NJ Physician Magazine December 2012

JULY 2012

Also In This Issue:House OKs Bill to Avert Fiscal Cliff and Doc Pay Cut

NJ Lawmakers Pass Bill for Rutgers-Rowan UMDNJ Merger

2013 Year of Transition for NJ Healthcare Consumers & Providers

Visit us now online atwww.NJPhysician.org

DECEMBER 2012

GANJ (Gastroenterology Associates of New Jersey) New Jersey Physicians Who Are Taking Care of Business to Better Care for Patients

An Overview of Stage 2 Meaningful Use

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Montdor Medical Media, LLC

Co-Publisher and Managing Editors

Iris and Michael Goldberg

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Iris Goldberg

Michael Goldberg

Jessica Zigmond

Jarrett Renshaw

Kelly Heyboar

Robert Pear

Reed Abelson

Andrew Kitchenman

Denise Anderson

Beth Christian

Layout and Design

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Publisher’s Letter

With warm regards,

Michael GoldbergCo-Publisher

Dear Readers,

Welcome to the December issue of New Jersey Physician Magazine, now reaching over 29,000 physicians throughout the state each month. If you know someone who would like to receive NJP, please email us their name, practice location and email address and we will be glad to include them in our circulation at no charge.

Once again, the House of Representatives and the Senate approved the last minute fiscal cliff package which holds off a sharp cut in Medicare reimbursements to physicians by cutting billions from other Medicare providers, including hospitals, pharmacies and dialysis centers. The 26.5% cut expected for physician payments has been once again put off, extending Medicare payment rates for doctors through Dec. 31, 2013.

Both houses of the state legislature approved a sweeping overhaul that will break up and merge parts of three of the state’s largest universities. Bottom line is that Rutgers takes over most of UMDNJ. In South Jersey, Rutgers-Camden will form a partnership with Rowan University in Glassboro with Rutgers retaining financial control of the Camden campus. University Hospital, UMDNJ’s teaching institution in Newark would become its own entity and partner with a private hospital chain to run operations. UMDNJ’s School of Osteopathic Medicine will be turned over to Rowan which will also enter into a quasi-merger with Rutgers-Camden to offer joint programs.

They finally got it right. A measure targeting “step therapy” in prescribing medication has been introduced, giving physicians more control than the insurance companies in prescribing pain meds. Under the bill, once one pain medication has been tried and failed, prior authorization for the doctor’s preferred medication wouldn’t be required. In addition, the doctor determines how long the medication required by the insurer must be tried before moving on to the doctor’s preferred choice.

This month’s cover story once again illustrates how medicine has changed so rapidly in terms of practice setup and management. Various models for structuring medical practices have emerged. The sole practitioner has become an anomaly and two physician partnerships are becoming scarce. Finding a solution that allows physicians to practice medicine without the burden of technology, billing, staffing and equipping offices seems to be the focus of many physicians now. Gastroenterology Associates of New Jersey, LLC offers a business model that provides physicians with a way to retain ownership of their individual practices while merging together to form an Integrated Group Practice. While they are now principally located in Passaic and Bergen counties, their plan is to add additional physicians to allow them to extend their network into a wider area of the state.

Contents

2 New Jersey Physician

CONTENTS

4

9

131417

STATEHOUSE

HEALTHCARE BUDGET

2013 YEAR OF TRANSITION

11 DR PAY CUT

19FOOD FOR THOUGHT

NJ HITECH

REGULATORY DEVELOPMENTS

20

GANJ (Gastroenterology Associates of New Jersey)

New Jersey Physicians Who Are Taking Care of Business to Better Care for Patients

COVER PHOTO

From Left to Right:

Standing in the Back: Gary J. Kosc, MD, George N Pavlou, MD, Michael J Martino, MD, Subodh H Patel, MD, Steven D Gronowitz, MD, Joseph G. Shami, MD, Ashok Gupta, MD

Middle: William S Albert, MD, Michael M Mainero, MD, Matthew Grossman, MD, Ralph A DeMaio, MD

Front on the floor: John J Farkas, MD, Dino Beduya, MD, Steven J Puchik, COO

Available for photography during surgical procedures, with clearance in most NJ hospitals.Familiarity with most procedures • 24/7 emergency availability if necessary.

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Cover Story

GANJ (Gastroenterology Associates of New Jersey)New Jersey Physicians Who Are Taking Care of Business to Better Care for Patients

Fig. 1

By Iris Goldberg

It cannot be said too often. The practice of medicine has changed drastically. Modern physicians have to be more than skilled and dedicated clinicians. They need the acumen to understand the numerous and sometimes complex business realities associated with having a career as a medical practitioner today and also to predict what will likely occur in the years ahead. Whether already in practice and attempting to adapt, or just starting out and having to choose a

William S. Albert, M.D.

71 Union Avenue

Rutherford, NJ 07070

Tel: 201-896-0400

Fax: 201-896-0863

Dino Beduya, M.D.

1011 Clifton Avenue

Clifton, NJ 07013

Tel: 973-471-8200

Fax: 973-471-3032

Ralph A.DeMaio, M.D.

205 Browertown Road, Suite 206

Woodland Park, NJ 07424

Tel: 973-837-0230

Fax: 973-837-0234

John J. Farkas, M.D.

716 Broad Street, 1st Floor

Clifton, NJ 07013

Tel: 973-777-5717

Fax: 973-777-0669

Steven D. Gronowitz, M.D.

1011 Clifton Avenue

Clifton, NJ 07013

Tel: 973-471-8200

Fax: 973-471-3032

Matthew Grossman, M.D.


Woodland Park, NJ, 07424

Phone: 973-283-5005

Fax: 973-812-5235

Ashok Gupta, M.D.

842 Clifton Avenue

Clifton, NJ 07013

Tel: 973-470-0101

Fax: 973-777-3024

Gary J. Kosc, M.D.



Tel: 973-812-8120

Fax: 973-785-0335

Michael M. Mainero, M.D.



Tel: 973-785-0102

Fax: 973-785-2205

Michael J. Martino, M.D.



Tel: 973-837-0230

Fax: 973-837-0234

Subodh H. Patel M.D.

1031 McBride Avenue, Suite D212


Tel: 973-890-1303

Fax: 973-890-5609

George N. Pavlou, M.D.



Tel: 973-812-8120

Fax: 973-812-8144

Joseph G. Shami, M.D.



Tel: 973-812-5230

Fax: 973-812 5235

workable business strategy, a physician’s ability to provide exemplary healthcare is significantly dependent upon how well he or she can survive the myriad of financial pitfalls that have to be navigated on a daily basis.

In recent years, various models for structuring medical practices have emerged. Certainly, the sole practitioner has become an anomaly and even two-physician partnerships are dwindling. With commercial and government-

Directory of Physicians and Locations

administered health insurance plans tightly regulating reimbursements to providers and the increasing costs in terms of staffing and equipping offices, it is difficult, if not impossible for one or two individuals to shoulder the burden. The term “strength in numbers” must now be considered as a catchphrase for physicians who wish to successfully meet both the clinical and business demands of practicing medicine today.

December 2012 5

Dr. Grossman holding the double balloon enteroscope.

Last month we profiled a large, statewide dermatology practice that has evolved through purchasing smaller practices from physicians who stay on as employees or from those who seize the opportunity to retire from practice altogether. This month, Gastroenterology Associates of New Jersey, LLC or GANJ, as it is best known, offers a business model that provides physicians with a way to retain ownership of their individual practices, while merging together to form an Integrated Group Practice (IGP).

With offices in Clifton, Woodland Park and Rutherford right now and 13 highly-trained gastroenterologists presently involved, GANJ provides comprehensive care and treatment to patients mainly within Passaic and parts of Bergen counties (see Fig. 1). However, as additional impressively-skilled physicians join its IGP, the plan is for GANJ to extend its network to include a much wider area of the state.

Steven J. Puchik, COO, shares how the IGP works. “What makes this model unique is that although there are many practices operating under one tax ID, each practice retains total autonomy regarding how it’s run clinically,” Mr. Puchik states. “But we’ve taken the business part out of each practice and that’s run here in the administrative office,” he further explains.

“The basic infrastructure of an IGP begins with one central business office that performs all of the administrative functions, that will no longer need to be performed by each individual practice,” states Mr. Puchik. “So they keep their autonomy but lose some of the work and obviously, the expense,” he adds. Some of the responsibilities delegated to the central office include:

• Accounts payable

• Accounting

• Payroll

• Human resource management (including benefits management, pension administration, employee handbook implementation and employee termination issues)

• Overseeing vendors who provide services such as EMR and billing

Mr. Puchik also makes a point of mentioning the increased leverage that the IGP has in terms of negotiating. For instance, reimbursement rates from third

party payers can be negotiated higher for the IGP than for an individual, while medical malpractice insurance rates for each member of the group are less expensive. Going forward, Mr. Puchik foresees enough partners joining the IGP for it to self-insure against malpractice.

“This leverage can also be used for bank financing deals, EMR purchase, medical supplies and equipment, etc. You get better rates when you have more people being supplied,” Mr. Puchik points out. “There’s enormous potential and unlimited possibilities of what everyone involved in an IGP can gain,” he continues. “Bigger is not always necessarily better but in the case of an IGP, bigger is most definitely better,” Mr. Puchik asserts. In fact, he is so confident, that he would like GANJ to eventually include gastroenterologists from across the entire tri-state area.

Besides the sharing of expenses of practice management amongst the large group of physicians that comprise GANJ and the substantially increased cost-efficiency, freeing physicians from the responsibility of dealing with the business end of practice management allows them to focus attention more completely on their patients. Just as important, having the resources that are generated from the efforts of the group, allows GANJ to recruit the brightest and the most expertly-trained physicians to join with them in practice.

Matthew Grossman, MD is the newest member of GANJ. He joined after completing a four year fellowship, where he specialized in advanced procedures such as double balloon enteroscopy, endoscopic ultrasound, endoscopic mucosal resection and radiofrequency ablation for Barrett’s esophagus. In


addition to seeing patients requiring the skills of an advanced endoscopist who have been referred to Dr. Grossman by his colleagues within GANJ, he also treats patients who have been referred by gastroenterologists in other practices.

Dr. Grossman, who is amongst the first to offer this technology in New Jersey, discusses the double balloon enteroscopy (DBE) and explains why it is so important for facilitating diagnoses and at times, treatments for certain disorders affecting parts of the small intestine that were unable to be visualized before.

“With the standard endoscope, it’s easy to get to the esophagus, to the stomach, to the colon and to the beginnings and the very end of the small intestine,” Dr. Grossman relates. “But the small intestine is 20 feet in length and has the surface area of a tennis court, if you were to lay it all flat. It’s a tremendous organ,” he emphasizes. Dr. Grossman goes on to elaborate that essentially, DBE allows the physician to access the entire length of the small intestine.

DBE involves the use of a balloon at the end of an enteroscope camera and an insertion tube that fits over the endoscope which is also fitted with a balloon. The endoscope is advanced through the small bowel by alternately inflating and deflating the balloons and pleating the small bowel on the tube like a curtain over a rod. The process is continued until the entire small bowel has been visualized.

The outpatient procedure can be performed through the mouth, via the upper gastrointestinal (GI) tract (antegrade), or through the colon and into the ileum to visualize the end of the small bowel (retrograde). DBE is indicated for patients who have problems in the small intestine, including bleeding, strictures, abnormal tissue, polyps or tumors.

“Admittedly, small intestinal disease is rare but when it presents itself, it’s ugly because the only way to go after it is with surgery,” Dr. Grossman reports. “Usually, surgeons, because they can’t see inside the small bowel, wind up taking out large sections of small intestine,” he continues.

treated without surgery. These include removing polyps, biopsy of a tumor, placing a stent, dilating a stricture or cauterizing an active bleed. Should surgery be required, a “tattoo” can be placed to enable the surgeon to locate the site easily.

In the case of a mass lesion, Dr. Grossman explains that traditionally, the surgeon can easily locate that and would remove it, taking out six inches on either end. “But is the mass benign or malignant? Does it require resection? Very often, the answer is no,” he states. With DBE, Dr. Grossman can perform a biopsy and remove those lesions that do not require surgical resection.

Besides accessing the small intestine with DBE to correctly identify and treat mass lesions, Dr. Grossman performs DBE quite often to treat tiny flat bleeding lesions called angioectasias. These are most commonly found in elderly patients with aortic stenosis, who usually present with chronic anemia. Turbulent blood flow across the aortic valve breaks down a clotting factor in the blood, making it less efficient at enabling platelets to adhere.

Injection needle to tattoo area in question during DBE.

the anemia, these patients eventually undergo a small bowel capsule endoscopy ( a capsule-sized camera is swallowed), that indicates the presence of these lesions. Once lesions in the small intestine are identified, the only way to treat them without surgery is with DBE.

Dr. Grossman shares that most often he treats the bleeding from these lesions during DBE with argon plasma coagulation (APC). APC involves the use of a jet of ionized argon gas that is directed through a probe passed through the endoscope. The probe is placed at a distance from the bleeding lesion. High-frequency electrical current is conducted through the jet of gas, resulting in coagulation of the bleeding lesion on the other end of the jet. Because no physical contact is actually made with the lesion, APC can be used to treat bleeding in parts of the GI tract that have thin walls, as the depth of coagulation is usually only a few millimeters.

Besides treating angioectasias, Dr. Grossman employs DBE to diagnose and treat various other conditions that affect the small intestine, thereby avoiding a surgical procedure. For example, strictures found in patients with Crohn’s disease or inflammatory bowel disease can be dilated with balloons through the scope.

The benefit of DBE is that it allows treatments for some conditions affecting the small bowel to be

Usually, in addition to other diagnostic procedures that have failed to identify the source of bleeding that has caused

December 2012 7

Villi of small bowel engorged with diffuse lymphangectasia.

In addition, Dr. Grossman relates that with DBE he has diagnosed carcinoids and also, metastatic disease, most commonly from malignant melanoma, that can cause the bowel to herniate into itself.

Whether for performing a biopsy, controlling bleeding or dilating a stricture, Dr. Grossman cannot overstate the valuable contribution of the DBE technology. “It’s all in the realm of therapeutic endoscopy, where you are sparing the patient the “slice and dice” method of treating small bowel disease,” he strongly states.

“To be honest, this is what drives me as a physician,” Dr. Grossman candidly shares. “I don’t want to just be a ‘look and see’ doctor. I want to be more than an intermediate to a surgeon. I want to be able to offer therapy to my patients.”

As an advanced endoscopist, Dr. Grossman also performs endoscopic ultrasound (EUS), which is a scope with an ultrasound probe on the tip. It allows visualization of the pancreas and the biliary tree, which is not possible with standard endoscopy. When indicated, an EUS-guided needle aspirate (FNA) can be performed by Dr. Grossman to identify the presence of cancer.

His specialized training and expertise afford Dr. Grossman the opportunity to

handle certain high-risk endoscopy and colonoscopy procedures that need to be performed in a hospital rather than at either of GANJ’s two state-of-the-art outpatient endoscopy centers. This precaution is taken in case of a complication that would require surgical back-up.

“The average polyp is about a centimeter in size, which is about the size of the tip of your thumb,” Dr. Grossman explains. He goes on to share the case most recently referred to him, in which the patient had a flat four and a half centimeter polyp.

“We had to use a sub-mucosal injection underneath the lining of the colon, lift up the polyp on a cushion of saline, mixed with epinephrine. Then we put a snare around this entire pillowed-up polyp, pulled the snare tight and used electro-cautery to remove it. Because there’s epinephrine in the solution, we are able to prevent any bleeding on the spot. We also put a tiny bit of blue dye into the solution so that we can visualize any sub-mucosal blood vessels. Then we go in with a closed biopsy forceps and buzz each little vessel. So, our rates of post-polypectomy bleed, even if there are huge polyps, are quite low,” Dr. Grossman is pleased to report.

trained. EMR allows the removal of large and/or flat lesions in the gastrointestinal tract that cannot be safely removed with traditional endoscopy. Additionally, EMR involves the removal of very shallow amounts of tissue, leaving deeper, healthy tissue intact.

Another innovative procedure in which Dr. Grossman specializes is radiofrequency ablation (RFA) for Barrett’s esophagus (BE). In patients with BE, the normal cells lining the esophagus are replaced with tissue that is similar to the lining of the intestine. A small minority of those patients with BE eventually develop adenocarcinoma of the esophagus, which is often deadly. RFA is a minimally invasive treatment for dysplasia associated with BE in which the inner lining of the esophagus, which contains the pre-cancerous cells, is destroyed by applying high radiofrequency waves to it, causing a thermal injury or “burn.” When these dysplastic cells are destroyed, normal tissue usually regenerates in its place.

Since joining GANJ, Dr. Grossman could not be happier. He has the highest regard for the skilled expertise of his colleagues at GANJ and thoroughly enjoys the opportunity to work with such an impressive group of physicians. “You should know that I love my job,” Dr. Grossman exclaims. “It’s a dream job,” he says with a smile.

George N. Pavlou, MD is a member of GANJ and one of the visionaries responsible for its creation. After experiencing, firsthand, some of the difficulties that can befall a medical practice that is not thoughtfully organized, Dr. Pavlou set out to structure a more practical business model.

“Dr. Pavlou not only had the vision for this group but he made sure that his vision was carried out,” Mr. Puchik informs. “So he really is the one who formed this from a seed to what it is today and Dr. Pavlou also is our future,” he adds.

As Dr. Pavlou reiterates, the basic foundation upon which GANJ is constructed is the invitation for skilled gastroenterologists to feel comfortable coming into the group or leaving the group if they are not happy. “We are basically encouraging practices to come in the way they are and to continue practicing the way they practice, taking advantage of some of our managerial

The procedure described by Dr. Grossman is endoscopic mucosal resection (EMR) and one in which he has been expertly


EUS showing dilated common bile duct.

A stone is present within the duct.

To perform EUS, a scope with an ultrasound probe on the tip allows visualization of the pancreas and biliary tree.

benefits,” Dr. Pavlou states.

“As a larger group, there are a lot of things we can do together that are much more cost-effective,” he elaborates, referring as Mr. Puchik did, to greater purchasing power for all the goods and services required to efficiently manage a practice. “And for gastroenterology, in particular, there are some special things that we can take advantage of and provide as a larger group, such as anesthesia services, pathology services, surgical endoscopy units – things like these that are much harder to do in smaller groups,” Dr. Pavlou points out.

In terms of reimbursements from insurance companies, Dr. Pavlou shares why a large group such as GANJ can potentially fare better. While it’s difficult to expect insurance companies to pay physicians in a large group more money than those in smaller practices for the same service, Dr. Pavlou explains that, instead, GANJ is attempting to provide more global services.

“For instance,” Dr. Pavlou offers, “A patient who comes in for an endoscopic procedure will have four or five individual charges for that one procedure. You have the doctor’s, fee, the facility fee, the anesthesia fee and in about 60 percent of the cases, two pathology fees. If we, as a larger group, can offer these services in a special package deal - a vertical assembly of charges - the insurance companies tend to be very receptive.”

Another extremely important advantage that the IGP has over a smaller practice is its ability to attract physicians with impressive training and expert skills to join. “Because we are a large group, we are able to recruit someone like Dr. Grossman to bring new talent and skills into the area,” Dr. Pavlou emphasizes. He goes on to share that unlike a relatively small practice, GANJ can keep a valuable new member like Dr. Grossman busy and can afford to compensate him until his practice further develops.

“One of the primary goals of GANJ is first and foremost to serve and treat the

community,” Mr. Puchik shares. Certainly, with an impressive team of physicians right now and more to be included as GANJ evolves, as well as a winning business model on which to build, GANJ will continue to reach that goal, however large that community becomes.

For more information please contact Steven Puchik, COO at (973) 812-1400.

Photography by Michael Goldberg

Dr Grossman views monitor during hospital based endoscopy.

December 2012 9

House OKs bill to avert fiscal cliff, doc pay cutBy Jessica Zigmond

The House of Representatives late Tuesday approved the Senate's last-minute fiscal cliff package (PDF) that staves off a sharp Medicare physician pay cut by cutting billions from other Medicare providers, including hospitals, pharmacies and dialysis clinics.

Early on New Year's Day, the Senate voted 89-8 to approve the American Taxpayer Relief Act, an amended version of a tax bill that House Ways and Means Chairman Dave Camp (R-Mich.) introduced last summer. House members on Tuesday considered the Senate-passed legislation in meetings during the day and floor debate in the evening. In a vote of 257 to 167, the House passed the measure, which permanently extends middle-class tax cuts and postpones the automatic spending cuts known as the sequester for two months. The legislation also averts the expected 26.5% Medicare physician payment cut and extends current Medicare payment rates for doctors through Dec.31, 2013.

Now that both chambers have approved the package, Congress will send the legislation to President Barack Obama for his signature. Moments after the House vote, the president said in a brief news conference that Tuesday's agreement helps reduce the nation's deficit by raising $620 billion in revenue from the wealthiest households in America. He also noted there will be more deficit reduction as Congress considers how to address the sequester, and he indicated he's open to reforms in the Medicare program.

“As I've demonstrated throughout the past several weeks, I am very open to compromise. I agree with Democrats and Republicans that the aging population and the rising cost of healthcare makes Medicare the biggest contributor to our deficit," the president said. "I believe we've got to find ways to reform that program without hurting seniors who count on it to survive. And I believe that there is further unnecessary spending in government that we can eliminate. But we can't simply cut our way to prosperity."

Dr Pay Cut

In a summary of the agreement (PDF)—which Vice President Joe Biden and Senate Minority Leader Mitch McConnell (R-Ky.) hammered out late Monday—the White House said the president “stood firm against Republican proposals to pay for this fix with cuts to the Affordable Care Act or the beneficiaries."

Instead, the bill offsets the cost of a one-year patch to the sustainable growth-rate formula through reductions to other Medicare programs, most of which affect hospitals. For instance, a documentation-and-coding adjustment that seeks to recoup past overpayments to hospitals because of the shift to Medicare Severity Diagnosis Related Groups, or MS-DRGs, would save about $10.5 billion. A measure to re-price end-stage renal disease payments would save about $4.9 billion. That provision comes a few weeks after the Government Accountability Office released a report suggesting the federal government is over-paying for end-stage renal disease treatment. The bill also calls for re-basing Medicaid Disproportionate Share Hospital (DSH) payments, which is estimated to save about $4.2 billion.

Providers criticized the legislation, with Chip Kahn, president and CEO of the Federation of American Hospitals, noting in a statement that it's not in the best interests of patients or caregivers to “rob hospital Peter to pay for fiscal cliff Paul.”

AHA President and CEO Richard Umbdenstock struck a similar note. “While fixing the physician payment formula is essential, it should not be done by jeopardizing hospitals' ability to care for seniors and their communities,” Umbdenstock said in a statement (PDF). “That's why we are very disappointed at the approach taken in this measure.”

Speaking on behalf of the nation's safety net providers, Dr. Bruce Siegel, president and CEO of the National Association of Public Hospitals and Health Systems (PDF), said the agreement will put at risk the essential healthcare needs for the country's most vulnerable citizens. “Solving one side of the provider equation must not come at the expense of the other—particularly the hospitals and health systems that care for a disproportionate share of Medicare and other low-income patients,” Siegel said.

Meanwhile, the nation's community pharmacists are upset by a provision in the bill—estimated to save about $600 million—that would apply a competitive-bidding program to diabetes test strips bought at retail pharmacies. In a statement, the National


Visit us now online atwww.NJPhysician.org

Association of Community Pharmacists said the measure could force many community pharmacists to stop providing diabetes test supplies to Medicare beneficiaries.

“The bill would do this by applying DTS (diabetes test supplies) reimbursement rates to local pharmacies that are effectively set by large mail order operations,” John Coster, a pharmacist and senior vice president for government affairs at the National Community Pharmacists Association, said in the statement.

The bill also extends several Medicare programs, such as the inpatient hospital payment adjustment for low-volume hospitals through Dec. 31, 2013 and ambulance add-on payments for urban, rural and super-rural providers through June 30, 2013. It also extends the existing floor on the "physician work" index in the Medicare fee schedule. That schedule is adjusted geographically for physician work, practice expense and medical malpractice insurance to account for differences in the cost of resources for physician services. And another measure would extend the current payment exceptions process for outpatient therapy services. Under current law, there is an annual per-beneficiary payment limit of $1,880 for all outpatient therapy services that are provided by non-hospital providers with exceptions for cases where additional therapy services are medically necessary. The bill would extend this exceptions process through Dec. 31, 2013.

The White House noted in its summary that the agreement saves about $24 billion, with half coming from revenue and the remaining half from spending cuts that are divided equally between defense and non-defense programs to delay the sequester. The move is intended to give Congress more time to permanently end the sequester.

“Although Congress again averted another massive Medicare physician payment cut at the 11th hour, this action only perpetuates another year of uncertainty for physician practices forced to continue their work under the dark cloud of looming SGR cuts and the new threat of sequestration cuts scheduled for March,” Dr. Susan Turney, president and CEO of MGMA-ACMPE, said in a statement that was released moments after the House passed the legislation. “Without action to permanently repeal the sustainable growth rate formula, Congress will replay this fiscally irresponsible scenario again and again, with even larger cuts awaiting practices in the near future.”

December 2012 11

Statehouse

NEW JERSEYSTATEHOUSE N.J. lawmakers pass bill for Rutgers-Rowan-UMDNJ merger

By Jarrett Renshaw and Kelly Heyboer/The Star-Ledger

In a historic day for higher education in New Jersey, both houses of the state Legislature approved a sweeping overhaul today that will break up and merge parts of three of the state’s largest public universities.

Still unsettled, however, was whether Rutgers University’s two governing boards would flex their muscles and block the deal. After days of private meetings with lawmakers, the university’s Board of Governors gathered hastily this morning and offered its lukewarm support on the condition that it retain financial control over the Camden campus.

Within hours, lawmakers added dozens of pages of amendments to satisfy board concerns and put the legislation before the Assembly and Senate for approval — even though no one knew the cost of the plan or how the final details would be received by the 11-member board.

The Assembly was first to vote tonight, approving the overhaul 60-18 without debate. Minutes later the Senate passed the measure 29-9 after about an hour of impassioned comments from both sides of the aisle.

State Sen. Donald Norcross (D-Camden), a co-sponsor of the bill, called the bill "the beginning of taking New Jersey out of 47th in the country and moving it to the top tier of colleges."

One of the people likely to gain the most from the bill’s passage is Norcross’s brother, George Norcross, arguably the most powerful Democrat in New Jersey and chairman of Cooper University Hospital, which is a partner with Rowan in a new medical school in South Jersey.

In the day’s most fiery speech, state Sen. Ronald Rice (D-Essex) intimated that George Norcross was controlling the process for his own advantage. "Maybe this whole thing should be investigated as to the relationship that’s driving this process so rapidly," Rice said.

State Sen. Bob Smith (D-Middlesex) told colleagues he reluctantly opposed the bill.

Smith said the state was adding a second research university even though it has not adequately financed its current one. "Shouldn’t we try to fund the first one properly," he said.

And complaining that the bill was railroaded, he added: "If I was an regular man or woman in New Jersey, I would be asking whether we are properly considering the reorganization of higher education in New Jersey."

The contentious proposal — called the New Jersey Medical and Health Sciences Education Restructuring Act — will have Rutgers take over most of the University of Medicine and Dentistry of New Jersey. In South Jersey, Rutgers-Camden will form a partnership with Rowan University in Glassboro, though the latest round of amendments weakened their ties and preserved Rutgers’ financial control of its Camden campus.

Leading lawmakers darted from one Statehouse meeting to the next as they tried to nail down the final details. Voting was delayed for several hours as the amendments were drafted.

The restructuring — proposed by Gov. Chris Christie, who chose to set a July 1 deadline for the Legislature to act — affects tens of thousands of students, the transfer of hundreds of millions of dollars of debt and complex changes to how the universities are financed and

Moments before the legslation was approved, Christie remarked during a call-in program on NJ101.5 FM: "This is going to bring higher education into the 21st century in New Jersey. This is going to make a bigger and stronger Rutgers."

Lawmakers have spent weeks massaging the legislation in an effort to appease university officials and legislators in North, Central and South Jersey who were concerned their regions would lose money or influence in the reshuffling.


Under the plan, Rutgers would take over most pieces of UMDNJ, including its medical schools in Newark and New Brunswick-Piscataway. University Hospital, UMDNJ’s teaching institution in Newark, would become its own entity and partner with a private hospital chain to run operations.

In South Jersey, UMDNJ’s School of Osteopathic Medicine will be turned over to Rowan, which will also enter into a quasi-merger with Rutgers-Camden to offer joint programs.

Yet despite the extensive rewriting of the legislation, and the arm-twisting and deal-making among lawmakers and educators, the best the Board of Governors could offer was a 9-1 vote, with one absention, to endorse the plan "in general."

The 11 members of the board — some participating by way of conference call — spent more than an hour in closed session. When they reconvened in public they approved a carefully-worded two-page resolution encouraging lawmakers to go forward. They said in a statement the takeover of UMDNJ could "elevate Rutgers’ status to among the top 25 most elite research universities in America."

Still, the board insisted that Rutgers retain control of its Camden campus, and that the university needed more time to determine how taking over UMDNJ would affect the state university’s finances.

The board also reminded lawmakers that it and the Board of Trustees had the right under state law to stop any merger they didn’t approve of.

"Under the Rutgers Act of 1956, both boards are required to consent to the changes proposed in the legislation before those changes can take effect," the board of governors said.

There is some disagreement within Rutgers over whether the university’s two boards should sign off on the deal at all, and several members of the more powerful board of governors emphasized their caution.

"We are not by this resolution endorsing legislation we have not read," Gerald Harvey, the board’s vice chairman, said.

The 59 trustees, who have been less enthusiastic about the restructuring, did not participate in today’s meeting, though some were in the audience or listened in.

"We reserve the right to respond after we receive a copy of the legislation and determine whether the concerns our joint committee has expressed to the bill sponsors have been appropriately addressed," the board of trustee’s executive committee said in a statement.

December 2012 13

Hospitals Fear They’ll Bear Brunt of Medicare CutsBy ROBERT PEAR and REED ABELSON

As President Obama and Congress try to thrash out a budget deal, the question is not whether they will squeeze money out of Medicare, but how much and who will bear the brunt of the cuts.

Republicans say that some of the savings should come from beneficiaries, and they are pushing proposals like raising the eligibility age or increasing premiums for people with high incomes, who already pay more than the standard premium. Even President Obama has proposed higher premiums, increasing the likelihood that the idea could be adopted. But any significant tinkering with the benefits for older Americans comes with significant political risks, and most Democrats in Congress strenuously oppose raising the age when Medicare coverage begins.

With growing pressure to reach an agreement on deficit reduction by the end of the year, some consensus is building around the idea that the largest Medicare savings should come from hospitals and other institutional providers of care.

“Hospitals will be in the cross hairs for more cuts,” said Lisa Goldstein, an analyst with Moody’s Investors Service, which follows nonprofit hospitals that issue bonds. While hospital executives fiercely defend the payments their own institutions receive, many acknowledge that Medicare is spending too much and growing too fast.

Those executives point out, however, that they have already agreed to $155 billion in cuts over a decade as part of the Affordable Care Act and they face billions more in additional cuts as part of the current negotiations. They argue that such large cuts to hospitals will ultimately affect beneficiaries.

“There is no such thing as a cut to a provider that isn’t a cut to a beneficiary,” said Dr. Steven M. Safyer, the chief executive of Montefiore Medical Center, a large nonprofit hospital system in the Bronx.

Mr. Obama and Speaker John A. Boehner continued trying on Tuesday to reach an overall budget agreement, which would call for significant savings in Medicare and would avert a deep cut in Medicare payments to doctors, scheduled to occur next month.

Mr. Boehner said that an increase in the eligibility age for Medicare, favored by many Republicans, could wait until next year.

“I don’t believe it’s an issue that has to be dealt with between now and the end of the year,” Mr. Boehner said Tuesday when asked about a possible change in the eligibility age. “It is an issue, I think, if Congress were to do entitlement reform next year and tax reform, as we envision, if there is an agreement, that issue will certainly be open to debate in that context.”

The starting point for the current negotiations is President Obama’s most recent budget request, which proposed legislation that would save $300 billion, or 4 percent of projected Medicare spending, over 10 years.

By contrast, Republicans in Congress are seeking savings of $400 billion to $600 billion, at least some of which should come from beneficiaries, they say.

Members of the Medicare Payment Advisory Commission, an influential panel that advises Congress, see many opportunities to rein in costs, and they say that financial pressure on providers could make them more efficient without harming the quality of care. At a meeting of the panel earlier this month, one commission member, Scott Armstrong, president of Group Health Cooperative, a nonprofit health system in Seattle, said Medicare spent “too much” on inpatient hospital care — $117 billion last year. “In an efficient system,” he said, “we wouldn’t be spending that kind of money on hospital services.”

Although Congress may leave the details of Medicare savings to be worked out next year, there is already discussion of cutting special payments to teaching hospitals and small rural hospitals. Lawmakers are also considering reducing payments to hospitals for certain outpatient services that can be performed at lower cost in doctors’ offices. Medicare pays substantially higher rates for the same services when they are provided in a hospital outpatient department rather than a doctor’s office. The differential added $1.5 billion to Medicare costs last year, and as hospitals buy physician practices around the country, the costs are likely to grow, the Medicare commission says.

The savings contemplated by Mr. Obama and Mr. Boehner are substantially larger than the Medicare savings that would be produced by automatic across-the-board cutbacks scheduled to start next month if Congress does not intervene. Those Medicare savings have been estimated at $123 billion from 2013 to 2021. Some hospital executives favor the automatic cuts as more equitable — and less painful — than some of the specific reductions being contemplated.

Hospital administrators and others warn of potential hospital closings, shutting down of unprofitable services like hospitalization for psychiatric care and less access to medical care for the most vulnerable if the cuts are too deep. Nancy M. Schlichting, the chief executive of the Henry Ford Health System in Detroit, says severe cuts might make it harder for hospitals like hers to treat patients without insurance. “It’s a big question whether we can continue to do that,” she said. “We would have to make tough decisions.”

Healthcare Budget

HEALTHCARE BUDGET


2013 Year of Transition

Twelve-month countdown to federal ACA will keep health sector moving ahead on key issues, like Medicaid eligibility and waiver, insurance exchange

By Andrew Kitchenman, Healthcare

There is at least one certainty for New Jersey's healthcare environment in 2013 -- it will be very different a year from now.

The major pieces of the federal Affordable Care Act will be rolled out on January 1, 2014, but preparations for those changes are already underway and will dominate the healthcare landscape in New Jersey and across the country this year.

A set of related issues are at the forefront of those changes: whether the state expands Medicaid eligibility; whether it forms a partnership with the federal government to operate a health benefit exchange or allows the feds to be the sole operator; how a wide-ranging state Medicaid waiver is implemented; and how New Jersey’s providers expand new models for healthcare delivery.

Each of these issues have the potential to make a difference in how New Jersey residents receive healthcare, as well as how doctors, hospitals, and other providers are paid.

Medicaid Expansion

When 2012 began, the major question hanging over healthcare was whether the U.S. Supreme Court would allow the Affordable Care Act to stand. While ACA supporters praised Chief Justice John Roberts’ crucial vote to uphold the law, Roberts opened up a major possibility that hadn’t been foreseen. By preventing the federal government from severely penalizing states from expanding Medicaid eligibility, Roberts opened up a possibility that could have major consequences for low-income New Jerseyans.

Gov. Chris Christie said soon after the decision that there is little room for the state to expand Medicaid. He has joined other Republican governors in asking federal officials to answer a series of questions about both Medicaid expansion and health benefit exchanges before deciding his next step.

If the expansion occurs, it would cover an estimated 291,000 additional New Jersey residents. The expansion would affect those with incomes up to 138 percent of the federal poverty line, currently $15,415 for a single person. It would do so at little initial cost to the state, with the federal government committed to picking up all of the additional cost through 2016, before the state share of the added cost would gradually rise to 10 percent by 2020.

While the federal government hasn’t set a deadline for states to opt in to the expansion, Christie may signal his decision on February 26, the scheduled date of his 2013-2014 budget address.

The expansion has garnered support among healthcare advocates and providers, with everyone from Healthcare Quality Institute of New Jersey President David Knowlton to Senate Majority Leader Loretta Weinberg (D-Bergen) describing it as a “no brainer.” But employer groups have been skeptical about its long-term costs, which they see falling on them if the federal government doesn’t uphold its funding commitment.

Along with residents who could receive coverage, another group with a major interest in Christie’s decision is the state’s hospitals. Federal funding for unreimbursed care such as charity care is disappearing under the ACA, and Medicaid expansion was expected to soften the impact.

“Roughly a quarter million covered lives are at stake and the potential financial impact on healthcare providers -- including hospitals -- could be huge,” said Joel Cantor, director of Rutgers University’s Center for State Health Policy.

Health Benefit Exchange

While Christie vetoed a bill that would have established a state-run health benefit exchange, the door remains open for the state to play a major role in operating an exchange.

The state has until February 15 to decide whether to join in a partnership with the federal government to operate the state exchange, an online marketplace allowing individuals and employers to buy insurance, as well determine whether they’re eligible for federal insurance subsidies.

Under a partnership, the state could oversee plan management and consumer assistance, while the federal government would handle other functions. If the state doesn’t move forward on a partnership, then the federal government would oversee all exchange functions.

2013 Year of Transitionfor NJ Healthcare Consumers, Providers

December 2012 15

Cost could become the determining factor in whether Christie opts for a partnership exchange. In the statement announcing the veto of the state bill, administration officials raised questions about whether the state share of partnership exchange costs would be paid through a federal fee on policies purchased through the exchange. As with Medicaid expansion, Christie wants a series of questions posed by Republican governors to be answered by federal officials before making a decision.

Policy experts are raising questions about how smoothly the exchange will function if the state doesn’t pursue a partnership.

“If we choose not to do the plan management function, then the next challenge will be how to coordinate the state regulatory function with the federal regulations,” Cantor said, adding that it will be more effective and efficient if a partnership is in place. He also noted that the state has experience reaching out to low-income residents for existing healthcare programs, an area in which the federal government doesn’t have “a lot of experience.”

Regardless of whether the exchange is a partnership or federally operated, the state’s insurers face a less than nine-month sprint to begin enrolling residents, since the ACA requires that exchange enrollment begin on October 1 for the January 1, 2014, launch.

Horizon Blue Cross Blue Shield of New Jersey spokesman Thomas Vincz said insurers would be ready.

“It’s a challenging time but it’s also exciting,” Vincz said, adding that Horizon has been experimenting with new models of retail outreach in advance of the exchange.

Medicaid Waiver Implementation

Many New Jersey residents receive healthcare funded by Medicaid and the five-year waiver granted by federal officials in October is affecting all of them.

The waiver gives the state more flexibility -- as well as more federal funding -- to provide healthcare to low-income residents.

The waiver includes a controversial provision that shifts the focus of long-term care toward managed care and away from a fee-for-service model. This is intended to help seniors stay at home as long as possible before moving to a nursing home. How this will affect both seniors and nursing homes remains unclear, with nursing home advocates raising concern about the future.

This change is part an overall shift toward managed care in the provision of Medicaid services in the state. From behavioral health services for those with mental illnesses to housing for residents with intellectual or developmental disabilities, managed care is becoming the focus of health services, A potential advantage of this change is an increased ability for providers to coordinate mental and physical healthcare.

In addition, the model of how hospitals and other providers are compensated for providing Medicaid services will be shifted toward one based on patient outcomes. This will have an unknown impact on hospitals, which are used to receiving Medicaid payments based on the number of Medicaid recipients they serve.

With an overall budget of more than $11 million serving 1.3 million New Jerseyans, Medicaid will remain a crucial part of the state’s healthcare landscape, even if Christie decides against expanding eligibility.

New Models for Healthcare Delivery

While many of the health policy changes in recent years have focused on increasing health insurance coverage for more New Jersey residents, rapid changes also are occurring in the delivery of healthcare.

Two related models figure to become even more prominent in the coming year -- patient centered medical homes (PCMH) and accountable care organizations (ACO).

In a PCMH, patient care is coordinated through a team-based approach, led by the patient’s primary care provider. Insurance companies pay providers in part for the time they spend coordinating care, rather than solely for the services they render to patients. Similarly, in an ACO, providers are held accountable for the cost and quality of the care provided to patients. Both of these models depend on patient care coordinators, employees who follow up with patients to ensure they get necessary care, something particularly needed for patients with chronic conditions like diabetes.

These similar approaches are expected to become increasingly common as the ACA is implemented. Vincz noted that Horizon has been expanding both programs.

Horizon now has 360 PCMH primary care practice locations throughout the state, which works out to more than 1,000 providers serving 250,000 residents.

The state’s major insurance companies have also been signing ACO agreements steadily, a trend that is expected to continue in 2013.

“We will be building on these programs, expanding the benefits to more of our membership, and really looking to take better integrated primary care to the next level,” said Vincz.

A landmark in expanding the ACO model is expected in the early weeks of the year, as the state unveils its plans for implementing a Medicaid ACO demonstration program, which was signed into law by Christie in 2011. The program is intended to demonstrate the effectiveness of the ACO model in providing services to Medicaid recipients.


Bill Would Let Physicians, Not Insurers, Decide on Strength of Pain MedicationsWhat doctor prescribes would override limits set by health plans

By Andrew Kitchenman,

New Jersey residents could receive quicker access to powerful pain relievers under a bill advancing in the Legislature.

The bill, A-1832 would prevent insurers from requiring people to try more than one pain medication before they would be able to receive the medication that their doctors want to prescribe.

The bill pits advocates for doctors and patients, who say patients shouldn’t be denied powerful drugs like opioids when they need them, against insurers and employers, who emphasize the higher costs and the danger of exposing patients to potentially addictive drugs.

The measure targets a practice known as “fail first protocol” or “step therapy,” in which insurers require that less-expensive medications be tried first. This can lead to a series of less-expensive drugs being tried before the medication preferred by the doctor.

While the state already has rules to prevent step therapy, insurers still delay doctors’ recommended prescriptions by various means, including requiring prior authorizations from the insurer for doctors’ preferred medications.

Under the bill, once one pain medication has been tried and failed, prior authorization for the doctor’s preferred medication wouldn’t be required. In addition, the doctor would determine how long the medication required by the insurer must be tried before moving on to the doctor’s preference.

Timothy J. Martin, a Medical Society of New Jersey lobbyist, said the bill is the right approach for pain medication.

“It is one thing to ask me to fail in my allergy medication for period of time and have the sniffles more than I would normally like to, it’s an entirely different proposition to ask somebody to fail on pain medication before they can move on to the medicine their physician thinks would be more effective,” Martin said. “That provider is in a better position to understand the pain that a patient is going through” than an insurer would be.

The doctor’s preferred prescription would come at a price, both to employers and to the state government, opponents argued.

Sarah McLallen, vice president of the New Jersey Association of Health Plans, noted that prescription costs comprise 15 percent of rising national healthcare costs.

“Fail-first protocols and prior authorization are important tools in helping reduce and prevent the abuse of drugs like pain medications, and they’re also important tools to help reduce and prevent unnecessary costs in the healthcare system,” she said. She noted that the bill would cost the state an additional $5.8 million, because the state would be paying more for pain medication for public employees.

Pfizer’s pain drug Celebrex costs roughly $150 per month, while similar generics cost $10 to $15 per month, McLallen said. In addition, Celebrex’s price increased by 18.7 percent in 2011, while most the prices of most generics decreased.

“When you take away important quality and cost controls such as these, it only adds to the exponentially increasing cost of healthcare,” McLallen said.

December 2012 17

An Overview of Stage 2 Meaningful Use: What It Means for Providers & How NJ-HITEC Can HelpBy Denise Anderson, Ph.D.

NJ-HITEC Director of Strategic Initiatives

The Centers for Medicare and Medicaid Services (CMS) released a Final Rule that specifies Stage 2 Meaningful Use (MU) criteria for providers, hospitals, and critical access hospitals (CAHs) that must be met in order to continue to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. All providers must achieve Stage 1 Meaningful Use (MU) before moving on to the Stage 2 requirements.

NJ-HITEC (New Jersey Health Information Technology Extension Center) is the sole federal Regional Extension Center in the Garden State working with providers to assist them on their path to Meaningful Use that at times can be frustrating and challenging. NJ-HITEC Executive Director, Bill O’Byrne, explains, “It is important for providers to understand the new Stage 2 MU requirements as well as the Stage 1 criteria that have been modified. Stage 1 MU established the basic functionalities that EHR technology must include such as capturing patient data and providing patients with their health data electronically. Stage 2 MU is designed to increase the exchange of health information among providers and promote patient engagement by giving patients secure online access to their health information.”

NJ-HITEC Meaningful Use Director, Bala Thirumalainambi, adds, “It is very important for the providers to realize that they have to be on a 2014 certified system for both Stage 1 and Stage 2 during 2014. They will have to start talking to their vendor to get on the waiting list as soon as possible.”

What is in the Stage 2 MU Final Rule?

The Stage 2 Final Rule explains the changes to Stage 1 MU that begin in 2013. Some key changes are that CMS removed the Health Information Exchange (HIE) core requirement. Second, the vital sign core requirement has changed as well. Instead of requiring physicians to record height, weight, and blood pressure, they can record height and weight or blood pressure or both based on their preference. Moreover, providers can request exclusions for one or both categories if this information doesn’t fit for the practice. In addition, the child’s age for pediatricians to record height, weight, and blood pressure has been raised from age 2 to age 3 that is more in line with the current medical practice.

Second, Stage 1 established a core and menu structure for objectives that providers were required to achieve in order to demonstrate MU. Under Stage 1 MU, providers had to meet 15 core objectives and five out of 10 menu objectives. Stage 2 retains this core and menu structure for MU objectives, however some of the objectives were either combined or eliminated. Most of the Stage 1 menu

Heather Cascone, senior manager of state government affairs for Express Scripts Inc., said allowing prescribers to determine the duration of time for trying medications would undermine an important tool for her company, which processes and pays prescription drug claims.

“Ultimately it’s our goal to keep prescription drugs safe and affordable,” Cascone said. She said pharmacy benefit manager companies like hers can make appropriate decisions based on both clinical safety and cost, without the influence of pharmaceutical manufacturers.

“Turning the authority for step-therapy initiatives over to the prescriber, we believe, would subvert the intent of these programs,” Cascone said.

Substance-abuse treatment providers support the measure, according to Randy Thompson of the New Jersey Association of Mental Health and Addiction Agencies Inc.

“Imposing step-therapy policies restricts access to medicine,” he said. “When patients are in need of medicine, they should not be denied that medicine that they need, or have to take a different medication that they don’t need.”

Thompson said patients should not have to go through unnecessary suffering, risk having their conditions get worse, and make unnecessary and expensive additional visits to doctors.

“We believe that medication should be determined between the doctor and the patient,” Thompson said.

Advocates and opponents of the bill also are sparring over whether it would prove harmful to prescription drug abusers.

Bill opponents contend that the risk for drug abuse would increase with easier access to opiates and other powerful pain drugs that are frequently abused.

Bill supporters argue that requiring patients to get unwanted and ineffective prescriptions will result in unused medications being left in medicine cabinets and open to being misused by people for whom they were not prescribed.

The bill was released by the Assembly Appropriations Committee on Dec. 13, when it was supported by six Democrats and one Republican and opposed by two Republicans. The Senate version of the measure has been referred to the Senate Commerce Committee.

NJ HITech


objectives are now core objectives under Stage 2.

Below is the list of core and menu objectives for Stage 2 MU for EPs:

EPs Must Report on All 17 Core Objectives

• Usecomputerizedproviderorderentry(CPOE)formedication,laboratory,andradiologyorders.

• Generateandtransmitpermissibleprescriptionselectronically(eRx).

• Recorddemographicinformation.

• Recordandchartchangesinvitalsigns.

• Recordsmokingstatusforpatients13yearsoldorolder.

• Useclinicaldecisionsupporttoimproveperformanceonhigh-priorityhealthconditions.

• Providepatientstheabilitytoviewonline,download,andtransmittheirhealthinformation.

• Provideclinicalsummariesforpatientsforeachofficevisit.

• ProtectelectronichealthinformationcreatedormaintainedbythecertifiedEHRtechnology.

• Incorporateclinicallab-testresultsintocertifiedEHRtechnology.

• Generatelistsofpatientsbyspecificconditionstouseforqualityimprovement,reductionofdisparities,research,or outreach.

• Useclinicallyrelevantinformationtoidentifypatientswhoshouldreceiveremindersforpreventive/follow-upcare.

• UsecertifiedEHRtechnologytoidentifypatient-specificeducationresources.

• Performmedicationreconciliation.

• Providesummaryofcarerecordforeachtransitionofcareorreferral.

• Submitelectronicdatatoimmunizationregistries.

• Usesecureelectronicmessagingtocommunicatewithpatientsonrelevanthealthinformation.

EPs Must Report on Three of Six Menu Objectives

• Submitelectronicsyndromicsurveillancedatatopublichealthagencies.

• Recordelectronicnotesinpatientrecords.

• ImagingresultsaccessiblethroughCEHRT.

• Recordpatientfamilyhealthhistory.

• IdentifyandreportcancercasestoaStatecancerregistry.

• Identifyandreportspecificcasestoaspecializedregistry(otherthanacancerregistry).

Third, the Final Rule defines Stage 2 MU requirements that include the new Clinical Quality Measures (CQMs) and the new reporting mechanisms. Beginning in 2014, all providers regardless of their stage of MU will report on CQMs in the same way. EPs must report on nine of 64 total CQMs. Eligible hospitals and CAHs must report on 16 of 29 total CQMs.

Additionally, all providers must select CQMs from at least three of the six health care policy domains recommended by the Department of Health and Human Services’ National Quality Strategy which include:

• Patient&FamilyEngagement

• PatientSafety

• CareCoordination

• PopulationandPublicHealth

• EfficientUseofHealthcareResources

• ClinicalProcesses/Effectiveness

Fourth, Stage 2 MU provides details on the Medicare payment adjustments. Qualified providers can earn incentive payments for up to five years if they elect to receive their incentive payment through Medicare or up to six years if they elect to receive their incentive payment through Medicaid. However, no Medicare EHR incentive payments will be made to providers whose first year of participation in the Medicare EHR Program is 2015 or later. Moreover, beginning in 2015, payment adjustments will take effect for Medicare Fee-For-Service providers who cannot successfully demonstrate MU using certified EHR technology. In addition, in 2014 Medicare providers will be choosing a 90-day quarter to report (for example January 1, 2014 to March 31, 2014) for Stage 2 MU.

December 2012 19

Regulatory Developments

Qualified providers can begin to participate in the Medicaid EHR incentive program until 2016, and there are currently no penalties for not demonstrating MU for Medicaid Eligible Professionals (EPs). However, starting in 2014, providers who had already met Stage 1 MU for two or three years will have to meet their Stage 2 MU requirements. Moreover, both Medicare and Medicaid providers should be on the new certified EHR systems starting 2014 regardless of their MU Stage.

NJ-HITEC Services Assist Providers Through the Process

NJ-HITEC understands the CMS requirements, provides the necessary services to assist providers, and guide doctors through the process as they transition to EHR technology. O’Byrne adds, “The transition from paper records to EHR technology tends to slow the practice down and there is a learning curve, but NJ-HITEC recommends that it’s better to get in the game early than wait until the end. Moreover, we have the knowledge, resources, and services to help providers meet their Health IT goals. For instance, Medicare audits have started for EPs. We can assist providers to ensure they have the proper documentation ready should they be called for an audit. Why proceed alone when you can tap into a host of services and expertise to help you through the process.”

"Moreover, the requirements and functions associated with Meaningful Use continue to get more and more complex as we transition from Stage 1 to MU Stage 1 (second year) to Stage 2 and beyond. It is critical that providers and their staff understand and master the intricacies associated with these challenges. The essential training, knowledge, and experience that NJ-HITEC can deliver to assist providers in this transformative process on a going forward basis clearly demonstrates the need for NJ providers to maintain their NJ-HITEC membership after they attest to Stage 1 MU,” states O’Byrne. “NJ-HITEC offers CMEs, weekly webinars, and training sessions as well as a secure, interactive member portal that provides our members access to unlimited data anytime, anywhere. Moreover, the data can be customized to meet the needs of the physician’s practice.”

NJ-HITEC is also an accredited by CMS as a Registry and Data Submission Vendor to provide physicians with the ability to submit Clinical Quality Measures (CQMs) to CMS for the Physician Quality Reporting System (PQRS) and E-Prescribing. Participation in PQRS and E-Prescribing programs can yield incentive payments for providers, and will soon help providers avoid payment adjustments to Medicare reimbursements. However, the effort it takes to capture clinical and claims data, the complexity of the submission process, and costs associated with using other qualified Registries has discouraged many providers from participating in these programs. NJ-HITEC, designated as a Registry, makes this process easier for providers. Furthermore, MU Stage 2 requires that providers only use a CMS accredited Registry.

Overall, the benefits of achieving Meaning Use are consistent with what most physicians want for their practice and patients because they know that health information technology improves the quality of healthcare delivery, engages the patient in his/her case management, improves the practice workflow, and reduces healthcare disparities.

For more information on Stage 1 and Stage 2 Meaningful Use requirements or to join NJ-HITEC, please call 973-642-4055, email at [email protected], or visit our web site at www.njhitec.org.

Posted by Beth Christian

Here are the most recent health care related regulatory developments as published in the New Jersey Register on:

• OnDecember17,2012at44N.J.R.3019,theDepartmentofBankingandInsurancepublishednoticeofitsadoptionof amendments to its regulations governing company action level events in connection with capital and surplus requirements for insurers and health maintenance organizations.

• OnDecember 17, 2012 at 44 N.J.R. 3075, the State Board of Pharmacy published notice of its administrativecorrection of the regulations governing procedures for centralized prescription handling and out-of-state pharmacy registration.

• OnDecember17,2012at44N.J.R.3087,theStateBoardofMedicalExaminerspublishednoticeofitsactiononaPetition for Rulemaking filed by the New Jersey Hospital Association. The Petition for Rulemaking requests that the Board amend N.J.A.C. 13:35-6.16(f ) to permit licensed physicians to be employees of a corporation which is a wholly controlled subsidiary of a licensed hospital. Under the proposal, the licensed hospital would monitor the activities of the subsidiary corporation through a quality assessment and performance improvement program and make the structure of this program available to the Board for review upon request. The hospital would not exercise control over employee-physicians’ independent medical judgment. Finally, the subsidiary corporation would have, as part of its governance structure, a committee comprised solely of licensed physicians who have sole responsibility for all corporate decision making involving the exercise of independent medical judgment. Under the proposal, licensed physicians would be permitted to provide input to the governing body of the corporation with regard to operational matters that are not solely clinical.

The Board announced that it was referring the matter for further deliberations by a committee in order to develop a better understanding as to the nature of the petitioner’s request and the implications the request would have for physicians and patients within the structures of the corporate practice that the petition envisions. The notice also indicated that the Board will also deliberate as to the implications that the petitioner’s request could have on other structures for the corporate practice of medicine. The Board will invite the petitioner to discuss the petition and its possible implications with a committee of the Board.


Food for Thought

Paramus and Woodland Park, New JerseyBy Iris Goldberg

I was first introduced to Fairway about six years ago. At that time, my daughter lived on the Upper West Side of Manhattan. Like her dad, Jenna is passionate about cooking and finds it to be a wonderful way to unwind after a stressful day. I often accompanied her to her favorite market to collect all of the fixings for the meal she would be preparing for us when we visited.

Located on Broadway and W. 74th Street, Fairway occupies two floors, filled to capacity with every possible food item you can imagine. The quality and variety of the items carried is so superb that the store is always packed with shoppers. I remember one time in particular, when it was so crowded that just navigating your way through the narrow aisles was a challenge. Even so, I wondered why we did not have a Fairway in New Jersey.

Apparently, others were asking the same question. In 2009, Fairway opened its first New Jersey store in Paramus and more recently, one in Woodland Park, which is nearer to where I live. Even if you are not a foodie, go and check Fairway out. It will definitely be an eye-opening experience.

The Woodland Park location occupies more than 63,000 sq. ft. Fairway is renowned for offering an unbelievable assortment of delectable items including: every possible type of the freshest produce, hand-selected USDA prime meats – custom cut by a trained butcher, a huge collection of wild and local-caught seafood, more than 600 artisanal cheeses and the largest selection of the highest quality of imported specialty items imaginable.

Fairway is famous for its directly imported olive oils from the most recent harvest, which it sells at extremely reasonable prices. Also, there are close to 100 coffees from all over the world, made from the highest quality hand-picked Arabica beans and freshly roasted on premises. Hand-crafted baked goods, including the most interesting array of breads as well as NY bagels are prepared each day. Hand-pulled mozzarella cheese is made daily as well and the selection of domestic and imported cheeses is unequaled.

Fairway carries an impressive selection of organic, natural and gluten-free foods plus a large selection of traditional groceries. There is a complete stock of liquors, beer and wine, although some of those prices may be a bit high. Additionally, there is an amazing array of tempting prepared foods. Fairway also offers a complete assortment of kosher items. In short, I can’t think of anything that has been overlooked.

Our most recent trip to Fairway was in preparation for a quiet Friday night dinner at home. We first went to the produce department where we picked out some beautiful, ripe tomatoes, some fresh basil and a sweet onion. We also bought about 20 oz. of fresh spinach and two large potatoes. Then we picked out a ball of fresh, hand-made mozzarella. Next we headed to the meat counter and selected a prime porterhouse steak that the butcher cut for us while we watched. We requested that he make it 2 inches thick and that’s just what he did. After that, we went to the bakery department and chose a freshly-baked multi-seed bread and a beautiful, yet tiny flourless chocolate cake. We could hardly wait to get home and enjoy our fabulous meal. Our dinner menu for that evening was:

•Saladoftomato,onion,basilandmozzarellacheesewithextravirgin olive oil and balsamic vinegar

•Multi-seedbreadwithgarlic-infusedextravirginoliveoil

• Porterhouse steak – cooked rare, home-made French friedpotatoes and home-made creamed spinach

•AMECaliforniaCabernet

•Flourlesschocolatecake

Everything was delicious! The fresh produce, hand-made cheese, prime meat and right- out-of-the- oven bakery items really made the difference between a good meal and a great one. If you are a foodie, Fairway is definitely a worthwhile destination. If you are not, a visit to Fairway just might convert you.

Fairway Market

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Documents

NJ Physician Magazine December 2012