Physicians

Fall 2022 Issue

Do you have the old or the new life insurance?

By Tom Strangstalien, Insurance Advisor

September is Life Insurance Awareness Month and is the time when I urge all our members to take a moment to reflect on the life insurance protection they have in place. Not too long ago, life insurance (especially term life), was generally viewed as a commodity.

Read more…


Build your financial wisdom

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

Join us for online educational sessions presented by WisMed Financial exclusively for Wisconsin Medical Society members. Session topics include retirement planning, social security and tax planning.

Read More…


Open enrollment

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

We’re rapidly approaching autumn and it’s time to start thinking about your open enrollment. Many companies fail to properly do an open enrollment, or maybe it’s your first time.

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Workers’ Compensation rate changes & good news for health care professionals

By Brian Fowler, WisMed Assure Account Director

Starting October 1, 2022, Workers’ Compensation rates in Wisconsin will drop for the seventh year in a row. Unlike many other states, Work Comp rates in Wisconsin are set by the state and are the same for every insurance carrier. The decrease is 8.47% over all employee classifications.  

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$111,000 more from Social Security

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

With more than 2,700 rules and 567 separate filing strategies for Social Security, 96% of people fail to make the optimal claiming decision and miss out on $111,000 of benefits for the average household.

$111,000 – that’s a lot of money. Let’s look at some of the rules for Social Security so your decision is better informed.

Read More…


How to prevent floods from damaging your business

photo of cars on a flooded road

By Society Insurance Team, reposted with permission from Society Insurance

The continued impact of extreme weather events isn’t lost on businesses: according to one report, businesses can expect to see roughly $13 billion in flood damage in 2022. Tornados, derechos, and severe thunderstorms all threaten billions in damage, but with spring just ahead, let’s focus on how you can protect your business from the threat of flooding.

Businesses everywhere are susceptible to flood damage—so how can they prepare?

Read more…


How to prevent floods from damaging your business

By Society Insurance Team, reposted with permission from Society Insurance

The continued impact of extreme weather events isn’t lost on businesses: according to one report, businesses can expect to see roughly $13 billion in flood damage in 2022. Tornados, derechos, and severe thunderstorms all threaten billions in damage, but with spring just ahead, let’s focus on how you can protect your business from the threat of flooding.

Businesses everywhere are susceptible to flood damage—so how can they prepare? Below, we’ll cover five flood-readiness essentials that your business should consider.

Use Natural Landscaping Techniques Around Your Business

Large paved areas such as surface parking lots collect water, and only have limited areas for drainage. Plus, if your community is flooding, these drains in your parking lot may be overwhelmed to a point where they aren’t helpful. Surrounding your building with a variety of shrubs, natural grass or bushes can help absorb excess water during floods.

Rain gardens, for example, are a type of landscaping that collects runoff rainwater. They can divide parking lots, flank walkways or be embedded into grassy areas. Additionally, incorporating an appropriate mulch into landscaping around your business can help protect your business’ foundation and exterior by slowing and absorbing water.

A rain garden divides a street and a walkway. Photo via EPA

 

Make Sure Your Gutters Are Clear

You should clean your gutters twice a year, and spring is one of the best times to do so. Cleaning your gutters ensures they’re clear of debris that could prevent proper drainage. If your gutters aren’t clear, water can collect on your roof or in the gutters themselves, weighing them down and potentially causing costly damage to your building. 

Don’t forget that directing your downspouts and drains away from your business’ foundation is just as important as clearing your gutters of debris. When high volumes of storm water is draining from your gutters, it should be diverted away from your building. If it pools at the base of your building, it can cause significant damage to your building’s foundation. 

Flood-Proof Your Building’s Most Susceptible Areas

The lowest point of elevation in your building should ideally be above the highest point expected in a flood. By learning your building’s base flood elevation (BFE), you can identify the areas of your business that are most vulnerable to floods. From there, you can determine what flood-proofing techniques will be most beneficial depending on your property’s level of risk.

If there are important areas below your BFE, dry floodproofing techniques can involve impenetrable barriers, plates or coatings that prevent flood water from entering your property. On the other hand, wet floodproofing is a technique where highly-durable areas are designed to allow water through, in effect creating a path of least resistance in order to protect your property. 

Dry floodproofing (top) and wet floodproofing (bottom) shown in a residential setting. Illustrations courtesy of FEMA. 

Shore Up Your Foundation

Floods or torrential rainfalls can cause significant damage to your foundation. Water is incredibly powerful; when it seeps into your building, it can expand existing cracks and displace walls. Overall, when a building is subjected to flowing or standing water, the structural integrity can be damaged, leading to burdensome repair or rebuild costs.

Use caulk and other sealants to ensure the locations where pipes enter your building are sealed. Consider hiring a contractor to assess and restore existing damage in your basement or foundation before spring thaws or floods. 

Use Water Detection Devices

Water detection devices can monitor moisture levels around your building. If there’s flooding, they can alert you to areas where water is seeping in so you can triage these places and protect anything that could be damaged before it’s too late.

Be Prepared to Weather the Storms

Spring is a time of new beginnings but it’s also a time of risk: melting snow unable to be absorbed by the still-frozen ground, heavy seasonal rains, and other environmental factors can lead to Spring floods. Being prepared for these risks can be the difference between a profitable spring and a summer spent recovering from it.

Contact Brian Fowler, WisMed Assure Account Director, at 608.442.3718 for a quote or with any questions.

Reposted with permission from Society Insurance

What is Inflation Guard?

By Society Insurance Team in 2021, reposted with permission from Society Insurance

In 2021, we’re seeing a unique economic environment. Supply chains have been affected by the pandemic and a few industries experienced weather-related setbacks. This, along with the new challenge of a labor shortage, is not allowing supply to keep up with demand, which leads to inflation.

Lumber is a relevant example and a commodity that has a significant impact on the cost of claims. The cost of claims in 2021 is significantly more than the cost of claims in recent years. This increase may subside quickly, however, economists believe inflation will persist.

What is Inflation Guard?

Inflation Guard is the automatic annual increase in property values on an insurance policy to keep up with rising costs of construction. It provides carriers with adequate premium to pay for losses and provides policyholders with protection against coinsurance penalties if a coinsurance requirement exists. Many insurance carriers apply an annual 4% Inflation Guard increase. If values don’t keep up with the pace of inflation, insurance premiums will eventually have to take a steeper spike upward.

What is Coinsurance?

Coinsurance language in a policy gives an insurance company the right to reduce the amount of a claim payment if the amount of insurance purchased was inadequate.

What Does This Mean for Policyholders & Insurance Agents? 

Policyholders could be underinsured at the time of total loss and find themselves with significant out-of-pocket costs in order to return to normal operations. If a partial loss occurs and the carrier imposes a coinsurance or underinsured penalty, the policyholder would also experience out-of-pocket costs. If the above occurs, there may be errors and omissions lawsuits against the insurance agent.

Does Society Insurance Include Inflation Guard in Policies?

Society Insurance does include Inflation Guard and does not include coinsurance or underinsured penalties in their policies. This provides protection for both policyholders and agents from some of the challenges in managing property values. Maintaining adequate values on insurance policies is critical. Inflation Guard – and annual conversations between insurance agents and policyholders – can fend off trouble.

Contact Brian Fowler, WisMed Assure Account Director, at 608.442.3718 for a quote or with any questions.

Reposted with permission from Society Insurance

Your life has only 3 planning scenarios

Mark Ziety

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

You’ll either have a long life, health problems along the way or a short life. That’s it.

Plan for those three situations whether you’re single, married, with or without kids and most of your planning is done. Let’s look at how to plan for each.

First, essential tasks for everyone

  • Manage monthly cash flow. Call it a budget, spending plan, living below your means or whatever makes it appealing to you. It doesn’t matter if you have high income or low income, everyone needs to control their inflow and outflow.
  • Life happens, have an emergency fund.
  • Pay off all high interest consumer debt.
  • Give of your time, resources and be thankful. Live happy.

Plan for a long life

  • Are you saving at least 15% for retirement with the right investments? Boosting it to 20-25% is even better.
  • Have you maximized your tax advantaged retirement accounts through your employer and on your own?
  • Will your tax burden be higher or lower in the future? Hint – if you have a lot of tax deferred investments, you could be igniting a tax bomb that hits later in life.
  • Save for kids’ education expenses.
  • Determine the monthly income you’ll have in retirement from all sources.
  • Dream about your future.

Plan for health problems

  • Health insurance is the obvious answer.
  • Auto and umbrella insurance can provide for you via uninsured/underinsured coverage.
  • Disability insurance that replaces two-thirds of your income if you can’t perform your own occupation is critical, especially during your early and mid-career. A policy with an inflation adjustment is even better.
  • Everyone over age 18 should have health care and financial power of attorney documents.
  • Do you have a source to pay for long-term care expenses? If not, consider an insurance policy.

 Plan for a short life

  • If anyone depends on you for income, get term life insurance. It’s cheap, so don’t skimp.
  • Are your beneficiary designations correct?
  • Do you need a will or trust?
  • Ensure your family knows where to find your documents and accounts.
  • Tell your family you love them. And if you’re faithful, pray.

Since we don’t know the future, all three plans are important for everyone. Our Physician’s Financial Guide has even more tips. Or, for one-on-one help schedule an appointment.

To your best life and healthy finances.

Mark Ziety, CFP®, AIF® 608.442.3750.
WisMed Financial, Inc. part of the Wisconsin Medical Society

Different Kinds of Debt: The Good, the Bad, and the Just-Don’t-Do-It!

By Rufus Sweeney

Amassing a considerable amount of debt during medical school is “situation normal” for practically every medical student. Even though debt is rarely seen as a good thing, you need to know the difference between good debt, bad debt, and debt to be avoided at all cost.

Choosing wisely now makes paying off your debt much easier.

In the category of “Just-Don’t-Do-It”, all sorts of credit cards are available and in many cases, actively promoted to medical students with special offers that include an interest free period, cash back on purchases, and all too easy sign up terms. But once that interest free introductory offer ends, you’re on the hook for anywhere from 12 to 25 percent interest on any balance you carry from month to month.

When you use a credit card to finance your lifestyle choices or, worse case, pay for essentials without a plan for paying off your balance each month, you’re playing with financial fire.

The “bad” in comparison to credit card debt, doesn’t look all that bad, but still with interest rates ranging from six to 10%, unsubsidized student loans are an expensive choice.

The “good” are those loans with the lowest possible interest. For example, interest rates for institutional loans from medical schools range from four to five percent. If low interest was the only criteria for determining “good” debt, then a mortgage at three to five percent and car loans at four to five percent would also fall into this category. That said, check out my previous blogs and podcasts on the pros and cons of buying a home and the reasons why it is a good idea to live like a resident, even after you become an attending physician.

Paying the piper

No conversation about interest rates is complete without a word or two about repaying debt.

Generally speaking, there are two popular methods: the snowball method and the avalanche method.

Popular financial expert Dave Ramsey recommends the snowball method because he says, “… personal finance is 20% head knowledge and 80% behavior. You need some quick wins in order to stay pumped enough to get out of debt completely.”

Here’s how it works:

Step 1: List your debts from smallest to largest regardless of interest rate
Step 2: Make minimum payments on all your debts except the smallest
Step 3: Pay as much as possible on your smallest debt
Step 4: Repeat until each debt is paid in full

Here’s an example using four different debts:

  1. $500 medical bill—$50 payment
  2. $2,500 credit card debt—$63 payment
  3. $7,000 car loan—$135 payment
  4. $10,000 student loan—$96 payment

Using the snowball method, you would make minimum payments on everything except the medical bill. You would pay as much as possible each month on the medical bill until it is paid off.  You would then take the money you used for the minimum payment on the medical bill, plus as much extra as you can afford and use it to pay off your credit card debt. As soon as that debt is paid, you take all the money you previously used to pay the medical bill and credit card debt off and apply it to your car loan.

By the time you are ready to pay off your student loan, you’ve got a pretty big debt repayment snowball working for you.

The avalanche method takes a more practical approach… at least mathematically speaking.  You make minimum payments on all debt and use any remaining money to pay off the debt with the highest interest rate. Like I said, this method is a more practical approach because it allows you to save hundreds of dollars in interest payments and reduce the time it takes to pay off all your debt.

When it comes to choosing which method to use, remember what Dave Ramsey says… “personal finance is 20% head knowledge and 80% behavior”.

In my next blog, we will explore the different ways in which interest rates are calculated.

If you need help managing your debt, one of your best resources is your financial aid officer. And, I highly recommend visiting the White Coat Investor website. It’s a great source for guidance on how to acquire and manage the “good” forms of debt.

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

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:

  1. The physician committed a breach of duty by not providing medical care another healthcare professional would have provided
  2. The patient suffered emotional or physical injury
  3. 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

Term Life Insurance

How much can I get for how little?”

This is the usual question from a potential buyer of “Term” Life insurance.

But for our Residents, Fellows, and young Physicians who want to protect their life and their family, it’s an incomplete question.

The better question is, “How can I inexpensively protect my family from bad consequences while we buy time for our assets to grow to a point where we won’t need Life Insurance anymore?”

Thinking through potential bad things that can happen is no fun, especially with the understanding that the probability of something catastrophic happening (other than death) is highly unlikely to happen to you.

And you’re right. It is not going to happen to you. That’s right … it is statistically NOT going to happen to you.

But it does happen to some … and when it does, the consequences are either tolerable or devastating, leaving one either emotionally comfortable or severely distressed.

Keeping in mind that insurance, by nature, is intended to cover “low probability/highly severe financial consequences”, there is a difference between “inexpensive” Life Insurance (the goal) and “cheap” Life Insurance (the mistake).

So, what makes term life insurance “cheap”?

After 24 years of working exclusively with Physicians, I’ve experienced a lot. The issues that follow are very real … (We’ll just leave it at that … but I can tell you that I am much more “mindful” of structuring Term Life Insurance now than I was 24 years ago …).

So, let’s look at an example of this low probability circumstance happening to someone like you…

A Physician, age 30, buys a $1,000,000, 20-year Level Term Life Insurance policy. She is delighted because, after a comprehensive search, she found the least expensive contract. She got the best rating class possible: only $25.73 a month. Such a deal!

Then, at age 42, with three young children, she is diagnosed with MS and is partially disabled and can practice only part time.

By age 45, she is totally disabled and not working at all.

So here’s the situation …

Typically, if one is disabled early in one’s career, one has not enough time to attain enough assets for retirement (and other objectives, such as a child’s college tuition).  This is because the monthly benefits being received from one’s disability insurance benefits leaves little to save. There simply is not enough money.

This was the reason for purchasing the Term Life Insurance 15 years ago.

Now the life insurance takes on greater value … It’s there to do what was intended … to make sure there are assets there for the family …

But does it?

Here is what her Life Insurance policy can and cannot do for her and her family …

This was the lowest premium … and it is, indeed, a cheap policy …

  1. She has 5 years left on her 20-year level term. Then you know what happens at the end of the level term? It becomes very expensive … onerously expensive … and increases in premium every year. So, with a tight budget, it quickly becomes unaffordable … at just the wrong time …
  2. She is now uninsurable and cannot get a new policy.
  3. Her policy could have been convertible to a longer term, but only during the first 10 years …

Talk about stress … At a time when one is emotionally vulnerable, now there is additional stress.

So, how could this have been avoided?

There could have been a longer “conversion” period put on the original policy. This would have allowed for the policy to be stretched to a longer term.

A conversion to a “permanent” policy is no bargain at this point; it has a much higher premium; it is around $1,000 per month; $12,000 per year … year after year. But, at least one would have had the option.

Please Note: longer conversion periods cost pennies more per month … but need to be applied for and put on the original policy at inception.

Could a better decision have been made back when the policy was originally purchased?

The answer is “yes”. There could have been a “Waiver Of Premium” Rider on the policy.

Waivers differ with each Insurer, but “strong” waivers waive premiums when one is totally disabled … and continue to waive them past the “level” term period … Many will waive it all the way until one passes … no matter how long one lives.

Disability waivers typically cost about $12 – $15 per million per month.

If this had been part of the policy, the contract would have stayed in force free of charge.

So, the result could have been less stress, knowing that one’s family would be getting that $1,000,000 no matter how long or how short one’s life would have been.

Could decisions have been made that would have been even better than this?

The answer is “Yes”. This could have been a contract with the ability to both “waive” the premium and then convert it to a permanent contract, which, if one is totally disabled, not only waives premiums, but it funds itself, that is, the Insurer pays the premium.

Now that same $1,000 per month is deposited into the contract by the Insurer and would have been building a cash reserve for the insured that could have been accessed later in life.  

At age 65, the cash would have probably been in excess of $500,000 … and, of course, there’s the Life Insurance …

Now, instead of stress, there is the emotional comfort of knowing that one’s family is financially sound no matter if one lives a long time or dies prematurely.

There’s a little bit more to this story …

A “20” year level term is, by far, the most common “term” chosen by young Physicians … and, with me having been around for 24 years, many of those 20-year terms are coming to an end.

As mentioned before, once the “level” term ends, these contracts get incredibly expensive … No one ever keeps them …

The thing is … Many, now at age fifty-something, still want some life Insurance. “The kids are still in college” … Not quite enough yet in the Retirement plan … Just want the extra million for another 10 – 15 years of so …” are commonly heard reasons.

Well, back at age 30, that 20-year term for $25 per month could have been a 30-year term for $44, but it was decided back then that was just a little too “pricey”.

Now, at age 50, if one is healthy, a new 10-year level term is $75 per month and a new 20 year term is $119 per month.

And again, that is assuming one is still in good health …

In closing, if you want the cheapest Life Insurance, anyone can shop for you.

But, as a young Physician, if you want “inexpensive” insurance with the appropriate protections for you and your loved ones, our promise is to watch out for you and provide the right kind of guidance.


Dave Serena

Dave Serena is in his 25th year as an Agent with the Wisconsin Medical Society’s Insurance Group: Wismed Assure. He has Physician clients in 36 states and continues to provide them with  life-long counsel and guidance. His position is that Physicians are free to practice high quality medicine and enjoy their families when they are confident about their personal financial security. He can be contacted at dave.serena@wismedassure.org  (414) 238-6105

Ask for more – it never hurts to try.

When negotiating employment contracts – always ask for more. Ask for a signing bonus or higher salary or money for relocation or more money for CME. Better benefits are often easier to negotiate than salary so even negotiating for more paid vacation per year is an option. It never hurts to ask and in mot cases you’ll be surprised that the answer is ‘Yes.’ And then make sure it is in writing!

Wendy M.

Keeping Wisconsin Safe: Why It’s the Best Place to Practice Medicine

Part 2 of 3

There’s a reason Wisconsin is one of the safest places to practice medicine; it’s long been a haven for affordable medical professional liability (MPL) insurance. Which, among many other reasons, also makes it a great state to be a patient in.

But now, as the rest of the country feels the impact of increased MPL premiums, it may only be a matter of time before Wisconsin physicians see similar increases.

The economics behind this growing threat are relatively simple- insurance companies make money by collecting premiums, investing those premiums, and then paying out claims that are less than the income they make on their investments. On a national level, adverse litigation trends, an increased frequency of severe claims, and years of poor investment returns are driving down insurance company profits. As a result, MPL insurers are increasing premiums for the first time since 2001. 

Several states have already seen significant premium hikes and higher deductibles, along with reduced coverage options and fewer (if any) risk management services. It gets worse; some insurers are exiting the market all together.

It’s a classic hard market scenario: if they aren’t already, physicians and employers of physicians will be paying more for less. 

However, because of a number of factors, Wisconsin physicians have been shielded from this trend. 

Wisconsin is different… in a good way

Thanks to the efforts of the Wisconsin Medical Society, the AMA, and the medical-legal community in general, Wisconsin has always been among the top states when it comes to affordable MPL insurance. 

One of the most significant factors was in 1975 with the creation of the Injured Patients & Families Compensation Fund. Physicians and other health care providers pay into the fund, which covers malpractice awards greater than $1 million. Physicians must purchase their own MPL insurance to cover claims less than $1 million. Bottom line: A physician’s personal assets are never at risk in Wisconsin thanks to this fund.

In addition to being instrumental in the creation of the fund, the Wisconsin Medical Society has consistently and effectively lobbied the state legislature resulting in the capping of non-economic damages and other legislation beneficial to physicians.

Wisconsin currently has capped non-economic damage claims at $750,000. The state also guarantees full recovery of economic damages awarded by a jury. This includes awards for past and future medical expenses as well as lost wages. 

When a 2012 malpractice suit resulted in a ruling the cap was unconstitutional, the Wisconsin Medical Society, along with the AMA’s Litigation Center, stepped in. They jointly argued against the ruling and asked the state Supreme Court to review the case. In 2018, the state Supreme Court rejected the lower court’s ruling and confirmed the cap’s constitutionality.

What the statistics tell us 

Consider these statistics for the period of 2004 to 2018 from the National Practitioner Data Bank managed by the Department of Health & Human Services:

  • In 2004, an approximate total of $4.6 billion in claims was paid. This sank to a low of just over $3.5 billion in 2012 and has risen to just over $4 billion as of 2018.
  • In the same time period (2004 – 2018) the number of claims has declined from approximately 17,000 to 11,584.
  • Conversely, the average paid claim has risen from around $260,000 to $348,000

Considering that the last time we saw a hard market was in 2001, these statistics are likely contributing to the national trend away from the historically lengthy soft market.

When it comes to the per-capita medical malpractice costs for all practitioners (from 2012 – 2016), Wisconsin was the lowest with an average of $3. This compared to New York’s number-one ranking of $36.

But, here’s something to watch in light of the national trends and the hardening of the MPL insurance market. Even though the number of claims paid in Wisconsin has dropped (as of 2016, the state ranked #50 out of 51 in the claims frequency category), we’ve seen a spike in paid claims from 2016 to 2017. Total paid claims for all healthcare providers went from 17 to 39 with the total payout jumping from $4.83 million to $14.28 million.

Who you gonna call?

While there are no hard market busting solutions out there, Wisconsin is most likely to remain one of the least expensive insurance havens in the country. Clyde “Bud” Chumbley, MD, CEO of the Wisconsin Medical Society, agrees saying, “The Society is vigilant and will continue to play a significant role in ensuring our physicians are protected from unreasonable and unnecessary insurance premium increases.”

While the Wisconsin Medical Society and others are acting on your behalf, there are some fundamental ways you can protect your ability to acquire and maintain the right amount of professional liability coverage. We will dig a little deeper into what you can do to better manage your risk and the help that you can expect from a dedicated and experienced insurance brokers in the third part of this article.

In the meantime, if you have any questions regarding what the future of MPL holds for you, contact your trusted insurance and risk advisor.


Shawna Bertalot, CIC, ACI, President WisMed Assure

shawna.bertalot@wismedassure.org

608.442.3738

History Repeats Itself: Medical Liability Insurance Premiums on the Rise

Part 1 of 3

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

Many younger physicians have never experienced a hard market because we have been in a “soft” market for an unprecedented length of time. The last time premiums increased was in 2001. And, prior to that, 1975 and 1986.

Here’s how it works. The insurance underwriting cycle is determined by the collective behavior of insurers. During a soft market, insurers are willing to provide coverage at or below cost, usually in an attempt to gain market share. But, at some point, insurers get nervous about low premiums failing to cover the payment of future claims.

Tom Baker, a University of Pennsylvania Law School professor, says understanding how insurers define cost is, “key to understanding the insurance under-writing cycle”. He goes on to say that when, “…insurers set their prices, most of the costs of the insurance coverage will be incurred only in the future. As a result, insurers constantly have to imagine the future to decide how to price their products today. This situation creates a remarkably high degree of uncertainty… This uncertainty about insurance costs is the fuel that drives the underwriting cycle.”

Insurers turn a profit by charging their clients premiums, investing those premiums and then paying out claims that are less than the income they make on premiums and investments.

Things are changing because 2018 was the third year in a row the industry’s combined ratio has exceed 100%. In other words, the industry would have been unprofitable each year since 2016 without investment income.

And, according to Don Tejeski, Senior Vice President at AmWINS Group Inc., no insurer is bucking the trend: “Underwriting overall has gotten more disciplined. No one is undercutting the market.”

Despite publishing an article earlier this year that forecast a continued soft market, Susan J. Forray, a principal and consulting actuary at Milliman (one of the world’s largest providers of actuarial and related products and services), when contacted directly cautiously advised, “The closest proxy to a nationwide market would be the market for reinsurance. Most companies would say the reinsurance market has hardened. This was the case when we wrote our article but I think the hardening has broadened across the reinsurance market since then. I think this will continue to contribute to a hardening market in states where the soft market has not yet ended.”

Wisconsin is an insurance haven

Nationally, adverse litigation trends, increased frequency of severe claims, and years of poor market results are driving insurers to look at raising premiums for the first time since 2001. Several states have already seen significant premium hikes and higher deductibles along with a reduction in coverage. It’s a classic hard market scenario; physicians and employers of physicians are paying more for less.

And it gets worse. Some insurers are exiting the market all together.

Because of a number of factors, Wisconsin physicians have been shielded from this trend. But, in the last three months, we have seen that shield start to give way.

Thanks to the efforts of the Wisconsin Medical Society and the medical community in general, Wisconsin has always been among the top states when it comes to affordable MPL insurance. One of the most significant factors was the creation in 1975 of the Injured Patients & Families Compensation Fund. Physicians and other health care providers pay into the fund, which covers malpractice awards of greater than $1 million. Physicians must purchase their own MPL insurance to cover claims less than $1 million. Bottom line: A physician’s personal assets are never at risk in Wisconsin thanks to this fund.

In addition to being instrumental in the creation of the fund, the Wisconsin Medical Society has consistently and effectively lobbied the state legislature resulting in the capping of non-economic damages and other legislation beneficial to physicians.

What can you do about it?

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, insurers may reduce claims and risk management personnel and services. Which makes it even more important for physicians to make sure they have their act together when it comes to risk prevention.

This means you’re going to have to be more self-reliant when it comes to risk management because every claim will have an increasingly significant adverse effect on your premiums and even your ability to be insured at all. If you make risk management a top priority, you are much more likely to be been seen as a preferred customer by your insurer.

We will dig a little deeper into what you can do to better manage your risk and the help that you can expect from a dedicated and experienced insurance brokers in the third part of this article.

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 marketplace. Here again, an experienced broker can play a key role in helping you understand the quality of the insurers willing to do business with you.

It is essential now more than ever to seek the help and advice of an experienced, committed adviser who can help you improve your underwriting profile if need be and navigate your options.


Shawna Bertalot, CIC, ACI, President WisMed Assure

shawna.bertalot@wismedassure.org

608.442.3738