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Presented by: Presented by:

Ronald E. Cline, MBARonald E. Cline, MBA

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What would America be like without What would America be like without Doctors, Nurses, or Hospital Emergency Doctors, Nurses, or Hospital Emergency Rooms?Rooms?

Can you imagine an ambulance driven by Can you imagine an ambulance driven by attorneys?attorneys?

How about your doctor saying, “We can How about your doctor saying, “We can save the leg or give you $50,000 right save the leg or give you $50,000 right now. which will it be?”now. which will it be?”

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These sound like ridiculous scenarios but These sound like ridiculous scenarios but the reality is that they are already the reality is that they are already possibilities and with a few bad decisions possibilities and with a few bad decisions by our government; they will become by our government; they will become reality.reality.

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Malpractice Insurance and Claims are the Malpractice Insurance and Claims are the single, greatest threat to healthcare today.single, greatest threat to healthcare today. It’s the threat of suits and the It’s the threat of suits and the premiums paid premiums paid

to insurance companies with astronomical to insurance companies with astronomical annual increasesannual increases..

Many practices pay 20 to 30% of their Many practices pay 20 to 30% of their gross gross revenuesrevenues..

Well-established specialty practices are Well-established specialty practices are closing or severely restricting services. closing or severely restricting services.

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Legislators truly don’t understand the driving Legislators truly don’t understand the driving forces here.forces here. Tort Reforms only limit economic damages (lost Tort Reforms only limit economic damages (lost

wages) not pain and suffering awards.wages) not pain and suffering awards. An entire industry of Risk Management professionals An entire industry of Risk Management professionals

was created simply because of the threat posed by was created simply because of the threat posed by litigious patients and a flawed legal process.litigious patients and a flawed legal process.

The legal system does not fairly represent doctors. The legal system does not fairly represent doctors. Juries are not filled with peers with a clear Juries are not filled with peers with a clear understanding of the medical terminology or even understanding of the medical terminology or even basic principles.basic principles.

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Why do Doctors have to pay “Tails” when they change Why do Doctors have to pay “Tails” when they change carriers or retire?carriers or retire? A Tail is a fee paid for continued coverage for any new claims A Tail is a fee paid for continued coverage for any new claims

filed for two years after you terminate/chamge carriers.filed for two years after you terminate/chamge carriers. Tail coverage is a fee charged for covering new claims Tail coverage is a fee charged for covering new claims

filed during the period a doctor was already covered for. filed during the period a doctor was already covered for. Essentially, you have to pay for the same coverage Essentially, you have to pay for the same coverage twice! The fee is typically two years worth of premiums.twice! The fee is typically two years worth of premiums. Imagine that you decided to change jobs and shortly after Imagine that you decided to change jobs and shortly after

starting your new job you receive a bill for two years premium starting your new job you receive a bill for two years premium from your previous healthcare insurance. Your spouse was from your previous healthcare insurance. Your spouse was hospitalized for 30 days recently for a serious illness costing at hospitalized for 30 days recently for a serious illness costing at least 100 thousand dollars and the bill wasn’t sent before you least 100 thousand dollars and the bill wasn’t sent before you changed coverage. Now your old medical insurance can refuse changed coverage. Now your old medical insurance can refuse payment unless you pay the additional two years premium. payment unless you pay the additional two years premium. Sounds horrible doesn’t it? Sounds horrible doesn’t it?

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How would you feel if you were told you How would you feel if you were told you have no choice in defending yourself. An have no choice in defending yourself. An Attorney can decide to settle any case Attorney can decide to settle any case without your input possibly ending your without your input possibly ending your professional career and you never had a professional career and you never had a choice.choice.

Malpractice carriers have the right in most Malpractice carriers have the right in most cases to settle cases over your objection.cases to settle cases over your objection.

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Speaking of SpinSpeaking of Spin

The Government Accounting Office (GAO) The Government Accounting Office (GAO) says it isn’t even a problem!says it isn’t even a problem! Everyone else says it is. What numbers are Everyone else says it is. What numbers are

they using?they using? Guess who they asked if there was a Guess who they asked if there was a

problem?problem?

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Insurance companies want caps on the Insurance companies want caps on the amount of money that can be awarded but amount of money that can be awarded but they spend millions to avoid limits on they spend millions to avoid limits on premium increases.premium increases. Increases of annual premiums are based on Increases of annual premiums are based on

claims* made regardless of the dollar amount claims* made regardless of the dollar amount and the vast majority of claims are very small.and the vast majority of claims are very small.

A 30% increase has become the norm for A 30% increase has become the norm for each claim made! Valid or not.each claim made! Valid or not.

*Claims can also include the threat of a claim, even if never pursued.*Claims can also include the threat of a claim, even if never pursued.

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Hospitals are so desperate, they are Hospitals are so desperate, they are creating their own insurance companies.creating their own insurance companies. Doctors are investing their own money to Doctors are investing their own money to

develop their own malpractice company so develop their own malpractice company so they can fight claims and retain some of the they can fight claims and retain some of the money they lose to malpractice carriers.money they lose to malpractice carriers.

Mega-claims will literally close health systems Mega-claims will literally close health systems down claiming thousands of jobs and leaving down claiming thousands of jobs and leaving vast rural areas devoid of any services at all!vast rural areas devoid of any services at all!

How would you like to live in one of these areas?How would you like to live in one of these areas?

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Judges, attorneys, expert witnesses, and Judges, attorneys, expert witnesses, and juries are all responsible for shutting down juries are all responsible for shutting down the world’s best healthcare system.the world’s best healthcare system. Do you feel qualified to act as a peer of a highly-trained physician? Do you feel qualified to act as a peer of a highly-trained physician?

Attorneys do. Juries are asked to.Attorneys do. Juries are asked to. Everyday, an attorney somewhere is explaining what a doctor did Everyday, an attorney somewhere is explaining what a doctor did

wrong. Which medical school did they go to? Which medical school did wrong. Which medical school did they go to? Which medical school did the jury go to?the jury go to?

““Expert witnesses” testify on cases they have never reviewed, on Expert witnesses” testify on cases they have never reviewed, on procedures they have never done, about patients they have never met procedures they have never done, about patients they have never met using terms that only medical professionals understand.using terms that only medical professionals understand.

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Doctors are forming Risk Retention Doctors are forming Risk Retention Groups (RRGs) to combat premium Groups (RRGs) to combat premium increases.increases. RRGs allow Doctors to have some control over the RRGs allow Doctors to have some control over the

increases arbitrarily exercised.increases arbitrarily exercised. RRG’s do not protect them from massive damage RRG’s do not protect them from massive damage

awards.awards. Once a doctor has a “mega claim” against them, they Once a doctor has a “mega claim” against them, they

face significant challenges in future medical practice.face significant challenges in future medical practice. Doctors can do everything right in a case by all Doctors can do everything right in a case by all

medical standards and still lose in court!medical standards and still lose in court!

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The only way this will ever be fixed is by enacting The only way this will ever be fixed is by enacting legislation that provides for a fair and just award legislation that provides for a fair and just award for claimants and eliminates mega-dollar for claimants and eliminates mega-dollar payouts to attorneys. Strangely enough, in payouts to attorneys. Strangely enough, in States where Tort Reform has been enacted, States where Tort Reform has been enacted, attorneys lose interest in these cases and attorneys lose interest in these cases and premiums for insurance are manageable.premiums for insurance are manageable.

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Thank you for your timeThank you for your timehttp://www.linkedin.com/in/ronaldclinehttp://www.linkedin.com/in/ronaldcline

roncline@roadrunner.comroncline@roadrunner.com