NJ Physician Magazine January 2014 by NJPhysician Magazine

JULY 2014 2012 JANUARY Visit us now online at

www.NJPhysician.org

Premier Pain Centers

Princeton Insurance knows New Jersey, with the longest continuous market presence of any company offering medical professional liability coverage in the state. Now a Medical Protective/Berkshire Hathaway company, Princeton Insurance offers even more resources, strength and innovation to those we insure. • Measured either by Gross Written Premium or by number of policyholders, Princeton Insurance is New Jersey’s leading healthcare malpractice insurer. • Serving New Jersey continuously since 1976 and the country since 1899 – the longest track record in the state, the oldest healthcare malpractice insurer in the nation • More than 57,000 New Jersey medical malpractice claims handled • Industry-leading financial strength, with a rating of A++ (Superior) from independent rating agency A.M. Best • Calls handled personally, specialized legal representation, knowledgeable independent agents, 24-hour new business premium quote • Unmatched ability to innovate, create, develop and support new products

Publisher’s Letter Dear Readers, Welcome to the January issue of New Jersey Physician Magazine. There has been much movement among the hospitals in our area. Barnabas Health has announced that a “Transformational Fundraising” effort has begun for Saint Barnabas Medical Center in Livingston to position the medical center for the future provision of continued exceptional care for their communities. Atlantic Health has agreed to purchase Hackettstown Regional Medical Center. Valley Hospital is eyeing a former UPS site to expand its services, and a coalition is attempting to make its case for the State to attach strings to the sale of St. Mary’s Hospital as the deal approaches its close. This is significant because it can have ramifications with Prime’s pending deals to purchase both St. Michaels and St. Clares. Senator Robert Singer’s pending legislation to draw more doctors to needed areas in New Jersey through a physician loan redemption program was advanced by the Senate and now rests on Governor Christie’s desk for approval.

Published by Montdor Medical Media, LLC

Co-Publisher and Managing Editors Iris and Michael Goldberg

Contributing Writers Iris Goldberg Michael Goldberg George Mast Christopher Robbins Beth Fitzgerald Riza I. Dagli Joe Carlson Michelle Mullins

As over 50% of the doctors in private practice in New Jersey consider whether to join in a large group, new business models develop. Trends toward a compromise position, where the practice remains physician owned but becomes a member of a group for billing, reimbursement negotiations, and other non-clinical matters are becoming more popular for those who wish to gain the benefits of business management while maintaining independence in their own practice.

Andrew Kitchenman

How comfortable are you to share with the public the prices you charge and the amount reimbursed by payers? Growing pressure by policymakers, employers, consumers and the media is forcing providers and payers to reconsider their longstanding opposition to price transparency. In fact, CMS has announced it would start providing information under the Freedom of Information Act requests on how much Medicare pays individual physicians.

Livingston NJ 07039

Significant pain is a major reason patients visit their physician. When the pain becomes so significant it interferes with a person’s life, a specialist in pain management may be called in. Our cover story this month is on Premier Pain Centers. With seven New Jersey locations, and an exceptionally trained team of physicians, this is a practice that can step in to restore quality of life to those patients in need. Trained at the top medical schools and hospitals, and active in state-of-the-art clinical trials, these doctors have a large array of tools at their disposal to help achieve relief in the suffering patient.

Although every precaution is taken to ensure accuracy of published materials, New Jersey Physician cannot be held responsible for opinions expressed or facts supplied by its authors. All rights reserved, Reproduction in whole or in part without written permission is prohibited.

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Contents

Premier Pain Centers

Comprehensive, Cutting-Edge, Compassionate Care Providing Dramatic Results to NJ Patients without the Need for Major Surgery

World Renowned Research-Based Advancements in the Management of Acute and Chronic Pain in a Patient-Friendly Community Practice Setting Cover Photo: Top Row L-R: Sean Li, MD, Kulbir Walia, MD, Mark Cattell, RPA-C Middle Row L-R: Renee Wolf, PA-C, Carmen Quiñones, MD, Michael O’Hara, DO, Cherie Weiss, PA-C Bottom Row: Scott Metzger, MD, Peter Staats,MD, John Mak, MD

CONTENTS Medical News

Physicians Group Gives Poor Grade To Emergency Care In NJ

Affiliated Practice

Valley Hospital Eyeing UPS Paramus Site

Is Your Practice Raising Red Flags?

Coalition Makes Case For State Attaching Strings To St. Mary’s Hospital Sale

Hospital Rounds

Revealing Times

Medical Bribes: Hundreds of NY, NJ Docs Took Cash, Says Lab Boss

2 New Jersey Physician

Talk to Bollinger about your Professional Liability … Before entering this room. • • • •

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www.Bollinger.com/pro Coverage is subject to meeting eligibility requirements and company approval.

Cover Story

Premier Pain Centers

Comprehensive, Cutting-Edge, Compassionate Care Providing Dramatic Results to NJ Patients without the Need for Major Surgery World Renowned Research-Based Advancements in the Management of Acute and Chronic Pain in a Patient-Friendly Community Practice Setting By Iris Goldberg Everyone experiences pain at times. Whether as the result of trauma, illness or merely the process of aging, when pain resolves on its own or with the help of a limited course of conservative treatment, we are grateful. When, however, the pain is severe and/or chronic, the quality of the life we knew can rapidly deteriorate. In fact, millions of Americans suffer the debilitating physical and emotional effects of unresolved pain, sometimes for years on end. Productivity is compromised, independence may be lost and often, personal relationships are affected. In short, the pain takes over. Consulting a physician who has been specialty-trained in pain management is certainly advisable when patients are having pain that interferes with the

Ideally, that pain specialist has received the highest level of training and is committed to pursuing the most technologically advanced and effective modalities that successfully resolve the pain in the most minimally invasive way. At Premier Pain Centers, with seven New Jersey locations, patients have access to a team of exceptionally-trained board-certified physicians, as well as expertly-skilled physician assistants and medical support staff. The result of a merger in 2012 of two successful practices that were each established in 2000, Premier Pain Centers has evolved into one of the most comprehensive centers for the treatment of acute and chronic pain anywhere. Some of the

Top Row, Left to Right: Carmen Quiñones, MD - Cherie Weiss, PA-C -John Mak, MD - Kulbir S Walia,MD - Mark Cattell, RPA-C

Bottom Row, Left to Right: Michael O’Hara, DO - Peter S. Staats, MD - Renee Wolf, PA-C - Scott Metzger, MD - Sean Li, MD

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painful conditions treated include but are not limited to: •Low back pain •Spinal stenosis •Vertebral Compression Fractures •Cervical and lumbar facet joint disease •Sciatica/Radiculopathy (“pinched nerve”) •Sacroiliac joint disease •Failed back surgery pain (FBSS) / Post-Laminectomy Neuropathic Pain •Neuropathic (Nerve) pain •Head pain / Occipital neuralgia (Scalp/head pain) •Hip pain •Intercostal neuralgia (Rib pain) •Peripheral neuropathy (Diabetic nerve pain) •Complex Regional Pain Syndrome or CRPS (Reflex Sympathetic Dystrophy - RSD) •Herniated discs and degenerative disc disease (discogenic pain) •Neck pain •Shoulder and knee arthritic pain (osteoarthritis) •Myofascial (Muscular) pain •Post-surgical pain •Cancer pain (pancreatic, colorectal, lung, breast, bone) •Pain from peripheral vascular disease •Angina (chest pains) •Post-herpetic neuralgia (shingles pain) •Nerve entrapment syndromes •Spasticity related syndromes/ pain •Spinal Cord Injury (central pain)

The mission of the practice is to provide cutting-edge treatments in order to help patients effectively manage pain and regain quality of life without undergoing invasive, open surgery. The physicians of Premier Pain Centers all share this commitment and work tirelessly together to ensure its fulfillment. When medication and/or other noninvasive therapies are not successful, the physicians at Premier Pain Centers utilize advanced, innovative minimally invasive techniques to mitigate the pain. (Some of the most commonly performed procedures are listed below). Minimally Invasive Procedures Offered by the Physicians of Premier Pain Centers • Lumbar and Cervical Epidural Steroid Injections • Facet/Medial Branch Block (Lumbar and Cervical) • Lumbar and Cervical Nerve Root Block • Minimally Invasive Lumbar Decompression (mild®) for lumbar spinal stenosis • Celiac Plexus Blocks • Spinal Cord Stimulators • Caudal Epidural Steroid Injections • Joint Injections • Radiofrequency Facet Ablation (Lumbar and Cervical) • Bursa Injections • Sacroiliac Joint Injections • Brachial Plexus Blocks • Discograms (Lumbar and Cervical) • Lumbar Sympathetic Blocks • Stellate Ganglion Blocks • Peripheral Nerve Blocks • Trigger Point Injections Scott Metzger, MD, who received his specialty training at the prestigious John Hopkins University’s Division of Pain Management, started Metzger Pain Management in 2000 upon returning to his native New Jersey with a strong desire to help people in his own community. He is dedicated to giving

patients the most compassionate care possible and concentrates on pioneering innovation in the science of pain medicine. Dr. Metzger shares a bit about how his practice grew from that point, beginning with partnering, in 2003, with his former teacher and mentor, Peter S. Staats, MD, MBA, Founder and Chairman of the Division of Pain Management at Johns Hopkins. “After Peter, we were fortunate to be joined by two other Hopkins-trained physicians,” informs Dr. Metzger. He refers to Kulbir S. Walia, MD, who was also trained by Dr. Staats and treats many painful conditions using a combination of conservative and minimally invasive interventional methods and Sean Li, MD, whose particular interests lie in neuromodulation and minimally invasive pain interventions. While at Hopkins, Dr. Li had the opportunity to be mentored by leading figures in the field of pain management, as well. “We really all had a strong sense of pride in our background and quality of our training, which translated into what we perceived as being able to offer the highest quality of practice,” Dr. Metzger shares. “Hopkins has always been recognized as one of the top programs in the world for the training of pain management physicians,” he emphatically adds. In 2012, Michael O’Hara, DO merged his equally thriving practice, NJ Center for Pain Management, with Metzger Pain Management and Premier Pain Centers was born. Dr. O’Hara, who specializes in the field of Interventional Pain Management, is board-certified in both Pain Management and Anesthesiology and received his training at the worldrenowned Hospital of the University of Pennsylvania. As far as the other physicians at Premier Pain Centers, Dr. Metzger points out that their training is equally impressive. John Mak, MD, who joined Dr. O’Hara in 2007, received specialty training at the Beth Israel Deaconess Medical Center-Harvard University and also at the Caritas St. Elizabeth’s Medical Center-Tufts University School of Medicine. Dr. Mak is boardcertified in Pain Management and Anesthesiology.

Dr. Quiñones examines the shoulder of a patient with rotator cuff tendonitis Carmen Quiñones, MD, who is board-certified in Interventional Pain Management, received her specialty training at Montefiore Medical Center in New York City and Emory University in Atlanta. Like her colleagues at Premier Pain Centers, Dr. Quiñones specializes in interventional pain management modalities such as lumbar epidural steroid injections, facet joint nerve blocks, radiofrequency ablation and trials with spinal cord stimulators. Bilingual in Spanish and English, Dr. Quiñones is dedicated to enhancing her patients’ quality of life by improving function and relieving pain.

An ultrasound guided steroid injection is administered into the shoulder in order to alleviate the patient’s pain. January 2014

which is the most exciting part of our practice with the different types of injections and treatments we have available,” he offers.

When speaking with the physicians, one cannot help but recognize the unwavering passion that each feels for helping their patients to win the battle against their pain and reclaim a good quality of life. Without exception, they all express, in their own way, the deepest commitment to the wellbeing of the patients they treat. “All of us are actually quite different personality-wise, yet we all share that common goal of really trying to be the best possible practitioner that we can be,” Dr. Metzger says. He explains that part of that involves consulting with one another regularly to discuss cases in order for patients to have the benefit of their collective expertise. In fact, the significant investment the practice has made in electronic record-keeping allows the physicians to stay in constant communication with one another when the need arises, regardless of where each might be at any time. Dr. Staats is equally dedicated to the quest of providing patients with the highest level of pain management available today. As an Adjunct Associate Professor at Johns Hopkins University School of Medicine and a prolific author of articles abstracts, chapters and books on the science of pain medicine, he remains at the forefront of advancements in that field. Dr. Staats also leads the research conducted at Premier Pain Centers, overseeing its ongoing clinical trials. “Pain is a tremendous crisis in America, probably costing the American people more than cancer and heart disease combined and is the leading cause of disability,” Dr. Staats asserts. He goes on to explain that part of the problem lies in the inability, in many cases, for there to be a consensus among physicians as to what the underlying cause of the pain actually is. “It’s important, I think, at the beginning of the pain problem, to start with someone who’s highly qualified to establish a diagnosis,” Dr. Staats maintains, alluding to the superior training received by the physicians at Premier Pain Centers and also the priority to keep abreast of and participate in ongoing research. Also, like his colleagues at Premier

6 New Jersey Physician

Dr. Staats oversees the ongoing clinical trials at Premier Pain Centers. Here, an innovative neurostimulator system under investigation is being placed. Pain Centers, Dr. Staats is acutely aware of the emotional component of pain, having written extensively about connecting the psychology of pain with the biology to determine, for example, why some patients would benefit more from bio-feedback and/ or other strategies. “Again, this all comes back to establishing a diagnosis and for some people, the emotional context can be very important,” he emphasizes. Dr. Mak, too, mentions the exceptional background of each physician and is extremely gratified to be able to bring that level of expertise to a community setting. Like Dr. Staats, Dr. Mak emphasizes the continual pursuit of the research. “We really try to gear our treatments to evidence-based medicine,” he remarks. “Everything we do is based on scientific evidence,” Dr. Mak reiterates. “Pain is very subjective, as we all know. You can tell someone that you are in pain but it can’t be measured like blood pressure or pulse can,” Dr. Mak points out. “That’s why it takes a lot of compassion and also the expertise of seeing many of these cases to accurately diagnose someone and provide the appropriate treatment,” he continues. Through a multidisciplinary and conservative approach, Dr. Mak describes how the physicians of Premier Pain Centers efficiently uncover and remedy the underlying source of pain. “We attack the problem from many different directions – from a medication standpoint, from a physical therapy standpoint and then from the interventional standpoint,

For example, epidural and facet joint injections can be therapeutic as well as diagnostic, hopefully, relieving the pain but if not, eliminating the area that was targeted as the pain source. A discogram, during which dye is injected into the center of a disc while the patient reports whether or not the pain he or she has been experiencing is triggered, is an excellent, minimally invasive way to identify if one or more discs require intervention, or if another source of pain must be investigated. Using his specialized skills in Anesthesiology, Dr. Mak can perform procedures such as ultrasoundguided nerve blocks in which he can actually see if where the locally injected anesthetic is placed relieves the pain. In fact ultrasound guidance is an integral part of pain management and can be used for joint, knee or shoulder injections, as well as for those in the spine. “These procedures can be performed much more accurately with ultrasound guidance,” Dr. Mak emphasizes. When primary care physicians are consulted about chronic back or joint pain, Dr. Mak and his colleagues, strongly believe that a referral to a comprehensive pain practice such as Premier Pain Centers should be made prior to recommending that the patient go directly to a surgeon. “This is the most logical and conservative next step,” he strongly asserts.

Dr. Mak follows up with a patient who had received an epidural injection in the cervical region.

From his perspective, Dr. Li, who often works with Dr. Staats on administering the clinical studies at Premier Pain Centers, defines pain as a total experience involving body and mind. “You just can’t separate the two,” he believes. “We always have to treat patients from their own experience and to realize and respect that pain affects everyone differently,” Dr. Li firmly states. “We may all come from different backgrounds,” Dr. Li says about the physicians of Premier Pain Centers, “but we all share that mantra or belief that everything we do is in the best interest of the patient. That pretty much sums up our practice,” he says. Dr. O’Hara also discusses the outlook and priority at Premier Pain Centers to consider the well-being of each patient as the primary goal and the importance of treating the whole person. “Pain does not exist in a vacuum,” states Dr. O’Hara. “It affects every aspect of a patient’s life. It affects them emotionally. It affects how they sleep and how they work. It affects their interpersonal relationships, making them anxious and depressed and certainly frustrated by being in pain routinely,” he elucidates. Dr. O’Hara strongly believes that in order to provide exceptional care, pain management physicians must assess all of these components and focus on the person behind the pain – not just the pain itself. He and the other physicians at Premier Pain Centers often work with psychologists and psychiatrists, when appropriate, who need to be included in the treatment plan for some patients. “We have to figure out how the pain is affecting each individual because that’s definitely going to impact on how that person will be treated.”

Like his colleagues at Premier Pain Centers, Dr. O’Hara focuses on the person behind the pain-not just the pain itself. Here he follows up with a patient after the administration of an epidural in the lumbar region.

Dr. Li, who often works with Dr. Staats on clinical trials, views the monitor as Dr. Staats places the leads.

In terms of the various treatments offered at Premier Pain Centers, Dr. O’Hara also points to the capability that he and the other physicians have to provide the most cutting edge and minimally invasive pain management procedures available. He mentions, for example, percutaneous disc decompressions, in which a needle or small scope is used to excise disc herniations and free up nerves that are being pinched or pressed upon. Percutaneous techniques are also used to remove small pieces of arthritic bone that have grown into a nerve area, instead of performing an open procedure. “The background we all have has really prepared us to do these kinds of procedures and quite frankly, do them better,” Dr. O’Hara relates. Dr. Walia characterizes Premier Pain Centers as one of the best practices for pain management in the country and possibly, the world. “We respect and care for our patients, treating them as a whole rather than localizing treatment to one aspect,” Dr. Walia remarks. “Additionally, we educate our patients to promote health,” he adds, referring to the widely embraced concept of improving the overall health of patients in order to prevent illness and associated pain from occurring in the first place. Also, stressing the importance of obtaining an accurate diagnosis before initiating treatment, Dr. Walia reiterates the necessity for patients to choose a pain practice, such as Premier Pain Centers, that offers the latest and most reliable diagnostic technology in order to provide appropriate care without causing greater harm. His strong belief and approach is to preserve the patient’s normal anatomy and restore normal physiology whenever possible.

“Our body has built-in defenses and rhythms to counter pain and if you can bolster those, I think, in many cases we can improve the quality of life and function.” Dr. Walia takes that point a bit further. He is concerned about those patients who get into subsequent trouble by consulting some pain management physicians that routinely over-prescribe addictive narcotics to relieve pain. Dr. Walia feels that not only has this contributed to the devastating epidemic of drug abuse but it potentially tarnishes the image of pain practices that prescribe responsibly. Like his colleagues, Dr. Walia is immensely proud of the research-driven medicine practiced by the physicians of Premier Pain Centers, especially as it relates to the ability to offer the most current, innovative and effective minimally invasive approaches to pain management. He is especially pleased to be a member of a practice that conducts its own ongoing research through the administration of valuable clinical trials.

Dr. Walia examines a new patient who has been suffering with chronic neck and back pain for years as a result of a motor vehicle accident. January 2014

As just one current example, Premier Pain Centers, under the direct supervision of Dr. Staats and Dr. Li, is participating in a national study to evaluate a potential new therapy for chronic limb pain. Neuropathic pain is induced by injury or disease of the nervous system. Neurostimulation, most commonly stimulation of the spinal cord, has been a safe and effective method to treat neuropathic pain for many years. Leads are implanted in the epidural space around the spinal cord. A neurostimulator (similar to a pacemaker), implanted in the abdominal wall or buttock and controlled by an external remote control, sends electrical pulses to the leads. These signals produce a mild tingling sensation where the severe pain had been felt. As explained by Dr. Staats, along with about two dozen sites across the country, Premier Pain Centers is enrolling patients for the ACCURATE study, a prospective, randomized, multicenter, controlled trial to determine the safety and efficacy of the Axium™ Neurostimulator System for chronic, neuropathic pain, affecting the lower limbs (such as the foot, leg or groin).

satisfaction for participants, who are not only having an opportunity to relieve their chronic pain but also to contribute to the science, since their data will help others in the future. Obviously, with the other ongoing research at Premier Pain Centers, the potential benefits to patients who are treated there is limitless. “This is just one of the cutting edge topics that we are focused on,” Dr. Li reports. Speaking of this and his other ongoing studies, as well as those upcoming, Dr. Staats reveals his personal hope. “I want to really be the person who’s helping to find the next step for people,” he candidly shares. In fact, the entire staff at Premier Pain Centers is on that journey together, each contributing the expertise, the compassion and the unyielding desire to relieve the pain and see the happiness on the faces of their patients who can fully enjoy their lives once again.

The I nvestigational Axium™ Neurostimulator System is the only spinal cord stimulation system that targets a branch of the spinal cord called the dorsal root ganglion (DRG), which plays a critical role in the development and maintenance of chronic pain, as it processes pain signals as they travel to the brain. “The dorsal root ganglion is really the traffic light, so to speak, of the superhighway of nerve conduction. It’s where the nerves all enter the spinal cord,” explains Dr. Staats. By stimulating the DRG, the Axium System interrupts these signals before they can travel to the brain. Dr. Li adds, “This procedure allows us to be a lot more specific. Rather than giving someone sort of a massage or buzzing sensation in their entire lower back and legs, we can hone in on to the left foot, for example. It’s a take-off on and a step beyond what we already know and what we already do and that’s why we’re excited to make that available to people.” Also, Dr. Li mentions the added

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In the ACCURATE study, leads are placed to stimulate the dorsal root ganglion (DRG).

Dr. Li places the leads with the help of fluoroscopic guidance.

Premier Pain Centers Office Locations Shrewsbury

Freehold

Brick

Old Bridge

(732) 380-0200

(732) 431-9544

(732) 458-0322

(732) 431-9544

Toms River

Manahawkin

East Brunswick

(732) 431-9544

(609) 256-4055

(732) 254-0883

For more information or to schedule an appointment, call one of the numbers above or visit premierpain.com

Medical News Medical News

Singer Bill Addressing Doctor Shortage in New Jersey Advances, Heads to Governor for Approval George Mast

Legislation originated and sponsored by Senator Robert Singer to draw more doctors to needed areas in New Jersey through a physician loan redemption program was advanced today by the Senate and will now head to the governor’s desk for approval. “It’s been shown that loan forgiveness programs have great influence in determining which practice medical students choose,” said Singer (R- Monmouth, Ocean). “Making certain New Jersey offers these types of incentives is more important than ever as communities across the state face a significant shortage of physicians and a growing demand for care.” Senator Singer’s legislation is based on a recommendation in a report issued by the New Jersey Council of Teaching Hospitals. The report found medical students give great weight to loan redemption programs and that New Jersey is facing significant future shortages in both primary care and several specialty areas. In eleven years there is a projected 12 percent shortfall in the physician supply versus the likely population demand for services. The bill, S162/A4507, provides for redemption of qualifying loan expenses for physicians in specialties that are projected to experience a significant shortage, so long as they work in New Jersey for 4 years in designated underserved areas. The legislation also provides tax incentives to employers who hire these new doctors. “I thank my Assembly colleagues and physician advocates for their collaboration and work in advancing this important measure,” Singer added. “This is an issue we can’t afford to delay. If we want to make certain that all communities are offered sufficient care we have to start addressing this problem before it becomes a crisis.”

Casagrande, Handlin legislation to curb state doctor shortage moves to Assembly floor Christopher Robbins Legislation pushed by two Monmouth County legislators to address New Jersey’s shortage of doctors will move to the Assembly floor. The Physician Loan Redemption Program, sponsored by assemblywomen Caroline Casagrande (R-Monmouth) and Amy Handlin (R-Monmouth, was released by the Assembly Budget Committee. The Physician Loan Redemption Program, redeems qualifying loan expenses over a four year period for physicians in specialties that experience a significant shortage in the state, if they work in New Jersey for that same amount of time in designated medically underserved areas. “This legislation addresses one of the biggest concerns expressed by medical students by offering them reimbursement for their loan expenses in return for a commitment to practice in our state’s underserviced areas,” Casagrande said. “We have learned much about this issue over the last year and we have listened to testimony from administrators, teachers and medical students. Now we can do something that provides a tangible benefit to our newest doctors while providing help in underserved areas which lack physicians.” The program is a response to estimates one million additional people will seek medical care in New Jersey under the Affordable Care Act, the landmark 2010 federal health care reform legislation, and reports that New Jersey is already training too few while exporting too many doctors. “We know from the report issued by the New Jersey Council of Teaching Hospitals that only about one-third of medical school graduates are opting to stay in New Jersey.” Casagrande said. “After speaking directly with stakeholders, repaying loans for their education is a major concern when they are ready to practice medicine. With an acute shortage of doctors expected in the near future, retaining new doctors in our state is a public policy challenge. In return for their commitment, the participants’ eligible qualifying loan expenses will be reimbursed, subject to the maximum amount authorized by federal law. January 2014

Affiliated Practice

Survey: Doctors consider new business models as future grows more uncertain By Beth Fitzgerald Faced with the uncertain future of health care reform, nearly half of the New Jersey doctors responding to a new survey are considering changing the structure of their practice this year, which could include joining forces with another practice or going to work for a hospital system. The Roseland law firm Brach Eichler conducted the annual survey among nearly 150 physicians statewide, including solo practitioners, members of a group practice or employees of a health care facility, in July. "The health care environment is a dynamic one in New Jersey, characterized by tremendous competition and an increasingly complex regulatory environment," said John Fanburg, managing member and head of the health care practice at Brach Eichler. Physicians with a negative outlook cited increasing insurance premiums, declining reimbursements, increased competition and declining autonomy as the most influential factors. Fanburg said more than 63 percent of respondents said their reimbursement rates decreased from last year. "A tremendous number of physicians in New Jersey have sold their practices to hospitals or large physician groups," echoing a national trend, Fanburg said. He said hospitals throughout the state are creating accountable-care organizations, mostly with Medicare, which are groups of health care providers and hospitals that come together to deliver higher-quality care, reduce duplication of services and spend health care dollars more efficiently. Fanburg said hospitals are acquiring physician groups "because as they develop their ACOs, they want to establish their footprint … they need to capture physicians before the other hospitals capture the physicians. So there is competition to get these doctors into these hospitals systems." Fanburg said these contractual arrangements are generally three- to five-year commitments, and what happens when that time is up "no one really knows at this point. The one thing everybody does acknowledge is the health care marketplace and the landscape is going to be very different — we just don't know how different." He said physicians are frustrated "that there is a lack of clarity as to where they are going, and that is very unsettling." Fanburg said in general, reimbursements to doctors are expected to decline in the future. "But I think there is going to be positive economic incentive for physicians to provide quality care and to be efficient. But the whole notion of just being paid for what you do, regardless of the quality and regardless of the efficiency — I think we can all assume those days are coming to a close." The survey also revealed about one in four physicians has joined an ACO, and of those that have joined, the vast majority — 95.2 percent — said they have not seen any benefits as a result. "The truth is, we simply do not know yet whether there are any meaningful benefits associated with joining an ACO, or whether we simply have not seen them yet," Fanburg said.

Medical News

Is your practice raising red flags? By Riza I. Dagli, Esq. Health care fraud investigators are being squeezed. The public demands more investigations, monetary recoveries, and prosecutions, but simultaneously tightens federal and state budgets. Similarly, insurance company special investigative units are trying to minimize losses due to fraud while suffering their own reductions in resources. They are all trying to uncover fraud faster and cheaper. And their solution to finding “red flags” appears to only be a mouse click away. The health care sector’s reliance on electronic storage and billing lends itself to one of the most effective and economic methods of detecting potential fraud : data mining. Since the Health Insurance Portability and Accountability Act of 1996, and continuing with the Medicare Modernization Act of 2003, public and private insurers and carriers have analyzed billions of bits of claims data with sophisticated algorithms to find “outliers”, i.e, claims that are unusually frequent compared to peers, unusually expensive, or inconsistent with the area of practice, equipment or staff. According to the Office of Inspector General, “DOJ and HHS have expanded data sharing and improved information sharing procedures in order to get critical data and information into the hands of law enforcement to track patterns of fraud and abuse, and increase efficiency in investigating and prosecuting complex health care fraud cases.”

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In fact, the federal government is so keen on data mining that it adopted rules in 2013 to encourage state Medicaid Fraud Control Units (MFCU) to data mine by reimbursing those efforts as part of the states’ federal grant. State agencies, such as the New Jersey Department of Human Services, New Jersey Department of Health, and many others, have access to multiple databases that allow them to find red flags. For example, the New Jersey Office of the Comptroller’s Medicaid Fraud Division established a Data Mining Unit, which, last year, used data mining to identify physicians that may have inappropriately or fraudulently prescribed Subaxone. With a simple comparison of databases, they found that the top 20 Medicaid billing providers for Suboxone were not on the Substance Abuse and Mental Health Services Administration list of certified providers. In total, they found 635 such physicians, and potential targets of investigation. Often, the red flags arise from carelessness or mismanagement, and not any criminal intent. But a criminal investigation can be disruptive and costly to a practice, regardless of the outcome. And, red flags are no longer limited to just “phantom billing” for expensive procedures not provided. Due to the broad language of both the federal and New Jersey’s health care fraud statute, a wide spectrum of services and activities may be considered fraudulent. The issue is whether a service was provided or not, and that distinction is not clear cut. For example, as the organizational structure of health care practice become more complex, billing for supervised services, rather than direct services, has become more common. Generally, there are three levels of supervision (personal, direct, and general) depending on the code being billed. Personal supervision requires that the physician be in the room while the procedure is performed. Direct supervision doesn’t require that the physician be in the same room, but must be present in the office suite and immediately available to give assistance and direction during the procedure. General supervision requires that the procedure be provided under the physician’s overall direction and control, but the physician’s presence is not required. Therefore, when a staff member provides a medical procedure to a patient, but the supervising physician was not in the room or in the building as required by the code, that service will be considered not to have been provided at all, even if it was performed competently and appropriately. And uncovering the claim is easy. With a few keystrokes, an investigator or auditor can review that physician’s billing and compare dates when the physician was in surgery at a hospital, for example, and also allegedly supervising procedures back at his office. Another example is a medical or other health-based license. Licensing allows the public to have a certain expectation of competence and education. Insurance claim forms will often require a certification that the service was provided by a licensed professional, and procedure codes will vary depending on which licensee is providing the service. A surgeon is licensed differently than a physical therapist, and those services will be reimbursed differently. So what happens when a license expires, or a licensee has a lapse of a few months or even days? Common sense says the licensee did not lose their skill or forget their education during that period of time. But from a fraud perspective, that person did not, and could not, provide the service, and the claims may be investigated for fraud. Again, from a data mining perspective, comparing billing to lapses in licensing is relatively easy, since both are stored electronically. Of course, not all unlicensed claims lead to criminal charges. The extent to which the person knew their license was not in effect is highly relevant, and would determine whether the submission of the unlicensed claim was a mistake, which would tend to keep the case civil or administrative, or knowing or reckless which may lead to criminal charges. Red flags can also be raised by the frequency and type of complex billing codes. For example, each code has a level of complexity and a corresponding estimation of time to perform that service. Based on a review of a practice’s billing on a given day, an auditor may find there were not enough hours in the day to provide the quantity and complexity of procedures claimed. Additionally, the data analysis may not be limited to a single insurer, Medicaid, or Medicare. Federal and state law enforcement agencies, such as the New Jersey’s Office of Insurance Fraud Prosecutor and the Department of Banking and Insurance’s Bureau of Fraud Deterrence, can obtain claims data from all insurance companies and review all claims data on a given date. If an initial review raises concerns, additional refined analysis may look at other factors, such as if the service was allegedly provided on a weekend or holiday. In January, 2014, the NJ Office of the Comptroller levied fines of $2.7M against three mental health facilities, and noted that one facility billed for health care and transportation services on days the center was closed. This can all be done without an investigator even going into the field. In addition to improper billing, investigators and auditors may find other red flags in the data. For example, a high frequency of common patients between different physicians or other practitioners may indicate the presence of kickbacks or improper financial relationships. Unusually high prescriptions of opiates may indicate distribution of controlled dangerous substances. Most physicians are keenly aware of the consequences of health care fraud convictions, from the imposition of prison terms and fines, to the loss of license and Medicare/Medicaid provider privileges. Accordingly, physicians are careful to submit claims for only those services they provide. However, fraud is increasingly construed more broadly, and even well-intentioned physicians need to be more careful in their office. Proper documentation, record-keeping, and an understanding of the codes by all staff members will go a long way toward keeping a practice from being interrupted by a criminal investigation. ---Riza Dagli is a Member and Chair of Criminal Defense and Government Investigations at Brach Eichler LLC, a full-service law firm with offices in New Jersey and New York. He has served as Director of New Jersey’s Medicaid Fraud Control Unit, Deputy Director of the NJ Division of Criminal Justice, and supervised the NJ Office of the Insurance Fraud Prosecutor. He can be reached at rdagli@bracheichler.com. January 2014

Revealing times Hospitals, physicians face mounting policy and market pressure to disclose prices By Joe Carlson Growing pressure by policymakers, employers, consumers and the media to publicly reveal the prices charged by healthcare providers and reimbursed by payers is forcing providers and payers to reconsider their longstanding opposition to price transparency. Last week, the CMS announced it would start providing information under Freedom of Information Act requests on how much Medicare pays individual physicians. Employers, news organizations and watchdog groups have been seeking that information for many years. The American Medical Association immediately protested that the policy could violate the privacy rights of doctors and patients. In addition, experts are pointing to a little-noticed 56-word provision buried in the Patient Protection and Affordable Care Act requiring all hospitals to publish a list of their standard charges for items and services, including Medicare DRG charges. While HHS hasn't yet issued a rule implementing that provision, Sect. 2718 (e), some experts say that when it is implemented, it could create powerful pressure for even greater price transparency. MH Takeaways New CMS policy on releasing doc pay data and ACA provision requiring hospitals to disclose charges may signal full price transparency is inevitable. Sen. Ron Wyden (D-Ore.), the likely new chairman of the Senate Finance Committee, and Sen. Chuck Grassley (R-Iowa) have introduced a bill to make Medicare payment data broadly accessible to the public on a searchable Web page. Both conservative and liberal policy analysts long have supported the concept of giving consumers price and quality information to enable them to shop around for the best deals on healthcare services. Over the past year, there's been increasing public attention to the issue of high U.S. healthcare costs. A major factor in the growing movement to reveal prices is the rapid increase in the number of Americans who are covered by health plans with high deductibles and coinsurance. Since they have to pay more out of pocket, consumers need to know which providers offer lower prices. Both public officials and private-sector groups have taken steps to provide more information. Last year, the CMS published data disclosing what hospitals charge and what Medicare pays them for common inpatient and outpatient procedures. Providers complained that the widely varying charges for the same services were misleading because the numbers did not reflect what patients and insurers are actually billed. But the Obama administration said the disclosures would help consumers make more informed healthcare decisions. Also last year, North Carolina passed one of the strongest state laws in the country on price disclosure, requiring the state's hospitals and ambulatory surgery centers to publicly disclose on a state website what they're paid by public and private insurers for 140 medical procedures and services. In addition, many employers, insurers and private firms have created price-comparison tools for their employees and customers. Meanwhile, the New York Times has published a series of articles over the past year documenting the much higher prices for medical services in the U.S. compared with other advanced countries, and Time magazine published a long and widely discussed article delving into hospital chargemaster rates. Research shows price transparency can drive down costs. An analysis by business school researchers at the University of Chicago last year found that government regulations forcing providers to reveal their prices resulted in an overall 7% reduction in the cost of common elective procedures. Prices, however, aren't the only type of information needed to make smart choices under consumer-directed care. Data on individual providers' performance on quality of care measures also are essential because evidence shows that more expensive providers may not be better quality-wise than cheaper providers. “We've made strides in making information about the quality of healthcare available to consumers,” said Suzanne Delbanco, executive director of the San Francisco-based not-for-profit Catalyst for Payment Reform, which works with employers to promote transparency in prices and quality information. “But all of us have been largely in the dark about what our healthcare will cost us at the end of the day.” Despite the growing clamor for transparency, providers and insurers continue to argue that the prices they charge and pay are business secrets and that publicly disclosing those rates would hurt their bargaining positions and jeopardize their finances. But even some healthcare providers are losing patience with that argument. “It is shocking to us, as a full-service academic medical center, to see that we have to pay 35% more when our employees end up at another hospital,” said Steven Sonenreich, CEO of Mount Sinai Medical Center in Miami Beach. “We need to continue to inform the public that a lack of price transparency is driving up expenses for employees and employers.” January 2014

Sonenreich announced last year that his hospital would publish its negotiated prices online, but he said that plan was dropped because of opposition from insurers. Regency Healthcare, an outpatient surgical practice in New York, has begun posting its prices online, as has the Surgery Center of Oklahoma in Oklahoma City. Both facilities are doctor-owned, and the prices only apply if the patient pays in cash or has a check cut from their employer's self-funded insurance plan. No hospitals currently are known to publish their prices, and consumer groups report it's often difficult for patients to find out in advance what they will have to pay. Some experts have criticized the Obama administration for talking a good game about transparency but not doing as much as it could. For example, CMS officials declined a request for comment from Modern Healthcare about why the government hasn't issued rules implementing the healthcare reform law's provision requiring hospitals to post their prices. Some say the administration has shied away from enforcing that provision because it has its hands full implementing many other aspects of the law and doesn't want to anger hospitals and insurers, whose cooperation it needs to make the law work. “Neither (Democrats nor Republicans) really likes it,” said Jonathan Gruber, a healthcare economist at the Massachusetts Institute of Technology who advised the Obama administration during the drafting of the reform law. “When you have a good public policy but both sides don't like the policy, it's hard to make it happen. I think it's going to happen, but it's going to be a slow process.” A former Democratic congressional aide who worked on the drafting of the law in 2009 said the transparency section was written during negotiations as a sweetener for skeptical Republicans worried about cost control. “We started to have conversations very late about this issue,” said the former staffer, who did not want to be identified. “This whole transparency discussion is so important, it's so difficult, and it always gets short shrift. We spent more time making sure that illegal immigrants didn't get healthcare and that people couldn't get abortions than we did on this. Ten times more.” But some observers say publishing hospital charges would have limited value because charges represent inflated retail rates that almost no one actually pays. That was the chief criticism last year when the CMS for the first time published rack-rate charges on the top 130 most common inpatient and outpatient services at 3,000 hospitals. “Looking at charge data in isolation does not take into account a full picture of the complex reimbursement environment in which all hospitals must operate,” Health Management Associates, a Naples, Fla.-based hospital chain said in a written statement. “Realistically, all hospitals only collect a small percentage of charges.” HMA owns three of the top 10 highest-charging hospitals in the country, according to an analysis by the labor union National Nurses United, which has advocated for greater transparency and a crackdown on hospital profiteering. Both the American Hospital Association and the Federation of American Hospitals declined to comment for this article. Still, charge data could offer valuable insights. And experts say publishing comprehensive charge data could trigger a wider national discussion about why prices vary so widely among hospitals. Even though hospital retail charges do not affect most patients' out-of-pocket costs, they do have some effect on costs for both Medicare and private insurers. That's because Medicare and private insurers reimburse hospitals extra for extraordinarily expensive cases under outlier payments, and those payments are based partly on retail prices. So hospitals with higher prices receive higher outlier payments. It's not clear that the Obamacare provision would not require the publication of actual prices paid by purchasers. “If I was in HHS, I would interpret it as being the amount that is actually paid,” said Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University. “That would be my reading of congressional intent, that they wanted actual price transparency.” While much of the discussion about price transparency has focused on hospitals, last week's policy shift by the CMS will put a brighter spotlight on physician prices as well. Since 1979, the federal government has been prohibited by a federal court injunction from releasing Medicare payment data on individual physicians. The judge at the time ruled such releases could violate physicians' right to privacy in their practices. When a federal judge in Florida lifted the injunction last year, the CMS moved to establish a process to begin disseminating the information. The agency now will consider requests to disclose individual physicians' Medicare payments through the Freedom of Information Act, which contains an exemption for data that would be considered an invasion of privacy. Each request will be considered on a case-by-case basis, and it remains to be seen how the CMS will construe the privacy protections. “Given the advantages of releasing information on Medicare payment to physicians and the agency's commitment to data transparency, we believe replacing the prior policy with a new policy in which CMS will make case-by-case determinations is the best next step for the agency,” CMS Principal Deputy Administrator Jonathan Blum wrote in a blog post last week. The new rule prompted criticism from some observers. “Ideally and ultimately, HHS should disseminate the information via a publicly accessible database rather than on a case-by-case basis,” said Joel White, president of the Washington-based interest group Council for Affordable Health Coverage, whose members include insurers, physician groups and the U.S. Chamber of Commerce. “These data have a value too great in reducing costs, curtailing fraud and improving quality to be handled on an ad hoc basis.”

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But Dr. Ardis Dee Hoven, president of the AMA, which has long opposed release of data on payments to individual physicians, said the AMA “strongly urges HHS to ensure that physician payment information is released only for efforts aimed at improving the quality of healthcare services and with appropriate safeguards.” Other physician leaders say the Medicare payment data contain little, if any, information that individual consumers would find useful because of their complexity. “While health systems, news outlets, government agencies, and other major healthcare players may be able to find useful information in physician payment data, the general public will not,” Dr. Manoj Pawar, a vice president with Catholic Health Initiatives, wrote in response to the CMS policy. But providers' efforts to block transparency reforms probably are doomed because they run counter to the strong movement toward “consumer-directed” healthcare, said Uwe Reinhardt, a healthcare economist at Princeton University. As Americans are forced to pay for a greater share of their healthcare bills, they need to know more about the real costs. “I've told hospitals, 'If you do your five-year plan, you might as well assume that your prices will eventually be known,' ” he said.

Medical Bribes: Hundreds of NY, NJ Docs Took Cash, Says Lab Boss By Michael Mullins $100 million dollar Medicare and insurance billing scheme is unraveling in the Garden State, leading to the Parsippany-based firm Biodiagnostic Laboratory Services alleging that hundreds of doctors in New York and New Jersey demanded bribes and kickbacks for giving the corrupt lab their business. Scott Nicoll, the former president of the Biodiagnostic Laboratory Services, pled guilty to paying millions in bribes to area physicians which would result in the doctors billing tens of millions in additional and often unnecessary blood tests that would then be sent to the lab, NBC News reported. Following the court hearing, Nicoll, speaking through his attorney, said that hundreds of doctors provided him with business in exchange for illegal cash payoffs. "This case clearly involves a two-way street between doctors and unfortunately, my client," defense attorney John Whipple told NBC News. Claiming that the doctors numbered "in the hundreds," Whipple added that "in many occasions, it was the doctors themselves that insisted upon the payment of funds to have their bloodwork and other tests sent to the lab." In total, seven lab workers, including Nicoll, pled guilty to conspiracy to bribe physicians and money laundering at Newark federal court on Monday. According Whipple, his client has accepted full responsibility for his actions and will pay back the money he stole. "Individual greed has no place in a treatment plan, and people seeking medical help deserve to know a doctor’s recommendations are based on professional expertise, not illicit profits," federal prosecutor Paul Fishman said. To date, 11 Doctors have been charged. The investigation is still ongoing and "we are looking to pursue every avenue that is available to complete the case," New Jersey FBI Director Aaron Ford tells NBC News. According to Whipple, all tests at the lab were always performed properly. The attorney added that in some cases however doctors would order additional blood or allergy tests that would result in an inflated bill to the insurance company. More than $100 million was earned by overbilling on blood samples and other tests, NBC News reports. Biodiagnostic Laboratory Services' offices were raided by FBI agents in April. In addition to duping Medicare and insurance providers, investigators say the scam also burdened patients, who had unnecessary tests performed and in turn paid higher insurance premiums due to the fraud. According to Whipple, the FBI now has in their possession the names of hundreds of doctors from New York and New Jersey who the attorney claims participated in the fraud with Biodiagnostic Laboratory Services.

Physicians Group Gives Poor Grade to Emergency Care in New Jersey

Andrew Kitchenman

Limited access due to hospital closures, malpractice rules cited in giving state a “D-Plus” New Jersey’s emergency care nearly earned a grade of “F” on a report card released by a physicians group this week. The American College of Emergency Physicians’ report card gave the state a “D-plus,” which is a full letter grade lower than the grade New Jersey received for the last ACEP report in 2009. There is one small consolation: The state’s dismal grade is the same grade that the group gave emergency care nationwide. January 2014

However, New Jersey’s mark fell further than the nation’s grade since the report issued five years ago, when the United States received a “C-minus.” The reasons for New Jersey’s low score were concentrated in two areas: access to emergency care and the state’s malpractice rules. ACEP officials identified the state’s hospital closures as a factor in declining access to emergency care, while the state’s longstanding relative friendliness to malpractice plaintiffs makes other states more attractive to emergency doctors. Current ACEP New Jersey President Dr. David Adinaro said access to emergency care has gotten much worse in the state over the past give years, with the ACEP grade for access falling from “C” to “F.” He said hospital closures, the low number of emergency physicians and insurance treatment of emergency visits are among the factors that fed into the grade. “Our system is at a tipping point in a crisis, in a way,” Adinaro said. “Continued loss of hospitals and the emergency departments that are attached to it means the emergency departments are going to get more and more full.” He also said that it is difficult for New Jersey emergency doctors to refer uninsured and Medicaid doctors to specialists for followup care. He noted that the state’s Medicaid reimbursement rates, which are among the lowest in the country, lead to a lack of orthopedists, plastic surgeons, neurologists and other specialists treating these patients. Adinaro would like to see the state increase its Medicaid reimbursements. “If physicians do not take Medicaid, it’s hard for us to get the care that patients need in follow-up,” he said. “You know, we can take care of your broken bone in the emergency department, but then you need to follow up for it.” The state also received an “F” for its medical liability environment, the same grade it received in 2009. Adinaro would like to see the state Legislature enact a bill reducing the legal liability for emergency doctors treating uninsured patients who they are required to treat under the 1986 Emergency Medical Treatment & Labor Act. He said passing such a bill would be a step in the right direction. “You need to not put so many roadblocks in the way” to encourage doctors who treat these patients, Adinaro said. Not all of New Jersey’s grades were bad. The state received a “B” for its public health and prevention environment. Adinaro said New Jersey’s strong disaster response preparations, stringent drunk-driving laws, and a ban on texting while driving are among the positives that fed into that grade. “There are some positive things happening in New Jersey – it’s not just all in the negative,” Adinaro said. In describing the overall environment faced by New Jersey’s emergency doctors, Adinaro said they are increasingly serving a key role in treating an aging population that will require more emergency services. While he applauds efforts to provide care that prevents patients’ problems from developing into emergency, he also cautioned against a sole focus on reducing emergency-department visits. He expressed concern that patients facing genuine emergencies that require the expertise of emergency doctors will be diverted to primary care settings.

Valley Hospital eyeing UPS Paramus site BY LINDA MOSS The Valley Hospital is in negotiations to buy the site in Paramus that global parcel distributor UPS is vacating, several commercial real estate sources said Monday. The Ridgewood-based hospital, which has been scouting for land in Bergen County to expand its services, is looking to purchase UPS' data-processing and software development facility on Winters Avenue, sources said. The parcel distribution company's site is at 640, 650 and 670 Winters Ave., not far from Route 17. That location is near a 128,000-square-foot facility Valley Hospital already has in Paramus, the Robert and Audrey Luckow Pavilion at 1 Valley Health Plaza, behind the Fashion Center shopping mall. If the Valley-UPS deal closes, the purchase price would be about $25 million, one source said. It would be the latest purchase for the hospital, which has been snapping up properties in the region in recent months. Valley picked up a property in November, the 112,000-square-foot Parkview Plaza at 1200 E. Ridgewood Ave., Ridgewood. The hospital purchased the office building, which is about one mile from its main campus, for $28 million from Hartz Mountain Industries Inc. in Secaucus. Cushman & Wakefield of New Jersey Inc. represented the hospital in that transaction, and sources said the real estate broker also is representing Valley in the talks regarding the UPS site in Paramus. Cushman officials couldn't be reached for comment. After first saying there was "no truth to the rumor that we have bought the property," Valley spokeswoman Megan Fraser could not be reached for comment. Valley officials have told real estate brokers that the hospital needs a site to build a fitness and wellness center. Hackensack University Medical Center opened such a facility, a 112,000-square-foot building, during the past month on Route 17 in Maywood.

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But Valley has other expansion needs, as well, stemming from its land-locked situation in Ridgewood. For nearly a year, Valley has been seeking village approval to amend the master plan for its 15-acre site so it can increase its footprint to 995,000 square feet from 562,000 square feet. That plan has met with opposition from some residents, who are concerned that there will an increase in traffic and more noise. To appease critics, in the past the hospital has promised to move some out-patient services to an off-campus site. Valley plans to open the Michael R. Luckow Heart Center at the Parkview Plaza in Ridgewood this year. Comprehensive heart imaging, cardiacrisk assessment and screening will be housed there, through a $5 million gift from the Luckow Family Foundation that was announced in December. UPS has three buildings on its Paramus property, each about 50,000 square feet, according to CoStar, which tracks commercial real estate data. The building at 640 Winters was constructed in 1960, the structure at 650 Winters was built in 1967, and 670 Winters was built in 1966, according to CoStar. "Real estate activity has been going back and forth, so I'm not going to comment on any specific statuses or negotiations," UPS spokeswoman Susan Rosenberg said. "We made it clear over a year ago that the three buildings on Winters Avenue in Paramus just didn't meet our needs for moving forward. But I'm not going to comment on any current status of the real estate transactions." UPS in December 2012 said it planned to shutter its Paramus location and relocate about 900 employees. At the time, UPS said it was getting more than $6.4 million in state tax incentives and was considering moving to an existing building in Woodland Park. But just last week, the global package deliverer said it was scuttling its plan to move to Woodland Park from Paramus. Instead, the company is considering building a 200,000-square-foot facility on Interpace Parkway in Parsippany, with the help of a $40 million state tax break.

Friendly, Compassionate Staff to Serve the Urban Patient The Smith Center for Infectious Diseases and Urban Health was developed to address infectious diseases in the inner city. This non-profit center, which is initially focusing on HIV, recognizes that inner city patients face many unique challenges in their daily lives. These challenges interfere with treatment of infectious diseases and foster an environment where infectious diseases are easily spread. When you treat a person with HIV, you greatly reduce the chances of transmission and treat the whole community. In the past 10 years there have been incredible advances in HIV treatment. We at the Smith Center believe that by using novel approaches we can rid New Jersey of HIV. We have designed programs to incentivize patients to continue their medications. We have created a personal atmosphere, where each patient is known by her or his first name. We work with our patients to ensure that we are providing the best service possible.

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Visit us now online at www.NJPhysician.org January 2014

Coalition Makes Case for State Attaching Strings to St. Mary’s Hospital Sale Andrew Kitchenman Unions part ways over whether NJ should require monitor for-profit hospital manager Prime Healthcare Prime Healthcare Services’ yearlong effort to buy St. Mary’s Hospital in Passaic is entering its endgame, as a coalition of opponents to the deal argue that it will put the community, patients and healthcare workers at risk if the state doesn’t attach more strings to the deal. This coalition, which includes unions that represent workers at other hospitals as well as healthcare advocates and community activists, alleges that the core of Prime’s business model – turning struggling nonprofit facilities into profit makers – is based on dangerous tactics that only a bevy of state requirements and a state-appointed monitor can combat. But Prime has gained a key ally – JNESO, the union that represents nurses and other healthcare workers at St. Mary’s, has already reached a contract agreement with Prime pending completion of the sale. The process will come to a head over the next two nights, as the state Department of Health holds a pair of legally required public hearings at Passaic High School, during which opponents and supporters of Prime are expected to make their case. The outcome will have ramifications for not only the St. Mary’s sale, but also for Prime’s bids for Saint Michael’s Medical Center in Newark and the three Morris County hospitals operated by Saint Clare’s Health System. India Hayes Larrier , an organizer for nonprofit coalition member New Jersey Citizen Action, said in a telephone press conference yesterday that Prime has a history of putting profits ahead of the interests of communities and patient care. The coalition is demanding a series of measures it wants the state to require if it approves the hospital’s transfer of ownership. They include keeping St. Mary’s as an acute-care facility, requiring that it maintain outpatient and clinical services, and mandating that St. Mary’s maintain in-network status with insurers. The coalition members said the state must also require Prime to address the health needs of the local community, which a survey determined to include treating patients with hypertension, asthma, diabetes and depression, as well as other mental illness and substance-abuse issues. In addition, the coalition wants a state monitor to ensure access to care and to prevent the hospital from shifting costs to consumers and other providers, weakening its quality and diminishing the standard of living for its healthcare workforce. The participation in the coalition by the Health Professionals and Allied Employees, a union that represents workers at other hospitals but not at St. Mary’s, has incensed JNESO Executive Director Virginia Treacy. “To place unrealistic restrictions on a new buyer will make (the sale) untenable,” Treacy said. Treacy said that both JNESO and Prime agree with most of the coalition’s goals, including that St. Mary’s continues as a fullservice hospital that meets the needs of the community. But JNESO opposes having a state financial monitor. Treacy noted that the HPAE represents workers at other New Jersey hospitals operated by for-profit owners and that only one of them has a monitor – Meadowlands Hospital Medical Center. “I find it absolutely hypocritical that HPAE has had for-profit buyers in so many different facilities and comes into a hospital (objecting to a sale) where they represent no one,” Treacy said. She also opposed the coalition’s demand that St. Mary’s join all insurers’ networks. She argued that every hospital in the state must be able to negotiate contracts with insurers, with the ability to remain out-of-network if an insurer isn’t willing to bargain. Prime has been in a long-running dispute with the Service Employees International Union in California. SEIU executive board member Stephanie Allen said that based on her experience as a respiratory therapist at Centinela Hospital Medical Center in Los Angeles, St. Mary’s patients can expect reduced services, staff layoffs, increased use of expensive testing and cancelled insurance contracts. Nelly Celi of the Peruvian American Coalition in Passaic, expressed a fear that St. Mary’s would ultimately be reduced to a shell, with an emergency department shifting patients to out-of-town hospitals that are inaccessible to patients’ families. “It is not enough to have a hospital that does not care about the day-to-day healthcare needs of our community,” Celi said. Renee Steinhagen, executive director of New Jersey Appleseed Public Interest Law Center, said St. Mary’s governing board has a track record that’s “blatantly” not in the hospital’s best interest. She cited reports that Prime will only pay off $15 million of the $40 million bond that the state provided the hospital, leaving taxpayers to pay the other $25 million. She expressed doubt that the hospital board fully explored a nonprofit purchaser before reaching its agreement with Prime. She said that in order to fulfill its fiduciary duty, Prime must appoint a locally based corporate board, not just an advisory panel, and pay for a state monitor for three years.

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“We have to ensure that this facility remains a community hospital,” Steinhagen said. Prime officials responded to the concerns with an emailed statement. "Prime Healthcare Services is committed to St. Mary’s Hospital, its employees and the greater Passaic community,” wrote Luis Leon, Prime’s president of operations. “We welcome the state of New Jersey’s thorough review process and look forward to the public hearings, which will allow community members to make their voices heard. We remain confident that this fair and open process will ultimately lead to St. Mary’s joining the Prime Healthcare family. Prime Healthcare’s goal is to make St. Mary’s one of the best hospitals in New Jersey.”

January 2014

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Hospital Rounds

HOSPITAL ROUNDS

Transformational fundraising effort underway at Saint Barnabas Medical Center By Beth Fitzgerald

Barnabas Health announced Tuesday that it's planning a “transformational fundraising” effort for Saint Barnabas Medical Center in Livingston. Barry H. Ostrowsky, chief executive of Barnabas Health, said in a statement that the goal is to position the medical center "for the future provision of continued exceptional care for our communities." Barnabas said the project is under study with key constituent groups to gain insights and opinions. Founded nearly 150 years ago, Saint Barnabas is New Jersey's oldest nonprofit, nonsectarian hospital and a leading regional medical center and teaching hospital. Barnabas said Hoda Blau, executive director of the Saint Barnabas Medical Center Foundation, has stepped away from corporate responsibilities to lead the development project. Blau's corporate responsibilities have been assumed by Glenn Miller, chief development officer of Barnabas Health, who previously served as associate dean for institutional advancement at Albert Einstein College of Medicine in New York since 2008. For 23 years, Blau has been involved in development activities for Saint Barnabas Medical Center and since 1996, for Barnabas Health. She has simultaneously served as executive director of the Saint Barnabas Medical Center Foundation and the Barnabas Health Foundation, which included responsibility for oversight of the seven Barnabas Health foundations.

Atlantic Health System to purchase Hackettstown Regional Medical Center for $54M By Tom Zanki

Atlantic Health System has agreed to purchase Hackettstown Regional Medical Center, a 111-bed acute care hospital in northwest New Jersey, from Adventist Health Care for $54 million. Boards of directors from Atlantic and Adventist agreed to the transfer of ownership, which is subject to regulatory review from the state Department of Health and the Attorney General's office. Executives said in a conference call Wednesday that completion of the deal could take up to a year, during which no changes will occur at Hackettstown. The Warren County hospital expects to add services after the deal is finalized by tapping into Atlantic's network in northern and central New Jersey. Executives also expect improved efficiency resulting from shared services and geographic proximity. No job cuts are currently planned at Hackettsown, which employs nearly 900. "As it stands now, there are no plans to reduce or eliminate any programs or services," Atlantic Health System CEO Joseph Trunifio said. "In fact, we hope we will be able to use this year for expansion of programs and services." HRMC President Jason Coe said the hospital is familiar with Atlantic's system. The deal will provide Hackettstown with access to more specialists and services, including cardiovascular, neonatal, oncology and neuroscience. "This is a just natural fit," he said. The deal follows a wave of acquisitions and consolidations in the health care industry as providers seek to improve efficiency and comply with mandates under the Affordable Care Act. The Wednesday announcement follows completion of a Jan. 1 merger between Atlantic Health System and Chilton Hospital. The Hackettstown center had been the only New Jersey facility owned by Adventist, a faith-based health organization based in Gaithersburg, Md., which operates mostly in the Washington, D.C., area. HRMC will remain a nonprofit hospital after the transaction. Cue said elective abortions are not performed at Hackettstown, partly due to Adventist's religious roots. He said it is too early to speculate as to whether that will change under Atlantic's ownership. Atlantic Health said the Hackettstown facility will gain the following benefits by becoming part of Atlantic's system: • Expanded outpatient and preventive medicine services available within the region; • Broader patient access to pediatric and other specialty care; clinical trials; and advanced protocols for emergent care, including complex stroke care, the latest cardiac diagnostic and treatment interventions, and advanced neonatal care; • Cost savings through shared services and more efficient use of resources January 2014

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