a u g u s t 2 0 11
University Orthopaedic Associates, LLC
With the Opening of its Brand New All-Inclusive Facility, UOA Offers One-Stop Comprehensive Care and Treatment Also in this Issue
• CMS Releases Proposed Rules for 2012 Medicare Payments • Medicaid RAC Program is Underway in New Jersey • New Jersey Durable Power of Attorney Laws
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Publisher’s Letter Dear Readers, Welcome to the August issue of New Jersey Physician, the state’s only publication serving the medical community.
Published by Montdor Medical Media, LLC
This month we feature University Orthopaedic Associates as our featured
Co-Publisher and Managing Editors Iris and Michael Goldberg
practice. Began in 1972 with three physicians, and now with fifteen, the very large, sub specialty practice, offering patients the entire gamut of non-surgical and surgical treatment is about to move into a new, comprehensive facility with its own ASC, Physical Therapy Center, and fully equipped, state-of-the-art imaging center, offering patients one stop care without the need to leave the building. Hackensack University Medical Center has announced the formation of an ACO. The employees of HUMC will pilot the attempt at accountable care through its self-insured employee health plan. The ProMutual Group, a leading provider of medical professional liablility insurance has announced the launch of its new name and brand. Now to be known as Coverys, the change reflects the continued integration of the member companies within ProMutual Group, including recently acquired Fincor Holdings and its subsidiaries. In the same vein, the “Saint Barnabas Health Care System” has rebranded itself into “Barnabas Health”. New Jersey’s Durable Power of Attorney Laws are most confusing. We have included a summation of the laws along with additional information that each of
Contributing Writers Iris Goldberg Mark Manigan, Esq. Debra Lienhardt, Esq. Joseph Gorrell, Esq. Kevin Lastorino, Esq. Carol Grelecki, Esq. John Fanburg, Esq. Lani Dornfeld, Esq. Caren Malone
New Jersey Physician is published monthly by Montdor Medical Media, LLC., PO Box 257 Livingston NJ 07039 Tel: 973.994.0068 Fax: 973.994.2063 For Information on Advertising in New Jersey Physician, please contact Iris Goldberg at 973.994.0068 or at igoldberg@NJPhysician.org Send Press Releases and all other information related to this publication to igoldberg@NJPhysician.org
our readers should be aware of in dealing with such patient issues as power of attorney, and other advanced directives for Health Care. The Department of Health and Human Services has announced draft guidelines
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Contents
4
University Orthopaedic Associates, LLC
With the Opening of its Brand New All-Inclusive Facility, UOA Offers One-Stop Comprehensive Care and Treatment CONTENTS
11
Statehouse
More information on Durable Power of Attorney Laws
12 16
Health Law Update
Hospital Rounds
18
Food for Thought
Serenade
Chatham, New Jersey
COVER STORY 2
New Jersey Physician
20
Coverys
ProMutual Group rebrands as Coverys
Call for Nominations
New Jersey Physician Magazine invites all medical practices to submit nominations for cover stories. Practices should include a brief description of what makes the practice special. Please contact the publisher Iris Goldberg at igoldberg@NJPhysician.Org August 2011
3
Cover Story
University Orthopaedic Associates, LLC
With the Opening of its Brand New All-Inclusive Facility, UOA Offers One-Stop Comprehensive Care and Treatment By Iris Goldberg
Back in 1972 University Orthopaedic Associates, LLC (UOA) began with two physicians and a mission to provide the most current, technologically advanced and personalized healthcare services available. This month, UOA welcomes the fifteenth orthopaedic surgeon to join its multi-faceted, subspecialty-trained team. Also, honoring the mission that began nearly four decades ago, University Orthopaedic Associates is preparing to move into its beautiful, newly constructed, comprehensive facility that will allow patients to travel to just one destination and receive a full circle of integrated orthopaedic care.
In addition to the pursuit of excellence in orthopaedic treatment, the surgeons of UOA are deeply committed and involved in the training of medical students and residents at their affiliated hospitals, as well as clinical and bench research. The promotion of community health and wellbeing is another priority at UOA and is accomplished through participation with numerous organizations throughout the state. Also, the physicians of UOA serve as the orthopaedic consultants for the athletic teams at Rutgers University, Princeton University, Rider University and US Rowing, as well as numerous high school teams.
Affiliated with Robert Wood Johnson University Hospital, Saint Peter’s University Hospital, Jersey Shore University Medical Center and University Medical Center at Princeton, the surgeons of UOA specialize in the entire spectrum of non-surgical and surgical orthopaedic care and treatment, including:
With the upcoming Fall opening of its impressive 62,000-sq.-ft. state-of-the-art facility in Somerset County, University Orthopaedic Associates is positioned to provide one- destination treatment to orthopaedic patients from many locations throughout the state. Housed within the new building will be three high-tech equipped ambulatory surgical suites to accommodate the many same day, minimally invasive procedures performed by the surgeons of UOA.
• sports medicine • arthroscopic surgery • surgery of the hand and upper extremity • surgery of the foot and ankle • surgery of the spine • surgery for traumatic injuries • joint replacement surgery
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New Jersey Physician
Also on site, complete orthopaedic diagnostic imaging services including
x-ray, MRI, ultrasound and dexa scanning will simplify the lives of patients, who no longer will need to travel from facility to facility in order to receive diagnosis and treatment. For patients with osteoporosis, a certified Nurse Practitioner, with ISCD accreditation, is on staff to assist with the screening and treatment regimen of each Michael P. Coyle, MD individual patient. Hand & Upper Extremity
Modern, fully equipped occupational and physical therapy centers, staffed with highly skilled professionals, are included in the new facility as well. For surgical patients, therefore, diagnosis, surgical treatment and post-surgical rehabilitation are all accomplished under one roof. This set-up allows for hands-on, personalized care
Aman Dhawon, MD Sports Medicine
Carlos A. Sagebien, MD Trauma
that is more efficient through better communication amongst all caregivers because each is in-house.
Charles J. Gatt, MD Sports Medicine
Christopher Doumas, MD Hand & Upper Extremity
David Harwood, MD Joint Replacement
John Delgado, MD Trauma
Mark S. Butler, MD Foot & Ankle/Trauma
Stephen Cook, MD Spine
Setting UOA further apart from other practices, the new facility has a comfortable learning center at which seminars for medical students and residents will be conducted. The learning center will serve patients and the community such as primary care physicians and athletic trainers as well. There, pre-surgical sessions will be conducted to answer questions patients have about upcoming procedures. The sessions will also help patients understand what will be expected of them during their course of treatment. Outcomes are always improved when patients are aware of the commitment they need to make prior to undergoing a surgical procedure. In this way, there are no surprises afterwards and patients can play an active role in the recovery process. Of course, the most important asset of any medical practice is the expertise of its physicians. At University Orthopaedic Associates, all of the surgeons treat general orthopaedic conditions affecting adult, adolescent and pediatric patients. Each, however, has also been fellowship trained in one of the subspecialty areas of orthopaedic care. New Jersey Physician had the opportunity recently to meet with some of the UOA surgeons in order to learn about the innovative developments within each of their specialties. One of the original founders of University Orthopaedic Associates was Joseph Leddy, MD, who is presently retired. Dr. Leddy sub-specialized in surgery of the hand and upper extremity. It is a great source of pride for the practice and most certainly for Dr. Leddy that his son, Timothy P. Leddy, MD, is currently one of the hand and upper extremity specialists at UOA. “It was a really unique and wonderful experience for me to train under him when he was one of the professors here and also to join with him in practice here for the few years before his retirement,” Dr. Leddy happily remembers.
Like his dad before him, one of the complex procedures Dr. Leddy performs is delicate surgery on infants with congenital differences of the hand. He relates a current case involving two sisters who were born with thrombocytopenia-absent radius (TAR) syndrome. Originally operating on the sisters as infants, Dr. Leddy recently operated on one of the sisters now that she is sixteen. Besides all of the innovative hand and upper extremity surgeries Dr. Leddy performs as an orthopaedic subspecialist at UOA, he receives immeasurable gratification from the work he does with Health Volunteers Overseas. This program sends specialists to other countries to impart expertise and also to learn from their international counterparts. Dr. Leddy serves as a site director for hand surgery in Peru, where there is a need for access to technological developments in the most sub-specialized areas of orthopaedics. In terms of the imminent opening of UOA’s all-inclusive new facility, Dr. Leddy looks upon this as the appropriate next step in the evolution of the practice, which has continually grown in size as well as expertise since his dad helped found it almost forty years ago. Along with the elder Dr. Leddy in 1972, the original foundation of the practice included Joseph Zawadsky, MD, who is also retired, and Michael P. Coyle, Jr., MD. Today, Dr. Coyle, who specializes in surgery of the hand and upper extremity, is the senior staff member of University Orthopaedic Associates. Dr. Coyle has witnessed the evolution of UOA firsthand and believes the opening of the new facility will be another positive development. “This is going to streamline things for us,” he says. We will be doing basically the same things we’ve done in the past, but probably much more efficiently for the patient,” Dr. Coyle foresees. Fortunately for patients and also colleagues at UOA, who can avail themselves of his considerable experience, Dr. Coyle has no immediate plans to retire.
Timothy M. Hosea, MD Sports Medicine
Timothy P. Leddy, MD Hand & Upper Extremity
James T. Monica, MD Hand & Upper Extremity
David R. Polonet, MD Trauma
Gino Chiappetta, MD Spine
Jeffrey R. Bechler, MD Sports Medicine August 2011
5
by Dr. Monica is the Latarjet procedure, which is used for stabilizing shoulders that suffer repeated dislocations. The procedure involves transfer of the coracoid with its attached muscles to an area in front of the socket (glenoid) that is deficient, thereby replacing missing bone and preventing further dislocations. He also shares information about a neurotization procedure to transfer healthy nerves from one part of the upper extremity to nerves that are no longer functioning, usually as a result of traumatic injury. Dr. Monica explains that the patients in question often have no bicep or deltoid function, preventing them from lifting or flexing the arm. Neurotization, which takes redundant healthy nerve, and brings it over to the nerve that feeds the deltoid or biceps, will help muscle with damaged nerves to eventually regain their function. Also fellowship trained in hand and upper extremity surgery, Christopher Doumas, MD, has been with UOA for almost five years. Dr. Doumas spends much of his time in UOA’s Monmouth County satellite office, located in Wall, N.J., and also serves as Director of Hand Surgery at Jersey Shore University Medical Center. “I really like the academic side of this practice,” Dr. Doumas mentions, as one important reason he decided to join. He is involved in researching bio-mechanics and feels that being a member of UOA will give him the opportunity to continue that pursuit.
p Dr. Harwood begins hip replacement as residents look on
Working with Dr. Leddy and Dr. Coyle in hand and upper extremity surgery is one of UOA’s newest members, James T. Monica, MD, who has specific fellowship training in shoulder surgery as well as in hand and upper extremity surgery. “Ailments of the shoulder, elbow, and hand are incredibly common. It’s a privilege to use my subspecialty training to help my patients,” Dr. Monica expresses, referring to the innovative upper extremity procedures that he is able to perform. Dr. Monica describes reverse total shoulder replacement surgery for people who have
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New Jersey Physician
severe arthritis and who also have rotator cuff tears that are irreparable. This would also be appropriate for a young person with a tear that could not be repaired in the traditional manner. In this innovative procedure that has not yet become commonplace, the socket and ball are switched. A metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm. Another cutting edge procedure performed
Dr. Doumas, who specializes in minimally invasive nailing of clavicle fractures and arthroscopic triangular fibrocartilage (TFCC) repairs, published two chapters on wrist fractures last year. He is currently developing a new TFCC ligament reconstruction procedure that is less invasive. Dr. Doumas is passionate about helping people and chose his profession in order to have the opportunity to do just that. In fact, Dr. Doumas is willing to donate his services to those in need. He spent time in Haiti, for example, to treat victims of the devastating earthquake there.
University Orthopaedic Associates spine surgeons include Stephen S. Cook, MD and Gino Chiappetta, MD. Joining the practice in 2005, Dr. Chiappetta treats patients with disorders of the spine caused by illness or injury. Dr. Chiappetta is gratified to be a member of UOA for many reasons. One of the most significant for him is its affiliation with academic medical centers like Robert Wood Johnson University Medical Center, which is a Level I trauma center, and also Jersey Shore University Medical Center, which is Level II. “We get referrals of patients with complex spinal cord injuries, spinal traumas, spinal cord tumors and also those who need revisions of prior surgeries. In terms of being here, we have the resources at the hospital as well as the surgical skills to handle any high-level, complex case,” Dr. Chiappetta shares. For example, Dr. Chiappetta cites an upcoming case of an adult scoliosis patient who requires revision of a past surgery performed by another spine surgeon. Dr. Chiappetta is also the first spine surgeon to perform both cervical and lumbar artificial disc replacement surgery at Robert Wood Johnson University Hospital. In addition to these extraordinary complex procedures, Dr. Chiappetta utilizes the most current technology for those procedures that are somewhat more commonplace, such as cervical and lumbar spine fusions. For instance, appropriate patients might opt for a lumbar fusion that is done using the minimally invasive Extreme Lateral Interbody Fusion (XLIF) technique of approaching from the side of the patient as opposed to anterior or posterior entry. In fact, with the opening of UOA’s new facility and its three state-of-the-art operating suites, Dr. Chiappetta looks forward to performing many minimally invasive spine procedures there. UOA’s joint replacement specialist is David A. Harwood, MD. Dr. Harwood shares some of the innovative joint replacement surgeries
p The incision in the hip is relatively small allowing for less blood loss
which he performs. For many younger, more active patients, traditional hip replacement surgery is not the best option because there are limitations to the activities that can be resumed afterwards. For these individuals, Dr. Harwood performs computer-assisted Birmingham hip resurfacing. Unlike total hip replacement, which requires removal of the femoral head and the insertion of a hip stem down the shaft of the femur, hip resurfacing preserves the femoral head and neck. Dr. Harwood shaves only a few centimeters of bone around the femoral head and shapes it tightly to fit the Birmingham hip implant, not unlike fitting a cap for a tooth. The vast majority of patients who undergo this procedure can eventually resume their active lives without limitation. Dr. Harwood is most excited about a knee replacement procedure he has recently incorporated that is practically bloodless. With the benefit of remarkable new technology developed by Smith & Nephew that uses MRI and x-ray images to custom-fit surgical instruments to each patient’s unique anatomy, Dr. Harwood can merely snap the computer-mapped, customized implant on the end of the femur, saving countless steps required in the traditional procedure. He
explains that before, a big hole was made in the femur bone for a rod to hold the jig needed to make the cuts. This created a great deal of blood loss. Now with this less invasive, computer-mapped approach, besides experiencing less blood loss, patients require less time under anesthesia and have a lower risk of infection. Combining patient-matched technology with technology also developed by Smith & Nephew that extends the life of the replaced knee allows Dr. Harwood to provide optimal results for patients of all ages. With implants created by using a combination of materials that have been tested to simulate 30 years of wear performance, Dr. Harwood explains that even patients in their 30s and 40s can now undergo knee replacement surgery without worrying about another procedure 10 or 15 years down the road. Like his colleagues at UOA, Dr. Harwood is looking forward to the opening of the new facility. “There’s going to be plenty of parking, plenty of comfortable places to wait and even a coffee shop where patients can grab a bite,” Dr. Harwood shares. He further reveals there will be accessibility not only for handicapped people in wheelchairs, August 2011
7
but also for patients on stretchers who come by ambulance. “It has been very well thought out,” he adds, wanting to credit those at UOA who have spent a great deal of time working on all of the details that will definitely set their facility apart from others.
p Dr Harwood prepares to fit the prosthetic hip into place
UOA’s comprehensive trauma specialists include Carlos A. Sagbien, MD, Mark S. Butler, MD, David R. Polonet, MD, and John M. Delgado, MD. In addition to treating patients who have been involved in a traumatic event resulting in an orthopaedic injury, many are involved in various research projects. In fact, at the 42nd Eastern Orthopaedic Association meeting taking place in Williamsburg, VA, this coming October, Dr. Sagebien and Dr. Harwood are presenting the protocol they developed to reduce blood loss in total knee replacement surgery, as described above. Dr. Sagbien points out the fortunate timing of this less invasive knee replacement in terms of the opening of UOA’s new facility - complete with ambulatory surgical suites. “In the near future, there is a high likelihood that for the right patient at the right age, same day knee replacement surgery will be performed at our new facility,” he predicts. Additionally, Dr. Sagbien is currently conducting research on bisphosporaterelated femur fracture in patients with osteoporosis who have been on medications like Fossomax for extended periods of time. He reiterates the importance of screening patients and monitoring their medications to prevent serious side effects. Again, the new facility, with dexa scanning on site and a dedicated NP, will be instrumental in providing patients who have osteoporosis the highest level of care. Whether it’s for the “weekend warrior” or the serious athlete, University Orthopaedic Associates offers the most innovative and effective sports medicine treatment. Jeffrey R. Bechler, MD, Charles J. Gatt, MD, Timothy M. Hosea, MD, and newest member Aman Dhawan, MD, ensure that patients can “get back in the game”.
p Dr Gatt begins shoulder arthroscopy by marking the incision site.
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New Jersey Physician
Dr. Hosea specializes in sports medicine at UOA and also serves as the team physician of US Rowing and Rutgers University. Dr. Hosea shares his work on a novel surgical system for one-step repair of damaged articular knee cartilage for patients between the ages of 18 and 55. Dr. Hosea was one of only five specialists nationwide and the only one in New Jersey to initially collaborate on a clinical trial to evaluate the safety and effectiveness of the Cartilage Autograft Implantation System (CAIS™) as compared to microfracture, which is the traditional surgical approach. Microfracture repairs have been shown to not hold up well over time. CAIS™ involves removal of a small sample of healthy cartilage from a nonweight or low-weight bearing area of the patient’s own damaged knee. That cartilage is then broken up and combined with an absorbable material (scaffold) on which cells can grow. This scaffold is implanted at the damaged site to promote healing. Dr. Hosea and the research team followed a group of 29 patients with damaged knee cartilage, randomly assigning the participants
to either the CAIS™ or microfracture group. Patients’ progress was monitored for two years using standardized assessment tools and MRI imaging. The results, published this past June in the American Journal of Sports Medicine, found CAIS™ to be a “safe, feasible and effective method that may improve long-term clinical outcomes” for patients with damaged knee cartilage. Since that pilot study, the FDA has now expanded the program to include 300 patients. Along with the other UOA surgeons, Dr. Hosea feels fortunate to be a member of a practice that embraces academic pursuit. “We try to set a good example for our residents and medical students so they see that you have to continue to grow,” Dr. Hosea relates. “You can read your journals and go to meetings, but you should be involved at the cutting edge of things. Our practice reflects this with our team of orthopaedic specialists, who are the ‘best of the best’ from throughout the country. For example, our newest sports medicine physician, Dr. Aman Dhawan, completed his fellowship in sports medicine and shoulder surgery at the
p Close up of shoulder arthroscopy as shown on the monitor
prestigious Rush University Medical Center. That’s where I think we like to see that our group is at—we always want to be at the cutting edge of orthopaedics in New Jersey,” he emphatically states. Charles J. Gatt, Jr., MD, is also a sports medicine surgeon at UOA and serves as Chairman of the Department of Orthopaedics at UMDNJ. Dr. Gatt is in total agreement with Dr. Hosea and the other surgeons at UOA regarding the obligation they have to teach and set an example for medical
p Dr. Gatt trains an orthopaedic surgical resident during shoulder surgery. Dr Gatt and his colleagues at UOA feel that keeping current with the latest technology in orthopaedic surgery is imperative to properly educate those who are in training. August 2011
9
school students and those who are in an orthopaedic surgery residency program. “Everyone at University Orthopaedics, including myself, is a faculty member at Robert Wood Johnson Medical School. With that responsibility there is a direction of the practice that keeps us at the cutting edge of orthopaedics,” Dr. Gatt states, unaware that Dr. Hosea voiced the same sentiments only moments before. Dr. Gatt feels that it is only by keeping current with all of the latest technologic developments in orthopaedic surgery that he and his colleagues at UOA can properly educate those who are in training. As part of his residency teaching, Dr. Gatt is also quite involved with basic science research. As such, he has been funded by the NIH and the Department of Defense to develop a tissue-engineered replacement for the meniscus. Perhaps the most common procedure in orthopaedic surgery is a partial meniscectomy, which is the removal of a torn meniscus. However, at present there is no replacement available on the market. Dr. Gatt is far enough along in this research that he is able to predict that clinical trials can begin
in as little as two years. Equally exciting, Dr. Gatt is also working on a tissue-engineered ACL replacement. Currently, the ligament is rebuilt by taking part of the patella or the hamstring. When this replacement device is approved, hopefully within five years or so, post-surgical pain that commonly occurs at the site of the harvested tissue will be eliminated and the entire recovery process will be hastened. As sports medicine specialists, Dr. Gatt and his colleagues at UOA are concerned about the welfare of the young athletes whom they treat as well as those throughout the state. In particular, Dr. Gatt refers to stress fractures which are common in adolescents. Very often pediatricians or primary care physicians will advise these youngsters to abstain from sports participation for a month or six weeks until the fracture heals. Dr. Gatt explains that in most cases activity modification is a better approach. While he will recommend limitations on practice sessions, Dr. Gatt’s treatment methods allow the patient to “stay in the game”. In an effort to educate PCPs, trainers, parents and young athletes, Dr. Gatt and other sports medicine
experts have created an Internet data base that shares correct information for a variety of stress fracture situations. Whether for a infant with a congenital difference, an adolescent or adult athlete with a sport-related injury, a weekend warrior, a victim of a traumatic event, or a person who is merely experiencing the wear and tear of an active life, the sub-specialized surgeons at University Orthopaedic Associates continue to offer comprehensive, cutting-edge care and treatment. In fact, throughout the almost 40 years since its inception, UOA has developed life-long relationships with patients, providing care as the situation warrants. With the opening of its magnificent, all-inclusive facility, University Orthopaedic Associates has a new home at which patients will receive the highest level of integrated orthopaedic healthcare services available. For more information about UOA and its office locations or to schedule an appointment, call 732-545-0400 or visit www.uoanj.com.
p The soon to be new home of University Orthopeadic Associates, where patients will be able to receive all inclusive care and treatment.
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New Jersey Physician
Statehouse
New Jersey Statehouse New Jersey Durable Power of Attorney Laws More Information on Durable Power of Attorney Laws Specific Powers, Life-Prolonging Acts Decisions to accept or refuse treatment, service, or procedure used to diagnose, treat, or care for a patient’s physical or mental condition including life-sustaining treatment. Includes decisions on acceptance or rejection of services of particular physician or health care provider or transfer of care; on the use of any medical device or procedure, artificially provided fluids and nutrition, drugs, surgery or therapy that uses mechanical or other artificial means to sustain, restore, or supplant a vital bodily function and thereby increase the expected life span of a patient; does not include provision of comfort care or alleviation of pain. Legal Requirements for Durable Power of Attorney (1) Competent adult; (2) signed; (3) dated; (4) 2 witnesses who shall attest that declarant is of sound mind and free of duress and undue influence or notarized or other person authorized to administer oaths. May be supplemented by video or audio tape recording; (5) directive implemented when determination of lack of decision-making capacity is documented and confirmed by physicians. Revocation of Durable Power of Attorney Revocable by (1) oral or written notification;
(2) execution of subsequent directive; (3) divorce revokes former spouse’s designation as representative. Patient’s clearly expressed wishes take precedent over any patient’s decision or proxy directive. Validity from State-to-State Effective if executed in compliance with New Jersey law or the laws of that state. Effective if executed in a foreign country in compliance with that country’s laws or the laws of New Jersey and is not contrary to public policy of New Jersey.
If Physician Unwilling to Follow Durable Power of Attorney Unwilling physician should act as soon as practicable to effect an appropriate, respectful and timely transfer care and to assure patient is not abandoned or treated disrespectfully. Immunity for Attending Physician No civil, criminal, or professional liability for any physician acting in good faith and pursuant to this act.
The healthcare business environment continues to be increasingly turbulent.
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11
Health Law Update
Health Law
Update
Provided by Brach Eichler LLC, Counselors at Law
Reducing the Gap: OIG Permits Waiver of In-Patient Deductible
In a recent Advisory Opinion (11-09), pub-
Medigap plan, would be reduced up to 100%
While the Anti-Kickback Statute prohibits re-
lished in near identical form to an opinion is-
when an insured is admitted to an in-network
muneration in the form of waivers of Medicare
sued in 2009, the Office of Inspector General
hospital participating in a preferred provider
cost-sharing amounts, regulations provide a
(OIG) of the Department of Health & Human
organization (PPO). The Medigap provider
safe harbor for inpatient deductibles when
Services stated that it does not object to an
would pay the PPO an administrative fee each
they are part of an arrangement with an in-
arrangement whereby a company licensed
time it receives this discount from an in-net-
surer. Further, the law provides a statutory
to provide Medigap policies contracts with
work participating hospital. Further, the sav-
exception for differentials in coinsurance and
hospitals to reduce or eliminate the Medi-
ings would be shared with the policyholder in
deductibles as part of a benefit plan design,
care in-patient deductible. This deductible,
the form of a $100 premium credit.
thus allowing for the premium credit.
which would otherwise be covered under the
Medicare Fraud Scheme Foiled: New Jersey Man Admits Posing as Doctor and Treating Elderly Patients On July 11, 2011, Patrick Lynch of Toms River,
care for elderly home-bound patients in the
ing as the licensed professionals, using their
New Jersey pled guilty and admitted to unlaw-
Monmouth and Ocean County areas. Since
names and government-issued identification
fully treating patients, prescribing medicine
Lynch was neither a licensed physician nor
numbers to write prescriptions and submit
and ordering procedures while posing as a
a nurse practitioner, he hired licensed indi-
billings to Medicare. Sentencing (including
licensed physician. Pursuant to documents
viduals to conduct patient visits. When Lynch
determinations of possible jail time, monetary
filed in the case and statements made during
failed to pay the licensed physicians and nurse
penalties and restitution) is scheduled for Oc-
the guilty plea proceeding, Lynch created Vis-
practitioners, they quit. Subsequently, Lynch
tober 17, 2011.
iting Doctors of New Jersey to provide medical
continued to carry on the business by pos-
New Physician Assistant Rules Adopted in Part and Rejected in Part Last year, the New Jersey State Board of Medi-
facilities and other appropriate agencies and
opted by the BME and was effective as of July
cal Examiners (BME), in consultation with
resources in the community, instead of “fa-
5, 2011, provides for the supervisory ratio of
the Physician Assistant Advisory Committee,
cilitating the referral� of such services. This
four PAs to one physician in all settings at any
proposed two amendments to N.J.A.C. 13:35-
amendment was rejected by the BME and
given time. Under prior BME rules, in a pri-
2B, concerning physician assistants (PAs).
was, therefore, not adopted.
vate practice setting, the supervisory ratio was
The first amendment would have allowed PAs to refer patients to health care practitioners,
12
New Jersey Physician
two PAs to one physician, and in all other setThe second amendment, which has been ad-
tings, the ratio was four PAs to one physician.
Health Law Update
CMS Releases Proposed Rules for 2012 Medicare Payments The Centers for Medicare & Medicaid Services
System (PQRS), the e-Prescribing incentive
takes into account the Consumer Price Index
(CMS) recently published proposed rules for
program (eRx), and the Electronic Health
for Urban Consumers (a 2.3% increase), as
Medicare payments in calendar year 2012 for
Records (EHR) incentive program
well as the productivity reduction under the
physician services, outpatient hospital and
• Provides for quality and cost measures for
ambulatory surgery services, and home health
a new value-based modifier (VM) that will
agency services. Comments to the proposed
reward physicians for providing higher
implementing a quality reporting program
rules must be submitted to CMS by August
quality and more efficient care.
Under
for ASCs in 2014; ASCs that do not report
30, 2011, and the final rules will be published
this proposal, CMS would use calendar
quality measures would receive reduced
sometime in November 2011. The following
year 2013 data for purposes of adjusting
Medicare payments
summarizes some of the key proposals:
payments in calendar year 2015
Affordable Care Act (a 1.4% decrease) • Proposes
eight
quality
measures
for
Home Health Agency Prospective Physician Fee Schedule: • Unless
Congress
enacts
legislation
Hospital Outpatient Prospective
Payment System:
Payment System:
• Reduces Medicare payments by 3.35%. This
otherwise, reduces Medicare payments by
• Increases Medicare payments by 1.5% for
takes into account the market basket and
29.5% due to the Sustainable Growth Rate
hospitals publicly reporting data on 23
wage index updates (a 1.5% increase), as
(SGR) formula imposed under the Balanced
quality measures, and decreases Medicare
well as the prospective payment system rate
Budget Act of 1997
payments by 0.5% for hospitals not
reduction (a 5.06% decrease) in response
submitting such data
to increases in aggregate case-mix due to
• Expands the Multiple Procedure Payment Reduction (MPPR) policy – which currently reduces
payment
component”
for
associated
the
“technical
with
certain
• Increases the number of quality measures that must be reported under the hospital quality reporting program;
billing practices rather than changes in the health status of patients
nine new
• Revises the case-mix system, including
procedures performed on the same patient,
measures would be added in 2012, and one
the exclusion of two hypertension codes
on the same day and in the same setting – to
new measure would be added in 2013
and lowering payments for high therapy
include a 50% reduction in payment for the
• Proposes a new independent review
“professional component” for CT, MRI and
process to determine the appropriate
• Allows greater flexibility, in acute care and
ultrasound services
level of physician supervision needed for
post-acute care settings, for a physician to
outpatient therapeutic services
satisfy the requirement of having a face-to-
• Provides criteria for performing health risk assessments as part of the annual wellness visit • Updates the Physician Quality Reporting
episodes
face encounter before certifying that the Ambulatory Surgery Services:
patient is eligible for home health benefits
• Increases Medicare payments by 0.9%. This
Medicaid RAC Program is Underway in New Jersey On July 7, 2011, the New Jersey Medicaid
The Centers for Medicare & Medicaid Services
Fraud Division, in association with the Divi-
(CMS) has yet to issue final regulations gov-
sion of Medical Assistance and Health Ser-
erning the Medicaid RAC program. CMS has,
vices (DMAHS), implemented the Medicaid
however, advised states that they can proceed
Recovery Audit Contractor (RAC) program.
with implementation. New Jersey has chosen
Additionally, DMAHS is expected to issue a
to move forward utilizing the proposed Med-
provider alert to introduce the choice of HMS
icaid RAC rules and the structure of the Medi-
Government Services as New Jersey’s Medic-
care RAC program as the basis for the Medic-
aid RAC.
aid RAC program.
August 2011
13
Health Law Update
SHOP and Exchange - Adding Up the Change in a State-Run Insurance Market Progressing toward putting America’s
partnership with other states (i.e., regional) or part
is examining implementation strategies for New
healthcare
into
of an existing state agency. The federal government
Jersey, in a project commissioned by Governor
action, the Department of Health &
has offered grants, and 48 states – including New
Christie. DHHS is accepting comments to the
Human Services (DHHS) announced
Jersey – have accepted such grants, to plan and run
proposed rules until September 24, 2011.
draft guidelines for states to follow
insurance exchanges. Presently, Rutgers University
in
system
crafting
overhaul
state-run
exchanges.
insurance
The Affordable Care
Act (ACA) mandates that states offer a competitive marketplace for consumers and small businesses to compare and purchase health insurance. exchanges
States will host two -
one
for
individual
consumers and one available for small businesses. States are required to go live by January 1, 2014.
Financial Wellness that Grows Practices
advising medical practices. We have
As proven business advisors and
is more difficult than ever. Using
guided our clients through the
mentors, we have structured our
an accounting professional that
complex issues of managed care,
firm around the philosophy of
specializes in Healthcare is no
government regulation and
Financial Advocacy. As Financial
longer a luxury, it is a necessity.
intervention, and the business of
Advocates, it is our job to fight for
The professionals at Dorfman
practice management.
your money, not just account for it.
Practicing in today’s environment
Standards that employers must meet
Mizrach & Thaler, LLP have more
We are dynamic, inquisitive, and
to participate in SHOP (Small Business
than thirty years of experience
challenging, ultimately, helping
Health Options Program), standards for establishing an exchange, basic
you to best utilize your income to achieve your financial goals while making sure that you are protected.
functions of an exchange and health plan participation criteria have each
• Practice Valuations
been illuminated as key areas by
• Compensation Formulation
DHHS.
• Practice Expansion Strategies
For instance, health plans
offered on the exchange must be certified as Qualified Health Plans (QHP), which must meet minimum standards stipulated by the ACA and the proposed rules in order to participate.
Small businesses will
be eligible to receive tax credits for insurance purchased on exchanges
• Practice Assessment and Benchmarking • Buy /Sell Agreements • Accounting, Auditing & Taxation • Mergers and Acquistions • Consulting • Employee Benefit Planning • Estate Planning To learn more, call Steve Mizrach,
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Partner-In-Charge, Healthcare
To reduce administrative duplication of efforts, states will be permitted to
Services at 732-404-1860 or visit us online at www.dmtcpas.com.
partner with the federal government, or states can develop their own exchanges in conformance with federally-mandated
rules.
The
proposed rules allow states to select whether to have the insurance exchanges run by a non-profit in
14
New Jersey Physician
555 Route 1 South, Iselin, NJ 08830 PH: 732- 404 -1860 • FAX: 732- 404 -1868 www.dmtcpas.com
Surgery Center Liability Specialists 30 Technology Drive, Warren, NJ 07059
•
(877)769 -1999
Argent Professional is New Jersey’s leading medical professional liability insurance agency, specializing in Ambulatory Surgery Centers, and other healthcare facilities. Our knowledge, expertise and access to all of the major NJ markets helps to ensure our clients find the best possible coverage at the lowest available rates.
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To obtain an indication, please complete and fax to (908)769-7477 Facility Name:
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Procedure type: Effective Date: Coverage Type: Insurance Company:
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This information will be used to provide indications only. Coverage cannot be bound without underwriting approval.
)
Hospital Rounds
New Chief Medical Officer Named at The Cancer Institute of New Jersey Montgomery Township Resident Tapped for Leadership Post A Belle Mead (Somerset County) resident has
she will be responsible for compliance with
and clinician, Dr. Toppmeyer has drawn upon
been named the new chief medical officer
all clinical medical policies, regulations and
and shared that wealth of experience in order
at The Cancer Institute
clinical performance standards of the state, the
to successfully meet the needs of patients
of New Jersey (CINJ).
federal government, and accrediting bodies.
while growing CINJ clinic operations and
Deborah L. Toppmeyer,
She will have oversight and responsibility for
clinical trial accrual. I have every confidence
MD, an associate professor
all of CINJ’s clinical objectives and serve as
that in her new role, she will help move CINJ
of medicine at UMDNJ-
CINJ’s ultimate authority on medical issues.
forward in an even greater capacity,” noted Dr.
Robert
Wood
DiPaola, a professor of medicine at UMDNJ-
Johnson
Medical School, was recently appointed by
Through her role as director both of CINJ’s
CINJ Director Robert S. DiPaola, MD. CINJ is a
Stacy Goldstein Breast Cancer Center and of
Center of Excellence of UMDNJ-Robert Wood
the LIFE (LPGA pros In the Fight to Eradicate
Toppmeyer is the author or co-author of
Johnson Medical School.
breast cancer) Center, Toppmeyer helps
more than 40 publications and serves on the
Robert Wood Johnson Medical School.
patients navigate through treatment options
editorial board of the journal Clinical Cancer
Dr. Toppmeyer joined CINJ in 1995 from the
while encouraging enrollment in clinical
Research. She also serves as a core member
Dana Farber Cancer Institute at Harvard
trials. She is also the chief of solid tumor
for the Breast Committee of the Eastern
Medical School. She is an expert in breast
oncology at CINJ.
Cooperative Oncology Group, which is one of the nation’s largest clinical cancer research
cancer, breast cancer genetics and the design and implementation of clinical trials that offer
“Over the past 16 years, Dr. Toppmeyer has
organizations that conducts clinical trials in all
promising new therapies targeted to specific
played an integral role in the advancement and
types of adult cancers.
types of breast cancer. As chief medical officer,
success of CINJ. As a renowned researcher
Children’s Hospital of New Jersey at Newark Beth Israel Medical Center
First in NJ to Place Pulmonary Valve via Catheter-Based Procedure New Jersey’s first transcatheter pulmonary
defects. These heart defects require treatment
In children born with certain kinds of heart
valve was placed on August 18 at Children’s
from a collaborative team of adult and
defects, the blood vessel leading from the
Hospital of New Jersey at Newark Beth Israel
pediatric cardiac specialists as the child grows
heart to the lungs and the valve, known as a
Medical Center. The 14-year-old young man
into an adult.
conduit, are surgically constructed early in the child’s life. “These conduits can have a
from Jersey City with congenital heart disease who received the device went home the
“The transcatheter pulmonary valve allows
limited lifespan and typically require repair or
following day and was able to avoid having
patients to undergo a much less invasive
replacement as the patients grows,” noted Dr.
what would have been the fourth open heart
procedure that improves the flow of blood
Verma. “The device allows us to replace the
surgery in his lifetime.
from the heart to the lungs,” said Rajiv Verma,
pulmonary valve in the conduit without the
MD, Director of the Children’s Heart Center
long recovery and risks associated with open
Thanks to advances in medical and surgical
at The Children’s Hospital of New Jersey at
heart surgery.”
care, most children with congenital heart
Newark Beth Israel Medical Center, who, along
defects are surviving into adulthood. In
with Marc Cohen, MD, Chief of Cardiology at
Placement of the Melody transcatheter
fact, today, there are more adults living with
Newark Beth Israel Medical Center, placed the
pulmonary valve, approved by the FDA in
congenital heart disease (500,000) than
first Melody valve in the state.
2010, requires the expertise of pediatric and
children diagnosed with congenital heart
16
New Jersey Physician
adult cardiologists, an experienced cath
Hospital Rounds and obstacles.
lab team of physician assistants, nurses and
each heart affected by congenital disease
technicians, as well as an available on-site
is unique and by the time these patients are
pediatric cardiac surgery team.
young adults, they have undergone multiple
Once deployed, the valve begins to function
heart surgeries,” said Dr. Cohen. He compares
immediately and the patient can resume
The Melody valve is placed with a catheter
the challenge of guiding a catheter through
normal activities within a few days. In
that is inserted into a vein in the leg and
such hearts to driving along a highway that is
comparison, full recovery from open heart
guided up into the heart. “The anatomy of
under construction with detours, blockages
surgery can take several months.
N.J.’s Hackensack University Medical Center announces ACO Hackensack
(N.J.)
University
Medical
Center said its employees would pilot the
for Hackensack’s new accountable care
across the U.S. The Patient Protection and
organization, a limited liability company
Affordable Care Act included a provision for Medicare to offer accountable care contracts—
organization’s attempt at accountable care, a payment model that has gained proponents
Hackensack
since the passage of the 2010 health reform
of
joins
number
which offer financial incentive to providers
private-market
that meet quality and cost-control targets—as
law. The 703-bed hospital said in a news
accountable care efforts. A recent Modern
early as 2012. Recently proposed Medicare
release that its self-insured employee health
Healthcare survey of accountable care
ACO rules drew criticism from providers, who
plan
called the Hackensack Physician
organizations found roughly one dozen such
argued that the financial risks of forming an
Alliance would provide the patients needed
initiatives in various stages of development
ACO according to the proposed regulations
hospitals
a
growing
launching
outweighed possible incentives.
Let Brach Eichler’s Health Law Practice Group Help You Chart a Strategic Course For Your Health Care Business Health care providers have long come to rely on the attorneys of Brach Eichler to navigate the regulatory environment at both the state and federal levels. Now that health care reform is being implemented, Brach Eichler is ready to help you make sense of the significant changes, the statutory framework and the ramifications for health care providers in New Jersey. Health Law Practice Group Todd C. Brower Lani M. Dornfeld
John D. Fanburg Joseph M. Gorrell
Richard B. Robins Jenny Carroll Chad D. Ehrenkranz
Carol Grelecki Debra C. Lienhardt Kevin M. Lastorino Mark Manigan
Lauren Fuhrman Eric W. Gross Rita M. Jennings
Leonard Lipsky Isai Senthil Edward J. Yun
101 Eisenhower Parkway • Roseland, New Jersey 07068 • t. 973.228.5700 • f. 973.228.7852 • www.bracheichler.com August 2011
17
Food for Thought
Serenade
Chatham, New Jersey By Iris Goldberg
I have consistently found that when you visit a restaurant that has been touted by reviewers or by personal acquaintances, it never lives up to its reputation. I think Serenade has fallen victim to this. Located in quaint Chatham, Serenade is the type of place that is often selected for a special occasion. In fact, before our visit this past month, the last time we were at Serenade was for a “milestone” anniversary celebration. At that time we opted for the wine sampling meal at which each course is paired with an appropriate and presumably notable wine. I remember enjoying the anticipation of each course and the accompanying wine. We found all of the wines selected to be wonderful but we were disappointed in the small amount offered in each glass, especially in
18
New Jersey Physician
light of the price charged. That evening we did enjoy our food but we would have preferred sitting in the room with the fireplace (our anniversary is in December) but instead sat at a table in another room that was far less romantic. We had our backs to the wall and were separated from any of the other tables in what I can only describe as an alcove in that outer eating area. Nevertheless, one mid-week August evening,
spent from a hectic work schedule and the endless number of last-minute details associated with our daughter’s upcoming wedding, Michael and I felt entitled to a somewhat decadent reward and so, decided to give Serenade another go. I must say, without the pressure of an “event” we were able to judge our meal more objectively. This time we were escorted to the room with the fireplace but of course one would not
p Leek, Potato and Zucchini Pancakes With Baby Lettuces
p Tomato Salad with Toasted Mozzarella Croquettes
expect a fire during the summer. Still the ambience was lovely and we prepared for a relaxing meal. At Serenade a charming sommelier visits your table to help with the wine selection. Michael is somewhat of a wine connoisseur and always enjoys these discussions. Finally, a moderately-priced 2007 Montvac Vacqueyras was chosen. I’ve mentioned this before and it is worth repeating – we in New Jersey are fortunate to have an abundance of BYOs here. Purchasing wine at a restaurant will be significantly more costly than bringing it in with you. That being said, we each took a sip of the Rhone and had to agree, it was splendid.
Anyway, back to the food. I really treated myself and selected the rack of lamb for my entrée. It is one of my favorite dishes and since I have been watching what I eat very carefully in anticipation of my appearance as “Mother of the Bride,” I needed to indulge myself a bit. I was not disappointed. The lamb, which was served with a variety of local beans, heirloom tomato broth and couscous roulade, was cooked just as I like – medium rare. The sides were a good accompaniment. I especially enjoyed the flavorful couscous. The wine Michael had selected paired perfectly as well.
For our first course Michael chose grilled octopus served with potatoes, preserved lemon, Nicoise olives and olive oil. Octopus is a favorite for Michael but it must not be overcooked. He took his first bite and smiled. The octopus was perfectly done. He offered me a bite and I had to agree it was lovely and not at all rubbery. I went with an escarole salad that included fava beans, Parmesan cheese, grilled asparagus and cherry tomatoes in a lemon dressing. The combination of flavors and textures made for an interesting and enjoyable first course. Despite comments I’ve read to the contrary, the service at Serenade is quite attentive but not overbearing. Our server did not interrupt nor did he leave us waiting for water refills, etc. I think we sometimes expect that a so-called “fancier” restaurant will never have an off night or perhaps an employee who is not at his or her best. We often accept this more readily at an everyday eatery.
Michael had a hard time choosing his dish. He kept vacillating between the calf’s liver which he hasn’t had in years and the hanger steak. Deciding on the lesser of two evils, health-wise, he opted for the steak. He ordered this rare and that’s exactly how it came. On the side was a grilled potato puree, summer ratatouille, artichokes and Spanish chorizo. He enjoyed his meal and commented that the chorizo was a novel and surprisingly appetizing accompaniment to the beef. He too was pleased with his wine choice as a great complement to the food. Of course Serenade has a scrumptious dessert menu which we glanced at briefly, not wanting to be tempted. We settled for coffee and the last sips of the delicious wine before heading back to the real world. People can say what they want. For us Serenade provided a much needed and certainly delightful evening that wasn’t at all a special occasion when it started but somehow ended up that way. Serenade is located at 6 Roosevelt Ave. (Main Street) in Chatham, NJ (973) 701-0303.
August 2011
19
Press Release
ProMutual Group Rebrands as Coverys Launches New Name, Logo, Website Boston, MA (July 25, 2011) – Effective today, ProMutual Group, a leading provider of medical professional liability insurance, is proud to announce the launch of its new name and brand, Coverys. This change is part of the continued integration of the member companies within ProMutual Group, including recently acquired FinCor Holdings, Inc. and its subsidiaries, and is representative of the enterprise’s now national reach. Accompanying the new name and logo is a new website, which will streamline communication between Coverys member companies and the public. “We believe the new name, Coverys, will better position the member companies as an integrated whole and will better reflect the services we offer,” said Richard W. Brewer, president and CEO of Coverys. “The enterprise is now strengthened with expanded geographic, product and policy diversity as well as an enhanced ability to share expertise and best practices – we feel it is important to communicate this via our brand. The Coverys organization will continue to be a strategic thought leader and forward-thinking partner for our policyholders, now and in the future. We thank our employees and policyholders for their continued support and dedication.” “This is an exciting and important change for the organization,” said Gregg L. Hanson, chief operating officer of Coverys. “We feel privileged to have the opportunity to reach and maintain the trust of a broader range of healthcare professionals and organizations. Our unwavering dedication to financial stability, profitable growth and to protecting the livelihoods of our policyholders remains the
20
New Jersey Physician
foundation of our organization.” The name Coverys is loosely derived from the word “coverage,” which encompasses the core of the organization’s mission and value proposition. As the enterprise transitions into its new brand, it will continue to be aware of healthcare and medical professional liability reform and proactive in providing a broad range of the best possible products and coverages to its policyholders. The enterprise will emphasize adaptation to the changing industry via relevant continuing medical education (CME) programs, its innovative disclosure and apology program, REACT® (Respond Effectively And Communicate Timely), and the highest level of claims and risk management services. Coverys is committed to delivering on its vision of outstanding protection, education and patient safety.
For more information about Coverys, visit www.coverys.com. To schedule an interview with a Coverys representative contact Katharine Gould, public relations specialist, at (617) 946-8665 or kgould@coverys.com. 101 Arch Street, P.O. Box 55178 Boston, MA 02205-5178 Phone: 617.330.1755 Toll Free: 800.225.6168 Fax: 617.330.1748 www.coverys.com
About Coverys (formerly ProMutual Group) Coverys is one of the top 10 medical professional liability insurance providers in the country based on direct written premium. Coverys member companies insure more than 20,000 physicians, surgeons, dentists, certified nurse midwives and allied healthcare providers as well as nearly 500 hospitals, health centers and
In the last several years, ProMutual Group, now Coverys, expanded throughout New England as well as into New Jersey, North Carolina, Pennsylvania and Virginia via member company ProSelect Insurance Company. In September of 2009, the company acquired FinCor Holdings, Inc., which provides medical professional liability insurance and services in the Midwest and Pacific Northwest through member companies MHA Insurance Company, Washington Casualty Company, FinCor Solutions and the Risk Management and Patient Safety Institute. As a whole, Coverys member companies insure more than 20,000 healthcare professionals as well as nearly 500 hospitals, health centers and clinics in 22 states from coast to coast. The legal names of the Coverys member companies will not be changing at this time.
clinics in 22 states from coast to coast. Coverys has net admitted assets in excess of $3.0 billion as of December 31, 2010. Coverys member companies Medical Professional Mutual Insurance Company, ProSelect Insurance Company, MHA Insurance Company and Washington Casualty Company have a Best’s Rating of A(Excellent). Other Coverys member companies include FinCor Solutions, a multi-line insurance agency, and the Risk Management and Patient Safety Institute, which focuses on clinical risk reduction, quality patient outcomes and education. Coverys as a whole is acknowledged as a leader in providing risk management and claim services to the healthcare community, and it offers risk management consultations and educational activities to healthcare providers across the country. For more information on the enterprise and its member companies, visit the Coverys website at www.coverys.com.
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