NJ Physician Magazine July 2013 by NJPhysician Magazine

JULY 2013 2012 JULY Visit us now online at

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New Jersey Urology

Innovative Prostate Cancer Treatment That’s Easy to Live With Also In This Issue: The New Jersey Medical Restructuring Act Incorporates Most of the Former UMDNJ into Rutgers Rutgers Launches Neuroscience Consortium Barnabas Health and Jersey City Medical Center Sign Definitive Agreement Medicaid Expansion Legislation Heads to Governor’s Desk and is Vetoed

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Publisher’s Letter Dear Readers, Welcome to the July issue of New Jersey Physician, offering you the news of the state critical to your practice.

Published by Montdor Medical Media, LLC

You will find a series of articles in this issue regarding the Medicaid Expansion issue. Originally endorsed by Governor Crhistie and also endorsed by the Senate Health Committee, it passed its final legislative hurdle. All that remained was the Governor’s signature, which everyone assumed was a done deal. Guess what, Vetoed! The reasoning behind this veto was that “it would add potentially hundreds of millions of dollars to state and local budgets”. The Governor says he is planning to expand Medicaid eligibility for low-income New Jersey residents, but he doesn’t want the expansion to be backed up by state law.

Co-Publisher and Managing Editors Iris and Michael Goldberg

Contributing Writers Iris Goldberg Michael Goldberg Beth Christian Andrew Kitchenman Mark Manigan John D. Fanburg

A study was published in the medical journal Pediatrics regarding the successful implementation of the 2011 law mandating a form of screening called pulse oximetry. A device placed on an infant’s foot tests the baby’s blood. A negative test can show there is an underlying health problem, such as congenital heart defect. Early screening allows for life-saving surgeries to repair infant’s damaged hearts.

Debra C. Lienhardt Joseph M. Gorrell Carol Grelecki Keith J. Roberts Robin Lally

Layout and Design

A plan has been unveiled for a statewide Health Information Network. The goal is to create a single secure network that will make it easier for providers to access their patient’s medical histories, information on medication allergies and lab test results. The state expects the network to begin operating in 2014.

Nick Justus

New Jersey Physician is published monthly by Montdor Medical Media, LLC., PO Box 257 Livingston NJ 07039 Tel: 973.994.0068

A definitive agreement has been signed for Jersey City Medical Center to become part of the Barnabas Health System. This change requires the approval of the state and local authorities, and it is expected the transaction will be completed by Fall, 2013.

F ax: 973.994.2063 For Information on Advertising in New Jersey Physician, please contact Iris Goldberg at 973.994.0068 or at igoldberg@NJPhysician.org Send Press Releases and all other information related to this publication to igoldberg@NJPhysician.org

Approximately 7,000 men statewide are diagnosed with prostate cancer each year. Deciding what to do about this condition can be difficult. There are many treatments that are available and the confusion comes from deciding just which will produce the best results in each case. Glen Gejerman, MD is New Jersey Urology’s Medical Director and specializes exclusively in the treatment of prostate cnacer. “By concentrating in one area, we have vastly more experience,” Dr Gejerman states. Please welcome Dr Gejerman and New Jersey Urology to the cover of New Jersey Physician.

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. No part of this publication may be reproduced or transmitted in any form or by any means without the written permission from Montdor Medical Media. Copyright 2010.

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New Jersey Physician Magazine

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Contents

New Jersey Urology

Innovative Prostate Cancer Treatment That’s Easy to Live With CONTENTS

STATEHOUSE

HEALTH LAW UPDATE

HOSPITAL ROUNDS

LIBRARY OF MEDICINE

FOOD FOR THOUGHT

2 New Jersey Physician

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Cover Story

New Jersey Urology Innovative Prostate Cancer Treatment That’s Easy to Live With

photography by Michael Goldberg

By Iris Goldberg According to the New Jersey Department of Health and Senior Services, roughly 7,000 men statewide are diagnosed with prostate cancer each year. Besides certain skin cancers, prostate cancer is the most frequently diagnosed cancer among men in New Jersey and the United States. Upon receiving a prostate cancer diagnosis, many patients are uncertain what the best course of treatment might be. In fact, today, perhaps more than ever before, the questions of how or even whether to treat remain mired in controversy. Consulting with those physicians who have amassed the greatest amount of expertise in treating prostate cancer is the best way for patients to ensure receiving a treatment plan that will produce the most successful outcome in each individual case. For men with prostate cancer throughout the state, New Jersey Urology (NJU), located in Bloomfield and Saddle Brook focuses solely on treating prostate cancer patients. Glen Gejerman, MD is New Jersey

Urology’s Medical Director. Dr. Gejerman is board-certified in radiation oncology and specializes exclusively in the treatment of prostate cancer. With greater than 20 years of experience, Dr. Gejerman has treated more prostate cancer patients than most physicians in tri-state area. Additionally, Dr. Gejerman is at the forefront of prostate cancer research, having written numerous articles for prostate cancer research and treatment that have been published in various medical journals. He is a frequent speaker at prostate cancer conferences and symposiums across the country where he is invited to present his work to other physicians. “By concentrating prostate cancer care in one center, we have vastly more experience,” Dr. Gejerman states. In fact, Dr. Gejerman, who personally evaluates each and every patient that comes to NJU for treatment, estimates the facility is handling two to three times the volume (100 patients a day) of prostate cancer patients seen in non-specialized cancer

Patients who are treated at New Jersey Urology are greeted each day with a smile.

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centers. “This is all we do constantly,” he emphasizes. “And that makes a big difference.” Perhaps the most unique aspect of New Jersey Urology is that it is all inclusive in terms of the treatment modalities offered. “We work with many of the premier urologists throughout the state and because there are so many treatment options, some with equivalent efficacy, it is important that when a patient comes in for consultation, we don’t direct him down one path but rather, lay out all of those options,” Dr. Gejerman strongly believes. “When patients come to see me, I do a complete history and physicaI exam and review all of their medical records,” he states. “Based on those findings, we’ll talk about what makes the most sense,” relates Dr. Gejerman. “And very often, it’s not really up to me. Once patients are educated and fully understand their options, I find that patients are much more comfortable with the decision they make,” he shares.

NJU offers the innovative Varian™ imageguided radiation therapy system.

When it comes to deciding whether to have surgery or undergo radiation therapy, for example, each patient’s individual circumstances and personal preferences are fully explored. “In this way, we can properly direct patients,” explains Dr. Gejerman. “This is, I think, the most uniquely qualifying factor for New Jersey Urology in terms of really offering patients with prostate cancer the very best care,” he adds. For appropriate patients who choose to undergo a surgical procedure to remove the cancerous prostate (prostatectomy), NJU has a number of outstanding surgeons on staff with significant expertise in the robotic approach. The da Vinci™ robotic prostatectomy is a minimally invasive procedure involving less blood loss and a faster recovery time than traditional open surgery. To treat those patients who prefer, or whose prostate cancers are more amenable to a non-surgical approach, New Jersey Urology offers the innovative Varian™ Image-Guided Radiation Therapy (IGRT) system. IGRT technology

Varian™ Image-Guided Radiation Therapy (IGRT) system. IGRT technology provides precise and exact information on the specific location of the tumor. By precisely tracking cancer, IGRT uses a smaller radiation field, sparing healthy tissue, decreasing side effects and improving outcomes.

At the onset of the patient’s course of radiation treatments, a “fiducial” gold marker is implanted in the prostate, which helps in the image-guided process by providing image fusion.

At the onset of the patient’s course of radiation treatments, a “fiducial” gold marker is implanted in the prostate, which helps in the image-guided process by providing image fusion. Before the patient starts treatment, a CT scan is performed whereby the computer can download three dimensional images that are used to outline or contour the target, which is the prostate. Also, the bladder and rectum are marked so that they can be avoided. When patients arrive for their daily treatment they first undergo CT imaging of the prostate gland with the gold markers. The fusion is based on the two gold markers as well as the bony anatomy and the soft tissue, which is an exact way of lining up the prostate.

CT Scanning is performed to download 3 dimensional images to outline the prostate.

July 2013

The benefit of IGRT is particularly significant for prostate cancer patients. As the bladder fills and empties, the prostate gets pushed and pulled and will not be in the same position each time a patient receives his radiation treatment. Similarly, the rectum can be empty or full (with gas or stool) and can cause a shift in the location of the prostate as well. Without IGRT, the radiation field must be made large enough to incorporate wherever the prostate might be on a day to day basis. This means that more healthy tissue is being irradiated than necessary. IGRT technology pinpoints the exact location of the prostate at all times, making the radiation field smaller and reducing damage to surrounding normal tissue.

The computer system uses RapidArc® therapy that comes around the body from different directions and allows the physicians at NJU to design a plan that can properly cover the prostate gland with 100 percent of dose while at the same time minimizing the dose to the bladder and rectum. Because it is delivered with such speed, RapidArc therapy provides maximum targeting precision in that the treatment is started and completed within 60 to 120 seconds, so that it actually decreases the chance that even a minor shift in the prostate’s position might occur. During RapidArc treatment there are no angles in which the beam stops. The treatment is delivered in one single rotation of the gantry around the body.

Therefore, the physicians at New Jersey Urology have nearly unlimited choices and degrees of freedom to design the most sophisticated treatment plan with less normal, healthy tissue in the highdose treatment fields, resulting in less non-cancerous tissue damage and fewer side effects. In fact, Dr. Gejerman relates that this technology, which provides pinpoint accuracy, completely eliminates the possibility of urinary incontinence as a result of treatment. He further shares that while 20 to 30 percent of patients do experience some degree of temporary erectile dysfunction, in the majority of cases this is effectively managed with medication. Patients are carefully monitored both during and long after their course of radiation therapy in order to minimize the occurrence of any adverse effects. It is important for those who are considering radiotherapy to treat their prostate cancer to understand the differences between the forms of radiation that are available today. When IGRT is compared to some of the newer modalities that patients may hear about, the benefits of IGRT over the others are difficult to ignore. For example, Cyberknife, also known as hypo-fractionation, delivers 5 large doses of radiotherapy instead of the standard 44 doses. At first glance, this might seem to be the more desirable option, with 1 week of treatment instead of 9. However, there isn’t any long-term data to determine whether the shorter treatment will achieve long-term cancer control. Also, there is a real concern amongst many radiation oncologists that these few large doses of radiation will have severe long-term consequences with rectal and urinary injury. In fact, unless a patient is enrolled in a clinical trial investigating Cyberknife and understands that there is no long-term efficacy data, the physicians at PCU strongly recommend that patients avoid this technique.

Dr. Gejerman implants the “fiducial” gold marker.

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Another alternative to IGRT is Proton beam therapy, which is unique in that it has a Bragg peak – a sharp dose gradient that can limit radiation that is delivered to normal structures. While Proton beam has been shown to be effective for treating tumors at the base of the skull and for pediatric cancers, it is unclear whether it will work for prostate cancer.

Due to the sharp gradient in the beam as well as limitations in image guidance, parts of the prostate may be missed during therapy. A large study recently published in the Journal of the American Medical Association demonstrated more severe sexual and bowel side effects as a result of Proton beam therapy. There are also concerns about absorbed dose in the hips, which can lead to hip fractures. Additional clinical trials will be required before Proton beam therapy can be considered as good as IGRT. It is an ongoing priority at New Jersey Urology to update equipment as technological advancements become available. So, for example, when Varian introduces improvements to its IGRT and/or RapidArc systems, NJU will make sure to acquire the newer technology. In this way New Jersey Urology maintains its status as a state-of-the-art facility. This, no doubt, is an integral factor which contributed to its recently receiving the prestigious American College of Radiology (ACR) Certificate of Approval. According to the American College of Radiology, the goals of the accreditation program are: to provide impartial, thirdparty peer review; to recognize quality radiation oncology practices through accreditation; to make recommendations for improvement in practice and patient outcomes according to the recognized standards of the scientific community; and to provide a referral list for patients. In addition, the on-site surveyors act as data collectors and submit their findings to the ACR Committee on Radiation Oncology Practice Accreditation, who makes the final recommendations. This committee is composed of boardcertified radiation oncologists and medical physicists who undergo special training in order to participate.

NJU patients can enjoy a comfortable waiting area complete with flat screen TV, fireplace, a quite reading area and plenty of snacks.

come in for their treatment….and that does facilitate men feeling like they’re in a club,” he notes. “We really don’t want it to feel like a clinical situation,” Dr. Gejerman explains. “Patients come for treatment every weekday for nine weeks,” he adds, reiterating the importance of having a pleasant environment for the men who are undergoing radiation therapy to spend that time in. The physicians and staff at New Jersey Urology have been so successful at making patients feel at home that many times, at the four month follow-up visit, patients share with Dr. Gejerman how much they actually miss coming for treatment and seeing the team. “From the moment they first arrive at our front desk, everyone they encounter is upbeat, warm and friendly,” he says.

In fact, during the nine week course of treatment, staff members learn much about the patients during their conversations with them. They inquire about their children and grandchildren and know about upcoming special occasions. “This is how our staff is trained,” Dr. Gejerman continues. “And the men really appreciate the opportunity to socialize,” he adds. In terms of accessibility to patients, there is always a physician available to answer any questions. In case a patient encounters a problem while away from the facility, Dr. Gejerman provides his cell phone number so that he can be reached at all times. “It is very important for patients to know that we are very much invested in their care and if anything comes up, we want to know about it,” he emphatically states.

Besides cutting edge technology, New Jersey Urology features a host of amenities that are attractive to patients and therefore, to referring physicians as well. A great deal of thought went into the construction and decoration of the facility so that men would feel comfortable. “It’s almost like a club,” Dr. Gejerman suggests, “with a fireplace, large screen TVs and even magazines that are geared towards a male audience, so that men do feel comfortable while they’re waiting to

Dr. Gejerman (extreme right) oversees the care of every patient at NJU.

Jully 2013

Frank Chimento is sixty-six years old. He was diagnosed with prostate cancer earlier this year after undergoing a biopsy of his prostate gland. After the results were received, Mr. Chimento’s urologist recommended that he begin treatment at New Jersey Urology. He was quite taken with the respectful way he was treated by the entire staff. Being handicapped and confined to a wheelchair, Mr. Chimento had concerns about how things would be handled. “They helped me out of my wheelchair and they always catered to me. I had a very good time there,” he is pleased to share.

Bloomfield Location Saddle Brook Location

As far as the facility itself, Mr. Chimento thought it was very impressive. “Everything is clean and neat,” he describes. “Very modern,” Mr. Chimento adds. “There was always something to drink and TV to watch,” he relates. While he found the waiting area to be extremely comfortable, Mr. Chimento was pleased with the fact that his treatments always began on schedule. Speaking of the technicians who delivered his treatment, Mr Chimento says, “They were tremendous people in every way possible – their personalities, the work process – everything they did was excellent.” In fact, Mr. Chimento was so satisfied with the care he received at New Jersey Urology that he has already recommended the facility to others. “Like I said, it was perfect in every way.” Robert Bisogno is a 74 year old gentleman who was referred to New Jersey Urology by his urologist after undergoing a biopsy which revealed a diagnosis of prostate cancer. “When I first got there I was very impressed,” Mr. Bisogno remembers. “It was immaculate and everyone there was terrific to me,” he continues. In addition to the extremely positive experience he had with the entire staff at NJU, Mr. Bisogno was most appreciative of the care he received from Dr. Gejerman. “What a great guy,” Mr. Bisogno wants to share. He found Dr. Gejerman to be accessible and easy to talk to. Perhaps, the most inspiring aspect of the experience Mr. Bisogno had at New Jersey Urology was the relationship that evolved amongst the other men who were being treated at the same time. He relates that a special camaraderie developed as newcomers were welcomed and

8 New Jersey Physician

reassured by those who were further along in the treatment cycle. “I actually looked forward to going each and every time,” he candidly states. Fifty-four year old Peter Kelly decided to undergo radiation at New Jersey Urology for his prostate cancer after consulting with Dr. Gejerman on the recommendation of his urologist. “Dr. Gejerman was very helpful. He explained everything to me,” Mr. Kelly remembers. For Mr. Kelly, having treatment for his cancer in a non-hospital setting was beneficial. “It was much easier to digest,” he says, explaining that he didn’t actually feel ill and going to a hospital each day might have been somewhat depressing for him. As far as the actual delivery of treatment, Mr. Kelly was very pleased. He found the staff to be extremely accommodating. When he expressed a desire to come earlier each day than when he was originally scheduled, he was worked into

an earlier slot within a short amount of time. Perhaps the most positive aspect of Mr. Kelly’s experience at NJU was the opportunity to meet and speak with other men who were dealing with the same situation. “Talking with the doctors and the technicians is very helpful but they’re not going through it,” Mr. Kelly notes. “You could compare notes with somebody else. If you feel soreness or tiredness and you hear that others are going through the same thing, it’s very reassuring,” he explains. While prostate cancer continues to be the most prevalent cancer affecting men in New Jersey, innovations in diagnosis and treatment offer promise for increasingly more successful outcomes. For referring physicians and their patients throughout the state, New Jersey Urology serves as a valuable resource, providing access to the highest level of care and treatment of prostate cancer available today.

New Jersey Urology Locations: 1515 Broad Street, Suite B130, Bloomfield NJ 07003. For more information or to schedule an appointment, please call (973) 873-7000. 160 Pehle Avenue, Saddle Brook, NJ 07663. For more information or to schedule an appointment, please call (201) 881-1000, Ext. 1.

Statehouse

NEW JERSEY STATEHOUSE July 1, 2013 Regulatory Developments Posted by Beth Christian Here are the most recent health care related regulatory developments as published in the New Jersey Register on July 1, 2013: • On July 1, 2013 at 45 N.J.R. 1658, the Department of Human Services issued notice of its readoption of its regulations regarding the provision of medical supplier services and durable medical equipment under the New Jersey Medicaid and New Jersey FamilyCare. • On July 1, 2013 at 45 N.J.R. 1658, the Department of Human Services published notice of its readoption of its regulations governing fee-for-service reimbursement to approved hearing aid providers by the New Jersey Medicaid and New Jersey FamilyCare programs.

Affordable Care Act Update Posted by Frank Ciesla With all of the delays to the Affordable Care Act, it is not clear as to the impact on those portions of the Affordable Care Act which are now in effect and those portions that will go into effect on January 1, 2014. As of this point in time, the administration has determined either to delay or not enforce the following portions of the Affordable Care Act: the Class Act; the small employer option; the Employer Mandate; the verification of eligibility for subsidies; the tobacco insurance premium. We still have not seen the impact of the nonexpansion by certain states of Medicaid, not applicable in New Jersey, as well as the implementation of the exchanges whether by the states (not New Jersey), or the federal government, the situation in the State of New Jersey. How will these delays impact the providers’ ability to be paid? How will the insurance companies react? Will they raise premiums to employers and beneficiaries? Will they reduce reimbursements to the providers? Providers should examine each delay as to its ultimate impact on the providers ability to provide services to their patients.

June 3 and June 17, 2013 Regulatory Developments Posted by Beth Christian Here are the most recent health care related regulatory developments as published in the New Jersey Register on June 3 and 17, 2013: • On June 3, 2013 at 45 N.J.R. 1400, the State Board of Pharmacy published notice of its amendments to its regulations and the adoption of new regulations governing compounding sterile and non-sterile preparations in retail and institutional pharmacies. • On June 17, 2013 at 45 N.J.R. 1563, the Department of Health published notice of its readoption of the general licensure procedures and standards applicable to all licensed health care facilities set forth in N.J.A.C. 8:43E.

ACA Requires NJ and Other States to Pay for New Healthcare Mandates If a new service pushes up the price of insurance on an exchange, New Jersey must pay all costs to provider By Andrew Kitchenman, New Jersey generally requires health insurance plans to cover a wider range of services than many other states, but a provision of the Affordable Care Act will likely have lawmakers checking the bottom line before adding any new mandates. That's because the act requires a state to fully reimburse an insurance provider for the cost of any mandate that drives up the price of a policy offered through the online health exchange. The proviso only applies to services added after January 2012. “I think the theory was that if the federal government was going to provide subsidies to folks to be able to get coverage, they didn’t want states tacking on a number of laws to make coverage very expensive,” said Wardell Sanders, president of the New Jersey Association of Health Plans, the state trade association for insurance companies. There are roughly 30 bills advancing in the state Legislature that could raise the cost of insurance sold through the exchange. But insurance industry officials indicated that while the state has started to track the potential fiscal impact of these bills, it’s too early to say how much future mandates could cost New Jersey. July 2013

The bills include a measure that would require insurers to cover ultrasounds for women whose mammograms determine that they have extremely dense breast tissue (which may indicate an elevated risk of cancer), as well as one that would mandate quicker access to powerful pain relievers. New Jersey's health insurance exchange is slated to launch October 1; individuals and small businesses can purchase coverage starting January 1, 2014. Subsidies will be targeted toward residents between 138 percent and 400 percent of the poverty line, which currently amounts to between $15,856 and $45,960 for individuals and $32,499 and $94,200 for a family of four. The state currently mandates 35 different services, 32 of which were passed before 2012. It’s not clear whether one of the the three mandates passed since then -- requiring coverage for sickle-cell anemia treatments, early refills for prescription eye drops, and oral anticancer medications -- will trigger additional costs for exchange plans and the state. The other two mandates passed since then won’t raise costs. But the ACA provision could lead to a slowing of legislative action on new mandates, since lawmakers may be wary of adding to the state budget. While the ACA may lead to fewer new state mandates, the 2010 federal reform also added some mandates of its own for insurance offered through the exchange. In New Jersey, these are dental and vision care for children. The insurers must calculate the cost of the mandate and report it to the exchange, which will be operated by the federal government in New Jersey. “It’s a message we’re trying to get across, and I know the fiscal notes are starting to include it,” Sanders said, referring to the analyses done by the nonpartisan Office of Legislative Services that estimate the future cost of legislation.

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Results of NJ Law Requiring Newborn Screening Resonate Nationwide Other states look to duplicate fast implementation, early success in detecting heart defects By Andrew Kitchenman, Three New Jersey babies with congenital heart defects had their conditions detected early thanks to newborn screening required under a law that has put the state in the forefront of a national movement to mandate the test. State officials have been receiving calls from across the country about the successful implementation of the 2011 law, which is the subject of a study published Monday in the medical journal Pediatrics. The law mandates a form of screening called pulse oximetry, in which a device placed on an infant’s foot tests the baby’s blood. A negative result can show that there is an underlying health problem, such as a congenital heart defect. Early screening allows for life-saving surgeries to repair infants’ damaged hearts. The study found that in addition to the three babies found to have congenital heart defects, another 17 of the roughly 73,000 infants screened had other serious health problems detected as a result of the testing . The study covered the first nine months of screening, from August 31, 2011, to May 31, 2012. Hospitals in New Jersey managed to screen more than 99 percent of eligible newborns even though the mandate kicked in only three months after the law went into effect. “During those 90 days, we worked quickly to convene a working group of experts” and to develop the steps to be used, said Dr. Lorraine Garg, a study author and the medical director of newborn screening and genetic services for the state Department of Health. As the first state to implement statewide screening, New Jersey is drawing interest from other states. Garg said she has spoken to health officials from more than a dozen states interested in how New Jersey implemented the screening. The state is now in the process of implementing a new screening designed to detect a series of genetic disorders. Law sponsor Assemblyman Jason O’Donnell (D-Hudson) became interested in early testing after his son was diagnosed with a heart murmur after he was born in 2006. A neonatal unit doctor recommended that the baby be examined by a pediatric heart doctor, who found within minutes that surgery was required. “It was just by chance that the doctor wanted to go above and beyond” what was required and called for the test, O’Donnell said. That experience stayed with him after he joined the Legislature in 2010 and he became aware of an effort at the national level to introduce newborn pulse oximetry screening. O’Donnell noted that every hospital already had the necessary equipment, which is used for many purposes. “The cost was minimal. The time is minimal...It’s a minute,” O’Donnell said. He said that the study results are gratifying. “The fact that it saved (at least) one child’s life, it’s something that all of our legislation should have in mind, what net benefit it would have to the community. – as testing gets better, we should find even more ways” to test, said O’Donnell, adding that he would like to see New Jersey lead the country in reducing infant mortality. O’Donnell noted that with a cost of roughly $14, it’s a worthwhile investment. He noted that while screening occasionally results in a false positive result, those results only result in more testing. He noted that his own son is now 7 and has a strong heart. One of the people who made O’Donnell aware of the benefits of the screening was Annamarie Saarinen, a Minnesota-based lobbyist who has advocated for the screening nationally after her daughter Eve, now 4, was born with a heart defect. “I think New Jersey has been a great example of successful” implementation of the screening, Saarinen said. Saarinen said she has stayed in touch with Garg and other state officials. “It’s quite a monumental task and I still point to New Jersey as the gold standard,” Saarinen said. In talking with officials in other states, “We hear things like, ‘We need two years to implement,’ and I say, ‘Oh really, guess what? New Jersey needed three months to implement and they did a good job,’” she said. A month after New Jersey enacted its law, U.S. Secretary of Health and Human Services Kathleen Sebelius urged other states to implement the screening. Thirty-five states have either implemented the screening or are considering it. Saarinen said nearly 40 percent of newborns are being screened nationally, saving many lives each year. “Every day that we hear about a baby that’s been detected is a good day,” Saarinen said. State officials will be highlighting the benefits of newborn screening at a series of events later this month, when a travelling national exhibit marking the 50th anniversary of newborn screening comes to New Jersey. State officials said that 6,400 babies in New Jersey have tested positive for genetic conditions out of nearly 2.4 million infants screened in the last 20 years. Many of those children benefited from early treatment. July 2013

Plans Unveiled for Statewide Health Information Network Healthcare leaders see advantages and challenges in expanding use of information technology By Andrew Kitchenman, Increased use of electronic records promises to help improve heathcare – but it also poses many challenges. That was a key point as plans by a coalition of health organizations to build a statewide electronic information network were announced yesterday by state officials. The goal is to create a single, secure network that will make it easier for providers to access their patients’ medical histories, information on medication allergies and lab test results, particularly when the patient has doctors who are not part of the same information-sharing organizations. State Health Commissioner Mary E. O’Dowd said state officials expect the $1.57 million New Jersey Health Information Network to begin operating in 2014. More than 2,000 doctors will be able to use the network when it launches. State officials expressed hope that the network will make it easier for doctors to quickly access patient information currently stored by separate organizations. “We anticipate that these members and these numbers will continue to grow over time, in particular as we see the expansion of the power of the exchange of this data, because they will not want to be left behind in the dust,” O’Dowd said. “Peer pressure is a very powerful force.” O’Dowd made the announcement at a health information technology summit held by the New Jersey Technology Council, which represents technology businesses. Summit participants noted that information technology has been useful in improving healthcare, but said many barriers have prevented IT from fully realizing its promise. These problems will likely remain even as the statewide network is rolled out. For instance, when different providers share a patient’s information, they can still have difficulty using it because they use different formats. One doctor may summarize essential patient information quickly, while another might write several-page reports that can be time-consuming to read. New Jersey State Nurses Association President Patricia Barnett said some of those who could benefit the most from providers using IT to send text messages with reminders about medication or appointments aren’t in a position to receive these messages. “Often they are poor, they don’t have access to care and they don’t have smartphones,” Barnett said, adding that these patients may also be elderly or not able to speak English. “They’re the people who are being left out of this electronic age.” Barnett also noted that the complexity of electronic health records can even trip up providers within the same health system, such as a hospital that uses different electronic-record formats for its emergency department and its inpatient admissions. “It’s time-consuming and there’s a real opportunity for patient error,” Barnett said. While the network announced by state officials yesterday could give providers quicker access to a wider range of records, it won’t resolvethe problem of providers using different formats. Dr. Paul Katz, dean of Rowan University’s Cooper Medical School, said that while information technology can be useful in improving patients’ knowledge about their own health, there are barriers preventing people in low-income areas from receiving the same benefits as higher-income patients. Katz said some of the greatest potential for using technology is in applications targeted toward children, such as programs teaching young people what to eat and how to take safety precautions. He added that some uses of technology – such as companies that make extravagant claims about being able to provide people with useful information about their genes – may do more harm than good. “There’s a great example of people with too much money investing it in things they probably shouldn’t be, without much regulatory control of the information they’re getting back,” Katz said. Barnett said some patients are becoming smarter about their own health by using technology, but they remain in the minority. “The question is, how do you translate that down to the rest of the population, who either doesn’t have access to that kind of technology or who have not been told, ‘You really are accountable for yourself,’ ” she said, adding that if providers aren’t successful in reaching that population, then some “million-dollar patients” will remain frequent and expensive users of healthcare. Technology can be used to reduce healthcare disparities, according to Dr. John Lumpkin, senior vice president and healthcare group director for the West Windsor-based Robert Wood Johnson Foundation and a speaker at the summit. Through the use of data, healthcare can be tailored to individual patients, Lumpkin said. “We can do better and it’s information systems that will bear the burden of getting information into the form where it can be read by regular people,” Lumpkin said.

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He said this will be important in turning the United States from its current position of having the best medical science in the world to one in which it has the best medical care in the world. “While the future is here, it’s just not very evenly distributed,” Lumpkin said of the current state of healthcare. Current medical practitioners also highlighted the importance of technology. Dr. Gabriela Bowers, an East Windsor-based internal medicine doctor, said her practice has relied on electronic records since it was founded in 2004. “It’s real helpful, particularly when it’s not one of your patients that you’re seeing,” Bowers said, adding that it remains challenging to integrate additional health data into the records. “If data isn’t simple and readily available, it’s going to be difficult for us to use.” Bowers expressed disappointment with one aspect of the system that is a recurrent theme among some doctors: Every practice uses its own format through one of 150 different electronic medical record companies. “Notes from a different system are difficult to read,” Bowers said. Health policymakers may need to step in to improve the ability for records to be used across different systems, according to Al Campanella, Virtua’s executive vice president of strategic business growth and analytics. "A little more regulation and policy probably is warranted,” he said. Jon Cooper, CEO of LifeVest Health, talked about creating economic incentives for reducing the long-term risks of illnesses. His company is working on such a market-based approach inspired by carbon-pricing proposals in energy policy.

Pressure Mounts to Fight Healthcare-Associated Infections in NJ Some improvements seen in state report, but federal regulations propose added penalties for hospitals that don't do better By Andrew Kitchenman, New Jersey’s hospitals have made some progress in reducing the infections that patients develop while in healthcare facilities, and they will soon be feeling more pressure to improve further. A state report found that New Jersey hospitals’ performance improved or held steady in four of the five types of healthcare-acquired infections compared with 2010. But those hospitals could be under increased pressure to continue to improve in coming years, as a result of proposed federal regulations that would cut Medicare payments for providers where hospital-associated infections do not continue to decrease. The report found that state hospitals did not do as well preventing infections from coronary artery bypass grafts as they did in past years. But state officials pointed to strong performance in reducing central line-associated bloodstream infections. State hospitals had 27 percent fewer of those infections than was expected based on national data. The data on healthcare-associated infections was one of three sections to the state report, which also found improvements in hospitals’ performance in maintaining recommended processes for providing care, as well as in other patient safety indicators. “New Jersey hospitals have been moving in the right directions,” state Health Commissioner Mary E. O’Dowd said of the report. The annual report was based on the most recent data, which ran through 2011. However, a New Jersey Hospital Association report released in May, which focused on a separate but more recent set of data, also found improvements in 2012. The issue of healthcare-associated infections, which include both those acquired in hospitals and in other healthcare facilities, is gaining increased attention from hospital officials, according to Suzanne Dalton, program manager for Healthcare Quality Strategies Inc. “There’s a change in the emphasis” toward reducing healthcare-associated infections, said Dalton, whose organization has a contract with the federal government aimed at helping providers improve healthcare quality. “The dollars are shrinking, the dollars continue to shrink, so while everybody used to say, ‘You had to do more with less,’ it’s even greater at this point,” she said. Dalton said hospital executives haven’t always understood the importance of investing in reducing in-hospital infection -- both directly through more testing of patients and indirectly through time spent by hospital staff to learn about safety procedures. But pressure from the federal government and insurers is starting to have an effect, she said. “It’s really hitting the pocketbook,” Dalton said. Dalton said the new emphasis on reducing infections would be just as important even if the federal government wasn’t cutting payments. That’s both because it will lead to healthier payments and because it can head off more expensive treatments later. She noted that 1,000 people receiving a $50 test may be expensive for a hospital, but early detection of bacteria could prevent spending 10 times as much to readmit and treat a patient with a dangerous hospital-acquired infection. This approach may actually lead to hospitals growing their revenue, she said. “You may not necessarily have to build more orthopedic beds if you educate your patient well, they do well, they get out faster, and July 2013

you bring the next orthopedic patient in,” she said. This emphasis on reducing infections was reflected in a recent educational session for healthcare quality professionals, the hospital workers who are focused on reducing infections. Kathy Duncan, a registered nurse and a faculty member with national nonprofit the Institute for Healthcare Improvement, noted that hospitals have seen improvements in reducing infections by taking steps like having patients use a special soap for three days prior to a surgery and screening patients for the presence of dangerous bacteria prior to an operation. Duncan suggested that healthcare quality professionals screen a small number of patients -- which may turn up several patients with potentially dangerous bacteria. They can use those results to argue with hospital administrators for expanded screening. “That’s a pretty powerful argument,” Duncan said of screening results. Another powerful argument may be the proposed federal regulations, which stipulate cuts to Medicare payments to hospitals that do not reduce healthcare-associated infections. The regulations are part of the annual process that the Centers for Medicare & Medicaid Services uses to set payments to hospitals. Federal officials are expected to finalize the changes in August.

Bill Aims to Aid Healthcare Price Transparency Through Claims Database Measure would establish arbitration to resolve payment disputes, limit some out-of-network charges By Andrew Kitchenman, Transparency in healthcare costs is becoming a major issue, with recent surveys revealing a vast disparity in charges for similar procedures throughout the state. A bill introduced in the Legislature seeks to shed light on this problem by requiring the state to develop a database of medical, pharmacy, and dental insurance claims; healthcare utilization; and safety and medical outcomes. The 2010 Affordable Care Act authorizes the federal government to foot the bill for developing the database, but states must indicate their intentions to do so by June 17. While many healthcare advocates are in favor of the bill, it has met with resistance from some industry stakeholders. The New Jersey All-Payer Claims Database Act (A-3603/S-2508), would require the Department of Banking and Insurance to collect the requisite data. It also would establish an arbitration process to resolve disputes between providers and insurers and would limit the amount that doctors outside a patient’s insurance network who work at an in-network hospital could be paid. For many healthcare advocates, the bill is a good idea whose time has come. They argue that it would allow healthcare policymakers and providers to analyze the data and craft strategies to improve healthcare quality. But some major healthcare stakeholders disagree. Their concern with various provisions of the bill is that they would allegedly increase costs without improving outcomes. Bill sponsor Assemblyman Troy Singleton (D-Burlington) said collecting the data across the state would allow businesses to compare their health plans to those of their peers; consumers to have more information in making healthcare decisions; providers to design and target quality-focused healthcare initiatives; and legislators to learn from communities that provide cost-effective care. “Comprehensive data about the quality and cost of healthcare allows all of us as policymakers to monitor the efforts to reduce healthcare costs and improve both care, quality, and population data,” Singleton said. New Jersey Health Care Quality Institute chief of staff Jeff Brown said the database would help consumers sort out healthcare costs. He pointed to the recently released report by the federal government about how much hospitals charge Medicare for services. It revealed that New Jersey hospitals have some of the highest charges in the country “We can’t contain healthcare costs without better information, if we don’t know how much services actually cost, or who’s doing a good job because we can’t see inside the healthcare system sufficiently,” Brown said. Medical Society of New Jersey CEO Lawrence Downs said he supports the concept behind the database, but is concerned about how the data would be collected and what it would be used for. The society is the largest professional group for doctors in the state. Downs said providers already have to deal with more than 800 reporting measures from the federal Centers for Medicare & Medicaid Services. He also believes that a state database should only use information from insurers and other payers, not information from providers. Downs also opposed a provision that would set a maximum amount that providers could charge for services, but wouldn’t object to settling disputes with payers through mediation as long as the charges weren’t limited. With information from a database, “a lot of these disputes could be resolved very quickly,” Downs said. He praised the nonprofit FAIR Health database, which includes a large amount of claims data, although it isn’t as comprehensive as the database that would be created under the bill. New Jersey Association of Health Plans President Wardell Sanders expressed concern that requests to insurers to provide information for all-payer claims databases in other states have presented challenges.

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“I think there is an increasing frustration with the databases because of the costs,” Sanders said, noting that the bill would apply a fee to insurers to maintain the database. While the doctors are concerned that the bill would limit the amount that they could charge for out-of-network services, Sanders said payers have a very different issue. He said insurers are worried that the maximum charge amounts would be too low since providers already bill too much to patients when the providers aren’t in their insurance networks. Singleton said it was important that the bill include both the new database and an arbitration system that would allow payers and providers to resolve disputes.

Medicaid Expansion Legislation Heads To Governor’s Desk Legislation sponsored by Senate Health Committee Chairman Joseph F. Vitale, Senate Commerce Committee Chairwoman Nia H. Gill, and Senate Majority Leader Loretta Weinberg that would provide Medicaid health insurance to hundreds of thousands of New Jersey residents passed its final legislative hurdle Monday and heads to the Governor’s desk. “The federal Affordable Care Act has the real opportunity to provide residents with access to affordable health insurance and a major component of the legislation – the expansion of Medicaid – will provide hundreds of thousands of low-income New Jerseyans with the quality health care coverage that all people deserve, without any initial cost to the state,” said Vitale, D-Middlesex. “With so many residents struggling for access to primary and preventive health care, we cannot in good conscience leave this funding on the table. The Governor has already committed to expanding Medicaid made possible by Obamacare and I look forward to him receiving and signing this legislation.” The bill, S-2644, would expand Medicaid income eligibility for non-elderly adult residents of New Jersey to 138 percent of the federal poverty line, authorized under the federal Patient Protection and Affordable Care Act (ACA). The ACA stipulates that the federal government will pick up 100 percent of costs associated with expanding Medicaid for the first three years. After a three-year phase down, the federal government will permanently pay 90 percent of the costs. Medicaid expansion could bring in up to $22 billion in federal funds over eight years, provide coverage to at least 234,000 of the uninsured and reduce by more than $300 million the state expenditure for uncompensated hospital care, according to numerous studies by health care and public policy organizations. “The federal Medicaid expansion program is a rare opportunity to provide health care coverage to hundreds of thousands of men, women and children throughout the state, many of whom may not have been able to afford primary health care without this federal subsidy,” said Gill, D-Essex and Passaic. “Many low-income residents are unable to afford the high-costs associated with physicians and primary care doctors and instead head to emergency rooms when they get sick, the cost of which is passed onto New Jersey taxpayers in the form of charity care. By broadening eligibility requirements for Medicaid, we can not only provide those most in need with quality preventive care, but also take advantage of significant savings from the federal government. This is simply good health policy.” Hospitals could realize additional savings through reduced charity care that isn’t reimbursed by the state. The state spent $675 million this year to partially compensate hospitals for unpaid bills, mostly for treating patients without insurance. This annual expense could be slashed in half, according to an analysis by New Jersey Policy Perspective, once Medicaid is expanded. “In recent years eligibility for New Jersey’s premiere health care coverage for children and adults, NJ FamilyCare, has been dramatically reduced – cutting access to the program for many low-income adults throughout the state. Combining that with a reduction in state aid to vital women’s health care organizations that provide preventive care, the poor in New Jersey have taken a real hit in terms of services and programs provided to them,” said Weinberg. “Unable to pay for doctor’s visits, many of these vulnerable individuals have since had to turn to emergency rooms to provide the health care necessary to get well. By joining the federal Medicaid expansion program, we can begin to close the disparate gap to make sure that all New Jerseyans, no matter their financial situation, have access to health care.” A recent study published in the New England Journal of Medicine found that Medicaid expansion saved lives and improved the health of newly-covered residents of states that expanded Medicaid. The health reform law increases Medicaid eligibility to as much as 138 percent of the federal poverty level, extending coverage to more than 15 million people nationwide, including at least 234,000 in New Jersey, according to a study by the Rutgers Center for State Health Policy. Most are childless adults – which constitute the largest segment of New Jersey residents who lack health insurance – who currently aren’t eligible in New Jersey. During his annual Budget Address, Gov. Chris Christie expressed plans to participate in the federal Medicaid Expansion Program. This bill would establish the statutory framework to make the expansion possible. The bill was approved by the General Assembly with a vote of 46-32-0. Last week the Senate approved the legislation 26-12. It now heads to the Governor’s desk.

Visit us now online at www.NJPhysician.org July 2013

Christie Shoots Self in Foot - Rejects Obamacare Medicaid Expansion for New Jersey (Reuters) - New Jersey Governor Chris Christie vetoed a bill that would have expanded Medicaid eligibility under the healthcare law known as Obamacare, his office said on Friday, in an apparent reversal of position for the presumed 2016 Republican presidential hopeful. Christie's office announced he vetoed eight bills that "would add potentially hundreds of millions of dollars to state and local budgets." He also signed a $32.9 billion budget and three other bills, his office said in a statement. Among the bills he vetoed was a Medicaid expansion under the U.S. Patient Protection and Affordable Care Act, President Barack Obama's signature healthcare law known as Obamacare.

To Christie, Medicaid Expansion Veto Keeps Options Open Conference focuses on need for cooperation as major shift looms in how care is delivered and success is measured. By Andrew Kitchenman Gov. Chris Christie is planning to expand Medicaid eligibility for low-income New Jersey residents, but he doesn’t want the expansion to be backed up by state law. On Friday, Christie vetoed a bill (S-2644/A-4233) that would have made the expansion he announced in February permanent. While he didn’t spell out why he vetoed the bill, he said when originally announcing the expansion that if the fiscal and public health benefits ever change “because of adverse actions by the Obama administration, I will end it as quickly as it started.” Christie also vetoed bills that would have: restored funding for family planning clinics -- S-2825/A-4172; expanded Medicaid family-planning funding for single residents -- A-4171/S-2824; and funded a public awareness campaign for the federally operated health insurance exchange -- A-3878/S-2673. While the Medicaid expansion veto may initially appear to be inconsistent with Christie’s support for the expansion itself, it was foreshadowed by concerns raised by Republicans during committee hearings on the bill. During those hearings, Republican legislators said Christie administration officials had told them that they were concerned that the bill would prevent the state from reversing course on the expansion if the federal government doesn’t live up to its obligations.

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.

Dr. Stephen Smith - named a Top Doctor of New Jersey by Castle Connolly 310 Central Avenue, Suite # 307 • East Orange, NJ 07018 Phone: 973-809-4450 Fax: 973-395-4120 • www.smithcenternj.org

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Where does insurance fraud end in New Jersey?

NJInsuranceFraud.org

HEALTH LAW Update Health Law Update

New Jersey Bills May Impact Health Care Providers

A4144 (identical to S2820), an act concerning medical records, was reported from the Senate’s Health, Human Services and Senior Citizens Committee on June 13, 2013 after being introduced in the Assembly and referred to the Assembly’s Health and Senior Services Committee on June 6, 2013. The bill would revise current regulations related to the fees that can be charged for replication of medical records. A4241 (identical to S2842), an act concerning medical marijuana, passed the Assembly on June 24, 2013 after passing the Senate on June 20, 2013. The bill would modify the New Jersey Compassionate Use Medical Marijuana Act to promote access to medical marijuana by severely ill children. A2182 (identical to S2896), the Dietician/Nutritionist Licensing Act, was reported out of the Assembly’s Health and Senior Services Committee, with amendments, and referred to the Assembly Appropriations Committee. The bill would provide for the licensing of dieticians and nutritionists in New Jersey. S2756 (identical to A3586), an act concerning declarations of death upon the basis of neurological criteria, was reported with amendments from the Senate’s Health, Human Services and Senior Citizens Committee on June 13, 2013. The bill would require that a declaration of death on the basis of neurological criteria be made by a licensed physician qualified by specialty or expertise, based upon the exercise of the physician’s best medical judgment and in accordance with currently accepted medical standards. S2779, an act concerning certain health care service referrals, was reported from the Senate’s Health, Human Services and Senior Citizens Committee on June 3, 2013. This bill would amend section 2 of P.L.1989, C.19 (C.45:9-22.5) to eliminate the prohibition on certain patient referrals for lithotripsy, which is a procedure that uses shock waves to break up stones in the kidney, bladder or ureter, after which pieces of the stones pass from the body. For more information, contact: Mark Manigan / 973.403.3132 / mmanigan@bracheichler.com John D. Fanburg / 973.403.3107 / jfanburg@bracheichler.com

Controversial Disclosure Bill Leaves Assembly with Amendments The Assembly Financial Institutions and Insurance Committee voted on June 18, 2012 to approve the “Healthcare Disclosure and Transparency Act” (A-2751). The bill continues the longstanding debate on regulating health care providers’ out-of-network charges. The amended version of the bill would require providers of health benefit plans to: • Disclose in writing to a covered person the reimbursement methodology used for determining out-of-network rates; and • Establish a website so that covered persons can access, among other things, quality ratings of physicians as well as descriptions of each plans’ out-of-network health care benefits, and the covered person’sfinancial responsibility for those benefits. At least three days prior to an elective procedure, health care providers would be required to furnish covered persons with a written disclosure form describing the network status of the facility and its physicians providing the services, as well as the financial responsibility of the covered person. The bill would require the physicians providing out-of-network services to furnish the covered person with a description of the procedure, an estimate of the costs charged by the physician for those services, and a notice to contact their insurance carrier for further consultation on the costs of the procedure. Additionally, the physician would be required to provide the covered person with a list of three facilities located close to the covered person that are in-network with respect to the person’s health benefit plan. The bill will now be voted on by the full Assembly, with the Senate yet to introduce a companion version. We have advised clients that, in its current form, we oppose the passage of A-2751. For additional information, contact: Mark E. Manigan | 973.403.3132 | mmanigan@bracheichler.com Debra C. Lienhardt | 973.364.5203 | dlienhardt@bracheichler.com

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OIG Approves Non-Emergency Ambulance Transportation Program In an Advisory Opinion (AO 13-05) published last month, the U.S. Department of Health and Human Services Office of Inspector General (OIG) concluded that a non-emergency ambulance transportation service operated by a non-taxing governmental entity under state law does not violate the federal anti-kickback statute. The non-governmental entity, referred to as the “Health District,” was created by the county, seven cities and a water district over 40 years ago. The Health District operates a federally qualified health center that provides primary care, counseling and dental services for the county’s residents. The Health District, through one of its divisions, also operates a non-emergency ambulance transportation service. Importantly, the transportation service does not involve the transport of any patients to the health center or to any other facility owned or operated by the Health District, the county or the cities. Under the arrangement, the county and the cities would grant the Health District the exclusive right to provide non-emergency ambulance transport service within their respective borders. The arrangement was a response to a history of instability resulting from frequent turnover of ambulance providers in the area as well as a way to ensure a stable and cost-effective means of providing non-emergency transportation service. At the end of each fiscal year, the Health District will determine whether the transportation service had a net loss or a net profit. The Health District would pay the county any net profits, minus 10% for a reserve fund to cover future losses. Conversely, the county would reimburse the Health District for any net losses. For more information, contact: Joseph M. Gorrell / 973.403.3112 / jgorrell@bracheichler.com Carol Grelecki / 973.403.3140 / cgrelecki@bracheichler.com

NJ Doctor Wins Significant Victory in United States Supreme Court In a rare 9-0 decision, the U.S. Supreme Court gave a boost to the medical profession’s efforts to address deceptive policies of large health insurers that are overwhelmingly bad for patients and physicians. Oxford Health Plans LLC v. Sutter (decided June 10, 2013) presented the question of whether physicians may arbitrate as a class when the agreement requires all disputes be submitted to arbitration. Dr. Sutter entered into a fee-for-service arrangement with Oxford Health Plans (OHP). He agreed to provide medical care to members of OHP’s network, and OHP agreed to pay for those services at prescribed rates. Several years later, Dr. Sutter filed suit against OHP on behalf of himself and a proposed class of other physicians under contract with OHP. He alleged that OHP failed to make full and prompt payment to the doctors in violation of their contracts. OHP moved to compel arbitration; the state court granted OHP’s motion and referred the suit to arbitration. The parties agreed the arbitrator should decide whether their contract authorized class arbitration, and he determined that it did. OHP filed a motion in federal court to vacate the arbitrator’s decision on the grounds that he had exceeded his authority under the Federal Arbitration Act. The district court denied the motion and the Court of Appeals for the Third Circuit affirmed. The Supreme Court upheld the Third Circuit finding that the language in the arbitration agreement permitted the arbitrator to decide whether or not the agreement authorized a class action. Indeed, what makes this case so important is the number of agreements out there that have arbitration agreements with a prohibition on class actions. Now, as long as one person is willing to step up, that person may have the opportunity to address the status of all similarly situated physicians. Predictably, some businesses have already started adding “no class action” clauses in their agreements and more are likely to do so in the future. However, there are actions filed by physicians across the country that have been on hold waiting for this decision. The plaintiffs in those cases will likely benefit greatly from this decision. For more information, contact: John D. Fanburg / 973.403.3107 / jfanburg@bracheichler.com Keith J. Roberts / 973.364.5201 / kroberts@bracheichler.com July 2013

Hospital Rounds

HOSPITAL ROUNDS Barnabas Health and Jersey City Medical Center Sign Definitive Agreement

Barnabas Health and Jersey City Medical Center signed a definitive agreement this morning for Jersey City Medical Center to become a member of the Barnabas Health system. The addition of Jersey City Medical Center (JCMC) to Barnabas Health (BH) requires approvals from state and federal authorities. It is anticipated that this transaction will be completed by Fall 2013. In the interim, JCMC and BH will continue to serve their patients with high quality health care delivered with a patient-centered focus. Both entities will explore new avenues for sharing of programs and services. “The rapidly changing healthcare landscape presents new challenges and opportunities in healthcare,” said Joseph F. Scott, FACHE, President and Chief Executive Officer, Jersey City Medical Center. “For several years, Jersey City Medical Center has had a relationship with many of the hospitals in the Barnabas Health system. Becoming part of Barnabas Health will give our hospital an opportunity to continue to grow our services and better serve the healthcare needs of this quickly growing community.” “Jersey City Medical Center is an important addition to the Barnabas Health system,” stated Barry H. Ostrowsky, President and Chief Executive Officer, Barnabas Health. “It is an outstanding facility and expands our breadth and strength in the north beyond Essex County to Hudson County, bordering on the Hudson River. We look forward to welcoming JCMC’s physicians, employees, and volunteers as colleagues in providing exceptional health care services to the residents of New Jersey.” Barnabas Health is the largest not-for-profit integrated healthcare delivery system in New Jersey and one of the largest in the nation, annually caring for more than two million patient visits and delivering 17,600 babies. The system includes six acute-care hospitals, two children’s hospitals, a free-standing behavioral health center, ambulatory care centers, geriatric centers, the state’s largest behavioral health network and comprehensive homecare and hospice programs. Among nationally recognized services are burn treatment; adult and pediatric cardiac surgery; heart (second largest adult program in the nation), lung, kidney (second largest program in nation) and pancreas transplant; neurology and neurosurgery, reproductive medicine and science; geriatrics; oncology; pediatrics; neonatology (three Level III NICUs); and women’s services. Five Barnabas Health hospital received “A’s”, and one received ‘B’ for Hospital Safety in 2013 by Leapfrog, a nationally recognized rating organization; U.S. News & World Report named Barnabas Health hospitals and medical specialties top in the region; and Becker’s Hospital Review named Barnabas Health as one of the “Top 100 Places to Work in Healthcare in the United States.” Barnabas Health includes 18,500 employees (making it the second largest private employer in New Jersey); 4,600 physicians (one-fifth of the actively practicing physicians in New Jersey); and 445 residents and interns. For more information, log on to the web site at www.barnabashealth.org. For physician referral, call 888-724-7123. Jersey City Medical Center (JCMC) is a modern 316-bed teaching hospital located on a 14-acre campus overlooking the Statue of Liberty and NY Harbor. This location makes it convenient to major highways, PATH, and bus, with a light rail stop on campus. JCMC is the largest provider of healthcare services in Hudson County, with over 18,000 admissions and 80,000 ER visits per year. JCMC is a not-for-profit hospital which is part of Liberty Health. It is a regional trauma center, a state-designated stroke center, the regional comprehensive cardiac center, the perinatal intensive care center, and the regional level 3 neonatal intensive care unit for the most critically ill newborns. Additionally, it is the provider of Advanced Life Support for Hudson County, provides 911 Medical Call Screening for Hudson County, and operates one of the state’s busiest EMS systems. Jersey City Medical Center also is a major provider of behavioral health services, including 24/7 psychiatric emergency / crisis screening programs. The hospital has been recognized: as a Magnet Hospital for Nursing Excellence; as a top performer in quality and safety by the Joint Commission; three consecutive “A” ratings for safety by the Leapfrog Group; as a “top hospital” for its size for two consecutive years by Castle Connelly; and recognition by U.S. News and World Report as a top regional hospital. In addition, in the past two years both Modern Healthcare Magazine and Becker’s Hospital Review chose Jersey City Medical Center as one of the “Top 100 Places to Work in Healthcare in the United States. Additional information about Jersey City Medical Center can be found at www.libertyhealth.org. For physician referral, call 855-JCMC-DOCS.

A new Rutgers, with a new mission Medical education joins Rutgers’ many existing strengths to create a more comprehensive research university that will better serve the people of New Jersey and beyond NEW BRUNSWICK, N.J. – The new Rutgers University – academically stronger, energized by an expanded mission of medical education – begins today. Rutgers University President Robert L. Barchi and leaders across the state welcomed a new era in higher education, as the New Jersey Medical and Health Sciences Education Restructuring Act incorporates most of the former University of Medicine and Dentistry of New Jersey into Rutgers.

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The restructuring act, which takes full effect today, positions Rutgers to assume greater prominence across the state and nation. "For decades, Rutgers has been recognized for outstanding faculty, students and programs in the arts, sciences, humanities, social sciences and professional schools,” President Barchi said. “Combining our many existing strengths with our broader mission of medical education will elevate Rutgers to the ranks of the nation’s finest comprehensive research universities." The new Rutgers will: • Offer undergraduate, graduate and professional school students a more complete education, with access to interdisciplinary programs not previously available. •

Strengthen public-private partnerships between Rutgers and the health-care industry statewide, nationally and globally.

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Create new economic opportunities for New Jersey businesses and residents.

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Launch new research initiatives to tackle many of society’s most difficult challenges.

In recent months, President Barchi noted, Rutgers faculty and students have begun to form interdisciplinary initiatives in key areas of research, instruction and public service – including neuroscience, medical ethics, public health and precision medicine. "The people of New Jersey finally have the world-class public university that they deserve, with a commitment to excellence in virtually every facet of higher education," President Barchi said. "We look forward to the day when Rutgers University is synonymous with research that eradicates disease and enhances medical care, while providing an excellent education each year to tens of thousands of students from all corners of the world. "I’d like to thank Gov. Chris Christie, Senate President Stephen M. Sweeney, Assembly Speaker Sheila Y. Oliver, members of our governing boards and all of the leaders across New Jersey who have made the restructuring of higher education a reality," President Barchi added. The restructuring act creates Rutgers Biomedical and Health Sciences, which includes all of the schools, centers and institutes that made up UMDNJ except for University Hospital in Newark and the School of Osteopathic Medicine in Stratford. University Hospital is now a freestanding institution, but remains the principal teaching hospital for the Newark-based medical and dental schools. The School of Osteopathic Medicine is now part of Rowan University. In addition, Graduate School of Biomedical Sciences programs at Stratford transfer to Rowan University. Rutgers Biomedical and Health Sciences also includes three existing Rutgers academic institutions: the Ernest Mario School of Pharmacy; the Rutgers College of Nursing; and the Institute for Health, Health Care Policy and Aging Research. Established in 1766, Rutgers, The State University of New Jersey, is America’s eighth oldest institution of higher learning and one of the nation’s premier public research universities. Serving more than 65,000 students on campuses, centers, institutes and other locations throughout the state, Rutgers is the only public university in New Jersey that is a member of the prestigious Association of American Universities.

Health Center in New Jersey is Integral to Botswana HIV Success Leaders of UMDNJ’s FXB Center to attend International Aids Conference, July 22–27 NEWARK, N.J.—The XIX International AIDS Conference in Washington, D.C., next week (July 22–27) is bringing HIV/AIDS back into the spotlight. At the conference, leaders from the worlds of science, diplomacy, politics, and philanthropy will gather to discuss the strides made in the HIV/AIDS prevention and treatment. The François-Xavier Bagnoud (FXB) Center at the University of Medicine and Dentistry of New Jersey–School of Nursing has been at the forefront of these initiatives since 1989. One of its success stories is its work to prevent mother-to-child transmission of HIV (PMTCT) in Botswana. “The FXB Center has worked closely with the Botswana PMTCT Program for nearly a decade. We have witnessed first-hand the resolve and dedication of the Ministry of Health staff, the nation’s nurses, and other health workers to overcome HIV,” says Carli Rogosin, Program Manager–Botswana, who has made several visits to Botswana on behalf of the FXB Center. “As the number of HIV infections in newborns and infants has declined, we take great pride in knowing that our technical assistance, including guidelines, job aids, and training workshops, has helped to counteract the epidemic and improve the lives of families andcommunities all over Botswana.” The southern African nation — which has one of the highest HIV rates in the world, with approximately 25 percent of all adults in the country infected — also has the most comprehensive and effective treatment programs on the continent. And part of the government’s plan begins with the country’s most vulnerable citizens, its children. Over the past decade, the nation has reduced the rate of transmission of HIV from infected mothers to their babies from 40 percent to under 4 percent. Since 2003, the FXB Center has been integral in Botswana’s aggressive efforts. The FXB Center — which provides clinical care, education and technical assistance in the United States and globally to support capacity building to address the HIV/AIDS epidemic — has collaborated with the Botswana Ministry of Health, the Botswana Institute of Health Sciences, CDC Botswana, University Research Co., and other partners to provide assistance in the following areas: July 2013

· Development of PMTCT guidelines for care and treatment · In-service PMTCT training curricula for healthcare providers · Healthcare provider development and retention · Integration of HIV and reproductive health services The Botswana initiative is representative of the overall mission of the FXB Center, which has focused on clinical care, HIV prevention, provider training and technical assistance in the state of New Jersey and throughout the US since 1989 and for global partners since 1990. The FXB Botswana program is primarily funded by the Centers for Disease Control & Prevention to prevent mother-to-child transmission of HIV. Representatives from FXB Center will be attending the XIX International AIDS Conference (July 22–27) in Washington, D.C., where they will present a poster on the success of the FXB program in Guyana.

U.S. News & World Report Names University Hospital Among the “Best” in New Jersey and NY Metro Area Hospital is Ranked Nationally in Ear, Nose and Throat, Nephrology and Orthopedics NEWARK – University Hospital has been ranked among the Best Hospitals in Northern New Jersey and the New York Metropolitan area, according to the 2013-2014 Best Hospitals rankings, published by U.S. News and World Report. Ranked #19 in New Jersey and #39 in the New York Metropolitan Area, University Hospital is also recognized for its “high performance” in specialties such as Ear, Nose and Throat, Nephrology and Orthopedics. Published annually by U.S. News for the past 24 years, the rankings have been published at http://health.usnews.com/best-hospitals and will appear in print in the U.S. News Best Hospitals 2014 guidebook, available in bookstores and on newsstands August 27. "We are proud to be recognized for the outstanding care, expertise and dedication that our physicians, nurses and staff provides for patients and their families at University Hospital," said James R. Gonzalez, MPH, FACHE, President and CEO of University Hospital. "Our consistent acknowledgment by U.S. News & World Report speaks to our continued leadership and excellence in quality and clinical care." “A hospital that emerges from our analysis as one of the best has much to be proud of,” said Avery Comarow, U.S. News Health Rankings Editor. “Only about 15 percent of hospitals are recognized for their high performance as among their region’s best.” U.S. News publishes Best Hospitals to help guide patients who need a high level of care because they face particularly difficult surgery, a challenging condition, or added risk because of other health problems or age. Objective measures such as patient survival and safety data, the adequacy of nurse staffing levels and other data largely determined the rankings in most specialties. The specialty rankings and data were produced for U.S. News by RTI International, a leading research organization based in Research Triangle Park, N.C. Using the same data, U.S. News produced the state and metro rankings. About University Hospital: University Hospital is one of the United States' leading academic medical centers. Located in the Central Ward of Newark, New Jersey, it is one of the principal teaching hospitals of Rutgers Biomedical and Health Sciences and offers high quality patient care across many medical specialties. www.uhnj.org To speak with a University Hospital regarding this story, please contact Stacie Newton at 973-972-6273 (office) or (201) 463-2335 (mobile).

CHRISTOPHER MOLLOY TO SERVE AS INTERIM CHANCELLOR OF RUTGERS BIOMEDICAL AND HEALTH SCIENCES Search for permanent chancellor nearing completion NEW BRUNSWICK, N.J. – Christopher J. Molloy, who has successfully managed the complex process of Rutgers University’s impending integration with most of the University of Medicine and Dentistry of New Jersey, will serve as interim chancellor of the new Rutgers Biomedical and Health Sciences beginning July 1. Molloy is expected to hold the position until the university completes its search for a permanent chancellor, Rutgers President Robert L. Barchi announced today. Molloy, a molecular and cellular pharmacologist, has served as interim provost for biomedical and health sciences at Rutgers since October 2011. He joined Rutgers as dean of the Ernest Mario School of Pharmacy in 2007. “Chris Molloy has done an outstanding job managing one of the most complex higher education restructuring initiatives in history,” President Barchi said. “In the days immediately following integration, Chris is clearly the individual most qualified at Rutgers to oversee this historic transition as we complete our search for a permanent chancellor for Rutgers Biomedical and Health Sciences.” Under the New Jersey Medical and Health Sciences Education Restructuring Act, which takes full effect July 1, most of the schools and institutes that make up the University of Medicine and Dentistry of New Jersey will become part of Rutgers Biomedical and Health

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Sciences, which also will include the Ernest Mario School of Pharmacy; the Rutgers College of Nursing; and the Institute for Health, Health Care Policy and Aging Research. This restructuring will elevate Rutgers to the ranks of the nation’s finest comprehensive research universities. Molloy received a Bachelor of Science degree in pharmacy at Rutgers in 1977. He went on to earn his Ph.D. from the joint RutgersUMDNJ Graduate Program in Toxicology. Subsequently, he was a post-doctoral fellow at the National Cancer Institute, National Institutes of Health. Before returning to Rutgers in 2007, Molloy worked for Johnson and Johnson Pharmaceutical Research and Development L.L.C., where he served as a senior research fellow and team leader in the East Coast Research and Early Development unit. Molloy previously held senior positions with 3-Dimensional Pharmaceuticals Inc. and the Bristol-Myers Squibb Pharmaceutical Research Institute. Established in 1766, Rutgers, The State University of New Jersey, is America’s eighth oldest institution of higher learning and one of the nation’s premier public research universities. Serving nearly 60,000 students on campuses, centers, institutes and other locations throughout the state, Rutgers is one of only two New Jersey institutions represented in the prestigious Association of American Universities.

Rutgers Launches Neuroscience Consortium More than 350 researchers will work together to unlock the mysteries of life-threatening nervous system disorders By Robin Lally 'The great thing now about the new Rutgers is that intellectually we have all the different skills needed to do big things in both science and medicine' - Marco Zarbin Monday, July 1, 2013 One Rutgers, A World of Discovery The new Rutgers, combining nearly 250 years of academic excellence with a renewed commitment to medical education, is inspiring faculty, students and staff to form innovative partnerships in academic research and public service. In a new online series, Rutgers Today examines the new ways that members of the university community are collaborating, across a wide range of disciplines, to better meet the needs of the people of New Jersey and beyond. – The Editors Alzheimer’s disease develops slowly. At first, there is mild forgetfulness – names, important details and the ability to follow directions. But as time progresses, irreversible structural and chemical changes in the brain rob people of their dignity, unable to function or recognize even their closest family members. It is estimated that 5.1 million Americans are living with this debilitating, life-threatening brain disorder. And it is only expected to get worse as the population ages. This neurological disorder is only one of many that underscore the complexity of the brain and what happens when it doesn’t function properly. The challenge of understanding the mysteries of the mind has prompted scientists and physicians from Rutgers University and its two new medical schools to launch a neuroscience consortium. Working together to gain more information about the mechanisms underlying basic brain function will serve as a strong foundation for better understanding disease processes. The consortium is the first step in an initiative by Rutgers to establish a teaching, learning, and research environment where resources and knowledge are readily available across all academic and medical disciplines and where neuroscientists are better equipped to compete for dwindling government research dollars. “This consortium is as important to developing our universitywide neuroscience program as having a travel guide when you are on the highway,” says Stephen José Hanson, director of the Rutgers University Brain Imaging Center (RUBIC) in Newark. “Not having one would be like being in the middle of a foreign country and not realizing it because you don’t have a guide or landmark familiarity that connects you to your surroundings.” Hanson is a leading researcher on memory, learning, and brain function and is among a group of 25 neuroscientists who began meeting in the spring. The neuroscientists came together to discuss the best way to harness the incredible talent once Robert Wood Johnson Medical School in Piscataway and New Jersey Medical School in Newark became part of Rutgers. The addition of the medical schools was the impetus for getting neuroscientists out of their laboratories and into a room where they could discuss research, resources, funding, brain and nervous system collaborations, and how to best move forward. Hanson, who helped Rutgers acquire a full-body magnetic resonance imaging scanner that uses a powerful magnet and radio waves to measure blood flow changes to the brain, realized just how important this was after introducing himself at an exploratory gathering of about 40 neuroscientists in December. When he mentioned the brain imaging center, Hanson heard one person immediately ask, “Really, Rutgers has a scanner?” Innovative Collaborations Robin Davis, Suhayl Dhib-Jalbut and Cheryl Dreyfus have been involved in establishing the Rutgers Neuroscience Consortium. Neuroscientist Robin L. Davis, acting director of Rutgers’ Brain Health Institute on the New Brunswick Campus, has led the charge in creating the neuroscience consortium. She says this comment is a prime example of why change is needed. July 2013

“This new consortium will coordinate efforts across Rutgers University and our two new medical schools that will not only establish innovative research collaborations, which are certainly important, but also will have an educational mission to reach out to our internal and external community and let them know just who we are,” says Davis, who is also the director of auditory aging research at Rutgers. She studies the auditory neurons that are vulnerable to aging, their loss ultimately leading to hearing disorders and deafness. There are more than 350 neuroscience researchers working – from bench to bedside – within the university’s departments and institutions and its two medical schools. They are studying human learning and decision making; language development; sensory perception; the impact of traumatic brain injury; and the degree to which disorders such as autism, schizophrenia, and Alzheimer’s disease affect memory and behavior. The neuroscience field integrates biology, chemistry, physics, mathematics, psychology, and computer science at the level of basic science with neurology, neuroscience, ophthalmology, and psychiatry on the clinical side. Christopher J. Molloy, Rutgers’ interim chancellor of the new Rutgers Biomedical and Health Sciences, says these neuroscientists are individually involved in critical research to prevent or cure many devastating neurological and psychiatric disorders. “Together, through collaboration, neuroscientists across all areas of Rutgers, including New Jersey Medical School and Robert Wood Johnson Medical School, will be at the forefront in the quest to fully understand the complexities of the human brain,” Molloy says. “It will be these scientists, working together, who will develop treatments to alleviate the debilitating and life-threatening effects of these nervous system disorders.” Funding Brain Research In 2012, funding for neuroscience-related projects topped $56 million, representing almost 28 percent of all grant dollars awarded to the science and clinical research departments that are part of the new Rutgers. This includes money for an array of neuroscience projects including a $2.1 million stem cell research grant from the National Institutes of Health, enabling the School of Arts and Sciences, Robert Wood Johnson Medical School, and the Cancer Institute of New Jersey to focus on researching the genetic mysteries of autism, a brain disorder characterized by communication difficulties, social impairments, and repetitive behaviors. New collaborative research projects investigating multiple sclerosis; the effects of environmental toxins on the nervous system, memory, learning, and brain cell development; and the cause and effect of traumatic brain injury are just some of the projects beginning to take hold as scientists who may not have worked together previously become Rutgers colleagues. And with President Obama calling for a multibillion-dollar plan to map the human brain to understand its complexities and unlock the mysteries of debilitating neurodegenerative diseases, many neuroscientists say Rutgers is positioning itself to be a university at the forefront of such research. Building a Bridge This is a good start, say those involved with the development of the new consortium. But too much information – critical to discovering preventive treatments and possible cures – is still falling under the radar of many who could benefit from the data, says Marco Zarbin, professor and chair of the Department of Ophthalmology and Visual Science at New Jersey Medical School in Newark. Zarbin has done research to develop treatments for retinal eye disease through cell transplantation. “We end up in our own little silos,” says Zarbin, a member of the consortium, who insists that scientists and physicians have become so specialized that fewer collaborations – necessary for big scientific discoveries – are occurring. “The great thing now about the new Rutgers is that intellectually we have all the different skills needed to do big things in both science and medicine.” Moving forward, Suhayl Dhib-Jalbut, professor and chair of the Department of Neurology at Robert Wood Johnson Medical School, says a virtual neuroscience institute needs to be created to connect the neuroscience programs at Rutgers to its medical schools and make access to information seamless. This means developing a robust website through which information about both the work being done at the university and critical funding mechanisms for neuroscience research could be easily accessed by researchers, faculty, and students. “What we have to do is bring basic science and clinical trials together by creating a structure that allows us to get this done so we can achieve the best results,” says Dhib-Jalbut, a leading multiple sclerosis researcher funded by the National Institutes of Health and the National MS Society and president of the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS). John McGann, an assistant professor in the behavioral and systems neuroscience program in the Department of Psychology, School of Arts and Sciences, says the new consortium represents a positive first step in undergraduate and graduate education: providing additional resources and opportunities to the next generation of neuroscientists studying at Rutgers. “What I can say unequivocally is that we (neuroscientists) love our research,” says McGann, who studies the brain mechanisms underlying the sense of smell. ”So I think that whatever we need to do, everyone will be more than ready. I think our department borders ultimately will become irrelevant as we determine the best way to get this important work done.”

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A New Beginning for a “New” Hospital DiFrancesco to Lead Board; Gonzalez Named President and CEO (NEWARK) – University Hospital’s new status as a standalone entity began on July 1, 2013, on a day that started with the inaugural meeting of the hospital’s new Board of Directors. The hospital had previously been operated by the University of Medicine and Dentistry of New Jersey, which on the same day was dissolved and most of its schools became part of Rutgers, the State University of New Jersey. The University Hospital Board of Directors will be led by former New Jersey Governor Donald T. DiFrancesco, currently of the Law Firm of DiFrancesco, Bateman, Coley, Yospin, Kunzman, Davis, Lehrer & Flaum, P.C. “Today is a historic day,” said DiFrancesco who was appointed as chairman by Governor Chris Christie. “It is the rebirth of University Hospital.” Among the first items of board business was the confirmation of James R. Gonzalez, MPH, FACHE, as President and Chief Executive Officer (CEO) of University Hospital. Gonzalez had been serving in an interim capacity since July 2011. “This is our opportunity to redefine how we execute our mission, how we serve our community, how we showcase the exceptional medicine practiced at our hospital, and how we can explore new opportunities to make University Hospital the gold standard for delivering care and services,” said Gonzalez. Gonzalez is also President and CEO of Broadway House for Continuing Care (a 78-bed, University Hospital affiliated acute care facility in Newark specializing in the care and treatment of people with HIV/AIDS). He began his first assignment at University Hospital in 1999. Gonzalez’s achievements have included leading a $14 million renovation of the emergency room, achieving major cost savings by revamping the admitting services organization and introducing just-in-time delivery of medical and surgical supplies. Also appointed to the Board of Directors by Governor Christie were: William D. Cassidy, III, PhD The Human Resource Partnership Domenic M. DiPiero, III President, Newport Capital Group James M. Orsini, MD Essex Oncology Associates Four others are serving as ex officio: Robert L. Barchi, MD, PhD President, Rutgers, The State University of New Jersey Cecile Feldman, DMD, MBA Dean, Rutgers School of Dental Medicine Robert L. Johnson, MD Dean, Rutgers New Jersey Medical School Christopher J. Molloy, PhD Interim Chancellor, Rutgers Biomedical and Health Sciences During the meeting, Dr. Orsini was elected vice chairman and Dr. Cassidy was elected secretary. Guests at the inaugural board meeting included Assemblyman Thomas P. Giblin, 34th District; Assemblywoman Mila M. Jasey, 27th District; Assemblywoman Nancy F. Muñoz, 21st District; Assemblywoman L. Grace Spencer, 29th District; Essex County Executive Joseph N. DiVincenzo, Jr.; and Newark Central Ward Councilman Darrin S. Sharif. BRIAN L. STROM TO BECOME INAUGURAL CHANCELLOR OF RUTGERS BIOMEDICAL AND HEALTH SCIENCES ON DEC. 2 Strom, a renowned physician and epidemiologist, is currently Executive Vice Dean for Institutional Affairs at the University of Pennsylvania’s Perelman School of Medicine NEW BRUNSWICK, N.J. – Brian L. Strom, M.D., M.P.H., a renowned epidemiologist, award-winning teacher and clinician, and longtime academic leader at the University of Pennsylvania, will become the inaugural chancellor of Rutgers Biomedical and Health Sciences (RBHS) on Dec. 2, Rutgers University President Robert L. Barchi announced today. “I have known Dr. Strom for many years. He is an internationally recognized scholar and researcher, a distinguished educator and a proven academic administrator. His leadership will guide Rutgers Biomedical and Health Sciences during this unprecedented transition and establish RBHS as a model for research and education in the biomedical and health sciences,” Barchi said. “Brian July 2013

has enjoyed a remarkable career at Penn, and his vision and leadership will be invaluable as the new Rutgers transforms higher education in New Jersey.” Under the New Jersey Medical and Health Sciences Education Restructuring Act, which took full effect July 1, most of the schools and institutes that made up the former University of Medicine and Dentistry of New Jersey were combined with existing Rutgers University units like the Ernest Mario School of Pharmacy; the Rutgers College of Nursing; and the Institute for Health, Health Care Policy and Aging Research to form Rutgers Biomedical and Health Sciences. This dramatic transformation of the university immediately elevates Rutgers to the ranks of the nation’s finest comprehensive research universities. “Bringing together the faculty, students and staff from the many schools and institutes that form the new Rutgers Biomedical and Health Sciences creates a division of extraordinary breadth and depth, positioning Rutgers University to excel in biomedical research, medical instruction and health care delivery,” Strom said. “Our ability to take new discoveries from the bench to the bedside – from research in the lab, through clinical trials, into the hands of doctors – will transform higher education in the biomedical and health sciences and will change the face of health care in the State of New Jersey.” Strom currently serves as executive vice dean for institutional affairs at the University of Pennsylvania’s Perelman School of Medicine. At Penn, Strom established a pioneering program in clinical epidemiology and biostatistics; oversaw a multi-institutional program called Bridging the Gaps, which addresses the needs of underserved populations while training community health and social service professionals; and developed a universitywide program in global health. He was also instrumental in founding the International Clinical Epidemiology Network, designed to assist clinical faculty in developing nations better understand the impact of disease and improve the health of their fellow citizens. More recently, Strom has been working to strengthen clinical care, research and leadership within the Penn-affiliated Philadelphia Veterans Affairs Medical Center. In his current position, his responsibilities include recruiting outstanding senior faculty to the Perelman School of Medicine. Strom’s achievements also include establishing four degree programs; conducting research critical to the rewriting of American Heart Association guidelines regarding prevention of infective endocarditis; and establishing the multi-disciplinary Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania, which includes more than 550 faculty, staff and trainees, and has a budget of approximately $67 million. Strom is George S. Pepper professor of public health and preventive medicine, professor of biostatistics and epidemiology, professor of medicine, and professor of pharmacology at Penn, and he maintains a primary care practice as a general internist. He holds a B.S. in Molecular Biophysics and Biochemistry from Yale University, an M.D. from the Johns Hopkins University School of Medicine, and an M.P.H. in Epidemiology from the University of California, Berkeley. Among his many positions leading national and international organizations, his awards and his honors, Strom was elected to the Institute of Medicine of the National Academy of Sciences in 2001.

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President Barchi also announced today that RBHS interim chancellor Christopher J. Molloy, who will continue to serve in this capacity until Strom’s arrival, will become Rutgers University’s senior vice president for research and economic development after completing his task as interim chancellor. Molloy joined Rutgers in 2007 as dean of the Ernest Mario School of Pharmacy. In 2011, he was appointed Rutgers interim provost for biomedical and health sciences and successfully managed the complex integration of Rutgers University and most of the former UMDNJ. He received his Bachelor of Science degree in pharmacy from Rutgers University and his Ph.D. from the joint RutgersUMDNJ Graduate Program in Toxicology. He was a post-doctoral fellow at the National Cancer Institute at the National Institutes of Health. Prior to joining Rutgers, Molloy held senior research and management positions at Johnson and Johnson Pharmaceutical Research and Development L.L.C., 3-Dimensional Pharmaceuticals Inc., and the Bristol-Myers Squibb Pharmaceutical Research Institute. As senior vice president for research and economic development, Molloy’s responsibilities will include oversight and strategic planning for the university’s $700 million in annual research expenditures and management of the many institutional offices and resources that support Rutgers’ research activities. His office also will focus on expanding the commercialization of research through patents, start-ups and the transfer of technology to industry, maximizing the university’s ability to conduct translational research in the life sciences and other critical research and development activities; and leading the formation of public-private partnerships that will bring new jobs to the State of New Jersey. Established in 1766, Rutgers, The State University of New Jersey, is America’s eighth oldest institution of higher learning and one of the nation’s premier public research universities. Serving more than 65,000 students on campuses, centers, institutes and other locations throughout the state, Rutgers is the only public university in New Jersey that is a member of the prestigious Association of American Universities.

Library of Medicine Library of Medicine LLC searches for healthcare providers Library Of Medicine, LLC has recently launched a healthcare provider search to recruit doctors, dentists, podiatrists and chiropractors as authors, reviewers and editors for their website LibraryOfMedicine.com. The main goal of the website is to provide medical information that is thorough, accurate and in an easy to read format for patients. The initiative is to educate the general population by creating an online open access and peer reviewed medical information database of review articles, Reviews at LibraryOfMedicine. com, written by physicians and other health care professionals. These articles will be written in layman's terms so that patients have an easier time understanding their conditions as well as the outcomes of various treatment options reported in the medical literature. General information, outcomes, a literature review, complications and prognosis will be included. The site will provide valuable information to assist patients in making more informed decisions regarding their healthcare. It provides a simple printable article which can be used by doctors to provide patients with information as well as to assist in providing informed consent for procedures. It also provides the opportunity for physicians to publish, in a peer reviewed format, without the burden of clinical or bench work research. This can be helpful with certain practice partnership agreements as well as in obtaining higher levels of appointments in some academic models. The website can also be useful in reviewing information for subspecialty re-certification examinations. It will be a helpful resource for patients since it provides comprehensive information that a doctor might read in a review article from his/her favorite medical journal, and, in a format that will be written, and one that the general population will be able to more easily understand with esoteric medical terms being eliminated, whenever possible. The articles will be appropriately referenced. The Journal of the LibraryOfMedicine.com will also launch simultaneously and provide an open access and peer reviewed online journal focusing on current and relevant clinical research in all the disciplines of medicine, surgery, dentistry, podiatry and chiropractic care. This will allow free open access publishing without the costs of submitting to typical print journals which charge fees ranging from $500-$5000 per submission. The emphasis of the journal will be on clinical research with emphasis on the diagnosis, prevention and treatment of medical disorders. The manuscripts will be blinded and peer reviewed to maintain high research standards. The review journal and research journal will apply to get indexed on Medline once operational. Other components of the site will assist in searching national university medical libraries, obtaining online CMEs, viewing medical and surgical videos as well as multiple interactive components that will be included at a later time. There is an online bookstore to offer healthcare providers and the general public the ability to purchase medical reference books as well as general health books. LibraryOfMedicine.com is currently recruiting contributors. They are looking for authors with an interest in publishing online, reviewers (with some research or reviewing experience) and editors with significant clinical, editing or reviewing experience. Potential contributors should apply online at, www.LibraryOfMedicine.com. It’s a great way to participate in changing the way patients receive and use medical information. Future plans include a mobile healthcare community outreach program to help educate those in lower socioeconomic and rural regions of the country. Questions and comments can be sent to contactus@libraryofmedicine.com July 2013

Food for Thought

Lenox, Massachusetts By Iris Goldberg

(Food For Thought is on a brief hiatus and will return with new articles in September. Here is a favorite from a past summer issue).

Music Festival

Although it is not located in New Jersey and is not a place one would attend for the sole purpose of having a unique dining experience, Tanglewood is the subject of this monthís Food For Thought. Located in the scenic Berkshires, Tanglewood is certainly worth the drive for anyone who enjoys classical music, beautiful surroundings and a great picnic, too. We have actually been enjoying the Tanglewood Music Festival regularly, for the past 35 years or so, since Michaelís parents purchased a small, cozy summer cabin in the town of Stockbridge, one of the charming, culturally-rich towns that comprise the Tanglewood community. Each summer we looked forward to our ‘Tanglewood weekend,’ eventually introducing our daughters and at times, their friends and ours, to the pleasures of lying under the stars on a New England summer evening in the company of composers like Mozart, Brahms or Beethoven. We would try to arrive by 6 P.M. on a Friday. In those days Michaelís parents would have had a picnic prepared for that nightís dinner. Baskets of food and drink, blankets, candles, chairs, napkins, eating utensils, insect repellent- all had to be carefully loaded into the car, along with people. We would arrive on the huge, perfectly manicured Tanglewood lawn at least an hour and a half before the concert was scheduled to begin. This would allow plenty of daylight and time to enjoy the food and each other. A typical meal would start with some wine for the adults, along with cheese, crackers, hummus and if we were really in luck, my fatherin-law would have made an early morning trip to find the man who smoked the bluefish. He never actually told us where this man performed this feat or how he heard about him but smoked bluefish is a delectable treat and Michaelís dad always got great pleasure out of watching his family devour it. Next might be some cold chicken, a mixed salad and maybe some cold pasta. For dessert, there was my mother-in-law’s apple cake. She knew how much her son loved it and always had some freshly-baked when we came. While we ate, we were busy looking around at the hundreds of other people who had arranged themselves on this beautiful lawn and were doing exactly what we were. It never ceased to amaze me the lengths to which some would go in order to create the perfect meal. Linen tablecloths, stemware, candlesticks and a variety of exotic foods could be spotted. For some, pizza, paper plates and Kentucky Fried Chicken were the ideal choice. The possibilities were endless, depending only upon oneís imagination and initiative.

At 8 o’clock or so the bell would sound, alerting us that the music was about to begin. We quickly cleaned up and arranged ourselves in a good listening position, some of us on the blanket, some sitting on folding chairs. As soon as the first note was played, all talking stopped. Hundreds of people, who were moments ago, eating and laughing and moving around all of the items they had brought with them, became absolutely quiet. That time with the music was always special to me, as I am sure it was to so many who were in attendance. I would gaze up at the incredible, star-filled sky and let the sounds wash over me. Sometimes I would find someone to snuggle with and that would be the best part of all. The music would always end too soon and that tremendous crowd of people would now busy themselves, packing everything up for the trip home. Amazingly, Iíve never seen anyone leave a scrap of refuse behind. We would drive home in a caravan of cars, each moving slowly as the traffic officers directed the procession. The good news was that another concert followed on Saturday evening and yet another on Sunday afternoon. Michael and I would usually oversee Saturdayís meal, spending the afternoon in town, shopping for whatever struck our fancy. Sunday would be brunch, maybe smoked salmon, bagels and mimosas on the lawn, or sometimes, a hearty meal in a restaurant before the concert. If the weather cooperated, the weekend would always be a success. Sometimes, the weather would not cooperate and thatís when the real fun began, especially if the skies opened up while we were already on the lawn. The regular concert-goers always had rain gear handy to protect them at a momentís notice. We, on the other hand, have gotten soaked to the skin more than once! However things went, Michaelís folks were always sorry to see us go on Sunday evening and we would sadly wave good-by from the car until they were no longer in view. Unfortunately, a few years back, my in-laws reluctantly gave up their Berkshires residence, preferring to be closer to family and continuity of medical care. We had not visited Tanglewood since and decided to rectify the situation this summer. Now that our accommodations were no longer guaranteed, we had to actually plan this back in April in order to reserve a decent motel room in this popular summer tourist area. About a week before our trip, Michael began planning our Friday night picnic. He shopped for just the right assortment of delicacies and as they accumulated in our kitchen, waiting to be packed, I couldnít help getting excited. He thought of everything, even purchasing new folding chairs and a portable little dining table. We had a huge cooler for the perishables to ensure that our food would be protected until we arrived. We checked into our motel and then made it to the Tanglewood lawn at about 6:30. The weather couldnít have been better. We found our favorite spot, kind of in the middle, behind the great shed that houses the Boston Symphony Orchestra and those in the audience who purchase traditional seating. As we unpacked, I had a moment of sadness, missing my in-laws and the kids and wishing I could turn back time. I was sure, however, that this was going to be a wonderful evening, especially as I took stock of the scrumptious picnic Michael had prepared. We started with some duck pate with Perigord truffles, served on crackers with Dijon mustard and cornichons. Also, there was a Manchego and a St. Andre cheese. With those appetizers we had a Sancerre, a white wine, which accompanied quite well. For our main course, Michael had actually cooked an entire lobster at home and used the meat to make the most luscious lobster salad, which he served as a ‘lobster roll’ on a brioche hot dog bun. Along with this were gourmet potato chips made from blue, sweet, dark russet and Yukon Gold potatoes. As a splendid companion to the lobster, we shared a bottle of Nicolas Feuillatte Brut champagne. Next, Michael went to the concession where food is sold for those who prefer buying their meal there, returning with two cups of strong coffee that we drank with the biscotti which he had brought for dessert. As we were finishing our meal, almost on cue, the bell sounded, reminding us that the concert was about to start. We had been looking forward to this performance. Kurt Masur, having just celebrated his 80th birthday, was conducting and Joshua Bell was performing on the violin. We were treated to Prokofiev’s Symphony No. 1 and Violin Concerto No.1, as well as Beethoven’s Symphony No. 1. The moon was unbelievable that night. I felt as if I could reach up and touch it- the ìman in the moonî quite visible, almost smiling down on all of us as we enjoyed the sweet music. At the end of the concert, as we were packing up, I made a mental note to call Michael’s parents first thing in the morning, to share as best we could, this delightful evening with them.

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