"Itâ€™s no secret that the health care landscape is changing and it will continue to evolve as new technology makes it more efficient for patients to access the health care system."
By Rhonda Miller PBN Staff Writer
Stephen W. Primiano is the health care specialist for Starkweather & Shepley Insurance Brokerage and is responsible for implementing effective risk management portfolios for existing and prospective health care clients, as well as overseeing the continued growth of Starkweather & Shepleyâ€™s health care practice.
He is community relations coordinator for the Alzheimers CURE Foundation and is an affiliate member of LeadingAge of Rhode Island and Massachusetts.
Primiano has a bachelorâ€™s degree in business with a focus in finance from Champlain College.
PBN: What is your first order of business in your new position as a health care risk specialist?
PRIMIANO: I firmly believe that insurance should be viewed as a continual portfolio with the focus being on risk management and patient safety. As the health care industry rapidly gravitates to more of a quality of care delivery system with the focus on patient safety, so must the risk management and insurance portfolios for every health care organization, no matter the size. My goal and first order of business is to educate my fellow health care professionals on the various risk management products available that center on patient safety and therefore, reduce the amount of liability put back on a health care entity. With the expansion of the Affordable Care Act and the goal being to deliver higher quality of care and reduce costs, health care entities need to be educated on the concept that their insurance portfolio can be utilized to improve patient safety and establish risk management procedures designed to reduce overall claims, therefore reducing the bottom line premium while at same time promoting patient safety. For far too long insurance policies have been structured around the bottom line premium, which, of course, is and always will be a factor. However itâ€™s reviewing and analyzing where claims trends are being generated within the industry and then applying that knowledge that will ideally prevent the claim from even occurring.
PBN: The implementation of the Affordable Care Act posed lots of questions around the evolution of health care entities. What have you found are the developments as the ACA has gone into effect?
PRIMIANO: Itâ€™s no secret that the health care landscape is changing and it will continue to evolve as new technology makes it more efficient for patients to access the health care system. The days of scheduling an appointment to see your primary care physician months ahead of time or waiting for hours in an emergency room for what might be a fractured bone are going by the wayside. One of the biggest agenda items within the ACA is to reduce health care costs while making health care available to the masses. This has sparked a growing number of entities to explore the use of telemedicine to deliver care and providing remote access to care givers to consult with patients. Physicians can now be accessed through web portals, Skype and even smart phones. As health care organizations explore this avenue, it is imperative to structure proper risk management policies to keep up with the technology. What I am also seeing is a surge of health care centers taking a franchise business model. The patient base consists primarily of walks-in and is most commonly in urgent care, dental, dermatology or chiropractic practices.
PBN: One of the areas you work with is cyber liability. Can you detail a bit how a health care entity or business can protect themselves on that issue?
PRIMIANO: No matter what industry weâ€™re discussing or the size of the business, all organizations have a cyber liability exposure. Since 2007, there have been more than 4,327 reported privacy breaches totaling more than 600 million confidential records. Given that the average cost of a data breach in 2012 was $3.7 million, these breaches can cripple an organization. As we move toward an increasingly digital world, an organizationâ€™s data is a valuable asset. I always encourage my clients to work with an outside IT specialist to review their infrastructure to test firewalls and set up data encryption for all computers and laptops. These reviews can outline any potential weak points in the system and help outline the proper steps to take if a breach occurs. Believe it or not, the most common data breach isnâ€™t from outside hackers attempting to steal data- itâ€™s from employee negligence when someone may open an infected email, have a lost or stolen laptops or an unsecured mobile device. Granted, no system is foolproof, so this has led to working with my clients and prospective clients to explore cyber liability policies. These policies are designed for both health care and non-health care companies to provide liability limits in the event of a breach. These policies also provide notification expense and public relations costs, as well as payment of fines or penalties related to HIPPA or other regulatory actions. Given that a best offense is a good defense, an organization can operate much more freely knowing that if a breach does occur, there is an insurance policy backing the organization, as typically these events are excluded under most policies.
PBN: Health care is an important and growing industry in Rhode Island. Have the risk management concerns, and costs, changed much in the past few years?
PRIMIANO: Health care is a very unique industry and what I love about working in this space is that itâ€™s continuously changing and evolving. Health care looked very different five years ago and I am sure five years from now, it will be drastically different. The biggest concern over the past few years regarding risk management has been cost. As health care organizations continue to grow in Rhode Island, in both size and geographic reach, alternative risk transferring and financial models, such as captive insurance programs, are being used to absorb some of the increase in costs, as well as create return on investment opportunities and tax shelters. It is crucial for an organization to look at industry claim trends to determine where the costs are being generated and then insulate the organization through various risk transfer products, such as traditional insurance policies, as well as captive programs and self-funded mechanisms.
PBN: Have you found that individual or small medical practices or any particular specialties or large facilities, like hospitals, are more affected by developments in health care, as far as risk management and insurance?
PRIMIANO: Think of a big pond for a second and as you throw a rock into the center you see a ripple effect spread and eventually that ripple make its way to the waterâ€™s edge. The health care industry reacts in a very similar way and as policies are set at both the state and federal levels, this ripple effect is seen at all levels - the solo physician, the small to medium doctor group and the large facilities. Changes such as the eventual role out of ICD-10 will impact medical coding at all levels. As organizations gear up for this change, it is critical for all health care providers, no matter the size, to look at and review how their risk management portfolio will respond in the event of procedural or compliance issues. For example, there is a big push in the industry for improper Medicare or Medicaid billing issues. While commonly referred to as â€śfraud prevention efforts,â€ť the allegations in these audits are rarely fraud or abuse â€“ instead, theyâ€™re subjective allegations that leave every health care provider vulnerable to being accused of improper billing by Medicare or Medicaid.