Convincing your Hospital to Allow you to go 'Bare' Florida Medical Economics - August 6, 2002 By: Marc Singer, CFP Q: As a result of exorbitant medical malpractice insurance costs, myself and several other physicians are exploring the idea of going bare. We would like to discuss this issue with the hospital where we all have staff privileges, however they don’t seem too receptive to the idea. How can we make a strong argument? A: The medical staff needs to speak with a unified voice. Initially, ob-gyns, orthopedists, neurosurgeons and cardiovascular surgeons should meet for discussion - since these are the highest risk groups, and also represent significant revenue to the hospital. If these specialties properly organize, there should be a reasonable probability of success.             This group of, say, 30-40 doctors can decide if there is any real interest and consensus of opinion in pursuing the issue. I have found that this core group of surgeons can usually rally the rest of the medical staff towards making the change. It may help to have either a financial advisor or health care attorney attend this meeting as a facilitator.             After this primary group is in place, a general medical staff meeting can be organized. It is important that the politically incorrect words ”go bare” never be used. The correct terminology is “self-insure.” The medical staff then will need to vote to change the by-laws pertaining to liability insurance coverage to read, “the physician agrees to comply with Florida law.”             Florida law allows physicians to self-insure if they’re financially responsible for up to $250,000 of a judgment and post a notice in their waiting room stating that they are uninsured. Remember, the physician doesn’t need to actually put up $250,000, he just must agree to be financially responsible at a point in the future.             If you go this route and the hospital board turns you down, more aggressive tactics may be required. What has worked well in some situations is public relations exposure in the media. Hospitals are very sensitive to publicity showing that they may be having difficulty with their medical staff. Remember, doctors are the good guys here. They would like to carry insurance, but simply can’t afford it anymore.             Another approach is competitive pressure. You could say, “If you won’t allow us to do surgery here, we may have to use the other hospital down the road.”             And, while your hospital may allow you to go bare, your managed care organizations (MCO’s) may not. Last year, when asked if a physician could drop coverage, several MCO’s said absolutely not. However, the climate is changing and many now are taking a more wait-and-see-attitude.             It might be possible to offer a $250,000 bond or letter of credit (LOC) to the MCO as a compromise. This could be a single bond or LOC for an entire group of doctors, and would not be the same structure as under Florida law, which requires a bond or LOC for $250,000 / $750,000 per doctor. However, this arrangement is too costly for most physicians. CURBSIDE CONSULT features a different health care industry expert every issue. This week’s expert is Marc Singer, MBA, certified financial planner and partner of Singer Xenos Wealth Management in Coral Gables, 305-443-0060. Singer Xenos does not provide any legal advice.   Please consult with your own attorney.