CNA, No. 5 on Modern Healthcare's rankings, with a 4.9% market share, saw a 3.1% increase in direct premiums written, to $477 million in 2013 from $463 million in 2012. It was the only carrier in the top five to see an increase.
The largest carrier, Berkshire Hathaway Insurance Group, had an 8.5% market share last year but saw its business go down 1.7%, falling to just under $826 million direct premiums written (DPW) in 2013 from almost $840 million in 2012.
Others in the top five were: Doctors Company Insurance Group with a 7.6% market share in 2013 and a 7.3% drop in DPW; Medical Liability Mutual Insurance Co., with a 5.6% market share and a 3% drop in DPW last year; and ProAssurance Insurance Group, with a 5.1% market share and an identical percentage drop in DPW in 2013. The decline could also be partly attributed to more providers seeking self insurance, Shapiro and other experts agreed.
ISMIE Mutual Group, ranked No. 10 on Modern Healthcare's ranking with a 2.5% market share and a 7.5% drop in 2013 DPW. Its chairman, Dr. Harold Jensen, noted that carriers are also experiencing a challenging market, another contributing factor to falling premium income.
“Fierce competition between companies writing MPL (medical professional liability) policies, and the trend toward hospitals and national practice-management firms buying medical practices make top-line growth very difficult for every MPL carrier,” Jensen said.
Brian Atchinson, CEO of trade group PIAA (formerly Physician Insurers Association of America) said the downward trend is also an indicator of a soft market that has lowered rates over the past eight years.
“In general, there is less opportunity for organic growth in the current MPL market. This is due to a reduction in number of the policyholders available because of the employment trend for physicians,” Atchinson said. But new insurer opportunities still can be found.
“It is worth noting that the increased roles and responsibilities of allied healthcare professionals throughout our nation's healthcare system could be an opportunity for market-share expansion,” Atchinson said. “Also, given that we are seeing more care delivered in ambulatory settings, there may be growth in these areas as well. Of course, along with these opportunities comes increased liability.”
Dr. John Jennings, president of the American College of Obstetricians and Gynecologists, said he believes liability claims are going down, in part because of new reimbursement formulas that emphasize value and quality.
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