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MPLI Executive Insights: Paul Greve, Executive Vice President - Willis Towers Watson Health Care Practice

By Paul Greve to Medical Malpractice Insurance


In today's Healthcare Matters segment, MPLI Executive Insights, where we interview top executives in the medical malpractice insurance industry on the state of the industry and where medical liability is going next, we sat down with Paul Greve, the Executive Vice President of Willis Towers Watson Health Care Practice. Paul joined us from the 2017 Professional Liability Underwriting Society (PLUS) Medical Professional Liability Symposium, where he spoke about how the hospital and healthcare industry wants the repeal and replace of Obamacare to play out, what type of tort reforms could be included in the new legislation and what he spoke about while moderating the PLUS MP Symposium panel: Hot Topics: Regulatory and Related Changes in Healthcare. 


Mike Matray: What do you think will happen with the attempt to repeal and replace Obamacare?  How does the MPL industry want to see this play out?

Paul Greve: What is going on is that some significant parts of the Affordable Care Act are going to be left intact, like being able to keep children on your own health plan till age 26, keeping intact the prohibition against insurers omitting people with preexisting conditions. So I think there’s gonna be more revision than there is complete repeal. As far as what the hospitals want, I think the main concern for hospitals is the effect on Medicaid monies. Hospitals agreed to back off on some reimbursement from Medicare and Medicaid back in 2009, 2010, in return for enactment of the Affordable Care Act. And so, if Medicaid monies get cut in the future, as is projected to happen now from 2020 on, then the hospital’s going to want in return some higher reimbursement rates, especially for Medicare and Medicaid.
Mike Matray: The MPLI industry was hopeful that through various court cases, the Affordable Care Act would mitigate the cost of future care.  Is that now gone?

Paul Greve: You know, I’ve been on the periphery of one of those cases in Ohio, Jones versus MetroHealth Medical Center. And in that case, the lawyers were able to successfully argue for a very significant reduction in future damages because of the requirement of the individual mandate. Because we were no longer looking at damages where the plaintiff’s economists could project out huge amounts of money in the future that are speculative, quite frankly. If the individual mandate goes away, and it isn’t replaced by something else that really requires people to buy insurance…and the law could be tweaked in such a way that there could be a penalty for you in some way, shape, or form, at least in higher cost, if you don’t buy insurance. So I do think, though, it really blunts our efforts to use the Affordable Care Act or something like it in the future to reduce future medical costs in malpractice cases

Mike Matray: According to Speaker Paul Ryan, there’s gonna be three phases in this repeal and replacement. The first is gonna be reconciliation, second is gonna be administrative, and then the third is gonna things like medical liability. There are competing bills right now, one for a $250,000 cap on non-economic damages, and there’s another one that’s going through and that’s the Safe Harbor one. Could you discuss the benefits of each, and which you think is more likely to become law?

Paul Greve: Yes. You know, I don’t know that I could speculate on what is more likely to become law, but naturally, we would love to see both. We would love to see a  $250,000 cap, which mirrors the MICRA laws from California, which we’ve had since the ’70s, and also many state tort laws, malpractice reform laws, have tried to mirror MICRA in that regard. So yes, certainly, we would like to see that. I think with Republican control of the Congress and also Republican control of many state legislatures, I do think that we may be in the best position we’ve been in in 15 years, since the last malpractice crisis, to get caps on non-economic damages put in place. The Safe Harbors I’m not as knowledgeable about, but I would like to see those laws enacted, maybe for emergency medicine doctors or treatment by any specialties where there might be a shortage. I’m much more optimistic about the possible passage of the caps on non-economic damages. The Safe Harbors laws might be a little trickier to get put into place, at least at a federal level.

Mike Matray: What reforms would the health care industry like to see, and which would be most effective?

Paul Greve: You know, again, I would come back to the caps on noneconomic damages. I would say anything that requires the plaintiff’s bar to get expert opinion that serves as a screen, like an Affidavit of Merit, as it’s often called in states where they have to get that medical record screened before the suit gets filed. Anything that makes that case tougher for the plaintiff’s bar to bring, and again, especially like an Affidavit of Merit, I think that’s a very effective for of tort reform that I’d like to see. I don’t know that you could see that done at a federal level. But certainly with Republican control of many state legislatures, I think we, as an industry, need to give a concerted effort once again to enact even more favorable tort malpractice reform than what we’ve had, what we saw enacted 15 years ago.

Mike Matray: You’re going to be moderating a PLUS MPL Symposium panel titled: Hot Topics: Regulatory and Related Changes in Healthcare. What will you be specifically talking about?

Paul Greve: Yes. Well, we’ve got quite a varied panel. I have Mike Stinson from the PIAA talking about malpractice reform at the federal level. And I’m interested to hear Mike take on what’s gonna happen with the American Health Care Act and what the possible impact to that might be. I have Leslie Jenny, who was the trial lawyer for the Jones versus MetroHealth case. And that case is significant not only because she argued successfully at two levels in Ohio, first at the trial level and then also within the second level of appeal in Ohio. That case did not go to the Ohio Supreme Court, although we actually were hopeful that it would because we felt as though it would have been upheld. But she’s gonna talk in more detail about where we’re likely to go, you know, in the future if the individual mandate goes away. And then I’ve got two people who are experts in claims, one from The Doctors Company, PJ Malnar, and Tony Stompanato from AIG. And they’re gonna talk about overall claim trends, frequency and severity, and also they’re gonna zero in on…one of the main concerns for our industry has been the so-called batch claims or systemic claims, where you see related events occurring, often it’s unnecessary surgeries or things like unnecessary stents, unnecessary medical devices put in people. Those are a concern, you know, for our industry because the dollars paid out are potentially so large, and those types of claims are very attractive to the plaintiff’s bar.

Healthcare Matters is brought to you by Cunningham Group, the medical malpractice insurance specialists.