Insurance and Risk Management Strategies for Physicians and Advisors

by David E. Marcinko

Overview

As a consequence of today’s litigious environment in the healthcare industry, physicians must now carefully assess their personal and practice risks as they seek to be indemnified should an event or cause of action occur. This process requires integrated knowledge of the healthcare industrial complex, as well as the rapidly changing insurance industry. Fortunately, Insurance and Risk Management Strategies for Physicians and Advisors confronts the reality that insurance planning in healthcare is decidedly more complex than most other businesses or professions and, in an easy-to-understand manner, explains to physicians and insurance professionals the background, theory, and practicalities of medical risk management and insurance planning. Certified Medical Planner® Dr. David Edward Marcinko and his team of contributing authors go into great depth on the growing range of insurance planning options in order to assist physicians, and their advisors, to choose the “right” course that balances risk, cost, time, outcome as well as his or her own personal risk tolerance life style.

Product Details

ISBN-13:	9780763733421
Publisher:	Jones & Bartlett Learning
Publication date:	08/25/2004
Edition description:	1E
Pages:	332
Product dimensions:	6.00(w) x 8.90(h) x 0.80(d)

About the Author

David Edward Marcinko is a healthcare economist, adjunctive clinical professor and former private practitioner from Temple University, in Philadelphia. In the past, he edited three practice management textbooks and four personal financial planning books for physicians and healthcare professionals. His clinical publications are archived in the Library of Congress, and the Library of Medicine at the National Institute of Health. His economic thought leadership essays have been referenced by Investment Advisor Magazine, Medical Group Management Association (MGMA), American College of Medical Practice Executives (ACMPE), American College of Physician Executives (ACPE), JAMA.ama-assn.org, Healthcare Management Associates (HMA), CFP© Biz (Journal of Financial Planning), Financial Planner’s Library Online, and the Business of Medical Practice, among others. A favorite on the lecture circuit, Dr. Marcinko speaks frequently to medical societies and financial institutions throughout the country, in an entertaining and witty fashion. Professor Marcinko received his undergraduate degree from Loyola College, in Baltimore, his business degree from the Keller Graduate School of Management, in Chicago, and his financial planning diploma from Oglethorpe University, in Atlanta. He is a licensee of the Certified Financial Planner© Board of Standards, in Denver, and holds the Certified Medical Planner© Designation. He earned a Series #7 (general securities), Series #63 (uniform securities state law) and Series #65 (investment advisory) license from the National Association of Securities Dealers (NASD), and a life, health, disability, variable annuity and property-casualty license, from the State of Georgia. He is also a board certified surgical fellow. Previously, Dr. Marcinko was co-founder of an ambulatory surgery center that was sold to a publicly traded company; Certified Professional in Healthcare Quality (CPHQ); American Board of Quality Assurance and Utilization Review Physician (ABQAURP); medical staff vice president of a general hospital; assistant residency director; founder of a computer based testing firm for doctors; and president of a regional physician practice management corporation in the Mid-West. Currently, Dr. Marcinko is Chief Executive Officer of the Institute of Medical Business Advisors, Inc., a national resource center and referral alliance providing financial stability and managerial peace-of-mind to struggling physician clients.

Table of Contents

	About the Editor	xvii
	Dedication	xix
	Foreword	xxi
	Preface	xxiii
	Introduction for Condensed Reading and Review	xxv
	Contributing Authors	xxvii
	Afterword	xxxiii
Chapter 1	Insuring the Doctor's Life	1
	The Geneva Papers on Risk and Insurance Theory	1
	Acturial Sciences	1
	Social Insurance	2
	Risk Management Principles	4
	General Types of Insurance Policies for Physicians	5
	Life Insurance Taxation	18
	Health Insurance Overview	22
	Life and Health Insurance Policy Provisions	27
	Annuity Overview	34
	Annuity Taxation	36
	Long-Term Care Insurance	38
	Additional Readings	40
	Websites	40
Chapter 2	Insuring the Doctor's Property and Possessions	43
	Fee Only Insurance Consultant	43
	General Types of Policies Covering Possessions	44
	Automobile Insurance Overview	47
	Umbrella Liability Insurance Overview	49
	Evaluting Insurance Companies and Policies	50
	Policy Replacement	53
	Lifetime (Viatical and Senior) Settlements	55
	Needs Analysis Approach to Life Insurance	58
	Additional Readings	59
	Websites	59
Chapter 3	Insuring the Doctor's Practice	61
	Business Uses of Life Insurance	61
	Other Business-Related Insurance	68
	Miscellaneous Insurance Policies	69
	Additional Readings	70
	Websites	70
Chapter 4	Risks of Medical Practice Noncompete Agreements	73
	Restrictive Covenants Defined	73
	Covenants for the Sale of a Medical Practice	74
	Covenants as Part of a Medical Employment Contract	75
	"Reasonable" Covenant Terms	75
	Remedies for Covenant Breach	76
	Agreements Restricting the Practice of Medicine	77
	Conclusion	78
	References	79
	Additional Readings	79
Chapter 5	Documentation and Medical Records Risks	81
	Historic Purpose of Medical Records	82
	The Medical Records Revolution	82
	Documentation Guidelines for Evaluation & Management Coding	84
	Legal Statutes Regarding Medical Billing	85
	References	87
Chapter 6	Health-Care Compliance Risk Management	89
	The Compliance Process	90
	The Rules	92
	Conclusion	104
	References	104
Chapter 7	Risk Management in Modern Medical Practice	107
	Medicare Recoupment Risks	108
	Health-Care Fraud Risks	109
	Provider Health-Care Fraud Considerations	110
	The Kennedy-Kassenbaum (HIPAA) Act	111
	The Balanced Budget Act	112
	The Federal False Claims Act	112
	Money Laundering	113
	Civil Asset Forfeiture Risks	113
	Self-Referral Risks	113
	Federal Agency Risks	116
	Occupational Safety and Health Agency Risks	116
	Drug Enforcement Agency Risks	116
	Environmental Protection Agency Risks	117
	Health and Human Services (Office of Civil Rights) Risks	117
	Antitrust Risks	117
	Business Practice Litigation Risks	119
	Patterns of Practice Risks	119
	Managed Care Contractual Risks	119
	Historic Bars to Managed Care Lawsuits	120
	The Contract Capitulation Dilemma	124
	Employee Risks	124
	Vicarious Risks	125
	Deselection Risks	126
	Risks of Collateral Consequences	126
	Medicare 5-Year Exclusion Risks	126
	State Board Action Risks	127
	Malpractice Risks	128
	New Practice Risks	128
	Education Debt Load Risks	129
	Suggestions to Help Avoid Medical or Legal Risks	130
	Conclusion	134
	Additional Readings	134
	Websites	135
Chapter 8	Sexual Harrassment Risks in Medical Practice	137
	Preferential Treatment	138
	Hostile Medical Office Work Environment	138
	Unreasonable Interference With Work Performance	139
	Two-Pronged Test for Offensive Behavior	139
	Examples of Sexual Harassment	140
	Gender-Based Animosity	144
	Same-Sex Harassment	145
	Doctor-Employer Liability	146
	Disciplinary Actions	147
	Tangible Employment Action	147
	Punitive Damages	147
	Financial and Economic Costs	148
	Commonsense Approach	149
	Endnotes	149
Chapter 9	Medical Office Workplace Violence Risks	151
	Introduction to Medical Workplace Violence	151
	Case Example	152
	Health-Care Workplace Violence Defined	153
	Financial Risk Management Impact of Workplace Violence	154
	Assessing the Risk of Workplace Violence	156
	Contributing Factors to Workplace Violence	157
	Focusing on Prevention: The Zero Incidents Approach	159
	Establish a Workplace Violence Prevention Committee	159
	Disastrous Planning Mistakes	166
	Analyzing the Business Impact of a Workplace Violence Incident	167
	Cost of Implementing a Prevention Effort	168
	The Hidden Cost of Conflict	169
	Cost of Recovery After an Incident	171
	Assessment	173
	Summary	173
	References	174
	Additional Readings	175
Chapter 10	Medical Malpractice and Tort Reform Risks	177
	Malpractice Insurance History	177
	Background	178
	The Corporate Tort Reform Movement	182
	Physician Self-Regulation	184
	The Medical Malpractice Crisis	188
	Conclusion	202
	References	204
Chapter 11	The Capitation Liability Theory	215
	The Liability Insurance Industry	216
	The Liability Premium-Setting Process	217
	The Capitation Liability Theory	217
	Premium Structures and Models	218
	Liability Coverage Forms	222
	The Contrary Viewpoint	223
	Miscellaneous Liability Factors	225
	Current Trends	225
	Specialty-Specific Insurers	226
	Conclusion	227
	References	227
	Additional Readings	228
	Websites	228
	Endnotes	228
Chapter 12	Medical Malpractice Trial Risks	229
	Dear Doctor, You Have Been Served a Lawsuit	230
	The Trial Players	232
	Burden of Proof	233
	Types of Trials	234
	Discovery Process	235
	Depositions	236
	Motions In Limine	236
	Jury Selection	237
	Opening Statements	240
	Presentation of Evidence	241
	Summation	244
	Final Instructions	244
	Jury Deliberations	245
	The Verdict	246
	Preventing and Reducing Incidents of Malpractice	246
	Conclusion	248
	Additional Readings	249
	Websites	249
	Endnotes	250
Chapter 13	Financial and Operative Risks of Divorce	251
	Domestic and Spousal Issues	251
	Prenuptial Agreements	253
	The Decision to Divorce	254
	An Overview of Family and Divorce Law	259
	Other Tax Considerations of Separation and Divorce	268
	Older Divorcing Medical Professionals	272
	Additional Readings	274
	Divorce Websites	274
	Additional Websites	275
Chapter 14	Asset Protection Principles	277
	Getting Started	278
	Appreciating the Risks	278
	Asset Protection Tools	279
	Complex Asset Protection Tools	289
	Timing Is Everything	299
	Additional Readings	299
	Endnotes	300
Chapter 15	Selecting Insurance Agents and Risk Management Advisors	301
	Insurance Company Selection	301
	Introduction to Insurance Agent Selection	304
	Why Do Regulators Target Insurance Agents?	305
	Hiring the Right Insurance Agent	306
	Insurance Agent Titles and Credentials	309
	Medical Risk Management Societies and Specialists	312
	The Role of Advisor/Agent Teamwork	315
	Acknowledgments	316
	Index	317