nj physician magazine february 2013

JULY 2012

Also In This Issue:Meaningful Use Insights: Tips & Tricks-What NJ-HITEC Learned from the Field

Class Action Lawyers Take a New Stab at Proving Horizon Shorted Providers

Physician Assisted Suicide Moves Ahead on Uncertain Path in NJ

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FEBRUARY 2013

Montclair Radiology Celebrating 70 Years of Excellence in Diagnostic Imaging

Published by

Montdor Medical Media, LLC

Co-Publisher and Managing Editors

Iris and Michael Goldberg

Contributing Writers

Iris Goldberg

Michael Goldberg

Mary Pat Gallagher

Andrew Kitchenman

Jennifer Covino

Arixmar Velez

Mary Beth Hall

Joseph M. Gorrell

Debra C. Lienhardt

Mark Manigan

John D. Fanburg

Lani M. Dornfeld

Todd C. Brower

Kevin M. Lastorino

Carol Grelecki

Dan Goldberg

Layout and Design

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Publisher’s Letter

With warm regards,

Michael GoldbergCo-Publisher

Dear Readers,

Welcome to the February edition of New Jersey Physician, now reaching over 28,000 practitioners statewide.

Plaintiff lawyers are making another attempt at a class-action suit accusing Horizon Blue Cross Blue Shield of an illegal scheme to cut reimbursements to certain health care providers-and this time they claim to have a smoking gun. The latest filing includes as exhibits a June 2003 business plan titled “Ancillary Services Out of Network Ceiling,” and emails discussing the plan that were turned over in discovery.

Medicaid expansion could save New Jersey over $6 Billion over the next nine years says a New Jersey think tank. The state would save the money because the federal government would be picking up the tab for both new and current participants in two Medicaid programs. The first covers childless adults with less than $2,520 per year in income which the state now covers 50% of the medical costs for 40,000 participants. The second, FamilyCare, is meant for poor adults and their dependent children. To qualify, a family of four must earn no more than $30,725 a year. The state currently pays 35% if the costs for the 134,000 participants in the program.

New Jersey residents who are terminally ill are closer to being able to choose to end their own life with the help of a physician. While a bill allowing physician assisted suicide was released by an Assembly committee, it faces a number of obstacles before it becomes law.

After months (even years) of anticipation, the Office for Civil Rights finally released the HIPAA/HITECH Act Final Rule. As expected, the rule modifies the breach notification rule, revises the enforcement rule and includes other general changes to the HIPAA Privacy and Security Rules. Among other things, the rule makes provisions of the Privacy and Security Rules applicable to covered entities’ business associates, as well as their subcontractors.

Our cover story this month is on Montclair Radiology, now celebrating 70 years of excellence in diagnostic imaging. From the start, Montclair Radiology has pioneered being on the cutting edge of imaging, including an early start with MRI, Cardiac CT and Ultrasound. This mission remains in force, with the addition of FTP MRI and color Doppler ultrasound. Recently, the addition of a hige-field strength totally open MRI was added to the West Caldwell location, providing maximum comfort for patients while producing image quality equal to that of a 1.5T cylindrical MRI scanner. We congratulate this practice on maintaining their position on the cutting edge of diagnostics.

Contents

2 New Jersey Physician

CONTENTS

4

9 10

18

STATEHOUSE

NJ HITECH

HEALTH LAW UPDATE16

FOOD FOR THOUGHT

LEGAL ISSUES

14


COVER PHOTO:TOP ROW / LEFT TO RIGHT: Patrick Harris MD, Stuart Moses MD, Denise McFadden MD, Anuj Tolia MD,Jennifer Doe MD, Steven Richman MDBOTTOM ROW / LEFT TO RIGHT: Daniel Levy MD, Brett Ferdinand MD, Lisa Bash MD, Linda Singletary MD, Michael Pollack MD, Ross Mondshine MD

HOSPITAL ROUNDS / MSNJ NEWS

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Cover Story


Lisa Bash, MD

Jennifer Doe, MD

Brett Ferdinand, MD

Patrick Hines, MD

Daniel Levy, MD

Denise McFadden, MD

Fig. 1

Montclair Radiology Physicians Ross Mondshine, MD

Stuart Moses, MD

Michael Pollack, MD

Steven Richman, MD

Linda Singletary, MD

Anuj Tolia, MD

By Iris Goldberg

For a great many referring physicians and patients in and around Essex County, Montclair Radiology has been and still is, perhaps the most well-known and certainly one of the most highly respected imaging facilities in the area. Now, with locations in Montclair, Nutley and West Caldwell, Montclair Radiology has amassed an even greater following. As Montclair Radiology marks its 70th year of service to the community, it is most appropriate to reflect back upon this impressive timespan to learn about its beginnings and the ways in which Montclair Radiology continues to provide the most current and comprehensive diagnostic radiology services available.

Michael Pollack, MD is one of Montclair Radiology’s physicians and also, a managing partner. (Please see Fig.1 for a complete list of Montclair Radiology physicians). In addition to his formal training in Diagnostic Radiology, Dr. Pollack completed fellowship training in Musculoskeletal Imaging and helped enhance those services at Montclair Radiology.

For example, MR arthrogram, which is particularly sensitive for evaluating tears of ligaments, tendons and cartilage, was added upon his arrival and has performed with increasing frequency ever since. Dr. Pollack was also instrumental in facilitating the addition of Coronary CT Angiography (CTA) at Montclair Radiology. CTA is a valuable technology for revealing the presence of coronary artery disease.

Dr. Pollack provides a history and overview of the practice and discusses some of the positive ways in which Montclair Radiology strives to set itself apart from other imaging facilities. “This year we are celebrating our 70th year anniversary,” Dr. Pollack is pleased to share. “Seventy years ago there was angiography and

x-rays but there was no MRI, no CT scan and no ultrasound,” he informs. “We had the first MRI in the United States that was used clinically. Previous units were only used for medical research,” relates Dr. Pollack. He goes on to share some of the other “firsts” that can be attributed to Montclair Radiology.

“We used the first color Doppler ultrasound, the first digital subtraction angiography in an office and we were the only ones using the prostate 3TP/FTP imaging,” Dr. Pollack reports as examples. In fact, he credits the founding partners with having the insight and the courage to make the investment to obtain

The Phillips Panorama Open MRI is totally open, provides maximum comfort for patients with performance and image quality that is equal to a 1.5T cylindrical MRI scanner.

photography by Michael Goldberg

1943 1954 1974 1979

1980 1983 1986 1995

2003 2005 2006

2008 2010 2012 2013

February 2013 5

Drs. John Thompson, Carl Knitzer & Ray Healey start Montclair Radiological Assoc., the Radiology Group at Mountainside Hospital.

Montclair Radiological Assoc. opens their first outpatient radiology facility at 116 Park Street, Montclair, NJ.

Montclair Radiology expands, opening a second office in Caldwell, NJ.

Montclair Radiology offered the first non-hospital based Ultrasound in the area.

First radiology facility to initiate Digital Subtraction Angiography (a type of fluoroscopy used to visualize blood vessels).

Montclair Radiology installed the first clinical MRI in the country.

Montclair Radiology continues to expand by opening their third office in Nutley, NJ.

Montclair Radiology is the first facility in Northern NJ to offer “True Open” MRI (.3T Open-Air).

First outpatient center in Essex County to be certified by the American College of Radiology.

Installation of the first 64 Channel CT Scanner in Essex County, starting the process to reduce radiation for CT scans.

Cardiac Scanning became readily available in Nutley. (Months after installation media coverage began about the revolutionary new test).

Montclair Radiology joins Chilton Memorial Hospital as their radiology group.

Radiology upgrades software to include FRAX analysis in bone density.

Montclair Radiology is the first facility in Northern NJ to offer “True Open” MRI (.3T Open-Air).

Celebratingour 70thAnniversary!

Improved Women’s Health Services to include modern facility with biopsies available.

“The risk they took, putting everything on the line to put in that first MRI at the time, when it was not yet FDA-approved and generated no income for the practice for at least eight months – that really paid off in terms of putting Montclair Radiology on the map,” Dr. Pollack believes.

At Montclair Radiology, the priority to invest in the latest technology is still strong. Just recently, a new high-field strength totally open MRI was purchased for the West Caldwell site. Historically, patients who were claustrophobic or obese underwent open MRI in a machine with a lower quality magnet and weaker field strength, usually .3 Tesla as compared with 1.5 Tesla. The resulting imaging was significantly inferior.

new technology as the foundation for Montclair Radiology’s constant role as a pioneer in diagnostic imaging and its continual success throughout the year. (For some of the highlights of Montclair Radiology’s distinguished 70 year history, see Fig. 2).

Fig. 2

Now with the Philips Panorama 1.0T High-Field Open MRI, high-resolution MR images can be obtained at Montclair Radiology for virtually any patient, including children and those who are claustrophobic or obese. While the

machine is totally open, providing maximum comfort for patients, the performance and image quality is equal to that of a 1.5T cylindrical MRI scanner, increasing the referring physician’s comfort level as well.

Also, to enhance patient comfort, Montclair Radiology has installed a sophisticated and computerized LED lighting system, which creates any color in the room that the patient chooses. “Providing patients with an environment that has been created using their favorite color can significantly reduce stress and enhance the patient experience,” says Dr. Pollack. “Patients love it,” he adds.

Dr. Pollack shares that in conjunction with the 70th Anniversary celebration other new initiatives are being undertaken that will enable Montclair Radiology to maintain its position as a leader in diagnostic radiology, going forward. “This year we are dedicating each month to focus on one patient experience,” Dr. Pollack offers, as an example of the endeavor at Montclair Radiology to continually improve the quality of services provided.

In January, the waiting room experience was thoroughly examined. “We spoke with staff and got feedback from patients

in order to determine how to improve that experience,” Dr. Pollack relates. “So for instance, one of the things we’ve done is purchase coffee machines for all of our sites,” he reports. Having a fresh, hot cup of coffee, while waiting, certainly helps pass the time more pleasantly.

February is dedicated to improving the scheduling process for patients. “We want to make scheduling more patient-friendly,” Dr. Pollack states. “Again, we want to take this 70th year anniversary and give back to our patients, really re-dedicate our efforts on patient care,” he emphasizes.

At Montclair Radiology serving physicians more effectively is also an ongoing goal. This past year the computer system was completely upgraded, to comply with the new government health care initiatives and also to begin the process of linking its system with those of referring physicians. The benefits of this for the physician’s office in terms of receiving imaging results and improving efficiency and accuracy of patient records are obvious.

Also, this year, Montclair Radiology is re-strengthening its focus on Women’s Imaging, with a particular emphasis on mammography. An initiative was begun to encourage women to schedule

photography by Michael Goldberg

MONTCLAIR RADIOLOGY


This year Montclair Radiology is restrengthening it’s focus on women’s imaging with a particular emphasis on mammography.

A private women’s lounge at Montclair Radiology’s West Caldwell location creates a relaxing environment for women while they wait for their mammograms.

a mammogram by donating a dollar to the Komen Foundation for each appointment scheduled through January 31, 2013.

A dedicated women’s lounge at Montclair Radiology’s West Caldwell location is a separate, attractive area where patients are provided with comfortable robes and can have coffee and watch television or listen to music in a relaxing environment. “It’s a much more pleasant experience than is possible in most hospital settings,” Dr. Pollack remarks.

As a result of the newly upgraded computer system, turn-around time for mammogram reports, which previously was no more than a day at Montclair Radiology, has now been significantly expedited to an hour or two, at most. This is a plus for both the patient and her physician.

When a screening mammogram reveals an abnormality, the patient is contacted and brought back in as soon as possible for additional testing such as breast ultrasound or breast MRI. Dr. Pollack and the other physicians at Montclair Radiology appreciate the anxiety women face in this situation. After breast ultrasound is obtained, whether the results are good or bad, the radiologist comes in to personally inform the patient. (MRI results may not be immediately available). If a biopsy is indicated, the referring physician gets a call from the radiologist as well. “Women are understandably quite nervous at this time and should not be required to go home and wait for two or three days to get results,” Dr. Pollack strongly states.

Montclair Radiology is also a leader in Prostate Imaging. In 2006, the practice acquired a new diagnostic imaging technique for use in the detection of prostate cancer, which had just emerged and was not yet in use anywhere in the area. The technique, then called 3TP (Three Time Point), makes use of existing MRI scanners and a safe contrast agent that is injected into the patient. The prostate is scanned repeatedly over a period of several minutes. Originally, the software developed for this method analyzed three of the MRI images, one before and two after the injection. The newer software analyzes seven images and the technique is now called FTP (Full Time Point).

FTP creates a colored likeness of the prostate gland based on the data

February 2013 7On the scan shown here, red indicates malignancy while blue and green indicate no presence of cancer.

The FTP imaging technique for use in the detection of prostate cancer utilizes existing MRI scanners and a safe contrast agent that is injected into the patient.

obtained. Typically, malignancies, which need a steady supply of oxygen and nutrients in order to grow, contain many small, new blood vessels. Blood flow in and out of the area of a cancerous tumor is usually accelerated. The tumor cells are distributed unevenly, with areas of densely packed cells that have tighter between-cell spaces than normal.

In order to obtain the FTP image, the contrast agent, which enhances the MRI images, is injected into the bloodstream and the flow of the agent into the area being scanned is traced. The agent, which quickly passes through the blood, will enter and clear out of a cancerous tumor faster. Contrast agent escaping vessel walls (new blood vessels tend to leak) will be highlighted, along with the spaces between cells. By making calculations based on comparisons between the images, the software can assign a color to each tiny pixel making up the graphic image. A preponderance of red indicates malignancy, while blue and green indicate no presence of cancer.

Like Dr. Pollack, Anuj Tolia, MD is one of the physician owners of Montclair Radiology. He is fellowship-trained

in MRI imaging, in Neuroradiology, Musculoskeletal Radiology and Body/Breast Imaging. Dr. Tolia discusses some of the significant benefits of FTP technology.

“This software allows us to map out the prostate gland in a way to help direct the urologist as to where to look for potential cancer,” Dr. Tolia offers. He refers to one of the main reasons a patient would be sent to Montclair Radiology for an FTP study. Dr. Tolia explains that when a man’s PSA level continues to rise, the urologist will most often perform a biopsy to look for cancer somewhere in the prostate. Because of the random nature of the biopsy procedure, the results can be negative, even though cancer may very well be present.

“Because we’re able to map out that prostate gland in terms of which areas might be more suspicious for cancer based on the vascularity, we can tell them which part of the gland to target when they go in for a second-look biopsy,” Dr. Tolia shares. “The results have been great,” he continues. “Our urologists report that we’re very accurate in terms of helping them on second biopsies, often to pick up cancers that they were

unable to detect on their initial biopsies,” Dr. Tolia is pleased to add.

Another situation in which a patient might be an appropriate candidate for FTP imaging would be post-radiation therapy for a previous prostate cancer. Dr. Tolia points out that generally, it is more difficult to identify the presence of cancer in a patient who has undergone radiation to that area. “In those cases we’re really helpful by providing a map that directs the urologist where to go,” he notes.

FTP is also a valuable tool for finding early extra-capsular spread of disease, in which the cancer has spread beyond the prostate gland and into the pelvis. “If there is extracapsular spread of disease, that’s definitely going to change how the urologist is going to treat the patient surgically and whether or not the patient gets radiation or chemo,” Dr. Tolia states.

“We’re able to do high resolution imaging whereby we can get great detail. MRI of the prostate is the most sensitive imaging technique for local staging, including detection of extracapsular spread of disease and therefore, guides management between primary surgical resection versus other less invasive treatment options,” he informs.


A comfortable waiting area, complete with fireplace is one of the ways in which Montclair Radiology prioritizes making the patient’s experience a positive one.

Some urologists send patients to Montclair Radiology for FTP imaging of the prostate because they are concerned about an infection or an abscess, for example. “The enhancement pattern for an infection is different from a cancer so in an older patient, especially, if you think it’s an infection, clinically but you want to make sure, the prostate FTP helps the physician rule out a malignancy,” Dr. Tolia explains.

Dr. Tolia reports that since prostate FTP is not yet offered at most facilities, patients travel to Montclair Radiology from towns all across the state to have this imaging. “In fact, I’ve had patients drive from Pennsylvania, he relates. Dr. Tolia and the other physicians at Montclair Radiology are accustomed to seeing many patients, in fact, who are willing to travel the extra distance for their imaging studies. Over its many years of service Montclair Radiology has developed a loyal following.

Montclair Radiology physician, Brett Ferdinand, MD, is an owner of the practice as well. Dr. Ferdinand, who completed a fellowship in Musculoskeletal Radiology, talks about the level of Orthopedic Imaging offered at Montclair Radiology. “We have three radiologists – Dr. Tolia, Dr. Pollack and I who have fellowship level training in musculoskeletal imaging,” Dr. Ferdinand shares. “Dr. Pollack and I trained at the Hospital for Joint Disease in New York and Dr. Tolia at Jefferson in Philadelphia. So, we bring that level of quality imaging to the community in New Jersey,” he adds.

“It’s really unique to have three people with our level of training and we do every sort of musculoskeletal imaging there is,” Dr. Ferdinand says. He discusses the benefits to patients in terms of having three expertly trained musculoskeletal radiologists who consult with one another regularly, especially on those cases that are challenging.

As an example of the level of imaging offered at Montclair Radiology, Dr. Ferdinand points to the many MR arthrograms skillfully performed by his group. “This study is a bit more sensitive for picking up certain abnormalities like tears of the shoulder labrum and labrum of the hip,” Dr. Ferdinand explains. “It’s also helpful for evaluating tears of the meniscus after meniscal surgery has been

performed previously because often it’s hard to distinguish a meniscal scar from an actual new tear,” he elaborates.

Dr. Ferdinand also mentions some of the interventional procedures performed at Montclair Radiology for the treatment of musculoskeletal conditions. These include but are not limited to: pain management injections and aspiration of joint cysts such as paralabral cysts in the shoulder and popliteal (Baker’s) cysts and parameniscal cysts in the knee.

“Another fact that’s important to mention, is that we can read things remotely. So, for example, if I’m at the Nutley office and there’s a difficult musculoskeletal case that comes through the West Caldwell or Montclair office, there is always a fellowship level person reading that particular case,” Dr. Ferdinand reports, referring to the constant updating of imaging systems at Montclair Radiology. “Even if I’m on vacation, I am able to pull up an image and consult on a case, wherever I am,” he remarks. It is because of the consistently high quality images and the expert skills of is musculoskeletal radiologists, that Montclair Radiology enjoys an extremely high retention rate of orthopedic referrers, Dr. Ferdinand believes

Like Drs. Pollack and Tolia, in addition to offering the most current and innovative imaging technology, Dr. Ferdinand emphasizes the unwavering priority at Montclair Radiology to make the patient’s experience a positive one from every perspective. “And,” he is pleased to share, “our patients come back to us time and time again.”

For more information or to schedule an appointment call (973) 661 - 4674

“The great thing that distinguishes us is that we’re owned by the doctors. The doctors run the practice and every decision is made with the patient’s care in mind and not the bottom line,” Dr. Ferdinand adamantly states. “We’re all embedded in the community. We take care of our friends, our neighbors, our family members,” he adds, reiterating Montclair Radiology’s commitment to providing its patients with the highest level of imaging quality and personalized care.

In fact, as the physicians at Montclair Radiology astutely point out, the landscape of the New Jersey healthcare environment is changing, with many mergers and acquisitions, not only on the hospital front but within radiology as well. During recent years a number of private imaging facilities have been sold to either hospitals or large corporations.

“We’re unique, now,” Dr. Pollack offers, echoing the sentiments of Dr. Tolia and Dr. Ferdinand. “Because we are physician-owned, our focus is naturally on patient care and that has led to our success because a lot of the others are cutting back hours, cutting services and not reinvesting,” he asserts.

The most convincing evidence of Montclair Radiology’s continued success is its longevity. As Montclair Radiology celebrates its 70th Anniversary, we in New Jersey take time to commemorate an illustrious past and look forward to what promises to be a groundbreaking future of excellence in imaging.

February 2013 9

Legal Issues

LEGAL ISSUESClass-Action Lawyers Take New Stab At Proving Horizon Shorted ProvidersBy Mary Pat Gallagher

New Jersey Law Journal

Plaintiff lawyers are making another attempt at a class-action suit accusing Horizon Blue Cross Blue Shield of an illegal scheme to cut reimbursements to certain health-care providers — and this time they claim to have a smoking gun.

The amended complaint, in Edwards v. Horizon Blue Cross Blue Shield of New Jersey, 08-cv-6160, filed Jan. 30 in federal court in Newark, is the latest salvo in a seven-year-long litigation alleging New Jersey's largest health insurer under-reimbursed ambulatory surgery/surgical centers outside its provider network.

A proposed $22 million settlement of consolidated similar suits won preliminary approval in October 2010 but fell through when more than 60 percent of the roughly 150 class members refused to be part of it.

With the litigation going forward, the plaintiffs obtained leave to file an amended complaint.

The latest filing includes as exhibits a June 2003 business plan titled "Ancillary Services Out of Network Ceiling," and emails discussing the plan that were turned over in discovery.

Horizon allegedly decided in 2003 that it wanted to save a certain amount of money in reimbursing out-of-network ambulatory care centers and hired a company called Navigant to prepare a new database that would realize those savings, "without regard to the levels of reimbursement that applicable laws, regulations and terms of health benefit plans require Horizon to pay."

The plan acknowledged legal exposure was a risk.

Due to a protective order issued on Jan. 11 by U.S. Magistrate Judge Michael Hammer, the version of the amended complaint accessible to the public is heavily redacted where it discusses the documents, and large portions of the documents themselves are blacked out.

Hammer denied Horizon's request to redact completely the versions of the complaint and exhibits that were posted on PACER and to partly redact those that were sent to the U.S. Departments of Labor and Treasury, as required for claims against ERISA fiduciaries.

"We have uncovered pretty blatant wrongdoing," says class counsel Bruce Nagel, of Nagel Rice in Roseland. "We believe the federal agencies are obligated to take a hard look at what they're doing." The federal government could decide to take over the case, he says.

The amended complaint replaces the original class representative, Glen Ridge SurgiCenter, which settled with Horizon, allegedly induced by being allowed to become an in-network provider. In Nov. 2011, U.S. District Judge Jose Linares held that Glen Ridge settled only its own claims and that the case could go forward with a new named plaintiff. North Jersey Ambulatory Surgery Center and Roxbury Surgical Center are the named plaintiffs in the current complaint.

Horizon's lawyers, Edward Wardell of Connell Foley in Cherry Hill, and B. John Pendleton Jr. of DLA Piper in Florham Park, decline comment.

Thomas Vincz, Horizon's public relations manager, says, "The amended complaint by the class attorneys is old information repackaged. The class attorneys are presenting no documents that are new to the case since it was last presented to the courts for settlement more than two years ago.

"Horizon BCBSNJ is confident that the new plaintiffs in this case are not adequate class representatives because, among other things, they were not in operation during the period of the alleged under-reimbursements."

The $22 million settlement that won preliminary approval in 2010 would have paid about a third of it to class counsel at Nagel Rice in Roseland and West Orange's Lampf Lipkind Prupis and Petigrow. Nagel says the agreement was worth an additional $50 to $75 million per year for three years, during which class members would have received higher rates of reimbursement.

Horizon has nearly 59 percent of the market share for small employer health insurance policies in New Jersey, nearly 54 percent for large employer plans and almost 79 percent of the individual policy market, according to Marshall McKnight, a spokesman for the New Jersey Department of Banking and Insurance.



Statehouse

NEW JERSEYSTATEHOUSEMedicaid Expansion Could Save State More Than $6 Billion Over Next Nine Years

New report from New Jersey think tank fails to find downside to increasing Medicaid coverageBy Andrew Kitchenman,

New Jersey would save more than $6 billion in healthcare spending over the next nine years, if Gov. Chris Christie

New Jersey Policy Perspective calculated that the state would accrue the savings because the federal government would be picking up the tab for both new and current participants in two Medicaid programs. The first, General Assistance, covers childless adults with less than $2,520 a year in income. The state pays 50 percent of the medical costs for 40,000 participants in this program.

The second, FamilyCare, is meant for poor adults and their dependent children. To qualify, a family of four must earn no more than $30,725 a year. The state currently pays 35 percent of FamilyCare costs for the 134,000 participants in the program. The federal government takes care of the other 65 percent.

But the federal government will stop kicking in its share for both programs on December 31, if New Jersey decides not to expand Medicaid eligibility.

“I would say that’s a no-brainer, that there’s no reason not to do this,” said David Rousseau, a former state treasurer under Gov. Jon S. Corzine and a budget analyst for NJPP. Rousseau said the federal government would kick in between $100 million and $200 million that the state is on track to spend on FamilyCare in the upcoming budget year. Again, those numbers only work if Christie chooses to expand Medicaid.

If the governor opts for expanded eligibility, the feds will cover 100 percent of the costs of both General Assistance and FamilyCare from 2014 to 2016, with the state share gradually rising to 10 percent by 2020.

It’s not clear whether Christie will address that matter in the budget proposal he releases on Tuesday. The issue has divided Republican governors nationally, with 13 opposing it, including Pennsylvania Gov. Tom Corbett. Seven support it, the most recent being Florida Gov. Rick Scott. State advocates for cutting federal spending are pushing for him to reject the expansion.

If Christie decides against the expansion, he could reduce spending on these current programs in another way: by eliminating them. The state could also try to negotiate continued federal funding for the two programs, but it’s not clear whether the federal government will be willing to aid a state that’s refused expansion.

“If we don’t do Medicaid expansion, FamilyCare is at tremendous

risk,” Rousseau said.

Raymond J. Castro, the author of the NJPP report and a senior policy analyst for the organization, noted the savings would more than offset any cost to the state of the expansion.

Castro said he’s concerned that Christie would consider cutting the programs, but added that he would be surprised if the governor did that.

“He could continue to serve the people they serve now, plus get the savings,” Castro said. “It would just be draconian” to cut the programs.

The report’s conclusions were disputed by Dr. Alieta Eck, who practices internal medicine in Piscataway and operates a clinic for low-income patients in Zarephath.

Eck said the potential for reduced FamilyCare and General Assistance costs from Medicaid expansion aren’t true savings, since state taxpayers pay for federal funding through their income taxes.

“I think that the whole program is so broken and needs to be totally revamped,” Eck said. Last year, she served as president of the American Association of Physicians and Surgeons, a group founded to oppose government involvement in medicine.

Eck suggested that Congress might continue to fight the expansion by not appropriating the funds for the program, noting that Republicans who oppose the expansion control the House of Representatives.

Instead, she supports a state bill that would allow doctors to receive immunity from medical malpractice claims in return for volunteering four hours per week in clinics for low-income residents.

The NJPP report received support from legislators pushing for the expansion.

Sen. Nia H. Gill (D-Essex and Passaic) said the report adds to the “enormous” evidence in favor of expansion.

“The bottom line is the state cannot afford not to take advantage of the opportunity to expand Medicaid,” Gill said in a statement. “Leaving billions of dollars on the table in Washington while other states reap the benefits of our federal tax dollars is irresponsible.”

She urged Christie to follow Scott’s lead on the issue.

February 2013 11

Expect to pay More for Policies Purchased On State Health-Benefit Exchange State chooses benchmark plan to make sure coverage is consistent with what's already on the market

By Andrew Kitchenman,

New Jersey residents who buy insurance through the state's health benefit exchange could wind up with a plan similar to what many small businesses offer their employees.

But the high cost of that coverage already has insurers concerned.

The federal government requires that states choose one of 10 existing plans to serve as a benchmark for benefits that will be offered through the exchange.

While every plan offered by an exchange will not be identical, each must be similar in value to the benchmark and cover the federally defined essential health benefits.

New Jersey's benchmark is based on the largest small-group plan currently offered in the state: Horizon’s HMO Access HSA Compatible coverage. The state had to choose the benchmark from among the three largest small-group, state-employee and federal-employee plans, as well as the largest HMO.

Gov. Chris Christie described the benchmark as the result of extensive consultation with the medical community, insurers, and advocates for children in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius.

Christie decided on Friday to have the federal government operate the exchange. He included the benchmark in a list of programs he submitted to demonstrate how the state is working with the feds on the 2010 Affordable Care Act.

New Jersey's laws and regulations already require health plans to deliver more services than many other states, including applied behavior analysis for autism. If the state had chosen for its benchmark one of the federal-employee plans that didn't cover some services mandated by the state, they would have to be added to bring the benchmark up to code.

The benchmark plan offers a wide range of benefits, including the vast majority of primary, specialist, and emergency-care services, as well as prescription drugs. Some services like home healthcare visits require pre-approval; others, such as physical and occupational therapy have a limited number of annual visits.

Benefits that aren’t covered by the benchmark include routine dental services for adults; long-term/custodial nursing home care; routine eye exams for adults; cosmetic surgery; routine foot care; acupuncture; weight-loss programs; and non-emergency care when traveling outside the country.

There also are exemptions for specific services. For instance, while the benchmark covers some infertility treatments, such as artificial insemination, it doesn’t cover others, including in-vitro fertilization.

The value of the plan still must be determined by the federal government based on actuarial calculations. While plans available on the exchange may differ slightly, they must cover similar services as the benchmark.

While it’s unclear how much consumers who don’t receive federal subsidies will pay, it will be more than the current cost

of the benchmark plan. The cost to individual customers now differs depending on the members of each small-group plan and was not available yesterday.

The reason that the price of plans offered through the exchange will be higher than the current cost of the benchmark plan is because the federal government requires exchange plans to include two areas that the benchmark currently doesn’t cover: pediatric dental and pediatric vision. In addition, there will be two taxes paid by insurers that will augment the cost of the plans.

New Jersey Association of Health Plans President Wardell Sanders cautioned that some consumers buying coverage on the exchange might experience sticker shock. New Jersey insurers will be paying an excise tax of $5 billion based on their market share over the next 10 years, which Sanders said would add to the price tag of all health insurance in the state. There also will be a 2.5 percent fee on insurance sold through the exchange.

“We’re concerned about questions about affordability,” he said.

Consumers purchasing insurance on the exchange will be able to choose plans from four different levels. Each will require them to pay a different percentage of the value of the plan, through a combination of copayments and deductibles.

The four levels will be set at 10 percent, 20 percent, 30 percent, or 40 percent of the plan’s value. Customers will have to pay higher monthly premiums to have lower copays and deductibles. Those who choose lower premiums will have higher copays and deductibles.

Federal subsidies will be set to offset 30 percent of consumer cost sharing. Subsidies will be available to residents with income between the poverty line and 400 percent of the poverty line, currently $23,550 to $94,200 for a family of four.

The other factors that will affect the cost to consumers are age and geographic location, as well as whether an individual or family plan is purchased.

The exchange will be an online marketplace for consumers who aren’t covered by their employers or government-provided insurance like Medicare and Medicaid. The website will allow consumers and small-business owners to compare plans and determine whether they are eligible for subsidies.

Sanders said the 10 options that the state faced for setting the benchmark were similar. He added that choosing a state-based small-group plan offered an advantage in that small employers will already be familiar with it.

“The selection was important, but it’s not like there were lots of differences,” said Sanders, whose association represents the state’s insurance companies.

Sanders said he expects that consumers buying insurance through the exchange will be able to choose between plans that limit services to in-network providers and those that don’t have in-network limits. There would be financial incentives to


choose an in-network plan.

Raymond J. Castro, senior policy analyst for the nonprofit New Jersey Policy Perspective, expressed disappointment that state officials didn’t seek more public input in how they chose the

benchmark.

Enrollment in plans offered through the exchange is scheduled to begin on October 1, with the coverage starting on January 1 2014.

Physician-Assisted Suicide Moves Ahead on Uncertain Path in NJDeath with Dignity Act could see changes before floor vote in Legislature

By Andrew Kitchenman,

New Jersey residents who are terminally ill are closer to being able to choose to end their own life with the help of a

But while a bill that would allow physician-assisted suicide with prescribed medication was released by an Assembly committee on Thursday, it faces a number of obstacles before it becomes law.

Legislators must decide whether to keep a provision in the New Jersey Death with Dignity Act (A-3328) that would require a statewide referendum on whether to approve physician-assisted suicide.

New Jersey would join Oregon and Washington as the third state to approve the measure through a ballot question. The Montana Supreme Court has allowed for judicially monitored assisted suicides.

Another major change being considered by lawmakers would require that a psychologist join a physician in evaluating a patient before approving life-ending drugs.

Even if the bill makes it through the Legislature, it faces a major hurdle in Gov. Chris Christie, who hasn’t taken a public position on the measure.

If the bill does advance, it will have survived at the center of a highly charged debate.

The personal stakes of each of the groups that have taken positions on the measure were on full display during a hearing on Thursday. Testimony focused largely on personal experiences with family members who faced terminal illnesses. It also showed a split among healthcare providers, with the state’s largest doctor’s group opposing the measure while others support it.

While bill supporters said they would attempt to incorporate suggestions from those testifying on the bill, it will be difficult to find a middle ground with opponents.

Assemblyman John J. Burzichelli (D-Cumberland, Gloucester and Salem) described the bill in a measured way, saying that it was legal “housekeeping” that raised aspects of other states’ laws for consideration in New Jersey. He said he wants to meet with all interested parties to propose amendments to improve the legislation.

“We’re early on in this,” Burzichelli said, who added that the bill “bubbled up through research” by legislative staff members.

Burzichelli said he had personally favored having the Legislature legalize the practice without a referendum, but agreed with legislative leaders to include the provision for a public vote.

“It’s a part of it as we presently stand,” Burzichelli said. “It’s designed to go to voter referendum.”

If the referendum provision survives the legislative process, the practice stands at least a fair chance of becoming law.

A Fairleigh Dickinson University poll in early December showed state voters backed physician-assisted suicide by 46 percent to 38 percent. Most of the difference stemmed from voters’ religious views, according to the poll.

However, most state residents said they hadn’t heard or read anything about the bill.

Before it goes to the ballot, it would go to the governor’s desk. Christie has sided with religious conservatives on some social issues, including abortion. But the governor hasn’t indicated his position on the assisted-suicide issue. While Burzichelli said he has had informal discussions with administration officials on the issue, he wouldn’t disclose what was said.

With the legislative fight expected to continue in coming months, the state’s medical community could play an important role. The Medical Society of New Jersey has sided with its national partner, the American Medical Association, in opposing physician-assisted suicide. National groups for women doctors and medical students have supported the practice.

Dr. Joseph Fennelly, chairman of the medical society’s bioethics committee, said that New Jersey faces different issues than Oregon or Washington. He said the state must move slowly on assisted suicide before addressing other problems, such the number of uninsured residents and the pressures that inhibit end-of-life discussions between patients and doctors.

“The best way to approach death with dignity is to assure that each and every patient receive appropriate care throughout their life,” Fennelly said.

The medical society’s chief operating officer, Mishael Azam, said several efforts are under way in the state to increase and strengthen existing end-of-life palliative programs that focus on reducing patients’ suffering.

“We just want to encourage improving palliative life, as opposed to this option,” Azam said.

The state’s hospices also oppose the measure.

The New Jersey Psychological Association supports the bill. Association member Virginia Waters said psychologists would be helpful in assessing patients’ mental health to help doctors determine who would be fit to have the option of deciding to take fatal drugs.

“It’s so important that we empower people in order to make a wise choice,” Waters said.

Burzichelli said he would consider the proposal to include

February 2013 13

psychologists in the process. He said “a significant number of our residents want the comfort of knowing they can have more control and choice when deciding what is best for them in facing their certain conclusion of their time on earth.” He emphasized that only a small number of people have chosen to end their lives using prescription drugs in the states where it is legal.

The debate over the legislation has been highly personal.

Bill supporter Claudia Dowling Burzichelli, the assemblyman’s sister-in-law, said she has struggled with a series of wrenching end-of-life situations, including her father’s suicide by gun while struggling with Parkinson’s disease and other diseases; the suicide of her husband’s friend by asphyxiation; and her mother-in-law’s struggle with terminal breast cancer.

Dowling Burzichelli was diagnosed with advanced lung cancer 18 months ago.

“It’s considered terminal. Don’t look up the statistics on the Internet – it’s depressing,” she said.

“I would hope that I would have more options than starving myself or taking my life in a violent way,” Dowling Burzichelli said. “I don’t know how I truly will feel when that time may come, but it comforts me to think there could be a process, a way to offer options that would not hurt my family.”

The assemblyman said his sister-in-law’s situation was not the driving force for his introducing the bill, and she said she first became aware of the measure after he introduced it.

The bill faces opposition from religious groups, including the New Jersey Catholic Conference.

Conference Executive Director Patrick J. Brannigan said he saw both of his parents die from prolonged illness, but that his mother benefited from hospice care, which assisted-suicide opponents support as an alternative.

Brannigan cited cases of residents who have lived for decades after being diagnosed as being terminally ill. He also said a

provision of the bill that allows doctors to list the underlying terminal illness as the cause of death is disturbing.

“That statement legalizes a misstatement that borders on a fraudulent report,” Brannigan said. “The cause of death should be listed as self-administrated drugs that ended life. Why not tell the truth?”

An important supporter of the bill is Assemblyman Herb Conaway Jr. (D-Burlington), chairman of the Assembly Health and Senior Services Committee, which released the bill. Conaway said after the committee hearing that attitudes in the medical community may be evolving on the issue.

“As people become aware of an issue and think about an issue, their thoughts and feelings about it may very well change,” said Conaway, who compared it to evolving societal views of same-sex marriage.

“One of the things that so disturbs about some of the attacks we saw in the run-up to the passage of national health reform was the idea that mere discussions of end-of-life issues raised the specter of a death panel,” Conaway said. “We should all think about what we would want to do by way of self-determination.”

Conaway, a doctor, added that he may feel differently when faced with the situation, but that he currently would not take part in an assisted suicide because of the uncertainty involved in patients’ prognoses.

“I helped this bill get out of committee today, but there are a number of details that need considering,” he said, adding, “I don’t know that I would be involved in assisting a patient to end their life, but I recognize that there are physicians who will and that there are patients who will want to avail themselves of their right to self determination.”

The Senate version of the bill has been referred to the Senate Health, Human Services and Senior Citizens Committee but hasn’t been scheduled for a hearing.


NJ HITech

Meaningful Use Insights: Tips & TricksWhat NJ-HITEC Learned from the Field

By Jennifer Covino, RHIA, HIT Pro-TR & Arixmar Velez with Mary Beth HallThe New Jersey Health Information Technology Extension Center (NJ-HITEC) is the only Regional Extension Center (REC) in the Garden State. NJ-HITEC has over 7,400 member providers with over 5,600 of those members live on their EHR system. Moreover, over 2,400 NJ-HITEC members have achieved Stage 1 Meaningful Use.

The NJ-HITEC Meaningful Use (MU) team continually assists a wide range of providers, practices, and specialists with achieving Meaningful Use of Electronic Health Record (EHR) systems. Through the course of many interactions, this team understands what works and what doesn’t work in practices and with various vendors. Here is what NJ-HITEC has learned out in the field.

Ramping Up for Meaningful Use:

• Prepare yourpractice for transitioning toMeaningfulUse. Get the staff excited and involved.

• Atleast80percentofpatientsneedtobeincludedinyour EHR system.

• Eligible Professionals (EPs) must use a location orlocations where 50 percent or more of their executions are in the EHR system and available at the start of the reporting period.

• Thepracticeshouldidentifyoneprojectleadertokeeptrack of the Meaningful Use progress and create a workflow process to show who is accountable for which measure (i.e., the physician would be responsible for e-prescribing, the front desk for demographic information).

• Theprovidershouldselectmenuandqualitymeasuresin advance. This will avoid feeling overwhelmed and will help to focus your attention.

• It iswiseforthepracticetoprovideNJ-HITECwithitsvendor representative contact information as it can often obtain a timely response from the vendor if an issue arises.

• The practice should gain access to NJ-HITEC’s onlinesecurity tool at the beginning of the reporting period as the tool is time stamped and is to be completed prior to or during the EHR reporting period to meet the measure.

Assessing Your Meaningful Use Report:

• There are four core Meaningful Use measures thatshould have matching denominators since these denominators are based on all unique patients:

• MaintainProblemList

• ActiveMedicationList

• ActiveMedicationAllergyList

• PatientDemographicData

The following two menu measures should also have the same denominator:

• PatientElectronicAccess

• Patient-specificEducationResources

If these do not match, you need to contact your vendor to determine why the EHR system has a reporting discrepancy between the denominators.

• It is important to remember the yes/noMeaningful Use measures may not be included on the EHR's Meaningful Use Dashboard report. There are five core yes/no measures:

• DrugInteractionChecks

• ReportonClinicalQualityMeasures

• ClinicalDecisionSupportRule

• ElectronicExchangeofClinicalInformation

• ProtectElectronicHealthInformation

The three menu measures that have a yes/no attestation response are:

• Drug-FormularyChecks (exclusionoption ifyouhaveless than 100 prescriptions)

• PatientsLists

• PublicHealthMeasure-ImmunizationRegistriesDataSubmission (exclusion option). Even if you do not provide immunizations, you still have to choose the immunization menu measure.

NOTE: Screenshots showing proof of implementation of these yes/no measures should be kept in a paper file and electronic file for six years, in case of an audit.

• If theEHR'sMeaningfulUseDashboard isflawedandcalculates the measures erroneously, the provider will be at no fault. (Please if Refer to CMS: FAQ #6097@ https://questions.cms.gov/faq.php?id=5005&faqId=6097.

How to Get a Head Start on Stage 2 Meaningful Use (Beginning 2014)

• Implement five or more Clinical Decision SupportRules.

• GetyourpatientssetuponthePatientPortal(Askyourvendor on how to get started on this if you have not already.)

• Interface with the Labs that your practice uses themost.

• Begin sending preventive/follow-up care remindersthrough your EHR system.

• Begin documenting patient education given in yourEHR system.

• If you perform immunizations, get interfaced withNJIIS.

February 2013 15

• Start collecting patient family health history asstructured data.

Important Note: Providers will not need to demonstrate Stage 2 Meaningful Use until they have demonstrated a 90-day and a full year of Meaningful Use Stage 1.

How Achieving Meaningful Use Can Prepare You for Additional Incentives:

• ThereareoverlapsinthecriteriaofachievingMeaningfulUse and achieving Patient-Centered Medical Home (PCMH) status. The PCMH standards align closely with many specific elements of the federal program that rewards clinicians for using Health Information Technology (IT) to improve the delivery of quality healthcare. For example, in achieving PCMH status, one PCMH standard focuses on patient access and communication. In alignment are the Meaningful Use measures such as providing patients with clinical summaries for each office visit, providing patients with an electronic copy of their health information on request, and providing patients with timely electronic access to their health information. Likewise, every standard of achieving

their health information. Likewise, every standard of achieving PCMH status has Meaningful Use measures that correlate to it.

• Achieving Meaningful Use also overlaps with thePhysician Quality Reporting System (PQRS) incentives. ManyoftheClinicalQualityMeasures(CQMs)havetheirorigininthePQRSincentiveprogram.Thereare30CQMsthatoverlapwithPQRSmeasures,forinstance,PQRI128AdultWeightScreeningandFollow-up(acoreCQM)andPQRI110PreventiveCareandScreening Influenza Immunization for Patients >= 50 years old (an alternatecoreCQM).TheMeaningfulUseCQMsareconsideredpotentially the most important aspect of Meaningful Use, with the objective to improve public health and can prepare you for PQRSincentives.

NJ-HITEC helps providers work through the process of achieving Meaningful Use regardless of where they are in the process. For further information about NJ-HITEC and how you can receive assistance, please call 973-642-4055, email [email protected], or visit www.njhitec.org.



Health Law Update

HEALTH LAW UpdateDCA Adopts Rule Authorizing Electronic Prescriptions for CDS

The New Jersey Division of Consumer Affairs has adopted its proposal to amend the rules pertaining to Controlled Dangerous Substances (CDS) under N.J.A.C. 13:45H to allow for electronic prescriptions for CDS.

The rules of both the New Jersey Board of Medical Examiners and the New Jersey Board of Pharmacy allow for electronic prescriptions for CDS, if permitted by federal law. On March 31, 2010, the federal Drug Enforcement Agency issued an interim final rule permitting prescribers to issue prescriptions electronically and for pharmacies to receive them.

The amendment allowing electronic prescriptions for CDS became effective January 7, 2013, making N.J.A.C. 13:45H consistent with the rules of the New Jersey Board of Medical Examiners and the New Jersey Board of Pharmacy.

For additional information, contact: Joseph M. Gorrell / 973.403.3112 / [email protected]

Debra C. Lienhardt / 973.364.5203 / [email protected]

Legislation Proposed to Establish New Jersey All-Payer Claims DatabaseAssembly Bill A3603 was recently introduced into the New Jersey State Assembly to establish the New Jersey All-Payer Claims Database (Database) and arbitration process for reimbursing out-of-network health care providers. The bill was referred to the Assembly Financial Institutions and Insurance Committee.

If the bill is passed into law, it would establish the Database within the New Jersey Department of Banking and Insurance (DOBI) to process, analyze and report health care data collected from health care facilities, health care professionals and health insurance payers. Reporting entities (payers and health care providers) would be required to submit various health care data at least annually. The Commissioner of DOBI would be required to produce and to make publicly available reports utilizing the data contained within the database, and to submit annual reports to the Governor and legislature analyzing health care cost trends across the state.

Following the 25th month after the start of data submission to the Database, a reasonable and clearly defined payment range limiting the amount charged by out-of-network health care providers and reimbursed by carriers for certain medically necessary services rendered within in-network health care facilities would be established. The bill also establishes an arbitration process for resolving payment disputes. The insurance carrier would be able to choose whether to pay the amount billed by an out-of-network provider or to negotiate reimbursement with the provider, and if the attempt to negotiate reimbursement does not result in resolution within 14 days after the carrier is billed by the provider, either the carrier or the provider would be able to initiate binding arbitration to determine payment for services on a per bill basis.

For additional information, contact:Mark Manigan / 973.403.3132 / [email protected]

John D. Fanburg / 973.403.3107 / [email protected]

Final HIPAA Rules PublishedAfter months (even years!) of anticipation, the Office for Civil Rights (OCR) finally released the HIPAA/HITECH Act Final Rule (Rule) on January 17, 2013. As expected, the Rule modifies the breach notification rule, revises the enforcement rule and includes other general changes to the HIPAA Privacy and Security Rules.

Among other things, the Rule makes provisions of the Privacy and Security Rules applicable to covered entities’ business associates, as well as their subcontractors. Such entities will be required to come into full compliance with the Security Rule by September 23, 2013.

Significantly, the Rule modifies the definition of “breach” for purposes of the Breach Notification Rule. Previously, the Interim Rule contained a “risk of harm” threshold, which meant that a breach was only reportable if it posed a significant risk of financial, reputational or other harm to affected individuals. Now, acquisition, access, use or disclosure of protected health information in violation of the HIPAA Privacy Rule is presumed to be a breach (thus, requiring notification), unless the covered entity or business associate can demonstrate that there is a low probability that the information has been compromised based on a risk assessment. Such assessment must include a review of whether the information was actually acquired or viewed and the extent to which the risk to the protected health information has been mitigated. In effectively deleting the “risk of harm” threshold, the OCR states that such a threshold was too subjective and resulted in inconsistent interpretations and implementation.

The Rule has an effective date of March 26, 2013, with compliance generally required by September 23, 2013. Covered health care providers and their business associates will need to review and revise their policies (or implement new policies) in accordance with these new requirements by the applicable compliance deadlines.

For additional information, contact: Lani M. Dornfeld / 973.403.3136 / [email protected]

Todd C. Brower / 973.403.3103 / [email protected]

February 2013 17

DHHS Approves 106 Additional ACOsThe Department of Health and Human Services (DHHS) recently approved 106 additional Accountable Care Organizations (ACOs) to participate in the Medicare Shared Savings Program pursuant to the Affordable Care Act. The purpose of the program is to facilitate greater coordination and cooperation among health care providers to improve quality of patient care for Medicare beneficiaries, while reducing costs. Health care providers participate in the Medicare Shared Savings Program by forming or participating in an ACO. The ACO’s receive a percentage of the savings they bring to Medicare as an incentive to accept new payment requirements and implement patient care initiatives.

The additional ACO’s were authorized to commence as of January 1, 2013, and include the following slated to provide services within New Jersey:

• AdvocareWalgreensWellNetwork

• AtlanticareHealthSolutions

• CentralJerseyACO,LLC

• HNMCHospital/PhysicianACO

• MeridianAccountableCareOrganization,LLC

• SummitHealth-Virtua,Inc.

The next application period to commence operations on or after January 1, 2014 as part of the Medicare Shared Savings Program will be in the summer of 2013 (additional details will be forthcoming from the Centers for Medicare & Medicaid Services).

For additional information, contact: Kevin M. Lastorino /973.403.3129 / [email protected]

Carol Grelecki / 973.403.3140 / [email protected]

Fiscal Cliff Deal Temporarily Addresses Sustainable Growth RateThe deal, passed by the House and Senate on January 1 and signed by President Obama on January 3, puts off for a year the 26.5% cut in physician reimbursement mandated by Medicare’s sustainable growth rate formula, originally scheduled for January 1, and pushes back another 2% cut for an additional two months. Savings come in part from cuts to hospital reimbursement, including empowering Medicare officials with the ability to take back an estimated $500 million in payments made to hospitals and physicians since 2007. The provision, known as “Removing Obstacles to Collection of Overpayments,” provides that Medicare contractors now have five years to collect on errors in Medicare payments. Before this change, the statute of limitations on non-fraudulent Medicare overpayments was only three years. The largest cuts occur in the five-year period from 2014 to 2018, when Medicare will reduce hospital payments by $10.5 billion. Medicare authorities will recoup what they consider overpayments to hospitals caused by a new system of diagnosing patients. The cliff deal also creates a “new high-level commission” to develop a national plan for long-term services for the elderly and disabled. Should the measure become law, the Commission on Long-Term Care will have six months to draft recommendations.

For additional information, contact: John D. Fanburg / 973.403.3107 / [email protected]

Mark Manigan / 973.403.3132 / [email protected]


MSNJ News

MSNJ Supports Medical Liability Reform Legislation as it Advances out of CommitteeMSNJ supported medical liability reform in the Assembly Health Committee this week. A1831, sponsored by Chairman Conaway, would prohibit the addition of defendants using fictitious names at least 120 days prior to the date on which the action is set for trial. This bill also clarifies the existing legal immunity for health care professional who volunteers to respond in good faith to an emergency at a hospital or health care, removing the requirement that the service be provided without payment.

The bill provides that an insurer cannot increase the premium of any medical malpractice liability insurance policy based on a claim of medical negligence or malpractice against an insured unless the claim results in a medical malpractice claim settlement, judgment or arbitration award against the insured. Finally, the bill also prohibits an insurer from increasing medical malpractice insurance premiums, if the alleged malpractice occurred in certain charitable or emergency situations. The trial lawyers oppose the bill. Read the New Jersey Lawsuit Reform Alliance’s support letter and flier on the benefit of reform on women’s health.

Hospital Rounds

HOSPITAL ROUNDSNewark's Saint Michael's to be bought by troubled for-profit hospital chain

By Dan Goldberg / The Star-Ledger

Prime Healthcare Services, the troubled California-based for-profit hospital chain, announced it has purchased Saint Michael’s Medical Center in Newark.

This is the second New Jersey hospital Prime has acquired in the last four months, and is the latest in a series of acquisitions the company has made as they aggressively expand across the country.

But concerns have been raised in other states over Prime’s business practices because of pending investigations into alleged Medicare fraud and violations of patient confidentiality.

The company has denied any wrongdoing.

Prime, according to a letter sent to Saint Michael’s employees, has agreed to maintain the medical center as an acute care hospital for at least five years, and provide charity care in a manner “similar” to the one that is currently provided.

"Every hospital has a specific policy as to charity care, essentially a policy that determines how patients without financial means will be treated," said Edward Barrera, a spokesman for the company. "Prime Healthcare typically reviews these policies and in virtually every deal it has done, it agrees to utilize the same policy under Prime Healthcare’s ownership that the seller had in pace. In this case as well as St Mary's, Prime Healthcare has agreed to have a policy similar to what they had before, even though they are both non-profit Catholic hospitals."

The California based company recently admitted that it is the subject of U.S. Justice Department investigation, according to documents filed with the Rhode Island state department of health.

Prime primarily owns hospitals in California but has purchased six hospitals in four other states in the last year including St. Mary’s in Passaic.

And it has been just over a year since Prime failed in its attempt to acquire Christ Hospital in Jersey City. The deal was scuttled after the proposal was met with strong opposition by labor unions and consumer advocacy groups who were concerned over investigations into the chain's medical and billing practices.

The transaction to acquire Saint Michael’s is pending approval from the state Department of Health and the state Attorney General's office as well as canonical approval.

February 2013 19

Food for Thought

Ma Maison BrasserieMillburn, New Jersey

By Iris Goldberg

It was the end of a difficult day at the end of a difficult week. I would have been happy to order a pizza and call it a night. We had made the reservation at Ma Maison, a BYOB, which describes its fare as French fusion, after reading a lovely review in the NY Times. On this cold and damp Friday evening, however, I was definitely having second thoughts. Somehow, I found the strength to pull it all together – fix the hair, do the make-up and manage a smile, in order to join my husband for a romantic French dinner for two.

We had a 7:15 reservation and arrived promptly. As we walked from the car, Michael, sensing my ambivalent feelings about the evening, held my hand tightly. This did improve my mood and I looked forward to our meal. The place was completely full. Newly renovated, Ma Maison is definitely designed to provide a stylish Parisian atmosphere. The main dining room, complete with fireplace, is warmly decorated with great thought and detail. A much smaller dining room is more casual with a wood burning oven, where they make artisan pizzas for those who might like a lighter meal.

When we had phoned for the reservation we were told there was only availability in the smaller room. When we got there both rooms were totally occupied and we waited along with a party of four who had arrived before us. The hostess took our coats and apologized for the delay. Michael asked if there was any way that we could be seated in the main dining room. She smiled and told him she would try.

The party of four was shown to their table. As 7:15 became 7:30, the hostess (Sharone, who is owner with husband Chef Franco Emilio) brought two wine glasses and asked if she might open our wine for us to sip, while waiting. She then assured us we would be seated in the main dining room. I must say, this was most appreciated.

By the time we were seated, it was 7:45. While it’s never pleasant to wait for more than a few moments for a table, especially one that had been reserved, I think I was able to observe why there was a significant delay. As I glanced from table to table, I could see that everyone was thoroughly enjoying their meal and the lovely ambience at Ma Maison. People were lingering over dessert and coffee, some engrossed in animated conversations,


while couples were sharing intimate exchanges. As she showed us to our seats, Sharone apologized again told us that dessert would be complimentary.

So far, we were impressed but we still hadn’t sampled any of the food. The first course menu includes four choices of mussels. One, is a traditional preparation with garlic, white wine and parsley and another adds chorizo and French fries. Also, there are mussels with fresh tomato and creamy pesto sauce and mussels with shallots and fresh fennel. Michael selected garlic, white wine and chorizo with a plate of fries on the side. I tasted a couple of the mussels, which were prepared perfectly. Michael really enjoyed this dish, particularly with the flavorful chorizo and the accompanying fries.

Among the other appetizers are traditional French onion soup, duck Foie Gras and Escargots. There is also a variety of salads – goat cheese, pears, baby greens and walnuts, as well as endive, arugula, bleu cheese and walnuts. I chose one of my favorite salads, Nicoise, which is mixed greens, served with tomato, tuna, boiled eggs, olives and chilled haricot verts. I was not disappointed. The green beans were still slightly crisp and the tuna was worthy. Actually, this could be a meal in itself, especially at lunchtime.

The entrees at Ma Maison include many traditional French dishes, prepared with Chef Franco’s own special touch. For example, the bouillabaisse is served beneath a pastry crust, sealing in the wonderful blend of seafood and saffron-seasoned broth. Michael chose Duck Parisian. Duck is the dish Michael orders most often. I’ve never seen him enjoy it more than he did on this occasion. The tantalizing crisp skin, with the meat perfectly cooked and the wonderful sauce of figs, it all came together beautifully and Michael savored every bite.

I selected the “Specialty of the Day,” which was rack of lamb cooked in Ma Maison’s wood-burning brick oven, served with mashed potatoes and spinach sautéed in garlic and oil. The lamb was nicely seared on the outside, yet cooked medium rare as I had requested. Not the most loyal fan of mashed potatoes, I really enjoyed these. Were they made with duck fat perhaps? I don’t know but they were special.

Of course we had to order dessert. After all, it was complimentary and as I told myself, it would be rude to decline. Then I told myself it would be rude to just order one dessert and share. So in order to seem appropriately appreciative, Michael ordered the Crème Brulee and I forced myself to have the Profiteroles au Chocolat, which were too heavenly. The chocolate sauce was amazing! I had to push my plate away after eating one and a half of these gelato-filled masterpieces, in order to prevent myself from eating all three.

As we readied ourselves to leave, Sharone came by to inquire about our meal. Although I rarely share who we are with those restaurants that find themselves in this column, I felt I had to tell her that we would be writing about Ma Maison for our audience of physicians. “Oh, you have made my day,” she said, with delight. She could not have known that with all we’d been going through of late – she and Ma Maison had made our month! I’m so glad we didn’t cancel that reservation for 7:15.

Ma Maison is located at 291 Essex Street, Millburn, NJ (973) 467-7873

Coverage is subject to meeting eligibility requirements and company approval.

www.Bollinger.com/pro

Talk to Bollinger about your Professional Liability … Before entering this room.

With one of the largest professional liability divisions in the region, Bollinger has the expertise and resources to help ensure that your liability threats are properly addressed.

To learn more about how Bollinger can help your practice, contact Brian S. Kern, Esq.

973-921-8497 or [email protected]

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