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Last Word: New health care venues, new risks

Last Word: New health care venues, new risks

One-stop shopping has reached new heights with the rise of walk-in clinics located in retail malls, Wal-Mart and Target stores. You can shop for clothing, furniture, sports equipment and groceries, eat lunch and see a doctor about your sinus headache all at one location.

Sparked by changes to reimbursement policies in employee benefit programs, Medicare and Medicaid-plus the fact that more and more Americans lack health insurance altogether-health care delivery is trending away from traditional venues toward unexpected locales. These nontraditional venues include big box stores, universities, churches and corporations that offer wellness programs and blood pressure readings. One department store has even worked with local health care providers to offer in-store mammogram screenings.

And it's not always physicians providing the medical care. Physician extenders, such as physician assistants or certified nurse practitioners, are increasingly common. We've also seen home health agencies partnering with multidisciplinary teams of professionals to bring full-service medical care direct to the patient, moving full circle back to the days of routine house calls.

With these changing health care venues come new risks for providers, and the need for appropriate liability insurance. As with any new and growing insurance need, the surplus lines carriers have been the first to respond with coverage.

Ultimately, these shifts to the nontraditional are being driven by economic considerations for both the consumer/patients and the provider. Consumers faced with dwindling health care benefits are eager to embrace less-expensive options. Health care providers are finding that moving into nontraditional spaces is often the most cost-effective option for them, too.

Another arena where nontraditional delivery is growing due to economic advantages-along with advancing technology-is the outsourcing of image reading and interpretation. Many providers are now exporting MRI, ultrasound and radiology images via computer to radiology firms in other states or countries.

However, not all the teleradiology companies in other countries have U.S.-trained and licensed physicians reading the images. That makes it essential that health care providers that are outsourcing ensure accurate documentation and good credentialing, and verify employment backgrounds and licensing.

Maintaining the privacy of patient records is also critical, and moving into some nontraditional settings can create security issues, whether patient records are kept on paper, handheld personal communication devices, computer disks or laptops. Health care providers should always verify that insurance is in force and that all physicians or physician extenders, wherever located, are covered.

For the health care provider, when outsourcing or using other nontraditional delivery venues, it's essential to have appropriate professional liability insurance and general liability coverage to respond to accusations of errors. This can be even more critical when medical services are outsourced to non-U.S. countries because not all countries and overseas providers carry medical malpractice insurance.

Again, it's the surplus lines carriers that have the resources and processes in place to provide the liability coverage that providers need. We can handle it because we look closely at the organization's protocols and procedures for hiring, credentialing, documentation and contacting patients with out-of-the-ordinary lab results, as well as emergency protocols/procedures if a higher-level practitioner or referral to an emergency room is needed.

It seems that the shift from traditional to nontraditional venues will continue to occur at an incredibly rapid pace, making it vital for health care providers to protect themselves in terms of risk-avoidance procedures, as well as malpractice and general liability coverage. It's the surplus lines insurers that are prepared to help health care providers meet this challenge and keep one-stop shopping venues open.

Fran O'Connell is vp and product manager of medical underwriting at Shand Morahan & Co. Inc., the Deerfield, Ill.-based managing general underwriter for Evanston Insurance Co.