With the coronavirus pandemic accelerating a shift towards telemedicine, 2020 [was] a year of tremendous change in the medical industry. 2021 will be no different, with the incoming Biden administration promising to shift the regulatory landscape. Insurers are still playing catch-up with these surprising developments. For practitioners, there are real and unsettling questions as to what awaits in the future. Practitioners will find a new and evolving landscape in searching for liability insurance for 2021 and beyond. 

Despite a lot of uncertainty, insurers and regulators have started to show their cards regarding what changes the medical industry can expect, with higher rates being number one on the agenda. For practitioners, here are three key considerations for the new year. 

1. Medical-malpractice insurance rates are going up. Based on the data we’re seeing so far, rates for new policies or 2021 renewals will increase an average of about 10 percent, with some specialty classes going up more than others. While internal medicine and family practice rates are only increasing around 5 percent, look for general-surgery insurance to go up about 15 percent, with some specialties and hospitalist rates going up as much as about 20 percent. This is largely due to payouts for claims increasing across the board and rising legal-defense costs. Unfortunately, even doctors that haven’t had a claim in the last five years will likely see increases. Some practices that have had fewer patients [amid the pandemic], such as those doing elective treatments, may be wondering where their rate reductions are, as revenues are down from lower patient volumes in 2020. But insurers and actuarial firms seem to have priced this in and are expecting these practices to be even busier in 2021. 

2. Telemedicine will start to cause insurance changes. Telemedicine is going to continue to gain traction, not only with providers, but also with patients who have gotten more used to it. Even a COVID vaccine is unlikely to stop the trend, as telemedicine is more efficient and allows doctors to see more patients. 

The most-immediate concern with telemedicine is that currently, with the national emergency, doctors may be legally allowed to conduct telemedicine with out-of-state patients. [The problem is] their insurers are usually not covering it — unless the provider is licensed in the state where the patients are located. The pandemic has caused states to allow for a non-licensed physician to treat patients within the state, even without a license in the state where the patient is located, but underwriters typically require that the physician be licensed in that state. Since these are temporary conditions, insurance carriers have not yet adapted to the law and allowed it, which limits the law’s usefulness. It’s still an open question whether some insurance companies will lead the way on modifying policies to cover out-of-state telemedicine, or whether new regulations could be passed that may require coverage. To expedite getting malpractice coverage for telemedicine across state lines, physicians should secure licenses in the states where their patients are located, a process which in many states is as simple as paying a modest fee. 

Could telemedicine cause an increase in insurance rates as well? That is a possibility, as if there are more patients seen, there could be more potential liability caused by sheer numbers. Also, insurers have expressed concerns that telemedicine leaves more room for doctors to misdiagnose or fail to notice significant medical issues, given there is no in-person physical exam. However, insurers don’t really know yet if this concern will be borne out by more claims. It could happen that telemedicine causes rates to go up, but the industry seems to be waiting for more information. 

3. Cyber-liability issues keep growing. Physicians and medical practices should look into additional coverage for cyberattacks. This coverage is usually included on liability policies up to a certain point, but higher limits of liability and more robust coverage should be considered. We have seen even small practices become targets for hackers who view health-care practitioners as soft targets and are typically looking for ransom after gaining access to private data. HIPAA and other regulations require measures to be taken to protect patient data. Exposure for physicians and medical practices includes liability for the loss of personally identifiable information of patients, as well as business interruption and other issues. This coverage may be too limited on many malpractice-insurance policies, so take a careful look at these policies and consider additional coverage in our world of expanding cyber threats.

Although 2021 will bring a lot more change to the industry, doctors who stay a step ahead and do some early planning, can have a healthy practice in the new year.        

Max Schloemann is a 12-year medical-insurance industry veteran and the founder of MEDPLI, a national medical-malpractice insurance brokerage. The company’s clients include over 200 doctors and surgeons, as well as physician assistants, nurse practitioners, and health-care entrepreneurs.

COVID-19 cases are surging across the U.S., a harsh reality that students, parents, teachers, and staff feared would happen when many schools opened for fall sessions. As a result, schools throughout the nation have closed and shifted to remote learning in recent weeks.

What will it take to return kids to the classroom and keep schools open? Though vaccines have been approved and started being rolled out, it may be months before most children, their families, and school personnel are vaccinated. Until then, implementing a plan that includes processes for virus detection and response is paramount.

The problem that schools are facing is there is still a significant prevalence of COVID in many communities. Schools need to do everything they can to prevent student outbreaks; otherwise it’s going to continue shutting down schools.

But on top of that you have to deal with a tremendous amount of anxiety. The students, parents, faculty, and staff are all on pins and needles because they are feeling insecure about their health. The only way to address all of this is through a comprehensive health-security strategy that can work when so many variables are in play.

Here are some suggestions to safely open schools while navigating the continuing COVID-19 crisis and waiting for vaccinations to become widespread:

• Daily temperature checks. They’re not a fool-proof way to see if someone has COVID. A significant number are asymptomatic, but fever is a common symptom, and because it is, temperature checks should be a fundamental daily procedure. Designate some staff members, who can each scan 200-300 students an hour; 2) use thermal scanners, a device that can scan 400-600 per hour.

• Screening for symptoms and close contacts. This starts at home, where parents can help prevent the spread at schools by keeping children home who are showing COVID-like symptoms or have been in close contact with someone with COVID. At schools, everyone returning should be screened on a range of symptoms. Those with symptoms should be sent home and referred for testing.

• COVID surveillance testing. Though this is rarely being done in K-12 schools, Frequent asymptomatic testing of the student population is a very effective way to limit the spread of the virus in the school. Positive test results necessitate the immediate need to perform contact tracing with the goal of identifying everyone who was in close contact with the infected student.

• Daily prevention protocols. Prevention measures include mask-wearing by all students and staff throughout the school day, frequent disinfection of surfaces, the availability of hand sanitizers in classrooms,  frequent reminders to wash hands, and as much social distancing as possible in classrooms.

Positivity rates in the community need to be held to a reasonable level for schools in an  area to be open. And when they are open, there are a lot of moving parts for school officials to deal with in order to avoid an outbreak. But if they’re not dealt with, ultimately your school could be closing again.            

Dr. Jonathan Spero (www.inhousephysicians.com) is a physician and an expert on pandemic preparedness and employee health. For over 30 years, he has been the CEO of InHouse Physicians. His company is delivering COVID-19 testing to K-12 schools in New York City.