, or their family member.

Part of many malpractice claims is the sense of revenge or “that jerk has to pay”, this can be avoided with a little effort, by being more likable. What a surgeon , or OB/Gyn wants their image to be to their patients (and or the family) is to feel: Dr X is such a great person and he/she tried everything and this was just one of those things. But what great physician Dr X is, he/she was very caring, kind, he/she explained that this was not a for sure thing.

Parting thoughts, remember you became a physician to help people, show this with your patients. Besides you lessen the chance of a law suit, you will build a very successful practice since people will refer you to their friends and family.

HCP National is a medical malpractice company, who specializes in surgical medical malpractice, General Surgeon malpractice insurance and Ob/Gyn Malpractice Insurance. This article is risk management technique ,and should not be seen as legal advice. If you are sued besides contact your insurer and attorney, read our article You’ver Been Sued For Medical Malpractice, Now What

Many details of healthcare reform are still unknown; as Ms. Pelosi, our former Speaker of The House, was quoted when pushing healthcare reform through that “we have to pass the (health care reform) bill so you can find what’s in it. Obviously, this is backwards logic, as are much of political decisions.”

There are however a few good ideas in the healthcare reform, and one of them are ACO’s. ACO’s are ( as proposed) integrated systems where providers and facilities work in tandem to minimize cost of healthcare for seniors while maintaining quality care. To accomplish this, the ACO will be given a defined budget, and will reap rewards if they spend less (ration healthcare) than the budget, or be punished (i.e. pay for it) if they exceed the budget.

This is not new, this is capitation and manages care, and the ACO is just a new name for a PHO or IPA. This idea has been around since the late 1980′s. It is prevalent throughout California. It is a concept that works at controlling cost. If most Americans were on capitated health plans, we would not need healthcare reform.

There will be backlash to ACO’s, this new/old concept, as seniors learn the details from slick PR Firms, whose employers want more and more of our GNP going down the drain in fee for service models. Capitation (defined budget healthcare) works and it caps spending. It eliminates fraud and creates an environment where healthcare can be rationed with sanity, versus money being sent through a fire hose (at max PSI) at a senior as they lay dying in the ICU.

In response to this we have a new stop loss product. ACO Stop Loss Reinsurance. Which will provide an outlier of reimbursement for the unpredictable shock loss claim, either stop loss reinsurance based on a per member basis, or on an aggregate budget basis?

HCP National is a Managed Care Stop Loss and Managed Care Reinsurance Broker and Reinsurance Intermediary. We do HMO Reinsurance and Provider Stop Loss and Employer Stop Loss and soon to be ACO Reinsurance and ACO Stop Loss