3 December 2015Actuarial & underwriting

Successes and challenges of covering obstetrics debated

The successes and challenges faced by captives covering liabilities associated with obstetrics was covered in detail at a session at the Cayman Captive Forum 2015, which is taking place this week.

It is well understood that obstetrics presents one of the biggest drivers of liability costs for healthcare captive claims. But the session looked at how the coverage has been stepped up in recent years, with efforts to mitigate claims and improve patient safety often met with great success.

Beth Cushing of malpractice insurance group CRICO/RMF, outlined some of the measures her firm has employed, having identified delay in treatment and improper pregnancy management as the key causes for claims, with clinical judgement, communication and technical skills cited as the leading contributors.

CRICO has also introduced its Maternal Early Warning System (MEWS), she said, which is focused on recognising the early indications of maternal complications.

Also in place is the OB Risk Reduction Programme, which includes three years of training, with refreshers and safety drills. “Our providers pay lower premiums for participating in the programme,” Cushing said, highlighting a decrease in OB cases observed after the implementation of the Risk Reduction Programme in 2004.

Charles Kolodkin of the Cleveland Clinic Foundation said assessments had been introduced for 257 nurses across five hospitals, scoring on knowledge and judgement, which allows them to identify the individuals that need to improve.

“We will fund this for the first two years through the captive and after that the institution will need to put resources behind it,” he said, adding that the assessments and the follow ups have been well received.

In addition to making improvements in claim frequency, the policy allows Cleveland to be more aggressive in going to trials, Kolodkin said. “If our nurses scored highly on their assessment then you know they will make a good witness,” he said.

A Towers Watson study over ten years, based on claims at 600 hospitals with 700,000 annual service deliveries, demonstrated a modest long term decline in OB claim frequency for claims of over $100,000.

While not exactly earth shattering, this was still good, according to Towers’ Ed Wrobel, compared with broader claim severity. With the study also showing a downward trend of 1.5 percent per year in loss cost per delivery - saving $180 per delivery - despite the inevitability of claims in this area, the safety focus looks to be paying off.