How Physicians Insurance Is Responding to Changes in the Health Care Environment
Mary-Lou A. Misrahy, ARM
President and CEO
Health care continues to present challenges for physicians, clinics, and hospitals here in the Northwest. Physicians of different specialties are finding that new requirements are expected of them in their daily practice. RAC (Recovery Audit Contractors) audits have intensified, causing physicians and clinics to investigate new ways of protecting their practice. Clinics are looking into medical stop-loss insurance and reinsurance to contain costs. Additionally, physicians and hospitals must find ways to satisfy the quality standards that will have a significant impact on their reimbursement for patient care services. On these issues and more, Physicians Insurance is in step with changing trends, and will remain a valuable resource for health care professionals who want to continue to provide excellent care and improve patient safety.
Specialty focus groups have allowed us to keep our ear to the ground for new developments and unique challenges faced by different medical specialties. The Risk Management Department has found that frank discussion among a small group of geographically diverse colleagues is invaluable for capturing the concerns faced by the larger specialty community. Issues identified by each group are compiled into a survey sent to all member physicians in that specialty. The resulting data informs the design of risk management resources and CME offerings.
We are expanding our use of professionally led focus groups as an important method for identifying liability risks and opportunities for practice improvement. Specialty focus groups are another way that Physicians Insurance is responding to the changes in health care that are affecting individual physicians.
Billing Errors & Omissions Coverage
Increased threats to health care practices motivate us to take a closer look for solutions. Because the federal government has adopted a zero tolerance policy for “improper” claims and the Centers for Medicare and Medicaid Services is authorized to deny and recover improper payments, audits of medical practices have been aggressive and subjective. We have been monitoring the RAC audits in our region and know what auditors look for, how exorbitant the costs can be, and how physicians might need help. Through Physicians Insurance Agency, we can provide coverage and expertise to assist physicians when faced with billing error claims brought by government and commercial payers.
Medical Stop-Loss and Reinsurance Opportunities
As more and more health care facilities consider self-funding, Physicians Insurance has become a key resource. Our Medical Stop-Loss Program offers secure risk coverage that protects medical practices from catastrophic medical costs, providing excellent customer service, flexibility, and value to customers. Our book of business has increased steadily, demonstrating both the need in the Northwest and our ability to provide the coverage clients are looking for. Also, through our reinsurance partner, Swiss Re, we offer complimentary consultation for catastrophic claims and care management challenges.
As we plan for developments in 2012 and beyond, we continue to work closely with the Washington State Medical Association (see "A Unique Partnership That Supports You"), explore ways to promote better health care outcomes and satisfy quality standards established by CMS and others, seek greater opportunities for new members in Oregon and Idaho (see "How Physicians Insurance Responds to Changes in Health Care in Eastern Washington and Idaho" and "Physicians Insurance Making Headway in Oregon"), and monitor legislative activity that can affect local health care practices (see "Mohr v. Grantham: Could This Supreme Court Decision Change the Practice of Medicine in Washington?"). In our meetings with physicians on the Board of Directors, Board committees, specialty focus groups, and personal visits with members, we continue to seek an open dialogue with physicians and health care professionals who are preparing for changes while striving to maintain the highest standard of care.