April 2001 Bulletin

In Brief

The Connecticut State Medical Society filed suit against six HMOs in state court seeking monetary damages and a court order to stop some HMO business practices. The lawsuits allege the for-profit HMOs are breaching contracts with doctors and violating state law by making decisions about patients’ care and failing to pay claims on time. The six companies being sued are Aetna U.S. Healthcare, Anthem Blue Cross and Blue Shield, CIGNA HealthCare, ConnectiCare, Oxford Health Plans and Physicians Health Systems. The medical society represents 7,000 doctors.

The Arizona House Business and Industry Committee tabled a bill to eliminate the sales tax on medical services. The bill would phase out the tax on gross receipts on a range of health care givers, including doctors, by July 1, 2005. Another bill would phase out the tax by July 1, 2003. The tax varies across the state but averages about 6 percent.

West Virginia
More than 300 doctors packed a Charleston, W. Va. room in February to meet state agency directors involved in health care issues and vent their frustrations over rising insurance costs, medical malpractice and the provider tax. Paul Nusbaum, secretary of the department of health and human resources, opened the meeting by saying the provider tax is not going away unless an alternative can be found. Providers pay 2 percent of their gross income. The tax produces about $125 million for the state’s Medicaid program that guarantees federal funding; this brings the annual total to $500 million.

A survey of 450 physicians by the Chester, Delaware and Montgomery County Medical Societies in Pennsylvania found 77 percent of local medical practices are jeopardized by the recent dramatic increases in the costs of the malpractice insurance. According to the Delaware County Medical Society, 58 percent indicated that they may have to close their practices and 69 percent cannot afford to hire the additional support staff they need in their practice because of the increased costs of malpractice insurance. Others reported reducing employee benefits, laying off staff, considering moving to another state or region, retiring early or entering another profession.

Private medical records would be protected from theft or use by marketing firms, according to a bill proposed by Michigan lawmakers and the state’s Attorney General. A blanket release form allowing patients’ records to be given to insurers or other physicians would be prohibited; a patient would have to authorize each release of a record. Also, patients would be guaranteed access to their own records. A health care provider would have to keep records available for at least seven years.

Joint negotiating
So far this year, five states have introduced legislation to allow physicians to jointly negotiate contract terms with insurers. The states are Alaska, Connecticut, Florida, Illinois, Massachusetts, Missouri, Rhode Island and Tennessee. A bill in Montana died for lack of action. A bill was passed by the New Jersey Senate and is awaiting action in the state House of Representatives.

Immunity<BR> Bills to grant volunteer physicians civil immunity from lawsuits for providing care are being considered in Connecticut, Massachusetts, Michigan, Mississippi, New Jersey, New York, Tennessee and West Virginia. A bill in Wyoming never advanced out of committee.

Prompt payment
Prompt payment bills were introduced in Alabama, Connecticut, Kentucky, Maine, Oklahoma, Oregon, Tennessee and Texas. The bill in Alabama excludes Blue Cross/Blue Shield, which covers the majority of people in the state. The Oregon bill was introduced by the Oregon Association of Orthopaedists. The Missouri bill allows doctors to file a civil action and obtain the amount of the claim, interest owed and a $50 a day penalty that starts 10 days after the interest penalty starts. The prompt payment bill in Utah, which was approved by legislators in February and awaits the governor’s action, gives insurers 30 days to pay clean claims, provide written explanation for a denial or specifically request additional information needed to process the claim. The provider has 30 days to respond with additional information. There is a provision to extend the insurer’s time period to further investigate the claim. Interest on late fees accrues at the rate of 0.1 percent a day for the first 90 days and at a rate of 10 percent a year thereafter.

Medical errors
Legislation to require reporting of medical errors or improve procedures has been introduced in Connecticut, Illinois, Iowa, Maryland, Massachusetts, New Mexico, New York, Pennsylvania, Tennessee and Washington. Bills to study the issue have been introduced in Kentucky, Massachusetts, and Missouri. Legislation to develop physician profiles has been introduced in Illinois, Indiana and Ohio.

On the Internet
If you want to keep tabs on what your state legislatures are doing, you can click on the web site set up by the National Conference of State Legislatures at www.ncsl.org/public/leglinks.cfm. The site provides direct links to the sites of state legislatures, and the home pages of legislators. There are also links to enable you to see and hear your legislators in 36 states on the Internet and/or TV.

Bone and Joint Decade
During the Board of Councilors meeting in February, several state societies were recognized for having obtained Bone and Joint Decade proclamations from their state officials. Receiving citations on behalf of the New York State Society were Thomas Lombardo, MD; James Striker, MD; Philip A. Fontanetta, MD; Edward Toriello, MD; and Leroy Cooley, MD. Donald Saltzman, MD, received a citation on behalf of the Maryland State Society; Dennis Gordon, Utah State Society; and Craig Smith, MD, Wyoming State Society. There are now 45 states which have Bone and Joint Decade proclamations.

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