- Email: [email protected]
Insuring our professional future
J Oral Maxillofac
Surg
48:913.1990
Insuring our Professional
Future
Although the AAOMS Mutual’s Underwriting Committee makes every effort to be responsive to the needs of the oral and maxillofacial surgeon, it has an equally important obligation to shield the company from high-risk participants, because only in this way can it control costs and remain fiscally sound, In exercising this responsibility, about 16% of those applying the last 2 years have been rejected. On the other hand, about 60% of those initially denied coverage were eventually insured after an appeal process. This is a clear indication of a responsiveness unlikely to exist with a profitoriented commercial carrier. Claims management is another important consideration in choosing an insurance company because indemnity payments and defense costs make up the largest expense of any liability carrier. AAOMS Mutual minimizes this expense by ongoing claims monitoring and management. This process is aided by those who are insured feeling confident that they can promptly report incidents without being unduly penalized. An ancillary benefit of peer-reviewed claims management is the ability, for the first time, to collect data that will help identify areas of risk. Such information not only will be used to run the company more efficiently, but it also will provide an opportunity to alert those insured regarding areas of potential increased liability. In addition to offering sound underwriting policies and careful claims management, the AAOMS Mutual Insurance Company offers a number of other outstanding benefits. These include premium waiver for primary tail coverage on retirement at age 591/2or later after 5 years in the program, availability of prior acts coverage upon transfer from many other programs, deferred surplus contribution during the first year in practice, and a periodic premium finance plan. In 1990, the company was even able to offer an average 10% nationwide rate reduction, an indication of its sound management. Currently, there are a number of companies competing for the liability insurance business of the oral and maxillofacial surgeon on the basis of lower premiums. Although price is an obvious concern in our current upward spiraling economy, one needs to take a long-range view in such matters. The AAOMS Mutual policy presently may not be the least expensive, but its other advantages still make
The sudden increase in malpractice claims beginning in the 1970s gave rise to changes in the insurance industry that are still being felt today. Many commercial companies suddenly stopped issuing liability insurance, leaving practitioners without coverage; others raised premiums astronomically. Those who remained in business generally began to classify oral and maxillofacial surgeons with other medical professionals, resulting in fluctuating premium rates based on the history of claims against the entire group. When an explanation was requested regarding what was occurring, we usually were told that claims and settlements against oral and maxillofacial surgeons had greatly increased. However, there was no way to document the basis for such statements. As the problems continued to magnify, the AAOMS Board of Trustees and the Committee on Insurance began to seek ways to protect the interests of its membership. After exploring numerous possibilities, the AAOMS Mutual Insurance Company was founded in 1988 to provide obtainable, stable, professional liability coverage tailored to the unique needs of the oral and maxillofacial surgeon. What this company has been able to achieve in a brief 2-year period is perhaps unparalleled in the insurance industry, and is a testament to the many dedicated members who have worked, and continue to work, on this project. A company founded by one’s professional organization, owned by the policy holders, and supervised by practicing oral and maxillofacial surgeons obviously has many advantages. First and foremost are its underwriting policies. The AAOMS Mutual’s Underwriting Committee consists of oral and maxillofacial surgeons who are aware of the dynamic aspects of our specialty, the ever-expanding scope of our practice, and the differing needs of our membership. Thus, they can respond quickly and responsibly to such changes. To ensure that each applicant receives a fair review, the Underwriting Committee has established a subcommittee to consider appeals from those who were initially denied coverage by the company. This provides a balance between conventional underwriting requirements and a system that is responsive to the needs of the practicing surgeon, and in which there is understanding of procedures performed and actual risks involved.
(continued
913
on page
1017)
CURRENT LITERATURE
Endurance and Recovery From a Sustained Isometric Contraction in Human Jaw-Elevating Muscles. Jow RW, Clark GT. Arch Oral Biol 34:857, 1989 Neuromuscular fatigue can be assessed by evaluating the electromyographic (EMG) signal, the maximum force ability, or the endurance capability of a sustained contraction. Studies have demonstrated that patients with myofascial pain dysfunction (MPD) have significantly less muscle endurance than healthy subjects. Although maximum force levels remain relatively constant, endurance times for each contraction decrease progressively. Research has shown that there is a shift of the mean power spectrum of the EMG frequency spectra to a lower frequency during sustained contraction. This shift is presumably secondary to neuromuscular fatigue. Unfortunately, no studies to data have checked for a concomitant change in the EMG/force ratio or a loss of bite force ability. This study was conducted in order to evaluate the effect of a variable postcontraction rest period on endur-
1017
ance time, and to check for changes in the EMG-force ratio before or after a sustained 100% maximum voluntary contraction (MVC). Ten males sustained MVCs of the elevator muscles. Electromyographic signal activity and unilateral bite force were measured from the right masseter and temporalis muscles. Three endurance trials were conducted, each consisting of two sustained 100% MVCs. Between tasks, subjects took a randomly assigned rest of either 30, 120, or 300 seconds. EMGs were taken before and after each MVC. The differences in endurance times between the first and second clenchings were greatest for the 30-second rest. The beginning EMG frequency was significantly greater than the end in each case. These findings suggest that even though the jaw elevators are resistant to a contractible element failure, a contraction-induced pain is produced which limits a sustained closing effort.-C.M. WORLEY Reprint requests to Dr Clark: Dental Research Institute, UCLA School of Dentistry, Center for Health Sciences. 73-029. Los Angeles, CA 90024-1762.
(Continued from page 913)
it the best value for the dollar. The intent at the moment is to build a fiscally solid company rather than to cut corners to compete monetarily. As membership increases, however, the fixed expenses will be shared by more, and everyone should pay less. Moreover, because it is a mutual company, the surplus contribution of each member could be returned in the future. AAOMS Mutual
gives all eligible AAOMS members the ability to obtain stable premiums and continued access to insurance from a solid, responsive, peer-controlled company. What better investment can we make to ensure our own professional destiny.
DANIEL M. LASKIN
Surg
48:913.1990
Insuring our Professional
Future
Although the AAOMS Mutual’s Underwriting Committee makes every effort to be responsive to the needs of the oral and maxillofacial surgeon, it has an equally important obligation to shield the company from high-risk participants, because only in this way can it control costs and remain fiscally sound, In exercising this responsibility, about 16% of those applying the last 2 years have been rejected. On the other hand, about 60% of those initially denied coverage were eventually insured after an appeal process. This is a clear indication of a responsiveness unlikely to exist with a profitoriented commercial carrier. Claims management is another important consideration in choosing an insurance company because indemnity payments and defense costs make up the largest expense of any liability carrier. AAOMS Mutual minimizes this expense by ongoing claims monitoring and management. This process is aided by those who are insured feeling confident that they can promptly report incidents without being unduly penalized. An ancillary benefit of peer-reviewed claims management is the ability, for the first time, to collect data that will help identify areas of risk. Such information not only will be used to run the company more efficiently, but it also will provide an opportunity to alert those insured regarding areas of potential increased liability. In addition to offering sound underwriting policies and careful claims management, the AAOMS Mutual Insurance Company offers a number of other outstanding benefits. These include premium waiver for primary tail coverage on retirement at age 591/2or later after 5 years in the program, availability of prior acts coverage upon transfer from many other programs, deferred surplus contribution during the first year in practice, and a periodic premium finance plan. In 1990, the company was even able to offer an average 10% nationwide rate reduction, an indication of its sound management. Currently, there are a number of companies competing for the liability insurance business of the oral and maxillofacial surgeon on the basis of lower premiums. Although price is an obvious concern in our current upward spiraling economy, one needs to take a long-range view in such matters. The AAOMS Mutual policy presently may not be the least expensive, but its other advantages still make
The sudden increase in malpractice claims beginning in the 1970s gave rise to changes in the insurance industry that are still being felt today. Many commercial companies suddenly stopped issuing liability insurance, leaving practitioners without coverage; others raised premiums astronomically. Those who remained in business generally began to classify oral and maxillofacial surgeons with other medical professionals, resulting in fluctuating premium rates based on the history of claims against the entire group. When an explanation was requested regarding what was occurring, we usually were told that claims and settlements against oral and maxillofacial surgeons had greatly increased. However, there was no way to document the basis for such statements. As the problems continued to magnify, the AAOMS Board of Trustees and the Committee on Insurance began to seek ways to protect the interests of its membership. After exploring numerous possibilities, the AAOMS Mutual Insurance Company was founded in 1988 to provide obtainable, stable, professional liability coverage tailored to the unique needs of the oral and maxillofacial surgeon. What this company has been able to achieve in a brief 2-year period is perhaps unparalleled in the insurance industry, and is a testament to the many dedicated members who have worked, and continue to work, on this project. A company founded by one’s professional organization, owned by the policy holders, and supervised by practicing oral and maxillofacial surgeons obviously has many advantages. First and foremost are its underwriting policies. The AAOMS Mutual’s Underwriting Committee consists of oral and maxillofacial surgeons who are aware of the dynamic aspects of our specialty, the ever-expanding scope of our practice, and the differing needs of our membership. Thus, they can respond quickly and responsibly to such changes. To ensure that each applicant receives a fair review, the Underwriting Committee has established a subcommittee to consider appeals from those who were initially denied coverage by the company. This provides a balance between conventional underwriting requirements and a system that is responsive to the needs of the practicing surgeon, and in which there is understanding of procedures performed and actual risks involved.
(continued
913
on page
1017)
CURRENT LITERATURE
Endurance and Recovery From a Sustained Isometric Contraction in Human Jaw-Elevating Muscles. Jow RW, Clark GT. Arch Oral Biol 34:857, 1989 Neuromuscular fatigue can be assessed by evaluating the electromyographic (EMG) signal, the maximum force ability, or the endurance capability of a sustained contraction. Studies have demonstrated that patients with myofascial pain dysfunction (MPD) have significantly less muscle endurance than healthy subjects. Although maximum force levels remain relatively constant, endurance times for each contraction decrease progressively. Research has shown that there is a shift of the mean power spectrum of the EMG frequency spectra to a lower frequency during sustained contraction. This shift is presumably secondary to neuromuscular fatigue. Unfortunately, no studies to data have checked for a concomitant change in the EMG/force ratio or a loss of bite force ability. This study was conducted in order to evaluate the effect of a variable postcontraction rest period on endur-
1017
ance time, and to check for changes in the EMG-force ratio before or after a sustained 100% maximum voluntary contraction (MVC). Ten males sustained MVCs of the elevator muscles. Electromyographic signal activity and unilateral bite force were measured from the right masseter and temporalis muscles. Three endurance trials were conducted, each consisting of two sustained 100% MVCs. Between tasks, subjects took a randomly assigned rest of either 30, 120, or 300 seconds. EMGs were taken before and after each MVC. The differences in endurance times between the first and second clenchings were greatest for the 30-second rest. The beginning EMG frequency was significantly greater than the end in each case. These findings suggest that even though the jaw elevators are resistant to a contractible element failure, a contraction-induced pain is produced which limits a sustained closing effort.-C.M. WORLEY Reprint requests to Dr Clark: Dental Research Institute, UCLA School of Dentistry, Center for Health Sciences. 73-029. Los Angeles, CA 90024-1762.
(Continued from page 913)
it the best value for the dollar. The intent at the moment is to build a fiscally solid company rather than to cut corners to compete monetarily. As membership increases, however, the fixed expenses will be shared by more, and everyone should pay less. Moreover, because it is a mutual company, the surplus contribution of each member could be returned in the future. AAOMS Mutual
gives all eligible AAOMS members the ability to obtain stable premiums and continued access to insurance from a solid, responsive, peer-controlled company. What better investment can we make to ensure our own professional destiny.
DANIEL M. LASKIN