NJ Physician Magazine October 2014 by NJPhysician Magazine

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

The Importance Pf Checking the OIG’s Exclusion List Cyber Liability, The Looming Threat for Doctors and the Health Care Industry Horizon’s Partnership with Practice Management Firm is Paying Off-In Cost and in Health- It’s Data Shows Summit Medical Group will Develop Cancer Center with MD Anderson

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Contents

T he Importance of Checking the OIG’s Exclusion List

CONTENTS

Cyber Liability: The Looming Threat for Doctors and the Health Care Industry

Horizon’s Partnership with Practice Management Firm is Paying Off in Cost and in Health-Its Data Shows

N.J.’s Hospitals Move Up to 4th in Safety, According to Leapfrog Score

Summit Medical Group Will Develop Cancer Center With MD Anderson

Hackensack, Meridian to Merge, Forming State’s Largest Health System

Barnabas Doctors Group Launches Medical-Information Blog

Atlantic Health to Open Chambers Center for Well-Being - A Center Specializing in Holistic Medicine- In Morristown

Barnabas Health Elects New Chairman of the Board

Former St. Joseph’s Healthcare System Executive Returning as New CEO

Valley Hospital Brings Back House Calls in an Effort to Reduce Readmission of Hearth Patients 4 New Jersey Physician

November 2014 5

Cover Story

The Importance of Checking the OIG’s Exclusion List

By Beth Christian

Just as you would do with any business transaction involving your practice, it is important to do your due diligence when hiring or contracting with individuals or entities to perform services on behalf of your practice. As discussed below, there can be draconian consequences for your practice if you fail to do so and either hire, or contract with, a person or entity that is excluded from Medicare or Medicaid.

services is made to a person or entity that is not itself excluded from Medicare or Medicaid, and can apply whether an individual is an employee or an independent contractor. The exclusion is applicable for items and services that go beyond direct patient care, and can also apply to administrative and management services (including billing and claims processing services) even if they are not separately billable.

Under federal law, the HHS Office of Inspector General (“OIG”) has the legal authority to exclude individuals and entities from participation in Medicare, Medicaid and other federal health care programs. If a person or entity is subject to an OIG exclusion, no federal health care program payment may be made for any items or services furnished by, or at the medical direction or on the prescription of, that person or entity. The exclusion and the payment prohibition follows an individual even if he or she switches from one health care profession to another during the period of the exclusion. The payment prohibition applies if the individual’s time is billed directly to the Medicare or Medicaid programs. The payment prohibition also applies if the excluded individual’s services are billed directly or indirectly as a part of a bundled payment, capitated payment, DRG payment or other payment system. Most importantly, the payment prohibition applies even if the payment for the excluded individual or entity’s

The risk to your practice if you employ or contract with an excluded individual or entity are significant. First, because no federal health care program payment may be made for services rendered by an excluded individual or entity, your practice cannot be paid by Medicare or Medicaid for services rendered by that individual or entity during the period of exclusion. If your practice is paid for such services, all such funds will constitute an overpayment and will have to be returned to the governmental payors. In addition, federal law authorizes the imposition of civil monetary penalties against providers that employ, or enter into contracts with, excluded persons to provide items or services payable by federal health care programs. If a health care provider arranges or contracts (by employment or otherwise) with a person that is excluded by the OIG, the employing or contracting provider may be subject to civil monetary penalty liabil

Cyber Liability: The Looming Threat for Doctors and the Health Care Industry

By Beth Christian

Almost daily, the news reports of the latest hacking incident to many big corporations and the federal government from a myriad of unknown sources. In some cases it’s the simple infecting of a system by a malicious virus or Trojans implanted by others of unknown origins, but in many cases it’s the hacking of individuals and patient’s records maintained by organizations and third party operators of individuals record used by organizations. Doctors and health care facilities will become particularly vulnerable as new rules require patient’s records and be maintained electronically in their data bases, and their relation to strict HIPPA laws when it comes to securing patient records. 6 New Jersey Physician

Healthcare facilities and doctor’s offices are increasingly becoming targets of hackers for the theft of patient records for various purposes. These records can be hacked directly from facilities and doctor’s systems, or through lost or stolen laptop and other computer devices. The hacking of records requires strict HIPPA law reporting to the state attorney general, hard letters sent to all the patients informing them of the breach, a call center be set up, forensic work to reveal why the breach occurred and the mandatory offering of 1 year free credit reporting to each record involved in the breach. The average cost estimated from industry experts is between $100-$200 per record, a cost born by the facility or doctor, even when a third party operator maintains the records. When one tallies the number of records any one facility or doctor can have on file, the potential cost can be astronomical. So what can be done? Careful examination of security for the systems in place is step one, including firewalls, anti virus, proper passwording, and limited user access is paramount. Health care related entities should be careful to fully examine their exposures by security professionals and follow all protocol. Even with the best security, systems are still breached every day and records hacked in almost every business, as evidenced by the virtual constant reports in the media. It’s important to note, most don’t even get reported, so the threat is large and growing. From a secondary protection standpoint, the insurance industry has also stepped up and is now offering “cyber” insurance coverage for this exposure from a number of insurance carriers. The coverage covers both third party exposures, (damage to other’s systems and suits brought by others) and first party coverage (damage to the insured’s systems and reimbursement due to expenses incurred if a breach occurs). Coverage is generally subject to deductibles and sublimits with respect to the reimbursement coverage for record breaches. Policies can range from a few thousand dollars to much higher premiums, depending on exposures. Many medical mal practice policies now build in some cyber cover-

age with basic limits of $50,000. However it is important to note, this would be considered inadequate when considering the potential costs, so a separate cyber policy should be purchased if the medical mal practice policy cannot raise limits to more adequate levels. Typical limits would be $1,000,000 for third party exposures and sublimits of $100,000 to $1,000,000 for privacy breaches and stolen patient record requirements. Deductibles can range from $1,000 to $25,000 in most cases.

Cyber extortion — coverage for a threat involving a party demanding cyber extortion funds or they will:

The coverage is typically written as follows:

• release confidential information of a third party;

Network security and privacy insurance — coverage for both electronic and physical information, virus attacks, hackers, identity theft, and defense costs for regulatory proceedings. Regulatory fines and penalties insurance — coverage for administrative fines and penalties a policyholder is required to pay as the result of an investigation conducted by a federal, state, or local government agency resulting from a privacy breach (such as HIPAA, HITECH, and state or federal notification requirements). Patient notification and credit monitoring costs insurance — includes all necessary legal, IT forensic, public relations, advertising, call center, and postage expenses incurred by the policyholder to notify third parties about the breach of information. This coverage will also pay for credit monitoring for all affected parties. Data recovery costs insurance — includes all reasonable and necessary costs to recover and/or replace data that is compromised, damaged, lost, erased, or corrupted. Multimedia insurance — coverage for both online and off-line media including claims alleging copyright/ trademark infringement, libel/slander, advertising injuries, and plagiarism.

• introduce malicious code; • corrupt, damage, or destroy the policyholder’s system; • restrict or hinder access to system including denial of service attack; or •

electronically communicate with policyholder’s patients or customers claiming to be the policyholder in order to obtain personal confidential information.  This coverage pays cyber extortion expenses, but such expenses can only be incurred with TMLT’s consent. The coverage would also reimburse cyber extortion funds paid (with TMLT’s consent) to terminate the threat. Cyber terrorism — coverage that pays for acts of terrorism, meaning a use of force or violence for political, religious, ideological, or similar purposes, including the intent to influence a government or put the public in fear. John Forrester is a Vice President at Boynton & Boynton, one of the tri state’s leading medical malpractice insurance firms, insuring over 4,000 doctors with offices located in New Jersey and Pennsylvania.jforrester@boyntonandboynton.com 1-800-822-0262

x 1185.+

November 2014 7

Insurance Issues

Horizon’s partnership with practice management firm is paying off — in cost and in health — its data show By Beth Fitzgerald Lower medical costs, fewer trips to the emergency room, more cancer screenings — those are some of the results so far of a collaboration between Horizon Blue Cross Blue Shield of New Jersey and Continuum Health Alliance, a Marlton firm that helps physicians improve their clinical and financial performance. Horizon and Continuum launched their program in 2012 to focus on better care and lower costs for 20,000 Horizon members who are patients of Advocare, one of the largest doctor practices in New Jersey; Continuum provides practice management services to Advocare. The program’s first year, which ended June 30, 2013, saw the cost of care decline 13 percent; ER visits were down 3.2 percent; hospital admissions fell 12.5 percent. The percentage of patients readmitted to the hospital within 30 days of discharge fell to 12 percent, compared with 18 to 20 percent for a comparable population. And the program hit the 90th percentile for care quality. Progress has continued on the cost and quality fronts in the program’s second year, which ended June 30, 2014; those results will be released once all the data is compiled. Dr. Steven R. Peskin, senior medical director for clinical innovations at Horizon, said, “Our ability to work collaboratively is what has really made the difference.” A critical component of the collaboration is sharing data: Horizon provides claims data and Continuum contributes electronic health record data from the patients, showing the medical care they’re getting, and how it’s impacting their health. 8 New Jersey Physician

“Another important part of it from Horizon’s standpoint is to reward value over volume,” Peskin said. The physician practices receive extra payments from Horizon to cover the cost of providing the extra services required to coordinate the patient’s medical care and make sure they are getting the right preventive care. “To be able to compensate great clinical organizations like Advocare and Continuum is a critical part of this,” Peskin said. On average, Advocare receives an upfront payment of $5 per patient per month from Horizon. And the physicians receive shared savings distributions from Horizon for meeting the program’s goals. Continuum President Christopher Olivia said a key has been Horizon’s commitment to getting the health care system to focus on both medicine and money. “While their goal is to help their client base save money, they also understand that improving the health of the individual and the population served is equally as important as bending the cost curve,” Olivia said.

more patients tested — and identified about 15 colon cancer cases. “Think about all the money that was saved by treating those cancers in the early stage,” Olivia said. “Then forget that and think about this: Think about the improvement in the lives of those 15 people, how much better off they are. And that is really why people sign up for Horizon heath insurance — they want to be healthy.” Peskin said achieving a better colon cancer screening rate reflects the efforts of care coordination “working behind the scenes to identify patients who had not been screened. This is an example of a systematic change” in health care. Continuum is one of many patient-centered health care collaborations that Horizon has forged across the state in the past few years. Horizon said about 500,000 of its members now get their care from patient-centered practices. Peskin said its work with Continuum and others “is redefining the way health care is coordinated and organized so you get better outcomes” by focusing more on “wellness care versus sickness care.”

Figuring out how to get more people screened for colon cancer has been a key victory. Colonoscopies are recommended for those over 50, but nationwide only about half the population has had the test.

Olivia explained that patient-centered care includes the work of the non-clinical office staff, who keep tabs on patients; for example, making sure all the diabetics receive the screenings and routine care required to keep their disease under control.

So the Advocare physicians worked on getting patients to instead take the FIT test, a simple stool-sample screening. That intervention got many

“A very important person in the process can be the front desk person who is very good at communicating and is very passionate about taking care of

patients,” he said. These individuals are not clinicians, “but they are empowered to get things accomplished, and they may have to hound the patients a little bit to get it done.” The care coordinators, generally nurses, “work with the really complex, 5 percent of the patients who drive 47 percent of the cost. They work on the cases that are at risk for hospitalization. They help patients navigate the system, and get them out of the emergency department.” He said, “When you put things together, you have a level of service and a level of attention that patients don’t typically get in an average medical office.”

Hospital Rounds

N.J.’s hospitals move up to 4th in safety, according to Leapfrog score By Beth Fitzgerald New Jersey now ranks fourth nationwide on the Leapfrog Hospital Safety Score, with 52 percent of the state’s acute care general hospitals getting an “A” grade for safety, according to the nonprofit Leapfrog Group, which gives safety letter grades of “A” to “F” to 2,500 hospitals nationwide. Leapfrog said the goal of its hospital safety report card is to promote patient safety by providing consumers and employers with information on how well hospitals are keeping patients safe from adverse events like infections and falls, as well as medication and surgical errors. Leapfrog issues its hospital safety report card twice a year. New Jersey moved up from seventh in the nation in April to fourth in the fall survey, now available online at www.hospitalsafetyscore.org. New Jersey, with 52.23 percent of its 67 hospitals getting an “A,” ranked below only Maine, at 67 percent; Massachusetts, at 63 percent; and Virginia, with 52.38 percent of its hospitals getting an “A.” In New Jersey, 35 hospitals got an “A,” up from 30 in April. “It’s really exciting to see such a big improvement in New Jersey in the number of ‘A’ hospitals,” said Erica Mobley, director of communications and development at Leapfrog. “We’re delighted to see New Jersey setting a national model for safety and transparency,” said Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute and a member of the Leapfrog board. “We especially congratulate the hospitals who worked to improve their quality by raising their Safety Score to an ‘A.’”

Schwimmer pointed out that, despite New Jersey’s overall high performance, regional variation still persists. She said that, in Newark, with the exception of Newark Beth Israel Medical Center, hospitals have consistently received “Cs” and “Ds” in the last three rounds of scoring, including this most recent round. Newark Beth Israel received a “B” score both in the current report and in April. Newark’s University Hospital scored “C” in both the fall and spring, while Saint Michael’s Medical Center scored a “D” in both rounds and is the only “D”-graded New Jersey hospital. Cathy Toscano, director of communications at Saint Michael’s, said: “Some of the data used to calculate hospital grades is dated and does not reflect more recent performance improvement efforts. We are consistently measuring, monitoring and taking action to ensure the safety of our patients through our patient safety and performance improvements committees and other hospital programs.” Leapfrog said Saint Michael’s scored below the national average in a number of areas. One issues, Leapfrog said, is that Saint Michael’s indicated it does not have intensivists treating patients in its intensive care unit. According to Leapfrog, staffing an ICU with intensivists who are specially trained in critical care medicine is shown to reduce patient mortality 40 percent. Toscano replied: “We have a medical intensive care unit and a cardiac recovery room. Both areas are staffed by rigorously credentialed physicians who are board-certified in the appropriate specialties to provide care for these patients. We also have advanced practitioners and fellows in support of the operations 24/7.” November 2014 9

Hospital Rounds the nation. The recent mishandling of Ebola cases proves that as a country, our hospitals must work harder to become prepared for this and any future threats.”

Meadowlands Hospital Medical Center got a “C” this time, down from an “A” in April. Leapfrog said the lower score was related to the Meadowlands computerized physician order entry system, an electronic prescription system that alerts hospital staff to potential medicine errors. According to Leapfrog, Meadowlands has a CPOE system, but because the hospital did not participate in an evaluation of how well the system is working, Leapfrog was unable to award Meadowlands points for its CPOE, which impacted the grade. A Meadowlands spokesman could not be reached for comment. Aline Holmes, a registered nurse and senior vice president of clinical affairs and director of the New Jersey Hospital Association Institute for Quality and Patient Safety, said all of New Jersey’s hospitals are part of the nationwide Partnership for Patients effort, which is led by the Centers for Medicare and Medicaid Services and is focused on quality and patient safety. “That work is now in its third year, and I think it has created a very robust, very active culture of safety in our hospitals that is reflected in many ways — not only in reports like this one from the Leapfrog Group, but also in our own findings in the NJHA Institute for Quality and Patient Safety,” Holmes said. She said NJHA data for 2013 show that hospitals’ improvements in reducing complications like infections saved an estimated $125 million in health care costs and averted 9,206 adverse patient events. “It’s important that we make this information easily accessible to consumers so that the public, employers and policymakers can pressure them to do better,” Schwimmer said. And she added: “It’s also important to note that, while Leapfrog assesses and publicly reports on hospital safety, they do not and cannot assess any hospital’s preparedness for the threat of Ebola. Ebola requires the highest level of preparedness from the American health care system and public health authorities, including sophisticated methods of infection control, training, triage and isolation. These means of preparedness are far outside the scope of the routine safe practices that Leapfrog monitors in American hospitals.” In fact, the Dallas hospital where two nurses contracted Ebola from a patient — Texas Health Presbyterian — received an “A” grade from Leapfrog, based on its past performance on safety metrics. Leah Binder, chief executive of Leapfrog, said: “Even ‘A’ hospitals make mistakes, and sometimes patients are harmed. Based on the data Leapfrog used in the Hospital Safety Score, Texas Presbyterian is among the safer hospitals in 10 New Jersey Physician

Saint Peter’s University Hospital in New Brunswick got a “C” this fall, down from an “A” in April. Spokesman Phil Hartman said the hospital expects to return to an “A” ranking next spring, and he said, “Saint Peter’s has addressed those areas detailed as shortcomings in 2013 and we have made significant gains in those areas for 2014.” Raritan Bay Medical Center’s hospitals in Perth Amboy and Old Bridge both got “C” grades from Leapfrog. Dr. Gregorio Guillen, president of the Raritan Bay medical staff, said: “For many years now, Raritan Bay Medical Center’s medical, nursing and support staff has made a concerted effort to improve the quality of care we provide our patients. Our goal is to ensure our community the best care possible and the complete safety of our patients. “This year, we continued to evolve our processes and protocols to better serve our patients by implementing electronic medical records, establishing a physician intensivist program and launching an online patient portal enabling patients to access their own medical test results. Because this has been an ongoing process this year, we elected to use the entire survey period that deadlines Dec. 31, 2014, to report data. As a result, several areas of measure for our medical center are not reflected as part of our current ‘C’ score. We anticipate our score improving over time as we provide the data on these new, high-quality care process initiatives.” Robert Wood Johnson University Hospital scores declined from an “A” to “B” at the New Brunswick, Somerset and Hamilton hospitals; the Rahway hospital maintained its “B” score. RWJUH said it “continues to support efforts, like the Leapfrog Group’s Hospital Safety Score, to encourage transparency and give individuals access to information that can help them better evaluate the quality of care provided by our state’s hospitals.” RWJUH said, “As this year’s report indicates, RWJUH continued to improve on some of the measures evaluated by the report. For example, at RWJ New Brunswick we have been able to reduce the number of central line-associated blood stream infections by 41 percent from last year. We have also decreased falls by 36.5 percent over that same time period. We will use the data in this report to benchmark our performance and develop quality improvement initiatives to address any areas of need.” Leapfrog said the Hospital Safety Score is designed to give the public information it can use to choose a hospital. “We want to turn patients into savvy health care shoppers by enabling them to take an active role in selecting a hospital,” Binder said. “By evaluating hospitals based on important safety measures and grading them accordingly, we can help

Hospital Rounds consumers make smarter choices for themselves and their families.” “New Jersey citizens should use every resource available when planning for a hospital visit, including the Hospital Safety Score,” Schwimmer said. “At the Quality Institute, we will continue to work with policymakers and employers on implementing value-based purchasing to spur safety improvements in our hospitals.”

Calculated under the guidance of Leapfrog’s Blue Ribbon Panel of patient safety experts, the Hospital Safety Score uses 28 measures of publicly available hospital safety data to produce a single score that represents a hospital’s overall performance in patient safety.

Summit Medical Group will develop cancer center with MD Anderson By Beth Fitzgerald

The Summit Medical Group and Houston-based MD Anderson Cancer Center have signed a letter of intent to develop a joint, outpatient cancer center as an extension of MD Anderson’s partnership with Cooper University Health Care. The center would provide an integrated, multidisciplinary approach to oncology care in northern New Jersey. The agreement is the first of its kind between MD Anderson and a physician-owned and governed multispecialty group. Summit Medical Group and MD Anderson will work together to plan and develop the new outpatient center. MD Anderson will provide clinical oversight and management for the program, which will include radiation oncology, medical oncology, infusion and diagnostic imaging. “We are thrilled to have MD Anderson, a national and global leader in cancer care, bring its unique knowledge and unparalleled expertise to this relationship,” said Dr. Jeffrey Le Benger, chairman and chief executive officer of Summit Medical Group. “Together with our multidisciplinary model that is transforming how health care is delivered in New Jersey, we are better positioned to provide comprehensive, world-class cancer care to patients and their families.” “Since partnering with MD Anderson Cancer Center, Cooper has had an overwhelming response, which shows the value that MD Anderson brings to the people of New Jersey,” said George E. Norcross III, chairman of the board of Camdenbased Cooper. “MD Anderson Cancer Center at Cooper is a hugely successful partnership that delivers MD Anderson’s proven model of cancer treatment, care and research to South Jersey patients,” said Dr. Thomas Burke, executive vice president of MD Anderson Cancer Network. “We look forward to extending our partnership with Cooper and building a relationship with Summit Medical Group to further elevate can-

cer care in northern New Jersey and advance our mission to end cancer.” Summit Medical Group would become a member of MD Anderson Cancer Network, the institution’s program to elevate the quality of cancer care in communities throughout the nation and the world. The relationship will enable Summit Medical Group to be operationally and clinically integrated with MD Anderson and contribute to the institution’s mission to end cancer. The relationship also will provide Summit Medical Group patients access to MD Anderson’s world-renowned treatment protocols, extensive clinical trials and cutting edge research, while remaining in the care of their Summit Medical Group primary care physicians, oncologists and other health care specialists. Summit Medical Group will be able to provide comprehensive cancer care to its patients from diagnosis to survivorship, ensure strong communication between all treating physicians and preserve the patient-physician relationships that have existed for many years. Located at the University of Texas in Houston, MD Anderson is the largest freestanding cancer center in the world. For the past 25 years, it has ranked as one of the top two cancer treatment centers in the United States, according to U.S. News & World Report’s “Best Hospitals” surveys. MD Anderson employs more than 20,000 people, including more than 1,800 physicians and scientists. Summit Medical Group is the state’s largest multispecialty physician group, with more than 500 practitioners in 50 locations throughout central and northern New Jersey and a headquarters campus in Berkeley Heights November 2014 11

Hospital Rounds

Hackensack, Meridian to merge, forming state’s largest health system By Beth Fitzgerald Hackensack University Health Network and Meridian Health on Thursday announced merger plans that would create the state’s largest health care system: annual revenue of $3.44 billion, nine acute care hospitals and two children’s hospitals, 23,400 employees, 3,181 hospital beds and more than 130,000 patient admissions a year. Hackensack Meridian Health would be larger than the $3 billion Barnabas Health, now the state’s largest health care system. The nine hospitals don’t include two additional ones that Meridian would pick up in the proposed merger it announced last month with Raritan Bay Medical Center in Perth Amboy. Hackensack and Meridian said they’ve signed a memorandum of understanding to merge, to be followed by four months of due diligence prior to a definitive agreement. For the first two and a half years after the merger is final, Hackensack’s Robert C. Garrett and Meridian’s John K. Lloyd would be co-presidents and co-chief executives; then Garrett takes over as president and CEO. Garrett, who is 57, joined Hackensack in 1981 and was named CEO in 2009. Lloyd, who is 68, joined Meridian’s Jersey Shore Medical Center in Neptune as president in 1982. In 1997 he led Jersey Shore’s merger with Ocean Medical Center in Brick and Riverview Medical Center in Red Bank to create Meridian Health; Lloyd was appointed CEO of Meridian. The two systems operate in different regions of the state, and they dominate their respective territories: Hackensack in northern New Jersey, centered in Bergen County, and Meridian in Monmouth and Ocean counties, with the Raritan Bay deal extending its reach into contiguous Middlesex. The Hackensack Meridian Health board would have an equal number of trustees from each system. “First and foremost, this is about delivering value to the patients we serve, which means the highest quality at the most appropriate cost,” Garrett said. “Our combined organization 12 New Jersey Physician

would serve a much broader geography, expanding access to services and developing a vast array of new non-hospital services to conveniently serve area communities.” “Today’s announcement brings us one step closer to providing our counties and surrounding regions with a strong community and patient-focused health care system while becoming a national leader in the transformation of health care delivery,” Lloyd added. He said the two organizations have a shared mission of “implementing innovative models of care, advancing education and research, and transforming health care delivery to thrive in the evolving environment.” Both Hackensack and Meridian are in the vanguard of the national drive to improve health care quality and stem the rising cost of health care. In 2012 they were among nearly a dozen New Jersey health care organizations that created Medicare Accountable Care Organizations, which partner with doctors to improve the medical care of the elderly and reduce excess hospital admissions. Hackensack and Meridian are among only three Medicare ACOs in the state that have so far saved the government money, and they are being rewarded with millions in bonuses from Medicare. Hackensack and Meridian already are working together as charter members of AllSpire Health Partners, a hospital system alliance created just over a year ago that includes Morristown-based Atlantic Health and four hospital systems in Pennsylvania. When the launch of AllSpire was announced in September 2013, its leaders said they were not planning a full-blown merger of their health care assets, but rather an alliance to share best practices in clinical programs, population health management and research, as well as to explore ways to save money through joint purchasing and other business strategies. Through the years, Garrett has orchestrated a nonstop succession of joint ventures and alliances.

Hospital Rounds

The Hackensack University Health Network is led by the flagship Hackensack University Medical Center, an academic and research center affiliated with Rutgers Medical School. Through a joint venture with Texas-based LHP, Hackensack reopened Pascack Valley Hospital in Westwood and acquired Mountainside Hospital in Montclair. Palisades Medical Center in North Bergen formed an alliance with Hackensack several years ago and in September plans were announced for a full merger. The Joseph M. Sanzari Children’s Hospital also is part of the Hackensack network. Hackensack also has several clinical and academic affiliations with Georgetown University in Washington, D.C., including cancer treatment and research, and bone and marrow stem cell transplants. It has various alliances with CentraState in Monmouth County and in New York with NYU Langone Medical Center, North Shore LIJ and Good Samaritan Regional Medical Center. In March, Hackensack announced plans to open urgent care centers in northern New Jersey through a partnership with CityMD of New York. Hackensack already has an affiliation with MinuteClinic, the walk-in clinics at CVS pharmacies; Hackensack physicians serve as medical directors for seven North Jersey MinuteClinics. In 2010, Southern Ocean Medical Center in Manahawkin and Bayshore Community Hospital in Holmdel joined the Meridian system, which also includes the Hovnanian Children’s Hospital in Neptune. Meridian provides services in 100 locations throughout the communities it serves, and has created an extensive net-

work of services beyond the traditional acute care hospital: home care, post-acute care and rehabilitation, urgent and ambulatory care centers, and occupational health, behavioral health and fitness centers. Meridian is also in the vanguard of the movement by health care providers to offer health insurance plans, thus taking financial risk for the care they provide. Last year, Meridian entered into a joint venture with Pennsylvania-based Geisinger to offer a Medicare Advantage insurance product, called Meridian Geisinger Gold. Gordon Litwin, chairman of the Meridian board of trustees, said Thursday’s announcement of a proposed merger is an important milestone on “an exciting and thoughtful journey to move from a good idea to a great and formal relationship.” Joseph Simunovich, chairman of the Hackensack board, added that, “Guided by strong executive leadership and involved voluntary boards, our health systems share cultural and strategic similarities that make exploring this merger a natural progression of our already collaborative relationship.” Joel Cantor, director of the Rutgers Center for State Health Policy, said: “This is part of a larger trend of hospital market consolidation. Such mergers offer opportunities to improve care as hospitals pool resources to improve the delivery system. But they can also be worrisome. There is ample evidence that greater concentration in hospital markets leads to higher negotiated rates with insurers. There is potential yin and yang to current market trends.” November 2014 13

Hospital Rounds

Barnabas doctors group launches medical-information blog By Beth Fitzgerald The Barnabas Health Medical Group, the physician group of Barnabas Health, New Jersey’s largest health care system, this week launched an online Healthy Living Blog to provide both the group’s patients and the general public with information on health care services and medical issues. The blog can be found online at www. barnabashealthmedicalgroup.org. “Barnabas Health Medical Group has been proactive in enhancing our online presence in order to provide convenient access to real-time informa-

14 New Jersey Physician

tion and educational resources,” said Kelly Fulton, vice president, Barnabas Health Medical Group. Fulton said the Healthy Living Blog will provide consumers with “tools they can use to become informed advocates for their health.” The Healthy Living Blog includes posts on a variety of topics authored by the group’s physicians. The first blog post, by BHMG breast surgeon Dr. Sumy Chang, provides information on breast cancer in recognition of National Breast Cancer Awareness Month.

The physicians in the Barnabas Health Medical Group practice in more than 70 locations in New Jersey, from Newark to Manahawkin

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Hospital Rounds

By Beth Fitzgerald

Atlantic Health to open Chambers Center for Well Being — a center specializing in holistic medicine — in Morristown

Atlantic Health today officially opens the new Chambers Center for Well Being in Morristown, a 20,000-square-foot space that will provide holistic care to individuals coping with health problems, as well as those who aren’t sick but want to gain vitality through wellness strategies that engage both mind and body. Philanthropist Ray Chambers is a major donor to the center, which has so far raised about $6 million for the initiative, according to Linda Reed, vice president, integrative and behavioral medicine for Atlantic Health. For more than a decade, Atlantic has offered integrative medicine, practiced by board-certified physicians who design care plans and lifestyle management programs for optimally treating the whole person. The Chambers Center houses Atlantic Integrative Medical Associates, a four-physician integrative medicine practice that includes an internist, a cardiologist, an endocrinologist and a pediatrician. Integrative medicine combines conventional Western medicine with such treatments as acupuncture, massage, mindfulness stress reduction, biofeedback, yoga and herbal medicine. Atlantic Health said the opening of the Chambers Center marks its continuing collaboration with Dr. Deepak Chopra. Atlantic said Chopra will collaborate with the Chambers Center to develop and deliver his programs, including stress reduction and meditation. Atlantic said Chopra has identified the Chambers Center as a future partner in his research into personalized medicine and the genome. Rick Weiss, president of Viocare in Princeton, which develops science-based wellness programs for employers, is impressed. “This is exciting,” he said. “For so long health care has focused on addressing the symptoms of disease and not looking at the complete picture.” 16 New Jersey Physician

Weiss said an integrative medicine approach understands the complexity of an individual. “It takes into account not only the physical body, but also the mind, spirit, and community improving the management of someone’s condition, reduce symptoms, and helping to prevent illness,” he said. “Integrative medicine will be more readily available to members of the community. It will help individuals know what additional care options are available and allow someone to choose the type of care that fits them best.” Reed said for years the Atlantic integrative medicine team has been providing care to patients in the hospital, who were admitted for surgery, or childbirth or another procedure. “We see patients who are stressed, who have nausea or pain or who just don’t feel well,” she said. “The benefits of integrative medicine prove that health is more than the absence of disease — it is a cohesive balance of body, mind and spirit that can lift individuals to their highest state of wellness.” Dr. Mimi Guarneri is a cardiologist and senior advisor for the Chambers Center. Among the programs that will be offered at the Chambers Center is the Dr. Dean Ornish Intensive Cardiac Rehabilitation program, which provides intensive lifestyle change coaching to patients who have experienced a cardiac event. Guarneri said the Ornish program is one of several integrative medicine programs covered by Medicare. She said some Chambers Center programs are covered by health insurance and others are not, depending on the plan. She said some individuals are able to use their flexible spending accounts to cover the cost, and she predicted that in the years ahead, more insurance plans will cover integrative medicine. She said the Chambers Center offers health and fitness classes that cost $10 or $15 a session, on topics such as

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cooking, yoga, meditation and T’ai Chi. And she said donors have contributed money for scholarships, including a scholarship program for veterans.

fective, if not more effective, than some of the medications we give. It is really taking to heart, literally, the concept that food is medicine and that your mind influences your body.”

“If someone really should be in a mindfulness based stress reduction program and they can’t afford it, we have money for them,” Guarneri said. “Our goal is to turn no one away but to figure out a way to make it work.

Working side by side with the doctors are licensed practitioners of acupuncture, nutrition, massage and other integrative medicine approaches,

“In Western medicine we have a science of disease care: we diagnose disease and we treat it.” National health care spending, she said, skyrockets because we are not focusing our energy on keeping people healthy. “There is also a science of health, a science of keeping people healthy, and that is what the Chambers Center is all about,” she said. Guarneri said the center’s physicians “are trained in Western medicine, but they are also trained in holistic, integrative medicine and understand how to use nutrition, vitamins, fitness, and mind-body medicine in a way that can be as ef-

Guarneri said the professionals at the Chambers Center will help patients make sense of the avalanche of health information that floods the culture. “Now they have a place they can go so they don’t have to rely on the latest magazine article about a supplement,” she said. Joel Cantor, director of the Rutgers Center for State Health Policy, said the Chambers Center will be attractive to a health-conscious clientele and is a promising business strategy for Atlantic Health. “From a health perspective, it can be of considerable value if well executed,” he said

Barnabas Health elects new chairman of the board By Eric Strauss Barnabas Health announced Thursday that Marc E. Berson was elected chairman of its board of trustees for a threeyear term, effective September 2014. Berson will remain chairman of the board of Newark Beth Israel Medical Center and Children’s Hospital of New Jersey, both Barnabas Health facilities, the West Orange-based health care system said in a news release. “Marc Berson is an extremely knowledgeable executive with a wealth of

experience in managing complex organizations,” Barry H. Ostrowsky, CEO and president of Barnabas Health, said in a prepared statement. “He is mission focused and will provide exceptional insight and expertise in guiding Barnabas Health during these most dynamic and transformative times in health care.” Berson succeeds Albert R. Gamper, Jr., as board chairman, Barnabas Health said. Other officers appointed to the board for three-year terms include Alan

E. Davis, Esq., first vice chairman; and Joseph Mauriello, second vice chairman. Berson has been a member of the Barnabas Health board since 2002. He is a philanthropist, lawyer and entrepreneur, focusing on business and real estate.

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Former St. Joseph’s Healthcare System executive returning as new CEO By Beth Fitzgerald

Kevin J. Slavin is returning to the Paterson hospital system as its president and CEO. - (St. Joseph’s Healthcare System) St. Joseph’s Healthcare System announced that Kevin J. Slavin is returning to the Paterson academic hospital system as president and CEO. He succeeds William A. McDonald, who is retiring at the end of the year. Slavin, who since March 2005 has been CEO of East Orange General Hospital, was previously executive vice president of St. Joseph’s. “It is an honor to return to St. Joseph’s during such an exciting period in the organization’s history,” Slavin said Monday in a prepared statement. “I look forward to working with the entire St. Joseph’s family to continue the current momentum.” Slavin brings more than 25 years of health care experience to his new role at St. Joseph’s. At East Orange General he led an organization-wide effort to build the strength and stability of Essex County’s sole remaining independent, community hospital that resulted in seven consecutive years of positive financial performance and balance sheet improvements, according to a news release. Prior to leading East Orange General Hospital, Slavin served as executive vice president and chief operating officer at St. Joseph’s. He began his career at St. Peter’s Medical Center in New Brunswick and then spent 15 years with the St. Clare’s Health System in Morris County. Slavin received his bachelor’s degree from Rutgers University and master’s in health administration from the University of Colorado, the news release said. He is the immediate past chairman of the Hospital Alliance of New Jersey, which represents the state’s safety net hospitals. A native of Trenton, Slavin and his wife, Wendy, live in Hackettstown and have five children and two grandchildren.

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Valley Hospital brings back house calls in an effort to reduce readmission of heart patients By Beth Fitzgerald The Valley Hospital in Ridgewood has started making house calls to patients who have been discharged from the hospital — to make sure they’re having a smooth transition to their home environment, and don’t suffer a relapse that lands them back in a hospital bed. Valley’s Mobile Integrated Health Program uses a team approach. The pilot program that began in August has hospital paramedics, accompanied by a critical care nurse and an EMT, making home visits to recently discharged patients with cardiopulmonary disease. The paramedics assess the patients’ home environment, making sure there are no hazards that could lead to a fall. And if the patients are in distress, the nurse can provide IV medication or a breathing treatment. Finally, the team makes sure the patients have the right medications, as well as the proper food in their kitchen if they’re on a restricted diet. Like hospitals nationwide, Valley is striving to reduce patient readmissions. Medicare now imposes financial penalties on hospitals if their 30-day readmission rate is excessive, and making sure patients thrive at home after they leave the hospital is an important benchmark of health care quality. Lafe Bush, Valley’s director of emergency services, oversees the paramedics making the home visits. He said sending paramedics to help stabilize patients after discharge from the hospital is common in the Midwest. He said Valley may be the first New Jersey hospital to pilot this approach. Robin Giordano, supervisor of Valley’s heart failure program, said, “This population of chronically ill patients, who

are generally elderly, have frequent bounce-backs to the hospital —which we know is not good for them.” Bush said the home visit occurs within 24 hours of the patient’s discharge from Valley: “We evaluate them at home, and check to see if they are in any distress.” If they are, the critical care nurse on the team can contact the doctor and start treating the patient. If necessary, the paramedics will transport the patient back to the Valley ER. But if the patient is doing fine, the visit will focus more on education: surveying the home environment for safety hazards, installing grab bars in the shower, reviewing medication instructions, reminding the patient to make a doctor’s appointment. The team also will evaluate whether the patient is a candidate for visiting nurse care, which is provided by Valley Home Care, or might need a home health aide for bathing and meal preparation. “This is a one-time home visit to make sure you’re on the right path and guide you to the next step,” Bush said. “It is part of the continuum of care.” Giordano said the program addresses the major issues that send patients back to the hospital: “Generally, patents don’t come back because of some illness; it is because some basic needs are not being met.” Medication issues, for example: The patient may not understand the meds, or hasn’t gotten a new prescription filled and is still taking the meds from before they went into the hospital.

“Another thing that brings people back is their home environment not being safe; patients will come back within days of going home because they’ve fallen,” Giordano said. Or the patients may be readmitted because their condition has taken a turn for the worse. Giordano said the team will ask, “Who is the care person at home: is it your son or your daughter or your neighbor?” For those who have no support system, the team may get a social worker on the case. Bush said the program is starting with heart failure and pulmonary disease patients and, eventually, “We want to expand this to everybody, regardless of their diagnosis.” Right now, Valley is covering the entire cost of the home visits, but Giordano predicted that eventually this will be covered by Medicare and commercial insurance This is the latest in a number of programs by Valley to reduce readmissions. And Giordano said they are having an impact: Valley now has a 30-day readmission rate of 22.3 percent, down from 26.4 percent 18 months ago. Peter Southway, 80, of Wyckoff, got one of the first Valley home visits in August. “It was excellent — they took my blood pressure and did an EKG and said my heart was fine,” Southway said. “They made me feel very comfortable. After you get home, they check to make sure you’re OK. I think it’s a good idea.”

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