2008 TMLT Annual Report

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# of Physiciansrisk management8JANE HOLEMANVice PresidentRisk ManagementRisk management services are an integralpart of TMLT’s unwavering commitment toprotect the practice of medicine, improvethe quality of health care, and reduce therisk of potential claims. Providing proactiverisk management services to policyholdersdifferentiates the Trust from other medicalliability carriers. Our customized servicesare designed to meet theindividual needs of ourpolicyholders.In 2008 the RiskManagement Departmentmaintained its reputationas innovative andprogressive in the medicalliability industry byproviding a wide rangeof programs and services.Risk management staffidentified important,timely risk managementtopics, developed and implementednew programs, tracked important trends,and enhanced existing services. The RiskManagement Department participated in anoutcomes measurement study to determinethe relationship between physician practicereviews and claims experience and theinitial results of the study were positive. Weplan on continuing similar studies in otherareas of risk management offered by TMLT.TMLT’s Risk Management Committeeis composed of physician leaders who arevigilant in overseeing a wide range of riskmanagement services and activities. Thiscommittee identifies specific trends andchallenges in the delivery of health care,and shares this information with us so thatwe can improve our services to better meetthe needs of our policyholders. They arealso key in helping us keep our policyholders’medical-legal knowledge current.Practice ReviewsThe professional risk managementstaff completed practice reviews for 2,368policyholders in 2008, approximately 16%of our policyholder base. This comprehensiveoffice evaluation is designed to assistphysicians and their staffs in identifyingareas of risk in their practices. Improvedinternal electronic processes at TMLTexpedite the dissemination of follow-upinformation to participating physicians. Asa result, 94% of physicians submit timelyresponses, indicating plans for implementingchanges in their offices to assistin mitigating risks. Nearly 48% of TMLTpolicyholders receivethe practice reviewpremium credit. Themedical record reviewcomponent of thepractice review reflectsa trend in the implementationand use ofelectronic health records(EHR). In 2003 TMLTrecognized electronicsystems had the potentialto assist physiciansin decreasing liabilityexposure in several areas. Appropriate useof an EHR system may decrease diagnosticerrors, as well as improve documentation,tracking of diagnostic test results, patientreferrals, patient communication, andaccess to practice guidelines. At that point,TMLT offered an additional premium creditfor policyholders participating in practicereviews and utilizing an EHR system.“TMLT will continue tomonitor and evaluate EHRuse in physician practice asa disincentive to lawsuitsand enhancementto defensibility.”2,5002,0001,5001,0005000Physician Practice Reviews2005-20081,7481,8072,0902,3682005 2006 2007 2008Years
# of ParticipantsOnly 56 physicians received premiumcredits for EHR use in 2003, comparedto 962 in 2008. Forty-one percent ofall physicians participating in practicereviews in 2008 were also utilizing anEHR system. As the movement towardsthe electronic documentation in medicalrecords continues, TMLT will continue tomonitor and evaluate EHR use in physicianpractice as a disincentive to lawsuitsand enhancement to defensibility.Following a request for proposal bythe governing board of the Texas MedicalLiability Insurance Underwriting Association(JUA), TMLT was selected to providerisk management services to JUA policyholders.The JUA is the Texas-sponsoredinsurance program for physicians withlimited or no access to other sources ofprofessional liability insurance. TMLTpractice reviews, CME courses, theReporter newsletter, and individualtelephone consultations are currentlyavailable to JUA policyholders. In ourdiligent efforts to continually improvethe health care environment and patientsafety in Texas, we are proud to offerthese services.EducationThe Risk Management Departmentpositively impacts the quality ofhealth care for Texans by educating andprotecting physicians. Since 1999 TMLThas been a provider of continuing medicaleducation accredited by the AccreditationCouncil for Continuing Medical Education(ACCME). TMLT is positioned to identifythe educational needs of our policyholders,and respond appropriately, developingeducation programs to assist our physiciansin mitigating their risk.The course, You’ve Received a Letterfrom the Texas Medical Board: What’sNext?, a one-hour course in 2007, wasexpanded to a three-hour course in 2008.A need for further education on this topicwas identified as a result of input from theTexas Medical Association and countymedical societies. Ongoing vigilanceby the Texas Medical Board (TMB)impacts our policyholders resulting in atopic that continues to be of particularinterest. This course was offered duringthe spring seminar series with 378 physiciansattending. The one-hour coursewas presented to 30 physician groupsand county medical societies. Receivingextremely positive feedback, this coursecontinues to be available upon requestin 2009.TMLT’s Risk Management Committeeprovided valuable input in developmentof the fall seminar series topics. Theseincluded changes in the physician-patientrelationship, evolving demographicsof medicine, communication amongproviders, and emerging technology.“Health Care Rock and Roll: Medicine inTransition” was presented in six locationswith 699 physicians attending.The Risk Management Departmentcollaborated with the Claim Department inevaluating the feasibility of accreditingthe Claims Review Committee (CRC)for CME. Subsequently, the CRC wasaccredited for 4.5 hours of CME. Duringthis activity, physicians of various specialtiesreview open claims involving complexmedical issues, and evaluate physicianrisks in diagnosis and treatment.Responding to the most commonpolicyholder inquiry, we developed a newone-hour CME course. Data gathered fromrisk management telephone consultationswas reviewed, reflecting physician concernregarding the physician-patient relationship.“Complexities in Beginning andEnding the Physician-Patient Relationship:When Can We Call It Quits?” focuses onthe establishment of physician-patientrelationships, when it may be necessaryRisk Management Education Programs2005-200818,00016,00014,00012,00010,000012,456 13,043 14,66216,1402005 2006 2007 2008Yearsto terminate them, and strategies to avoidpatient abandonment allegations.PublicationsRisk management representativeswrote five one-hour CME articles aswell as contributed closed claims studiesto each edition of the Reporter. Recognizingthe importance of timely notificationregarding pertinent health care issues,staff monitored FDA notices and specialtysociety postings for risk alerts related toproblems discovered with medicines andother health related products. This information,posted on the TMLT web site, wascontinuously updated. Current advisoriesmay be found at www.tmlt.org.We continue to receive positivefeedback from physicians across Texasregarding the scope and quality of thevalue-added risk management services.A family practitioner from Houstoncompleting a practice review surveystated, “Your professionalism and upbeatattitude is refreshing and pleasant. Weappreciate your time in assisting us withimproving our office processes. We don’tget many visitors whose sole purpose is toactually help us. Thank you, Tanya.”9
Page 4 and 5: CHAIRMAN’S MESSAGEDAVE W. KITTREL
Page 6 and 7: PRESIDENT’S MESSAGEBOB R. FIELDSP
Page 8: Claim OperationsJill MclainSr. Vice
Page 13 and 14: April 5, 2002Texas Governor Rick Pe
Page 15 and 16: that augments lasting financial sta
Page 18 and 19: SUPPORT SERVICESGAIL NICHOLSVice Pr
Page 20 and 21: MESSAGE FROM THE CFORAY DEMELSr. Vi
Page 22 and 23: FINANCIALSCondensed Consolidated Fi

2008 TMLT Annual Report

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