NJ Physician March 2012 by NJPhysician Magazine

m a rc h 2 012

Visit us now online at www.NJPhysician.org

Femino-Ducey-Queler Orthopaedic Group Bringing Movement Back to Life Also in this Issue • CMS Publishes Proposed Rule on Reporting and Returning Medicare Payments • New Jerseyans Get Loud in DC as hundreds join health care law protest • The Business of Medicine: Prohibited Business Activities That Restrict Patient Care

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Publisher’s Letter Dear Readers, Welcome to the March issue of New Jersey Physician, the voice of the state’s medical

Published by Montdor Medical Media, LLC

community.

Co-Publisher and Managing Editors Iris and Michael Goldberg

New Jersey Physician is pleased to announce the launching of our website, www.

Contributing Writers Iris Goldberg Michael Goldberg Lani Dornfeld, Esq John Fanburg, Esq Kevin Lastorino, Esq Todd Brower, Esq Keith Roberts, Esq Mark Manigan, Esq Trish Graber Bonnie Delaney Rose Suriano, Esq Leon Smith, MD

njphysician.org. We will have our current issue and past issues available for viewing, as well as an interactive version of Diagnosis and a frequently updated “Breaking News” column covering all important issues developing in the healthcare market as they occur. Additionally, we will have space for physicians to comment on current issues in healthcare including editorial and an area for op-ed opinions you wish to share with readers. Please visit us often and regularly to keep yourselves aware of developing matters of importance to your practices. CMS has recently published a proposed rule implementing sections of the health reform law regarding reporting and returning overpayments under the Medicare program. This is crucial to your practice as failure to return an overpayment imposes liability under the federal False Claims Act exposing the provider or supplier to treble damages and penalties.

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Contents

Femino-Ducey-Queler Orthopaedic Group Bringing Movement Back to Life CONTENTS

Health Law Update

• DOBI Proposes Several Substantive Changes to New PIP Regulations Introduced Last August • The Cullen Act’s Civil Immunity Protection Successfully Tested in Court • CMS Publishes Proposed Rule on Reporting and Returning Medicare Overpayments

Statehouse

• (Slow) Progress Towards Uncovering Sex-Linked Differences in Drug and Device Safety and Efficacy • Medicaid ACO Demonstrations • Senate Hears Bill on Health Insurance Exchange

Legal Issues

• The Business of Medicine: Prohibited Business Activities that Restrict Patient Care • ASC Licensure Required for One Room Surgery Centers

Food for Thought

Lez Rendez-Vous

Kenilworth, New Jersey

Monmouth Medical Center

• Monmouth Medical Center Brings the DaVinci Robotic Surgical System to the Monmouth Mall

Diagnosis

COVER STORY

• Famed Infectious disease specialist Leon Smith, MD has some difficult cases for you this month

Cover Photo: From the left, Dr Seth Queler, Dr Frank Femino and Dr Stephen Ducey. cover PHOTOs BY michael goldberg

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March 2012

Cover Story

Femino-Ducey-Queler Orthopaedic Group Bringing Movement Back to Life By Iris Goldberg

In the cyber-propelled world we live in today,

returning patients to an independent and active

where limitless information is available in an

lifestyle. For the many patients who come to

instant, making informed decisions about our

FDQ that have been suffering with debilitating

healthcare is a given. It is not surprising there-

pain for a lengthy period of time, finding the

fore, that Femino-Ducey-Queler Orthopaedic

pathway towards a successful resolution is

Group (FDQ), located in Belleville, attracts pa-

especially gratifying for the surgeons.

tients from areas throughout New Jersey. In fact, many come from surrounding states and some

Dr. Femino is the senior partner at FDQ. He

have even traveled from other countries to re-

joined the practice in 1997, after completing

ceive care from this highly experienced team of

fellowship training in adult reconstructive

fellowship-trained, sub-specialized experts.

surgery and joint replacement. At that time, the two other physicians who were there were

Frank P. Femino, MD, Stephen A. Ducey, MD

nearing the end of their careers. Once they

and Seth R. Queler, MD have each become

left, Dr. Femino recruited Dr. Ducey, who is

renowned for the level of skill achieved in his

fellowship trained in sports medicine.

particular area of expertise (See Fig.1). All three share the primary goal of eliminating pain and

“Sports medicine and total joint replacement complement one another very nicely,” Dr. Femino relates. “We continued to build the practice together until we hired Dr. Queler, who is fellowship-trained in orthopaedic foot and ankle and he is now in his third year with us,” he adds. “So we cover head to toe,” Dr. Femino says with a smile. When

discussing

the

joint

replacement

surgeries he performs, Dr. Femino reveals how the techniques he employs result in excellent outcomes for his patients. “Minimal collateral damage summarizes it in three words,” he says. That means less blood loss, less soft tissue damage, less pain and quicker recovery,” Dr. Femino emphatically states. A great many patients consult with Dr. Femino because of chronic hip pain and disability, mostly as a result of osteoarthritis, rheumatoid arthritis or traumatic arthritis. p Dr Femino goes through the smaller opening and spreads the soft tissues apart to get down to the hip joint rather than cutting through them.

New Jersey Physician

When conservative treatment modalities are not effective in adequately reducing pain and

Specialty Services Offered at FDQ The Femino-Ducey-Queler Orthopaedic Group specializes in adult reconstructive surgery, joint replacement surgery, treatment of sports-related injuries and foot and ankle disorders. The following are some of the procedures performed by the surgeons within each of their specific areas of expertise: Dr. Femino – Hip and Knee Replacement •Total Hip Replacement •Anterior Hip Replacement •Minimally Invasive Total Hip Replacement •Same-Day Partial Knee Replacement •Small-Incision Total Knee Replacement • Minimally Invasive Unicompartmental Knee Replacement •Revision Total Hip replacement •Revision Total Knee Replacement Dr. Ducey – Shoulder and Knee Arthroscopy •Knee Arthroscopy •Patellafemoral Realignment •ACL Repair •Meniscus Repair •Shoulder Stabilization •Rotator Cuff Repair •Shoulder Replacement •Hip Arthroscopy •Wrist Arthroscopy •Elbow Arthroscopy Dr. Queler – Foot and Ankle Procedures • Deformity Correction (flat foot and high arch deformities) •Ankle Fusion •Total Ankle Replacement •Bunion and Hammer Toe Correction •Tendon Transfers •Achilles Repair • Fusion of Midfoot and Hindfoot for Arthritis •Ligament Reconstruction and Repair •Treatment of Tendon Injurues •Lisfranc Injuries •Fractures of the Foot •Fractures of the Ankle •Osteotomies Fig. 1 •Ankle Arthroscopy

“You’re not cutting muscles across their fibers.

While forty percent of the total joint replace-

You’re not damaging any of the supporting

ments performed by Dr. Femino are in the hip,

structures around the hip,” he emphasizes.

sixty percent are total knee replacement procedures for patients who suffer from severe

p Dr Femino with one of the instruments he designed for performing a minimally invasive hip replacement.

In fact, Dr. Femino, who also has training in

degenerative disease of the knee joint. Mini-

mechanical engineering, shares that many of

mally invasive total knee arthroplasty involves

the surgical instruments he utilizes are actually

replacing the lost cartilage and diseased bone

prototypes which he designed himself. “Those

with prosthetic components that, like the hip

instruments allow me to do a hip replacement

implants used by Dr. Femino, are state-of-the-art

the way I want to do it – to give me that access

and allow him to tailor his joint replacements to

through a minimal approach,” he asserts.

each patient’s needs.

“It’s like the ship in a bottle philosophy,” he

Dr. Femino reiterates that when conservative

suggests. “Get in there through a small approach

treatments are not effective, joint replacement

that doesn’t damage the soft tissue envelope.

surgery gives patients, many of whom are

restoring function, Dr. Femino may suggest

You’re really sneaking the hip replacement into

otherwise healthy, the opportunity to resume

total

the patient without awakening the soft tissues,”

their normal activities without the pain and

offers Dr. Femino.

loss of mobility they had been experiencing.

hip

arthroplasty

(replacement).

During this procedure, the damaged bone and cartilage in the hip joint are removed and replaced with prosthetic components.

Much like the total hip replacement surgeries, Besides a repeatedly successful minimally in-

Dr. Femino and his experienced team employ a

vasive technique, Dr. Femino uses prosthetic

minimally invasive approach and complete the

Dr. Femino’s philosophy regarding total hip re-

implants that are tried and true as well. “I’m

total knee procedures in a short amount of time

placement is that his first priority is to relieve

giving my patients the best possible implant

to decrease the risk of complications.

pain and to accomplish this in the least invasive

for long-term survivorship,” he informs. Incor-

way in order to minimize the risk for complica-

porating the most current implant technology,

An important distinction between Dr. Femino’s

tions. “The shorter the surgery, the better for

such as a newer Vitamin E-enhanced polyeth-

surgeries and some other total joint procedures

the patient,” Dr. Femino explains, referring to

ylene, which has demonstrated greater resis-

is that Dr. Femino’s patients receive an injection

less time under anesthesia, less blood loss, de-

tance to harmful oxidation and a highly porous

of anesthetic in the spine and mild sedation as

creased potential for blood clots and infection

metal that has been engineered to allow bone

compared to general anesthesia. This allows

and an overall faster rehabilitation period.

integration and enhance fixation, assures Dr.

those patients with medical conditions such

Femino that his joint replacement patients will

as COPD, heart disease or diabetes to receive

“We’re not rushing. We are very precise and

keep their prosthesis for many years to come,

medical clearance for surgery when they might

deliberate in what we are doing,” Dr. Femino

some now lasting a lifetime.

otherwise be rejected. Also, especially with the

wants to make clear. “When I perform a surgery, I like to think of it as a symphony, where I’m the conductor and everyone works in harmony with one another,” he shares. Dr. Femino explains that because his highly skilled surgical team has been working with him for years, everyone does his or her part with extreme efficiency, allowing the procedure to be completed precisely, thereby minimizing risk and producing an excellent result. In order to perform a minimally invasive total hip replacement, Dr. Femino does use a relatively smaller incision but he points out that it’s the surgical technique he employs within the hip that is most important. Dr. Femino describes going through the smaller opening and spreading the soft tissues apart to get down to the hip joint rather than cutting through them.

p Dr Femino uses prosthetic implants that are the most technologically current to ensure long term survivorship March 2012

p As in hip replacement surgeries, Dr Femino and his experienced team employ a minimally invasive approach and complete the total knee procedures in a short amount of time to decrease the risk of complications.

p Dr Ducey performs a variety of highly specialized sports medicine procedures (see fig 1 on page 4)

total knee replacement, a nerve block included

left untouched. This procedure produces a

Arthroscopic knee surgeries performed by

with the anesthesia interrupts the pain pathway

much quicker recovery. “Some of my patients

Dr. Ducey include anterior cruciate ligament

and allows patients to wake up from their

have been playing golf in less than a week,” Dr.

(ACL)

procedure without pain.

Femino reports.

replacing the torn ligament with a tissue graft.

reconstruction,

which

involves

Also, Dr. Ducey uses his arthroscopic expertise From the time a patient consults with Dr.

Another innovative yet less invasive knee

to repair meniscal tears, which are among

Femino about having a joint replacement until

procedure for degenerative disease within the

the most common knee injuries. Menisci are

the surgery has been done and rehabilitation

knee offered at FDQ is partial patellofemoral

pieces of cartilage that act as “shock absorbers”

has been completed, Dr. Femino shares that

arthroplasty performed by Dr. Ducey. This

between the thighbone and the shinbone. They

he maintains a seamless relationship with that

procedure, which is also done on an outpatient

help cushion the joint and keep it stable.

patient. He is particularly proud of the care

basis, replaces only parts of the knee cap

patients receive at Clara Maass Medical

area. “If someone has isolated arthritis just

Dr. Ducey discusses some of the other highly

Center, where he is Chief of Orthopaedics.

in that area, we can do something to help

specialized

There, a brand new, beautiful hotel-like unit,

them,” Dr. Ducey says, explaining that like

he performs (see Fig.1). He relates that

the Joint and Spine Institute is dedicated

the unicompartmental procedure, only the

interestingly, he has a dichotomy of patients

to house joint replacement patients from the

damaged part of the knee is replaced, leaving

that includes older individuals who, through

time they leave the recovery room until they

the healthy part of the knee intact.

the wear and tear of the aging process, have

sports

medicine

procedures

are discharged from the hospital. All the rooms are private and therapy begins immediately in the impressive large-windowed gym. Many other amenities designed specifically for the comfort of post-surgical patients have also been provided. It is important to note that for some patients that only have degenerative disease in one part of the knee, Dr. Femino performs a same day minimally invasive unicompartmental partial knee replacement, where only the damaged compartment is replaced with an implant and the healthy cartilage and bone in the knee are

New Jersey Physician

p All rooms in the Joint and Spine Institute are private and specifically designed for the comfort of post surgical patients.

p Dr Queler cuts the heel bone to shift it from the outside, where it sits in those with acquired flatfoot deformity, more towards the inside or midline of the body

p Shown here, one of Dr Ducey’s shoulder replacement surgeries in progress

Hip arthroscopy, which is still emerging within

patient satisfaction with the physicians and

the sports medicine arena, is a technique that

staff at FDQ. “Patients know that we are always

Dr. Ducey skillfully employs that can allow

available to answer any question or concern.”

appropriate patients to avoid major surgical developed significant symptoms within a

reconstruction of the hip joint. Additionally Dr.

When Dr. Queler joined Drs. Femino and

knee or shoulder and younger patients who

Ducey performs elbow and wrist arthroscopies

Ducey almost three years ago, he brought a

have sustained injuries to these joints through

which also can eliminate the need for more

third area of sub-specialized orthopaedic care.

participation in sports.

invasive procedures.

Fellowship-trained in conservative and surgical care of the foot and ankle related to sports

“I see a lot of patients who require arthroscopic

Along with the excellent treatment results

injuries, trauma, arthritis, bunions, hammer

rotator cuff repairs,” Dr. Ducey relates, citing

achieved at FDQ, Dr. Ducey strongly believes

toes, diabetic problems and foot deformities,

the many patients whose rotator cuff tendons

that patients benefit greatly from its warm and

Dr. Queler performs a variety of procedures

have been damaged over time, resulting in a

friendly environment. “We want our patients

(see Fig.1), some of which are quite complex.

tear and some who have sustained an acute

to feel confident and comfortable with us,” he

tear. Other shoulder surgeries that Dr. Ducey

strongly states.

number of orthopaedic surgeons in the

performs include shoulder replacement, including

reverse

shoulder

and

also

shoulder resurfacing. In the innovative reverse shoulder replacement

It is significant to note that there are a limited

Dr. Ducey points to the many patients who

New Jersey and surrounding areas who are

return to Femino-Ducey-Queler for subsequent

specifically trained in foot and ankle care.

surgeries after having a very positive experience

“There are 26 bones in the foot,” Dr. Queler

previously, as an indication of the high level of

informs, citing the importance for patients to

procedure, the socket and ball are switched. A

have access to a physician who sub-specializes

metal ball is attached to the shoulder bone and

in treating this part of the body.

a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid

Dr. Queler describes some of the surgeries

muscle instead of the torn rotator cuff to lift the

he performs. He begins with a posterior

arm.

tibial tendon reconstruction that includes a transfer of the flexor digitorum longus tendon

Dr. Ducey explains the difference between

and an osteotomy of the calcaneus (heel bone).

shoulder replacement, where the head of the

This is a standard procedure for potentially

humerus is replaced with a metal ball and

painful acquired flatfoot deformity in an

stem and shoulder resurfacing, which involves

adult, a condition that results in a fallen arch

replacing only the joint surface of the humeral

with the foot pointed outward, usually as a

head with a cap-like prosthesis without a stem. Resurfacing may be suitable for patients who are younger and more active.

p In posterior tibial tendon reconstruction, Dr Queler removes the diseased portion of the posterior tibial tendon and transfers the flexor digitorum longus tendon into the navicular bone.

result of damage to the posterior tibial tendon. Acquired flatfoot deformity is a relatively common disorder, as Dr. Queler explains. March 2012

Basically, this procedure involves removing the diseased portion of the posterior tibial tendon and transferring the flexor digitorum longus tendon that sits behind it, into the navicular bone, thereby replacing the non-functioning tendon with one that can now act as a support for the arch. Then Dr. Queler cuts the heel bone to shift it from the outside, where it sits in those with acquired flatfoot deformity, more towards the inside or midline of the body. For patients with severe ankle arthritis, total ankle replacement is a state-of-the-art procedure for which Dr. Queler has received specialized training. “Studies have shown that when it comes to end-stage arthritis of the ankle and all conservative methods have failed, total ankle replacement is an excellent option,” Dr. Queler offers. “There are a lot of advantages to

p Dr Queler is one of only a limited number of orthopaedic surgeons in New Jersey and surrounding areas who are specifically trained in foot and ankle care

this procedure such as maintaining motion and a comparatively improved gait,” he continues. He is especially excited about some of the newer

Other foot and ankle problems treated by Dr. Queler occur as the result

ankle prostheses that have been developed recently, which he feels, have

of illness. For patients with peripheral neuropathy, usually as a result of

the potential to provide excellent long-term results, although data is still

diabetes, often Dr. Queler expertly performs Charcot reconstruction.

being compiled.

Charcot foot is a progressive degenerative condition causing damage to ligament, cartilage and bones in the foot. Charcot affects the metatarsal,

Dr. Queler emphasizes that candidates for total ankle replacements must

tarsometatarsal and tarsal joints, which are located in the forefoot and

be carefully selected. “The ideal patient would be someone over the

midfoot. During surgery, structures within the foot are reshaped and bony

age of 50, who doesn’t smoke and is not overweight,” Dr. Queler shares.

protrusions are removed. In some cases hindfoot and ankle realignment

Although the procedure is a promising alternative to ankle fusion

fusion is performed to stabilize the bones.

surgery for some, Dr. Queler reports that there are many for whom fusion is still the best option. For these patients Dr. Queler skillfully fuses

In conjunction with some of the fusion procedures he performs and to

the bones of the joint completely, making one continuous bone.

promote bone healing after certain types of fractures, Dr. Queler will harvest the patient’s own stem cells and then inject them into the area in

During his residency training at UMDNJ in Newark, Dr. Queler had the

question. Also, Dr. Queler shares that bone stimulators that patients use

opportunity to treat a great many foot and ankle trauma cases. As a result,

at home after surgery are another way to ensure that the bone in question

he is highly experienced and skilled to handle the gamut of injuries that

heals properly.

can occur. Whether from sports participation, slipping and falling, motor vehicle accidents, etc, Dr. Queler has significant expertise in this area.

There are many non-surgical modalities which Dr. Queler incorporates to successfully treat disorders of the foot and ankle. Of course conservative

One example of foot trauma often seen by Dr. Queler is the Lisfranc

treatments such as bracing and physical therapy can sometimes be

injury, in which the bones in the midfoot are broken or ligaments that

helpful and a procedure will not be necessary.

support the midfoot are torn. Dr. Queler will often perform complex surgery to realign the joints of the midfoot and return the fractured bone

One innovative non-surgical treatment he discusses for the treatment of

fragments to a normal position.

Achilles tendonitis is platelet rich plasma (PRP) injection. Platelets contain growth factors that aid in the healing process. Dr. Queler obtains the PRP from a sample of the patient’s blood and injects it into the injured area in order to promote healing. It is obvious to anyone who meets with the orthopaedic surgeons at Femino-Ducey-Queler Orthopaedic Group that the complementary partnership they have created works extremely well in terms of providing their patients highly specialized care within each physician’s area of expertise. Equally impressive is the mission they share to treat their patients with compassion and respect and above all, to resolve pain and restore a good quality of life.

p During a procedure to correct a non union fracture of the fibula, Dr Queler injects stem cells harvested from the patient in order to promote healing.

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For more information or to schedule a consultation, call (973) 751-0111 or visit www.femino-duceyorthopaedics.com

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Health Law Update

Health Law

Update

Provided by Brach Eichler LLC, Counselors at Law

The Cullen Act’s Civil Immunity Protection Successfully Tested in Court The Superior Court of New Jersey, Appellate Division, recently ruled in favor of a health care entity that was sued by a former employee after the entity provided negative reference letters. Senisch v. Carlino, No. A-6218-09T3, 2011 N.J. Super. LEXIS 211 (N.J. App. Div. Dec. 1, 2011).

DOBI Proposes Several Substantive Changes to New PIP Regulations Introduced Last August In response to comments received by the New Jersey Department of Banking and Insurance (DOBI) to the new personal injury protection

In essence, this was a test of the civil immunity protection that the Health Care Professional Responsibility and Reporting Enhancement Act (also known as the “Cullen Act”) provides to entities that comply with the Act’s requirements. By way of background, hospitals are statutorily required under the Cullen Act to provide, in relevant part, “information about a current or former employee’s job performance as it relates to patient care.” In the case of a former employee, the entity must also disclose the reason for that employee’s separation. N.J.S.A. 26:2H-12.2c(a)(2). In Senisch, the plaintiff was involuntarily terminated from his work as a physician assistant. During the process of seeking employment, the plaintiff’s former employers were requested to provide reference letters. The plaintiff then filed suit against those who provided the references, alleging defamation, tortuous interference with economic advantage and violation of the Conscientious Employee Protection Act. In May 2010, the trial court granted the defendant’s motion for summary judgment. On appeal, the plaintiff argued that the trial court erred by concluding as a matter of law that the defendants acted in good faith and without malice -- a requirement for obtaining the civil immunity protection under the Cullen Act. The Appellate Division agreed with the lower court’s finding that the plaintiff had failed to introduce any evidence to show that the references were provided

(PIP) regulations initially proposed on August 1, 2011, DOBI has made substantive changes published for public comment. Significantly, DOBI has now proposed a separate fee schedule for services performed in a hospital outpatient surgical facility (HOSF), thereby distinguishing these services from procedures performed in ambulatory surgical centers (ASCs). According to DOBI, the newly proposed Exhibit 7 to the PIP fee schedule regulation reimburses HOSFs at higher amounts than ASCs and more accurately reflects the increased costs associated with surgical procedures performed in a hospital setting. Accordingly, the HOSF fee schedule is set at 300% of the 2011 geographically wage-adjusted Medicare Hospital Outpatient Department fees for Bergen County (northern NJ) and Atlantic County (southern NJ), and also permits certain outpatient surgical services that would not otherwise be eligible for reimbursement if performed in an ASC. In addition, DOBI has also eliminated the previously proposed option for a Worker’s Compensation Managed Care Organization that would have permitted carriers to direct patients to networks for treatment. Further, DOBI has also deleted 117 CPT codes from the Physician’s Fee Schedule for low-frequency but high-cost procedures performed by neurosurgeons and spine surgeons.

in bad faith or with malice. Without such a showing, and because the health care provider followed the requirements of the law, the Cullen Act’s civil immunity protection prevented the plaintiff from succeeding in the lawsuit.

New Jersey Physician

Please visit us now online at www.NJPhysician.org

Health Law Update

CMS Publishes Proposed Rule on Reporting and Returning Medicare Overpayments The Centers for Medicare & Medicaid

regulations that generally limit the claims

Referral Disclosure Protocol disclosures

Services

reopening period to 4 years to allow for a

would also be subject to the 10-year look-

proposed rule implementing sections of the

10-year reopening period for claims resulting

back period.

health reform law regarding reporting and

in a reported overpayment. Medicare Self-

(CMS)

recently

published

returning overpayments under the Medicare program. The law requires a person who has received an overpayment to report and return the overpayment by the later of (i) 60 days after the overpayment was identified; or (ii) the date any corresponding cost report is due. The knowing and improper failure

Moving Forward. TOGETHER.

to return an overpayment imposes liability

Our healthcare group delivers

under the federal False Claims Act (FCA),

financing options, cash management

exposing the provider or supplier to treble

tools, and expert guidance to

damages and penalties.

hospitals, surgical centers, and practices across the region.

Under the proposed rule:

Let’s talk today about how we

• A person would be considered to have

can move forward, together.

“identified” an overpayment if the person

Call 800-SUN-9066

has actual knowledge of the existence

Visit sunnb.com/healthcare

of the overpayment or acts in reckless disregard or deliberate ignorance of the overpayment • Where a provider receives information about a potential overpayment, such as from an anonymous tip through a compliance hotline, the provider would have a duty to investigate the information; if, after reasonable inquiry, the provider or supplier identifies an overpayment, it would then have 60 days from that time to report and return the overpayment CMS also proposes a 10-year look-back

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period (i.e., the obligation to report and return an overpayment applies if the overpayment is discovered within 10 years of the date the overpayment was received), which is in alignment with the FCA statute of limitations.

To facilitate this look-

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back period, CMS proposes to amend its March 2012 ®

Statehouse

New Jersey Statehouse Christie Administration Announces $8.1 Million in Grants for Care and Treatment of New Jerseyans Living with HIV/AIDS Continues Christie Administration Commitment to Providing a Safety Net for Most Vulnerable through Hospitals, Health Centers, and Community Organizations Across New Jersey During a visit to Henry J. Austin Health

A second grant of $1.8 million in funding

Deputy Commissioner Dr. Arturo Brito said

Center in Trenton, Health and Senior Services

from the U.S. Centers of Disease Control and

community organizations receiving Ryan

Commissioner

today

Prevention (CDC) will enhance HIV testing and

White grants are required to spend at least 75

announced $8.1 million in grants to hospitals,

Mary

O’Dowd

allow clinics in five cities to buy HIV testing

percent of the award on medical services and

health centers, community organizations and

kits and hire patient navigators to help those

public health agencies providing medical and

who test positive for HIV to enroll in treatment.

support services to those living with HIV/

The Department also provides approximately

AIDS. Seventeen organizations will receive

7,000 low-income individuals with access to a

$6.3 million in U.S. Department of Health and

wide range of HIV/AIDs medications through

Human Services Ryan White funds to provide

its AIDS Drug Distribution Program.

health care services, home health care, transportation, substance abuse treatment,

“New Jersey received one of the largest CDC

mental health counseling, hospice care and

grants in the nation as part of a national HIV/

other social services.

AIDS strategy to overcome barriers to identify and link people with HIV to services,” said

“The Ryan White grants will help hospital

Commissioner O’Dowd. The CDC grant

clinics, community-based organizations and

includes $1.4 million to UMDNJ-Robert

public health agencies who make such a

Wood Johnson Medical School to enhance

difference in the lives of those with HIV/

rapid HIV testing and grants of $87,500 to

AIDS with the comprehensive services they

Newark, Camden, Atlantic City, Neptune and

provide,” said Commissioner O’Dowd. “New

Jersey City to hire patient navigators to help

Jersey has been in the forefront of Rapid HIV

individuals who test positive for HIV enroll

testing for 20 years. We have partnered with

in HIV/AIDS care programs. The navigators

the CDC to enhance Rapid testing so those

will also provide counseling and outreach

who test positive can learn their results as

services to those living with HIV/AIDS.

soon as possible and begin treatment.”

New Jersey Physician

Ryan White Grantees are: ATLANTIC COUNTY: Access One, Inc. $408,220 Atlanticare Regional Medical Center $871,486 John Brooks Recovery Center $54,166 South Jersey AIDS Alliance $272,306 CAMDEN COUNTY: Kennedy University Hospital $682,989 CUMBERLAND COUNTY: CompleteCare Health Network $75,000 MERCER COUNTY: Community Health Law Project $30,000 Henry J. Austin Health Center $788,771 New Jersey Association on Corrections $160,000 St. Francis Medical Center $54,250 MIDDLESEX COUNTY: Hyacinth AIDS Foundation $160,000 MONMOUTH COUNTY: Discovery Institute for Addictive Disorders $62,000 Jersey Shore University Medical Center $1,184,600 Monmouth Medical Center $465,811 Riverview Medical Center $340,986 OCEAN COUNTY: Ocean County Board of Health $514,009 Ocean County Board of Social Services $30,000

Category no more than 25 percent on support services

provider will join our established HIV care

third in the percentage of pediatric cases

like transportation and case management.

team, integrating primary and mental health

and 7th in the overall number of cases.

service for these vulnerable patients,” said

Minority and multicultural populations are

The Henry J. Austin Health Center will

Dr. Kemi Alli, Henry J. Austin’s chief medical

disproportionately impacted. Women account

receive $788,771. It provides all aspects of

officer. “Numerous studies have shown

for one third of the adult and adolescent

patient care including counseling and testing,

improved health outcomes and reduced

HIV/AIDS cases in the state. New Jersey has

transportation, pharmaceutical assistance and

health disparities when patients have the

had great success in recent years in virtually

two patient navigators who link patients into

opportunity to receive both primary and

eliminating mother-to-newborn transmission

care and provide monitoring. The center is

mental health services at the same visit.”

of the disease.

For more information on the Department’s

also adding mental health services. than

45,000

people

are

living

“Henry J. Austin is excited about this new

with HIV/AIDS in New Jersey. The state

Division on HIV/AIDS, STD, TB Services,

opportunity to enhance our HIV care team

ranks 5th nationally in the percentage

please visit: http://www.state.nj.us/health/

to include a mental health provider. This new

aids/freemeds.shtml

women

diagnosed

with

HIV/AIDs,

New Jerseyans Get Loud in D.C. as Hundreds Join Health Care Law Protest Love it or hate it, the Affordable Care Act has

“If they (the Supreme Court) strike down the

“Life is full of mandates. We are obligated by

already helped New Jersey’s senior citizens

mandate and the provisions, too, the next

law to vaccinate our children. We are obligated

save an estimated $95 million by closing the

question becomes whether there is enough

by law to educate them. We are obligated by

Medicare prescription plan doughnut hole.

pressure on Congress to salvage portions of

law to feed and clothe them. We are obligated

As of last June, 2.5 million young adults

the law,” she said.

to report our income for taxation. These

nationwide have gained coverage through a

mandates ensure that people do the absolute

provision that requires employers and health

Wednesday was the last day of a three-day

bare minimum that is necessary to protect

insurers to allow them to stay on their parents’

session by the high court on President Barack

society. So it is with health care coverage,”

plans until they turn 26.

Obama’s health care overhaul.

Lynch said.

But those popular components of the act — as

A ruling isn’t expected until June on whether

“I find it interesting that the political party

well as many others like guaranteed coverage

the government can compel people to

that considers itself the party of personal

for people with pre-existing conditions —

buy health insurance — the government’s

responsibility wants to allow people to freeload

could be lost if the U.S. Supreme Court strikes

argument is their uninsured status affects

off the system at the expense of middle-class

down the 2010 law passed by Congress and

other’s health care costs, and they are likely to

Americans who are already overburdened,”

challenged by 26 states as unconstitutional,

need it at some point — and whether certain

said Lynch, adding that she believes that the

said Joel C. Cantor, director of the Rutgers

provisions of the law can stand without the

Republican Party is pushing for repeal of the

Center for State Health Policy and a professor

health insurance mandate.

law “with one objective in mind … the defeat

of public policy at Rutgers.

of Barack Obama.” Pro and Con

“The question becomes what has to go (if the

Laura Siegel Lynch, a 51-year-old resident

But out-of-work Lavallette resident Jennifer

mandate is struck down),” Cantor said.

of Brick, said she supports the law and the

Bradshaw, 40, who does not have health

coverage mandate.

insurance and could potentially be helped by

Christina Ho, an assistant professor at Rutgers

the law, said , “it would stress me out if I had to

School of Law in Newark who led then-Sen.

“It’s true that in a medical crisis, if an uninsured

Hillary Rodham Clinton’s health policy

person goes to an emergency room, the

legislative staff, predicted that if the health

doctors and hospital are ethically obligated

Bradshaw said she has health issues and has

insurance mandate is stricken, guaranteed

to treat them. But what would happen if

been denied charity care in the past while

health insurance for those with pre-existing

everybody decided to take that route? The

unemployed.

conditions, such as diabetes, “will be

health care system would collapse,” she said.

pay for health insurance and couldn’t afford it.”

gone because it can drive an insurer out of

“But I just don’t think the government should

business.”

force anyone to buy health insurance,” she said March 2012

Statehouse

Gill/Vitale Sponsored ‘New Jersey Health Benefit Exchange Act’ Approved by Both Houses Would Provide New Jerseyans Access to Affordable Quality Health Coverage, Accomplish Key Requirement of Federal Health Care Reform By Trish Graber

Legislation sponsored by Senators Nia H.

and providing clear information to consumers

and Insurance and Human Services, or their

Gill and Joseph F. Vitale to accomplish a key

about the coverage available,” said Senator

designees, and the chairperson of a 15-member

requirement of the federal health care reform

Gill (D-Essex), chair of the Senate Commerce

Advisory Committee made up of stakeholders

law by creating a state health insurance

Committee. “The exchange will also allow

who will provide advice to the board. The final

exchange, a competitive marketplace where

residents and businesses, through a central

five members of the governing board would

individuals, families and employers will be

virtual marketplace, to purchase health care

be residents of the state appointed by the

able to purchase affordable, quality health care

coverage and to apply for additional financial

governor with advice and consent of the Senate

coverage, was approved today by the both

assistance offered by the government to make

as follows: one person who is a member of the

houses of the Legislature.

insurance more affordable. This system will

American Academy of Actuaries, two persons

allow all New Jerseyans to obtain the most

recommended by the Assembly Speaker and

Required under the federal Patient Protection

appropriate health care coverage at the most

two persons recommended by the Senate

and Affordable Care Act, the health insurance

competitive rates.”

President, each with knowledge and expertise

exchange is the first major step toward

in specific areas. The governing board would

implementing federal health care reform in

“The exchange is an essential part of the federal

appoint and set compensation for an executive

New Jersey. The “New Jersey Health Benefit

health reform act that is aimed at ensuring

director; board members would serve terms of

Exchange Act” (S-1319) would serve as a

that all residents have access to affordable,

four years.

one-stop shop for individuals, families and

quality health coverage,” said Senator Vitale

employers seeking coverage, providing easy-

(D-Middlesex),

to-understand

health

Health, Human Services and Senior Citizens

•C ertify health care plans offered by the

allow

Committee. “With this legislation, we will create

Exchange and facilitate the purchase of

consumers to compare coverage, cost and

a simple, user-friendly process for obtaining

value of participating plans. It also would

insurance so that people are informed about

•E stablish the State Business Health

provide a streamlined process for individuals

their options and given seamless access to the

Options Program (SHOP) to assist

and businesses to apply for private insurance,

type of coverage they need to keep themselves

participating employers in facilitating the

Medicaid, NJ FamilyCare, federal tax credits or

and their families healthy.”

enrollment of their employees in qualified

insurance

information

options

which

about would

chairman

the

Senate

other subsidies to be used towards the cost of insurance, through the use of a single website.

The governing board of the exchange would:

plans by individuals.

plans; To be established “in but not of” the Department

•C reate and offer a Basic Health Plan to

of Banking and Insurance, the exchange would

enable uninsured persons with incomes

“With 1.3 million people uninsured, New

be governed by an independent eight-member

of between 133 percent and 200 percent

Jersey is facing a health care crisis. The

board that is free of business ties to interested

of the federal poverty level (for a family

health insurance exchange is intended to

stakeholders.

of four, incomes between $30,657 and

capture these individuals by creating more

include as non-voting ex-officio members the

$46,100 a year) to purchase essential

affordable health plans through competition

commissioners of the Department of Banking

health benefits through the provision of

New Jersey Physician

The

governing

board

will

Statehouse federal funds pursuant to the federal act;

and lowering health costs for all consumers.”

• Develop and implement a plan of

The legislation would take effect on the first day of the seventh month following enactment,

operation for the exchange, including the

The bill would establish the New Jersey

but would authorize the Commissioners of

procedures and minimum requirements

Health Benefit Exchange Trust Fund in the

DOBI and Human Services to take anticipatory

for the selection, certification and

Department of Treasury to be the repository

administrative action in advance as necessary

recertification of qualified plans;

for funds collected from carriers and other

for its implementation. The Senate approved

• Provide a customer service center

monies received as grants or otherwise

the bill by a vote of 22-13. The Assembly

and an Internet website that provides

appropriated for the purposes of the Exchange.

approved the bill 42-35. It now heads to the

standardized comparative information

The Fund could only be used for the purpose

desk of the governor.

on qualified plans, as well as an online

of supporting the activities of the Exchange.

calculator that will allow consumers to determine the cost of a plan after any premium tax credits or subsidies ; and • Apply for any available federal funding. Should a state fail to implement an exchange, or if a state is determined by the US Secretary of Health and Human Services no later than

Making critical decisions every day is hard.

January 1, 2013 not to be sufficiently far along in implementation and ready to perform all exchange functions on January 1, 2014, the federal government will administer the exchange in that state. To date, New Jersey has received two federal grants totaling $8.7 million to assist in planning and creation of the state exchange. “The state is facing a January deadline to demonstrate that it is making progress toward implementation. If we fail to adhere to that timeline, we risk the federal government stepping in to operate our system,” said Senator Gill. “A state-operated exchange is the most optimal path forward for New Jersey. A locally-run program will ensure close oversight of the state’s health insurance market and fair competition among carriers, which are the conditions that will provide for low-cost quality coverage for all residents.”

So why not make choosing your malpractice insurer easy. Positive Physicians Insurance Exchange, Pennsylvania’s premier medical malpractice insurer for the past 12 years is proud to announce its entry into New Jersey. Among the only physician-driven insurers in New Jersey, we guarantee focus, mutual respect for the practice of medicine and better rates than just about anyone. Just call to find out.

“Creating a health insurance exchange, the centerpiece of federal healthcare reform, is the first step toward ensuring that every single New Jerseyan has access to affordable health care coverage,” said Senator Vitale. “The exchange also begins the process of creating a more stable and robust health care delivery system in New Jersey, improving the quality of coverage

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Legal Issues

The Business of Medicine:

Prohibited Business Activities that Restrict Patient Care By Rosaria Soriano of Marcus, Brody, Ford & Kessler

A patient has the right to seek medical treatment from his or her physician of choice. However, a physician can be restricted from treating a patient , if the treatment violates a restrictive covenant in an employment agreement, service agreement or lease agreement with a hospital. A restrictive covenant, or covenant not to compete, is typically used to restrict competition, restrict the solicitation of patients, the solicitation of co-employees, and an employer’s referral sources. Thus, when a physician leaves his employment or if the practice breaks up, a restrictive covenant will preclude a physician from taking the patients of the practice, from taking staff, such as a nurse, a receptionist or a technician, from soliciting patients and other employees, and from contacting prior referral sources. Many physicians are focused, not on the business aspects of their practice, or the corporate structure, but on developing the medical practice and employing gifted and talented physicians, who in their zeal to focus on patient care and patient development, pay little attention to a restrictive covenant, the office policies and controls and what happens should there be a death, a break up or departure of a colleague. However, these aspects of a medical practice are as significant as that of patient care. Restrictive covenants are commonly contained in physician agreements and have

New Jersey Physician

been viewed as intruding on a physician’s relationship with a patient.Despite recent challenges to restrictive covenants by members of the medical profession, in the recent case of The Community Hospital Group, Inc. v. More, 183 N.J. 36 (2005), the Supreme Court of New Jersey declined to find a restrictive covenant “per se” unreasonable and unenforceable. Rather, the court focused on the physicianemployer’s legitimate interest in protecting ongoing relationships with patients and applied a “reasonableness test”, reviewed on a case by case basis, to determine whether a covenant not to compete is valid. A covenant that also restricts solicitation of other employees and patients, will be enforced if found to be reasonable. A. The Employer’s Legitimate Interest If the restrictive covenant is used simply to restrict competition, it is not enforceable because a physician, like any other employer, has no legitimate interest in preventing competition. Thus, an employer must meet a legitimate business interest test. Here, the employer will have to prove that the covenant is needed to protect patient lists, patient relationships, referral sources and the investment made to train the departing physician or the acquisition of unique skills possessed by the departing physician. For example, the payment of continuing education courses, medical insurance, medical license fees, travel related fees, and speaking engagements are the types of “investments” which relate to whether a restrictive covenant protects

the employer’s legitimate interests. Patient lists and retaining the customer base, patient relationships and referral sources arealso valuable business assets that will be protected under a covenant. B. The Reasonableness of The Covenant The convent must also be reasonable in the activities restrained, its geographic scope and in its duration. If a covenant attempts to prevent a physician from practicing in his or her specialization, for any given period of time without a geographic boundary, it is unenforceable. For example, a restrictive covenant that prevents a physician from practicing anywhere in New Jersey is typically void. If the covenant prevents a physician from treating a patient or group of patients without a geographic boundary, it is unenforceable. For example, if the covenant indicates that the departing physician can not treat a former patient at all, the covenant will be void because it must only restrict patient access within a specific geographic location. If the covenant attempts to restrict a physician for an unreasonable period of time, it is unenforceable. A covenant that restricted a dermatologist from practicing within a ten-mile radius for five years was enforceable, because patient access was not completely restricted. Rather, the patient could be treated by the departing dermatologist, so long as it was outside of the ten-mile radius. Moreovera covenant can be “blue penciled” meaning a court can change it to limit the geographic scope or duration.

Legal Issues C. Undue Hardship On The Departing Physician A covenant will not be enforced if it will unduly burden the departing physician. New Jersey courts have been reluctant to find undue hardship and to deny enforcement of acovenant that is reasonable in time and geographic location. D. Public Policy Concerns A restrictive covenant will not be enforced if a physician can show that it will be injurious to the public. For example, if a physician restrictive covenant will lead to a shortage of a particular specialty in a geographic area, it may be void or modified by a court. Recently,a neurosurgeon who entered into a series of successive employment agreements containing restrictive covenants

with a hospital, challenged a restrictive covenant and asked the court to adopt a ban on restrictive covenants involving physicians because he believed they restrict a patient’s choice of physicians. He argued that the two (2) year, thirty mile radius restriction on his employment caused serious harm to the public interest because of the shortage of neurosurgeons within the 30 mile radius. The Supreme Court upheld the restrictive covenant against the neurosurgeon, finding that the neurosurgeon was not restricted from treating patients,rather he was restricted only from treating patients within the 30 mile radius. In addition, although the American Medical Association discourages restrictive covenants between physicians, it only declares them unethical if “excessive in geographic scope or duration, or of they

fail to make reasonable accommodation of a patient’s choice of physician.” E. Conclusion In New Jersey, restrictive covenants in the medical profession are common place. So long as the public interest takes precedence over private concerns, a restrictive covenant will be enforced, entitling a former employer to damages such as lost profits, loss of profits, dimmunition in the value of a practice and possibly even investment damages. The reasonableness of the covenant is key and each covenant will be examined ona case by case basis. Attorney review and negotiation of a restrictive covenant, and other agreements that affect the business aspect of the medical practice, is the key to avoiding costly litigation and potential damages.

ASC Licensure Required for One Room Surgery Centers By Mark Manigan - Brach Eichler L.L.C.

The NJ Department of Health and Senior Services has recently taken the position that one room surgery centers set up as general business corporations (i.e., “Inc.’s”) require ASC licensure even if all of the other criteria for licensure exemption are met (that is, even if the facility in question is limited to one operating room, owned only by physicians, and used only by its physician owners or employees). The Department’s position is based on NJ Board of Medical Examiner rules which 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 is set up as an “Inc.”, the Department will send a “cease and desist” letter requiring the facility to close and warn that failure to close could subject the center to civil penalties up to $1,000 per day.

We have successfully assisted a number of one room ASCs that were set up as “Inc.’s” and received “cease and desist” letters obtain appropriate corporate designation and avoid penalties. We have been able to do it in a manner to that reduces exposure to reimbursement recoupment claims

from insurance companies as much as possible. We have also assisted our clients in changing the corporate designation with CMS. Please feel free to contact me with any questions.

Call for Nominations

New Jersey Physician Magazine invites all medical practices to submit nominations for cover stories. Practices should include a brief description of what makes the practice special. Please contact the publisher Iris Goldberg at igoldberg@NJPhysician.Org March 2012

Food for Thought

Livingston Bagel Livingston, New Jersey By Iris Goldberg

I grew up in Brooklyn, New York in the 1950s and 60s. I cherish so many memories from those years. We were far from wealthy but I always had what I needed to exist comfortably. Even back then, food was an important part of life. My dad was definitely a “foodie,” although we didn’t have that word at the time. He loved all kinds of foods from many different cultures but the delicacies from his Jewish heritage pleased his palate the most. Each Saturday afternoon he performed the weekly ritual of buying the bagels and all that went with them. “I’m going to get the appetiz-

Every Saturday night - no matter what plans any

food to bring back home with him. Other times,

ing,” he would announce. And then to my sis-

of us had for later on – we shared this delicious

he would stop at Livingston Bagel along the

ter and me, “Would anyone like to come?” We

meal.

way and bring everything to our house and we would re-create those Saturday night dinners in

actually did enjoy accompanying him at times because for my dad this was no ordinary shop-

When Michael and I moved from Brooklyn

ping trip. This was a strategic mission.

to Livingston in the late 70s, I was homesick

Brooklyn.

for Brooklyn for a long time. Discovering

Today Livingston Bagel has expanded to be-

I honestly think that when the guys behind the

Livingston Bagel was truly soul-soothing

come a popular destination for many in the

counter at Fred & Murray’s (my dad’s favorite

for me. They had everything there! In those

area. There’s a large casual dining area, a coun-

place) saw him coming, they probably each

days, the place was mostly take-out with a

ter where you can order breakfast, lunch or

hoped not be the one to have to serve him.

few tables on the side for those who wanted

dinner to eat in or take out. Besides bagels and

Each item of the smoked fish was a negotiation.

to eat there.

smoked fish there’s Sloppy Joes and any other sandwich you can imagine. They make custom-

“Are those the only chubs you have?” These were the small whitefish that my father bought

The first time I sampled a bagel with nova and

ized salads fresh for you right there, as well

each and every week. He would make the

cream cheese, I knew that things were getting

as wraps and paninis. In the warmer weather,

gentleman go through the entire pile until the

better. The bagel was still warm and the lox was

there are tables outdoors for those who don’t

fattiest-looking ones were selected. Then he

simply perfect. Just as good as it was back in

mind the hustle and bustle of Northfield Ave.

would watch carefully as the “nova” (Nova

Brooklyn. In fact, all of the smoked fish was

Scotia lox) was sliced. “Not so thin,” or please

great. Of course the true test was introducing

Livingston Bagel has an unending variety of

lay it out carefully,” he would instruct.

Livingston Bagel to my dad and vice-versa. I

prepared foods and they undertake catering

was a little worried because I did want to be

jobs of all dimensions. Customers from many

By the time we left with one big bag of freshly-

able to go back and I wasn’t sure if the guys

different ethnic groups are there at any given

baked bagels and bialys and another filled with

at Livingston Bagel could handle my father. No

time and I often see people of my age with

lox, whitefish, pickled herring in cream sauce

worries! They were pros. In fact, I think they

an elderly parent enjoying the food and each

with onions and sometimes other specialties

actually enjoyed the challenging experience of

other. At those times I really miss my dad. As

of the week, my sister and I couldn’t get to the

waiting on my dad.

long as Livingston Bagel stays around, though, I’ll always have a little bit of Brooklyn and a

car fast enough. We were exhausted from the ordeal and needed to sit down.

From then until the end of his life, my father

bridge back to those wonderful days with him.

looked forward to his trips to Livingston Bagel. It was all worth it, though, when a few hours

Sometimes we would eat there - my mom, dad,

Livingston Bagel is located at 37 E. Northfield

later, our family sat together at the dinner table

Michael, me and our daughters – all crowded

Road, Livingston NJ 07039. (973) 994-1915

and feasted on all that had been purchased.

together at a small table. Often he would buy

New Jersey Physician

Community

Monmouth Medical Center Brings the DaVinci Robotic Surgical System to the Monmouth Mall

The robotic surgical department of Monmouth Medical Center offers a hands-on opportunity to try their skills operating the DaVinci Surgical Robot

p The DaVinci Robotic Surgical System

p Some of the young people attending a nearby robot contest try their skills in operating the precision instruments that move the arms of the robot.

p Iris Goldberg, Co-publisher of New Jersey Physician joins Michael LaSalle, MD and Michael Esposito, MD in conversation March 2012

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 we go with some quite difficult cases for you. Case I A 30 year old white nun was admitted to the hospital after a gyn exam in which she had the â&#x20AC;&#x153;Chandlier Signâ&#x20AC;? reaching for the ceiling on touching of the cervix. Dx of acute gonorrhea salpingitis using treatment with Rocephin and Levoquin. The pain continued Case 2 12 year old white female excellent rider of horses developed a huge non tender abscess of the buttocks. Her father bought a new saddle recently from Afghanistan. A febrile and negative laboratory studies except aspiration of nontender abscess (3 x 4 cm) gram stain gram positive rodeo aerobic

Case 3 40 year old white female developed severe tenderness in the right upper quadrant of the abdomen. The gall bladder was full of stones. A cholecystectomy did not relieve the pain, tenderness and fullness which progressed. The patient was in severe distress. All labs, CT, MRI and ultrasound were negative Case4 48 year old white female developed a bizarre neurological disease with mental fogginess, generalized intermittent parethesia and peripheral leg neuropathy. She recently remarried a business executive who traveled the world. Prior to this she was in good health taking

care of her farm with horses. The exam and all laboratory studies were negative. Epidemiology: her husband had chronic prostatitis for years which did not respond to antibiotics or massage. He had an episode of fever and chills in Peru several years ago. No diarrhea.

Please send responses to MGoldberg@NJPhysician.org

What You Don’t Know about the Board of Medical Examiners Can Hurt You: Regulations You Need to Know to Protect Your License Whether you are an established practitioner or new to the profession, there is likely quite a lot you don’t know about Board of Medical Examiners regulations. The program will cover the following: ■ Anatomy of a Board Investigation ■ The Board of Medical Examiners Regulations: – Sexual Misconduct – Impairment – Alternative Resolution Program (PAPNJ) – Patient Records – Office Policies – Termination of Patient-Physician Relationship – Duty to Report Changes in Status – Prescribing CDS – Billing & Fraud – Duty to Cooperate

Faculty Disclosures: No relevant financial relationship(s)

Speakers will include: Dr. Gregory Rokosz, Senior Vice President for Medical and Academic Affairs, Saint Barnabas Medical Center, and former President, New Jersey State Board of Medical Examiners and Joseph M. Gorrell, Todd C. Brower, Carol Grelecki and Keith J. Roberts, all of Brach Eichler LLC Moderator: John D. Fanburg, Brach Eichler LLC

Monday, April 30, 2012 Light dinner: 5:30 pm Program: 6:00 – 8:30 pm

Offices of Brach Eichler 101 Eisenhower Parkway, Roseland, NJ 07068

RSVP to Alan Levine at alevine@bracheichler.com or 973.364.8389 by April 23. Saint Barnabas Medical Center designates this educational

2.5 activity for a maximum of 2.5 AMA PRA Category 1 Credit(s). CME Physicians should only claim credit commensurate with the Credits extent of their participation in the activity. Saint Barnabas Medical Center is accredited by the Medical Society of New Jersey to provide continuing education for physicians.