A group led by the California Medical Association has filed a lawsuit claiming that insurer Aetna punishes and illegally threatens physicians and patients seeking out-of-network medical providers.

Three county medical groups, 4 California surgery centers and an unidentified patient have joined the association - the state's largest physician group - in filing the claim in Los Angeles County Superior Court. According to the suit, Aetna grossly underpays out-of-network providers including surgery centers, or refuses to authorize care at their facilities. The lawsuit also alleges that Aetna threatens patients with phone calls and letters if they attempt to use their out-of-network benefits, despite advertising and selling health insurance policies to individuals "representing that they can obtain their health care from any physician of their choice, including out-of-network providers."

In addition, the suit charges that the company has terminated or threatened to terminate the contracts of some physicians for referring patients outside the network. The physicians involved in the suit seek an injunction against Aetna's actions and reinstatement for physicians who claim they were unfairly terminated from the company's network.

Aetna claims that physicians are referring patients to out-of-network facilities that they own without informing patients of this conflict of interest. The Hartford, Conn.-based company has sued physicians and surgery centers in California, Texas and New Jersey for allegedly overbilling insured patients receiving care outside the Aetna network.

"The wildly inflated bills of these facilities drive up the out-of-pocket costs for unwitting patients and needlessly add to premium costs for everyone," says Aetna spokesperson Anjie Coplin.

Mark McGraw

Jennifer Matton, RN, is heading back to school to earn her bachelor of science degree in order to keep her job at Abington Hospital in the suburbs of Philadelphia. The married mother of 4 joins a national groundswell of grizzled veterans who must turn their RNs into BSNs for hospitals that have raised minimum education employment requirements.

"I wanted to get the bachelor's at the start, but I needed to start earning some money," Ms. Matton told the New York Times. "Now I need to do this for job security, to have opportunities down the road."

No states currently have legislation in place requiring nurses to have BSNs, but AORN says a pair of bills pending in New York and New Jersey would call for nurses to earn their bachelor's degrees within 10 years of licensure.

AORN says its 2011 salary survey revealed that 38.4% of respondents currently have a bachelor's degree in nursing. The organization believes the minimal preparation for future entry into the practice of nursing should be a baccalaureate degree, which is consistent with recommendations included in an Institute of Medicine report.

Last March, the American Association of Colleges of Nursing reported enrollment in entry-level nursing baccalaureate programs increased by 5% in 2011 as nurses were asked to advance their educations. However, the AACN notes, about 75,000 qualified applicants were not accepted at nursing schools due primarily to faculty shortages and limited resources.

"Today's nurses are undereducated for the demands of practice," notes a report from the Carnegie Foundation for the Advancement of Teaching. According to the report, nurse administrators worry about the practice-education gap, as it becomes harder for nursing education to keep pace with the rapid changes driven by research and new technologies.

"Many hospitals are only hiring new RNs with bachelor's degrees - ours included," says Donna Ferguson, RN, MBA, director of outpatient surgery for the breast center and GI lab at Henry Mayo Newhall Memorial Hospital in Valencia, Calif. While current nurses at Henry Mayo are not required to earn their BSNs, they are encouraged to do so. The hospital has even dedicated a classroom on campus where nurses who are studying for their BSNs can gather 1 night a week.

She's in favor of requiring nurses to head back to school. "I think elevating the standard of RNs to include a BSN degree is a great idea," she says. "It is expensive to go back to school, however, so I would like to see hospitals and other employers increase the employee education reimbursement benefits to assist in the cost."

Daniel Cook

Your surgeons may be as gung-ho about improving patient safety as you, your QI director and the accreditation surveyors who visit your facility are, but they're also very busy. They're constantly on the move and have a lot on their minds. That's why it's important to reach out to them in the most effective method possible. Here's some advice on presenting and communicating your efforts toward a safer environment in a way that's more likely to engage your surgeons. If you "make it easy," "respect their time," and follow the rest of these strategies, your surgeons will be more inclined to follow your lead.

David Bernard

As we report in this issue of E-Weekly, there's been talk within nursing for years about making a BSN the minimum requirement for RN licensure. What about at your facility: Do you require your nurses - new hires and veterans alike - to have their BSN? Tell us in this week's InstaPoll and check back next week to see the final results.

Only about 1 in 5 (22%) of the 122 who took last week's poll are happy with their facilities' web pages. Somewhat surpisingly, 16% of respondents don't even have a web page to grade. The results:

How would you rate your facility's web page?