Bill Klaproth (host): This is AAOMS On the Go. I'm Bill Klaproth and I'm pleased to welcome Dr. Anthony Spina, Chair of OMSNIC, here to discuss what oral and maxillofacial surgeons need to understand about malpractice risk.

Dr. Spina, welcome.

Anthony M. Spina, DDS, MD: Yeah. Thanks Bill. I appreciate you having me.

Host: Yeah. Thank you so much. Always great to talk with you. So let's start with this. What is your background and how did you end up involved with OMSNIC?

Anthony M. Spina, DDS, MD: Okay, great question. I'm a practicing oral and maxillofacial surgeon in Chicago. I attended dental school at Loyola in Chicago and my residency and medical degree at the State University of New York at Buffalo. I started my career in academics. I was a faculty at the University of Kentucky for two years, and then transitioned into private practice here in Chicago.

Early in my career, I became involved with some AAOMS committees. And then was appointed to the Illinois Dental Board for eight years. I was asked to participate in the OMSNIC Advisory Board, which started in 2007 for me. I was then asked to participate in the claims committee in 2011, and in 2013 I was honored and fortunate enough to be nominated to the Board of Directors and have served on the board since 2013.

And in September of 2024, I became chair of OMSNIC.

Host: Love it. Well, thank you so much for your service, and obviously you know this space very well being very tenured in this. So, Dr. Spina, can you provide some insight about malpractice insurance that your OMS colleagues might find helpful?

Anthony M. Spina, DDS, MD: Sure. So malpractice insurance is also known as medical professional liability insurance. I always view this as the most fundamental insurance we need as healthcare providers. I only insure what I cannot afford to replace, and I cannot afford to replace my profession. I want to protect my profession with the best liability insurance available, and that's OMSNIC.

The malpractice insurance protects our ability to practice and deliver care to our patients. In addition, it also protects us if we have a dental board action. Everybody thinks of liability insurance with legal actions and claims in a courtroom, but our license can also be impacted by dental board actions and medical professional liability insurance protects and represents us if we have dental board actions.

You have to have medical professional liability insurance. Every state has requirements. When we apply for hospital privileges, they ask if we have liability insurance. When we apply for credentialing with insurance companies, the payers, they want to make sure we have liability insurance. It's part of what we need in order to practice.

Host: It’s really powerful when you say, I insure things that I cannot afford to replace and I cannot afford to replace my profession. So that is really powerful. And I understand there's two types of policy, a claims-made versus occurrence policy. I'm wondering, does it matter what type of policy an OMS has?

Anthony M. Spina, DDS, MD: It’s a great question and one we hear frequently, and it can be a little confusing. As you said, two types of policy – claims-made and occurrence. And we're always asked, “What's the difference?”

Claims-made is the most common type of coverage in the medical professional liability space, and we believe the superior coverage for a variety of reasons.

A claims-made policy covers an alleged negligent incident that occurs and is reported while a policy is in effect. Think about claims-made with a start and an end date to the policy. The start date may involve retroactive date or nose coverage, and the end date may involve tail coverage. It's a continuous policy coverage within those dates.

An occurrence policy responds and covers treatment or an alleged incident that occurred during the policy year, regardless of when the claim is reported. And you can think about occurrence policies as an annual policy. You buy a policy one year at a time. That's an occurrence policy.

We're often asked, “What happens if I change my insurance carriers during my career?” Or, “What happens if I want to increase my limits later in my career?”

With an occurrence policy, you are locked into that carrier. You've bought coverage for a particular year, and that carrier will cover you for that particular year, even if you change. There's some disadvantages to that. You may no longer be insured with that company and have to rely on a previous relationship to manage a claim for you. That company may or may not be deeply involved in the OMS space at the time you have an alleged incident or a claim occur. And you can't change your limit. You're locked into that limit. You purchased a limit for that year, and that's your limit. It can't be changed.

The claims-made is different. When you have a claims-made policy, it's portable. You can change carriers if you want, and you can get a retroactive date that will cover you for previous timeframes.

The other advantage is if you want to increase your limits later in your career and you're with the same carrier, your insurance has been with OMSNIC your entire career, that increase in limits goes back in time to your start date. So as long as you've had that continuous policy and you want to increase your limits, it's just not for that year, it's for your whole policy, and it goes back in time. Huge advantage in the medical professional liability space.

Host: So claims-made policy, if I heard you correctly, that is the most common and preferred because it does offer superior protection over the full course of their career. Is that right?

Anthony M. Spina, DDS, MD: It’s correct. We believe it's the superior product. It provides some flexibility as you practice. It's portable. You can change locations and that policy can move with you.

Host: Yeah, absolutely. So that's a good distinction between the two. So Dr. Spina, you mentioned you're a practicing OMS, so as an OMS yourself and the Chair of OMSNIC, you have a unique perspective. Can you share what makes OMSNIC distinctive as a malpractice insurance company?

Anthony M. Spina, DDS, MD: Sure. I think the best way to answer that is maybe provide a little history. So in the mid-80s, 1984 to ‘87, the medical professional liability space was going through a hard market, which means the rates were increasing steadily, sometimes over 150 percent. And at that time, the claims were not being vigorously defended. The OMS were frustrated by the increasing premiums, not receiving the defense that they thought that they needed or deserved.

So in 1987, AAOMS, our association, our national association had a committee that they charged with investigating professional liability and insurance, and through the work of that committee in 1988, AAOMS Mutual Insurance Company was formed.

That company existed in that present name until 1992 when the company demutualized and formed AAOMS National Insurance, which now was a stock holding company, and therefore the policy holders became stockholders.

In 2001, the company was rebranded as OMSNIC and that's when we adopted the “Defending the Specialty” logo or tagline, which is part of our mission.

And the company in the ‘80s was founded on some principles that still hold true today. First, aggressive defensive claims. We wanted to defend the specialty. We wanted to have a reputation of standing behind our policy holders, our colleagues, and defending their care and treatment.

We wanted them to have some control of their liability insurance. So, by being engaged and stockholders, they have a voice in the company. A formal voice through our proxy and our shareholder vote annually, but an informal voice because the company has always been run by OMS. And because we are such a small community, the ability to reach out to a director is real, and our policy holders have the ability to talk to all of us and share their ideas and thoughts so we can protect them and make the company the best OMS liability company there is.

The third thing that we did is we thought that not only we needed aggressive defensive claims, but we also needed to provide really good risk management. It's called patient safety and risk management, and the company was founded on the principle that if we educated our insureds and provided them with good risk management strategies, tried to improve patient safety, we would create a group of better practitioners. Hopefully safer practitioners. Practitioners who were really good at documentation. So in the event of a claim, we were able to defend them well.

Host: That is quite an evolution. I love the history, so thank you for that, Dr. Spina. That committee in 1987, they really did a great job in getting it on the right path.

Anthony M. Spina, DDS, MD: They did. And I was fortunate enough to know several of those initial committee members and know them well and speak to them directly about the early days of the company. And it was a heavy lift and a lot of work. But I think the right people were on that committee and working with that AAOMS committee, the company had a great genesis.

Host: Absolutely. A job well done. So let's switch gears a little bit because I'm sure this is a question that's asked a lot. Can you tell us about what the claims review process looks like?

Anthony M. Spina, DDS, MD: Sure. This is why people buy the insurance. People buy it in case there's a claim, and I think we manage OMS claims better than anybody else. Throughout the history, we have over 21,000 claims, and I'm going to let that number sink in for a minute. Over 21,000 claims.

And with that number of claims, we have lots of experience and data, which helps us every year go forward and defend our policy holders.

So if a claim is reported, we have a team of claims analysts, many of whom are attorneys, and that's the contact for an insured at the company. The claims analyst gathers records, puts a file together, and then that claim is presented at a claims meeting.

The claims committee meets every other month. There are seven thought-leading OMS on that committee. There's a few of us that are standing committee members, and then we have guest reviewers who rotate through. As part of that committee, we have the doctors, all the claims analysts, representative from patient safety and risk management, and a representative from underwriting.

And the doctors on the committee review 21 claims at each meeting. So the claims are divided amongst the docs. And it’s our responsibility to comb through the file and learn about the claim. The doctors present the claim to the committee, and our job is to evaluate the medicine. We want to look for every strength in that claim to defend the claim, but we're also looking for some potential weaknesses, some potential areas of liability, so we can discuss them and have strategies to mitigate them.

We're really looking at the defensibility of the claim, and then the legal aspect is laid on top of that as a secondary look. The committee has a robust discussion. It's an open, honest discussion. Seven doctors all asking questions, claims analysts asking questions. We review x-rays at those meetings. We come to a conclusion about the disposition of the case: defensible, sometimes we need to settle, sometimes we need more information. It's very dependent on the facts of the case.

And then the claims analyst works with the assigned attorney and the insured. It's a team effort. But it's really, it starts with the insured. The insured wants to, has to be able to defend their care and treatment, and that's where it starts.

And then the claims analyst and the attorney work in concert to defend and manage that claim.

Listen, the other thing I just wanted to mention, because all the OMS there are practicing, because we are all involved in the specialty and we understand the medicine. We also understand the emotional component of this. We understand what it's like to be named in a suit or a department of professional regulation suit claim.

And we understand it, and I think it's what makes us special is that we're all practicing. We understand the medicine, we understand what patient care involves, and we understand that we are representing a colleague when we sit at that claims table.

Host: Yeah, the emotional component is really important as well, so I'm glad you brought that up. And with 21,000 claims defended, as you said, you've got the experience and the data behind you. So if someone does bring a claim, you probably pretty much have already seen it. So over time, the benefit of all the claims that you've defended certainly helps the specialty without question.

Anthony M. Spina, DDS, MD: Yeah, it's a very good point. And it's true. Certainly every claim is individual and there's individual facts to every case. But the experience matters. That large volume of cases matters. And we have some claims analysts who have been involved at the company for decades. So it's not only the data that we have as history, but it's also people sitting at the table who have been there for a long time who understand the claims and can comment on the claims from historical perspective as well.

Host: Important points to consider and remember. So Dr. Spina, what recommendations can you offer to help OMSs prevent malpractice allegations?

Anthony M. Spina, DDS, MD: So that's another question we get asked all the time. There's no way to prevent an allegation. That is completely dependent on a patient. The patient has complete control over that. But what we try to teach is strategies that if that happens, how to manage that.

Certainly, you have the backing of the company. The company is here to represent you.

Probably the best advice I can offer is excellent documentation. When there's an allegation, patients most often come with a story, and we have the advantage of having a written record. And that record should work in our favor. It should be a good, honest, detailed record that helps defend the care and treatment. It's the foundation of the defense.

So if there's one big message in this conversation we're having, it's to be a really good, thorough, honest, accurate documentarian, because your defense is based on that.

I was taught a long time ago by some mentors that the success falls within three A's. You have to be available, you have to be affable, and you have to be able. And I think those three A's of success apply to lowering the chance of having a claim filed against you in a medical professional liability action. If you're available for patients, you take good care of them, you're affable and honest with patients, and you do your best surgical job; I think the chance of having a suit goes down. It's not eliminated, but I think if we all did those things, we'd have a lower chance or lower frequency of maybe being involved in a suit.

Host: Again, good points to remember and that documentation angle really, really is important. Dr. Spina, this has really been wonderful. You've really given us a lot of things to think about and really given us a lot of education on the background of this. Before we wrap up, are there any final thoughts that you'd like to add?

Anthony M. Spina, DDS, MD: Yeah, just, one final thought. When we're all doing surgery and patients come in and they're anxious and nervous, part of that is because it's the fear of the unknown. And I like to tell my patients, I know you're anxious because you're unknown. You don't know what's going to happen. But we do. And you have to trust us and remember that we know the process here, let us take care of you.

The same thing happens on the liability side. As surgeons, we're not used to being embroiled in a legal action. It's unknown to most of us. It's fearful because of the unknown. But at OMSNIC, we know the process.

I just want our insureds to know that we're here to take care of you. We understand all the aspects of a liability claim, and we want you to know we know it, and we're here to take care of you.

Host: A great way to wrap up Dr. Spina, thank you so much for educating us about malpractice risk. All of this information is always vitally important. Dr. Spina, thank you again. We really appreciate it.

Anthony M. Spina, DDS, MD: Yeah. Bill, thank you for your time. I really appreciate it. Thank you so much.

Host: Absolutely, and once again, that is Dr. Anthony Spina, Chair of OMSNIC. To learn more, you can visit AAOMS.org and OMSNIC.com.

Once again, AAOMS.org and OMSNIC.com for more information.

And if you enjoyed this podcast, please share it on your social media and make sure you subscribe so you don't miss an episode. I'm Bill Klaproth. This is AAOMS On the Go. Thanks for listening.