Summer 2011
Vol 110.2
How to Evaluate Managed Care Contracts Strengthening Our Profession—A Look to the Future AROC 2011 Highlights
C M on a g 11 rtin rat 5 th Le ula v of Pre ine tion AO sid , D s A en O t
Insurance Considerations When Joining an ACO
We Weextend extendour ourcongratulations congratulations and andbest bestwishes wishesto to AOA AOAPresident President Martin MartinS. S.Levine, Levine,DO DO
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NJNJ Locations: Locations:Moorestown Moorestown • •Short Short Hills Hills• •Sparta Sparta• •Vineland Vineland• •Wall Wall• •and, and, Greenwich, Greenwich, CTCT• •New New York, York, NYNY• •Philadelphia, Philadelphia, PAPA
The Journal
Editorial and Executive Staffs
Executive Editor Robert W. Bowen Managing Editor Brooke Liebowitz
Contributors Laurie A. Clark Michael S. Lewis Deborah R. Mathis Executive Officers President President-elect Vice President Treasurer Secretary Immediate Past President NJAOPS Staff Executive Director Business Manager Director, Medical Education Director, Communications Office Manager Membership Coordinator Sales & Marketing Coordinator
Timothy L. Hoover Mark E. Manigan
Antonios Tsompanidis, DO Karen Kowalenko, DO John LaRatta, DO Todd Schachter, DO Robert Pedowitz, DO Lee Ann Van Houten-Sauter, DO
Robert W. Bowen Alice Alexander Lila Cleaver Brooke Liebowitz Diana Lennon Jennifer A. Sarnelle Skip Heymann
The Journal is the official magazine of the New Jersey Association of Osteopathic Physicians and Surgeons (NJAOPS). NJAOPS is the sixth largest state affiliate of the American Osteopathic Association. NJAOPS represents the interests of more than 3,600 active osteopathic physicians, residents, interns and medical students. Founded in 1901, NJAOPS is one of the most active medical associations in New Jersey with 12 county societies. Opinions expressed in The Journal are those of authors or speakers and do not necessarily reflect viewpoints or official policy of NJAOPS or the institutions with which the authors are affiliated, unless expressly noted. NJAOPS/The Journal is not responsible for any statements made by any contributor. Although all advertising is expected to conform to ethical medical standards, acceptance does not imply endorsement by this publication. The appearance of advertising in The Journal is not an NJAOPS guarantee or endorsement of product or service, or the claims made for the product or service by the advertiser. When NJAOPS has endorsed a product or program it will be expressly noted. All advertising contracts, insertion orders, inquiries, correspondence, and editorial copy should be mailed to: The Journal (attention: Executive Editor), NJAOPS, One Distribution Way, Suite 201, Monmouth Junction, NJ 08852-3001. Telephone: 732-940-9000. The Journal editorial staff reserves the right to edit all articles and letters to the editor on the basis of content or length. The Journal (ISSN 0892-0249) is published quarterly (March, June, September and December) from the executive and editorial offices at NJAOPS headquarters in Monmouth Junction, New Jersey. Periodical postage paid at Princeton, New Jersey, and additional mailing offices. POSTMASTER, please send address changes to The Journal of the New Jersey Association of Osteopathic Physicians and Surgeons, One Distribution Way, Suite 201, Monmouth Junction, NJ 08852-3001. Subscription to The Journal is included in NJAOPS membership dues. Non-member subscription is $25. Designed and printed in the USA by Mastergraphx, Monmouth Junction, New Jersey. The Journal is printed on environmentally friendly paper. By using products with the FSC label you are supporting the growth of responsible forest management worldwide.
THE JOURNAL | summer 2011
TABLE OF CONTENTS President’s Message: Strengthening Our Profession . . . . . . . . . . . . . . . 2 Newly installed NJAOPS President Antonios Tsompanidis, DO, shares his goals and vision for the upcoming year in this abridged version of his inaugural address given at AROC 2011.
From the Executive Director. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 NJAOPS Executive Director Robert Bowen recounts the highlights of AROC 2011 and announces the recipients of this year’s New Jersey Osteopathic Education Foundation scholarships.
Capital Views. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Government Affairs and Legislative Counsel Laurie Clark details the action taken in Trenton on several key bills this quarter.
AROC 2011 Highlights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Revisit the highlights of AROC 2011 and get the first news of the 2012 convention.
Managing Liability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 NJAOPS medical liability insurance expert Timothy Hoover discusses important considerations you should take into account regarding your professional liability coverage when contemplating making the change from private practice to joining an ACO.
The Professional Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Medical management experts Deborah R. Mathis and Michael S. Lewis explain how careful evaluation of managed care contracts can help improve your bottom line.
Member News. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 NJAOPS recognizes the latest achievements of our members.
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PRESIDENT’S MESSAGE
Strengthening Our Profession Antonios Tsompanidis, DO
The following is an abridged version of the inaugural address by 2011–2012 NJAOPS President Antonios Tsompanidis, DO
B
efore I officially begin, I would like to take this opportunity to congratulate our moderator and one of my mentors, Dr Albert Talone, who was recently honored by the Lourdes Health Foundation with the prestigious “Healing Spirit” Award. The award was presented to him as a physician who exemplifies Lourdes’ mission and core values of compassion, commitment, integrity, excellence, and stewardship. Congratulations. I would thank you all for being here today and say to you: Kalos orisate and kalimera (welcome and good morning)! Welcome to AROC 2011. Every President has a theme for their presidency. My ancestor Hippocrates, the Greek father of Western Medicine, said that “life is short and art is long.” As incoming president, I find that one year is such a short period to take care of everything that needs to get done, but mastering the art of promoting osteopathic medicine will strengthen our profession for the future. To that end, I would like to continue to build on out-going President Dr. Van-Houten Sauter’s theme of getting the word out that DOs do it better. We can let the world know that we do it better by strengthening our profession. As always, of course, herein lies the challenge. How exactly do we do that? Much like Poseidon’s trident, our strengths can be broken down into three parts: osteopathic medical education, leadership, and of course NJAOPS. If we strengthen these three, we cannot be broken. The largest and most important of these, to me, is osteopathic medical education. Although this may seem complex, it is very simple and easy. OME begins with undergraduate training, but does not end there. It encompasses graduate medical education, and all of the interns, residents, and fellows, and the continuum of post-
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graduate education for lifelong learning. As Hippocrates also said, “There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.” The CMEs you will receive here today help us beget as much knowledge as we can. This need for lifelong learning is why we are here today at the AROC conference. I encourage you all to become a volunteer — to be a mentor, a preceptor, or volunteer faculty. Teach others and pass on your knowledge and skills. Demonstrate to them what an osteopathic physician should be. Where do we find this pool of young minds to mold? We need to go to the source. We are fortunate in New Jersey to have one of the premier osteopathic medical schools in the country. We need to support and strengthen UMDNJ—SOM. As a state school, the majority of enrolled students are from New Jersey. As I learned here at the AROC conference, eighty-five percent of the incoming class are New Jersey residents. These students are the source of our future New Jersey DOs. Many of these students will continue their postgraduate training within the system and then hopefully remain in the state. By teaching, we touch their lives, we open opportunities for students, residents, and fellows, and we allow the school to expand and become stronger. Teaching is not as hard as it seems. Teaching is actually easier than most people think, which I say to my preceptors all the time. Teaching does not always mean standing before a classroom, but can also include passive teaching. One can learn a lot just by watching a good physician at work. If you are asking yourself if a good teacher really can make a difference, I encourage you to look back at your training. I’m sure you can remember a few names of excellent teachers throughout your training. Who taught you? Who encouraged you on your path? I have several outstanding teachers I remember that I would like to acknowledge: Dr. Masterson and Dr. Steiner who helped formulate my OT skills, Dr. Joseph Berger, with whom I spent 18 weeks doing family medicine, and Dr. Steven Rubin, who pretty
much scared me into becoming a family physician, and many others. Leadership, the next part, builds on the foundation of education. We need to identify, involve, cultivate and capture those individuals, physically if necessary, who demonstrate an interest. It begins at the student level, but we also find leaders who have quietly gone on with their postgraduate lives who have now just realized they want to become involved. My answer is, come one, come all! Our current leaders are role models, and we will continue to be role models. We need to take those interested individuals under our collective wings. At NJAOPS we continue to involve both students and residents by having them serve as directors on our board. These individuals have both a vote and a voice in what we do. For example, Dr. Yancy Van Patten, who was our two-year resident director, has now been elected onto the board as a full member. Dr Julieanne Sees, who is going to be a senior orthopedic resident, will be our new resident director. She has been involved on student council, both at her local school and nationally. Dr. Hetal Patel, who is to be a second year resident, has already expressed interest in serving next year. She wants to come and observe our meetings so she can get a feel for what we do here at NJAOPS. I tell individuals if you want to get involved, just ask one of us and we will gladly find your niche and something for you to do. You never know where it could lead. Here at NJAOPS, as the organization which represents DOs in New Jersey, we need to remain strong. Our strength depends on membership growth, as well as unity and leadership. With strong leaders, and strength in numbers, we can best represent you. And remember, NJAOPS not only represents all current DOs; we also represent all future DOs. If not for the strong foundation built by NJAOPS, headed by Bob Bowen, our capable Executive Director, and his tremendous staff: Diana Lennon, Lila Cleaver, Alice Alexander, Jen Sarnelle and Skip Heymann, this continued on page 4
THE JOURNAL | summer 2011
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convention would not be what it is. I thank you for all of your help. My upcoming year would be difficult without them and Laurie Clark, our government affairs counsel, who keeps me busy in the forefront representing all of you. NJAOPS is a sum of its parts. Much as NJAOPS is the sum of its parts, the AOA is also the sum of all of its state parts. If New Jersey is strong, the AOA is strong, and our profession is strong. It is easy to see that the strength of our profession truly is a continuum and a sum of all of the parts. We should not look at it as separate pieces but as a flow between all parts as needed to continue to build, expand, and strengthen ourselves. Does this work? Well, one day back in 1991 after an exam, (I can now tell this story since the dean is not here today and I already got my diploma) several of us from UMDNJ—SOM decided to come down to AROC and see what it was all about. So we played hooky and came down to Atlantic City. I bumped into these three very interesting gentlemen in double breasted suits who invited me to come in to hear the noon lecture. I kindly declined. That’s the first time I learned there was a word in Dr. Rubin’s vocabulary that doesn’t exist—and that is the
word “no”. After corralling us into the lecture, led by Dr. Rubin, Dr. Tancer, and Dr. Morris, (the three men in the double-breasted suits) I can tell you that meeting them encouraged me to become involved from that point forward. The simple act of having them take me under their wing by inviting me to attend their lecture had a profound impact on me. And here I am today, twenty years later, proud to serve as your president and eager to give back what they gave to me. I am just an example and I hope to cultivate many more of these examples. I want to lead by example and through our combined efforts, we will strengthen our profession.
Rutgers in Newark—not New Brunswick— but Newark, the little-known campus.
Abraham Lincoln had a great quote: “I like to see a man proud of the place in which he lives. I like to see a man live so that his place will be proud of him.” I’m proud of several things I have done. But before I could be proud of anything, I am very proud of my parents for coming here from Greece, making their way here in the typical immigrant story and letting me be born in this country. I am proud of going to Bergen Catholic (go Crusaders!). I am very proud to be an Eagle Scout and believe very strongly in Scouting. As my son is now a Tiger Cub, I hope we can inspire him to do the same thing. I am proud of going to
After serving on the board as a student and later as a physician, I have learned and acquired much knowledge and skills from past leadership. Armed with that knowledge, I know that I am up for the challenges that lie ahead of me. I am proud, I am honored, and I am deeply humbled to serve as your president, representing you, my osteopathic brethren, during my 2011–2012 term.
I am also very proud of being an SOM graduate. If it wasn’t for the fateful day on the first day of orientation, when my father-inlaw poked me in the chest and asked me a question and I noticed my future wife-to-be, I guess we never would have met. So I have to thank the school for that and obviously I have to thank my wife, DinaMarie, and my children Antonios and Stephanos who will have to put up with what I need to do this year. Knowing that I have their support, I feel more empowered in the coming year.
Efharisto! Thank you.
■
Antonios Tsompanidis, DO, is the 2011– 2012 president of NJAOPS. He is a family physician practicing in Hazlet.
The Burlington County Society of Osteopathic Physicians and Surgeons extends its warm congratulations and best wishes to
Martin s. levine, DO 2011–2012 President of the American Osteopathic Association
The leadership you lend our profession is much appreciated by your colleagues.
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THE JOURNAL | summer 2011
C
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NJAOPS night at the
BALLPARK Friday, August 19 TD Bank Ballpark Somerville BBQ Dinner ~ 6:30PM First Pitch ~ 7:05PM Somerset Patriots vs. Bridgeport Bluefish Tickets are $25.00 per person and MUST be purchased by August 10. The first 1,500 fans will receive a FREE Slider Bank, so make sure you get there early! Call NJAOPS to purchase your tickets today.
732-940-9000
THE JOURNAL | summer 2011
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FROM THE EXECUTIVE DIRECTOR
Celebrating the Past While Looking Towards the Future Robert W. Bowen
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his year, NJAOPS celebrates its 110th anniversary, acknowledging the contribution that osteopathic physicians have made to advancing medical care in New Jersey and recognizing the dedication of NJAOPS members in building our state professional association. When NJAOPS was founded, William McKinley was President of the United States, and the Governor of New Jersey was William Augustus Newell. In the realm of medical research, Karl Landsteiner discovered the existence of different human blood types. In Newark in 1901, the New Jersey Osteopathic Society (NJOS) was founded with a call to membership for “all reputable
osteopathic physicians.” Two years later, NJOS incorporated with 35 physician members.
can save you hundreds of dollars each year and is also available to the office staff of member physicians.
The enduring strength of NJAOPS has always been the faithful support of our members. We’ve continued to add new member benefits to enhance the value of membership. This spring we introduced two more member benefits designed to save physicians money on their monthly expenses. The first is a 22-percent discount from Verizon Wireless on personal calling plans of $34.95 or more. New and existing customers are eligible by signing up through the NJAOPS portal link on the member benefits page at www.njosteo.com. Depending on your plan, this discount
Also new on the member benefits page are discounts on electricity and natural gas for your home and business through Energy Plus. Promoted as saving participants at least ten percent on electricity supply costs, we subscribed to the service here at NJAOPS headquarters to confirm the savings and have saved over $2,100 in the first nine months, far more than ten percent. Check out the members-only benefits section at www.njosteo.com for more member benefits.
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In April 2011, the former NJOS, now NJAOPS, attracted 1,400 health care professionals and exhibitors to Atlantic City for four days of fellowship and education at AROC 2011. A newly designed format allowed for clinical sessions enhanced by stellar speakers such as Dr. Richard Jadick, DO author of On Call in Hell, a moving story of osteopathic medicine on the front line of modern warfare. Ginamarie Foglia, DO, Director of Clinical Development at Sanofi-Pasteur, spoke about a professional journey that included vaccine research in sub-Saharan Africa. Dr. Martin Levine, President–elect of the AOA, teamed with Dr. Michael Kuchera, Director of OMM research at PCOM to remind attendees of the place that OMT has in the osteopathic physician’s armamentarium. The resounding message was that osteopathic medicine is vibrant, growing, and increasingly influential with a commitment to improved patient care and the public health. In remembering AROC 2011, we would be remiss in not remembering our 2011 Physician of the Year, Dr. Charles Steiner. Dr. Steiner passed away on June 27th, having practiced medicine for the past 66 years. Dr. Steiner, who maintained regular office hours up until the end of last year will be remembered by his patients for continued on page 34
THE JOURNAL | summer 2011
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CAPITAL VIEWS
New Jersey State Legislative Update Laurie A. Clark
Bill Updating Licensure Requirments for One Room Ambulaltory Surgery Centers Passes Senate
In late June, S-2780 sponsored by Senator Joseph Vitale (D-Middlesex) was amended on the Senate floor and passed the Senate (27-0). The bill in its current form changes the current regulatory framework and requires that all “surgical practices” be licensed by the Department of Health and Senior Services (DHSS) as ambulatory surgery facilities within one year of the date of enactment of the bill. Pursuant to P.L.2009, c.24, (“The Codey Law”) all surgical practices were required to register with DHSS by March 21, 2010, and were subject to limited oversight by DHSS. In essence, although smaller in
size with only one-operating room, these physician-owned practices provide the same type of surgical services as the larger, licensed ambulatory surgery facilities. Recently, these facilities have come under increased scrutiny for various regulatory violations, some of which have caused irreparable harm to patients. In short, this bill repeals the requirement that surgical practices be registered by DHSS, instead requiring that all surgical practices must be licensed by DHSS within one year of the enactment of the law, as ambulatory care facilities licensed to provide surgical and related services. The definition of surgical practice remains unchanged. It is defined as a
structure or suite of rooms that has the following characteristics: ■■ has no more than one room dedicated for use as an operating room which is specifically equipped to perform surgery, and is designed and constructed to accommodate invasive diagnostic and surgical procedures; ■■ has one or more post-anesthesia care units or a dedicated recovery area where the patient may be closely monitored and observed until discharged; and ■■ is established by a physician, physician professional association surgical practice, or other professional practice form specified by the State Board of Medical Examiners pursuant to regulation solely for the physician’s, association’s, or other professional entity’s private medical practice. However, key committee amendments, adopted in late May, make it possible for a surgical practice to apply to DHSS for a waiver of one or more physical plant requirements in accordance with N.J.A.C.8:43A-2.9. The Commissioner of DHSS can grant the waiver of those requirements as the commissioner deems appropriate, if the waiver does not endanger the life, safety, or health of patients or the public. In addition, Senate floor amendments, included in late June, provide: ■■ A surgical practice certified by the Centers for Medicare & Medicaid Services (CMS) as an ambulatory surgery center provider shall not be required to meet the physical plant and functional requirements specified in N.J.A.C.8:43A-19.1 et seq.; if it is not CMS-certified, it may apply for a waiver of one or more physical plant and functional requirements in accordance with N.J.A.C.8:43A-2.9, as the bill currently provides; and ■■ These surgical practices shall be exempt from the ambulatory care facility assessment pursuant to continued on page 10
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THE JOURNAL | summer 2011
continued from page 8 N.J.S.A.26:2H-18.57; except that, if the entity expands to include any additional rooms dedicated for use as an operating room, the entity shall be subject to the assessment.
Assemblyman Herb Conaway, MD (D-Burlington) is the sponsor of the Assembly companion bill, A-4099. The Assembly version has not yet been heard in committee.
Legislature Approves Package of Bills Assisting with End-Of-Life Care Decisions New CME Requirement Included A package of bills sponsored by Assemblywomen Annette Quijano (D-Union), Connie Wagner (D-Bergen), L. Grace Spencer (D-Essex), Nancy Munoz (R-Union) and Assemblyman Herb Conaway, Jr. MD (D-Burlington), designed to make end-of-life care decisions easier for New Jersey families has received final legislative approval and now awaits action by the Governor.
The first measure, A-3475, would require the state to create a form called the Physician Orders for Life-Sustaining Treatment (POLST) to enable New Jersey patients to indicate their preferences for health care. The bill was approved by the New Jersey General Assembly with a vote of 60-6-10. The Senate companion measure S-2197 was sponsored by Senators Weinberg (D-Bergen) and Ruiz (D-Essex). The POLST form would serve as a complementary measure to the use of an advance directive for health care, or in lieu of an advance directive if the patient has not executed such a document. Unlike an advanced directive, which varies in nature and is the responsibility of a patient to have prepared, the POLST form would be a standardized printed document made available to health care professionals and facilities to use with their patients. Under provisions of the bill, the Commissioner of DHSS would be responsible for instituting the program and charged with: ■■ promoting awareness among health care professionals and the general public; ■■ encouraging ongoing training of health care professionals about the POLST form; and ■■ prescribing additional requirements for the completion of a POLST form applicable to a patient with mental illness or a developmental disability;
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Health care professionals and institutions would be required to treat a patient who has a completed POLST form in accordance with the information contained in the form. The bill also places a new requirement for CME on physicians and advance practice nurses. If the bill is signed into law in its current version, the Board of Medical Examiners will be required to adopt regulations that stipulate that two credits of the existing biennial continuing medical education requirement be fulfilled with courses on topics related to end-of-life care. The bill on the Governor’s desk would become effective within 180 days for the POLST requirements, and within one year for the new continuing medical education requirements. The second bill in the package, A-3839, sponsored by Assemblywoman Spencer (D-Essex), would establish the New Jersey Advisory Council on End-of-Life Care in the Department of Health and Senior Services. The bill was approved by a vote of 71-4. The Senate companion measure S-2199 was also sponsored by Senators Weinberg (D-Bergen) and Ruiz (D-Essex). The advisory council would be charged with conducting a thorough and comprehensive study relative to the quality and cost-effectiveness of, and access to, end-of-life care services for all residents in New Jersey. The council would also be required to develop and present policy recommendations relating to state agencies, policymakers, health care providers, and third party payers. In developing its recommendations, the advisory council’s overriding concern would be to promote an end-of-life care paradigm in which patients’ wishes are paramount and they are provided with dignified and respectful treatment that seeks to alleviate their physical pain and mental anguish as much as possible. The advisory council would be comprised of 21 members, including: the Commissioners of Health and Senior Services and Human Services, or their designees; two members each from the Senate and the General Assembly to be appointed by the President of the Senate and the Speaker of the General Assembly, respectively, who in each case are to be members of different political parties; the Ombudsman for the Institutionalized Elderly or his designee; and 14 public members who are residents of New Jersey,
to be appointed by the Governor with the advice and consent of the Senate, with a wide variety of specified backgrounds related to end of life care. The advisory council would be required to report to the Governor and the Legislature no later than 18 months after the date of its organization on the results of its activities.
Medicaid Accountable Care Organization (Aco) Demonstration Project Approved by Legislature
Bill Would Create Three-Year Pilot Program in Department of Human Services Legislation sponsored by Senators Joseph F. Vitale (D-Middlesex) and Jim Whelan (D-Atlantic) which establishes a three-year pilot program in the Department of Human Services for a Medicaid Accountable Care Organization was approved by the Senate on June 29 by a vote of 29-9. The bill, S-2443, would create the “Medicaid Accountable Care Organization Demonstration Project” to ensure that Medicaid recipients in New Jersey have access to high-quality, costeffective medical care. The bill would establish a demonstration project within the Department of Human Services to increase access to primary care, behavioral health care, and dental care by Medicaid recipients in a particular region. The bill would also improve the quality of health care by establishing objective metrics and relying on patient experience, and would reduce unnecessary and inefficient care without interfering with a patients’ access to the health care providers and services they need to stay healthy. The bill would authorize Accountable Care Organizations (ACOs), defined as nonprofit corporations, to provide coordinated, high-quality care to Medicaid recipients in a municipality or defined geographic region with more than 5,000 Medicaid recipients. If the program proves successful in lowering costs and improving care, the sponsors said they would consider working with the Department to establish a permanent program. The Assembly companion measure, A-3636, sponsored by Assemblymen Coughlin (D-Middlesex) and Greenwald (D-Camden), also passed the Assembly on the same day, by a vote of 74-2. The bill is now on the Governor’s desk. ■ Laurie A. Clark is NJAOPS’ government affairs and legislative counsel. She is also president of LegisServe.
THE JOURNAL | summer 2011
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William A. Reilly Joseph A. Britton Agency Mountainside, NJ – 800-462-3401
Burt C. Szerlip BC Szerlip Insurance Agency Little Silver, NJ – 800-684-0876
Mary Donohue Brown & Brown Metro Mt. Laurel, NJ – 856-552-6330
Ed Lynch Healthcare Risk Solutions Fort Washington, PA – 800-215-2707
Rory Rineer Professional Liability Agency Harrisburg, PA – 800-375-3056
Robin Voorhees The NIA Group Somerset, NJ – 800-669-6330
s t h g i l h Hig Bally’s Atlantic City April 6–9
T
he 2011 Atlantic Regional Osteopathic Convention (AROC) attracted more than 1,400 participants to Bally’s Atlantic City, April 6–9, as attendees and exhibitors gathered for four days of clinical presentations, workshops, alumni and county district events and exhibit education and demonstrations. Approved for 30 AOA Category 1-A CME credits, attendees were also eligible to earn an additional three 1-A CME credits by participating in an online outcomes measurement survey designed to indicate how much of the education had been learned and adopted into the clinical practice.
AROC 2011 keynote speaker Cdr. Richard Jadick, DO. MC, USN presented “Osteopathy on the Battlefield” and recounted his experiences as a physician in Iraq. Dr. Jadick is the recipient of the Bronze Star with a Combat “V” for Valor for his medical care of soldiers while assigned with the 1st Battalion, 8th Marine Regiment. Convention attendees received a copy of his book, On Call in Hell, and enjoyed an author book signing during lunch in the exhibit hall. In appreciation for their support, each exhibiting company also received a copy of the book with additional copies being presented to each exhibitor from the army and navy recruiting booths.
eneral New Jersey G an Caroline om yw Assembl -Monmouth) Casagrande (R ndees at the addressed atte n general sessio ng Friday morni lth ea H in en Wom as part of the st . The younge Care program ted ec el er an ev Assemblywom e sh y, or st hi in New Jersey a reputation as has earned a ian ic ys ph e th champion of r d is a sponso community an e tort siv en eh pr m of the first co an ion in more th reform legislat ven se an th e or ten years. M cond nt with her se months pregna an mblywom child, the Asse tion with apprecia ed dg le ow ackn , O D , ed Nichols moderator Fr st n/gynecologi ia ric et st an ob unty. Co ex ss Su in practicing
In addition to the outcomes survey, other new features introduced this year were county district dinner programs at local restaurants, OMM sessions throughout the educational program and an exhibit card raffle which replaced CME credits previously available. More than 200 attendees completed and returned their exhibit cards by the convention’s close for a $25 AROC 2012 registration credit and were entered into the prize drawing. Congratulations to the winners of an iPad 2: Edwin Jensen, DO, F. Elyse Kopp-Mulberg, DO, Arthur Nahas, DO and Steven Nickles, DO. Congratulations to the winners of an AROC 2012 registration: Clifford Botwin, DO, Joseph Dic, DO, Gary Safier, DO, Vytas Siliunas, DO and Marie-Grace Witham, DO. And Justin Torres, OMS-I won a $200 Visa gift card. ■
12
NJAOPS 2011–2012 President, Antonios Tsompanidis, DO, shares a moment at the anniversary reception with six NJAOPS past presidents. Left to right: Alan Carr, DO, Richard Tancer, DO, Susan Volpicella-Levy, DO, Ira Monka, DO, Dr. Tsompanidis, Paul Morris, DO and Lee Ann Van Houten-Sauter, DO.
THE JOURNAL | summer 2011
Over 350 exhibitors with more than 100 booths were featured in the exhibition halls at AROC 2011 offering attendees a comprehensive selection of practice and professional solutions and resources. Exhibiting companies complemented the program sessions ranging from clinical medications and devices to hospice care, and from risk management to office and surgical supplies.
Antonios President 11–2012 0 Ann 2 e S e P L t O NJA -Presiden ring in of residents. ediate Past -p m st The swea a Im p y n b rr, d fourtee idis, DO , Alan Ca Tsompan O include berg, DO n -Sauter, D e n st te a a u Ir K o , s H Van Charle otwin, DO ft to right: Clifford B , D O, Pictured le o n e , D O, st ert Talone ck lb la A B r, w te u re a d cer, n -S n A D O, ichard Tan n Houte O, Dr. Va panidis, R artin m M so , T O r. D D Monka, D , bert, DO, ul Morris m Pa a , L nd O a n D ry O Kath lla-Levy, Ratta, D n Volpice ct John La le e tn e d DO, Susa resi . O, Vice P owitz, DO Levine, D obert Ped R t c le -e Secretary
NJAOPS 2011–2012 president Antonios Tsompanidis, DO gives his presidential address during the keynote general session after being sworn in with his officers Karen Kowalenko, DO, president-elect; John LaRatta, DO, vice president; Todd Schachter, DO, treasurer, Robert Pedowitz, DO, secretary, and Lee Ann Van Houten-Sauter, DO, immediate past-president. Dr. Tsompanidis highlighted his theme for the year of strengthening osteopathic medical education, leadership, and the professional community through NJAOPS. Fourteen NJAOPS past-presidents presided over the installation of the new officers.
Th is ye a r in st e a d o f a st a n d -a wo rk sh o p lo n e se ss s w e re in io n , O M M te g ra te d th in c o rp o ra ro u g h o u t ti n g th e re th e p ro g ra le va n t te c to p ic s o f m h n iq u e s w th e p re se it h th e c li n te r. M ic o f P h il a d h a e l Ku c h n ic e lp h ia C o e ra , ll e g e o f O D O, d ir e c OMM Re st e o p a th ic to r se a rch d e M e d ic in e si g n e d th w it h th e A ’s e w o ROC OM rk sh o p s in M ta b le tr c o n ju n c ti ove rwh e lm a in e rs . Th on in g ly p o si e re sp o n se tive w it h va ri e ty o f wa s m a ny a tt e sp e c ia lt ie n d s p a rt ic ip e e s fr o m th e fi rs t ti a ti n g in th a me. e wo rk sh o p s fo r
AOA President Karen J. Nichols, DO joined NJAOPS President Antonios Tsompanidis, DO for the presentation of the cake at the 110th anniversary gala. Created by Carlo’s Bake Shop in Hoboken, the bakery has gained an international reputation being featured in the television series The Cake Boss. The Inscriptions on the cake included “For the immediate relief of healthcare headaches and practice pains” and for osteopathic medicine, “Substitutions: none.”
THE JOURNAL | summer 2011
13
Comments from Charles Steiner, DO NJAOPS’ 2011 Physician of the Year when patients were manipulated, I described the compressive forces of muscle spasm and the restriction of joint motion and the irritation of the motor and sensory nerves and the benefit of restoring mobility, What was missing was the answer to the question, “WHERE ARE YOUR DATA?”
At AROC 2011, Charles Steiner, DO was honored with the 2011 Physician of the Year award. Below are Dr. Steiner’s comments presented by his daughter Jeanne Steiner, DO on his behalf. Unfortunately, Dr. Steiner passed away this June, weeks shy of his 93rd birthday.
M
any thanks for the honor you have bestowed on me, and particular thanks to Bob Maurer for the nomination. He is surely one of the bedrocks of our profession. With all the great advances we have made over the years, there is a single issue which I believe is still unmet. After my internship in Philadelphia I had a surgical residency in Maine and then returned to New Jersey to open a “general practice,” which meant surgery, obstetrics and anything else that came into the office. I had many MD friends, and the general medical community was rather open and congenial. From the beginning, I recommended the encouragement of motion when the standard practice was just the opposite: bed rest, braces, traction, and surgical fusion. And, particularly with back disorders, I used manipulative procedures and exercise when the “standards” insisted on rigidity. If I had been sued at that time, no one would have defended me for violating the code of the standards of medical practice. I produced physical changes that relieved pain, and restored normal function. This was not unique for osteopathic physicians. In many cases the patients were physicians themselves, many of whom had unsuccessful surgery. Fortunately, I wasn’t sued, and fortunately I got results.
Good question. Where are the studies that demonstrate changes brought about by manipulation? When hands touch a patient in order to produce beneficial effects, what forces are used? In what direction? With what alteration to superficial tissues and to deeper ones? Muscle? Tendons? Fascia? Are there alterations in joint position? How far–with what angles–with what effect on joint forces and on the production of synovial fluids? When I became chairman of the Department of Osteopathic Sciences at New Jersey School of Osteopathic Medicine, I recruited a bio-engineering PhD from Princeton and outlined the
project. He designed a study which involved patients, controls, EMGs of normal tissues versus those with pain, testing both under physical stress with forcedisplacement meters, pressure transducers, all producing computer-generated data. All physicians, evaluators and engineers were blinded to the work of others. The study was too small, only 12 patients and 12 controls, but it earned PhDs for three graduate students. And a title for me: Adjunct Professor of Biomedical Engineering at Rutgers University College of Engineering–without having taken a single course in engineering. All of this was 25 years ago. We now have students better-trained in scientific study and hosts of better instruments of measurement. Students ask your teachers, teachers ask your administrators, and administrators ask yourselves how long can you go along without answering the question: WHERE ARE YOUR DATA? ■
UMDNJ-SOM 30 Years!
But there was something missing. When physicians asked me just what happened
THE JOURNAL | summer 2011
15
j|à{ fÑxv|tÄ g{tÇ~á j|à{ fÑxv|tÄ g{tÇ~á AROC exhibitors, sponsors, sponsors and and educational educational partners partners play play aa vital vital role role in in the the convention convention each each year. year. The time physicians spend with exhibitors and sponsors in the hall as they showcase their products and services benefits everyone. Not only are insights gained into the latest clinical and practice management offerings available, but also the support by the exhibitors, sponsors and educational partners subsidizes attendees’ convention registrations and allows the association to offer programs that might not otherwise be possible. It is with appreciation that NJAOPS acknowledges those companies that helped make AROC 2011 such a success and looks forward to their participation again in 2012. For more information about the companies listed here, please visit the Registered Exhibitors page at www.njosteo.com/exhibit and click on the link for the 2011 exhibitors at the bottom of the page
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Key: *Exhibitor, ◊Diamond Sponsor, †Gold Sponsor, ‡Silver Sponsor, ○Bronze Sponsor, ±General Sponsor
1st Care Consulting Services, Inc.*
Abbott*○ ACOFP–New Jersey State Society† Alcon Laboratories* Allerta* American Express* Amgen* Amylin Pharmaceuticals* ANSAR Medical Technologies* Astellas Pharma U.S.* AstraZeneca*○ Atlantic Medical Imaging* Auxilium Pharmaceuticals, Inc.* Bayada Nurses* Bayer† Biogen Idec◊ Berkshire Medical Technologies (e-MDs)* Boehringer Ingelheim Pharmaceuticals* Bollinger Inc.*○ Bowman Home Medical & Respiratory* Boynton & Boynton* Bristol-Myers Squibb* Callahan Financial Group± Calloway Labs* Capital Toxicology* Cephalon* Compassionate Care Hospice* Continuum Health Alliance* Conventus Inter-Insurance Exchange*○ Cowan, Gunteski & Co, PA*○ Daiichi Sankyo* David Lerner Associates* Deborah Heart and Lung Center* DePuy Mitek*
Eisai, Inc.* Elsevier/Saunders/Mosby* Emdeon Business Services* Endo Pharmaceuticals* Fox Rehabilitation* Genova Diagnostics*‡ GlaxoSmithKline*○ Guna, Inc.* Healsa* Heartland Hospice & Rehabilitation* Holy Redeemer Home Care* Ideal Protein* Injured Workers Pharmacy* Jersey Shore Pharmacy* KeyArx Capital*○ Kennedy Health System† Kowa Pharmaceuticals* LabCorp* Lighthouse Hospice* Lilly USA*◊ LipoScience* Masimo* Masonic Hospice Service* McKesson* MDAdvantage*○ Medent–Community Computer Services*‡ The Medwin Group Merck & Co., Inc.*‡ Meridian Health* Microwize Technology Inc.* Mosby/Saunders/Elsevier* nextEMR* New Jersey Army National Guard* Nixon Uniform Service & Medical Wear*
ftäxà{x ftäx à{xWtàx Wtàx AROC 2012 April 18-21, 2012 Ballys Atlantic City
NJIT/NJ-HITECH* NJ PURE*‡ Novartis Pharmaceuticals Corporation* Novo Nordisk Inc.* ◊ Patient Physician Trust Partnership* Physician Sales & Service○ Pfizer*◊ Premier Systems* Princeton Insurance*‡ ProAssurance* Professional Data Systems* ProMutual Group*○ PSS World Medical* Quest Diagnostics*○ Reckitt Benkiser Healthcare* Robard Corporation*○ Sanofi-Aventis* Sanofi-Pasteur* Santarus, Inc.* Shiel Medical Laboratory*○ South Jersey Radiology Associates* STI Computer Services* Summit Pharmacy* UMDNJ–School of Osteopathic Medicine*○ University Services* U.S. Navy Healthcare* Upright MRI of Cherry Hill*○ Vascular Access Centers* Verizon Wireless* Vertical Pharmaceuticals, Inc.* Visiting Physician Associates of South Jersey* VITAS Innovative Hospice Care*‡ Warner Chilcott* The Woodland Group*○
New Jersey Association of Osteopathic Physicians congratulates
Martin S. Levine, DO 115th President of the American Osteopathic Association 1897-1898 ▪ ILLINOIS
1919-1920 ▪ MICHIGAN
1898-1899 ▪ PENNSYLVANIA
1920-1921 ▪ WASHINGTON
D.B. MACAULEY, DO S.C. MATTHEWS, DO 1899-1899 ▪ MISSOURI
A.G. HILDRETH, DO 1899-1900 ▪ INDIANA
F.W. HANNAH, DO 1900-1901 ▪ OHIO
C.M.T. HULETT, DO
1966-1967 ▪
WALTER E. BAILEY, DO
JOHN W. HA
W.E. WALDO, DO
C. ROBERT STARKS, DO
EARL K. LYO
S.L. SCOTHORN, DO
C. ROBERT STARKS, DO
G.W. GOODE, DO
JOHN P. WOOD, DO
1921-1922 ▪ TEXAS
1922-1923 ▪ MASSACHUSETTS 1923-1924 ▪ OHIO
W.A. GRAVETT, DO
1901-1902 ▪ OHIO
1924-1925 ▪ WASHINGTON
1902-1903 ▪ NEW YORK
1926-1927 ▪ IOWA
E.R. BOOTH, DO
1943-1944 ▪ MISSOURI
H.W. CONKLIN, DO
ASA WILLARD, DO
1944-1945 ▪ COLORADO 1945-1946 ▪ COLORADO 1946-1947 ▪ MICHIGAN
1947-1948 ▪ EST VIRGINIA
ROBERT B. THOMAS, DO 1948-1949 ▪ WASHINGTON
1967-1968 ▪ A
1968-1969 ▪ M
ROY S. YOU
1969-1970 ▪ O
J. SCOTT HEATH
1970-1971 ▪ F
W.S. HOR
1971-1972 ▪ TE
STEPHEN M. PUGH, DO
MARION E.
H. DALE PEARSON, DO
J. VINCENT MU
1949-1950 ▪ PENNSYLVANIA
1972-1973 ▪ M
C.C. TEALL, DO
RAY B. GILMOUR, DO
CHARLES HAZZARD, DO
GEORGE V. WEBSTER, DO
VINCENT P. CARROLL, DO
JOHN C. TAY
C.P. MCCONNELL, DO
D.L. CLARK, DO
FLOYD W. PECKHAM, DO
PAUL E. WIL
JOHN MACDONALD, DO
DONALD HAMPTON, DO
EARL A. GAB
WARREN B. DAVIS, DO
ALLAN A. EGGLESTON, DO
ARTHUR D. BECKER, DO
JOHN W. MULFORD, DO
VICTOR W. PURDY, DO
ROBERT C. MOORE, DO
DONALD SI
E.C. PICKLER, DO
PERRIN T. WILSON, DO
R.D. MCCULLOUGH, DO
DALE DODS
A.G. HILDRETH, DO
GEORGE J. CONLEY, DO
J.L. HOLLOWAY, DO
THOM. THORBURN, DO
GEORGE W. NORTHUP, DO
FLOYD KREN 1981-1982 ▪ FRANK J. MCD
C.B. ATZEN, DO
JOHN E. ROGERS, DO
GALEN S. YOUNG, DO
A. ARCHIE FEIN
P.H. WOODALL, DO
EDWARD A. WARD, DO
ROY J. HARVEY, DO
C.A. UPTON, DO
ARTHUR E. ALLEN, DO
CHARLES L. NAYLOR, DO
STANLEY N. W
O.J. SNYDER, DO
FRANK F. JONES, DO
CHARLES SAUTER II, DO
JOHN H. BUR
W.B. MEACHAM, DO
F.A. GORDON, DO
WALLACE M. PEARSON, DO
EUGENE L. SIK
GEORGE W. RILEY, DO
PHIL R. RUSSELL, DO
CAMPBELL A. WARD, DO
MCFARLANE TILLEY, D0
WESLEY B. LARSEN, DO
1903-1904 ▪ NEW YORK 1904-1905 ▪ ILLINOIS
1905-1906 ▪ TENNESSEE
A.L. EVANS, DO
1906-1907 ▪ MASSACHUSETTS
S.A. ELLIS, DO 1907-1908 ▪ OREGON F.E. MOORE, DO 1908-1909 ▪ MISSOURI
THOMAS L. RAY, DO 1909-1910 ▪ TEXAS
1910-1911 ▪ MINNESOTA 1911-1912 ▪ MISSOURI 1912-1913 ▪ TEXAS
1913-1914 ▪ NEBRASKA 1914-1915 ▪ ALABAMA
1915-1916 ▪ MINNESOTA 1916-1917 ▪ PENNSYLVANIA 1917-1918 ▪ N. CAROLINA 1918-1919 ▪ NEW YORK
H.H. FRYETTE, DO
1927-1928 ▪ NEW YORK
1928-1929 ▪ COLORADO
1929-1930 ▪ MASSACHUSETTS 1930-1931 ▪ CALIFORNIA 1931-1932 ▪ MISSOURI
1932-1933 ▪ WISCONSIN
1933-1934 ▪ MASSACHUSETTS
1950-1951 ▪ CALIFORNIA 1951-1952 ▪ ILLINOIS 1952-1953 ▪ OHIO
1953-1954 ▪ CANADA 1954-1955 ▪ OHIO
1955-1956 ▪ MICHIGAN
1956-1957 ▪ NEW JERSEY
1934-1935 ▪ MISSOURI
1957-1958 ▪ PENNSYLVANIA
1935-1936 ▪ NEW YORK
1958-1959 ▪ MICHIGAN
1936-1937 ▪ WISCONSIN 1937-1938 ▪ MICHIGAN
1938-1939 ▪ MINNESOTA 1939-1940 ▪ GEORGIA 1940-1941 ▪ IOWA 1941-1942 ▪ EXAS
1942-1943 ▪ NEW YORK
CARL E. MORRISON, DO 1959-1960 ▪ ILLIONIS 1960-1961 ▪ OHIO
1961-1962 ▪ MASSACHUSETTS 1962-1963 ▪ MISSOURI
1963-1964 ▪ MICHIGAN 1964-1965 ▪ MICHIGAN 1965-1966 ▪ ILLINOIS
1973-1974 ▪ I
1974-1975 ▪ M
1975-1976 ▪ F
1976-1977 ▪ TE
GEORGE J. LU
1977-1978 ▪ M
PHILIP ADL
1978-1979 ▪ M
1979-1980 ▪ F
1980-1981 ▪ PENN
1982-1983 ▪ PENN
1983-1984 ▪ F
MERVIN E. M
1984-1985 ▪ IN
1985-1986 ▪
1986-1987 ▪ M
1987-1988 ▪ PENN
JOSEPH W. ST
1988-1989 ▪ F
MARCELINO O
cians and Surgeons
n
966-1967 ▪ OHIO
1989-1990 ▪ MISSOURI
HN W. HAYES, DO
WILLIAM H. VOSS, DO
RL K. LYONS, DO
MITCHELL KASOVAC, DO
Y S. YOUNG, DO
GILBERT BUCHOLZ, DO
7-1968 ▪ ARIZONA
-1969 ▪ MICHIGAN
69-1970 ▪ OREGON
T HEATHERTON, DO
1990-1991 ▪ ARIZONA 1991-1992 ▪ OHIO
1992-1993 ▪ MICHIGAN
E.A. LONIEWSKI, DO
70-1971 ▪ FLORIDA
1993-1994 ▪ RHODE ISLAND
1-1972 ▪ TENNESSEE
1994-1995 ▪ MICHIGAN
W.S. HORN, DO
RION E. COY, DO
2-1973 ▪ MICHIGAN
L. BOUCHARD, DO
WILLIAM ANDERSON, DO 1995-1996 ▪ FLORIDA
CENT MURPHY, DO
HOWARD L. NEER, DO
N C. TAYLOR, DO
JOHN P. SEVASTOS, DO
73-1974 ▪ ILLINOIS
4-1975 ▪ MISSOURI
UL E. WILSON, DO
75-1976 ▪ FLORIDA
L A. GABRIEL, DO
6-1977 ▪ TENNESSEE
1996-1997 ▪ OHIO
1997-1998 ▪ NEW JERSEY
HOWARD M. LEVINE, DO 1998-1999 ▪ PENNSYLVANIA
RONALD A. ESPER, DO 1999-2000 ▪ MICHIGAN
RGE J. LUIBEL,K DO
EUGENE A. OLIVERI, DO
HILIP ADLER, DO
DONALD J. KRPAN, DO
-1978 ▪ MICHIGAN
8-1979 ▪ MISSOURI
NALD SIEHL, DO
9-1980 ▪ FLORIDA
LE DODSON, DO
981 ▪ PENNSYLVANIA
YD KRENGEL, DO 81-1982 ▪ TEXAS K J. MCDEVITT, DO
983 ▪ PENNSYLVANIA
CHIE FEINSTEIN, DO
83-1984 ▪ FLORIDA
RVIN E. MECK, DO
4-1985 ▪ INDIANA
LEY N. WILSON, DO
985-1986 ▪ TEXAS
2000-2001 ▪ CALIFORNIA 2001-2002 ▪ ARKANSAS
JAMES E. ZINI, DO
2002-2003 ▪PENNYSLVANIA
ANTHONY MINISSALE, DO 2003-2004 ▪ MINNESOTA
DARRYL BEEHLER, DO 2004-2005 ▪ OHIO
GEORGE THOMAS, DO 2005-2006 ▪ FLORIDA
PHILIP L. SHETTLE, DO 2006-2007 ▪ KENTUCKY
JOHN A. STROSNIDER, DO 2007-2008 ▪ MICHIGAN
PETER B. AJLUNI, DO
2008-2009 ▪ PENNSYLVANIA
PH W. STELLA, DO
CARLO J. DIMARCO, DO 2009-2010 ▪ MISSOURI LARRY A. WICKLESS, DO 2010-2011 ▪ ARIZONA KAREN J. NICHOLS, DO
CELINO OLIVA, DO
MARTIN S. LEVINE, DO
N H. BURNETT, DO
6-1987 ▪ MICHIGAN
NE L. SIKORSKI, DO
988 ▪ PENNSYLVANIA
88-1989 ▪ FLORIDA
2011-2012 ▪ NEW JERSEY
Congratulates
Dr. Martin levine on becoming the aoa’s 115th president
Continuum Health Alliance develops dynamic management solutions for hospital-based and independent physician groups, helping doctors to deliver cost-effective, quality care.
the Healthcare Management solution 856.782.3300
•
www.challc.net
MANAGING liability
Insurance Considerations When Joining an ACO Timothy L. Hoover, CPCU
T
hese days it seems that a growing number of physicians are considering leaving a private practice in favor of joining a partnership or an employment model with a hospitalcentered Accountable Care Organization (ACO). These options may seem attractive to those who are overwhelmed by administrative and capital costs, such as EHR requirements, or uneasy about the uncertainty of the future of heath care reform in general. That’s understandable. However, within the context of any discussion about moving to an ACO, there should be a thorough exploration and understanding of the nature of the liability risks that may come with this change. Among those risks is transitioning from individual malpractice protection to insurance (or self-insurance) on a collective basis. After all, coordination is at the heart of the ACO model, and consolidation of malpractice insurance is often a key expense-saving priority. When this consolidation results in a
program, which is often a captive insurance company. If the physician’s private practice was previously insured on a claims-made policy, hospitals will often require the purchase of expensive tail coverage. Physicians need to know if they, or the hospital, will be paying for all or a portion of the transition cost. Physicians need to explore all of their options, within acceptable guidelines, to ease the cost of this purchase to protect run-off liability arising from the closing of their private practice. It may be possible to negotiate keeping the physician’s own insurance, or at least bargain for a financing arrangement for the transition costs. Too often, however, this expense is unaddressed until after the deal is closed. Another area of concern is the nature and scope of the hospital’s replacement malpractice insurance coverage. It will most likely be on a claims-made basis which raises the question of who is
Providers in an ACO may put themselves at risk of a malpractice lawsuit because they are members of an ACO responsible for coordinating care of a patient. singular unified front in the defense of a malpractice claim, then that can be a productive benefit. Unfortunately, this is not always the case. Physicians need to be aware that there is a cost to this benefit, and the cost is often the forfeiture of their individual right to personally oversee the protection of their professional reputation.
An Uneven Playing Field There is often a lack of symmetry in the negotiating positions between physicians and hospitals in setting up or joining an ACO. This imbalance can result in negative consequences for physicians when it comes to making malpractice coverage decisions. For example, it is common that a hospital will require a physician to obtain medical liability coverage through its controlled insurance
22
responsible for the tail coverage in the event the physician leaves the ACO. Is this available? What is the duration? Who pays the cost? What is the financial strength of the insurance company? Where is the company licensed? It is not uncommon to find that the company is domiciled offshore in the Cayman Islands, for example, making it virtually impossible to file a legal action in the event of a coverage or claim settlement dispute. All of these are critical questions that need to be answered before signing on to the ACO. Another overlooked issue is the scope of the coverage offered by the hospital’s program. Is it restricted to just the practice within the ACO? What happens if the physician works elsewhere? Does it give the physician the right to consent to settle any claim against the
physician? Examining the policy coverage provisions offered through the hospital captive insurance company is critically important. If a consent provision is not provided, is the defense and settlement of a malpractice claim directed centrally by the hospital? Are you comfortable conceding the potential of a claim payment against you to a hospital administrator? If not, other options may need to be explored. Finally, ask for a copy of the captive company’s insurance policy. You may be surprised to find that this critical document does not offer the breadth or scope of individual coverage. No physician should ever consider switching malpractice companies without a critical comparison of what the replacement policy actually covers. I commonly see doctors join ACOs and willingly accept without question insurance coverage that is far inferior to what they currently purchase. In one instance, a client of mine was shocked to find that the Cayman Island captive company owned by the hospital had only the most basic malpractice policy coverage for physicians. The policy even included a provision that required physicians to share a common policy limit with multiple parties, including the hospital, all of its allied professionals, and all of the other employed physicians! Watered down coverage is usually no bargain.
Do ACO’s Actually Increase Liability? One of the objectives of an ACO is to coordinate care and outcomes across the spectrum of a patient encounter. This coordination extends to malpractice risk as well. Often, however, it is unclear who within the ACO is liable if this coordination does not occur or if outcomes are not as expected. The American College of Gastroenterology recently expressed concern that “providers in an ACO may put themselves at risk of a malpractice lawsuit because they are members of an continued on page 34
THE JOURNAL | summer 2011
We Salute
Martin S. Levine, DO, MPH, FACOFP dist. President of the American Osteopathic Association The 20,000 members of the American College of Osteopathic Family Physicians (ACOFP) congratulate Martin S. Levine, DO, MPH, FACOFP dist. on his election as 2011-2012 President of the American Osteopathic Association (AOA). We are ready to stand behind an outstanding osteopathic physician who will well represent the aspirations, ideals and concerns of the entire osteopathic profession. On behalf of our ACOFP colleagues, we salute Dr. Levine’s leadership, compassion and dedication to osteopathic medicine. He has been a valued member and volunteer within the ranks of ACOFP and we wish him great success during his year as President of AOA.
George T. Sawabini, DO, FACOFP dist. ACOFP President
Paul A. Martin, DO, FACOFP dist. ACOFP President-elect
The Professional Practice
How To Evaluate Managed Care Contracts Deborah R. Mathis, CPA, CHBC Michael S. Lewis, MBA, FACMPE
Managed Care — The Past
Managed Care — The Future
Health care has seen a significant transition in the area of managed care from the 1970’s when health maintenance organizations were first approved by Congress to today. Managed care was supposed to offer a planned and coordinated approach to providing health care. It put more emphasis on primary care providers and was supposed to have a significant preventative component. The risk shifted from patient and payer to primary care providers who, by receiving capitation, were hoping to maintain a healthy population. Physicians applied to be on managed care panels and referrals and treatment plans became a new part of the physician lexicon.
Managed care didn’t prove to be the salvation of the health care system that many people thought it would be. It has now evolved into a “consumer-directed” program with high-deductible health plans, health savings accounts (HSA), and tiered benefit designs. The plans have economic incentives for consumers to seek lower-cost services and an open choice of physicians with economic restrictions. Patients have copays and deductibles under these plans and are supposed to have a substantial voice in referrals to specialists and treatment plans. There are now more choices for physicians, however, with corresponding economic restrictions. Patients are being urged to participate in their health care decisions and voice
their opinions about the cost of treatment. Physicians are being asked to provide deep discounts from full charge with fee schedules to their patients. Payers and others will rate physicians and hospitals for quality of care and patient satisfaction. Many insurance companies will be publicizing these ratings and patients will be able find a great deal of information online. Pay-for-performance will be a significant portion of physician revenue under managed care plans.
Why Doctors Sign Up There are different motivations for physicians to participate with managed care plans. Doctors who are just starting to build their practice participate in order to get patients. Established physicians want to keep their existing patients and often find that large employers keep changing their health benefits in order to reduce cost. Therefore physicians must participate with a wide variety of plans. Physicians feel it can also give them a competitive edge. If the physician down the street participates, it’s difficult to be the outlier. Some physicians feel they can’t afford not to participate. In some practices, a steady flow of capitation dollars can help solve cash issues.
Evaluating the Plan Evaluating the plan should be a multi-prong approach. It is extremely important to research the reputation of an insurance carrier before choosing to participate. Call employers that provide health benefits with the company and find out if they and their employees are satisfied. Call other doctors that participate to find out how the plan has been with respect to timely payments, denials and ease of access for pre-certification and referrals. Gather data from the state where you practice to determine the market penetration of the plan. If the insurance plan has a very small market penetration, it may not be worth the paperwork to participate. It isn’t fair to you or your front desk to do the necessary paperwork to be a participating doctor with plans that do not have a significant number of patients in your catchment area. continued on page 26
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THE JOURNAL | summer 2011
New Jersey Osteopathic Education Foundation congratulates our friend and colleague
Martin S. Levine, DO, MPH, FACOFP dist. on his inauguration as the 115th President of the American Osteopathic Association
Through the generous support of NJAOPS' members and friends of the profession, the foundation has provided more than $750,000 in scholarships to deserving New Jersey residents attending osteopathic medical schools across the country.
Dr. and Mrs. Jerome B. Cohen Memorial Osteopathic Scholarship Ronald J. Goldberg, DO Memorial Scholarship Howard M. Levine, DO Memorial Scholarship NJAOPS Auxiliary Scholarship Paul A. Van Houten, DO Memorial Scholarship
continued from page 24 It’s also important to find out what the competing managed care plans are doing in your area. Check the rates of the plan you are considering to ensure they are competitive to the others in your area. Research the success rate in enrolling new members. Finally, and perhaps the most important piece of information to look for when comparing to the competition, is the financial position of the carrier. Is the managed care company financially solvent or will you be at risk for not getting paid at some point down the road? This is a very important question that needs to be addressed before making your decision.
Membership, Market Share and Other Issues When choosing a managed care plan, you want to look at total enrollment numbers, historical growth, and projected growth. Knowing the carrier’s actual market share will also help in making the decision. Once you have this data, find out where the carrier hopes to go. What is their projected market share? This will give you a good indication on how successful the carrier sees itself and what their growth path will be. How do they plan on achieving their growth? Who
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are they reaching out to? How are they keeping their providers happy? Finally, checking on their participating employers can unlock more information about the level of service you might receive once you make the choice. Most states require that an insurance carrier have a minimum number of providers signed up to participate before they will give them a license to do business. This is the reason why carriers may often make promises about their plans that don’t necessarily come to fruition. If you are a primary care physician, you must determine whether or not the specialists you utilize are in the plan. It will be very difficult to manage the care of your patients if you have trouble finding specialists who are willing to accept this insurance plan. For example, a major problem with many managed Medicaid plans is that there are few specialists who will accept patients. It is also a good idea to check if the hospitals at which you have privileges are participating with the plan.
Evaluating Risk There can be risks to providers and their practice and these must be evaluated before making a decision to participate with a managed care plan. You must
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know how many patients have to select you as a primary care physician before the reimbursement method changes from fee-for-service to capitation if the carrier still uses capitation. You want a minimum of 500, although many plans such as Horizon convert to capitation at 250. You want to be sure you have a broad enough panel of patients so that there are healthy individuals to offset those that use more of your time.
Services to be Rendered Under the Plan Before deciding to participate with a managed care plan, physicians should get answers to the following questions regarding the services they render: ■■ What services am I required to provide? ■■ What is non-covered and billable? ■■ What services do I have to provide to people who are no longer covered but are in the middle of treatment? ■■ How quickly will the company notify me of disenrollment and take back payments already made to me? ■■ Do I have to accept all patients? ■■ Can I limit the number of patients in my panel? ■■ Can the managed care plan carrier deny care retroactively and refuse to pay? Knowing this information up front can save a lot of time and possible financial loss for the practice. It is also important to get any utilization review requirements up front before you sign a contract and never agree to rules you haven’t seen in writing.
Evaluating Reimbursement Some managed care plans reimburse based on a discounted fee for service. Physicians should get the fee schedule and determine the payment in comparison to both their own practice fee schedule as well as Medicare’s. Many carriers reimburse as a percentage of Medicare. Research the plan to see if there are any “carve-outs” that exclude certain services such as mental health services or durable medical equipment (DME).
Billing Rules There are often precertification requirements for managed care plans as well as time limits for filing claims. It is important to get information on the payment turnaround time for paying claims. There may be special paperwork that needs to be completed in order to receive payment for services. Some managed care plans require a second opinion. Understanding the fee schedules and co-pay collection rules will help with the transition when deciding to be a provider for continued on page 28
THE JOURNAL | summer 2011
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continued from page 26 a managed care plan. Check on additional contract terms before signing such as: ■■ Exclusivity ■■ Licensure requirements ■■ Medical necessity/emergency ■■ Restriction on referrals ■■ Required malpractice coverage ■■ Hold harmless clause ■■ Provider coverage requirements ■■ Claim filing, appeals and grievance process ■■ Unapproved services ■■ Terminating the contract
Building a Relationship It is important to establish and build a relationship with your local plan representatives. Having regular meetings with the representatives and offering to participate in planning committees help build a relationship with your plan provider. Those doctors who do participate in plan committees and meetings frequently have a more favorable reception when there are problems that need resolution.
Evaluating Continued Participation Once you’ve made a decision and are established with a plan, you should continue to evaluate to make sure that
participation is in the best interest of your practice. There are non-financial and financial reasons to leave a plan if certain criteria have not been met. On the nonfinancial side, analyze utilization (is it higher than expected?), the level of risk (it is unacceptable?) and the volume of patients (is it too small?). Are there administrative burdens because of the referral process, precertification process, accounting requirements or record retention? Are competing providers reducing their patient pool? If these questions are producing answers that are less than acceptable, it is time to think about your participation and if it is really a benefit to your practice. There can also be financial issues including money lost on capitated payments fee discounts that are too steep, and difficulty in getting claims paid. These administrative burdens can cause financial damage. It is important to analyze the profitability of the contract, not solely the revenue it brings to the practice. Are available patient slots being used by patients who have an insurance plan where reimbursement is significantly lower than for other payers? If your demand exceeds your available patient openings, it may be time to withdraw from those carriers.
As you can see, choosing a managed care plan requires various aspects and levels of research. This decision takes time to ensure the plan works with, and not against the practice. While there are benefits to participation, there are also risks that need to be analyzed to see if the decision is the correct one for your practice Since the insurance participation decision has a major impact on the financial condition of your practice, you should expend the effort necessary to make the most informed decision possible. Results should be monitored continuously to ensure it remains the right decision, and not one that eats away at your profit. ■ Deborah R. Mathis, CPA, CHBC, Shareholder-In-Charge and Michael S. Lewis, MBA, FACMPE, Shareholder/ Director, are with the Healthcare Services Group at Cowan, Gunteski & Co., one of the leading certified public accounting and profitability consulting firms for the healthcare industry. They can be reached at 732-349-6880. Visit www.CowanGunteski.com for more information on the valued-based services provided to physician practices.
The Tri-County Osteopathic Society congratulates one of our own
Martin S. Levine, DO American Osteopathic Association President 2011–2012 Thank you for your commitment to your new jersey . family and the osteopathic profession
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THE JOURNAL | summer 2011
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MEMBER NEWS New Members NJAOPS welcomes the following new members approved by the Board of Directors June 1, 2011. Active Membership Andrew Becker, DO Family Practice, West Orange, NJ ■■ Stephen Hoey, DO Internal Medicine, Voorhees, NJ ■■ Elyse Kopp Muhlberg DO Family Practice, Burlington, NJ ■■ Mario Maiese, DO Cardiology, Sewell, NJ ■■ Alexsandr Martirosov, DO Osteopathic Manipulative Treatment, Fair Lawn, NJ ■■ Mona Patel, DO Palliative Medicine, New York, NY ■■ Mary Ann Sciamanna, DO Acupuncture, Marlton, NJ ■■
Intern, Resident and Fellow Membership ■■ Marina Weinstein, DO UMDNJ-SOM, Internal Medicine, Cherry Hill, NJ Medical Student Membership Ashley Dorazio UMDNJ-SOM class of 2014, West Berlin, NJ ■■ William Matthews PCOM class of 2014, Philadelphia, PA ■■ Marc Sciarra UMDNJ-SOM class of 2014, Sicklerville, NJ ■■
Member News David Abend, DO, was part of a group of medical professionals honored May 17th by the American Red Cross of Northern New Jersey for their
Retired Membership Jeffrey Helfand, DO
■■
Life Membership Philip Hollander, DO
■■
volunteer efforts during national and international disasters. Dr. Abend spent several months at Ground Zero in New York City following the attacks of 9/11 treating those involved with search and rescue and clean-up of the disaster. Dr. Abend spent hours every day using OMT on anyone and everyone from the FDNY, NYPD, Red Cross, FBI, and Army who needed a treatment for their neck, headache, or back pain due to the incredible amount of physical labor and associated stress of the clean-up efforts. Select osteopathic medical students from the New England College of Osteopathic Medicine and the Kirksville College of Osteopathic Medicine as well as Daniel P. Conte III, DO, also helped in these efforts. Dr. Abend and Dr. Conte were recognized by NJAOPS with Special Service Awards in 2002. John Bertagnolli, DO, UMDNJ—SOM Assistant Professor, Family Medicine, facilitated a group of 18 missionaries, continued on page 32
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THE JOURNAL | summer 2011
The Camden County Society of the New Jersey Association of Osteopathic Physicians and Surgeons salutes
Martin S. Levine, DO upon his installation as the 115th President of the
American Osteopathic Association Wishing you all the best as you provide vision and leadership in the year to come
FM CME ad6211_Layout 1 6/6/11 2:16 PM Page 1
continued from page 30
Department of Family Medicine presents
for Osteopathic Physicians
September 2011 - January 2012 CARDIOLOGY (9/24/11
PAIN MANAGEMENT (10/2/1)
PEDIATRICS (11/12/11) WEIGHT MANAGEMENT (12/3/11)
OB/GYN (1/7/12) HELD AT UMDNJ-SOM’S STRATFORD CAMPUS, ACADEMIC CENTER ONE MEDICAL CENTER DRIVE, STRATFORD, NJ 08084
including seven medical students and two family medicine physicians, and provided health care to physically and mentally challenged people in Kingston, Jamaica in April. Martin A. Finkel, DO, FACOP, FAAP, UMDNJ—SOM Professor of Pediatrics, founder and Director of the Child Abuse Research, Education and Service (CARES) Institute at UMDNJ—SOM, was reappointed by Governor Christie to the New Jersey Task Force on Child Abuse and Neglect. He has served on this Task Force for over 25 years, including as co-chair, and has been appointed to it by six Governors. Adarsh Gupta, DO, MS, UMDNJ—SOM Associate Professor, Family Medicine, was named to a two-year term as co-chair for the Evidence-Based Medicine Group at the 44th Annual Society of Teachers of Family Medicine (STFM) Spring Conference held in New Orleans, LA from April 27, 2011–May 1, 2011. He also co-presented a poster entitled, “Need for Information Mastery Skills: an Analysis of Web Analytics Data” at the conference. Kathryn C. Lambert, DO, UMDNJ—SOM Assistant Professor, Family Medicine and Acting Assistant Dean for Student Affairs, was awarded Fellow status in the American Osteopathic Academy of Sports Medicine (AOASM) and participated in a Research and Case Presentation expert panel at the AOASM Annual Educational Conference in Providence, RI, April 27– April 30, 2011. Julieanne Sees, DO presented two publications, “Ankle Injury in Water Skiing–Acute Rupture of Flexor Hallucis Longus Tendon,” with Joseph N. Daniel
DO, and “Thigh Pain in Football and Wrestling–Acute Presentation of Osteomyelitis,” with Richard W. Kruse, DO, MBA, at the American College of Sports Medicine Annual Meeting and World Exercise Congress held June 1–4 in Denver, CO. Matthew Mergh received the New Jersey American College of Emergency Physicians’ Medical Student of the Year award, given each year in recognition of a student from a New Jersey medical school for leadership and expertise in the field of emergency medicine. Robert Pearson, DO, a retired physician for more than 50 years, recently published a novel through Xlibris publishing. House Calls reflects the struggles of several generations of families who immigrated to the United States in order to achieve the American dream, a task made more complicated by Jewish traditions and the assimilation of a new culture. As a young osteopathic physician in Emerson, New Jersey, Dr. Pearson rapidly built up a very successful practice in Family Medicine and always believed in making house calls. His work was rewarded with recognition in 1998 when he was honored as NJAOPS’ Physician of the Year.
Send Us Your News Send your professional achievements to The Journal so we can share them with your colleagues. Email a brief description to bliebowitz@njosteo.com for inclusion in the next issue.
Early Registration Fee for the 5 Block Subscription (25 CME 1A Credits): $395 prior to August 24, 2011 Individual Block Registration: $125.00 per block (5 CME 1A Credits Each) For inquiries about this event or to register contact: Cari Schenkel, Program Coordinator at 856-566-6085 or e-mail: schenkcl@umdnj.edu For information on this CME series or future UMDNJ-SOM CME events visit: som.umdnj.edu/cme1a
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NJAOPS Award Recipient: Kahyun Yoon-Flannery (pictured with Thomas A. Cavalieri, DO, FACOI, FACP, Dean, UMDNJ and NJAOPS President Antonios Tsompanidis, DO ‘94)
THE JOURNAL | summer 2011
The Bergen-Passaic Osteopathic Medical Society warmly congratulates
Martin S. Levine, DO on his inauguration as the
115th President of the American Osteopathic Association
Best wishes to our friend and colleague for much success in your year in office.
FROM THE EXECUTIVE DIRECTOR continued from page 6 providing quality health care, and honored by his colleagues as exemplifying what it means to be a healer in the osteopathic tradition.
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In June 2011, the New Jersey Osteopathic Education Foundation (NJAOEF) awarded its annual scholarships to four deserving first-year medical students. Congratulations are extended to Mukarram Razvi of Clifton, the Howard M. Levine, DO Memorial Scholarship recipient; Stephen Klepner of Morganville, the Dr. and Mrs. Jerome B. Cohen Memorial Osteopathic Scholarship recipient; Laura Belden of Cranford, the NJAOPS Auxiliary Scholarship; and Jason Keiner of Galloway, the Paul A. Van Houten, DO Memorial Scholarship recipient. To date, the NJOEF has awarded $752,000 in student scholarships thanks to the generous support of the membership. From July 15–17, the NJAOPS delegation will join other AOA affiliates in Chicago for the 2011 Annual Business Meeting. NJAOPS delegates are particularly
looking forward to the installation of former NJAOPS president, Dr. Martin Levine as the 115th President of the AOA. With a strong family history of dedicated service to the osteopathic profession, Dr. Levine will be a passionate and tireless advocate for advancing the profession. Over the past year, the CME County Dinner Series continued to provide members with ongoing education in a variety of therapeutic areas, offering over 60 programs statewide. The 2011–2012 series will begin in September and some special events are planned. Members are reminded to check the Calendar of Events at www.njosteo.com/calendar for updated information. We look forward to seeing more of you at the county dinners when they resume in September. In the meanwhile, we wish you a Jersey summer full of weekends “down the shore;” sweet corn from the local farm stand, and the good company of family and friends. ■ Robert W. Bowen is the executive director of NJAOPS.
MANAGING liability continued from page 22 ACO responsible for coordinating care of a patient.” An important question to ask is if the physician or the ACO is liable for directing utilization. If the physician is liable, this exposure is rarely covered by malpractice insurance. A separate managed care liability policy that extends specifically to include the individual physician as an insured person may be needed. It is important to ensure that the ACO has this consideration in place. Others have suggested that plaintiff attorneys may seek larger awards from hospital-centric ACOs based upon their greater assets or higher malpractice limits. The bottom line is that individual physicians may find themselves drawn into a new environment of litigation. Of greater concern is that these new exposures may not fall within traditional definitions of many medical liability policies.
Due Diligence is Key When negotiating with a hospital, be sure to clarify exactly what is and what is not covered by their malpractice
policy. Are outside medical directorships included? If not, additional protection may need to be purchased. Also, ask for details about the claims management process and what input physicians will be allowed to provide. Is the process controlled by the hospital’s corporate counsel, an outsourced administrator, another entity, or by an attorney of the physician’s choosing? Remember, regardless of who provides malpractice protection, any suit will still name physicians personally, and the outcome of any malpractice litigation will still ultimately affect personal assets, future insurability, and professional reputation. So don’t go blindly into an ACO without fully investigating available alternative insurance and assessing the quality of the insurance you may be forced to accept. ■ Timothy L. Hoover, CPCU, is the Healthcare Practice Leader with the Woodland Group, a part of Bollinger, Inc. He can be contacted at tim_hoover@woodlandgroup. com or 973-300-4216.
THE JOURNAL | summer 2011
The New Jersey Chapter of ACOFP congratulates one of its own
Martin S. Levine, DO as he becomes our 115th President of the American Osteopathic Association
NJACOFP Board Antonios J. Tsompanidis, DO Carman Ciervo, DO Steven Nickles, DO Scott Druckman, DO Randy Spector, DO Ira Monka, DO Steve Rubin, DO Paul Morris, DO
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The Touro College of Osteopathic Medicine Family salutes and congratulates
Martin S. Levine, DO Associate Dean at the Harlem Campus
for his lifetime achievements to advance medical education and the osteopathic profession. Alan Kadish, MD - President and CEO Jay Sexter, PhD and Sheldon Sirota, DO Deans Michael Clearfield, DO, Mitchell Forman, DO, Robert Goldberg, DO, and Ralph O’Connell, MD
www.touro.edu/med