4 Insurance Model

“We Do It All For You”: a Quasi-Insurance Approach to
Wills, Wonts and Won’ts.
A. Steven Frankel, Ph.D., J.D.i

Welcome to the fourth and final article on ways to address the problem of preparing for unanticipated disruptions or terminations of practice due to death or disability. In this article, I address a most efficient and effective way of approaching the problem – an approach which has developed as a result of the
view that, given the enormity of the task, colleagues need considerable support in order to fulfill the legal/ethical responsibility to prepare for thee transitioning of practices when colleagues die or become disabled – a quasi-insurance approach. Currently all medical malpractice insurance companies are focused on “risk management” or “prevention.” The program I write about in this article and its options are risk prevention tools for the new world order where people continue to function into what used to be called “advanced age”. Insurance plans typically respond with funds or funded services when a condition which is covered by a policy occurs. The quasi-insurance approach to the problem of dealing with sudden disruptions of practices goes a step further, in that it funds an annual visit with a psychiatrist-colleague with at least 20 years of practice experience, who has been trained to assess practices and to facilitate
transitions when the time comes for transition services. That colleague is termed a “Transition Specialist”

Subscription Services:
When a practitioner subscribes to the quasi-insurance program s/he becomes a subscriber and a TS is paid to make annual visits to the subscriber’s practice to assist with ensuring that patients have been advised of the subscriber’s involvement with the program, that proper releases have been signed by each and every patient, providing for the TS to review charts, talk with patients when transition services are rendered, and to refer the patients for continuing care with a psychiatrist in the community – and referral priority is given to other subscribers, thus providing a way to increase the practice value of
subscribers. During the annual visits, the TS reviews the condition of the records of treatment, including medication records, and apprises the quasi-insurance company of any support needs that a subscriber might have (e.g., recordkeeping, medication prescriptions/records, etc). TSs also have authority, per the
quasi-insurance company’s planning, to prescribe limited medications for patients who may short or out of medications at the time of an “event,” which will carry the patient through the time needed to transition to another provider of continuing care.
If the subscriber employs one or more office staff members, those staff members will be provided with a Manual created by the quasi-insurance company that provides for all of the “heavy lifting” needs discussed in prior articles, such as where furnishing and furniture should be transported, how to take care of funds, billables, receivables, telephone and electronics (computers), record storage, etc. If the subscriber does not employ such staff, a trained “office temp” who is familiar with similar manuals may be assigned to the practice to carry out those same functions. By following these procedures, the TS and office staff or temp collaborate to transition the practice with maximum efficiency and care for patients,
colleagues and the families of subscribers. Finally, since subscribers’ practices have been vetted by TSs, they are eligible to receive patient referrals when other subscribers cease to practice.
Emergency Services:
In addition to the subscription services for planning and implementing the practice transition, the company also provides an emergency service for practitioners who have not subscribed or planned ahead. This emergency service also makes use of paid TSs and office staff/temps, armed with a court
order signed by a probate judge, when necessary, to contact the affected colleague’s family or personal legal representative and then to provide all of the services described above.ii
Opportunities for Subscribers to Become TSs:
One of the features of the Quasi-Insurance approach lies in the possibility that a subscriber can become a TS. Subscribers who see the helpfulness and compassion of the quasi-insurance model may, given that they have been in practice for at least 20 years, become TSs by taking the training and learning
from how their own practices have been assessed and supported by subscribing, assist other professionals who are interested in preparing for unanticipated disruptions of practice.
Time Commitments for TSs:
TSs who work with subscribers typically put in one 4-6 hour visit to each TS’s practice per year. When an “event” occurs, if it falls after the first year or two of TS visits, the TS’s responsibilities are less demanding, in that the patients have already been advised as to their follow-up treater and have already signed releases such that records can be transferred. TSs might be needed by some patients who are grieving the loss of their subscribing treater, for support during the transition. However the bulk of the work will be under the purview of the office staff or temp. Since we do not contemplate a rash of needs for subscribed practice transitions in any given community, it is not likely that the company’s
calls to engage a TS will be a very frequently occurring event, and thus the TS’s practice and personal life will not likely be disrupted by the call to duty very often. The presence of several trained TSs in a professional community will also allow the frequency of the company’s calls to be low and non-disruptive, while the services are, in the words of one of the subscribers, “a god-send.” TSs who are willing to be involved with emergency transitions will be putting in more hours per case than those who work with subscribers. Files will have to be reviewed for appropriate follow-up care, patients will likely need to talk
to TSs, to sign releases, review their records, and deal with their grief. Office staff and temps will still cope with the “heavy lifting” described in prior articles, but TSs should count on putting in a week-10 days for emergency practicetransitions.
Administrative Involvement:
The company has an administrator who is available and accessible to TSs and office staff and temps. The administrator will coordinate the activities of the TSs and office staff and temps, will arrange for court orders when needed, and will have direct interaction with the families of the stricken colleagues. The
administrator will be able to support the on-site work of the company’s agents at all times.
Up-sides and Down-sides of the quasi-insurance model:
The up-side to the quasi-insurance model is that the company does the entire project in ways that care for patients, colleagues and families of practitioners. Those people are safe to grieve their losses and carry on with their lives with minimal disruption or distraction. The feelings of safety and being
cared about are priceless, which leads to the down-side of the quasi-insurance model: as with insurance of any sort, payment must be made to the company to secure its services. It should be noted, however, that I have strongly recommended that subscribers purchase term life insurance policies for their
colleagues if they us either the partnership or team models, such that payment, in and of itself, is found in all three models.
Thank you for reading the four articles that have described the problems of practice transition and the various solutions to those problems. The three pathways to manage and address these problems each have their own advantages and disadvantages, and may suit particular individuals differently,
depending on their practices, their locations and their life situations.
Summary of Four Models of Preparation for Practice Terminations:
Model: Do Nothing Single Partner Team Quasi-Insurance Intervention: Emergency One TS 5 TSs TS, Office Staff Advantages: None Completion Completion Completion Disadvantages: Disruptions Excessive work Group Financial Dysfunction Commitment i i If you are interested in a closer look at the issues and support systems, you’re
welcome to contact me via www.practice-legacy.com
ii The company’s programs have been vetted and endorsed by the second largest psychiatric malpractice insurer in the United States, and the company is actively seeking professionals interested in both subscription services and in becoming TSs.