f e b rua ry 2 012
Atlantic Cardiology Group, LLP Comprehensive Cardiovascular Care with a Pulse of its Own Also in this Issue • Senate Hears Bill on Health Insurance Exchange • Codey Regulations Published, Establishing Formal Mechanism for Registration of One-Room Surgical Practices • NJ Rx Monitoring Program a Good Step to Stop Abuse
Princeton Insurance knows New Jersey, with the longest continuous market presence of any company offering medical professional liability coverage in the state. Leadership: Over 16,000 New Jersey policyholders Longevity: Serving New Jersey continuously since 1976 Expertise: More than 55,000 New Jersey medical malpractice claims handled Strength: Over $1 billion in assets and $353 million in surplus as of December 31, 2010 Service: Calls handled personally, specialized legal representation, knowledgeable independent agents, in-office visits by our skilled risk consultants Knowledge: New Jersey-specific knowledge and decades of experience Innovation: Three corporate options, specialty reports, practitioner profiles, office practice toolkits, optional data privacy coverage
Publisher’s Letter Dear Readers, Welcome to the February issue of New Jersey Physician.
Published by Montdor Medical Media, LLC
The confusion regarding the licensing of single room surgical facilities continues.
Co-Publisher and Managing Editors Iris and Michael Goldberg
After the legislature passed the bill in both houses, the governor allowed the session to terminate without signing it, subjecting it to a pocket veto. The bill was re-introduced in the new legislative session . Simultaineously, the NJ DHSS has published regulations setting forth the specific procedures and form to be used for registration of one room practices as required under the “Codey Law”. If the bill requiring surgical practices to be licensed is passed into law as currently written,
Contributing Writers Iris Goldberg Carol Grelecki, Esq Joseph M Gorrell, Esq Deborah Lienhardt, Esq Keith J. Roberts, Esq Mark M. Manigan, Esq Beth Fitzgerald Kate Greenwood
it will repeal the registration requirement. In the meantime, one room surgical
from malpractice lawsuits under the NJ Charitable Imminunity Act. The NJCIA
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
protects volunteer physicians providing medical care in NJ from prosecution for
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Physician, please contact Iris Goldberg at
This month we feature a most interesting cardiology practice. With five physicians
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practices will need to register under the “Codey Law”. The US Court of Appeals for the Third Circuit recently held that the US is protected
and three locations including a very large and very beautiful restored mansion as
973.994.0068 or at igoldberg@NJPhysician.org
related to this publication to igoldberg@NJPhysician.org
their headquarters in Mendham, Atlantic Cardiology Group prides itself on having physicians available 24/7 in the office or at the hospital for their patients. The
Although every precaution is taken to ensure
caring doctors participate in all aspects of the testing and treatment of their patients,
Physician cannot be held responsible for opinions
including observing all tests personally. The practice’s philosophy is that every patient who receives testing in their facilities gets to discuss the results of the tests
accuracy of published materials, New Jersey expressed or facts supplied by its authors. All rights reserved, Reproduction in whole or in part without written permission is prohibited.
on the same day, whenever feasible, many times before the patient even leaves the office.
No part of this publication may be reproduced or transmitted in any form or by any means without the written permission from Montdor Medical
I usually don’t comment on the Food for Thought column, but I think we’ve brought
Media. Copyright 2010.
you a real find this time. Le Rendez vous in the restaurant area of Kenilworth is the most legitimate French bistro I’ve encountered in New Jersey. Excellent food, service and atmosphere accompanied by a BYO policy and reasonable pricing make this worth the trip. I do suggest that reservations are made, as the entire storefront has no more than about 30 seats. With warm regards,
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4
Contents
Atlantic Cardiology Group, LLP
Comprehensive Cardiovascular Care with a Pulse of its Own
COVER STORY
Cover Photo: The Physician Team of Atlantic Cardiology Group, from left to right: Nicholas Ricculli, DO, Phillip J Oliveri, MD, Charles A Shiloleno, MD, Domenick Randazzo, MD, and John Mondelli, MD
CONTENTS
9
Statehouse
• ( Slow) Progress Towards Uncovering Sex-Linked Differences in Drug and Device Safety and Efficacy •M edicaid ACO Demonstrations •S enate Hears Bill on Health Insurance Exchange 2
New Jersey Physician
12
14
Health Law Update
Food for Thought
Lez Rendez-Vous
Kenilworth, New Jersey
14
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
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 February 2012
3
Cover Story
Atlantic Cardiology Group, LLP Comprehensive Cardiovascular Care with a Pulse of its Own By Iris Goldberg
When a patient arrives at the central office
Founded in 1986 by Charles A. Shioleno,
was just starting,” Dr. Shioleno relates. “I was
location of Atlantic Cardiology Group (ACG)
MD, Atlantic Cardiology Group is now a
one of the original interventional people at
for the first time, there could be a brief moment
five-physician preventative, diagnostic and
Morristown Memorial Hospital,” he adds.
when that patient might forget why he or
interventional cardiology practice. In addition
In fact, Dr. Shioleno has the distinction of
she is there. In the early 1990s the practice
to the Mendham location, ACG has an
performing the first angioplasty that was done
acquired and renovated an historic residence
impressive suite of offices across the street
there and happily reports that the patient in
in Mendham that was originally constructed in
from Morristown Memorial Hospital and
question is alive and well today.
1840, transforming it into a magnificent 10,000
also in Bridgewater in order to conveniently
square foot medical facility while maintaining
accommodate its many patients throughout
During the years that Dr. Shioleno has been
its charm and authenticity. Complete with
the region.
affiliated with Morristown Memorial Hospital
working fireplaces, this unusual medical office
he has been an instrumental participant in
setting is a welcome environment for patients
Dr. Shioleno discusses some of the ways in
that facility’s transformation from a small
and for staff as well. Most important, it provides
which ACG has evolved since its inception
community hospital with very limited cardiac
the perfect backdrop for the physicians of
more than 25 years ago. He emphasizes the
capabilities to a medical center that today
ACG, who hold the comfort and well-being of
role that changing technology has played.
offers extensive cardiology services such as
patients as their top priority.
“Back in the mid 80s, interventional cardiology
advanced cardiac imaging, a highly-developed
4
New Jersey Physician
“Our practice has always been about continuity of care for our patients,” Dr. Shioleno emphasizes. Working closely with internists and other referring physicians to make sure all health care providers involved in a patient’s care share the most current information regarding medications, etc. and also, that patients are complying with prescribed treatment regimens is of paramount importance to the physicians of ACG. It is not surprising, therefore, that the four physicians who practice along with Dr. Shioleno at ACG share his thoughts regarding utilizing technology to its fullest in order to maximize patient care. Putting the patient first in terms of being accessible on a continuous basis and also sharing information amongst
p Patients can relax in this charming waiting area
themselves and with other integral caregivers angioplasty program as well as an impressive
Today ACG has incorporated the most
cardiac surgical program. “Our surgical
sophisticated EMR software technology to link
program here at Morristown is phenomenal,”
all three office locations and to provide the five
Phillip J. Olivieri, MD has been a member
Dr. Shioleno is pleased to share.
cardiologists with a secured site that allows
of Atlantic Cardiology Group since 1999. Dr.
home access to patients’ medical information
Olivieri spends his time consulting with and
In terms of evolving technology within the
as well. As a result, the physicians of Atlantic
managing the diagnosis and treatment of
practice itself, Dr. Shioleno has embraced all
Cardiology Group can participate in the care
patients who come to be seen in the office and
of the advancements along the way that have
of their patients and also consult with one
also cares for patients who are hospitalized.
enabled his colleagues and him to provide the
another whenever the need arises. Whether
highest level of care to patients. “We have had
by “smart” phone, tablet or computer, they are
Dr. Olivieri discusses the emphasis he and
electronic records on everything we’ve done
always connected with each other, their offices
his colleagues at ACG place upon educating
in the office since 1986. All of our histories
and with the hospital and pharmacies as well.
patients about the ways in which they can
is inherent for each.
and physicals, discharge summaries, cath reports, non-invasive reports, etc. have always been in electronic format since the day I started the practice. All of that was then able to be incorporated into our current EMR,” he explains. Despite the well-known challenges most practices
face
in
complying
with
the
regulations to convert to electronic medical record keeping, which were certainly present at times for ACG as well, Dr. Shioleno praises the technology. “This is something that has changed the entire way that our work flow is managed. Before, there really was no easy way of accessing certain data,” Dr. Shioleno states, referring to having to read through many pages of a patient’s chart to get the necessary information prior to EMR. “We always did what we needed to but now it’s so much easier to just electronically pull up that information.”
p This lovely office with working fireplace provides a comfortable environment for the physicians to work and consult with patients February 2012
5
•N uclear stress test •H olter and event monitoring •B lood testing with onsite laboratory facility Also, at ACG, the physician is in the room with the patient to oversee testing and intervene if necessary. He gets to see, firsthand, how, for example, a patient appears while exercising on a treadmill. This is extremely reassuring for the patient and yet another way in which the cardiologists at ACG go the extra distance to provide their patients with the highest level of personalized care. Setting Atlantic Cardiology Group apart from many other cardiology practices or from most practices within any specialty, for that matter, is the policy of the physician sitting down with p An ACG physician is always present to oversee patient testing and intervene if necessary. Shown here, Dr Ricculli observes a patient undergoing a stress test.
patients to provide test results and explain their significance that same day, before the patient leaves the office. “Our patients don’t have to
reduce their risks for developing heart disease
also reduce anxiety, ACG offers many diagnostic
sit at home waiting and worrying,” Dr. Olivieri
and also, for those who have been diagnosed,
tests within the office setting including but not
notes.
ways to most effectively manage their disease.
limited to:
Whether it’s dispensing reading material about diet, cholesterol, exercise, not smoking,
• Contrast, trans-esophageal and stress echocardiography
For ACG patients who are in need of cardiac catheterization
and
perhaps,
subsequent
controlling hypertension and diabetes – even
• Ultrasound
intervention,
providing glucometers for patients in need, or
• Carotid Doppler studies
Domenick Randazzo, MD work together
simply sitting down with a patient and having
• Peripheral venous Doppler studies
to make that experience as comfortable
an earnest conversation about appropriate
• ECG stress test
and stress-free as possible. Dr. Mondelli,
John
Mondelli,
lifestyle choices that need to be made, Dr. Olivieri relates that the physicians at ACG go to great lengths to communicate the importance of these factors. Being sensitive to the needs of patients is a constant for everyone on staff at ACG and a crucial component of delivering the best possible care in Dr. Olivieri’s opinion. “When patients have questions about their medications or other issues, I want to make myself available to them,” he states. “In fact I give my cell phone number to some of my patients so they can contact me directly,” he adds, explaining that for some, especially within the significant group of geriatric patients whom he treats, going through an answering service or making a trip to the ER can be overwhelming, particularly when there is a pressing concern. In an effort to simplify the lives of patients and
6
New Jersey Physician
p At ACG, physicians review in-office test results and discuss them with patients that same day in most cases.
MD
and
Atlantic Cardiology. “We don’t have five people doing interventions,” he says. “The patients know Domenick (Dr. Randazzo). Many have seen him here in the office,” he continues. Both physicians agree that patients’ anxiety levels before any procedure are lessened when there is an established relationship with their physician. In fact, both Dr. Randazzo and Dr. Mondelli are specialty-trained and certified to interpret nuclear stress tests and do so for their patients and for the patients of the three other cardiologists of ACG as well. Dr. Mondelli points out that the communication amongst ACG physicians about their patients who are undergoing catheterizations and possible angioplasty procedures allows for care to be collaborative and correlated. p Dr. Randazzo has entered the femoral artery from the groin in order to perform the angioplasty.
“All the pieces fit,” explains Dr. Randazzo. It’s not some random person lying on that
who joined Atlantic Cardiology Group in
Morristown Memorial. “You have cath lab
table. We have been provided with the whole
January of 2003, performs diagnostic cardiac
facilities, bypass surgical capabilities, so if
clinical scenario behind that patient and when
catheterizations in the state-of-the-art cath lab
a patient comes in on an elective basis for
he or she winds up on the cath table – we’ve
at Morristown Memorial Hospital. If it turns
a catheterization and needs a stent- that
also seen that person’s stress test and we
out that Dr. Mondelli finds that a balloon or
can be done in one visit,” Dr. Randazzo
know exactly what to look for,” Dr. Randazzo
stenting procedure is indicated, Dr. Randazzo,
states. Of course, the physicians point out,
emphatically reports.
an interventional cardiologist who has been
in an emergent situation a patient could be
with the practice since 1997, is called in.
immediately referred on to a cardiac surgeon if
“Ours is a small enough group that we tend to
bypass surgery was indicated.
know one another’s patients and they know
“We coordinate things so that we are both in
us,” Dr. Mondelli shares. This is really a plus
the hospital at the same time,” Dr. Randazzo
Dr. Mondelli reiterates the emphasis placed
when the physicians cover for one another. It
explains. I come in, we view the pictures
upon the comfort level of patients treated at
should be noted that there is always an ACG
together and if that is indeed the course of action, I scrub in and we then work together,” he adds, explaining that Dr. Mondelli will assist during the procedure. “In some instances it’s better to have four hands, four eyes and two brains,” Dr. Randazzo says. “This is also really good for patients so they don’t need to undergo two procedures,” remarks Dr. Mondelli. He refers to the situation faced by some patients treated elsewhere, who are sent home after the catheterization and asked to return at a later date for an angioplasty procedure. “We really try to streamline things for patients,” he adds. Dr. Randazzo and Dr. Mondelli discuss the advantages of working at a hospital such as
p Blockage in a vein bypass graft shown here. February 2012
7
He appreciates his role in helping people understand that it is possible to live a long and healthy life with proper management of their condition. Like his colleagues at ACG, Dr. Ricculli is sensitive to the particular issues that must be addressed in order to provide women with the highest level of cardiac care and treatment. Key to this is the understanding that heart disease in women may present with different symptoms and/or patterns. “It’s important to listen and to take what people say seriously,” Dr. Ricculli says. “Most important, you have to go that extra mile and make sure that everybody has a fair hearing in appropriate objective testing,” he adds. p Dr Ricculli appreciates his role in helping people understand that it is possible to live a long and healthy life with proper management of their condition
It is clear to anyone who spends time with the physicians of Atlantic Cardiology Group
cardiologist on call for hospital patients and
Dr. Ricculli shares that one significant reason
that they share much more than office space.
outpatients alike. With all patients’ information
why he is able to structure his schedule
There is a philosophy regarding how patients
always accessible to each, no matter what time
predominantly around seeing patients in the
should be treated that each has embraced.
of day or night or where the physician might
office is because today, more effective methods
Also, there is a priority to incorporate all of the
be physically located, continuity of care is
to treat and also prevent heart disease have
technological advancements at their disposal
ensured.
greatly reduced hospital admissions as well as
that will better enable them to provide the
the length of hospital stays. “We try to do as
highest level of care.
ACG cardiologist Nicholas Ricculli, DO
much on an outpatient basis as we can to keep
merged his clinical cardiology practice with
people out of the hospital, regardless of what
As the founder and original member of ACG, Dr.
Atlantic Cardiology Group in 1996. Dr. Ricculli
their diagnosis is,” Dr. Ricculli shares.
Shioleno has seen an unbelievable evolution in
spends the vast majority of his time seeing
what can be accomplished within the field of
patients in the office. This arrangement works
“Even if someone goes into the hospital for
cardiology to prolong and enhance life. “It’s
very well as Dr. Ricculli explains. “Patients
a cardiac catheterization and requires an
been a great field to work in,” he relates.
understand that the reason I can see them in
angioplasty, the chances are they will have both
the office whenever they need me is because
done on the same day and be discharged the
Going forward, Dr. Shioleno anticipates more
I don’t have to be at the hospital most days.”
next morning. Getting people up and moving
exciting developments in cardiology that will
He goes on to share that his patients are
and out of the hospital is a very important part
soon be realized. For example, he predicts
comfortable being seen in the hospital by one
of better patient management,” he elaborates.
there will be access to even better cardiac
of his colleagues at ACG.
imaging that will further enhance diagnostic In terms of helping his patients to comply, be
capabilities.
Conversely, he is available to accommodate an
healthier and attain a good quality of life, Dr.
office visit for patients who have a somewhat
Ricculli believes in keeping things as simple
As far as what’s on the horizon for Atlantic
urgent concern, when their own ACG physician
as possible. “I think the best you can do for
Cardiology Group, Dr. Shioleno is quite pleased
might be unavailable. Again, Dr. Ricculli,
patients is to make their treatment regimen as
with the way the practice has turned out thus
like the others, points to the sophisticated
easy to understand and follow as you can. You
far and looks towards a bright future. When
technology employed at ACG which allows
have to put things in a context that people can
asked if he has any plans to retire, he quickly
immediate accessibility and sharing of patient
relate to,” he strongly states.
responds, “I really enjoy what I’m doing and
information as the facilitator, making it possible
I’m not going anywhere.”
for the physicians of ACG to collaborate in
“A big part of what we do is to be psychologically
order to provide the highest level of care to all
soothing. Speaking to people plainly and with
For more information about Atlantic Cardiology
of its patients on a continuous basis.
confidence reassures them, especially after an
Group or to schedule an appointment call
unexpected cardiac event,” asserts Dr. Ricculli.
(973) 543-2288 or visit www.mccardio.com.
8
New Jersey Physician
Statehouse
New Jersey Statehouse (Slow) Progress Towards Uncovering Sex-Linked Differences in Drug and Device Safety and Efficacy By Kate Greenwood
In 2000, the General Accounting Office (since
to have their papers published in high-profile
Government agencies and other funders
re-named the Government Accountability
journals,” “editorial policies implemented by
have a role to play too. The NIH should more
Office) reported that more women than ever
those journals can be effective in modifying
stringently enforce the statutory requirement
were being included in clinical trials funded
behavior.” But several participants in the IOM
that certain later-stage trials it funds be
by the National Institutes of Health. In fact,
Workshop noted that studying population
designed to evaluate sex-linked differences,
the GAO noted, over 50% of the participants
subgroups poses “methodologic and analytic”
and the FDA should take similar action with
in the trials that NIH funded in fiscal year 1997
challenges.
regard to trials funded by drug and device
were women. At the same time, the NIH had
reports, “achieving statistical significance for
made much less progress implementing the
subgroup analyses would require unattainable
requirement that certain clinical trials it funds
or unjustifiable numbers of participants.”
A study published last year by Sanket Dhruva,
be designed to reveal sex-linked differences in
Workshop participant Gregory Curfman, who
Lisa Bero, and Rita Redberg in the journal
a treatment’s safety and efficacy.
is the Executive Editor of the New England
Circulation highlighted how little progress the
In
many
cases,
Wizemann
companies.
Journal of Medicine, “cautioned against
FDA made on the device side over the last
In 2012, sex-linked differences in responses
editorial policies that require trials to be
decade. In 1994, the FDA issued a directive
to treatments are still not being studied in
designed to reach valid statistical conclusions
requiring that every time it makes a decision
research funded by the government or by
for males and females separately,” because
on an application for approval to market a
the private sector. In a summary released last
“such editorial policies would create a ‘steep
new device, it issue a Summary of Safety
month of an Institute of Medicine workshop on
mountain to climb for investigators and for
and Effectiveness Data (SSED) that includes,
the problem, Theresa Wizemann reports that
funding agencies.’”
among other things, a “gender bias” statement
“even when women are included in clinical
addressing the following two questions:
trials, the results are often not analyzed by
The participants in the Workshop seemed to
sex” despite “growing acknowledgement
be largely in agreement that journals could
that men and women have substantial and
not, acting alone, re-shape “research culture
widespread biologic differences.”
to embrace consideration of sex differences as part of sound study design.” There are
1. Did the proportion of men and women in the clinical trial reflect the distribution of the disease? 2. Were there any sex-linked differences in safety or effectiveness?
As its title — “Sex-Specific Reporting of
steps that journals could (and should, I think)
Scientific Research” — suggests, a focus of the
take short of dictating study design, though,
Dhruva and colleagues reviewed all of the
IOM Workshop was whether medical journals
including requiring study authors to tabulate
of the SSEDs for all of the cardiovascular
could drive reform in this area by requiring that
and make available raw sex-specific data to
premarket approval applications submitted
authors report sex-specific data. Wizemann
facilitate future studies that draw on data from
and approved between 2000 to 2007 and
writes that because “researchers are eager
multiple trials.
found (1) that women were underrepresented February 2012
9
Statehouse in the underlying clinical trials and (2) that
of 2011 it released a draft guidance in which
(4) “reporting sex-specific information in
less than half (41%) of the SSEDs included the
it
device
summaries and labeling for approved devices.”
required “gender bias comment or analysis.”
companies work closely with the agency to
Whether these strong recommendations
Nearly a third (28%) did not even report the
“investigate and report differences in study
translate into strong and consistent agency
percentages of men and women enrolled in
outcomes of treatment by sex.”
action remains to be seen, but the Guidance
“strongly
recommends”
that
the studies supporting the application. And,
is an excellent start. As Carolyn Clancy,
there was no improvement over time; “there
The Guidance provides clear direction for
the Director of the Agency for Healthcare
was no change in the presence of gender bias
companies regarding (1) increasing the
Research and Quality, who participated in
comments or analyses over the 8-year period”
percentage of enrollees in device trials who
the IOM Workshop, emphasized, “better
studied.
are women, (2) designing studies to allow
data on women would be better data for
for the “consideration of sex and associated
everyone,” allowing for more specific clinical
The FDA has been working for several years
covariates” such as body size, (3) analyzing
practice guidelines and better-tailored care of
to address the problem and in December
study data for sex-linked differences, and
individual patients.
Senate Hears Bill on Health Insurance Exchange
State insurers line up in opposition, saying measure would squelch competition By Beth Fitzgerald in Healthcare
A bill to create a New Jersey health insurance
“We think the consumers can shop based on
Cantor said the bill’s language empowers the
exchange -- an online virtual marketplace
price, based on network, based on reputation
insurance exchange board “to certify those
where consumers and small businesses
for service and so forth,” Sanders said. The
plans that it determines provide good value
will buy health coverage -- heads for its first
provisions that allow the board to evaluate
and high-quality coverage to enrollees, and
hearing in the Senate today.
products, “based on some measure of value, and
the board does appear to have authority to
then screening products for the marketplace, is
deem a plan as not high value or high quality.”
The legislation (S1319) isn’t likely to have a
just not something we can support.”
smooth time of it: The state’s heath insurers
If an insurance exchange law is enacted,
oppose the bill, unhappy with the amount of
But some consumer advocates maintain the
regulations will be written “and the board
power it vests in the insurance exchange’s
measure does not go far enough. Ev Liebman,
will have to come up with criteria they can
governing board. They argue that the
associate state director of advocacy for AARP,
objectively apply to determine quality and
board will limit consumer choice and stifle
said the bill’s language “gives the exchange
value; otherwise they will be in court,” Cantor
competition. Some consumer advocates,
the power it needs to seek the best products,
said. “It has to be very clear.”
however, argue that the board should have
based on quality and value. We think it
more power.
could be strengthened a bit and be more
The bill was approved earlier this month by an
proscriptive.”
Assembly committee, and if voted out of the
Meanwhile, both sides disagree on who should sit on the governing board.
Senate Commerce Committee today, heads “It’s not unusual at all for the state of New
to the full legislature. Last week, the Obama
Jersey, in every single department, to actively
administration awarded $7.7 million to the
The legislation “would appear to empower
negotiate with consultants, with vendors, with
state Department of Banking Insurance to
the board to decide what products come to
whoever it might be, to get good contracts,”
move New Jersey to the next level of planning.
market and which products don’t, and we
Liebman said.
An initial $1 million grant in 2010 funded
just fundamentally don’t believe in that,” said
research by Rutgers and hired consultants
Ward Sanders, president of the New Jersey
“This does not strike me as very heavy
from KPMG, who are now analyzing the
Association of Health Plans, whose members
handed,” said Joel Cantor, director of the
technology the state needs for such an online
include the five insurance companies doing
Rutgers Center for State Health Policy, which
marketplace.
business in New Jersey.
is helping to design the insurance exchange.
10
New Jersey Physician
Statehouse The Assembly version of the bill directs to the
Also fueling debate is another area of
The bill creates a separate advisory board
board “to certify those plans that it determines
contention -- who will be permitted to serve
with insurance, healthcare, and consumer
provide good value and offer high quality
on the governing board.
advocate representatives. The Senate version
coverage to enrollees.” That language was
gives the chair of the advisory committee
deleted from the Senate bill and language
The bill excludes individuals employed by
a non-voting seat on the eight-member
substituted that directs the board to certify
health insurers and healthcare providers,
insurance exchange governing board. The
plans that “offer the optimal combination of
and prohibits them from taking jobs in the
Assembly version has a seven-member board
choice, value, quality and service.”
insurance and health industry for two years
with no advisory board representative.
after leaving the board. Sanders said the change doesn’t alter
The Christie administration has not come out
the substance of the bill -- or temper his
Consumer advocates say this provision will
in favor of the proposed bill, and under the
opposition. “It still places the exchange in
close the revolving door between government
Affordable Care Act, if a state decides not to
the role of restricting a consumer’s access
and industry and avoid conflicts of interests.
run its own exchange, the federal government
to otherwise lawful and compliant plans,”
But insurers argue the board will be far less
will step in and do it instead.
he said. “The [Senate] amendments merely
effective without the expertise that industry
change the exchange’s standard of review.”
insiders would bring.
Medicaid ACO Demonstrations A broad coalition of stakeholders of business,
from that geography on the board of the
hospital, healthcare provider, and consumer
organization. The providers in the community
groups, led by the NJ Chamber of Commerce,
will continue to receive their usual Medicaid
has joined together to propose the creation
payments and the ACO, if its providers meet
Why Medicaid Patients in New Jersey?
of Medicaid Accountable Care Organizations
quality benchmarks, would be eligible to
The concept of Medicaid ACOs in New
(ACOs) in the State of New Jersey. New
receive shared savings payments, that can
Jersey makes particular sense because NJ
legislation (S2443 / A3636) was recently
be distributed to participants based on a
has a very fragmented provider, hospital,
introduced in New Jersey to test the idea in
proposed gain sharing plan.
and payer marketplace. Medicaid patients
through the state action immunity doctrine.
a Medicaid ACO demonstration
are highly concentrated in urban,
project. Aligned closely with
impoverished cities, with a high
the ACOs described in the
percentage covered by government-
federal Affordable Care Act,
sponsored health plans that will
the legislation would create
make implementation of an all-
multi-stakeholder,
payer ACO model easier. Also,
geographic
reducing unnecessary ER and
Medicaid ACOs.
hospital use for complex, Medicaid
A Geography-Based Medicaid ACO Demonstration Project
patients is less disruptive to the
The proposed New Jersey law
providers.
existing business model of New Jersey’s hospitals and healthcare
would authorize a three-year The
Medicaid ACO demonstration
groundwork
has
already
been laid through the work of the
project whereby communitybased, non-profit coalitions can apply for
ACOs involve some complex legal issues,
Camden Coalition of Healthcare
recognition by the State of New Jersey
and the Legislature has declared its intent
Providers, a non-profit organization committed
as a Medicaid ACO. The applicants must
to exempt activities undertaken pursuant
to improving the quality, capacity, and
propose a geographic focus and will need
to the Medical ACO demonstration project
accessibility of the healthcare delivery system
100% of the acute care hospitals, 75% of the
that might otherwise be constrained by state
in Camden, New Jersey. Two similar citywide
primary care providers, two behavioral health
antitrust laws and to provide immunity for
healthcare coalitions have been formed in the
providers, and two community residents
such activities from federal antitrust laws
cities of Trenton and Newark. February 2012
11
Health Law Update
Health Law
Update
Provided by Brach Eichler LLC, Counselors at Law
NJ Supreme Court Ruling Limits Administration of EMGs to Physicians, Not PAs Last month, the Supreme Court of New Jersey unanimously ruled, in Selective Insurance Co. of America v. Rothman, M.D., that needle electromyography (EMG) studies must be performed by the physician ordering the test as opposed to a physician assistant (PA). Further, the statute providing that a person may not perform EMGs unless licensed to practice medicine and surgery prohibited physician
The new database has been collecting information from thousands of New Jersey pharmacies since September 1, 2011. To date, more than 4 million prescriptions have been entered. Starting this year, doctors and pharmacies can search and access detailed patient information on prescriptions for various drugs. The database includes, among other things, the patient’s name and date of birth; the dates on which the prescription was written and the drug was dispensed; the name, quantity and strength of the medication; the method of payment for the medication; and the identities of the prescriber and pharmacy. Law enforcement agencies also will have access to the information, via a court order.
assistants from inserting needle electrodes into a patient’s muscle and recording electrical activities during EMG tests, as this would not be merely assisting the physician, but would constitute performing the procedure itself. In reaching its decision, the court declined consideration of the defendant’s motion that the court’s decision be given only prospective, and not retrospective, effect. Thus, the defendant in the case is left to form a record on the retrospective/prospective issue in other cases that are pending for him. Since Selective Insurance and the State Board of Medical Examiners have filed complaints against the defendant alleging, among other things, fraud, the outcome of the pending matters on this issue will be of critical importance not only to the defendant in this matter, but also other physicians and PAs in the state who have interpreted the law in the past to allow for PAs to perform EMGs.
Adopted Amendment Permits Multiple Schedule II Prescriptions at the Same Time An amendment to N.J.A.C. 13:45H-7.5, which pertains to the manner of issuance of prescriptions, took effect on January 3, 2012. The amendment permits a physician to issue, and a pharmacist to accept, up to three separate prescriptions (a 90-day supply) of a Schedule II controlled substance at one time. When all prescriptions are presented at once, the second and third prescriptions are required to be held by the pharmacist until those respective prescriptions can be filled, which must be no later than 30 days after the date indicated on those respective prescriptions. In the event the first of multiple
NJ Rx Monitoring Program a Good Step to Stop Abuse Last month, Attorney General Jeffrey Chiesa announced the New Jersey Prescription Monitoring Program. The program establishes a new database which will be maintained and overseen by the Division of Consumer Affairs to track the prescribing and dispensing of controlled dangerous substances.
12
New Jersey Physician
prescriptions is submitted to a pharmacy before the others, that first prescription must be filled no later than 30 days after the date of its issuance. Subsequent prescriptions must be presented to the pharmacy and filled no later than 30 days after the date indicated on the respective prescription.
Health Law Update
Federal Court Holds NJ Law Bars Suit Against US in Malpractice Action
as currently written, it will repeal the registration requirement. In
The United States Court of Appeals for the Third Circuit recently held,
Bill Requiring Surgical Practices to be Licensed by the NJDHSS Subject to Pocket Veto; Reintroduced in New Legislative Session
in Lomando v. United States, that the United States is protected from malpractice lawsuits under New Jersey’s Charitable Immunity Act (NJCIA). The NJCIA protects volunteer physicians providing medical care in New Jersey from prosecution for malpractice. The Third Circuit Court’s decisions are controlling in New Jersey. In the case, the estate of a woman who died sued certain health care
the meantime, one-room surgical practices will need to register in accordance with the Codey Law.
providers who treated her, including a nonprofit health clinic located in New Jersey where three volunteer physicians cared for her. The
We previously reported on S2780/A3909, which would require surgical
physicians were deemed Public Health Service employees pursuant
practices in New Jersey to be licensed as ambulatory care facilities by
to the federal Public Health Services Act (PHSA) so that they would
the New Jersey Department of Health and Senior Services. In the last
be free from suit under the Federal Tort Claims Act (FTCA). Instead,
day of the legislative session, January 9, 2012, the bill was passed by
any suit for malpractice was required to be brought against the United
both houses and went before Governor Christie for action. However,
States. Although the plaintiff contended that the volunteers were not
the Governor allowed the session to terminate without signing the bill,
protected under the NJCIA because they were federal employees
subjecting the bill to a pocket veto and allowing it to come to an end
under the PHSA, the court disagreed.
with the last legislative session.
Consequently, the Court held that application of the NJCIA, coupled
The bill was re-introduced on January 23, 2012 in the new legislative
with the protections of the FTCA, precluded a suit against the United
session (S1210). We will continue to monitor the progress of the bill.
States for the alleged malpractice of the physician volunteers.
Codey Regulations Published, Establishing Formal Mechanism for Registration of One-Room Surgical Practices On January 17, 2012, the New Jersey Department of Health and Senior Services (NJDHSS) published regulations setting forth the specific procedures and form to be used for registration of one-room surgical practices, as required by the 2009 amendments to New Jersey’s “Codey Law.” The form, HFEL-8, may be found at http://web.doh. state.nj.us/apps2/forms/. The deadline for registration of one-room surgical practices in operation as of January 17, 2012 is April 16, 2012. Note that if the bill requiring surgical practices to be licensed by the NJDHSS (see article immediately following) is passed into law February 2012
13
Food for Thought
Le Rendez-Vous Kenilworth, New Jersey By Iris Goldberg
I had never been to Kenilworth to dine although
its
Boulevard
has
become
somewhat renowned as a “restaurant row.” When my sister-in-law asked if we might meet for dinner, I thought Kenilworth would be a convenient equidistant location for both of us and we could have the opportunity to sample one of its eateries. Perhaps if I had ever actually been to Kenilworth or bothered to check a map, I would have known that it is much closer to Livingston than to Manasquan, where Michael’s brother and his wife live. Nevertheless, determined to find just the right place, I took to the internet and came upon Le Rendez-Vous, which in light of the circumstances, seemed to be aptly named for our purposes. Also, I was sure that French cuisine would be fine with them. After further investigation I became convinced, based on
that Michael and I could never make it until
strange expression on his face. I got out of
the rave reviews I read, that this would be the
8:30 for dinner nor would we then be able
the car while trying to calculate how far his
ideal place.
to feel comfortable enough to get to bed at a
brother would be driving to meet us.
I contacted Janis and asked if she and Ross would like to give it a try. After doing her own research she answered back that they would be delighted to meet us there. I guess what she read really enticed her as well. Still
reasonable time. I was sure that since Janis and Ross are five years younger, they would
The restaurant is lovely. A corner storefront
prefer 8:30 and we would have to beg off. I
with about ten tables, Le Rendez-Vous is a
told the woman I would check with the other
quaint bistro that could easily be located
couple and call her back.
on a cobblestone street in Paris. The simple décor is French as well as the background
ignorant about the geography at that point, I
I was shocked when Janis e-mailed me
music. This BYO is intimate and for those
called Le Rendez-Vous to make a reservation
asking if we would mind terribly eating at
couples out for a special evening together
for the next Saturday evening.
6. Apparently, she and Ross are also too old
– quite romantic. We were shown to our
to eat late. Feeling a little better about our
table to await the arrival of Janis and Ross.
“early bird” status, I called and booked a
Thankfully, they walked in at about five past
table for 6 PM.
the hour and did not seem at all bothered by
I was surprised to hear that Le Rendez-Vous has only two seatings, one at 6 PM and another at 8:30. The woman on the phone
their trip.
shared that in this way all diners have ample
On the night in question we left our house
time to thoroughly enjoy their meals. While
at 5:15 and arrived at the restaurant by 5:40.
We started with some champagne to toast
appreciating this logic, I felt it might be a
That’s when I realized my mistake. “I didn’t
the joyous events our families have recently
deterrent. Six seemed a bit early to dine,
know we lived so close to Kenilworth,” I
shared and to accompany our appetizers. I
especially on a Saturday night but I knew
remarked. Michael looked at me with a
ordered the Napoleon of warm goat cheese,
14
New Jersey Physician
I believe the other selections in our group included a pan seared branzino with grilled polenta, asparagus and ratatouille and also a seared red snapper with black quinoa and fava beans. I did taste the snapper which was fresh as could be and most flavorful. Of course the desserts at Le Rendez-Vous are sinfully good. There’s a chocolate ganache cake served with vanilla ice cream that must be ordered at the beginning of the meal. Also creamy apple cake with lavender ice cream, cappuccino latte mouse cake and caramelized banana crepe with ice cream and chocolate sauce, to name a few. Don’t plan to dine at Le Rendez-Vous if you are dieting.
tomato confit, and baby arugula salad,
ability to so efficiently handle all of the subtle
drizzled with a twelve year old Balsamic
details involved.
vinegar. This was presented beautifully. The delicate layers of warm cheese along
For my main course I selected a pan seared
with the arugula and tomato made for a
Pekin duck breast with mushroom risotto
wonderful blend of textures and flavors, with
and a dried cherry sauce. The slices of duck
the Balsamic adding the perfect touch to pull
were perfectly cooked, not too rare but still
it all together.
pink, tender and moist. I especially enjoyed the slight sweetness of the sauce with the
The menu at Le Rendez-Vous is not extensive
meat and also as a counter point to the
but it changes continually to incorporate
risotto.
seasonal ingredients. Some of the other
The evening was wonderful and flew by. When there was nothing left to eat or drink and time for the next seating was fast-approaching, we headed for our cars. The night was raw and chilly so we quickly hugged and kissed good-by with a promise to meet again soon. To be fair, I think next time, we’ll ask them to choose. Le Rendez-Vous is located at 520 Boulevard, Kenilworth NJ 07033. (908) 931-0888
appetizers of the day included crispy duck confit with candied baby beets over a frisee salad, a mushroom fricasee with prosciuttogoat cheese ravioli and a pan-seared Foie Gras with black mission fig in a red wine reduction. To be perfectly honest, I hadn’t planned to write about Le Rendez-Vous so I did not keep track of who ordered what but I can remember everyone commenting on how much they were enjoying their food. The service at Le Rendez-Vous is unobtrusive and yet attentive. For me, this is always key to an enjoyable dining experience. The conversation flowed, uninterrupted and none of us wanted for anything. I think the owners have put a great deal of thought into how to best serve their patrons. Perhaps it’s the two structured seatings that provide the February 2012
15
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