The Journal by NJAOPS

Winter 2010

Vol. 109.4

Why You Donâ&#x20AC;&#x2122;t Need a Billboard Medical Marketing Simplified

Practices Face New Billing Challenges Court Sides with Physicians in PIP Fight Remembering Stephen G. Papish, DO

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The Journal

Editorial and Executive Staffs

Executive Editor Robert W. Bowen Managing Editor Bonnie Smolen

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, Exhibit Services Director, Medical Education Director, Marketing & Communications Office Manager

Timothy L. Hoover Mark E. Manigan

Lee Ann Van Houten-Sauter, DO Antonios Tsompanidis, DO Karen Kowalenko, DO John LaRatta, DO Todd Schachter, DO Alan Carr, DO Robert W. Bowen Alice Alexander Kristen Bowen Lila Cleaver Bonnie Smolen Diana Lennon

TABLE OF CONTENTS President’s Message. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 NJAOPS President Lee Ann Van Houten-Sauter, DO, encourages NJAOPS members to strive for “greatness” along with the AOA as they release their new strategic plan for 2011–2013.

From the Executive Director. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 NJAOPS Executive Director Robert Bowen remembers a proud champion of the osteopathic profession, former NJAOPS President Stephen G. Papish, DO, FACOFP, who died Sept. 22 at the age of 65.

Capital Views. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Government Affairs and Legislative Counsel Laurie Clark fills us in on the latest happenings with the out-of-network provider bill, medical marijuana regulations and the new state health care reform council.

Marketing Misconceptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

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.

Facing rising costs and reduced compensation, more and more physicians who want to see their practices grow are wondering what they can do to reach new patients and retain current ones. In this issue’s main feature, NJAOPS turns to medical practice marketing experts Laura Nozicka, founder and president of Fuzenology, and Irene S. Doti, senior marketing and training consultant for Practice Builders, for answers that will help you plot your growth.

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.

Thinking of starting a marketing campaign? NJAOPS’ medical liability insurance expert Timothy Hoover tells you what you need to know to be protected against “advertising injuries.”

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.

A recent ruling by the New Jersey Court of Appeals will help protect physicians against insurance companies’ overly intrusive requests for business information, health law specialist Mark Manigan explains in his column this quarter.

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 (January, April, July, and October) 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 | winter 2011

Managing Liability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Legal Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

The Professional Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Medical management experts Deborah R. Mathis, CPA, CHBC, and Michael S. Lewis, MBA, FACMPE, provide tips for dealing with billing issues associated with high deductible health plans and rapidly increasing insurance copayments.

Member News. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 NJAOPS welcomes our new physicians and student members and recognizes the latest achievements of our members.

Medical Ethics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 In this new column, guest author Joseph C. d’Oronzio, PhD, MPH explores the reasons behind persistent patient complaints of “unprofessional conduct.”

ADVERTISERS INDEX AROC 2011......................................................................................... 2 Brach Eichler, LLC.............................................................................. 19 Conventus Inter-Insurance Exchange.................................................... 9 Cowan Gunteski & Co........................................................................ 20 Martek Pharmacal Co......................................................................... 24 MDAdvantage............................................................Inside Front Cover NJ PURE............................................................................... Back Cover Princeton Insurance.............................................................................. 5 Professional Liability Group of South Jersey, The.................................. 6 ProMutual Group....................................................... Inside Back Cover 2011 Obesity Conference..................................................................... 7 Upright MRI of Cherry Hill................................................................. 13 Woodland Group, The........................................................................ 17

education & resources for the successful physician April 6–9, 2011 • Bally’s Atlantic City

AR OC 2011

30 hours of AOA 1-A CME credit anticipated

$150 OFF ONSITE PRICING

Featured speaker Cdr. Richard Jadick, DO Military surgeon, physician expert on combat medicine and recipient of the Bronze Star with a Combat V for Valor for courage under fire in Fallujah, Iraq.

732-940-9000 njosteo.com/aroc

“It is estimated that without Jadick at the front, the Marines would’ve lost an additional 30 men. Of the hundreds of men he treated, only one died after reaching a hospital.” — Lt. Col. Mark Winn

April 6–9, 2011 • Bally’s Atlantic City AROC Information: 732-940-9000 AROC Registration Fax: 732-940-8899 Bally’s Group Reservations Desk: 800-345-7253 Monday–Friday, 9:00 a.m.–5:00 p.m. (Group Code “GBAR11”)

Convention Registration Online registration and hotel reservations are available at www.njosteo.com/aroc. Please print clearly if you complete and fax this form. AOA#:

Medical School:

Year of Graduation:

Name:

Specialty:

Office Information (Required for badge bar code)

Preferred Contact Information (If different from office)

Practice Name:

Street Address:

Street Address: City, State, ZIP:

City, State, ZIP:

Office Phone:

Preferred Phone:

Office Fax:

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Office E-mail:

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Office Web Site: Badges are required by registrants and accompanying guests (including children of any age) for exhibit hall entry. First and Last Names of Guests (i.e., spouse, children, etc. @ $35 each):

Registration Type (Check one)

Postmarked by January 31 March 21

Membership in state associations is verified prior to AROC.

DO or MD Active/Associate Member in respective state society (state: ) DO Retired Member DO Life Member APN Physician Assistant DO Intern Member* Resident Member* Student Member* (*Reception/gala not incl.) DO Applying for Active Membership in New Jersey Non-member DO or MD

After March 21 or Onsite

$425

$475

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$235

$285

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$425

$475

$575

$700

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$100/ person

Note: NJAOPS dues must be paid by March 31, 2011.

Additional Function Tickets NJAOPS 110th Anniversary Reception & Gala (One reception/gala ticket is included in a full registration) Yes! I plan to attend the gala. No. I am unable to attend. Total number attending: Number of additional tickets:

Registration Totals Registration Fee

Registration Payment Method $

Guest Fee (Includes spouse/children @ $35 each) $

Check (made payable to NJAOPS) Check #: American Express MasterCard Visa

Additional Tickets (Anniversary gala)

Credit Card #:

TOTAL:

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Billing Address: City, State, ZIP: Signature:

Cancellation Policy: Requests for cancellation refunds must be postmarked by March 2, 2011, otherwise an AROC 2012 credit will be issued. Mail or fax completed registration to: AROC • One Distribution Way • Suite 201 • Monmouth Junction, NJ 08852 • (FAX) 732-940-8899 9/2/10

PRESIDENT’S MESSAGE

On the Path to Achieve “Greatness” Lee Ann Van Houten-Sauter, DO

had the pleasure recently of hearing famed college football coach Lou Holtz speak at the 115th Osteopathic Medical Conference and Exhibition, OMED 2010 Unified, in San Francisco. Holtz, known for inspiring his teams to greatness, was an apropos speaker for this event as we try to inspire our colleagues on to new levels of greatness in the profession. One way the AOA is doing this is by setting a new Strategic Plan for 2011–13. As the NJAOPS representative, I was asked to attend seminars that explored the plan, which the AOA calls “The AOA: A GREAT Family of DOs.” GREAT Family, I learned, is a mnemonic for Governance, Research, Education, Advocacy, Teamwork and Family, the six pathways or areas of emphasis that will help the AOA prioritize its activities over the next three years to advance osteopathic medicine. The AOA’s plan for “GREATness” is what allows us — to use DO lingo — to have “structure which drives function” and to have the direction to move our team into the future. The following are some highlights of the plan that are of special interest to NJAOPS members. I invite you to share with me your thoughts about the direction the AOA plans to take in the next three years.

Governance The AOA plans to review the structure of its House of Delegates to ensure that it operates efficiently. The board will also analyze the AOA’s organizational structure. Ethical standards will also be reviewed to address member conduct beyond the physician-patient relationship. This includes conduct in other settings including Stark, insider trading and other business endeavors. All of these issues will involve input from the affiliate organizations.

Research Clinical research is important to the advancement of osteopathic medicine and helps us show its value. The AOA has set aside funding for research to advance osteopathic medicine. Subcommittees have been organized to seek additional funding streams

Gift Card Giveaway Visit Dr. Van Houten-Sauter’s blog to access a link to a quick survey about The Journal and you’ll be entered to win a $100 gift card. Visit www.njosteo.com before Jan. 24, 2011, and click on the link to the President’s Forum to enter. for national and state research initiatives. One goal is to increase participation in the Clinical Assessment Program-Physician Quality Reporting Initiative (CAP-PQRI) to 400 members by February 1, 2011. CAP participating physicians are reimbursed 2% of their Medicare gross billable dollars for reporting patient data and outcomes. It’s so simple too! Just log in the data and collect the check. The information doesn’t even have to be entered by a physician. A staff member can log it for you. There are various assessment models, including diabetes, chronic pain, osteoporosis and coronary artery disease. In the spring of 2011, CAP will add obesity to the mix. Obesity affects onethird of all adults and 17% of adolescents and has become a serious epidemic. Our patients’ diets, exercise regimens and weight loss plans are issues that, regardless of your specialty, affect quality outcomes.

Education The future of osteopathic medicine rests with our students and residents, as well as our board certified physicians. The AOA plans to address the need for more OGME graduates. The AOA will prepare a report detailing which colleges are the leaders in accomplishing this goal. The report will be distributed to the other institutions to help promote best practices. Another goal in this pathway is to provide greater financial aid and debt repayment options for our students. And since education doesn’t end when you finish your residency, the AOA is working on an improved definition of Category 1 CME and ideas for joint CME ventures to pool both speaker resources and financial resources.

Advocacy The Advocacy pathway involves marketing to the public, student grass-root efforts, protecting practice rights and expanding the

global reach of osteopathic medicine by getting a minimum of three new countries to grant full practice rights to DOs by June 2011.

Teamwork With 22 specialty colleges represented at OMED and physicians from all over the country, the teamwork among the branches of the profession is apparent, but there is always room for improvement. One idea is to create a document to better delineate the relationship between the affiliates and the AOA. Another goal is to develop a plan to better educate members about osteopathic continuing certification so DOs can remain compliant with licensure requirements.

Family The final pathway — Family — helps develop the personal and professional relationships in our AOA family. This will be achieved by creating a stronger osteopathic culture within the colleges of osteopathic medicine. This idea needs the support of the deans and student leadership to be a success. Also, mentor programs for students, interns and residents must be enhanced. There must also be a way for osteopathic graduates who have completed an MD residency to re-enter the DO family and be welcomed with more ease than the current system allows. This big undertaking will greatly assist in the reunification of our DO family. And finally, as I’ve been championing during my presidency, we must bring a broader awareness of osteopathic medicine to the public. We can help achieve this by participating in advocacy initiatives such as DO Day on the Hill, town hall meetings and letter-writing campaigns. At OMED, Lou Holtz asked the audience to imagine how effective Martin Luther King would have been if, instead of proclaiming “I have a dream,” he’d said “I have a strategic plan.” So let’s remember to “dream” big so we can provide quality care to our patients and promote our profession to our community and legislators. Please stay informed, participate and be a part of the AOA and NJAOPS team. ■ Lee Ann Van Houten-Sauter, DO, is 2010– 2011 president of NJAOPS. She is a family physician practicing in Williamstown.

THE JOURNAL | Winter 2011

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FROM THE EXECUTIVE DIRECTOR

Remembering a Champion of New Jersey DOs Robert W. Bowen

tephen Papish, DO, was a mountain of a man: large in stature and immovable in his commitment to the osteopathic profession. Dr. Papish was the first NJAOPS president I had the pleasure of working with when I joined the association seven years ago in 2003. I still remember his advice just after arriving at the association and before our first board meeting: “Good luck, you’ll figure it out.” Already dealing with significant health issues at that time, he mentioned them only in passing, and it was through others that I learned the real nature of his condition. Despite this, he regularly participated in meetings with policymakers in Trenton.

At his funeral service on Sept. 26, he was remembered by every speaker for his passion and commitment to his family, faith, profession and patients. An active member of the Morris County Osteopathic Medical Society, he was instrumental in reinvigorating the chapter as well as recruiting other physicians into membership and then grooming them for leadership. Recognizing the essential need to support and build the osteopathic community, he remained active in his county society and as an AOA House delegate, even scheduling his medical treatments around this year’s House meeting in Chicago. As chairman of the Membership Committee in 1994, he expressed his passion for the profession and NJAOPS in a letter we still

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Dr. Papish will be remembered for speaking his mind. As a solo family practitioner in Morris County for most of his career, he was direct and efficient in his communications but always thoughtful and considerate of those with whom he worked. During his NJAOPS presidency we spoke by phone regularly. He was always prepared with a short list of action items so he could quickly wrap up our business and move on to caring for his patients.

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“To continue our success we need you! We need you, the doctor who never joined and thinks it is too late to join our ranks. We need you, the doctor who left us because you did not agree with past officers, past administrators or past policies. We need you, the specialist who thinks NJAOPS is only for the primary care physician. We need you, the primary care physician who thinks NJAOPS is only for the specialist. We need you, the resident just starting your practice. We need you all! There is strength in numbers (and percentages). The governor and legislature listen when they know we represent the majority. If you have never joined, join now. If you left us, join now and let your reason for leaving be known. If you know someone who doesn’t belong, give them an application or our phone number and give us their phone number. Don’t wait to see what’s happening, YOU are what’s happening. You, your practice, your future. Let us hear from you now!”

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use in recruitment. Although written for non-member physicians, it continues to be a powerful reminder to all of us. Below is an excerpt from his original letter:

Dr. Papish always championed the association. He was notorious for asking all of his pharmaceutical reps to participate at AROC. He told them it was important to the profession and it was personally important to him to see AROC thrive. Many did participate. And when one rep who had promised to attend didn’t, Dr. Papish Continued on page 23

THE JOURNAL | Winter 2011

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CAPITAL VIEWS

Election Brings Changes in Health Policy Leaders Laurie A. Clark

ew Jersey voters went against the tide of change that swept over the rest of the nation in the November mid-term elections, returning all but one incumbent representative to Congress. The GOP rode that wave to take over control of the House, with Democrats maintaining control in the Senate. As the election results came in, NJAOPS closely watched two key races whose outcomes directly affected health care policy. In the first, U.S. Rep. Frank Pallone, a Democrat who heads the House Health Subcommittee, managed to retain his seat in the sixth district but will lose his chairmanship, as that position will now go to a Republican. Congressman Pallone will undoubtedly serve as the ranking minority member of the subcommittee and continue to be a strong force for our issues in the new session. On the state level, challenger Linda Greenstein (D-Plainsboro) captured the state Senate seat for the 14th District held by Tom Goodwin (R-Hamilton). Greenstein will likely be appointed to the state Senate Health and Human Services Committee seat held by her predecessor. The results of the November elections will foster an intense political climate for 2011 in Trenton, where new state legislative district maps will be drawn over the next several months. The new map will be completed early in 2011, in time for incumbent legislators to run in the new districts beginning with the June primaries. Once the district maps have been finalized, we will re-adjust our grassroots network. Stay tuned for more information. We need your participation.

Out-of-Network Bill Tabled A bill (A-3378) that looks to put increased regulations on the out-of-network insurance market was tabled by the Financial Institutions and Insurance committee after committee members failed to reach a consensus. The legislation, sponsored by Assemblyman Gary Schaer (D-Passaic), was drafted in response to concerns by

insurance carriers that out-of-network reimbursement rates were unjustifiably high and that patients were being enticed to use out-of-network physicians through the routine waiver of copayments, coinsurance and deductibles. These were cited by insurers as major factors contributing to the high cost of providing health insurance in New Jersey. The current version of the bill seeks radical changes to the current law that pose additional regulatory burdens on already stressed physician practices. For instance, one especially problematic section of the bill requires practices to inform patients at the time an appointment is made whether the services to be provided are out of network. The bill would require that the practice explain to the patient their financial responsibility concerning deductibles, copayments or coinsurance relative to the practitioner’s status as in network or out of network with that particular insurance plan. The bill also requires entities providing selffunded health benefits plans to include links on their websites to information regarding: 1. Quality rankings for health care practitioners, in a manner prescribed by the Department of Banking and Insurance (DOBI), in consultation with the state Board of Medical Examiners (BME), the Division of Consumer Affairs and the Department of Health and Senior Services (DHSS); and 2. Any other information that DOBI determines is appropriate and necessary to ensure that covered persons receive sufficient information needed to make well-informed health care decisions. While the Assembly version of the bill remains in committee, the Senate version (S-2372) has been introduced by state Sen. Joseph Vitale (D-Middlesex) and assigned to the Senate Commerce Committee. We will continue to keep you informed of future developments via our website. Please visit for the latest action alerts.

Deal Reached on Medical Marijuana Governor Christie announced on Dec. 3 that he has come to an agreement on the state’s medical marijuana regulations that will have the program operating by the summer. Last month, the state Assembly rejected the proposed regulations written for the medicinal marijuana law, saying the rules were too restrictive and inconsistent with the law’s intent. In the agreement announced by Govornor Christie’s office, the state will license six centers to grow and dispense medical marijuana to patients with chronic illnesses including glaucoma and seizure disorders.

NJAOPS to Have Voice on Council The proposed state council that will help usher in the changes mandated by the federal health care reform act will include a representative of NJAOPS. The New Jersey Health Care Reform Implementation Council will plan and coordinate the implementation of health care reform. The council will also develop and present policy recommendations to state agencies, policymakers, health care practitioners and insurers. The 25-member council will be made up of 21 members from various state professional associations and organizations, including NJAOPS, the AARP, the NJ Business and Industry Association, the NJ Association of Health Plans, the state AFL-CIO and the Rutgers Center for State Health Policy, among others. The commissioners of DOBI, DHSS and the state departments of Human Services and Children and Families will comprise the other members. The bill (S-2239) establishing the council will now head to the state Senate. The Assembly version is sponsored by Assemblyman Herb Conaway, MD (D-Burlington). ■ Laurie A. Clark is NJAOPS’ government affairs and legislative counsel. She is also president of LegisServe.

THE JOURNAL | Winter 2011

Conventus. The word is spreading Frustrated with commercial insuance companies, a group of New Jersey private practice physicians formed Conventus Inter-Insurance Exchange. Conventus is the only medical professional liability insurance company in NJ that’s 100% owned and 100% governed by its member physicians and managed by insurance experts.

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Putting Physicians First TM

Medical Marketing Simplified

fter all the years spent studying, doing rounds and rotations, weekends and nights on call and finally establishing yourself in your own practice, the idea that you have to still prove your worth by

“selling yourself” to the public is not what many physicians want to hear. But these days with rising costs and reduced compensation, more and more physicians who want to see their practices grow are asking “What can

I do to reach new patients, retain my current ones and grow my practice?” NJAOPS asked these very questions — and others that you wanted to know — to two medical practice marketing experts. Here are their answers.

THE JOURNAL | Winter 2011

Our Expert

Find the Right Marketing Mix

Laura Nozicka, founder and president of Fuzenology, (www.fuzenology.com) a medical marketing firm based outside of Chicago, develops strategic, integrated marketing plans and marketing communications programs for physician practices, medical groups and hospitals. She answered our questions about traditional marketing techniques. NJAOPS: I’m not comfortable “marketing” myself. My father never did it when he was in practice. Why should I? Laura Nozicka: Marketing and sales tend to be very taboo among physicians. There is a stigma that marketing cheapens the profession so many physicians are uncomfortable with the idea of “selling” themselves. Often, the term “marketing” is misconstrued as only “advertising,” which is very costly and only one part of the marketing mix. Marketing a practice means that you are growing your practice through activities that maintain your patient base and bring in new patients. These activities might include providing good customer service, a patient seminar, participating in a screening, talking to other physicians who would be appropriate referral sources or having a pleasant and clean waiting area and exam room. So if you think you’re not marketing, think again… you are! Something as seemingly commonplace as a patient making an appointment is an opportunity for that patient to have a positive experience and spread the word about your practice. Call it “marketing,” call it the “patient experience” or call it “practice promotion.” Regardless, your marketing mix should be a combination of activities — there isn’t one magic bullet. A lot of physicians also have the misconception that insurance contracts will drive their business. I call this the “If I build it, they will come” mentality. A patient’s insurance plan may offer a hundred different physicians to choose from in a 10-mile radius from their home. The patient still has a choice to make. So how are you going to influence patients to choose your practice over all those others? Being on the right plans certainly has its part, but marketing should not be counted out. It is an investment in your practice. NJAOPS: With all my expenses rising, I can’t afford the additional expense of advertising. How do I get the best bang for my buck?

THE JOURNAL | winter 2011

Nozicka: My general philosophy is that advertising — whether in the newspaper, on billboards or on radio and television — is the last strategy to consider in a marketing plan because it is expensive. It can consume an entire promotional budget and will not give you the consistency and traction needed over the course of a 12-month marketing plan. Most offices don’t have marketing plans and marketing gets assigned to the practice manager, who usually doesn’t have expertise in that area nor the time to develop a consistent, effective and measurable plan. Often they turn to advertising because many believe that it’s easy to place an ad to educate the community about what the practice offers. Costly-but-simple is not a formula for success. Neither is cheap-but-ineffective. Physicians need to think of their practices as small businesses, and they need to maximize what dollars they have. There are many promotional activities physicians can do on a small or low budget that when combined have high impact and are effective.

Another key to developing an effective strategy for building your practice is to know where the majority of your business is coming from and how you want that audience to grow. Physicians don’t always know who their patients are. Looking at this data will shed light on your target audience and drive a marketing plan. Ask yourself these questions: ■■

■■

NJAOPS: What kind of gains can I expect from a marketing plan? Nozicka: It really helps to understand what your long-term practice goals are. Everyone would like to see their revenues grow but getting there is in the details. The first thing to do is set reasonable goals that can be measured. Most practices want to increase patient retention, bring in greater numbers of new patients and increase referral rates. Let’s say you’re a busy family physician who is about to add a new physician to the practice. Some realistic, measurable goals may include: ■■ ■■ ■■

Add x number of new patients a month to Dr. Jones’ schedule. Participate in two community events a month for the next six months. Meet two physicians a month who are good referral sources.

Give yourself a timeline to meet your goals so you stay on track with your plan.

■■

Where do your patients live? Having the knowledge that the majority of your patients are coming from only the three or four towns surrounding your office, for example, means that it probably won’t be as valuable for you to do outreach, like participating in a family health day, in the next county over. Same idea with advertising. Why buy an expensive radio ad campaign that reaches people in 150 different zip codes when your patients come from 12? How old are your patients and are you looking to expand a certain age group or demographic? Knowing the age of your patients helps with honing in on the right venues and opportunities in your marketing efforts to attract new patients. For instance, if the majority of your patients are women 35-plus, you should seek out community events that this demographic may attend or give lectures on topics of interest to this group. It also helps your writer develop copy for your practice brochure, direct mail pieces, patient letters and web site. How are your patients referred? Training your office staff to ask new patients how they heard about your practice and tracking the information helps grow your practice by allowing you to follow up with your referral sources. If referrals are being given by friends or family, patients are obviously leaving your practice feeling good about how they were treated by your staff and are happy with the time and level of care you are giving — and they are spreading the word! As for your actual marketing efforts, asking “how

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did you hear about us” also allows you to track your promotional activities to gauge what is and isn’t working. How long do your patients stay with your practice? Knowing how long your patients stay with your practice is key to addressing operational issues that impact the long-term stability and growth of your practice. If a patient’s lifecycle in your practice is short, you have lost out on a longterm relationship as well as future word-of-mouth opportunities. Are your patients scheduling annual exams? Are they keeping follow-up appointments? Knowing how many visits your patients make per year and the kinds of procedures they generate can clue you in to the demographic of your target market.

Knowing your competition helps too. Patients have more access than ever to research about their physicians. Patients having the ability to choose will seek out information about your practice, the practice down the street and beyond. Competition is no longer only local, it’s global, especially for patients searching for a specialist. What makes a patient choose another practice over yours? If you don’t know, find out. You have access to the same information as your patients, so learn about what the other practices in the area are offering. For instance, one family doctor told me recently that most of his colleagues don’t see infants, but that he realized very early that if you don’t, the parents end up sticking with the pediatrician as the baby gets older. So he started seeing infants and continues to see them through their childhood. Other factors to consider: ■■ ■■

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How do your office hours compare to your competitors? Ease and convenience in making appointments (Do you offer same day appointments?) Do other offices communicate electronically? Are the physicians in the competing group more well-known in the community? Does the competing office offer services in the office versus off-site? Are you no longer taking new patients or a particular insurance plan?

NJAOPS: What can I do that will bring in new patients right away?

Nozicka: There isn’t one promotional activity that will work by itself. Everything you do needs to work together over time and be consistent. The first place to start is with marketing collateral, which includes everything from your practice brochure, patient education materials, physician bio, business cards and stationery. Every practice should have a brochure that really explains what they do, their specialties and any special procedures that they perform or other information that would be of interest to your target audience. This is your opportunity to differentiate your practice from your competitors and educate your patients and prospective patients on the unique services you offer. Do you perform Osteopathic Manipulative Therapy for pain management? Perhaps you have a nutritionist on staff who can tailor a weight loss plan for your diabetic patients. Even if your services aren’t different than those of your colleagues, you can still point out features that make your practice attractive, such as easy and ample parking, convenient evening and weekend hours, ability to download patient forms from your website, etc. Display your brochures in your office and give one to all new patients. They can also be handed out at lectures, community days and any other events you attend. Ensure your brochures look professional by having them done by an experienced graphic designer and a professional writer who will make sure there is consistency in your message, colors, style and logo. This same look should be used in your business cards, stationery and patient forms. Don’t be tempted to use a do-it-yourself desktop publishing program. Remember this brochure represents your image to prospective patients. Some other ideas that can help you bring in new patients include: ■■

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Community events. Health screenings, program/event sponsorships, fundraising walks for an illness that is a particular interest of yours or expertise of your practice… all get your name known within the community and promote your practice in venues where you find your target audience. Speaking engagements. Look for opportunities to speak about patient-

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friendly health topics at schools, houses of worship, Chamber of Commerce meetings and the Rotary and other organizations. Hospitals are a great exposure point as well. Develop a presentation and contact your hospital’s marketing department about getting on their calendar of events. Attending a few of the more popular classes will give you a good idea of what attracts patients. Physician directories. Participate in your hospital’s or medical association’s online physician referral directory and keep your practice information up to date

Q: As a specialist, my practice relies on referrals from primary care doctors. How can I broaden my outreach to referring physicians? Nozicka: Referral outreach is an important part of building any practice. Physicians who neglect to take advantage of their professional medical associations and hospital department meetings are missing out on a great opportunity to build relationships. These meetings provide the opportunity to meet with referral sources, shake hands and build business. When a physician refers a patient, you should follow up and send a thank you note. You will want to stay in touch with this referral source on a regular basis so that you stay fresh in his or her mind. Here’s another great idea for staying in touch that helps you gain referrals at the same time. Volunteer to write articles for your professional association. It will establish your expertise, credibility and help you gain new referrals. Then you can send a copy of the published article you’ve written to your referral sources along with a letter or email to maintain an ongoing relationship. Getting to know the physicians who are referring patients to you allows you to reach out to other physicians in similar specialties who are most likely to be potential referral sources. Of course, be sure your office provides excellent service to all those newly referred patients because they most likely will let your referral source know if the service is poor. If they do, you may have lost an important referral source.

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Q: I noticed my patient retention rate is pretty poor. What am I doing wrong? Nozicka: If patients only stay in your practice for a short time, you need to find out the reason. Were they not treated well? Was the practice too far away? Did they wait too long? Did the office seem chaotic? Were they billed incorrectly? Having a patient satisfaction survey can be a great tool for fixing operational issues that may be impacting your ability to hold on to your patients. Many of your operational issues become marketing issues and can make or break a practice. Your expertise is first and foremost the most important service you can offer. However, it’s the customer service or patient experience that patients will remember. When was the last time you went to a restaurant with great food but you waited an hour and a half and the service was less than hospitable? In that case, you aren’t telling your friends and family about the great food—you’re telling them about your poor experience. The same goes for your patients and

their experience and expectations. Most people don’t want to be in a physician’s office, wearing a paper gown with the back open, waiting long periods of time to be poked, prodded or given less than good news. Make their experience the best it can be so that they not only talk about your expertise but the great office experience, too.

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Some other things you can do to help hold on to your patients and keep them coming back on a regular basis: ■■ ■■

Use hold time effectively. When your patient is on hold, what do they hear? Dead silence, canned music, a local radio station? One patient told me that while she was on hold with her physician’s office listening to music piped in from a local radio station, she actually heard a radio ad for competing practice! Services like IntelliSound (www.intellisound.net) or Illinois Audio Productions (www. ilaudio.com) can help you tailor a message that will promote your

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services and procedures. Reminders. Do you send your patients postcards reminding them about upcoming annual checkups? Add reminders for flu shots, vaccinations, screenings and annual checkups and exams. If your office is really savvy and has collected email addresses, try sending reminders and important developments in health news and medicine via e-newsletters using Constant Contact or other electronic service. Follow-up calls. Do you have a system in place to follow up with patients regarding tests that were ordered or new medications that were tried? Handling patient complaints. How your office handles complaints has a huge impact on patient attrition. Does your staff rationalize or get defensive in the face of a complaining patient? Train your staff to calmly listen to patient complaints. Make a serious attempt at fixing whatever the issue is. Take it as an opportunity to learn ways to improve your practice. ■

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Make Your Presence Felt Online Our Expert

Irene S. Doti, senior marketing and training consultant for Practice Builders (www.practicebuilders.com), a health care marketing agency based in California, answers your questions about online marketing, social media and websites. NJAOPS: I am the newest partner in a medical group with two other physicians. I want to convince my partners that a website would be good for business. Help! Irene S. Doti: With statistics showing that a whopping 83% of Internet users — or 61% of all American adults — have looked online for health information1, it’s hard to argue with the fact that a website is an important tool in helping your patients stay connected to your practice. Even more convincing is that in 2008, when the Pew Internet and American Life Project conducted its research, almost half of all Internet users went online specifically to look up information about a doctor or other health care professional. (Read the full Pew Report online at (www.njosteo. com/Journal.) Knowing this, the question becomes who are you going to let represent you online? An insurance company website that lists your name along with scores of other physicians in your area, a generic phone directory website listing, a “rate your doctor” website or your own website that allows you to shine in a way that will both attract new patients and make it more convenient for your current patients to stay with your practice? What’s more, younger patients — those from age 18 to 49 — more frequently turn to online sources when researching a doctor. The Pew study predicts that as younger adults age and face more healthcare issues, they will likely turn to online tools to gather health advice. So the number of Web users who look for medical information online is likely to grow. Taking an online leadership position will help ensure that you get your fair share of the 30 million-plus new patients expected to enter the healthcare system between now and 2019. NJAOPS: I decided to finally put up a website. But I’m not sure where to start. Plus I’m concerned about budget. What does it cost to do something like this and what features should my website have? Doti: A website acts like a shop window to your “business.” It should properly represent your practice capabilities, values, services and brand. A poor website can harm your practice’s reputation, so it’s important that you have a professionally designed and developed website. People often judge a book by its cover. Just as often, they judge a practice by its website. Your website should look attractive and welcoming and be easy to navigate. The look and feel of your website

should be consistent with your practice’s other marketing and communications materials. Website costs can vary widely but remember that old adage that you get what you pay for. A good, well-designed, functional, userfriendly and marketing-based website can cost $5,000 or more. Beware of the many “free” or low-cost template sites being offered by companies who do not understand the unique needs of healthcare practices. Make sure you own your site after it is built. Too many low-cost sites and services have hidden clauses in their agreements. If you don’t host with them or you stop hosting with them, you can lose your site, the content, images and search engine page rankings.

referral sources have to say about your practice. (If they express dissatisfaction, you’ll gain an opportunity to improve your practice. Likewise, when they tout your praises, you can find new ways to give them more of the same great experience.) Remember that social media websites offer a space for you to engage in authentic dialogue. If you treat social media solely as a method for pushing your promotional messages, you will turn off prospects and waste your time. Here are some more dos and don’ts for getting the most out of your social network: ■■

Your website should also be aimed at the right “target audience” — that universe of current and potential patients and referrers your practice wants to work with. The content on your website should be written so that patients will understand and enjoy reading it. There should be information about you, your colleagues and the types of procedures preferred by your practice. Consider adding features that have the potential to make your patients’ lives easier and perhaps even improve your staff’s efficiency. These may include the ability to download forms and consents, update insurance information, contact the office with questions, get lab results and make appointments and payments online.

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NJAOPS: Everyone keeps talking about “social media.” Can this help attract new patients? What are the keys to making it really work for my practice? Doti: As with any marketing you undertake, it’s important to plan what you want to achieve before starting your foray into social media. It pays to invest time into “social media,” which includes sites like Facebook, Twitter, YouTube, LinkedIn and blogs, because these platforms allow you to talk directly to your patients and prospects, answering questions, providing information on disease states and even providing tips for healthy living and lifestyles — all things that can help you build trust and recognition over time. But social media should be only looked at as one tool in your marketing arsenal and it is only as effective as you make it. Social media can also help you: 1. Increase traffic to your website. 2. Get valuable input on what patients/

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Do think about using social media as a way to encourage discussion on the health topics of the day. Short on ideas? Subscribing to a consumer health news website is a great way to come up with new and current topics of discussion. Do link blog posts to your Facebook page to encourage users to comment on your blog and build readers. Do add pictures or video of your staff to your professional account to help generate traffic. Pictures and videos give fans with typically short attention spans more reasons to stay connected to your page and to you. The meteoric rise of YouTube has proven that consumers are powerfully attracted to video and visual media. Do monitor what’s being said about your practice and respond when necessary. Once you allow the public to comment on your blog or Facebook page, you open yourself up to criticism. The best way to approach this is to be honest about the issue rather than combative and try to learn how to improve your practice from what’s being said. As long as you monitor the page, you can always delete negative comments. Don’t build a Facebook page for your medical practice without having a solid website first. It’s important to provide a link back to your main website on all of your social media profiles in order to build credibility and visibility. Don’t respond to personal medical questions on Facebook or any public forum. Doing so could open you up to legal issues and HIPAA violations. Don’t, under any circumstances, post any identifying information about patients online. Clearly, this is a HIPAA violation and a potential lawsuit. Do maintain a separation between

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personal and professional. Don’t “friend” your patients on Facebook. Keep your presence professional. Instead, steer your patients to “like” you on a professional/ business page. Likewise, think twice about having personal friends “like” you on your professional page. If friends who are not patients posted a personal comment on your wall, would you want your patients to see it? Don’t get too personal in the status updates on your professional page. Do you really want your patients to know where you went for dinner last night or that your kids had a great soccer game this weekend? Don’t expect to achieve results overnight. It can take weeks or months to see positive changes in your practice through social media.

negative review?” Patients are more likely to lash out when they are treated poorly by someone in your practice, or ignored, or made to wait too long for an appointment, or any number of other slights, whether real or imagined. Many patients complain about impersonal treatment or excessive waiting times. They don’t feel that they or their time are being valued or respected. A little investigation may reveal whether the complaint was justified, or the patient is merely a difficult personality. Talk to your staff and anyone who treated that patient. Look at other reviews you’ve received. Are they negative or positive? One negative review has far less impact if it is surrounded by accolades, so encourage your long-time patients to go online to praise your practice.

NJAOPS: My patients are always bringing information that they find on websites to their visits. Some of it is just plain wrong! I wish for the days when “doctors knew best.” How can I combat this misinformation?

Another possibility is that the person who wrote bad things about your practice isn’t your patient at all. It could be a competitor trying to gain a competitive advantage, or someone else who stands to gain by giving you a bad review.

Doti: This is a great opportunity to educate your patients about where to find reliable health information online. There are many reputable website that offer peer-written and peer-reviewed medical information, but many patients are either unaware of them or unaware of how to distinguish reliable data from the bad stuff. Unfortunately, with billions of sites available, there’s a good deal more garbage than gold nuggets in cyberspace. Including links on your own website to articles about the disease states and conditions you see most often in your office combats misinformation and helps build a dialogue between you and your patient. Some sites that provide excellent consumer health information include:

To prevent future negative reviews, address any issues that may have led to the first one. Perhaps your staff needs customer service training. Or your practice is scheduling too many patients in too little time. Understand that patients have busy, stressful lives, too. And they want to feel valued and taken care of.

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The American Osteopathic Association’s Health Conditions Library (www. osteopathic.org > About Your Health > Health Conditions Library) The Cleveland Clinic (www. clevelandclinic.org/health) The Mayo Clinic (www.mayoclinic.com) The Pri-Med Patient Education Center (www.patientedu.org)

The extra time you invest in helping your patients find good information will pay huge dividends in trust and your patient relationships. After all, they really want to trust you. NJAOPS: I recently discovered that a patient that I saw only once wrote some bad things about my practice on a review website. How can I get it off or, if I can’t, how do I stop this from happening in the future? Doti: It is difficult to have a negative review removed. So the first question to ask yourself is: “Was the patient justified in writing the

THE JOURNAL | winter 2011

NJAOPS: I have a website, but I don’t know whether anyone is even using it. How can I increase my usage? Doti: The two main conduits to your website from various search engines are search engine optimization (SEO) and pay-per-click (PPC). If you are investing in a website, you owe it to yourself to ensure your return on investment through one or both of these conduits. SEO catalogs your web pages so that your site will appear high on the search engine results page every time a prospective patient makes a query. Search engines like Google, Yahoo, Bing and MSN index billions of Web pages every day to return relevant data to their search patrons. Your website could have structural “walls” and “bumps” you’re unaware of that prevent search engines from finding it at all. Keep in mind that only 8% of search engine users review more than the first three results before clicking on one. If your site gets buried too deep down the results page, you’ll likely remain invisible on the Web. An SEO professional can help make your Internet presence known. Once your website is properly optimized, your practice will benefit from a level of web presence that can generate a steady stream of new patients. For maximum visibility, make your practice accessible from all points of the search engine — whether from the natural search results list

or from Google’s sponsored links. When a potential patient types in a keyword related to your practice, your practice ad will appear right next to the returned list of search results — quite visible as a standalone ad or together with only one or two competitor links. With PPC, you pay only when a user clicks your ad, not every time it is displayed. And you can customize your ad to reflect your practice and branding. You decide how much you want to spend on your ad. You can apply your own fixed spending limit and keep costs to a minimum. You can further ensure the effectiveness of your PPC ad by choosing only certain adwords aimed at your preferred target audience. You can also restrict your ad’s visibility to a 5-, 10-, 25-mile (or more) radius of your practice location. This will narrow “click-throughs” to your specific market area. With PPC, you control when and where you will be visible — yielding the best returns at the lowest costs. Also don’t forget to make sure that your current patients know your website exists by including your URL on all your forms, stationery and other marketing material. Having your front office staff understand the importance of promoting your website is important too. The more user-friendly and useful your site is, the more your patients will return to it over and over. NJAOPS: Does email marketing work for medical practices? Doti: The short answer is yes. Email can be an excellent addition to your strategic marketing mix, if it is written and targeted correctly. You need to understand who you are trying to reach; what message are you trying to convey; what kind of outcome are you hoping for. Email can be an excellent tool for staying in touch with patients and referral sources, educating patients or promoting any new services you have to offer. If you routinely collect patient email addresses, you’re already ahead of the game. If not, now is a good time to start. You can also purchase opt-in email addresses. You can learn more about this by visiting www.infoUSA.com or www.USdatacorporation.com. If you have never done email marketing before, spend some time researching the medium. Learn how to avoid spam filters and write subject lines that will encourage people to open and read your emails. Constant Contact is a well-known company with an excellent reputation. Another good resource is: www.icontact.com. ■ 1. The Social Life of Health Information. Jun

11, 2009 by Susannah Fox, Sydney Jones. Pew Internet and American Life Project. Accessed online on Nov. 9, 2010.

MANAGING liability

Promoting Your Practice? You Are Covered Timothy L. Hoover, CPCU

o you’ve decided to grow and expand your practice. Congratulations! Maybe you’re adding a new physician, another location or new diagnostic or elective procedures to your current list of services. Whatever the case may be, you’ll probably want to get the word out to prospective patients. There are many creative ways to promote your practice. But before you place that first ad or print that first brochure, it’s wise to know where the risks are and what claims you are covered for as you build your promotional campaign. Almost every commercial liability policy includes coverage for “personal and advertising injury.” The coverage is included at no added cost and can provide protection for a variety of acts above and beyond typical general liability or physical damage claims. But as with all insurance, specific coverage varies, not every exposure is covered and not all polices are alike. So

to be advertising regardless of audience size. So be sure to have every marketing communication and publication reviewed by legal counsel for potential problems.

Where Trouble May Arise One of the areas where a physician may run into advertising trouble is when a competitor claims that an advertisement (or any act, publication or comment that you or your staff has made) has damaged their business. This is called an “advertising injury” and rises from a perceived offense that occurred during the course of your advertising activities. Advertising injuries can include libel, slander, defamation, violation of privacy rights, piracy, unfair competition or infringement of copyright, title or slogan. For example, you run an ad with a statement such as “Our open MRI provides better results than traditional scans.” This could present a problem if there is

Almost every commercial liability policy includes coverage for “personal and advertising injury.” be sure to review your own policy or ask your adviser if you are covered. Here’s an overview that may help you determine what you have and what more you may need.

What Constitutes Advertising? Most commercial general liability policies define advertising as “a notice that is broadcast or published to the general public or specific market segment about your goods, products or services for the purpose of attracting customers or supporters.” So while it’s pretty clear that an ad placed in your local newspaper is considered “advertising” under your policy, often not as clear is whether brochures, websites and other marketing activities are covered as advertising. Various courts have come up with different definitions for “advertising.” Certainly, in the Internet age most advertising is not geographically limited with some courts requiring the advertising activity in question to be wide-ranging communication to a broad audience while other courts define the simple act of business promotion

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a traditional scanning center nearby. The competitor may sue your business for false statements or defamation. Or let’s say your slogan or logo is suspiciously similar to that of a large corporation’s. They might claim copyright infringement. Your business commercial policy would provide a defense and indemnity for these kinds of claims provided they don’t fall under one of the typical exclusions, such as: ■■

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Knowingly publishing false information. Claims resulting from false or misleading information that are unintentional are covered. Knowingly violating the rights of another. Coverage will be excluded if you, for instance, publish details about a patient’s medical condition without their permission. Criminal acts, such as copyright and trademark infringement or other criminal acts. If you are using the trademark or name of a specific

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medical product or device, be sure you have the legal right to do so. Breach of contract and contractual liability. Your business cannot assume the advertising liability of others by contract and be covered. Let’s say your practice agrees to market a medical or dietary product, and you sign a holdharmless agreement with the distributor as part of the deal, any pass-through liability arising as a result of the agreement is not covered. Price, quality and performance. Damages incurred because of a wrong price, quality or performance claims are not covered. If you advertise that a procedure is covered by medical insurance and it is not, the resulting damages are not covered.

One common exclusion pertaining to “professional advice or service” has particular importance to medical practices. If you advertise the health benefits of a procedure or service, this could be considered professional advice and may not be covered. What’s more, unless the resulting damage was to your patient, your medical liability policy may not cover the claim either. So avoid giving out specific medical or diagnostic information, especially when posting comments on social media sites, blogs and other websites. If your practice has its own website, coverage generally extends to the promotional material on the site with some important exceptions. Most policies exclude coverage for electronic forums, such as blogs and other social media sites, or bulletin boards hosted by the insured. Policies also now often exclude claims related to mass email marketing. If you have a significant exposure in this area you may need to arrange for separate insurance coverage. Talk to your insurance professional to see what’s right for you. ■ Timothy L. Hoover, CPCU, is the Healthcare Practice Leader with the Woodland Group. He can be contacted at tim_hoover@ woodlandgroup.com or 973-300-4216.

THE JOURNAL | Winter 2011

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Legal Perspectives

Court Sides with Physicians in PIP Fight Mark E. Manigan, Esq.

ew Jersey physicians gained a measure of protection from overly invasive requests for confidential business information during insurance company investigations, thanks to a recent ruling by the state appeals court. The ruling forbids insurance carriers from asking physicians involved in personal injury protection (PIP) arbitration to produce documentation beyond what is expressly allowed by law. This latest ruling overturns a lower court decision that would have allowed automobile insurer Selective Insurance Company, which provides PIP benefits in its policies, to gather documentation from several health care professionals who Selective alleged might have been violating state laws against self-referrals and kickbacks. Under Selective’s agreement with the physicians, the participating doctors would directly bill Selective for these patients, and

1. Ownership of the defendant facilities; 2. Compliance with the Department of Health and Senior Services and Board of Medical Examiners regulations requiring disclosure of the facility’s medical director; 3. Identities and credentials of persons performing services at the facilities, including employees and independent contractors; and 4. Identities of any companies providing billing or management services to the defendants. Selective asserted that all of this information was necessary to determine whether the defendants complied with the Codey law. When the defendants refused to provide the information, Selective filed an action to force them to do so. Selective also filed an Order to Show Cause, claiming they were entitled to the documents under the cooperation clause of Selective’s insurance policy and pursuant to the discovery provision of the PIP statute.

The ruling forbids insurance carriers from asking physicians involved in personal injury protection arbitration to produce documentation beyond what is expressly allowed by law. Selective would reimburse the providers based on those bills. If the parties could not agree on the amounts billed, they would proceed to PIP arbitration. After reviewing the submitted bills, Selective alleged that they discovered common ownership and intertwined management among several of the health care facilities, adding that they observed a “systematic pattern of treatment” of the insured patients at the facilities. According to Selective, this raised questions about the relationship between the health care professionals and pointed to possible violations of the Codey Law, which prohibits self-referrals. Selective claimed these suspicions prompted them to seek extensive discovery materials to investigate, including documents related to:

The trial court judge ordered the defendants to comply with Selective’s discovery requests, and the defendants appealed, arguing that the trial court erroneously expanded the reach of the PIP statute. The Appellate Division of the state Superior Court reversed the trial court’s decision, focusing on the language of the PIP statute, which requires a physician to furnish a “written report of the history, condition, treatment, dates and cost of such treatment of the injured person.”1 The court found that nothing in the statute provided for the disclosure of the broad range of materials sought by Selective and barred the carrier from requesting “corporate charters, partnership agreements, annual reports, shareholder agreements and lease agreements.” Further, the ruling said that none

of the requested documents related to the “history, condition, treatment and dates and costs of such treatment of the injured person” as required by the PIP statute. As a result, the court ruled that Selective’s discovery request fell far outside the scope of the PIP statute.

Insurer’s Argument Rejected Selective argued that it was entitled to the requested documents under various laws requiring that insurance carriers investigate alleged fraud. In the face of New Jersey’s strong public policy to deter insurance fraud, the court ruled that none of the rules presented by Selective gave them the authorization to force the physicians to produce the documents they had asked for. Further, Selective’s complaint failed to allege a violation of the Codey Law, Insurance Fraud Protection Act or any other statute or regulation, under which its demands would have been substantiated. Therefore, the court refused to allow Selective to proceed with its request for documents. The court was also not convinced by Selective’s argument that the insurance agreement’s “cooperation clause” required the physicians to produce the requested documents. The court held that this clause was binding on the insured patients, but was not binding on the physicians. The Appellate Division concluded that Selective failed to offer a solid legal argument in support of its discovery demands, and as a result, Selective was not entitled to the materials it sought. The court’s decision will certainly provide support to all New Jersey physicians in their future PIP dealings with insurance carriers. Hopefully, this decision will also act as a deterrent and prevent insurance carriers from making outlandish discovery requests during PIP arbitration proceedings. ■ Mark Manigan is a member of Brach Eichler LLC’s Health Law Practice Group. Brach Eichler L.L.C. serves as NJAOPS’ general counsel. He was assisted in the writing of this article by Lauren Fuhrman, an associate of Brach Eichler LLC’s Health Law Practice Group. They can be reached at 972-228-5700. 1. NJSA 39:6A-13(b).

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Let Brach Eichler’s Health Law Practice Group Help you Chart a Strategic Course For Your Health Care Business Health care providers have long come to rely on the attorneys of Brach Eichler to navigate the regulatory environment at both the state and federal levels. Now that health care reform is being implemented, Brach Eichler is ready to help you make sense of the significant changes, the statutory framework and the ramifications for health care providers in New Jersey.

Health Law Practice Group Todd C. Brower Lani M. Dornfeld

John D. Fanburg Joseph M. Gorrell

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The Professional Practice

Practices Facing New Billing Challenges Deborah R. Mathis, CPA, CHBC Michael S. Lewis, MBA, FACMPE

s if the business of medicine didn’t already present enough challenges for practices, the advent of high deductible health plans and rapidly increasing insurance copayments has created another layer of difficulties for billing. High deductible health plans (HDHP) have gained popularity in the past few years as employers have looked for ways to reduce the cost of employee benefits. Participation with a qualified HDHP is also a requirement for Health Savings Accounts, Health Reimbursement Accounts and other tax advantaged options. We are also seeing a significant increase in the copayment levels that are part of insurance contracts. Copayments of $40

to $60 are now common. In some cases, the copayment is actually higher than the allowance by the insurance company for the service that was rendered. Both of these trends have put an additional burden on front desk staff and billing personnel to collect funds as early as possible in the process to avoid impacting the cash flow of the practice. The introduction of health maintenance organizations (HMOs) and preferred provider organizations (PPOs) in the 1970s initiated the concept of copayments for medical services. Previously, in most cases, patient responsibility was in the form of coinsurance, a percentage of the

allowable amount as determined by the insurance company. Initially copayments were low — in some cases even zero. Over the past thirty years, we have seen a gradual increase to the level that they are at today. Physicians haven’t seen an increase in reimbursement as a result of higher copayments, rather insurance companies now pay less. The following example illustrates how this works. Insurance Company XYZ allows $52 for a 99213, a level three follow-up visit for an established patient. If the patient has a $10 copayment for their plan, the patient will pay $10 and Insurance Company XYZ will pay $42. If the patient has a $50 copayment for their plan, the patient will pay $50 and Insurance Company XYZ will pay $2.

The Cost of Collecting Payments Failure to collect copayments at the time of service not only delays cash flow but also adds expense to the practice. Industry estimates show that each bill you send to a patient costs you $7.50. This includes the cost of the bill, postage and staff time. We strongly suggest that patients be asked to pay their copayment prior to the time they see their physician. We know of practices that refuse to see patients in non-emergent cases when the patient is unwilling to pay their copayment. Front desk staffs have heard every possible excuse as to why paying the copayment isn’t possible. We suggest that practices make it as easy as possible for patients to pay in the office — which means accepting both credit and debit cards. There are many new credit card processing companies offering medical practices low pricing for accepting credit and debit payments. Many practices have begun to charge patients a “billing fee” of $10 to $20 if they fail to make their copayment at the time of service. Patients with high deductible health plans present another challenge. For calendar year 2010, the minimum deductible is $1,200 for single coverage with an out-ofpocket maximum of $5,950. To accelerate cash flow, we recommend that practices Continued on page 23

THE JOURNAL | Winter 2011

In Memorium Stephen G. Papish, DO Former NJAOPS President Stephen G. Papish, DO, FACOFP, a private practice family physician in Parsippany for 35 years and outspoken advocate for the osteopathic profession, died Sept. 22 at St. Claire’s Hospital in Denville, NJ. He was 65. A graduate of New York University, Dr. Papish received his DO from the College of Osteopathic Medicine at Des Moines University and completed an internship at Metropolitan General Hospital in Philadelphia. He served in the U.S. Navy from 1971 to 1973, as Battalion Surgeon in Gerald I. Ringold, DO Gerald I. Ringold, DO, a Willingboro family physician who for many years served as the Willingboro police and high school doctor and Burlington County deputy medical examiner, died Oct. 6th at Samaritan Hospice in Mount Holly. He was 77. Dr. Ringold was a Life Member of NJAOPS with 51 years of faithful service

Hawaii and General Medical Officer in Thailand. A member of NJAOPS since 1971, Dr. Papish served on the NJAOPS Board of Directors from 1991 to 2005, including a one-year term as President from 2003 to 2004. Named the 2007 NJAOPS Physician of the Year, he was also a member NJAOPS’ delegation to the AOA House of Delegates, a position he held since 1993. Dr. Papish was an active member of the Morris County Osteopathic Society and was instrumental in reorganizing the county society to begin holding regular membership and educational programs. to the osteopathic profession. A graduate of Woodrow Wilson High School in Camden, Dr. Ringold completed his undergraduate degree at Rutgers University in 1954. A member of the Philadelphia College of Osteopathic Medicine Class of 1958, he completed his post graduate training at Metropolitan Hospital in Philadelphia. During his career, Dr. Ringold served as chairman of the Department of Family Practice at Lourdes Medical Center of Burlington

Dr. Papish served as President of the Medical Staff and Vice Chairman of the Board of Trustees at Saint Claire’s Hospital. For nearly two decades, he trained the next generation of physicians as an Adjunct Clinical Professor of Family Practice at New York College of Osteopathic Medicine. Dr. Papish is survived by his wife Lori; his mother Marian; three sons, Barry, Marc and Adam; two brothers, Edward and David, and a grandson, Matthew. Memorial donations may be made to The American Heart Association, the National Kidney Foundation or the New Jersey Osteopathic Education Foundation. County, as well as president of the medical staff. He was a Past President of the Burlington County Society of Osteopathic Physicians & Surgeons. Dr. Ringold is survived by his wife Dolores, son Michael, daughter Melissa Zapata and four grandchildren. Contributions may be made in honor of Dr. Ringold to the South Jersey Breast Cancer Coalition, Samaritan Hospice or the New Jersey Osteopathic Education Foundation.

MEMBER NEWS Member News Please join us in congratulating the following NJAOPS members on their well-deserved honors and achievements. NJAOPS congratulates the following osteopathic physicians and surgeons who were named “Top Doctors” by New Jersey Monthly magazine. The peer-nominated and reviewed list included:

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Christopher Freer, DO Emergency Medicine

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Jose Flores, DO Family Medicine

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Claudia A. Komer, DO Anesthesiology & Pain Management

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Leonard Goldsmith, DO Neonatal-Perinatal

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David Conyack, DO Anesthesiology & Pain Management

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Michael A. Schalet, DO Gastroenterology

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Dean P. Boorujy, DO Family Medicine

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Michael Gartner, DO, FACS Surgery: Plastic & Reconstructive

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Michael G. Giuliano, DO Family Medicine

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Domenic Mariano, DO Cardiovascular Disease

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Michele Nitti, DO Family Medicine

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Michael Guma, DO Rheumatology

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Dwayne Siu, DO Cardiac Electrophysiology

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Nicholas A. Bertha, DO Surgery Bariatric

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Ronald J. Librizzi, DO Maternal & Fetal Medicine

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Emery Fisher, DO Pediatrics: Anesthesiology

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Robert D. Zenenberg, DO Nephrology

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Ira P. Monka, DO Family Medicine

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Emily Bahler, DO Geriatric Care

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Robert L. Sweeney, DO Emergency Medicine

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Leonard J. Moss, DO, FACC, FACP Cardiovascular Disease

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Eric R. Cohen, DO Neurology

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Thomas E. Hackett, DO Gynecologic Oncology

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Carl Postighone, DO Internal Medicine

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John Villa, DO Pulmonary Disease

THE JOURNAL | winter 2011

MEMBER NEWS David Abend, DO, a family physician with a practice in Oradell, has been appointed to head a new Osteopathic Manipulative Medicine Clinic at St. Michael’s Medical Center, Newark. Dr. Abend will supervise family practice, emergency room and surgical residents in the application of OMT in regard to all phases of outpatient medicine treatment. Dr. Abend is board certified in Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine and in Family Practice and Osteopathic Manipulative Medicine.

Afshan Mohsin Khan, DO Intern, Family Medicine, Jersey City

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Jim Nguyen, DO Resident, Family Medicine, Jersey City

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Hetal Patel, DO Intern, Family Medicine, Jersey City

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Naishami Patel, DO Resident, Family Medicine, Jersey City

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Ellen Wang, DO Intern, Internal Medicine, Stratford

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Elena Pappas, DO Family Practice, Toms River

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Marina Weinstein, DO Intern, Stratford

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Abraham Chacko, DO Intern, Internal Medicine, Stratford

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Mark Condolucci, DO Intern, Internal Medicine, Stratford

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Joseph Dombroski, DO Intern, EM/IM, Stratford

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Alan Ghaly, DO Resident, Internal Medicine, Stratford

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Melanie Howell, DO Intern, Pain Management & Rehab, Jersey City

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Lori Kopperman, DO Intern, Family Medicine, Stratford

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Neha Kumar, DO Intern, Jersey City Ashley McBrearty-Hindson, DO Intern, Internal Medicine, Stratford

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Michael Cantor, DO Intern, Pain Management & Rehab, Jersey City

Astrid Figueroa, DO Intern, Internal Medicine, Stratford

Yancy Van Patten, DO Resident, Family Practice, Jersey City

UMDNJ-SOM Student Membership

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Jessica Douyard, DO Intern, Jersey City

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Amanda Valvano, DO Resident, Internal Medicine, Stratford

Manjushree Matadial, DO EM/IM, Paterson

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Mirza Baig, DO Intern, Family Medicine, Jersey City

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Javier Talamo, DO Intern, Stratford

Ralph Cifaldi, DO OB/GYN, Ridgewood

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Active Membership

Intern, Resident and Fellow Membership

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New Members

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Frank Savage, DO Intern, Internal Medicine, Stratford

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NJAOPS is pleased to welcome the following physicians into new membership this month.

Nitin Putchu, DO Intern, Pain Management & Rehab, Jersey City

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Osman Abbasi Jesse Abesh Bruce Abramowitz Bharat Allam Shawn Amin Joseph Asaro Diana Bacal Justin Berkowitz Stefani Birnhak Sundeep Bojedla Paul Boulos P. Benedict Brown John Campbell Amanda Cardella Stephanie Chapin Raymond Chen Katherine Chiapaikeo Chung Chiu Jules Chyten-Brennan Jalal Damani Mark Darokci Shreemayee De Lissa Diaz Andrea DiMaio Amy Dooley Ashley D’Orazio Dmitry Esterov Carly Fabrizio Kiera Farry Svetlana Fleyshmakher Shivani Gandhi Bill Gartlan

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Eilliot Gauer Robert Gesumaria Maria Geyman Paul Girardi Erica Gomez Marcus Greco C. Eric Gullbrand Joseph Hanna Brittany Herits Ji-Sun Hong Patricia Hughes Andrew Isleib Jumana Jaloudi Nosheen Jawaid Megan Jimenez Karen Johnson Jason Kim Kourtney Krohn Jirayu Kukiratirat Percy LeBlanc Kyley Leroy Amanda Lezanski-Gujda Carol Li Annie Lin Meredith Linder Rich Lopez Danielle Macina Mary Mannix Michael Matrale Jacob Melnick Kiran Mian Jeffrey Mojica Katherine Mollo Belinda Montoya Jason Mora Peter Murphy Dhaval Naik Yrene Naling Murtaza Naqvi Jillian Norton Kimberly Owens Ani Pahlawanian Michael Paiva Gary Panagiotakis Katie Parisio Arpan Patel Dolly Patel Komal Patel Mitul Patel Priya Patel Roshni Patel Laura Patitucci Barry Perlman Harla Pfeiffer Mara Piltin Arlene Pineda Rebecca Rothstein Ramy Saleh Michael Savakese

Continued on page 23

THE JOURNAL | Winter 2011

MEMBER NEWS Continued from page 22

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Eli Scher Alyssa Schlatmann Amy Schmelzer Matthew Schwartz Justin Sciancalepore Marc Sciarra Jonathan Sedeyn Isata Sesay Victoria Shadiack Anand Shah Mahima Shah Satvik Shah Sayar Shah Sweta Shah Shakil Shaikh Pamela Sheridan Quidest Sheriff Sarah Snyder

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Sara Soliman Sabrina Solorzano Jasen Sood Asher Stein Ryan Stephenson Scott Steven Michele Style Fadwa Sumrein Reem Taha David Temmermand Maria Tempera William Tenpenny Hanna Tesfaye Justin Torres Perihan Ulema Sonya Vankawala Saurabh Varma Viliane Vilcant Sophia Vogiatzidakis Parth Vyas

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Raswana Wahdat Ingrid Walfish Ashley Wallis Amy Wang Beth Warren Kari Whitesell Naomi Will Chuck Wisniewski Mena Yacoub Susan Yoon Ning Yueh Mariam Zakhary

Student Membership ■■

Hassan Kidwai Touro College of Osteopathic Medicine, New York, NY

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Corey Lanzet New York College of Osteopathic Medicine

The Professional Practice Continued from page 20 determine the deductible status of patients with a HDHP as of the day that they are seen. The patient should be asked to pay for any services that would be applied to the deductible. This avoids the practice of having to wait for the insurance company to respond to the claim, finding out that the service was applied to the deductible and then billing the patient.

Create a Policy to Address Billing Both of the scenarios above should be addressed in your practice’s financial policy. We recommend that every medical practice have a financial policy that outlines the patient’s financial obligations. The policy should be presented to every new patient and it

should be a requirement that the patient sign and agree to the terms. Your financial policy should include the following terms: 1. Requirement of copayments to be paid at time of service. 2. Payment requirements for patients with no insurance. 3. Type of payments accepted in the practice — cash, check, credit and debit cards. 4. Fees that will be charged for returned checks. 5. Submission of claims to insurance carriers is done as a courtesy to patients, but ultimate financial responsibility resides with the patients. The financial policy should outline the insurance companies with which the

practice participates. 6. Availability of payment plans for patients who cannot afford to make payment in full. 7. Obligations of patients with respect to referrals and pre-certifications. Practices can tailor their financial policy to their specific needs and requirements. A detailed financial policy will be of significant benefit to practices as they face new challenges in collecting balances from patients. ■ Deborah R. Mathis, CPA, CHBC, is Shareholder-in-Charge, Healthcare Services Group for Cowan, Gunteski & Co, and Michael S. Lewis, MBA, FACMPE, is Shareholder/Director, Healthcare Services Group for Cowan, Gunteski & Co. They can be reached at (732) 349-6880.

FROM THE EXECUTIVE DIRECTOR continued from page 6 banned every rep from that company from his office for months. His actions were reported to the highest levels of the company, and AROC participation was renewed the following year. NJAOPS always recommends that physicians maintain professional relationships that

THE JOURNAL | winter 2011

enhance patient care, but we were also grateful to have such an impassioned advocate that recognized the value of his relationships. Dr. Papish was one of those “I-wish-I-hada-hundred-more-like-him” members, the embodiment of an osteopathic physician who was proud to be part of the profession

and wove NJAOPS into his practice. His contribution was not a single highlight but a consistent, career-long commitment. He will be missed, but his legacy will live on through those he mentored and those inspired by his example. ■ Robert W. Bowen is the executive director of NJAOPS.

medical ethics

Ethics is Fundamental in Medicine Joseph C. d’Oronzio, PhD, MPH One of the initiatives proposed by NJAOPS President Lee Ann Van Houten-Sauter, DO is to utilize The Journal to highlight articles on medical ethics. The following is a reprint of an article originally published by the Center for Personalized Education for Physicians. Physicians who are interested in authoring a piece on Medical Ethics for The Journal should contact Communications Director Bonnie Smolen at bsmolen@njosteo.com.

nprofessional conduct” is the second most frequently cited basis for physician discipline by medical licensing boards. According to the Federation of State Medical Boards, this has been the case for the past decade. It is a fact that must cause consternation in both the house of medicine and in the regulatory agencies. With such a long menu of possible infractions and actionable behaviors, what accounts for the consistent occurrence of deficient professionalism? The short answer is that every medical act — “good” or “bad” — reflects on the professional ethic of the doctor. Indeed, a well-established tradition in medical ethics contends that medicine is intrinsically a moral profession. Every application of all the science, technology and technique that we view as modern

medicine is to be evaluated by how it serves the fundamental moral goals of medicine — to do good for the patient. Virtually any deviation from medical standards is therefore, in this sense, unprofessional conduct. Still, it is often difficult to identify and analyze the substantive elements of the medical ethic. Should we focus on the virtues of the “good doctor”? Or had we better ask what are the behaviors of the professional that determine his conformance with medical ethics? This distinction between “virtues” (how this doctor should be) and “behaviors” (what this doctor should do) is important because they represent two ways to look at ethics. Roughly speaking, the older tradition of medical professionalism has depended upon

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the doctor’s character, or virtues, to guide her ethics. This is derived from the qualities of the gods who had knowledge, wisdom, truth, justice and beauty that were enshrined in the classical tradition of oaths, and in the modern publication of professional codes of ethics. The inheritors of this tradition is organized medicine, the professional societies, colleges and certifying boards, all of whom devote themselves to setting, teaching and testing the standards of professional ethics. A more recent tradition of ethics focuses on the actions of doctors as the measure of their professional ethic. Here, the physician’s character, training and vows matter less than his conduct. The individual’s virtues — upbringing, demeanor, moral precept and indeed technical skill — matter less than the concrete consequences of specific behaviors. Actions, not the mere assertion of virtues, determine whether the moral mission of the profession is fulfilled. This tradition finds expression in the practice of accountability and the protection of the public health, such as is found in the work of licensing boards and the state Medical Practice Acts they administer and apply. The facile historical truth is that the failure of the professions to self-regulate has generated the need for public regulation of the professions. A deeper conceptual truth is that both the house of medicine and the medical board community can agree on the primacy of maintaining professional ethics as the baseline of their respective activities. Physicians who reach the level of medical board discipline generally satisfy both of these conceptions of ethical violations — lack of virtue and overt harmful behavior — well described as “unprofessional conduct.” ■ Joseph C. d’Oronzio, PhD, MPH, who is the Program Director of The ProBE Program (CPEP, the Center for Personalized Education for Physicians), recently retired as Associate Clinical Professor at the Mailman School of Public Health, Columbia University. Reprinted with permission. Retrieved from http://www.cpepdoc.org/documents/ EthicsinMedicine8.05.pdf.

THE JOURNAL | Winter 2011

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