NJ Physician Magazine September 2012 by NJPhysician Magazine

JULY2012 2012 SEPTEMBER

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University Spine Center A Novel Approach to the Diagnosis and Treatment of Pediatric Scoliosis Also In This Issue: Bill Aims to Block HMO Cuts in Medicaid Reimbursements High Readmission Rates Mean Lower Medicare Payments for New Jersey Hospitals EMR Update-Assisting Providers Prepare for Stage 2 Meaningful Use

Publisher’s Letter Dear Readers,

Published by

Welcome to the September edition of New Jersey Physician, the voice of the state’s medical community.

Montdor Medical Media, LLC

Co-Publisher and Managing Editors Iris and Michael Goldberg

The DCA has proposed to amend rules pertaining to CDS under NJAC 13:45H to allow for electronic prescriptions for CDS. Presently the rules of both the Board of Medical Examiners and Board of Pharmacy allow for electronic prescriptions for CDS if permitted by federal law. The state rules are being amended to align with the federal law which has permitted these scripts since 2010.

Contributing Writers Iris Goldberg Michael Goldberg Poonam Alaigh Keith J. Roberts Joseph M. Gorrell Mark Manigan

Medicare makes the news again. Hospitals with frequent Medicare readmissions will see a reduction in their Medicare reimbursement under the ACA initiative. A readmission is defined as being admitted at the same or different hospital within a 30 day period post-discharge for certain applicable conditions including myocardial infarction, heart failure and pneumonia.

John D. Fanburg Lani M. Dornfeld Kevin M. Lastorino Joe Tyrrell Loren Bonner Bill O’Byrne

Layout and Design Nick Justus

Stage 2 Meaningful Use has been released specifying the criteria hospitals, professionals and critical access hospitals must meet in order to participate in the HER incentive programs. NJ HiTech has provided us with a guideline for you to follow in your practice to ensure you receive the maximum benefit from this act. Please see inside for details. Just about every day we receive short blurbs regarding interesting situations medical professionals and practices find themselves in. Many times we find value in presenting them to you before you find yourself inadvertently in the same situation. As these items now arrive we will share them with you in both a column titled News Bits and will also regularly post them online. I think you will find them both amusing and helpful. Our cover story this month is University Spine Center. Incorporating the most current advances in technology to manage the diagnosis, evaluation and treatment of pediatric scoliosis, the physicians of USC work closely with pediatricians and parents to structure the most appropriate treatment regimen for each individual case.

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Contents

University Spine Center

A Novel Approach to the Diagnosis and Treatment of Pediatric Scoliosis CONTENTS

10 HEALTHLAW UPDATE

18 ID CARE

12 STATEHOUSE

19 HOSPITAL ROUNDS

21 STATE LEGISLATURE

HI TECH

17 NEWS BITS 2 New Jersey Physician

24 FOOD FOR THOUGHT

Cover Story

University Spine Center A Novel Approach to the Diagnosis and Treatment of Pediatric Scoliosis By Iris Goldberg Parents of growing children have many questions and concerns regarding normal, healthy development. The pediatrician performs the multitude of required screenings and parents are always reassured when the results of these assessments prove to be within normal limits. On occasion, a “red flag” may be raised during the course of an examination. Whether it suggests a minor abnormality or something more serious, parents and family physicians alike want to investigate further, often by consulting with an expert, in order to obtain a definitive diagnosis and to develop the best available treatment plan. For young patients in New Jersey who have been found to have an abnormal curvature of the spine, the surgeons at University Spine Center incorporate the most current advances in technology to manage the diagnosis, evaluation and treatment of pediatric scoliosis. Arash Emami, MD, Ki Soo Hwang, MD, Kumar G. Sinha, MD and Michelle Brenner, NP, work closely with pediatricians and parents to structure the most appropriate treatment regimen in each individual case. Whether by curve observation, spinal bracing and/or surgery, the goal at University Spine Center is to prevent curve progression and restore self-image and confidence. Pediatric scoliosis can affect an infant, child or adolescent. Infantile scoliosis can be congenital or develop until age 3 and is the least common. Juvenile idiopathic (cause unknown) scoliosis usually develops between the ages of 4 and 10. Adolescent idiopathic scoliosis (AIS) develops between ages 10 and 20 and is the most commonly diagnosed type of pediatric scoliosis. More girls than boys develop AIS. Certainly, early diagnosis is a key factor in best managing pediatric scoliosis and avoiding progression of the curve and in some cases, deformity. At University Spine Center, a thorough review of each

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child’s medical and family history is the first step. This is important because scoliosis is hereditary to some extent. Along with this, a complete set of fulllength standing x-rays is obtained to capture the entire length of the spine, viewed from the front, back and side of the body. Some patients might also require CT scanning or MR imaging.

Most notably, in addition to the use of these criteria to formulate an individual treatment plan for each patient, the surgeons at University Spine Center have recently incorporated an exciting new technology, to help them make an even more informed decision. SCOLISCORE™ is a genetic test administered at University Spine Center by collecting a saliva sample that is sent to a laboratory for analysis. SCOLISCORE testing predicts the likelihood of curve progression for each child, based on his or her DNA. Most appropriate for those children diagnosed with AIS and having a small curvature that is less than 25°, the test is administered prior to beginning any treatment. Though AIS affects 2-3% of the general population, only 1- 4% of those individuals experience curve progression requiring multi-level instrumentation and fusion. Predicting which curves will progress to the point of requiring surgery has proven to be a challenging problem for decades.

The severe curvature of the spine is quite noticeable.

Much information is gathered as a result of this evaluation. For example, whether or not the child has structural or nonstructural scoliosis can be ascertained. Structural scoliosis involves rotation of the spine’s vertebral bodies, while nonstructural scoliosis does not. Characteristics of the curve such as its size, angulation and its relative stiffness or flexibility are revealed as well. There are also many different classifications of curves. The specific type of curve is determined for each individual patient. A simple pelvic x-ray is used to detect the Risser sign, which is a skeletal marker for maturity, indicating how many years are remaining until skeletal maturity is reached and the spine will have stopped growing. This will help determine the type and length of treatment the surgeons at University Spine Center will recommend.

Dr. Emami explains why the SCOLISCORE test is a significant breakthrough. He relates that typically, when a child is diagnosed with scoliosis during a school screening or by a pediatrician, he or she is sent for evaluation by a specialist, such as Dr. Emami and the other surgeons at University Spine Center. Dr. Emami describes the traditional process from that point. “When they come in, we thoroughly evaluate them, we get some x-rays and based on the curve that they have we either observe them and get serial x-rays to see if there is progression, or brace them, or if the scoliosis is very large, we operate,” he shares. Of course prior to the availability of genetic testing, as Dr. Emami reiterates, every child with a curve that was not at the point of requiring surgery needed to have some type of continuous monitoring and/or treatment to avoid a

Hwang and Dr. Sinha have incorporated the latest advancements in surgical instrumentation and hardware and also, innovations in surgical techniques in order to approach curve correction t h r e e - d i m e n s i o n a l l y, i n d i v i d u a l l y derotating each of the vertebrae. This means addressing the curve in all three planes of the deformity: the coronal (front and back), sagittal (left and right) and axial (upper and lower). Performed from the posterior in the overwhelming majority of cases, this approach involves significantly less blood loss. Pedicle screws are used in the thoracic spine to anchor each of the vertebrae in all three columns (posterior, middle and anterior). Because of the strength of these pedicle screws the surgeons can anchor the entire vertebrae, not just the posterior, as was done previously with hooks and wires. The pedicle screws go through the posterior aspect, all the way to the vertebral body. The current AIS Treatment pathway and appoximate number of patients at each step according to the National Scoliosis Foundation (NSF) surgical procedure in the future. “Now, through a sputum sample, we can look for genetic markers to determine if a scoliosis that a child has is an aggressive scoliosis that will progress, or is benign and will not be very progressive,” Dr. Emami reports. “It’s like we have a crystal ball and we can predict the future,” he offers. “The value of the genetic testing is that when a child comes in for that first visit with a small curve, if the genetic marker is negative – there is no need for bracing, no need for x-rays and radiation exposure,” Dr. Emami elaborates. Further, he emphasizes how important this is for the emotional well-being of patients and their parents. “Frankly, there is peace of mind in knowing that this will not progress.” Although this technology can have a huge impact upon how children who have been diagnosed with scoliosis will be treated, Dr. Emami is concerned that the SCOLISCORE test is not yet being utilized as a standard of care tool. Besides the significant amount of money that could be saved for our struggling healthcare system by eliminating the need for unnecessary imaging studies and braces, Dr. Emami feels certain that

emotional distress could be avoided for many young people. Adolescents, especially, who often have problems with self-image, should be spared the ordeal of bracing and worrying about curve progression, if at all possible, he believes. For those children who do require surgery, the physicians at University Spine Center incorporate innovative developments in surgical technology in order to obtain better corrections than were previously possible. Also, the more efficient and less invasive techniques serve to minimize both physical and emotional trauma for these young patients. Traditional scoliosis surgery involved using hooks and wires to stretch and strengthen the whole spine, often involving an invasive and bloody anterior approach for larger curves. However, in many patients with scoliosis, the vertebrae along the curve have actually rotated out of position, potentially causing severe physical deformities and associated health problems. Rotated vertebrae in the thoracic spine, for example, can turn the rib cage out of position, creating a “rib hump” and possibly impairing lung function. At University Spine Center, Dr. Emami, Dr.

After scoliosis correction surgery pedicle screws used to anchor the vertebra are seen in the post surgical X-Ray. September 2012

As a result, the surgeons are able to manipulate and maneuver each of the vertebrae in a much more efficient manner, effecting a vastly superior correction. In fact, in addition to untwisting the vertebrae, this method reduces the rib hump since the ribs associated with the deformity are attached to the vertebrae being derotated. Although most of the children with scoliosis who have surgical procedures performed by the physicians at University Spine Center are basically otherwise healthy, some scoliosis patients have additional problems, some of which may be debilitating. Dr. Hwang cites a current patient, who is scheduled for surgery that is a good example of the extremely challenging cases taken on by him, Dr. Emami and Dr. Sinha. “This is a child who has a congenital spinal deformity and also a disease causing severe muscular atrophy, essentially making her wheelchair-bound,” Dr. Hwang shares. “In addition to that, for her, because the muscle tone is so weak, her spine doesn’t stay straight and as she grows the curve takes on a life of its own, progressing rapidly,” he further relates. Without intervention, Dr. Hwang explains that eventually the curve could press on her lungs and other organs, producing devastating complications for her. He points out that in her case the curve is not caused by misaligned vertebrae and so in order to accomplish a correction, her entire spine needs to be reinforced and strengthened to compensate for the lack of muscle tone. “We use a very innovative technique involving a metal rod to hold the spine and a special tape that brings the spine into alignment without cutting muscles or bones,” Dr. Hwang informs. The strong nylon tape, called a u-clamp, is nonmetallic and therefore, cannot eat through bone. It is a significant improvement upon the hooks and wires that were used in the past. Dr. Hwang feels passionately about informing parents in New Jersey with children who are afflicted with challenging spinal deformities that there is no need to travel out of state to receive care from specialists who are among the most qualified experts in the field. “We utilize the most highly innovative techniques to make sure children like these are helped,” he emphatically states.

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AIS impacts young people who are otherwise in good health. AIS is much more common in girls than boys by a ratio of 8 to 1.

Further, Dr. Hwang goes on to share that at St. Joseph’s Regional Medical Center, where the surgeries take place, there is a multidisciplinary team of experts in place, including pediatricians, pediatric neurologists, nutritionists, physical and occupational therapists, etc. to offer care, when necessary. “This is particularly important for special needs children such as these,” he remarks. Many cases of scoliosis involve adolescents. Dr. Sinha discusses how AIS impacts young people, who are otherwise in good health. “These kids are completely healthy, with no medical problems whatsoever. They’re running around - doing their thing and all of a sudden they start to develop this curve,” Dr. Sinha relates. He also points out that AIS is much more common in girls than boys by a ratio of 8 to 1. “You can imagine the psychological component to this, all of a sudden happening during the teenage years,” says Dr. Sinha. He explains the difficult challenge, in addition to the physical abnormality itself, for those teens that must undergo bracing. Basically, Dr. Sinha and the other surgeons at University Spine Center are very sensitive to the emotional state of a young person who must commit to wearing a brace for many hours a day. “We offer emotional support to the adolescent and also have a family discussion as well,” Dr. Sinha states. He shares that while the physicians are doing whatever they can to help the child to cope, at the same time, they must emphasize the importance of wearing the brace. “We have to help them to understand that wearing the brace properly every day is the best way to avoid surgery,” Dr. Sinha strongly states. For those who do require surgery, Dr. Sinha feels that even though scoliosis surgery is somewhat complex and lengthy, the fact that it is elective and the end result is to restore one’s normal appearance, puts a positive spin on things. “Once the surgery is done the kids do remarkably well,” Dr. Sinha is pleased to report. “They’re very happy that they’re a little taller and have a cosmetically balanced posture,” he shares.

Once the surgery is done, Dr Sinha reports the teens are quite happy with the results.

Also, Dr. Sinha explains that recovery is much easier for the younger patient. In fact, within two weeks after surgery, September 2012

they are usually able to walk around and require minimal medication for pain. Once complete healing has taken place, there are no restrictions and normal life can resume. Dr. Sinha, Dr. Emami and Dr. Hwang obviously find it most gratifying to help restore confidence, self-image and quality of life for these young people. In order to provide optimal outcomes for their scoliosis patients and in fact, for all of their patients, the surgeons at University Spine Center share a deep commitment to stay on the cutting edge of technology. “It has to make sense and it has to work,” Dr. Sinha says, explaining the continuous research done by the surgeons to thoroughly investigate new technologies before incorporating them.

realized that the best course of treatment for her would be to go ahead and have the surgery before the curve progressed any further. She couldn’t be happier with the decision she and her parents made. She talks about how, during the entire experience, Dr. Hwang and everyone at University Spine Center got to know her and her parents and understood what the family was feeling.

Through a non-profit medical organization called the “Butterfly Foundation,” a group dedicated to improving the lives of children with complex spinal deformities, the surgeons of University Spine Center travel to a disadvantaged location each year to donate their services and operate on children with scoliosis. The cases are extremely challenging and the surgical environments are certainly not optimal. Pre and post surgical radiographs

This was understandably upsetting for her and concerning to her parents, who went with Ashna to her pediatrician. He referred her to an orthopaedist, who confirmed that Ashna did, in fact, have scoliosis. From that point, months of traveling to various specialists and doing their own extensive research on scoliosis and spine surgeons finally led Ashna and her parents to a consultation with Dr. Hwang at University Spine Center. “Dr. Hwang was so nice and so personable,” Ashna remembers. “Even though I was only 16, he still talked to me directly, rather than to my parents,” she relates. Ashna makes a point of mentioning that although her situation was explained very carefully and all questions were thoroughly answered, there was never any pressure for her to decide upon having the surgery. Ashna, with maturity and wisdom beyond that of many others at her age,

8 New Jersey Physician

Six weeks later Ashna began to feel somewhat like her old self. Three months later her appearance was improving. A little more than a year later, Ashna looks and feels perfectly fine. When asked what she would tell another young person with scoliosis about University Spine Center, Ashna says without hesitation, “For those eight hours when my safety was out of my parents’ hands, there were no better hands I could be in.” While Ashna was fortunate to receive exemplary treatment for her scoliosis, there are many children with scoliosis in disadvantaged counties around the world who don’t have access to proper medical care. Some of these children become severely deformed as a result of neglect.

Also, the surgeons meet often to discuss emerging research and to share information on all current cases. The collegial environment provides Dr. Emami, Dr. Hwang and Dr. Sinha the opportunity to ensure that every patient is getting the benefit of their combined experience and expertise. Ashna Bhatia is a 17 year old young woman who began noticing a problem when she was 12. Being quite thin, she observed her right hip bone protruding out more than her left. She didn’t think much of it until, while participating in a try-out at school, one of the other girls actually told Ashna that her body “looked weird.”

hospital room to check on her.

It is for this reason that only the most clinically capable spine surgeons are recruited to participate. Dr. Emami shares that within the last few years he has been to Viet Nam and the Dominican Republic. “It really pushes your technical skills and challenges you cognitively as well,” he says, describing the immense sense of gratification he and the other surgeons derive from being able to help children who are in such great need. For children with scoliosis here in New Jersey and in New York as well, University Spine Center employs the most innovative non-surgical and surgical technologies to achieve a superior outcome in each individual case. For Dr. Emami, Dr. Hwang, Dr. Sinha, Michelle Brenner and the entire staff, seeing the smile return to the faces of patients like Ashna is always a thrill.

“Dr. Hwang stood by us the whole time,” Ashna recalls. “He spoke with me right before and he was there when I woke up,” she clearly remembers. She also shares that he phoned her parents at different times during the procedure to reassure them that all was going well. Bright and early the next morning he was in her

University Spine Center is located at 504 Valley Road, Suite 203, Wayne NJ 07470. For more information or to schedule an appointment, please call (973) 686-0700. University Spine center also has a location in New York at 95 University Place, 8th Floor, New York NY 10003

www.universityspinecenter.com Photography by Michael Goldberg

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

September 2012

HEALTH LAWUpdate Health Law Update

DCA Proposes Two Rules: Addition of Synthetic Cannabinoids to CDS Schedule I and Allowing ERx for CDS The New Jersey Division of Consumer Affairs (DCA) recently issued a proposed rule that would permanently add synthetic cannabinoids to controlled dangerous substances (CDS) Schedule I, including synthetic cannabinoid products that are currently available and classes of cannabinoides from which new synthetic cannabinoid products with altered chemical structures may emerge. If passed, the manufacture, possession, sale and distribution of products containing these substances will be a crime of the third degree, punishable by 3-5 years in prison and a penalty of up to $25,000. Comments to the proposed rule are due by October 5, 2012. The DCA also proposed to amend rules pertaining to CDS under N.J.A.C. 13:45H, to allow for electronic prescriptions for CDS. Presently, the rules of both the Board of Medical Examiners

and the Board of Pharmacy allow for electronic prescriptions for CDS if permitted by federal law. On March 31, 2010, the federal Drug Enforcement Agency issued an interim final rule permitting prescribers to issue prescription electronically and for pharmacies to receive them. The rules under N.J.A.C. 13:45H are being amended to make them consistent with the rules of the Board of Medical Examiners and the Board of Pharmacy to allow electronic prescriptions for CDS. Comments to the proposal are due by October 19, 2012. For additional information, contact: Keith J. Roberts / 973.364.5201 / kroberts@bracheichler.com Joseph M. Gorrell / 973.403.3112 / jgorrell@bracheichler.com

HHS Releases State Health Insurance Exchange Blueprint In implementing the health reform law, the Department of Health & Human Services (HHS) recently issued a final “blueprint” that states can use to operate their own health insurance exchange market. This blueprint outlines the functions that will be performed by various types of exchanges, including exchanges operated by states, partnerships between the federal government and states, and federally facilitated exchanges.

exchange application, to HHS by November 16, 2012 for plan years beginning in 2014. HHS must approve or conditionally approve state-based exchanges or state partnership exchanges by January 1, 2013. HHS will approve exchanges if the state adequately demonstrates its ability to perform all the required exchange functions.

States seeking to operate a state-based exchange or electing to participate in a state partnership exchange must submit a complete blueprint, comprised of a declaration letter and an

Mark Manigan / 973.403.3132 / mmanigan@bracheichler.com

For additional information, contact: John D. Fanburg / 973.403.3107 / jfanburg@bracheichler.com

Hospital Readmission Payment Reduction & Value-Based Purchasing Programs As of October 1, 2012, hospitals with frequent Medicare readmissions will see a reduction in their Medicare reimbursement under a Patient Protection and Affordable Care Act (ACA) initiative called the Hospital Readmissions Reduction Program (HRRP). A “readmission” is defined as being admitted at the same or different hospital within a 30 day period postdischarge for certain applicable conditions (which, for this year, have been identified as acute myocardial infarction, heart failure and pneumonia). Pursuant to the HRRP, the Centers for Medicare and Medicaid Services (CMS) will withhold up to 1% of diagnosis-related group payments from hospitals that have too many patient readmissions within the 30-day timeframe for the specified medical conditions. The percentage reduction will increase over the next few years.

thousand hospitals across the country. That money will then be redistributed over the course of the year to hospitals that meet certain performance standards based on clinical quality measures and patient satisfaction survey results. The clinical quality measures include evaluating, among other things, what percent of heart attack patients were given instructions on discharge about how to take care of themselves, as well as what percent of pneumonia patients had a blood culture taken before they were given antibiotics. The patient satisfaction survey asks, among other things, how well nurses communicated with patients and how the hospital stay rated overall. While some hospitals will lose money, some may receive additional funds through the VBPP.

Another ACA program effective October 1, 2012 is the Hospital Value-Based Purchasing Program (VBPP). Under this program, CMS will withhold 1% of its regular reimbursements to several

Joseph M. Gorrell / 973.403.3112 / jgorrell@bracheichler.com

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For additional information, contact: Keith J. Roberts / 973.364.5201 / kroberts@bracheichler.com

DHHS and DOJ Send Letter Alerting Hospitals of Concerns Relating to EHR-Related Health Care Fraud On September 24, 2012, the Secretaries of the U.S. Department of Health and Human Services (DHHS) and the U.S. Department of Justice (DOJ) issued a strongly-worded letter to the country’s most influential hospital organizations—the American Hospital Association (AHA), the Federation of American Hospitals, the Association of Academic Health Centers, the Association of American Medical Colleges, and the National Association of Public Hospitals and Health Systems— expressing their growing concerns relating to the use of electronic health record (EHR) technology to commit health care fraud. The Secretaries warned American hospitals about the use of EHR technology to “game the system” by cloning medical records to inflate what providers get paid, and upcoding the intensity of care or severity of a patient’s condition in order to receive excess profits. They underscored their resolve to combat health care fraud, and advised that law enforcement will take appropriate steps to pursue providers who misuse EHR technology to bill for

On the same day, the AHA responded to the letter, stating that “American hospitals take seriously their obligation to properly bill for the services they provide to Medicare and Medicaid beneficiaries.” The AHA contended that more accurate documentation and coding does not necessarily equate with fraud, stating that the Medicare and Medicaid payment rules are highly complex. The AHS outlined its numerous requests of the Centers for Medicare & Medicaid Services (CMS) to develop national guidelines for the reporting of hospital emergency department and clinic visits, stating that clearer guidance is needed, not “duplicative audits that divert much needed resources from patient care.” For additional information, contact: Lani M. Dornfeld / 973.403.3136 / ldornfeld@bracheichler.com Kevin M. Lastorino / 973.403.3129 / klastorino@bracheichler.com

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

Visit us now online at www.NJPhysician.org September 2012

Statehouse

NEW JERSEY STATEHOUSE

VITALE/SWEENEY LEGISLATION REVAMPING NJ'S EMERGENCY MEDICAL SERVICES SYSTEM CLEARS SENATE TRENTON – Legislation sponsored by Senator Joseph F. Vitale and Senate President Steve Sweeney that would revamp the emergency medical services system in New Jersey was approved by the full Senate.

“From decreasing response times to providing greater efficiency and reducing costs, this legislation will bring common-sense reforms to New Jersey’s emergency care,” said Senator Vitale, D-Middlesex. “By centralizing oversight and review of EMS services and personnel, the state will gain a better understanding of where we might need to shift resources and attention to ensure quality emergency transport care for all New Jerseyans, which in turn, could be critical to saving someone’s life.” “Having one unanswered 9-1-1 call in the state is one too many,” said Senate President Sweeney, D- Gloucester, Cumberland and Salem. “Prior to centralizing EMS services in Gloucester County, unanswered calls topped 800 in one year. That is simply unacceptable. Now we have response times that are lower than the national average. With this legislation, we can bring this type of quality and efficient care to all communities in the Garden State.”

The bill, S-1650, would require that, under the direction of the Commissioner of Health and Senior Services, the Office of Emergency Medical Services in the Department of Health and Senior Services (DHSS) would serve as the lead state agency for oversight of emergency medical services delivery in New Jersey. DHSS would also ensure the continuous and timely statewide availability and dispatch of basic life support and advanced life support to all New Jersey residents through ground and air, adult and pediatric triage, treatment and transport, and emergency response capability. The bill would require paramedics, EMTs and emergency responders to be licensed by DHSS and to undergo a criminal history record background check as a condition of licensure. Additionally, DHSS would be required to make a current list of licensed paramedics and EMTs available to the public on its Internet website. The bill was approved by the Senate with a vote of 22-16. It now heads to the Assembly.

Bill Aims to Block HMO Cuts in Medicaid Reimbursements Senate panel hears emotional testimony on potential harm to children, elderly and disabled By Joe Tyrrell, in Healthcare A state Senate committee has moved to set up roadblocks in the face of reimbursement cuts planned by HMOs that oversee New Jersey’s Medicaid program. Often-emotional testimony by health-care providers and workers helped convince the Senate Health, Human Services and Senior Citizens Committee that cuts by Horizon NJ Health and the other HMOs would hit services for the frail elderly, children with disabilities and other vulnerable populations. The committee already was inclined to act as its chairman, Sen. Joseph Vitale (D-Middlesex) sponsored legislation -- S2241 -- with Sen. Loretta Weinberg (D-Bergen) to require state administrative approval before the HMOs can lower reimbursements. Weinberg declared that the issue is of “increasing importance” to the state as it tries to encourage keeping people in their own homes instead of nursing homes, while shifting Medicaid clients into managed care. Last year, the state moved almost 155,000 people from fee-for-service Medicaid programs into the HMOs, with almost half going to Horizon.

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with almost half going to Horizon. The company notified health-care agencies that it was cutting the reimbursement rate for personal-care aides by 10 percent, from $15.50 per hour to $13.95 per hour. “To its credit, Horizon delayed the cut and reduced it to 4.5 percent” after public outcry, Weinberg said. “While we appreciate their willingness to sit down and discuss this… that’s something that should have occurred before their rate-cut announcement.” A parade of representatives from hospitals, medical day care, adult day care and home care agencies supported the bill’s requirement of a public hearing and approval from the state commissioner of human services before reimbursements could be cut. Pay for Home Health Aides Called Already Too Low Many said the previous reimbursement rate already was too low.

Weinberg said HMOs would be required to show they had taken other steps to reduce costs and that the lower rates “would not adversely affect the quality and quantity of health-care services.” Reimbursement rates already are so low that many agencies are challenged to recruit and keep home health aides, said Irma Camaglian, vice president of Accredited Health Services in Franklin Township. With any further cuts, she said, “We will be competing with the pay rates at McDonald’s or Burger King,” she said. Speaking through an interpreter from 1199 Service Employees International Union, Belen Jaramillo told the committee she is paid only $9.75 as a home health care worker in Union County. “Low wages and unstable working hours make it hard to do the work I love and survive,” she said. Many of her patients are elderly, frail and lonely, Jaramillo said. She told of finding one, a 73-year-old man, lying in a fetal position, unable to rise and greet her as usual. Only after she convinced him that he would not be alone in the hospital because she would visit him did he consent to go for treatment, she said. “We cannot look the sick and elderly in the eyes and turn our backs and abandon them,” Jaramillo said. Legislators and providers said Jaramillo’s salary is about average for the roughly 30,000 home health aides working across the state, and amounts to about $20,000 a year. Reimbursement rates for such services were $14 an hour two decades ago, according to some. State Sen. Barbara Buono (D-Middlesex), told of driving a health aide caring for her late mother and seeing the woman falling asleep. It turned out, Buono said, “She was working two jobs because she was not making enough to support herself” as an aide. Insurance reimbursement cuts could force program cuts Officials of the Voorhees Pediatric Facility, which assists “medically fragile” children, said their services could also be hurt by a reduction in rates. The facility accepts “children that could not be cared for in a regular day-care program,” said administrator Scott Goldberg. In a quavering voice, admissions director Susan Muracco read a letter from a parent who wrote she “would not be able to

work full-time” without such a program for her child. “It was not our choice to have children with disabilities,” but they deserve attention, the parent wrote. Prodded by a sympathetic Sen. Diana Allen (R-Burlington), Goldberg eventually said the reimbursement reduction could result in elimination of some programs, although he was unwilling to say that about Voorhees. If anything, Allen said, more resources are needed, because “we already have so many children who are not being served.” State Sen. Ron Rice (D-Essex), said he was about to fly to Texas to make arrangements for his late brother, who lived alone and whose decomposing body was found only when neighbors became concerned. His brother might have benefitted from having a health aide to check on him, Rice said. In the face of what he acknowledged was “compelling and very emotional testimony,” Ward Sanders, president of the New Jersey Association of Health Plans, said the HMOs are only trying to provide “quality and cost-effective” care. “Soon, over 98 percent of Medicaid patients will be in managed care,” he said. The industry has launched education and prevention programs to help patients take better care of themselves, Sanders said. But reining in costs remains a key tool, he said. While wellintended, he said the legislation would “set up a sort of extreme bureaucratic process that would divert resources away from care.” “A hospital contract is a very complicated document,” Sanders said. “There are cases where there are going to be rate increases and rate decreases within the same plan.” He did convince Rice to question the need for hearings. “We’re the Legislature, and ought to be able to do this directly” without punting to administrative procedures, Rice said. But Buono said the process “will add more transparency.” The HMOs should not separate “the human impacts on a patient from the monetary issues,” she said. The committee made a slight language change to clarify the kinds of health institutions and services affected, but then passed the bill unanimously, although Rice and Sen. Samuel Thompson (R-Middlesex) both said they did so merely to move it out of committee.

High Readmission Rates Mean Lower Medicare Payments for New Jersey Hospitals

Influencing what happens after patients are discharged is key to keeping them out of hospital for good. By Loren Bonner, in Healthcare .All but two New Jersey hospitals will get hit with a Medicare reimbursement reduction for excess readmissions, as defined by the Affordable Care Act of 2010, which links Medicare payments to the quality of care that hospitals provide. The penalty kicked in at the beginning of the month. “New Jersey will be facing some of the highest downward adjustments that you could call readmission penalties,” said Sujoy Chakravarty, assistant research professor at the Rutgers Center for State Health Policy.

The penalties don't come as a surprise to state healthcare facilities, which have been struggling to rein in readmission rates. The New Jersey Hospital Association (NJHA) has been looking into the issue for almost three years now. Its Readmissions Collaborative has helped hospitals implement programs that attempt to address the problem, which they believe primarily stems from readmitted patients not having access to a primary care physician -- a critical first step to curbing readmissions. Thus far, 50 state hospitals are participating in NJHA's Readmissions Collaborative. September 2012

Whether under the aegis of the NJHA or independently, New Jersey hospitals are trying a variety of approaches to improve critical aftercare. Some are scheduling face-to-face visits with discharged patients to ensure that they set up appointments with primary care physicians and that they understand how and when to take their medications. Others are using the phone to follow-up. Still others are hiring advanced-care registered nurses, who hold advanced degree and are trained in critical analysis, problem solving and evidence-based decision making. Still others are teaming up with Accountable Care Organizations, which provide a continuum of care for patients, extending from discharge for as long as it is needed. According to data from the federal Centers for Medicare and Medicaid (CMS) and compiled per state by Kaiser Health News only Overlook Hospital in Summit and Morristown Memorial Hospital will be spared the Medicare cuts -- out of a total of 64 acute care hospitals in New Jersey. The reductions are capped at 1 percent this year and are enforced if the number of patients readmitted at a particular healthcare facility climbs above the national average for readmissions. The CMS has set up a penalty schedule for the next three fiscal years. • FY2013 payment adjustments are based on readmission rates from July 1, 2008 through June 30, 2011;

The Medicare cuts are already in place for FY2013 and FY2014. Hospitals that can bring their readmission rates in line should be able to reduce their reductions for FY2013. CMS based its calculations for fiscal year 2013 on readmission data for heart attack, heart failure, and pneumonia. According to the Medicare Payment Advisory Commission, or MedPac, these three conditions were singled out because they account for the highest hospitalization and readmission rates. The CMS may ultimately penalize hospitals for other conditions and procedures that MedPac identifies as preventable readmissions. There appears to be no mystery to reducing readmission rates. “For virtually all hospital discharges, the best practice is to see a primary care physician within seven to 10 days,” said Aline Holmes, senior vice president of clinical affairs at NJHA. But even if a patient has access to a primary care physician, she said, scheduling an appointment in a timely manner is next to impossible for patients. Besides doctors’ appointments, Holmes said that understanding medication and discharge instructions were additional obstacles contributing to high readmission rates among Medicare patients.

• FY2014 will be based on readmission rates from July 1, 2009, through June 30, 2012;

Since follow-up is outside the province of hospitals, Chakravarty said there is a concern about the fairness of these facilities facing a penalty

• FY2015 payment adjustments will be based on readmission rates from July 1, 2010, through June 30, 2013.

“If you come to see who the patients are who have less access to primary care, it might be minority and poorer patients, so the

14 New Jersey Physician

hospitals getting hit the most are the safety net hospitals. They are the ones serving patients with less access to outpatient care and also operating on low margins,” he said. In fact, a majority of the New Jersey hospitals being slapped with the top 1 percent penalty are in the Camden and Newark referral regions, according to Kaiser Health News. Although it may take some time to really know how the penalties will affect hospitals throughout the state, those that have adopted aftercare programs this year are already seeing lower readmission rates. Robert Wood Johnson University Hospital in New Brunswick launched a transitions-in-care program in January. Since then they’ve seen a 25 percent reduction in readmissions for heart failure and pneumonia. “We are not yet there with heart attack and we feel it may be because of coding. Some patients who have heart attacks come back for procedures so when they come back, it’s kind of like a readmission [code],” said Teresa De Peralta, the hospital’s transitions-in care-coordinator. The program, funded through a grant from the Robert Wood Johnson Foundation, includes face-to-face home visits with patients 24 hours after discharge by Robert Wood Johnson Visiting Nurses. De Peralta said the home visit portion is mostly about making sure patients are on the correct medications and helping them with their primary care follow-up appointments. Face-to-face visits are also critical to get patients to participate in the program. “Our enrollment is about 95 percent and we feel that’s because of our initial face-to-face explanation of the program,” said De Peralta. The program includes an advanced screening process, in which

electronic health records alert the provider if the patient is high risk (individuals who have been back in the hospital within 30 days of discharge) and eligible for the program. The care team then comes up with a list of candidates, visits each one in the hospital and explains the voluntary program. Other hospitals in the state are enhancing the discharge process using similar models. According to Holmes, many state hospitals have put in phone programs that call patients within 24 hours of discharge to see if they are setting up doctor's appointments and taking their medications correctly -- a model created by Dr. Eric Coleman from the University of Colorado School of Medicine. (Coleman is one of 23 recently announced MacArthur Fellows for 2012.) Other New Jersey hospitals have hired advanced practice registered nurses to follow high-risk patients from the hospital to the primary care doctor’s office. And many hospitals in South Jersey have equipped patients with telehealth tools so providers can monitor their vital signs remotely. Finally, some New Jersey hospitals are making aftercare their business, teaming up with Medicare Accountable Care Organizations (ACOs) to ensure that doctors and nurses follow up on patient progress starting with the first day of discharge. This is more than good medical practice. Readmissions drive up the cost of healthcare. Medicare will share some of the savings that accrue from keeping people out of the hospitals with ACOs. “We’re just trying to learn more about what the best model is,” said Holmes. Whatever the NJHA learns will probably be all the good. The association has also been working with agencies on advanced care planning, since New Jersey holds the dubious distinction of having the highest readmission rates for nursing homes in the country.

Hi Tech

Electronic Health Record Update – Assisting Providers Prepare for Stage 2 Meaningful Use By Bill O’Byrne NJ-HITEC Executive Director The Centers for Medicare and Medicaid the new Stage 2 Meaningful Use Services (CMS) released its Final Rule requirements as well as the Stage 1 in late August 2012 specifying Stage criteria that have been modified. CMS 2 Meaningful Use criteria that eligible took into consideration the feedback that professionals, hospitals, and critical it received during the comment period. access hospitals must meet in order to Based upon NJ-HITEC’s knowledge and continue to participate in the Medical expertise, the following briefly outlines Electronic Health Record (EHR) Incentive a few of the key changes that providers Programs. All providers must achieve should understand: Stage 1 Meaningful Use before moving Differences Between Stage 1 and on to the Stage 2 requirements. Stage 2 Meaningful Use The New Jersey Health Information Technology Extension Center (NJ-HITEC) is the sole federal Regional Extension Center in the Garden State working with physicians to assist them on their path to Meaningful Use that at times can be frustrating and challenging. It is important for providers to understand

For those providers planning to achieve Stage 1 MU in 2013, it will be a little different. First, CMS removed the Health Information Exchange (HIE) core requirement. Second, the vital sign core requirement has changed as well. Instead of requiring physicians September 2012

to record height, weight, and blood pressure, they can record height and weight or blood pressure or both based on their preference. Moreover, providers can request exclusions for one or both categories if this information doesn’t fit for the practice. In addition, the child’s age for pediatricians to record height, weight, and blood pressure has been raised from age 2 to age 3 that is more in line with the current medical practice. These are not all of the changes, but some of the key differences for providers. Overall, it seems that CMS listened to the feedback it received during the comment period and implemented the new rules accordingly. All of the changes take effect on January 1, 2013 for Stage 1 and are also applicable to Stage 2 that begins on January 1, 2014. Core Measure Changes from Stage 1 to Stage 2 Meaningful Use Stage 1 MU, providers have to meet 15 Core measures and five out of 10 Menu Measures. In Stage 2, providers have to meet 17 Core measures and three out of six Menu Measures. Many of the Stage 1 Menu Measures moved to the Stage 2 Core measures. The total remains 20, but the major difference is that a number of Stage 1 Core Measures have been combined in Stage 2 and for a good reason. The Clinical Quality Measure (CQM) requirement in Stage 1 Core list, is a separate requirement in Stage 2, in other words, it is not a Core or Menu requirement. Moreover, the providers will have to report this electronically to meet this measure in 2014. Foreseeing the requirement, NJ-HITEC just created a certified registry to accept Clinical Quality Measures for both Meaningful Use and PQRS incentives. Stage 1 MU focuses on data collection and Stage 2 MU is all about interoperability, i.e., systems talking to each other. Stage 2 MU has many use cases as opposed to Stage 1 MU that is more about data collection. In fact, three of the six Stage 2 Menu Measures relate to providers connecting their EHR system to registries. Moreover, unlike in Stage 1 when providers could exclude themselves from specific Menu Measures, Stage 2 does not count the exclusions as meeting these measures. The good news is that if a provider is connected to a Health Information Exchange (HIE) which connects to public health registries, then he/she has met

16 New Jersey Physician

all the registry requirements that the HIE is connected to, provided the HIE is connected to the registries using the Office of the National Coordinator (ONC) prescribed standards. NJ-HITEC is working with several HIEs in the State and also has DIRECT capabilities to facilitate the electronic exchange requirement for Stage 2.

timeframe to meet the federal requirements, from 2011 through 2021 that includes all three stages of Meaningful Use. These providers have to demonstrate one year of AIU and five years of Meaningful Use within this time period to receive the maximum federal incentive. However, the six years do not have to be consecutive.

Certified Version of EHR Software in 2014

Conclusion

Providers also need to know that they must be using a 2014 ONC certified version of an Electronic Health Record (EHR) system regardless if they are in Stage 1 or Stage 2 starting 2014. One of the reasons CMS is beginning Stage 2 MU in 2014 is because it is going to take time for the EHR vendors to understand, adapt, and develop their software to meet the federal government standards. It is also a welcome change for the providers as well because they will have to install and learn how to effectively use the updated software.

The transition from paper records to EHR technology tends to slow the practice down and there is a learning curve, but NJ-HITEC recommends that it’s better to get in the game early than wait until the end. Overall, the benefits of achieving Meaning Use are consistent with what most physicians want for their practice and patients because they know that health information technology improves the quality of healthcare delivery, engages the patient in his/her case management, improves the practice workflow, and reduces healthcare disparities.

Consequently, based upon this key change, NJ-HITEC is strongly urging our members and all providers to get in the queue for their vendor software upgrade. Moreover, initially it was thought that providers would have to demonstrate Stage 2 MU for one year, however, the Final Rule requires providers to demonstrate MU for only 90 days, similar to Stage 1 MU. The reason for the 90-day ruling is because it gives providers more time to understand how the new software works and how to use the software efficiently to meet the federal requirements to attain their third, possibly their fourth, incentive payment.

For more information on Stage 1 and Stage 2 Meaningful Use requirements or to join NJ-HITEC, please call 973-6424055, email at info@njhitec.org, or visit our web site at www.njhitec.org.

Meaningful Use Target Dates The Medicare providers who started in 2011 and have attested to the 90-day MU period and completed a full year of Stage 1 MU in 2012 will be doing a consequent year of Stage 1 MU in 2013. But keep in mind the removal of the HIE core requirement and vital sign changes will go into effect for those providers as well on January 1, 2013. In 2014, providers will begin working on the Stage 2 MU standards beginning with the 90-period, followed by a full year of Stage 2 MU in 2015. Stage 3 MU should begin in 2016 and those standards are currently under development. Medicaid providers have a longer

About NJ-HITEC NJ-HITEC provides support and assistance to New Jersey’s Primary Care Providers (PCPs) in the selection, implementation, and achievement of “Meaningful Use” of an ONC accredited Electronic Health Record (EHR) system. The organization was established in June 2010 by the New Jersey Institute of Technology (NJIT) through a $23 million grant from the U.S. Department of Health and Human Services (HHS), Office of the National Coordinator (ONC) as part of the American Reinvestment and Recovery Act (ARRA) of 2009. NJ-HITEC is one of 62 federally designated Regional Extension Centers nationwide established to improve American healthcare delivery and patient care through the investment in health information technology.

Visit us now online at www.NJPhysician.org

News Bits

Natural Medical Inc v. New Jersey Dept of Health and Senior Services HEALTH LAW-Medical Marijuana-Administrative Law The Department of Health did not act arbitrarily, unreasonably or in violation of the Compassionate Use of Medical Marijuana Act in limiting the number of permits that it would initially issue to operate alternate treatment centers to six.

Hospital Staffing Agency Liable for ‘Independent Contractor’ Physician A New Jersey appeals court ruling may spell bad news for businesses that contract with physicians and hospitals to staff emergency rooms and other treatment facilities. The Appellate Division held that those businesses can be vicariously liable for medical malpractice if there is a high enough level of control over the contractors or sufficient economic interdependence between the contractor and the business he serves. The court, in Monk v Emergency Physician Assocs, A-489-11, reinstated a claim over a patient’s death at Virtua/West Jersey Hospital in Voorhees. The lower court had found that the allegedly negligent doctor, Joseph O’Connell, was an independent contractor rather than an employee of Emergency Physician Associates, a Woodbury company that staffed the hospital emergency room

Court Ponders How Specialized A Medical Expert Witness Must Be

M oving Forward.TOGETHER. Ourhealthcare group delivers

The state Supreme Court is considering whether an expert in a medical malpractice case must be certified in the same specialty as the defendant or needs only practice in a similar field. The court heard arguments in an interlocutory appeal from a trial judge’s order that took the broader view. The case, Nicholas v. Mynster, A-6/7-11, turns on an interpretation of the 2004 Medical Care Access and Responsibility and Patients First Act, N.J.S.A. 2A:53A-38 et seq., which put strictures on expert’s qualifications.

ﬁnancing options,cash m anagem ent tools,and expert gui dance to hospitals,surgical c enters,and prac ticesacrossthe region. Let’stalktodayabouthow w e can m ove forw ard,together. Call800-SUN-9066 Visit sunnb.com/healthca re

Patient’s Hunch Not Enough To Start Medical Malpractice Clock Running A patient’s mere suspicion that surgery has gone awry is not enough to trigger the medical malpractice statute of limitations, a state appeals court ruled in reinstating a suit. The Appellate Division found the trial court wrongly applied a subjective standard in finding the suit time-barred and the discovery rule inapplicable. Cases of complex medical causation require a “special focuse on the nature of the information possessed by the claimant,” the judges said in Urban v. Naame, A-2596-11. Since the existence of an injury is often masked in such cases, more than suspicion is required to start the running of the statute of limitations, they added.

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September 2012

Lawyer Suspended For Concocting Tale of Settlement That Didn’t Exist A plaintiff lawyer who neglected a medical malpractice suit, blew the statute of limitations and then lied to the client that the case had been favorably settled drew a three-month suspension from the State Supreme Court. Once Mark Yates, of Flemington, discovered that his client’s case had languished, he “chose a cover-up, through a series of lies to the client,” including

creation of a false document memorializing a fictious $600,000 settlement agreement, the Disciplanary Review Board found. The DRB had recommended a censure for Yates, citing precedent that limited suspensions to lawyers who had neglected multiple cases. But the court took a harder line on the deceitful conduct, as the Office of Attorney Ethics had recommended.

Hackensack Names Parrillo Chairman of Heart Institute Hackensack University Medical Center named Dr. Joseph Parrillo chairman of its Heart and Vascular Institute. Parrillo, 65 joins the 696 bed hospital from Cooper University Hospital in Camden where he was director of the Cooper Heart Institute. He also served as chief of the hospital’s department of medicine,

according to a news release announcing the appointment. Previously, he was a professor and chairman of the medicine department at Rowan University’s Cooper Medical School. Parrillo succeeds Dr. Gregory Simonian and Dr. Louis Teichholz, who served as the institute’s co-interim chairmen.

ID Care

When Charity Work is Your Vacation New Jersey Infectious Disease specialist Dr. Donald Allegra spends vacations helping others

Sounds futile, spending vacations working, doesn’t it? Not for Dr. Donald Allegra. For him, bushman’s holidays are his preferred vacation choice. By traveling to rural villages throughout the developing world, the infectious disease specialist keeps abreast of worldwide health issues, helps others learn about infectious disease treatment, and improves the health of both the medically underserved abroad and his own patients at home. “Home” is Randolph, N.J., where Dr. Allegra serves as a specialist at Travel Care, an infectious disease specialty clinic affiliated with the ID Care network of infectious disease practices. Travel Care provides advice, immunizations, treatment, and other services for those traveling abroad, so one could say that with his frequent trips to the Third World, Allegra is merely doing his homework. “It’s like the best kind of hands-on classroom training,” he says. “The kinds of diseases I treat are rare in the United States, yet physicians have to be aware of them. Physicians get to see so much more by traveling overseas.” Dr. Allegra has been making these trips since he worked for the Centers for Disease Control and Prevention years ago. Each year, Dr. Allegra takes one or two trips abroad to medically underserved hot spots. Some of his most recent trips took him to the Philippines in January 2011, Haiti in March 2012, and Honduras in May 2012. On his May trip to Honduras, his fourth to that country, he took his family with him – his wife is a nurse and his son, a pre-med student – as well as a team of physicians from St. Clare’s Hospital in Denville, N.J.: an OB/GYN specialist, a urologist, an emergency room physician, and a surgical team. Honduras can be a dangerous place to visit. As a repeat visitor,

18 New Jersey Physician

Dr. Allegra has become familiar with Honduras and knows people who help determine what is safe and what is not. The team worked out of a new hospital. During the day, the surgical team would work at the hospital while the medical team traveled with Catholic priests to see patients in local churches. The altar would become a makeshift pharmacy while the patients waited in the pews. When Charity Work is Your Vacation “Hundreds of people would line up,” he continues. “Some of them had never seen a doctor before, because they’re poor farmers living in isolation. People come from far away to be treated.” Dr. Allegra’s travels allow him to stay up-to-date with health trends in the developing world. On his most recent Honduras trip, he noted he saw more people with diabetes, heart disease, and skin problems – conditions arising from a combination of the hot environment and people living longer. Malnourished children also accounted for many of the cases treated. What he sees in his travels abroad makes its way into both the classes he teaches and the advice and treatment he gives patients in his clinical practice. Information gathered overseas helps him provide better advice to people who come into Travel Care before heading abroad. It also reminds him why he became a doctor in the first place and what good medical care should be like. “Going abroad to do this kind of mission work is very rewarding,” he says. “It makes you a better problem-solver. You meet challenges and discern ways to overcome them with the knowledge, skills, and resources you have. It’s a different mindset from running a

practice back home in the United States.” “You also gain more hands-on experience as opposed to ‘book and classroom’ training,” he says. “There are no tests, no CAT scans – you’re doing more of the feeling and talking and touching. The experience teaches you how to do good physical exams. It helps keep you grounded in medicine.” Dr. Allegra also recommends this type of travel for anyone considering or embarking on a career in medicine. “Young people who are unclear about where they’re going to do in life will get a better idea of whether the medical route is right for them by volunteering for medical missions like this,” he says. And with the rising trend of volunteerism, Dr. Allegra advises physicians, too, to educate themselves in this fashion. “With travel the way it is and how diseases can spread so quickly, it’s even more important now to be knowledgeable about rarer diseases. Going to countries where the physician has a better

chance of encountering and treating these diseases enables the physician to bring that knowledge back to practice at home.” About ID Care ID Care is the most comprehensive group of infectious disease specialists in the State of New Jersey and the second largest of its kind in the country, with 32 physicians all board certified in Infectious Diseases. The practice has nine locations in Cedar Knolls, Hillsborough, Old Bridge, Pennington, Randolph, Somerset, Union, Wayne, and West Long Branch, New Jersey. ID Care has affiliations with 90 medical facilities including hospitals, long-term and sub-acute care facilities, ambulatory surgical centers providing patient care, and infection control consultations. For more information on Travel Care and ID Care, visit www. idcare.com or call 888-830-5970.

Hospital Rounds

Physicians at The Cancer Institute of New Jersey Named Among ‘Top Docs’ in Nation Listing compiled by ‘U.S. News & World Report’ Several physicians at The Cancer Institute of New Jersey (CINJ), who are faculty members at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, have been named as a ‘Top Doctor’ by U.S. News & World Report. CINJ is the state’s only Comprehensive Cancer Center as designated by the National Cancer Institute and a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School. Each year, U.S. News & World Report releases a list of the nation’s top physicians in conjunction with Castle Connolly Medical Ltd., which publishes America’s Top Doctors. Based on peer nominations, attributes such as clinical skills, training, achievements and other criteria are reviewed and assessed by a physician-led research team. The listing represents nearly 31,000 of the nation’s 800,000 physicians. CINJ physicians on this year’s list are: • Joseph Aisner, MD, Associate Director, Clinical Science; specialty: lung cancer • David A. August, MD, Chief, Surgical Oncology; specialty: gastrointestinal malignancies • Robert S. DiPaola, MD, Director, CINJ; specialty: prostate cancer • James S. Goydos, MD, Director, Melanoma and Soft Tissue Oncology Program; specialty: melanoma and skin cancer • Bruce G. Haffty, MD, Chair, Radiation Oncology; specialty: breast cancer • Thomas Kearney, MD, FACS, Director, Breast Care Services; specialty: breast cancer • Lorna Rodriguez, MD, PhD, Director, Precision Medicine; specialty: gynecologic cancers

• Roger Strair, MD, PhD, Chief, Hematologic Malignancies/ Hematopoietic Stem Cell Transplantation; specialty: leukemia and lymphoma • Deborah L. Toppmeyer, MD, Chief Medical Officer; specialty: breast cancer • Robert E. Weiss, MD, urologic oncologist; specialty: urologic cancers “Serving as New Jersey’s only National Cancer Institutedesignated Comprehensive Cancer Center, CINJ carries a tremendous responsibility in providing the latest novel treatments to patients through cutting-edge research. We are honored that our peers across the nation recognize dedicated CINJ physicians who by collaborating with a larger team of nationally known researchers and clinicians work toward eradicating cancer,” said CINJ Director Robert S. DiPaola, MD, who is also the associate dean for oncology programs at UMDNJRobert Wood Johnson Medical School. A full listing of ‘Top Doctors’ can be found at: http://health. usnews.com/top-doctors. Full profiles of CINJ doctors named to the list can also be found at http://www.cinj.org/physician/ index.php. About The Cancer Institute of New Jersey The Cancer Institute of New Jersey (www.cinj.org) is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center dedicated to improving the detection, treatment and care of patients with cancer, and serving as an education resource for cancer prevention. CINJ’s physician-scientists engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. To make a tax-deductible gift to support CINJ, call 732235-8614 or visit www.cinjfoundation.org. CINJ is a Center of September 2012

Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. Follow us on Facebook at www.facebook.com/TheCINJ. The CINJ Network is comprised of hospitals throughout the state and provides the highest quality cancer care and rapid dissemination of important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. System Partner: Meridian Health (Jersey Shore University Medical Center, Ocean Medical Center, Riverview Medical Center, Southern Ocean Medical Center, and Bayshore Community

Hospital). Major Clinical Research Affiliate Hospitals: Carol G. Simon Cancer Center at Morristown Medical Center, Carol G. Simon Cancer Center at Overlook Medical Center, and Cooper University Hospital. Affiliate Hospitals: CentraState Healthcare System, JFK Medical Center, Robert Wood Johnson University Hospital Hamilton (CINJ Hamilton), Somerset Medical Center, The University Hospital/UMDNJ-New Jersey Medical School*, and University Medical Center of Princeton at Plainsboro. *Academic Affiliate

UMDNJ Researcher Mona Batish Earns Special NIH Award NEWARK, N.J. – Mona Batish, PhD, a postdoctoral researcher at the University of Medicine and Dentistry of New JerseyNew Jersey Medical School, is one of 14 scientists nationwide who have received the 2012 National Institutes of Health (NIH) Director’s Early Independence Award. This prestigious award program, which includes funding of $1.25 million for five years, is designed to encourage young scientists who have demonstrated outstanding scientific creativity, intellectual maturity and leadership skills with the opportunity to conduct independent biomedical research by skipping the conventional post-doctoral training period and moving directly into a faculty position at a sponsoring university. Dr. Batish, who soon will become an assistant professor in the Department of Microbiology and Molecular Genetics at UMDNJNew Jersey Medical School, plans to use the award to work toward developing tools for the detection of tumor-causing alterations in chromosomes, which are an underlying cause of several kinds of cancers. These tools will provide early diagnosis so that appropriate treatment can be performed to prevent the development and spread of cancers. Carol Newlon, PhD, professor and chair of the department and Associate Dean for Faculty Affairs at New Jersey Medical School, says, “The fact that so few people receive this award from the NIH confirms something I knew already, what a stellar researcher Dr. Batish is. She has a bright career ahead of her, and it is my

honor and that of this department that she has embarked upon it here.”

As she worked toward her PhD, Dr. Batish received several best poster and oral presentation awards. In 2011, she received an Executive Women of New Jersey Graduate Merit Award. This year she was awarded the Stanley S. Bergen, Jr., M.D., Medal of Excellence as the top graduating PhD student atUMDNJGraduate School of Biomedical Sciences, and a New Jersey Medical School Faculty Organization Outstanding Graduate Student Award for academic excellence, leadership & research accomplishments. Dr. Batish, a native of Chandigarh, India, now resides in Newark, New Jersey. About UMDNJ: The University of Medicine and Dentistry of New Jersey (UMDNJ) is New Jersey’s only health sciences university with more than 6,000 students on five campuses attending three medical schools, the State’s only dental school, a graduate school of biomedical sciences, a school of health related professions, a school of nursing and New Jersey’s only school of public health. UMDNJ operates University Hospital, a Level I Trauma Center in Newark, and University Behavioral HealthCare, which provides a continuum ofhealthcare services with multiple locations throughout the State.

Probiotics Are Found to Be a Secret Weapon for Fighting Symptoms of the Common Cold in College Students

A study by UMDNJ researchers finds that probiotic supplementation may reduce the severity and duration of colds and upper-respiratory infections. NEWARK, N.J.—College students are notoriously sleepdeprived, live in close quarters and lead stress-filled lives, makingthem especially susceptible for contracting colds and upper-respiratory infections. For these reasons, a team lead by researchers at the University of Medicine and Dentistry of New Jersey–School of Health Related Professions (UMDNJ– SHRP) selected this population to study the effects of probiotic supplementation on health-related quality of life (HRQL) during the common cold. The study, led by Registered Dietitian Tracey J. Smith, an adjunct professor at UMDNJ–SHRP, randomized 198 college students aged 18 to 25 and living on-campus in residence halls at Framingham State University in Massachusetts. Groups received either a placebo (97 students) or a powder blend containing Chr. Hansen’s probiotic strains BB-12® and LGG® (101 students) for 12 weeks. Each day, students completed a survey to assess the effect of the probiotic supplementation.

20 New Jersey Physician

Although there have been previous studies on the effect of probiotics on the duration of colds and severity of symptoms, this is the first study to investigate the effect of probiotic strains on HRQL during upper-respiratory infections, taking into account duration, symptom severity and functional impairment—all important factors of HRQL. “HRQL is subjectively assessed by the patient and most simply defined as ‘the component of overall quality of life that is determined primarily by the person’s health and that can be influenced by clinical interventions,’” Smith says. An article detailing the results of the study,“Effect of Lactobacillus rhamnosus GG (LGG®) and Bifidobacterium animalis ssp lactis (BB-12®) on health-related quality of life in college students with upper respiratory infections,” was published in the October 2012 issue of the British Journal of Nutrition. “We know that certain probiotic strains support immune health and may improve health-related quality of life during upper-respiratory

infections,” says Smith. “This double-blind study assessed how probiotic supplementation affects the duration and severity of symptoms, and the impact of symptoms on the daily life of infected students.” The study found that while all students caught colds at roughly the same rate, the students who took the probiotic supplementation experienced: • A duration of colds that was two days shorter (four days vs. six days) • Symptoms that were 34% less severe and • A higher quality of life that resulted in fewer missed school days (15 vs. 34 missed by students taking theplacebo). What makes probiotics so effective in treating symptoms of upper-respiratory infections? “Cold symptoms like a stuffy nose and sore throat are the body’s inflammatory response toward a virus, not a direct action of the virus itself,” explains Smith. “Probiotic microorganisms may soften your immune system’s reaction by reducing your body’s inflammatory response.” The Take-Away for the Public: “If cost is not an issue, then otherwise healthy persons who are especially stressed, sleep-deprived or living in close quarters [such as a college dormitory] could supplement daily during cold season with both LGG and BB12 to improve their quality of life if/when they do get a cold,” says Smith. However she cautions that not all probiotics are created equal. “The study supports the combination of LGG and BB12—two very specific strains of probiotics. These two strains also are in a number of supplement-type products that are available over the counter,” she says, “but consumers need to read the label to be sure that the product contains Lactobacillus rhamnosus GG [LGG] and Bifidobacterium animalis lactis BB12 [BB12]. There also are some yogurts that contain LGG and/or BB12 but check the labels, since

companies change the probiotics strains often.” “People should also recognize that probiotics are not for everyone,” Smith continues. “Those considering probiotic supplementation should consult with their physician first.” Investigators are available for interviews. Contact Patti Verbanas at verbanpa@umdnj.edu or 973.972.7273. Investigators: From the University of Medicine and Dentistry of New JerseySchool of Health Related Professions, Newark, N.J.: Tracey J. Smith, PhD, RD, Adjunct Assistant Professor, Department of Nutritional Sciences; Diane Rigassio-Radler, PhD, RD, Associate Professor, Department of Nutritional Sciences; Robert Denmark PhD, Interim Assistant Dean for Research; and Riva TougerDecker, PhD, RD, Chair, Department of Nutritional Sciences. From the U.S. Army Research Institute of Environmental Medicine, Natick, Mass.: Timothy Haley, MD, Office of Medical Support and Oversight. Funding: This study was funded by Chr. Hansen A/S, Hoersholm, Denmark. About the University of Medicine and Dentistry of New Jersey The University of Medicine and Dentistry of New Jersey (UMDNJ) is New Jersey’s only health sciences university with more than 6,000 students on five campuses attending three medical schools, the State’s only dental school, a graduate school of biomedical sciences, a school of healthrelated professions, a school of nursing and New Jersey’s only school of public health. UMDNJ operates University Hospital, a Level I Trauma Center in Newark, and University Behavioral HealthCare, which provides a continuum of healthcare services with multiple locations throughout the State.

State Legislature

ASSEMBLY, No. 866 STATE OF NEW JERSEY

215th LEGISLATURE

PRE-FILED FOR INTRODUCTION IN THE 2012 SESSION

A866 CHIUSANO, DIMAIO