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
Emergency Medicine, Middlesex Hospital gave a
lecture on the opioid epidemic at the annual meeting
of the New London, Middlesex, Tolland, and
Windham County Medical Societies held 12/12/2017
at the Riverhouse in Haddam. He discussed the history
of opioid abuse over the centuries, the origins of the
current crisis, and his recommendations going forward.
The Legislative Committee of the Connecticut State
Medical Society met 10/4/2017 to discuss the
prioritiesfor the 2018 legislative session. Lobbying will
focus on the following:
1. Tort reform: Health Courts: Specialty
courts already exist for workman’s compensation,
bankruptcy, family law, and tax law. Vaccine makers
are also shielded from the tort system with special
courts for disputes (easily achieved in 1986 after
drug companies were going to stop making
vaccines – unfortunately doctors cannot afford to
stop working).
Tort reform: Safe Harbor: if a practitioner
2. 
practices according to established guidelines, and
there is a bad outcome, the doctor cannot be sued.
Tort reform: Good Samaritan Law (no
3. 
malpractice suits) for physicians who do not have a
doctor-patient relationship but have no choice but
to treat the patient: (e.g. obstetrician called to the
emergency room to handle the delivery of a woman
with no pre-natal care, or a neurosurgeon called to
the E.R. to handle a head bleed).
4. Insurance Companies: Anthem -25 modifier
fee reduction. Anthem tests out new ideas in certain
states, with CT as the test for -25 fee reduction.
Anthem originally wanted a 50% reduction in
payment for a separately performed evaluation
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on the same day as a procedure; lobbying got the
reduction down to 25%. CSMS plans on seeking
elimination of the fee reduction.
5. Insurance Companies: An attempt to end the
requirement of doctors to collect deductibles,
commonly in the $3,000 - $5,000 range. This
should be the job of the insurance company which
they can easily do: patients will pay it to the
insurance company so they do not lose insurance.
The present deductible system creates a high rate
of bad debt with adverse effects on the physician
patient relationship.
Numerous other issues were discussed and may
see lobbying as well: strengthening immunity for
practitioners who report suspected child abuse;
removing the 6% gross receipts tax on ASC; a
proposed bill by the CT Pain Society that anything
covered by Medicare is by definition not experimental
and must be covered by insurance companies (such as
Anthem classifying knee synvisc injections, occipital
blocks, and percutaneous disk decompression as
“experimental and not covered”); supporting hospitals
on taxation issues; requiring that breast ultrasound be
covered and not subject to deductible; collective
bargaining rights for physicians; requiring coverage of
3D-mamography; and numerous scope of practice
issues.
The CSMS council met 1/31/2018 and approved
the following:
• The Workman’s Compensation system in
CT has been criticized of being high cost by the
Workman’s Compensation Research Institute
(WCRI), an insurance company sponsored
organization. Other states that have been criticized
have formed their own research organization
that will look at quality and return to work rates
O P E N JO URNAL • W I NTE R 2018
societies to research cost and effectiveness of
WC treatment.
Dr. First is an e-prescribing system that will be
•. 
available to those who want to e-prescribe and don’t
have an EMR. The first year is free, and will be half
off the usual rate ( $250?) thereafter: check the CT
State Web site if interested.
MIPS/MACRA exemptions: an increased
• 
number of doctors will be exempt from reporting in
2018: those who earned less than 90K from Medicare
in 2017 or saw less than 200 unique Medicare patients.
The letters of exemption have an unknown arrival
date, possibly in the next 1-3 months. Doctors who are
not exempt won’t receive a letter.
Anthem has run amuck: declaring procedures
• 
covered by Medicare to be “experimental,”
cutting payment for the -25 modifier, having prior
authorizations for all opioids more than 7 days
(with the authorizations good for only 6-months
to one year and have to be repeated), and most
interesting: attempting in a few southern states
not to cover ER visits for anyone who “does not
have an emergency.” A Kentucky woman recently
got a $12K bill from a hospital after her workup
for appendicitis showed Mittleshmerz or a small
ovarian cyst; Anthem would not cover despite her
severe pain that prompted her to an ER visit. Since
Anthem is too powerful to be bargained with or
reasoned with, CSMS considers them to have the
power of an employer and therefore subject to
National Labor Relation Board adjudication. Since
doctors are contractually powerless, complaints
against Anthem may well be allowed in labor court.
CSMS is looking into this possibility.
United Healthcare was going to follow
• 
Medicare and not pay for consult codes.
However after much complaint and lobbying, they
temporarily put this plan on hold.
Cigna owes $125 million to 25,000 physicians
• 
docs in CT after being successfully sued by CSMS
in 2001 for unfair and illegal billing practices
(down coding, bundling, ignoring modifiers). Cigna
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owes twice the original amount with interest,
and has not yet paid. CSMS is in the process of
binding arbitration.
• C
 SMS is giving an amicus brief in an
attempted lawsuit of a doctor by the girlfriend of
a patient who never saw the doctor. The woman
contracted an STD after the doctor’s office failed
to contact the male patient to inform him that he
had an STD. The issue is whether a patient can
sue for malpractice if they never were a patient of
the physician.
Issues of scope of practice: psychologists and
• 
naturopaths want prescriptive authority, PAs want
independence from physicians (similar to APRNs)
CSMS agreed to write a letter of support to
• 
an addiction specialist who is being sanctioned by
the DPH for allowing a medical assistant to inject
Vivitrol (the injection of which reimburses $6).
CSMS re-affirmed the belief that CT is an outlier
as only one of two states in the country that does
not allowMedical Assistants to give IM injections
under supervision. CSMS previous has attempted
in the past to change state law was unsuccessful as
the nurse’s lobby is somehow more powerful.
Eight physicians in CT have been sued
• 
by patients for HIPPA violations (on top of
the government HIPPA fines) for “infliction of
emotional distress.”
The New London County Medical Society
has ongoing discussions about ways to
increase value for its members and patients.
The following are proposed and will be discussed further:
• An evening lecture series for patients on timely topics.
• A NLCMA website with each physician’s profile/
office website listed, and a poster in each member’s
waiting room informing patients about the site
which will include information of interest to
patients suchas insurance coverage. Ads will be sold
to pay for the site.
continued on page 24
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• 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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