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AMA: Ruling Makes It Easier for Insurers to Terminate Doctors

Posted on Sat, Aug 29, 2015
AMA: Ruling Makes It Easier for Insurers to Terminate Doctors

Court supported insurance company in termination of doctors after dispute over necessity of services

FRIDAY, Aug. 28, 2015 (HealthDay News) -- The outcome of a recent case regarding the termination of physicians by an insurance company following a dispute over the necessity of medical services provided has serious implications for physicians and their patients, according to a report published by the American Medical Association (AMA).

Two New York physicians and their medical practice sued Cigna after the health plan decided that it should not have paid the physicians for certain allergy tests, which it alleged were not in line with coverage policies. As well as asking for the overpayment to be returned, Cigna decided to terminate the physicians from its network.

The physicians argued that, under the Employee Retirement Income Security Act (ERISA), they could not be terminated because they should be considered plan beneficiaries based on assignment of benefits by their patients. The physicians contended that they were beneficiaries based on signed assignment-of-benefit forms, while the court said these forms would transfer patients' rights to be paid by Cigna, and consequently the benefit belongs to patients. The court ruled that, because the plaintiffs were not seeking payment, ERISA did not apply.

"[The decision] threatens the ability of providers ever to assert any ERISA claim, even if the provider is designated by the plan and an insured as entitled to benefit payments," according to an amicus brief filed by the Litigation Center of the AMA and State Medical Societies, along with the Medical Society of the State of New York, and backed the physician plaintiffs. "That conclusion is contrary to virtually every other circuit court decision addressing providers' rights to bring claims under ERISA."

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More Physicians Reporting Dissatisfaction With EHR Systems

Posted on Sun, Aug 16, 2015
More Physicians Reporting Dissatisfaction With EHR Systems

Compared with survey five years earlier, fewer physicians report being satisfied or very satisfied

THURSDAY, Aug. 13, 2015 (HealthDay News) -- More physicians report being dissatisfied or very dissatisfied with their electronic health record (EHR) system, compared with five years ago, according to a report published by the AmericanEHR Partners and the American Medical Association.

AmericanEHR Partners, founded by the American College of Physicians (ACP) and Cientis Technologies, surveyed physicians on use of EHRs. In a similar survey conducted five years ago, most respondents reported being satisfied or very satisfied with their EHR system (39 and 22 percent, respectively); in the current survey, 22 and 12 percent, respectively, reported being satisfied and very satisfied.

According to the report, 42 percent of respondents thought their EHR system's ability to improve efficiency was difficult or very difficult and 72 percent thought their EHR system's ability to decrease workload was difficult or very difficult. More than half of respondents (54 percent) found that their total operating costs were increased with their EHR system. Forty-three percent reported that they had yet to overcome EHR-related productivity challenges.

"While EHR systems have the promise of improving patient care and practice efficiency, we are not yet seeing those effects," Shari Erickson, M.P.H., vice president of ACP's Division of Governmental Affairs and Medical Practice, said in a statement. "We need to focus on figuring out how we can help physicians and practices to more effectively implement and use these systems."

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