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ORA Reporter


Aetna Settles Class Action Suit

Aetna settled a class-action suit in May imposed by physicians and medical societies who claimed that the healthcare giant unfairly cut reimbursements to them by using code-bundling software. The medical community hails the settlement that will only pay approximately $142 in reparations to each doctor but will allow physicians to have a say in the software implementation as a precedent in insurance provider accountability. Tim Norbeck, executive director of the Connecticut State Medical Society, one of the 19 medical societies that charged Aetna with the suit, stated that Aetna “is the first and only insurer to step up and attempt to make this managed care system fair and equitable for physicians to navigate. This may not be perfect but it is a tremendous step in the right direction.”

Aetna also agreed to use a “Billing Dispute External Board” that will allow physicians to address billing disputes through an independent appeals process. Also, Aetna must provide clear coding guidelines including clear definitions to determine “medical necessity.”

While doctors hope Aetna’s leadership will “raise the bar” on insurer responsibility, groups charged with similar class-action suits such as Humana and WellPoint Health Network continue to fight allegations. Beyond the $100 million restitution promised to 700,000 doctors and the $50 million paid to the doctors’ attorneys, Aetna will grant $20 million to create a foundation with the mission to reduce medical errors and racial disparities in treatment. Also, settlement changes that will simplify claims processing and procedures, lessen administrative hassles, and speed payments from Aetna are estimated to decrease costs to physicians by $300 million over the next several years.

One physician states that it is “not about the money,” rather it is about making system changes. “It gets the extra chair out of the exam room—the extra chair being the insurance company.“ A hearing in Miami on October 14th of this year will allow a federal judge to grant final approval of the settlement terms. Additional information can be found at www.aetna.com/legal_issues/suits/agreement.html

Ultrasonography Specialists Featured

Musculoskeletal imaging including standard radiograms, musculoskeletal ultrasound, computerized axial tomography and magnetic resonance imaging is quickly moving to the forefront in rheumatic disease diagnosis. This year’s Annual Fall Meeting CME lectures will focus on advanced musculoskeletal imaging for rheumatic diseases.

Dr Richard Wakefield, MRCP (UK), will present a lecture and demonstration on Imaging Techniques in Rheumatoid Arthritis, allowing attendees to become familiar with the use of grey scale x-rays, MRI, CT and US in the diagnosis and monitoring of patients with rheumatoid arthritis. He will review the limitations of the various scanning techniques and the clinical literature on imaging in rheumatoid arthritis. Dr Wakefield will discuss the place for US in the diagnosis and management of rheumatic diseases, provide an understanding of how serial images can monitor the disease course of rheumatoid arthritis, and discuss the role of future imaging techniques in disease monitoring.

Dr. Antonio Bouffard, radiologist, Henry Ford Hospital, will discuss Musculoskeletal Ultrasonography, What Is In It For The Rheumatologist?  The objectives of this lecture are to understand a brief history of ultrasonography, to appreciate the science of musculoskeletal ultrasonography, to see and understand the basics of normal US, and to use the mechanisms of US to visualize disease states and ultrasonographic images of regional and systemic diseases. CME is provided by OHSU.

The 2003 ORA Annual Fall Meeting will be held at the Westin Salishan Lodge and Resort on Oregon’s beautiful northern coast near Lincoln City. The lodge offers an 18 hole Scottish-style golf course and a network of jogging and hiking trails linking the Lodge with the forest and the sea throughout the 760 wooded acres and 3 miles of unspoiled beach along the Salishan Peninsula. Other amenities include an indoor swimming pool, indoor tennis center, and each room has a fireplace and balcony that overlooks either the forest, golf course, or bay.

ORA’s business meeting will follow the lectures. Support for this meeting is graciously provided by Abbott, Amgen, Centocor, Daiichi, Pfizer, P&G, and Wyeth. Many thanks to meeting coordinators Drs Emori and Barkhuizen for coordinating this meeting.

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ACR Continues Practice Advocacy Efforts
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Physicians Avoid Treatments Insurers Fail to Cover
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