Physician: Heal Thyself!

Don’t look to the federal or state legislatures to control medical malpractice costs. “We can do it ourselves,” is the mantra of Pediatricians Insurance Risk Retention Group of America (PIRRGA). Now in its second year, the small, innovative insurance provider is having real success in Florida. “Doctors can reduce their risk, practice better medicine, be aware of problem patients, and avoid lawsuits,” says the company’s president, Gene Rosov. PIRRGA first issued Florida policies in February, 2004. According to the industry’s “Crittenden Medical Insurance News,” Texas and Utah are next in line.

“Doctors and legislators are looking for solutions in all the wrong places,” says Rosov, who runs the company with a team of insurance, medical and legal experts. PIRRGA provides substantial premium refunds to the doctors who participate in its risk management education and loss prevention programs. The company is owned by its doctor/members.

PIRRGA examined the principal causes of malpractice litigation and constructed a comprehensive program to help its member/physicians avoid lawsuits. The program begins with proper patient “charting.” PIRRGA is providing a special “sick-visit encounter form” to its physicians, which leads the doctor through a stepwise process to cover all the key bases. The forms are faxed daily to the company. The next morning, it reports in one page on laboratory tests, specialist referrals, patient vital signs measurement and pricing/coding guidelines. Forms are then electronically available to the physician on a protected website. “Many physicians will find that they’re cheating themselves of real revenue,” says Rosov, who claims that the coding program alone can add $500 to $2000 to a pediatrician’s monthly revenue.

PIRRGA requires its doctors to digest a monthly article on medical and medical-malpractice issues and answer questions. Quarterly small-group teleconferences keep physicians in touch with the latest changes in pediatric healthcare, diagnosis and regional issues. PIRRGA members use the company’s discharge form handouts for most sick-visits. The forms provide detailed guidance about what do if a child’s condition changes or worsens after leaving the office. Parents sign the form to show understanding and compliance, and this helps to forestall a common lawsuit complaint: “The doctor never told me.”

The company provides a Patient-Physician Arbitration Agreement, available on the Internet (www.arbitrationagreement.com) and promoted with an office handout. “The Agreement assures the patient that if there’s a problem, it will be settled by qualified arbitrators and paid quickly, not over the 2 to 3 years typical for a court case – and it reduces frivolous lawsuits,” says PIRRGA’s Chief Medical Officer, Dr. Todd Zimmerman. Dual board-certified in pediatrics and pediatric emergency medicine, Dr. Zimmerman chairs PIRRGA’s Underwriting & Risk Management Committee. “Discharge forms, arbitration agreements, daily encounter forms reporting, monthly information articles and teleconferences all help our doctors practice safer medicine, and alerts them to possible practice problems,” he says.

“We can’t legislate better medicine,” says Dr. Zimmerman, “or forestall a few unscrupulous law firms from persuading people to sue doctors unfairly. But we can help improve the quality of care, and we can increase our members’ awareness of problems, issues, and ‘lottery-minded’ patients.”

For more information about PIRRGA (www.pirrga.com), contact Gene Rosov, President, at 305 751-9195. Domiciled in Vermont, PIRRGA has offices in Miami and is a Florida-approved insurance carrier.