nj physician magazine may 2011

Also in this Issue• Legal Update-Selling Your Practice to Wall Street

• Practical Considerations in Merging Your Practice in Today’s Healthcare Environment

• Governor Christie Signs First in the Nation Legislation to Monitor Newborns

The Heart and Vascular Institute at Englewood Hospital and Medical CenterExemplary Cardiac Care and an Enduring Vision for Continued Advancements in Excellence

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

HEALTH NETWORKM A N A G E M E N T

A Full Service Billing, Collection and Practice Management Company

Contracting

Payroll

Financial Management

Coding/Compliance

Services . . .Billing/Collections

Credentialing

InsightEarn more

DollarsEarn more

Earn more

Respect

Publisher’s Letter

Dear Readers,

It’s been quite awhile since you last heard from me. Other projects and other

issues kept me quite busy for the past year and a half, but now I’m back. Iris and

I are now co-publishers of New Jersey Physician. She will be concentrating on

cover stories and her famous “Food for Thought” reviews, while I will be dealing

with the political, legal and financial climate so unique to the New Jersey medical

community. I must say, it is good to be home again.

The acquisition of numerous smaller specialty practices by publicly traded or

venture capital backed physician practice groups is a rapidly growing occurrence

in the business of medicine. We’ve seen numerous instances of practices joining

together to share operating expenses while pooling resources to invest in high

end specialty equipment such as state of the art tomography. Judging whether

this is the right move for your practice is crucial. John Fanburg and his team

share their insights into the process of determining whether this is a beneficial

move for your group.

The still unclearly defined formation of new business models falling under

the term “ACOs” is the topic of conversation when physicians gather together.

Before acting upon one of these new entities, there are practical considerations

that must be examined. Steve Mizrach shares his insights into this changing

environment and helps clear up one of the most confusing new business forms

that has crossed the path of New Jersey medicine.

Governor Christie sometimes gets it right. He recently signed the first in the

nation legislation to protect the health of newborns from potentially life-

threatening congenital birth defects by requiring all inpatient or ambulatory

health care facilities licensed by DHSS to perform pulse oximetry screenings

within 24 hours on all newborns. Good move, Governor!

This month’s cover story is on the Heart and Vascular Institute at Englewood

Hospital and Medical Center. Eleven years ago, EHMC committed to create a

comprehensive program for cardiac care unlike any in the surrounding region.

They kept their commitment throughout these years and now have one of

the best and most comprehensive departments available, with state of the art

equipment, a dedication to reduction of blood loss in all procedures, and a most

respected, dedicated staff of physicians and surgeons available to their patients.

With data showing rates of success consistently among the highest in both New

Jersey and the nation.

It feels great to be back, with warm regards,

Michael GoldbergCo Publisher

New Jersey Physician Magazine

Published by Montdor Medical Media, LLC

Co-Publisher and Managing EditorsIris and Michael Goldberg

Contributing Writers Iris GoldbergMichael GoldbergJohn D. Fanburg, Esq.Mark Taffet, Esq.Leonard Lipsky, EsqBrian Kern, Esq.Steven Mizrach, CPADeidre Hartmann, CPARobert Pear

New Jersey Physician is published monthly by Montdor Medical Media, LLC.,PO Box 257Livingston NJ 07039Tel: 973.994.0068Fax: 973.994.2063

For Information on Advertising in New Jersey

Physician, please contact Iris Goldberg at

973.994.0068 or at [email protected]

Send Press Releases and all other information

related to this publication to

[email protected]

Although every precaution is taken to ensure

accuracy of published materials, New Jersey

Physician cannot be held responsible for opinions

expressed or facts supplied by its authors. All

rights reserved, Reproduction in whole or in part

without written permission is prohibited.

No part of this publication may be reproduced or

transmitted in any form or by any means without

the written permission from Montdor Medical

Media. Copyright 2010.

Subscription rates:

$48.00 per year

$6.95 per issue

Advertising rates on request

New Jersey Physician magazine is an

independent publication for the medical

community of our state and is not a publication

of NJ Physicians Association

2 New Jersey Physician

CONTENTS

9

Insurance

10

Legal Issues

Legal Update: Selling your practice to Wall Street

12

Finance

Considering an ACO? Financial advantages or consequences, you decide.

Practical Considerations in Merging a Practice in Today’s Healthcare Environment

14

Statehouse

Frome the office of the Govenor: Govenor Christie signs first in the nation legislation to monitor newborns

16

Hospital Rounds

18

Food for Thought

Cocco Bello Café Livingston, New Jersey

20

In The News

Contents

The Heart and Vascular Institute at Englewood

Hospital and Medical CenterExemplary Cardiac Care and an Enduring Vision for Continued Advancements in Excellence

COVER STORY

4

New Jersey Physician 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]

BLEED SIZE: 7-1/4 x 5-1/16 TRIM SIZE: 7 x 4-13/16 COLOR: 4/process color

DESIGN: JSM Concepts, Inc., John Malinowski - (516) 379-8221 [email protected]

The Professional Liability Specialists130 Technology Drive, Warren, NJ 07059 • (877)769-1999

Learn more about our commitment to physicians, and read important news and articles at www.insuranceagent.com

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.

Agents for:


Cover Story

When it opened its doors in July of 2000, the Heart and Vascular Institute

at Englewood Hospital and Medical Center was the realization of a

vision to create a comprehensive program for cardiac care unlike any

in the surrounding region. Cardiac services including invasive and

non-invasive cardiology, cardiac surgery and cardiac electrophysiology

were offered to area patients who previously had to travel elsewhere

to receive comparable care. In the years since, data has continued to

show rates of success that are consistently among the highest in New

Jersey and in the nation at large. Also, Englewood Hospital has a track

record of accepting the most complex cardiac cases.

Englewood Hospital and Medical Center has received numerous

accolades for its highly successful and well recognized cardiac

program:

• New Jersey Department of Health and Senior Services Cardiac

Surgery Report lists a 100% survival rate for Englewood Hospital in

isolated coronary artery bypass surgery – a perfect record in the

past four reports.

• CareChex® presented Englewood Hospital and Medical Center with

its prestigious Medical Excellence Award for cardiac care, ranking it

as the #3 hospital for cardiac care in the state of New Jersey (2009-

2011).

• HealthGrades recognized Englewood Hospital with a Five-Star

rating for Treatment of Heart Attack and Coronary Artery Bypass

Surgery (2010-2011).

• J.D. Power and Associates recognized Englewood Hospital and

Medical Center for providing an “Outstanding Cardiovascular Patient

Experience” (2010).

• The Center for Medicare and Medicaid Services (CMS) ranked

Englewood Hospital and Medical Center #1 in New Jersey and # 3

nationwide for heart attack survival (based on CMS data for Medicare

patients discharged between July 2006 and June 2007).

Emphasizing individualized patient care and a multi-disciplinary team

approach, the specialized cardiac experts at Englewood Hospital and

Medical Center diagnose and treat all manifestations of cardiovascular

disease. Additionally, recognition by the team of the cardiac needs of

The Heart and Vascular Institute at Englewood Hospital and Medical CenterExemplary Cardiac Care and an Enduring Vision for Continued Advancements in Excellence

p Englewood Hospital and Medical Center offers a comprehensive program for Cardiac Care unlike any in the surrounding region.

By Iris Goldberg


specific populations within the community

and reaching out to those groups with

a variety of educational and support

services further enhances the dramatic role

Englewood Hospital and Medical Center has

in preserving heart health for so many New

Jersey residents.

Jeffrey S. Matican, MD,

Section Chief of Cardiology

at Englewood Hospital and

Medical Center discusses

some of the important

factors that set the Heart

and Vascular Institute apart from other

facilities.

“There is a very collegial relationship amongst

all of the doctors – the cardiologists from

various groups, the electrophysiologists and

the cardiac surgeons. It is common practice

here for doctors in these various disciplines

to engage in a group-think consultation about

how to best handle a particular patient,” Dr.

Matican states.

Another source of pride for Dr. Matican is

Englewood Hospital’s dedicated nursing staff,

which has earned Magnet status for excellence

in nursing for the third time – a distinction

shared by only 6% of hospitals, nationwide.

“In addition to their clinical experience, the

nurses here are interested, energetic and

committed to staying informed about medical

advances to help their patients,” he notes.

In addition to the informal sharing of ideas,

Dr. Matican proudly points to the weekly

cardiology conference at the Heart and

Vascular Institute as a crucial component of

the well-established success of the cardiac

program at Englewood Hospital. Originally

started to discuss the various issues regarding

patients undergoing cardiac catheterization,

the meeting – still informally called a “Cath

Conference” – has now evolved into a

valuable forum for the entire cardiology team.

“At these meetings, we review cardiac-related

articles in the medical literature and even in

the lay press. We discuss new developments

in cardiology and cardiac programs,” Dr.

Matican shares. “Whether it’s a new treatment

or modality for acute coronary syndromes,

or one of our cardiac electrophysiologists

talking about something new in arrhythmias,

or perhaps the cardiac surgeons speaking

about the latest advances in aortic aneurysm

surgery, there’s a wealth of information shared

amongst the cardiac team at these weekly

meetings,” he adds.

The weekly conference

is led by Richard S.

Goldweit, MD, Director of

the Cardiac Catheterization

Laboratory and Director of

Interventional Cardiology

at Englewood Hospital and Medical Center.

“Our dynamic weekly cardiology conference

is unique in that all cardiology-related

disciplines attend - cardiac surgeons, the

entire array of cardiologists, including the

electrophysiologists, non-invasive cardiology

and invasive cardiologists, nurses and cath

lab technologists. Everyone finds value in

these meetings,” Dr. Goldweit states. “That

interdisciplinary cooperation carries over into

how we practice here. We pride ourselves on

having an interactive program where a team

of specialists in various disciplines work

together,” he adds.

It would be impossible to enumerate the

ways in which Englewood Hospital’s cardiac

program is distinctive without a discussion

of Patient Blood Management (PBM), which

has become the standard of care at the

Medical Center, a world-renowned leader in

PBM. A growing body of evidence points to

an increased risk of infection, complications

and death associated with blood transfusions.

PBM is an initiative to improve patient

outcomes that seeks to avoid unnecessary

blood transfusions and reduce the risks

and costs associated with blood and blood

products.

“By practicing Patient Blood Management,

we have strategies and methods to help

avoid unnecessary transfusions and the risks

associated with them,” Dr. Matican explains.

“We don’t transfuse ‘by the numbers’ but

rather assess each patient’s individual

situation.”

Patient Blood Management is based on

three main principles or “pillars”: optimizing

hematopoiesis and appropriate management

of anemia; minimizing bleeding and

blood loss; and harnessing and optimizing

physiological tolerance of anemia. As assistant

director of Englewood Hospital’s renowned

Institute of Patient Blood Management and

p Englewood Hospital’s state-of-the-art Cardiac Catheterization laboratory


Bloodless Medicine and Surgery, Dr. Goldweit

emphasizes the importance of PBM in

improving patient outcomes.

“There is no question in my mind that if you

look at the literature in general, bleeding

is a horrible thing in the interventional

cardiologist’s arena. In fact, in terms of all

of us – cardiac surgeons, interventional

cardiologists, electrophysiologogists –

bleeding is associated with bad outcomes,”

Dr. Goldweit maintains.

“It’s not just the bleeding itself or the loss of

blood but the changes that might have to be

made to stem the excessive bleeding may

not be best for the patient in other ways,”

he adds. As an example of this he notes

that if a patient with a cardiac stent bleeds

excessively, that patient will have to stop anti-

platelet therapy, which is key to keeping stents

open and preventing another heart attack. “If

you bleed, you might be told to stop those

agents and then you become compromised,”

Dr. Goldweit notes.

Dr. Goldweit also points to evidence-based

treatment decisions as another factor

supporting positive patient outcomes. “At

Englewood Hospital, we emphasize doing

only what the data suggests will be effective.

If the data suggests an option that is less

complex, less fancy, or less high-tech but

it delivers an equally good result, that’s the

option we’ll choose,” Dr. Goldweit states.

He shares that this option is preferable in

terms of reducing excessive costs but most

importantly in terms of doing the best for the

patient, who, generally will do better with a

simpler approach. “In the end it’s all about

the patient. We want data-driven approaches

that enhance quality and length of life,” Dr.

Goldweit emphasizes.

Dr. Goldweit’s point is well-illustrated in

the impressive survival rate for heart attack

patients brought to the Emergency Medicine

Department at Englewood Hospital. With an

interventional cardiologist on staff 24/7, an

excellent ER team and vital patient information

called in ahead by EMS transporters,

Englewood Hospital has held one of the three

best heart attack survival records in the nation.

The time from patient arrival to the start of a

cardiac interventional procedure, known as

“door to balloon” time, has for the past five

years been, on average, nearly 15 minutes

below the limit set by national guidelines.

Patient outcomes for cardiac surgery at

Englewood Hospital are consistently excellent

as well. Since the inception of its cardiac

surgery program 11 years ago, the average

mortality rate for isolated bypass surgery is

0.57% - a survival rate of 99.43% over the past

11 years, as defined by the State of New Jersey.

James J. Klein, MD,

Chief of the Department

of Cardiothoracic Surgery

at Englewood Hospital

discusses the significantly

successful outcomes the

medical center’s cardiac surgery team has

had for bypass surgery as well as for various

other complex procedures such as multi-

valve repair, aneurysm/aortic dissection

repair and endovascular thoracic aneurysm

graft (TAG) repair.

“In the 11 years since the inception of

Englewood Hospital’s cardiac surgery

program, we’ve submitted multiple pieces

of literature that have been accepted by

peer reviewed journals, including two in the

prestigious Annals of Thoracic Surgery. These

articles explored our success with avoiding

blood transfusions during cardiac surgery. I

do believe this is certainly part of the reason

that our cardiac surgery survival rates are so

high and our complication rates are so low,”

asserts Dr. Klein.

With each passing year Dr. Klein relates that

more and more hospitals come to Englewood

Hospital to learn the blood management

techniques that are so closely linked to

its superb record of successful surgical

outcomes. Nearly 80% of cardiac surgeries at

Englewood Hospital are performed without

blood transfusions. Dr. Klein points out

that Jehovah’s Witnesses, who for religious

reasons may not accept blood transfusions,

comprise 13% of his practice. Close to 200

Jehovah’s Witnesses from areas across the

United States have undergone cardiac surgery

at Englewood Hospital since the start of its

cardiac surgery program.

At Englewood Hospital the Department of

Cardiothoracic Surgery works in partnership

with the Department of Vascular Surgery

to perform innovative, minimally invasive

thoracic endografting to an increasing number

of patients with diseases of the thoracic aorta.

p Since the inception of it’s cardiac surgery program 11 years ago, patient outcomes at Englewood Hospital have been consistently excellent.


Herbert Dardik, MD,

Chief of Surgery and Vas-

cular Surgery at Englewood

Hospital, relates how this

collaboration has resulted

in substantially improved

outcomes over traditional approaches to

repair an aneurysm in the chest. “Now

instead of making a large incision in the

chest, we can puncture an artery, remote

from where the problem is and repair the

problem with minimal impact on the patient,

physiologically,” he explains.

Dr. Dardik looks forward to the establishment

of a Hybrid Angiographic OR Suite, which will

further advance the ongoing collaborative work

of cardiac and vascular patient care. This state-of-

the-art facility joins highly advanced equipment,

technology and computer systems with

skilled surgeons, interventional cardiologists,

radiologists, anesthesiologists and specialized

nursing and technical staff to perform complex

cases. For example, Dr. Dardik reports, in

the new hybrid suite, minimally invasive

percutaneous (through needle puncture of a

peripheral artery) aortic valve replacement can

be performed for certain appropriate patients,

rather than a more invasive open procedure.

“This is another reflection of how cardiac

surgery and vascular surgery will continue to

work together more and more in the years to

come,” Dr. Dardik foresees.

The continuous introduction of ground-

breaking technology is also the driving force

behind the renowned

success of the Arrhythmia

Center within the Heart

and Vascular Institute

at Englewood Hospital.

Grant R. Simons, MD is

Director of Cardiac Electrophysiology, which

focuses on the detection, diagnosis and

treatment of abnormal heart rhythms.

“Most recently, for example, we’ve

incorporated technology that significantly

enhances our mapping systems, providing

a high-resolution 3-D model on a graphic

interface,” Dr. Simons shares. He reports that

Englewood Hospital has just invested in one

of the newest mapping systems available to

most accurately visualize real-time images of

electrical activity within the heart.

Robotically guided catheter ablation for the

treatment of atrial fibrillation (AF) is another

innovative procedure performed by the

cardiac electrophysiology team at Englewood

Hospital. Instead of the physician manually

manipulating the catheter during the curative

ablation, as was traditionally the case, a

robotic arm, integrated by computer with

the mapping system, precisely guides the

catheter while the physician operates the

controls from a workstation located a few

feet away from the patient. “This technology

enables us to produce more durable lesions

because we can achieve better contact and

better stability,” asserts Dr. Simons.

Looking towards the future, Dr. Simons

is excited about a clinical trial presently

being conducted at Englewood Hospital to

dramatically alter the treatment for patients

with AF who must remain on anti-coagulant

p Englewood Hospital recently invested in one of the newest mapping systems available to visualize real-time images of electrical activity within the heart

p The physician operates the controls of a robotic arm that is integrated with the mapping system to precisely guide the catheter during ablation for the treatment of atrial fibrillation.


medication to prevent blood clots and stroke. “We are one of the

few sites in the country and the only one in New Jersey that is now

involved in a trial of a device called the ‘Watchman’,” Dr. Simons

shares.

The device, which is delivered via catheter through a puncture in the

groin, seals off a pouch in the left atrium to prevent clots from traveling

to the brain and causing a stroke. The hope is that this technique

will negate the need for blood thinners, which can cause dangerous

bleeding and have therapeutic levels that are difficult to maintain,

even with frequent blood testing.

“In the trial that has been published, the atrial fibrillation patients

with this device who stopped their medication had fewer strokes

than those patients who did not have the device and were on blood

thinners,” Dr. Simons reports. Therefore, if and when the device

receives FDA approval, patients with AF will have a safer and more

effective treatment option to prevent strokes. “Our Arrhythmia Center

is at the forefront of advances in the treatment of arrhythmia so that

we can deliver the best therapies to our patients,” he says.

Englewood Hospital’s cardiac team recognizes that all cardiac

patients benefit from effective follow-up care. “If someone already has

heart disease, the best way to prevent a recurrence, in addition to

medications, is to help minimize the risk factors

with exercise,” says Englewood Hospital’s Director

of Cardiac Rehab, Samuel Suede, MD.

The Cardiac Rehab Center at Englewood Hospital

is equipped with treadmills, bicycles, elliptical

machines, step machines and a rower. Also, the aerobic exercise

is supplemented with resistance training. There is one registered

nurse on site for every five patients and a staff of exercise specialists

who assist patients with their work-out regime. Patients, who have

recently had a significant event, such as heart attack, angioplasty or

bypass surgery, are placed in a 12 week monitoring program. These

individuals have their blood pressure and heart rate checked before

they exercise. Diabetics will also have their glucose tested. While

they exercise their heart rate is being continuously monitored in

order to detect a possible arrhythmia that will then be reported to

the patient’s physician. If an emergent problem occurs, the patient -

already in the hospital - is sent for immediate treatment.

In addition to physical activity, those in the monitoring program attend

weekly lectures which have a dedicated “topic of the week,” such as

Smoking Cessation, Stress Reduction, Cholesterol Reduction, How to

Read a Food Label, etc. At the inception of the monitoring program

patients are administered Endurance Testing, a Quality of Life Test and

an Educational Quiz. After their 12 week program is completed, patients

are asked to re-take those tests and the two sets of scores are compared.

“Patients see the benefit they derived in just 12 weeks and hopefully,

this will be an incentive for them to continue,” Dr. Suede relates.

After 12 weeks in the monitoring program many individuals do opt

to continue at the Cardiac Rehab Center at Englewood Hospital in

its maintenance program, even though insurance no longer covers

this service at that point. A nominal fee is charged and Dr. Suede

reports that many patients have been coming to the center for years,

a testimony to the valuable contribution that Englewood Hospital

continues to make towards the goal of restoring and maintaining

cardiac health within the community.

As the data shows, the comprehensive cardiac program at Englewood

Hospital’s Heart and Vascular Institute has a long track record of

accomplishing its goal of providing the highest quality care for patients

with heart disease. With a consistent ranking amongst the top facilities

in the nation for cardiac care and treatment and a determination to

build on its record of excellence, Englewood Hospital and Medical

Center continues its journey into another decade. Along the way,

countless New Jersey patients with heart disease will have the

opportunity to live a longer, healthier and more productive life.

For more information, call (201) 894-3000 or visit

www.BestHeartDocs.com

p The patient’s heart rate is continuously monitored during exercise.


Insurance

A risk retention group (RRG) called

Obstetricians and Gynecologists Risk

Retention Group of America (OGRRGA) is

taking the unusual step of claiming that it

should not have to cover medical malpractice

claims filed against an obstetrician that it

insured, despite the fact that it provided a

policy for her both when the incidents that

led to the claims occurred, and when the

lawsuits were filed.

OGRRGA filed a declaratory judgment action

in an attempt to disclaim coverage because

the incidents occurred during one policy

period, but were not reported until the next

policy period.

According to court documents, if the

physician had “disclosed either ……

incident in connection with the 2009

Renewal Application, OGRRGA would have

substantially increased…. premiums or

declined to issue the [new] Policy.”

Interestingly though, OGRRGA did not

appear to take either of these actions when it

learned of the claims, even at the time of the

subsequent renewal several months later. In

fact, an email sent by an agent for OGRRGA at

that time suggested that the physician renew

the policy for another year term. Moreover,

even if the claims had been reported at the

time OGRRGA is claiming that they should

have been, OGRRGA seemingly would have

had to cover the claims anyway.

But despite all of these facts, OGRRGA is

relying on a highly technical argument to

win its case.

The company is taking the position that by

operation of the policy form – a claims-made

and reported policy – its insureds must report

an incident during the same policy year that

it occurred. Regardless of any “retroactive

date,” (as the argument goes) once a policy

expires, so does coverage for any incidents

that have not been reported, if reasonably

expected to result in a claim - an argument

with support under NJ case law.

The matter gets more complicated though.

According to court documents, OGRRGA

also added language amounting to what

is known as a “written demand reporting

trigger” to its policy. According to the policy

language,

A “Claim means:

1. a written notice received by an Insured ….

demanding monetary damages…or

2. the filing of a civil lawsuit or arbitration

proceeding seeking monetary damages.”

According to an attorney familiar with

the case, no coverage extends to medical

incidents unless a “claim” is actually asserted

against a physician, and is reported to

OGRRGA. There is no provision that triggers

coverage if a physician merely renders notice

of a medical incident that might lead to a

claim, because the policy requires that an

actual claim be asserted. Since a physician

must report a potential claim at the time of

renewal though, coverage for such a claim

would be precluded under the renewal

policy.

Therefore, a claims-made and reported

policy that includes a written demand trigger

effectively gives a company the ability to

deny virtually any claim, unless of course

an incident occurs, and a written demand

is made, and it is reported to the carrier,

all within the same policy year. So despite

paying OGRRGA nearly $100,000 a year for

coverage, the physician at the center of

this action may not have purchased what

she expected, and a judge could void the

language by relying on the “doctrine of

reasonable expectations” if he/she finds it

too restrictive.

Unfortunately for the physician involved, just

making this argument may cost in the tens

of thousands of dollars. And if a judge does

decide in favor of OGRRGA, the obstetrician

will likely be forced into bankruptcy court.

This case is just one more reminder that

physicians should work with specialized

consultants before purchasing professional

liability insurance.

Brian S. Kern, Esq. is a co-founder and partner with Argent Professional Insurance Agency, LLC. He can be reached at [email protected]

Buyer Beware

By Brian S. Kern, Esq.


Legal Issues

As a follow-up to last month’s article, Sell-

ing your Practice to a Hospital, this month’s

legal update focuses on issues surrounding

the sale of a physician practice to a large

publicly-traded or venture capital-backed

physician practice group. These Wall Street

practice groups are usually created by the

merger or acquisition of numerous smaller

specialty practices, which then seek to

leverage their greater purchasing and ne-

gotiating power to spread the cost of IT

upgrades over a larger revenue base and ex-

pand the range of services offered to their

patients.

To grow efficiently, institutionally financed

practice groups will approach and negoti-

ate with dozens or even hundreds of target

physician practices at one time, with only

1% to 5% of targets actually being acquired.

To assure that valuable time is not wasted,

best terms are achieved, or if necessary,

negotiations are terminated appropriately

and efficiently, it is imperative for a selling

group’s partners to be equipped to interface

with a potential buyer’s transaction profes-

sionals. M&A specialists should be hired or

contracted to run the acquisition program,

providing an expertise that managing part-

ners of most target practice groups do not

have.

For Wall Street practice groups, valuation

ultimately drives transactions. As a result,

it is important for the target practice group

to keep things in perspective on a potential

transaction. This requires a target practice

group to understand both its own motiva-

tions for selling and those of the potential

purchaser for buying.

Is a transaction right for the

practice and its partners?

There are many reasons why partners of

a target practice group may want to sell.

Health care economics are uncertain; com-

petition with large multi-specialty groups

and hospitals is increasing; IT and other

infrastructure investments are large and fi-

nancing often requires personal guarantees

by the partners; and payors are increasingly

reducing reimbursement. A merger or ac-

quisition could result in cash to the partners,

professional management of their practice,

superior infrastructure, and greater negoti-

ating power with third-party payors.

Exploring an institutionally financed prac-

tice group’s good faith inquiry to purchase

a practice takes a significant amount of time

and effort. Accordingly, it is imperative that

the target group’s partners be on the same

page prior to entering negotiations. Besides

the significant costs associated with evalu-

ating acquisition or merger proposals, the

process will distract from running the prac-

tice and the practice of medicine itself.

Understanding each other’s goals also pro-

vides negotiation parameters for what the

group can concede and where it must stay

firm. If the partners do think that they could

benefit from a sale or merger, they are en-

couraged to pursue discussions efficiently

and knowledgably.

Being smart may not be enough

Smart, analytical and seasoned physicians

may feel that it is best to simply invite a

potential purchaser to their office to nego-

tiate a transaction. Such an approach may

not be prudent. The issues involved are

complex and outside the normal range of

activity and experience of many physicians.

Transactions often involve valuation, op-

erational, governance, legal and regulatory

issues with which even veteran physicians

are not familiar. Enlisting the help of a CPA,

investment banker and legal advisor may

LegaLUpdate

Provided by John D. Fanburg, Esq., Mark Taffet and Leonard Lipsky, Esq.

Selling Your Practice to Wall Street

Understanding each other’s goals also provides

negotiation parameters for what the group can

concede and where it must stay firm.


Legal Issuesbe necessary to successfully complete the

transaction.

Determining valuation from the

perspective of the purchaser

Publicly-traded or venture capital-backed

practice groups primarily seek a superior

return on investment. The specific pur-

chaser may have an interest in health care

services and even more specifically in the

target group’s specialty. Unlike, however,

a sale of a physician practice to a hospital

or another privately-held physician group,

which may take into account community

relations, professional expertise and certain

other goodwill considerations, Wall Street

acquisitions are typically driven by the valu-

ation of the target practice and the financial

return the transaction will provide to its in-

vestors.

From the purchaser’s standpoint, there are

three critical points of analysis, which are

often intertwined, that help determine if

they will complete a transaction and what

they want to pay for the physician practice:

Quality of Earnings, Synergy and Scalability.

Quality of earnings focuses on how likely it

is that the target practice’s profits will con-

tinue after its acquisition. Factors affecting

quality of earnings include whether the

target group has long-term referral arrange-

ments in place, dominates its geographic

market, and expects third-party payor reim-

bursement to increase.

Synergy revolves around the degree to

which costs and expenses can be elimi-

nated, or revenues increased, in the target

practice through a merger with the pur-

chaser. Potential purchasers will analyze

how administrative costs can be reduced,

medical malpractice rates improved, and if

a stronger negotiating position will impact

reimbursements from third-party payors.

Scalability addresses whether or not the

revenues of the target practice will grow

due to its acquisition by the institutionally

financed practice group. For example, po-

tential purchasers will analyze whether the

transaction would increase the likelihood

for the target practice to acquire additional

local practices, obtain new contracts, open

additional office locations, offer a wider

range of services or retain more referrals.

If the stars line up, a purchaser will be able

to cut the target practice’s costs, improve

reimbursement and increase revenue. If all

of these things happen, the purchaser is

in a position to pay more for the practice

in the form of cash, salaries, bonuses and

stock. Often, however, all of the stars do not

align and a valuation compromise must be

reached.

It is also important to understand that, af-

ter a transaction is closed, if profits do not

meet an institutional buyer’s requirements,

it is likely that cost cutting measures may be

taken in an attempt to maintain a financial

return on the investment. A buyer may not

be as sensitive to non-financial issues as are

the partners of a privately-owned practice,

nor will they be sentimental toward former

partners or staff in seeking their financial

goals.

Target practices are encouraged to retain

the services of an experienced investment

banker that can assist them in countering

the expertise of M&A professionals em-

ployed by a potential purchaser and who

will work to maximize value and minimize

risk in a transaction.

Regulatory framework

Besides the valuation issues pervasive in

transactions, the target practice should

also be aware of the applicable regulatory

issues. It is common for publicly-traded or

venture capital-backed physician practice

groups to enter into management services

agreements with third-parties that provide

a host of services to their entire organiza-

tion, such as general administrative ser-

vices, billing and collection, staffing, and

maintenance. Because such management

companies are often owned in part by non-

physician entities or individuals, physicians

should be careful not to run afoul of the cor-

porate practice of medicine rules and fee-

splitting prohibitions in certain states.

For example, New York has stringent corpo-

rate practice of medicine and fee-splitting

statutes that do not permit physicians to

share professional fees with non-healthcare

professionals. Obtaining the advice of coun-

sel knowledgeable in such transactions is

crucial to appropriately structure any merg-

er or acquisition to comply with all appli-

cable state and federal laws.

Entering into an agreement to sell or merge

one’s practice with a publicly-traded or

venture capital-backed physician practice

group is not an easy decision to make, nor

one that should be undertaken without

careful reflection and analysis. Understand-

ing the nuances of such transactions, par-

ticularly the valuation and regulatory con-

siderations that drive such transactions, are

critical to negotiating favorable terms and

getting back to what matters – practicing

good medicine.

John D. Fanburg chairs the health law practice, and

Leonard Lipsky is an associate in the health law

practice of Brach Eichler L.L.C., a Roseland, NJ-

based law firm. Contact Mr. Fanburg at jfanburg@

bracheichler.com or at 973-403-3107. Mark Taffet is

the President and CEO of Mast Advisors and can

be reached at [email protected] or at

973-718-7341.

From the purchaser’s standpoint, there are three

critical points of analysis, which are often intertwined,

that help determine if they will complete a transaction

and what they want to pay for the physician practice:

Quality of Earnings, Synergy and Scalability.


Finance

Have you been approached to join an Accountable Care Organization

(ACO), or have you considered forming your own? By now, most of

us should have heard the term ACO, whose concept was introduced in

Section 3022 of the Affordable Care Act (ACA). The goal of an Accountable

Care Organization as stated by Dr. Donald M. Berwick, Administrator

for the Center for Medicare and Medicaid Series, is “Triple Aim” which

means better care for individuals, better health for populations, and lower

growth in expenditures. These goals should be achieved by groups of

providers of services and suppliers (i.e. physician groups, individual

physicians, hospitals, etc.) working together to manage and coordinate

care for Medicare beneficiaries, increasing the quality of patient care

while decreasing patient care costs. Much of the talk to date has been

very conceptual. However, recently proposed rules were issued that

give us some additional detail as to how Medicare intends to implement

this program. Being a CPA this article’s objective is to illustrate a basic

calculation of how savings or losses are determined, so those considering

participation in an ACO can determine if this is a financial arrangement

that should be considered.

In the ACO model, the third prong of the “Triple Aim” is lowering the

growth of expenditures for Medicare beneficiaries. Medicare’s objective

isto reduce the per capita expenditures per Medicare beneficiary for Part

A (hospitals and facilities) and Part B services (physicians and other

providers). Savings will be achieved by the ACO if the expenditures per

their assigned beneficiaries are less than the benchmark set by Medicare.

The benchmark will be calculated by using the most recently available

three years per beneficiary expenditures for Medicare Part A and Part

B services. This benchmark will be adjusted to reflect risk factors (i.e.

diabetes or other chronic illness), geographical area, and growth factors.

In addition the benchmark would be adjusted for a minimum savings

rate, which means the ACO would have to beat the benchmark, plus

obtain savings of a minimal amount. The minimum savings rate for a

Track 1 ACO is based upon the number of beneficiaries assigned to the

ACO and ranges from 3.9% down to 2%, where as the Track 2 minimum

savings rate is a flat 2%. The actual costs per the Medicare beneficiaries

assigned to the ACO would then be compared to the adjusted benchmark

to calculate the shared savings or losses. Participants in an ACO (i.e.

physician groups, individual physicians, hospitals, etc) would still be paid

on a fee for service basis for the services they rendered under their own

business entity. The ACO would only receive the savings achieved, or be

responsible for the losses incurred.

Under the proposed rules participation in an ACO is a three year

agreement with a choice of two “tracks” for participation in the shared

savings or losses. Under Track 1 (One Sided Model), the ACO can share

in up to 50% of the savings based upon quality performance, with no

downside risk for years one and two, but in year three the ACO would

be responsible for losses, essentially converting to Track 2. Under Track

2 ( Two Sided Model), the ACO can share in up to 60% of the savings

based upon quality performance, however the ACO would be subject to

losses startingin year one.Shared savings under both tracks are limited to

7.5% of the benchmark for Track 1 and 10% of the benchmark for Track

2. Losses for Track 2 are limited and phased in as a percentage of the

benchmark starting at 5% for year 1, 7.5% for year 2 and 10% in year 3. Any

savings realized by an ACO would be subject to a 25% withholding, in case

they were losses in future years. Those considering Track 2 may also be

required to obtain reinsurance or surety bonds, place funds in escrow,

or establish a line of credit to cover any losses that may exceed the 25%

withholding.

Considering an ACO?Financial Advantages or Consequences, You Decide.By Deirdre Hartmann, CPA and Manager – Nisivoccia & Company, LLP

Calculation of Shared Savings Year 1 Track 1 Track 2

Assumed benchmark per Medicare ACO beneficiary 8,000 8,000

Minimum savings rate 3.2% 2.0%

Minimum savings adjustment 256 160

Benchmark less minimum savings adjustment 7,744 7,840

Acutal costs per Medicare ACO benficiary 6,500 6,500

Shared savings 1,244 1,340

ACO shared savings rate 50% 60%

Calculated Savings 622 804

Maximum Savings Cap as % of Benchmark 7.5% 10%

Benchmark 8,000 8,000

Maximum savings cap 600 800

Payment from CMS to ACO, lesser of calculated savings or

maximum savings cap

600 800

Calculation of Shared Losses Year 1 Track 1 Track 2

Assumed benchmark per Medicare ACO beneficiary 8,000 8,000

Minimum loss rate 0% 2%

Minimum loss adjustment - 160

Benchmark plus minimum loss adjustment 8,000 8,160

Acutal costs per Medicare ACO benficiary 8,800 8,800

Shared losses (800) (640)

ACO shared loss rate N/A 40%

Calculated losses (256)

Maximum Loss Cap as % of Benchmark, increases to

7.5% in Yr 2, and 10% in Yr 3

N/A -5%

Benchmark 8,000

Maximum loss cap (400)

Payment from ACO to CMS, lesser of calculated losses or

maximum loss cap

- (256)


Finance

Practical Considerations in Merging a Practice in Today’s Healthcare EnvironmentBy Steven Mizrach, CPA

As you can see, the proposed rules are very

complex and confusing.I have prepared an

illustration comparing Track 1 and Track 2 in

a year with savings, and another illustration

comparing Track 1 and Track 2 in a year

with losses. This illustration demonstrates

the savings or losses per ACO beneficiary,

depending on the number of beneficiaries

assigned to your ACO (the minimum is 5,000)

the total savings or losses per beneficiary would

be multiplied by the number of participants in

your ACO. This illustration doesn’t take into

account the costs to establish an ACO, the plan

for how savings will be distributed among the

participants, and other related costs. Stayed

tuned, I am sure there will be more to come.

Deirdre M. Hartmann is CPA and Manager

of Nisivoccia & Company, LLP, a multi-

dimensional CPA firm with offices in Mt.

Arlington and Newton, New Jersey. The firm

offers traditional tax, accounting and audit

services, and maintains practice specialties

in sectors including healthcare, technology,

municipal government, education, nonprofit

and financial services. Contact her at

[email protected].

As we all know it is more difficult than ever

to practice medicine in today’s ever changing

environment.

Not only are practices facing a shortage of

physicians as today’s generation places a

greater priority on lifestyle issues, the demand

for certain specialties has never been higher.

Coupling this with an increased emphasis on

regulatory compliance and healthcare reform

as well as the formation of new business models

such as Accountable Care Organizations

(ACOs), some practices have evolved from

relatively small businesses into sophisticated

organizations.

By now you must be wondering when I would

finally mention the impact of the reduction

in reimbursement rates for services and the

pressure organizations face having built their

business models around the out of network

market.

Practices are running an obstacle course that

would make a Marine proud. As a result of these

developments many practices are considering

joining forces, swimming upstream or selling

out.

Target Practice’s Objectives

In order for a group to consider changing

their business model by merging with another

practice it is important to clearly define the

goals that a practice would hope to achieve

as a result of the combination as well as the

likelihood of success.

Some of the objectives that should

be considered are as follows:

Relief of Management Overload

Many practices are ill equipped to face the

issues discussed above as many doctors

“just want to practice medicine” and might

welcome being relieved of these administrative

responsibilities.

Recruitment and Greater Access

to Resources

Given the shortage of physicians, many

practices are facing the challenge of recruiting

others to join their practice. The question

that I often ask our clients is whether they

would want to join their practice if they had

just completed their residency. This in effect

becomes the practice’s “gut check”.

In addition to staff many practices are limited

from purchasing the “latest and greatest” in

medical equipment, software systems and other

technology that enable practices to perform

at its highest level as these expenditures

cannot be cost justified based on its projected

utilization.

Succession Plan

A common concern among many smaller

practices is a lack of future leaders within their

practice that can carry on when the founders

retire or have an illness.

This causes various levels of concern

The founders would like to realize a retirement

benefit from the sale of their interests.

The founders would like to preserve the legacy

of their practice.

How will the practice survive if one of the

physicians is temporarily incapacitated and

just as importantly how will the rest of the

employees can maintain their positions?

If these objectives are met and things go

according to plan one should expect to

increase their earnings as well as improve the

overall quality of patient care delivered while

also providing insulation from the risks referred

to above.

I would like to point out that as most things in

life there will often be a need to compromise

between having security while relinquishing

autonomy.

In our next article we will discuss the acquirer’s

objectives as well as identify certain precautions

that one should consider in finding the right match.


Statehouse

NEW JERSEYSTATEHOUSE

Governor Chris Christie signed first-in-the-nation legislation today

to protect the health of newborns from potentially life-threatening

congenital birth defects by requiring all inpatient or ambulatory

health care facilities licensed by the Department of Health and Senior

Services to perform pulse oximetry screenings. The screenings

must be completed a minimum of 24 hours after birth and on every

newborn at a facility. The legislation makes New Jersey the first state

to mandate pulse oximetry testing on newborns statewide.

“As the father of four, I know the birth of a child should be a joyous

occasion for parents and family,” said Governor Christie. “There are

times when an infant does not readily exhibit symptoms of a potential

defect and the condition may not be detected in a routine exam. This

legislation will help identify infants who may have hidden, serious

heart problems before they leave the hospital, making a significant

difference in the lives of these babies, their families and their treating

physicians.”

Pulse oximetry is a non-invasive, low-cost test used to identify

congenital birth defects in newborns. It measures the percent of

oxygen in the blood of an infant and whether a baby’s heart and lungs

are healthy. The screening involves taping a sensor to the newborn’s

foot that beams red light through the foot to measure blood oxygen

content.

“Before they leave the hospital, the 102,000 babies born in our state

each year will now have a simple, painless screening test to ensure

that any hidden, but potentially life-threatening heart defects will

be detected,” said Health and Senior Services Commissioner Mary

O’Dowd, who is expecting her first child in a few weeks.

“We expect the pulse oximetry test to detect about 100 congenital

heart defects in infants each year, enabling early treatment and

preventing life-threatening injury or death,” O’Dowd said.

According to the United States Secretary of Health and Human

Services’ Advisory Committee on Heritable Disorders in Newborns

and Children, congenital heart disease affects approximately seven to

nine of every 1,000 live births in the United States and Europe. About

100 heart defects a year are detected in newborns in New Jersey.

The federal Centers for Disease Control and Prevention report that

congenital heart defects are the leading cause of infant death due to

birth defects. When left untreated, congenital birth defects may cause

physical and mental disabilities, or even death.

Sponsors of the legislation in the Assembly include Assemblypersons

Jason O’Donnell (D-Hudson), Connie Wagner (D-Bergen) and Ruben

J. Ramos, Jr. (D-Hudson). Senate version sponsors are Senators

Richard J. Codey (D-Essex) and Joseph F. Vitale (D—Middlesex).

From the Office of the Governor:

Governor Christie Signs First in the Nation Legislation to Monitor Newborns


NEW JERSEY STATEHOUSE State of New JerseyDepartment of Health and Senior Services / Department of Human ServicesHospital Funding As of 02/25/2011

Charity Care HRSF GMESFY 2011 665,000,000$ 166,600,000$ 60,000,000$ SFY 2012 675,000,000$ -$ 90,000,000$

$10,000,000 $30,000,000

Diff SFY 12 vs. 11Hospital Name CC HRSF GME TOTAL CC HRSF GME TOTAL Difference

Atlanticare Regional Medical Center 23,988,962$ 7,611,734$ 1,084,783$ 32,685,479$ 24,514,139$ 6,790,083$ 1,621,741$ 32,925,964$ 240,485$ Bayonne Medical Center 2,903,745$ -$ -$ 2,903,745$ 3,072,956$ 9,723$ -$ 3,082,679$ 178,933$ Bayshore Community Hosp 259,330$ -$ -$ 259,330$ 386,800$ 25,164$ -$ 411,964$ 152,634$ Bergen Regional Medical Center 37,538,860$ 13,020,588$ -$ 50,559,448$ 37,238,107$ 14,277,423$ 371,097$ 51,886,627$ 1,327,179$ Cape Regional Medical Center 912,022$ -$ -$ 912,022$ 1,024,183$ 328,278$ -$ 1,352,461$ 440,439$ Capital Health System at Fuld 20,657,267$ 4,906,980$ 473,602$ 26,037,849$ 21,111,364$ 3,612,185$ 950,143$ 25,673,692$ (364,157)$ Capital Health System at Mercer 7,588,307$ 2,403,061$ 47,262$ 10,038,630$ 7,812,232$ 2,004,479$ 75,611$ 9,892,322$ (146,308)$ CentraState Medical Center 2,112,872$ -$ 143,388$ 2,256,260$ 2,317,777$ 470,112$ 144,019$ 2,931,908$ 675,648$ Chilton Memorial Hospital 609,609$ -$ -$ 609,609$ 611,992$ 133,256$ -$ 745,248$ 135,639$ Christ Hospital 12,405,014$ 1,963,712$ 210,181$ 14,578,908$ 12,763,158$ 2,241,729$ 340,484$ 15,345,371$ 766,464$ Clara Maass Medical Center 4,591,963$ 2,256,399$ -$ 6,848,362$ 4,424,661$ 2,877,028$ -$ 7,301,689$ 453,327$ Community Medical Center 2,644,564$ -$ -$ 2,644,564$ 2,836,177$ 464,965$ -$ 3,301,142$ 656,578$ Cooper Hospital / Univ Med Ctr 35,543,600$ 7,757,211$ 7,586,681$ 50,887,492$ 35,881,989$ 6,218,870$ 9,709,459$ 51,810,318$ 922,826$ Deborah Heart and Lung Center 6,880,595$ -$ -$ 6,880,595$ 6,856,916$ 572$ 96,411$ 6,953,899$ 73,304$ East Orange General Hospital 11,474,716$ 3,901,771$ -$ 15,376,487$ 11,328,636$ 2,749,701$ -$ 14,078,337$ (1,298,150)$ Englewood Hospital and Medical Center 1,422,994$ -$ -$ 1,422,994$ 1,350,122$ 426,075$ 156,577$ 1,932,774$ 509,780$ Hackensack University Medical Center 8,572,904$ -$ 3,198,497$ 11,771,401$ 9,409,011$ 1,462,953$ 3,116,569$ 13,988,533$ 2,217,132$ Hackettstown Regional Medical Center 166,996$ -$ -$ 166,996$ 298,061$ 176,721$ -$ 474,782$ 307,787$ Hoboken University Medical Center 15,054,329$ -$ 285,454$ 15,339,783$ 15,464,202$ 1,078,602$ 494,640$ 17,037,445$ 1,697,662$ Holy Name Hospital 934,175$ -$ -$ 934,175$ 964,209$ 299,682$ -$ 1,263,891$ 329,716$ Hunterdon Medical Center 1,590,677$ -$ -$ 1,590,677$ 1,660,072$ 126,393$ 31,371$ 1,817,835$ 227,157$ Jersey City Medical Center 48,064,130$ 8,906,357$ 2,059,140$ 59,029,627$ 48,905,236$ 7,700,781$ 3,880,519$ 60,486,536$ 1,456,908$ Jersey Shore University Medical Center 4,791,768$ -$ 1,867,509$ 6,659,277$ 5,089,296$ 3,578,428$ 2,548,996$ 11,216,720$ 4,557,444$ JFK Medical Center / Anthony M. Yelencsics 3,792,747$ -$ -$ 3,792,747$ 4,350,397$ 423,787$ 102,956$ 4,877,140$ 1,084,392$ Kennedy Hospitals / UMC 10,843,553$ 7,550,486$ 3,516,270$ 21,910,309$ 10,413,583$ 6,182,034$ 4,381,288$ 20,976,905$ (933,403)$ Kimball Medical Center 10,202,328$ 5,263,629$ -$ 15,465,957$ 10,102,200$ 5,132,827$ -$ 15,235,027$ (230,930)$ Lourdes Medical Center of Burlington County 2,570,579$ 2,212,838$ 71,256$ 4,854,673$ 2,640,992$ 2,058,510$ 124,324$ 4,823,825$ (30,848)$ Meadowlands Hospital Medical Center 542,138$ -$ -$ 542,138$ 743,876$ 224,762$ -$ 968,637$ 426,500$ Memorial Hosp of Salem County 261,687$ -$ -$ 261,687$ 480,840$ 192,735$ -$ 673,574$ 411,887$ Monmouth Medical Center 9,018,124$ 9,222,535$ 2,251,276$ 20,491,936$ 8,655,034$ 7,915,215$ 3,308,226$ 19,878,475$ (613,460)$ Morristown Memorial Hospital 3,276,312$ -$ -$ 3,276,312$ 2,696,923$ 464,965$ 661,797$ 3,823,685$ 547,373$ Mountainside Hospital 1,287,806$ -$ -$ 1,287,806$ 1,193,612$ 274,518$ 127,025$ 1,595,155$ 307,349$ Newark Beth Israel Medical Center 33,340,270$ 15,750,774$ 9,770,435$ 58,861,479$ 34,787,887$ 12,508,535$ 11,963,675$ 59,260,097$ 398,618$ Newton Memorial Hospital 914,546$ -$ -$ 914,546$ 1,050,254$ 150,985$ -$ 1,201,239$ 286,692$ Ocean Medical Center 1,359,148$ -$ -$ 1,359,148$ 1,210,126$ 285,384$ -$ 1,495,511$ 136,362$ Our Lady of Lourdes Medical Center 2,594,416$ 2,918,647$ 658,420$ 6,171,483$ 3,042,958$ 2,413,287$ 1,048,975$ 6,505,219$ 333,736$ Overlook Hospital 1,523,635$ -$ -$ 1,523,635$ 1,365,238$ 281,953$ 178,807$ 1,825,998$ 302,363$ Palisades Medical Center 7,106,905$ -$ -$ 7,106,905$ 7,081,675$ 946,516$ -$ 8,028,190$ 921,286$ Raritan Bay Medical Center 10,934,106$ 2,238,016$ 397,706$ 13,569,828$ 11,508,623$ 2,465,839$ 627,785$ 14,602,248$ 1,032,420$ Riverview Medical Center 2,770,892$ -$ -$ 2,770,892$ 2,492,126$ 285,384$ -$ 2,777,511$ 6,619$ RWJ University Hospital 8,708,149$ 5,898,678$ 7,825,417$ 22,432,244$ 8,264,328$ 4,008,967$ 10,592,929$ 22,866,224$ 433,979$ RWJUH at Hamilton 606,142$ -$ -$ 606,142$ 622,666$ 218,471$ -$ 841,137$ 234,994$ RWJUH at Rahway 1,687,759$ -$ -$ 1,687,759$ 1,827,281$ 1,716$ -$ 1,828,997$ 141,238$ Saint Barnabas Medical Center 1,296,793$ -$ -$ 1,296,793$ 1,028,493$ 491,845$ 471,846$ 1,992,184$ 695,391$ Saint Clare's Hospital / Denville 11,023,812$ 5,350,245$ -$ 16,374,057$ 11,143,641$ 5,650,378$ -$ 16,794,019$ 419,962$ Saint Clare's Hospital / Sussex 334,318$ -$ -$ 334,318$ 386,641$ 4,003$ -$ 390,644$ 56,327$ Saint Francis Medical Center (T) 14,707,292$ 1,797,990$ 235,571$ 16,740,853$ 14,383,534$ 1,277,220$ 382,740$ 16,043,494$ (697,359)$ Saint Joseph's Regional Medical Center 73,269,763$ 11,026,618$ 7,384,309$ 91,680,690$ 73,610,785$ 10,876,963$ 9,225,481$ 93,713,229$ 2,032,539$ Saint Joseph's Wayne Hospital 351,906$ -$ -$ 351,906$ 345,399$ -$ -$ 345,399$ (6,507)$ Saint Mary's Hospital (P) 10,459,129$ 1,976,958$ -$ 12,436,087$ 10,778,375$ 2,315,861$ 3,125$ 13,097,360$ 661,273$ Saint Michael's Medical Center 25,430,422$ 7,990,679$ 1,797,770$ 35,218,870$ 26,241,712$ 6,757,836$ 2,910,372$ 35,909,920$ 691,050$ Saint Peter's University Hospital 6,550,730$ 6,718,773$ 2,254,273$ 15,523,776$ 5,819,520$ 4,564,176$ 2,669,652$ 13,053,348$ (2,470,428)$ Shore Memorial Hospital 785,942$ -$ -$ 785,942$ 930,368$ 366,596$ -$ 1,296,964$ 511,022$ Somerset Medical Center 3,351,870$ -$ -$ 3,351,870$ 3,279,722$ 336,857$ 71,563$ 3,688,141$ 336,272$

SFY 2012

SFY 2011 SFY2012

s:\hsp\nos\GME\Hospital Funding Gov SFY12 Budget Impact Summary 2-25-11.xls: Summary Page 1 of 2 1/17/08

Hospital Funding As of 02/25/2011

Charity Care HRSF GMESFY 2011 665,000,000$ 166,600,000$ 60,000,000$ SFY 2012 675,000,000$ -$ 90,000,000$

$10,000,000 $30,000,000

Diff SFY 12 vs. 11Hospital Name CC HRSF GME TOTAL CC HRSF GME TOTAL Difference

SFY 2012

SFY 2011 SFY2012

South Jersey Healthcare / Elmer 167,298$ -$ -$ 167,298$ 305,066$ 64,626$ -$ 369,692$ 202,394$ South Jersey Healthcare Regional MC 1,863,184$ 2,532,124$ -$ 4,395,307$ 2,422,113$ 4,439,774$ 29,135$ 6,891,022$ 2,495,715$ Southern Ocean Cty Hosp 320,265$ -$ -$ 320,265$ 434,831$ 145,838$ -$ 580,669$ 260,404$ Trinitas Hospital 43,174,408$ 6,374,168$ 1,328,460$ 50,877,036$ 44,015,815$ 9,682,060$ 2,187,794$ 55,885,669$ 5,008,633$ Underwood Memorial Hosp 1,324,443$ -$ -$ 1,324,443$ 1,663,569$ 768,438$ 56,805$ 2,488,812$ 1,164,369$ University Hospital - UMDNJ 99,298,190$ 19,049,028$ 5,298,079$ 123,645,298$ 101,012,076$ 13,797,463$ 14,804,084$ 129,613,624$ 5,968,326$ University Medical Center at Princeton 1,031,756$ -$ 254,261$ 1,286,017$ 1,094,389$ 332,281$ 337,888$ 1,764,558$ 478,541$ Valley Hospital 745,118$ -$ -$ 745,118$ 610,058$ 152,701$ -$ 762,759$ 17,641$ Virtua - Mem Hsp of Burlington County 2,026,639$ -$ -$ 2,026,639$ 2,132,881$ 712,031$ 45,231$ 2,890,144$ 863,505$ Virtua - West Jersey Health System 2,496,703$ -$ -$ 2,496,703$ 2,382,691$ 346,579$ 109,959$ 2,839,228$ 342,525$ Warren Hospital 877,176$ -$ -$ 877,176$ 1,126,408$ 26,880$ 38,901$ 1,192,189$ 315,013$ Wm. B. Kessler Mem Hosp 62,200$ -$ -$ 62,200$ -$ -$ -$ -$ (62,200)$ TOTALS: 665,000,000$ 166,600,000$ 60,000,000$ 891,600,000$ 675,000,000$ 166,600,000$ 90,000,000$ 931,600,000$ 40,000,000$

Diff SFY 12 vs. 11Hospital Systems CC HRSF GME Total CC HRSF GME Total Difference

Atlantic Health System 4,799,947$ -$ -$ 4,799,947$ 4,062,161$ 746,918$ 840,604$ 5,649,683$ 849,736$ AtlantiCare Health System 23,988,962$ 7,611,734$ 1,084,783$ 32,685,479$ 24,514,139$ 6,790,083$ 1,621,741$ 32,925,964$ 240,485$ Adventist HealthCare Inc. 166,996$ -$ -$ 166,996$ 298,061$ 176,721$ -$ 474,782$ 307,787$ Capital Health System 28,245,574$ 7,310,041$ 520,864$ 36,076,479$ 28,923,595$ 5,616,664$ 1,025,754$ 35,566,014$ (510,465)$ Catholic Health East 45,302,709$ 14,920,154$ 2,763,017$ 62,985,880$ 46,309,196$ 12,506,852$ 4,466,411$ 63,282,459$ 296,579$ Kennedy Health System 10,843,553$ 7,550,486$ 3,516,270$ 21,910,309$ 10,413,583$ 6,182,034$ 4,381,288$ 20,976,905$ (933,403)$ Liberty HealthCare Systems, Inc. 48,064,130$ 8,906,357$ 2,059,140$ 59,029,627$ 48,905,236$ 7,700,781$ 3,880,519$ 60,486,536$ 1,456,908$ Meridian Health Systems 9,501,403$ -$ 1,867,509$ 11,368,912$ 9,613,179$ 4,320,199$ 2,548,996$ 16,482,374$ 5,113,462$ Merit Health Systems 1,287,806$ -$ -$ 1,287,806$ 1,193,612$ 274,518$ 127,025$ 1,595,155$ 307,349$ Raritan Bay Health Services 10,934,106$ 2,238,016$ 397,706$ 13,569,828$ 11,508,623$ 2,465,839$ 627,785$ 14,602,248$ 1,032,420$Robert Wood Johnson Health System 11,002,050$ 5,898,678$ 7,825,417$ 24,726,145$ 10,714,275$ 4,229,153$ 10,592,929$ 25,536,357$ 810,212$ Saint Barnabas Health Care System 61,094,042$ 32,493,337$ 12,021,711$ 105,609,090$ 61,834,451$ 29,390,415$ 15,743,748$ 106,968,614$ 1,359,523$ Saint Clare's Health Services 11,358,130$ 5,350,245$ -$ 16,708,375$ 11,530,282$ 5,654,382$ -$ 17,184,663$ 476,288$ Solaris Health System 3,792,747$ -$ -$ 3,792,747$ 4,350,397$ 423,787$ 102,956$ 4,877,140$ 1,084,392$ South Jersey Healthcare System 2,030,482$ 2,532,124$ -$ 4,562,605$ 2,727,179$ 4,504,400$ 29,135$ 7,260,715$ 2,698,110$ St. Joseph's Healthcare System 73,621,668$ 11,026,618$ 7,384,309$ 92,032,596$ 73,956,184$ 10,876,963$ 9,225,481$ 94,058,628$ 2,026,032$ Virtua Health System 4,523,342$ -$ -$ 4,523,342$ 4,515,572$ 1,058,610$ 155,189$ 5,729,372$ 1,206,030$

Total 350,557,648$ 105,837,790$ 39,440,726$ 495,836,164$ 355,369,726$ 102,918,322$ 55,369,561$ 513,657,609$ 17,821,445$

2008 Closed HospitalsMuhlenberg Regional Medical CenterColumbus HospitalSt. James HospitalGreenville Hospital

SFY2012SFY 2011

s:\hsp\nos\GME\Hospital Funding Gov SFY12 Budget Impact Summary 2-25-11.xls: Summary Page 2 of 2 1/17/08

State Hospital Funding 2011-2012


Hospital Rounds

Call for Applications for New Bergen County General Hospital

LHP and Hackensack University Medical Center Announce CEO of Hackensack University Medical Center at Pascack ValleyRichard Freeman Named to Reopen Former Pascack Valley Hospital

On June 1, 2011, in response to the New Jersey

Department of Health and Senior Services’ call

for applications for a new general hospital in

Bergen County, Hackensack University Medical

Center (HUMC) submitted a Certificate of Need

application for review. HUMC’s application

strongly demonstrates the need for a proposed

128-bed, acute care community hospital in

Westwood; restoring much needed hospital

services to the Pascack Valley and Northern

Valley communities formerly served by the

Pascack Valley Hospital.

In 2007, Pascack Valley Hospital (PVH) closed

due to poor management and overexpansion

precipitated a bankruptcy. Since 2008, HUMC

has operated a satellite emergency department

at Pascack Valley, but the healthcare needs of

this community extend far beyond the limited

services currently available at this facility.

Access to convenient, comprehensive hospital

services is essential.

The application to open HUMC at Pascack

Valley, provides a strong, in depth, need-

based analysis addressing the criteria for a

new hospital as outlined in the call issued on

February 18, 2011.

In addition, there is continued, widespread

community support to open a hospital in

Westwood. During a November 2009 general

election, a referendum appeared on the public

ballot with an overwhelming 75% supporting

the reopening of a hospital in Westwood.

Hackensack University Medical Center looks

forward to a constructive application process,

and is focused on opening Hackensack

University Medical Center at Pascack Valley.

LHP Hospital Group, Inc. (LHP) and

Hackensack University Medical Center (HUMC)

today announced that Richard S. Freeman has

been named CEO of Hackensack University

Medical Center at Pascack Valley (HUMC-PV).

HUMC and LHP formed a joint venture in 2009

to reopen the former Pascack Valley Hospital in

Westwood, NJ, which was closed in April 2008.

This announcement follows yesterday’s filing

of the Certificate of Need application on behalf

of LHP and HUMC, doing business as Pascack

Valley Health System, LLC.

“I am thrilled to have Rich Freeman come

aboard as we work to restore the much

needed hospital services to Pascack Valley

and Northern Valley,” said Robert C. Garrett,

president and chief executive officer of

Hackensack University Medical Center. “His

proven leadership experience will help us to

bring high quality care to Westwood, while

maintaining the close-knit community once

familiar at Pascack Valley Hospital.”

Freeman recently served as the COO of Beth

Israel Medical Center in New York City, where

he was responsible for the ongoing operations

of the two campus, 1,200-bed major academic

community hospital. Prior to his tenure at Beth

Israel, Freeman held a number of positions

with Tenet Healthcare as the CEO of Medical

College of Pennsylvania, Vice President of

the Tenet Louisiana Operations, and CEO of

Delray Community Hospital. Freeman began

his healthcare career with National Medical

Enterprises (now Tenet) and held regional

positions in California in addition to several

CEO and COO positions in Florida and

Louisiana.

“Rich Freeman is an outstanding, experienced

hospital administrator, and we are fortunate

to have him join the LHP team in this critical

leadership role. Rich has had a very successful

career of working with physicians and

employees to deliver high quality patient care

to the communities we serve,” said Dan Moen,

LHP CEO.


Hospital Rounds“I am honored to join the teams at LHP

and Hackensack University Medical Center.

LHP is recognized nationally as a leader in

collaborating with physicians and employees.

LHP’s strategy of forming joint ventures with

not-for-profit hospitals is unique and well-

respected throughout the healthcare industry,”

said Freeman. “Hackensack University Medical

Center is one of the most outstanding systems

in our nation based on any quality measure.

They have been recognized regularly for care

quality, outcomes, and clinical research-both

locally and nationally, and we are fortunate

to benefit from their clinical expertise and

standards. The people of Westwood and the

surrounding communities deserve to have

their local hospital reopened. It is a privilege

for me to be on the team that will respond to

the overwhelming support this project has

enjoyed,” Freeman went on to say.

Freeman holds an MBA from Temple University,

where he was awarded the Kellogg Grant for

Hospital Administration, and completed his BS

degree at LaSalle College in Philadelphia. He

and his wife, Lisa, have three children: Michael,

30; Lauren, 28 and Nick, 19.

Amyloidosis Treatment at Newark Beth Israel Medical Center Gives Union City Man a Second LifeWhen Ricardo Negron, 52 of Union City, NJ,

rides his stationary bike he leaves the memory

of heart failure further and further behind. After

he was diagnosed with amyloidosis earlier this

year, specialists at Newark Beth Israel Medical

Center were able to arrest the production of

amyloid protein that destroyed his heart and

perform a heart transplant.

Mr. Negron had felt his life waning for two years

but doctors could not find the problem. “I used

to walk a mile and a half to work but suddenly

I was so exhausted that just taking a shower

was a mission. None of the medications helped

me,” he remembers.

Mr. Negron has primary AL amyloidosis, a rare

blood disorder that results in production of

abnormal protein (amyloid) that is deposited

as fibers on organs such as the heart, kidneys,

nerves and intestines. Because the condition

is uncommononly about 3,000 American are

diagnosed each yearmost physicians have

little experience diagnosing or treating the

condition.

“In patients with unexplained heart failure,

gastrointestinal symptoms or neuromuscular

disorders, a diagnosis of amyloidosis should

be considered,” said Indu Sabnani, MD,

hematologist/oncologist at Newark Beth Israel

Medical Center. There are many different kinds

of amyloidosis which can be hereditary or

acquired.

“When I met Mr. Negron his heart was

functioning at 15 percent of its normal

capacity,” said Mark J. Zucker, MD, JD, Director

of the Heart Failure Treatment and Transplant

Program at Newark Beth Israel Medical Center.

A biopsy was performed, the only definitive

test for amyloidosis. “The walls of his heart

were stiff from the deposit of starchy material,”

explained Dr. Zucker.

The national Amyloidosis Foundation

recognizes Newark Beth Israel Medical Center

as experienced in diagnosing and treating

this condition that requires a symphony of

amyloid specialists in cardiology, hematology,

gastroenterology, neurology, nephrology,

pulmonology and pathology. “Until recently,

AL amyloidosis was considered incurable,”

said Dr. Sabnani. “Research studies in stem

cell transplantation are showing good results

and now offer hope to people with ‘stiff heart

syndrome.’”

The team at Newark Beth Israel fully evaluated

Mr. Negron’s disease among the many types

of amyloidosis and planned specific treatment

aimed at reducing the abnormal cells that

produce the amyloid while managing the heart

failure it caused.

The husband and father of three received a heart

transplant in April, only a month after being

listed as a heart transplant candidate. Today,

Mr. Negron is walking his wife to work early in

the morning, riding up to 12 miles a day on his

stationary bike and taking the stairs whenever

he can. After he is fully recoverd from transplant

surgery, the Newark Beth Israel specialists have

recommended a stem cell transplant that could

completely cure his disease.

About the Heart Center at Newark Beth Israel Medical Center

The Heart Center at Newark Beth Israel Medical Center provides New Jersey residents with access to one of the nation’s finest and most comprehensive cardiovascular programs that was ranked among the nation’s 50 best in Heart and Heart Surgery by U.S .News & World Report’s America’s Best Hospitals for two consecutive years and top in New Jersey in 2010- 2011. The Heart Failure Treatment and Transplant Program is the fifth most active in the country, with long-term survival rates that consistently exceed national benchmarks. Highly specialized care includes minimally invasive and robotic-assisted cardiac procedures, state-of-the-art technology that provides astounding images of the heart for more precise diagnosis, and the latest generation of ventricular assist devices designed to take over the pumping action for a diseased heart.


Food for Thought

This is not so much about the food, although

I will gladly share some “tidbits.” For me,

this is about enjoying the company of

women friends. I’m not just talking about

best friends, whom you see all the time and

have known forever. I’m talking about those

women you’ve met along the way, perhaps at

work, or maybe through your children and it

might have started with a cup of coffee or an

extended phone conversation, then suddenly,

a relationship is born. I am fortunate to be the

member of a foursome of women who meet a

few times during the year to share a meal and

anything else that comes to mind. This has

been going on for many years and we have

seen each other through a lot.

Since we all live in Livingston, we usually do

try to stay local. Last week we met at Cocco

Bello Café which is a popular spot for good

Italian cuisine with those who live in the area

and it has actually developed a following of

diners who travel from farther away, as I have

been told. The proprietors know many of the

regulars and the atmosphere is family-like and

warm. There is nice greeting when you arrive

and the service is always attentive.

I won’t mention names but our group is

an interesting mix. There’s a physician, an

educator, a children’s textbook editor and a

healthcare magazine publisher (that would

be me, of course). We’ve been through the

death of three parents, one divorce, two bouts

of cancer, three career moves, marriages of

children, divorce of children, anything and

everything we need to vent about children,

birth of grandchildren, husband’s illnesses,

anything and everything we need to vent

about husbands and menopause- to name

only some of the added spice that is served

with the food.

With the exception of one of these women,

with whom I share a special relationship

outside of the group, we don’t call each other

regularly. Months can go by when we don’t

see each other at all. Then the email comes.

By Iris Goldberg

Cocco Bello Café Livingston, New Jersey

Let Brach Eichler’s Health Law Practice Group Help You Chart a Strategic Course For Your Health Care Business

Health care providers have long come to rely on the attorneys of Brach Eichler to navigate the regulatory environment at both the state and federal levels. Now that health

care reform is being implemented, Brach Eichler is ready to help you make sense of the significant changes, the statutory framework

and the ramifications for health care providers in New Jersey.

Todd C. BrowerLani M. Dornfeld

John D. FanburgJoseph M. Gorrell

Carol GreleckiKevin M. Lastorino

Debra C. LienhardtMark Manigan

Health Law Practice Group

Richard B. RobinsJenny CarrollChad D. Ehrenkranz

Lauren FuhrmanEric W. GrossRita M. Jennings

Leonard LipskyIsai SenthilEdward J. Yun

101 Eisenhower Parkway • Roseland, New Jersey 07068 • t. 973.228.5700 • f. 973.228.7852 • www.bracheichler.com


“Ladies, it’s been too long!” One of us gets the ball rolling

and a dinner date is made.

This last time came after many months had passed. There

was so much to catch up on. We began with two salads

for the four of us. One, a salad of mixed greens, endive,

radicchio and walnuts in an oil and vinegar dressing

topped with imported gorgonzola cheese and the other,

a “Della Casa” salad consisting of mixed baby greens

with artichoke hearts, marinated black olives, hearts of

palm, roasted peppers and fresh mozzarella in a balsamic

vinaigrette.

By the time our salads were eaten we had covered a

home improvement project in one of the women’s home,

my daughter Jenna’s upcoming wedding, an unfortunate

health development with an encouraging treatment plan for

another who, by the way, is leaving for a lovely European trip

at the end of the month, despite her illness and an update on

all grandchildren. It’s amazing how fast and how much you

can communicate while your mouth is full.

Okay, for those who actually read this column for the

food, here’s what we had for the main course. I’m sorry

to have to tell you but three of us ordered the same dish.

We couldn’t resist. As a Special of the Day, Cocco Bello

was serving soft shell crabs that are only available in

season. They were large in size, fried and served on top

of angel hair pasta in a zesty marinara sauce. The crabs

were cooked perfectly and the marinara had quite a zing. I

really enjoyed this dish. The fourth member of the group

also had one of the Specials. I believe it was half a duckling

served with a luscious black cherry glaze. I do remember

that she thought it was superb.

By the time our meal was over we had caught up on

absolutely everything. What a relief to talk it all out and

then file it back where it belonged. We always say that

we won’t let too much time pass before our next dinner.

But we always do. One thing’s for sure. When we meet

again, there will be much more to discuss and wherever

we decide to eat, the evening with my women friends will

definitely not be about the food.

As far as Cocco Bello goes, it’s a worthwhile BYO place

for a casual Italian-style, moderately priced dinner that

is well-prepared and attentively served in a comfortable

setting. Perhaps I’ll write about it again when I go there

with Michael. Although I do enjoy my dinners out with

him, they usually aren’t cathartic experiences, so I will be

able to pay more attention to my meal, his meal and the

rest of the food on the menu.

Cocco Bello Café is located at 155 South Livingston

Avenue. (973) 992-1999

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


In The News

Medicare uses inaccurate, unreliable data to pay

doctors and hospitals, the National Academy of

Sciences said.

Although Medicare is a national program, it

adjusts payments to health care providers to

reflect regional differences in wages, rent and

other costs.

But in a new report, a panel of experts from

the academy’s Institute of Medicine said the

payment formulas were deeply flawed.

The system of paying doctors has “fundamental

conceptual problems,” and the method of

paying hospitals is so unrealistic that almost

40 percent of them have been reclassified into

higher-paying areas, the report said.

White House officials agreed to commission the

study in March 2010 — in the last tense days of

Congressional debate over President Obama’s

health care overhaul — as a way to secure the

votes of lawmakers from Iowa, Minnesota,

Wisconsin and other states who believed

their doctors and hospitals had long been

shortchanged by Medicare. As a result of such

underpayments, the lawmakers said, many parts

of their states have difficulty recruiting doctors,

nurses and other practitioners, and consumers

often have difficulty finding specialists.

However, the new study says that geographic

adjustments should be used to increase the

accuracy of Medicare payments, not to address

shortages of providers in some places.

The report criticizes the current arrangement

under which Medicare distributes tens of

billions of dollars based on regional variations

in wages, rents and other costs in 441 hospital

labor markets and 89 payment zones for doctors.

Of the physician payment zones, 34 cover entire

states.

The panel said Medicare should recognize a

single set of 441 payment areas for doctors and

hospitals alike.

As a result of such a change, the panel said,

“higher-cost areas would be separated from

lower-cost areas,” and payments to doctors in

metropolitan areas would generally increase,

while payments to doctors in some rural areas

could be expected to decrease.

Michael D. Abrams, executive vice president of

the Iowa Medical Society, said he was “a little

surprised” and disappointed that the panel did

not acknowledge that Medicare overemphasized

the importance of geographic differences in

office rents.

“You could argue that it costs more to deliver

health care in rural America, in sparsely

populated areas, than in densely populated

areas,” Mr. Abrams said.

“Office space is a lot more expensive in

Brooklyn, N.Y., than in Brooklyn, Iowa,” he said,

but Medicare’s payment formula gives too much

weight to such differences.

Mr. Abrams said he was concerned that the

panel’s recommendations could “make things

worse” for many doctors and patients in his

state. The panel will analyze the impact of its

recommendations in a report next spring.

By the end of this year, under the new health

care law, the secretary of health and human

services must send Congress a plan to revise

the way Medicare adjusts payments to reflect

regional differences in hospital wages.

Any such plan could have major economic and

political implications. Wages account for about

two-thirds of hospital costs, the panel said,

and regional differences are substantial, with a

registered nurse paid almost twice as much per

hour in San Francisco as in Springfield, Mo.

Under the new health law, geographic

adjustments may not increase total costs to

Medicare, so that an increase in payments to one

hospital or group of hospitals must generally be

offset by decreases in payments to others.

Frank A. Sloan, a professor of economics at

Duke University and chairman of the study

panel, said Medicare needed to find a new

source of data on commercial office rents.

The current measure, based on rent for a two-

bedroom apartment, does not accurately reflect

the prices doctors face, he said.

Report Finds Inequities in Payments for Medicare

Virtua Joins as an Owner of QualCareVirtua joined 12 other New Jersey hospital

systems and physician organizations as an

owner of QualCare, Inc., the state’s largest

provicer sponsored managed care company.

Qualcare of Piscataway, NJ, has more than

750,000 members enrolled in self-insured

health, workers’ compensation and liability

insurance products.

Virtua, which has more than 8,000 employees,

will have its health benefits become self-insured

through QualCare effective next January 1.

“Having Virtua join our organization as a

partner anchors our expanding provider and

customer base in southern New Jersey and

Philadelphia,” said Annette Catiino, QualCare’s

president and CEO.

Virtua, based in Marlton, NJ, operates four

hospitals with 1,073 beds, two health and

wellness centers, two rehab centers, two

medically based fitness centers, and a variety

of outpatient health services in South Jersey.

Providing financial solutions to healthcare businesses is our specialty. We know that unlike other businesses, you rely on insurance companies for reimbursement and often see many patients before you see a dime. At The Provident Bank we understand that doctors, dentistsand other healthcare-related businesses have unique banking needs. We have a team of dedicated healthcare lenders that customize lending solutions for all types of medical practices, partnerships and physician/dental groups. So if your business is due for a financialcheckup or could benefit from a banking partner that makes house calls – call us today, andexperience the Provident difference.

Consult our experts.

Equal Opportunity LenderEqual Housing Lender

Member FDIC

TERM LOANS & LINES OF CREDIT

EQUIPMENT FINANCING

COMMERCIAL MORTGAGES

AMBULATORY SURGICAL CENTER FINANCING

CASH MANAGEMENT SERVICES

PRACTICE ACQUISITION FINANCING

For more information call: Vincent Bagarozza, VP, 732-726-5403Ross Mazer, VP, 973-644-5406

www.ProvidentNJ.com

Fast financing relief. No side effects.

More than 22,000 healthcare professionals across the country depend on medical malpractice insurance from ProMutual Group for protection and peace of mind.

• We have the long-term vision and financial resources to provide the coverage you need today and in the future. • We proactively partner with you to minimize risk, increase patient safety and improve patient care.• And if you do face a claim, we will aggressively defend good medicine and provide the emotional support you need to rest assured.

To learn more about ProMutual Group, call us at (800) 225-6168 or visit us online at www.promutualgroup.com.

PROTECT, PREVENT, DEFEND.

ProMutual Group Agents:Michael R. Bernal-SilvaMBS InsuranceBoonton, NJ – 800-347-3417

John BisbeeBoynton & BoyntonRed Bank, NJ – 800-822-0262

Kevin ByrneAcorn Professional ServicesWest Conshohocken, PA – 800-454-2429

William CareyHealthcare Risk SolutionsFort Washington, PA – 800-215-2707

Bob CottoneRUE InsuranceTrenton, NJ – 800-272-4783

Yvonne DiLauroBollinger InsuranceMoorestown, NJ – 856-273-8100

Mary DonohueBrown & Brown MetroMt. Laurel, NJ – 856-552-6330

Tim HooverThe Woodland GroupSparta, NJ – 800-253-1521

Henry S. KaneArgent Professional InsuranceWarren, NJ – 908-769-7400

Steven KlingerProfessional Consulting ServicesLivingston, NJ – 973-597-0400

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

Rory RineerProfessional Liability AgencyHarrisburg, PA – 800-375-3056

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

Robin VoorheesThe NIA GroupSomerset, NJ – 800-669-6330

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

101 Arch Street, Boston, Massachusetts 02110 | 1.800.225.6168 | www.promutualgroup.com

nj physician magazine may 2011

Documents

new entities

new jersey medical community

path of new jersey medicine

confusing new business

physician practice groups

business of medicine

nation legislation

englewood hospital