nj physician magazine march 2011

Also in this Issue• CareCore Assures NYS Attorney General of Discontinuance of

Restrictive Practices

• Medical Marijuana Could Be Available by Late Spring

• NJACO Pilot Bill Approved by Senate Budget and Appropriations

Sabatino Ciatti, MD, Advanced Dermatology, Mohs & Laser Surgery Center, PASpecializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer

m a r c h 2 0 11

www.HNManagement.com973-660-9334/ext 125Located in Florham Park, NJ

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Publisher’s Letter

Dear Readers,

Welcome to the March issue of New Jersey Physician, the only publication advocating

for the state medical community.

We usually focus exclusively on New Jersey medical matters, but I couldn’t resist

crossing over to our neighbor to the east when it involves CareCore getting into trouble.

Seems CareCore preferred its radiologist owners in network decisions while refusing

to contract with qualified physicians and physician groups for some or all of the

modalities they offer. The NYS OAG alleged this is a violation of the Sherman Act which

has resulted in CareCore having to purchase the full ownership interests of each of its

radiologist owners.

“Staggering high medical malpractice rates” are being blamed for an alarming loss of

physicians statewide. Senator Jennifer Beck and Assemblyman Declan O’Scanlon have

introduced legislation that is designed to reform medical malpractice laws. They claim

that allowing med-mal companies to increase rates to physicians when a suit is brought

against a medical professional regardless of the outcome of the case is akin to a judge

handing down a sentence before the verdict is in. The bill simply aims to change the

ability to raise insurance rates to the point after a decision is reached in the case.

I know I’ve said this before, but perhaps this time it is real. Medical Marijuana could be

available by late summer. The unique delivery model, the strictest in the country, has

been agreed upon and dispensary sites have been chosen.

We’ve had the unique privilege of watching masterful surgeons at work in the past seven

years and I always enjoy presenting another to our readers. Dr. Sabatino Ciatti, one of

the few fellows trained through the distinguished American College of Mohs Surgery, is

not only a thorough and accurate remover of cancerous facial tissue, but one of the most

competent reconstruction artists when it comes to restoring the damage caused by the

removal of the tumor. What makes watching these surgeries even more fascinating is that

the entire process can be done in a single visit.

With warm regards,

Iris GoldbergPublisher

New Jersey Physician Magazine

Published by Montdor Medical Media, LLC

Publisher and Managing EditorIris Goldberg

PhotographerKen Alswang, At Home Studios

Contributing Writers Harlene Stevens, CPAIris GoldbergJohn Fanburg, Esq.Kevin Lastorino, Esq.Michael GoldbergDerek DeliaLouise B. Russell

New Jersey Physician is published monthly by montdor medical media, LLc.,PO Box 257Livingston NJ 07039Tel: 973.994.0068Fax: 973.994.2063

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2 New Jersey Physician

Contentsm a r c h 2 0 11

Sabatina Ciatti, MD

Advanced Dermatology, Mohs & Laser Surgery Center, PASpecializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer

COVER PHOTO: Sabatino Ciatti, MD of Advanced Dermatology, Mohs & Laser Surgery Center, PA

CONTENTS

10

Health Law Update

11

Statehouse

16

Finance

An Action Plan for 2011Practical suggestions to help you increase practice revenues, decrease costs and develop an action plan for 2011.

18

Food for Thought

Corso 98 Montclair, New Jersey There are those rare occasions when you come upon a restaurant that you’ve never been to, take a chance and hit the jackpot.

20

Events

Inaugural Meeting of the NJ Women in HealthcareNew Jersey Physician recently met with Debra Lienhardt, Esq. to discuss the New

Jersey Women in Healthcare.COVER STORY

4

COVER PHOTOS BY KEN ALSwANG, AT HOME STuDIOS

March 2011 3

Call for NomiNatioNs

New Jersey Physician magazine invites all medical practices to submit nominations for cover stories.

Practices should include a brief description of what makes the practice special.

Please contact the publisher Iris Goldberg at [email protected]

CLIENT: Argent Professional Insurance Agency, LLC Scott Parker - (908)769-7400, [email protected]

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Argent Professional is the leading regional medical professional liability insurance agency, and specializes in writing physicians, large groups, ASCs and other healthcare facilities.

Our knowledge, expertise and access to all of the major NJ markets helps to ensure our clients find the best possible coverage at the lowest available rates.

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Cover Story

In 1941 Frederick E. Mohs, MD published results he

obtained after removing basal cell cancers from 440

patients using a novel technique which he called

“chemosurgery.” In its original form the technique

involved applying a 20% zinc chloride paste directly to

the skin of the patient for fixation of tissue. Then the skin

in question was surgically removed by serial excision

in thin layers of tissue with microscopic control of the

tissue margins. The layers were color-coded with dyes.

Dr. Mohs created a unique mapping system that allowed

him to orient the excised, color-coded tissue back to

the patient. Astonishingly, 99% of primary cancers and

95-96% of recurrent cancers were cured.

Although extremely successful, chemosurgery, in its

original form, could be painful and the entire process

sometimes took days to be completed. In the 70 years

since Dr. Mohs first introduced the technique, it has

been significantly refined and improved. In 1953 the

need for zinc paste was eliminated and surgeries were

performed using the “fresh tissue” technique. More

recently, the development of cryostats to freeze and

cut tissue and the use of automatic staining machines

significantly assist in the processing of tissue samples

from the increasing number of skin cancer patients.

Throughout all of the technical improvements and

refinements of Dr. Mohs’ technique, his original

principle of surgically removing skin cancer in layers

with microscopic guidance to ensure that the tissue left

behind is cancer-free, is still upheld. The color-coded

mapping of excised specimens and their thorough

microscopic examination remains the focal point of the

procedure, now called Mohs surgery. Today, with the

use of local anesthetics, tissue is excised, processed

and immediately examined. For a majority of patients,

the entire process, including reconstruction, can be

completed in one visit.

By Iris Goldberg

Sabatino Ciatti, MDAdvanced Dermatology, Mohs & Laser Surgery Center, PASpecializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer

p Dr. ciatti is one of only 900 mohs surgeons to receive fellowship training through the american college of mohs Surgery

March 2011 5

Sabatino Ciatti, MD, of Advanced Derma-

tology, Mohs & Laser Surgery Center, PA,

is one of a relatively limited number of Mohs

surgeons (about 900) to receive fellowship training

through the distinguished American College of

Mohs Surgery, of which Dr. Mohs, himself, served

as its first President. As such, Dr. Ciatti received

advanced training and has developed significant

expertise in cutaneous oncologic surgery

encompassing the removal of skin cancer, the

histopathologic interpretation of tumors and the

reconstruction of post-surgical defects.

Dr. Ciatti performs Mohs surgery for the treatment

of non-melanoma skin cancers, primarily basal

cell and squamous cell carcinomas. The

surgery is performed at his Westfield office or

his satellite office in Morristown. It is important

to note that Dr. Ciatti does not use Mohs surgery

to treat melanoma skin cancers but instead,

wide excision with permanent sections. “It is

controversial as to whether or not melanomas

should be treated with Mohs surgery,” Dr. Ciatti

shares. “My opinion is that they are very difficult

to interpret with frozen sections, which is how

Mohs tissue sections are processed. Melanomas

are best interpreted using permanent paraffin

sections and sometimes, special stains or

immunostains. You don’t want to make a mistake

on a melanoma and miss it,” he emphasizes.

“The difference between the non-melanoma

skin cancers and the melanomas is that if a

non-melanoma comes back, it is usually local.

If a melanoma skin cancer comes back, it could

have distal metastases,” Dr. Ciatti warns. He

goes on to explain that melanomas, therefore,

require a larger margin of excision because of

the potential threat a recurrence would pose.

“With Mohs surgery we want just the opposite.

We are trying to get the smallest margin possible

in order to preserve normal tissue and avoid

cosmetic disfigurement,” Dr. Ciatti states.

This is one of the main reasons to have Mohs

surgery. If the cancer is in an area where it is

important to preserve as much healthy tissue as

possible for maximum functional and cosmetic

result, such as eyelids, nose, ears, lips, fingers

or toes, Mohs surgery is the most appropriate

treatment modality.

Mohs surgery is also the treatment of choice if

the cancer is large, if its edges cannot be clearly

defined or if it was treated previously and has

recurred. With the Mohs micrographic surgical

technique, Dr. Ciatti relies on the precision and

accuracy of the microscope to trace skin cancer

down to its roots in order to ensure that it has

been completely removed.

p Dr. ciatti begins mohs surgery by marking the surgical site

OVERVIEW of the MOHS SURGERY PROCESSStep 1: After local anesthesia has been injected, the

visible part of the tumor is scraped to better define

the margin.

Step 2: A thin layer of tissue is removed around the

scraped skin and divided into sections. It is placed

on a reference map of the surgical site to maintain

correct orientation of the tissue.

Step 3: Dr. Ciatti color codes each of these sections

with dyes and makes reference marks on the skin to

show the source of each section. This is all carefully

diagrammed on the map.

Step 4: A technician freezes the tissue. It is then cut

into thin slices, placed on glass slides and stained by a

series of special tissue stains to distinguish malignant

from benign cells.

Step 5: Dr. Ciatti examines the undersurface and

edges of each section under the microscope for

evidence of cancer at any of the tissue margins.

Step 6: If cancer cells are found under the

microscope, Dr. Ciatti marks their location onto the

map and returns to the patient to remove another

layer of skin – but only from precisely where the

cancer cells remain.

Step 7: The removal of each layer requires

approximately 15-20 minutes. The removal process

is complete when there is no longer any evidence of

cancer remaining in the excised tissue.


Once the Mohs procedure is completed, the

patient is left with a surgical wound (defect) that

can be treated in one of several ways, depending

upon each individual case. Some wounds will

heal by spontaneous granulation which involves

letting the wound heal by itself. Dr. Ciatti

explains that there are some areas of the body

where nature will heal a wound as nicely as any

further surgical procedure.

In most cases, however, Dr. Ciatti will perform a

reconstructive procedure. For small lesions, he

often closes the wound with sutures, loosening

or undermining the adjacent skin as necessary

and suturing the edges together. Larger defects

often require a flap or graft. To develop a flap,

Dr. Ciatti is able to mobilize tissue from a site

adjacent to the wound and then bring that tissue

into the wound, securing it with sutures. With

both simple side-to-side closures and more

complex flaps, Dr. Ciatti utilizes plastic surgery

techniques to conceal the scar within natural

facial contours or wrinkle lines.

Sometimes there is not enough tissue adjacent

to a large wound to create a flap. In these cases

a graft may be used. Dr. Ciatti takes tissue from

a donor site, such as the back of the ear and

sutures that donor skin onto the wound. The

donor site, in most cases, is also sutured.

Rarely, a patient will require more extensive

reconstruction, such as a significantly larger

graft or flap. These procedures typically involve

sedation/general anesthesia and are best done

in an operating room setting for the comfort and

safety of the patient. Generally, Dr. Ciatti plans

this ahead of time and has arranged for these

individuals to have a consultation with one of

several physicians who are skilled in performing

various reconstructive procedures. In this way,

the Mohs surgery and the reconstruction can

be coordinated so that they are both performed

within a 24-hour period.

Patients who undergo Mohs surgery can expect

the highest cure rate of any method (97-99%),

even if other methods have failed. As the most

exact and precise method of tumor removal, it

minimizes the chance of re-growth and lessens

the potential for unnecessary scarring and

disfigurement.

A sizeable number of Mohs patients are

elderly. Some are in their eighties and nineties.

Many would have difficulty obtaining medical

clearance for surgery with general anesthesia.

Mohs surgery is ideal for these patients because

it is done with local anesthesia only. “We’re

removing a lot of tumors that would be left

untreated if the patient had to go to the OR and

have general anesthesia,” Dr. Ciatti offers. Also,

having the procedure performed in an office

setting as opposed to a hospital is much less

stressful, especially for the elderly.

Another significant advantage of Mohs surgery

is its cost-effectiveness, particularly as the

incidence of skin cancer continues to rise.

Recent data show that there are 3.5 million non-

melanoma skin cancers diagnosed in the U.S.

every year. As health care dollars continue to

shrink and many patients are faced with lack of

insurance or higher deductibles, it is important

to keep cost in mind.

Although more expensive than a standard

excision, Mohs surgery offers savings on

several levels. First, because the likelihood of

recurrence following Mohs surgery is less than

1-3%, additional and possibly more extensive

surgeries to retreat the same cancer are

avoided. Also, since the tissue is processed

and clean margins are verified at the time of

surgery, there is no additional expense to re-

excise an area because tissue was processed

by an outside laboratory where positive margins

were subsequently found. Finally, because the

procedure is performed in an office setting, the

expense of facility fees and general anesthesia

is avoided.

In addition to these benefits of having Mohs

surgery, Dr. Ciatti shares what is perhaps, the

most convincing reason to opt for the Mohs

procedure. He explains the difference between

Mohs surgery and having a routine excision

performed without Mohs surgery. “If you were

to just do an excision you would be sending that

p a thin layer of removed tissue is placed on a reference map. Dr. ciatti color codes each of these sections with dyes.

p a technician freezes the tissue and cuts it into thin slices. Those are then placed on slides and stained to distinguish malignant from benign cells.

March 2011 7

tissue out for analysis. Because the tissue would

be sent out you would need a larger margin,

typically about 4 or 5 millimeters to ensure clean

margins,” explains Dr. Ciatti.

He relates that the wound would then be

sutured and the tissue would be sent out for

pathology. “If those margins weren’t found to

be clear, the procedure would have to be done

all over again but you wouldn’t know that for a

week to ten days. If the margins were clear, you

might have taken too much tissue and therefore,

created a larger and less desirable incision than

necessary,” Dr. Ciatti proclaims.

If a surgery center or operating room is utilized

for excision and reconstruction, time becomes a

huge factor. In an operating room setting frozen

sections can be obtained but they are processed

differently than Mohs sections. Only a partial

representative section is analyzed in order to

allow the surgeon to have a result within 20-

30 minutes. This is necessary because an OR

cannot be held up indefinitely as other surgeries

are scheduled.

Dr. Ciatti reports that in 85-90% of cases the

results are correct. In 10-15% of cases, however,

he explains that once the more extensive

post-operative analysis is done on the entire

specimen, it is found that the margins are not

clean. Dr. Ciatti continues, “At this point again,

the patient is home and has been reconstructed

and you have to call him or her to come back

in.”

Once this situation occurs, it becomes

challenging to repeat the procedure and derive

an optimal cosmetic result. Dr. Ciatti sees

patients who unfortunately did not have Mohs

surgery initially and now must undergo Mohs

surgery with him to remove the remaining

cancer. Dr. Ciatti discusses the problem. “You

now have to go back and you don’t know exactly

where to go back so you have to go back along

the entire incision,” he shares.

Dr. Ciatti goes on to further explain that in some

reconstructions where a flap of skin has been

taken from one side, placed over the defect

and sutured in place, the entire flap has to be

removed in order to go back and remove the

residual cancer. “Now a huge defect is created,”

relates Dr. Ciatti, pointing out the obvious fact

that if Mohs surgery had been done in the first

place, this could have been avoided.

Mohs surgery eliminates the possibility of

unknowingly leaving some of the cancer

behind. “We process the tissue in the office at

the time of surgery, so there is no suturing done

until we know that the tumor is out,” Dr. Ciatti

emphatically points out. He explains that the

tumor is mapped in quadrants (superior, inferior,

medial, lateral). As the tissue is analyzed, if there

are positive margins, Dr. Ciatti knows exactly

where to return. “If the margin is only positive

in one quadrant, then we only go back to that

quadrant,” he says.

“We start with only a one or two millimeter

margin in a circular fashion. The whole idea is to

keep that defect as small as possible,” Dr. Ciatti

reiterates. He shares that minimizing the defect

makes all the difference in reconstruction or in

allowing the wound to just heal on its own. This

is especially important for the head and neck

where a good cosmetic result is a primary goal.

“When you’re dealing with the eyelid, the lip, the

tip or rim of the nose, the ears – these are areas

where minimizing the amount of tissue removed

is very important,” Dr. Ciatti explains. “The

larger the defect, the less likely you will be able

to reconstruct that defect using adjacent tissue

or to allow the defect to heal by spontaneous

granulation. Size matters because the wider the

defect gets, the more extensive and complicated

the reconstruction becomes,” he strongly states.

The skill with which Dr. Ciatti performs Mohs

surgery and the exceptional cosmetic results

he is able to achieve with his reconstructive

techniques have not gone unnoticed. Many

patients come to him through referrals from

other physicians, particularly dermatologists.

Still others have heard about or seen the quality

of Dr. Ciatti’s work through a friend or relative

that he has treated.

p Dr. ciatti examines the undersurface and edges of each section for evidence of cancer at any of the tissue margins


p here, a mohs procedure involving a large portion of the patient’s cheek shown from start to finish. Dr. ciatti excises the tumor in layers until margins are clear and reconstructs the defect during one visit.

p another mohs surgery is shown from exicision to reconstruction. On photos far right here and above, the superb quality of Dr. ciatti’s cosmetic closures is evident.

Robert Marinaro, MD has a busy dermatology

practice in Morristown and is one the many

physicians who refer patients that are Mohs

surgery candidates to Dr. Ciatti. “Not only is he

a superlative Mohs surgeon but his cosmetic

closures are on par with the best I’ve ever seen,”

Dr. Marinaro shares, when asked why he sends

his Mohs patients almost exclusively to Dr. Ciatti.

Dr Marinaro goes on to relate the positive

feedback he receives from patients, without

exception, regarding Dr. Ciatti’s skill and the

caring attention shown by Dr. Ciatti and his

entire staff. Dr. Marinaro and his own staff are

often amazed when patients return, some having

had extensive Mohs procedures, at the excellent

results Dr. Ciatti is able to achieve with his

cosmetic closures.

Undoubtedly, the fact that Dr. Ciatti has

consistently been performing Mohs surgery

and reconstruction for many years with great

success is the reason he has become a highly

regarded expert in the particular surgical and

reconstructive techniques associated with

this procedure. Besides his great skill, there is

something else that sets him apart. His kindness

and compassion and that of his entire staff, have

earned the gratitude and loyalty of countless

patients throughout the years.

Ms “V” has had nine basal cell cancers removed

by Dr. Ciatti. “He is an absolute artist!” Ms V

exclaims. She wants to emphasize the fact that

patients who undergo their Mohs procedure

with Dr. Ciatti do not then need to see a

plastic surgeon. She describes one particular

time when she had an extensive procedure to

remove a lesion on her forehead over one of her

eyes. She relates that when Dr. Ciatti finished

suturing, she looked as if she had been in a fight.

To her amazement, when she returned to have

the sutures removed, not only was the bruising

gone but there was no visible scar whatsoever.

“Not only is he amazing as a doctor but I have

to say that he is amazing as a person,” shares Ms

V. She continues, “He is wonderful and his staff

is too. They are absolutely phenomenal.” Ms V

goes on to relate that after nine procedures she

feels very much “at home” whenever she is at Dr.

Ciatti’s office. In fact, her experience is always

enjoyable. She and Dr. Ciatti share their mutual

love of baseball. “He doesn’t rush to do things –

he takes as much time as is necessary - and I’ve

never felt any pain,” Ms V is eager to add.

Another long-time patient is Ms “L.” Dr. Ciatti has

performed Mohs surgery and reconstruction

on numerous basal and squamous cell cancers

located in different areas on her face, including

her nose, forehead and lip. When asked, during

a telephone interview, if her face was marred as

a result, she replies without hesitation that no

one would be able to notice anything unusual

because of Dr. Ciatti’s skillful work.

“He is one of the best doctors I know of. He

has an eye for zeroing in on cancer. Never once

has he said that he thought I had cancer when I

did not,” Ms L reports. “His staff is the greatest,”

she wants to share as well. She talks about their

kindness and gratefully remembers one of Dr.

Ciatti’s nurses tightly holding her hand while the

local anesthetic was being injected.

Although Ms L is predisposed to skin cancer and

at 80 years old certainly has had more than a

fair share of Mohs procedures, she is extremely

positive and very thankful that she has Dr. Ciatti

taking care of her. “You can’t ask ‘why me?’ But

when you have an expert like Dr. Ciatti, you

know you’re in good hands,” Ms L says with

conviction. Her next statement is a window into

the type of warm, comfortable and good-natured

relationship Dr. Ciatti develops with his patients.

“And besides,” Ms L confides with a lilt in her

voice, “I bribe him with chocolate.”

As our population continues to age and as skin

cancer becomes more prevalent, skilled Mohs

surgeons will be in even greater demand than

they are today. For many referring physicians

and patients in New Jersey who are dealing

with skin cancer presently, Dr. Ciatti offers his

expert surgical and reconstructive skills and a

caring and compassionate manner. Those who

are training to become Mohs surgeons would do

well to follow his example.

Dr. Ciatti’s locations are: • 240 E. Grove Street, Westfield NJ 07090

(908) 232-7235• 20 Community Place, Morristown NJ 07960

(973) 538-1560

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Health Law Update

CareCore Assures NYS Attorney General of Discontinuance of Restrictive Practices; Will Buy-Out Radiologist OwnersBy John Fanburg, Esq. and Kevin Lastorino, Esq.

CareCore National LLC, a radiology benefits management company

owned and controlled by radiologists, and the Office of the Attorney

General of the State of New York (OAG), entered into an assurance of

discontinuance requiring CareCore to refrain from conduct that restrains

trade in the market for specialty health services providers.

The assurance stems from the OAG’s investigation into complaints

that CareCore, which contracts with managed care organizations to

provide radiology utilization management and manage networks of

outpatient radiology practices, preferred its radiologist-owners in

network decisions and refused to contract with qualified physicians and

physician groups for some or all modalities that they offer. The OAG

alleged that CareCore’s business practices constitute a violation of New

York law. A month earlier, a jury verdict in Stand-Up MRI v CareCore

National, EDNY Case No 08 Civ 2954 (LDW) (ETB) concluded that

CareCore violated the Sherman Act by denying competing radiologists

from joining CareCore-managed networks.

In lieu of commencing a special proceeding, the OAG accepted

CareCore’s assurance that it will use its best efforts to purchase at fair

market value, within 210 days, the full ownership interests of each of its

radiologist owners. The assurance also requires CareCore to establish

an appeals process for providers that have been denied membership in

a network and provides guidelines by which CareCore must make New

York network contracting determinations going forward.

HealtH lawUpdateProvided by Brach Eichler LLC, Counselors at Law

Surgical Care Affiliates (SCA), one of the country’s largest providers of

specialty surgical services, announced today it has entered into a joint

market development agreement with the Saint Barnabas Health Care

System (SBHCS), New Jersey’s largest integrated health care delivery

system.

Under the terms of the agreement, SCA and SBHCS will work together

to acquire ownership interests in physician-owned ambulatory surgery

centers in northern and central New Jersey, with SCA providing day-to-day

management services.

“We look forward to building an exceptional network of surgery centers in

New Jersey,” said Barry Ostrowsky, President and Chief Operating Officer

of the Saint Barnabas Health Care System. “Combining SCA’s operational

platform and the strength of our System will present a compelling

opportunity for our physicians, patients, and payors.”

Andrew Hayek, President and Chief Executive Officer of SCA, said, “We

are honored to be selected to enter into this relationship with the Saint

Barnabas Health Care System. The strength of our clinical programs was

a critical factor in this decision. We believe this relationship will improve

healthcare in New Jersey, and further position SCA as the partner of

choice for health systems and physicians.”

About Surgical Care Affiliates:SCA’s vision is to be the partner of choice for physicians, hospitals, and health systems in developing and operating ambulatory surgery centers and surgical hospitals across the country. SCA operates 125 ambulatory surgery centers and surgical hospitals, in partnership with approximately 2,000 physicians and 20 not-for-profit health systems across the country. SCA’s clinical systems, efficiency programs, benchmarking process, and training programs create measurable advantage for surgical facilities – clinically, operationally, and financially.

About Saint Barnabas Health Care System:The Saint Barnabas Health Care System is the largest integrated healthcare system in New Jersey, providing treatment and services for more than two million patients each year at over 50 facilities. The system’s 18,200 employees, 4,600 physicians and 445 residents and interns are united in their mission to deliver the highest quality of care in the best possible environment. For more information on Saint Barnabas, visit www.saintbarnabas.com.

Surgical Care Affiliates, Saint Barnabas Health Care Announce Agreement

March 2011 11

Statehouse

NEW JERSEYSTATEHOUSE

Beck’s Medical Malpractice Bill Passes Assembly CommitteeThe Assembly Health and Senior Services Committee today passed

S-760/A-1982, a bill sponsored by Senator Jennifer Beck in the Senate and

by Assemblyman Declan O’Scanlon in the Assembly. The legislation is

designed to reform the medical malpractice laws in New Jersey that are a

major cause of a physician shortage in the State.

“The New Jersey Council on Teaching Hospitals has reported that New

Jersey is losing physicians at an alarming rate,” said Beck, who was on

hand to testify at today’s hearing, “and this is attributed in large part to

New Jersey staggeringly high medical malpractice insurance rates.

These high rates are a reflection of New Jersey’s malpractice laws, which

unfortunately permit suits to be brought against medical professionals

with little discretion. This bill simply aims to put in place reasonable

restrictions on what may be considered in a malpractice law suit and how

insurers may react to those suits.

“Currently, New Jersey allows malpractice insurance providers to

increase rates when a suit is brought against a medical professional,” Beck

continued, “regardless of the outcome of the case. That is akin to a judge

handing down a sentence before the verdict is in. This bill would change

that so that only in the case that a settlement is made that a customer’s

rate may be increased.”

The bill will also requires that a malpractice action against a health care

provider shall be commenced within two years after the plaintiff or patient

discovers the injury, but not more than four years after the alleged act;

that only licensed medical professionals may be permitted to give expert

testimony on the standard of practice in a malpractice case; and that

physicians licensed in the State of New Jersey shall not be liable for civil

damages in the case of rendering treatment in good faith, as a volunteer

at a clinic or other health care facility.

Medical Marijuana Could Be Available by Late SummerA half-dozen alternative treatment centers across New Jersey could be

legally selling marijuana to patients with certain medical conditions by late

summer, state Health Department officials said Monday. The centers were

culled from 35 applications from 21 nonprofit entities, the officials said.

Under proposed state regulations, each treatment center would grow

and sell up to three strains of marijuana. The pot would be available

only to patients with certain conditions, including multiple sclerosis and

glaucoma. Patients say it can ease symptoms such as pain and nausea.

Home delivery, as the proposed regulations currently stand, would not

be allowed.

Some groups that were considering applying said they didn’t because the

proposed rules were too onerous - for instance, limiting the potency of the

legal pot, which none of the 13 other states that have legalized medical

marijuana has done.

Most of the winners came from outside the close-knit group of the most

public advocates for legalizing medical marijuana.

Devon Graf, the Health Department’s director of legal and regulatory

compliance, said the successful applicants are a mix of big and small

operations.

“It was pleasant to see that there are some little-guy, some small-business

providers in there,” Graf said.

He said the winners had strong financial backing and had secured

preliminary approvals for their locations from local zoning boards and

town governments and prepared training manuals for employees.

The applicants were required to show they had plans for security, quality

control, and other aspects of the businesses.

Some have strong ties to hospitals. One of the successful applications

was Compassionate Care Centers of America Foundation, which will

work with Meadowlands Hospital. The group’s facility in New Brunswick

was approved.

“We are grateful to Gov. Christie’s administration that [Health]

Commissioner [Poonam] Alaigh is a visionary who has devised a medical

model that will ensure much needed relief to patients suffering serious

debilitating conditions in a safe, strict, and appropriate manner,” said Raj

Mukherji, a spokesman for the group.

The group’s application says it expects to spend $4.5 million a year to

operate the facility.

Peter Rosenfeld and his organization, Compassion Collective of Camden

County, applied to run a center in Pennsauken but did not get a license.

“The process, I would characterize as interesting,” he said. “They gave

us six business days from the announcement to the day it had to be


NEW JERSEY STATEHOUSE submitted. It was a little hard to figure out which way they were heading.”

The successful applicants are in the populous corridor between the New

York City and Philadelphia areas.

They are the Breakwater Alternative Treatment Center Corp., in Manalapan;

Compassionate Care Centers of America Foundation, in New Brunswick;

Compassionate Care Foundation Inc., in Bellmawr; Compassionate

Sciences Inc., with a facility planned in Burlington or Camden County;

Foundation Harmony in Secaucus; and Greenleaf Compassionate Center

in Montclair.

Roseanne Scotti, New Jersey director of the Drug Policy Alliance, said the

regulations would be better if they included a home-delivery option for

far-flung patients.

“We’re a little concerned there’s nothing in Atlantic County,” she said.

State Sen. Nicholas Scutari, a Democrat from Linden, has called

for lawmakers to nullify the proposed regulations from Christie’s

administration.

Scutari says the regulations fall short of the Legislature’s intent when

it voted 14 months ago to allow medical marijuana. He said Monday

he wanted to negotiate changes to the regulations with Christie’s

administration.

NJ ACO Pilot Bill Approved by Senate Budget and AppropriationsA bill sponsored by Senators Joseph F. Vitale and Jim Whelan which

would establish a three-year pilot program in the Department of Human

Services in order to make sure Medicaid recipients have access to quality

health care was approved by the Senate Budget and Appropriations

Committee by a vote of 7-5.

“Under the current health care delivery and payment structure, Medicaid

recipients are often unable to access high-quality, cost-effective health

care,” said Senator Vitale, D-Middlesex, and Vice Chair of the Senate

Health, Human Services and Senior Citizens Committee. “As a result, we

pay more money for less-than-stellar results in terms of positive patient

outcomes. It’s time that we move away from the existing system which

puts vulnerable New Jerseyans at a disadvantage to receive high-quality

care, and begin to invest State resources in a smarter, cost-effective model

of health care for Medicaid enrollees.”

“This bill is about spending State health care dollars smarter, and

improving care for people who depend on our State’s health care safety

net for access to medical services,” said Senator Whelan, D-Atlantic, and

a member of the Senate health panel. “Right now, we lack the objective

evaluation and cost-effective protections to make sure that we’re getting

the biggest bang for our buck, and providing the best care possible for

people enrolled in the Medicaid system. It’s time that we do better for

New Jerseyans in need.”

The bill, S-2443, would create the “Medicaid Accountable Care Organization

Demonstration Project” to ensure that Medicaid recipients in New Jersey

have access to high-quality, cost-effective medical care. The bill would

establish a demonstration project within the Department of Human

Services to increase access to primary care, behavioral health care, and

dental care by Medicaid recipients in a particular region. The bill would

also improve the quality of health care by establishing objective metrics

and relying on patient experience, and would reduce unnecessary and

inefficient care without interfering with a patients’ access to the health

care providers and services they need to stay healthy.

The bill would authorize Accountable Care Organizations (ACOs),

defined as nonprofit corporations, to provide coordinated, high-quality

care to Medicaid recipients in a municipality or defined geographic

region with more than 5,000 Medicaid recipients. If the program proves

successful in lowering costs and improving care, the sponsors said they

would consider working with the Department to establish a permanent

program.

“As part of the federal health care reform law, states have been given

the authority to empower ACOs to provide coordinated, high-quality,

cost-effective health care to Medicaid recipients,” said Senator Whelan.

“Frankly, we’re flying blind right now in terms of the level of care available

to Medicaid recipients, and it’s time to try something new to create a

high-quality standard of care that allows us to achieve the best patient

outcomes at a fraction of the current price. By shifting to a smarter model

of care, we can maximize the impact of our health care investment.”

“Whether it’s FamilyCare or the medical home pilot program, New Jersey

has been a laboratory for best practices in administering and delivering

health care for New Jerseyans in greatest need, and the Medicaid ACO

Demonstration Project is another step forward in better health care at less

cost to the State’s taxpayers,” said Senator Vitale. “We recognize that we

have a responsibility to provide quality care for people who depend on

Medicaid, and we have to stretch limited health care dollars as far as they

will go. By moving to an ACO model of delivering health care services,

we can achieve both, and will once again set New Jersey up as a national

model for other states to follow.”

The bill now heads to the full Senate for consideration.

Assembly Passes Measure to Improve Emergency Medical Services In New JerseyConaway/Fuentes/Evans/Quigley Bill Aims to Boost Delivery of Urgent Care

The full Assembly on Monday approved a measure sponsored by

Committee Chairman Herb Conaway, Jr., M.D., and Assembly members

Angel Fuentes, Elease Evans and Joan Quigley to improve the quality and

delivery of emergency medical services in New Jersey.

“Emergency medical services are among the most fundamental functions

we can provide as a government,” said Conaway (D-Burlington/Camden).

“We need to overhaul our system in order to improve efficiency and

ensure compliance with applicable standards of pre-hospital care. This

bill recognizes the important work of emergency volunteers by providing

March 2011 13

NEW JERSEY STATEHOUSE free licensing and background checks as a condition of service.”

According to a 2007 report that was issued after a comprehensive analysis

was conducted at the behest of the Legislature, New Jersey’s two-tiered

EMS system is in a “state of near crisis” due to the system’s financial

structure, decline in volunteer membership, lack of comprehensive

legislation and a weakened Advanced Life Support (ALS) system. The

bill (A-2095), approved by a vote of 44-31-3, incorporates many of the

recommendations from the report.

“This legislation would institute various measures that will revolutionize

services, making them more efficient and effective, while streamlining the

system to save taxpayer dollars,” said Fuentes (D-Camden/Gloucester).

Under the direction of the Commissioner of Health and Senior Services,

the Office of Emergency Medical Services in the Department of Health

and Senior Services (DHSS) would serve as the lead state agency in

overseeing emergency medical services to ensure the continuous and

timely availability and dispatch of basic and advanced life support through

ground and air, adult and pediatric triage, treatment and transport and

emergency response capabilities.

The bill would consolidate numerous groups, task forces and advisory

boards, into one governing body - the Emergency Medical Care Advisory

Board (EMCAB) - to advise DHSS on pre-hospital issues, medical care and

the establishment of provider standards.

Furthermore, the bill would create a number of subcommittees under

EMCAB, including one charged with exploring shared services and

consolidation in order to make recommendations for municipalities and

counties to consolidate EMS services.

The bill would also require a minimum of one emergency medical

technician (EMT) as the standard of care for every ambulance in the state.

DHSS would also be responsible for arranging advanced life support

services in response to 9-1-1 calls statewide.

“This is an important measure because it provides a uniform standard for

responding to emergencies and treating and transporting patients. The

ultimate goal is to ensure proper care for all of our residents,” said Evans

(D-Passaic/Bergen).

“This bill will enhance professionalism, transparency and coordination of

the state’s EMS system, making patients the ultimate priority,” said Quigley

(D-Hudson/Bergen).

The bill would also require paramedics, EMTs, and emergency medical

responders to obtain a license from DHSS and undergo a criminal history

background check as a condition of licensure or other authorization to

practice.

The commissioner would also have the authority to revoke the license for

violation of certain laws and regulations.

Despite the political uncertainty around national

health reform, New Jersey is moving forward with

a major innovation in its Medicaid program. By

authorizing the formation of Medicaid Accountable

Care Organizations (ACO’s), the state will take a

leadership role in the struggle to contain Medicaid

costs without disenrolling patients or withholding

beneficial care.

ACO’s are the latest big idea in health reform. They

are networks of physicians, hospitals, and other

providers that work together to improve quality

of care and reduce expenditures for a defined

patient population. The purpose is to achieve three

interrelated goals:

• Improve objectively measured health care

quality and patient safety

• Improve patients’ experiences with care

• Achieve savings large enough to be shared by

health care providers and payers

On the surface, the ACO idea looks a lot like old

fashioned managed care with the image of HMO’s

telling providers how to practice medicine. The

key difference is that ACO’s are designed to be

more “bottom up” than “top down”. Providers form

ACO’s voluntarily, set their own rules for organizing

care, and establish a plan to share savings.

By authorizing Medicare to contract with ACO’s,

the Affordable Care Act (ACA) will encourage

the expansion of ACO networks throughout the

nation. But in the current political environment,

implementation of the ACA, or at least some

of its provisions, has become highly uncertain,

presenting a challenge for states that must lay the

groundwork for implementing health reform by,

for example, establishing procedures to expand

Medicaid enrollment. One thing that is very certain

is that, with or without federal health reform, states

must find solutions to the enormous budgetary

problems associated with rising Medicaid costs.

Pending legislation in New Jersey shows that states

do not have to wait for the politics of national

health reform to work themselves out. On January

6, a bill to create a demonstration project for

Medicaid ACO’s was introduced in the New Jersey

State Legislature. Under the bill, New Jersey’s

Department of Human Services would certify as

ACO’s nonprofit coalitions of local health care

providers who organize themselves to improve

care for a defined population of at least 5,000

Medicaid enrollees. A defined population might

Medicaid Accountable Care OrganizationsOpportunities for State Cost ControlSubmitted by Derek Delia and Louise B. Russell


include Medicaid enrollees living in a city or

cluster of smaller municipalities.

Certified ACO’s would have to meet specific

requirements for health care quality and outcomes

and, in fee-for-service Medicaid, would be eligible

to share in savings from care improvements.

The bill would also permit Medicaid HMOs to

engage with certified ACO’s. The demonstration

projects would be subject to annual evaluation.

If successful, they would open the door for

expanding the Medicaid ACO concept across

New Jersey and the nation.

The approach in New Jersey stands in stark

contrast to approaches currently contemplated in

other states. Arizona is attempting to address its

budget woes by disenrolling 280,000 beneficiaries

from Medicaid. Florida’s newly elected governor

has expressed interest in requiring more Medicaid

beneficiaries to move from traditional Medicaid

into Medicaid HMO’s. Unlike the New Jersey

reform, these approaches have a distinctive

“been there, done that” feel to them. They also fall

into the “top down” category mentioned above

where payers impose new requirements without

any input from patients and providers.

In contrast, the New Jersey effort was initially

proposed by a coalition of medical providers from

the city of Camden. The Camden Coalition was

designed to better organize care for low-income,

complex patients in Camden, one of America’s

poorest cities. (Readers of the New Yorker magazine

may recall Atul Gawande’s profile last month of Dr.

Jeffrey Brenner, who leads the Camden Coalition.)

The Coalition, whose work has been supported by

philanthropic grants and donated services, seeks

to sustain its efforts by forming a Medicaid ACO,

which would use the savings from reduced costs

to sustain and expand patient services.

A clever element of the New Jersey reform is

that it allows the state to take full advantage of

federal health reform without being contingent

upon it. For example, lessons learned from the

Medicaid ACO experience will place New Jersey

stakeholders ahead of the curve, as they consider

the formation of Medicare ACO’s encouraged by

federal reform. In addition, Secretary of Health

and Human Services (HHS) Kathleen Sebelius

recently wrote a letter to state governors inviting

them to collaborate with HHS to find ways of

containing Medicaid’s costs as it prepares to add

millions of new enrollees. Her letter emphasizes

care coordination and innovations in health care

delivery similar to the path that New Jersey is

taking. This will leave the state well positioned

to take advantage of federal assistance for

implementation and surveillance of Medicaid

innovations. But even if federal efforts stall, New

Jersey’s Medicaid ACO efforts can move forward

on their own.

ACO’s in Medicaid are also likely to avoid

some of the thornier issues that have been

raised about ACO’s in general and ACO’s that

contract with private insurers in particular. First,

a large ACO might have so much consolidated

market power that it could command large

reimbursement increases, offsetting any savings

from improved efficiency. Second, ACO’s achieve

their efficiencies largely by creating incentives to

avoid expensive services that are preventable,

marginal, or downright unnecessary. Of course,

one person’s unnecessary service is another

person’s profit margin. Providers who see their

profit margins decline will have every incentive

to argue that their services really are needed

and the so-called efficiencies are illusory. As

the readers of this blog well know, it is not hard

to generate political outrage over reductions in

medical services (regardless of their effectiveness,

appropriateness, or safety).

Medicaid ACO’s, in contrast, raise fewer concerns

about market power. In fee-for-service Medicaid,

reimbursement rates are set by the state, leaving

no room for providers to raise prices. Although

Medicaid HMO’s do negotiate reimbursement

rates, the HMO’s cannot spend beyond the

limited amount that Medicaid allocates to them to

pay for patient care.

In addition, most providers, especially those who

provide the most expensive forms of care, do

not build their profits on maximizing Medicaid

volume. On the contrary, many providers do not

even accept Medicaid patients because payment

rates are usually too low to be profitable. As a

result, the pushback against reducing avoidable

services in a Medicaid ACO is likely to be much

less intense.

A great deal of work still lies ahead for New

Jersey’s Medicaid ACO’s. This includes the

final passage of legislation and several years

of implementation. But as the process unfolds,

lessons learned will be important not just for

New Jersey but for all states struggling to serve

their Medicaid populations well and in a fiscally

sustainable way.

ART#: 187321_NJS_NJPM.inddPUBLICATION: NJPMSIZE: 4.75x4.8125D: sd

The State of New Jersey

EEO/AA

State of New Jersey

Department of Health and Senior Services

Deputy Commissioner Public Health Services

This key management position, which reports directly to the

Commissioner of Health and Senior Services, will provide leadership for

planning, policy implementation, budgeting, and executing the goals

and mission of the department as it relates to the assigned areas of

responsibilities: The Divisions of HIV/STD/TB Services; Family Health

Services; Epidemiology, Environmental and Occupational Health Services;

Public Health Infrastructure, Laboratories and Emergency Preparedness.

Successful candidate must be a licensed physician.

For a full description of the position, including the education and

experience requirements, and addresses for filing either via electronic or

hard copy visit: www.nj.gov/health/jobs.

NEW JERSEY STATEHOUSE

March 2011 15

HELP SAVE THE PRACTICE OF MEDICINE!CALL 888-806-5362

OR VISIT OUR WEBSITE AT WWW.NJPHYSICIANS.COMFOR MEMBERSHIP INFORMATION

NJ_Ad2.indd 1 1/8/10 10:23 AM


How often have you heard a physician say,

“Medicine is the easy part. It’s everything else

about running the office that is stressful,” or “I went

to medical school to practice medicine; I am not a

business person.” I hear similar statements from

my clients time and time again. The goal of this

article is to provide some practical suggestions to

help you increase practice revenues, decrease

costs and develop an action plan for 2011.

• Analyze your fee schedule. When was

the last time you increased your fees? Many

physicians feel guilty about increasing fees

in light of these difficult economic times.

However, most practices have experienced

increased labs, medical supplies, payroll and

general overhead especially with employee

costs. A modest fee adjustment once a year is

preferred over a significant hike in fees every

couple of years. For those practices whose

fees are regulated by PPOs or managed care

plans, remember that the fees you submit

on medical claims are factored into future

contracted fee schedules. So submit your full

fees to all insurance carriers and adjust the

contracted write-offs when posting payments

to patients’ accounts as required by the EOBs.

• Perform a monthly analysis of your

collection percentages. Do you know

how your practice is being paid by your top

5-7insurance companies on your top 20-25

procedures? Your office manager should be

aware of frequent denials and resolutions to

determine if they are being resolved or written

off as an adjustment? Incorporating some

monthly practice statistical calculations when

performing the monthly bank reconciliation

is crucial to monitoring current vitals of the

practice’s revenue cycle.

• Conduct a “patient service review”

and look for those patients who may require

medical treatment, or are due for annual

physical exams.

• Analyze your accounts receivable with

special attention to accounts that are 90 days

or more past due. All insurance claims past 90

days should be researched. I have found that

in practices where the 90 day plus accounts

receivable are over 20%, there may be collection

issues, which are hindering prompt payment.

It is important to look at days in accounts

receivable by payer, not just the practice as a

whole. Sometimes the insurance company is

waiting for information from the patient. Reach

out to overdue accounts with a personal phone

call and try to work out payment arrangements.

If the accounts are deemed uncollectable,

consider sending them to collection or to small

claims court if appropriate. After all options

have been exhausted, consider writing off the

uncollectable accounts so that your accounts

receivable total is accurate.

• Evaluate the growth of your practice.

Run a demographics report of collections and

new patients. Is your practice growing? If it is

not growing to your satisfaction, now may be

the time to engage in or ramp up internal and

external marketing.

• Update your website. The majority of my

medical clients have a website, but many have

not updated it since inception. Do you have

any promotions or new services you now offer

in your office that patients may not be aware

of? (i.e., cosmetic procedures or supplements

for retail).If so, those promotions should also

be highlighted on your home page.

• Analyze your overhead costs as

compared to the prior year. Do you

anticipate your overhead costs changing in

2011? Are there any practice costs that can be

cut this year? I have seen practices reduce their

telephone bill by over 50% simply by using the

same vendor for both phone and internet.

• Review your HIPAA compliance procedures.

Just because you do not hear as much about

HIPAA compliance does not mean you can

relax privacy and security measures. Review

and revise your HIPAA policies and procedures

as necessary. Make sure that all employees are

familiar with your policies and procedures and

have had a chance to ask questions. Document

employee training updates, and make sure that

all patients sign their own HIPAA forms once

they turn 18 years of age (or the age of majority

in your state, if younger than 18).

• Consider initiating your Electronic Medical

Records (EMR) research and selection

process. Electronic medical records promote

better communication between patients,

doctors and specialists, with the overall goal

of better patient care, as well as to improve

office management efficiency. In addition,

successful EMR implementation can lead to

financial incentives for your practice. For more

information regarding EMR selection send an

email to [email protected] with “EMR

Selection Guide” in the subject line.

• Take an inventory your medical supplies.

Expired supplies should be discarded. Review

your ordering procedures with staff so as to

minimize waste.

• Scrutinize payroll costs, which are typically the

largest expense in a medical office. Analyze

employee performance and revise hours as

necessary. Limit overtime hours for employees

(other than physicians), which typically must

be paid at time and a half. Review health

An Action Plan for 2011By Harlene S. Stevens, CPA – Nisivoccia LLP

Finance

March 2011 17

By Harlene S. Stevens, CPA – Nisivoccia LLP

insurance costs, which have increased

dramatically in recent years. If you pay at least

50% of your employees’ health insurance you

may be entitled to a health care credit on your

tax return. Update and revise your employee

manuals if needed.

• Provide each employee with at least one

written performance review annually.

For a copy of a very basic performance review

send an email to [email protected]

with “Performance Review” in the subject line.

• Conduct regular staff meetings. I prefer

monthly lunch meetings. These meetings

should be scheduled for a set amount of time

(i.e., one hour) and have a specific agenda.

One purpose for having regular staff meetings

is to build a sense of “team” by keeping all

staff informed of practice-related issues and

providing practice managers an opportunity to

show staff they are appreciated. When staff feel

appreciated they often display more energy

and enthusiasm at work.

• Maximize your retirement contri-

butions by saving early in the year.

I recommend physicians open a separate

account to accumulate earnings that they

intend to use to fund retirement plans and pay

taxes at year end.

• Set up appointments with your

accountant, attorney, and financial

advisor to be sure that your business plan

and personal finances are in sync for 2011.

By utilizing these guidelines early in the year,

you should develop an action plan that you are

comfortable with and one that should enhance

the financial health of your practice.

Princeton Insurance knows New Jersey, with the longest continuous market

presence of any company offering medical professional liability coverage in the state.

Leadership: Over 16,000 New Jersey policyholders

Longevity: Serving New Jersey continuously since 1976

Expertise: More than 55,000 New Jersey medical malpracticeclaims handled

Strength: Over $1 billion in assets and $335 million in surplus as ofSeptember, 2010

Service: Calls handled personally, specialized legal representation,knowledgeable independent agents, in-office visits by ourskilled risk consultants

Knowledge: New Jersey-specific knowledge and decades of experience

Innovation: Three corporate options, gap coverage, specialty reports,practitioner profiles, office practice toolkits

Harlene S. Stevens, CPA, Supervisor is a leader of the Nisivoccia LLP Healthcare Segment, which concentrates in providing services to physician and dental practices. The Company is a multi-dimensional CPA firm with offices in Mt .Arlington and Newton, New Jersey. The firm offers traditional tax, account-ing, audit and business advisory services. Contact her at [email protected] or 973-328-1825.


Food for Thought

Every now and then a dinner out becomes an unexpected experience,

especially when it’s your first time at a particular restaurant.

Sometimes, a place has been highly recommended and ends up

being a huge disappointment. We’ve all been there. Then there are

those rare occasions when you come upon a restaurant that you’ve

never been to, take a chance and hit the jackpot. That’s exactly what

happened last night when Michael and I had the pleasure of sampling

the contemporary Italian cuisine and the hospitality provided at

Corso 98 in Montclair.

From the moment we entered this storefront, family-owned BYO on

Walnut Street, we were treated royally. We were shown to an elegantly

set table for two in a cozy nook by the window. That’s definitely

my favorite type of seating when we are dining alone. Even an old

married couple like us appreciates the romantic ambience that is

created. In fact, the entire place is beautifully decorated and arranged

so that every table is situated to allow for a warm and comfortable

dining experience. The lighting is soft and the music (Italian as well),

is definitely in the background and not at all distracting. Actually, it

was the perfect accompaniment to the food and the atmosphere.

The menu at Corso 98 offers an ample selection of salads, appetizers,

seafood, pastas, fine meats and cheeses which showcase classic

Italian dishes that are creatively prepared and presented. There is

also a separate menu featuring the specials of the day. This is what

Michael and I focused on since there were a number of intriguing

choices. We decided to share two of the tempting appetizers.

First, we had a frisse salad served with beets stuffed with feta cheese,

garnished with grapes and walnuts and finished with an orange

vinaigrette. Our server was kind enough to have this divided in

the kitchen. The presentation was a lovely arrangement of colors

and textures. I found the beets and feta cheese to be a winning

combination.

Once our salads were done our server placed the impressive bowl

of Vongole con Ceci between us. This was fresh little neck clams

steamed in roasted garlic in a saffron scented tomato-herb broth with

chick peas and a few slices of toasted bread for dipping on top. Dip

we did as the broth was heaven with just the right amount of clam

juice. Also, the clams were fresh as could be. We really enjoyed this

dish.

At this point I must comment on the exemplary service we received.

Every need was anticipated yet our server did not hover or interfere

By Iris Goldberg

Corso 98Montclair, New Jersey

p Grilled rack of lamb is one of the most elegant ways to serve the traditional specialty.

p Puff-pastry-wrapped Brie with shaved pears, mango, strawberry flower, and cranberry-watermelon-pineapple reduction.

March 2011 19

with our enjoyment of the food or each

other. When we did have an opportunity

to speak with him, we couldn’t help but

appreciate his warm demeanor and his

quick sense of humor.

Now for the main course. Michael

immediately decided on Risotto con

Gamberi, Salsiccae e Piselli, which

is slowly simmered Arborio rice with

brown butter-seared shrimp, roasted

Italian sweet sausage, tomato, pecorino

Romano cheese and early spring green

peas. I can always tell by the look on his

face if Michael is enjoying his meal. His

eyes, which have always revealed to me

exactly how he is feeling at the moment,

were smiling.

After a bit of deliberation, I went for the

Osso Buco, which is a long-time favorite

of mine. I was not disappointed. The

veal shank was cooked to perfection,

slowly braised, making it tender as can

be. It was served in a rich and flavorful

tomato-vegetable red wine demi-glace

over risotto Milanese. A small fork was

provided to reach the succulent marrow

within the large bone and I am sure not

a spec was left after I was done.

Although we often skip dessert, things

were going so well that we decided to

indulge ourselves. We ordered some

pistachio gelato and a piece of Italian

ice box cake which consists of layers

of graham crackers with chocolate

pudding, topped with whipped cream

and fresh strawberries. Yes, it was as

scrumptious as it sounds.

As we were lingering over coffee

and waiting for our credit card to

return, Executive Chef, Darek Haupt

approached our table. He graciously

asked if we had enjoyed our meal. We

ended up in a long conversation about

his extensive training, including studying

at the CIA and his mastery of the art of

Italian cooking, which has become his

passion. He shared that he is going to be

a contestant on an upcoming episode of

“Chopped,” which has become quite a

popular TV show amongst food channel

watchers.

He also told us about a special private

luncheon that would be served at Corso

98 on the Sunday that was approaching. It

was for notable professionals (including

physicians) within the community

and was to showcase the dishes from

Abruzzo, an area east of Rome on the

Adriatic Sea, where co-owners and

brothers, Elio and Corradino Suriano

were born. Here is the menu:

Sunday, March 27, 2011

BACALA FREDDITraditional salt cod salad with chick peas, celery, shaved garlic, cerignola olives, capers, hot cherry peppers, lemon, flat leaf parsley and extra virgin olive oil

CHITARRA LAMB RAGUFresh chitarra pasta made by Mama Suriano with slow-braised lamb, carrots, celery, shallots, tomatoes and herbs

FRISEE SALADFrisee lettuce, fresh fennel, blood oranges, roasted skinless almonds, red grapes and a light citrus vinaigrette

CHOICE OFPrime center cut pork chop grilled with broccoli rabe, roasted potatoes, hot cherry peppers and a tomato-herb demi-glace

– OR –Pan seared fresh Alaskan salmon with roasted tomato, rosemary-goat cheese polenta, citrus scented arugula and an orange-basil reduction

DESSERTOrange mascarpone tartlets with macerated Grand Marnier strawberries and a warm espresso-dark chocolate sauce

In case you haven’t realized by now, I

would definitely recommend Corso 98

for an intimate dinner for two, a large

group or a special celebration. The food

is fantastic and the service is top-notch.

No effort is spared to make you feel

welcome. In fact, we plan to return very

soon. Perhaps we’ll see you there.

Corso 98 is located at 98 Walnut Street,

Montclair NJ 07042. (973) 746-0789

p Pan-roasted Prince Edward Island mussels with Pinot Grigio butter sauce, roasted garlic cloves, croutons, and roma tomatoes.

p Juicy roasted salmon with whipped potatoes, wilted spinach, roasted peppers, pancetta, and grilled fennel.

p herb-crusted Georges Bank flounder over roasted sweet cubanelle peppers, surrounded by a spicy puttanesca sauce.

p Zucchini blossoms stuffed with prosciutto and fresh mozzarella over a citrus beurre blanc.

p handmade pasta chitarra alla mamma with Bolognese sauce.


Events

Recently, New Jersey Physician had the pleasure of

attending the first meeting of New Jersey Women

in Healthcare. Founded by Lani M. Dornfeld, Esq.,

Carol Grelecki, Esq., and Debra Lienhardt, Esq., all

of the healthcare division of Brach Eichler, this very

well attended event mixed significant speakers

from the state healthcare field with lunch and a

wine tasting. The audience was most enthusiastic

and felt this type of networking event was a

long time in coming and was most appreciative

someone had taken the initiative to put it together.

New Jersey Physician recently met with Debra

Lienhardt, Esq. to discuss the association.

NJP: Can you give us a brief history of

how the association was born?

DL: My partners, Lani and Carol, and I have

been practicing in the health care group of Brach

Eichler and representing health care providers and

institutions for a number of years. In such capacity,

we have been counseling a large and growing

number of women in the health care field, including

physicians, other practitioners and key executives

of hospitals, ambulatory surgery centers, nursing

homes, and other facilities and organizations. We

realized that there was no existing forum for these

professional women to get together, network and

share ideas. Therefore we developed the New

Jersey Women in Healthcare association and have

been working since the beginning of the year to

put together the inaugural event. Brach Eichler,

the leading health law practice in New Jersey,

always looks for ways to support the health care

community and was delighted to sponsor and

promote the event.

NJP: What are the goals that you and

your partners would like to see reached

by the group?

DL: Our goals are clear. NJWH expects to grow

and provide a forum for women to come together

and address shared interests and concerns. It

will provide information regarding the health

care industry and national and local trends and

foster strong professional networks. This event

was our first. Based on the level of enthusiasm

from the women who attended-as well as the

disappointment from the women who didn’t-we

will be creating additional programs aimed at

achieving these goals for women leaders in health

care.

NJP: Can you discuss the difficulties faced

by women in health care previously and

currently? Has this changed and where

do you see it going? What can the group

do to lessen this problem and how can

this be done?

DL: Although women have always played a large

role in the provision of health care and the health

industry generally, with respect to key leadership

and executive positions, it was largely male

dominated. In recent times this has changed and

female colleagues are being recognized for their

achievements. However, in order to ensure that

this continues, we, the women leaders in health

care, need to focus on building professional

relationships and using those resources. We

hope that through the efforts of NJWH, we can

begin offering the growing number of women in

the health care community a way to join together,

share information and ideas and reach their

professional goals.

New Jersey Physician DiscussesThe Inaugural Meeting of the New Jersey Women in Healthcare with Debra Lienhardt, Esq. of Brach Eichler

A full-day program followed by a networking cocktail reception offering presentations and panel discussions by industry leaders on the latest ASC developments.

• What is Your ASC Worth?

• Latest Regulatory Developments from Washington and Trenton

• ASC Mergers, Acquisitions and Consolidations

• Key Insights from New Jersey Insurance Industry Leaders

• Hospitals Getting Into the Game

• Analysis from Key New Jersey Government Officials

• PIP, Out-of-Network and Other Reimbursement Issues

The 3rd Annual

NJ ASCReviewA timely seminar on the latest regulatory and business developments affecting the New Jersey ambulatory surgery centers. This seminar provides an opportunity for more than 300 national and statewide ASC leaders to come together and discuss the latest and hottest issues affecting the industry.

Wednesday | April 27, 20118:00 – 9:00 a.m. Registration and Networking Breakfast

9:00 – 4:00 p.m.Program

4:00 – 6:00 p.m.Networking Cocktail Reception

The Palace at Somerset Park Somerset, NJ

For sponsorship opportunities or to attend the event, please contact Alan Levine at [email protected] or 973-364-8389

Mark Manigan Program Chair

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Shawn KnechtelWiderman & CompanyHaddonfield, NJ – 800-220-3434

Carol MaselliConner Strong CompaniesPhiladelphia, PA – 267-702-1375

Jennifer M. MoserBrown & BrownBethlehem, PA – 610-974-9490

Richard PetryGlenn InsuranceAbsecon, NJ – 609-641-3000

William A. ReillyJoseph A. Britton AgencyMountainside, NJ – 800-462-3401

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Don RobertsUSI MidAtlanticPlymouth Meeting, PA – 482-351-4600

Patty SchaefferAON/Affinity InsuranceHatboro, PA – 215-773-4600

Kim SoricelliArthur J. Gallagher AssociatesMontclair, NJ – 973-744-8500

Burt C. SzerlipBC Szerlip Insurance AgencyLittle Silver, NJ – 800-684-0876

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Chris ZuccariniCornerstone Professional Liability ConsultantsRadnor, PA – 800-508-1355

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nj physician magazine march 2011

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