Spring 2005

The Role of Insurance in Preventing Medical Injury: An Antidote to Malpractice?

 April 4, 2005

University of Connecticut School of Law, Hartford, Connecticut

 

Insurance bears much of the costs of medical injuries. Public and private health insurance pays for most of the medical expenses that result from medical injuries. Malpractice insurance pays for most malpractice settlements and defense costs.

 

As a result, health insurance and medical malpractice insurance have an enormous stake in reducing the frequency and severity of medical injuries. Malpractice insurers address patient injuries through risk management initiatives. Health insurers have begun to address patient injuries through “pay for quality” initiatives.

 

The Insurance Capital – Hartford – presents an ideal setting to consider the implications of these developments for health policy and for law and medicine.

 

What does “pay for quality” really mean? What are private health insurers and managed care organizations doing about medical injuries? What might they do in the future? What about Medicare?

 

What do malpractice insurance companies do to prevent medical injuries? Are they only concerned about preventing claims or are they concerned about injury prevention, too? How has the recent malpractice insurance crisis affected the risk management role of malpractice insurance companies?

 

This conference features insurance and health care industry leaders and experts, as well as one of the most senior Medicare officials responsible for developing and implementing Medicare policy regarding patient industries. Joining them will be four of the leading legal scholars in the field of medical malpractice and health policy.

 

By design, the conference will not address the politically charged topic of medical malpractice tort reform. Our focus will be on insurance and loss prevention – what is being done, what might be done, and what other legal reforms might improve the ability of insurance institutions to promote injury prevention.

 

Schedule

 

 

Speakers

Tom Baker is Connecticut Mutual Professor and Director of the Insurance Law Center of the University of Connecticut School of Law, where he teaches and writes about insurance, risk and responsibility. His book on medical malpractice will be published by the University of Chicago Press in Fall 2005.

 

Susan R. Chmieleski APRN, CPHRM, JD is Vice President and Director of Risk Management and Client Services in the Farmington, Connecticut office of Darwin Professional Underwriters. Darwin Healthcare specializes in professional liability insurance such as medical professional liability coverage, managed care errors and omissions (E&O) coverage, and directors and officers (D&O) liability coverage. She earned her JD degree from the University of Connecticut School of Law, where she was editor in chief of the Connecticut Insurance Law Journal. She teaches healthcare law and ethics to second year medical students at the University of Connecticut Medical School. She is also the Vice Chair of the Litigation and Risk Management Committee of the Health Law Section of the American Bar Association.

 

Eleanor DeArman Kinney, JD, MPH, is Professor of Law and Co-Director of the Center on Law and Health at Indiana University-Indianapolis, where she teaches courses in health law and administrative law. A widely published author and respected lecturer on the subjects of America’s health care system, medical malpractice, health coverage for the poor, and issues in administrative law, Professor Kinney recently published Protecting American Health Care Consumers (Duke University Press 2002) and edited the Guide to Medicare Coverage Decision-Making and Appeals (ABA Publishing 2002). She currently serves as chair of the Patient Safety Subcommittee of the Indiana Commission on Excellence in Health Care. Professor Kinney is vice chair of the American Bar Association’s Section on Administrative Law and Regulatory Practice in August 2003, and will be section chair in 2005-2006.

 

Lynda Nemeth is Compliance Officer and Director Risk Management for Norwalk Hospital.

 

Leslie V. Norwalk, JD is the Deputy Administrator for the Centers for Medicare & Medicaid Services (CMS). In this role she directs the complex and demanding task of implementing the hundreds of changes to be made under the Medicare Modernization Act. Ms. Norwalk continues to direct the day-to-day operations of Medicare, Medicaid, Child Health Insurance Programs, Survey and Certification of health care facilities and other federal health care initiatives, such as physician referral regulations, HIPAA and EMTALA. CMS has the second-largest budget outlay of the Federal Government, directly responsible for $1 out of every $3 spent on healthcare in the United States. The organization insures approximately 25% of the population of the United States (more than 84 million beneficiaries) including the elderly, disabled, and some of the lowest income individuals in the country. CMS processes over one billion claims each year and it contracts with approximately one million providers.

 

Fay A. Rozovsky, JD, MPH is the manager of clinical risk management consulting services for the Health Care Group of Chubb Specialty Insurance, part of the Chubb Group of Insurance Companies. Ms. Rozovsky has over twenty years experience as a healthcare risk management consultant and attorney. She has authored or co-authored numerous articles and books including Consent to Treatment: A Practical Guide, Clinical Trials and Human Research (with Rodney Adams, Esquire) and What Do I Say? Communicating Intended or Unanticipated Outcomes in Obstetrics (with Dr. James R. Woods). Her most recent book, Patient Safety Compliance Manual (co-edited with Dr. James R. Woods) will be published in Spring 2005. Ms. Rozovsky is a Distinguished Fellow and Past President of the American Society for Healthcare Risk Management and a recipient of the Distinguished Service Award, the highest honor bestowed on a member of ASHRM. Currently, she is the Chair of the Professional Technical Advisory Committee for Hospitals of the Joint Commission on Accreditation of Healthcare Organizations.

 

William M. Sage, MD, JD, is Professor of Law at Columbia University, where he teaches courses in health law, regulatory theory, and the professions. Professor Sage is the lead editor of Medical Malpractice Reform in the United States: New Century, Different Issues (Cambridge University Press forthcoming 2005). In 2002, Professor Sage was principal draftsperson for the liability demonstration proposal of the Institute of Medicine’s Committee on Rapid Advances in Health Care. He is currently a member of the liability and patient safety task force of the Joint Commission on Accreditation of Healthcare Organizations. From 2002-2005, he serves as principal investigator of the Project on Medical Liability in Pennsylvania, funded by The Pew Charitable Trusts.

 

W. Allen Schaffer, MD FACP, is the Chief Clinical Officer for CIGNA and Senior Vice President of Clinical Strategy and Health Policy. He leads a team that develops CIGNA’s clinical public policy and is responsible for articulating the company’s initiatives to improve health outcomes, assure patient safety and provide integrated patient-centered health benefits. Dr. Schaffer has responsibility for clinical community leadership across all health businesses. He also serves as Privacy Officer for CIGNA HealthCare and is responsible for Advocacy Outreach and External Clinical relationships. A Fellow of the American College of Physicians, Dr. Schaffer has been published in a number of medical and professional journals, including the New England Journal of Medicine and the Annals of Internal Medicine. He currently serves on the Board of the Jacobs Institute of Women’s Health, and the Bazelon Center for Mental Health Law. He has previously served on the Boards of National Committee for Quality Assurance (NCQA), the American Association of Health Plans (AAHP), and the National Advisory Board for the Agency for Healthcare Research and Quality (AHRQ). Before joining CIGNA, Dr. Schaffer served as head of professional affairs and quality management at Aetna Health Plans. He earlier had led quality management and primary care delivery programs at Humana. He also has administered hospital and institutional programs, founded and managed a multi-office medical group, and practiced general internal medicine.

 

Charles Silver holds the Roy W. and Eugenia C. McDonald Endowed Chair at the University of Texas School of Law, where he writes and teaches about civil procedure, professional responsibility and, increasingly, health care law and policy. His recent works include “The Poor State of Health Care Quality in the U.S.: Is Malpractice Liability Part of the Problem or Part of the Solution?”, Cornell Law Review (forthcoming 2005). Professor Silver is a principal investigator on the research team conducting the first thorough analysis of the medical malpractice claims in the comprehensive closed claim database of the Texas Department of Insurance.