Physicians

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

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 This may result in the information generated by ChatGPT being erroneous or out of date, or perpetuating an incomplete or distorted picture of the subject matter.1,5 Misinformation may be overlooked or unknown, and inadvertently passed on in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

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.

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.

WisMed Assure clients benefit from access to Zywave solutions

By Martin Hurst, Insurance Service Representative

Martin Hurst

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. These tools help HR professionals navigate complex regulatory requirements, manage employee benefits programs efficiently, and ensure compliance with evolving laws and regulations. By automating routine HR tasks and centralizing data management, Zywave’s software empowers HR teams to focus more on strategic initiatives and employee engagement.

By providing ZyWave, we aim to not only streamline your operations but also strengthen our partnership, ensuring that together we can overcome obstacles and achieve remarkable outcomes. We’re honored to support you every step of the way.

Key Features Zywave Provides our Clients:

Industry-Specific Expertise: Zywave is tailored specifically for insurance professionals, providing industry-specific tools and resources that address the unique needs and challenges of insurance agencies. This specialized focus ensures that you have access to solutions that are finely tuned to your industry, offering greater relevance and efficiency.

Comprehensive Suite of Solutions: Zywave offers a comprehensive suite of solutions beyond traditional HR systems, including compliance management, employee benefits administration, risk management, and client communication tools. By consolidating multiple functions into a single platform, Zywave streamlines your workflow and reduces the need for multiple software subscriptions.

Up-to-Date Regulatory Compliance: Staying compliant with regulatory requirements is critical in the insurance industry. Zywave’s Reference Center provides timely updates on regulatory changes at the federal, state, and local levels, helping you stay informed and avoid costly penalties or fines.

Efficiency and Productivity: Zywave’s tools are designed to enhance efficiency and productivity within your agency. From automated client communications to streamlined policy comparisons and employee training, Zywave simplifies complex tasks, allowing you to focus more time and energy on serving your clients and growing your business.

Customization and Flexibility: Zywave offers customizable solutions that can be tailored to your agency’s unique needs and preferences. Whether you’re a small independent agency or a large enterprise, Zywave can scale to accommodate your requirements, offering flexibility and adaptability as your business grows and evolves.

ZyWave is just one example of our commitment to delivering value beyond insurance, empowering our clients with tools to enhance efficiency and success within their groups. With WisMed Assure, you can count on personalized support and a wide array of services designed to help you thrive, because your success is our success.

If you would like to discuss your employee benefits, please email me at martin.hurst@wismedassure.org  or call 608.442.3728.

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.

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.

Upon investigation, we discovered that the relatively small amount of monthly benefit protection included in the contract he purchased as a resident included a Future Increase Option. This allowed us to increase his disability protection with no medical underwriting! The uncertainty of his eye condition was of no consequence, and we were able to increase his monthly benefit amount to a level much more suitable to his current income.

We understand that as residents and fellows your income and budget are limited. You are far from the income you’ll receive as an attending physician in your intended specialty. You need disability protection and the earlier you purchase this protection, the less expensive it will be throughout your career. However, with your current budget, you may think you just can’t afford it at this point. This is not necessarily true. But how do you get affordable disability insurance?

As referenced above, the key here is the Future Increase Option. Insurance companies vary their name and definition of the benefit. It may be referred to as a “Future Purchase Option,” a “Maximize Your Benefit” option, or other terms. The purpose of the option remains the same; it allows you to increase your disability monthly benefits in the future without the worry of medical underwriting! But what about your budget concerns?

I’ve worked with several physicians this week whose budget was a concern, so we applied for a relatively small amount of disability monthly benefits coverage. For example, $2,000 or $3,000 per month, well short of what you will need as an attending physician. However, we included the Future Increase Option in the contract to allow you to adjust it once you’re earning more. In each case, our client is paying less than a $100 per month for this essential coverage! My advice for every resident and fellow is to put at least a base amount of coverage in place with the future increase option included. As your income increases and your budget allows, we can easily increase your coverage.

You help your patients manage their health conditions every single day. Will you ever experience any of these conditions? Your ability to earn an income is your most valuable financial asset, so protect it now. At WisMed Assure, our allegiance is to you and to serving your financial needs. We are here to provide you with quotes for this protection at any time, at your convenience, with absolutely no obligation. As always, thanks for all that you do!

For help with your insurance planning, contact Tom Strangstalien at 608.442.3730 or the WisMed Assure team at insurance@wismedassure.org, complete this quick online form or call 608.442.3810.

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.

2024 Volume 2

Med Mal 101 Refresher for All Physicians

By Shawna Bertalot, CIC, ACI, WisMed Assure President

Graphic explaining Claims-Made and Occurrence Med Mal

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.

Read more…

An Invaluable Secret for Residents and Fellows

Disability Insurance

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.

Read more…

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.

Read more…

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.

Read more…

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.

Read More…

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

Futuristic AI icon processing data

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. The application can help develop quality and informative content in the form of articles, reports, blogs, tweets, and emails.

Read More…

Life, Death and Taxes

By Lisa Koerner, Insurance Advisor

If you are looking for some creative ways to avoid paying taxes, don’t overlook the benefits of life insurance. There are several different types of life insurance policies that serve different objectives, the greatest is a tax-free death benefit for your beneficiaries. Also, the death benefit does not go through probate, so only your beneficiaries can receive the money. There are a few things to look for when searching for the right life insurance.

When choosing life insurance programs, term life policies are typically the most popular. Term policies offer a larger death benefit for a smaller premium, however, the rates are only locked in for a certain number of years and don’t provide any cash return if you outlive the term or cancel the policy.

The advantage of a permanent policy is that it can build cash value in the policy that you can access tax-free while you are living and still provide a tax-free death benefit for your beneficiaries.

Universal life plans offer more flexibility but are also driven by interest rates. When setting up this policy, it is very important to work with your agent to make sure it is properly funded in the beginning to avoid the need to put more money into it later on.

Whole life policies can also be a good option for cash value growth, but there are things to look for here as well. If you choose a policy that has dividend options, you can set up the policy to allow you to access the dividends tax-free in the future without worrying about having a loan on the policy that could affect how the policy pays out. The biggest thing to be aware of with cash value policies is that if you take out more money than what you put in, the gains would be considered taxable income.

To learn more, reach out to Lisa Koerner or the WisMed Assure team at insurance@wismedassure.org, complete this quick online form or call 608.442.3810 for help with your insurance needs.

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.

Tax Treatment of Long-term Care Insurance a Game Changer

By Tom Strangstalien, Insurance Advisor

We put my dad into a nursing home on Monday. My mom had been his caretaker since he was diagnosed with a somewhat rare neurological disorder. My mom has been superwoman, a real- life example of a family member caring for a loved one. However, even superwoman has a kryptonite, hers being a diagnosis of breast cancer with an impending dual mastectomy this Friday. In need of her own care, our family had no choice but to concede to the fact that dad needed continuous care from qualified professionals. The cost? $8,000 per month, and that does not include costs for prescription medications and other needed skilled medical treatments. My parents are faced with a common long-term care phenomenon, which asset do we liquidate first?

As part of our financial planning, we should all anticipate being faced with this conundrum. Which asset should we set aside to be liquidated first in the event of the need for exorbitant long-term care expenses? In considering the tax treatment of “qualified” long-term care insurance products, we may be able to make this decision much easier.

Qualified long-term care insurance premium deduction

First, the IRS allows a tax deduction for qualified long-term care insurance premiums. These premiums could be in the form of a traditional long-term care policy or for the prevalent “hybrid” life insurance with long-term care benefits available today. In essence our premiums can be combined with our unreimbursed medical expenses to the extent that they do not exceed 7.5% of our adjusted gross income. The maximum we can deduct is subject to age limits, but this by itself can be significant, especially if we combine the sum-total over a respective number of years. If we do not claim the deduction on our Federal return, we can claim the expense of our premiums on the State of Wisconsin income tax return. All states vary with how these premiums are treated, so you need to check with your individual state.

The 2024 federal IRS deduction limits are:

Age 40 and below       $470

Age 41-50                    $880

Age 51-60                    $1,760

Age 61-70                    $4,710

Age 71 and over          $5,880

How are long-term care insurance payments for care treated by the IRS for tax purposes?

When determining which asset to liquidate first, this can be the determining game changer! If the policy is “qualified” per IRS guidelines, typically the payments for any level of care including home health care, assisted living or skilled nursing home care are not taxed. For my parents that would mean an estimated $96,000 in annual benefits received that would not be taxed. If assets were set aside and allocated to a taxable investment for future long-term care, it likely would need to achieve a significant rate of return to compete and almost certainly involve volatility and risk. I would say most of the time it makes much more sense to purchase “tax qualified” long-term care protection. My grandmother was in a home with cognitive impairment for 12 years. In her case at an average nursing home cost of $100,000 per year, she would have received $1,200,000 in tax-free benefits. Can a savings account or investment compete with that? And how will inflation and supply and demand affect future costs?

Using a Health Savings Account for long-term care insurance premiums

Another tax consideration worth mentioning is that qualified long-term care insurance premiums can be funded with Health Savings Account (HSA) assets. As we know, our health savings accounts accumulate on a tax-free basis, are deductible for individual contributions and can be funded with employer contributions. This fact can further enhance the benefits of purchasing long-term care protection.

I work with insurance planning for our physicians every day. Yet, the value of proper planning still resonates with an abrupt wake-up call when faced in real life. How much expense will accrue with my dad’s nursing home stay? Only the future holds the answer. One fact is undisputable, knowing which asset we will liquidate first should be planned well in advance. That asset may very well be and should be a tax qualified long-term care insurance policy.

For help with your insurance planning, contact Tom Strangstalien at 608.442.3730 or the WisMed Assure team at insurance@wismedassure.org, complete this quick online form or call 608.442.3810.

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.

Tornadoes Can Strike in Seconds. Are You Ready?

By The Hartford, reposted with permission

     
 
Tornado season is upon us and could bring more storms in the months ahead. In fact, the U.S. experiences the most tornadoes of anywhere in the world.1 Last year alone 1,197 tornadoes tore through the country, costing over $1 billion in property damage.2
 
While we can’t prevent tornadoes, we can help you craft a safety plan and prepare. And know that if a tornado has damaged your property and you need to file a claim, we’re here to help you online or by phone (800 243 5860).
 
 
 
Before a Tornado
 
     
     
Designate a Shelter
     
The best shelters are sturdy, windowless spaces with room for you, your family, and pets.
     
A basement is ideal, though any low level, windowless room works, including closets, hallways, interior stairwells, or a bathtub if you have a heavy blanket or mattress as cover.
     
     
     
Create an Emergency Kit
     
Be sure your kit includes:
     
Food & Water Icon   Food and Water for 72 hours, such as canned soup, granola bars, or shelf stable goods, plus a can opener
     
Whistle Icon   Whistle or horn to attract attention should you become trapped
     
Flashlight Icon   Battery or generator powered lights to conserve mobile phone power
     
First aid kit Icon   First aid kit that includes bandages, antiseptic, and essential medicines
     
Radio Icon   Battery or crank radio because cell towers may be down
     
Money Icon   Important documents, including copies of your ID, insurance information, Social Security cards, a small amount of cash, and other legal documents, such as wills
     
Pet food Icon   Extra pet food if needed
     
     
 
During a Tornado
 
     
 
Know the signs of a tornado:
 
  • Dark green or sickly looking sky
 
  • Large hail
 
  • Low clouds, especially if they’re rotating
 
  • A roar often compared to a train whistle
 
If you hear or see these signs, or there’s a local tornado warning, shelter with family and pets.
 
If you’re far from that shelter, try to find a sturdy community building, such as a church or office building nearby.
 
If you’re in a vehicle and can’t find shelter, stay inside, and cover your head.
 
     
 
After a Tornado
 
     
 
  • Use your horn or whistle, or another implement to attract help if trapped.
 
  • Check your structure’s integrity. If you see cracks, rubble, or fallen beams, exit until it’s deemed safe to return.
 
  • You may need shelter. If so, text "Shelter" and your zip code to FEMA (43362).
 
  • Avoid downed powerlines. Even if they look inactive, wires may still carry a live current.
 
  • Avoid using lighters or flames. Even if you don’t smell gas, there may still be a leak.
 
  • Use generators safely. Vent generators outside. Carbon monoxide poisoning comes fast and can be deadly.
 
  • Monitor the radio. Stay informed and safe by tuning your radio to reliable local news or emergency services.
 
     
 
File your claim with The Hartford
 
     
 
We want to help you get your life back on track as fast as possible. We’ll be there after a disaster – and anytime you need us. You can reach us 24/7 online or at our toll free number 800 243 5860.
 
     
 
Thank you for your business.
 
Steve Deane Signature
Steve Deane
Chief Claims Officer
 
     

Please reach out to the WisMed Assure team at insurance@wismedassure.org, complete this online form or call 608.442.3810 to explore your insurance options.

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.

Disability and Life Insurance Taxation

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

Chris Noffke

Taxation of benefits is a unique and important topic. Many groups I work with want to make sure their employees are not taxed for an employer paid life insurance benefit and other clients want to ensure that if an employee becomes disabled, they do not have to pay taxes on their already reduced income. Making sure these benefits are set up correctly, both by the insurance carriers and in your payroll service, is vital to tax-free benefits for employees.

Life insurance

Life insurance is the easier of the benefits to establish correctly. If an employer provides up to a $50,000 benefit to each employee, then this benefit and premiums paid for it can be excluded from an insured employee’s taxable wages. If you offer coverage to employees for a benefit over $50,000 and it is employer paid, you are required to tax premiums for the amount above $50,000.  

Disability insurance

A bigger discussion happens regarding disability insurances (both Long-term and Short-term). When an employee or owner/partner is out of work due to a disability, they will receive only a fraction of their pre-disability earnings, the average benefit being 60% of pre-disability earnings. If an employer is paying 100% of the disability premiums, the employer can decide to offer these benefits as a “gross-up” to employees. A gross-up is structuring the premiums paid by the employer to be a taxable benefit on the employee payroll. The benefits received by the disabled employee (disability income) will then be tax deferred. The rule is direct, if employees are paying payroll taxes on the premiums that the employer is paying, the benefit will be tax free – however – it is very important that the payroll taxes begin prior to the benefits being received.

When premiums are split between the employer and employee, we need to make sure there are a few rules followed. If a benefit has a premium contribution of 50% paid by the employer and 50% paid by the employee, the setup will determine if the benefit is partially or fully taxable. If in this situation the employee pays their premiums pre-tax and there is no gross-up for the amount the employer pays, this full benefit will be taxable income. Another example is if the employer pays 50% of the benefit (not grossed-up) and the employee is paying for 50% of the benefit with post-tax dollars, then when the employee receives this disability income benefit, 50% of the benefit will be taxable. So, to make the full benefit tax deferred, you need to have the employer premiums paid be grossed-up and the employee portion needs to be paid with post-tax deductions.

This can get a bit confusing, and I would love to talk if you have any questions. Please email me at chris.noffke@wismedassure.org or call 608.442.3734.

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.

Change Healthcare ™ Attack Highlights Often Overlooked Cyber Insurance Coverage

By Shawna Bertalot, CIC, ACI, WisMed Assure President

Shawna Bertalot

Many health care practices rely on a third party for access to their EMR and for billing. This creates a “contingent” or “dependent” risk. The February 21 cyberattack on Change Healthcare changed the world for many patients and health care providers. The March 14 and March 28 issues of Medigram included resource links and information on potential payment programs for Part A and Part B providers impacted. For practices and organizations that contracted with Change Healthcare™ to facilitate the electronic transfer of medical documentation and billing for all their insurance claims, revenue stopped, expenses continued and funding programs from Optum and CMS/Medicare have not been comprehensive solutions.

Cyber Insurance programs can provide additional coverage for a scenario like this, but only if the policy includes Business Income or Business Interruption coverage and includes Contingent Business Interruption or Dependent Business Interruption coverage. Without contingent or dependent coverage, your policy would only respond if the cyberattack were on your organization and would not respond if the attack were against a third party upon whom you are dependent. We discussed the importance of comprehensive cyber insurance in the November 2, 2023 issue of Medigram and the Fall 2023 issue of The Antidote.

Important Considerations for Cyber Insurance Coverage:

  • Cyber insurance policies do not always include contingent or dependent coverage.
  • Cyber coverage included as an add-on to other policies, like a business owners’ package or medical professional liability, typically do not include this coverage.
  • Business Interruption or Business Income options are not automatically covered.
  • Paying claims for cyber policies is complicated and typically requires forensic information technology and legal review to confirm the breach or attack. This can take weeks or months before any payment will be made.
  • Policyholders must provide proof of loss and that the incident in question directly resulted in the policyholder’s loss of income, without regard to whether an event has been widely reported in the news.
  • Deductibles and waiting periods will apply.
  • Reach out to the insurance carrier as soon as you become aware of an incident, before you hire your own consultants, and respond promptly and completely to their requests for supporting documentation. Your insurer will have specialized relationships at pre-negotiated rates.

If you are concerned about your Contingent or Dependent Risk and wondering if your current cyber insurance policy has coverage, how that coverage works or if you can obtain coverage, contact your WisMed Assure agent or shawna.bertalot@wismedasure.org.

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.