STATE LEGISLATIVE UPDATE

OCTOBER 2003 STATE LEGISLATIVE UPDATE

October is a slow month for legislation so I will take the opportunity to discuss research and studies that are related to the health care topics discussed in the state legislative updates, in addition to the state legislative news.

As of the end of the month, the following state legislatures were in regular session or in recess: MA, MI, NJ, NY, OH, PA, and WI. Through October there have been 172,692 new bills introduced in the states and 41,326 have become law.

Some of the bills the Department of Socioeconomic & State Society Affairs is tracking are outlined below. If you have any questions please give Jay Fisher a call at 800-346-2267, x4336.

TORT REFORM

The Center for Studying Health Center Change in a report about the health care marketplace in Miami notes that Miami physicians "reportedly have become more reluctant to serve as attending physicians for hospitalized patients, to be on call in hospital emergency departments, to provide non-obstetrical consultations for pregnant women with other medical conditions and to serve Medicaid and uninsured patients because of perceptions that these patients are more likely to file malpractice claims." Rising premiums have "prompted growing numbers of physicians to drop their coverage and adopt more defensive practice styles that threaten to increase health care costs and diminish access to care." The report is available at http://www.hschange.org/CONTENT/596/.

Another report by the Center for Studying Health Center Change:
http://www.hschange.com/CONTENT/605/#tr2 concluded that in at least six of the twelve sites studied, "many obstetricians-gynecologists had stopped delivering babies to lower their malpractice premiums. Some ob-gyn practices have concentrated deliveries among relatively few physicians in their groups to reduce overall liability insurance premium costs. In Little Rock, many family physicians have stopped delivering babies. There were also examples in Phoenix, Cleveland, Seattle and Miami of hospitals dropping maternity services altogether or limiting high-risk deliveries. Physicians in many communities, including Orange County, were referring patients more frequently to safety net hospitals and academic health centers. Low-income patients were more likely to be referred because of incorrect physician perceptions that such patients are particularly litigious."

The Wisconsin House of Representatives passed a bill to ensure that money from the Patient Compensation Fund is used only to pay for claims. Earlier in the year the Governor proposed taking $200 million from the fund to help the Medicaid budget. The Fund pays for judgments in excess of the $1,000,000/$3,000,000 coverage that physicians carry in Wisconsin.

SCOPE OF PRACTICE

The Ohio House of Representatives passed a bill to allow podiatrists to have independent admitting privileges to hospitals. Currently, they must co-admit with a MD or DO. The bill now goes to the Senate.

Bills in Massachusetts to expand the podiatric scope of practice to include the ankle have been passed from the Joint Committee on Health Care to committees in the House and Senate.

REIMBURSEMENT

A federal judge approved a settlement between physicians and CIGNA in the major class action suit over alleged federal racketeering charges and violations of state prompt pay laws. According to BNA "Under the settlement agreement, physicians may opt either for a fixed-amount payment calculated on a per-capita basis from a $30 million settlement fund or to resubmit certain claims filed during the class period that would come from a $40 million fund."

Additionally, "CIGNA also will create a physician Web site to provide detailed information about claim coding policies and other payment guidelines . . . . The company will establish an e-mail procedure for physicians to inquire about fee schedules and to obtain claim coding information. In addition, CIGNA will eliminate a requirement that physicians submit copies of their medical records to obtain payment for most office visits occurring on the same day as surgeries and other procedures."

The courts also approved a settlement between Aetna and physicians over racketeering and prompt pay charges. The settlement will improve communication between Aetna and physicians and streamline the payment process.

INSURER LIABILITY

A study published in the September/October issue of Health Affairs reports that lawsuits under state right to sue laws have been rare. In Texas there have been only twelve to fifteen and "In all of the other states combined, experienced lawyers and other key informants knew of only a few suits being filed . . . . Both plaintiffs' lawyers and defendants' lawyers reported that the state right-to-sue laws had not greatly increased managed care organizations' liability exposure, and in the words of more than one observer, they have been a 'non-event.' "

PATIENT PROTECTIONS

The New York State Insurance Department recently released data on the number of appeals in 2002 under the external review law. Forty-four percent of the 878 appeals were decided in the patient's favor. Another 80 cases were decided partly in the patient's favor. Denial of surgical services, inpatient hospital services, and mental health treatment were most often appealed.

EMERGENCY CARE

A study by the Center for Studying Health Center Change found that emergency visits increased to 108,000,000 in 2001, a 16% increase from 1997. Interestingly, visits by privately insured persons increased by 24%, while visits by uninsured persons increased only 10%. There was no change in visits by Medicaid patients and a 10% increase in visits by Medicare patients. Medicare and privately insured patients constituted two-thirds of the increase in emergency room visits. The increase in the number of visits also led to an increase in waiting time in the emergency room. The report can be seen at http://www.hschange.org/CONTENT/613/.