new jersey chapter Summer 2019 • vol 65 • num 4
• Artificial Intelligence and Healthcare Finance • New Tools to Combat the Opioid Crisis • Medicare For All • Meet the 2019-2020 Chapter Leaders
43rd Annual Institute presented by the HFMA New Jersey and Metro Philadelphia Chapters Borgata Hotel, Casino & Spa October 2-4, 2019
Two Panel Discussions Value-Based Care ❖ CFO Panel Keynote Session – Ed Eichhorn, Co-Author of Healing American Healthcare, will be discussing his compelling and common-sense proposal for a national healthcare policy that he has called “Allcare.” Networking Wednesday Night Charity Event Benefitting the NJ Sharing Network Thursday Night President’s Reception Thursday Late-Night Networking Event CPE Credits Earn up to 18.2 CPE Credits Connect us on:
#NJHFMAAI2019
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focus
•advertisers•
ARMC & BPS Strategies Besler CBIZ KA Consulting Services, LLC McBee Associates, Inc. William H. Connolly & Assoc. Withum Smith+Brown
focus features •
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Artificial Intelligence Makes Healthcare Finance More Human
by Jane C. Kaye, MBA……………………………………………………………………… 6
The Expansion of Medication Assisted Treatment (MAT) to Combat the Opioid Crisis
by Gloria Seel……………………………………………………………………………… 10
New Jersey Takes Important Step to Improve Access to Behavioral Healthcare by Enacting Behavioral Health Parity Law
by Tara Adams Ragone……………………………………………………………………… 13
New Jersey Becomes Eighth State to Pass Death with Dignity Legislation
by James A. Robertson & Parampreet Singh………………………………………………… 16
Medicare for All: What it Means, and Where it’s Headed
focus cover •
•
Cover Courtesy of Hermitage Press, Inc.
by Billy Wynne and Josh LaRosa …………………………………………………………… 18
Five Things You Need to Know About NJ Workers’ Compensation & No-Fault Auto E-Billing Laws
by Sally Balioni …………………………………………………………………………… 20
Revenue Integrity and CARE Forums Host Successful Educational Event
by Betsy Weiss…………………………………………………………………………… 24
focus points •
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Who’s Who in the Chapter...... … 2 The President’s View by Mike McKeever ....................... … 3 From the Editors by Brian Herdman and Adam Abramowitz..................... …4
Job Bank Summary.................. …11 Who’s Who in NJ Chapter Committees............. …12 New Members............................ …21 Focus on Finance...................... …22 Save the Date............................. …24 Certification Corner.................. …31
43rd Annual Institute!
by BJ Welsh……………………………………………………………………………… 25
The 2019 Institute Schedule at a Glance………………………………… 26-27 Welcome to the New Chapter Year
by Michael P. McKeever, CPA, FHFMA……………………………………………………… 28
NJ HFMA Wins Six Awards at Annual Conference………………………… 29 New Jersey Transitioning to a State-based Health Insurance Exchange
by Ward Sanders…………………………………………………………………………… 30
The 2019 NJ HFMA Scholarship Recipients…………………………………… 32 2019 NJ HFMA Golf Outing…………………………………………………… 33-36 NJ HFMA Leadership 2019-2020…………………………………………… 37-40 Perspectives in Healthcare:
Healthcare Community Addresses Chronic Homelessness Through Public-Private Partnerships
by Victoria Brogan ..................................................................................... Inside back cover Focus
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focus/hfma
Who’s Who in the Chapter 2019-2020 Chapter Website……………………………………..www.hfmanj.org
Communications Committee
NJ HFMA Board Members
Brian Herdman, Director.......................................................................CBIZ KA Consulting Adam Abramowitz, Chair......................................................................CBIZ KA Consulting Scott Besler...................................................................................................... AtlantiCare Rachel Gisser...........................................................................WithumSmith + Brown, P.C. Laura Hess, FHFMA ............................................................................................. NJHFMA David A. Mills...................................................................................................................... Pamela Nichols.........................................................................AtlantiCare Health System Amina Razanica..............................................................New Jersey Hospital Association James A. Robertson, Esq............................McElroy, Deutsch, Mulvaney & Carpenter, LLP Elizabeth Litten, Esq............................................................................... Fox Rothschild, LLP
Leslie Boles....................................................................Saint Peter's Healthcare System Heather Stancisi........................................................................Arcadia Recovery Bureau Hayley Shulman...................................................................... WithumSmith + Brown, P.C. Michael George....................................................................Pricewaterhousecoopers LLP Jane Kaye...............................................................Jane Kaye Healthcare Consulting LLC Maria S. Facciponti............................................................................................................ Christin Fenton........................................................................ AtlantiCare Health System Dave Murray..................................................................................Inspira Health Network Nicole Rosen – Associate Board Member............................................. Acadia Professional Jonathan Besler.....................................................................................................BESLER Scott Besler...........................................................................AtlantiCare Physician Group Jason Friedman – Associate Board Member....................................Atlantic Health System
NJ HFMA Chapter Officers
NJ HFMA Advisory Council
President, Michael McKeever............................................ Saint Peter’s University Hospital President-Elect, Stacey Medeiros.................................... New Jersey Hospital Association Erica Waller................................................................................... Princeton Penn Medicine Treasurer, Jill Squiers.....................................................................AmeriHealth New Jersey Scott Mariani............................................................................. WithumSmith + Brown, P.C. Secretary, Brian Herdman.......................................................................CBIZ KA Consulting Dan Willis ................................................................................................................ Aetna Heather Weber............................................................................................ Baker Tilly LLP
Advertising Policy/Annual Rates The Garden State “FOCUS” reaches over 1,000 healthcare professionals in various fields. If you have a product or service you would like the healthcare financial industry to know about, please take advantage of this great opportunity! Contact Laura Hess at 888-652-4362 to place your ad or receive a copy of the Chapter’s advertising policy. The Publications Committee reserves the right to refuse any ad not consistent with the overall mission of the Chapter. Inclusion of an ad in this Newsmagazine does not infer endorsement of the product or service by the Healthcare Financial Management Association or the Publications Committee. Neither the Healthcare Financial Management Association nor the Publications Committee shall be responsible for slight variations in production quality of published advertisements. Effective July 2015 Rates for 4 quarterly issues are as follows:
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Ads should be submitted as print ready (CMYK) PDF files along with hard copy. Payment must accompany the ad. Deadline dates are published for the Newsmagazine. Checks must be payable to the New Jersey Chapter - Healthcare Financial Management Association.
DEADLINE FOR SUBMISSION OF MATERIAL Issue Date Fall Winter Spring Summer
Submission Deadline August 15 November 1 February 1 May 1
IDENTIFICATION STATEMENT Garden State “FOCUS” (ISSN#1078-7038; USPS #003-208) is published 4 times a year by the New Jersey Chapter of the Healthcare Financial Management Association, c/o Scott Besler, AtlantiCare, 6550 Delilah Rd, Suite 301, Egg Harbor Township, NJ 08234. Periodical postage paid at Trenton, NJ 08650. POSTMASTER: Send address change to Garden State “FOCUS” c/o Laura A. Hess, FHFMA, Chapter Administrator, Healthcare Financial Management Association, NJ Chapter, P.O. Box 6422, Bridgewater, NJ 08807 OBJECTIVE Our objective is to provide members with information regarding Chapter and national activities, with current and useful news of both national and local significance to healthcare financial professionals and as to serve as a forum for the exchange of ideas and information.
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EDITORIAL POLICY Opinions expressed in articles or features are those of the author(s) and do not necessarily reflect the view of the New Jersey Chapter of the Healthcare Financial Management Association, or the Communications Committee. Questions regarding articles or features should be addressed to the author(s). The Healthcare Financial Management Association and Communications Committee assume no responsibility for the accuracy or content of any articles or features published in the Newsmagazine. The Communications Committee reserves the right to accept or reject contributions whether solicited or not. All correspondence is assumed to be a release for publication unless otherwise indicated. All article submissions must be typed, double-spaced, and submitted as a Microsoft Word document. Please email your submission to: Adam Abramowitz aabramowitz@cbiz.com REPRINT POLICY The New Jersey Chapter of the HFMA will not reprint articles published in Garden State FOCUS Newsmagazine. Individuals wishing to obtain reprint authorization must obtain it directly from the author(s) of the article. The cover of the FOCUS may not be used in the reprint; however, the reprint may note that the article was published in a specific issue. The reprint may not imply endorsement by the HFMA, directly or indirectly.
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The President’s View . . . Welcome to the Summer Edition of the Garden State Focus, kicking off the 2019 – 2020 Chapter Year. It is both an honor and a pleasure to be serving as President of the New Jersey Chapter of HFMA this year. As healthcare continues to evolve at a rapid pace, so does the role HFMA plays in this evolution. As you may have already noticed, there are changes happening at the Association, specifically with the pricing structure of membership dues, which you can read more about in the article in this issue about the Leadership Training Conference held in April. And there is much more to come, including the rollout of a new, more interactive and comprehensive website that was recently launched. Each year the National Chairman chooses a theme that sets the tone for the Association for the entire year. Last year’s Chairman, Kevin Brennan, who is no stranger to the NJ Chapter, chose as his theme “Imagine Tomorrow,” charging the membership with seeing a future that might not have seemed possible a few short years ago. This year the Chairman, Michael McKeever Michael Allen, chose as his theme “Dare You To Move,” or DY2M. I have to admit that when I first heard this phrase I couldn’t quite wrap my mind around its meaning. Throughout my career, healthcare has been in a state of constant change, and we’ve all adapted along the way to the new reality, whatever it may have been. At the Leadership Training Conference Mike explained the meaning of his theme, and it is both brilliant and simple at the same time. The theme addresses the gap that exists between how things currently are and how they should be, and our inherent reluctance to recognize that this gap is not insurmountable. So what does this mean to the NJ Chapter, its members, and the organizations we represent? Only time will tell, but for now we need to be ready to move. Once again this year the NJ Chapter is committed to providing quality education and networking experiences to our membership. Along with our increasingly popular webinar series the Regulatory and Reimbursement Committee will be presenting an all-day educational event on September 10, the FACT Committee’s session will take place on November 12, the Charge Master Update occurs on December 10, and the combined PFS/PAS session will be on January 14, 2020. Also in the works are the P2C2 Committee session, the combined Revenue Integrity/CARE Forum session, the Annual Cost Report Update, Finance for Clinicians, and our ever-popular Women’s Session (which is not for women only!). And let’s not forget the Golf Outing in May, and the 43rd Annual NJ Metro Philadelphia Institute that will take place on October 2 – 4, 2019 at the Borgata Hotel, Casino and Spa in Atlantic City. The Membership Services and Networking Committee is also hard at work planning events where we can just kick back and enjoy each other’s company in a relaxed and fun atmosphere. And I have to admit that I was at first skeptical of the recent ax throwing event, but I’ve heard from those who participated that I missed a fun and interesting experience. Maybe next time… Additional information on all events will be available on the Chapter’s website at hfmanj.org. And I would be remiss if I didn’t take this opportunity to congratulate Erica Waller on her year as Chapter President. An unbelievable amount of hard work and dedication is required to successfully lead a Chapter as large and dynamic as we have in New Jersey. For years I’ve jokingly referred to my commitment to NJ HFMA as my full-time, unpaid job. But I’ve only recently come to appreciate the truth in that statement as I prepared to assume the role of President. Hats off to you Erica for a job well done! Finally, I wanted to take this opportunity to thank our Board, committee Chairs and Co-Chairs, volunteers, members and sponsors for your dedication and commitment to the success of the New Jersey Chapter. None of this works without each and every one of you, and with that in mind I’m looking forward to working with you all during this Chapter Year, and thank you in advance for all of your support and assistance. All that being said, here’s to a GREAT CHAPTER YEAR! Sincerely, Michael P. McKeever, CPA, FHFMA
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From The Editors . . . Summer is the time of transition for HFMA Chapters across the country. New leadership assumes control armed with initiatives to reinforce the strength of their Chapters and to provide value for their membership. And in the grand HFMA tradition, the old guard doesn’t escape to some remote enclave, exiled after their years of service; they stick around to contribute, to volunteer, to be a sounding board for new ideas. Similar to other Chapters across the country, NJ HFMA recently had its leadership transition. After a wildly successful year at the helm as President, Erica Waller has now returned to her civilian life at Penn Medicine at Princeton. Mike McKeever of St. Peter’s will now be the New Jersey Chapter’s head honcho. We’ve known Mike for many years and his passion and commitment toward HFMA will be a great benefit for the Chapter. Mike will have a dynamic leadership team working with him this year (more on this in a moment) and of course Erica will be providing guidance to the new team as a member of the Advisory Council. And still more transitions will occur. This will be our last issue as co-editors of the Garden State Focus. Brian Herdman will now be on the leadership track of NJ HFMA and will serve this year as Secretary. Adam Abramowitz will be returning full time to his sales and marketing role with CBIZ KA Consulting Services. But we’re leaving you in great hands. Scott Besler of AtlantiCare will be the new editor of the Focus. Scott, a frequent author and contributor over the years, brings a breadth of experience and a command of the financial and regulatory issues that will resonate with our membership. And of course we will be there to support Scott as he assumes his editorship. His new role will be a big undertaking, but we know he’s going to do a fantastic job. It’s been our pleasure to have been involved with the Focus over the last two years. We are fortunate that we have a large stable of contributors to the magazine. In reviewing many of the other HFMA Chapter publications across the country, we don’t think that there’s a rival to the Focus. As many other Chapters have transitioned to an on-line publication or dispensed with a formal publication entirely, the Focus continues to have some of the best articles you’ll read in the industry. We’d like to take some of the credit for it, but in reality it’s the strength of our membership and their desire to inform and educate that allow this magazine to flourish. We also should thank the Chapter leadership for their continued support of the Focus. It would be easy for leadership to downsize and cut costs, but the Focus remains a priority for the Chapter. As we leave you for now, we’d like to highlight some of the great content you’ll find in this issue. This edition highlights a number of policy issues that are vital to the well-being of
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our healthcare institutions and population as a whole. Gloria Seel delineates the crucial steps that New Jersey is undertaking to address the opioid epidemic (p 10). Tara Ragone analyzes the new state behavioral health parity law (p 13). Billy Wynne and Josh LaRosa tackle “Medicare for All” and what may occur at the federal and state levels in the near future (p 18). Ward Sanders provides insight into New Jersey’s push for a state-based health insurance exchange (p 30). Victoria Brogan details how the healthcare community is coming together to address chronic homelessness (inside back cover). As always, if you have an interesting idea for an article or a topic that you think should be covered, let us know. If you would like to become more involved with the Focus, the Communications Committee meets the first Thursday of every month and we’re always looking for new perspectives. Again, we’d like to thank you for your feedback and contributions over the last two years. This has been an enriching experience for us. And we’ve worked with some truly great people putting this magazine together. We’d like to thank Laura Hess for her tireless devotion. Joe and Joy at Hermitage Press, thank you very much for all of your assistance, and most of all, your patience! We’d also like to thank the members of the Communications Committee for your guidance, assistance and support. Finally, we wish all of you continued success, and we hope to see you soon. About the Authors Adam Abramowitz is a senior manager for sales and marketing at CBIZ KA Consulting Services, LLC in East Windsor, NJ. Adam can be contacted at aabramowitz@cbiz.com.
Brian Herdman is an operations manager in financial reimbursement services for CBIZ KA Consulting Services, LLC in East Windsor, NJ. Brian can be contacted at bherdman@cbiz.com.
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Artificial Intelligence Makes Healthcare Finance More Human by Jane C. Kaye, MBA Jane C. Kaye
We’re seeing it everywhere. It’s Siri, it’s Alexa, it’s Google. It can suggest email responses, predict your Netflix preferences, understand your online shopping behavior. It’s the promise of a future where the cars drive themselves and the robots do the thinking. It’s all Artificial Intelligence. And it’s less dystopian than it sounds. Artificial Intelligence (AI) is broadly defined as the development of computer systems able to perform tasks that typically require human intelligence. Applied to business, AI allows organizations to automate repetitive processes through learning -- and it’s changing the type of work employees expect and the pace in which it gets done. The healthcare industry is no exception. But while the clinical side is seeing a boom in flashy AI technology, from surgical robots to automated diagnosing, the backend financial operations have been slower to adopt. So what would an AI-optimized healthcare financial system look like? When we think about how it affects the rest of our lives -- saving time and increasing efficiency -- we can begin to understand how it applies to healthcare business operations. By simplifying and streamlining repetitive tasks, AI technologies have the potential to make our work in healthcare finance more human, creating space for critical thinking, opening up new career pathways, allowing employees control of the process, and potentially even contributing to lower healthcare costs. Applying AI to Healthcare Finance Most of the immediate and relevant applications of AI in healthcare finance center on streamlining data gathering through robotic process automation (RPA), which uses software robots to automate business processes. These “bots” are configurable software that perform tasks of which an employee can assign and control, interacting with multiple programs as a human employee would. Within healthcare finance, these bots typically apply to repetitive tasks like pulling billing data from disparate sources into one place, or performing time- and labor-intensive monthly account reconciliations. Brian Huggins, Corporate Controller at Partners Health-
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Care, has been working to implement these sorts of efficiencies across his organization’s accounting operations. A system incorporating Massachusetts General Hospital, Brigham and Women’s Hospital, Spaulding Rehabilitation Network, McLean Hospital and many other healthcare entities across the Boston area and beyond, Partners continues to merge and expand, increasingly demanding an efficient financial operation for strategic growth. “At Partners, the foundation for any of our automation starts with process improvement,” Brian says. And from Brian’s experience, one of the biggest areas benefiting from process improvement is the account reconciliation part of the monthly financial statement close. In the traditional closing process, accountants focus on reconciling transactions -- a repetitive task with little added value. RPA tools enable employees to write a command that quickly reconciles transactions and highlights errors or mismatches, thereby freeing time to thoughtful analysis focused on understanding, correcting and preventing these mismatches. In this way, the RPA system allows people within the finance function to take on a whole new capacity, increasing analytical thinking while also increasing the accuracy of the information analyzed. “No matter how proficient machines become in automating transactional accounting tasks, they can’t analyze the data,” echoes Vin Messina, Strategic Account Manager at BlackLine, a software company supplying cloud-based financial automation solutions. “You need people to do that.” Vin has worked across many different industries making the transition to AI-enabled period-end financial close, and has noticed that healthcare financial operations are slower to adapt. Yet with the mergers and growth we’re seeing across the hospital industry -- and as Brian is experiencing firsthand at Partners -- streamlining financial processes and creating efficiencies in the workforce are more important now than ever. “The benefits go beyond process optimization, improved accuracy and increased efficiency,” Vin says. “Automation software enables the deployment of finance personnel to take on more involvement in higher value-add activities – and become
Summer 2 0 1 9 strategic advisors to the business.” As healthcare finance operations catch up with automation technology, Vin and Brian are both seeing how it can allow for more strategic hiring to accompany expansion, thereby contributing to a reduction in healthcare administrative costs going forward.
been identifying individuals who know the organization, team and processes to build bots to operate within these systems. A People-Centric Implementation Approach “The best finance leaders are going to use AI as an opportunity to up-skill their team by eliminating repetitive tasks that are currently being executed within the finance function and focus on more value-add tasks that will be more analytical in nature and provide more insight to the business,” says Michael continued on page 8
Keeping Pace with the Next Generation of Workers In New Jersey, John Doll, Chief Financial Officer of RWJBarnabas Health, is piloting similar strategies. John sees AI entering healthcare finance at the perfect time -- in conjunction with a new generation of employees with different skills, education and career expectations. “A challenge we have is disconnected systems requiring repetitive work,” John says. “And at the same time, we’re seeing a new generation of workers looking for a different type of job.” Technologically minded, today’s millennial workers are seeking a higher level of employment: one that enables them to think critically, understand the big picture and make informed decisions. Ideally the entrylevel, disconnected and repetitive work John identified can be automated through process automation, giving the employee a higherlevel duty to oversee and manage it. Under John’s leadership, RWJBarnabas Health’s finance team is exploring process automation for people-intensive, repetitive tasks, such as insurance follow-up or cash posting. Encouraging employees to do more highlevel thinking, data analysis and reporting can also help increase satisfaction and retention and catalyze career growth, John comments. As this elevated level of critical thinking brings even more humanity into the process, employees are empowered with the time and mental capacity to bring their full brain New Jersey’s Leading to the job. Hospital/Healthcare Insurance Broker While John notes that process automaWe provide our clients with the best combination tion elevates the type of work humans are responsible for on a big-picture level, Brian also of coverage, pricing and risk management. observes that it opens up new and different career paths for healthcare finance employees interested in RPA’s more technical applications. RPA technology implementation and maintenance brings a demand for employees 56 Park Street/Montclair, NJ 07042-2999 with specific organizational knowledge and 973.744.8500 fax: 973.744.6021 technical brains, especially when it comes to www.whconnolly.com building effective bots to do the job. Brian has
We know the risks
We have the solutions
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Summer 2 0 1 9 continued from page 7 George, Audit Partner at PwC. While the global consulting firm may be developing advanced ways to apply AI in serving clients, the healthcare finance industry can look to its example, especially when it comes to empowering employees with the right opportunities to develop their digital acumen, which will be leveraged in running the business in the future. As part of an organization-wide digital transformation strategy across 55,000 employees in the U.S., PwC identified over 2,000 employees called "digital accelerators" to train on several forms of automation including AI technologies and tools, fulltime, for two years, and then deployed them as experts to train their colleagues within the different lines of service. The firm also empowered its employees to identify mundane, repetitive processes in their everyday workload and automate them. This sort of employee-driven and -led development and implementation again reminds us that automation including AI exists to help employees think bigger, better and more strategically. Brian’s own AI implementation experience at Partners Health took a similar approach. Though he led Partners through an RPA system transformation, Brian ultimately entrusted his team -- those closest to the everyday work and technology -- with the decision of which software system to implement. He then identified a handful of managers to run the actual software rollout, as they understood the systems the best. Involving people in this sort of change helped mitigate any perceived threats while empowering employees to elevate their own abilities.
What About ROI? As a costly investment for a healthcare organization, AI automation technology brings with it pressure to demonstrate an immediate ROI. But it’s an iterative process, creating a variety of organizational impacts that aren’t immediately quantifiable. As John, Brian and Michael have observed, the technology can elevate the employee experience and open up new career opportunities, while creating efficiencies that allow healthcare systems to scale up strategically. AI in healthcare finance can save time, reduce errors and increase capacity, and, through all this, has the potential to lower the administrative cost of providing healthcare. “You think about everything on the clinical side, where they’re using AI to make better, more informed decisions on healthcare. I have to imagine that if we can make better, more informed financial decisions, we’d ultimately come to a lower cost,” Brian observed. “What I do know now though is that we’re more efficient.” Regardless of a quantifiable ROI at this time, we’re seeing what Brian refers to as “soft dollar savings” -- more efficient financial operations and more productive employees. While cost savings may be ahead, the benefits to the financial workforce are immediate -- cultivating a more human way of functioning after all. About the Author Jane Kaye is the founder and President of HealthCare Finance Advisor. Jane also teaches healthcare finance at Rutgers, The State University of New Jersey. Jane can be reached at jane@hcfadvisors.com.
What’s In Your Beach Bag? NJ HFMA Members share their personal and professional reading picks
“Where the Crawdads Sing” by Delia Owens. Written by a naturalist, it describes the marshes of North Carolina in stunning detail. In addition, it is a coming-of-age story and a murder mystery. Beautifully written. I was at first leery about reading this book because I do not like mysteries; however I was delightfully surprised at how much I enjoyed this book. Recommended by Sally Cummings “A Thousand Splendid Suns” by Khaled Hosseini. A mother-daughter story of sorts that describes the life of Afghan women, their resiliency and their incredible stories of survival. Wasn’t the kind of book that I would have normally selected to read, but it was recommended to me and I found that I couldn’t put it down! Recommended by Laura Hess “The Lying Game” by Ruth Ware. Four girls who were inseparable during their coastal boarding school days in England bond over an unusual game where they earned points for successfully lying. They end up expelled suddenly during their senior year and make a pact to never share what really happened. Seventeen years later it comes back to haunt them and potentially destroys successful careers. Ruth Ware gives her readers a phenomenal roller coaster of twists and turns. Recommended by Laura Hess
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The Devil Opportunity is in the Detail.
CBIZ KA Consulting Services, LLC Information. Not Intuition.
Revenue Assurance Coding and Compliance
Eligibility Physician Practice Management
1-800-957-6900 www.kaconsults.com
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The Expansion of Medication Assisted Treatment (MAT) to Combat the Opioid Crisis Gloria Seel by Gloria Seel
Drug overdose deaths continue to rise in the United States. In 2017, opioid overdose deaths rose to 47,600 nationally. Opioids are among a class of drugs that includes prescription medications such as oxycodone, morphine, and hydrocodone, as well as the illegal drug heroin. They are used most frequently as a pain reliever; however, when abused they can make an individual feel sedated, very relaxed and “high.” This is dangerous because opioids are highly addictive and due to their sedating properties, they put individuals at high risk for overdose and death when misused. Over 3,000 New Jersey residents died as a result of opioid overdose in 2018. These numbers have led to the Murphy Administration recently announcing several strategies for combating the epidemic in New Jersey; working with the administration, New Jersey Medicaid has developed three key initiatives. As of April 2019, Medicaid has removed the requirement for prior authorization for Medication Assisted Treatment (MAT). MAT is an evidence-based form of treatment that provides medication, like methadone or buprenorphine, to an individual diagnosed with a substance use disorder. These medications serve a three-pronged purpose; they bind to the receptor sites to block euphoric (high) effects of other opioids an individual may take, they manage the withdrawal symptoms an individual is experiencing from not using opioids, and they reduce cravings to use substances. When MAT fulfills these three purposes it allows the individual’s brain to begin to heal and to participate effectively in therapeutic services to address their substance use behaviors. The removal of prior authorizations will allow for timelier access to MAT services. This means an individual can begin taking the medication as soon as they see a provider. Historically, prior authorizations could take days to obtain, which led to frequent recurrence of substance use due to wait times to begin these medications. Medicaid is also launching the Office-Based Addiction Treatment (OBAT) program. This program is intended to cre-
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ate more access, increase the number of buprenorphine-waivered providers in the state, and incentivize primary care providers to provide MAT for Opioid Use Disorder. Through this program there are opportunities to add reimbursable services through patient navigators and recovery specialists at primary care facilities, ambulatory care clinics, Federally Qualified Health Centers (FQHC), Certified Community Behavioral Health Centers (CCBHC), and Opioid Treatment Programs (OTPs). Historically, these medications were primarily offered at OTPs and specialty substance use treatment facilities. With this incentive program, the state is making buprenorphine more available and is driving to integrate these services into primary care practice. Lastly, Medicaid will be building Centers of Excellence for opioid treatment at Rutgers New Jersey Medical School and Cooper Medical School of Rowan University. These facilities are being created with the intention to provide training, consultation and peer-to-peer support services specifically around MAT to combat the opioid epidemic. The most anticipated outcome of this project is to increase the number of buprenorphine providers. This will be achieved through subsidized training opportunities, increased consultation and technical assistance to support obtaining the reimbursement incentives. These initiatives have large-scale implications in the fight against the opioid epidemic. Medicaid’s support of MAT services offers validation of these as evidence-based tools and the gold standard of care for treatment of opioid use disorders. The support brings the research to the forefront of the discussion and highlights the positive outcomes and retention in treatment associated with the use of MAT for opioid use. Another way to combat opiod overdose deaths is through the use of naloxone. Naloxone is an opioid antagonist, meaning it binds to opioid receptors and can reverse and block the effects of other opioids. It can restore normal breathing to a
Summer 2 0 1 9 person whose breathing has stopped as a result of an opioid overdose. Naloxone is frequently carried by EMS, police and other first responders, but is also available for prescription to an individual. Naloxone is a covered medication under New Jersey Medicaid. Currently, New Jersey has a Naloxone Standing Order program in which pharmacies can apply for a standing order. This program allows for any individual to obtain Naloxone, even without a written prescription from their provider. The standing order allows for easier access and training around Naloxone; it also provides the medication to family,
friends, and anyone who may witness an opioid overdose. The work Medicaid and the state are doing demonstrates the importance of utilizing a multi-faceted approach to combat the opioid epidemic. About the author Gloria Seel, LCSW LCADC MAC is Senior Director Addictions at AtlantiCare. She can be reached at GloriaAnn.Seel@atlanticare.org.
•Focus on...New Jobs in New Jersey• JOB BANK SUMMARY LISTING NJ HFMA’s Publications Committee strives to bring New Jersey Chapter members timely and useful information in a convenient, accessible manner. Thus, this Job Bank Summary Listing provides just the key components of each recently-posted position in an easy-to-read format, helping employers reach the most qualified pool of potential candidates, and helping our readers find the best new job opportunities. For more detailed information on any position and the most complete, up-to-date listing, go to NJ HFMA’s Job Bank Online at www.hfmanj.org. [Note to employers: please allow five business days for ads to appear on the Website.]
Job Position and Organization Internal Auditor I (Hospital-Medical-Academic) University Hospital
Assistant Director of Patient Financial Services Preferred Behavioral Health Group
Senior Accountant South Jersey Radiology Associates
Reimbursement Manager Bergen New Bridge Medical Center
Site Finance Officer Robert Wood Johnson University Hospital - Hamilton
Director, Corporate Accounting The University of Vermont Medical Center
Manager, Revenue Analytics, Regional HMH
Vice President Strategic Planning and Projects University Hospital
Budget Analyst III HMH
Medical Practice Manager Women's Health Facility - Princeton NJ
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•Who’s Who in NJ Chapter Committees• 2019-2020 Chapter Committees and Scheduled Meeting Dates *NOTE: Committees have use of the NJ HFMA conference Call line. The call-in number is (515) 604-9094 If the committee uses the conference call line, their respective attendee codes are listed with the meeting date.
PLEASE NOTE THAT THIS IS A PRELIMINARY LIST - CONFIRM MEETINGS WTH COMMITTEE CHAIRS BEFORE ATTENDING. COMMITTEE
PHONE
DATES/TIME/ ACCESS CODE
MEETING LOCATION
First Thursday of Each Month 9:00 AM Access Code: 274-926-602
Conference Calls
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Summer 2 0 1 9
New Jersey Takes Important Step to Improve Access to Behavioral Healthcare by Enacting Behavioral Health Parity Law
Tara Adams Ragone
by Tara Adams Ragone, Seton Hall Law School
On April 11, 2019, New Jersey Governor Phil Murphy signed S.1339/A.2031 into law, bipartisan legislation aimed to improve implementation and enforcement of behavioral health parity laws in the state. In doing so, New Jersey joins a growing number of states, including Colorado, Delaware, Illinois, and Tennessee, and the District of Columbia, that have enacted similar laws focused on facilitating and strengthening implementation of the federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) through enhanced transparency and accountability. MHPAEA, as extended by the Affordable Care Act (ACA), generally prohibits most individual, small, and large group health plans and health insurance issuers that provide mental health (MH) and substance use disorder (SUD) benefits from imposing less favorable annual and lifetime dollar limits, financial requirements, or treatment limitations on MH/SUD benefits than on medical/surgical benefits that they provide. Importantly, this law reaches beyond regulating the terms of coverage to examine how plans manage coverage and make coverage determinations. MHPAEA requires “parity” or comparability and fairness between the processes for establishing benefits and cost-sharing requirements and making medical necessity and coverage determinations for medical/surgical, as well as MH/SUD services. There was considerable excitement when Congress enacted MHPAEA, which followed years of contentious federal and state efforts to enact parity laws to address long-standing unequal coverage of MH/SUDs under many health insurance plans. There is some evidence that coverage of and, as a result, access to behavioral health treatment has improved somewhat since MHPAEA’s enactment. Yet, more than ten years after MHPAEA became law, despite modest gains, many patients, providers, and advocates are
frustrated and cite evidence that much inequity remains. Federal and state regulators continue to struggle to implement this law; its complexity and inherently comparative nature requires judgment regarding whether plans are employing comparable processes and strategies to determine which MH/SUD and medical/surgical benefits to cover and in what circumstances. Many consumers are unaware of parity’s requirements and, moreover, are unsure how to evaluate if their plans are in compliance. The law is replete with undefined terms and vexing comparative analyses. Some MH/SUD services, such as applied behavioral analysis (ABA) services for patients with autism, for example, do not have a clear medical/surgical analogue. In addition, parity compliance often is not apparent from the surface of plan documents or regulatory filings. Rather, determining whether a plan complies with parity often requires a nuanced, granular assessment of plan data and processes. Even seasoned legal experts report difficulty obtaining plan disclosures for comprehensive parity analysis, which disclosures are required under the law, its implementing regulations, and agency guidance. Regulatory enforcement also has been limited, due to varying factors that include limited resources, lack of training, and inadequate information regarding plan processes to permit a thorough parity analysis. In a report released in 2016, my colleague, John V. Jacobi, and I identified a number of gaps in the reports plans must file in New Jersey that prevent regulators from obtaining the requisite comparative data to complete a comprehensive parity analysis. Assessing nonquantitative treatment limitations (NQTLs), such as medical management standards that limit or exclude benefits based on medical necessity or medical appropriateness, formulary design for prescription drugs, network tier design, and standards continued on page 14
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Summer 2 0 1 9 continued from page 13 for provider admission to participate in a network, including reimbursement rates, for parity compliance presents an especially formidable implementation challenge. That parity also must be assessed both in plan terms as written and in operation poses additional challenges to regulators. Against this backdrop, a coalition of New Jersey consumers, providers, and advocates collaborated to advance S.1339/A.2031 through the state legislature. This legislation was based on model legislation developed by a number of national parity advocates, including the Kennedy Forum, ParityTrack, and the American Psychiatric Association. The law, which applies to insurance companies, health service corporations, hospital service corporations, medical service corporations, and health maintenance organizations (HMOs) authorized to issue health benefits plans in the state or any entity contracted to administer health benefits in connection with the State Health Benefits Program (SHBP) or the School Employees’ Health Benefits Program (“carriers”), requires carriers to provide coverage for behavioral healthcare services “under the same terms and conditions as provided for any other sickness under the contract,” and to meet the requirements of MHPAEA. It is of note that the law broadens the scope of behavioral healthcare services subject to parity requirements. Prior to enactment, the definition of “behavioral healthcare services” in New Jersey law was limited to biologically-based mental illnesses. Under the new law, carriers must provide coverage for “mental health conditions” and “substance use disorders” in compliance with MHPAEA; both of which terms are defined as conditions “consistent with generally recognized independent standards of current medical practice referenced in the most current version of the Diagnostic and Statistical Manual of Mental Disorders.” Recognizing the impact inadequate network adequacy has on access to behavioral healthcare in the state, the law expressly requires carriers to “approve a request for an in-plan exception if the carrier’s network does not have any providers who are qualified, accessible and available to perform the specific medically necessary service,” and it itemizes specific requirements on carriers with respect to communicating the availability of in-plan exceptions to consumers. To facilitate regulatory oversight of parity compliance and improve transparency, New Jersey’s law requires detailed plan filings that are carefully keyed to parity’s technical requirements. Specifically, carriers that provide hospital or medical expense benefits through individual or group contracts must submit an annual report to the state’s Department of Banking and Insurance (DOBI) regarding parity compliance. The statute identifies a number of items that the report must contain, “to the extent the commissioner determines it practicable,” in-
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cluding a description of the processes used to select medical necessity criteria for MH/SUD and medical/surgical benefits; identification of all NQTLs applied to MH/SUD benefits and medical/surgical benefits; and the results of a comparative analysis demonstrating how these criteria and processes comply with MHPAEA. The law also expressly requires DOBI to implement and enforce applicable provisions of MHPAEA. In service of this responsibility, DOBI must accept, evaluate, and respond to complaints regarding possible parity violations and maintain and regularly review for possible parity violations a publically available consumer complaint log. DOBI then must detail its parity implementation and enforcement efforts in an annual report to the legislature; the contents of which are itemized in the statute. It also must post on its web site the Department’s conclusions as to whether the analyses submitted by carriers in accordance with the statute demonstrate parity compliance. Carriers will not be named in this public disclosure, however. The legislation further empowers DOBI to adopt rules as may be necessary to effectuate the legislation and MHPAEA. The law went into effect on the 60th day after enactment. New Jersey’s parity legislation is a vital step that offers to facilitate parity enforcement, thereby likely increasing access to behavioral health services to insured consumers in the state. However, there are two important caveats: First, New Jersey’s bill only applies to health insurance plans subject to state regulation; it does not apply to the significant proportion of consumers who have self-insured employer plans that are exclusively subject to federal regulation. On May 21, 2019, Representative Joseph Kennedy introduced the Behavioral Health Coverage Transparency Act (H.R. 2874), which proposes parity reforms at the federal level that are similar in many respects to New Jersey’s legislation. Second, as we have seen with MHPAEA and similar state laws, the mere enactment of parity laws is not sufficient to improve coverage of and access to behavioral health services. The value of New Jersey’s legislation will lie in how the state implements its provisions. It is critical for consumers, providers, and advocates to remain engaged with DOBI and carriers to ensure that the law is faithfully executed and implemented. There is much promise, but it demands much work. DOBI Commissioner Marlene Caride announced a Parity Listening Tour, and I hope that these conversations will be well-attended and robust. About the Author Tara Adams Ragone is an Assistant Professor in Seton Hall Law’s Center for Health & Pharmaceutical Law & Policy. She can be reached at Tara.Ragone@shu.edu.
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Summer 2 0 1 9
New Jersey Becomes Eighth State to Pass Death with Dignity Legislation by James A. Robertson & Parampreet Singh
On March 25, 2019, both the New Jersey Assembly and the New Jersey Senate passed the Medical Aid in Dying for the Terminally Ill Act (the “Act”). The final version of the bill was sponsored by Assemblyman John J. Burzichelli and Assemblyman Tim Eustace. Governor Phil Murphy signed the bill into law on April 12, 2019 stating, “Today’s bill signing will make New Jersey the eighth state to allow terminally ill patients the dignity to make their own end-of-life decisions – including medical aid in dying. We must give these patients the humanity, respect, and compassion they deserve.” The bill will go into effect on August 1, 2019. The Act “permits qualified terminally ill patient[s] to selfadminister medication to end [their] live[s] in [a] humane and dignified manner.” Under the Act, “terminally ill” is defined as a patient who “is in the terminal stage of an irreversibly fatal illness, disease, or condition with a prognosis, based upon reasonable medical certainty,” with a life expectancy of six months of less. Furthermore, qualified patients choosing to exercise their rights under this Act will be required to submit their request in writing, stating, among other things, that they have been fully informed of any available alternatives. Two individuals, one who must not be a relative, entitled to any portion of the patient’s estate, or the patient’s doctor, must witness and attest to the voluntariness of the patient’s request. Proponents of the Act believe that it gives adults the right to control their lives, die with dignity if they so choose, and decrease their prolonged pain and suffering. Supporters also believe that there are sufficient safeguards in place to protect vulnerable, elderly adults. For example, the Act requires a patient to make several requests prior to receiving a prescription. Additionally, not all terminally ill patients who request and receive the medication will actually end up selfadministering the medication – some patients simply like having the option of requesting such medication. Opponents of the Act argue that once the “right-to-die”
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James A. Robertson
Act is passed, New Jersey will be unable to outlaw the practice. Further, they argue that vulnerable adults may misuse the Act; certain adults may feel pressured to end their lives, viewing themselves as burdens to their families. Furthermore, the Medical Society of New Jersey opposes such a bill, believing Parampreet Singh such legislation “puts physicians at odds with their professional ethical requirements.” However, a 2015 Rutgers-Eagleton poll found that 63% of New Jersey residents support the passing of a “right-to-die” bill. With the passage of the Act in New Jersey, and the growing trend across the country to pass similar legislation, it will be interesting to monitor how, if it all, the insurance industry responds. Currently, most life insurance companies issue a benefit to beneficiaries when the insured has taken his or her own life, so long as the insured does not take his or her own life within the first two years of the policy’s effective date, known as the contestability or exclusionary period. For now, many insurance policies do not distinguish between an individual committing suicide and an individual exercising their right to die. This may or may not change in the future. Additionally, the Act allows patients to self-administer the medication. Although the legislation requires the attending physician to “[a]dvise the patient about the importance of having another person present if and when the patient chooses to self-administer the medication,” it may be problematic if the patient chooses to administer the medication independently, and/or in a public place. Issues of liability would most definitely arise from a patient’s decision to self-administer such medication in a public place. For example, individuals, including children, may experience trauma if they witness a
Summer 2 0 1 9
patient self-administer the medication, or discover a patient who has already self-administered the medication. The Act also does not provide specific guidance with respect to disposing unused medication other than simply stating, “[A] ny medication dispensed . . . that a qualified terminally ill patient chooses not to self-administer shall be disposed of by lawful means.” This could lead to issues of liability with respect to the misuse or theft and redistribution of the medication, among other things. Finally, as the number of states with such legislation and the amount of patients exercising their rights to die increase it will be interesting to monitor the effects of these statutes on physicians psychologically and professionally. It is debatable whether providing such medications to terminally ill patients in pain can be reconciled with a physician’s Hippocratic Oath
to do no harm. It will also be interesting to see what, if any, pressure will be placed upon doctors to provide such services to patients given that many may have moral objections to administering such medications. Although passage of the Act has provided many answers, it has also given rise to just as many questions. About the Authors James A. Robertson is a Partner and Chair of the Health Care Practice Group at McElroy, Deutsch, Mulvaney & Carpenter, LLP. Parampreet Singh is an Associate in the Health Care Practice Group at McElroy, Deutsch, Mulvaney & Carpenter, LLP. Jim can be reached at jrobertson@mdmc-law.com. Param can be reached at psingh@mdmc-law.com.
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Summer 2 0 1 9
Medicare for All: What it Means, and Where it’s Headed by Billy Wynne and Josh LaRosa Billy Wynne
Medicare for All is the titular banner carrying the promise of comprehensive healthcare coverage for every U.S. resident and, along with it, reduced costs, improved quality, and patient-focused care. While phrases like “universal coverage” and “single-payer” have traditionally been reserved to the fringe of American politics, the idea of a single, government-run insurance plan is now taking center stage. But what does it really entail? And can we reasonably expect its fruition? We seek to provide some clarity on both questions.
pose a “public option” plan. Under these proposals, states would develop and administer Medicare-like plans through the Exchange market, and would have them compete alongside other private plans. Such a paradigm, stakeholders assert, could serve as a gradual transition into a full-blown The Spectrum of Proposals single-payer system, offering Although Medicare for All has become the singular tagline an arguably more measured for the American single-payer movement, the litany of policy approach. These plans would Josh LaRosa proposals underlying this umbrella exist along a rather wide base provider payments on spectrum. Some policies lay out the design for a full-blown, Medicare rates; require Medicare providers to participate; single-payer system with the federal government administer- and, cover all 10 ACA essential health benefits. Like any othing one public plan available to all U.S. residents – likely er Exchange plan, enrollees would pay premiums adjusted what most individuals imagine when they think of Medicare based on geography, and would be able to apply Exchange for All. subsidies. The proposals in this vein – there are two, the most “faThe remaining bills take a mixed approach that lands mous” of which being led by somewhere in between these two Senator Bernie Sanders (I-VT)1 bookends. For example, two (one Although Medicare for All has become – generally feature the same basic in the Senate2 and one in the the singular tagline for the American House3) would create a Medicare provisions. The policies would buy-in program through the Exbe open to all U.S. residents; single-payer movement, the litany of change markets, but only for indiwould cover all medically necespolicy proposals underlying this sary services in 13 benefit categoviduals between the ages of 50 and umbrella exist along a rather ries, including long-term services 64. Another plan – the Medicare and supports; would require no for America Act4 – approaches the wide spectrum. issue in a step-wise fashion. First, cost-sharing of beneficiaries; and, it would implement a public opwould finance all such services through increased taxation. Of note, these plans would autho- tion plan for the first two years. In the third year, the system rize the HHS Secretary to negotiate drug prices directly with would then transition into a single-payer program closely remanufacturers, which proponents tout as an important cost- sembling other Medicare for All proposals. It does differ from savings measure. Finally, the plans would effectively eliminate those in some respects. For example, it covers more benefit private insurance options, leaving the public plan as the only categories and it would also authorize the federal government to procure intellectual property to develop pharmaceuticals option for consumers. Lawmakers at the other end of the spectrum instead pro- itself, if necessary.
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Summer 2 0 1 9 The Political Trajectory While this array of policy proposals reflects U.S. singlepayer ideals, whether any of them will gain much traction is far less clear. To be sure, discussions are happening at the federal level: The House Rules Committee held the first ever hearing on Medicare for All at the end of April 2019, and the House Budget Committee followed with its own on singlepayer in May 2019. However, it is far more likely that these discussions will remain in the hypothetical, as the challenges of enacting a single-payer system will still prove politically challenging. First, Republicans, who control the Senate, will most likely block these bills. Moreover, the cost of Medicare for All puts the idea at even greater risk. The highly-anticipated Congressional Budget Office (CBO) report on single-payer policies plainly stated that such a program would pose substantial costs, though it did not provide a firm dollar figure.5 Other studies estimate costs would be in the double-digit trillions. By not being in the majority in the Senate, Democrats will not have access to the process that facilitated passage of components of the Affordable Care Act – budget reconciliation. That process, which allows passage of legislation by a simple majority vote in the Senate, requires provisions that increase the deficit to sunset within ten years and bars the non-budgetary policymaking that would be necessary to implement the program fully.
lesser, but still notable change. As mentioned, states may begin testing their own policy changes, which will provide federal policymakers and stakeholders an opportunity to assess their efficacy at the local level. Moreover, ACA stabilization – now a seemingly more centrist approach – may become the preferable option for Republicans who must answer to the public demand for healthcare reform but who wish to avoid single-payer implementation. Last, the intersection of the Medicare for All debate and discussions around the high cost of healthcare services have created fertile ground for bipartisan action on reducing healthcare costs to improve access – something both chambers of Congress are currently working on. Whatever changes become finalized are still left to be seen, but one thing is clear: change is coming.
What to Expect So, what can we expect from the Medicare for All debate in the near-term? Foremost, nothing significant is set to happen at the federal level. That does not preclude change from occurring, however. States have much more flexibility in this regard, and have begun exploring implementation of their own single-payer systems or public option Exchange plans. Washington State, most notably, has passed the very first public option plan in the U.S., slated for 2021 implementation.6 Other states, such as Colorado,7 are in the more nascent stages of developing a public option plan, but are pressing forward nonetheless. As such, while federal politics stall sweeping change from occurring, states may drive this change from the ground up. The Medicare for All movement has sprung from the belief that access to healthcare can still be better. Although we likely will not see the plan materialize in the way its proponents envision, the swelling of momentum behind it may drive forward
Footnotes https://www.congress.gov/bill/116th-congress/senatebill/1129 2 https://www.congress.gov/bill/116th-congress/senate-bill/470 3 https://www.congress.gov/bill/116th-congress/housebill/1346 4 https://www.congress.gov/bill/116th-congress/housebill/2452 5 https://www.cbo.gov/system/files/2019-05/55150-singlepayer. pdf 6 https://app.leg.wa.gov/billsummary?BillNumber=5526&Year =2019 7 https://leg.colorado.gov/bills/hb19-1004
About the Authors Billy Wynne, J.D., is the founder and CEO of the Wynne Health Group, a mission-driven health policy consulting and advocacy firm based in Washington, DC. Previously, Billy served as Health Policy Counsel to the U.S. Senate Finance Committee. He can be reached at billy@wynnehealth.com. Josh LaRosa, M.P.P., is a Policy Associate with the Wynne Health Group. Prior to that, Josh was a consultant at the Lewin Group, where he advised the Center for Medicare and Medicaid Innovation regarding implementation of value-based purchasing programs. He can be reached at josh@wynnehealth.com. 1
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Summer 2 0 1 9
Five Things You Need to Know About NJ Workers’ Compensation & No-Fault Auto E-Billing Laws by Sally Balioni
Background: The N.J. Workers’ Compensation EDI Law (Senate P.L. 2016 C64), and No-Fault Auto Law (Senate P.L. 2017 C369), as issued by the State of NJ Department of Labor and Workforce Development and published in the New Jersey Register, make it mandatory for all workers’ compensation and no-fault auto healthcare practitioners, insurance carriers, TPAs, and medical management companies to process bills electronically. This legislation is now in effect and allows for an adoption period after which it becomes mandatory. Deadlines for mandatory electronic submission are September 1, 2019 for New Jersey no-fault auto and November 1, 2019 for workers’ compensation. There’s no reason to wait another day. Payers have been implementing clearinghouse services in anticipation of the enactment dates with most New Jersey payers ready to accept electronic billing now. Healthcare practitioners can act now to begin enjoying the benefits of electronic bill processing – better known as Electronic Data Interchange (EDI). What is healthcare EDI? It is more than just a way to communicate; it is a structured opportunity to transmit data between computer systems, governed by industry standards that ensure accurate transmission of medical claims. Over 95% of health insurance bills are transmitted electronically today. However, for workers’ compensation and no-fault auto fewer than 30% of bills are transmitted electronically. States have strict e-billing rules and responsibilities for providers and claims administrators. Most e-billing is handled by electronic billing clearinghouses that have the technology needed to compliantly process them. The new legislation demonstrates the significance of electronic billing in streamlining processes and reducing costs, which requires advanced tech-enabled capabilities. New Jersey healthcare providers will benefit from enhanced management of their revenue cycles, with e-billing leading not only to faster payment, but also increased efficiency. Implementation of electronic filing of medical bills will lead to an overall reduction in administrative costs and will result in a more efficient process.
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Sally Balioni
This new legislation heralds a welcome era of paperless transactions for workers’ compensation and no-fault auto medical claims, with all data to be transferred electronically rather than manually on paper. Here are five key points to understand about the legislation and the benefits to healthcare practitioners: 1. Electronic processing – Under this newly enacted legislation: a. All healthcare practitioners or their billing representative shall submit medical bills and supporting documents electronically in accordance with the established guide lines b. Insurance carriers, medical management companies, or their third-party administrators shall accept all bills electronically and acknowledge receipt of complete elec tronic medical bills to the submitting parties in compli ance with the established guidelines 2. Compliance – The legislation requires all healthcare pro viders and hospitals who submit over twenty-five (25) workers’ compensation medical bills per month to now pro vide electronic bills for payment on standardized forms compliant with guidelines. A complete electronic bill meets the following criteria: a. Treatment information normally submitted on a CMS1500 form is converted to an electronic file known as an 837 and is sent electronically to the administrator b. The bill includes all medical reports attached electroni cally providing specific information required under the guidelines established 3. Acknowledgement – Insurance carriers, medical manage ment companies or their third-party administrators shall acknowledge receipt of a complete electronic medical bill to the submitting party
Summer 2 0 1 9 4. HIPPA Compliance - all parties must ensure that electronic medical information exchange is confidential and meets privacy standards 5. Timelines – Both laws were approved in 2018 and include adoption periods for implementation; however, nothing prevents from earlier adoption of electronic bills transmis sion. The adoption periods end on the following dates after which submission of electronic medical bills is required: a. No-Fault Auto: September 1, 2019 b. Workers’ Compensation: November 1, 2019
While other industries such as banking and travel have utilized EDI for decades, the healthcare industry lagged for many years. Now it’s time for workers’ compensation and no-fault auto providers to follow the path to improved efficiency, reduced administrative costs and faster payments. About the Author Sally Balioni is with Carisk Intelligent Clearinghouse, and can be emailed at Sally.balioini@cariskpartners.com.
New Members Kate Alexander KPMG Associate (513) 378-6865 katealexander@kpmg.com
Stephanien Santana Santana Consultant (201) 310-6570 ssantana@deloitte.com
Vanessa Cofield Hackensack Meridian Health Site Finance Controller (551) 996-3650 vanessa.cofield@hackensackmeridian.org
Janice Stewart, CRCR AtlantiCare Regional Medical Center Denials Team Lead (609) 272-2520 janice.stewart@atlanticare.org
MatthewnDempsey Virtua Medical Group Sr. Financial Analyst (609) 617-0879 mdempsey@virtua.org
Shane Bornstein Strategic Outpatient Services, Inc. Controller (973) 744-6688 sbornstein@sosinc.biz
Wali Ullah, MD, CRCR AtlantiCare Regional Medical Center Patient Access Associate (609) 553-1624 md.ullah@atlanticare.org
Jason Bryll Parable Associates Principal (810) 348-7780 jason.bryll@parableassociates.com
Chanique Wright Atlantic Regional Medical Center (609) 652-3454 chanique.wright@atlanticare.org
Mark Roarty The Valley Hospital (201) 447-8000 mroarty41@gmail.com
Robert Neu State of New Jersey, Department of Health Director, Office of Hospital Finance & Charity Care (609) 968-1669 robtneu@yahoo.com
Minette Pantlitz Cerner Revenue Cycle Client Manager (973) 262-4101 minette.pantlitz@cerner.com
Douglas Zehner Newark Beth Israel Medical Center Chief Operating Officer (973) 926-6982 douglas.zehner@rwjbh.org
Catherine McCarville KPMG Manager (973) 763-8024 catherinemccarville@kpmg.com
Simi Bakshi University Physician Associates of New Jersey
Daniel Demetrops Medix Account Executive (845) 608-4866 ddemetrops@medixteam.com
Bruce Williams Cooper Health System (Camden, NJ) Manager, Managed Care Dept (267) 325-6589 williams-bruce@cooperhealth.edu Joshua Rosen AtlantiCare Director (609) 569-7009 joshua.rosen@atlanticare.org
Naphiza Pescasio, CRCR, CSPPM Consultant (732) 637-5265 nmpescasio@gmail.com Robert Timberlake Sidra Hospital Consultant (201) 275-9920 ratimberlake@yahoo.com Hardik Choksi Healthcare Consulting Consulting Project Manager (608) 443-9990 hardikc@gmail.com Dan Piereth Capital Health Revenue Integrity Data Specialist (848) 228-9919 dpiereth1@gmail.com
Catherine McCarthy AtlantiCare (973) 219-1328 catherine.mccarthy@atlantichealth.org Laura Birch AtlantiCare Financial Analyst (609) 272-2558 laura.munyon@atlanticare.org Sourav Chaudhuri, CHFP ToneyKorf Partners Director (609) 598-3332 schaudhuri@svcmcny.org Stacey Ford AtlantiCare Behavioral Health registrar (609) 272-8580 stacey.ford@atlanticare.org Doradeen Martin-Mejias AtlantiCare CBO (609) 569-7478 doradeen.martinmejias@atlanticare.org Danielle Trojan AtlantiCare Central Billing Clerk (609) 272-8580 danielle.trojan@atlanticare.org Mary Ann Hughes AtlantiCare Billing Clerk (609) 272-7803 maryann.hughes@atlanticare.org
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Summer 2 0 1 9
•Focus on Finance• Qualified Transportation Fringe Benefits and Parking Benefits
By Maria A. Inciardi, MS, CPA
Q. A.
How does the creation of the IRC §512(a)(7) impact tax-exempt organizations?
On December 22, 2017,The Tax Cuts and Jobs Act (“TCJA”) was signed into law. The TCJA added Internal Revenue Code “IRC” §274(a), which provides that no deduction will be allowed for expenses of qualified transportation fringe benefits (“QTF”) provided by an employer to its employees. IRC §512(a)(7) requires tax-exempt employers (including multi-employer benefit plans) to treat QTFs disallowed under IRC §274 as unrelated business taxable income (“UBTI”). The TCJA added §512(a)(7) to the IRC, effective for amounts paid or incurred after December 31, 2017, certain employee fringe benefits for tax-exempt organizations are treated as UBTI unless they would otherwise be deductible under IRC §274. QTFs include (1) transportation in a commuter highway vehicle between the employee’s residence and place of employment; (2) mass transit passes; and (3) qualified parking. Qualified parking is further defined under IRC §132(f )(5)(c) as parking provided to an employee on or near the business premises of the employer or on or near a location from which the employee commutes to work. Under IRC §132(a)(5) the maximum amount during 2018 of a QTF that could be provided to an employee and excluded from the employee’s gross income was $260 per month. This amount increased to $265 per month for calendar year 2019. Any QTF provided to an employee in excess of this amount is taxable compensation reportable on Form W-2, Wage and Tax Statement. Under IRC §274(e)(2), QTF expenses are deductible to the extent the fair market value of the QTF exceeds the limit discussed above in IRC §132(a)(5). Any amount by which the QTF exceeds these limits is includible as taxable compensation to the employee. IRC §274(e)(7) provides an exception to the disallowance under IRC §274(a) if the goods, services or facilities expenses of the taxpayer are also made available to the general public.
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With the introduction by the TCJA of IRC §512(a)(7), John Smith tax-exempt organizations were required, effective January 1, 2018, to treat, as UBTI, amounts that are determined to be non-deductible under IRC §274 and paid by the tax-exempt organization for: Any QTF defined in IRC §132(f ) above; or Any parking facility used in connection with qualified parking.
Q. A.
What is determined to be QTF qualified parking and how is it calculated for organizations?
Under IRC §512(a)(7), payments to third parties for parking off organization premises; reserved parking spaces; employee-only parking lots/garages; and mixed use parking lots/garages should be analyzed and reviewed for inclusion as QTF qualified parking. In the event a taxpayer pays a third party to provide a place for its employees to park, the nondeductible amount (or amount that is treated as UBTI) is generally equal to the taxpayer’s annual cost. Remember the nondeductible amount or the amount of UBTI is currently limited to $265 per month per employee; any cost over and above this amount is taxable compensation to the employee. If the taxpayer owns or leases a parking facility where its employees can park, taxpayers can use a four-step methodology that is deemed to be a reasonable method under current IRS rules and regulations. These four steps are to: Calculate the amount of disallowed parking expenses for reserved employee spots; Determine whether the primary use (greater than 50%) of the remaining spots is for the general public, if primary use of the remaining spots is for the general public then the remaining costs are not subject to UBTI; If primary use is not for the general public, then calculate the allowance for reserved non-employee spots; and
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If parking spaces remain after completing steps 1-3 then determine the remaining use and allowable expenses. A parking facility includes indoor and outdoor garages and other structures, as well as parking lots and other areas, for qualified parking. Total parking expenses include: repairs, maintenance, utilities, insurance, property taxes, interest, snow/ice removal, leaf removal, trash removal, landscaping, parking lot attendants, security, shuttle service and the applicable portion of rent or lease payments.
Q. A.
The introduction and enactment of IRC §512(a) (7) has had a detrimental impact on many tax-exempt organizations. Is there a change or repeal in the future?
On June 14, 2019, the Subcommittee on Oversight of the House Committee on Ways and Means (“Committee”) released a document (Joint Committee on Taxation, Overview of Section 512(a)(7), Unrelated Business Taxable Income Increased by Disallowed Fringe Benefits (JCX-25-19)) prepared by the staff of the Joint Committee on Taxation which indicated that the Committee has scheduled a hearing for June 19, 2019, relating to IRC §512(a)(7). The document released provides an overview of IRC §512(a)(7) and describes recent legislative activity at the federal and state levels in response to IRC §512(a)(7). As included within the document, the following describes current legislation related to federal repeal or modification of IRC §512(a)(7): H.R. 513 (116th Congress), the “Nonprofits Support Act,” was introduced January 11, 2019, by Representative Michael Conaway. The bill would repeal both section 512(a) (6) (requiring that UBTI be computed separately for each of an organization’s unrelated trades or businesses) and 512(a) (7) (increasing UBTI for qualified transportation fringes). The repeal would be retroactive, as if originally included in Public Law 115-97. S. 501 (116th Congress), the “Stop the Tax Hike on Charities and Places of Worship Act,” was introduced on February 14, 2019, by Senator Sherrod Brown. The bill would repeal section 512(a)(7). The repeal would be retroactive, as if originally included in Public Law 115-97. The bill would also increase the income tax rate on corporations from 21% to 22%, effective for taxable years beginning after the date of enactment. H.R. 1223 (116th Congress), the “Stop the Tax Hike on Charities and Places of Worship Act,” was introduced on February 14, 2019, by Representative James Clyburn. The bill would repeal section 512(a)(7). The repeal would be retroactive, as if originally included in Public Law 115-97. The bill would also increase the income tax rate on corporations from
21 percent to 21.03 percent, effective for taxable years beginning after the date of enactment. S. 632 (116th Congress), the “Lessen Impediments From Taxes (LIFT) for Charities Act,” was introduced on February 28, 2019, by Senators James Lankford and Christopher Coons. The bill would repeal section 512(a)(7). The repeal would be retroactive, as if originally included in Public Law 115-97. H.R. 1545 (116th Congress) was introduced on March 5, 2019, by Representative Mark Walker. The bill would repeal section 512(a)(7). The repeal would be retroactive, as if originally included in Public Law 115-97. S. 1282 (116th Congress), the “Preserve Charities and Houses of Worship Act,” was introduced on May 2, 2019, by Senators Ted Cruz and Jeanne Shaheen. The bill would repeal both section 512(a)(6) (requiring that UBTI be computed separately for each of an organization’s unrelated trades or businesses) and 512(a)(7) (increasing UBTI for qualified transportation fringes). The repeal would be retroactive, as if originally included in Public Law 115-97.
Q. A.
In the meantime, what should tax-exempt organization’s do?
Although many are hopeful for the repeal of IRC §512(a)(7), the outcome is still unknown. For now, most tax-exempt organizations have chosen to take the conservative approach and continue to treat any QTF and parking benefits that are disallowed under IRC §274 as UBTI and report these amounts on their Form 990-T, Exempt Organization Business Income Tax Return. About the author John Smith is a supervisor with WithumSmith+Brown. He can be reached at jsmith@withum.com.
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Revenue Integrity and CARE Forums Host Successful Educational Event Betsy Weiss
by Betsy Weiss
The Revenue Integrity and CARE Forums joined forces this year to host Two Sides of the Same Coin: How Revenue Integrity and Compliance Work Together. The conference was held on June 11th at the DoubleTree by Hilton Hotel in Tinton Falls. There were over 100 participants in attendance representing 19 health systems. The goal of the conference was to provide various perspectives on timely and relevant topics that healthcare organizations are facing. Industry experts in the field provided topic overviews and strategies through panel discussions. The discussion topics included appropriate use criteria, total knee arthroplasty, protecting revenue during system conversions, and drug diversion. Speakers who provided their industry expertise represented private industry, consulting firms and hospital systems. They included: Nancy Toll Perilstein (Deloitte and Touche LLP); Rob Senska, Esq., MBA; Leslie V. Boles, CCS, CPC, CPMA, CHC, CPC-I (Saint Peter’s Healthcare System); Gloria Johnston, MBA, RN, RHIT (HealthAdvanta); Christine Gordon (Virtua Health System); Kate S. Gillespie, MBA, RN, NEBC (Virtua Health System); Debbie Minnucci, CHC, CPC (Hackensack Meridian Health); Lori Pietropola, CPA (Virtua Health System); Thomas Barnes (e4 Services); Elaine Dunn,
DHA, RRT, RPSGT, CPCO (Craneware); Ken Bevenour, R.Ph, MBA (Jefferson Health New Jersey); Barbara Piascik (Bergen New Bridge Medical Center); Eva Goldenberg, Esq., CHC, CHPC (Atlantic Health System); and Craig Dolan, R.Ph, PharmD, MBA (McKesson Pharmaceutical Solutions and Services). Helene O’Donnell of Capio Partners once again wowed the crowd as the emcee of the event. The vendors who generously supported the event included: Arcadia Recovery Bureau, BeyondPay, Craneware, Paths and Pena4. Many thanks to these Revenue Integrity and CARE Forum members who dedicated their time and effort towards planning and executing the event: Betsy Weiss, Debbie Minnucci, Deborah Carlino, Eric Shubin, John Byrne, Kate Walsh, Laura Hess, Leslie Boles, Lisa Tonkinson, Melanie Sponholz, Mike McKeever, Nancy Toll Perilstein, Rob Senska and Susan Hatch. About the Author Betsy Weiss, RN, MPH, is the Director, Revenue Cycle at St. Francis Medical Center in Trenton, NJ. She was the Chair of the Revenue Integrity Forum’s 2018 – 2019 season. Betsy can be reached at BWeiss@stfrancismedical.org.
the
SAVE DATE
Tuesday, September 10, 2019
The Regulatory & Reimbursement Education Event The APA Hotel, Iselin, NJ October 2 – 4, 2019
2019 Annual Institute Borgata Hotel Casino & Spa 24 F o c u s
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43rd Annual Institute! by BJ Welsh
30 Breakout Sessions 8 General Sessions
BJ Welsh
2 Lunch and Learns 3 Days of Education & Networking No matter how you do the math, it adds up to the event of the chapter year - the NJ HFMA Annual Institute at the Borgata in Atlantic City. The AI Committee has been hard at work putting together what we hope to be the best Institute ever. Our Chapter President, Mike McKeever, has previously chaired the AI Committee, and now this is his year to shine. He’s trained us well and last year he handed over the reins to Tony Panico, this year’s returning AI Chair. The fun begins on Wednesday morning with three sets of breakout sessions. During each hour, you’ll be able to select from sessions in five distinct learning tracts – Compliance, FACT & Data, Payer, Revenue Cycle or General Hot Topics. Wednesday afternoon offers keynotes from the NJDOH to our very own John Dalton, who always brings an exciting new perspective on the healthcare landscape. Wednesday evening we’ll spend time with our vendors in the exhibit hall raising funds for a very worthy cause – the NJ Sharing Network. Our general sessions take place on all three days. Day Egusquiza, one of our most popular general session speakers, is back this year. Day will speak on the revenue cycle impacts of disruption. Nathan Mueller will cover lessons learned from an $8.5 million fraud in his session on integrative ethics. Deborah Visconi and Barbara Piascik will discuss how transforming culture impacts the bottom line. And Kevin Brennan will do a general session on price transparency. In his keynote address, Ed Eichhorn, co-author of Healing American Healthcare, will discuss his compelling and common sense proposal for a national healthcare policy he has called “Allcare.” We’ll offer two panel discussions this year, Value-Based Care on Thursday, and then our ever-popular CFO Panel on Friday morning. Thursday night’s President’s Reception will be followed by our late-night networking event in the Premier Nightclub.
Mark your calendar for October 2nd to October 4th and make your hotel reservation today. A block of rooms is being held at the special rate of $144 per night at the Borgata. All guestrooms include complimentary Wi-Fi and access to the hotel’s fitness facility. The $15 resort fee will be waived for those booking in the room block, which is open until September 2nd. Use the Group Code GBHFM19. Don’t forget to register for the Institute itself on our chapter website. Early bird pricing is good through September 25th. Please note that the registration application will ask you to log into your HFMA account or create one if you don’t have one. Finally, we couldn’t bring you this great event every year without the generous support of our corporate sponsors. Please spend time with them at their booths when the exhibit hall is open. Sponsorships are still available; either go to our website and click on the Sponsorship/Exhibitor Opportunities tab or contact DL Planners at 609-344-1333. All this fun and 18.2 CPE credits, too. How can you go wrong? See you in October Atlantic City! About the author BJ Welsh, CHC, FHFMA is Chief Compliance & Privacy Officer for Saint Peter’s Healthcare System. She also serves on the Annual Institute Committee and CARE Forum. BJ can be reached at bjwelsh@saintpetersuh.com
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Wednesday October 2nd, 2019 9:30 AM - 10:20 AM: Breakout #1
Transparent and Optimal Pricing Strategies Brian Workinger, Craneware Transformation is on: How Will Blockchain Technology Help Shape the Future of Healthcare? Mary Butler-Everson, PNC Healthcare Tom Walsh, PNC Healthcare Using Data Analytics to Maximize Gainsharing Opportunities Jo Surpin, Applied Medical Software Making the Most out of Revenue Cycle KPIs Maria Facciponti Setting Your BPCI Advanced Strategy: Understanding the Key Drivers of Success Amanda Brown, Veralon
10:20 AM - 10:25 AM:
Transition Break
10:25 AM - 11:15 AM: Breakout #2 11:15 AM - 11:20 AM: 11:20 AM - 12:10 PM: Breakout #3
Non-Traditional Revenue Capture Panel Lauren Beard, Triage Consulting Group Angela Horn, DCM Services & Forte, LLC Stefanie Jackman, Ballard Spahr LLP A Systematic Way to Improve Your Medicare Quality Measures by Using Data Analytics Sam Donio, CBIZ KA Consulting Services Brian Herdman, CBIZ KA Consulting Services Improving Maternity Care in NJ - A Multi-Stakeholder Response Michelle Merchant, Horizon BCBSNJ Linda Schwimmer, NJ Healthcare Quality Institute Fast and the Furious 2.0: Revenue Cycle of the Future Brad Cross, EnableComp Greg Snow, University of Chicago Medicine It's Not Just IT: Why Cybersecurity and Risk Management Needs a Multi-Disciplinary Approach Gerry Blass, ComplyAssistant Robert Babin, Saint Peter’s Healthcare System
The Advantages of Aligning Case Management with Revenue Cycle Mary Devine, BESLER Meliza Weiner, BESLER Tracking Savings and Getting Results in a Comprehensive Savings Program Meaghan Lutts, Children's Hospital of Philadelphia Dhara Patel, Strata Decision Technology
Studio 4
12:10 PM - 1:15 PM: 1:15 PM - 1:30 PM: Welcome
Lunch Michael Mckeever, President, NJ HFMA Anthony Panico, Chair, NJ HFMA Institute Committee
Vendor Hall Ballroom
1:30 PM - 2:20 PM: General #1
NJ DOH Commissioner's Office
Ballroom
2:20 PM - 3:10 PM: General #2
Healthcare Reform 101: How Did We Get Here and What Are Our Options? John Dalton
Ballroom
3:10 PM - 3:40 PM:
Break with Sponsors
Vendor Hall
3:40 PM - 4:30 PM: General #3
NJ Sharing Network Presentation Charity- NJ Sharing Network
Ballroom
Transition Break How Healthcare Providers Can Win in the New Age of Pricing Transparency Tara Bogart, PMMC Greg Kay, PMMC Using Data to Create a Healthier New Jersey Sean Hopkins, New Jersey Hospital Association Stacey Medeiros, New Jersey Hospital Association Unravel Payer Compliance To Win The Ultimate Audit and Recoupment Game Karlene Dittrich, MedRevenue Solutions, LLC
Studio 1 Studio 2
Studio 3 Studio 4 Boardroom 1
Studio 1
Studio 2
Studio 3
Studio 4
Boardroom 1
Studio 1
Studio 2
Studio 3
Boardroom 1
4:30 PM - 4:40 PM: Transition 4:40 PM - 5:30 PM: Breakout #4
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Telepsych and Telehealth: A Compliance Perspective on Program Success Anthony Caroleo, Rutgers, The State University of NJ David Chin, Rutgers Health- University Behavioral Health Care A & A Update Michael Serluco, Withum Kimberly Maffei, Withum Creating Provider Solutions for Employers That Drive Down Medical Expense and Generate Incremental Volume for a Healthcare System Kevin Joyce, Atlantic Health System Robert Goldsmith, Novartis Pharmaceutical Company Catherine McCarthy, Atlantic Health System
Studio #1
Studio #2
Studio #3
Summer 2 0 1 9 5:30 PM - 8:00 PM:
The Path to Better Health with an Increased Resident Cap Scott Besler, AtlantiCare Regional Medical Center Joseph Glazer, Joseph D. Glazer Law Revenue Integrity: Preparing for Today's Challenges Kristin Greenstreet, Navigant Charity Networking Event Benefiting NJ Sharing Network
Studio #4
Boardroom #1 Vendor Hall
Thursday, October 3rd, 2019 8:45 AM - 9:00 AM: 9:00 AM - 9:50 AM: General #4 9:50 AM - 10:40 AM: General #5
Awards Ballroom Annual NJ HFMA Chapter Awards Revenue Cycle Impacts of Disruption Ballroom Day Egusquiza How Transforming Culture Impacts the Bottom Line Ballroom Deborah Visconi, Bergen New Bridge Medical Center Barbara Piascik, Bergen New Bridge Medical Center
10:40 AM - 11:00 AM: 11:00 AM - 12:00 PM: General #6 (Keynote) 12:00 PM - 1:15 PM: 12:10 PM - 1:00 PM: Lunch & Learn 1:15 PM - 2:05 PM: Breakout #5
Break with Sponsors Universal Healthcare for America - A Practical Approach to Affordable Quality Care Edward Eichhorn, Medilink Consulting Group, LL Lunch The Hidden Costs and Waste in the Pharmacy Michael Ferris, Diverse Healthcare Solutions Review HFMA Certification Programs Hot Topics in Billing Compliance Robert Bacon, Penn Medicine
Vendor Hall Ballroom
2:05 PM - 2:35 PM: 2:35 PM - 3:25 PM: Breakout #6 3:25 PM - 3:35 PM: 3:35 PM - 4:50 PM: Breakout #7 (Panel)
Healthcare Industry Tax Update 2019 Scott Mariani, WithumSmith+Brown, PC Hayley Shulman, WithumSmith+Brown, PC Managed Care Contract Modernization David Gregory, Baker Tilly Keith Needham, Baker Tilly Clinical Denial Prevention: A Collaborative Approach Leveraging Physician Advisor, Utilization and Revenue Cycle Leader Expertise Ronald Hirsch, R1 RCM Inc. Worksheet S-10 Is Here to Stay: A Look at MAC S-10 Audits Kyle Pennington, Southwest Consulting Associates Jeff Norman, Southwest Consulting Associates Break with Sponsors Create the Village: The Compliance/Revenue Cycle/Quality Partnership Barbara Piascik, Bergen New Bridge Medical Center Angela Melillo, Cooper University Health Care Evaluating Your Compliance Program for Best Practice Bret Bissey, Gateway Health Top 7 Methods to Improve the Financials of Your Physician Enterprise: Optimizing Performance and Strategic Value Robert Hill, Veralon Making Your "Pre-Registration" Sizzle Kas Garnes, Thomas Jefferson (Jefferson Health) Mindy Kilroy, Revint The last bastions of Medicare Cost Reimbursement - Organs & NAHE Michael Rossi, Penn Medicine Adam Flade, Lourdes Health System Transition Value-Based Care Discusson
Studio 2
6:00 PM - 8:00 PM:
President’s Reception – Borgata Beer Garden
10:00 PM - 1:00 AM:
Late Night Networking Event – Premier Nightclub
Vendor Hall Studio 1 Studio 2 Studio 1
Studio 3
Studio 4
Boardroom 1
Studio 1
Studio 2 Studio 3 Studio 4
Boardroom 1
Ballroom
Friday, October 4th, 2019 9:00 AM - 9:50 AM: General #8 9:50 AM - 10:00 AM: 10:00 AM - 10:50 AM: General #9 10:50 AM - 12:05 PM: General #10 (Panel)
Price Transparency - An Alternative for Medicare Kevin Brennan, SunStone Consulting Break Lessons From An $8.5 Million Fraud Nathan Mueller, Integrative Ethics CFO Panel
Ballroom Ballroom Ballroom Ballroom
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Welcome to the New Chapter Year by Michael P. McKeever, CPA, FHFMA Chapter President
As I’m sure you all know, the HFMA Chapter Year began on June 1, and this year has already seen a lot of changes from the Association. First of all, the parent entity is no longer going by the name “HFMA National,” but rather is being referred to as “the Association.” This follows on the heels of a change made a few years back when the ANI (Annual National Institute) was rebranded as the Annual Conference. When this change was made, as the story goes, there was a $1 fine imposed at the Association’s main office on anyone who used the old handle for the Annual Conference. Rumor has it that Joe Fifer, the President and CEO of HFMA, was caught more often than anyone else, and therefore was assessed the largest penalty. Every spring there is a meeting of the Chapter leaders from around the country that is known as the Leadership Training Conference, or LTC. The Presidents-Elect are encouraged to attend with their incoming leadership teams. The LTC this year was held in April in Anaheim. Attending along with me were the officers: Stacey Medeiros, Jill Squiers and Brian Herdman, as well as Tony Panico, the Chair of the Annual Institute Committee; Heather Stanisci, our Membership Services and Networking Committee Chair; Heather Weber, our Assistant Treasurer; and Laura Hess, Chapter Administrator. During the LTC there were breakout sessions where we met with the Association’s leadership, as well as our peers, to learn about the changes being made across the organization and to share best
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practices in education, memMichael P. McKeever bership and marketing. There was also time set aside for the Chapters in Region 3 to meet and discuss topics of common interest. This year the Regional Executive for our region is Tracy Davison-DiCanto, former NJ Chapter President. She was assisted by the Regional Executive-Elect, Mike Rossi, from Metro Philadelphia. For those who are unaware, Region 3 consists of the New Jersey Chapter and the four Pennsylvania Chapters: Metro Philadelphia, Northeast PA, Central PA and Western PA. There was also a networking event, where the regions competed against each other in a contest to see which region could pack more for the Ronald McDonald House. In addition, each region was called upon to show their true talents up on the big stage. Embarrassing, maybe? But definitely fun! On May 6 at NJHA we held the Chapter LTC. This is where the Officers, Board, Chairs and Co-Chairs get together to discuss the upcoming Chapter Year. It’s also a chance to welcome new members to the Leadership Team, and to give them a glimpse into the operations of the Chapter. After introductions Erica Waller gave an update on the results of the recently-ended year, followed by my thoughts on what we want to accomplish in the upcoming year. There were breakout discussions for the various committee and forum leaders, where we brainstormed for new ideas and programs to implement. This year’s LTC also included
Summer 2 0 1 9 a webinar that the Association presented, wherein they explained to the group the initiatives being implemented that will benefit all members. The day ended with a description of the tools available to assist in administering the committees, an update on regional activities, and of course a discussion on the Annual Institute. The one welcome change that was recently implemented was an upgrade to the Association’s website. For anyone who has been frustrated trying to access the voluminous content that the Association has available, this is indeed a huge improvement. The address is the same, but there the similarity ends. The layout is very intuitive, with links to recent news and information and a much smoother search function. The goal is to establish active communities of members with similar job duties and interests, where ideas can be shared in real time. If I didn’t know better I’d almost think that they’ve modeled this on the NJ Chapter’s extremely effective forums. A recent change that may have come as a shock was the increase in the price of membership dues. What the Association has done is bundle all of the previously available services into an all-inclusive membership that includes member-only content, certifications, online forums and newsletters, and webinars and virtual conferences. In the past the NJ Chapter
would reimburse successful certification candidates the fees paid for the study guides and tests once they had completed the CHFP process; so this change will save the Chapter money over the long run. The Association also offers specialized certifications, of which had not been reimbursed by the Chapter. So be sure to check out the certification section of the new website. I expect to see our certified member list grow exponentially based on the new membership model. About the Author Michael P. McKeever, CPA, FHFMA, CHC, CHRC, CHIAP, is Director of Internal Audit at Saint Peter’s Healthcare System, and this year's Chapter President. He can be reached at mmckeever@saintpetersuh.com.
NJ HFMA Wins Six Awards at Annual Conference
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New Jersey Transitioning to a State-based Health Insurance Exchange by Ward Sanders Ward Sanders
On March 22, 2019, Governor Murphy announced that his administration intends to move New Jersey to a statebased health exchange (SBE) in order to allow the state to have “greater control over its health insurance market and ability to establish stronger protections” than are currently afforded under federal law. New Jersey’s health insurance marketplace is currently run under the federal program through Healthcare. gov. Most of New Jersey’s nine million residents get their coverage from their employer, and therefore are not familiar with a health insurance exchange, but for the 350,000 or so residents who do shop for their own coverage, this is an important change. First, what is a health insurance exchange? In short, it is an online comparison shopping tool that allows individuals and families that purchase their own coverage to shop from among options and purchase health insurance directly rather than through their employer. Private plans list information about benefit levels, prices, networks and more, and consumers are able to pick which plan best fits their needs. These exchanges became a central feature of the Affordable Care Act (ACA) for the individual market. While coverage is also available directly from carriers, for those eligible for an income-based subsidy the exchange is the only way to obtain the benefits of a premium subsidy. Exchanges rolled out in 2014 and states could rely on the federal government’s platform (https://healthcare.gov) or could establish their own SBE. New Jersey chose to use the federal government platform. However, that comes with certain restrictions. For example, states cannot select their own open-enrollment period, and must defer to the federal rules. Moreover, a fee is assessed under the federal law on premiums in the exchanges, which is used to offset the cost of the infrastructure (“the technology platform”) that is the “federally facilitated exchange.” That fee is currently 3.5% of premium and the monies collected go to the federal government. Especially in politically-leaning blue states, there has been an interest in moving to an SBE and away from the federal
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platform. In an SBE, user fees go to state capitals, and states have more flexibility in setting market rules. In addition to greater regulatory autonomy, recent reports suggest that SBEs are out-performing the federal exchange in terms of enrollment, carrier participation, and successfully attracting younger and healthier enrollees. Many SBEs also use their state-based platform as an eligibility platform for Medicaid and public programs that provide subsidized health coverage to their residents. SBEs also allow those states to enable a “no wrong door” approach to ensuring the broadest possible access to health insurance coverage. Currently, the Legislature is considering bills to establish an SBE and to adopt some of the more popular elements of the Affordable Care Act in order to make sure that they are codified in state law in the event of a repeal of the ACA or its invalidation. As of the writing of this article, committees in both houses have reported the legislation out of committee. From our perspective, there are a couple of important considerations for the state in establishing an SBE: • The performance of the existing SBEs and the greater flexibility strongly warrant consideration of an SBE here in New Jersey. • Of critical importance will be the price tag for setting up an SBE. Startup funding is no longer available from the federal government. Since a user fee on health insur ance premiums is the funding source, and these fees end up being paid by consumers, it will be important for the state to be able to establish an exchange at around or below current costs. The benefits of an SBE may not be outweighed if the user fee has to be much higher than the current federal user fee. • Execution of this IT project will be important. Although the federal exchange did not work well in 2014 when it was first established, it functions pretty well now and has evolved significantly since its debut, including more readily available information to compare networks, products, etc. Success or failure will depend on finding
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both an efficient and capable partner to buildout the SBE technology platform. • The SBE must provide what many have called a “no wrong door” for Medicaid-eligible individuals. Ideally the SBE needs to be an enrollment vehicle for anyone interested in individual or Medicaid coverage. • Key New Jersey stakeholders need to have a voice in providing input to the SBE, most importantly con sumers, insurers, brokers, and state officials from a number of different departments. • Lastly, the SBE will need to be nimble to meet the state’s aggressive timetable. State procurement and rulemaking processes are generally not built for speed,
and some accommodations may need to be made, while still allowing an opportunity for input and transparency. Establishment of an SBE is a worthy goal. It has some clear rewards, but comes with attendant risks; however, we think the rewards will outweigh the risks. About the author Ward Sanders is President of the New Jersey Association of Health Plans. He can be reached at wsanders@njahp.org.
•Certification Corner• The Healthcare Financial Management Association (HFMA) has recently partnered with the digital credential leader Credly and is now providing all certified members with web-enabled digital credentials through Credly Acclaim badging platform. The Credly Acclaim platform is a result of partnership between Credly and Person’s Acclaim and is the most comprehensive global solution for recognizing skills, capabilities, and achievements, reaching everywhere learning takes place and skills are assessed. As of June 2019, all active earners of an HFMA credential can receive a new digital badge as a recognition of earning the credential, which they can share with their peers. In addition to HFMA certification credentials, the digital badge will contain data describing a member’s qualifications as well. Badges can be displayed in an email signature, electronic resume and on social sites such as LinkedIn, Facebook and Twitter. There is no fee for this service and acceptance of the badge is totally up to the individual. Why digital credentialing? Digital credentials are a graphical representation of a person’s abilities and competencies, combined with a verifiable description of the knowledge and activities it took to earn each credential. Digital credentials are the quickest, most secure way to verify someone’s knowledge, skills, and abilities. HFMA digital badges will: • Increase your credibility: An HFMA credential validates that you have the education needed to succeed in your field.
• Position yourself for advancement: Show your manager you are committed to staying up-to-date in your profession. • Differentiate yourself in the job market: Maintain the proficiencies leaders in the field are seeking to meet their organizational goals. What happens next? All HFMA-certified members will soon receive an email from Acclaim inviting them to claim their badge. An email will contain instructions and link to an Acclaim account. Registration is very simple, and members can claim their badges and start sharing them within minutes. Here is a sneak peek at HFMA’s new digital badges:
We hope you take advantage of this new feature and enjoy the convenience and professional recognition afforded by HFMA badging program. Any questions? Contact Amina Razanica, CHFP, CSBI at arazanica@njha.com, or HFMA at careerservices@hfma.org.
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The 2019 NJ HFMA Scholarship Recipients This year NJ HFMA presented three scholarships to dependents of Chapter members. Past President Erica Waller presented the students with the awards at the June 11th Revenue Integrity/ CARE Educational Session at the DoubleTree in Tinton Falls. We wish the best of luck to the scholarship recipients as they continue to pursue their education in the field of healthcare. Kevin Alwell Kevin Alwell will be entering his senior year at the University of Connecticut where he is in the honors program majoring in Mathematics, Statistics, Economics and Sports Management. This year, he will be continuing his role as Director of Operations for the UConn Women’s Soccer team, as well as a member of the operations staff for both the New York Red Bulls and Philadelphia Union of Major League Soccer. Kevin is very active with the UCONN Sports Business Association, currently serving as Chief Marketing Officer, and had the opportunity to spend time with executives of ESPN and Fox Sports. When he is home, Kevin enjoys hanging out with his friends from Whippany Park High School or playing in pick-up soccer games. He will be looking forward to his final two years at the University of Connecticut, where he will begin doing undergraduate independent studies for the Statistics Department. Ryan Besler Ryan Elisabeth Besler is a Bordentown native and graduated on June 9th, from Notre Dame High School with a 3.7 GPA. Ryan was inducted to the Spanish Honor Society and has been a peer leader at Notre Dame for the past three years. She has been recognized for excellence in community service, working with Notre Dame’s service learning program. Ryan, was a three-year starter on their varsity field hockey team and captain her senior year. She received the Coach’s Award her senior year. This award is given to the teammate that exemplifies qualities of leadership, organization, and teamwork. Ryan has lettered in both field hockey and lacrosse, and is a
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member of Catholic Athletes for Christ. She has worked as a camp counselor at Liberty Lake Day Camp, a hostess at Delorenzo’s Pizza in Hamilton, and as a lifeguard at both RWJ Fitness Center and Trenton Country Club. Ryan will be attending the University of Tampa in August pursuing her BSN degree. She is the oldest child of Jessie and Scott Besler, and has a younger sister named Halle. Cole Sayde Cole Sayde is a graduating senior from West Windsor Plainsboro South High School. He is the President of the WWPHSS Student Council, a National Honor Society member, captain of the varsity lacrosse and cross country track teams, and an active volunteer in various community youth athletic programs. Cole will be attending Rutgers Business School in the fall and will pursue an education in Supply Chain Management.
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Fiddler's Elbow Country Club
2019 HFMA NJ Golf Outing May 14th Scramble Results
The Meadow Course
Place
Team Members
Score
1st
Jack Hoban Joe Hoban Jed Hoban
59
2nd
Sam Donio Tom Shanahan Greg Dietrik Keith Givand
61
3rd
Jim Pender Dr. Anthony DePaola Mark Stewart Brian Kern
63*
*Denotes a win based on a Match of Cards
Special thanks to our sponsors for the day that help us make this great event possible. And to Steve Aaron of HBCS for volunteering his talents to serve as our event photographer again this year.
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2019 NJ HFMA Golf Outing Fiddlers Elbow Country Club May 14, 2019
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Thank You To Our Golf Outing Sponsors! COCKTAIL PARTY Co-Sponsorships:
DRIVING RANGE
PHOTOGRAPHY Steve Aaron, HBCS
PUTTING GREEN
GOLF CARTS BAG TAGS
BREAKFAST
LUNCH STATION
Tee Sponsors:
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NJ HFMA Leadership 2019-2020 Officers
Michael McKeever NJ HFMA President CLE Designate m.mckeever2@verizon.net St. Peter’s University Hospital
Stacey Medeiros NJ HFMA President-Elect SMedieros@njha.com New Jersey Hospital Association
Jill Squires NJ HFMA Treasurer jill.squiers@amerihealth.com AmeriHealth New Jersey
Brian Herdman NJ HFMA Secretary BHerdman@cbiz.com CBIZ KA Consulting Services, LLC
Scott J. Mariani smariani@withum.com WithumSmith+Brown, PC
Dan Willis Dkwillis6@gmail.com Aetna
Heather Weber heather.weber@bakertilly.com Baker Tilly
Advisory Council
Erica Waller erica.waller@pennmedicine. upenn.edu Princeton Penn Medicine
Board of Directors
Leslie Boles lboles@saintpetersuh.com Saint Peter’s Healthcare System
Heather Stancisi hstanisci@arcadia recovery.com Arcadia Recovery Bureau
Hayley Shulman HShulman@Withum.com WithumSmith+Brown, PC
Michael George michael.george@us.pwc.com Pricewaterhousecoopers LLP
Jane Kaye Education Committee jane@hcfadvisors.com Jane Kaye Healthcare Consulting LLC
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Board of Directors (Cont’d)
Maria S. Facciponti Christin Fenton facciponti.maria@gmail.com Christin.Fenton@ atlanticare.org AtlantiCare Health System
Dave Murray Finance, Accounting, Capital & Tax (FACT) Committee murrayd@ihn.org Inspira Health Network
Associate Board Directors
Ex-Officio
Nicole Rosen Marketing/Networking Acadia Professional nrosen@acadia.pro
Jonathan Besler Regulatory & Reimbursement Committee JBesler@besler.com BESLER
Scott Besler Communications scottbesler@atlanticare.org AtlantiCare Physician Group
Jason Friedman Regulatory and Reimbursement Atlantic Health System jason.friedman@ atlantichealth.org
Roger Sarao RSarao@NJHA.com New Jersey Hospital Association
Robert Booth Rrbooth@comcast.net Summit Medical Group
Mike Costa costam@aetna.com Aetna
Melanie Sponholz Compliance, Audit, Risk & Ethics (CARE) Committee Msponholz@ waudcapital.com Waud Capital Partners
Rob Senska Compliance, Audit, Risk & Ethics (CARE) Committee RSenska3@yahoo.com
Scott Besler Communications scottbesler@atlanticare.org AtlantiCare
Sandra Gubbine Education Committee Sandra.Gubbine@atlanticare.org AtlantiCare Health System
Committees
Heather Weber Assistant Treasurer heather.weber@bakertilly.com Baker Tilly
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Committees (Cont’d)
Jane Kaye Education Committee jane@hcfadvisors.com Jane Kaye Healthcare Consulting LLC
Hayley Shulman Education Committee HShulman@Withum.com WithumSmith+Brown, PC
Amina Razanica Certification Committee arazanica@njha.com New Jersey Hospital Association
John Smith Finance, Accounting, Capital & Tax (FACT) Committee jsmith@withum.com WithumSmith+Brown, PC
Alex Filipiak Finance, Accounting, Capital & Tax (FACT) Committee alfilipiak@gmail.com New Bridge Medical Center
Tony Panico Institute Committee Tony.Panico@mariner wealthadvisors.com Mariner Wealth Advisors
Sandra Gubbine Institute Committee Sandra.Gubbine@ atlanticare.org AtlantiCare Health System
Heather Stancisi Marketing and Networking Committee hstanisci@arcadia recovery.com Arcadia Recovery Bureau
Nicole Rosen Marketing/Networking nrosen@acadia.pro Acadia Professional
Maria Lopes-Tyburczy Patient Access Services Committee MLopes-Tyburczy@ palisadesmedical.org Palisades Medical Center
Jacqueline Lily Patient Access Services Committee jacqueline.lilly@ atlanticare.org AtlantiCare Health System
Steven Stadtmauer Patient Financial Services Committee sstadtmauer@csandw-llp.com Celentano Stadtmauer & Walentowicz, LLP
Michael Berger Patient Financial Services Committee mberger10@comcast.net
Michelle Merchant Payer & Provider Collaboration Michelle_Merchant@ horizonblue.com
Holly Fritz Payer & Provider Collaboration holly.fritz01@aetna.com
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Committees (Cont’d)
Christin Fenton Regulatory & Reimbursement Committee Christin.Fenton@atlanticare.org AtlantiCare Health System
Lew Bivona CPE Designation ldbcpa@verizon.net
Jason Friedman Regulatory and Reimbursement Atlantic Health System jason.friedman@ atlantichealth.org
Kate Walsh Revenue Integrity Committee K.Walsh@craneware.com
Debra Ann Minnucci Revenue Integrity Committee debraannminnucci@ hackensackmeridian.org
Michael McKeever CLE Designation m.mckeever2@verizon.net St. Peter’s University Hospital
continued from page 41 In addition to investing in their community and creating more affordable housing, these projects give hospitals the opportunity to affect the well-being of their community directly, especially the homeless and vulnerable people who currently seek refuge in their emergency department. Other healthcare providers are partnering with NJHMFA and the Department of Community Affairs on housing-first initiatives. Housing-first projects are a form of supportive housing that helps chronically homeless people move directly into housing and receive wraparound supportive services that help them improve and maintain their health, stabilize their lives and maintain their housing. NJHMFA and DCA have worked with groups of healthcare providers in Camden, Hudson and Middlesex counties to commit funding to provide permanent supportive housing
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solutions directly to individuals experiencing homelessness. Local governments are also participating in housing-first coalitions, such as the Cumberland County Housing First Collaborative, which includes Inspira Health. This non-profit collaborative housed 60 chronically homeless individuals in an 18-months span during 2017 and 2018. Supportive housing provides an avenue for people with housing insecurity issues to find permanent housing, stability and opportunities to improve their overall well-being, including their health. About the author Victoria Brogan is NJHA’s Senior Vice President, Strategic Initiatives. She can be reached at VBrogan@NJHA.com.
Perspectives in Healthcare: Healthcare Community Addresses Chronic Homelessness Through Public-Private Partnerships By Victoria Brogan
Common sense says that if a person doesn’t have a stable living environment, sustaining a healthy lifestyle is not among that person’s top priorities. The overlaps between poor health and housing instability are numerous and exacerbate one another; homelessness leads to poor health, and poor health can lead to housing instability. Research shows that the average life expectancy for the homeless population is between 42 and 52 years – drastically shorter than the national and state life expectancies. Contributing to this high mortality rate are health issues that appear more frequently in the homeless community, including substance use disorder, mental illness, musculoskeletal issues, upper respiratory tract infections, issues with parasites, and exposure-related conditions such as hypothermia, trauma and chronic diseases. In New Jersey, the U.S. Department of Housing and Urban Development reports 9,303 homeless men, women and children on any given night. When accounting for populations that are traditionally at risk for housing insecurity, including families engaged with the mental health or corrections systems, the Corporation for Supportive Housing estimates that there are more than 25,000 chronically homeless people in the Garden State. And according to the Journal of Urban Health, medical issues and physical or developmental disabilities are contributing factors in nearly 1 in 5 instances of homelessness in New Jersey. Research by the Center for Healthcare Analytics, Research and Transformation at the New Jersey Hospital Association (NJHA) shows that these vulnerable residents seek help regularly from hospital emergency departments, one of the most expensive settings of care. According to uniform billing data, in 2017 there were 3.1 million emergency department visits from patients who were treated and released without needing to be admitted for more advanced care, including nearly 25,000 patients identified as homeless accounting for $13.5 million in healthcare costs. Homeless New Jerseyans were admitted to an acute care hospital 9,197 times in 2017 and incurred treatment costs of $85 million, at an average of $9,267 per admitted patient. Despite this often overwhelming – and expensive – societal problem, there is evidence that a solution that benefits everyone exists. Supportive housing programs for chronically homeless residents recognize that permanent housing with wraparound support services, such as primary care, counseling, job training, case management and life skills assistance, have been proven to improve health outcomes and reduce healthcare costs. Supportive housing incorporates these voluntary services into properties developed for both market-rate rentals and housing for low and very low-income people. There are a multitude of local, state and federal programs that provide tax credits or subsidies to encourage the development of these housing projects. Cost studies in six different states and cities by the Corporation for Supportive Housing found that supportive housing results in tenants’ decreased use of homeless shelters, hospitals, emergency rooms, jails and prisons. As the healthcare community shifts its attention to the health factors affecting patients outside of hospital walls, or social determinants of health, the natural overlap between housing and health outcomes makes a promising starting point for engaging public-private partnerships between hospitals, health systems, government and private business. In a first-of-its-kind pilot program, the New Jersey Housing and Mortgage Finance Agency (NJHMFA) has partnered with NJHA to connect hospitals and health systems interested in creating supportive housing with funding avenues. Participating hospitals are required to develop multi-family supportive housing either on or near the hospital’s campus in order to receive matching funds up to $3 million per project from NJHMFA. These developments would then set aside a certain number of units specifically for vulnerable community members who frequent the emergency department. In addition to matching funds, NJHMFA will work with these hospitals and their partners to secure other financial support, including tax credit equity, the Special Needs Housing Trust Fund, deferred developer fees and other avenues of investment. The Corporation for Supportive Housing, engaged by NJHA to help its members through the process, has developed resources to support and connect hospitals to experts already engaged in supportive housing initiatives. continued on page 40
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