Spring 2013 | www.doctorsdirectinsurance.com C. Travis Watts Vice President – Sales & Marketing Doctors Direct Insurance, Inc. Travis.Watts@ddiimail.com (708) 406-7695
Dear Physicians, From its founding several years ago, Doctors Direct has devoted itself to only one market: the practicing physicians of Illinois. At DDI, we understand that medical malpractice insurance is not just about handling claims, it is about protection. We are here, first and foremost, to protect our physician policyholders amid the sometimes volatile arena of medical liability. This goal—protecting the physicians—provides orientation for everything we do within the Company. Our physician-dominated Board of Directors has the responsibility for setting corporate policy for DDI. Over the years, I have never seen DDI, in their deliberations, fail to ask the core question: “Is this action good for our doctors?” In underwriting, the Company seeks a delicate balance between wanting to help an applicant find insurance and applying solid standards of risk acceptability, which protect the whole group of insureds from the effects of adverse claims. Where DDI really shines is in its claims management, because getting a lawsuit dismissed or a victory at trial clearly vindicates the physician when a patient brings a frivolous allegation. DDI’s reputation among plaintiffs and their attorneys is clear: we will do everything we reasonably can to defend our policyholders aggressively. In doing so, we back up this commitment with a full consent-to-settle provision in our policy. Clearly, it is not just an insurance policy that you are buying. It is protection of your reputation
and your livelihood.
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Cash-Flow Shortage Survival Tips for Doctors
By Ike Devji, JD
I’ve been talking to more doctors who are contemplating if and how they can keep their doors open given the fact that their fixed expenses were based on old revenue models that are rapidly evaporating. Decreases in insurance compensation, Medicare contract losses, increasing incursion into nearly every area of practice by hospitals that are sucking up every available insurance contract and pushing doctors that have been successful providers for years into insolvency, the list goes on and on. The medical business is a microcosm of the larger economy itself and as always, cash flow is king. In our current economy, the lack of cash flow has become all too common to all business owners, including doctors, who were extremely profitable to the tune of sixand seven-figure incomes even only two to three years ago. In those “good old days” when revenue and liquidity were taken for granted, there was little or no thought given to monthly overhead requirements for payroll, vendors, the practice’s rent/lease, or even the commercial mortgage payments on the facility itself. These lease and mortgage obligations are almost always personally guaranteed by one or more of the principal physicians in the practice, so an economy like this one threatens both the viability of the practice itself and the personal solvency of the doctors who own it. As this economic pressure continues doctors are working hard on ways to diversify their practices, increase marketing and adding new revenue streams, but as we’ve seen with our government, solvency is an issue that needs to be addressed with an eye towards both revenue and spending. Below are some specific actionable tips to consider, which were shared with me by Mark Johnson, a partner with B2b CFO in Phoenix, Ariz., which has helped business owners nationwide with a variety of business and succession-planning issues. Johnson has worked at the CFO level for business in nearly every channel including health care for decades. Article continues on page 2
STRATEGIES IN transitioning to ICD-10 As the October 1, 2014 deadline for transition to ICD-10 coding approaches, anxieties associated with the cost and organizational burden on both healthcare providers and the healthcare industry rise. Those who plan ahead and devote time and financial resources to education and training will experience a much smoother transition and a much earlier return on their investment. To assist with the transition, the Center for Medicare and Article continues on page 2
Doctors Direct Client Spotlight: Jay F. KiOKEMEISTER, D.O. ? Does Going Direct Really Make a Difference in the Service You Receive?
The service is not only efficient it is accurate. When first switching to DDI, I didn’t think that going direct was going to make much of a difference, but it certainly has in regards to service and response. I know that if I have a question, I can get an answer right away, from the decision maker of the company.
Jay F. Kiokemeister, D.O. has been a board certified anesthesiologist in the Chicagoland area for 20 years. He graduated from the Chicago College of Osteopathic Medicine in 1991, and completed his anesthesiology residency at Northwestern University Medical Center in 1995. Dr. Kiokemeister became the President of Ambulatory Anesthesiologists of Chicago, LLC in 1999, and has gained recognition for growing the practice to 20 providers and servicing 8 outpatient surgery centers.
Is Doctors Direct One of Those “Here Today, Gone Tomorrow” Companies?
DDI has been here for me as an insurance carrier and as a partner, and I am confident that DDI will be here tomorrow. I meet with my company 8 times a year and we discuss various aspects of the business. Their direct model proves that they are evolving with the modern healthcare environment.
Do You Miss Having a Broker?
Discovering how much my broker was actually being compensated and being able to put that back into my practice was enough for me to switch to DDI. I am getting the best coverage, service and price available in Illinois.
Did You Have to Buy a Tail to Switch Companies?
No, it was unnecessary as DDI assumed all of my prior acts coverage. I am confident that should a claim arise from something in the past, that DDI is more than capable to manage that claim.
Can Doctors Direct Settle a Claim Without My Consent?
Absolutely not! Their policy language specifically states the physician has the Full Consent to Settle clause, which indicates that they will not settle a claim without my consent to do so.
Article from page 1: Cash Flow Shortage
1. Do not pay your suppliers until the due dates and, if necessary, go past the due date with the vendor’s concurrence. 2. Accelerate all accounts receivable collections through timely customer follow-ups on past due receivables. Consider something like a discount for cash payments made prior to the due date. 3. Renegotiate lease terms on both rent and equipment when you are in the last two-to-three years of a contract. Lessors would rather keep you in a longer contract at a lower rate than lose you as a client altogether. 4. Utilize outside consultants who work on a contingency basis to lower costs for expenses such as telecom, property, and casualty insurance. These arrangements allow for lower expenses and the savings is usually split with the consultant. 5. Reduce inventory levels and manage work-flow production with a minimum of on-hand product for manufacturing. 6. Research your deposits paid over a year ago to utility companies in order to determine if the deposits are still required; there is a chance they may not be. 7. Defer principal and interest on outstanding loans with banks and other creditors. Additional assistance and guidance in the area of cash-flow management can be provided by your finance and accounting professional. Finally, get experienced help. Whether renegotiating your lease, going back to a bank for a loan modification (even interest-rate reductions
have been critical to some doctors), or dealing with creditors in a more advanced stage of default, you will almost always have better results when dealing with experienced counsel that knows the law, the players who can depersonalize the situation and present it as a good business decision to the other parties. There are lawyers out there that have extensive experience in this specific area, find one and ask them some qualifying questions on their specific experience and their results in solving a problem like yours. ............................................................................................................................ An Asset Protection Attorney helps protect a national client base including several thousand doctors. The article above was originally written for PhysiciansPractice.com where Mr. Devji has over 120 bylines. Ike Devji can be reached at (602) 808-5540 or by email at email@example.com You can also connect with Ike through Linked In and see more of his work here: http://www.proassetprotection.com/ Mr. Devji’s article appears here with permission.
Article from page 1: Strategies in Transitioning to ICD-10
Medicaid services offers an email subscription service, www.cms.gov/ ICD10, providing regular updates on topics related to how to anticipate the transition’s impact on your practice, how to formulate a realistic budget in preparation, and how to assemble a project management team to spearhead the transition. Throughout this transition, no assumptions should be made in regard to provider knowledge and acceptance of its expected benefits. Devoting the resources to support a seamless transition may be fruitless without buy-in from the healthcare team. For practical guidance related to engagement of the healthcare team in the transitional effort, visit:
Letter from page 1
Online Protection of a Professional Reputation By Michael J Sacopulos, JD The words of Warren Buffett have never been more true: “It takes 20 years to build a reputation and five minutes to ruin it.” With everyone from patients to jurors judging physicians based off of online ratings, many physicians are looking for ways to insure their cyber reputation is accurate. Companies like Reputation Changer and Digital Whiteout work with their clients to change what people can read about them online. A physician who is involved in a legal situation in his personal life, for example, divorce can be showcased in a simple Google search. Even though a potential patient may search the physician’s professional background, their personal life details can be tied together In the past, it was easier to keep private lives out of the public’s eye. The increase of the internet connectivity and exponential growth of social media has further blended personal with public. If you make one uncalculated move in today’s society your reputation can be scorned publically online.
Jury Instructions Much has been made recently of the risk of jurors using social media. Dozens of cases around the country involving jurors use of social media during trials have been reported. As one author put it, social networking sites have “wreaked havoc” upon the jury system. The problem is so pervasive; in 2010 the United States Judicial Conference Committee on Court Administration and Court Management issued model jury instructions relating to the use of social media and internet research. In October, 2011 a survey of active and senior federal court judges found that 60% of them used the conference committee on Court of Administration and Case Managements jury instructions.
Changing A Client’s Online Reputation Some litigators are moving beyond recognition of the issue. They are proactively creating and polishing online reputations for potential advantage in litigation, in the event jurors stray from the courtroom into cyberspace. Industry experts argue, once someone anticipates being sued or is served papers, it is best to get a jump start on what potential jurors, lawyers, and investigators will find when looking online. They caution the longer the negative information is visible online, the greater chance it has to spread virally by people reading it.
In The Shadows While it seems realistic to acknowledge that trials may no longer take place solely in the courtroom, this leads to uncomfortable consequences. When and what goes through a juror’s search engine is impossible to fully know. Anticipating some level of juror misconduct via online activities seems both unsettling and justified. Like it or not, we have entered an age of shadow litigation. Costs for such services can start at $2,500, and can go as high as $20,000 for extreme crisis management. .............................................................................................. Michael J Sacopulos, JD is the CEO of Medical Risk Institute (MRI).Medical Risk Institute is a firm formed exclusively to provide proactive counsel to the healthcare community to help providers understand where liability risks originate, and reduce or remove these risks. He may be reached at firstname.lastname@example.org.
There is a lot going on in healthcare today—and many of the emerging changes are quite problematic for physicians. Yet, the fact remains that physicians are highly-skilled providers of care. Patients want to receive that care and to trust their doctor. A doctor’s reputation and integrity plays a huge part in being able to deliver that care. Having a carrier like DDI behind you is the best way to insure that your good name is maintained. I have spent my entire career in insurance in the medical malpractice field. No company comes close to DDI in its care for its insured physicians. This dedication starts with the Board of Directors and flows to our 6-member Physician Advisory Board, the dedicated members of our staff and our panel of defense attorneys. We will not rest for a minute in our determination to protect you, the practicing physicians. As always, our Board members and all of the management staff would be very happy to speak with you about this or any other issue. The physicians who are insured by Doctors Direct have access to all levels of the Board and management, and we would welcome each and every opportunity to visit with you. Sincerely,
C. Travis Watts Vice President, Sales and Marketing Claims from back cover
The echocardiogram was performed that afternoon and revealed aortic dissection. A hospital team unsuccessfully tried to find a surgeon to perform an emergency repair of the dissection, and the patient died later that afternoon of cardiac arrest. Attorneys for the various defendants argued over who was at fault for the patient never receiving a contrast CT scan. In the end the hospital and the internist were found guilty. Mid-trial the hospital admitted negligence, but denied it was the cause of the patient’s death. Several of the defendants entered a high/low agreement prior to the trail, capping their liability costs. ....................................................................................... This is not an actual DDI claim, but that of another company. It was reprinted with permission of the Jury Verdict Reporter, a Division of the Law Bulletin Publishing Co.
Here to Defend You. At DDI, we defend physicians. Our in-house claims professionals work closely with you and top-flight Illinois defense counsel. Our goal is to get claims dismissed on your behalf and to send a message to the plaintiff’s bar that we will not go quietly. After all, it’s not just a legal action. It’s an attack on your reputation. We are here to defend you.
Always. Spring 2013
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»In this Issue Cash-Flow Survival Tips Q & A with Anesthesiologist Jay F. Kiokemeister, DO
5 BENEFITS of being DDI Insured 1. The Only 100% DIRECT Writer of Malpractice Insurance in Illinois— Providing direct answers to your direct inquiries. 2. We are the physician-friendly company. You have a choice and it is yours. We do not stronghold you to stay insured by us with threats of not re-writing you should you leave and return. 3. Our premiums are tied to your exposure, not the general specialty classification—we do not have a broker commission built into your premium.
Online Professional Reputation Protection
4. Our policy is comprehensive. Practices are expanding their services to supplement the diminishing income due to decreasing reimbursement. We understand this and extend coverage in many instances.
Claims in the News
5. DDI Clients realize premium savings now, unlike some companies, who charge higher rates with a promise to pay you back later via dividends and “loyalty” rewards programs.
CLAIMS IN THE NEWS
Lack of Timely CT Scan Leads to Patient Death Tried: October 15 – 30, 2012 Verdict: $4.5 million $4 Million for Loss of Society and $500,000 for Conscious Pain and Suffering
Early in the morning of August 4, 2008, an adult male patient was brought to a hospital’s emergency room (ER) for severe chest pains. The defendant ER doctor determined the patient was not having an acute heart attack. A CT scan showed that he had a dilated aorta and may have been suffering from an aortic dissection, which would require immediate surgery to save his life. A CT scan with contrast was needed to confirm the aortic dissection diagnosis. As the ER doctor’s shift was ending, he decided to delay the contrast CT test until the patient was admitted to a room. He gave the defendant internist instructions to admit the patient and take over as the patient’s attending physician. The ER doctor also asked the defendant cardiologist to provide a consultation. However, the cardiologist never saw the patient or had anyone from his office see him.
The patient was admitted to his room where two nurses evaluated him. However, neither nurse saw, entered or completed the ER doctor’s order for a contrast CT test. The internist called the hospital twice to inquire about the patient, but did not check on the status of the contrast CT scan or the patient’s diagnosis. Later in the morning, a second defendant cardiologist saw the patient but he knew nothing about the ER doctor’s order for a contrast CT. After examining the patient and reviewing his records, he suspected an aortic dissection and ordered a contrast CT scan, but did not put a rush on the test. He also ordered an echocardiogram. The nurses never saw, entered or completed the second order for a contrast CT test.
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Published on May 6, 2013