opinion

Doctors rewarded by organized medicine's legal victories

A message to all physicians from Rebecca J. Patchin, MD, chair of the AMA Board of Trustees.

By Rebecca J. Patchin, MDis an anesthesiologist and pain management specialist in Loma Linda, Calif. She served as chair of the AMA Board of Trustees during 2009-10. Posted May 17, 2010.

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As I conclude my year as chair of the AMA Board of Trustees, it occurs to me that while much of the physician community has been focused on events unfolding on Capitol Hill, the American Medical Association has fought for reform in another important arena -- the courtroom. And we have had many victories.

As a result of settlements in 2009, patients and physicians are now beginning to reap the rewards of more than 10 years of effort by the Litigation Center of the American Medical Association and the State Medical Societies to expose the scheme used by UnitedHealth Group and other health insurers to underreimburse patients and their physicians for out-of-network care. UnitedHealth Group's $350 million reimbursement settlement marks the largest monetary settlement by patients and health care professionals against a single health insurer in the United States.

In addition, New York Attorney General Andrew Cuomo's $50 million settlement calls for the creation of a new UCR database for out-of-network reimbursements. This new database will replace the flawed one used by UnitedHealth Group and bring much-needed transparency to insurance company payment procedures.

By now, many of you have received notices in the mail and have begun to fill out the claim forms. Bear in mind that you must submit your claim by Oct. 5, 2010, to share in the UnitedHealth Group settlement fund. If you have not received a form, you can obtain an electronic copy -- as well as a step-by-step guide and answers to frequently asked questions -- online (link).

While thousands of physicians and patients will receive financial compensation, the benefits of the UnitedHealth Group settlements go far beyond monetary recovery. The Litigation Center originally filed the suit due to concerns that insurance company underpayment for out-of-network services was contributing to acrimony between physicians and their patients. The new UCR database will support the patient-physician relationship by helping ensure that patients' out-of-pocket costs are minimized and physicians are paid fairly. Moreover, public access to UCR data will help both in-network and out-of-network doctors negotiate fair payment rates. Similar suits are pending against Aetna, Cigna and WellPoint.

Another recent legal win was the Litigation Center's partnership with the New Hampshire Medical Society in support of a successful effort by Georgia Tuttle, MD, to defend a state-mandated patient compensation fund. When faced with a budget shortfall last year, the New Hampshire Legislature sought to appropriate money from the fund. At stake was a $110 million surplus designated for liability needs of physicians and other health care professionals. In January, the New Hampshire Supreme Court ruled in Dr. Tuttle's favor, protecting the rights of doctors throughout the state. In cases such as this one, support from an organization as large as the AMA plays a vital role in helping physicians level the playing field.

Another Litigation Center highlight of the past year -- Assn. for Molecular Pathology v. U.S. Patent and Trademark Office -- is likely to create a landmark precedent in patent law. The Litigation Center joined in amicus support of an effort to curb the proliferation of genetic patents. The case has broad-reaching implications in terms of the ability to patent genetic research, and the initial court ruling represents a tremendous victory for organized medicine. Since the ruling is the first of its kind, it is currently being appealed by the biopharmaceutical company that developed the patented genetic tests in question.

These are just a few examples of the more than 200 cases the Litigation Center has participated in since its inception in 1995. Whether it is through financial grants, in-kind services, or amicus support, the Litigation Center continues to serve AMA physicians and address the issues that are most important to them. During this time of change, it is important for all of us to remember that the battle for reform of America's health care system is not only being waged in Congress and the White House, but also in courtrooms across the country. To learn more about recent Litigation Center efforts and the various services the center offers, visit it online http:/www.ama-assn.org/go/litigationcenter.

I am grateful for the opportunity to have served as board chair during these most interesting of times and look forward to the year ahead under the leadership of Ardis Hoven, MD.

Rebecca J. Patchin, MD is an anesthesiologist and pain management specialist in Loma Linda, Calif. She served as chair of the AMA Board of Trustees during 2009-10.

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