Trends in Risk Management in Medical Indemnity · 2016-02-23 · Trends in Risk Management in Medical Indemnity Trends in Risk Management in Medical Indemnity_final_101109.doc 6 An

Trends in Risk Management in Medical Indemnity

Prepared by Ian Burningham, Gillian Harrex & Mimi Shepherd

Presented to the Institute of Actuaries of Australia 12th Accident Compensation Seminar

22‐24 November 2009 Melbourne

This paper has been prepared for the Institute of Actuaries of Australia’s (Institute) 12th Accident Compensation Seminar

The Institute Council wishes it to be understood that opinions put forward herein are not necessarily those of the Institute and the

Council is not responsible for those opinions.

© Finity Consulting Pty Limited

The Institute will ensure that all reproductions of the paper acknowledge the Author/s as the author/s, and include the above copyright statement:

The Institute of Actuaries of Australia

Level 7 Challis House 4 Martin Place

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Telephone: +61 2 9233 3466 Facsimile: +61 2 9233 3446

Email: [email protected] Website: www.actuaries.asn.au

mailto:[email protected]

http://www.actuaries.asn.au/

Abstract

Over the last 10 years the medical indemnity market for doctors has undergone significant change while at the same time the whole external environment for the delivery of health services has also been subject to change. This paper seeks to explore what’s been happening both in Australia and globally in relation to medical indemnity risk management as it relates to doctors and to draw some parallels with the general insurance market as a whole. We also look at whether it’s possible to measure the effectiveness of some of the medical indemnity risk management approaches and propose some ways to consider this difficult issue. Keywords: medical indemnity, medical malpractice, risk management



1 Introduction 2

2 Background 4

3 Providing Risk Management in Medical Indemnity 5

4 What does practice risk management look like? 7

5 Is risk management effective? 12

6 Comparisons with other professions & the insurance industry 14

7 Medical Indemnity and Insurance Risk Management 16

8 Conclusion 19

Part III Appendices 20

A Glossary 20

B Summary of risk management programs 21

C End Notes 25


Trends in Risk Management in Medical Indemnity_final_101109.doc

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1 Introduction

Over the last 10 years in Australia, the medical indemnity market for doctors has undergone significant change, with:

Substantial government intervention to stabilise the market (with a range of support still in place) following the provisional liquidation of the largest medical indemnity organisation in the country.

The market moving from one of discretionary indemnity to contracts of insurance for doctors.

A change to the cover offered to doctors now being on a claims made basis from a claims occurring basis.

Increased competition, including a new market entrant.

At the same time, the whole external environment for the delivery of health services has been subject to change with:

A rise in the general level of complaints about health services.

Increased focus on “risk management” across the health sector as a whole – in both the public and private sectors.

Increasing levels of litigiousness across society as a whole, including medical negligence.

Increasing ‘corporatisation’ of medicine, with medical practitioners increasingly operating as part of Groups.

This paper seeks to explore what’s been happening both in Australia and globally in relation to medical indemnity risk management as it relates to doctors and to draw some parallels with the general insurance market as a whole. We also look at whether it’s possible to measure the effectiveness of some of the medical indemnity risk management approaches and propose some ways to consider this difficult issue.

1.1 Acknowledgements

We would like to acknowledge the contribution of all those who have shared with us their expert knowledge in this area, including Larry Gill, Vice President Marketing & Loss Prevention, KaMMCo

Dr Gord Wallace, Director of Education, Canadian Medical Protective Association

Dr Douglas Bell, Associative Executive Director & Managing Director Risk Management Services, Canadian Medical Protective Association

Matthew O’Brien, Managing Director, Cognitive Institute

Richard Lyon. CFO Invivo



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Pamela Lee, Risk Services Manager MIGA

1.2 Thanks

Thanks also to Ben Wang at Finity for his assistance in developing the appendices for this paper.



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2 Background

2.1 Medical Malpractice Insurance

Medical malpractice insurance, or in some countries discretionary medical indemnity, indemnifies medical practitioners in the event that they are sued in the course of the practice of medicine. Cover is also often extended to situations where a doctor may be required to appear before a medical board or other panel. In this paper, we have considered medical malpractice as it applies to doctors. We have not considered arrangements that cover hospitals or other medical professionals. In Australia medical indemnity historically was offered to doctors via medical defence organisations (MDO’s) who offered cover as discretionary indemnity, rather than insurance. These organisations were mutuals, owned by doctors and largely state based. Cover was (and continues to be in some states) provided by the state for work in the public sector and so MDOs were primarily concerned with doctors’ private practice. Since 2003 medical indemnity protection has only been available from insurers licensed by the Australian Prudential Regulatory Authority (APRA). In excess of 90% of doctors purchasing medical indemnity insurance do so from insurers owned by the medical defence organisations. The last 5 years has seen increasing levels of competition in the marketplace with many insurers establishing interstate offices and making inroads into other states, and the entry of a new market participant from the commercial sector. Despite this increasing level of competition the market overall remains quite ‘sticky’ with retention rates in excess of 90% not uncommon. The background to medical indemnity in Australia and other western countries is important when considering the ethos of the companies offering medical indemnity insurance. These companies were established by, and run for the benefit of, doctors. Their reason for existing was to defend doctors (as suggested by their names). Historically medical defence organisations offered indemnity to doctor members and little else. This worked well in an environment where claims frequency, and cost, was relatively low. Risk management, or seeking to influence the risk profile of the membership, if it was thought about at all, had little relevance to the insurance process. However, over the last 20 years or so a number of things have occurred:

There has been an increase in general litigiousness in society.

Claims frequency and cost have increased for many doctor groups.

A number of countries have experienced ‘crises’ of affordability in the medical malpractice marketplace as liabilities have exceeded assets and premiums have been subject to rapid escalation.

There have been many responses to these events but one of the responses has been an increased focus on risk management by medical indemnity insurers.



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3 Providing Risk Management in Medical Indemnity

3.1 What does it mean?

When considering risk management in a medical sense there are two primary areas:

Clinical risk management: this aspect of risk management deals with clinical aspects of practice – e.g. surgical techniques, methods of examination etc.

Practice risk management: this aspect of risk management deals with the aspects of risk management that occur ‘alongside’ the primary care of patients. This includes such areas as records management, communication, informed consent etc.

Insurers and medical defence organisations are involved in both areas of risk management, although many of the programs offered by medical indemnity organisations to their insureds are aimed more at what we have termed practice risk management. The Colleges have tended to be the main bodies delivery clinical risk management services.

3.2 Why offer risk management?

Avant (the largest medical indemnity organisation in Australia) summarises the reasons for introducing risk management as follows:

“Risk management can be defined as the identification, investigation, analysis and evaluation of risks, and applying appropriate measures to correct or reduce identifiable risks. Introducing risk management into your practice can help you to:

Identify preventable and predictable risks that have the potential to lead to claims.

Develop practical risk management strategies.

Reduce your personal and practice exposure to litigation.” i

The key reason in this statement, and most other reasons cited by medical indemnity organisations, for introducing risk management is that it has the aim of reducing the incidence of claims against doctors and so decreasing costs overall. This goes to the heart of why these organisations exist and if such programs can reduce the likelihood of claims occurring at all then this ultimately benefits their members. However, for medical indemnity organisations the reasons for offering risk management can extend beyond pure cost considerations, and to understand this it is important to consider the historical background (as set out in Section 2) and reason for these organisations existing. In our discussions with a number of organisations it was made clear that offering risk management is seen not just as a means of benefiting “the bottom line” of the indemnity provider, but is intended to improve the practice of medicine more generally and lead to better patient outcomes.



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An example of this is the Canadian Medical Protection Association, where risk management is seen as central to part of the suite of services offered to doctors and very much extends from the mutual roots of the organisation, and a desire to improve the practice of medicine in Canada. An interesting alternative example is New York State in the US, where it is “compulsory” for medical indemnity insurers to offer risk management and for doctors to complete it annually in order to be eligible for access to the New York State Excess Medical Malpractice Insurance Program.



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4 What does practice risk management look like?

4.1 Risk Management programs

The majority of medical malpractice insurers, both domestically and internationally, have now implemented practice risk management programs designed to improve the risk profile of their portfolio by changing underlying doctor behaviour and improving the doctors’ knowledge and skill set. These programs include:

Education programs

• Seminars and on-line seminars

Practice visits

Publications

Online e-learning programs

Manuals on improving clinical practice (generally developed in conjunction with professional colleges)

Internationally, risk management programs have been operating for in excess of 20 years. In Australia, similar programs are in place, but have largely been introduced in the last 5-10 years. All major medical indemnity providers in Australia now provide some form of risk management program to members. Examples of the kinds of programs offered are set out below. Appendix B provides a more detailed summary of publicly available information on risk management programs both in Australia and overseas. Education Programs

The predominant focus of doctor education programs offered by medical indemnity providers tends to be on communication (e.g. quality of doctor patient interaction/relationships, handling of adverse events, handling complaints), documentation & other office procedures. Some medical indemnity providers also offer case study based learning modules which utilise learnings from the insurers’ own claim history.

In Australia, examples of topics from some of the medical indemnity providers includes:

• Missed and delayed diagnosis

• Informed consent

• Open disclosure

• Managing patient expectations

• Understanding the medico-legal framework



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• The importance of notes

• How to say sorry: open disclosure for private practitioners.

Some of the Australian medical indemnity providers as well as a number of international providers use the Cognitive Institute (a provider of communications skills and risk management training to medical practitioners based in Brisbane but owned by MPS (UK)) in areas such as:

• Leadership and management

• Open disclosure

• Incident Management

• Communication

• Patient Communication

• Difficult patient interactions

• Difficult colleague interactions

• Interpersonal skills training

• Risk Management

• Mastering Your Risk

• Mastering Shared Decision Making

• Mastering Adverse Outcomes

• Mastering Professional Interactions

• Mastering Patient Expectations

• Quality and Safety

• Stress Management

• General practice issues

The New York State compulsory risk management requirement mandates that medical indemnity risk management programs cover topics such as

• Recordkeeping

• Informed consent

• Legislation

• Legal environment

• Communication

• Office procedures

Often medical indemnity providers will run seminars and conferences featuring lectures by healthcare industry experts on current trends and topics considered relevant to ongoing and effective risk management. Such seminars also provide networking opportunities for doctors in similar fields and encourage shared learning from strategies adopted by colleagues.



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Practice visits

Some medical indemnity providers offer a consultation service to doctors at their place of practice with the aim of identifying any areas for improvement in the risk management of the practice. Such practice visits will include review and assessment of doctors practices in areas of:

Safety procedures

Documentation

Record keeping

Communication.

Practice visits provide doctors with feedback on their practices, identify key areas of risk and provide assistance in areas identified as requiring improvement. For the medical indemnity provider, practice visits can provide them with better knowledge on which to base underwriting decisions.

Some medical indemnity providers insist on practice visits for members who are identified as ‘high risk’ (high risk generally being identified from frequency of claims relative to peers).

Publications

Many of the medical indemnity providers publish regular newsletters which discuss various topics of interest including developments in various fields and offer risk management ‘tips‘. A number also offer access to a library of published educational articles on their web-site, often via a “Members only” section of their web-site. One such provider is MDA Nationalii who offer a range of publications on topics such as:

Medical Records

Patient and Test Tracking Systems

Practice Review

Effective Complaints Management

Retirement from Medical Practice

Medicolegal Handbook for General Practice

When Things Go Wrong.

Others providers (e.g. MIGA in Australia) offer access to case studies and claims statistics taken from their own records.

Online programs

To a large extent, risk management education programs and guidance are increasingly offered online through various

Self assessment courses

Online coursework and seminars



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Web-based practice/risk management ‘tips’.

In some cases these online offerings are restricted to members whereas others, such as the Canadian Medical Protection Association programs, are freely available to the general public. Clinical Risk Manuals

In addition to the other areas identified above, some providers have developed programs or manuals, generally in conjunction with the various professional Colleges, to assist in the development of new practices that are expected to lower the risk of claims. An example of this is the “Fetal Ultrasound Clinical Risk Modification Program” offered by Avant in Australia.

Support to hospitals

In some countries risk management services are extended beyond doctors to the hospitals in which doctors work. This is particularly the case in Canada, where the CMPA has a virtual monopoly on indemnity for doctors and so has a real interest in improving the risk management in hospitals as well. The kinds of support offered to hospitals include:

Risk management and audit services

Software to assist with risk identification, incident management, and measuring of effectiveness of risk management initiatives.

4.2 Features of Risk Management Programs

Compulsory or Voluntary?

Other than in jurisdictions where risk management is mandated by law, doctor participation in risk management is almost always voluntary. Some medical indemnity providers keep very detailed records of participation, including types of activities completed etc, while others keep very few or no records. Participation across medical indemnity providers we talked to varied but is generally thought to be in excess of 50% of members and in some cases is as high as 80%. Professional Associations

Many providers have established arrangements with the various professional Colleges whereby participation by the members in the risk management arrangements count for credit with ongoing Professional Developmental requirements of the profession (i.e. count for CPD). Such ‘accreditation’ is important in terms of acceptance of and participation in risk management offered by medical indemnity organisations. All the large medical indemnity organisations in Australia have their programs recognised by at least some of the major colleges (General Practitioners, Surgeons, etc). Discounts

A small number of insurers offered discounts for participation in risk management programs. In these cases, various activities are given ‘credits’ and achieving a certain number of credits results in a discount to the base premium rate. Across the board discounts are generally 5% or less (one



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insurer offers 10%). The level of discount is generally not based on specific observed outcomes from the risk management program, but based rather on commercial considerations designed to provide an incentive to participate in such programs. In one instance the level of discount has been ‘wound back’ over time. Higher individual discounts may occasionally be offered but are generally also accompanied by more detailed underwriting. The majority of insurers we reviewed do not offer any form of discount for participation in risk management programs.



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5 Is risk management effective?

5.1 What’s being done?

In the previous section we highlighted the diversity of programs on offer to doctors. Medical indemnity organisations are spending significant amounts of money on these programs, in the belief that they are effective – the CMPA for example spends about 20% of total expenses or 4% of total premiums in a year on risk management and related activities. With such large amounts of time and money being spent on these activities, this leads to an obvious question about whether or not these programs are actually effective in terms of achieving their desired or planned outcomes. This includes reducing the incidence and severity of claims, in addition to any of the broader perceived benefits. In our discussions and investigations we were somewhat surprised to find that while many insurers asked participants in their programs to provide feedback on the various program offerings, very few insurers had attempted to measure the efficacy of their risk management programs – even in cases where discounts for participation in risk management were offered. Only one insurer was making a serious effort at measuring the efficacy of the program, with regular monitoring of trends in frequency, size and severity of claims for those doctors who had completed their risk management program relative to a control group of doctors who had not.iii Amongst the other insurers, reasons cited for not measuring included:

A belief that risk management was a ‘good’ thing to do and measurement of its effectiveness was really of second or third order importance.

Programs had not been in place long enough to measure effectiveness – it takes some years for the effectiveness of any program to become apparent and relies on members staying around and participating each year.

The difficulties in measuring – establishing a base line, allowing for differences in doctor risk groupings etc.

In some cases, no central record was kept of which members were participating, so it was not possible to measure.

As actuaries, our natural inclination is to want to review, and by implication measure, the effectiveness of a particular activity. However, there are impediments to measuring the effectiveness of this style of risk management including:

It may take a number of years for changes in behaviour to become evident and translate into lower claims.

Not all organisations keep good records of which members are participating, and in what activities.

Members do change insurers over time making it harder to see the impact of risk management (although medical indemnity is characterised by high levels of retention from year to year).



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Most medical malpractice is written on a claims made basis, while risk management is going to have an impact on a claims occurring basis (and so making the impact more difficult to observe).

Other external influences, e.g. tort law reform, changes in procedures at hospitals, may actually have a bigger impact on claim outcomes, again making it harder to identify whether risk management is really having an impact.

Claims frequency for most groups of doctors is relatively low and so it may be difficult to identify what reductions are due to normal volatility in claims costs compared to permanent changes in experience.

Despite these difficulties, we consider that it would be beneficial to at least try to measure the effectiveness of risk management. To that end, we have considered the elements of any successful measurement structure.

5.2 Issues to consider

We consider that a measurement structure for risk management should take account of:

The mix of doctors participating by specialty (as some doctor groupings are by their very nature higher risk), and how this changes over time.

The level of participation of doctors over time – e.g. a doctor who participates ‘fully’ (which again needs definition) over a period of 5-10 years would be expected to see a bigger reduction in frequency than a doctor who only participates over one year.

• Level of participation might be defined by giving ‘points’ for participation in various events - e.g. 1 point for completion of an on-line seminar, 3 points for attendance at an interactive workshop, etc.

Claims frequency. Most areas of focus of practice risk management would be expected to reduce the incidence of claims.

Mix of claims by severity of injury. It is possible that risk management programs may improve the mix of claims by severity, but unless the organisation has a good system of recording claims by severity, this may be much more difficult to measure.

Trends rather than absolute levels of claims frequency and severity. This would mean that where groups participating had different risk profiles to those not participating this could be taken into account.

A further possibility would be to measure the frequency of reported incidents (as opposed to claims). Many organisations record incidents as well as claims and it could be expected that incident frequency would also reduce.



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6 Comparisons with other professions & the insurance industry

It is useful to compare how medical indemnity compares to insurance offered to other professions and also to the general insurance industry overall in relation to the kinds of risk management offerings that are made to members or insureds.

6.1 Legal and Other Professions

The most similar example to what is offered to doctors occurs in the legal profession. Most legal societies (the membership organisation for lawyers in a particular jurisdiction) offer some form of ongoing risk management program with the aim of reducing both the incidence and severity of claims. An example of this is Law Cover in NSW who provide practice and risk management services such as seminars, papers, education courses, self assessment tools and risk management advice with the aim of reducing situations that may lead to negligence claims. The overall aim of the program is very similar to the programs offered to doctors. Law Cover offers a discount on premiums of 2.5% where all the principals of a law firm have recently participated in a minimum number of risk management activities. A further example is the Guild Group in Australia, who provide insurance and other services to pharmacies and a variety of other health and allied professionals across Australia. Whenever Guild takes on the insurance for a particular profession they develop a risk management guidance framework for that profession including online tools and regular publications.

6.2 Workers’ Compensation

There are also some interesting parallels in the area of accident compensation, and particularly workers’ compensation where Occupational Health & Service (OH&S) initiatives, code of practice requirements for employers, advertising, information and education campaigns are intended to influence both insured’s (employers) and also workers’ behaviour. There have been a number of papers published on the effectiveness of risk management in workers’ compensation and OH&S remains a critical focus for most workers’ compensation schemes.

6.3 Health Insurance

There are a number of examples where health insurers have sought to change insured’s behaviour and so improve claims costs. These include:

Discovery Health in South Africa – through their Vitality program - which aims to encourage ‘healthy’ behaviours with an ultimate goal of lowering claims profiles.

MBF/BUPA in Australia – through the in2Life offering which has a similar aim to the Vitality program.

ahm (a health insurer operating in Australia) – offers free on line risk assessments, publications and again encouragement of healthy behaviours.



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One other example in health insurance has been the practice of some health funds to meet the costs of things such as gym memberships, pilates, etc, which are believed to have a preventative focus in terms of health costs.

6.4 General Insurance

While there are fewer examples of risk management for insureds in the general insurance market they do exist. Brokers are often involved in risk management for larger commercial accounts. For domestic insurance examples include things such as driver education offered by some of the insurers associated with the various motor clubs.

6.5 Conclusion

This section has shown that medical indemnity is not unique in its focus on providing risk management to its insureds. What may set them apart, however, is the focus on risk management and the significance of the annual spend on such programs.



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7 Medical Indemnity and Insurance Risk Management

In the previous sections of this paper we have discussed what’s happening in risk management in medical indemnity and what other insurers may be doing in this area. A summary of the various approaches used to reduce insurance risk to the insurer are shown below, contrasting general insurers, workers’ compensation schemes, health insurers and medical indemnity providers.

Table 7.1 - Comparison of risk management techniques employed Approach General insurers Workers

Compensation (Australia)

Health insurers (Australia)

Medical Indemnity Providers

Policy Design

Limits Yes Not generally Extensive (general treatment)

Not generally

Exclusions Some Not generally Yes - extensively Not generally

Deductibles/ excesses

Yes Some (but generally low levels)

Yes - extensively Very limited

Underwriting

Risk selection

Yes - extensively Not allowed under legislation

Not allowed under legislation

Mostly outside home state

Pricing Yes - extensively Yes - experience rating


Some

Managing Statistical Volatility

Reinsurance Yes - extensively Limited for government underwritten Schemes. Yes for others


Yes – extensively

Changing insured’s behaviour

Limited Yes – OH&S, legislation, advertising, etc.

Limited Yes (see elsewhere in this paper)

The table above highlights some very considerable differences between the practice of various types of insurers, and it is worthwhile considering for medical indemnity insurers why this is the case.



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Medical indemnity organisations have generally been founded by and operate for the benefit of doctors. They have an interest in ensuring that the practice of medicine can continue, across all the various specialties, and as such are generally prepared to cross subsidise some of the ‘higher risk’ specialties for the ‘greater common good’. This framework then influences the forms of risk management these organisations are prepared to use in the insurance process. This can be contrasted with general insurers, who may be more willing to consider deductibles, materially higher premiums or even cease underwriting certain specialties to protect the profitability of their insurance portfolio. Workers’ compensation schemes operate in a similar sort of framework – the provision of insurance against injuries to workers is considered in the public’s interest, and results in a strong impetus to integrate life saving OH&S measures into the insurance process and vice versa. In our discussions with various medical indemnity providers we noted that few providers were prepared to make use of common insurance techniques such as excesses and exclusions. While this may be due in part to the ‘personal’ nature of medical indemnity insurance, it was interesting to note that some of the commercial insurers offering medical indemnity were more prepared to consider such techniques. We have outlined below some of the possible considerations/issues involved with considering the use of these types of approaches in medical indemnity: Policy exclusions

Policy exclusions are generally used to carve out high risk areas for which insurance is not appropriate. For medical indemnity this may be more difficult as there are some areas, such as obstetrics or neurosurgery, which are high risk but where there is a societal benefit in the practice of these areas of medicine. Broad brush exclusions may also run ‘counter’ to the original intent of medical indemnity which was to defend doctors.

The most common use of policy exclusions is to limit cover in terms of jurisdiction (e.g. exclude the US) and limit cover for various groups to areas they would be expected to have sufficient practical expertise.



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Deductibles/Limits

Deductibles are rarely used in medical indemnity, at least in Australia. The administrative complexity of dealing with a deductible is generally thought to outweigh any potential benefit. With a reasonably large % of claims resulting in no damages being paid (but potentially significant legal costs) this could also create further complexity. We are aware that in some limited cases in Australia deductibles have been imposed on individual doctors, rather than across the board.

Risk acceptance

In practice in Australia, the legislative requirement for each medical indemnity insurer to provide insurance to doctors in their ‘home state’ makes risk acceptance more problematic.

There are some examples of medical indemnity insurers not underwriting particular groups of doctors outside their home state and declining to underwrite / charging significant additional premiums to some doctors with particularly poor claims experience.

Risk pricing

Pricing for risk is an area where medical indemnity organisations have made some considerable progress over the last 20-30 years but they continue to be hampered by the lack of data at individual profession level.

Pricing, while detailed at the specialist and billings level, does not generally take into account the claims experience of a particular doctor.

Some risk groups will always be cross subsidised, due to the small size of the profession and the inherently ‘risky’ nature of the work they do – e.g. neurosurgeons.



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8 Conclusion

Medical indemnity has, in some ways, been at the forefront of the development of risk management for insureds over the last 20 years. This has been borne largely out of necessity (needing to control costs) but has also hopefully resulted in better patient outcomes. There are some interesting parallels between the programs undertaken for insureds across the general and health insurance spectrum. However, unlike other insurance risk mitigation approaches, little progress appears to have been made with assessing the efficacy of risk management for insureds. While the difficulties associated with assessing the value of practice risk management are real, insurers may still benefit from attempting to quantify this value and seeking to identify where to best invest their risk management dollars.


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Part III Appendices

A Glossary

Term Definition

Claim frequency The number of claims expressed as a proportion of a measure of exposure (e.g. the total number of insureds).

Claims occurring Cover that provides protection for incidents that occur during the period of cover, regardless of when the claims is reported.

Claims made Cover that provides protections for incidents that are notified during the period of cover, with the incident occurring before or during the period of cover (the period will be specified in the cover)

Discretionary indemnity Cover where the MDO can choose whether to indemnify the doctor in the event of the doctor being sued. The indemnity is not able to be exercised capriciously

Medical Defence Organisation (MDO)

A (generally) mutual organisation owned by medical practitioners to offer a range of services to members, including discretionary indemnification in the event of a incident which gives rise to a claim against the member.

Medical Indemnity Insurance Also known as medical malpractice insurance, insures medical practitioners in the event that they are sued in the course of the practice of medicine. Cover is also often extended to situations where a doctor may be required to appear before a medical board or other panel.

Medical Indemnity Insurer (MII) Medical Indemnity Insurer – a licensed insurer providing Medical Indemnity insurance.


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B Summary of risk management programs

The following summary is based on publicly available information (primarily web-based). We have not included information provided to us confidentially as part of this assignment and as such this list should not be considered to be exhaustive.


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B.1 Australian medical indemnity providers

Organisation Full Name States Covered History Risk Management Program Description

AVANT Avant Mutual Group Limited

Headquarters: NSW

106 years(since 1893)

1. Case studies and claims analysis2. Self assessment tools3. Risk management tips and fact sheet4. Risk advisory service (on the phone or practice visits)5. Medico-legal advisory service (by phone or in person)6. Member support services (professional counselling, peer mentoring, etc)

MDA National MDA National Insurance Pty Ltd

Headquarters: Western Australia

84 years(since 1925)

1. Online risk management modules (case studies, Q&A, audio, visual)2. Self assessment tool 3. Publications4. Practice visits5. Advisory services6. Communication training7. Workshops (through the Cognitive Institute)

MIPS MIPS Insurance Pty Ltd

Headquarters: Victoria

21 Years(since 1988)

1. Online CPD risk management modules 2. Workshops (through the Cognitive Institute)3. Case studies (available online)

Invivo (underwriting agency writing medical indemnity for QBE Insurance Australia Limited)

Invivo Medical Pty Ltd

Headquarters: NSW

4 years(since 2005)

1. Individual tailored workshops/programs2. Practice Visits3. CPD supporting College Continual Medical Education4. Publications and case studies5. Medico-legal support 6. Counselling

MIGA Medical Insurance Group Australia

Headquarters: South Australia over 100 years

1. Practice self-assessment2. Conferences3. Workshops (earn CPD points)4. Surveys5. Resources (factsheets, case studies, claims summaries, check lists)6. Online questionnaires and quizzes

Premium discounts offered for participation (up to 10%)


International medical indemnity providers


KaMMCOKansas Medical Mutual Insurance Company

Head Office: Kansas

20 years (since 1989)

1.On-site evaluations and office reviews 2.Education programs and seminars 3.C.A.R.E (Creating Advocacy through Responsive Education) - gatherings to discuss survival techniques during litigation4.Video/DVD Library 5.Publications 6.Website 7. Practice visits (offered as a part of a package of consulting services offered)

Premium discounts offered for participation.

MLMICMedical Liability Mutual Insurance Company

Head Office: New York 34 years

1. Consulting services - Onsite review/assessment - Network meetings - Self-assessment tools2. Annual risk management seminar 3. Continual Medical Education provided online4. Publications (newsletters and case studies)5. Library (over 2,000 books and audiovisuals on quality medical practice)6. Risk management tips7. Legal services/advice


PRI Physicians’ Reciprocal Insurers

Head Office: New York

27 Years (since 1982)

1. In-office consultations2. Telephone consultation on risk management and legal issues3. Web-based education programs4. Live seminars and workshops, providing access to experienced risk management faculty5. Annual risk management conference6. Network meetings7. Annual surveys on insured's risk management procedures


B.2

Trends in Risk Management in Medical Indemnity_final_101109.doc 23


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ProMutual ProMutual Group Head Office: Massachusetts


1. REACT program - provides advise on how to maintain positive patient-doctor relationship following adverse event2. Continual Medical Education provided online3. Library4. Newsletter5. Practice visits 6. Emotional support groups

COPIC COPIC Insurance Co

Head Office: Colorado


1.3 Rs Program - advice on how to communicate unexpected medical outcome2. Practice visits3. Newsletter on risk management4. Risk management seminars5. Website tips

Premium discounts offered for participation (up to 10%).

NORCALNORCAL Mutual Insurance Company

Head Office: California


1. Onsite reviews2. 24/7 hotline for risk management consultation3. Continual Medical Education provided online4. Risk management self assessment5. Monthly risk management publications

Premium discounts offered for participation (up to 5%).

ISMIEISMIE Mutual Insurance Company

Head Office: Illinois


1. Risk management helpline2. Online tips 3. Risk management handbook4. Continual Medical Education

Premium discounts offered for participation (up to 15%)

CMPACanadian Medical Protective Association

Canada 100 years1. Continual Medical Education2. Online library3. Online risk management tips

MPS Medical Protection Society UK 107 years

(since 1892)

1. Courses/Education program2. Communication Course3. Practice Visits4. Monthly Publication5. Consultancy Services6. Events and Conferences



C End Notes

i Avant website: www.avant.org.au

ii MDANI website www.mdanational.com.au iii Anderson, Mandy, June 2007 “Risk management – It’s working!!!”; source: MIGA Bulletin http://www.miga.com.au/library/June%20Bulletin%202007.pdf

http://www.avant.org.au/

http://www.miga.com.au/library/June%20Bulletin%202007.pdf

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Trends in Risk Management in Medical Indemnity · 2016-02-23 · Trends in Risk Management in Medical Indemnity Trends in Risk Management in Medical Indemnity_final_101109.doc 6 An