What You Should Know Proprietary and Confidential Proprietary and - PowerPoint PPT Presentation

What You Should Know Proprietary and Confidential Proprietary and Confidential

A New Medical Liability Crisis The medical liability situation worsened in the late 1990’s  Minimal reforms of 1995 failed  Mandatory rate roll backs were not supported by the ineffective reforms  Payouts were out of control  Carriers were going out of business or leaving the state  JUA grew to record numbers Proprietary & Confidential

2003 – When Pigs Flew & Chicken Had Teeth House Bill 4 was the name of our 2003 Tort Reform bill  Signed into law June 11, 2003 by Governor Perry  Took effect September 1, 2003  Touted nation-wide as the model of effective tort reform Proprietary & Confidential

Still Effective After 10 Years +  Miraculous accomplishment considering the magnitude of the bill  Passing the constitutional amendment assured us that the courts would not, in prompt fashion, overturn the noneconomic caps, enabling insurers to provide immediate rate relief  The law was so well written, with language provided by attorneys who actually try malpractice cases and handle their appeals, that unlike many other similar laws, it has stood the test of time and judicial review over and over. Proprietary & Confidential

WE NEVER SAID MEDICAL CARE WOULD BE CHEAPER Our goal was to improve access to medical care, and our tort reform has done that. 5 Slide supplied by Jon Opelt - TAPA

6 Slide supplied by Jon Opelt - TAPA

Why Do We Have Lobby Teams? Why not just let TMA and TAPA handle it?  While our needs are generally consistent with theirs, priorities can be different. Sometimes someone else is needed to take on the battle.  “Two heads are better than one” etc  “It takes a village…” -Old African Proverb  We might not know of issues without someone who is on the political scene regularly telling us  Like we know about med mal – lobbyists know about government and politics! Proprietary & Confidential

TMB and Pain Management Proprietary and Confidential Proprietary and Confidential

Pain Management Rules Rule 170 establishes a standard of care not “reasonable physician” standard Keeping pain at satisfactory level and patient functional not sufficient TMB thinks long term narcotics do not work Rule 170 sets out specific steps Proprietary & Confidential

Needed Revisions: Remove emphasis on urine drug screens – 1. expensive and destroys trust Allow for a treatment goal of stability rather than 2. “progress toward treatment goals” Eliminate requirement to document “effect of 3. the pain on physical and psychological function” Mid-levels can prescribe, but refills need consult 4. with physician - backwards Proprietary & Confidential

"In my many years I have come to a conclusion that one useless man is a shame, two is a law firm, and three or more is a congress." JOHN ADAMS Proprietary & Confidential

Risk Management Services Proprietary and Confidential Proprietary and Confidential

Risk Management Department TMLT’s risk management department is dedicated to providing policyholders with comprehensive services to assist in the avoidance, reduction, and defense of medical liability claims, as well as Texas Medical Board complaints and privacy regulation violations. The risk management department offers continuing medical education programs, practice reviews, telephone/e-mail consultations, and sample resources enabling physicians to reduce their risk. Services are customized to policyholder needs and the rapidly changing healthcare environment physicians practice in today. Proprietary & Confidential

Risk Management Services  CME seminars Continuing  On-line CME activities Medical Education  CME publications  Medical record review and practice evaluation Practice  Personalized wrap-up discussion Reviews  Customized, specialty-specific recommendations  Phone/E-mail consultations Consultations &  Sample tools Resources  Practical resources Proprietary & Confidential

CME: Accreditation with Commendation TMLT has achieved Accreditation with Commendation – the ACCME’s highest level of recognition Proprietary & Confidential

CME: Popular Program Topics • Describe physician responsibility related to Informed Consent informed consent and areas of vulnerability inherent in informed consent • Identify when a physician-patient relationship Patient Termination has been established and develop strategies Ethics CME to appropriately terminate • Recognize “hot buttons” arising in post Texas Medical Board tort-reform litigation and complaints to the TMB • Assess compliance level with privacy HIPAA protections under HIPAA and address new protections afforded to Texas patients • Address how EMR’s impact patient Electronic Medical safety, quality reporting, and risk Records management Proprietary & Confidential

CME options at your fingertips Proprietary & Confidential

Practice Reviews The Risk Management Department has Texas covered During a practice review, a risk manager will:  Tour and assess practice  Review medical records for strengths and weaknesses  Review policies and procedures  Meet with physicians to discuss findings and recommendations  Prepare a written recommendation report and assess responses Proprietary & Confidential

Practice Reviews: Common Recommendations • Templates should be edited as Preformatted Text necessary to ensure record accurately or Templates EMRs reflects care delivered Locking Encounter • Prompt completion of patient encounter notes provides protection from perception that note Notes could have been altered Documentation • Duty of providing informed consent lies Informed Consent with provider and should be documented in the medical record • Education of any form should be documented Patient Education to verify patient was provided pertinent information regarding care P&P Policies and • Standardization in critical areas limits Procedures miscommunication and enhances training Proprietary & Confidential

Consultations and Resources A risk management representative is available daily for confidential phone or e-mail consultations and to provide resources regarding risk management issues, such as:  Termination of the physician/patient relationship  Release of medical records  Treatment of noncompliant patients  Texas Medical Board rules  Treatment of minors Proprietary & Confidential

Medical Director Coverage Proprietary and Confidential Proprietary and Confidential

Definition L. "medical director" means a physician who serves in an administrative capacity as head of an organized medical staff and whose duties include (1) training and supervision of medical staff (both physician and non-physician); (2) drafting and implementation of appropriate policies and procedures; and/or (3) assuring the facility's compliance with federal, state and local laws. Medical director services do not include employment related practices. Proprietary & Confidential

Cyber Liability Coverage Proprietary and Confidential Proprietary and Confidential

Types of Risks  lost laptops;  theft of hardware or data;  improper disposal of medical records;  hacking or virus attacks;  rogue employees;  cyber extortion; or  cyber terrorism. Proprietary & Confidential

A Growing Problem  Panda labs, an antivirus software vendor, reported that there were 60,000 strains of malware in existence in 2010.  In 2010, FBI’s International Crime Complaint Center (IC3) received the second-highest number of identity theft complaints since its inception. IC3 also reached a major milestone this year when it received its two millionth complaint. On average, IC3 receives and processes 25,000 complaints per month.  Texas is third in cybercrime complaints (7.3%) in the U.S.  Texas is fourth for cybercrime perpetrators (6.9%) in the U.S. Proprietary & Confidential

Laws Federal  HIPAA (1996)  HIPAA Privacy Rule (2002)  HIPAA Security Rule (2003)  HITECH additions to HIPAA (2009)  Non-HIPAA: Federal Confidentiality Law 42 CFR Part 2, CMS, JCAHO, CLIA, FERPA, ERISA, FTC Red Flags Rule… State  Texas new privacy law HB300 (2012)  Texas Medical Practice Act (Occupations Code)  Various other statutes Proprietary & Confidential

Limits Cyber liability policy limits are $50,000 per claim subject to a $50,000 aggregate per policy period and there is no deductible. If the policy is on a group policy form, the policy aggregate for all policyholders is $250,000. Higher limits of $1 million are available at a discounted cost, should a policyholder request them. Payment directly to physician for system damage Payments to others if claim against physician for privacy breach Proprietary & Confidential

Coverages  Network security and privacy insurance  Regulatory fines and penalties insurance  Privacy breach response costs, patient notification expenses, and patient support and credit  Monitoring costs insurance  Network asset protection  Multimedia insurance  Cyber extortion  Cyber terrorism Proprietary & Confidential

TMLT EPLI Policy – eff. 2-1-13 Proprietary and Confidential Proprietary and Confidential