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News from the New London County and

CT State Medical Societies


John Paggioli, MD - President, New London County Medical Society

Dr. Michael Saxe, Chairman Emeritus, Dept. of on the same day as a procedure; lobbying got the
Emergency Medicine, Middlesex Hospital gave a reduction down to 25%. CSMS plans on seeking
lecture on the opioid epidemic at the annual meeting elimination of the fee reduction.
of the New London, Middlesex, Tolland, and
Windham County Medical Societies held 12/12/2017 5. Insurance Companies: An attempt to end the
at the Riverhouse in Haddam. He discussed the history requirement of doctors to collect deductibles,
of opioid abuse over the centuries, the origins of the commonly in the $3,000 - $5,000 range. This
current crisis, and his recommendations going forward. should be the job of the insurance company which
they can easily do: patients will pay it to the
The Legislative Committee of the Connecticut State insurance company so they do not lose insurance.
Medical Society met 10/4/2017 to discuss the The present deductible system creates a high rate
prioritiesfor the 2018 legislative session. Lobbying will of bad debt with adverse effects on the physician
focus on the following: patient relationship.
1. Tort reform: Health Courts: Specialty
courts already exist for workman’s compensation, Numerous other issues were discussed and may
bankruptcy, family law, and tax law. Vaccine makers see lobbying as well: strengthening immunity for
are also shielded from the tort system with special practitioners who report suspected child abuse;
courts for disputes (easily achieved in 1986 after removing the 6% gross receipts tax on ASC; a
drug companies were going to stop making proposed bill by the CT Pain Society that anything
vaccines – unfortunately doctors cannot afford to covered by Medicare is by definition not experimental
stop working). and must be covered by insurance companies (such as
Anthem classifying knee synvisc injections, occipital
Tort reform: Safe Harbor: if a practitioner
2.  blocks, and percutaneous disk decompression as
practices according to established guidelines, and “experimental and not covered”); supporting hospitals
there is a bad outcome, the doctor cannot be sued. on taxation issues; requiring that breast ultrasound be
covered and not subject to deductible; collective
Tort reform: Good Samaritan Law (no
3.  bargaining rights for physicians; requiring coverage of
malpractice suits) for physicians who do not have a 3D-mamography; and numerous scope of practice
doctor-patient relationship but have no choice but issues.
to treat the patient: (e.g. obstetrician called to the
emergency room to handle the delivery of a woman The CSMS council met 1/31/2018 and approved
with no pre-natal care, or a neurosurgeon called to the following:
the E.R. to handle a head bleed). • The Workman’s Compensation system in
CT has been criticized of being high cost by the
4. Insurance Companies: Anthem -25 modifier Workman’s Compensation Research Institute
fee reduction. Anthem tests out new ideas in certain (WCRI), an insurance company sponsored
states, with CT as the test for -25 fee reduction. organization. Other states that have been criticized
Anthem originally wanted a 50% reduction in have formed their own research organization
payment for a separately performed evaluation that will look at quality and return to work rates

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societies to research cost and effectiveness of owes twice the original amount with interest,
WC treatment. and has not yet paid. CSMS is in the process of
binding arbitration.
Dr. First is an e-prescribing system that will be
•. 
available to those who want to e-prescribe and don’t • C
 SMS is giving an amicus brief in an
have an EMR. The first year is free, and will be half attempted lawsuit of a doctor by the girlfriend of
off the usual rate ( $250?) thereafter: check the CT a patient who never saw the doctor. The woman
State Web site if interested. contracted an STD after the doctor’s office failed
to contact the male patient to inform him that he
MIPS/MACRA exemptions: an increased
•  had an STD. The issue is whether a patient can
number of doctors will be exempt from reporting in sue for malpractice if they never were a patient of
2018: those who earned less than 90K from Medicare the physician.
in 2017 or saw less than 200 unique Medicare patients.
The letters of exemption have an unknown arrival Issues of scope of practice: psychologists and
• 
date, possibly in the next 1-3 months. Doctors who are naturopaths want prescriptive authority, PAs want
not exempt won’t receive a letter. independence from physicians (similar to APRNs)

Anthem has run amuck: declaring procedures


•  CSMS agreed to write a letter of support to
• 
covered by Medicare to be “experimental,” an addiction specialist who is being sanctioned by
cutting payment for the -25 modifier, having prior the DPH for allowing a medical assistant to inject
authorizations for all opioids more than 7 days Vivitrol (the injection of which reimburses $6).
(with the authorizations good for only 6-months CSMS re-affirmed the belief that CT is an outlier
to one year and have to be repeated), and most as only one of two states in the country that does
interesting: attempting in a few southern states not allowMedical Assistants to give IM injections
not to cover ER visits for anyone who “does not under supervision. CSMS previous has attempted
have an emergency.” A Kentucky woman recently in the past to change state law was unsuccessful as
got a $12K bill from a hospital after her workup the nurse’s lobby is somehow more powerful.
for appendicitis showed Mittleshmerz or a small
ovarian cyst; Anthem would not cover despite her Eight physicians in CT have been sued
• 
severe pain that prompted her to an ER visit. Since by patients for HIPPA violations (on top of
Anthem is too powerful to be bargained with or the government HIPPA fines) for “infliction of
reasoned with, CSMS considers them to have the emotional distress.”
power of an employer and therefore subject to
National Labor Relation Board adjudication. Since The New London County Medical Society
doctors are contractually powerless, complaints has ongoing discussions about ways to
against Anthem may well be allowed in labor court. increase value for its members and patients.
CSMS is looking into this possibility.
The following are proposed and will be discussed further:
United Healthcare was going to follow
•  • An evening lecture series for patients on timely topics.
Medicare and not pay for consult codes.
However after much complaint and lobbying, they • A NLCMA website with each physician’s profile/
temporarily put this plan on hold. office website listed, and a poster in each member’s
waiting room informing patients about the site
Cigna owes $125 million to 25,000 physicians
•  which will include information of interest to
docs in CT after being successfully sued by CSMS patients suchas insurance coverage. Ads will be sold
in 2001 for unfair and illegal billing practices to pay for the site.
(down coding, bundling, ignoring modifiers). Cigna

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O PEN J O UR NAL • W I NT E R 2 0 18 - 23 -
• O
 btaining emails of all physicians in New London County for urgent notification of votes and bills of interest
especially related to tort reform, trial attorney bills, and insurance company issues in order to have quick
coordinated action to oppose or support these bills.

• Addressing the problem of “physician burnout”: A support group therapy for physicians who have been
sanctioned, sued, or given reprimands; and meetings with a psychologist to discuss burnout and teach Cognitive
Behavior Therapy/Mindfulness techniques.

Please email me (jpaggioli@easternctpain.org) any issues that should be brought up at the county or state level,
and email any necessary procedures or drugs that are classified as experimental and not covered, the insurance
company involved, and if Medicare covers the drug/procedure. g

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