Medical Professional Liability Insurance

Artificial Intelligence (AI)-Generated Healthcare Content; Understanding the Limitations

July 9, 2024

By Kaelin O’Reilly, ProAssurance communications specialist

Artificial intelligence (AI), including chatbot tools like the popular ChatGPT, has made possible many useful applications in the healthcare sphere. ChatGPT’s ability to generate human-like responses to natural language inputs has made it an attractive tool for professional and student writers.¹ The application can help develop quality and informative content in the form of articles, reports, blogs, tweets, and emails.² This content may be produced in less time than traditional writing, and the burden of arduous research tasks can be reduced. In the fields of medicine and science, healthcare providers, researchers, and academics can access valuable medical education; supplement record documentation; and produce journal articles, clinical studies, and research papers with assistance from the tool.¹

ChatGPT’s natural language processing model builds on older technologies of speech recognition, predictive text capability, and deep learning.³ It can function as a search engine, providing direct responses to user queries by applying specific criteria to locate appropriate resources. ChatGPT can aid in topic generation and provide translation for some medical and technical jargon. Because its algorithm is “trained” on a robust dataset of conversational text, the tool can address and generate practical written responses for a broad range of prompts, capturing many of the nuances and variations unique to human speech. It can also present language that is clear, easy to follow, often eloquent, and in the appropriate, specified structure.¹

While AI tools like ChatGPT present significant advantages for writers, these applications are not without shortcomings. AI-generated content raises the following concerns⁴:

Authorship and Accountability
Inaccuracies and Errors
Biases and Prejudices
Lack of Regulations, and Privacy and Security
Dependence and Job Displacement

Moreover, developing and fine tuning the ChatGPT algorithm necessitates the collection and analysis of huge volumes of text data across the internet. Notably, these data collections have been relatively sporadic, with the last two collections covering information only up to September 2021, then up to April 2023 with its newer model. This may result in the information generated by ChatGPT being erroneous or out of date, or perpetuating an incomplete or distorted picture of the subject matter.^1,5 Misinformation may be overlooked or unknown, and inadvertently passed on in published work.² As AI implementations become even more commonplace, both readers and writers should be mindful to question the validity and reliability of content and familiarize themselves with the functional limitations of chatbots like ChatGPT.¹

The Limitations and Concerns of ChatGPT-Generated Content

Authorship and Accountability

AI-generated content invites questions about authorship and accountability and, specifically, whether tools like ChatGPT should be applied in research and writing, including healthcare works. Credit for published material has traditionally been given to the individual contributors for their work in applying intelligence to idea generation, research and analysis, design, and execution. It is suggested that definitions of authorship may need to be revisited and specified, considering use of ChatGPT and other AI tools in the healthcare ecosystem is only growing. However, most journals will not allow designation of ChatGPT as an author, suggesting that although the tool does mimic human thought progression and language, create a logical and well-developed piece of writing in an appropriate format, it may not have the capability to produce information that is 100% reliable. As AI is non-human, it cannot be held responsible for its content in the same way as individuals with intention and legal obligations.^1,4

Supporting the argument of accountability is an acknowledgment of the continued need for human intervention with use of these tools, despite their impressive capabilities. Specifically, processes like editing and applying reason and specialized expertise lie beyond the product’s scope of training but are nevertheless essential in writing It may be acceptable, however, and even beneficial for writers to include references to such AI tools along with the other resources they have used in the development of their work. Doing so might establish greater transparency while allowing the author to claim appropriate responsibility for the validity of their content. Further, such citations may bring awareness to the merits of AI resources like ChatGPT as supplemental assistants to the research and writing processes.^1,4

While AI algorithms evolve with new and expanding data collections, opportunities for misuse and plagiarism emerge. In one study, plagiarism detection software and detection tools used to identify AI-generated content (“AI output detector”) were applied to 50 research abstracts that were generated solely by ChatGPT. The ChatGPT had created these abstracts following its review of excerpts from journals like JAMA and The New England Journal of Medicine. The plagiarism detection software found no plagiarism by ChatGPT, while the AI-output detector recognized only 66% of the abstracts as being AI-created. It is encouraging that ChatGPT was not found to have plagiarized the journal articles. However, as ChatGPT seemed to be able to pass through the AI-output detector checks with relative ease, it may be deduced that an individual reader would be unable to make the differentiation.¹

Inaccuracies and Errors

Accuracy and reliability of text generated by AI models depend on the quality of data used in training the models. ChatGPT, like any AI model, may have errors or biases built into its core algorithm and, as a result, its output based on these inaccuracies will sometimes be incorrect.¹ Language models are inherently intricate, complex, and potentially difficult to understand. A user may lack the foresight or knowledge necessary for gauging the correctness of an AI-generated answer or spotting specific errors, especially if the user is not aware how the tool arrived at these conclusions.⁴ There may be ambiguities in the user’s prompt or question (i.e., vague wording, meandering, or unfocused speech), resulting in an answer that is in turn, also ambiguous.¹ In addition, using preset calculations to parse through data and elect the “best” answer in mere fractions of a second—even when there is no clear or easy answer available—can result in incomplete, skewed information. These types of outputs, known as AI “hallucinations,” are presented as factual but are really more of an improvised best guess generated by the chatbot, and have a high potential for inaccuracy.⁶

ChatGPT has a limited ability to apply deductive reasoning in its approach to answers, or to deconstruct and prioritize answers to layered questions. It can have trouble inferring underlying meanings or handling complex, “niche” topics. This weakness becomes even more challenging in detailed areas of science and medicine, which require subject matter expertise and an acute awareness and ability to analyze the constant changes and developments characteristic of these fields. Though ChatGPT is skilled in performing some language translation and adjustment to make medical conditions and treatment terminology more digestible for the average person, the tool may have a hard time interpreting or “understanding” certain medical phrases or jargon specific to a lesser-known subject or subspecialty.⁷

Biases and Prejudices

Data used in the development of AI algorithms may be limited to over- or under-represent certain groups, genders, ages, races, and cultures.⁸ A close examination will reveal that this overgeneralized and unbalanced data base fails to properly include certain populations. Therefore, the results from AI chatbots may be unreliable as applied to those groups. The potential biases and discriminatory attitudes that may be apparent in data collected across the web, and that inform the outputs generated by tools like AI chatbots, reflect not only society’s culture but also the potential culture of technological innovators of the AI-assisted product. A lack of diversity among these teams, as well as collective misconceptions or prejudices can become “embedded” in product development, meaning that product may exclude sizable groups of the population. As well, an unintentional flaw in the product design or in the algorithm’s data input can also yield such biases. These biases perpetuate when AI presents flawed conclusions to users, who may rely upon and pass along that skewed information. Large, varied groups and underrepresented communities should be included in research studies, to effectively create more diverse training sets for new algorithms. Doing so will allow ChatGPT and similar tools to provide a more valuable application that generates more accurate, reliable, and inclusive results.⁹

Lack of Regulations; Privacy and Security

Training of algorithms for ChatGPT and other chatbot implements incorporates access to extensive datasets, which may potentially include health information, particularly if the AI tool is utilized across healthcare facilities through sharing of patient information. Of course, a concern with utilizing health information is the privacy and security of the details within that gathered data, which may be vulnerable to hackers and data breaches. When the underlying data for an AI algorithm contains health information of an actual person, utilizing only properly de-identified data that does not contain protected health information of any individual will avoid violations of HIPAA and breaches of privacy. With no universal guidelines in place to govern the use, efficacy, implementation, and auditing of newer AI tools like ChatGPT in the healthcare sector, legal and ethical debates circulate around the handling and quality of data, patient consent, and confidentiality. A lack of clarity about data models and algorithms plus inadequate training on the user functions of AI equipment invite warranted skepticism and present a need for greater transparency and education across healthcare organizations. It is suggested that collaboration among AI innovators, security experts, and policymakers, as well as healthcare clinicians and providers, is necessary for the development and implementation of rules, regulations, and guidelines to address these novel issues of transparency and security and provide a smoother integration of AI into clinical practices. Specifications in these guidelines could include restrictions on data usage and the sharing of information and impose quality control measures for de-identification, encryption, and anonymization. These specifications would help ensure privacy and security, while maintaining quality of patient care and compliance with existing national healthcare regulations.^8,9

Dependence and Job Displacement

There does exist a concern for dependence and overreliance on AI-assisted tools, especially if their algorithm models are flawed, contain biases, or are simply outdated. Leaning too heavily on these tools can result in missed errors, and a complacency around fact checking and quality assurance for documentation and other important practical applications in healthcare. Regarding the production of healthcare and scientific-related written content, it holds that creativity, personal experience, and an individual voice contribute to quality and originality. The potential for overreliance on AI causes deep concern that these attributes may be lost using a tool like ChatGPT. Content generated through a chatbot should be reviewed and edited for factual merit, quality, grammar, consistency, and timeliness. While AI technology advances in functionality and versatility, researchers and writers may fear job loss or a reduction of employment opportunities. However, the elements common to valuable written pieces illustrate integral contributions that can only come from individual authors: demonstrated depth of knowledge, critical and applied thinking, anecdotes and specific deductive reasoning, and a personal connection to the audience. These are human attributes that cannot be fully replicated or recreated by any technology. ChatGPT and other chatbot tools currently work best alongside humans, serving as resources and tools, making the processes of writing and research smoother and more manageable.^4,8

References

1. Tirth Dave, Sai Anirudh Athaluri, Satyam Singh, “ChatGPT in Medicine: An Overview of Its Applications, Advantages, Limitations, Future Prospects, and Ethical Considerations,” Frontiers in Artificial Intelligence 6 (May 4, 2023), https://www.frontiersin.org/articles/10.3389/frai.2023.1169595/full.

2. Jodie Cook, “6 Giveaway Signs of ChatGPT-Generated Content,” Forbes, Dec. 6, 2023, https://www.forbes.com/sites/jodiecook/2023/12/06/6-giveaway-signs-of-chatgpt-generated-content/?sh=10b8c9181e7d.

3. “The Benefits of AI in Healthcare,” IBM Education, July 11, 2023, https://www.ibm.com/blog/the-benefits-of-ai-in-healthcare/.

4. Alexander S Doyal et al., “ChatGPT and Artificial Intelligence in Medical Writing: Concerns and Ethical Considerations,” Cureus Journal of Medical Science 15(8) (August 10, 2023), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492634/#:~:text=Some%20suggested%20uses%20of%20ChatGPT,in%20the%20writing%20of%20medical.

5. Aaron Mok, “ChatGPT Is Getting an Upgrade That Will Make It More Up to Date,” Business Insider, Nov. 6, 2023, https://www.businessinsider.com/open-ai-chatgpt-training-up-to-date-gpt4-turbo-2023-11#:~:text=ChatGPT%20users%20will%20soon%20have,at%20its%20first%20developer%20day.

6. Sindhu Sundar and Aaron Mok, “How Do AI Chatbots Like ChatGPT Work? Here’s a Quick Explainer,” Business Insider, Oct. 14, 2023, https://www.businessinsider.com/how-ai-chatbots-like-chatgpt-work-explainer-2023-7.

7. Bernard Marr, “The Top Limitations of ChatGPT,” Forbes, Mar 3, 2023, https://www.forbes.com/sites/bernardmarr/2023/03/03/the-top-10-limitations-of-chatgpt/?sh=5b49a2158f35.

8. Josh Nguyen and Christopher A. Pepping, “The Application of ChatGPT in Healthcare Progress Notes: A Commentary From a Clinical and Research Perspective,” Clinical and Translational Medicine 13(7) (July 2, 2023), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315641/.

9. Bangul Khan et al., “Drawbacks of Artificial Intelligence and Their Potential Solutions in the Healthcare Sector,” Biomedical Materials & Devices 1-8 (Feb. 8, 2023), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9908503/.

Originally posted in ProVisions, reposted with permission

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

Med Mal 101 Refresher for All Physicians

July 8, 2024July 9, 2024

By Shawna Bertalot, CIC, ACI, WisMed Assure President

The WisMed Assure team spends a lot of time the first half of the year doing Medical Student and Resident education on topics especially important to those who are completing their education and heading off to their first jobs. Part of that education is Medical Professional Liability (Med Mal) 101. While most physicians are now employed by large groups, hospitals or health systems that purchase their Med Mal insurance for them, there are a few key elements and responsibilities that every physician should know.

Med Mal insurance requirements vary by state. Wisconsin has strong tort reform laws* and requires all physicians and CRNAs who are licensed and practice in the state to carry insurance limits of $1M per medical incident and $3M aggregate per policy year. This insurance must be with an insurance carrier approved by the Wisconsin Office of Commissioner of Insurance to qualify for the unlimited excess coverage of the Injured Patients and Families Compensation Fund (IPFCF). Illinois by comparison has no requirement for physicians to carry insurance, no excess liability fund and no tort reform, thus insurance premiums and severity of claim awards are much higher than in Wisconsin.

It is important for you to know and track the type of Med Mal policy you have throughout your career. The two types are Claims-Made and Occurrence; the primary difference being whether the policy covers claims that are MADE during the policy year or claims where the alleged wrongful event OCCURRED during the policy year.

Graphic explaining Claims-Made and Occurrence Med Mal

The most important difference is that if you have a Claims-Made policy and you leave your employer or cancel the policy, all coverage ends unless an “Extended Reported Period,” commonly called “Tail” coverage, is purchased. If you are employed, you need to know if your policy is Claims-Made and who is responsible for purchasing a Tail per your contract. If your employer requires you to pay for the tail upon leaving, then it would be beneficial to check with your employer’s risk manager, insurance agent, or company to determine the cost. The IPFCF requires that a tail is purchased.

Understanding your responsibilities under the IPFCF is an important responsibility that rests with each individual physician. In January 2023, the IPFCF implemented a new policy and administration system that allows participants to review their status and pay online. Your employer may handle the primary insurance and payment of IFPCF fees; however, it is the responsibility of every resident and physician to know their status and maintain compliance with the IPFCF. Click here for more information.

We recommend all physicians keep their own file on their Med Mal coverage. This file should include a Certificate of Insurance for each year of coverage. This certificate will show your policy number, insurance carrier information, and limits of coverage. Generally, Medical Staffing and Credentialing offices can provide you with copies of your insurance information. You should also keep a file on any claims including dates and final resolution. This will allow for a much smoother credentialing and on-boarding experience.

Wisconsin is a great state to practice medicine, especially for physicians. As discussed above, the IPFCF and the state law that established it, Wis. Statute Chapter 655, create certain responsibilities to carry Med Mal insurance and pay annual IPFCF fees. That said, Statute 655 and the tort reform that the Wisconsin Medical Society advocates for and works hard every year to protect make Wisconsin one of the best judicial environments with the lowest Med Mal premium rates. Only eight states have some sort of excess patient compensation fund for Med Mal, and Wisconsin is the only state to provide unlimited coverage beyond the required $1M primary Med Mal insurance.

Please contact your WisMed Assure agent or shawna.bertalot@wismedasure.org with any questions.

*Thirty-three states have imposed caps on damages sustained in Med Mal lawsuits. The caps range from $250,000 per incident to as much as $2.25 million. In Wisconsin, non-economic damages are capped at $750,000.

2024 Volume 2

June 28, 2024July 9, 2024

Med Mal 101 Refresher for All Physicians

By Shawna Bertalot, CIC, ACI, WisMed Assure President

An Invaluable Secret for Residents and Fellows

By Tom Strangstalien, Insurance Advisor

I recently spoke with a physician regarding an eye condition that he has developed. He doesn’t know his prognosis, but there’s a strong possibility that it could be debilitating and threaten his ability to practice medicine in his specialty. He inquired if there’s any way to increase his disability insurance coverage as his current limits are significantly below his income.

WisMed Assure clients benefit from access to Zywave solutions

Vector illustration of an abstract scheme, which contains people icons.

By Martin Hurst, Insurance Service Representative

At WisMed Assure, we are committed to providing more than just insurance solutions; we are dedicated to fostering the success and prosperity of our valued customers. That’s why we proudly provide our customers access to Zywave free of charge, as a testament to our unwavering commitment to your organization’s success. Zywave provides HR solutions that assist with employee benefits management, compliance tracking, and HR administration.

Essential Estate Planning Documents in Wisconsin

Information about Estate planning and old glasses.

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Planning your estate isn’t just about paperwork; it’s about giving your loved ones peace of mind. Here’s a breakdown of key documents in a Wisconsin estate plan.

Practice managers: join us for virtual discussions!

Virtual meeting with laptop and notebook on table.

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

In the constantly changing field of health care management, it is crucial to collaborate and share insights to achieve success. With this in mind, we are pleased to announce that we will be hosting virtual discussions for practice managers.

Artificial Intelligence (AI)-Generated Healthcare Content; Understanding the Limitations

by Kaelin O’Reilly, ProAssurance communications specialist

Fall 2023 Issue

December 6, 2023December 11, 2023

Peace of mind this holiday season

By Martin Hurst, Insurance Service Representative

The agents here at WisMed Assure do not focus solely on revenue, our agents go that extra mile to address individual and specific concerns and provide coverage within each customer’s budgetary needs. By putting clients’ needs first, our agents demonstrate their commitment to providing excellent service and building trust with physicians.

Helping clients with strategies, not just quotes

photo of calculator and stethoscope on top of graphs

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Managing the costs of employee benefits while still providing robust resources for your employees can be a challenge. If your insurance agent just gives you a few quotes to compare, you might not be getting the best plans for your team.

Consolidation leads to $600,000 student loan forgiveness – a case study

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Good financial planners do much more than help with investments. They look at the entire financial picture, which includes debts too. Today’s case study shows how a unique rule, available until December 31, is facilitating more than $600,000 in student loan forgiveness.

Nightmare before Christmas success story: cyber hacker stopped

By Shawna Bertalot, CIC, ACI, WisMed Assure President

Message from IT Manager: “Unusual activity has been detected on your exchange and our files cannot be backed up.”

This is not how any clinic administrator or managing partner wants to start their Monday morning, but exactly what happened to a long-time WisMed Assure client last December. This highly experienced, professional administrator of a 15-physician independent clinic with over 50,000 patient records was facing a situation she had never experienced before.

Finding insurance and financial advisors I trust

By Tim Bartholow, MD

I have several connections to our Wisconsin Medical Society, and I’d like to share some good and bad experiences with on the street financial advising and insurance advising, and how WisMed Financial and WisMed Assure cut through market confusion.

Should I convert my term life insurance policy?

photo of a young family looking out the window at fresh snow

By Tom Strangstalien, Insurance Advisor

As we celebrate the holiday season, we’re especially thankful for our loved ones. It’s the most popular time of year to reflect on our life insurance needs to determine whether we have the right coverage and enough coverage to protect our loved ones. The most common form of life insurance protection is term life, and a planning tool that often gets overlooked is the potential to convert your term life insurance coverage to some form of permanent life insurance, without any medical underwriting requirement.

Protecting your most important asset can be a daunting task

By Lisa Koerner, Insurance Advisor

What is your most important asset? It’s your ability to earn an income. When choosing disability programs to protect your income, there are a number of different companies and benefits. It’s often a task that takes time and research, along with several discussions with an insurance agent.

Making Part D of Medicare brighter

photo of an elderly man looking at medications with his physician

By Mary Krueger, Medicare Specialist

As many of you on Medicare know, October 15 to December 7 is the Annual Election Period for Medicare Part D and Medicare Part C (Medicare Advantage). This often coincides with a flurry of research needed and concerns expressed by client recipients and this year was no exception.

Summer 2023 Issue

August 14, 2023August 15, 2023

When and why to schedule a life and disability insurance policy review with your agent

By Lisa Koerner, Insurance Advisor

Many people think that once they have a life insurance or disability policy in place, they can file it away and forget about it. However, as your life changes, your needs often change as well. The policies that you took out when you were young, single and starting your career may not still cover your needs after you get married, buy a house, have children and start your dream job. As your life changes, it’s a good idea to review your policies.

The power of planning: a physician’s journey to financial wellness

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

With uncertainties and change a constant, financial planning stands as a beacon of security and peace of mind. Today, we bring you a remarkable story that sheds light on how a dedicated physician and her family reaped the rewards of a well-structured financial plan, proving that even the busiest of physicians can find stability and fulfillment through proper financial planning.

Innovation and improvements

Employee benefits manual with stethoscope on it

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

June marked my eighteenth year in the insurance industry; my entire career has been focused on employee benefits and helping clients save money and improve employee confidence in benefits. When I was asked to join the WisMed Assure team, I was given the chance to be innovative and truly build something the way I felt it should be and that’s exactly what my team and I are doing!

Workers Compensation rate decreases

By Brian Fowler, WisMed Assure Account Director

Starting October 1, 2023, for the eighth consecutive year, Workers’ Compensation rates in Wisconsin will drop. Work Comp rates in Wisconsin are set by the state and are the same for every insurance carrier. Overall, we’re seeing a decrease of 8.4% across all employee classifications. Physician rates remain low and competitive, with no change to the rates this year. Rates have decreased for physicians within hospital systems and hospital employees other than professional employees.

You bet your life

Cropped shot of young woman hugging her grandmother & helping her with her finances on a laptop

By Mary Krueger, Medicare Specialist

Most of us don’t spend our time concerned about our life insurance because it’s “set up” already through our employer, parents, bank or other sources. Have you really investigated how life insurance works? Is term insurance the best purchase or should you look at long term cost averaging?

Log in to the new IPFCF portal to ensure compliance

May 22, 2023May 22, 2023

By The WisMed Assure Service Team

The Injured Patients and Families Compensation Fund (IPFCF) has implemented a new policy and administration system. The new system allows participants to review correspondence from IPFCF and pay their bill online.

Currently all carriers have access to file certificates of insurance on behalf of their insureds. Participants will be onboarded in phases and should check the IPFCF website and watch for an email regarding the timeline for getting access to the new system.

The new provider portal can be accessed at ipfcfsecure.oci.wi.gov. The IPFCF encourages physicians to log in and provide their personal email address. Click here for IPFCF provider portal instructions. For assistance logging into the new system or other questions, please contact the IPFCF at 608.360.8001 or via email at OCIIPFCF@wisconsin.gov.

Spring 2023 Issue

May 19, 2023May 23, 2023

Why purchase individual disability protection during residency

By Tom Strangstalien, Insurance Advisor

As a resident or fellow, your biggest asset is quickly becoming your ability to earn an income. Until you become independently wealthy and can sustain a loss of earning power without consequence, it is imperative that you have disability protection. But why do this as a resident or fellow, before the dramatic income increase of becoming an attending physician?

Group disability insurance can coordinate with individual policies

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Planning for the unexpected is the only way to protect yourself, your family, your business and your finances. Unfortunately, the death of a loved one or becoming disabled are often unexpected. If you no longer had an income, how would you and your family fare?

What’s in a financial plan?

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

A financial plan is like a roadmap that helps you navigate through the twists and turns of life, whether you’re saving up for a new car or preparing for retirement. Think of it as your secret weapon to achieving your financial goals and living your best life.

WisMed Assure can assist you with your Medicare decisions

By Mary Krueger, Medicare Specialist

Many Medicare eligible participants are familiar with Medicare, but the process is confusing to them so we’re here to assist you with those issues. Here are the answers to some common questions.

Log in to the new IPFCF portal to ensure compliance

By The WisMed Assure Service Team

Don’t forget to call your mom, and your insurance agent

October 26, 2022October 28, 2022

By WisMed Assure Service Team

With the intention of easing administrative burden for WisMed Assure client physicians, several of our Medical Professional Liability (MPL) carriers have significantly reduced or suspended asking for renewal applications over the past few years. While this does save time, renewal applications were an opportunity to touch base, review and discuss any changes to your practice that could impact your premium or coverage.

Please contact WisMed Assure if any of the following changes have occurred or are anticipated in your practice:

Have any health care professionals changed practice procedures, such as added or reduced surgical procedures?
Have you contracted with any independent health care professionals to provide services?
Are any physicians changing their practice hours? How many hours per week are they working now?
Have you added or changed your use of telemedicine?
If you are a Wisconsin Medical Society Member with Medical Professional Liability coverage through ProAssurance, you can earn premium credit on your renewal by completing their online risk management coursework. If you are not a member and would like to become one, please let us know.

Contact your agent or insurance@wismedassure.org 608.442.3810 with any questions or changes to your practice.

WisMed Assure is the Wisconsin Medical Society’s insurance agency – profits earned support the mission of the Medical Society.

WisMed Increases Your MPL Choices

September 9, 2020December 21, 2020

More options available even while insurers brace for uncertainty

By Shawna Bertalot, CIC, ACI, President WisMed Assure

A recently published report by A.M. Best says medical professional liability (MPL) insurance providers continue to experience decreased profitability. The rating firm is maintaining its negative rating for the segment and reports a growing amount of uncertainty due to potential increases in claims coupled with premium refunds, both stemming from the COVID crisis.

Even before COVID-19 swept through the country, the market was hardening – which means premiums were on the rise and terms and conditions were become more stringent. (See September 2019 Antidote Article “History Repeats Itself”)

While insurance companies continue to assess what their products cover and the cost of coverage, governments are introducing new laws that can directly and indirectly impact risk and insurance. It is a constantly evolving situation which we are closely monitoring.

To better serve the medical profession, our team has sought out alternative carriers and products to ensure you have the greatest amount of choice possible. Some of the new options we provide are directly related to the changes care givers have had to make due to the coronavirus. (E.g.: Retired physicians returning to work have new options. Physicians who have increased their telemedicine activity have new options.)

Exploring Options: What to Look For

When choosing an MPL insurance policy, or when replacing or updating your existing policy, it is easy to put too much focus on premium costs. That is certainly understandable, but it is not the only criteria you should be basing your decision on. The most important thing to focus on is choosing the broadest coverage with a financially strong insurance carrier dedicated to the MPL market and excellent track record in claims handling.

Your Best Bet

To get what you need, and feel confident about the decisions you make, your best bet is to work with an experienced insurance advisor. The WisMed Assure advisory team has many decades of experience and a commitment to be your financial partner for life. We know your world because we only serve physicians and medical professionals. Plus, we are in it for the long haul as our profits contribute to The Wisconsin Medical Society’s ability to fulfill its mission: To improve the health of the people of Wisconsin by supporting and strengthening physicians’ ability to practice high-quality patient care in a changing environment.

If you have questions, want to learn more, or concerns to address, contact WisMed Assure today.

shawna.bertalot@wismedassure.org

608.442.3738

Shawna Bertalot is the president of the WisMed Assure agency. With her strong leadership skills and knowledge of the industry, our skilled team of agents are motivated and well prepared to find solutions for our clients.

Play Defense and Offense to Win the Medical Liability Game: A game plan for success in a hard insurance market

January 17, 2020January 17, 2020

Part 3 of 3

By Shawna Bertalot, CIC, ACI, President WisMed Assure

“Physicians in Wisconsin will soon be paying more for medical professional liability (MPL) insurance thanks to a cyclical “hardening” of the market.”
(Excerpt from Part 1)

Three of every four primary care physicians will be sued by a patient during the course of their career. The numbers are even worse for specialties.

Which is why physicians as a whole are not willing to take the chance they will be among the lucky few who never get sued. To guard against the financial impact of a law suit, they purchase Medical Professional Liability (MPL) insurance. But, as Wisconsin physicians begin to experience rising MPL premiums along with greater underwriting scrutiny, the question becomes, “How can I get the coverage I need and avoid paying too much?”

The answer is to play defense and offense at the same time; defense by reducing the chances of being sued and offense by managing your insurance purchase.

It’s simple: don’t get sued

Well, if only it was that simple. In reality, a physician can do everything perfectly for a patient and still be sued because of a poor outcome.

Legally speaking, to be successful in court, a patient’s legal team has to prove three things:

The physician committed a breach of duty by not providing medical care another healthcare professional would have provided
The patient suffered emotional or physical injury
The physician caused the damage to the patient

But, even when one or more of these three are not provable in court, no physician wants to end up in court in the first place… nor does their MPL insurer want to pay the legal bills.

How’s your Patient CRED?

Playing defense could be as conceptually simple as applying the “CRED” concept to your medical practice:

C – communication

R – relationship

E – education

D – documentation

Communication

A breakdown in patient-provider communication is a leading contributor to malpractice lawsuits. While it is absolutely essential to obtain adequate informed consent, doing so as part of an open, two-way conversation with the patient and their family when appropriate goes a long way to helping you avoid your day in court.

By taking the time answer questions, address concerns and openly discuss potential complications, you can avoid false assumptions and miscommunication while building patient confidence.

Relationship
Patients and families are much less likely to sue a physician when they feel they have a good relationship. Even if you deliver the best possible care, without a good relationship, its perceived value and effectiveness can be significantly diminished in the eyes of your patient.

That’s why approaching each patient with compassion and empathizing with their concerns and condition throughout the cycle of care, is one of your best defensive strategies. Most of the time all it takes is for you to stop for a few seconds and truly engage with patients. Making eye contact, actively listening, just being there for a moment instead of worrying about where you have to be next, can make all the difference.

Education
When a patient or a member of their family doesn’t understand the diagnosis, treatment or regulations, it is far too easy for them to feel you’ve done something wrong or inadequate.

If you don’t educate them, they instead rely on assumptions, what they read on the Internet, and what their cousin in Oconomowoc heard on the Doctor Oz Show.

To protect yourself, to play strong defense, take time to educate your patients and their family so they understand why you are recommending all tests and treatments ahead. Plus, they need to know what to expect including risks and possible side effects, recovery times, and results.

Clearly explaining why and what helps you avoid having to justify your actions and decisions by making the patient and their family part of the decision-making process.

Documentation.
Malpractice law suits occur when a patient thinks they’ve been harmed and are supported by others in making a case against a physician. Defense then is conceptually simple; you must accurately document the patient’s condition and why your diagnosis and treatment decisions were made.

But, in practice, it’s a lot more complicated. One complicating factor you cannot afford to overlook are the decision-making (or at least decision-influencing) conversations you have with patients and their families. When you use the other three elements of Patient CRED, these conversations gain importance and the need to document them is essential.

Going on the offensive

Inevitably, you will pay more for MPL insurance. But, to avoid an even worse-case scenario, where you can no longer find adequate coverage at all, there are several things you can do.

As the market hardens, underwriters will begin to clamp down on exceptions. This means that if your risk management practices and policies are irregular, you will pay a lot more and your options could be severally limited.

Unfortunately, to protect their profits, some insurers may reduce claims and risk management personnel and services. And some may sell directly and not through licensed insurance agents who can help you play offense. Which makes it even more important for physicians to make sure they have their act together when it comes to risk prevention.

Here is a risk management checklist you can use to improve your offense and be seen as a preferred risk to an insurance company.-

I understand and have taken advantage of the premium discounts and credits my insurance company offers. Yes No Not Sure
I regularly participate in risk-reduction CME courses and seminars and receive discounts from my insurance company for doing so. Yes No Not Sure
I utilize electronic medical records in my practice and receive discounts from my insurance company for doing so. Yes No Not Sure
My organization pursues ongoing risk-management efforts such as claims management, quality initiatives, and risk assessments. Yes No Not Sure
My organization has an effective peer-review process. Yes No Not Sure
My organization has practical guidelines for medical record documentation and consent forms. Yes No Not Sure
I (we) have chosen the location for our organization by balancing market/patient accessibility and location-specific insurance costs. Yes No Not Sure
When completing annual insurance renewal forms, I am careful to answer all questions as accurately as possible and include any and all substantive changes to my practice (e.g.: changes to hospital staff privileges, joining a managed-care network, gaining specialty board certification). Yes No Not Sure
I understand the difference between claims-made and occurrence coverage and have chosen the coverage most appropriate for my situation: Yes No Not Sure

It takes two to Tango

Playing offense goes beyond implementing risk management strategies. It also means playing tough with your insurance company. Given that the likelihood of a law suit occurring is so high, you need to be aware of your insurance company’s track record when it comes to managing claims.

Here are some important questions to ask:

How many law suits do they defend annually?
What is the percentage of cost they spend on defense vs. settlement?
How does their success rate in court compare to the national average?

Nationally, only about five percent of cases go to trial. And, of those, about 80 percent are decided in favor of the physician.

What should you do now?

For now, assuming your house is in order, you will want to look for stability and security by renewing your coverage with a financially strong insurer; a long-term player committed to the MPL insurance market place. This is where an experienced broker can play a key role in helping you understand the quality of the insurers willing to do business with you.

As the market continues to harden, it is essential to seek the help and advice of an experienced, committed advisor who can help you improve your underwriting profile if need be and navigate your options.

If you would like to discuss this article or your insurance needs and concerns, please feel free to contact me.

Shawna Bertalot, CIC, ACI, President WisMed Assure

shawna.bertalot@wismedassure.org