m a r c h 2 0 11
Sabatino Ciatti, MD,
Advanced Dermatology, Mohs & Laser Surgery Center, PA Specializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer Also in this Issue
• CareCore Assures NYS Attorney General of Discontinuance of Restrictive Practices • Medical Marijuana Could Be Available by Late Spring • NJACO Pilot Bill Approved by Senate Budget and Appropriations
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Publisher’s Letter
Dear Readers, Welcome to the March issue of New Jersey Physician, the only publication advocating for the state medical community. We usually focus exclusively on New Jersey medical matters, but I couldn’t resist crossing over to our neighbor to the east when it involves CareCore getting into trouble. Seems CareCore preferred its radiologist owners in network decisions while refusing to contract with qualified physicians and physician groups for some or all of the modalities they offer. The NYS OAG alleged this is a violation of the Sherman Act which has resulted in CareCore having to purchase the full ownership interests of each of its radiologist owners. “Staggering high medical malpractice rates” are being blamed for an alarming loss of physicians statewide. Senator Jennifer Beck and Assemblyman Declan O’Scanlon have introduced legislation that is designed to reform medical malpractice laws. They claim that allowing med-mal companies to increase rates to physicians when a suit is brought against a medical professional regardless of the outcome of the case is akin to a judge handing down a sentence before the verdict is in. The bill simply aims to change the ability to raise insurance rates to the point after a decision is reached in the case.
Published by Montdor Medical Media, LLC Publisher and Managing Editor Iris Goldberg Photographer Ken Alswang, At Home Studios Contributing Writers Harlene Stevens, CPA Iris Goldberg John Fanburg, Esq. Kevin Lastorino, Esq. Michael Goldberg Derek Delia Louise B. Russell 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
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I know I’ve said this before, but perhaps this time it is real. Medical Marijuana could be available by late summer. The unique delivery model, the strictest in the country, has been agreed upon and dispensary sites have been chosen.
Although every precaution is taken to ensure accuracy of published materials, New Jersey Physician cannot be held responsible for opinions expressed or facts supplied by its authors. All
We’ve had the unique privilege of watching masterful surgeons at work in the past seven
rights reserved, Reproduction in whole or in part without written permission is prohibited.
years and I always enjoy presenting another to our readers. Dr. Sabatino Ciatti, one of the few fellows trained through the distinguished American College of Mohs Surgery, is not only a thorough and accurate remover of cancerous facial tissue, but one of the most competent reconstruction artists when it comes to restoring the damage caused by the removal of the tumor. What makes watching these surgeries even more fascinating is that the entire process can be done in a single visit.
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Contents
march
2 0 11
4
Sabatina Ciatti, MD
Advanced Dermatology, Mohs & Laser Surgery Center, PA Specializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer
CONTENTS
10 11 16
Health Law Update
Statehouse
Finance
An Action Plan for 2011 Practical suggestions to help you increase practice revenues, decrease costs and develop an action plan for 2011.
18
Food for Thought
Corso 98
Montclair, New Jersey There are those rare occasions when you come upon a restaurant that you’ve never been to, take a chance and hit the jackpot.
20
Events
Inaugural Meeting of the NJ Women in Healthcare
COVER STORY
New Jersey Physician recently met with Debra Lienhardt, Esq. to discuss the New Jersey Women in Healthcare.
COVER PHOTO: Sabatino Ciatti, MD of Advanced Dermatology, Mohs & Laser Surgery Center, PA
2
New Jersey Physician
cover PHOTOs BY Ken Alswang, At Home Studios
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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 March 2011
3
Cover Story
Sabatino Ciatti, MD
Advanced Dermatology, Mohs & Laser Surgery Center, PA Specializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer By Iris Goldberg
In 1941 Frederick E. Mohs, MD published results he obtained after removing basal cell cancers from 440 patients using a novel technique which he called “chemosurgery.” In its original form the technique involved applying a 20% zinc chloride paste directly to the skin of the patient for fixation of tissue. Then the skin in question was surgically removed by serial excision in thin layers of tissue with microscopic control of the tissue margins. The layers were color-coded with dyes. Dr. Mohs created a unique mapping system that allowed him to orient the excised, color-coded tissue back to the patient. Astonishingly, 99% of primary cancers and 95-96% of recurrent cancers were cured. Although extremely successful, chemosurgery, in its original form, could be painful and the entire process sometimes took days to be completed. In the 70 years since Dr. Mohs first introduced the technique, it has been significantly refined and improved. In 1953 the need for zinc paste was eliminated and surgeries were performed using the “fresh tissue” technique. More recently, the development of cryostats to freeze and cut tissue and the use of automatic staining machines significantly assist in the processing of tissue samples from the increasing number of skin cancer patients. Throughout all of the technical improvements and refinements of Dr. Mohs’ technique, his original principle of surgically removing skin cancer in layers with microscopic guidance to ensure that the tissue left behind is cancer-free, is still upheld. The color-coded mapping of excised specimens and their thorough microscopic examination remains the focal point of the procedure, now called Mohs surgery. Today, with the use of local anesthetics, tissue is excised, processed and immediately examined. For a majority of patients, p Dr. Ciatti is one of only 900 Mohs surgeons to receive fellowship training through the American College of Mohs Surgery
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New Jersey Physician
the entire process, including reconstruction, can be completed in one visit.
Sabatino Ciatti, MD, of Advanced Dermatology, Mohs & Laser Surgery Center, PA, is one of a relatively limited number of Mohs surgeons (about 900) to receive fellowship training through the distinguished American College of Mohs Surgery, of which Dr. Mohs, himself, served as its first President. As such, Dr. Ciatti received advanced training and has developed significant expertise
in
cutaneous
oncologic
surgery
encompassing the removal of skin cancer, the histopathologic interpretation of tumors and the reconstruction of post-surgical defects. Dr. Ciatti performs Mohs surgery for the treatment of non-melanoma skin cancers, primarily basal cell and squamous cell carcinomas. The surgery is performed at his Westfield office or his satellite office in Morristown. It is important to note that Dr. Ciatti does not use Mohs surgery to treat melanoma skin cancers but instead, wide excision with permanent sections. “It is controversial as to whether or not melanomas should be treated with Mohs surgery,” Dr. Ciatti shares. “My opinion is that they are very difficult to interpret with frozen sections, which is how Mohs tissue sections are processed. Melanomas
OVERVIEW of the MOHS SURGERY PROCESS Step 1: After local anesthesia has been injected, the visible part of the tumor is scraped to better define the margin. Step 2: A thin layer of tissue is removed around the scraped skin and divided into sections. It is placed on a reference map of the surgical site to maintain correct orientation of the tissue. Step 3: Dr. Ciatti color codes each of these sections with dyes and makes reference marks on the skin to
p Dr. Ciatti begins Mohs surgery by marking the surgical site
are best interpreted using permanent paraffin
This is one of the main reasons to have Mohs
sections and sometimes, special stains or
surgery. If the cancer is in an area where it is
Step 4: A technician freezes the tissue. It is then cut
immunostains. You don’t want to make a mistake
important to preserve as much healthy tissue as
into thin slices, placed on glass slides and stained by a
on a melanoma and miss it,” he emphasizes.
possible for maximum functional and cosmetic
show the source of each section. This is all carefully diagrammed on the map.
series of special tissue stains to distinguish malignant
result, such as eyelids, nose, ears, lips, fingers
from benign cells.
“The difference between the non-melanoma
Step 5: Dr. Ciatti examines the undersurface and
skin cancers and the melanomas is that if a
edges of each section under the microscope for
non-melanoma comes back, it is usually local.
evidence of cancer at any of the tissue margins.
If a melanoma skin cancer comes back, it could
Mohs surgery is also the treatment of choice if
have distal metastases,” Dr. Ciatti warns. He
the cancer is large, if its edges cannot be clearly
map and returns to the patient to remove another
goes on to explain that melanomas, therefore,
defined or if it was treated previously and has
layer of skin – but only from precisely where the
require a larger margin of excision because of
recurred. With the Mohs micrographic surgical
cancer cells remain.
the potential threat a recurrence would pose.
technique, Dr. Ciatti relies on the precision and
Step 7: The removal of each layer requires
“With Mohs surgery we want just the opposite.
accuracy of the microscope to trace skin cancer
approximately 15-20 minutes. The removal process
We are trying to get the smallest margin possible
down to its roots in order to ensure that it has
in order to preserve normal tissue and avoid
been completely removed.
Step 6: If cancer cells are found under the microscope, Dr. Ciatti marks their location onto the
is complete when there is no longer any evidence of cancer remaining in the excised tissue.
or toes, Mohs surgery is the most appropriate treatment modality.
cosmetic disfigurement,” Dr. Ciatti states. March 2011
5
safety of the patient. Generally, Dr. Ciatti plans
incidence of skin cancer continues to rise.
this ahead of time and has arranged for these
Recent data show that there are 3.5 million non-
individuals to have a consultation with one of
melanoma skin cancers diagnosed in the U.S.
several physicians who are skilled in performing
every year. As health care dollars continue to
various reconstructive procedures. In this way,
shrink and many patients are faced with lack of
the Mohs surgery and the reconstruction can
insurance or higher deductibles, it is important
be coordinated so that they are both performed
to keep cost in mind.
within a 24-hour period.
p A thin layer of removed tissue is placed on a reference map. Dr. Ciatti color codes each of these sections with dyes.
Once the Mohs procedure is completed, the patient is left with a surgical wound (defect) that can be treated in one of several ways, depending upon each individual case. Some wounds will heal by spontaneous granulation which involves letting the wound heal by itself. Dr. Ciatti explains that there are some areas of the body
Although more expensive than a standard
Patients who undergo Mohs surgery can expect
excision, Mohs surgery offers savings on
the highest cure rate of any method (97-99%),
several levels. First, because the likelihood of
even if other methods have failed. As the most
recurrence following Mohs surgery is less than
exact and precise method of tumor removal, it
1-3%, additional and possibly more extensive
minimizes the chance of re-growth and lessens
surgeries to retreat the same cancer are
the potential for unnecessary scarring and
avoided. Also, since the tissue is processed
disfigurement.
and clean margins are verified at the time of
A sizeable number of Mohs patients are elderly. Some are in their eighties and nineties. Many would have difficulty obtaining medical clearance for surgery with general anesthesia. Mohs surgery is ideal for these patients because it is done with local anesthesia only. “We’re removing a lot of tumors that would be left
surgery, there is no additional expense to reexcise an area because tissue was processed by an outside laboratory where positive margins were subsequently found. Finally, because the procedure is performed in an office setting, the expense of facility fees and general anesthesia is avoided.
untreated if the patient had to go to the OR and
In addition to these benefits of having Mohs
have general anesthesia,” Dr. Ciatti offers. Also,
surgery, Dr. Ciatti shares what is perhaps, the
having the procedure performed in an office
most convincing reason to opt for the Mohs
In most cases, however, Dr. Ciatti will perform a
setting as opposed to a hospital is much less
procedure. He explains the difference between
reconstructive procedure. For small lesions, he
stressful, especially for the elderly.
Mohs surgery and having a routine excision
where nature will heal a wound as nicely as any further surgical procedure.
often closes the wound with sutures, loosening or undermining the adjacent skin as necessary and suturing the edges together. Larger defects
Another significant advantage of Mohs surgery is its cost-effectiveness, particularly as the
performed without Mohs surgery. “If you were to just do an excision you would be sending that
often require a flap or graft. To develop a flap, Dr. Ciatti is able to mobilize tissue from a site adjacent to the wound and then bring that tissue into the wound, securing it with sutures. With both simple side-to-side closures and more complex flaps, Dr. Ciatti utilizes plastic surgery techniques to conceal the scar within natural facial contours or wrinkle lines. Sometimes there is not enough tissue adjacent to a large wound to create a flap. In these cases a graft may be used. Dr. Ciatti takes tissue from a donor site, such as the back of the ear and sutures that donor skin onto the wound. The donor site, in most cases, is also sutured. Rarely, a patient will require more extensive reconstruction, such as a significantly larger graft or flap. These procedures typically involve sedation/general anesthesia and are best done in an operating room setting for the comfort and
6
New Jersey Physician
p A technician freezes the tissue and cuts it into thin slices. Those are then placed on slides and stained to distinguish malignant from benign cells.
Dr. Ciatti goes on to further explain that in some reconstructions where a flap of skin has been taken from one side, placed over the defect and sutured in place, the entire flap has to be removed in order to go back and remove the residual cancer. “Now a huge defect is created,” relates Dr. Ciatti, pointing out the obvious fact that if Mohs surgery had been done in the first place, this could have been avoided. Mohs surgery eliminates the possibility of unknowingly leaving some of the cancer behind. “We process the tissue in the office at the time of surgery, so there is no suturing done until we know that the tumor is out,” Dr. Ciatti emphatically points out. He explains that the tumor is mapped in quadrants (superior, inferior, medial, lateral). As the tissue is analyzed, if there are positive margins, Dr. Ciatti knows exactly where to return. “If the margin is only positive in one quadrant, then we only go back to that quadrant,” he says. “We start with only a one or two millimeter margin in a circular fashion. The whole idea is to keep that defect as small as possible,” Dr. Ciatti reiterates. He shares that minimizing the defect makes all the difference in reconstruction or in p Dr. Ciatti examines the undersurface and edges of each section for evidence of cancer at any of the tissue margins
allowing the wound to just heal on its own. This is especially important for the head and neck
tissue out for analysis. Because the tissue would
cannot be held up indefinitely as other surgeries
be sent out you would need a larger margin,
are scheduled.
typically about 4 or 5 millimeters to ensure clean margins,” explains Dr. Ciatti.
where a good cosmetic result is a primary goal. “When you’re dealing with the eyelid, the lip, the
Dr. Ciatti reports that in 85-90% of cases the
tip or rim of the nose, the ears – these are areas
results are correct. In 10-15% of cases, however,
where minimizing the amount of tissue removed
He relates that the wound would then be
he explains that once the more extensive
is very important,” Dr. Ciatti explains. “The
sutured and the tissue would be sent out for
post-operative analysis is done on the entire
larger the defect, the less likely you will be able
pathology. “If those margins weren’t found to
specimen, it is found that the margins are not
to reconstruct that defect using adjacent tissue
be clear, the procedure would have to be done
clean. Dr. Ciatti continues, “At this point again,
or to allow the defect to heal by spontaneous
all over again but you wouldn’t know that for a
the patient is home and has been reconstructed
granulation. Size matters because the wider the
week to ten days. If the margins were clear, you
and you have to call him or her to come back
defect gets, the more extensive and complicated
might have taken too much tissue and therefore,
in.”
the reconstruction becomes,” he strongly states.
Once this situation occurs, it becomes
The skill with which Dr. Ciatti performs Mohs
challenging to repeat the procedure and derive
surgery and the exceptional cosmetic results
If a surgery center or operating room is utilized
an optimal cosmetic result. Dr. Ciatti sees
he is able to achieve with his reconstructive
for excision and reconstruction, time becomes a
patients who unfortunately did not have Mohs
techniques have not gone unnoticed.
huge factor. In an operating room setting frozen
surgery initially and now must undergo Mohs
patients come to him through referrals from
sections can be obtained but they are processed
surgery with him to remove the remaining
other physicians, particularly dermatologists.
differently than Mohs sections. Only a partial
cancer. Dr. Ciatti discusses the problem. “You
Still others have heard about or seen the quality
representative section is analyzed in order to
now have to go back and you don’t know exactly
of Dr. Ciatti’s work through a friend or relative
allow the surgeon to have a result within 20-
where to go back so you have to go back along
that he has treated.
30 minutes. This is necessary because an OR
the entire incision,” he shares.
created a larger and less desirable incision than necessary,” Dr. Ciatti proclaims.
Many
March 2011
7
p Here, a Mohs procedure involving a large portion of the patient’s cheek shown from start to finish. Dr. Ciatti excises the tumor in layers until margins are clear and reconstructs the defect during one visit.
p Another Mohs surgery is shown from exicision to reconstruction. On photos far right here and above, the superb quality of Dr. Ciatti’s cosmetic closures is evident.
Robert Marinaro, MD has a busy dermatology
with Dr. Ciatti do not then need to see a
did not,” Ms L reports. “His staff is the greatest,”
practice in Morristown and is one the many
plastic surgeon. She describes one particular
she wants to share as well. She talks about their
physicians who refer patients that are Mohs
time when she had an extensive procedure to
kindness and gratefully remembers one of Dr.
surgery candidates to Dr. Ciatti. “Not only is he
remove a lesion on her forehead over one of her
Ciatti’s nurses tightly holding her hand while the
a superlative Mohs surgeon but his cosmetic
eyes. She relates that when Dr. Ciatti finished
local anesthetic was being injected.
closures are on par with the best I’ve ever seen,”
suturing, she looked as if she had been in a fight.
Dr. Marinaro shares, when asked why he sends
To her amazement, when she returned to have
his Mohs patients almost exclusively to Dr. Ciatti.
the sutures removed, not only was the bruising
Dr Marinaro goes on to relate the positive
gone but there was no visible scar whatsoever.
Although Ms L is predisposed to skin cancer and at 80 years old certainly has had more than a fair share of Mohs procedures, she is extremely positive and very thankful that she has Dr. Ciatti
feedback he receives from patients, without
“Not only is he amazing as a doctor but I have
taking care of her. “You can’t ask ‘why me?’ But
exception, regarding Dr. Ciatti’s skill and the
to say that he is amazing as a person,” shares Ms
when you have an expert like Dr. Ciatti, you
caring attention shown by Dr. Ciatti and his
V. She continues, “He is wonderful and his staff
know you’re in good hands,” Ms L says with
entire staff. Dr. Marinaro and his own staff are
is too. They are absolutely phenomenal.” Ms V
conviction. Her next statement is a window into
often amazed when patients return, some having
goes on to relate that after nine procedures she
the type of warm, comfortable and good-natured
had extensive Mohs procedures, at the excellent
feels very much “at home” whenever she is at Dr.
relationship Dr. Ciatti develops with his patients.
results Dr. Ciatti is able to achieve with his
Ciatti’s office. In fact, her experience is always
“And besides,” Ms L confides with a lilt in her
cosmetic closures.
enjoyable. She and Dr. Ciatti share their mutual
voice, “I bribe him with chocolate.”
Undoubtedly, the fact that Dr. Ciatti has consistently been performing Mohs surgery and reconstruction for many years with great
love of baseball. “He doesn’t rush to do things – he takes as much time as is necessary - and I’ve never felt any pain,” Ms V is eager to add.
As our population continues to age and as skin cancer becomes more prevalent, skilled Mohs surgeons will be in even greater demand than
success is the reason he has become a highly
Another long-time patient is Ms “L.” Dr. Ciatti has
they are today. For many referring physicians
regarded expert in the particular surgical and
performed Mohs surgery and reconstruction
and patients in New Jersey who are dealing
reconstructive
with
on numerous basal and squamous cell cancers
with skin cancer presently, Dr. Ciatti offers his
this procedure. Besides his great skill, there is
located in different areas on her face, including
expert surgical and reconstructive skills and a
something else that sets him apart. His kindness
her nose, forehead and lip. When asked, during
caring and compassionate manner. Those who
and compassion and that of his entire staff, have
a telephone interview, if her face was marred as
are training to become Mohs surgeons would do
earned the gratitude and loyalty of countless
a result, she replies without hesitation that no
well to follow his example.
patients throughout the years.
one would be able to notice anything unusual
techniques
associated
Ms “V” has had nine basal cell cancers removed
because of Dr. Ciatti’s skillful work.
by Dr. Ciatti. “He is an absolute artist!” Ms V
“He is one of the best doctors I know of. He
exclaims. She wants to emphasize the fact that
has an eye for zeroing in on cancer. Never once
patients who undergo their Mohs procedure
has he said that he thought I had cancer when I
8
New Jersey Physician
Dr. Ciatti’s locations are: • 2 40 E. Grove Street, Westfield NJ 07090 (908) 232-7235 • 2 0 Community Place, Morristown NJ 07960 (973) 538-1560
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Health Law Update
Health Law
Update
Provided by Brach Eichler LLC, Counselors at Law
CareCore Assures NYS Attorney General of Discontinuance of Restrictive Practices; Will Buy-Out Radiologist Owners
network decisions and refused to contract with qualified physicians and
By John Fanburg, Esq. and Kevin Lastorino, Esq.
CareCore violated the Sherman Act by denying competing radiologists
CareCore National LLC, a radiology benefits management company
from joining CareCore-managed networks.
physician groups for some or all modalities that they offer. The OAG alleged that CareCore’s business practices constitute a violation of New York law. A month earlier, a jury verdict in Stand-Up MRI v CareCore National, EDNY Case No 08 Civ 2954 (LDW) (ETB) concluded that
owned and controlled by radiologists, and the Office of the Attorney General of the State of New York (OAG), entered into an assurance of
In lieu of commencing a special proceeding, the OAG accepted
discontinuance requiring CareCore to refrain from conduct that restrains
CareCore’s assurance that it will use its best efforts to purchase at fair
trade in the market for specialty health services providers.
market value, within 210 days, the full ownership interests of each of its radiologist owners. The assurance also requires CareCore to establish
The assurance stems from the OAG’s investigation into complaints
an appeals process for providers that have been denied membership in
that CareCore, which contracts with managed care organizations to
a network and provides guidelines by which CareCore must make New
provide radiology utilization management and manage networks of
York network contracting determinations going forward.
outpatient radiology practices, preferred its radiologist-owners in
Surgical Care Affiliates, Saint Barnabas Health Care Announce Agreement Surgical Care Affiliates (SCA), one of the country’s largest providers of specialty surgical services, announced today it has entered into a joint market development agreement with the Saint Barnabas Health Care System (SBHCS), New Jersey’s largest integrated health care delivery system. Under the terms of the agreement, SCA and SBHCS will work together to acquire ownership interests in physician-owned ambulatory surgery centers in northern and central New Jersey, with SCA providing day-to-day management services. “We look forward to building an exceptional network of surgery centers in New Jersey,” said Barry Ostrowsky, President and Chief Operating Officer of the Saint Barnabas Health Care System. “Combining SCA’s operational platform and the strength of our System will present a compelling opportunity for our physicians, patients, and payors.” Andrew Hayek, President and Chief Executive Officer of SCA, said, “We are honored to be selected to enter into this relationship with the Saint
10
New Jersey Physician
Barnabas Health Care System. The strength of our clinical programs was a critical factor in this decision. We believe this relationship will improve healthcare in New Jersey, and further position SCA as the partner of choice for health systems and physicians.” About Surgical Care Affiliates: SCA’s vision is to be the partner of choice for physicians, hospitals, and health systems in developing and operating ambulatory surgery centers and surgical hospitals across the country. SCA operates 125 ambulatory surgery centers and surgical hospitals, in partnership with approximately 2,000 physicians and 20 not-for-profit health systems across the country. SCA’s clinical systems, efficiency programs, benchmarking process, and training programs create measurable advantage for surgical facilities – clinically, operationally, and financially. About Saint Barnabas Health Care System: The Saint Barnabas Health Care System is the largest integrated healthcare system in New Jersey, providing treatment and services for more than two million patients each year at over 50 facilities. The system’s 18,200 employees, 4,600 physicians and 445 residents and interns are united in their mission to deliver the highest quality of care in the best possible environment. For more information on Saint Barnabas, visit www.saintbarnabas.com.
Statehouse
New Jersey Statehouse Beck’s Medical Malpractice Bill Passes Assembly Committee The Assembly Health and Senior Services Committee today passed S-760/A-1982, a bill sponsored by Senator Jennifer Beck in the Senate and by Assemblyman Declan O’Scanlon in the Assembly. The legislation is designed to reform the medical malpractice laws in New Jersey that are a major cause of a physician shortage in the State. “The New Jersey Council on Teaching Hospitals has reported that New Jersey is losing physicians at an alarming rate,” said Beck, who was on hand to testify at today’s hearing, “and this is attributed in large part to New Jersey staggeringly high medical malpractice insurance rates. These high rates are a reflection of New Jersey’s malpractice laws, which unfortunately permit suits to be brought against medical professionals with little discretion. This bill simply aims to put in place reasonable restrictions on what may be considered in a malpractice law suit and how insurers may react to those suits. “Currently, New Jersey allows malpractice insurance providers to increase rates when a suit is brought against a medical professional,” Beck continued, “regardless of the outcome of the case. That is akin to a judge handing down a sentence before the verdict is in. This bill would change that so that only in the case that a settlement is made that a customer’s rate may be increased.” The bill will also requires that a malpractice action against a health care provider shall be commenced within two years after the plaintiff or patient discovers the injury, but not more than four years after the alleged act; that only licensed medical professionals may be permitted to give expert testimony on the standard of practice in a malpractice case; and that physicians licensed in the State of New Jersey shall not be liable for civil damages in the case of rendering treatment in good faith, as a volunteer at a clinic or other health care facility.
Medical Marijuana Could Be Available by Late Summer A half-dozen alternative treatment centers across New Jersey could be legally selling marijuana to patients with certain medical conditions by late summer, state Health Department officials said Monday. The centers were culled from 35 applications from 21 nonprofit entities, the officials said. Under proposed state regulations, each treatment center would grow
and sell up to three strains of marijuana. The pot would be available only to patients with certain conditions, including multiple sclerosis and glaucoma. Patients say it can ease symptoms such as pain and nausea. Home delivery, as the proposed regulations currently stand, would not be allowed. Some groups that were considering applying said they didn’t because the proposed rules were too onerous - for instance, limiting the potency of the legal pot, which none of the 13 other states that have legalized medical marijuana has done. Most of the winners came from outside the close-knit group of the most public advocates for legalizing medical marijuana. Devon Graf, the Health Department’s director of legal and regulatory compliance, said the successful applicants are a mix of big and small operations. “It was pleasant to see that there are some little-guy, some small-business providers in there,” Graf said. He said the winners had strong financial backing and had secured preliminary approvals for their locations from local zoning boards and town governments and prepared training manuals for employees. The applicants were required to show they had plans for security, quality control, and other aspects of the businesses. Some have strong ties to hospitals. One of the successful applications was Compassionate Care Centers of America Foundation, which will work with Meadowlands Hospital. The group’s facility in New Brunswick was approved. “We are grateful to Gov. Christie’s administration that [Health] Commissioner [Poonam] Alaigh is a visionary who has devised a medical model that will ensure much needed relief to patients suffering serious debilitating conditions in a safe, strict, and appropriate manner,” said Raj Mukherji, a spokesman for the group. The group’s application says it expects to spend $4.5 million a year to operate the facility. Peter Rosenfeld and his organization, Compassion Collective of Camden County, applied to run a center in Pennsauken but did not get a license. “The process, I would characterize as interesting,” he said. “They gave us six business days from the announcement to the day it had to be March 2011
11
N ew Jersey Statehouse submitted. It was a little hard to figure out which way they were heading.” The successful applicants are in the populous corridor between the New York City and Philadelphia areas. They are the Breakwater Alternative Treatment Center Corp., in Manalapan; Compassionate Care Centers of America Foundation, in New Brunswick; Compassionate Care Foundation Inc., in Bellmawr; Compassionate Sciences Inc., with a facility planned in Burlington or Camden County; Foundation Harmony in Secaucus; and Greenleaf Compassionate Center in Montclair. Roseanne Scotti, New Jersey director of the Drug Policy Alliance, said the regulations would be better if they included a home-delivery option for far-flung patients. “We’re a little concerned there’s nothing in Atlantic County,” she said. State Sen. Nicholas Scutari, a Democrat from Linden, has called for lawmakers to nullify the proposed regulations from Christie’s administration. Scutari says the regulations fall short of the Legislature’s intent when it voted 14 months ago to allow medical marijuana. He said Monday he wanted to negotiate changes to the regulations with Christie’s administration.
NJ ACO Pilot Bill Approved by Senate Budget and Appropriations A bill sponsored by Senators Joseph F. Vitale and Jim Whelan which would establish a three-year pilot program in the Department of Human Services in order to make sure Medicaid recipients have access to quality health care was approved by the Senate Budget and Appropriations Committee by a vote of 7-5. “Under the current health care delivery and payment structure, Medicaid recipients are often unable to access high-quality, cost-effective health care,” said Senator Vitale, D-Middlesex, and Vice Chair of the Senate Health, Human Services and Senior Citizens Committee. “As a result, we pay more money for less-than-stellar results in terms of positive patient outcomes. It’s time that we move away from the existing system which puts vulnerable New Jerseyans at a disadvantage to receive high-quality care, and begin to invest State resources in a smarter, cost-effective model of health care for Medicaid enrollees.” “This bill is about spending State health care dollars smarter, and improving care for people who depend on our State’s health care safety net for access to medical services,” said Senator Whelan, D-Atlantic, and a member of the Senate health panel. “Right now, we lack the objective evaluation and cost-effective protections to make sure that we’re getting the biggest bang for our buck, and providing the best care possible for people enrolled in the Medicaid system. It’s time that we do better for New Jerseyans in need.” The bill, S-2443, would create the “Medicaid Accountable Care Organization
12
New Jersey Physician
Demonstration Project” to ensure that Medicaid recipients in New Jersey have access to high-quality, cost-effective medical care. The bill would establish a demonstration project within the Department of Human Services to increase access to primary care, behavioral health care, and dental care by Medicaid recipients in a particular region. The bill would also improve the quality of health care by establishing objective metrics and relying on patient experience, and would reduce unnecessary and inefficient care without interfering with a patients’ access to the health care providers and services they need to stay healthy. The bill would authorize Accountable Care Organizations (ACOs), defined as nonprofit corporations, to provide coordinated, high-quality care to Medicaid recipients in a municipality or defined geographic region with more than 5,000 Medicaid recipients. If the program proves successful in lowering costs and improving care, the sponsors said they would consider working with the Department to establish a permanent program. “As part of the federal health care reform law, states have been given the authority to empower ACOs to provide coordinated, high-quality, cost-effective health care to Medicaid recipients,” said Senator Whelan. “Frankly, we’re flying blind right now in terms of the level of care available to Medicaid recipients, and it’s time to try something new to create a high-quality standard of care that allows us to achieve the best patient outcomes at a fraction of the current price. By shifting to a smarter model of care, we can maximize the impact of our health care investment.” “Whether it’s FamilyCare or the medical home pilot program, New Jersey has been a laboratory for best practices in administering and delivering health care for New Jerseyans in greatest need, and the Medicaid ACO Demonstration Project is another step forward in better health care at less cost to the State’s taxpayers,” said Senator Vitale. “We recognize that we have a responsibility to provide quality care for people who depend on Medicaid, and we have to stretch limited health care dollars as far as they will go. By moving to an ACO model of delivering health care services, we can achieve both, and will once again set New Jersey up as a national model for other states to follow.” The bill now heads to the full Senate for consideration.
Assembly Passes Measure to Improve Emergency Medical Services In New Jersey Conaway/Fuentes/Evans/Quigley Bill Aims to Boost Delivery of Urgent Care
The full Assembly on Monday approved a measure sponsored by Committee Chairman Herb Conaway, Jr., M.D., and Assembly members Angel Fuentes, Elease Evans and Joan Quigley to improve the quality and delivery of emergency medical services in New Jersey. “Emergency medical services are among the most fundamental functions we can provide as a government,” said Conaway (D-Burlington/Camden). “We need to overhaul our system in order to improve efficiency and ensure compliance with applicable standards of pre-hospital care. This bill recognizes the important work of emergency volunteers by providing
New J ersey Statehouse free licensing and background checks as a condition of service.” According to a 2007 report that was issued after a comprehensive analysis was conducted at the behest of the Legislature, New Jersey’s two-tiered EMS system is in a “state of near crisis” due to the system’s financial structure, decline in volunteer membership, lack of comprehensive legislation and a weakened Advanced Life Support (ALS) system. The bill (A-2095), approved by a vote of 44-31-3, incorporates many of the recommendations from the report. “This legislation would institute various measures that will revolutionize services, making them more efficient and effective, while streamlining the system to save taxpayer dollars,” said Fuentes (D-Camden/Gloucester). Under the direction of the Commissioner of Health and Senior Services, the Office of Emergency Medical Services in the Department of Health and Senior Services (DHSS) would serve as the lead state agency in overseeing emergency medical services to ensure the continuous and timely availability and dispatch of basic and advanced life support through ground and air, adult and pediatric triage, treatment and transport and emergency response capabilities. The bill would consolidate numerous groups, task forces and advisory boards, into one governing body - the Emergency Medical Care Advisory Board (EMCAB) - to advise DHSS on pre-hospital issues, medical care and the establishment of provider standards.
Furthermore, the bill would create a number of subcommittees under EMCAB, including one charged with exploring shared services and consolidation in order to make recommendations for municipalities and counties to consolidate EMS services. The bill would also require a minimum of one emergency medical technician (EMT) as the standard of care for every ambulance in the state. DHSS would also be responsible for arranging advanced life support services in response to 9-1-1 calls statewide. “This is an important measure because it provides a uniform standard for responding to emergencies and treating and transporting patients. The ultimate goal is to ensure proper care for all of our residents,” said Evans (D-Passaic/Bergen). “This bill will enhance professionalism, transparency and coordination of the state’s EMS system, making patients the ultimate priority,” said Quigley (D-Hudson/Bergen). The bill would also require paramedics, EMTs, and emergency medical responders to obtain a license from DHSS and undergo a criminal history background check as a condition of licensure or other authorization to practice. The commissioner would also have the authority to revoke the license for violation of certain laws and regulations.
Medicaid Accountable Care Organizations Opportunities for State Cost Control Submitted by Derek Delia and Louise B. Russell
Despite the political uncertainty around national health reform, New Jersey is moving forward with a major innovation in its Medicaid program. By authorizing the formation of Medicaid Accountable Care Organizations (ACO’s), the state will take a leadership role in the struggle to contain Medicaid costs without disenrolling patients or withholding beneficial care. ACO’s are the latest big idea in health reform. They are networks of physicians, hospitals, and other providers that work together to improve quality of care and reduce expenditures for a defined patient population. The purpose is to achieve three interrelated goals: • Improve objectively measured health care quality and patient safety • Improve patients’ experiences with care
• Achieve savings large enough to be shared by health care providers and payers On the surface, the ACO idea looks a lot like old fashioned managed care with the image of HMO’s telling providers how to practice medicine. The key difference is that ACO’s are designed to be more “bottom up” than “top down”. Providers form ACO’s voluntarily, set their own rules for organizing care, and establish a plan to share savings. By authorizing Medicare to contract with ACO’s, the Affordable Care Act (ACA) will encourage the expansion of ACO networks throughout the nation. But in the current political environment, implementation of the ACA, or at least some of its provisions, has become highly uncertain, presenting a challenge for states that must lay the
groundwork for implementing health reform by, for example, establishing procedures to expand Medicaid enrollment. One thing that is very certain is that, with or without federal health reform, states must find solutions to the enormous budgetary problems associated with rising Medicaid costs. Pending legislation in New Jersey shows that states do not have to wait for the politics of national health reform to work themselves out. On January 6, a bill to create a demonstration project for Medicaid ACO’s was introduced in the New Jersey State Legislature. Under the bill, New Jersey’s Department of Human Services would certify as ACO’s nonprofit coalitions of local health care providers who organize themselves to improve care for a defined population of at least 5,000 Medicaid enrollees. A defined population might March 2011
13
N ew Jersey Statehouse include Medicaid enrollees living in a city or cluster of smaller municipalities. Certified ACO’s would have to meet specific requirements for health care quality and outcomes and, in fee-for-service Medicaid, would be eligible to share in savings from care improvements. The bill would also permit Medicaid HMOs to engage with certified ACO’s. The demonstration projects would be subject to annual evaluation. If successful, they would open the door for expanding the Medicaid ACO concept across New Jersey and the nation. The approach in New Jersey stands in stark contrast to approaches currently contemplated in other states. Arizona is attempting to address its budget woes by disenrolling 280,000 beneficiaries from Medicaid. Florida’s newly elected governor has expressed interest in requiring more Medicaid beneficiaries to move from traditional Medicaid into Medicaid HMO’s. Unlike the New Jersey reform, these approaches have a distinctive “been there, done that” feel to them. They also fall into the “top down” category mentioned above where payers impose new requirements without any input from patients and providers. In contrast, the New Jersey effort was initially proposed by a coalition of medical providers from the city of Camden. The Camden Coalition was designed to better organize care for low-income, complex patients in Camden, one of America’s poorest cities. (Readers of the New Yorker magazine may recall Atul Gawande’s profile last month of Dr. Jeffrey Brenner, who leads the Camden Coalition.) The Coalition, whose work has been supported by philanthropic grants and donated services, seeks to sustain its efforts by forming a Medicaid ACO, which would use the savings from reduced costs to sustain and expand patient services. A clever element of the New Jersey reform is that it allows the state to take full advantage of federal health reform without being contingent upon it. For example, lessons learned from the Medicaid ACO experience will place New Jersey stakeholders ahead of the curve, as they consider the formation of Medicare ACO’s encouraged by federal reform. In addition, Secretary of Health and Human Services (HHS) Kathleen Sebelius recently wrote a letter to state governors inviting them to collaborate with HHS to find ways of containing Medicaid’s costs as it prepares to add millions of new enrollees. Her letter emphasizes care coordination and innovations in health care delivery similar to the path that New Jersey is
14
New Jersey Physician
taking. This will leave the state well positioned to take advantage of federal assistance for implementation and surveillance of Medicaid innovations. But even if federal efforts stall, New Jersey’s Medicaid ACO efforts can move forward on their own. ACO’s in Medicaid are also likely to avoid some of the thornier issues that have been raised about ACO’s in general and ACO’s that contract with private insurers in particular. First, a large ACO might have so much consolidated market power that it could command large reimbursement increases, offsetting any savings from improved efficiency. Second, ACO’s achieve their efficiencies largely by creating incentives to avoid expensive services that are preventable, marginal, or downright unnecessary. Of course, one person’s unnecessary service is another person’s profit margin. Providers who see their profit margins decline will have every incentive to argue that their services really are needed and the so-called efficiencies are illusory. As the readers of this blog well know, it is not hard to generate political outrage over reductions in medical services (regardless of their effectiveness, appropriateness, or safety).
Medicaid ACO’s, in contrast, raise fewer concerns about market power. In fee-for-service Medicaid, reimbursement rates are set by the state, leaving no room for providers to raise prices. Although Medicaid HMO’s do negotiate reimbursement rates, the HMO’s cannot spend beyond the limited amount that Medicaid allocates to them to pay for patient care. In addition, most providers, especially those who provide the most expensive forms of care, do not build their profits on maximizing Medicaid volume. On the contrary, many providers do not even accept Medicaid patients because payment rates are usually too low to be profitable. As a result, the pushback against reducing avoidable services in a Medicaid ACO is likely to be much less intense. A great deal of work still lies ahead for New Jersey’s Medicaid ACO’s. This includes the final passage of legislation and several years of implementation. But as the process unfolds, lessons learned will be important not just for New Jersey but for all states struggling to serve their Medicaid populations well and in a fiscally sustainable way.
State of New Jersey Department of Health and Senior Services
Deputy Commissioner Public Health Services This key management position, which reports directly to the Commissioner of Health and Senior Services, will provide leadership for planning, policy implementation, budgeting, and executing the goals and mission of the department as it relates to the assigned areas of responsibilities: The Divisions of HIV/STD/TB Services; Family Health Services; Epidemiology, Environmental and Occupational Health Services; Public Health Infrastructure, Laboratories and Emergency Preparedness. Successful candidate must be a licensed physician. For a full description of the position, including the education and experience requirements, and addresses for filing either via electronic or hard copy visit: www.nj.gov/health/jobs.
EEO/AA
The State of New Jersey
HELP SAVE THE PRACTICE OF MEDICINE! CALL 888-806-5362 OR VISIT OUR WEBSITE AT WWW.NJPHYSICIANS.COM FOR MEMBERSHIP INFORMATION
March 2011
15
Finance
An Action Plan for 2011 By Harlene S. Stevens, CPA – Nisivoccia LLP
How often have you heard a physician say,
• Conduct a “patient service review”
anticipate your overhead costs changing in
“Medicine is the easy part. It’s everything else
and look for those patients who may require
2011? Are there any practice costs that can be
about running the office that is stressful,” or “I went
medical treatment, or are due for annual
cut this year? I have seen practices reduce their
to medical school to practice medicine; I am not a
physical exams.
telephone bill by over 50% simply by using the
business person.” I hear similar statements from my clients time and time again. The goal of this article is to provide some practical suggestions to help you increase practice revenues, decrease costs and develop an action plan for 2011. • Analyze your fee schedule. When was the last time you increased your fees? Many physicians feel guilty about increasing fees in light of these difficult economic times. However, most practices have experienced increased labs, medical supplies, payroll and general overhead especially with employee costs. A modest fee adjustment once a year is preferred over a significant hike in fees every couple of years. For those practices whose fees are regulated by PPOs or managed care plans, remember that the fees you submit on medical claims are factored into future contracted fee schedules. So submit your full fees to all insurance carriers and adjust the contracted write-offs when posting payments to patients’ accounts as required by the EOBs. • Perform a monthly analysis of your collection percentages.
Do you know
how your practice is being paid by your top 5-7insurance companies on your top 20-25 procedures? Your office manager should be aware of frequent denials and resolutions to determine if they are being resolved or written off as an adjustment? Incorporating some monthly practice statistical calculations when performing the monthly bank reconciliation is crucial to monitoring current vitals of the practice’s revenue cycle.
• Analyze your accounts receivable with special attention to accounts that are 90 days
• Review your HIPAA compliance procedures.
or more past due. All insurance claims past 90
Just because you do not hear as much about
days should be researched. I have found that
HIPAA compliance does not mean you can
in practices where the 90 day plus accounts
relax privacy and security measures. Review
receivable are over 20%, there may be collection
and revise your HIPAA policies and procedures
issues, which are hindering prompt payment.
as necessary. Make sure that all employees are
It is important to look at days in accounts
familiar with your policies and procedures and
receivable by payer, not just the practice as a
have had a chance to ask questions. Document
whole. Sometimes the insurance company is
employee training updates, and make sure that
waiting for information from the patient. Reach
all patients sign their own HIPAA forms once
out to overdue accounts with a personal phone
they turn 18 years of age (or the age of majority
call and try to work out payment arrangements.
in your state, if younger than 18).
If the accounts are deemed uncollectable, consider sending them to collection or to small claims court if appropriate. After all options have been exhausted, consider writing off the uncollectable accounts so that your accounts receivable total is accurate.
New Jersey Physician
• Consider initiating your Electronic Medical Records (EMR) research and selection process. Electronic medical records promote better
communication
between
patients,
doctors and specialists, with the overall goal of better patient care, as well as to improve
• Evaluate the growth of your practice.
office management efficiency.
In addition,
Run a demographics report of collections and
successful EMR implementation can lead to
new patients. Is your practice growing? If it is
financial incentives for your practice. For more
not growing to your satisfaction, now may be
information regarding EMR selection send an
the time to engage in or ramp up internal and
email to lthomas@nisivoccia.com with “EMR
external marketing.
Selection Guide” in the subject line.
• Update your website. The majority of my
• Take an inventory your medical supplies.
medical clients have a website, but many have
Expired supplies should be discarded. Review
not updated it since inception. Do you have
your ordering procedures with staff so as to
any promotions or new services you now offer
minimize waste.
in your office that patients may not be aware of? (i.e., cosmetic procedures or supplements for retail).If so, those promotions should also be highlighted on your home page. • Analyze
16
same vendor for both phone and internet.
your
overhead
costs
• Scrutinize payroll costs, which are typically the largest expense in a medical office. Analyze employee performance and revise hours as necessary. Limit overtime hours for employees
as
(other than physicians), which typically must
compared to the prior year. Do you
be paid at time and a half. Review health
Harlene S. Stevens, CPA, Supervisor is a leader of the Nisivoccia LLP Healthcare Segment, which concentrates in providing services to physician and dental practices. The Company is a multi-dimensional CPA firm with offices in Mt .Arlington and Newton, New Jersey. The firm offers traditional tax, accounting, audit and business advisory services. Contact her at hstevens@nisivoccia.com or 973-328-1825.
insurance
costs,
which
have
increased
dramatically in recent years. If you pay at least 50% of your employees’ health insurance you may be entitled to a health care credit on your tax return. Update and revise your employee manuals if needed. • Provide each employee with at least one written performance review annually. For a copy of a very basic performance review send an email to Hstevens@nisivoccia.com with “Performance Review” in the subject line. • Conduct regular staff meetings. I prefer monthly lunch meetings. These meetings should be scheduled for a set amount of time
Princeton Insurance knows New Jersey, with the longest continuous market presence of any company offering medical professional liability coverage in the state.
(i.e., one hour) and have a specific agenda.
Leadership: Over 16,000 New Jersey policyholders
One purpose for having regular staff meetings
Longevity: Serving New Jersey continuously since 1976
is to build a sense of “team” by keeping all staff informed of practice-related issues and providing practice managers an opportunity to show staff they are appreciated. When staff feel appreciated they often display more energy and enthusiasm at work. • Maximize
your
retirement
contri-
butions by saving early in the year. I recommend physicians open a separate account to accumulate earnings that they intend to use to fund retirement plans and pay taxes at year end.
Expertise: More than 55,000 New Jersey medical malpractice claims handled Strength: Over $1 billion in assets and $335 million in surplus as of September, 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, gap coverage, specialty reports, practitioner profiles, office practice toolkits
• Set up appointments with your accountant, attorney, and financial advisor to be sure that your business plan and personal finances are in sync for 2011. By utilizing these guidelines early in the year, you should develop an action plan that you are comfortable with and one that should enhance the financial health of your practice. March 2011
17
Food for Thought
Corso 98
Montclair, New Jersey By Iris Goldberg
Every now and then a dinner out becomes an unexpected experience, especially when it’s your first time at a particular restaurant. Sometimes, a place has been highly recommended and ends up being a huge disappointment. We’ve all been there. Then there are those rare occasions when you come upon a restaurant that you’ve never been to, take a chance and hit the jackpot. That’s exactly what happened last night when Michael and I had the pleasure of sampling the contemporary Italian cuisine and the hospitality provided at Corso 98 in Montclair. From the moment we entered this storefront, family-owned BYO on Walnut Street, we were treated royally. We were shown to an elegantly set table for two in a cozy nook by the window. That’s definitely my favorite type of seating when we are dining alone. Even an old married couple like us appreciates the romantic ambience that is created. In fact, the entire place is beautifully decorated and arranged so that every table is situated to allow for a warm and comfortable dining experience. The lighting is soft and the music (Italian as well), is definitely in the background and not at all distracting. Actually, it was the perfect accompaniment to the food and the atmosphere. The menu at Corso 98 offers an ample selection of salads, appetizers, seafood, pastas, fine meats and cheeses which showcase classic Italian dishes that are creatively prepared and presented. There is also a separate menu featuring the specials of the day. This is what Michael and I focused on since there were a number of intriguing choices. We decided to share two of the tempting appetizers. First, we had a frisse salad served with beets stuffed with feta cheese,
p Grilled rack of lamb is one of the most elegant ways to serve the traditional specialty.
garnished with grapes and walnuts and finished with an orange vinaigrette. Our server was kind enough to have this divided in the kitchen. The presentation was a lovely arrangement of colors and textures. I found the beets and feta cheese to be a winning combination. Once our salads were done our server placed the impressive bowl of Vongole con Ceci between us. This was fresh little neck clams steamed in roasted garlic in a saffron scented tomato-herb broth with chick peas and a few slices of toasted bread for dipping on top. Dip we did as the broth was heaven with just the right amount of clam juice. Also, the clams were fresh as could be. We really enjoyed this dish. At this point I must comment on the exemplary service we received. Every need was anticipated yet our server did not hover or interfere
18
New Jersey Physician
p Puff-pastry-wrapped Brie with shaved pears, mango, strawberry flower, and cranberry-watermelon-pineapple reduction.
with our enjoyment of the food or each
popular TV show amongst food channel
other. When we did have an opportunity
watchers.
to speak with him, we couldn’t help but appreciate his warm demeanor and his quick sense of humor.
He also told us about a special private luncheon that would be served at Corso 98 on the Sunday that was approaching. It
Now for the main course. Michael
was for notable professionals (including
immediately decided on Risotto con
physicians)
Gamberi, Salsiccae e Piselli, which
and was to showcase the dishes from
is slowly simmered Arborio rice with
Abruzzo, an area east of Rome on the
brown butter-seared shrimp, roasted
Adriatic Sea, where co-owners and
Italian sweet sausage, tomato, pecorino
brothers, Elio and Corradino Suriano
Romano cheese and early spring green
were born. Here is the menu:
peas. I can always tell by the look on his face if Michael is enjoying his meal. His eyes, which have always revealed to me exactly how he is feeling at the moment, were smiling. After a bit of deliberation, I went for the Osso Buco, which is a long-time favorite of mine. I was not disappointed. The veal shank was cooked to perfection, slowly braised, making it tender as can be. It was served in a rich and flavorful tomato-vegetable red wine demi-glace over risotto Milanese. A small fork was provided to reach the succulent marrow within the large bone and I am sure not a spec was left after I was done. Although we often skip dessert, things were going so well that we decided to indulge ourselves. We ordered some pistachio gelato and a piece of Italian ice box cake which consists of layers of graham crackers with chocolate pudding, topped with whipped cream and fresh strawberries. Yes, it was as scrumptious as it sounds. As we were lingering over coffee and waiting for our credit card to return, Executive Chef, Darek Haupt approached our table. He graciously asked if we had enjoyed our meal. We ended up in a long conversation about his extensive training, including studying at the CIA and his mastery of the art of Italian cooking, which has become his passion. He shared that he is going to be
within
the
community
p Pan-roasted Prince Edward Island mussels with Pinot Grigio butter sauce, roasted garlic cloves, croutons, and Roma tomatoes.
Sunday, March 27, 2011 BACALA FREDDI Traditional salt cod salad with chick peas, celery, shaved garlic, cerignola olives, capers, hot cherry peppers, lemon, flat leaf parsley and extra virgin olive oil CHITARRA LAMB RAGU Fresh chitarra pasta made by Mama Suriano with slow-braised lamb, carrots, celery, shallots, tomatoes and herbs
p Zucchini blossoms stuffed with prosciutto and fresh mozzarella over a citrus beurre blanc.
FRISEE SALAD Frisee lettuce, fresh fennel, blood oranges, roasted skinless almonds, red grapes and a light citrus vinaigrette CHOICE OF Prime center cut pork chop grilled with broccoli rabe, roasted potatoes, hot cherry peppers and a tomato-herb demi-glace – OR – Pan seared fresh Alaskan salmon with roasted tomato, rosemary-goat cheese polenta, citrus scented arugula and an orange-basil reduction DESSERT Orange mascarpone tartlets with macerated Grand Marnier strawberries and a warm espresso-dark chocolate sauce
p Handmade pasta chitarra alla Mamma with Bolognese sauce.
p Juicy Roasted salmon with whipped potatoes, wilted spinach, roasted peppers, pancetta, and grilled fennel.
In case you haven’t realized by now, I would definitely recommend Corso 98 for an intimate dinner for two, a large group or a special celebration. The food is fantastic and the service is top-notch. No effort is spared to make you feel welcome. In fact, we plan to return very soon. Perhaps we’ll see you there.
a contestant on an upcoming episode of
Corso 98 is located at 98 Walnut Street,
“Chopped,” which has become quite a
Montclair NJ 07042. (973) 746-0789
p Herb-crusted Georges Bank flounder over roasted sweet Cubanelle peppers, surrounded by a spicy puttanesca sauce. March 2011
19
Events
New Jersey Physician Discusses
The Inaugural Meeting of the New Jersey Women in Healthcare
with Debra Lienhardt, Esq. of Brach Eichler Recently, New Jersey Physician had the pleasure of attending the first meeting of New Jersey Women in Healthcare. Founded by Lani M. Dornfeld, Esq., Carol Grelecki, Esq., and Debra Lienhardt, Esq., all of the healthcare division of Brach Eichler, this very well attended event mixed significant speakers from the state healthcare field with lunch and a wine tasting. The audience was most enthusiastic and felt this type of networking event was a long time in coming and was most appreciative someone had taken the initiative to put it together. New Jersey Physician recently met with Debra Lienhardt, Esq. to discuss the association. NJP: Can you give us a brief history of how the association was born? DL: My partners, Lani and Carol, and I have been practicing in the health care group of Brach Eichler and representing health care providers and institutions for a number of years. In such capacity, we have been counseling a large and growing number of women in the health care field, including physicians, other practitioners and key executives of hospitals, ambulatory surgery centers, nursing homes, and other facilities and organizations. We realized that there was no existing forum for these professional women to get together, network and share ideas. Therefore we developed the New Jersey Women in Healthcare association and have been working since the beginning of the year to put together the inaugural event. Brach Eichler, the leading health law practice in New Jersey, always looks for ways to support the health care community and was delighted to sponsor and promote the event. NJP: What are the goals that you and your partners would like to see reached by the group? DL: Our goals are clear. NJWH expects to grow and provide a forum for women to come together
20
New Jersey Physician
and address shared interests and concerns. It will provide information regarding the health care industry and national and local trends and foster strong professional networks. This event was our first. Based on the level of enthusiasm from the women who attended-as well as the disappointment from the women who didn’t-we will be creating additional programs aimed at achieving these goals for women leaders in health care. NJP: Can you discuss the difficulties faced by women in health care previously and currently? Has this changed and where do you see it going? What can the group do to lessen this problem and how can this be done?
DL: Although women have always played a large role in the provision of health care and the health industry generally, with respect to key leadership and executive positions, it was largely male dominated. In recent times this has changed and female colleagues are being recognized for their achievements. However, in order to ensure that this continues, we, the women leaders in health care, need to focus on building professional relationships and using those resources. We hope that through the efforts of NJWH, we can begin offering the growing number of women in the health care community a way to join together, share information and ideas and reach their professional goals.
The 3rd Annual
NJASC
Review Mark Manigan Program Chair A timely seminar on the latest regulatory and business developments affecting the New Jersey ambulatory surgery centers. This seminar provides an opportunity for more than 300 national and statewide ASC leaders to come together and discuss the latest and hottest issues affecting the industry.
Wednesday | April 27, 2011 8:00 – 9:00 a.m. Registration and Networking Breakfast 9:00 – 4:00 p.m. Program 4:00 – 6:00 p.m. Networking Cocktail Reception
The Palace at Somerset Park Somerset, NJ For sponsorship opportunities or to attend the event, please contact Alan Levine at alevine@bracheichler.com or 973-364-8389
A full-day program followed by a networking cocktail reception offering presentations and panel discussions by industry leaders on the latest ASC developments. • What is Your ASC Worth? • Latest Regulatory Developments from Washington and Trenton • ASC Mergers, Acquisitions and Consolidations • Key Insights from New Jersey Insurance Industry Leaders • Hospitals Getting Into the Game • Analysis from Key New Jersey Government Officials • PIP, Out-of-Network and Other Reimbursement Issues
PROTECT, PREVENT, DEFEND. More than 22,000 healthcare professionals across the country depend on medical malpractice insurance from ProMutual Group for protection and peace of mind. • We have the long-term vision and financial resources to provide the coverage you need today and in the future. • We proactively partner with you to minimize risk, increase patient safety and improve patient care. • And if you do face a claim, we will aggressively defend good medicine and provide the emotional support you need to rest assured. To learn more about ProMutual Group, call us at (800) 225-6168 or visit us online at www.promutualgroup.com. 101 Arch Street, Boston, Massachusetts 02110 | 1.800.225.6168 | www.promutualgroup.com ProMutual Group Agents: Michael R. Bernal-Silva MBS Insurance Boonton, NJ – 800-347-3417
Yvonne DiLauro Bollinger Insurance Moorestown, NJ – 856-273-8100
Shawn Knechtel Widerman & Company Haddonfield, NJ – 800-220-3434
Rory Rineer Professional Liability Agency Harrisburg, PA – 800-375-3056
Robin Voorhees The NIA Group Somerset, NJ – 800-669-6330
John Bisbee Boynton & Boynton Red Bank, NJ – 800-822-0262
Mary Donohue Brown & Brown Metro Mt. Laurel, NJ – 856-552-6330
Carol Maselli Conner Strong Companies Philadelphia, PA – 267-702-1375
Don Roberts USI MidAtlantic Plymouth Meeting, PA – 482-351-4600
Chris Zuccarini Cornerstone Professional Liability Consultants Radnor, PA – 800-508-1355
Kevin Byrne Acorn Professional Services West Conshohocken, PA – 800-454-2429
Tim Hoover The Woodland Group Sparta, NJ – 800-253-1521
Jennifer M. Moser Brown & Brown Bethlehem, PA – 610-974-9490
Patty Schaeffer AON/Affinity Insurance Hatboro, PA – 215-773-4600
William Carey Healthcare Risk Solutions Fort Washington, PA – 800-215-2707
Henry S. Kane Argent Professional Insurance Warren, NJ – 908-769-7400
Richard Petry Glenn Insurance Absecon, NJ – 609-641-3000
Kim Soricelli Arthur J. Gallagher Associates Montclair, NJ – 973-744-8500
Bob Cottone RUE Insurance Trenton, NJ – 800-272-4783
Steven Klinger Professional Consulting Services Livingston, NJ – 973-597-0400
William A. Reilly Joseph A. Britton Agency Mountainside, NJ – 800-462-3401
Burt C. Szerlip BC Szerlip Insurance Agency Little Silver, NJ – 800-684-0876