New Jersey Physician May 2014 Issue

JULY2014 2012 MAY Visit us now online at

www.NJPhysician.org

Positive Physicians Insurance Exchange A Physician-Driven Medical Malpractice Insurer That Continues to Grow in New Jersey Also In This Issue: Growing Number of NJ Hospitals Earn “A” Grades on Report Card The List: How N.J. Hospitals Stack Up Against Other States in Medical Specialists The Expensive Consequences of Failing to Create Corporate Documents For Your Practice

Publisher’s Letter Welcome to the May issue of New Jersey Physician, reaching over 31,000 members of the state medical community. New Jersey Physician is strictly owned by state residents and offices are located in New Jersey.

We are members of the state medical associations and active participants in their events.

Published by

A growing number of NJ hospitals have earned “A” grades on the safety rankings of Leapfrog Group’s Hospital Safety Score report. Thirty of the state’s 66 hospitals achieved “A” grades which is the highest number earned in any of the five reports released since the first one in 2012. New Jersey ranked seventh among the states in the number of “A” grades. No New Jersey hospitals were among the 22 hospitals in the country with failing grades.

Montdor Medical Media, LLC

To help address what experts see as a looming and acute shortage of primary care doctors, HackensackUMC Mountainside has created the Mountainside Medical Group, a network of physicians who are employed by the hospital and practice at different locations in the community.

Seven doctors are currently treating patients at three of the group’s locations, and more physicians and offices will come on board in the coming months.

Michael Goldberg

Continuing on the topic of physician shortages, the question of whether New Jersey will have enough doctors to meet the growing demand for medical services is a long-running discussion. Using data from the Kaiser Family Foundation about the number of doctors practicing in each state, along with the latest Census population estimates, this list backs up the concerns. While New Jersey is 13th among the states in the number of doctors per 100,000 residents, it is 45th in family doctors. This low showing doesn’t hold true for other primary care practices such as internists, obstetricians/gynecologists and pediatricians are all relatively common in New Jersey in comparison with other states.

Doctors and other medical professionals will be required to enroll in the Medicare program to prescribe drugs that are paid for by the federal healthcare program, under a rule finalized by CMS. There has been concern about instances where unqualified individuals are prescribing Part D drugs, and CMS is addressing this problem through this action.

MEDNAX has announced the acquisition of Anesthesia and Pain Management Group, a private physician group practice in Millburn.

The practice will become part of MEDNAX’s American Anesthesiology division. MEDNAX’s division consists of more than 2050 anesthesia providers, more than 875 physicians and 1,175 anesthetists practicing in 10 states.

With warm regards,

Michael Goldberg Michael Goldberg Publisher

Co-Publisher and Managing Editors Iris and Michael Goldberg

Contributing Writers Iris Goldberg

Andrew Kitchenman Ari G. Burd Joseph Conn Paul Demko Beth Fitzgerald Meg Fry Beth Kutscher Emily Bader

Layout and Design - Nick Justus

New Jersey Physician is published monthly by Montdor Medical Media, LLC., PO Box 257 Livingston NJ 07039 Tel: 973.994.0068 F ax: 973.994.2063 For Information on Advertising in New Jersey Physician, please contact Iris Goldberg at 973.994.0068 or at igoldberg@NJPhysician.org Send Press Releases and all other information related to this publication to igoldberg@NJPhysician.org Although every precaution is taken to ensure accuracy of published materials, New Jersey Physician cannot be held responsible for opinions expressed or facts supplied by its authors. All rights reserved, Reproduction in whole or in part without written permission is prohibited.

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

Copyright 2010.

Subscription rates: $48.00 per year $6.95 per issue Advertising rates on request New Jersey Physician magazine is an independent publication for the medical community of our state and is not a publication of NJ Physicians Association

Contents

Positive Physicians Insurance Exchange

4 A Physician-Driven Medical Malpractice Insurer That Continues to Grow in New Jersey CONTENTS

7 Hospital Rounds 10 Medical News Expensive Consequences 11 The Of Failing To Create Corporate Documents For Your Practice

Anxieties Linger As CMS 12 Physician Sets Oct. 1, 2015 Conversion Date for ICD-10

15 Amerihealth 16

Amsurg’s $2.35B Bid For Sheridan Spotlights Growing Interest In Physician Outsourcing

16 MEDNAX 17 HUMC

Singups: Horizon, 13 ACA Amerihealth N.J.

18

Saint Michael’s Receives Approval To Help Community Members Manage Diabetes And Hypertension

14 Medicare

20

Vendor News

14

Bay Announces Partnership 22 Raritan With Joslin Diabetes Center

Technology

2 New Jersey Physician

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Cover Story

Positive Physicians Insurance Exchange A Physician-Driven Medical Malpractice Insurer That Continues to Grow in New Jersey 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 an admitted carrier in Pennsylvania, New Jersey, Delaware, and Ohio, Positive Physicians Insurance Exchange (PPIX) is taking root as an industry leader in New Jersey.

As an Orthopaedic Surgeon and past president of the Pennsylvania Orthopaedic Society, PPIX President & CEO Lewis Sharps, MD, recognized the need for a doctor driven, professionally managed alternative for doctors seeking doctor focused, professional liability coverage. By bringing together experts from the insurance industry, Positive Physicians Insurance Exchange was created and has been serving its doctor insureds since 2002.

PPIX has a multi-specialty perspective and covers all aspects of primary and specialty medicine, which includes but is not limited to;

4 New Jersey Physician

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 Positive Physicians Insurance Exchange is reinsured by Catlin, an A-Rated member of Lloyds of London. PPIX is also covered by the Insolvency Funds of each state it operates within.

It is without question that the cornerstone of PPIX is its aggressive, team-oriented approach to risk management.

That, combined with a proactive system of claims management has allowed PPIX to prosper and grow.

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. The personal touch is at the heart of what they do. Clients will always speak to someone who is knowledgeable about their issues and concerns and will never have to navigate through a series of automated prompts.

Additionally, PPIX 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 the PPIX team accompany him or her to meet with a client. In this way there is more than just a voice on the other end of the phone in the event that a problem does arise. This approach to customer service may be partially responsible for the 95% retention rate of PPIX clients.

PPIX 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 (RMC) of that practice.

The RMC monitors any potential risk concern that might arise and acts as a liaison between the practice and PPIX, where knowledgeable staff is accessible on a 24/7 basis to advise on how to proceed. At that point either the staff at PPIX 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 and up to date about possible malpractice risks and know the ways in which to preemptively act to prevent or control a potential claim, PPIX offers ongoing consultations as well as regularly scheduled conference calls to update them and to discuss any and all concerns. Controlling physiciansí exposure to risk is unquestionably the most effective way of minimizing the number of malpractice claims and keeping premiums affordable. To this end, PPIX leaves no stone unturned.

Dr. Sharps emphasizes the importance of dealing with any patient related concern as soon as it arises. “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 to completion.”

In fact, Dr. Sharps goes on to explain that the way in which risk management is handled at PPIX 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, allows us to have a better chance of preventing a claim. This in turn improves quality of care by default.”

Executive Director of PPIX, Leslie Latta, clearly explains that the way PPIX 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 the RMC with an additional set of resources in order to help them elevate that level of care even further, thereby 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 have been taken seriously, that patient is obviously less likely to sue.”

Most instrumental in PPIX 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, New Jersey, and Delaware.

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.

No one understands physician issues better than them.

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 PPIX in every situation. If, however, it is not possible to have an expedient resolution to a claim, PPIX 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, PPIX 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 physicians report savings of as much as 10-30% when compared to previous policies.

Perhaps the greatest source of pride for Dr. Sharps and the management team at PPIX 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, PPIX is proving to be a welcome addition.

Phone: (610) 644-5262 Toll Free: (888) 335-5335 "mail to: info@positivephysicians.com" info@positivephysicians.com or visit www.positivephysicians.com May 2014

5

The attorneys in the Health Care Practice Group at Giordano, Halleran & Ciesla, counsel clients on a broad range of issues, integrating traditional legal principles with the special body of federal and state law governing the health care field.

Our health care services include: Health

Care Reform Anti-kickback Law/Stark Law/NJ SelfReferral Law Professional Practice Formation and Related Agreements, such as Partnership Operating, and Shareholder Agreements Preparation and Negotiation of Contracts, such as Management, Employment, Physician Recruitment, Vendor, and Managed Care Contracts Purchase and Sale of Professional Practices and Practice Divorces Regulatory Compliance HIPAA and Confidentiality Issues Lease Preparation and Negotiation Joint Venture Formation Acquisition, Mergers and Considerations Physician Practice Management Issues Medicare and Other Reimbursement Issues Licensing Issues Litigation

Visit our Healthcare Blog for updates healthcare news, events, and legislation.

www.njhealthcareblog.com Giordano, Halleran & Ciesla PC | 732.741.3900 | info@ghclaw.com | www.ghclaw.com Follow us on Twitter: @GHCLawFirm

HOSPITAL ROUNDS

Hospital Rounds

Growing Number of NJ Hospitals Earn ‘A’ Grades on Report Card Andrew Kitchenman

Safety rankings by nonprofit healthcare watchdog group are state’s best ever New Jersey hospitals are continuing to become safer for patients, according to a twice-yearly report card issued by healthcare watchdog organization.

Thirty of the state’s 66 hospitals achieved “A” grades in the Leapfrog Group’s Hospital Safety Score report.

That’s the highest number of “A” grades earned by New Jersey hospitals in any of the five report cards released since the first one in 2012. New Jersey ranked seventh among the states in the number of “A” grades.

Hospital executives are changing policies in response to both the public attention given to the reports and financial incentives tied to the scores, according to health advocates and representatives of the Leapfrog Group, a Washington, DC, nonprofit founded by employers and focused on increasing hospital safety, quality and affordability.

The scores are are based on 28 measures, which range from whether hospitals have intensive-care specialists in their ICUs to how many patients acquire pressure ulcers during their hospital stays.

“What we hear anecdotally is that hospitals across the country are working quite hard to try to improve their grades,” said Leah Binder, Leapfrog Group president and CEO. This is particularly true in states like New Jersey, where the grades are rising. Hospitals have been touting their positive grades -- in part because insurers are weighing hospital safety in making payments to hospitals.

The two hospitals that saw the biggest change in their grades since the fall are both in Monmouth County: Jersey Shore University Medical Center in Neptune and Riverview Medical Center in Red Bank, which both raised their grades to “A” from “C.” Both hospitals chalked up broad-based improvements, including increasing the coverage of their ICUs by specialists and implementing recommended practices for washing hands.

No New Jersey hospitals were among the 22 hospitals in the country with failing grades.

Saint Michael’s Medical Center in Newark was the only hospital in the state to receive a “D.” Officials there rejected the significance of the report, with hospital spokeswoman Cathy Toscano saying that it relies on “limited, dated information and does not reflect quality improvements we have made and continue to make.”

Toscano said the hospital has implemented electronic medical records, quality action committees to review workflow and documentation processes, and an infection-prevention team. She added that various ratings systems can be useful to patients, but that they shouldn’t rely on any one of them.

But Binder said safety should be the primary consideration when patients choose a hospital.

“The first thing you want to know when you step foot into a hospital is whether it’s safe,” Binder said, noting that other factors like whether the hospital is strong in the services a patient needs should be considered.

Binder added that the scores are a work in progress.

“There’s a good number of measures that we just don’t have access to,” including details about hospital-acquired infections and medication errors, she said.

She also noted that hospital accreditation reports are used by the federal Centers for Medicare & Medicaid Services, which are “owned by the taxpayers,” but details from the reports aren’t publicly available.

“There’s a good number of hospitals that would like to see all this public reporting go away but I have some bad news for them – this is a free country” and residents have a right to know how hospitals are doing, Binder said. “Americans are May 2014

7

unwilling to go back to the time when hospitals kept everything private.”

She expressed certainty that “our children will have much more information available about hospitals than we do now and hopefully our grandchildren will have even more.”

This is particularly important as more people are enrolled in health plans in which they have to pay more out-of-pocket expenses and want to know “how much is it going to cost me and how much am I getting for my money,” said Binder, adding that instituting safety checklists and “hand hygiene” campaigns isn’t costly but can make a big difference in safety.

Of the 66 New Jersey hospitals, 13 improved their scores, while eight dropped by a letter grade. The grades of the other 45 hospitals were unchanged.

Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute, praised the improvements made by New Jersey hospitals. She noted that Horizon Blue Cross Blue Shield of New Jersey is using Leapfrog scores in calculating their bonus payments for hospital quality improvements.

Hospitals “always cared about quality but that makes it even more of an incentive,” she said.

Schwimmer said institute officials would like to see every hospital in the state receive an A, which she said is possible without lowering the grading standards.

As the hospitals continue to consolidate and insurers offer plans with fewer hospitals, “it’s more important for consumers to know the safety of the hospitals available to them,” Schwimmer said, noting that the scores can be searched quickly by ZIP code through a mobile application.

Visit us now online at www.NJPhysician.org

8 New Jersey Physician

Hospitals in state-federal initiative will get funds tied to how well they perform New Jersey hospitals that rely on government subsidies will have to target specific illnesses – and succeed in making progress in treating them – as part of a new federal program.

Under the Delivery System Reform Incentive Program (DSRIP, pronounced “diss-rip”), $166.6 million annually is being divided among 55 participating hospitals based on their performance in treating a single condition that each hospital chose.

The program, funded equally by the state and federal governments, is part of a national move toward paying healthcare providers based on how successful they are in improving health of their patients, rather than on the amount of services that they provide.

New Jersey is only the fourth state to have a similar program.

“We’re really on the cutting edge, in terms of providing incentives for improving the quality of care and population health, using hospitals to be able to do so,” state Health Commissioner Mary O’Dowd said yesterday.

As part of the comprehensive Medicaid waiver that the state received in 2012 – which emphasized home- and community-based long-term care – the state agreed to participate in DSRIP. The program replaces the 20-year-old Hospital Relief Subsidy Fund, which provided payments to hospitals based on the amount of care they provided to patients who receive Medicaid or who are uninsured.

CMS allowed hospitals to choose an initiative to improve care for one of eight conditions. Of the hospitals, 23 chose cardiac care; 17, diabetes; five, substance abuse; four each chose asthma and behavioral health; and one each chose obesity and pneumonia.

No hospitals chose to focus on HIV/AIDS. For example, Saint Michael’s Medical Center in Newark is launching a patient-centered medical home – a model that focuses on care coordination -- to serve patients with diabetes and hypertension. The program will include community health screenings and education; referrals and access to services; assistance with lifestyle changes and nutritional counseling; and help making appointments and receiving social services.

The fiscal year starting on July 1 is officially the third year of the five-year DSRIP, but some important details have yet to be finalized, such as how hospitals’ performance will be measured to determine how much they are paid. Roughly 100 different measurements will be used, depending on which condition a hospital chooses to focus on. Until those details are finalized, hospitals are continuing to receive money based on how much they were receiving under the relief subsidy program.

However, once the details are worked out, hospitals will be paid based on achieving “measurable, incremental clinical outcome results demonstrating the initiatives’ impact on improving the New Jersey healthcare system,” according to a state description of the program.

Suzanne Ianni, president and CEO of the Hospital Alliance of New Jersey, said hospitals chose the areas that they would focus on based on assessments of their communities’ health needs.

Ianni said DSRIP presents a challenge to hospitals. She is one of three co-chairs of a state-appointed committee that helped design the program.

“Hospitals are being asked to do more to keep existing dollars,” Ianni said of the program, noting that some other states received additional federal funding to launch their DSRIP programs. That’s because New Jersey had to agree to join DSRIP as part of the negotiations to receive the waiver, in order to keep the federal funding that had been part of the relief subsidy program. The alliance includes the “safety-net” hospitals concentrated in cities that serve much of the state’s low-income population.

Ianni emphasized that the subsidy funds have been critically important to the hospitals that received them. She noted that researchers have found that safety-net hospitals suffer in comparison with hospitals that serve higher-income communities in efforts to reduce hospital readmission rates. This could prove a challenge in the DSRIP program, since readmission rates will be among the measurements used to measure some hospitals’ performance.

But Ianni lauded the motivation behind paying for performance, adding that urban hospitals are concentrating on improving access to preventive care as well as other strategies that could improve residents’ health while lowering costs. She also emphasized that since DSRIP is funded through the federal Medicaid program, the money ultimately must benefit the hospitals that serve low-income populations.

“It is a much more challenging task for a safety-net hospital when the population is so used to relying on the emergency room, and may not have additional social supports,” she said.

That point was reinforced by O’Dowd, who said the hospitals that disproportionately serve Medicaid and uninsured patients will receive more of the funding.

Sen. Nellie Pou (D-Bergen and Passaic) expressed concern that hospitals must pay some costs upfront to develop their DSRIP initiatives, without knowing what their ultimate funding levels will be.

O’Dowd said state officials “were very successful at negotiating a glide path” that allows the hospitals to continue to receive monthly payments until the program is fully implemented. CMS officially initially suggested a faster transition “and we said we May 2014

9

can’t disrupt their cash flow and expect to get good results,” and CMS agreed to a slower transition, O’Dowd said.

While some hospitals may experience some pain as they sustain upfront costs, “I think we’ll all be better off in the long run,” O’Dowd said.

All but six of the 55 hospitals had their applications to participate in the program approved in April by the federal Centers for Medicare & Medicaid Services (CMS), although some received conditional approvals that depend on making adjustments to their applications. CMS officials have indicated that they expect to approve the remaining six hospitals in the coming weeks, after the hospitals made changes to their applications based on comments from CMS, according to state officials.

The participating hospitals all serve enough low-income residents to make their participation in the program potentially worthwhile. Nine of the 64 hospitals that had received money from the subsidy fund decided against participating in DSRIP, perhaps because the amount of work needed to be in the program wouldn’t be worth the amount they would likely receive in payments. The roughly $1.2 million these hospitals received will be given to the participating hospitals.

The state has hired Indiana-based accounting firm Myers and Stauffer to manage the program. O’Dowd said state officials determined that hiring a contractor for a five-year program “was the most appropriate and responsible action.”

Medical News

Medical News

The list: How N.J. stacks up against other states in medical specialists The List: How NJ Stacks up Against Other States In Medical Specialists Whether New Jersey will have enough doctors to meet the growing demand for medical services is a long-running discussion in state health-policy circles.

The issue has been a particular source of concern for the state’s family doctors, who have cited the relatively high costs of practicing in the state -- as well as the relatively low pay compared to doctors who specialize in other areas.

Using data from the Kaiser Family Foundation about the number of doctors practicing in each state, along with the latest U.S. Census population estimates, this list backs up the family doctors’ concerns.

While New Jersey is 13th among the states in the number of doctors per 100,000 residents, it is 45th in family doctors. But this low showing doesn’t hold true for other primary-care field: internists, obstetricians/gynecologists, and pediatricians are all relatively common in New Jersey in comparison with other states.

The following list ranks the specialties and practice areas in order of how they stack up against other states. For example, anesthesiologists are first on the list because their rank -- fourth -- compared with other states is higher than New Jersey doctors from any other specialty or practice area.

Kaiser tracked seven medical specialties and four primary-care fields, while including all other specialties in a separate category.

The healthcare information is from November 2012, while the population estimate is for July 2013.

1. Anesthesiologists (4th) New Jersey has 16.6 anesthesiologists per 100,000 residents, behind only Massachusetts, Vermont, and New York (Washington, D.C., would rank as having the highest concentration of doctors in nearly every specialty or practice area if it was a state).

2. Cardiologists and pediatricians (tie, 6th) New Jersey has 11.8 cardiologists and 29.6 pediatricians per 100,000 residents, ranking sixth in both areas. One factor that may contribute to the large number of doctors in the state is its proximity to the medical-education centers of New York City and Philadelphia. The states of New York and Pennsylvania are among the five with more cardiologiists than New Jersey, while New York also has more pediatricians.

4. Endocrinologists, diabetes, and metabolism specialists/internists (tie, 7th) The percentage of endocrinologists and internal medicine specialists per 100,000 New Jersey residents is the seventh highest in the country. However there is a big difference in actual numbers -- only 2.5 endocrinologists/100,000 compared with 64.7 internists/100,000. While internal medicine was traditionally considered a primary-care area, many internists subspecialize and have more in common with other specialists than with primary-care doctors.

10 New Jersey Physician

6. Obstetricians/gynecologists (8th) Like pediatricians, ob-gyns are relatively common in New Jersey when compared with the largest primary-care field, family doctors.

There are 16.3 ob-gyns per 100,000 New Jersey residents, significantly higher than the 14.2 per 100,000 national average.

7. Psychiatrists, (11th) There are 16.6 psychiatrists per 100,000 New Jerseyans, well above the national average of 15 per 100,000.

8. Oncologists and all other specialists (tie,16th) There are 4.3 oncologists per 100,000 state residents, while there are 68.9 doctors in all other specialties. When considering all non-primary-care specialties, New Jersey ranks 13th in the country. While this number may appear to be impressive, the ranking is lower every other Northeastern state, except New Hampshire.

10. Surgeons ( 24th) New Jersey’s 14.0 surgeons per 100,000 residents ranks just below the national average of 14.3 per 100,000.

11. Emergency medicine doctors (32nd) Emergency medicine is the only non-primary-care specialty in which New Jersey is well below the national average, with 11.9 ER doctors per 100,000, compared with 13.1 nationally. This statistic lends support to the “D-plus” grade the American College of Emergency Physicians gave the state in January, citing declining access to emergency care and the state’s malpractice laws.

12. Family and general practice (45th) Raymond Saputelli, executive director of the New Jersey Academy of Family Physicians, was not surprised that family doctors in New Jersey would have the worst national ranking compared with other specialties and practice areas.

“That number could be even worse,” considering that some doctors who list family medicine as their specialty actually work in hospitals in areas other than primary care, Saputelli said. The high cost of being a primary-care doctor in New Jersey make the state’s environment “toxic” when compared with other states, he said. “From the very beginning, we don’t bring enough students who are predisposed to primary care into the medical schools,” he said.

There are 24.6 family doctors per 100,000 residents, while the national average is 37 per 100,000.

The Expensive Consequences of Failing to Create Corporate Documents For Your Practice by: Ari G. Burd, Esq. Giordano, Halleran & Ciesla, PC. It is imperative for every practice, big or small, to have written documents setting forth the rights, duties and obligations of the practice owners. Regrettably, having your accountant file your LLC Certificate of Formation or Articles of Incorporation when applying for your EIN, is not adequate. If you are a partnership, you should have a partnership agreement. If you are an LLC, you should have an operating agreement. If you are a PC, you should have a shareholder agreement. If you have non-owner physician employees, you should have employment agreements in place. These agreements not only establish the manner in which your practice will be run, but also address what will happen in a variety of circumstances. Failing to take the time to create these agreements is a shortcut that will leave you vulnerable to a variety of pitfalls that can potentially cost you tens, if not hundreds of thousands of dollars in the long run.

Imagine for a moment that after years of building up your practice, your practice goes through a divorce. How will the practice be split? Today, while everyone is happy, those answers seem simple and easy. But how do you think those same discussions will go years from now, when the animosity between you and your fellow practice owners has reached the point that you’ve decided the practice cannot continue?

What about when you or your fellow practice owners are ready to retire, die or becomes disabled? How will the value of the practice be determined? Or what happens if a physician in your practice decides to quit and open up a competing practice down the street? These are all issues that can and should be addressed within shareholder, operating, partnership and employment agreements.

You should also consider who will hear and decide serious disputes that arise between members of the practice. If you create a partnership, operating or shareholder agreement, you can agree ahead of time that all disputes will be heard by a neutral arbitrator, who can hear evidence and render an enforceable decision for the practice’s eyes only. Fail to do so and your only avenue for recovery may be the courts, where your practice’s dirty laundry will be aired in public for all to hear.

Giordano, Halleran & Ciesla has been assisting physicians for over forty years. Let us help you put in place agreements that will protect you and your practice from these and other avoidable pitfalls.

May 2014

11

Medical News Physician anxieties linger as CMS sets Oct. 1, 2015 conversion date for ICD-10

By Joseph Conn The countdown has restarted toward the compliance deadline with the federally mandated conversion to the ICD-10 diagnostic and procedural codes. The new ICD-10 start date is Oct. 1, 2015, according to a terse statement from the CMS. But many of the problems and anxieties that led to last month's congressional pushback of the ICD-10 start date are still unresolved, several experts said.

HHS “expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015,” the CMS statement said. “The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through Sept. 30, 2015.”

CMS may be tipping its hand on ICD-10 start date The previous compliance deadline had been Oct. 1, 2014, but that was shot down by Congress in a law signed by President Barack Obama on April 1 that ordered HHS to not set a ICD-10 compliance date any sooner than Oct. 1, 2015.

Physician groups led the charge in opposition to the 2014 deadline, citing a host of potential problems. Those included the inability of many vendors of electronic health-record and practice-management systems to have their ICD-10 updated systems delivered in enough time for physicians and their staffs to have them installed; train themselves on how to use them; and have the claims generated by them adequately tested against the systems and rules of their health plans and claims clearinghouses.

Top of mind for doctors was the potentially crippling effects to their practices if their claims flows sputtered at the switchover from ICD-9 to ICD-10. Those concerns continue, even with the new date nearly 18 months away.

“We had been pushing for two things at the same time” before Congress intervened, said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. “We had been pushing for a delay in implementation until there was true end-to-end testing to make sure small practices would not be affected, and we were saying to our members if it was going to be Oct. 1, 2014, that small practices should be ready.”

End-to-end testing would ensure that a claim can be generated and sent by a physician practice or hospital, received by a clearinghouse and/or health plan, processed and adjudicated by the plan, and then accurately returned to the sending provider as a remittance advice and a funds transfer.

Blackwelder said his organization was “very pleased” with last month's delay. “We didn't believe things were ready to roll out.

While larger practices could handle a glitch, smaller practices don't have the kinds of reserves to handle a payment challenge.”

It remains to be seen, Blackwelder said, whether even the 18-month extension is sufficient to do the ICD-10 conversion right.

“Enough time should be defined not by time but by successful demonstration of end-to-end testing,” he said.

The timeline to ICD-10 launch needs to be clearly delineated and communicated, said Dr. William Bria, president of the Association of Medical Directors of Information Systems, a professional association for physicians working in applied medical informatics.

AMDIS members, he said, won't be shocked by the CMS' decision to reset the ICD-10 date with as little delay as possible.

But Bria warned of “a rapid crescendo of frustration and even anger beginning to appear (among) U.S. healthcare providers, especially physicians, that seems to be worsening with each pronouncement. It's past time that a clear and specific communication plan be laid out for all affected in American healthcare.”

Stanley Nachimson, principal with healthcare IT consultancy Nachimson Advisors and an ICD-10 expert, said the Workgroup for Electronic Data Interchange, convened a meeting of representatives Tuesday from health plans, providers, health IT developers and the government to talk about a way forward on ICD-10. Simply plunking down a new deadline won't overcome resistance, Nachimson said. “We tried to engage with these folks who are against ICD-10 and change their minds or see what we could do to accommodate them,” he said. “I think there was a recognition that we have to change the way we do the ICD-10 implementation.”

Nachimson said he expects to see an interim final rule delivered by the CMS “sometime this month, and then it's going to open up the debate again.”

AMA, MGMA, AHIMA weigh in The American Medical Association and the Medical Group Management Association were among several physician groups that lobbied hard for a delay, and both still remain leery about the ICD-10 conversion.

“The AMA has long considered ICD-10 to be an unfunded mandate that comes at a time when physicians are being asked to make a number of other significant changes to their practices,” said AMA President Dr. Ardis Dee Hoven, in a statement. “While the AMA did not support the legislation that extended the ICD-10 deadline because it failed to reform Medicare's flawed payment formula, we believe a delay would have been inevitable for a coding system that has not completed end-to-end testing. The postponement will give physicians extra time to work with vendors on necessary system updates, train their staff, and test the ICD-10 changes with payers, clearinghouses and others.”

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Hoven said the industry should use the extra time “to conduct more robust and widespread testing on all aspects of ICD-10, including its application in reimbursement and quality reporting systems. We continue to harbor deep concerns about the burden this transition places on physicians, the complexity of ICD-10, the high risk of disruptions to Medicare claims and the industry's capability of converting to ICD-10 on a single date.”

Robert Tennant, the MGMA's senior policy adviser in Washington, attended the WEDI meeting with Nachimson and said if the group can come up with a list of “a half a dozen or a dozen things that the industry and government can reach agreement on, there is possibility there could be a seamless transition” to ICD-10 given the new deadline.

But, Tennant said health plans, vendors and the CMS had not done the necessary testing before the Oct. 1, 2014 deadline to ensure the ICD-10 launch would be successful. They must do those things now in the new, 18-month runup period, he said.

“Without sufficient testing, providers will likely encounter significant cash-flow disruption,” he said.

The Chicago-based American Health Information Management Association, a strong advocate for ICD-10 adoption and an opponent of delay, said in a written statement that it “applauds” the CMS' new start date. “We know that the industry has already invested considerable time and money in implementation,” the group said. “We particularly want to reach out to the physician community and are prepared to support programs such as the field support training for small physician practices proposed by CMS.”

ACA signups: Horizon, AmeriHealth N.J. Most New Jerseyans who've purchased health insurance on the Affordable Care Act Marketplace — Healthcare.gov — chose plans from two well-known insurance brands: Horizon Blue Cross Blue Shield of New Jersey and AmeriHealth New Jersey.

"We are still finalizing our information, but we estimate that approximately 100,000 members enrolled during the open enrollment period, continuing Horizon's top market share position in New Jersey's individual market," Horizon spokesman Tom Vincz said. "We expected a surge of enrollments in the closing weeks and we intensified our marketing and outreach efforts during this period."

AmeriHealth N.J. said 80 percent of the 118,766 new members it signed up for plans taking effect through May 1, or about 95,000, came on board via the Marketplace. The rest enrolled directly with AmeriHealth N.J. through its website or insurance brokers.

"Overall, enrollment has exceeded our expectations," AmeriHealth NJ spokeswoman Jill Roman said. "We believe this is the direct result of the wide range of competitively priced products we have to offer."

Under the ACA, individuals must sign up on the Marketplace in order to get federal subsidies that substantially reduce the cost of health insurance for low and moderate income people.

The federal government released preliminary numbers last week showing that 161,775 Jerseyans bought insurance policies on the Marketplace since healthcare.gov launched Oct. 1 on healthcare.gov. The health insurers are reporting enrollment numbers that exceed the numbers reported by the government.

And the numbers will continue to change.

While open enrollment on healthcare.gov officially ended March 31, individuals can still sign up throughout 2014, as their existing policies expire and can be replaced with plans that meet the new ACA rules.

In addition, 98,240 New Jerseyans have signed up for Medicaid, which covers more than 1 million low-income state resident and is undergoing a huge expansion under the ACA. The state of New Jersey contracts with health insurers to provide the Medicaid program, and Horizon is the largest provider.

"We have seen our Medicaid business grow by more than 50,000 to over 600,000 members, and we expect that figure to rise as the state completes its processing of all applications received during the enrollment period," Vincz said.

Joel Cantor, director of the Center for State Health Policy, said the healthcare.gov enrollment "exceeds" expectations for New Jersey.

"We saw quite a surge at the end of open enrollment," he said. "I think this bodes well for the market."

Cantor said that since individuals can continue to buy new policies on the ACA during 2014, as their non-ACA compliant policies run out, it will be several months before a full picture emerges of how many new customers the insurance companies have gained via healthcare.gov.

"At this point, though, I think it is safe to say that competition has become more vigorous in this market," he said. "That can only be a good thing."

The third insurer on the Marketplace, the new co-op Health Republic Insurance of New Jersey that was created by the ACA, said it has garnered a small share of the signups but said the actual total was not yet known.

"Our numbers are not completely finalized yet," spokeswoman Cynthia Jay said.

May 2014

13

Medicare Docs will need to enroll in Medicare if they want to prescribe Part D drugs

By Paul Demko Doctors and other medical professionals will be required to enroll in the Medicare program to prescribe drugs that are paid for by the federal healthcare program, under a rule finalized Monday by the CMS. The new requirement takes effect June 1, 2015, five months later then the federal agency had initially proposed.

“We have been concerned about instances where unqualified individuals are prescribing Part D drugs,” the CMS wrote in explaining the rationale for the change. “In fact, in a June 2013 report (PDF), the OIG found that the Part D program inappropriately paid for drugs ordered by individuals who clearly did not appear to have the authority to prescribe.”

Doctors and other medical professionals can seek an exemption from the new registration requirement.

The change is part of a wide-ranging final rule issued by the CMS involving administration of the Medicare prescription drug and Medicare Advantage programs. The proposed rule was initially issued in January and generated more than 7,500 comments. The CMS claims the changes will save the federal government $1.6 billion over the next decade.

The agency is also seeking to crack down on doctors and other medical professionals that are reckless or abusive in prescribing drugs to Medicare patients. The final rule cited another report by the OIG that found abuses in prescription practices by some physicians. For instance, the report noted that 108 physicians scrutinized ordered an average of 71 prescriptions per Medicare beneficiary – or five times the national average.

“The OIG has expressed particular concern over the potential for beneficiaries to become addicted to or otherwise be seriously harmed by certain drugs if they are inappropriately prescribed in dangerously excessive amounts,” the rule states. “We share this concern, particularly as we continue to receive reports of improper prescribing practices.”

Under the new rule, CMS officials will have the authority to strip providers of the ability to enroll in Medicare if their certification by the Drug Enforcement Administration to handle controlled substances has been revoked or if they've been stripped of their authority to prescribe drugs by a state licensing board. In addition, the agency will be able to revoke a provider's Medicare enrollment if they are deemed to have been prescribing drugs in an abusive manner that threatens the safety of patients.

The CMS asserted that this authority would be utilized only in rare instances where abuses have been well-documented. “Honest physicians and eligible professionals who engage in reasonable prescribing activities would not be impacted by our proposal,” the rule states.

Technology

Going digital: NJ-HITEC to help more than 450 health providers transition to electronic medical records

By Beth Fitzgerald The physician-owned health care network Partners In Care announced Tuesday that NJ-HITEC will help the more than 450 providers in its network transition to electronic health records technology.

In a move spurred by the Affordable Care Act, NJ-HITEC will help Partners In Care members qualify for federal funding of up to $64,000 to purchase and implement health IT. NJ-HITEC has been designated by the federal government to help doctors in New Jersey go digital. To date, NJ-HITEC member physicians have gotten more than $74 million in federal incentive money to fund the transition from paper medical charts to electronic medical records.

Under the ACA, physicians are required to adopt health IT by 2015 or face penalties. Federal funding is available to physicians who achieve “meaningful use” of health IT.

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Dr. Steven Goldberg, chairman and a founding physician of Partners In Care, said, “Many of our providers operate smaller independent practices, and we pride ourselves on being a resource to them both financially and clinically. This partnership significantly furthers that goal by providing them the opportunity to improve the delivery and cost of patient care through health IT without the burden of incurring hefty costs or having to rely on internal staff to navigate the challenging federal compliance and incentive requirements.”

“We are very excited about this important partnership with NJ-HITEC as it aligns perfectly with our mission to support and enable our providers to better practice medicine and thrive in an increasingly technology-driven and dynamic health care environment,” said Ralph Tang, chief executive of Partners In Care. “In conjunction with Partners In Care’s centralized clinical team and proprietary health IT technology, it allows us to more effectively and efficiently work with our provider network in delivering better health and better care at a lower cost to the patients we serve.”

NJ-HITEC Executive Director Bill O’Byrne said, “We are eager to begin working with Partners in Care and welcome this alliance.

Our experience and knowledge are our keys to success because we have worked with many physicians to solve their most challenging technology-related issues.”

Founded in 1995, Partners In Care is an independent physician association and health care management company with expertise in coordinating patient care and improving the health of particular patient populations. PIC clients include commercial and Medicare health plans, self-insured employers and local and state government agencies and school districts. PIC develops health care management programs aimed at improving the health of the patient population and thereby lowering health care costs.

The PIC network includes more than 450 primary care physicians, multispecialty physicians and other health care professionals located mainly in central and southern New Jersey.

NJ-HITEC provides support and assistance to New Jersey’s physicians to enable them to adopt electronic health record systems.

It was created in 2010 by the New Jersey Institute of Technology with a $23 million federal grant.

AmeriHealth AmeriHealth, Regional Women's Health plan to improve the quality of care for 350,000 N.J. women annually

By Meg Fry In an effort to guide New Jersey residents toward cost-effective comprehensive and preventative care, AmeriHealth New Jersey announced Monday a new contract agreement with Regional Women's Health Group LLC. The Regional Women's Health Group is a large OB/GYN and IVF group practice with 55 locations throughout New Jersey and more than 140 participating obstetrical gynecologists and mid-level practitioners.

"At Regional Women's Health Group our goal is to provide efficient practice management, electronic medical records and care coordination services that help physicians and medical centers gain greater control of patient care and financial management," Frank J. Caso, president and CEO of Regional Women's Health Group, said in a press release.

By partnering with AmeriHealth New Jersey, which has the largest provider network in the state, Regional Women's Health Group can improve the quality of care for approximately 350,000 women annually.

Headquartered in Cranbury, AmeriHealth New Jersey provides health insurance coverage to employers and individuals statewide in addition to offering value for customers through wellness, incentive and benefits programs.

May 2014

15

Medical News

Amsurg's $2.35B bid for Sheridan spotlights growing interest in physician outsourcing

By Beth Kutscher Amsurg Corp. is seeking to buy Sheridan Healthcare in a $2.35 billion deal that analysts believe showcases the growing interest in the physician outsourcing market.

The proposed transaction takes Nashville-based Amsurg outside of its core market of operating ambulatory surgery centers.

Sheridan Healthcare provides outsourced physician services, most notably in anesthesia. The Sunrise, Fla.-based company also provides outsourced pediatric, emergency medicine and radiology services.

The deal is subject to regulatory approval and expected to close in the third quarter.

In announcing the deal, Amsurg said the tie-up will allow it to enter an adjacent market and integrate anesthesia into its portfolio of ambulatory surgery centers. The company also alluded to the potential to participate in new payment and care-delivery models, citing new opportunities to engage with payers and build competencies that “address innovation and change in healthcare.”

The combined company is expected to achieve $30 million to $40 million in additional financial benefits within three years, according to Amsurg, $10 million of which will come from the cost and operational side and the remainder from growth, including new outsourcing contracts and partnerships with health systems.

The transaction also will double Amsurg's revenue from just under $1.1 billion to nearly $2.2 billion.

In a research note, Darren Lehrich, an analyst at Deutsche Bank, described Amsurg's move as bold, allowing Amsurg to enter a new space that has been increasingly converging with the one in which it already operates. The ASC market has been subject to sluggish growth and limited opportunities to expand through consolidation, he added.

The deal also points to continued interest in hospital-based physician specialties such as anesthesia, said Jeff Swearingen, managing director at Edgmont Capital Partners, a healthcare investment bank. There are a number of synergies that Amsurg can achieve by bringing Sheridan's services into its facilities, he agreed, but cautioned that the company will still need to sidestep anti-kickback statutes.

Sheridan Healthcare, backed by private equity firm Hellman & Friedman, last month was reported to be preparing for an initial public offering. But selling the company to Amsurg could provide a faster exit for the private equity firm and reduces the risk of an unsuccessful IPO, Swearingen said.

MEDNAX MEDNAX announces acquisition of N.J. anesthesiology practice

By Emily Bader Fort Lauderdale, Fla.-based MEDNAX Inc. announced Tuesday it has acquired Anesthesia and Pain Management Group LLC, a private physician group practice in Millburn.

According to the announcement, the practice will become part of MEDNAX’s American Anesthesiology division.

“After evaluating our options, it was American Anesthesiology’s mission and culture that aligned with ours, and their backoffice infrastructure gives us confidence that we can excel even as we face the changes occurring with health care reform,” Idrees Ahman, M.D., who will serve as medical director for the practice, said in a prepared statement. “We look forward to collaborating with a national network of physicians as part of the company’s research, education and quality initiatives as we look to grow our niche outpatient anesthesia services.”

MEDNAX’s division consists of more than 2,050 anesthesia providers, more than 875 physicians and 1,175 anesthetists practicing in Florida, Georgia, Maryland, Michigan, New Jersey, New York, North Carolina, Tennessee, Texas and Virginia, the company said.

Financial terms were not disclosed, but according to the announcement it was a cash transaction.

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HUMC HUMC establishes Mountainside Medical Group to address looming doctor shortages

By Beth Fitzgerald To help address what experts see as a looming and acute shortage of primary care doctors, HackensackUMC Mountainside has created the Mountainside Medical Group, a network of physicians who are employed by the hospital and practice at different locations in the community.

Montclair-based Mountainside, part of the Hackensack University Health Network, said seven doctors are currently treating patients at three of the group’s locations, and more physicians and offices will come on board in the coming months.

“Although it has been proven that primary care physician relationships promote wellness and improve quality of life, there’s also a documented shortage of such practitioners locally and nationally,” said John Fromhold, chief executive of HackensackUMC Mountainside. “The Mountainside Medical Group will help to alleviate that concern in our region and afford area residents the opportunity to build productive, long-term relationships with doctors who have exceptional clinical skills and a genuine interest in getting to know them.”

Fromhold said it may seem counter intuitive for a hospital to invest in primary care, which seeks to improve the “well care” of the patient population and thus “ideally will reduce hospital admissions.”

But, this new venture “is consistent with Mountainside’s long and distinguished history of adapting to changing times. The health care landscape has changed dramatically since our hospital was founded in 1891, yet we’ve successfully served multiple generations and become a hub for comprehensive care by keeping abreast of emerging local needs and medical advances,” Fromhold said.

Mountainside and the Hackensack University Health Network are among a number of hospitals statewide that are increasing the number of primary care physicians that they employ.

Health care is moving toward the “accountable care organization (ACO)” model, where hospitals and doctors get financial incentives from government and commercial payers if they can improve care and control costs. There’s a widespread view in the industry that for ACOs to work, primary care needs to be tightly integrated with the care provided by hospitals and other clinicians.

The Atlantic Health System, whose hospitals include Morristown and Overlook Medical Centers, is taking a different approach to strengthening primary care via Primary Care Partners, a large physician group that is owned by the doctors and affiliated with Atlantic’s hospitals. Headed by Dr. David Shulkin, vice president of Atlantic Health, Primary Care Partners has more than 50 physicians and is continuing to grow. Its physicians continue to practice medicine in their communities while getting the benefits and resources of a large practice.

May 2014

17

Hospital Rounds

Saint Michael's Receives Approval to Help Community Members Manage Diabetes and Hypertension Newark, NJ—Saint Michael’s Medical Center (SMMC) received approval by the State of New Jersey and Centers for Medicare and Medicaid Services (CMS) for the Delivery System Reform Incentive Payment (DSRIP) Program demonstration. The fiveyear demonstration is one component of New Jersey’s Comprehensive Medicaid Waiver, which provides hospitals with the opportunity to improve patient care for New Jersey’s low income population by incentivizing delivery system reform to improve access, enhance quality of care, and promote health for certain prevalent , chronic conditions in the state, such as diabetes and hypertension.

According to the American Diabetes Association, more than 25 million people in the U.S. have diabetes. SMMC’s application to “Improve the Overall Quality of Care for Patients with Diabetes and Hypertension” was selected based on a comprehensive community needs assessment which identified this chronic condition as opportunity to fill an unmet need for access to care and service in the local Newark community—diabetes is the sixth leading cause of death in the community.

Slated to begin in the fall of 2014, SMMC will implement a patient-centered medical “home” for patients with diabetes and hypertension, based in the Medical Center’s Primary Care Center. Some highlights of the program will include community health screenings and education, referrals and access to needed health care services, focus on lifestyle modification and nutritional counseling, and offer a dedicated patient navigation system as well as assistance with social services.

“The project seeks to improve the health of the community by providing greater access to primary and specialty care, ultimately reducing costly admissions, readmissions, emergency department visits and length of stay for patients with diabetes and hypertension,” said David A. Ricci, President and CEO, SMMC. “Additionally, we will implement specific clinical quality measures to monitor improvement in the health outcome for the program’s patients.”

A steering committee consisting of hospital members, physicians and community partners will monitor the five-year project. The DSRIP program supports the Healthy New Jersey 2020 vision: “For New Jersey to be a state in which all people live long, healthy lives.”

Established by the Franciscan Sisters of the Poor in 1867, Saint Michael’s Medical Center is a 357-bed regional tertiary-care, teaching, and research center in the heart of Newark’s business and educational district. Saint Michael’s Medical Center is currently a member of CHE- Trinity Health. More information is available at www.smmcnj.org.

Morristown is first N.J. hospital to offer innovative NanoKnife cancer treatment

By Beth Fitzgerald

Patients with inoperable cancer looking to use the innovative NanoKnife technology no longer need to leave the state to get the procedure done.

Morristown Medical Center now offers the treatment, becoming the first hospital in the state to do so.

Dr. Aaron Chevinsky, chief of surgical oncology at Morristown’s Carol G. Simon Cancer Center, said he and three other surgeons at Morristown were trained in the NanoKnife and started doing procedures last October.

Chevinsky said NanoKnife attacks the tumor inside the body, in cases where surgical removal is too difficult or dangerous, including certain pancreatic, liver and colon cancers. The procedure, Chevinsky said, involves the insertion of thin probes that enable electric current to run through the tumor. “(This) allows the pores of the cell to open up so fluid rushes into the cell, causing the cell the rupture,” he said. “(NanoKnife) does not harm any underlying (blood) vessels or ducts, so you can treat a tumor that surrounds a major vessel.”

18 New Jersey Physician

NanoKnife NanoKnife is one of several procedures for treating inoperable tumors that Morristown offers, and a multidisciplinary team of oncologists works in concert to determine which procedure is right for each patient.

“Not everybody with (inoperable) cancer is amenable to this technology, and this is not the only thing we offer, but it is one more tool we have to deal with tumors from the earliest to the most advanced,” Chevinsky said.

Chevinsky said NanoKnife is available at a few hospitals in New York City and Philadelphia. Morristown is among a number of leading New Jersey hospitals that for years have been developing clinical programs that address the tendency of New Jerseyans to leave the state for advanced medical care.

“I think that if you offer something that is comparable or of better quality, locally and close to home, then people will certainly be drawn to it,” he said. “There’s a certain percentage of people in any area close to a major city that feel that they need to go to the city (for medical care).”

Chevinsky said those who seek care at Morristown will find “the most up-to-date, best care available.”

He said it makes sense for patients to travel a long distance for specialized care for a condition that is extraordinarily rare — but he said that is not the situation with most cancer cases.

“They are very common and we take care of them every day,” he said.

Among his patients is Deborah Keraitis, 58, of Lincoln Park, who underwent a NanoKnife procedure in February for an inoperable tumor in her liver; the cancer had originated in her colon.

Keraitis had never had a colonoscopy to screen for colon cancer, and she is now an advocate for colonoscopies.

Chevinsky noted that it’s recommended that everyone have an initial colonoscopy at age 50, but he said less than half of Americans follow that advice.

“People are so resistant to colonoscopies and I guess I fell into that category,” Keraitis said.

She feels she is now in good hands.

“When I walked into the cancer center at Morristown, I felt: ‘This is the place that is going to help me; these people are trying to save my life,’” she said.

May 2014

19

Vendor News EANJ, Qualcare's small business health plan expects enrollment to increase by 20 percent this year

By Beth Fitzgerald The Employers Association of New Jersey launched a small business health plan in partnership with Qualcare in anticipation for what the Affordable Care Act's implications would be.

About three years ago, the Employers Association of New Jersey launched a small business health plan in partnership with Qualcare in anticipation for what the Affordable Care Act's implications would be. And good thing they did.

Enrollment this year is expected to increase by 20 percent as employers explore new options in a health insurance landscape being transformed by the Affordable Care Act. "The ACA has done what we thought it would do, which is to raise prices and homogenize coverage," John Sarno, president of EANJ, said. "That is why we formed and launched (the plan): to provide an alternative to employers who want to offer health care to their employees."

EANJ is an association of employers who focus strongly on human resources issues. In 2011, the EANJ partnered with QualCare to offer its members a new health plan via QualCare’s Affiliated Physicians & Employers Health Plan, a self-insured multiple employer plan that currently covers about 14,500 lives.

Sarno said enrollment by EANJ members has exceeded expectations and grew 20 percent in the first quarter of 2014 with 225 new members. Enrollment typically averages 70 employers per month.

The opportunity to join the plan is bringing new members into EANJ, Sarno said.

"So far this year, eight out of 10 of our new members have enrolled in EANJ primarily because of the plan." He said Employers who join the plan in many cases are leaving health insurance plans that presenting them with double-digit premium increases, he said. EANJ members now make up about 20 percent of the Affiliated Physicians & Employers Health Plan's membership. Members of the plan will see their rates increase 5.9 percent on average this year, he said. But, it doesn’t include the ACA's tax on health insurance, which will be an additional $5.25 a month per member, or $63 a year.

Sarno said EANJ employers ranging from eight lives to 500 lives have joined the plan, which offers a choice of 12 plans and access to Piscataway-based QualCare’s large network of hospitals and doctors.

But, the plan isn't right for every employer, he said.

To be eligible, 75 percent of the employer's workers have to reside in New Jersey.

20 New Jersey Physician

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Hospital Rounds Raritan Bay announces partnership with Joslin Diabetes Center Michael D'Agnes knew he had a problem with diabetes. As the CEO of Raritan Bay Medical Center, he knew first-hand that the disease continually topped the list whenever the Perth Amboy-based hospital did a community needs assessment.

And he knew his center did not have the resources to address the issue on its own. So he found an organization that did.

Earlier this month, Raritan Bay became the third New Jersey hospital to affiliate with the Boston-based Joslin Diabetes Center, a leading diabetes treatment and research organization.

D'Agnes said the affiliation brings to the Raritan Bay community a world-class diabetes program that puts as much emphasis on the education and counseling of the diabetic as it does on providing clinical care.

"I wasn't comfortable that we had a full-scope program of services," he said. "I felt the best way to do it was with a well-known brand and an accomplished partner."

D'Agnes said Joslin provides policies and procedures, from screening through comprehensive care.

"And they have the people, the physicians, the dieticians, the nurses that can work with our people so that they can augment the skills that we have and raise the level of service and professionalism," he said.

The goal, he said, "is to really move faster and begin to deal with diabetes in a much more efficient way."

Raritan Bay will send people to Boston for training, and Joslin will send staff to Raritan Bay on a quarterly basis.

"(They will) monitor our center, take a look at our statistics and our outcomes and make sure we are in sync with the kinds of outcomes they expect from a Joslin center," D'Agnes said.

Joslin has affiliations with AtlantiCare in Atlantic County and with Deborah Heart and Lung Center in Burlington County.

Dr. Jenine Vecchio, the medical director of the Joslin Diabetes Center at Deborah Heart and Lung Hospital, said their partnership with Joslin — which was launched in early 2011 — has been invaluable.

Vecchio said the Joslin focus on the education of the patient is a key differentiator.

"Education is key to treating someone with diabetes, and that's what we have," she said.

What they have is a new reputation.

"They hear the Joslin name and they know what it means," she said.

That name recognition is important.

D'Agnes said the affiliation required an upfront investment by Raritan Bay, though studies show the return on investment will be strong.

"Our forecast indicates (the investment) will be returned multiple times," he said. "We think this gives us an opportunity to reach out to an awful lot of potential patients in the counties north of Monmouth County."

Ultimately, D'Agnes said the affiliation is a money-saver for everyone since diabetes often leads to kidney and heart disease.

"Just think of the potential savings if we can avoid the progression of disease that comes as a result of either undiagnosed or untreated diabetes," D'Agnes said. "This is one of those things that hopefully we will look back in five years or so, and we'll see that we really have made an impact on patient quality of life, patient outcomes and on cost as well."

22 New Jersey Physician