Policyholder Services

Underwriting the Multi-state Practice

By Betsy Kelley, OMIC Underwriting Manager

Digest, Summer, 2002

Recently, OMIC has seen an increase in the number of ophthalmologists who routinely practice in more than one state. No longer are such practices limited to satellite offices located in a neighboring border town. Instead, physicians may now have practices hundreds or even thousands of miles apart. While OMIC, as a nationwide carrier, is able to accommodate this growing trend, ophthalmologists who practice in multiple states present unique underwriting exposures. Factors such as licensing, coordination of patient care, and rating issues all must be taken into consideration.

Physician Licensure

While some states may grant exceptions to physicians who limit their interstate practices to consultations, most, if not all, states require any out-of-state physician performing professional services within their boundaries to maintain full and unrestricted licensure in their state. Ideally, the physician also should maintain hospital privileges in each location of practice. If a physician chooses not to maintain hospital privileges in a satellite location due to his or her restriction of services in that location to non-surgical activities, the hospital’s on-call or emergency room requirements, or other reasons, it is essential that the doctor have appropriate arrangements in place with another physician locally to admit patients when needed.

Patient Care

Whether a physician alternates between locations every few days or spends weeks at a time at one location, there will be situations in which a patient requires care during the physician’s absence. To ensure that patients receive prompt medical attention and to reduce the likelihood of claims of abandonment, delayed diagnosis, or delayed treatment, it is essential that the physician establish a protocol for the treatment of such patients. Depending upon the distance between offices, the physician may be available on short notice to care for such patients personally or may need to arrange for a local physician to treat patients in his or her absence. In any event, it is critical that these arrangements be coordinated before the need actually arises and that patients be made aware of the physician’s schedule and of whom to contact for interim care.

When planning the schedule, it is important for the physician to consider the special needs of surgical patients. It is the surgeon’s responsibility to determine whether the patient is an appropriate candidate for surgery and to have an informed consent discussion with the patient prior to surgery. Therefore, the physician should plan to be in each location frequently enough to conduct these preoperative visits within a reasonable period of time prior to the date of surgery. Similarly, the physician should arrange to stay in each location long enough to perform the necessary postoperative care.

Premium Rates

Provided that the physician’s practice protocol falls within OMIC’s underwriting guidelines, the insured’s policy will extend coverage for claims arising from services rendered in either state. The premium that will apply to the policy will depend upon the physician’s practice situation. Some carriers apply the higher-rated territory’s premium regardless of practice volume in that territory while others charge a blended premium based upon the amount of time in each rating territory. OMIC generally rates the policy based upon the premium applicable to the primary location of practice. Provided that the percentage of time spent and the percentage of income generated in the higher-rated territory does not exceed 25% of the physician’s total activities, the premium for the lower-rated territory will apply.

If you have questions about OMIC’s coverage of multi-state practices, please contact an underwriting representative at (800) 562-6642 or by email at underwriting@omic.com.