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Med Mal Q & A Print E-mail
Written by Matt Gracey   
Monday, 05 July 2010 16:43

by Matt Gracey  


When choosing a malpractice insurance company, how can I tell which one is going to vigorously defend me?


Defending claims is really where "the rubber meets the road" in malpractice insurance!  Doctors and their administrators often get hung up in looking just at premium quotes, marketing slogans, brokers' service or personalities, or insurance-policy provisions that they might or might not like.  The real reason one purchases malpractice insurance is to be assured of a strong and affordable defense if a lawsuit is threatened or filed against your practice.  Unfortunately, figuring out each insurer's true claims-defense track record has been tricky at best.  The good news is that in recent years, the Florida Office of Insurance Regulation (OIR) has been gathering more and more data on claims defense and now has enough data to make for a credible examination and analysis. 

In looking at claims-defense records, the most useful measurement index is the one gathered on the percentage of cases each insurer has closed without any indemnity payment to the plaintiffs.  A higher percentage indicates a stronger claims-defense philosophy. The industry average in 2008 was just under 50% of filed cases closed without any payment to the plaintiff.  One popular insurer's numbers have fallen rather dramatically, from 90% of their cases closed with no indemnity payment to only 37% of them in the three-year span from 2006 through 2008, despite their marketing folks talking about their strong defense. This example demonstrates why doctors and their administrators need to "look behind the curtain" at the independent OIR data to analyze what kind of claims-defense they are really buying. 

A few notes are important, though.  Some insurers' marketing will show the percentage of their cases closed with no indemnity payment.  However, some of that marketing will skew that percentage by including closed "incident reports" as well as actual cases filed, to make their defense data look better.  Also, some newer or less-popular insurers have so few closed claims that their percentage closed is almost meaningless.  The top insurer in Florida, FPIC, handles so many cases against their large number of Florida insureds that trying to compare their above-average percentage with another insurer handling a fraction of their numbers can be a bit distorting.  Experience does count in Florida courtrooms though, and you can see from the OIR reports how many more cases an insurer like FPIC handles than their counterparts. The OIR data also show the average defense costs spent by each insurer, which is another indication of an insurer's defense philosophy.         

If you would like a copy of the most recent OIR report or to discuss your particular insurer's record, do not hesitate to contact us.  We are independent malpractice insurance experts and will help you through this maze and look out for you.  

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By the Numbers: Active Licensees Print E-mail
Written by Jeffrey Herschler   
Monday, 05 July 2010 16:30


Medical Doctors                          # of Active  Licensees 

Alachua                                                      1635

Brevard                                                      1201

Broward                                                     4696

Collier                                                          802

Dade                                                          7229

Duval                                                         2830 

Escambia                                                   848 

Hillsborough                                           3695

Lee                                                             1250

Liberty                                                        1 

Orange                                                     2956

Palm Beach                                             3789

Pinellas                                                    2724

Polk                                                           948

Sarasota                                                  1106

Seminole                                                   791

Volusia                                                      970

                         SOURCE: FL DOH 


Last Updated on Monday, 04 April 2011 06:12
By the Numbers-Provider Type Print E-mail
Written by Jeffrey Herschler   
Monday, 05 July 2010 15:51
Provider Type                                         # of Licensees
Chiropractic Physician                         5,165
Medical Doctor                                    55,147
Osteopathic Physician                         5,224
Podiatrist                                                1,636
Physician Assistant                              5,008
Registered Nurse                               231,505
Last Updated on Monday, 04 April 2011 06:11
Interview Exclusive - Executive Commentary on HCR (conclusion) Print E-mail
Written by Jeffrey Herschler   
Monday, 05 July 2010 15:43

Publisher's note:

I was in Orlando April 22nd and 23rd attending the Florida Institute of CPA's Annual Health Care Industry Conference (

There, I had the opportunity to interview Micky Smith, CEO of Oak Hill Hospital, Lee Huntley, CEO of Central Florida Health Alliance and John Kolosky, COO of H. Lee Moffitt Cancer Center.  Excerpts from that meeting were published last week. I caught up with Mr. Smith, Mr. Huntley and Mr. Kolosky recently and posed one final question.  Thanks for reading FHIweekly.

 Jeff Herschler

Proponents of Obama Care predict that 21st century healthcare providers will meet the current challenges and that today's healthcare practices and facilities can not only survive but perhaps even prosper.

And of course the cynics are predicting runaway costs, unfunded liabilities and a nation headed towards mediocrity, a lower standard of living and crushing debts.

Who is closer to the truth, the buoyant optimists or the doomsday prophets?

Mr. Smith stated, "As always, the truth lies somewhere in the middle. The most powerful engine in healthcare reform is data transparency. Look how the rate of hospital acquired infections in Florida has plummeted since the state began publishing that information on the web. As cost, pricing, and quality data is shared with the consumer, ultimately at the physician level, we will see dramatic improvements in our health care system. If for no other reason that the poor performers will disappear."

Mr Huntley added, "I'd say it is too soon to tell.  It's true that as an industry, health care is expensive, highly regulated and cannot afford itself as millions of boomers enter the bounds of Medicare while at the same time trying to cover 60 million uninsured.  I'm biased as a provider of care. Too much too fast with too little input by experts into big government's solution. On the other hand, Obama tried. I can tell you this, healthcare won't prosper, especially as funds are reallocated from one topic to another, without regulatory relief. There are a lot of good ideas though, inside healthcare reform: e.g. bundling, emphasis on primary care and more.  But one not there is individuals and society taking responsibility for their own health status. Heck, we can't even regulate fat, sodium ridden fast food.  Sorry to be all over the place on this one.  It's just too soon to tell.  My gut: 40% buoyant optimism, 60% pessimism."

Mr. Kolosky responded, "This is more related to the riots in Greece than we would like to think.  We simply cannot afford the way we have always done things. The Bad News:  We, as a society, are living beyond our means, and runaway health care costs are one manifestation.  The Good News:  We, as a society, have faced bigger challenges head on and addressed them.  So why be optimistic?  When we face these challenges and deal with them, we are better off as a society.   This will not be painless.  When we take "waste" out of the system  in, for example, administrative bureaucracy, we will cost jobs and changes to people's careers. When we take duplicative or unnecessary services out of the system, we will cost someone money.  When we hold people accountable for performance, it may be revelatory and somewhat painful. However, we will adjust and be better off than we were before.   More importantly, patients will be better off than before.  So, in the end, I'm optimistic.......but as my doctor sometimes says "this may hurt a bit"." 

Last Updated on Thursday, 23 December 2010 07:04
Interview Exclusive-Executive Commentary on HCR (Part I) Print E-mail
Written by Jeffrey Herschler   
Monday, 05 July 2010 15:35

Executive Commentary on HCR

April 23, 2010                                      Orlando, FL

Publisher's note:

I was in Orlando April 22nd and 23rd attending the Florida Institute of CPA's Annual Health Care Industry Conference (

There, I had the opportunity to interview Micky Smith, CEO of Oak Hill Hospital, John Kolosky, COO of H. Lee Moffitt Cancer Center and Lee Huntley, CEO of Central Florida Health Alliance. Excerpts from that meeting appear below.  Thanks for reading FHIweekly.

 Jeff Herschler 


Can HCR bend the cost curve?

Mr. Huntley asserted that bending the cost curve was inevitable as reimbursements are being cut. "Providers will be forced to do more with less" he stated.  As one example, Mr. Huntley pointed to the CMS emphasis on reducing hospital readmissions within 30 days.  "The jig is up" Mr. Smith commented succinctly adding the readmission penalty can unfairly punish the facility. One example of this would be the case where the readmission is caused by patient non-compliance with diet/lifestyle orders issued at discharge on the original admission. Mr. Kolosky suggested that EHR will vastly reduce duplicate testing. 

Will HCR force consolidation in the industry?

The panelists were unanimous that consolidation was an inevitable result of HCR.  Mr. Smith pointed out that highly leveraged practices and facilities will be forced to seek a merger or close their doors as the debt service will be unsustainable in a reduced reimbursement environment.  Meanwhile providers will be under close scrutiny by payers and those that regularly order unnecessary procedures "are out of business".  Mr. Smith went on to predict health industry job losses over the next several years as unnecessary and duplicate tests are eliminated.  Meanwhile, developments in information technology will lead to work force reductions in administration.

Should hospitals be organized as for profit institutions? Is that the right environment for optimal patient care?

Mr. Huntley pointed out that revenues must exceed cost in any business model.  "You must make money to survive regardless of your not for profit or for profit status" he asserted.  Mr. Kolosky suggested non profits will be threatened by local and state governments desperate for revenue sources. Loss of property tax exemptions would endanger the solvency of many non-profit entities in his view.

How will HCR affect your organization's health plan?

Mr. Kolosky noted that healthcare service utilization is typically high among the industry's workforce.  "They have access; they know all the new technologies" he stated.  Mr. Huntley suggested that HCR will accelerate some existing trends.  For example his facility will offer fewer health plan choices and continue to emphasize prevention and wellness programs

This and That

Another industry trend expected to accelerate is hospital acquisition of group practices according to thepanel.  All panelists agreed that our industry is in for half a decade, or more of "chaos" as providers and payers adjust to the new law, its interpretation and its enforcement.  Mark Fromberg of Marcum Rachlin suggested HCR was incomplete without tort reform.  The panelists agreed that defensive medicine contributes to healthcare inflation.  Kim Griffin of Deloitte asked what contributions Florida's CPA's could make to ease the transition for their clients.  Mr. Huntley emphatically demanded accurate and reliable data and analysis so executives can optimize rational decision making.

Last Updated on Thursday, 23 December 2010 07:06
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