2012 Hospital and Physician Professional Liability

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1 2012 Hospital and Physician Professional Liability Benchmark Analysis October 2012 Risk. Reinsurance. Human Resources. Empower Results

2 Introduction 2 Executive Summary 3 Emerging Trends in State Legislation 8 Administration of Consolidated Physician and Hospital Risks 15 Aon Risk Maturity Index 19 Countrywide Benchmark Statistics 26 Closed Claims Statistics 29 Benchmark Statistics for Health Care Acquired Conditions 33 Benchmark Statistics by Service Line 34 State Specific Benchmark Statistics 38 Alabama 40 Arizona 41 Arkansas 42 California 43 Colorado 44 Florida 45 Georgia 46 Illinois 47 Indiana 48 Kentucky 49 Louisiana 50 Maryland 51 Massachusetts 52 Michigan 53 Minnesota 54 Mississippi 55 Missouri 56 New Jersey 57 New Mexico 58 New York 59 North Carolina 60 Oklahoma 61 Pennslyvania 62 South Carolina 63 Tennessee 64 Texas 65 Virginia 66 Washington 67 West Virginia 68 Remainder of States 69 High Risk Jurisdiction Severity Trends 70 Pediatric and University Trends 72 Benchmark Relativities and Factors 75 Examples for Applying Benchmarks to your Facility 79 Database Participants 80 Hospital Professional Liability Database 80 Physician Liability Database 80 Data Collection 81 Methodology 82 Conditions and Limitations 83 Definitions 84

3 Introduction In the interest of continuing to recognize trends in health care professional liability, Aon s actuarial and analytics specialists have produced the thirteenth annual edition of the Aon/ASHRM Hospital and Physician Professional Liability Benchmark Analysis. This benchmark study is produced under a co-marketing agreement between Aon and The American Society for Healthcare Risk Management (ASHRM). Participation in this edition of the benchmark study was open to all ASHRM members. The study is designed as a hands-on tool to provide health care risk managers with a better understanding of their cost of risk compared to an industry benchmark. Through measurement, analysis, and comparison of the claim and exposure data, risk managers develop proactive strategies to reduce risk-related costs and ultimately improve outcomes. The database of hospital professional liability ( HPL ) and physician professional liability ( PPL ) claims underlying the industry benchmarks contains 93,363 non-zero claims, representing over $13.3 billion of incurred losses. The database contains historical claim information for ten accident years (2002 to 2011). The study provides actuarial analysis and research related to professional liability costs from varying perspectives including: Countrywide HPL benchmark claim costs based on the entire database of 125 systems Emerging trends in state legislation (New in 2012) Survey results for hospital self-insurance of employed physicians Hospital findings from Aon s Risk Maturity Index survey (New in 2012) Benchmark statistics for hospital service lines, hospital acquired conditions and claim disposition types Benchmark statistics for twenty-nine states having sufficient volume and credibility Analysis of trends in high-risk venues for professional liability claims Claim frequency and severity statistics for pediatric hospitals and academic systems (New in 2012). The study examines trends in frequency, severity and overall loss rates related to hospital and physician professional liability exposures. Unless noted otherwise, these statistics are defined as follows: Frequency number of non-zero claims per Occupied Bed Equivalent ( OBE ) or per Class 1 Physician Equivalent Severity (limited to $2 million per occurrence) average loss per claim, where loss includes indemnity and expense Loss Rate (limited to $2 million per occurrence) annual incurred loss dollars per OBE or per Class 1 Physician Equivalent Occupied Bed Equivalent ( OBE ) a standard measure of overall hospital professional liability risk including weighted contribution from 11 hospital volume metrics Class 1 Physician Equivalent a standard measure of physician professional liability risk based on the risk represented by one full-time Internal Medicine (no surgery) physician over the course of one year. The participation of ASHRM in the Benchmark Analysis is limited to providing promotion and distribution support. Aon is solely responsible for the design, conduct and interpretation of the Benchmark Analysis and holds the copyright thereto Hospital and Physician Professional Liability Aon Risk Solutions

4 Executive Summary Key Findings Based on our actuarial analysis of the hospital professional liability and physician liability claim data, we find the following: Hospital and Employed Physician Trends The frequency of medical professional liability claims has stabilized and is growing at a 1% annual rate. Claim severity, including both indemnity and defense costs, continues to increase at a consistent rate. We project that claim severity (subject to a $2 million per occurrence limit) will increase at a 2.5% annual rate. For the upcoming 2013 accident year, we project that hospitals will experience an annual loss rate of $3,030 per occupied bed equivalent and $7,510 per Class 1 employed physician for professional liability events. This projection applies at the countrywide level and is made assuming a $2 million per occurrence limit. We project that loss rates are increasing at a 3.5% annual rate. Current Issues Affecting the Professional Liability Environment There are new trends in state legislation addressing professional liability that are focused on delivering timely and fair compensation to patients suffering a medical injury. These reforms are also compatible with several goals of the Patient Protection and Affordable Care Act. Physicians are increasingly being employed by hospitals and are, in most cases, being incorporated into the hospitals self-insurance programs. The self-insurance of employed physicians gives rise to administrative issues which are handled in a variety of ways by risk managers. Data from Aon s Risk Maturity Index reveals that hospitals generally outperform other industries in nine key risk management areas. However, opportunities exist to elevate risk issues to higher levels of strategic planning and decision making within health care organizations. Health Care Acquired Conditions More than one out of every four claims or 29% of total hospital professional liability costs are associated with the following health care acquired conditions: health care acquired infections, health care acquired injuries, medication errors, objects left in surgery, and pressure ulcers. State Trends Frequency, severity, and loss rate benchmark statistics vary significantly by state. We have separately analyzed 29 states where we had sufficient state specific information to perform a credible analysis. These 29 states account for 80% of the U.S. population. Excess Layer Losses and High Severity Venues Extremely large losses are more likely to occur in key high risk venues. Data and findings contributed to the study by The Beazley Group identify eight specific high risk venues and provide a comparison of average claim sizes and probability of loss percentages for high risk and tort reform geographies. Trends and Differentials For Pediatric and University Systems Analysis provided by The Beazley Group shows that pediatric and academic health care systems exhibit lower frequency but significantly higher severity when compared to the overall average. This trend is especially apparent in Pediatric systems where the severity of claims is over three times the overall level in key high risk geographies Hospital and Physician Professional Liability Aon Risk Solutions 3

5 About Aon Aon plc (NYSE: AON) is the leading global provider of risk management, insurance and reinsurance brokerage, and human resources solutions and outsourcing services. Through its more than 61,000 colleagues worldwide, Aon unites to empower results for clients in over 120 countries via innovative and effective risk and people solutions and through industry-leading global resources and technical expertise. Aon has been named repeatedly as the world s best broker, best insurance intermediary, reinsurance intermediary, captives manager and best employee benefits consulting firm by multiple industry sources. Visit aon. com for more information on Aon and aon.com/manchesterunited to learn about Aon s global partnership and shirt sponsorship with Manchester United. About Aon s Actuarial & Analytics Practice Aon s Actuarial & Analytics Practice is the third largest North American property and casualty consulting firm, providing actuarial services to clients for more than 20 years. Our international capabilities are matched by our strong local presence that positions us to deliver timely results and meaningful communication to every level of your organization. Our practice is comprised of highly skilled and experienced professionals in the risk quantification and analysis field. We have more than 95 consultants and 45 Fellows and Associates of the Casualty Actuarial Society. As part of Aon Global Risk Consulting, we are dedicated to expanding our solutions to help our clients effectively and proactively manage their risk in the current dynamic and challenging global economic market. The Aon Risk Maturity Index The Aon Risk Maturity Index is an innovative tool that enables risk and financial leaders to self-assess their organizations risk management practices and receive Aon feedback in the form of a Risk Maturity Rating Report and commentary for improvement. The Index combines the experience and knowledge of Aon Risk Solutions, Aon Global Risk Consulting and Aon Hewitt into an easyto-understand questionnaire on risk management processes, corporate governance and risk understanding. Since launching in mid-2011, nearly 500 organizations from all industry sectors around the world have participated in the Index. The Aon Centre for Innovation and Analytics in Dublin, the Wharton School of the University of Pennsylvania and experts from Aon s Enterprise Risk Management are analyzing the aggregate data to provide industry benchmarking information and key insights into the risk management community Hospital and Physician Professional Liability Aon Risk Solutions 85

6 Aon plc, All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,or transmitted in any way or by any means, including photocopying or recording, without the written permission of the copyright holder, application for which should be addressed to the copyright holder. # /2012 aon.com 86 Risk. Reinsurance. Human Resources. Empower Results 2012 Hospital and Physician Professional Liability Aon Risk Solutions

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