Eyeworld

tion Data Bank will be notified. Sim- ilar to auto insurance in which a dri- ver's premium will increase after an accident, many insurance compa- nies will review a physician's rates and the settlement could be grounds for increasing the malpractice rates. While Mr. Mills has not had any personal experiences during his 22 years of representing physicians and hospitals in medical malpractice cases, he said he has heard that in some cases, an insurance company could offer a discount to a physician who is willing to negotiate away a consent clause. Mr. Widi said ophthalmologists should be wary of assessable policies. Under these policies, the insurance company charges an initial pre- mium, with the stipulation that it retains the right to charge additional premiums, even years in the future, if their losses exceeded premium in- come for that particular year. Locating an insurance provider The availability of insurance providers is usually only an issue during poor market conditions. With more than 50 PIAA carriers and a few commercials in the United States, there are usually many op- tions and competition in the mar- ket, Mr. Widi said. Most physicians are covered by one of the 58 physician-owned carri- ers belonging to the Physician Insur- ers Association of America (PIAA). PIAA's website (www.piaa.us) in- cludes a directory of carriers, and users can sort by state, Mr. Widi said. Mr. Mills said that if he were an ophthalmologist looking for an in- surer, he would lean strongly toward OMIC or a physician-owned com- pany. OMIC is a specialty group that caters only to ophthalmologists, so it is more attuned to ophthalmolo- gists' needs. Similarly, physician- owned companies typically have a better grasp on a physician's needs. There are also a few national commercial carriers that provide medical malpractice insurance such as Medical Protective (Fort Wayne, Ind.) and The Doctors Company (Napa, Calif.), Mr. Widi said. Physi- cians can perform a simple internet search for agents or brokers in their area that sell coverage for these com- panies. Other resources include the vari- ous ophthalmic societies and associ- ations such as the American Acad- emy of Ophthalmology (AAO), American Society of Cataract and Refractive Surgery (ASCRS), American Association for Pediatric Ophthalmology and Strabismus (AAPOS), American Society of Oph- thalmic Plastic and Reconstructive Surgery (ASOPRS), Association of University Professors of Ophthal- mology (AUPO), Contact Lens Asso- ciation of Ophthalmologists (CLAO), and Women In Ophthalmology (WIO). Furthermore, local or state soci- eties might have information on malpractice carriers. "Ophthalmolo- gists should ask the medical societies they belong to if there are any spe- cial deals they've worked out with businesses or vendors, including malpractice carriers, as sometimes they negotiate lower rates or dis- counts," Mr. Widi said. Reducing malpractice risk Mr. Widi said to maintain low-cost insurability, ophthalmologists should do what they can to avoid claims activity. Although sometimes hard to measure directly, there is a definite correlation between risk management, claims activity, and the ability to successfully defend a claim. Basic risk management and preventative procedures can have a major effect on how a claim is de- fended. This is because many claims revolve around issues not related to clinical outcome, such as (lack of) informed consent or false claims in advertising. Informed consent means the practice has obtained "the patient's consent for treatment or procedure after explaining the nature of the procedure, the potential risks, and the alternative treatments," Mr. Mills said. This is a process that is more involved than simply getting a patient to sign a consent form. To satisfy informed consent, Mr. Mills said the practice needs to take ample time with the patient and ex- plain the nature of the procedure, the risks, benefits, and alternatives of surgery, as well as to answer all of the patient's questions. Practices should have a proce- dure in place to document the steps of informed consent, he said. A checklist would include document- ing that the patient understands the procedure, risks and complications, alternatives, and consents to con- tinue with the procedure. Mr. Mills also recommended that physicians practice within the standard of care; consider adopting diagnostic protocol; obtain essential consults and make necessary refer- rals; review and initial consultant, laboratory, and radiographic reports prior to filing them; and implement a system for following up on refer- rals for consults, missed/canceled appointments, and missing test re- sults. EW Editors' note: Mr. Mills and Mr. Widi have financial interests with OMIC. Contact information Mills: 312-578-7524, dmills@pretzel-stouffer.com Widi: 415-202-4564, rwidi@omic.com EW Ophthalmology Business 53 July 2011

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