OMIC E-Bulletin Announcements

This page was last updated on 06/30/2009

		Richard L. Abbott, MD, Named Chairman of the Board of the Ophthalmic Mutual Insurance Company
		Triamcinolone Acetonide Risk Management Recommendations and Consent Form
		New FDA Email Service Provides Patient Safety Alerts: Sign Up Now
		OMIC Bylaws Updated
		Broad Regulatory Protection Policy for OMIC Insureds
		Coverage Question of the Month
		Risk Management Forms and Documents Update
		New Online Risk Management Courses

Richard L. Abbott, MD, Named Chairman of the Board of the Ophthalmic Mutual Insurance Company

December 10, 2008

SAN FRANCISCO – The Ophthalmic Mutual Insurance Company (OMIC) announced today that Richard L. Abbott, MD will succeed Joe R. McFarlane Jr., MD, JD, as Chairman of OMIC's Board of Directors effective January 1, 2009. Dr. McFarlane, who is rotating off the OMIC Board as required under the company's bylaws, sees this as a natural progression for the nation's largest insurer of ophthalmologists.

"I can't think of a better person to lead OMIC," said Dr. McFarlane. "Dr. Abbott's entire career has been dedicated to the support and protection of the ophthalmic profession." Holding the Thomas W. Boyden Endowed Chair of Ophthalmology as a clinical professor at the prestigious Beckman Vision Center of the University of California, San Francisco, Dr. Abbott has been devoted to ophthalmic research, clinical care and education for more than two decades and is widely regarded as one of America's foremost authorities on quality of care and risk management issues in ophthalmology.

Dr. Abbott joined OMIC's Board of Directors as chairman of the Underwriting Committee in 1999, after serving on the committee for six years. In 2006, he was elevated to the Executive Committee. In addition to his work at OMIC, Dr. Abbott has held several leadership positions within the American Academy of Ophthalmology, including serving on the Academy's Board of Trustees. He has also served on the boards of the International Council of Ophthalmology and The Cornea Society and was a director of the American Board of Ophthalmology. He is the current president of the Pan American Association of Ophthalmology as well as a past chair of its foundation.

"OMIC is the leader in our industry because ophthalmologists trust and rely on our expertise," according to Dr. McFarlane. "Dr. Abbott's commitment to improve the delivery of ophthalmic care and identify the trends that result in lower exposure to malpractice claims will benefit the entire ophthalmic community."

When accepting his nomination for chairman of OMIC's Board, Dr. Abbott acknowledged the tremendous contributions of Dr. McFarlane during his 20 years of leadership at OMIC. "Dr. McFarlane exemplifies all of the qualities that I hope to emulate during my service as OMIC's chairman. During his tenure, our company experienced not only tremendous growth but also considerable influence within our specialty. The result has been a stable market serving ophthalmologists."

More about Dr. Abbott

After completing his Bachelor of Science degree at Tufts University in Boston, Dr. Abbott earned his medical degree at the George Washington University School of Medicine in Washington, DC. He performed his residency at the California Pacific Medical Center in San Francisco and was a Heed fellow at the Bascom Palmer Eye Institute in Miami. Dr. Abbott has served on the editorial boards of several ophthalmic journals and continues to lecture and publish on a variety of topics focusing primarily on corneal and external diseases of the eye. He has received numerous honors, including the prestigious U.S. President's 25 year Volunteer Service Award, the International Distinguished Golden Service Award from the Chinese Academy of Ophthalmology, and the American Academy of Ophthalmology Lifetime Achievement Award. Dr Abbott has been elected into both the American Ophthalmological Society and the Academia Ophthalmologica Internationalis. He is recognized in Who's Who in America, Who's Who in the World, and Best Doctors in America. He lives in Mill Valley, California, with his wife, Cecilia. They have three children and four grandchildren.

About OMIC

The Ophthalmic Mutual Insurance Company is the largest insurer of eye physicians and surgeons in the United States and the premier source for ophthalmic risk management information. OMIC maintains educational alliances with more than 31 state and subspecialty ophthalmic societies and enjoys the exclusive endorsement of the American Academy of Ophthalmology.

Contact: Robert Widi
Vice President, Underwriting, Marketing and Sales
415-202-4654, rwidi@omic.com

Triamcinolone Acetonide Risk Management Recommendations and Consent Form

On June 18, 2008, the American Academy of Ophthalmology (AAO) announced in the Academy Express that the FDA had approved an injectable triamcinolone acetonide suspension (TA) for ophthalmic use. Trivaris,™ manufactured by Allergan Inc. (Irvine, CA), is the second approved drug; it joins Triesence™ (Alcon, Ft. Worth, TX). These drugs were approved for a limited number of indications: sympathetic ophthalmia, temporal arteritis, uveitis, and ocular inflammatory conditions unresponsive to topical corticosteroids. All other use is, therefore, "off-label." While not approved for ocular use, Kenalog™ (Bristol-Myers Squibb, New York, NY) remains available and will no doubt continue to be widely used. OMIC has revised its consent form for triamcinolone acetonide so that it can be used for these three medications. If you are using Trivaris™ or Triesence™ off-label, or using Kenalog,™ inform the patient of the off-label use and include an explanation of this in your consent form. See "Triamcinolone acetonide: Risk Management Recommendations" for a detailed discussion of the patient safety and liability risks associated with TA.

At the May 31, 2008, meeting, OMIC's Board of Directors voted to endorse a service provided by the Food and Drug Administration (FDA) called the Health Care Notification Network or HCNN. This online network will take important product-related patient safety alerts which are mandated by the FDA and are currently sent to you through the U.S. mail and move these onto a secure, online network. You will receive a letter in the near future with instructions on how to enroll.

OMIC's Board of Directors has revised OMIC's Bylaws for clarity and to better reflect the current governance of the Company. Areas of revision include specific charges for all of the Committees of the Company, a clearer explanation of voting rights, and a change to allow proxies to remain in effect for the duration of an insured's membership. Click here to view and download a copy of the current OMIC Bylaws.

Broad Regulatory Protection Policy for OMIC Insureds

As a benefit of membership, OMIC has purchased a $25,000 Broad Regulatory Protection Policy (BRPP) for each of its professional liability policyholders and qualifying entities for 2007. This policy extends coverage for fraud and abuse claims related to billing errors and HIPAA privacy proceedings to include fines and penalties (where allowed by law) as a standard policy feature. Coverage also includes legal expense reimbursement for alleged violations of EMTALA, DEA, and STARK violations. Higher coverage limits up to $1 million are available at competitive rates. Non-OMIC professional liability insureds who are members of the American Academy of Ophthalmology may purchase the Broad Regulatory Protection Policy at limits of $25,000 to $1 million. Click here to learn more.

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Coverage Question of the Month

June 2009

I am the supervising physician for a tele-ophthalmology reading center in which retinal photos taken in primary care offices are evaluated and interpreted by trained non-physicians for signs of diabetic retinopathy. Does my OMIC policy cover me for this activity?

It is not uncommon for trained, qualified non-physician readers to participate in the screening of diabetic retinopathy, and literature indicates that non-physician readers may be as good as comprehensive ophthalmologists at interpreting results. However, this activity is not without risk. The level of exposure varies based upon the training and qualifications of the reader, technical issues regarding the camera system used, communication to the patient regarding the limited scope of services provided, protocols for handling non-diabetic pathology, and the duties and responsibilities of the supervising physician. Some of these risks may be mitigated by the contract language between you and the reading center.

Whether the physician's policy would respond to a resulting claim from such screening activities would depend upon the facts of the case, including the physician's role in the screening process. For example, coverage would apply to the supervising physician for the review of retinal photos identified by the screeners as suspicious of non-diabetic pathology or for providing a second opinion when there is uncertainty about the reading. OMIC's policy includes coverage for the insured's direct patient treatment, including not only making diagnoses and rendering opinions to a patient but also consulting about a patient with another health care provider. Coverage also extends to the physician for his or her vicarious liability coverage for direct patient treatment provided by a person acting under the supervision, direction, and control of the insured, provided the person was acting within his or her scope of training and licensure. Coverage does not apply, however, for allegations against the insured as a medical director of any entity not named in the Declarations. In addition, no coverage would apply to the non-physician readers unless they are employees of the physician and rendering services for the direct benefit of the physician's practice.

In addition to their professional liability coverage, physicians insured by OMIC are also covered under a Broad Regulatory Protection Policy (BRPP). The BRPP provides policyholders with free legal reimbursement coverage, including fines and penalties where allowed by law, for fraud and abuse allegations relating to physician billing practices. To minimize the risk of fraudulent billing claims, physicians must use caution when coding these screening activities. CPT code 92250 is a physician-based service; physicians must provide direct input on each billed procedure to meet the «interpretation and report« requirements established by Medicare.

For additional information regarding diagnostic reading services, please read the lead article, "Hidden Costs of Non-Traditional Revenue Sources," and "Policy Issues: Coverage for Non-Traditional Services" in the Spring 2008 Digest.

• Chalazion consent form.
• Kenalog Injection consent form.
• Mitomycin-C with Corneal Surgery consent addendum.
• Punctal Plugs consent form.
• Restylane Injection consent form.

• The ALT/SLT consent form has been amended to be a "stand-alone" document. The former version was inadvertently attached to the glaucoma filtering surgery consent form.
• The Avastin™ consent form has been revised to better address the possible increased risk of stroke in Lucentis.
• The Cataract Surgery consent form has been significantly revised and shortened at the request of OMIC policyholders. This version contains the information that OMIC recommends the ophthalmologist personally discuss with the patient. See the "Risk Management Recommendations" section below for a patient information sheet and loss prevention advice.
• The Fluorescein Angiography consent form has been revised.
• The LASIK and PRK consent forms have been revised to better address ectasia and pupil size. Click here for LASIK, here for IntraLASIK, here for retreatment, and here for PRK.
• The Lucentis Injection consent form was recently revised in response to the preliminary report of an increased risk of stroke in patients with a prior history of stroke who were administered the approved dosage.

• Amblyopia Risk Reduction: Recommendations, Treatment Agreement, Referral Report
  Medical malpractice lawsuits for negligent treatment of amblyopia are infrequent, but the risk to the pediatric patient’s vision is extreme. If not treated appropriately by age nine, the child can have permanent vision loss. The main risk issue is noncompliance with patching and follow-up appointments. Click here for recommendations, a treatment agreement, and a referral report.

• Cataract Surgery Risk Reduction Materials
  To reduce the ophthalmologist’s exposure to cataract surgery claims, we offer various materials. The risk management recommendations highlight the actions physicians can take to reduce the likelihood of claims and increase their defensibility. The information sheet for patients gives a detailed explanation of the risks, benefits, and alternatives to cataract surgery; staff can give it to patients to review prior to the informed consent discussion with the surgeon. The sample consent form contains the minimum information OMIC recommends that the surgeon personally disclose to the patient.

• EMTALA (Emergency Medical Treatment and Active Labor Act) Overview and On-Call Obligations
  This federal law governs how patients are treated in emergency rooms and imposes duties on ophthalmologists who serve on-call to hospitals. Click here for an overview of the basic obligations hospitals and physicians have under EMTALA. Click here for information about on-call and follow-up duties.

• Endophthalmitis/TASS Recommendations and AAO/ASCRS Report
  While not all adverse events can be prevented, there is much ophthalmologists can do to reduce the incidence of endophthalmitis and TASS. Based on a review of OMIC claims experience, these recommendations offer risk management guidance for more effective prevention, recognition, and response to these sight-threatening conditions. The AAO and ASCRS have asked ophthalmologists to track and report TASS cases. This document also contains the necessary reporting form. Dr. Mamalis's group has developed an Excel-based protocol that can be used for individual or clustered cases of infectious or sterile endophthalmitis. Click here for this protocol.

• Fluorescein Angiography: Preventing and Responding to Complications
  While generally well tolerated, fluorescein angiography is an invasive procedure with associated risks, including a very rare but notably life-threatening allergic reaction. These risk management recommendations have been compiled to help you and your staff both prevent and better respond to the risks of this procedure. Issues addressed here include delegation of tasks, informed consent, emergency response equipment, and management of complications.

• Giant Cell (Temporal) Arteritis
  Allegations of failure to diagnose are common in medical malpractice lawsuits against ophthalmologists. This document focuses on giant cell (temporal) arteritis. These risk management recommendations can help promote patient safety and reduce liability exposure.

• Terminating the Physician-Patient Relationship for Financial Reasons
  It is well established that physicians may discharge a patient for a number of reasons, including non-payment. Click here for a discussion of this issue and a sample letter.

Revised Risk Management Recommendations

• The Avastin risk management recommendations have been revised to better address the possible increased risk of stroke in anti-VEGF drugs.
• The Lucentis risk management recommendations have been revised to better address the possible increased risk of stroke in Lucentis.
• ROP: Creating A Safety Net document was revised to conform to the 2006 AAP/AAO/AAPOS joint statement and errata to the joint statement. Click here for this document.
• ROP: Sample Indemnification Language was revised to conform to the recommendations contained in ROP: Creating A Safety Net. Click here for the new language.
• Telephone Screening of Ophthalmic Problems now contains an updated version of the after-hours contact form.

New Online Risk Management Courses

• Ophthalmic Anesthesia Liability helps ophthalmologists reduce the likelihood of anesthesia-related malpractice claims and includes a video on Sub-Tenon's anesthesia. Please contact Linda Nakamura at (800) 562-6642, ext. 651 or 652, or email lnakamura@omic.com to register for the course.
• Responding to Unanticipated Outcomes is nearly complete. OMIC has always encouraged its policyholders to communicate honestly and compassionately with their patients about care outcomes. Using actual calls to our Risk Management Hotline, this course provides recommendations on disclosure discussions, documentation, event analysis, and refunding fees.