SEATTLE — The nation's largest and most influential physicians organization has joined Washington state physicians in their lawsuit against Regence BlueShield. The American Medical Association (AMA) announced yesterday that it will be represented in the case as a co-plaintiff, along with the Washington State Medical Association and six of its physician members.

"This lawsuit has repercussions far beyond Washington state as more health insurers impose financial disincentives which threaten to disrupt patients' longstanding relationships with physicians they know and trust," said AMA Past President J. Edward Hill, MD.

On Thursday, Sept. 21, the Washington State Medical Association (WSMA) announced a lawsuit filed by the WSMA and physicians against Regence BlueShield.

The lawsuit, filed on behalf of six physician plaintiffs and the WSMA, is in response to Regence's Select Network plan that affects over 8,000 patients and their physicians. In May, the insurer sent letters to members of Society of Professional Engineering Employees in Aerospace (SPEEA) in the Puget Sound area stating that their physicians were lacking in the "quality and efficiency of their practices" which resulted in over 500 physicians being dropped from Regence's Select Network.

This lawsuit is in response to the insurer's defamatory introduction of its "high performance" network program and the serious flaws in the program — a program that dropped physicians from Regence's network for SPEEA members — our patients — based on a flawed methodology and inaccurate information.

"Our patients were justifiably outraged to receive letters from Regence saying that their physicians were not in this new 'Select Network' and, in essence, that their physicians did not meet certain quality and efficiency standards," said Dr. W. Hugh Maloney, president of the WSMA.

"Regence's clumsy effort to compare and rank physicians is short-sighted and represents a seriously flawed and misleading approach," said Dr. Hill. "Their use of simplistic and unproven economic criteria discriminates against physicians by failing to recognize the complexities of the health care system, some of which are outside physicians' control."

While Regence has agreed to postpone implementation of the program until July 2007, it has not demonstrated an effort to tangibly work with the WSMA and SPEEA in order to improve the program.

The lawsuit seeks an injunction against Regence to prevent it from implementing the Select Network Program. It also seeks money damages for the insurer's improper and inaccurate statements to patients that certain physicians failed to meet certain quality and efficiency standards.

Added Dr. Maloney, "At the core of this matter is that true quality improvement programs need the active involvement of physicians to make sure the standards that are applied are fair, accurate, and do not unduly interfere with the doctor/patient relationship."

The causes of action addressed in the suit include:

* Violation of the Unfair Business Practices Act (also known as the "Consumer Protection Act") RCW 19.86, which prohibits unfair or deceptive acts or practices in trade or commerce.

* Defamation/libel. Regence sent written notice to patients stating that their doctors were not providing quality care. These statements were false, defamatory and adversely impacted physicians.

* Intentional interference with commerce. Regence fundamentally interfered with the doctor/patient relationship, which is based on trust and confidence. This impacts the patients, as well as the physicians.

* Breach of contract. Regence has contracts with these doctors that give them certain rights, such as:

o A promise by Regence that the providers will be allowed to provide medical care to Regence subscribers.

o A credentialing procedure, that if Regence chooses to take away a physician's privileges, he or she has the right to appeal, including a judicial remedy. By de-selecting them from this "Select Network," Regence skirted this credentialing process.

o An appeal procedure that by law provides physicians the right to dispute Regence's unilateral decisions.