A p r i l 2 012
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ID Care
New Jersey’s Largest Infectious Disease Practice is Covering All Bases Statewide
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Publisher’s Letter Dear Readers, Welcome to New Jersey Physician magazine, now reaching over 28,000 practitioners in our state. We are now offering you the ability to receive your copy of New Jersey Physician through email, and have added a subscription form to our website for your convenience. If you select to obtain your monthly copy digitally, you will receive your copy instantly and we give you our assurance that you email address will not be shared, sold or made available to any other source. Also on our website (www.njphysician.org) there are many other features beyond those appearing in our monthly issue. These include the latest breaking news within the state healthcare community, an editorial column with the opportunity to respond to controversial issues affecting the practice of medicine today and an opportunity to directly interact with Dr. Leon Smith regarding his puzzling cases. The ongoing saga of the one room surgery center continues. If your center is set up as a general business corporation, it must be licensed even if all other business and usage requirements are met. If you are practicing in a center that is set up this way, please contact your attorney immediately to have this corrected, as you can be subject to civil penalties of up to $1,000 per day. In a swipe at President Obama’s health care legislation, Governor Christie has
Published by Montdor Medical Media, LLC Co-Publisher and Managing Editors Iris and Michael Goldberg Contributing Writers Iris Goldberg Michael Goldberg Kate Zernike John Fanburg, Esq Carol Grelecki, Esq Mark Manigan, Esq Rachel Fields Kelsey Brimmer Leon Smith, MD Joseph Gorrell, Esq Keith Roberts, Esq New Jersey Physician is published monthly by Montdor Medical Media, LLC., PO Box 257 Livingston NJ 07039 Tel: 973.994.0068 Fax: 973.994.2063 For Information on Advertising in New Jersey Physician, please contact Iris Goldberg at 973.994.0068 or at igoldberg@NJPhysician.org
vetoed an online marketplace the legislature created to help residents and small businesses buy insurance through the affordable care act. Governor Christie said in his veto message that the exchange approved in March was premature and could impose unnecessary obligations upon the state’s citizens.
Send Press Releases and all other information related to this publication to igoldberg@NJPhysician.org Although every precaution is taken to ensure
The New Jersey Healthcare Disclosure and Transparency Act is being discussed in the state legislature. The bill will require health plans to explain to their members the methodology for calculating the portion of a bill they will cover for out of network care, and may result in the legislature forcing out-of network physicians to accept in-network reimbursement rates. Keep your eyes open for this one. Our cover story this month features ID Care, the state’s largest infectious disease practice, with specialist in every aspect of ID prevention. The practice is currently comprised of 33 physicians and has evolved to include a myriad of diversified areas, including hospital epidemiology, travel medicine, wound care, contagious disease, and the most effective methods of treatment using antibiotics.
accuracy of published materials, New Jersey Physician cannot be held responsible for opinions expressed or facts supplied by its authors. All rights reserved, Reproduction in whole or in part without written permission is prohibited. No part of this publication may be reproduced or transmitted in any form or by any means without the written permission from Montdor Medical Media. Copyright 2010. Subscription rates: $48.00 per year/$6.95 per issue Advertising rates on request New Jersey Physician magazine is an
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4
Contents
ID Care
New Jersey’s Largest Infectious Disease Practice is Covering All Bases Statewide
3
Health Law Update
•N ew Jersey’s Medical Marijuana Program •O ne-Room ASCs • New Rules Governing Medical Laboratories’ Reporting of Personal Health Information
9
Statehouse
• Christie Vetoes Health Insurance Exchange •M ove to Expand Women’s Access to Critical Health Care Services •N ew Jersey Legislation Could Force Out-of-Network Physicians to Accept In-Network Rates •B ill to require financial transparency for all NJ hospitals
13
Special Feature
Positive Physicians Insurance Exchange
16
F ood for Thought
The Orange Squirrel Bloomfield, New Jersey
18
Association News
• Mary F. Campagnolo, MD, MBA Installed as 220th President of Medical Society of NJ • MGMA Conference a Huge Success
20
COVER STORY
2
New Jersey Physician
Diagnosis
• F amed Infectious disease specialist Leon Smith, MD has four more cases for you this month
Health Law
Update
Provided by Brach Eichler LLC, Counselors at Law
Department of Banking and Insurance Proposes New Rules Governing Medical Laboratories’ Reporting of Personal Health Information In mid-April, the New Jersey Department
electronically, tests results must be delivered to that medical provider in an alternate format. Once a medical provider has the capacity to receive the information electronically, all test results should be delivered in that manner.
The New Jersey Department of Health and Senior Services has recently taken the position
June 15, 2012, to Robert Melillo, Chief, Legislation
that one-room surgery centers set up as general
and Regulation, Department of Banking and In-
business corporations (i.e., “Inc.’s”) require
surance, 20 West State Street, PO Box 325, Tren-
ASC licensure even if all other criteria for
ton, New Jersey 08625-0325; Fax (609) 292-0896.
licensure exemption are met (that is, even if the facility in question is limited to one operating room, owned only by physicians, and used
Development, Implementation and Deployment (Office for e-HIT) proposed new standards for the collection and reporting of personal health information by medical laboratories. By way of background, one of the goals of the Office of e-HIT, which was established by the 2008 New Jersey Health Information
Urgent Update Concerning One-Room ASCs
Comments to the proposal must be submitted by
of Banking and Insurance’s Office for the of Electronic Health Information Technology
Health Law Update
only by its physician owners or employees).
Lawsuit Filed over Delays in Commencement of New Jersey’s Medical Marijuana Program
The department’s position is based on Board of Medical Examiner rules that do not include “Inc.’s” as permissible structures for physician practices. The department argues that if the entity is not a set up as a physician practice, it cannot qualify for the exemption. Upon discovering that a one-room surgery
Technology Act, is to effectuate health
The NORML Legal Committee, on behalf of a
information technology which can eliminate
center is set up as an “Inc.,” the department will
disabled New Jersey man and his physician,
the many different and conflicting standards
send a “cease and desist” letter requiring the
recently filed a lawsuit against the New Jersey
for collecting and reporting personal health
facility to close and warn that failure to close
Department of Health and Senior Services
information within the health care community.
could subject the center to civil penalties up to
(DHSS), DHSS Commissioner Mary O’Dowd,
The proposal adds several new definitions and
$1,000 per day.
and John O’Brien Jr., a retired state trooper who
amends the definition of a “clean claim,” in
heads the medical marijuana program, for their
We have successfully assisted a number of
the regulation governing prompt payment of
failure to implement the Compassionate Use
one-room ASCs that were set up as “Inc.’s” and
claims, to include claims for reimbursement
Medical Marijuana Act, signed on Jan. 18, 2010.
received “cease and desist” letters to obtain
for laboratory tests which have been submitted
The lawsuit alleges that the defendants have
appropriate corporate designation and avoid
as required by NJAC 11:22-1.4(b) (see below),
not completed parts of the medical marijuana
penalties. We have been able to do it in a man-
which sets forth the minimum requirements for
program as mandated by law, including a
ner that reduces exposure to reimbursement
the submission of a claim for laboratory tests.
physician registry, criminal background checks
recoupment claims from insurance companies
for the operators of the dispensaries and
as much as possible. We have also assisted our
patient and caregiver registries.
clients in changing the corporate designation
The proposal’s new NJAC 11:22-1.4(b) states that all claims for reimbursement for laboratory tests
must
include
proof
of
with Centers for Medicare & Medicaid Services.
electronic
The State’s program was required to commence
submission of the results of the tests to the
by July 1, 2010 and then, after an extension, by
carrier and the medical provider who ordered
October 1, 2010. The DHSS failed to meet both
the tests. If the medical provider does not
deadlines and has yet to implement the program.
have the capability to receive the information
Please visit us online at www.NJPhysician.org April 2012
3
Cover Story
ID Care
New Jersey’s Largest Infectious Disease Practice is Covering All Bases Statewide Specialists in Every Aspect of ID Prevention, Control and Treatment Continue to Make a Real Difference for Patients, Physicians, Medical Facilities and the Community at Large By Iris Goldberg
We’ve come a long way from the time when the
One of the critical areas in which ID Care has
benefits derived for those facilities that choose
infectious disease (ID) specialist functioned
a significant presence throughout the state is
to contract with ID Care for the services of its
predominantly to evaluate and treat in-hospital
hospital epidemiology. This involves the
epidemiologists.
patients who were admitted with an infectious
responsibility of ensuring that hospitals are
disease or had contracted one during the
safe for patients, staff and visitors in terms of
ID Care physician Edward J. McManus, MD,
course of their hospital stay. Although that
infection prevention and control and also
FACP is a specialist in hospital epidemiology.
is still an important part of infectious disease
advising on the proper use of antibiotics
Dr. McManus talks about the evolving process
medicine, as the healthcare needs of society
(antibiotic stewardship). ID Care is contracted
of changing the perception amongst the
have dictated over time, the specialty has
to provide these services to a number of New
medical community regarding the need to
evolved to include a myriad of diversified
Jersey facilities (see Fig.2). To this end ID Care
areas. With 33 specialty-trained physicians
is involved in program development at each
ID Care Physicians
(see Fig.1), office locations throughout the
that addresses the ways in which the risk of
state and affiliations with many major New
infection can be minimized within the hospital
Jersey hospitals and medical centers, ID Care
environment.
Nebu T. Alexander, MD Donald T. Allegra, MD, FACP, FIDSA Rohit Bhalla, DO Najah I. Doka, MD, MPH Manish Doshi, MD Sukrut Dwivedi, DO Rachna Gupta, MD, MPH David J. Herman, MD, FACP Ellen J. Hirsh, MD, FACP Joseph Kim, MD Richard E. Krieger, MD Andrew Lee, MD Rosario Manalo, MD Rebecca A. Marsh, MD Ajay Mathur, MD Edward J. McManus, MD, FACP, HBO2 John Richard Middleton, MD, MACP, FIDSA Ronald G. Nahass, MD, FACP, FIDSA Lisa A. Pittarelli, MD, FACP Natalia Raoof, MD Nazar Raoof, MD Sireesha Reddy, MD Shelly A. Roseff, MD Meena Seenivasan, MD Robert E. Segal, MD Ajanta Sen, DO Jerry Sheen, MD, HBO2 Scott W. Sinner, MD, FACP Edith Sonnenberg, MD Damanpreet K. Ubhi, MD Danya Wenzler, MD Stephen J. Williams, MD
is well-positioned to carry out its mission to deliver the highest level of comprehensive
“We’re engaged in monitoring the process of
infectious disease services.
hand washing. We’re engaged in making sure that the right antibiotics are given at the right
Ronald G. Nahass, MD, FACP, FIDSA is
time and at the right dose. We’re engaged in
President of ID Care. Dr. Nahass discusses
making sure that devices that are used to
how he and his colleagues at ID Care view
help manage patients - foley catheters, central
their role as it relates to the primary focus
intravenous lines, ventilators – are all used in
of today’s healthcare environment, which is
a way to minimize risk and make it as small as
centered upon reducing risk and preventing
possible,” Dr. Nahass elaborates.
disease wherever possible. “We’re really all about that,” Dr. Nahass says, referring to the
Dr. Nahass explains that the size and scope of
potentially harmful consequences of not
ID Care with 33 physicians, a number of whom
identifying and treating an infection in an
are specialists in each of the service areas,
expedient way.
creates the ideal situation for the sharing of the most current information. He discusses this
“We’re about providing early, accurate, rapid
with respect to the prevention and control of
diagnosis to minimize morbidity, minimize
hospital infections.
mortality and improve outcomes. By doing that we enhance the value of the healthcare
“The advantage of ID care is our sheer level
system to both patients and to the community,”
of engagement across the country and across
he emphasizes. “We impact that across the
the field which allows us to be early adopters
whole spectrum of services we provide,” Dr.
of improved methods of protecting patients
Nahass adds.
and staff,” Dr. Nahass relates, pointing to the
4
New Jersey Physician
Leon Smith, MD (Emeritus)
ID Care has been working with Somerset Medical Center since 1993. CEO Kenneth Bateman discusses how that association has benefited his facility. “At Somerset Medical Center the ID Care team provides a service that truly enhances the value of the care we provide by protecting patients, ensuring the best outcomes and minimizing the costs. They are the high quality providers of infection prevention services in the state of New Jersey.” Mr. Bateman states. Dr. McManus shares that besides the services they provide for medical facilities within New Jersey, he and other epidemiologists at ID Care p ID Care works with various New Jersey facilities to help them maximize infection control and more efficiently manage their resources. Here, Dr McManus consults with staff at St. Clare’s Hospital regarding a patient.
devote time to sit on committees that help set national policies for resource management, antibiotic utilization and antibiotic stewardship.
proactively and aggressively address infection
specialist has amassed regarding antibiotic
prevention within medical facilities. He relates
therapy. “We are really good guides at putting
“There’s no other organization that has the
that for a long time the feeling was that hospital
each patient on the best pathway to getting
scope and experience that we have in the in-
infections and the complications that resulted
better,” Dr. McManus adds.
fectious disease world right now,” Dr. McManus
were unavoidable occurrences associated with
emphatically says. He feels that ID Care’s asso-
a hospital stay, even though there were tens
Many hospitals already recognize the valuable
ciation with numerous facilities, each having its
of thousands of people dying from hospital-
contribution that ID Care has made in helping
own set of challenges, has enhanced the ability
contracted infections each year.
them to better manage resources. “We can
to know what the best options are for accom-
look at things much more objectively,” Dr.
plishing the goals in individual situations. “One
“Now the paradigm is that these things are all
McManus asserts. He explains that as an
size does not fit all,” he firmly states.
preventable,” Dr. McManus reports. “We’re not
impartial participant, the ID Care physician can
going to accept any defects or shortcomings.
help make informed choices that use resources
“We’re communicators and facilitators. That’s
We’re going to try to bring those risks as close
most efficiently.
our skill set. We’re going to come to whatever
to zero as possible,” he says, discussing the role that he and the other hospital epidemiologists at ID Care have in preventing infections at the facilities where they consult. Although the mindset within the community is gradually changing, Dr. McManus feels that he and his colleagues are still underutilized not only in terms of preventing hospital infections but also to mentor other physicians with respect to better use of antibiotics and also to help hospitals manage resources more effectively. He points out that having the ID Care epidemiologist on site actually helps to reduce costs.
circumstance we’re brought to, whether it’s
NJ Facilities Utilizing ID Care Epidemiology Services Hospitals • Carrier Clinic/East Mountain Hospital • Hackettstown Regional Medical Center • Newton Medical Center • Saint Clare’s Hospital • Somerset Medical Center • University Medical Center at Princeton
Long-Term Acute Care Centers (LTACS) • Care One at Raritan Bay • Kindred at Dover • Kimball LTAC at Long Branch and Lakewood
Subacute Rehab (SAR)
a patient issue or a hospital issue and we’re going to be good listeners and correlate the information to help facilitate the best plan under the circumstances. We’re interested in being in partnership with patients and with our hospital organizations to provide the highest levels of care,” informs Dr. McManus. Besides the revolutionary impact ID Care has had with regard to ensuring the safety of New Jersey hospital patients and staff during this past decade, its role in successfully treating HIV and Hepatitis C (HCV) patients throughout the state has been equally impressive. Again, Dr. Nahass points to ID Care’s level of engagement
advise when to stop antibiotics. We provide
• Bridgeway Senior Health Care • Care One Madison • Willow Creek
a comfort level to reducing that intensity of
Ambulatory Surgery Centers
treatments that allow patients with HIV to live a
“Sometimes the biggest role we play is to
services appropriately,” he offers, citing the vast experience and judgment the ID Care
• Digestive HealthCare Center • University Radiology
which puts its specialists at the forefront of the latest, innovative advancements in medical normal lifespan and to cure 80 to 90 percent of patients with HCV. April 2012
5
“ID Care has been very active in the field of clinical research for both HIV
ID Care has a significant role in New Jersey with regard to Tuberculosis
and Hepatitis C to help develop and also test these treatments and get
(TB) care and treatment as well. Two ID Care physicians, Lisa A.
them out and available to people throughout New Jersey and the U.S.,”
Pittarelli, MD and Stephen Joseph Williams, MD sit on the New
Dr. Nahass shares. Beyond the obvious significance of this for patients,
Jersey Tuberculosis Medical Advisory Board where they contribute their
Dr. Nahass discusses the tremendous benefits for the healthcare system.
expertise to the development of guidelines for the management and
“Hepatitis C, just as an example, is a disease that has been increasingly
treatment of TB. Additionally, ID Care serves as the directors for two TB
costly and an increasingly deadly problem for patients. With these new
treatment centers in New Jersey, where again, its specialists are actively
treatment modalities, as we apply them more broadly, it is expected we
involved in developing treatment guidelines. “The goals within these
will dramatically bend the cost curve. Not only will people be cured of
programs have been to make sure that patients are identified and treated
this disease but the cost of managing this disease will drop dramatically.
properly in order to limit the risks. As a result, the numbers have actually
The cost of liver transplants will go down. The cost of treating people
dropped during the last decade,” Dr. Nahass is pleased to report.
with liver failure will go down and patients will continue to be functional members of society,” Dr. Nahass foresees.
Wound care is another area in which the specialty-trained physicians of ID Care are experts. As such, the ID Care wound specialist is a crucial
For the past decade ID Care has been actively involved in training and
resource for primary care and other referring physicians. With specialized
education for patients with HIV and HCV and their caregivers in communities
certification in wound care and in the administration of hyperbaric oxygen,
with limited resources such as prisons, clinics, community health centers,
the ID Care team provides wound care services in all of its hospitals and
etc. Working with Columbia University, ID Care as an organization and Dr.
in five wound care centers throughout the state.
Nahass, personally, has been dedicated to making sure that patients and front line care providers in these challenged areas have access to education
Jerry Sheen, MD is an ID Care physician who spends much of his time
and training about treatments for HIV and Hepatitis C.
treating the many patients who are referred to the wound clinic at St. Peter’s University Hospital and Medical Center. He and the other wound care specialists also visit New Jersey nursing homes where they treat patients with bed sores and other wounds and instruct staff about proper wound care in each case. Whether it’s the diabetic patient with foot ulcers, the elderly patient with peripheral artery disease, venous disease or any patient with a wound that is not healing properly, Dr. Sheen explains that the specialized training he and his colleagues at ID Care have received in both infectious disease and wound care enables them to provide treatment to expedite healing that would not be available elsewhere. Working with other wound specialists such as vascular surgeons and podiatrists and also consulting with primary care physicians regarding the medical history of each patient, the wound care specialists at ID care have helped many patients with persistent wounds heal properly and in certain cases, avoid amputation. Dr. Sheen goes on to share that dressing, debridement (cleaning), culturing, biopsy, hyperbaric oxygen, even synthetic grafts can all be accomplished on an outpatient basis in the wound clinics with regular follow up visits. “Ninety-nine percent of patients we treat do not require hospitalization,” Dr. Sheen relates. The benefits of this in terms of convenience for patients, less cost to the healthcare system and keeping referring physicians involved are obvious. Because they are infectious disease specialists, Dr. Sheen explains that the ID Care physicians are skilled at distinguishing between those wounds that are infected and those that are merely inflamed. “Many times, physicians who are not specialists in infectious disease are prescribing antibiotics when they really are not needed,” he relates.
p Dr. Sheen is shown debriding a wound on this patient’s leg. Culturing, biopsy, hyperbaric oxygen and even synthetic skin grafts can all be accomplished on an out-patient basis by ID Care physicians with regular follow-up visits.
6
New Jersey Physician
“As infectious disease doctors, we can avoid the over-use of antibiotics
and eliminate a lot of potentially dangerous side effects,” Dr. Sheen continues. He particularly mentions Clostridium difficile colitis as a serious, sometimes life-threatening side effect of treatment with certain antibiotics. Dr. Sheen additionally points out that over-utilization of antibiotics leads to the development of antibiotic-resistant strains of bacteria. Also, Dr. Sheen cautions that physicians who are not specialists in ID and wound care might use medications or treatments that can be harmful. Keeping aware of the most current research within this specialty allows Dr. Sheen and the other wound specialists at ID Care to utilize important information as soon as it’s released. He cites the widespread use of Betadine solution as an antiseptic. “The newest data now shows that Betadine actually kills cells and can impair the healing process,” Dr.
p Patients who receive their infusion at ID Care have access to a physician at all times and can be monitored on a daily basis.
Sheen remarks. and infusion services are available 7 days a
physician is also appropriate when patients
Sometimes patients contract infections for
week. Besides antibiotics, other medications
don’t respond to standard therapies.
which they require prolonged intravenous
that require intravenous administration such
antibiotic therapy. ID Care specialist Joseph
as certain drugs for osteoporosis and some
“We are trained to diagnose and treat difficult
Kim, MD is one of the physicians on staff who
for immune deficiencies, for example, are also
infections,” Dr. Herman offers. He cautions
oversees in-office infusion care, which he
provided by ID Care.
non-ID
physicians
against
prescribing
additional antibiotics when a standard course
explains is most often a preferable alternative to a hospital admission. “Many times patients
Dr. Kim goes on to share that Medicare patients,
of medication for Lyme disease, for example,
are sick enough that they require intravenous
particularly benefit from this service because
fails to improve symptoms. “There might
antibiotics but at the same time may not
most often, home infusion is not covered by
be something else going on causing those
actually need to be admitted to the hospital
insurance while treatment at an infusion center
symptoms and the patient needs to be re-
and be observed as an in-patient,” explains
is. Daily trips to a hospital are extremely hard
evaluated,” Dr. Herman points out.
Dr. Kim.
to negotiate for the older patient and a hospital admission may be overwhelming as well.
“Antibiotic therapy for Lyme disease beyond a thirty day treatment course is rarely needed,”
Especially with advances in pharmacology which allow administration of antibiotics only
For many New Jersey residents, contracting
Dr. Herman states, reiterating the need for an
once daily in many instances, Dr. Kim questions
a tick borne illness such as Lyme disease
infectious disease specialist. “In some cases
the advisability of exposing patients to the
is a realistic concern. At ID Care, David J.
Lyme symptoms take time to resolve, even
discomfort and inconvenience of remaining
Herman, MD, FACP is one of the physicians
after drug treatment has ended,” he adds.
in the hospital. “If patients are clinically able
who specialize in diagnosing and treating
to be monitored as an outpatient, it is always
Lyme disease and other tick borne illnesses.
Also, Dr. Herman explains that one tick can
better to provide treatment in the office and
Dr. Herman explains the importance of
carry more than Lyme disease. Anaplasma,
then send them home where they can sleep
consulting an ID physician when symptoms
ehrlichia and babesiosis are other diseases
in their own bed,” he maintains. Of course,
that might be related to a tick bite appear.
that are carried by the same tick. “Although
outpatient infusion is far less costly and
He reveals that sometimes blood test results
these are all carried by the same tick that
therefore helps reduce the financial strain on
and symptoms are not consistent. “It may be
carries Lyme disease, they can have different
our struggling healthcare system.
difficult for a non-ID physician to figure out
manifestations and require slightly different
how the two jive,” he says, citing one reason
treatments. And, it’s possible to be infected
Patients who receive their infusion at ID Care
that a primary care physician might want to
with all from one tick bite,” he relates, further
have access to a physician at all times and can
refer the patient. Dr. Herman mentions that
documenting the importance of consulting
be monitored on a daily basis. Parking is ample
a second opinion from an infectious disease
with an infectious disease specialist. April 2012
7
Besides going to ID Care to be prepared for some of the less obvious health risks, in terms of the vaccines, Dr. Allegra feels that travelers who avail themselves of ID Care’s travel services are much better off than going to a pharmacy or travel clinic. He mentions that it’s especially important that he and his colleagues at ID Care evaluate each individual’s medical history and can determine possible interactions with other medications, etc. “If you have a problem with a reaction to the vaccine or if you get sick while you’re there, we’re available day or night. In fact, I give patients my phone number and tell them to give me a call if they run into any trouble. The advantage is if you come to us, there will always be someone available to answer your questions in the event of a problem,” Dr. Allegra makes a p Dr Allegra discusses vaccinations and other precautions with a patient planning a trip abroad.
point of sharing.
Dr. Herman discusses ID Care’s role within
“Travel medicine is a lot broader than just
It is interesting to note that Dr. Allegra
the community in terms of benefiting patients,
giving vaccines,” Dr. Allegra emphasizes.
takes time several times a year to travel to
other physicians and the healthcare system
“People don’t realize, for example, that one
disadvantaged areas around the world to offer
with regard to tick borne illnesses. “We
of the most important problems when you
his services. “Most of the time I try to leave
are teachers. We give talks to people in the
go overseas is motor vehicle accidents. The
something behind, to impart knowledge and
community and to other doctors, explaining
roads in underdeveloped companies are not
get a plan together for controlling diseases so
how to determine if it is a tick bite and if it is
good. There are bandits at night, often riding
that when the next person comes, it can be
– how to diagnose it, how to treat it - and also
without headlights. Food and water safety,
carried forward,” Dr. Allegra says. His passion
what to expect,” Dr. Herman shares.
sun exposure, altitude exposure in certain
for traveling and for helping those who travel,
countries, special concerns for those who are
as well as his commitment to improve the
ID Care recently participated in a clinical
pregnant or diabetics, perhaps traveling with
lives of people who live in underdeveloped
study which focused on predicting which
syringes and insulin, are all important. So, part
countries around the world comes through
Lyme disease patients might be more prone to
of travel medicine is just common sense things
loud and clear.
having symptoms that linger on. Again, being
that you might not think about and then there
on the forefront of developments within the
are real risks to your health beyond what’s
For
field gives ID Care the edge when it comes to
covered with vaccinations,” he elucidates.
medical facilities in New Jersey, ID Care is a
providing the most effective treatments.
patients,
referring
physicians
and
valuable resource. Through the expertise of traveled
its specialty-trained physicians, ID Care has
ID Care also offers a significant advantage to
Dr.
extensively, often to second and third tier
Allegra,
who
himself
has
been able to accomplish much for our state’s
anyone planning a trip outside of the U.S.,
countries, informs those who are going to
healthcare community. Looking ahead, ID
especially to some of the second and third tier
places like Viet Nam, or on safari to Botswana
Care plans to further its mission to reduce
countries in Asia, Africa and South America.
or climbing the Himalayas, for example, to be
the occurrence of infectious diseases and
Donald T. Allegra, MD, FACP, FIDSA is a
aware of the significant risks to their health.
to provide the most innovative and effective
specialist in Travel Care/Travel Medicine,
“People who take these types of trips are
methods to treat them. Undoubtedly, this will
being one of only a very few physicians in
usually in pretty good health,” Dr. Allegra says.
positively impact all who live and work in New
New Jersey to achieve certification in tropical
“They’re thinking about all the things they need
Jersey in the years to come.
medicine and travelers’ health. Dr. Allegra also
to do – packing, getting the bills paid before
spent two years as an epidemic intelligence
they leave, taking care of things at their jobs
For more information or to make an appointment
service officer for the Centers for Disease
– but they don’t recognize that there are real
call (908) 281- 0221 or visit www.idcare.com
Control (CDC).
issues in these countries that you really ought to be prepared for,” he emphatically adds.
8
New Jersey Physician
Statehouse
New Jersey Statehouse Christie Vetoes Health Insurance Exchange By Kate Zernike
In a swipe at President Obama’s signature
New Mexico, who is also a Republican. In New
Assemblyman Herb Conaway of Burlington,
health care legislation, Gov. Chris Christie
York, Gov. Andrew M. Cuomo, a Democrat,
a doctor who was the lead sponsor of the
of New Jersey vetoed on Thursday an online
took the opposite tack last month: after the
legislation in the chamber, said the governor
marketplace that the Legislature created to
Legislature declined to create an exchange, he
was sending a message that “he doesn’t care”
help residents and small businesses buy health
established one by executive order.
about the 1.3 million state residents without
insurance.
health insurance. Ultimately, Mr. Christie’s veto is largely
The Affordable Care Act, the federal law passed
symbolic. The federal law requires states to
“By vetoing this bill, Governor Christie has failed
in 2010, requires most Americans to have health
offer health care exchanges by January 2014,
New Jersey’s uninsured residents, hurt New
insurance and mandates states to have health
but provides that Washington will step in to
Jersey’s chances of fully benefiting from federal
care benefits exchanges to help them buy it.
administer them in states that fail to make
health care reform and ignored the need to
With the Supreme Court debating whether the
progress by January 2013. In either case, the
provide relief to hospitals for uncompensated
health care law is constitutional, Mr. Christie
state pays to set up the health care exchange,
care,” Dr. Conaway, a Democrat, said.
said in his veto message that the exchange,
but states that fail to create the exchanges lose
approved in March, was “premature” and could
the ability to oversee them.
Democrats in the Legislature had billed the exchange as one-stop shopping for people or
impose “unnecessary obligations upon the Democratic lawmakers accused the governor
businesses seeking health insurance, allowing
of playing politics with the needs of the most
consumers to compare the benefits and the
vulnerable residents.
costs of participating plans.
the individual mandate to procure health insur-
“It’s clear from his actions that he is more
The Web site it proposed would have also
ance as well as the jurisdictional mandate to
focused on winning praise from national
allowed people to apply for tax credits or other
establish an exchange may not survive scrutiny
Republican pundits than protecting New
subsidies toward the cost of insurance.
by the Supreme Court,” he wrote.
Jersey families’ access to health care,” said
state’s citizens.” “Indeed, the very constitutionality of the Affordable Care Act is cloaked in uncertainty, as both
Assemblyman Louis Greenwald of Camden,
In his veto message, the governor said he was
“Because it is not known whether the
the leader of the Democratic majority in the
concerned about the potential costs of the
Affordable Care Act will remain, in whole or
State Assembly.
exchange.
now to create an exchange before these critical
The Democrats warned that the governor’s veto
The bill passed by the Legislature would have
threshold issues are decided with finality by
would leave the state scrambling to comply
established a Medicaid-like plan for people
the court,” he added.
with the federal law and could jeopardize future
with incomes between 133 percent and 200
in part, it would be imprudent for New Jersey
grant money. New Jersey had already received
percent of the federal poverty level. Mr. Christie
Mr. Christie was the second governor to veto
two federal grants, totaling $8.7 million, to
argued that it was unclear whether there would
such a law, following Gov. Susana Martinez of
prepare the exchange.
be federal financing to support such a plan. April 2012
9
Statehouse In addition, he argued that the mechanism the
Jerseyans who will be required to finance these
Washington and Trenton argued that the bigger
bill set up to approve plans would limit the
policy choices,” the governor wrote.
cost was allowing so many residents to remain
number of companies that could participate,
uninsured.
which he said would both reduce options and
Mr. Christie said that if the federal law
increase costs.
was upheld, he would oversee the state’s
“New Jersey taxpayers are on the hook every
compliance “in a responsible and cost-effective
time someone without coverage shows up
manner.”
in an emergency room, whether it’s for life-
“In all, with basic issues regarding the future of the Affordable Care Act unresolved, it is
threatening treatment or routine medical care,”
impossible to know whether this legislation
But while the governor cited the cost of
best suits the interests and needs of all New
putting the exchange into effect, Democrats in
United States Senator Robert Menendez said.
New Jersey Legislation Could Force Out-of-Network Physicians to Accept In-Network Rates The New Jersey Healthcare Disclosure and
understandable” explanation of the plan’s out-
providers from billing a patient any more than
Transparency Act is up for discussion today
of-network benefits.
they would have to pay if the provider were
in the state legislature, prompting healthcare
in-network. The physician would then only
stakeholders to discuss the legislation’s
The bill is not popular with physicians for
receive what he or she would have received as
potential effect on the industry and out-of-
several reasons. First, the bill would require
part of the health plan network.
network providers, according to an NJ Spotlight
physicians to make a “good faith” effort to
report.
collect the patient’s share of the bill before
Randy Minniear, senior vice president of
billing the insurer. The legislation would allow
government relations and policy spokesman
The bill will require health plans to explain
providers to waive the patient’s share in the
for the New Jersey Hospital Association, said
to their members the methodology for
event of financial hardship, as long as they
he’s concerned that if out-of-network providers
calculating the portion of a bill they will cover
don’t routinely waive the contribution.
can’t bill the patient, they will bill the hospital
for out-of-network care. The bill requires health plans to post on their website a “clear and
because they have no ability to collect out-ofThe bill would also prohibit out-of-network
network costs. “We can’t afford
Marking National Women’s Health Week in NJ, Winberg and Gill Move to Expand Women’s Access to Critical Health Care Services Senators Call on Governor to End ‘War on Women’ Marking National Women’s Health Week in New
to end his assault on women’s health care.
of New Jersey since taking office, essentially
Jersey, Senate Majority Leader Loretta Weinberg
Senators Weinberg and Gill announced their
creating a health care crisis for thousands of
and Senator Nia H. Gill today announced a new
intention to restore funding for family planning
women of this state. Each time we have put
effort to expand women’s access to critical
services in the FY2013 budget and to leverage
forward a proposal to fund critical family
health care services in New Jersey.
millions of dollars in additional funding for
planning services, the governor has hidden
these services through a generous 9-to-1 match
under the cover of ‘budget austerity.’ This year,
offered by the federal government.
he claimed we were entering healthier fiscal
During a press conference attended by health care
professionals
and
women’s
health
advocates, the Senators called on the Governor
10
New Jersey Physician
times, yet family planning services remained “The governor has waged a war on the women
unfunded. Apparently, women weren’t part of
Statehouse the ‘comeback’ he had in mind,” said Senator
fiscally prudent to provide access to preventive
group “Are You Dense, Inc.,” 40 percent of
Weinberg (D-Bergen).
services for women, but it is a health care
women have dense breast tissue, and many do
necessity for this state. Today, we are calling
not even know it. Only one in 10 women learns
“It’s time for the governor to end the ‘War on
on the governor to reject his party’s ideological
about breast density from their physician, which
Women.’ Despite the recent slumping revenue
stance in opposition to needed health care for
can prove tragic. Mammography misses breast
figures, we know that budgets are about
women and to accept the funding the federal
cancer in at least 40 percent of women with
priorities. We have identified a funding source
government has made available for vital health
dense breast tissue.
that will restore family planning services in this
services in this state.” The bill would require mammogram reports
year’s budget, and leverage millions of dollars in federal funding to reverse the disturbing
The Senators called the governor’s veto of
to contain information on breast density,
decline in women’s access to health care that
legislation to create a state-based health
based on the Breast Imaging Reporting and
we have seen over the last two years.”
benefit exchange his latest assault on women’s
Data System established by the American
health care, noting that as much as any group,
College of Radiology. When applicable, the
The Senators announced they will sponsor two
women benefit from health care reform by
bill would require the mammography report
budget resolutions to restore critical funding
making it more affordable, more accessible
to include a notice to the woman regarding
for family planning services in the FY2013
and by eliminating certain abuses that
the availability of supplementary screening
budget; the funding source for the restoration
disproportionately affect women. They said
tests for breast density, and that the report of
is a Salary Increases and Other Benefits
by refusing to move forward with a state-based
the mammography results would be sent to
account averaging $49 million in unexpended
exchange, the governor is denying women the
her physician. New Jersey would become the
balances over the past two years. The first
best way to create a marketplace for insurance
fourth state in the nation to enact such a law,
resolution would provide $7.59 million in
care and the best means of enforcing the
following Connecticut, Texas and Virginia.
grants for family planning services – grants the
patient rights for women and others. “New Jersey had historically been at the
governor eliminated in the FY2011 spending plan and failed to provide in the FY2012
“Seventeen percent of adult women in New
forefront when it comes to providing innovative
budget and the proposed FY2013 budget.
Jersey are uninsured, and for those who are
preventive health measures for our residents.
The second resolution will make available $1
earning a lower annual income and struggling
Despite the governor’s resistance to protecting
million to provide family planning services
to make ends meet, that rate more than
New Jersey women, we will continue our effort
under Medicaid, which will be matched by
doubles,” said Senator Gill, who sponsored
to march forward on that front,” said Senator
$9 million in federal Medicaid funding. The
the New Jersey Health Benefits Exchange Act.
Gill. “This important legislation will improve
measure would require the state to submit a
“These are women who would benefit from a
early detection of breast cancer for thousands
State Plan Amendment to the federal Centers
state-based health insurance exchange, but
of women for whom a mammogram screening
for Medicare and Medicaid Services to expand
may lose out because the governor is playing
would potentially miss the existence of a lump
the state’s Medicaid program to offer family
politics, presumably to curry favor with
or tumor. Ultimately this measure will save lives.”
planning services to individuals with incomes
Mitt Romney, who has vowed to repeal the
of up to 200 percent of the federal poverty
Affordable Care Act if elected president, as well
“This legislation is an important women’s
level, up from the current 133 percent of the
as the extreme right wing of his party.”
health measure that will vastly improve our ability to detect cancer early, and to treat
federal poverty level. The state will receive $9 in reimbursement for every $1 spent on family
In their continued fight to expand women’s
it when the likelihood for a positive health
planning services.
health care access in New Jersey, the Senators
outcome is at its best,” said Senator Weinberg.
sponsored
health
“It’s a commonsense policy from both a health
“Since Governor Christie took office, six family
legislation, approved unanimously today by the
and financial standpoint, as it will improve
planning clinics have closed and more than a
Senate Commerce Committee, to expand access
health care outcomes for women but also
dozen facilities have reduced services, scaled
to critical breast screenings for thousands of
significantly reduce the cost of treatment for
back hours of operation or laid off staff. We
women who are at high risk of getting breast
women diagnosed with cancer. These are the
must halt the continued shrinking of health care
cancer. The legislation (S-792) would require
kinds of policies we will continue to fight for in
services for women in the state and reinvest
health
order to provide New Jersey women with the
in health clinics and family planning centers
ultrasound breast screenings for women in
across New Jersey so that women can get the
the event a mammogram demonstrates dense
preventive care they need,” said Senator Gill,
breast tissue – which can block detection of
National Women’s Health Week is celebrated
(D-Essex, Passaic). “The reality is, we cannot
a tumor by a mammogram – or if a woman is
from May 13 through May 19 to promote
afford to continue down this dangerous path
believed to be at increased risk for breast cancer
awareness,
of reducing services to women. Not only is it
due to family history. According to the advocacy
activities that improve the health of all women.
important
insurers
to
pro-women’s
cover
comprehensive
best health care services possible.”
prevention,
and
educational
April 2012
11
Statehouse
Bill to Require Financial Transparency for All NJ Hospitals By Kelsey Brimmer
In an effort to standardize financial transparency
According
a
the hospital is actually making,” Joseph Scott,
for nonprofit and for-profit hospitals in New
spokesperson for the New Jersey Hospital
CEO of non-profit Jersey City Medical Center,
Jersey, the state’s Senate’s Health Committee
Association, for-profit hospitals in the state
told the NJ Spotlight.
approved a bill that would require for-profits to
would be required to report the same
publicly disclose the same financial information
information non-profit hospitals are required
New Jersey’s Department of Health and Senior
that nonprofit entities must file with the Internal
to report in the IRS 990 non-profit tax form,
Services would collect and post the information
Revenue Services.
Schedule H.
on its website, according to the bill.
The bill passed 9-0 with one abstention on
For-profit
care
McKean-Kelly said the New Jersey Hospital
Thursday.
from New Jersey to cover some of the
Association has not taken a position yet on
uncompensated care they provide to uninsured
whether it will be backing the bill or not.
to
Kerry
hospitals
McKean-Kelly,
receive
charity
Just as non-profit hospitals do, the bill would
and low-income patients. The bill, S-782 would
require for-profit hospitals to report their
require for-profit hospitals to report the same
“While we support the purpose of the bill to
operating budget, business holdings and
information in order to receive charity care
improve transparency among all hospitals, we
executive compensation, among other financial
funding, said McKean-Kelly.
were originally worried about the inconsistency within the bill,” she said. “The bill has since
data, to the state Department of Health and Senior Services to receive charity care funding.
Given that public funds finance charity care,
been amended so that the levels of reporting
The hospitals also must post the information to
“we should have the right to see how that
between non-profit and for-profit hospitals are
their own websites.
funding impacts them, and how much money
the same.”
Let Brach Eichler’s Health Law Practice Group Help You Chart a Strategic Course For Your Health Care Business Health care providers have long come to rely on the attorneys of Brach Eichler to navigate the regulatory environment at both the state and federal levels. Now that health care reform is being implemented, Brach Eichler is ready to help you make sense of the significant changes, the statutory framework and the ramifications for health care providers in New Jersey. Health Law Practice Group Todd C. Brower Lani M. Dornfeld
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New Jersey Physician
Special Feature
POSITIVE PHYSICIANS Insurance Exchange
A Physician-Driven Medical Malpractice Insurer That’s Proving to Be Just What the Doctor Ordered in New Jersey By Iris Goldberg
Obtaining reliable, long-term medical malpractice insurance coverage at an affordable cost continues to be challenging, to say the least, for a great many of the practitioners within our state. Equally daunting is the prospect of finding an insurer that offers ongoing personalized risk management support in order to minimize exposure for each individual client. As a long-standing, fully-regulated and leading Pennsylvania domiciled insurance exchange, Positive Physicians Insurance Exchange (PPIX) is taking root as an industry leader in New Jersey as well, where its mission is to provide the same cost-effective and proactive medical liability coverage. PPIX began its existence first as a Risk Retention Group (RRG) in Pennsylvania back in 2002 and transitioned into an Insurance Exchange in 2004. President & CEO Lewis Sharps, MD, in his position as President of the Political Action Committee of the Pennsylvania Orthopaedic Society, recognized the need, during the challenging economic circumstances of the time that many of his colleagues in Pennsylvania had for affordable liability coverage. He and another orthopaedic surgeon, Richard Balderston, MD along with several professional experts in the insurance industry joined forces, writing their first policy in October, 2002. Originally, Positive Physicians insured orthopaedic surgeons only but that quickly changed in order to accommodate the many other specialties in need of affordable coverage. The company widened its umbrella in early 2003 to insure a multidisciplinary group that now includes but is not limited to: • Anesthesia • Cardiology • Emergency Medicine
• General Surgery • Internal Medicine • Neurology • Neurosurgery • Ophthalmology
• Orthopaedic Surgery • Pain Management • Physiatry • Plastic Surgery
• Podiatry • Primary Care • Radiology • Sports Medicine • Urology
In 2004, as the young company continued to grow, attracting more practices and receiving a wealth of positive feedback, the decision was made to apply for approval to transition from an RRG to become a Reciprocal Insurance Exchange in Pennsylvania. This would ensure eligibility to provide its clients with a layer of coverage from the Pennsylvania Insurance Guarantee Fund. Coinciding with this important step, the company began the process of putting together its first reinsurance contract with Lloyd’s of London. April 2012
13
Special Feature Today, PPIX, a Pennsylvania and New Jersey fully-regulated, domiciled insurance exchange, maintains relationships with a supportive network of industry leaders and professionals: • Endorsed by Pennsylvania Orthopaedic Society • Reinsured by Lloyd’s of London • Regulatory Compliance and Accounting by Strategic Risk Solutions, Ltd. • Actuarial Services by Huggins Actuarial Services, Inc. • Accounting and Auditing by Eisner Amper LLP • Claims and Risk Management by Gateway Risk Services, Inc. • Relationships with many major Insurance Brokerage firms It is without question that the cornerstone of Positive Physicians is its aggressive, team-oriented approach to risk management. That, combined with a system of claims management that is proactive and aggressive as well, has allowed PPIX to thrive for more than a decade. Operated by practicing physicians and experts from both the healthcare and insurance communities, Positive Physicians now offers the same affordable, experienced insurance and risk management services to New Jersey’s practitioners as it has to those in Pennsylvania since 2002. Exceeding its actuarial reviews each year and consistently putting underwriting profits back into the company, PPIX also earns praise by focusing on providing customized “boutique” services to its clients. This personal touch begins with a phone answering system in which a prospective or existing client will immediately be connected to someone on staff, instead of having to navigate through a series of automated prompts. Additionally, Positive Physicians makes it a practice to have a representative go out and personally meet with the physicians and staff of every new client. Many times a client’s existing broker will request that the PPIX team accompany him or her to meet with that client. In this way there is more than just a voice on the other end of the phone in the
14
New Jersey Physician
event that a problem does arise. This may be responsible, to a great extent, for the 95% retention rate that PPIX has enjoyed in Pennsylvania and undoubtedly, this trend will be duplicated in New Jersey going forward. Positive Physicians prides itself on the ongoing communication with its policyholders as a significant factor that helps achieve the goal of reducing the frequency of claims submissions and the associated potential risks. In fact, PPIX requests that each practice selects one of its employees to be designated as the Risk Management Coordinator of that practice. He or she then monitors any potential risk concern that might arise and acts as a liaison between the practice and Positive Physicians, where knowledgeable staff is accessible on a 24/7 basis to advise on how to proceed. At that point either the staff at Positive Physicians or, if necessary, a third party Administrator will communicate with the practice immediately. To ensure that the Risk Management Coordinator and other key members of the practice are educated about possible malpractice risks and know the ways in which to preemptively act to prevent or control a potential claim, Positive Physicians offers ongoing consultations as well as regularly scheduled conference calls to update them and to discuss any and all concerns. Controlling physicians’ exposure to risk is unquestionably the most effective way of minimizing the number of malpractice claims. To this end, PPIX leaves no stone unturned.
at Positive Physicians actually elevates the quality of care for patients as well. “Anything that allows us to get closer to an event that has made a patient unhappy, also allows us to intervene earlier and that in turn can result in significant improvements in care for patients,” he points out. Executive Director of PPIX, Leslie Latta, clearly explains that the way Positive Physicians has structured its risk management does not result in any additional overhead to its insureds. Rather, it’s a process that’s managed through the practice which involves utilizing personnel who have contact with patients and understand patient care. PPIX provides these individuals with an additional set of resources in order to help them elevate that level of care even further, thereby, also decreasing risk for the practice. “Many malpractice claims do not come from malpractice but from unhappy patients,” Dr. Sharps candidly reports. “By decreasing risk, we decrease claims and therefore, decrease premiums. This is how it works,” Ms. Latta succinctly explains. “In this way we also supply the patient with support by eliminating any issues that result in patient dissatisfaction. We can actually intervene and correct,” Dr. Sharps adds. “If a patient feels that his or her concerns
POSITIVE PHYSICIANS Insurance Exchange Management Team Lewis Sharps, MD, FACS President & CEO
Dr. Sharps emphasizes the importance of dealing with any and all concerns as soon as they arise. “We are extremely proactive in our risk management approach,” he strongly states. “As soon as anything comes in, we’re right on it and work it through the entire process,” Dr. Sharps shares. “The fax comes in as what we call a PCE or potentially compensable event and it’s dealt with immediately.”
Richard Balderston, MD, FACS Chairman of the Medical Review Board
Steve Zabinski, MD Chairman of the Board, NJ
Kurt Gingrich President Gateway Risk Services
Leslie Latta Executive Director
Brian York Director of Underwriting
In fact, Dr. Sharps goes on to explain that the way in which risk management is handled
Jason Sharps Director of Sales & Marketing
have been taken seriously, that patient is obviously less likely to sue.” Most instrumental in Positive Physicians’ expert handling of risk management is its Medical Review Board which is comprised of leading practicing physicians from multiple specialties and representing a diversity of geographic areas within Pennsylvania and New Jersey. Brian York is Director of Underwriting at PPIX. “I don’t think anyone understands medical and surgical risk better than we do,” he asserts, referring to its unique and all-encompassing Medical Review Board. In fact, as Positive Physicians continues to establish here in New Jersey, there are some specialty chairs still available. Those proactive physician leaders who might be interested in adding their expertise by serving on PPIX’s New Jersey-based Medical Review Board are urged to call. In the unfortunate event that a risk concern
escalates into a claim, PPIX has an armamentarium of resources at its disposal. An experienced team of claim professionals and legal counsel launches a proactive and aggressive effort to verify and defend a claim. Resolving incidents as early as possible is the best way to protect the physician and actually benefits patients as well. This is the primary goal of Positive Physicians in every situation. If, however, it is not possible to have an expedient resolution to a claim, Positive Physicians’ legal counsel has a consistent record of successfully defending malpractice lawsuits in both Pennsylvania and New Jersey. In addition to its expertise in the areas of claims and risk management, Positive Physicians has also focused on controlling expenses. By maximizing efficiency and maintaining a low overhead, PPIX is able to pass savings along in terms of lower premiums without compromising the
superior customer service that has now come to be expected by its many clients. Many report savings of as much as 10-20% when compared to previous policies. Perhaps the greatest source of pride for Dr. Sharps and the management team at Positive Physicians is the tremendous amount of client loyalty and satisfaction. “We look at our relationship with our insureds as a partnership,” Dr. Sharps says. “We protect them and they protect us,” he shares. “When it comes to taking care of our clients, we are absolutely dedicated to not leaving anything unanswered,” Dr. Sharps emphatically adds. For many in New Jersey’s distinguished healthcare community, Positive Physicians Insurance Exchange is proving to be a welcome addition. Phone: (610) 644-5262 Toll Free: (888) 335-5335 info@positivephysicians.com www.positivephysicians.com
April 2012
15
Food for Thought
The Orange Squirrel Bloomfield, New Jersey By Iris Goldberg
For those who are regular readers you know that “Food For Thought” does not necessarily guarantee that my thoughts will be exclusively devoted to the food. Way back when I started this column I explained that I am not a trained food critic by any means. Food has been an integral part of our lives since we met and Michael and I have spent a great deal of time experiencing food from many different venues and cultures. Whether it’s pricey haute cuisine or supposedly the best hamburger around, we’re eager to investigate.
We also enjoy
entertaining and preparing interesting meals for our guests. For us, food has always been a way to celebrate and also to console ourselves, at times. These occasions have often prompted me to discuss the circumstances at the time as hold. We were awed by the coincidence that
about, Executive Chef and owner Francesco
had us consumed with the loss of one life and
Palmieri and staff did know who we were and
Last evening we dined for the first time at the
the beginning of another during the same exact
adjusted things a bit to give us a somewhat
Orange Squirrel in Bloomfield. We met our
time period.
more diverse sampling of the fare at the Orange
well as the food itself.
Squirrel. I am absolutely sure, however, that
dear friends Bonnie and Ben. I’ve mentioned them before. Bonnie and I are actually cousins.
As is always life’s pattern, the immediate crisis
the food itself was prepared for us exactly as
Our paternal grandmothers were sisters but the
did resolve.
Thankfully, my brother-in-law
it would be for any other patron. For example,
relationship the four of us share is based on
passed peacefully in his sleep and although his
while we were waiting for our appetizers we
our sheer enjoyment of each other. They are
loss will be mourned, we were all grateful that
were each treated to an amuse bouche of one
amongst our most favorite dining companions –
his suffering was finally over. Four days later
of the appetizers we had not selected, a fried
always ready to try something new and engage
our daughter’s obstetrician gave her the green
PEI mussel on a bed of superbly seasoned
in scintillating conversation during our meal.
light to gradually resume normal activities. Not
corn, mango and watermelon salsa. This was
wanting to go to press without a current food
quite a delicious tease!
I had gotten a few emails from a couple of
column, we quickly made arrangements to
readers about the creative menu at the Orange
meet Bonnie and Ben at the Orange Squirrel.
Our appetizers arrived, each one beautifully presented. I chose a wild mushroom tempura
Squirrel during the past year or so but we had never had a chance to actually go. We thought
The décor is somewhat understated and gives
with cherry tomato and white truffle oil with
Bonnie and Ben might enjoy checking it out
no hint of the pleasures to come, although
an aioli of baby artichoke on the side. The
with us. Here come the circumstances – When
the orange hanging lights and other Italian
tempura batter had just the right crispness and
we finally got in touch to schedule something,
accents are festive. Our server welcomed us
flavor while allowing the distinctive taste and
life suddenly presented Michael and me with
and immediately inquired if there were any
texture of the mushrooms to be appreciated
some lemons.
food allergies or other dietary restrictions. The
and the baby artichokes were a wonderful
Orange Squirrel is one of the few restaurants of
complement. Michael’s spinach salad looked
Our brother-in-law was hospitalized after a
its type to have a bar on premises and they offer
too good to eat with the delicate baby leaves of
long illness and given only weeks to live. Our
a very decent and reasonably-priced wine list.
spinach arranged in a circle around the bacon,
pregnant daughter took a fall and had to be
mushrooms and other ingredients. He ate it in
confined to bed for a month. Any plans to
At this point it would be fair to mention that
dine out or socialize in any way were put on
unlike the situation at most restaurants I write
16
New Jersey Physician
record time, savoring each bite.
Bonnie
ordered
a
tomato
and
buffalo
When dessert time came we were all stuffed.
more than three years. For his bio and other
mozzarella salad which came with slices
We were intrigued, however by the Three Dirt
interesting information about the restaurant
of watermelon.
What an unexpected, yet
Tasting which is a variety of three tall, thin
please visit www.theorangesquirrel.com.
delicious combination. Ben chose the most
glasses of layered mousse and crumbs with
interesting appetizer of all – an eggplant soup,
the flavors changing monthly. In addition, Chef
To bring things full circle, I must share
usually served with a froth of goat cheese
Palmieri brought an artfully decorated plate of
something Chef Palmieri said.
on top. Since he mentioned that he is not a
four tiny homemade chocolates, a chocolate
about a spiritual relationship he has with the
tremendous fan of goat cheese, his came with
bread pudding and an orange crème brulee.
preparation of food.
the goat cheese on the side. He enjoyed every
There was also a small glass of Chef Palmieri’s
the way in which he expresses his feelings,
spoonful!
homemade Irish Crème.
especially his joy in creating foods that excite
He spoke
It is his passion and
and please the eye and the palate. The main dishes were equally creative. Bonnie
By this point my taste buds, although as happy
and Ben shared a whole Bronzini prepared
as they’ve ever been, were not able to identify
On this evening the food was spiritual for me
with blood orange and beurre blanc, served
the subtle flavors of each sweet delight. I can
too. Not only was it extraordinary but it was a
beautifully in the cast iron pan in which it was
tell you that every spoonful that went from one
reminder that the cycle of life goes on and on.
prepared. I had a smoked tuna, cooked rare
dessert to the other was a joy. I do remember
Here we were, enjoying a wonderful meal with
and sliced atop
the corn and mango salsa,
the refreshing mint flavor of one of the mousse
cherished friends once again. Unfortunately,
served with a creamy mushroom risotto and
selections and the very special quality of the
yet another dear person is lost to us but we are
a bowl of spicy popcorn on the side. The
homemade chocolates that were actually
consoled when we remember all of those who
smokey flavor with tuna was a totally new
provided by our gracious server’s mom.
are still with us to share the good times as well
experience for me and it worked exceptionally
The name of her establishment is Matisse
as the bad - and so excited to celebrate the new
well. Michael had a skate wing that was lightly
Chocolatier with a New Jersey location in
life to come.
floured and sauteed and served with a fried
Englewood. The Orange Squirrel is located at 412 Bloomfield
plantain, decoratively placed on top. This too, came with the mushroom risotto. We also
While we feasted on the sweets Chef Palmieri
all shared an order of delicious caramelized
gave us a history of the Orange Squirrel, which
Cippolini baby onions.
has been operating with much success for
Avenue, Bloomfield, NJ 07003. (973) 337-6421
April 2012
17
Association News
Mary F. Campagnolo, MD, MBA Installed as 220th President of Medical Society of New Jersey counsel. “She is focused on issues important to our organization, including the integration of medical practices, advancing women in medicine and building equity and payment reforms in networks and Medicaid to increase the public’s access to physicians.”
Mary F. Campagnolo, MD, MBA was installed as the 220th president of the Medical Society of New Jersey (MSNJ) at its annual meeting held on May 5th. She is the third woman to hold the title of MSNJ president since the organization was established in 1766. Dr. Campagnolo practices family medicine at Virtua Lumberton Family Physicians in Lumberton, N.J., and is chief of the Department of Family Medicine at Virtua Memorial Hospital in Mt. Holly. She also cares for nursing home and subacute rehabilitation patients at Virtua Health and Rehabilitation Center and serves as medical director for primary care at Virtua Medical Group in Marlton. “Mary’s role as an advocate for medical quality and quality improvement, coupled with her dedication as a family physician, make her the perfect choice for president,” said Larry Downs, MSNJ CEO & general
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New Jersey Physician
As a recognized leader in a number of organizations, Dr. Campagnolo is past president of the New Jersey Academy of Family Physicians and still serves on its Board of Trustees. She has chaired the Virtua Medical Group Quality Committee for the past three years; is an appointee to the New Jersey Department of Health and Senior Services Nursing Home Administrator’s Licensing Board; and is a member of the Mandated State Health Benefits Committee of the Department of Banking and Insurance. Dr. Campagnolo earned her undergraduate and medical school degrees at George Washington University in Washington, D.C.,
and she completed her residency in family medicine at Overlook Hospital in Summit, N.J. She is a Diplomate of the American Board of Family Medicine and holds a Certificate of Added Qualifications (CAQ) in geriatrics. Dr. Campagnolo was awarded an MBA with a concentration in operations management from Rutgers School of Business in Camden, N.J. About MSNJ Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. MSNJ has a mission to promote the betterment of the public health and the science and the art of medicine, to enlighten public opinion in regard to the problems of medicine, and to safeguard the rights of the practitioners of medicine. MSNJ represents all medical disciplines and serves as an advocate for patient and physician rights. Its members are dedicated to ensuring delivery of the highest quality medical care throughout New Jersey.
Association News
MGMA Conference a Huge Success
p Ross Mazer and the Provident Bank Healthcare Group have many services to offer healthcare practices.
p Patrick Robinson and the PNC Bank team has exhibited at every MGMA conference since its inception.
p Brian Kern (left) and Henry Kane, formerly founders of Argent Professional Insurance have now joined forces with Bollinger Insurance to create a new professional insurance group for this long established firm
p Jason Sharp of Positive Physicians Insurance Exchange waits at his booth to introduce his company to the attendees. While new to New Jersey, Positive Physicians has had 10 years of success in Pennsylvania.
p The record setting crowd at this years MGMA conference sits down to breakfast prior to the start of the program. April 2012
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Diagnosis Food for Thought
D IAGNOSIS Famed Infectious Disease Specialist Leon Smith, MD has suggested we start a contest. He will submit symptoms and the correct diagnosis will win a New Jersey Physician T-Shirt, as well as getting honorable mention in our column. Here are this months cases for you. Case 1 A prominent 62 year old world class movie director developed daily shaking, chills, and fever with up to 104 fever for 2 weeks while shooting a movie in Japan. He was toxic while febrile and the fever and chills were aggravated by fried foods and apples. The laboratory studies revealed an elevated white count with 10 bands. The blood cultures were negative and the alkaline phosphates were slightly elevated.
Case 2 89 year old white female developed severe diarrhea in a retirement home along with 100 other residents.
Case 3 A 27 year old white female prominent actress with loss of vision in both eyes occurring in one eye at a time. MRI of brain and carotid were negative. Gr II S murmur of the heart of long standing. No fever or splinter spleen tip felt.
Case 4 A 42 year old white female with chronic sore throat for years and later hoarseness. She was very sexually actice for years having oral sex with many men. Exam of the throat was negative. ENT doctor scoped the area. A biopsy revealed squamous cell cancer of the vocal cord polyps.
Rx
Please send responses to MGoldberg@NJPhysician.org 20
New Jersey Physician
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