Dobbs v. Jackson – One Year Later
By Mallory Earley, Southeast Regional Manager, Risk Management
In the one year since the Dobbs v. Jackson Women’s Health Organization decision overturning the constitutional right to an abortion, individual states have responded in various ways. Prior to the Dobbs decision, 22 states had a ban on abortions at a specific gestational age ranging from the first through second trimesters. However, many of these bans could not be enforced due to the federal standard put in place by Roe v. Wade, stating an individual’s right to abortion before fetal viability was protected by the 14th amendment to the Constitution. In the wake of the Dobbs decision, several states made immediate changes to laws governing abortion rights, while others continue to litigate and use state legislatures to advance changes to state abortion laws.1,2
One year after the Dobbs decision, the number of states with a pre-viability ban jumped to 25 with various exceptions and limitations regarding gestational age. Some of the more complicating issues that become apparent when examining these abortion bans are the various exceptions allowing the procedure. These exceptions include: a risk of death or serious harm to the mother, a pregnancy due to rape or incest, or the presence of a fetal anomaly.3 Although some states focus on gestational age as a measuring point when considering abortion bans, other states have focused on enacting changes to waiting periods, consent requirements for minors, and access to abortion-inducing medications.4
Remanding these reproductive rights issues to the states has led to the creation of countless measures meant to protect or limit an individual’s right to an abortion. A close examination of states that have active legislation or that have made recent changes is the best way to gain a snapshot of where the United States stands, at the state level, on this issue.
State Spotlights
One year after the Dobbs decision, many states are left with more questions than answers now that federal protections for abortion have been lifted, leaving each state to decide on this issue.
Damage Caps
Summary of enacted and outstanding legislation
This report covers enacted and pending legislation that addresses noneconomic, economic, and/or punitive damages. It does not include bills that were withdrawn, did not pass, or died in committee.
Source: MPL Association
The Future of Surgery
Making surgery smarter, safer, and more profitable
Through our collaboration with Caresyntax, the InfluenceOR app is now available to ProAssurance-insured surgeons in select surgical specialties at no additional cost.
With InfluenceOR, Caresyntax provides board-certified reviews of surgical videos using industry standard assessments. The innovative program empowers data-driven surgeons to upload, publish, benchmark, and promote qualified surgical videos while building their brand recognition and reputation. Publishing and promoting data-driven surgical techniques can help educate patients and increase referrals and direct better patient outcomes and experience.
This complimentary program is available for data-driven surgeons wanting to participate in this first-of-its kind surgical community built on technical, real-world surgical excellence.
InfluenceOR: The Key to Building a Data-driven Practice
We are helping to make surgery smarter by empowering surgeons to improve patient outcomes, enhance operational efficiency, and increase profitability with data-driven surgery using AI, automation, and analytics.
To help your clients start building their data-driven practice, have them visit Caresyntax.com/Get-Surgeon-App. Once they upload their surgical procedure videos, board-certified reviewers will personally and privately assess their procedures using industry-standard assessments. This will help them earn “blue badge” status on YouTube Health, confirming the quality of your clients’ procedures and enabling them to share their videos and best practices with the broader healthcare community.
About Caresyntax
Caresyntax has worked with the largest medical professional liability insurer in Europe to prevent and reduce surgical risk by utilizing its platform for video and other real-world data assessments linked to patient outcomes. The company creates, benchmarks, and promotes risk sharing, risk mitigation, and value-based care models. Caresyntax is offering its risk management model in the United States in partnership with ProAssurance.
Learn more at ProAssurance.com/InfluenceOR.
PA Superior Court: Advances in Technology May Mitigate the Need for Venue Transfers
In our May 2023 issue of ProVisions, we reported on the Pennsylvania Supreme Court’s reversal of a key 20-year-old Medical Care Availability and Reduction of Error Act (MCARE) reform. This ruling went into effect in January 2023, returning medical malpractice venue rules to those in effect before the reform. Earlier this year, a venue change order was appealed to the Pennsylvania Superior Court (the “Court”)—reversing a judge’s order in the Court of Common Pleas of Philadelphia County, Civil Division, to transfer a personal injury case (Ehmer v. Maxim Crane Works) from Philadelphia to the plaintiff’s home county of Columbia. The defendant argued that a move to Columbia County would provide easier access to his medical records as well as the scene of the accident. They also argued a trial in Philadelphia would pose a hardship to three of their witnesses.
Citing precedent, the Court affirmed that a plaintiff’s choice of forum “is entitled to great weight, and must be given deference by the trial court” but may be overridden if the defendant proves “with detailed information on the record” that the forum is oppressive. The Court found that the defendant’s petition for the venue change did not sufficiently meet its burden to warrant the change of venue. They cited a prior Court ruling that there is “a vast difference between a finding of inconvenience and one of oppressiveness.”
Additionally, the Court noted in its opinion that “since technology allows the quick and easy transfer of medical records, the initial location of the records is not a factor that establishes the need” for a change in forum.
It can be a difficult balance treating patients’ pain while also taking crucial steps to avoid misuse, abuse, dependence, and overdose of opioids. In the context of treatment for chronic pain, addictive behaviors may be particularly difficult to identify. Providers must recognize “red flags” and signals of misuse, abuse, or dependence.
That’s why we’ve partnered with Sure Med Compliance.
Their mission is to end the overdose epidemic through greater prescribing compliance. Sure Med addresses this by offering the first and only digital health platform scientifically validated to mitigate risk to both patient and provider in pain management settings. By delivering clinical insights that help influence safer prescribing decisions, we can help protect healthcare providers from liability and allow doctors to create safer exposures to controlled substances.
The Sure Med program is available to ProAssurance insureds at no additional cost.
Overview
Sure Med recognized a point-of-care problem: to initiate or continue controlled substance therapy legally, a physician must determine and document up to 26 data points in a five- to 10-minute office visit. This may not be feasible for busy doctors, so it may not get done. The unintended consequences may lead to poor outcomes and provider liability.
With Sure Med’s digital health platform, the patient is evaluated electronically, and the results are delivered immediately to their Electronic Health Record. This eliminates 80% of the time needed to determine and document the necessary data points before initiating or continuing controlled substance therapy.
Through our exclusive affiliation with Sure Med, ProAssurance is at the forefront of helping physicians to prescribe more responsibly, leading to better outcomes for patients. We want to encourage our insureds who regularly prescribe opioids, especially for chronic pain, to learn how Sure Med can help them develop and maintain safe and responsible prescribing practices. These practices, in turn, should lead to better outcomes for their patients.
By partnering with companies dedicated to new technologies and innovation that benefit patients and improve lives, ProAssurance is able to reduce provider risk and ultimately protect others. It is an intersection of potential that aligns with our purpose.
Visit ProAssurance.com/SureMedCompliance for more information and download the new flyer to share with your clients.
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A Crossroads for Cross-Selling
For years I ignored the pressure from my company to cross-sell. I had several reasons (okay, they were excuses).
I consistently exceeded my sales quota by concentrating on selling the company's total hip and knee implants. Thousands of items were in the catalog, but I didn't want to divert my attention from these lucrative products.
Another reason was that I feared being perceived as greedy by surgeons when I already had their high-volume business. A few even said they wanted to share the wealth by giving their non-joint business to other sales reps.
A third rationale was that I didn't know most of the other products well enough to sell them, and I didn't feel it was worth the time. When I did cross-sell, I selected a few unique products and only approached customers I felt would be interested. I believed I knew my surgeons well enough to make that judgment—until one proved that I didn't know them as well as I thought.
Mark was a joint replacement surgeon I had done business with for over a decade, and we were also friends who socialized outside of work. He shied away from new procedures and products, instead relying on the tried-and-true he had used since his residency. A few times each year Mark performed revision hip surgery, which involves removing an existing hip implant and replacing it with a new one. When bone cement anchors the original implant, the surgery is more challenging because removing the old cement is tedious and risks perforating or fracturing the femur. My company sold a product that simplified removing the old cement, but conceptually it was counterintuitive. It required injecting new bone cement into the bone to bond with the existing cement. Many surgeons balked at the premise of adding more cement because if the removal system failed they'd have twice as much to chisel out by hand.
When I mentioned the product casually to Mark one day, he scoffed and said, "That's a crazy idea." I decided to leave well enough alone and didn't try to sell him on the concept.
About a year later I was staffing my company's booth at an orthopedic meeting when Mark, who had been exploring the exhibits, rushed up to me with a stern expression. "I'm a bit angry with you,” he said. “I was walking around your booth and discovered you have a system for removing bone cement that's been available for years. Why didn't you ever show it to me?"
Feeling defensive, I reminded Mark of the brief exchange we had. "I mentioned the product to you, and when I described adding more cement to the femur you thought it was a crazy idea. So I let it go. You didn't seem interested."
He responded, "You never showed me the product! Look, I know I’m a creature of habit, and you know how I do things. But it’s not your job to decide whether or not I’ll like a product. Your job is to keep me informed and to let me decide what's right for my patients and me. Okay?"
Eventually Mark used the cement removal system and, much to my surprise, he loved it.
I learned a valuable lesson: Cross-selling is essential to selling in healthcare. It demonstrates a higher level of professionalism by keeping clients informed and getting them to consider situations and needs they’d otherwise dismiss. It also avoids the embarrassment of a client learning about a product/service on their own.
One more thing—cross-selling offers the added benefit of increased sales and commissions, and that's what I call a true win-win!
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Written by Mace Horoff of Medical Sales Performance. Mace Horoff is a representative of Sales Pilot. He helps sales teams and individual representatives who sell medical devices, pharmaceuticals, biotechnology, healthcare services, and other healthcare-related products to sell more and earn more by employing a specialized healthcare system. Have a topic you’d like to see covered? Email your suggestions to AskMarketing@ProAssurance.com. |
ProAssurance Welcomes Michele Crum
We are pleased to announce that Michele Crum, MSM, MSN, RN, CPHRM, FASHRM, has joined ProAssurance as Northeast Regional Risk Manager, effective August 21, 2023.
Michele has nearly four decades of healthcare and risk management experience and is currently president-elect for the Pennsylvania Association of Health Care Risk Management (PAHCRM).
She has been a nurse for 39 years, specializing in maternal-child health and working in pediatric rehabilitation, home care, and her personal favorite, neonatal intensive care. She transitioned to risk management in 2006 at a 600-bed community hospital in Lancaster, Pennsylvania, and became manager of the department in 2017. In running the day-to-day operations for the department, she grew a strong team of fellow risk managers and doubled the number of reported events received.
Michele has also worked in loss prevention and claim management. She is a Certified Professional in Healthcare Risk Management (CPHRM) and, at the national level, is a fellow at the American Society for Healthcare Risk Management (ASHRM). She has presented at the New England Chapter of ASHRM twice on electronic medical records, discovery, and the legal medical record. With her two masters degrees—one in nursing and one in management—Michele is an accomplished healthcare and risk management professional who is a great addition to ProAssurance.
You can reach Michele directly at 717-431-4345 or MicheleCrum@ProAssurance.com.
Please join us in welcoming Michele to ProAssurance and wishing her success in her new role.
Recent Rate Changes Effective 10/1/2023
We are committed to responsible pricing that reflects the current risk environment. In keeping with our commitment to apprise you of developments within your market, we would like to share with you our recently updated rate strategies for Pennsylvania and Louisiana. Upon recent review of our rate plan and rating factors, it was determined that the following changes may impact NORCAL insureds:
PENNSYLVANIA
- Revised Limits of Coverage factors
- Revised Suspension of Coverage rule
- Revised Territory factors
- Increased premium charge for vicarious liability for each healthcare professional not individually insured on the policy
- Updated medical specialties and classes
- Overall rate impact of 9.72%, not applicable to all insureds
LOUISIANA
- Revised Limits of Coverage factors
- Revised Suspension of Coverage rule
- Increased premium charge for vicarious liability for each healthcare professional not individually insured on the policy
- Update to Per Exposure Rating Factors
- Updated medical specialties and classes
- Updates to who is eligible for the Part-Time Discount and the amount of discount available
- Updates to the New-to-Practice Discount
- Elimination of the Group Size Discount
- Overall rate impact of 19.4%, not applicable to all insureds
