AMC/NOMA representatives met with Ann Womer Benjamin, the new director of the Ohio Department of Insurance, on February 27th. The AMC/NOMA representatives in attendance were: Elayne R. Biddlestone, EVP/CEO, John A. Bastulli, M.D., Vice-President of Legislative Affairs, Richard Ludgin, M.D., J.D., Kevin T. Geraci, M.D., President, and lobbyist, Carolyn Towner.
AMC/NOMA representatives discussed the medical liability situation that is severely affecting physicians in Cuyahoga County. New concerns are arising from the recent downgrading of OHIC to B++ by A.M. Best. Ohio hospitals require physicians to have coverage by carriers rated at A- or better. Northeast Ohio physicians are already limited to three carriers. Some suggestions for keeping options open for physicians might be to change current bylaws, to allow a specified timeframe for changing carriers who fall below acceptable ratings or to allow for change at next renewal period.
Additional topics of conversation focused on stabilizing premiums. Director Benjamin stated that she did not expect immediate stabilization based on recent discussions with carriers. Carriers are citing various reasons that include high review costs, rising patient care costs as well as out-of-control lawsuits and inappropriate rates set in the past.
Director Benjamin also provided a summary of the agency’s activities, of which a large part is reviewing rates (with the exception of life insurance). While they cannot set rates, they evaluate actuarial factors and claims data to ascertain whether rates are excessive. ODI does audit domestic insurance companies, and liquidates insolvent companies. They handle complaints and are now monitoring prompt payment claims under SB4. They license agents and can also pursue criminal conduct. An underutilized service of the ODI is their ability to appeal denials by insurance companies. A recent ad campaign ran statewide to inform the public of this option. Director Benjamin also indicated that the ODI was working on the issue of a Patients Compensation Fund as outlined in SB 281.
Director Benjamin was asked to consider the AMC/NOMA as a resource for future ODI initiatives relevant to the various insurance issues affecting physicians and their patients.
April 2003
I write to you today on behalf of the membership of the Academy of Medicine of Cleveland/Northern Ohio Medical Association, as a member of its Board of Directors and Chair of its Physician Advocacy Committee. That we are all in the midst of a crisis in the availability and cost of professional liability insurance is not a surprise to anyone.
Even though it is not required under Ohio Law, most, if not all of you, have internal requirements that members of your medical staff be insured by a company rated A- or better by A.M. Best. OHIC’s downgrade to B++ creates a significant and immediate dilemma for physicians insured by that company.
There are various factors impacting upon the medical liability crisis in Northeastern Ohio. We ask that you consider the following points when evaluating this issue within your institution.
The key issue confronting
OHIC insured physicians and hospitals alike is the meaning of the
downgrade. If OHIC is still financially
viable, you and your patients are protected. Since OHIC is a company domiciled in Ohio and audited by the
Department of Insurance, we recommend you write to the Commissioner of
Insurance and to OHIC to ask that the outcomes of the audit be made available
to you for use in the decisions you will have to make.
In the interim we ask that you consider taking one of
the following two courses of action:
a. Modify your rules to accept a rating less than an A- from A.M. Best Co., or
b. Permit your medical staff to make an orderly transition to an A.M.Best A- company when they renew their policies. If a policy were due for renewal prior to July 1, 2003, we would also ask that you take into consideration accepting OHIC for an additional year and require the change at the practitioner’s subsequent renewal.
If you choose to alter your current threshold liability limits requirement, we recommend you advise all members of your medical staff, in the strongest possible terms, of the following:
We well recognize your need to protect your institution and the patients for whom you care. However, at some point, we believe that hospitals have to realize and understand that they while they need to protect the hospital they also need to help the physicians within that hospital continue to provide care to the patients they serve. The AMC/NOMA and our membership seek to partner with each of you to help solve this unending dilemma in a manner that serves our collective concerns and that is in the best interests of our patients and our community.
I hope you will feel free to ask for our assistance
and to let us work with you to find reasonable, permanent solutions.
If you have any questions, concerns or additional comments please feel free to contact me or Elayne Biddlestone, the Executive Vice President/CEO of the AMC/NOMA.
Very truly yours,
J. Richard Ludgin, M.D., J.D.
The recently enacted medical liability reform legislation -
SB 281 - included arbitration language that can be utilized in the State of
Ohio. Ohio Revised Code § 2711.21–24
authorizes health care providers to enter into an agreement to resolve future
medical malpractice claims through binding arbitration. However, it is important to note that there
are specific points to be followed when utilizing the arbitration agreement.
The Physician Advocacy Group reviewed a model arbitration form for our members. The form reflects current law, as amended by SB 281. The model form will be mailed to AMC/NOMA physician members in the coming weeks, along with guidelines for its use. Additional questions on this topic can be addressed to Elayne R. Biddlestone at 216-520-1000, ext. 321 or at ebiddlestone@amcnoma.org.
Both the executive and legislative committees have been reviewing the matter of mandatory arbitration in the state of Ohio. SB 281 included arbitration language, however, it is not mandatory. The AMC/NOMA would like to see mandatory arbitration language legislation in Ohio modeled after the California language – which enables the patient to agree to arbitration up front. If the patient agrees, the agreement is irrevocable and binds the patient to arbitration in case of a dispute. The executive committee recently approved the recommendation to support mandatory arbitration as part of any new tort reform legislation and would be willing, as an organization, to provide testimony on the matter. Additional information on this legislative initiative on the part of the AMC/NOMA will be available in the coming months
AMC/NOMA signs Common Good petition
A group of healthcare experts have come together under the leadership of Common Good, a legal reform coalition dedicated to restoring the ability to make common choices – and promote legal reform. The group calls upon Congress to immediately initiate hearings on the broad effects of litigation on healthcare, not just on the immediate litigation insurance crisis, and to consider recommendations on how to create new systems of medical justice that will promote better care. A petition has been prepared and signed by a large number of health care groups and medical schools including the dean of CWRU and referred on to Congress. The AMC/NOMA has joined in supporting this petition on behalf of the physicians in Northeastern Ohio. To view the petition go to the Common Good web site at www.ourcommongood.com.