April, 2001

The Connecticut State Society
of Anesthesiologists

President: Mark Gerber, M.D.
Vice President: Jeffrey Gross, M.D.
Secretary: Franklin Rosenberg, M.D.
Treasurer: John Satterfield, M.D.
Director, ASA District 3: Jan Ehrenwerth, M.D.
Alternate Directors: Jonathan Katz, M.D
Richard Browning, M.D.
Delegates to the ASA: Jeffrey Gross, M.D.
Anthony Peluso, M.D.
John Muller, MD
Stanley Rosenbaum, M.D.
Alternate Delegates: Zeev Kain
Kenneth Stone, M.D.
David Mancini, M.D>
Kenneth Gutierrez, M.D.
Program Chairman: David Mancini, M.D.
Newsletter Editors: Richard Kemp, M.D.
Craig Dennen, M.D.
CSSA Website: Kenneth Gutierrez, M.D.
Placement Committee: Zeev Kain, M.D..
Executive Secretary: Jill Fuggi
Legislative Consultants: Sullivan & LeShane, Inc.

Keep Those Cards and Letters Coming

Jonathan D. Katz, M.D.

As you know, an ill- conceived last minute Clinton decision has the potential of dramatically and definitively changing how anesthesiology is practiced throughout this country. This proposed rule change would be issued from HCFA and would essentially remove the current federal requirement for physician administration or supervision of anesthetics administered to Medicare and Medicaid beneficiaries. In a not- unlikely scenario, Connecticut law, and eventually hospital by-law would sooner or later follow suit. These latter two would not be specific as to beneficiary status and would include ALL patients. These drastic changes would occur despite overwhelming scientific data that show significantly fewer deaths and overall improved anesthesia outcomes when an anesthesiologist either supervises or directly administers the anesthesia care. (For further details on this proposed change, please visit the ASA website.)

Well, the die is not completely cast. Each anesthesiologist who practices in Connecticut MUST mail/ e-mail/ telephone/ FAX his or her U.S. Representative and Senators to express their concern about this proposed regulatory change. Your elected officials are already well aware of the potential impact on their constituents of this decision. Several of our representatives have responded to our concerns by directing their own inquiries to the appropriate HCFA and administration officials. What they need to know is how each of you feels about this course of events. You are the expert in anesthetic patient care and your elected officials rely on you for advice. Your representatives hold the power to reverse this decision. Few items on the health care agenda of recent years has demanded your input more.

I want to switch gears now for a personal note. I have decided not to seek reelection this spring to my position as ASA Alternate Director. I have been offered a "promotion", to Chair the ASA’s Committee on Occupational Health and have eagerly accepted that offer. I have been an elected officer of the CSSA and ASA since 1978 and am proud of the work that we have done in those years. Today, we are as strong and vital as we have ever been, a claim that can be made by few arms of organized medicine. A fundamental strength of the CSSA is the plethora of young, committed anesthesiologists who are willing and able to serve. I believe it is time for me to make room for these incredibly talented anesthesiologists to make their own contributions.

I am very excited by the challenges and opportunities offered in my new role with the Committee on Occupational Health. I expect to continue to receive your help and support. See you at the next CSSA meeting!

The Promise of Spring

Mark Gerber, MD

As winter turns into spring, there is another renaissance on the horizon-this one in the health care industry. Last month the Connecticut State Medical Society filed a lawsuit against six managed care companies. The CSMS is not seeking financial damages, but rather a change in the way these managed care companies conduct business. The ultimate goal is to restore the physician-patient relationship. This will allow physicians to practice medicine in accordance with their education and training and not be governed by arbitrary and capricious rules set forth by the insurance industry. This is a historic lawsuit (one the managed care companies never expected) with far reaching ramifications. Connecticut’s Attorney General has also filed a similar lawsuit. Connecticut’s physicians must support the CSMS in this endeavor.

Another issue of significance to anesthesiologists is the restoration of funding for the dually eligible population. The Medicaid co-payment for this vulnerable group was eliminated in the governor’s 1999 budget, reducing by 20% the amount of reimbursement for the treatment of these patients. Currently, the general assembly is considering a bill, which would restore this funding. It is incumbent upon us, as physicians, to advocate for our patients by contacting our legislators on the importance of this issue.

On March 29, we participated with the CSMS in a press conference calling for inclusion of the funding in the 2001-2003 budget. Several key legislators joined with the physicians in support of this goal including Senators Jepson, Crisco, Cook and Representatives Truglia and Flaherty. In addition, many of the 40 co-sponsors of this legislation were present at the Doctors’ Day rally.

As the budget process moves forward, it is important for us to voice our opinions to our legislators. The Physicians of Connecticut must stay focused on our goal of making this state one in which our patients are afforded the highest quality of medical care. If we are not successful, we physicians will forever be relegated to second class citizens in the world of health care. Neither our patients nor we can afford to let this happen.

CSSA Political Agenda

Anthony Peluso, MD

The 2001 CSSA legislative cocktail reception on March 1st proved to be an enjoyable evening. The reception provided a unique opportunity to converse with state legislators in a comfortable and relaxed setting. The 2001 Legislative Advocacy Award was presented to Senator Thomas Bozek (D-6th District) and the 2001 Patient Advocacy Award was presented to Representative Dennis Cleary (R-80th District). Both these individuals were recognized for being champions of patient advocacy and managed care reform. On behalf of our patients, we applaud the work of Senator Bozek and Representative Cleary.

At the federal level, many of you are already aware that during the week of March 12th, Secretary of Health and Human Services Tommy Thompson signed an order to extend the effective date of the Clinton approved rule change eliminating mandatory physician supervision of nurse anesthetists to mid May.

As you recall, the proposed rule change eliminates the language that all nurse anesthesia care of Medicare and Medicaid participants must be supervised by a physician and defers to state law regarding physician oversight of nurse anesthetists. It is apparent that Secretary Thompson is concerned about the elimination of physician supervision - enough that he requires more time to consider the matter. It is imperative for all anesthesiologists to write to Secretary Thompson and to contact your senators and representatives in order to convey our concern about this rule change.

Please contact me at 860-676-9071 or e-mail me at tcoiae@aol.com for addresses and questions. CSSA has sent a sample letter to every anesthesiology practice in the state. As an aside, bills have been introduced in both chambers of Congress (SB 332 and HR 716), similar to those introduced during the 106th Congress, mandating an outcome study to determine the appropriateness of eliminating the physician supervision rule. The ASA legislative conference in early May will enable us to meet legislators to discuss this matter.

Statewide, there has been a lot of action during this long session. On February 14th, the Connecticut State Medical Society (CSMS) sued six major insurance companies in Connecticut. The lawsuits allege that the health plans of these insurance companies systematically breach the terms of their contracts with physicians and engage in illegal policies and deceptive practices. Attorney General Richard Blumenthal participated in the press conference announcing the lawsuit, quite a dramatic step for a state whose capital is known as the "insurance capital of the world".

As usual, there are dozens of health care related bills introduced this session. Sullivan and LeShane have performed admirably in screening the bills that effect our specialty and guiding us in preparation of testimony during public hearings. I will highlight a few of the bills. SB 128 AAC Medicaid Patient Requirements for Health Care Provider Licensing would require Medicaid participation as a condition of medical licensure. On behalf of the CSSA and the CSMS I testified against this bill which would be tantamount to forced medical servitude. I also testified on HB 6806 AAC the Establishment of Medicaid Rates which strives to reimburse physicians taking care of Medicaid patients at Medicare levels of reimbursement. Passing this bill will be a formidable task with a constitutional state budget cap in place but I can tell you that the legislators are sympathetic to our plight as evidenced by a favorable vote in the Public Health Committee. The dually eligible matter is still out there and faces the same hurdles as HB 6806.

Dr. Gerber and I testified on SB 472 AA Requiring Timely Payment on Health Insurance Claims introduced by Senator Prague. This bill proposes a 300% penalty to insurance companies for late payments. While this bill as written has as much chance as a Chicago Cub-Boston Red Sox world series, the word is out regarding the stall tactics that insurance companies like to employ when it comes to fulfilling their payment obligation to physicians. SB 174, SB 1288 and SB 1198 seek to provide cooperative negotiations by creating a state action exemption from federal antitrust law and enable physicians who do not share economic risk to negotiate with managed care companies under the guidance of the attorney general rather than the federal government.

Dr. Gerber testified on SB 174 before the Public Health Committee. On the patient safety front, HB 6727 AAC Standards of Patient Safety in Physician Offices would require physician offices performing surgical procedures under anesthesia other than local or topical anesthesia to be accredited by JCAHO, AAASF, AAAAHC or Medicare. The CSSA hopes for swift passage of this bill which has been endorsed by the Connecticut Hospital Association. Please note that this issue is completely separate from the Certificate of Need issue.

The outcome of these and other bills will be discussed in a subsequent newsletter after adjournment of this legislative session.

In closing, I would like to extend my sincerest gratitude to my partners at Hartford Anesthesiology Associates for covering my clinical responsibilities so that I can participate in matters that benefit and advance the society's agenda.

Medicare Update

Kenneth Stone, M.D.

The major issue of interest for anesthesiologists regarding Medicare is the proposed rule change in the final days of the previous Administration which would allow independent practice of nurse anesthetists. I am certain that most or all of you are familiar with this matter as a result of the extensive efforts of the ASA to recruit members in an effort to reverse the proposed changes.

As of late March, Secretary Tommy Thompson of the Department of Health and Human Services announced that he would delay implementation of that rule until mid-May. This has given the ASA and its supporters additional opportunity to influence the process by which the final recommendations will be made.

It is absolutely imperative that all CSSA members write to: Secretary Thompson and the Director of the Office of Management and Budget, as well as our elected representatives in Washington (Senators Dodd and Lieberman and your Congressman). Information on how to contact these individuals and what to say can be found on the ASA web site (www.asahq.org).

Anyone who has not yet written letters is urged to do so, and others may consider sending follow up correspondence or telephone calls.

Regarding other matters, the Washington office of the ASA is working to favorably impact a currently ongoing five-year review of anesthesia work codes. The matter is currently being considered by the Relative Value Update Committee and a recommendation to HCFA is expected to be submitted in late April.

On a local level, First Coast Service Options (FCSO) has now been handling Medicare Part B claims for Connecticut for about six months. The former co-medical directors under United Health no longer hold their positions with FCSO. Dr. Sidney Sewell, who serves as the FCSO Carrier Medical Director for Florida, is serving as interim director for Connecticut. It is expected that a new Carrier Medical Director for Connecticut will be named by the end of April.

Minutes of the Executive Board & Business Meeting

Connecticut State Society of Anesthesiologists

March 7, 2001

Max Downtown

^{Members Present:}

M. Gerber
J. Gross
F. Rosenberg
J. Satterfield
A. Peluso
J. Fuggi
J. Ehrenwerth
L. Winkler
K. Stone
P. Leshane
C. Dennen
W. Conrad
R. Kemp

The meeting was called to order by Dr. Mark Gerber.

Presidents Report:

Dr. Mark Gerber

The next CSSA meeting will be in April or May. Roberta Hines, M.D. will be nominated for the ABA. Jan Ehrenwerth will be nominated for District Director and Jonathan Katz, M.D. be renominated for alternate District Director. Paul Barash, M.D. will be submitted for the ASA Distinguished Service Award. The ASA has funds available for state societies ASA related legislative issues.

The CSSA is currently seeking an anesthesiologist who will serve as a mentor for the Resident Component Society of the CSSA.

The ASA Legislative meeting in Washington, D.C. is April 29-May 2, 2001. Those interested in attending should contact Jill Fuggi. Appointments with Key Legislators are being arranged.

The ASA is having a Regional Spokesperson Training Program on Saturday March 31, 2001 in Boston.

Correspondence from the ASA states the CSSA is one of only a few state components that have a communications committee and web site. Letters to Secretary Tommy Thompson regarding the CRNA/MD issue was appreciated and noted. Currently HCFA’s ruling on nurse anesthetists coverage by MDA has not changed do to a suspension of former President Clinton’s ruling by President Bush (see * below).

The Southern New England Anesthesia Conference will be June 2 and 3, 2001 in Boston, Massachusetts.

District Director’s Report:

Dr. J. Ehrenwerth

The Wood Library will have a color version of the A.S.A. seal. The ASA has spent 4.1 million dollars on lobbying efforts. An additional 1.3 million will be spent in the next several months. Net loss last year was approximately 2.5 million dollars.

Officials from the ASA have met with several Bush appointees regarding the HCFA nurse anesthetist issue. At this point several options exist; suspend regulations and go back to the 30 year old CRNA/MDA coverage or reintroduce a MD/CRNA study.

The ASA statement on Professionalism is available from the ASA office.

Many third party payors state TEE should be bundled into the base units. The ASA is trying to establish that TEE is a separate service and warrants a separate fee.

The average Medicare Conversion Fee is $17.77. CT Medicare Conversion Fee is $19.00.

The Federal Government is pursuing a Performance Based Outcome Study. The National Committee on Clinical Outcome Research is presently working with the Feds on this issue. The ASA is presently evaluation different options for these outcome studies.

The ASA has recently published a new brochure on Dealing with the Media.

The ASA has created a new MBA program in Texas.

There is now a Capnography Society started by the ER MD’s.

A.C.O.G has agreed to review its policy on epidural analgesia and C sections.

Members of the Military and VA Anesthesiologists (700 members) would like to have their own component society. Those members are encouraged to participate in their state component societies. Presently members of the Military and VA pay decreased dues.

This years ASA meeting will be in New Orleans, La.

2002 is the 100th Anniversary of the Founding of Academic Anesthesiology by Ralph Waters, M.D.

The ASA has joined with several other professional organizations to help you or your practice create a web site related to your medical practice.

Eight to ten states have legislative issues with nurse anesthetists currently.

Treasurer’s Report:

Dr. J. Satterfield

A $1000.00 contribution will be made to the ASA Patient Safety Foundation, $500.00 to the Anesthesia Foundation and $1,500.00 to F.A.E.R.

For the calendar year 2000 the CSSA is operating within budget. This is primarily due to $3,500 in contributions made by drug and equipment manufacturers to our quarterly meetings throughout the year. For the calendar year 2001 the CSSA will be approximately $1,000 in the red.

Dues notices were recently sent to all members. All members are encouraged to pay their dues and make PAS/PAC contributions promptly.

Secretary’s Report:

Dr. Franklin Rosenberg

Membership has slightly declined this year as several members have relocated out of Connecticut. This may be in part due to reimbursement and cost of living issues.

Lobbyist’s Report:

Lisa Winkler

At the midpoint of the hearing process, and with so many bills introduced during the long session, we thought is appropriate to provide this legislative update on priority bills of interest to the CSSA. As the session continues, we will provide periodic updates and finally, a legislative wrap up following the legislative session.

CSSA Legislative Priorities

Medicaid and Dually Eligible

Restoring funding for the Medicaid co-payment and deductible for dually eligible patients remains a priority of the CSSA, as well as the Connecticut State Medical Society. Central to this discussion is the larger issue of Medicaid reimbursement. We have done a good job at keeping this issue in the forefront of many key legislators minds, and as a result, several bills have been introduced on the issue. It is important to understand, however, the impact of the state spending cap and its effect on the General Assembly’s ability to resolve the budget situation as it relates to the dually eligible. Below is a summary of the bills introduced on the dually-eligible/Medicaid issue.

SB 35, AAC Physician Payments Under Medicaid, SB 469, AAC the Medicare Part B Deductible for Patients Eligible for Both Medicaid and Medicare, SB 927, AA Reinstating Medicaid Funding for Dually-Eligible Patients, HB 6014, AAC the Restoration of Funding for Payments for Patients Eligible for both Medicaid and Medicare, and HB 6444, AA Providing for Full Payment to Physicians for Services Provided to Dually Eligible Patients have all been introduced in response to concerns raised by the CSMS. HB 6444 is the bill we have focused our efforts on, generating 27 co-sponsors. The bill will likely have a public hearing before the Human Services Committee on March 15th. On March 29th, CSMS Doctors’ Day at the Capitol, a press conference will be held on the issue, including several legislative cosponsors.

In the Public Health Committee, SB 1170, AAC Crossover Claim Payments for Patients Eligible for Both Medicaid and Medicare, was raised and a hearing was held on March 1st, generating a great deal of support from the physician community.

And increase in Medicaid rates has also been proposed, at our request, in a variety of bills, HB 6436, AA Increasing the Medicaid Reimbursement Rate Payments, SB 206, AA Increasing Inpatients Medicaid Rates for Aged, Blind and Disabled Beneficiaries, SB 209, AAC Outpatient Payment for Mental Health Services, and SB 426, AA Requiring the Increase of Medicaid Rates.

SB 940, AAC the Provider Fee Schedules Under the Medicaid Program, was introduced by Sen. Crisco at our request, to index Medicaid rates.

In addition, Sen. Harp proposed SB 128, AAC Medicaid Patient Requirements for Health Care Providers Licensing, to require Medicaid participation as a condition of licensure. We met with Sen. Harp to express our opposition and she assured us that it was introduce to generate discussion on the Medicaid issue. Dr. Peluso presented testimony in opposition to the proposal before the Public Health Committee on March 1st. He also testified in support of HB 6806, AAC the Establishment of Medicaid Rates, citing the lack of an increase in 20 years and its impact on the ability to continue treating Medicaid patients.

As the budget process continues, it is important for members of the Appropriations Committee to hear from physicians on the importance of this issue, as well. Physicians testified before the Appropriations Committee on the evening of February 23rd, to discuss the importance of restoring funding and the low rate of reimbursement under the Medicaid program. Our efforts will focus on continuing to increase interest in this issue in the coming months, including media attention and leadership involvement.

Managed Care Reform

Several managed care issues also top the agenda of the CSSA this session. The ability to negotiated with managed care companies, fairness in contracting, and timely payment improvements, have all been introduced and raised for hearing. Already, some legislators have indicated that due to the CSMS lawsuit many issues may not be addressed this session. We expected this response, but will continue to lobby for their passage.

Fairness in Contracting

At our request, Sen. Bozek introduced SB 683, AAC Standards for Contracting Between Physicians and Managed Care Organizations to bring a level of fairness to the contract negotiations between physicians and managed care companies. Under the bill, managed care companies would be required to disclose fee schedules, be prohibited from unilaterally changing contract provisions, ban all product clauses, except for HUSKY, and would prohibit the sale of provider networks without the physician’s knowledge or consent. The CSSA supported the bill before the Insurance Committee at a public hearing on February 27th. HB 5634, AAC Physician Contracts with Health Insurance Plans, was also heard by the Insurance Committee and is similar to SB 683.

Cooperative Negotiations

Similar to the fairness in contracting legislation, cooperative negotiations would create a state action exemption from federal anti-trust law and enable physicians to negotiate with managed care companies under the guidance of the attorney general, rather that the federal government. We were able to get three bills raised in separate committees on this subject, although the Public Health Committee in general and Rep. Eberle remain opposed to their passage.

In the Public Health Committee, Sen. Harp. Introduced SB 174, AAC Health Care Provider Cooperative Agreements. Dr. Gerber joined the Connecticut Society of Eye Physicians, and the CSMS in testifying in support of the bill before the Public Health Committee on February 15th. Despite co-chair support for the bill, Rep. Eberle remains opposed to the measure.

The Insurance Committee also raised SB 1288, AAC Cooperative Health Care Arrangements which has not yet been scheduled for a hearing and Labor Committee raised SB 1198, AAC Cooperative Health Care Arrangements, which will be heard by the committee on Thursday, March 8th. Dr. Peluso will join the CSMS and the CSEP in support of the measure.

Because many issues which originate from the Labor Committee are sometimes not taken seriously in committees of cognizance, we are focusing our efforts in the Insurance Committee.

Payment Issues

Payment issues and late payment problems have become priorities of several legislators as physicians raise concerns with the payment practices of many managed care companies. Several bills have been introduced which address these practices, they include:

SB 472, AA Requiring Timely Payment of Health Insurance Claims, introduced by Sen. Prague, increases the penalty for health insurers that fail to pay health insurance claims within the statutory time period from fifteen percent interest to three hundred percent interest per annum. The bill was referred to the Insurance Committee where Drs. Peluso and Gerber joined the CSMS and the CSEP in support of the legislation on February 8th. The committee voted to draft the legislation. Further action is expected, although several republican members of the committee voiced opposition during a recent committee meeting somewhat based on the CSMS lawsuit.

SB 679, AAC Insurer Liability for Late Payment of Claims, introduced by Sen. Harp, clarifies that a health insurer shall remain liable for paying claims within the statutory time limits regardless of whether the health insurer delegated responsibility to a subcontractor. The Insurance Committee voted to draft the bill on February 1st, and further detail will be added to the bill, and a public hearing scheduled.

HBO 5621, AA Ensuring Timely Payment of Health Insurance Claims, introduced by Rep. Amman ensures that health insurance claims submitted by insureds are paid within the statutory time frames. With other bills already raised on this issue, it will not be scheduled for a public hearing.

SB 257, AA Prohibiting Financial Incentives Based on a Physician’s Treatment Decisions. As drafted the bill would prevent physicians from assuming risk preventing them from negotiating jointly as a group, and resulting in individual contracting. The result would be to remove any bargaining power currently afforded to physician groups. We explained this concern to Sen. Kissel and explained the joint negotiation legislation and its benefits for patients and providers. The bill was proposed with the intent of helping the physician community. A public hearing was held on February 8th, where the insurers joined the CSMS in opposing the bill.

SB 404, AAC Managed Care Organization Reimbursement Rates and Third-Party Management Contracts, referred to the Insurance Committee was reserved for public hearing. Proposed by Sen. Aniskovich, the bill prevent managed care organizations from arbitrarily changing reimbursement rates and to require managed care organizations to provide notice and disclosure of any contracts with third parties. A public hearing was held on February 8th, and the committee voted to draft the bill on February 20th.

Office Based Surgery

Although Certificate of Need regulations for physician offices performing surgical procedures were recently rejected by the attorney general restarting the process within the Office of Health Care Access, the CSMS has again proposed legislation to establish patient safety standards within physician offices. HB 6727, AAC Standards of Patient Safety in Physician Offices, would require physician offices performing surgical procedures under anesthesia other than local or topical to be accredited by JCAHO, AAASF, AAAAHC or Medicare. The issue is completely separate from the CON issue and was heard by the Public Health Committee on March 1st. The Connecticut Hospital Association is on the record in support of the bill based on its merits. We expect the committee to move forward with the measure.

Other bills of Interest

We will continue to monitor and oppose the following proposals in accordance with the CSMS legislative agenda.

SB 169, AAC Medication Related Errors, to require each hospital and surgical clinic, as a condition of licensure, to adopt a formal plan to eliminate or substantially reduce medication-related errors.

SB 177, AAC Collections by Health Care Providers, to require health care providers to complete all the internal and external appeals processes a patient’s insurer may have prior to beginning collection proceedings against the patient.

SB 583, AAC Prescription Errors, to require that all errors made in filling prescriptions be reported to the Department of Public Health and that the department prepare and make available a yearly report concerning prescription accuracy.

HB 6025, AAC Internet Posting of Information Involving Health Care Providers and Insurers, to require the Insurance Commissioner to place on the Internet, for public access, disciplinary actions and other health care related information that is difficult to obtain involving health care providers and insurers.

HB 6045m AA Prohibiting Forced Overtime in the Health Care Industry, to prohibit mandatory overtime for health care workers.

Bills being tracked for the CSSA

In addition to the bills actively supported or opposed by the CSSA, we monitor a host of other bills during the session for possible amendments or other activities. Below is a list of those bills still pending at this point in the session.

Senate Bills

SB 282, AA Eliminating Mandatory Overtime in Health Care Facilities.

SB 560, AA Requiring an Evaluation of Outreach Activities for the HUSKY Plan.

SB 581, AAC Psychologist Licensure by Endorsement.

SB 582, AAC the Licensure of Psychologists by Endorsement.

SB 695, AA Prohibiting Managed Care Organizations from Restricting the Scope of Practice of Licensed Health Care Providers.

SB 700, AA Prohibiting Discrimination of Fees Paid by Managed Care Organizations for Identical Services.

House Bills

HB 5030, AAC Occupational License Fees.

HB 5144, AAC the Licensing of Perfusionists.

HB 5427, AAC the Working Hours of Health Care Professionals.

HB 5676, AAC the Reporting of Cardiac Care Statistics by Hospitals.

HB 5698, AAC Working Hours of Health Care Facility Employees.

HB 5872, AA Implementing the Connecticut Health Care Security Act.

HB 5913, AA Adopting Biennial Licensure Renewal for Certain Professions.

HB 6219, AAC a Tax Credit for Occupational Taxes or Licensing Fees.

HB 6668, AAC the State Budget for the Biennium Ending June 30, 2003 and Making Appropriations Therefor.

HB 6822, AAC Occupational Licenses.

In closing the public hearing process will continue until late March and then committees will take final action on bills under consideration. The CSMS is hosting a legislative reception in the evening on March 29th at the Officers’ Club in recognition of Doctors’ Day. At noon that same day, the society is hosting a press conference on the Medicaid/Medicare issue. We will continue to provide updates and opportunities for grassroots activity throughout the session. You can expect our final legislative wrap-up after the session adjourns on June 6th, around the first week of July.

Political Action Committee:

Dr. A. Peluso

Fifty people attended the Legislative Reception on March 1,2001 at the Town and Country. Patient advocate awards were presented to Representative Cleary and Senator Bozek.

All members of the CSSA are strongly encouraged to contribute to the PAS/PAC and ASA PAC.

After a lengthy discussion the CSSA agreed to a one year contract with the Lobby Firm of Sullivan and Leshane.

Featured Speaker

Attorney Cam Staples was invited to discuss the C.S.M.S. class action lawsuit against six health plans.

An Overview:

The CSMS Class Action Lawsuit

-Provided by Milberg Weiss, Bershad Hynes and Lerach LLP

The Connecticut State Medical Society (the "CSMS"), on behalf of its members, filed separate lawsuits against the following health plans: Cigna, Aetna, PHS, Anthem, Connecticare, and Oxford. The suits, which are brought against six of the state’s largest health plans and which were filed in Connecticut state court, allege that each of these health plans has systematically breached the terms of its contracts with physicians and engaged in improper and/or deceptive practices in violation of the Connecticut Unfair Trade Practices Act. As a result of these practices, the health plans are alleged to have been able to deny, impede, delay and reduce lawful claims for reimbursement to thousands of physicians in the State of Connecticut. Moreover, these practices are alleged to substantially interfere with the physician/patient relationship.

The lawsuits identify specific practices that the health plans are alleged to have employed to systematically breach the terms of their contacts with physicians and engage in unlawful business practices. Although the complaints are based on the particular contracts employed by the respective health plans and the ways in which each of the plans operates, the complaints identify a number of common practices used to avoid fully compensating physicians and interfere with their ability to deliver quality care to their patients. These common practices include, among others, arbitrarily reducing a physician’s payment for rendering medically necessary care by downcoding, bundling or refusing to pay a modifier on claims for services; arbitrarily overruling a physician’s "medical necessity" determinations without conducting a proper analysis or review; failing to pay physicians in a timely fashion; failing to provide a proper explanation when a claim has been denied payment; failing to pay interest on claims according to Connecticut’s Prompt Payment Law; failing to properly staff clinical and utilization departments and engaging in improper claims review by employing computerized programs to automatically reduce or deny claims; and exploiting the parties’ unequal bargaining power to force physicians to enter into one-sided, non-negotiable contracts which infringe upon the physician/patient relationship and threaten the continuity of care physicians provide to their patients.

The lawsuits are brought by the CSMS in its representative capacity as an associational organization and seek injunctive relief on behalf of its members. The CSMS lawsuits are parallel actions to six lawsuits brought by individual physicians against the same health plans on behalf of themselves and separate classes of CSMS physicians who have entered into contractual relationships with the health plans. In addition to injunctive relief, the lawsuits brought by the physicians seek damages caused by the defendants’ improper behavior.

There being no further business, the meeting was adjourned.

Respectfully submitted,

Franklin I. Rosenberg, M.D.