nj physician magazine june 2012
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New Jersey Physician MagazineTRANSCRIPT
Supreme Court Upholds Healthcare Reform LawControversial Disclosure Bill Leaves Assembly with AmendmentsUninsured Awaiting Governors’ Decisions on Obama’s Health Reform Act
J U L Y 2 0 1 2
Also in this Issue
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Visit us now online atwww.NJPhysician.org
More Positive Outcomes for PatientsDiagnosis and Treatment Translates into
Center For Digestive DiseasesUp to the Minute Technology for Screening,
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J U N E 2012
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Dear Readers,
Michael Goldberg
Publisher’s Letter
Published by Montdor Medical Media, LLC
Co-Publisher and Managing EditorsIris and Michael Goldberg
Contributing Writers Iris GoldbergMichael GoldbergMark Manigan, Esq.Mark ShermanJoe CarlsonRicardo Aloso-ZaldivarCarol Grelecki, Esq.John D. Fanburg, Esq.Debra Lienhardt, Esq.Todd Brower, Esq.
Mary Pat Gallagher
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Welcome to the June issue of New Jersey Physician, the voice of the state’ physicians.
Pease join Iris and I in welcoming our �rst gandchild, Isabel Pearl, intothe world. It is most hard to �nd the words that express this wonderfuladdition to our family.
Though more than a month has gone by since the Supreme Court ruledon the healthcare reform law, the debate on the ruling and the aftere�ects of this are still being discussed. The impact on hospitals,physicians and payors will certainly be signi�cant. How does a practiceor hospital deal with the rami�cations of the decision? Mark Manigandiscusses these issues in our issue. The Medicare Shared SavingsProgram, based on accountable care organizations has already spurredcooperation between many physicians and hospitals in New Jersey.Going forward, Attorney Manigan believes that these ACOs willcontinue to develop and exand to include hospitals and physicians.Please see the article for more insights into the future ofhealthcare under the ACA.
Going beyond the after-e�ects of the decision to the individual practice, there is a downside to the states who have said “no” to the federalhealth care law, including New Jersey. As many as 245,000 uninsuredNJ residents who fall below the poverty line will be left behind in a coverage gap being called the new “doughnut hole”. Neither Medicarenor Medicaid would cover these uninsured individuals and the solutionto this has not yet been proposed.
A class action settlement against Horizon Blue Cross Blue Shield of NewJersey over delayed health-care payments to doctors won appeals courtapproval including a $4.7 million ruling covering legal fees and costs.Doctors and medical groups who objected to the deal are likely topetition for Supreme Court review.
For the past 8 years we have watched the Center for Digestive Diseasesgrow into a state-of-the-art practice utilizing the latest in technology todiagnose and treat patients. Dr Samiappan Muthusamy, MD, FACP,FAGG, AGAF Medical Director of the practice and his associates havedeveloped CDD into one of the largest procedure basedgastroenterology practices within New Jersey. Please come inside andsee the myriad of diagnostic tools they use to solve complex gastroenterologic problems.
With warm regards
Michael Goldberg
Co-Publisher
2 New Jersey Physician
CONTENTS
9
Supreme Court Decision
12
Health Law Update
Statehouse 14
Hospital RoundsU.S. News Ranks UMDNJ17
19
Contents
Center for Digestive DiseasesUp to the Minute Technology for Screening,Diagnosis and Treatment Translates into MorePositive Outcomes for Patients
4
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18 ASC Meeting
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Beth Israel Medical Center. The practice has fully converted to EMR, allowing round the clock communication amongst the physicians concerning patients and with hospitals and pharma-cies, in order to ensure accurate and expedient care.
The vast majority of procedures performed by the physicians of CDD are done on an outpatient basis at ambulatory Endo-Surgi Centers located in Union and Old Bridge. Both facilities are JCAHO-accredited for more than ten years and equipped with state-of-the art screening and treatment capabili-ties.
(CDD 2)
Since its inception in 1980, the Center for Digestive Diseases (CDD) has been continuously evolving in order to best serve the ever-growing number of patients who come for diagnosis and treatment of the entire gamut of gastrointestinal disorders. Sami-appan Muthusamy, MD, FACP, FAGG, AGAF, Founder and Medi-
involved in developing CDD into one of the largest procedure-based gastroenterology practices within the state of New Jersey.
Along with Dr. Muthusamy, the physicia of CDD are Dhanaseka-ran (Dan) Ramasamy, MD, CNSP, Mahesh R. Desai, MD and Sujala Chirla, MD. Dr. Desai, who was a successful sole practitioner in Millburn for many years, with vast experience in treating the spectrum of GI disorders, recently merged his gastroenterology practice with that of Dr. Muth-usamy and the others at CDD. Also, physician assistant Aaron Javier, MS, PA-C and a highly-
-als are on hand to provide patients with the highest level of care.
Union, Old Bridge, Millburn and West Orange, CDD is conveniently located to treat patients from many areas of New Jersey including Morris, Essex, Union and Middlesex counties. The physicians of CDD are
Trinitas Hospital, Overlook Hospital, Saint Barna-bas Medical Center and Newark
Most impressively, both have been recognized by the American Society for Gastrointestinal Endoscopy (ASGE) for Promoting Quality in Endoscopy. This distinc-tion has only been awarded to about 70 such facilities nation-wide. Since its founding in 1941, ASGE has been dedicated to advancing patient care and diges-tive health by promoting excel-lence and innovation in gastroin-testinal endoscopy. ASGE promotes the highest standards for endoscopic training and practice. Much like JCAHO accredi-tation, ASGE recognition can only be maintained through ongoing examination and inspection.
Endoscopic ultrasound (EUS) is an outpatient procedure that combines endoscopy and ultrasound in order to obtain images and information about the digestive tract and the surround-ing tissues and organs. AT CDD, this technology has become well established as a minimally inva-
Both Endo-Surgi Centers have been JCAHO accedited for more than 10 years
Dr Ramasamy is a skilled endoscopist whohas established EUS as the “Gold Standard”for both diagnostic and therapeutic use fora myriad of gastrointestinaland thoracic disorders
4 New Jersey Physician
Cover Story
Center forDigestive DiseasesUp to the Minute Technology for Screening, Diagnosis and Treatment Translates into MorePositive Outcomes for Patients
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By: Iris Goldberg
An area of irritation is shown in the esophagus
Fine needle aspiration of solid andcystic lesions of the pancreas toevaluate for cancerFine needle aspiration of medicinallymphadenopathyStaging of gastrointestinal cancers.These would include esophageal,gastric, rectal and pancreatic can-cers. EUS can determine how deep-ly a tumor penetrates the gut wall and by examining adjacent lymphnodes, can also indicate whether the cancer has spreadLung cancer staging - non invasivemediastinal evaluationAmpullary lesions including aden-oma and cancer
Unexplained chronic abdominalpain (microlithiasis and early chro-nic pancreatitis)Submucosal lesions noted on end-oscopy (stromal tumors, etc.)Fecal incontinence (anal sphincterevaluation)Barrett’s esphagus with high-gradedysplasiaFine needle injection of anti-tumoragentsNeuroendocrine tumors
sive, cost-e�ective alternative to surgery. EUS involves passing a thin, �exible tube (endoscope) through a patient’s mouth or anus. A small ultrasound transducer in the endoscope produces sound waves that create a viewable image of surrounding tissue, including the lining of the upper and lower GI tract and nearby organs such as the pancreas, liver, adrenals, bile duct and gallbladder.
EUS is technically demanding and complex, requiring the skills of a specially-trained endoscopist. Dr. Ramasamy, who joined the practice in 2008, received advanced endoscopic training at St. Luke’s Medical Center in Milwaukee from Dr. Joseph Geenen and Dr. Marc Catalano, both of whom are world-renowned for their expertise in pancreatobiliary endoscopy. For patients treated at CDD, he has been instrumental in establishing EUS as the “gold standard” for both diagnostic and therapeutic use for a myriad of gastrointestinal and thoracic disorders. Common indications for endoscopic ultra-sound include:
Dr. Ramasamy emphasizes the important role EUS plays in the diagnosis and treatment of pancreatic cancer. He explains that by the time pancreatic cancer is found, in most cases, it has already advanced too far for a possible cure. “Now with endo-scopic ultrasound, we can diagnose a lesion as small as one centimeter,” he reports. “At this stage, it may be curable,” Dr. Ramasamy is pleased to share.
For patients who have a strong family history of pancreatic cancer or those who are experiencing vague, possible early symptoms, EUS is a valuable and potentially life-saving tool. When high-risk patients are screened using EUS, a malignancy can be detected much earlier than would be possible with CT scanning. Lesions found in the very early stage of disease are signi�cantly more likely to be successfully removed during a surgical resection.
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The physicians at CDD are deter-mined to eradicate colon cancer. They have established stringent criteria, based on the latest clinical �ndings, to determine when a patient requires his or her initial screening colonoscopy. While it is true that everyone should be screened by or at age 50 and those with family history at age 40, it is now known that other higher-risk groups exist. Dr. Muthusamy cites data that suggests obesity, diabe-tes, hyperlipidemia and coronary artery disease can also be harbin-gers of earlier onset of colon cancer, requiring many patients with these conditions to be screened at a younger age.
Dr. Ramasamy elaborates further, “Anybody with lower GI symptoms such as diarrhea, bleeding, or change of bowel habits should have a colon examination, regard-less of their age. They should not wait until age 50,” he adds.
Besides monitoring their patients closely to reduce the number of deaths caused by pancreatic and colon cancers, the physicians at CDD take an extremely vigilant approach with those who are at risk for developing esophageal cancer, which is most often fatal if not prevented altogether or detected at an early stage. High-risk patients include white males, especially those with a history of acid re�ux and or those who drink
NJP_June2012.indd 3
June 2012 5
alcohol excessively or smoke. A pre-cancerous condition, Barrett’s Esophagus, which refers to the presence of abnormal cells that can become cancerous, is also more prevalent within this popula-tion.
At CDD, the physicians are incor-porating cutting edge technology to successfully treat Barrett’s Esophagus before it develops into esophageal cancer. BARRX is a newer treatment option available at CDD that is performed in conjunction with upper endos-copy to ablate or remove these cells in order to prevent the tissue from becoming cancerous.
BARRX is performed as an outpa-tient procedure. The patient is sedated and swallows a thin,
which transmits an image of the inside of the esophagus. The CDD physician will view the esophagus and measure the area that requires treatment. Then, a radiofrequency ablation catheter is inserted into the esophagus to deliver energy only to the abnormal tissue. The pre-cancerous cells are destroyed and new healthy cells develop in their place.
Of paramount importance to the physicians of CDD is catering to the logistic needs of their patient
treatment options such as Satur-day appointments. Also, to avoid
facilities, at CDD’s on-site GI lab, patients can undergo diagnostic testing for a variety of chronic conditions such as irritable bowel
intolerance and gastroparesis or other motility problems. Often, patients for whom a diagnosis remains elusive or for whom treatment thus far has been unsuc-cessful are referred by primary care physicians or even other gastroen-terologists whose practices are less procedure-oriented.
high resolution manometry (Manoscan) testing to evaluate the esophageal motility in patients with suspected swallowing disor-ders, atypical chest pain and acid
catheter is placed through the nostril into the esophagus to record the esophageal peristalsis. All relevant data from the stomach to the pharynx are collected automatically and processed digitally. The entire procedure takes less than 30 minutes.
Manometry testing evaluates the esophageal motility in patients withswallowing disorders, atypical chest pain and GERD
To measure esophageal pH and determine if a patient has gastroe-
especially those who are not responding to treatment, or have non-esophageal symptoms such as chronic throat congestion, cough, etc., the physicians at CDD perform 48-hour BRAVO wireless esophageal pH testing. A small
capsule, about the size of a gel cap, measures pH levels in the esopha-gus and transmits readings by radio telecommunications to a receiver worn on the patient’s belt or waistband. The receiver is equipped with several buttons which the patient will press to record symptoms of GERD such as heartburn, when starting and stopping eating, lying down and getting up, etc. The receiver and diary are returned when the moni-toring period is over and the information is downloaded and analyzed to be reviewed with the patient.
-e Smart-
Pill, which is an ingestible, wireless capsule that measures pressure, pH and temperature as it transits through the GI tract. This informa-tion is used to provide the physi-cians at CDD with the gastric emptying time, combined small and large bowel transit time and motility patterns from the antum and duodenum.
The SmartPill is most useful for diabetics with chronic upper GI symptoms such as nausea, vomit-ing and post-paradial discomfort to diagnose gastroparesis. This technology, which involves no radiation, allows the patient to conduct normal activities during the entire course of the test. If colonic dysfunction is diagnosed, novel drug therapies that hasten motility and help with chronic constipation can be prescribed.
In order to examine the lining of the small intestine and uncover the causes of anemia due to intes-tinal blood loss, to diagnose
The smart pill is an ingestible wireless cap-sule that measures pressure, pH and temp-erature as it transits through the GI tract
NJP_June2012.indd 3
6 New Jersey Physician
to examine the lining of the small intestine
diseases that involve the small intestine such as Crohn’s disease, or to evaluate chronic diarrhea, the physicians at CDD were amongst
wireless capsule endoscopy. The procedure is painless, requires no sedation and is performed in the
video capsule, containing a video chip, light bulb, battery and radio transmitter. As the capsule travels through the esophagus, stomach and intestine, it takes photographs in rapid succession. The photos are transmitted by the radio trans-mitter to a small receiver that is worn by the patient. After the procedure, the photographs are downloaded from the receiver to a computer located at CDD. The images are then reviewed by the physician and test results are discussed with the patient.
Hydrogen breath testing is performed at CDD to diagnose irritable bowel syndrome (IBS). Thirty percent of IBS is caused by an overgrowth of bacteria in the small bowel. By measuring the amount of hydrogen in a patient’s breath, the physicians can ascer-tain whether colonic bacteria have backed up into the small intestine, causing pain, bloating, distention and diarrhea. If the test is positive for bacteria, antibiotic treatment is initiated to arrest the problem.
Hydrogen breath testing is also done by the physicians at CDD to detect improper digestion of sugars such as lactose. When a patient is lactose intolerant, large amounts of the lactose consumed reach the colon because they are not properly digested and absorbed in the small intestine, increasing the level of gas that is formed. Thus, a higher concentra-tion of hydrogen will be detected in the patient’s breath. To detect the presence of H. pylori, the physicians at CDD perform urea breath testing. Dr. Muthusamy points out that if left untreated, H.pylori can lead to
ulcers, atrophy of the stomach, or even stomach cancer. H. pylori have the ability to break down
urea into a product made up of nitrogen and carbon. Patients swallow a capsule containing urea made from an isotope of carbon. If H. pylori are present in the stom-ach, the isotope will be detected in the patient’s breath. H. pylori can
-otics. A subsequent breath test
the H. pylori have been eradicated.
Besides incorporating the most current technology to perform newer procedures that dramati-cally improve patient outcomes, the physicians at CDD prioritize the discovery of newer and more
example, for CDD patients who are infected with the hepatitis C virus (HCV)triple therapy, which combines a protease inhibitor (telaprevir or boceprevir) with traditional interferon and ribavirin therapy to prevent development of resistance.
“Awareness of hepatic C is increas-ing and we are seeing more patients who are now coming
forward,” Dr. Ramasamy notes. In fact, the number of patients who are currently being treated for
-cant. Mr. Javier, CDD’s physician assistant plays a crucial role in the ongoing monitoring of these patients to ensure that they are receiving the highest level of care. It has been most gratifying for the physicians at CDD to witness the growing percentage of patients who can now be cured as a result of advances in drug therapy.
There are also an increasing number of patients who are treated at CDD for hepatitis B. Most healthy adults (90%) who are infected with hepatitis B will develop protective antibodies against future hepatitis B infec-tions. A small number (5-10%) will be unable to clear the virus and will develop chronic infections. Unfortunately, this is not true for infants and children - 90% of infants and up to 50% of young children infected with hepatitis B will develop chronic infections. Therefore, vaccination is essential to protect infants and children.
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June 2012 7
Most of the patients with chronic hepatitis B seen at CDD are those who have immigrated to the United States from locations such as Asia or Africa, where newborns and young children are not univer-sally vaccinated, even though the disease is most often passed from an infected mother to her unborn child, or contracted by a young child from contact with infected secretions. Among HIV, hepatic C and hepatitis B, hepatitis B is the most contagious by far. In fact, 2 billion people worldwide have been infected (1 out of 3 people) and 400 million are chronically infected.
In the communities surrounding
population of people who have come to the United States from Asia and Africa. Dr. Ramasamy discusses why being screened and receiving treatment is so vital for these individuals. “Hepatitis B is a cancer-causing virus. This can
developing cirrhosis,” he explains. Dr. Ramasamy suggests beginning treatment for hepatitis B after determining the patient’s viral load, genotype and perhaps the degree of liver damage revealed by a liver biopsy.
For many of the CDD patients who are chronically infected with hepa-titis B, the physicians use novel antiviral drug therapies to
promote improvement in the liver. These medications can be taken orally in the majority of cases and have been associated with few
be carefully monitored but all of the physicians at CDD agree that advancements in drug develop-ments and treatment options are paving the way for a much brighter future for patients with hepatitis B.
As is the case with many of the debilitating and sometimes life-threatening diseases that continue to strain our healthcare system, such as diabetes and heart disease, obesity is playing an ever-increasing role in the devel-opment of liver disease and at times, eventual liver cancer. Non-alcoholic fatty liver disease, which can progress to cirrhosis, and possibly, even liver cancer, is becoming more prevalent amongst the growing number of people who are considered to be obese.
At CDD, the physicians are deter-mined to raise the level of aware-ness of their patients concerning the serious consequences of being overweight. Educating patients about making healthier food choices and also increasing activity levels is of paramount importance. “This not only decreases the chance of developing these condi-tions,” Dr. Muthusamy reports, “but it also helps patients to feel better,” he adds.
Visit us now online atwww.NJPhysician.org
Women’s GI health is another important concern at CDD. Some disorders are more common amongst women, such as irritable bowel syndrome (IBS) and celiac disease, for example. Dr. Chirla, who recently joined CDD after spending four years with a practice in Doylestown, PA, where she managed a wide variety of pathol-
diseases, specializes in helping women understand how to main-tain a good quality of life through proper understanding and management of gastrointestinal disorders.
Dr. Chirla discusses some confu-sion surrounding the much-publicized situation concerning the growing number of people, mostly women, who must follow a gluten-free diet. “Although this is generally thought to be necessary only for people with celiac disease, not all people who cannot eat gluten have celiac disease,” she says, explaining that you can be sensitive to gluten for other reasons.
Dr. Muthusamy, Dr. Ramasamy, Dr. Desai and Dr. Chirla, along with the
-sionals at CDD provide a valuable resource for many New Jersey referring physicians. Cutting edge technology, convenient treatment options and compassionate care have earned a stellar reputation for the Center for Digestive Diseases as one of the most impressive gastroenterology practices within the state.
For more information or to make an appointment, please call (908)688-6565 or visit www.cddnj.com
To detect the presence of H. pylori the physicians at CDD perform urea breath testing.
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8 New Jersey Physician
Supreme Court upholds healthcare reform lawBy Joe Carlson The U.S. Supreme Court ruled that the insurance provisions of the Patient Protection and A�ordable Care Act are constitutional, handing President Barack Obama a major election-year victory and shunning 26 states that had sought to overturn the reform law.
The court ruled that Congress has the power to compel individu-als to purchase insurance as a tax on people who do not have health insurance.
In a complex 193-page opinion and dissent (PDF), the court ruled that Congress has the power to compel individuals to purchase insurance as a tax on people who do not have health insurance.
"The individual mandate cannot be upheld as an exercise of Congress power under the Commerce Clause," Chief Justice John Roberts wrote in the majority opinion. "In this case however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income but choose to go without health insurance. Such legislation is within Congress' power to tax."
Contrary to some predictions, Roberts joined the court's politi-cally liberal wing as a swing vote, while Justice Anthony Kennedy joined the court's conservative majority, which sought to strike down the insurance mandate.
“Whatever may be the conceptual limits upon the Commerce Clause and upon the power to tax and spend, they cannot be such as will enable the federal government to regulate all private conduct and to compel the states to function as administrators of federal programs,” the minority dissent says. “That clear principle carries the day here.”
The landmark decisions end two years of legal uncertainty and clear the way for full implementation of the 906-page law. Doing so includes establishing insurance exchanges in each state, prohibiting insurance companies from discriminating against the sick, and requiring nearly all Americans to prove on their income taxes that they carry health insurance starting in 2014.
"Today's historic decision lifts a heavy burden from millions of Americans who need access to health coverage. The promise of coverage can now become a reality,” said American Hospital Association President and CEO Richard Umbdenstock in a state-ment. “The decision means that hospitals now have much-needed clarity to continue on their path toward transformation.”
The insurance industry's national interest group, America's Health Insurance Plans, released a statement reiterating its position that “universal coverage” was essential to avoiding signi�cant increases in cost and decreases in choices for health insurance.
“The law expands coverage to millions of Americans, a goal health plans have long supported,” AHIP President and CEO Karen Ignagni said in a statement, “but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.”
The court, however, did strike down part of the reform law's mandated expansion of Medicaid. Congress had aimed to expand the insurance program for the poor by at least 16 million people, but the court ruled that Congress did not have the power to cut o� Medicaid funding for states that refused to comply with the law's eligibility rules.
The law said that states "must either accept a basic change in the nature of Medicaid or risk losing all Medicaid funding," Roberts wrote. "The remedy for that constitutional violation is to preclude the federal government from imposing such a sanction … As a practical matter that means states may now choose to reject the expansion; that is the whole point. But that doesn't mean all or even any will.”
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June 2012 9
Supreme Court Decision
Recently the Supreme Court upheld the constitutionality of the Patient Protection and A�ordable Care Act (the “ACA”). The Court’s ruling, issued by Chief Justice John Roberts, addresses a number of constitutional challenges to the ACA, and paves the way for continued changes that will signi�cantly impact New Jersey physicians and hospitals.
The Court’s Ruling
The most notable challenge to the ACA was directed at an ACA provision referred to as the “individual mandate.” The individual mandate requires all individuals to maintain a certain minimum level of health insurance or face a penalty. In its ruling, the Court found the individual mandate fell within Congress’s constitutional power to levy taxes. The Court also upheld, with some limitations, the ACA’s expansion of Medicaid eligibility.
Where Does This Leave New Jersey Health Care Providers?
The ACA has ushered in a number of changes that impact physi-cians, hospitals and payors. Many provisions will take e�ect in 2014. However, many other important provisions are already underway and have required action on behalf of physicians and hospitals. Most notable of these reforms is the Medicare Shared Savings Program. This program – based on the accountable care
organization (“ACO”) model – has already spurred cooperation between many physicians and hospitals in New Jersey. Going forward, we believe that these ACOs will continue to develop and expand to include hospitals and physicians.
In light of the Court’s decision, hospitals and physicians should continue to consider vertical and horizontal consolidation to maximize the diversity of the services they perform as well as the geographic area that they serve. The Court’s decision reinforces what we already know: that fee-for-service reimbursement has a limited life, and that physicians, hospitals and insurance compa-nies will continue to evolve alongside each other to become more e�cient. Moreover, physicians and hospitals together should seek additional avenues for cost-sharing savings arrangements to promote more coordinated care and e�cient rendering of health care services.
If you have questions or concerns please do not hesitate to contact us.
Mark ManiganBrach Eichler L.L.C.101 Eisenhower Parkway | Roseland, New Jersey 07068Direct: 973.403.3132| Firm: 973.228.5700 | Fax: [email protected] | www.bracheichler.com | attorney bioRoseland | New York City
RICARDO ALONSO-ZALDIVAR
WASHINGTON (AP) — For Gov. Rick Perry, saying "no" to the federal health care law could also mean turning away up to 1.3 million Texans, nearly half the uninsured people who could be newly eligible for coverage in his state.
Gov. Chris Christie not only would be saying "no" to President Barack Obama, but to as many as 245,000 uninsured New Jersey residents as well.
The Supreme Court's recent ruling gave governors new �exibility to reject what some Republicans deride as "Obamacare." But there's a downside, too.
States that reject the law's Medicaid expansion risk leaving behind many of their low-income uninsured residents in a cover-age gap already being called the new "doughnut hole" — a reference to a Medicare gap faced by seniors.
Medicaid is a giant federal-state health insurance program for the poor, now mostly covering children, mothers and disabled people. The expansion in Obama's health care overhaul was originally expected to add roughly 15 million uninsured low-income people, mainly adults without children, who currently are not eligible in most states. Washington would pick up the entire cost for the �rst three years, with the federal share then dropping to 90 percent. The Medicaid expansion accounts for about half the total number of uninsured people projected to get coverage under the law.
If every state were to reject that Medicaid expansion — as the Supreme Court ruling now allows — some low-income people would still be picked up by other coverage provisions meant to help the middle class.
But nearly 11.5 million uninsured people below the federal poverty line would be left behind in a new coverage gap, accord-ing to recent estimates from the Urban Institute. That brings to mind the infamous "doughnut hole" in the Medicare prescription drug bene�t, in which seniors with high drug costs �nd them-selves paying out of pocket much of the year.
Those who fall into the new gap would neither qualify for Medic-aid in their states under current rules nor be eligible for subsidized private insurance in new state marketplaces that Obama's law calls exchanges.
Low-income children and mothers would continue to have insur-ance through Medicaid. Then, starting in 2014, millions of people over the poverty line would have subsidized private coverage through the new exchanges. "And then this group in the middle has nothing," said Matt Salo, executive director of the National Association of Medicaid Directors. His organization takes no position on what states should do.
Things only get trickier from there.
Many states might actually go along with the Medicaid expan-sion.
"This is a lot of federal dollars that will lead to a lot of people having health care," said Salo. That means federal taxes from states opting out would be helping to subsidize coverage elsewhere.
And hospitals in opt-out states would still get hit with cuts programmed in the law under the assumption that every state would take the Medicaid expansion and fewer uninsured people would be needing charity care.
NJP_June2012.indd 3
10 New Jersey Physician
Where does Supreme Court Decision Leave Health Care Providers?
States saying no to ‘Obamacare’ could see downside
"You are still paying for that coverage expansion but not getting the bene�t of it," said Herb Kuhn, president of the Missouri Hospi-tal Association. "So you as a state are exporting your dollars to another state. If you have some adjoining state that accepts (the Medicaid expansion) then you are basically sending your dollars to your neighbor."
Kuhn's state is leaning against the expansion. Since the Supreme Court ruling last month, Republican leaders in at least 10 states have indicated they will reject or lean toward rejecting the Medic-aid expansion. They cite a combination of reasons, including strained budgets, lack of con�dence that Washington will honor its �nancial commitments in the long run and years of frustration with Medicaid mandates that limit state choices and shift costs from the federal government.
But other state o�cials are saying they will study their options and wait until after the November elections to decide. If Republi-can Mitt Romney wins the White House and starts dismantling Obama's law, opt-out states might not have to face the Medicaid doughnut hole. But the whole calculation changes if Obama is re-elected and his overhaul starts looking more and more like a done deal.
If that happens, some experts expect that states now refusing will try to cut deals with the federal government, angling for conces-
sions on the expansion itself or the rest of their Medicaid programs.
"One of the things that happens in cases like these is negotiated settlements with speci�c states," said Dan Mendelson, president of Avalere Health, an analytical �rm serving health care industry and government clients. "What I expect to happen here is that the federal government is going to be more �exible and allow states to do the expansion in ways that suit them."
It's hard to see that happening now. Opponents of the health care law are as adamant as ever, even after the Supreme Court upheld most of it, including the mandate that most Americans carry health insurance or pay a �ne.
"I will not be party to socializing health care and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government," Texas Gov. Perry said last week. About one-fourth of Texas residents are uninsured, the highest percentage of any state.
But John Hawkins, top lobbyist for the Texas Hospital Association, says his group isn't dropping the subject.
"We have told the governor we are willing to continue the discus-sion," said Hawkins. "It's hard to imagine how you get from here to there without accessing federal funds at some level."
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The Supreme Court upheld the constitu-tionality of the Patient Protection and A�ordable Care Act (ACA). The Court’s ruling, issued by Chief Justice John Roberts, addresses a number of constitutional challenges to the ACA, and paves the way for continued changes that will signi�cantly impact New Jersey physicians and hospi-tals.
The Court’s RulingThe most notable challenge to the ACA was directed at a provision referred to as the “individual mandate,” which requires all individuals to maintain a certain minimum level of health insurance or face a penalty. In its ruling, the Court found the individual mandate fell within Congress’s constitu-tional power to levy taxes. The Court also upheld, with some limitations, the ACA’s expansion of Medicaid eligibility.
Where Does This Leave New Jersey Health Care Providers?The ACA has ushered in a number of changes impacting physicians, hospitals and payors. Many provisions will take e�ect in 2014. However, many important provi-sions are already underway and have required action on behalf of physicians and hospitals. Most notable of these reforms is the Medicare Shared Savings Program. This program – based on the accountable care organization (ACO) model – has already spurred cooperation between many physi-cians and hospitals in New Jersey. Going forward, we believe these ACOs will continue to develop and expand. In light of the Court’s decision, hospitals and physi-cians should continue to consider vertical and horizontal consolidation to maximize the diversity of the services they
perform as well as the geographic area they serve. The Court’s decision reinforces what we already know: that fee-for-service reimbursement has a limited life, and that physicians, hospitals and insurance compa-nies will continue to evolve alongside each other to become more e�cient. Moreover, physicians and hospitals, together, should seek additional avenues for cost-sharing savings arrangements to promote more coordinated care and e�cient rendering of health care services.
For additional information, contact:
sure form describing the network status of the facility and its physicians providing the services, as well as the �nancial responsibil-ity of the covered person. The bill would require the physicians providing out-of-network services to furnish the covered person with a description of the procedure, an estimate of the costs charged by the physician for those services, and a notice to contact their insurance carrier for further consultation on the costs of the procedure. Additionally, the physician would be required to provide the covered person with a list of three facilities located close to the covered person that are in-network with respect to the person’s health bene�t plan. The bill will now be voted on by the full Assembly, with the Senate yet to intro-duce a companion version. We have advised clients that, in its current form, we oppose the passage of A-2751.
For additional information, contact:
Suprme Court Upholds Constitutionality of Health Reform Law
The Assembly Financial Institutions and Insurance Committee voted on June 18, 2012 to approve the “Healthcare Disclosure and Transparency Act” (A-2751). The bill continues the longstanding debate on regulating health care providers’ out-of-network charges. The amended version of the bill would require providers of health bene�t plans to:
• Disclose in writing to a covered person the reimbursement methodology used for determining out-of-network rates; and
• Establish a website so that covered persons can access, among other things, quality ratings of physicians as well as descriptions of each plans’ out-of-network health care bene�ts, and the covered person’s �nancial responsibility for those bene�ts.
At least three days prior to an elective procedure, health care providers would be required to furnish covered persons with a written disclo-
12 New Jersey Physician
Health Law Update
HEALTH LAW Update
NJP_June2012.indd 9
Carol Grelecki | 973.403.3140 |[email protected]
John D. Fanburg | 973.403.3107 |[email protected]
Mark E. Manigan | 973.404.3132 |[email protected]
Debra C. Lienhardt | 973.364.5203 |[email protected]
Controversial Disclosure Bill Leaves Assembly wih Amendments
Alaska Medicaid Agency Settles with the OCR for $1,700,000Even the government is not exempt from enforcement of HIPAA! Recently, the Alaska State Medicaid agency entered into a settlement agreement with the O�ce for Civil Rights (OCR) to pay $1,700,000 to settle potential HIPAA violations. The Alaskan agency also agreed to take corrective action to properly safeguard the electronic protected health information (ePHI) of their Medicaid bene�ciaries, and to review, revise and maintain policies and procedures to ensure compli-ance with the HIPAA Security Rule. This is OCR’s �rst HIPAA enforce-ment action against a state agency. In its announcement, the OCR stated that it expects organizations to comply with their obligations under HIPAA regardless of whether they are private or public entities.
The OCR’s investigation followed a breach report submitted by the State Medicaid agency as required by the Health Information Technol-ogy for Economic and Clinical Health (HITECH) Act. The report indi-cated that a USB hard drive possibly containing ePHI was stolen from the vehicle of one of the agency’s employees. Over the course of the investigation, OCR found that the agency did not have adequate poli-cies and procedures in place to safe-guard ePHI.
For additional information, contact:
Todd C. Brower | 973.403.3103 | [email protected] M. Dornfeld | 973.403.3136 | [email protected]
NJP_June2012.indd 3
June 2012 13
Millions of uninsured people may have to wait until after Election Day to �nd out if and how they can get coverage through President Obama’s health care law.
More than two weeks after the Supreme Court gave the green light to Obama’s signature legislative achievement, many gover-nors from both parties said they haven’t decided how their states will proceed on two parts under their control: an expansion of Medicaid, expected to extend coverage to roughly 15 million low-income people, and new insurance exchanges, projected to help an additional 15 million or so purchase private insurance.
In some states, such as Colorado, Oklahoma and Wyoming, gover-nors said they’re crunching the numbers to determine what’s best for their residents. But in other states, including Virginia, Nebraska and Wisconsin, Republican governors said not to expect a decision before Obama and Republican challenger Mitt Romney square o� in November.
If Romney wins, the argument goes, he’ll work to throw out the health care overhaul, and the issue will be moot.
"I don’t think I can look the taxpayers of Virginia in the eye and say I’m going to spend a lot of your money building exchanges that four months from now I may not need," Gov. Bob McDonnell (R-Va.) said on the sidelines of the National Governors Association meeting.
Although the high court upheld the requirement that individuals either have insurance or pay a �ne, the justices undercut Obama’s plan to get almost all Americans insured, ruling that states can opt out of the expansion of Medicaid, the government-run insurance plan. People earning up to 138 percent of the federal poverty level qualify for Medicaid under the health care law, except in states that reject the expansion.
The Obama administration said last week that people won’t be �ned for not having insurance in states that turn down the expan-sion, meaning Obama’s hard-fought overhaul could fall far short of the 30 million or more uninsured he had hoped would get coverage.
Also left to the governors is what to do about the exchanges — Internet-based markets designed to o�er one-stop shopping for insurance — that are also part of law. States are supposed to set up their own exchanges, but if they don’t, the federal government will run them instead.
In New Jersey, Gov. Chris Christie suggested after the ruling that he’d follow the lead of other Republican governors and refuse to adopt any voluntary components of the law. That was a shift in position from May, when in a statement attached to the veto a bill
to create a marketplace for coverage, called an exchange, he wrote that his administration "stands ready to implement the A�ordable Care Act i�ts provisions are ultimately upheld."
Christie said in an interview on the television program "Fox & Friends" after the ruling that he would let the Obama administra-tion create an exchange if it saved the state money. "If it’s more cost-e�ective to let the federal government set this up, we may consider going that route," he said. "I don’t want to spend any money I don’t have to."
The governor also said it might not be necessary for the state to expand Medicaid as the federal law envisions "because of the legacy of previous Democratic governors, I don’t think there is all that much to do."
About a half-dozen states have announced plans to forgo the Medicaid expansion and relinquish the massive infusion of federal dollars that would come along with it. All have Republican governors, many of whom argued Medicaid is an underfunded entitlement already weighing down their cash-strapped budgets.
Others faulted the Obama administration for failing to provide the speci�cs that states need to make an informed decision. That sentiment was echoed in a list of 30 questions about the law that the Republican Governors Association sent Obama last week.
The law picks up the entire cost of covering more people for the �rst three years, and then drops to 90 percent, with states cover-ing the remaining 10 percent. It’s a great deal, proponents argue, especially compared to the current Medicaid rates, wherein Wash-ington pays as little as half of the cost in some states.
But a handful of GOP governors attending the NGA meeting said they suspected a bait-and-switch in which states would agree to the expansion only to see Congress cut some or all of the funds, leaving governors on the hook and potentially bankrupting state budgets.
"At any whim they could just pull the money," Arizona Gov. Jan Brewer told the Associated Press. "So yeah, I’m a little gun-shy."
Wisconsin Gov. Scott Walker, who survived a recall election in June, said in an interview that governors were grumbling among themselves about the federal government’s track record on special education. Congress in 1975 pledged to fund 40 percent of the cost of special education, but routinely has fallen far short of that commitment.
The politics are tricky for governors weighing how to proceed. Just one-third of Americans supported the health care overhaul in Associated Press-GfK poll conducted in mid-June. But because
14 New Jersey Physician
Statehouse
NEW JERSEYSTATEHOUSE
Uninsured Awaiting Governors Decisions on Obama’s Health Act
NJP_June2012.indd 2/22/12 8:45 PM
Horizon Blue Cross Settlement Approved, With $4.7M in FeesBy Mary Pat Gallagher
A class-action settlement against Horizon Blue Cross Blue Shield of New Jersey over delayed health-care payments to doctors won appeals court approval including $4.7 million in legal fees and costs.
However, the 10-year-old litigation, Sutter v. Horizon Blue Cross Blue Shield of New Jersey, A-5725-09, might not be over, as the doctors and medical groups who objected to the deal are likely to petition for Supreme Court review.
The objectors challenged the settlement because it paid nothing to the class of more than 18,000 doctors and arguably too much to the �rm of Mazie Slater Katz & Freeman, which brought the suit.
Superior Court Judge Stephen Bernstein in Essex County awarded $6.5 million in fees and costs in 2007 but slashed $1.8 million after a 2009 remand demanded a closer look at how much the deal was worth to class members.
The complaint, �led by name plainti� Dr. John Ivan Sutter in 2002, accused Horizon of "repeated improper, unfair and deceptive acts and practices ... which [were] designed to delay, deny, impede and reduce compensation" to physicians treating Horizon insureds. That and other practices allegedly violated state law and the insurance company's contracts with doctors. A class was certi�ed in 2004.
The settlement was all reforms and no money. Horizon agreed not to reduce reimbursement rates more than once a year, to forgo seeking recoupment of overpayments more than 18 months old, to provide a schedule of fees and to allow participating physicians to close their practices to all new Horizon patients.
The settlement also obligated Horizon to give 90 days' written notice of material adverse changes to contract terms and permit-ted doctors unhappy with the changes to terminate the contract. And Horizon was barred from revoking a "medical necessity" determination on a precerti�ed claim and from using "most favored nations" clauses to extract better terms than other carriers.
The deal also provided for up to $6.5 million for legal fees and litigation costs.
A report by plainti�s' economic expert, Teresa Waters, Ph.D., an assistant professor at the University of Tennessee, valued the settlement at $39 million.Almost 1,000 doctors excluded themselves from the class and six
objected. A dozen medical societies, representing pediatricians, orthopedists, radiologists and other medical practice areas, were not allowed to intervene but were permitted to appear and argue against it.
The objectors groused that class members would receive no payment, that the reforms were illusory because they required nothing more than what Horizon was already required to do by law and by contract, and that the legal fees were grossly exces-sive.
In 2007, Bernstein approved the settlement as fair and the fees — amounting to 16.7 percent of the Waters' $39 million valuation — as reasonable.
Two years later, the Appellate Division Judges Lorraine Parker, Dorothea We�ng and Laura LeWinn left the settlement in place but remanded for a testimonial hearing, which Bernstein had not allowed, and for reconsideration of the fees. They held that Bernstein incorrectly applied a percentage-of-recovery analysis without requiring a detailed a�davit of services or determining the hourly rate.
Following a �ve-day hearing on remand, Bernstein once more found the settlement fair. He relied on Waters' revised valuation of $35 million, roughly $1,747 per doctor, which was based on a survey of how much doctors would save because sta� would not have to spend so much time dealing with Horizon claims. The objectors did not present their own expert but cross-examined Waters.
Applying the lodestar method this time, Bernstein cut the fees to $4.7 million, including about $600,000 for out-of-pocket costs. He found the 5,628 hours billed by Mazie Slater were warranted and approved billing rates of $550 per hour for partners Eric Katz and David Mazie and $100 for law clerks, augmented by a 35 per cent multiplier for the di�culty and risk of the case.
On the appeal decided Wednesday, the objectors added a new gripe: that Bernstein should have taken into account the April 20, 2008, settlement of a nationwide federal class action against Horizon in the Southern District of Florida over the same claims-processing practices.
Because that case, Love v. Horizon Blue Cross and Blue Shield Association, 03-cv-21296, settled on similar terms, the Sutter reforms added nothing of value, the objectors contended.
Bernstein had refused to consider Love, stating that it was not
federal tax dollars are covering the Medicaid expansion, states that opt out are essentially consigning their residents to subsidize coverage for those in other states.
Also, Alabama, Pennsylvania, Utah and other states that are still weighing their options were among those that sued the federal government in an attempt to have the law overturned. If they were so opposed then, the law’s supporters ask, why are they leaving the door open to implementing it now?
Both the Medicaid expansion and the exchanges don’t kick in until 2014, meaning states technically have some breathing room before they need to make a �nal decision. But governors who’ve agreed to take the expansion accused their more taciturn
colleagues of playing election-year politics at the expense of taxpayers.
"It’s not only irresponsible, it’s disingenuous," Vermont Gov. Peter Shumlin said at a news conference organized by Democratic governors. "To say ‘I’m going to criticize the plan, but I won’t tell you whether I’m taking the loot until after the election,’ that’s what breeds cynicism in the American people."
Shumlin didn’t back down even when reminded that some Democrats too are taking the wait-and-see approach, including Colorado Gov. John Hickenlooper.
"I believe my comments should apply to every governor in the nation, on a bipartisan basis," Shumlin said.
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June 2012 15
Bernstein had refused to consider Love, stating that it was not part of the remand instructions, that it could be equally argued that the Love settlement would not have been as valuable if it had not copied the Sutter terms and that considering the impact of Love could have led him to conclude that it extinguished the Sutter cause of action.
Appellate Division Judges Jose Fuentes, Ellen Koblitz and Michael Haas agreed. They also rejected the position that the objectors should have been allowed to depose Mazie and Katz in addition to questioning them at the remand hearing.
"Objectors attempt to paint the picture of class counsel obtaining undeserved fees at the expense of an undesirable settlement for the class," the panel said, adding that money damages should not be emphasized at the expense of injunctive or declaratory relief. Without the possibility of fee shifting, lawyers might not have incentive to explore all possible forms of relief, the judges said.
Katz, the lead counsel in the case, calls the ruling "a complete vindication for what I've been arguing for these many years about how signi�cant this settlement is, the bene�ts it provides and why we are entitled to the fees that we have requested and were awarded."
He points out that the reforms took e�ect years ago and that the lawyers in Love — a "copycat case" — have been paid, while his �rm not only hasn't received its fees but has been carrying more than $600,000 in expenses going back to 2002. He blames the objectors, saying they had a "misguided" and "completely destructive" agenda.
Charles Gormally, of Brach Eichler in Roseland, who represents
nine of the medical societies, terms the settlement one "with no speci�c value to any of the class members but substantial dollar value to the attorneys who prosecuted the case."
He also points out that the settlement did nothing to address the delayed payments, though Waters, the plainti�s' expert, found they caused the class almost half a million dollars in damages.
Gormally says he is considering an appeal. There is a body of law suggesting that when class members don't get ascertainable bene�ts but their lawyers do, there is a danger of collusive behav-ior and "that's the thing the Supreme Court might be interested in getting a look at."
Neil Prupis of West Orange's Lampf, Lipkind, Prupis & Petigrow, the lawyer for three objectors, says he will probably seek certi�ca-tion.
Horizon's lawyers were John Murdock of Benton Potter & Murdock in Falls Church, Va., and Maxine Neuhauser of Epstein Becker & Green in Newark.
Murdock referred a request for comment to the company. Spokes-man Thomas Vincz said, "Horizon is pleased that the Appellate Division has found the settlement reached between Horizon and the plainti� physician class in the Sutter litigation to be a fair, reasonable and mutually agreeable resolution to the litigation. The settlement included a wide range of business practice reforms by Horizon, which Horizon has faithfully implemented in accordance with the terms of the settlement. Horizon has always worked with the provider community and our view is that the settlement will further that working relationship."
Some New Jersey Doctors, Small Business OwnersNot Happy with Supreme Court Ruling on Health Care
Gov. Chris Christie isn’t the only person in New Jersey who is unhappy with Thursday’s Supreme Court ruling on health care.
The decision upholds the “individual mandate” component of President Barack Obama’s health care reform law.
Dr. Alieta Eck, M.D. is the President of the American Association of Physicians and Surgeons. She has a practice in Piscataway.
“Doctors are going to be retiring. I’m not sure who’s gonna �ll in the gaps,” said Dr. Eck. “There’s just not enough of us to ful�ll this in�nite demand for medical services.”
Dr. Eck adds that under Obama’s plan, many payouts will go down – and many practices will go under.
“We don’t have to go back to the way it is now,” Dr. Eck said. “It’s actually way too expensive for taxpayers the way it is now, but ‘Obamacare’ will actually be worse.”
Similarly, small business owner Je� Scheininger is concerned with how the health care changes will a�ect his small business.
He says the cost for small business is huge, and will result in less hiring and fewer raises. Scheininger owns a modest-sized manu-facturing company in Linden and is also the Chair of the NJ Cham-ber of Congress.
“There’s less money for business expansion,” he said. “Who’s gonna pay for this?”
It a�ects what his current workers will get in terms of compensa-tion and 401k contributions.
Gov. Christie said he was disappointed in the Supreme Court’s ruling. Meanwhile, another New Jersey lawmaker says she is resurrecting a bill to establish a health insurance exchange in the state after the U.S. Supreme Court upheld key parts of President Barack Obama’s health insurance overhaul.
Sen. Nia Gill, a Democrat from Montclair, says the exchange will help New Jersey’s 1.3 million uninsured residents get health insur-ance.
Lawmakers passed the bill previously, but Gov. Chris Christie vetoed it in May. The Republican said at the time that he wanted to wait for the highly anticipated court ruling before spending state money on it.
Christie also said in May that he would move ahead to implement the state’s parts of the changes if the law was upheld by the court.
NJP_June2012.indd 3
16 New Jersey Physician
VISIT US NOW ONLINE AT
www.NJPhysician.org
U.S. News & World Report today released its annual Best Hospitals rankings. This year’s Best Hospitals, the 23rd annual edition, showcases more than 720 of the nation’s roughly 5,000 hospitals. Fewer than 150 are nationally ranked in at least one of 16 medical specialties. The rest of the recognized hospitals met a standard of performance nearly as demanding in one or more specialties.
In the Best Hospitals rankings, UMDNJ-The Univer-sity Hospital ranked #16 in New Jersey and is recog-nized among the Best Hospitals in Northern New Jersey. UMDNJ-The University Hospital is also ranked #34 in the New York metro area.
In addition, the rankings also recognized UMDNJ-The University Hospital as high-performing in:
-- Gynecology
-- Nephrology
-- Orthopedics
“We are very proud of the rankings,” said James R. Gonzalez, MPH, FACHE, Interim President and CEO, UMDNJ-The University Hospital. “We are even more proud of our sta�’s continuous commitment to providing outstanding care to our patients.”
The hospital rankings, said U.S. News Health Rank-ings Editor Avery Comarow, are like a GPS-type aid to help steer patients to hospitals with strong skills in the procedures and medical conditions that present the biggest challenges. “All of these hospi-tals are the kinds of medical centers that should be on your list when you need the best care,” said Comarow. “They are where other hospitals send the toughest cases.”
The rankings were published by U.S. News in collaboration with RTI International, a research organization based in Research Triangle Park, N.C. Highlights of the 2012-13 rankings will appear in the U.S. News Best Hospitals 2013 guidebook, to go on sale in August.
The complete rankings and methodology are avail-able at http://health.usnews.com/best-hospitals.
UMDNJ-The University Hospital is one of the United States' leading university medical centers and the principal teaching hospital for University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Medical School (NJMS). Located in the Central Ward of Newark, the hospital o�ers the highest quality of care across many medical specialties. The University of Medicine and Den-tistry of New Jersey (UMDNJ) is New Jersey’s only health sciences university with more than 6,000 students on �ve campuses attending three medi-cal schools, the State’s only dental school, a gradu-ate school of biomedical sciences, a school of health related professions, a school of nursing and New Jersey’s only school of public health. UMDNJ operates University Hospital, a Level I Trauma Center in Newark, and University Behavioral HealthCare, which provides a continuum of health-care services with multiple locations throughout the State.
U.S. News Ranks UMDNJ- The University Hospital#16 in New Jersey, #34 in New York Metro AreaHospital also high-performing in gynecology,
nephrology and orthopedics
17 June 2012
Hospital Rounds
NJP_June2012.indd 4
Recently the Brach Eichler ASC Meeting was held at the Ocean Resort in Long Branch. A crowd of over 300 joined to hear the expert speakers discuss the direction of the ASC market and what the future might hold for the industry.
Chaired by Mark Manigan, Esq of Brach Eichler, the event was once again a worthy experience which must be attended by executives, management and physician partners of ASCs who are interested in the concerns involving
the rapid legislative changes taking place with ASCs, hospital partners and the insurance industry.
ASC Meeting Sponsored by Brach Eichlera Huge Success
NJP_June2012.indd 3
18 New Jersey Physician
June 2012 19
There were numerous delights to experience for those of us who grew up in Brooklyn, New York. One distinct advantage was and still is, I am sure, its proximity to the Atlantic Ocean. Summer days at the beach were only a short car or bus ride away. Fresh seafood was abundant and a favorite of many Brooklynites back then was Lundy’s Restaurant in Sheepshead Bay, where many �shing boats are docked.
When Michael and I met, we had both been to Lundy’s with our fami-lies and it remained a favorite for us. In fact, whenever there was a special occasion, we usually celebrated by going to Lundy’s for its amazing “Shore Dinner.” Costing about $11.00 in those days, the dinner included: clam chowder, a bucket of steamers, fresh hot biscuits, a whole lobster of about 1 ½ pounds, choice of potato, cole slaw or vegetable, dessert and co�ee.
The restaurant was huge, seating hundreds of people at a time. There wasn’t a host to show you to a table. When you arrived you looked around to see who was nearing the end of their meal and hovered nearby, ready to stake your claim the moment that party stood to leave. I remember the disputes that often took place when two di�erent groups had eyed the same table.
It may not sound like the perfect place for a festive dinner party but the atmosphere, with the noise of the many diners and the tremen-
dous hustle and bustle of servers, combined with the fact that the food was always terri�c, made it a memorable event each and every time we went.
When the place closed its doors years later, we were devastated. Although it could never be the same, we have managed to re-create a version of Lundy’s shore dinner that we prepare at home and we still reserve it for certain special occasions during the summer months.
This past month Michael and I had the ultimate special occasion! On June 21, our daughter gave birth to Isabel Pearl, our �rst grandchild. When she came for her �rst visit to our home, Michael and I served our shore dinner out on the deck for the family to enjoy. The weather was sublime and Isabel was an angel, sleeping peacefully in her carriage. Of course we stopped eating every �ve minutes to gaze at her and marvel but we did manage to appre-ciate the food as well.
We didn’t serve chowder but started with a mountain of steamers. These are so easy to prepare. After rinsing, they are cooked in a big pot of boil-ing water until they open. The resulting broth is saved and served in cups to each person for dipping the shelled clam into to remove sand. Some melted butter is served for dipping as well. It’s di�cult to describe how delectable they are so I implore you to try them if you never have.
Michael had bought the lobsters at Shop-Rite for $6.99 a pound, which is a good price. Unfortunately, they were on the small side – a pound and a quarter to a pound and a half. We prefer ours steamed in boiling water but they may be cut open and broiled if desired.
Although they weren’t large, they were succulent and as fresh as can be. In fact, even without lemon or butter, the lobster meat was delicious. On the side we served corn on the cob and homemade cole slaw which I make with white cabbage, red cabbage, chopped red pepper and shreds of carrots. I dress it with mayonnaise and either Japa-nese or apple cider vinegar, salt, pepper and celery seed. Of course there were also hot biscuits. Some had ice cold beer as a beverage. My younger daughter and I chose chilled white wine.
For dessert we had warm apple pie a la mode with vanilla ice cream. Afterwards we were completely stu�ed and quite amazed at the pile of shells we had created. It had been a wonderful celebratory meal! It really stirred memories of our younger days back in Brooklyn. The best part was after dinner, though. That’s when Isabel woke up!!
Food for �ought
S h o r e D i n n e rL i v i n g s t o n , N e w J e r s e yBy Iris Goldberg
Hospital News Casey resigns as Atlantic Health CMO
By Andis Robeznieks
Dr. Donald Casey has resigned as chief medical o�cer and vice president of quality, academic a�airs and research at Morristown, N.J.-based Atlantic Health System.
According to an e-mail from Atlantic President and CEO Joseph Trun�o, Casey left "to pursue another opportunity" at NYU Langone Medical Center. A representative from NYU could not be reached for comment.
"Don's vision, leadership and commitment to improvement raised the bar for quality, clinical research and medical education at AHS," Trun�o said in the e-mail. "He will be missed."
Casey, who joined the three-hospital Atlantic system in 2005, was a chief critic of the National Quality Forum's endorsement of a quality measure targeting hospital readmissions as well NQF's endorsement process.
"We have some real concerns about the readmissions measure, and we wanted to emphasize that we don't think it is ready for prime time," Casey told Modern Healthcare in June. The NQF board later voted to uphold its endorsement of the measure.
Trun�o credited Casey with engaging the Atlantic board on quality and safety issues, standardizing quality processes across di�erent system institutions, acquiring the system's �rst National Institutes of Health research grants, and integrating quality improvement and research into graduate medical education.While Atlantic looks for a replacement, Trun�o said Je�rey Levine, director of academic a�airs, will assume Casey's academic a�airs duties; Dr. Eric Whitman will take over his research duties; and Dr. Jan Schwarz-Miller will handle Casey's quality-related responsibilities.
National News Mo. Supreme Court overturns malpractice caps
By Joe Carlson
Overturning decades of prior legal rulings, the Missouri Supreme Court ruled this week that the state Legislature's $350,000 cap on noneconomic medical malpractice damages is an illegal violation of residents' constitutional right to a trial by jury.
A divided court on Tuesday overturned (PDF) the court's own 20-year-old decision to uphold caps on noneconomic damages, ruling that "while this court always is hesitant to overturn precedent, it nonetheless has followed its obligation to do so where necessary to protect the constitutional rights of Missouri's citizens."
The court ruled that the mother of Naython Watts, who was born in 2006, was entitled to the full $1.45 million in noneconomic damages that a jury awarded her after concluding that physicians for Cox Medical Centers provided negligent care that led to disabling brain injuries in the child. A trial court judge reduced the verdict to $350,000 after the jury decision, as required by state law.
Mother Deborah Watts appealed, saying the caps violated the state constitution. Attorneys for Cox Health argued in court that a 1992 decision from the Missouri Supreme Court, Adams By and Through Adams vs. Children's Mercy Hospital, had already upheld the constitutionality of 2005 tort reforms limiting medical malpractice awards for claims such as pain
and su�ering.
But writing for the majority on Tuesday, Chief Justice Richard Teitelman said Adams was wrong and overruled it, citing similar court decisions to overturn legislative malpractice damage caps in states such as Washington (1989), Oregon (1999), Alabama (1991) and Florida (1987).
Speci�cally, Teitelman said, the state's 1820 constitution grants citizens an "inviolable right" to a trial by jury for noneconomic damages in medical malpractice cases, and the cap on damages violated that right by removing a jury's ability to decide the magnitude of damage done to a litigant.
In an e-mailed statement, Cox Health o�cials said they were disappointed in the decision.�
"Nearly every physician and every hospital in the state will be adversely a�ected by this ruling," Cox Health said in the statement. "Our greatest concern lies with how this will a�ect physicians in our state."
NJP_June2012.indd 3
20 New Jersey Physician
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