2012 Report on the Availability and Affordability of Health Care Medical Professional Liability Insurance in Maryland

Transcription

1 212 Report on the Availability and Affordability of Health Care Medical Professional Liability Insurance in Maryland August 212

2 Table of Contents Executive Summary...1 Introduction...2 Medical Malpractice Insurance Market...2 Medical Malpractice Insurance Premiums...3 Closed Claims...5 Conclusion...5 Exhibit List...6

3 Executive Summary The availability and the cost of medical professional liability insurance (hereinafter medical malpractice insurance ) have far-reaching consequences for Maryland s health care system. When dramatic premium increases threatened to undermine Maryland s health care system, the General Assembly intervened in 24 and 25 to stabilize the medical malpractice insurance market and, in addition, directed the Maryland Insurance Administration ( MIA ) to collect pertinent data about medical malpractice insurance. The data is summarized in Exhibits A through L. Medical malpractice insurance is available from admitted insurers, surplus lines insurers and risk retention groups. The number of companies offering medical malpractice insurance in Maryland has remained relatively stable over time. However, this is a highly concentrated market. In 211, two insurer groups wrote 6 percent of all medical malpractice insurance premiums. Medical malpractice insurance is a highly volatile line of insurance. Medical malpractice insurance premiums increased significantly between 22 and 25 then decreased or remained the same through 211. The largest writer of medical malpractice insurance implemented a rate increase for 212, but has advised the Administration that there will be no change in rates for

4 Introduction The availability and the cost of medical malpractice insurance have far-reaching consequences for Maryland s health care system. While health care providers are not required by law to purchase and maintain medical malpractice insurance, providers cannot participate in health care networks supporting preferred provider organizations, health maintenance organizations or managed care organizations unless they carry medical malpractice insurance. The cost of medical malpractice insurance is a part of the overall practice costs for providers. Medical malpractice insurance premiums began to increase in 22 and jumped dramatically in 23 and 24. Because of the widespread implications of medical malpractice insurance, the General Assembly intervened in 24 and 25 to stabilize this market. In addition, the General Assembly directed the Maryland Insurance Administration ( MIA ) to collect data on closed claims and to report annually pertinent facts about this important line of insurance. This report provides information about the number of insurers actively writing medical malpractice insurance, the premium rates for selected medical specialties, and data regarding closed medical malpractice claims. Medical Malpractice Insurance Market Different types of companies are authorized to write medical malpractice insurance in the State. These include admitted insurers, surplus lines insurers and risk retention groups. These companies provide medical malpractice insurance for all types of health care providers, not just physicians and surgeons. 1 In 211, 6 insurer groups 1 Refer to the MIA s Comparison Guide to Medical Professional Liability Insurance Rates ( Comparison Guide ) for a detailed listing of insurers and premiums across the State. 2

5 wrote medical malpractice insurance in Maryland. Exhibits A1 through A3 provide detailed information about these insurer groups. Two companies, Medical Mutual Liability Insurance Society of Maryland ( Medical Mutual ) and MCIC VT INC RRG ( MCIC ), wrote 6 percent of all medical malpractice insurance premiums in 211. This demonstrates how highly concentrated this market is. Medical Mutual is an admitted insurer created by the General Assembly. 2 MCIC is a risk retention group organized under Vermont law and is a non-admitted insurer. 3 Medical Mutual wrote 43.5 percent and MCIC wrote 16.6 percent of all medical malpractice insurance in 211. Exhibit A4 shows the percentage of medical malpractice insurance premium written by the top four companies from 2 through 211. With the exception of 22 and 23, Medical Mutual s market share exceeds 4 percent. MCIC s market share decreased slightly for the second straight year. Medical Malpractice Insurance Premiums Medical malpractice insurance premiums increased dramatically between 22 and 25. In response to these increases, the General Assembly created the Maryland Health Care Rate Stabilization Fund which operated to subsidize medical malpractice insurance premiums paid by eligible health care providers to admitted insurers that elected to participate in the program through calendar year 28. Exhibit A5 shows the percentage change in Medical Mutual s rates between 1996 and 212. Medical malpractice insurance premiums increased the most between 22 2 See Chapter 544, Section 1, Laws of Maryland, Examples of the risks insured by risk retention groups are the Johns Hopkins Hospital network and the University of Maryland. 3

6 and 25 then decreased or remained the same through 211. For the first time since 25, Medical Mutual requested and implemented a rate increase (4 percent) for 212; however, Medical Mutual advised that its rates will not change in 213. Medical malpractice insurance premiums vary by specialty, policy limits and practice location. Exhibits B through E provide premium comparisons for 18 different specialties utilizing a base premium for policy limits of $1 million per incident/$3 million annual aggregate for the years 29 through 212. Although the premium may differ for a given company in a given specialty, overall these Exhibits indicate stability in medical malpractice insurance premiums over this time period. These Exhibits also highlight the differences in premiums between companies. To assist providers in shopping for medical malpractice insurance, the MIA annually updates the Comparison Guide. This guide is available on the Maryland Insurance Administration s website, as well as in brochure form. The Comparison Guide allows health care providers to compare general pricing among the major admitted insurers. The Comparison Guide now includes surplus lines insurers and risk retention groups to allow health care providers to compare general pricing among all companies offering medical malpractice insurance in Maryland. Features of medical malpractice insurance, such as the deductible, influence the premium. By law, medical malpractice insurers are required to offer policies high deductibles: $25,, $5, and $1,. Exhibits H and I show that these policies have not been attractive to providers. However, these Exhibits also show that health care providers do, on occasion, purchase policies deductibles less than $25,. 4

7 Closed Claims One of the factors driving medical malpractice insurance premiums is claims frequency. Since 26, admitted insurers have been required to submit certain closed claim information on a quarterly basis to the MIA. 4 Exhibit J summarizes the data provided to the MIA by company and Exhibit K summarizes the data by specialty. While closed claims increased overall by 92.7% from 25 to 211, there are significant yearly fluctuations. Some of the fluctuation may be attributable to the manner in which this data has been collected by the MIA 5 and no meaningful conclusions can be drawn from the data at this time. Conclusion The number of companies offering medical malpractice insurance in Maryland has remained relatively stable over time and the premiums remained constant from 26 through 211. In 212, premiums for the largest underwriter of medical malpractice insurance in the State increased on average by 4%. The number of closed claims appears to have increased dramatically between 25 and 211; however, due to changes in data collection methodology, little credence can be given to the percentage increase. 4 The total number of suits is also reported by company. See Exhibit L. As this Exhibit shows, the total number of suits filed is nearly identical to the total number of closed claims. 5 The MIA had initially used one form of on line reporting, but that tool became unworkable. Since 29, the data has been collected using a different tool that enables the MIA to access and query the data more easily. This change in systems may have resulted in a change in data collection. 5

8 EXHIBIT LIST Exhibit A1 Exhibit A2 Exhibit A3 Exhibit A4 - Page Medical Professional Liability Premiums by Insurance Group Change in Written Premium by Insurance Group by Type of License from 21 to Market Share of the Nine Largest Admitted Carriers 211 Market Share of the Top Nine Carriers (Including Surplus Lines and RRG's) Market Share of the Top Carriers from 2 to 211 (Based on 211 Market Share) Exhibit A4 - Page 2 Industry and MMLIS Written Premiums (in Millions) from 2 to 211 Includes Surplus Lines and RRG's Change in Written Premium from the Prior Year for the Industry and MMLIS Exhibit A4 - Page 3 Market Share by License Type from 2 to 211 Exhibit A5 Medical Mutual Rate Change History from 1996 to 212 Exhibit B Rate Comparison Charts for Certain Physician Classes from 29 to 212 Exhibit C Rate Comparison Charts for Certain Surgeon Classes from 29 to 212 Exhibit D Rate Comparison Charts for Psychiatrist (Including Child) Class from 29 to 212 Exhibit E Rate Comparison Charts for Certain Nursing Classes from 29 to 212 Exhibit F Rate Comparison Charts for Physical Therapists (Employed) from 21 to 212 Exhibit G Rate Comparison Charts for Dentist Class from 29 to 212 Exhibit H Exhibit I of Admitted Policies Amounts Mandated under Section of the Insurance Article of Policies All Other Types of s, Including Surplus Lines Policies Exhibit J of Closed Claims by Insurer from 25 to 211 Exhibit K of Closed Claims by Specialty from 25 to 211 Exhibit L Closed Claims by Maryland Jurisdiction and Venue from 25 to 211

9 211 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 211 Group Code 211 Insurance Group Premium 211 Market Share 211 Surplus Lines Premiums 211 Admitted 211 RRG 211 Group Name Premium Premium MEDICAL INS OF MD GRP 122,23, % 122,23,693 2 MCIC VT INC RRG 46,532, % 46,532, DOCTORS CO GRP 22,823, % 22,441, , AMERICAN INTL GRP 13,951,831 5.% 2,719,881 11,231, BERKSHIRE HATHAWAY GRP 11,459,82 4.1% 9,111,56 2,348, PROASSURANCE CORP GRP 1,754,75 3.8% 1,27,2 484, CNA INS GRP 8,322,15 3.% 6,824,584 1,497,431 8 HEALTHCARE PROVIDERS INS EXCH 5,519,37 2.% 5,519, SIRIUS GRP 4,12,68 1.4% 168,968 3,843, ALLIED WORLD ASSUR HOLDING GRP 3,81,16 1.4% 1,199,797 2,61, MARKEL CORP GRP 2,621,477.9% 2,621, WR BERKLEY CORP GRP 2,555,18.9% 255, IRONSHORE GRP 2,414,319.9% 2,414, ZURICH INS GRP 2,34,781.8% 47,755 2,293,26 15 PREFERRED PHYSICIANS MEDICAL RRG 2,164,541.8% 2,164, ARCH INS GRP 2,76,636.7% 2,76, CHRISTUS HLTH GRP 1,88,293.6% 1,88, LIBERTY MUT GRP 1,758,59.6% 1,57, , ACE LTD GRP 1,712,726.6% 1,566, , NATIONAL GRP 1,61,68.6% 246,284 1,355, CATLIN US INS GRP 1,226,85.4% 1,226,85 22 OPHTHALMIC MUT INS CO RRG 95,97.3% 95, TORUS INS GRP 725,218.3% 725, NCMIC GRP 724,67.3% 724, CINCINNATI FIN GRP 713,479.3% 78,349 5, FAIRFAX FIN GRP 74,13.3% 74, ALLEGHANY GRP 672,928.2% 672, CARING COMMUNITIES RECIP RRG 51,583.2% 51,583

10 211 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 211 Group Code 211 Insurance Group Premium 211 Market Share 211 Surplus Lines Premiums 211 Admitted 211 RRG 211 Group Name Premium Premium 29 MEDSTAR LIAB LTD INS CO INC RRG 365,124.1% 365, THE HANOVER INS GRP 362,684.1% 362, AMERICAN SAFETY HOLDING GRP 295,.1% 295, 32 KINSALE INS CO 29,171.1% 29, HALLMARK FIN SERV GRP 284,932.1% 284, APPLIED MEDICO LEGAL SOLUTIONS RRG 278,264.1% 278, JAMES RIVER GRP 261,287.1% 261, HEALTHCARE SAFETY & PROTECTION RRG I 261,125.1% 261, MUNICH RE GRP 248,377.1% 122, ,16 38 ALLIED PROFESSIONALS INS CO RRG 239,77.1% 239,77 39 AMERICAN ASSOC OF OTHODONTISTS RRG 226,913.1% 226,913 4 CONTINUING CARE RRG INC 161,632.1% 161, OCEANUS INS CO A RRG 149,15.1% 149, ALLIANZ INS GRP 142,5.1% 17, , PEACE CHURCH RRG INC 139,484.% 139, NATIONAL MEDICAL PROFESSIONAL RRG IN 127,152.% 127, CHUBB INC GRP 7,73.% 7,73 46 SUNLAND RRG INC 57,2.% 57,2 47 CARE RRG INC 57,74.% 57, STATE FARM GRP 5,45.% 5, WESTERN WORLD GRP 47,335.% 47,335 5 FAIRWAY PHYSICIANS INS CO RRG 36,952.% 36, CHURCH MUT INS CO 32,842.% 32, PHARMACISTS MUT GRP 28,894.% 28, LANCET IND RRG INC 25,59.% 25,59 54 GREEN HILLS INS CO RRG 21,858.% 21, URGENT CARE ASSUR CO RRG INC 17,99.% 17,99

11 211 Medical Professional Liability Premiums by Insurance Group Exhibit A1 Page Premium Rank 211 Group Code 211 Insurance Group Premium 211 Market Share 211 Surplus Lines Premiums 211 Admitted 211 RRG 211 Group Name Premium Premium HCC INS HOLDINGS GRP 15,438.% 15, AFFILIATES RISK GRP 13,46.% 13,46 58 WELLSPAN RRG 12,.% 12, 59 DOCTORS & SURGEONS NATL RRG INC 11,626.% 11,626 6 OBSTETRICIANS & GYNECOLOGISTS RRG OF 1,716.% 1, STATE AUTO MUT GRP 3,697.% 3, XL AMER GRP 1,735.% 1, AMERICAN EXCESS INS EXCH RRG 1,7.% 1,7 The following companies had premium in 21, but not in 211, n/a NOVUS INS CO RRG n/a 3617 FIRST MERCURY FIN GRP Industry Totals 28,968, ,452,252 36,541,955 53,674, % 12.87% 18.9%

12 Change in Written Premium by Insurance Group by Type of License from 21 to 211 Exhibit A2 Page Premium Rank 211 Group Code 211 Insurance Group Premium Surplus Lines Premium Group Admitted RRG 211 Group Name Premium Premium Premium MEDICAL INS OF MD GRP 122,23, % -1.36% n/a n/a 2 MCIC VT INC RRG 46,532, % n/a n/a -8.89% DOCTORS CO GRP 22,823, % -.99% 59.93% n/a 4 12 AMERICAN INTL GRP 13,951, % % -4.8% n/a 5 31 BERKSHIRE HATHAWAY GRP 11,459, % -9.5% 5.83% n/a PROASSURANCE CORP GRP 1,754, % -1.7% 24.31% n/a CNA INS GRP 8,322, % -.8% % n/a 8 HEALTHCARE PROVIDERS INS EXCH 5,519, % 8.28% n/a n/a SIRIUS GRP 4,12, % 26.41% 64.8% n/a ALLIED WORLD ASSUR HOLDING GRP 3,81, % 9.87% 2.79% n/a MARKEL CORP GRP 2,621, % n/a % n/a WR BERKLEY CORP GRP 2,555, % n/a -79.6% n/a IRONSHORE GRP 2,414, % n/a 791.3% n/a ZURICH INS GRP 2,34, % 84.84% 16.21% n/a 15 PREFERRED PHYSICIANS MEDICAL RRG 2,164,541.1% n/a n/a.1% ARCH INS GRP 2,76, % n/a % n/a CHRISTUS HLTH GRP 1,88, % 9.54% n/a n/a LIBERTY MUT GRP 1,758, % 52.15% 4.7% n/a ACE LTD GRP 1,712, % 6.37% % n/a 2 58 NATIONAL GRP 1,61,68 7.2% 6.18% n/a 7.39% CATLIN US INS GRP 1,226, % n/a -34.3% n/a 22 OPHTHALMIC MUT INS CO RRG 95, % n/a n/a 1.43% TORUS INS GRP 725, % n/a % n/a NCMIC GRP 724, % 2.87% n/a n/a CINCINNATI FIN GRP 713, % 6.52% n/a n/a FAIRFAX FIN GRP 74,13 n/a n/a n/a n/a ALLEGHANY GRP 672, % n/a % n/a 28 CARING COMMUNITIES RECIP RRG 51, % n/a n/a 5.84%

13 Change in Written Premium by Insurance Group by Type of License from 21 to 211 Exhibit A2 Page Premium Rank 211 Group Code 211 Insurance Group Premium Surplus Lines Premium Group Admitted RRG 211 Group Name Premium Premium Premium 29 MEDSTAR LIAB LTD INS CO INC RRG 365, % n/a n/a 9.39% 3 88 THE HANOVER INS GRP 362, % -5.34% n/a n/a AMERICAN SAFETY HOLDING GRP 295, 85.56% n/a 85.56% n/a 32 KINSALE INS CO 29, % n/a 58.35% n/a HALLMARK FIN SERV GRP 284, % n/a % n/a 34 APPLIED MEDICO LEGAL SOLUTIONS RRG 278, % n/a n/a % JAMES RIVER GRP 261, % n/a % n/a 36 HEALTHCARE SAFETY & PROTECTION RRG I 261,125 n/a n/a n/a n/a MUNICH RE GRP 248, % 34.71% n/a n/a 38 ALLIED PROFESSIONALS INS CO RRG 239, % n/a n/a 3.15% 39 AMERICAN ASSOC OF OTHODONTISTS RRG 226, % n/a n/a -1.39% 4 CONTINUING CARE RRG INC 161, % n/a n/a 4.6% 41 OCEANUS INS CO A RRG 149, % n/a n/a 85.32% ALLIANZ INS GRP 142, % % % n/a 43 PEACE CHURCH RRG INC 139, % n/a n/a 3.71% 44 NATIONAL MEDICAL PROFESSIONAL RRG IN 127, % n/a n/a 35.54% CHUBB INC GRP 7, % n/a 62.96% n/a 46 SUNLAND RRG INC 57,2 n/a n/a n/a n/a 47 CARE RRG INC 57, % n/a n/a 24.55% STATE FARM GRP 5, % -3.61% n/a n/a WESTERN WORLD GRP 47, % n/a 4.29% n/a 5 FAIRWAY PHYSICIANS INS CO RRG 36, % n/a n/a 9.2% 51 CHURCH MUT INS CO 32, % -27.6% n/a n/a PHARMACISTS MUT GRP 28, % -5.19% n/a n/a 53 LANCET IND RRG INC 25,59 n/a n/a n/a n/a 54 GREEN HILLS INS CO RRG 21, % n/a n/a -2.86% 55 URGENT CARE ASSUR CO RRG INC 17, % n/a n/a % HCC INS HOLDINGS GRP 15, % n/a % n/a

14 Change in Written Premium by Insurance Group by Type of License from 21 to 211 Exhibit A2 Page Premium Rank 211 Group Code 211 Insurance Group Premium Surplus Lines Premium Group Admitted RRG 211 Group Name Premium Premium Premium AFFILIATES RISK GRP 13, % n/a n/a 18.7% 58 WELLSPAN RRG 12, 2.% n/a n/a 2.% 59 DOCTORS & SURGEONS NATL RRG INC 11,626 n/a n/a n/a n/a 6 OBSTETRICIANS & GYNECOLOGISTS RRG OF 1, % n/a n/a % STATE AUTO MUT GRP 3,697 n/a n/a n/a n/a XL AMER GRP 1, % 35.34% n/a n/a 63 AMERICAN EXCESS INS EXCH RRG 1,7.% n/a n/a.% The following companies had premium in 21, but not in 211, n/a NOVUS INS CO RRG n/a 3617 FIRST MERCURY FIN GRP Industry Totals 28,968, % -1.36% 4.75% -7.51%

15 Exhibit A3 211 Market Share of the Nine Largest Admitted Carriers.96%.83% 1.44% 3.17% MEDICAL INS OF MD GRP 3.62% 4.83% 2.93% DOCTORS CO GRP PROASSURANCE CORP GRP BERKSHIRE HATHAWAY GRP 5.45% CNA INS GRP HEALTHCARE PROVIDERS INS EXCH AMERICAN INTL GRP 11.91% CHRISTUS HLTH GRP LIBERTY MUT GRP 64.85% REMAINING 211 Market Share of the Top Nine Carriers (Including Surplus Lines and RRG's) 2.% 3.% 1.4% 12.6% MEDICAL INS OF MD GRP MCIC VT INC RRG DOCTORS CO GRP 3.8% 4.1% 5.% 8.1% 43.5% AMERICAN INTL GRP BERKSHIRE HATHAWAY GRP PROASSURANCE CORP GRP CNA INS GRP HEALTHCARE PROVIDERS INS EXCH SIRIUS GRP 16.6% REMAINING

16 Exhibit A4 Page 1 Market Share of the Top Carriers from 2 to 211 (Based on 211 Market Share) 5.% 45.% 4.% 35.% 3.% 25.% 2.% 15.% 1.% 5.%.% MMLIS 42.9% 42.8% 34.7% 32.5% 4.9% 46.4% 44.1% 43.2% 42.3% 42.1% 43.6% 43.5% MCIC 13.5% 12.2% 18.7% 22.1% 19.1% 17.8% 19.5% 18.4% 2.4% 21.1% 18.% 16.6% Doctors 1.1% 2.% 4.% 5.7% 7.1% 7.5% 7.8% 8.5% 8.9% 7.8% 8.1% 8.1% MedPro 1.2% 3.7% 4.5% 6.7% 7.9% 5.4% 5.8% 5.1% 6.1% 5.1% 4.3% 4.1% The four carriers listed above are the four of the five largest carriers based on 211 market share. This does not imply that they are the top 4 of 5 carriers for the entire time period shown above. MMLIS - Medical Mutual Group MCIC - MCIC RRG Vermont Doctors - The Doctors Company MedPro - Medical Protective Insurance Company

17 Industry and MMLIS Written Premiums (in Millions) from 2 to 211 Includes Surplus Lines and RRG's Exhibit A4 Page Industry MMLIS Change in Written Premium from the Prior Year for the Industry and MMLIS 4.% 35.% 3.% 25.% 2.% 15.% 1.% 5.%.% -5.% -1.% -15.% Industry 8.3% 3.8% 24.2% 7.7% 11.4% 8.% -4.4% -6.1% -2.6% -3.8% -1.1% MMLIS 8.% 5.9% 16.5% 35.2% 26.5% 2.6% -6.3% -8.% -3.2% -.2% -1.4%

18 Exhibit A4 Page 3 Market Share by License Type from % 8.% 7.% 6.% 5.% 4.% 3.% 2.% 1.%.% -1.% Admitted 79.6% 76.8% 65.6% 6.8% 65.9% 69.5% 68.7% 7.7% 68.7% 67.1% 67.3% 66.4% Surplus 3.1% 4.9% 11.6% 14.8% 13.7% 11.3% 1.2% 9.3% 9.3% 1.% 12.3% 12.9% RRG 15.1% 13.8% 19.8% 23.3% 2.4% 19.3% 21.% 2.% 22.% 23.% 2.4% 18.9% Other 2.2% 4.5% 2.9% 1.2%.%.%.%.%.%.%.%.% Other License type includes carriers that no longer write medical professional liability and license type cannot, as of the last year of writing business, be determined. This also includes carriers that were in runoff or license suspended/revoked.

19 Exhibit A5 Medical Mutual Rate Change History from 1996 to % 35.% 33.% 3.% 28.% 25.% 2.% 15.% 1.% 5.%.%.% -1.2%.%.% 9.7%.% 1.3%.% -2.%.%.% 4.% -5.% -6.6% -8.% -8.% -1.% -15.% Rate Change -6.6%.% -1.2%.%.% 9.7%.% 1.3% 28.% 33.%.% -8.% -8.% -2.%.%.% 4.% The above reflects the effective rate change per year. The changes are effective January 1st of each year. There are no pending rate filings for Medical Mutual.

20 Notes for Rate Comparison Charts (Exhibits B through G) The company names have been abbreviated on the charts for readability purposes. Name on Charts Full Company Name Exhibits MMLIS Medical Mutual Liability Insurance Society of Maryland B to F ProAd Professional Advocates Insurance Company (1) G MedPro Medical Protective Insurance Company All TDC The Doctors Company B to E, G PRAIC ProAssurance Indemnity Company All PPIC Preferred Professional Insurance Company All HPIX Healthcare Providers Insurance Exchange B to F USFIC United States Fire Insurance Comapny (2) B, C & D NORCAL NORCAL Mutual Insurance Company (3) B, C, D & E Darwin Darwin National Assurance Company D & F Chartis National Union Fire Insurance Company of Pittsburgh E & G Granite State Insurance Company F CNA American Casualty Co of Reading, PA E & F Continental Insurance Company G FFIC Chicago Insurance Company E & F American Insurance Company G ACE-USA ACE American Insurance Company D, E, F & G LibertyIU Liberty Insurance Underwriters (4) E, F & G (1) - Member of the Medical Mutual Liability Insurance Socierty Group (2) - New to 212. Company is a member of the Crum&Forster Group (3) - New to 212. (4) - Member of Liberty Mutual Insurance Group Notes to Charts 1) Company information not shown if it had no rates for 212 2) Percentage change only shown if company had rates for the period 29 to 212.

21 Fam/Gen Prac (No OB) - Minor Surgery Exhibit B Page 1 of 7 Baltimore City and Baltimore County 35, 3, 25, 2, 15, 1, 5, 29 27,63 28,439 24,427 29,883 19,53 33, ,63 28,439 24,427 29,883 19,53 29, ,63 28,439 26,137 29,883 19,53 29, ,77 28,439 26,137 29,883 19,53 29,222 15,722 29,873 % chg 9 to 12 4.%.% 7.%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 35, 3, 25, 2, 15, 1, 5, 29 25,91 25,276 22,683 27,351 17,752 3, ,91 25,276 22,683 27,351 17,752 26, ,91 25,276 24,271 27,351 17,752 26, ,95 25,276 24,271 27,351 17,752 26,564 14,482 27,155 % chg 9 to 12 4.%.% 7.%.%.% -12.% Rest of State 3, 25, 2, 15, 1, 5, 29 22,82 21,64 19,193 24,379 14,452 26, ,82 21,64 19,193 24,379 14,452 23, ,82 21,64 2,536 24,379 14,452 23, ,965 21,64 2,536 24,379 14,452 23,379 13,243 23,899 % chg 9 to 12 4.%.% 7.%.%.% -12.%

22 Fam/Gen Prac (No OB) - No Surgery Exhibit B Page 2 of 7 Baltimore City and Baltimore County 25, 2, 15, 1, 5, 29 15,335 17,775 17,448 2,71 13,2 18, ,335 17,775 17,448 2,71 13,2 16, ,335 17,775 18,67 2,71 13,2 16, ,948 17,775 18,67 2,71 13,2 16,235 9,112 19,916 % chg 9 to 12 4.%.% 7.%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 2, 15, 1, 5, 29 13,94 15,798 15,267 19,22 11,835 16, ,94 15,798 15,267 19,22 11,835 14, ,94 15,798 16,335 19,22 11,835 14, ,498 15,798 16,335 19,22 11,835 14,758 8,424 18,13 % chg 9 to 12 4.%.% 7.%.%.% -12.% Rest of State 2, 15, 1, 5, 29 12,268 13,165 12,693 17,4 9,635 14, ,268 13,165 12,693 17,4 9,635 12, ,268 13,165 13,581 17,4 9,635 12, ,759 13,165 13,581 17,4 9,635 12,988 7,735 15,932 % chg 9 to 12 4.%.% 7.%.%.% -12.%

23 Anesthesiology Exhibit B Page 3 of 7 Baltimore City and Baltimore County 4, 3, 2, 1, 29 15,335 19,196 2,611 34,654 2,528 18, ,335 19,196 2,611 34,654 2,528 16, ,335 19,196 22,54 34,654 2,528 16, ,948 19,196 22,54 34,654 2,528 16,235 15,722 23,899 % chg 9 to 12 4.%.% 7.%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 4, 3, 2, 1, 29 13,94 17,62 17,313 31,683 18,66 16, ,94 17,62 17,313 31,683 18,66 14, ,94 17,62 18,525 31,683 18,66 14, ,498 17,62 18,525 31,683 18,66 14,758 14,482 21,724 % chg 9 to 12 4.%.% 7.%.%.% -12.% Rest of State 3, 2, 1, 29 12,268 14,219 14,656 28,195 15,191 14, ,268 14,219 14,656 28,195 15,191 12, ,268 14,219 15,683 28,195 15,191 12, ,759 14,219 15,683 28,195 15,191 12,988 13,243 19,119 % chg 9 to 12 4.%.% 7.%.%.% -12.%

24 Dermatology No Surgery Exhibit B Page 4 of 7 Baltimore City and Baltimore County 2, 15, 1, 5, 29 9,661 11,375 13,485 11,536 1,416 11, ,661 11,375 13,485 11,536 1,416 1, ,661 11,375 14,429 11,536 1,416 1, ,47 11,375 14,429 11,536 1,416 1,227 9,112 16,928 % chg 9 to 12 4.%.% 7.%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 2, 15, 1, 5, 29 8,782 1,111 12,257 1,692 9,468 1, ,782 1,111 12,257 1,692 9,468 9, ,782 1,111 13,115 1,692 9,468 9, ,133 1,111 13,115 1,692 9,468 9,298 8,424 15,388 % chg 9 to 12 4.%.% 7.%.%.% -12.% Rest of State 15, 1, 5, Dermatology No Surgery 29 7,729 8,426 9,979 9,71 7,78 9, ,729 8,426 9,979 9,71 7,78 8, ,729 8,426 1,677 9,71 7,78 8, ,38 8,426 1,677 9,71 7,78 8,182 7,735 13,543 % chg 9 to 12 4.%.% 7.%.%.% -12.%

25 Internal Medicine No Surgery Exhibit B Page 5 of 7 Baltimore City and Baltimore County 25, 2, 15, 1, 5, 29 15,335 17,775 19,629 2,71 13,2 18, ,335 17,775 19,629 2,71 13,2 16, ,335 17,775 21,3 2,71 13,2 16, ,948 17,775 21,3 2,71 13,2 16,235 1,764 19,916 % chg 9 to 12 4.%.% 7.%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 25, 2, 15, 1, 5, 29 13,94 15,798 18,321 19,22 11,835 16, ,94 15,798 18,321 19,22 11,835 14, ,94 15,798 19,64 19,22 11,835 14, ,498 15,798 19,64 19,22 11,835 14,758 9,938 18,13 % chg 9 to 12 4.%.% 7.%.%.% -12.% Rest of State 2, 15, 1, 5, 29 12,268 13,165 14,831 17,4 9,635 14, ,268 13,165 14,831 17,4 9,635 12, ,268 13,165 15,87 17,4 9,635 12, ,759 13,165 15,87 17,4 9,635 12,988 9,112 15,932 % chg 9 to 12 4.%.% 7.%.%.% -12.%

26 Pediatrics No Surgery Exhibit B Page 6 of 7 Baltimore City and Baltimore County 25, 2, 15, 1, 5, 29 15,335 17,775 18,721 2,71 13,2 18, ,335 17,775 22,246 2,71 13,2 16, ,335 17,775 23,84 2,71 13,2 16, ,948 17,775 23,84 2,71 13,2 16,235 9,112 19,916 % chg 9 to 12 4.%.% 27.1%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 25, 2, 15, 1, 5, 29 13,94 15,798 15,824 19,22 11,835 16, ,94 15,798 18,721 19,22 11,835 14, ,94 15,798 2,31 19,22 11,835 14, ,498 15,798 2,31 19,22 11,835 14,758 8,424 18,13 % chg 9 to 12 4.%.% 26.6%.%.% -12.% Rest of State 25, 2, 15, 1, 5, 29 12,268 13,165 22,246 17,4 9,635 14, ,268 13,165 15,824 17,4 9,635 12, ,268 13,165 16,932 17,4 9,635 12, ,759 13,165 16,932 17,4 9,635 12,988 7,735 15,932 % chg 9 to 12 4.%.% -23.9%.%.% -12.%

27 Radiology (Diagnostic) No Surgery Exhibit B Page 7 of 7 Baltimore City and Baltimore County 4, 3, 2, 1, 29 27,63 24,883 29,232 25,296 13,2 33, ,63 24,883 32,767 25,296 13,2 29, ,63 24,883 35,6 25,296 13,2 29, ,77 24,883 35,6 25,296 13,2 29,222 15,722 35,848 % chg 9 to 12 4.%.% 19.9%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 4, 3, 2, 1, 29 25,91 22,116 24,71 23,186 11,835 3, ,91 22,116 29,232 23,186 11,835 26, ,91 22,116 31,279 23,186 11,835 26, ,95 22,116 31,279 23,186 11,835 26,564 14,482 32,856 % chg 9 to 12 4.%.% 26.6%.%.% -12.% Rest of State 4, 3, 2, 1, 29 22,82 18,431 32,767 2,71 9,635 26, ,82 18,431 24,71 2,71 9,635 23, ,82 18,431 26,44 2,71 9,635 23, ,965 18,431 26,44 2,71 9,635 23,379 13,243 28,678 % chg 9 to 12 4.%.% -19.3%.%.% -12.%

28 Emergency Medicine - Inc. Major Surgery Exhibit C Page 1 of 8 Baltimore City and Baltimore County 9, 8, 7, 6, 5, 4, 3, 2, 1, 29 64,867 54,59 46,731 52,579 52,786 78, ,867 54,59 46,731 52,579 52,786 68, ,867 54,59 5,2 52,579 52,786 68, ,462 54,58 5,2 52,579 52,786 68,673 52,91 49,789 % chg 9 to 12 4.%.% 7.%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 8, 7, 6, 5, 4, 3, 2, 1, 29 58,964 48,447 41,689 47,959 47,982 7, ,964 48,447 41,689 47,959 47,982 62, ,964 48,447 44,68 47,959 47,982 62, ,323 48,447 44,68 47,959 47,982 62,425 48,563 45,258 % chg 9 to 12 4.%.% 7.%.%.% -12.% Rest of State 7, 6, 5, 4, 3, 2, 1, 29 52,953 43,884 35,24 42,536 29,498 62, ,894 4,374 35,24 42,536 39,61 62, ,894 4,374 35,24 42,536 39,61 54, ,97 4,374 37,76 42,536 39,61 54,938 44,226 39,831 % chg 9 to % -8.% 7.%.% 32.4% -12.%

29 Emergency Medicine (No Major Surgery) Exhibit C Page 2 of 8 Baltimore City and Baltimore County 6, 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX USFIC 29 38,338 48,452 46,731 2,71 28,643 46, ,338 48,452 46,731 2,71 28,643 4, ,338 48,452 5,2 2,71 28,643 4, ,872 48,452 5,2 2,71 28,643 4,587 27,72 % chg 9 to 12 4.%.% 7.%.%.% -12.% Anne Arundel, Howard, Montgomery, Prince George's 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX USFIC 29 34,849 43,63 41,689 19,22 26,37 41, ,849 43,63 41,689 19,22 26,37 36, ,849 43,63 44,68 19,22 26,37 36, ,243 43,63 44,68 19,22 26,37 36,894 25,464 % chg 9 to 12 4.%.% 7.%.%.% -12.% Rest of State 5, 4, 3, 2, 1, MMLIS MedPro TDC PRAIC PPIC HPIX USFIC 29 3,67 35,887 35,24 17,4 21,196 36, ,67 35,887 35,24 17,4 21,196 32, ,67 35,887 37,76 17,4 21,196 32, ,897 35,887 37,76 17,4 21,196 32,47 23,226 % chg 9 to 12 4.%.% 7.%.%.% -12.%