Enjoy DDI’s low rates and superior direct service that comes from being DDI insured.

You don’t have to wait until your current policy expires!

Move your insurance coverage to DDI today.

MOVE EARLY and Start Saving Today

sales@ddiimail.com or (630) 574-9800

Cash-Flow shortage survival tips For DoCtors By Ike Devji, JD

i’ve been talking to more doctors who are contemplating if and how they can keep their

doors open given the fact that their fixed expenses were based on old revenue models that

are rapidly evaporating. Decreases in insurance compensation, Medicare contract losses,

increasing incursion into nearly every area of practice by hospitals that are sucking up every

available insurance contract and pushing doctors that have been successful providers for

years into insolvency, the list goes on and on.

the medical business is a microcosm of the larger economy itself and as always, cash

flow is king. in our current economy, the lack of cash flow has become all too common to

all business owners, including doctors, who were extremely profitable to the tune of six-

and seven-figure incomes even only two to three years ago. in those “good old days” when

revenue and liquidity were taken for granted, there was little or no thought given to monthly

overhead requirements for payroll, vendors, the practice’s rent/lease, or even the commercial

mortgage payments on the facility itself. these lease and mortgage obligations are almost

always personally guaranteed by one or more of the principal physicians in the practice, so

an economy like this one threatens both the viability of the practice itself and the personal

solvency of the doctors who own it.

as this economic pressure continues doctors are working hard on ways to diversify their

practices, increase marketing and adding new revenue streams, but as we’ve seen with

our government, solvency is an issue that needs to be addressed with an eye towards both

revenue and spending. Below are some specific actionable tips to consider, which were

shared with me by Mark Johnson, a partner with B2b CFo in phoenix, ariz., which has

helped business owners nationwide with a variety of business and succession-planning

issues. Johnson has worked at the CFo level for business in nearly every channel including

health care for decades.

AN ILLINOIS INSURANCE COMPANY CREAtEd fOR ANd bY ILLINOIS PhYSICIANSspring 2013 | www.doctorsdirectinsurance.com

Letter continues on page 3 Article continues on page 2

Article continues on page 2

strategies iN traNsitioNiNg to iCD-10as the october 1, 2014 deadline for transition to iCD-10 coding approaches, anxieties

associated with the cost and organizational burden on both healthcare providers and the

healthcare industry rise. those who plan ahead and devote time and financial resources

to education and training will experience a much smoother transition and a much earlier

return on their investment. to assist with the transition, the Center for Medicare and

C. TraviS WaTTS vice President – Sales & Marketing Doctors Direct insurance, inc. Travis.Watts@ddiimail.com (708) 406-7695

Dear Physicians,From its founding several years ago, Doctors Direct

has devoted itself to only one market: the practicing

physicians of Illinois. At DDI, we understand that

medical malpractice insurance is not just about han-

dling claims, it is about protection. We are here, first

and foremost, to protect our physician policyholders

amid the sometimes volatile arena of medical liability.

This goal—protecting the physicians—provides

orientation for everything we do within the Company.

Our physician-dominated Board of Directors has the

responsibility for setting corporate policy for DDI. Over

the years, I have never seen DDI, in their deliberations,

fail to ask the core question: “Is this action good for our

doctors?” In underwriting, the Company seeks a deli-

cate balance between wanting to help an applicant find

insurance and applying solid standards of risk accept-

ability, which protect the whole group of insureds from

the effects of adverse claims. Where DDI really shines

is in its claims management, because getting a lawsuit

dismissed or a victory at trial clearly vindicates the

physician when a patient brings a frivolous allegation.

DDI’s reputation among plaintiffs and their attorneys is

clear: we will do everything we reasonably can to defend

our policyholders aggressively. In doing so, we back up

this commitment with a full consent-to-settle provision

in our policy.

Clearly, it is not just an insurance policy that you

are buying. It is protection of your reputation and your livelihood.

?

?

?

?

?

1. Do not pay your suppliers until the due dates and, if necessary,

go past the due date with the vendor’s concurrence.

2. accelerate all accounts receivable collections through timely

customer follow-ups on past due receivables. Consider something

like a discount for cash payments made prior to the due date.

3. renegotiate lease terms on both rent and equipment when you

are in the last two-to-three years of a contract. lessors would

rather keep you in a longer contract at a lower rate than lose

you as a client altogether.

4. utilize outside consultants who work on a contingency basis to

lower costs for expenses such as telecom, property, and casualty

insurance. these arrangements allow for lower expenses and the

savings is usually split with the consultant.

5. reduce inventory levels and manage work-flow production with

a minimum of on-hand product for manufacturing.

6. research your deposits paid over a year ago to utility companies

in order to determine if the deposits are still required; there is a

chance they may not be.

7. Defer principal and interest on outstanding loans with banks and

other creditors.

additional assistance and guidance in the area of cash-flow manage-

ment can be provided by your finance and accounting professional.

Finally, get experienced help. whether renegotiating your lease, going

back to a bank for a loan modification (even interest-rate reductions

have been critical to some doctors), or dealing with creditors in a more

advanced stage of default, you will almost always have better results when

dealing with experienced counsel that knows the law, the players who can

depersonalize the situation and present it as a good business decision to

the other parties. there are lawyers out there that have extensive experi-

ence in this specific area, find one and ask them some qualifying questions

on their specific experience and their results in solving a problem like yours.

............................................................................................................................

An Asset Protection Attorney helps protect a national client base including several thousand doctors. The article above was originally written for PhysiciansPractice.com where Mr. Devji has over 120 bylines. Ike Devji can be reached at (602) 808-5540 or by email at id@thewealthy100.com You can also connect with Ike through Linked In and see more of his work here: http://www.proassetprotection.com/Mr. Devji’s article appears here with permission.

Article from page 1: Cash Flow Shortage

Article from page 1: Strategies in Transitioning to ICD-10

Jay F. Kiokemeister, D.O. has been a board certified anesthesiologist in the Chicagoland area for 20 years. He graduated from the Chicago College of Osteopathic Medicine in 1991, and completed his anesthesiology residency at Northwestern University Medical Center in 1995. Dr. Kiokemeister became the President of Ambulatory Anesthesiologists of Chicago, LLC in 1999, and has gained recognition for growing the practice to 20 providers and servicing 8 outpatient surgery centers.

Does Going Direct Really Make a Difference in the Service You Receive?The service is not only efficient it is accurate. when first switching to DDi, i didn’t think that going direct was going to make much of a difference, but it certainly has in regards to service and response. i know that if i have a question, i can get an answer right away, from the decision maker of the company.

Is Doctors Direct One of Those “Here Today, Gone Tomorrow” Companies?DDi has been here for me as an insurance carrier and as a partner, and i am confident that DDi will be here tomorrow. i meet with my company 8 times a year and we discuss various aspects of the business. their direct model proves that they are evolving with the modern healthcare environment.

Do You Miss Having a Broker?Discovering how much my broker was actually being compensated and being able to put that back into my practice was enough for me to switch to DDi. i am getting the best coverage, service and price available in illinois.

Did You Have to Buy a Tail to Switch Companies?No, it was unnecessary as DDi assumed all of my prior acts coverage. i am confident that should a claim arise from something in the past, that DDi is more than capable to manage that claim.

Can Doctors Direct Settle a Claim Without My Consent?absolutely not! their policy language specifically states the physician has the Full Consent to settle clause, which indicates that they will not settle a claim without my consent to do so.

Medicaid services offers an email subscription service, www.cms.gov/

iCD10, providing regular updates on topics related to how to anticipate

the transition’s impact on your practice, how to formulate a realistic

budget in preparation, and how to assemble a project management team

to spearhead the transition.

throughout this transition, no assumptions should be made in regard to

provider knowledge and acceptance of its expected benefits. Devoting

the resources to support a seamless transition may be fruitless without

buy-in from the healthcare team. For practical guidance related to

engagement of the healthcare team in the transitional effort, visit:

DoCtors DireCt ClieNt spotlight: Jay F. KiOKEMEiSTER, D.O.

At DDI, we defend physicians. Our in-house claims

professionals work closely with you and top-flight Illinois

defense counsel. Our goal is to get claims dismissed on

your behalf and to send a message to the plaintiff’s bar that

we will not go quietly. After all, it’s not just a legal action.

It’s an attack on your reputation. We are here to defend you.

Here to Defend You.

always.

Letter from page 1

Claims from back cover

oNliNe proteCtioN oF a proFessioNal reputatioNBy Michael J Sacopulos, JD

the words of warren Buffett have never been more true: “it takes 20 years to build a reputation and five minutes to ruin it.” with everyone from patients to jurors judging physicians based off of online ratings, many physicians are looking for ways to insure their cyber reputation is accurate.

Companies like reputation Changer and Digital whiteout work with their clients to change what people can read about them online. a physician who is involved in a legal situation in his personal life, for example, divorce can be showcased in a simple google search. even though a potential patient may search the physician’s professional background, their personal life details can be tied together

in the past, it was easier to keep private lives out of the public’s eye. the increase of the internet connectivity and exponential growth of social media has further blended personal with public. if you make one uncalculated move in today’s society your reputa-tion can be scorned publically online.

Jury instructions Much has been made recently of the risk of jurors using social media. Dozens of cases around the country involving jurors use of social media during trials have been reported. as one author put it, social networking sites have “wreaked havoc” upon the jury system. the problem is so pervasive; in 2010 the united states Judicial Conference Committee on Court administration and Court Management issued model jury instruc-tions relating to the use of social media and internet research. in october, 2011 a survey of active and senior federal court judges found that 60% of them used the conference committee on Court of administration and Case Managements jury instructions.

Changing a Client’s online reputation some litigators are moving beyond recognition of the issue. they are proactively creating and polishing online reputations for potential advantage in litigation, in the event jurors stray from the courtroom into cyberspace.

industry experts argue, once someone anticipates being sued or is served papers, it is best to get a jump start on what potential jurors, lawyers, and investigators will find when looking online. they caution the longer the negative information is visible online, the greater chance it has to spread virally by people reading it.

in the shadows while it seems realistic to acknowledge that trials may no longer take place solely in the courtroom, this leads to uncomfortable consequences. when and what goes through a juror’s search engine is impossible to fully know. anticipating some level of juror mis-conduct via online activities seems both unsettling and justified. like it or not, we have entered an age of shadow litigation.

Costs for such services can start at $2,500, and can go as high as $20,000 for extreme crisis management.

.............................................................................................. Michael J Sacopulos, JD is the CEO of Medical Risk Institute (MRI).Medical Risk Institute is a firm formed exclusively to provide proactive counsel to the healthcare community to help providers understand where liability risks originate, and reduce or remove these risks. He may be reached at msacopulos@medriskinstitute.com.

Spring 2013 | www.doctorsdirectinsurance.com | 3

The echocardiogram was performed that afternoon and revealed aortic dissection. A hospital team unsuccessfully tried to find a surgeon to perform an emergency repair of the dissection, and the patient died later that afternoon of cardiac arrest.

Attorneys for the various defendants argued over who was at fault for the patient never receiving a contrast CT scan. In the end the hospital and the internist were found guilty. Mid-trial the hospital admitted neg-ligence, but denied it was the cause of the patient’s death. Several of the defendants entered a high/low agreement prior to the trail, capping their liability costs. .......................................................................................This is not an actual DDI claim, but that of another company. It was reprinted with permission of the Jury Verdict Reporter, a Division of the Law Bulletin Publishing Co.PR

OTEC

TION

There is a lot going on in healthcare today—and

many of the emerging changes are quite problematic

for physicians. Yet, the fact remains that physicians

are highly-skilled providers of care. Patients want to

receive that care and to trust their doctor. A doctor’s

reputation and integrity plays a huge part in being able

to deliver that care. Having a carrier like DDI behind

you is the best way to insure that your good name is

maintained.

I have spent my entire career in insurance in the

medical malpractice field. No company comes close

to DDI in its care for its insured physicians. This

dedication starts with the Board of Directors and flows

to our 6-member Physician Advisory Board, the dedi-

cated members of our staff and our panel of defense

attorneys. We will not rest for a minute in our determi-

nation to protect you, the practicing physicians.

As always, our Board members and all of the man-

agement staff would be very happy to speak with you

about this or any other issue. The physicians who are

insured by Doctors Direct have access to all levels of

the Board and management, and we would welcome

each and every opportunity to visit with you.

Sincerely,

C. Travis Watts Vice President, Sales and Marketing

5 BENEFiTS of being DDI Insured1. The Only 100% DIRECT Writer of Malpractice Insurance in Illinois—

Providing direct answers to your direct inquiries.

2. We are the physician-friendly company. You have a choice and it is yours. We do not stronghold you to stay insured by us with threats of not re-writing you should you leave and return.

3. Our premiums are tied to your exposure, not the general specialty classification—we do not have a broker commission built into your premium.

4. Our policy is comprehensive. Practices are expanding their services to supplement the diminishing income due to decreasing reimbursement. We understand this and extend coverage in many instances.

5. DDI Clients realize premium savings now, unlike some companies, who charge higher rates with a promise to pay you back later via dividends and “loyalty” rewards programs.

Scan with your SMARTPHONE to learn about the DDI Difference

CLAIMS IN THE NEWS

Early in the morning of august 4, 2008, an adult male patient was brought to a hospital’s emergency room (ER) for severe chest pains. The defendant ER doctor determined the patient was not having an acute heart attack. A CT scan showed that he had a dilated aorta and may have been suffering from an aortic dissection, which would require immediate surgery to save his life. A CT scan with contrast was needed to confirm the aortic dissection diagnosis.

As the ER doctor’s shift was ending, he decided to delay the contrast CT test until the patient was admitted to a room. He gave the defendant internist instructions to admit the patient and take over as the patient’s attending physician. The ER doctor also asked the defendant cardiologist to provide a consultation. However, the cardiologist never saw the patient or had anyone from his office see him.

The patient was admitted to his room where two nurses evaluated him. However, neither nurse saw, entered or completed the ER doctor’s order for a contrast CT test. The internist called the hospital twice to inquire about the patient, but did not check on the status of the contrast CT scan or the patient’s diagnosis.

Later in the morning, a second defendant cardiologist saw the patient but he knew nothing about the ER doctor’s order for a contrast CT. After examining the patient and reviewing his records, he suspected an aortic dissection and ordered a contrast CT scan, but did not put a rush on the test. He also ordered an echocardiogram. The nurses never saw, entered or completed the second order for a contrast CT test.

laCk oF tiMely Ct sCaN leaDs to patieNt Death Tried: October 15 – 30, 2012 Verdict: $4.5 million

1140 West Lake Street, Suite 500Oak Park, IL 60301

Doctors Direct insurance

$4 Million for Loss of Society and $500,000 for Conscious Pain and Suffering

Claim continues on page 3

NAME THIS NEWSLETTER! Creativity wins an iPad miniCreate a catchy name for DDI’s quarterly newsletter and submit your idea to sales@ddiimail.com to be entered into the drawing to win an iPad Mini. Please email your idea to us with your name and contact no later than July 1, 2013. *Limit 1 entry per email address or contact. Some restrictions may apply, contact Doctors Direct Insurance for full details.

»In this IssueCash-Flow Survival Tips

Q & A with Anesthesiologist

Jay F. Kiokemeister, DO

Online Professional Reputation Protection

Claims in the News