AHLA Seeks Clarification on Physician Malpractice Insurance

Common Program Features

For all of these solutions there are certain common questions that arise as to what risk management and quality of care related requirements are appropriate from a regulatory perspective. Requirements that are often considered include:

• Excluding physicians representing a higher indemnity risk (eg, due to prior claims experience) or a higher quality risk (eg, based on disciplinary or investigative record).
• Minimum practice levels to demonstrate and maintain competency (eg, active staff of the hospital, minimum average weekly clinical hours, minimum number of procedures in a specialty in the hospital subject to the hospital's risk management program).
• Minimum CME requirements (including risk management courses approved by the hospital).
• Limiting coverage in a hospital setting to the “four walls” of the sponsoring hospital and/or restricting the percentage of covered services at other hospitals (so that the sponsoring hospital is not effectively assuming responsibility for losses at other hospitals where it does not control the risk-management function or quality of care practices).
• Varying the limits of coverage depending on the setting, in direct proportion to the likelihood of joint and several or vicarious liability of the hospital for incidents in that setting.
• Limiting premium assistance to designated insurance carriers that meet the hospital's requirements regarding financial condition.

These programs, however, typically do not restrict the ability of independent staff physicians to maintain privileges at other facilities. Likewise, these programs typically would not restrict the physician's ability to exercise independent medical judgment to admit or refer patients to another facility or other provider.