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JULY 2013 2012 APRIL

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Richard A. Rosa, MD and Jason P. Garcia, MD Advanced Orthopaedic and Joint Replacement Pioneering the Latest Technology to Keep Patients on the Move Also In This Issue: Pending New Jersey Legislation Addresses Lack of Health Insurance NJ-HITEC: The Benefits of a Patient Portal In Acquiring Share of AmeriHealth, Cooper Crosses Hospital-Insurer Divide Obama Administration Plans to Cut Medicare Advantage Reimbursements


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Publisher’s Letter Dear Readers, Welcome to the April edition of New Jersey Physician, and for those of you reading this at the MGMA conference, welcome to the conference as well. I’m sure you will come away from this meeting with much to think about in the management of your practice. Medicare seems to be the big word, these past two weeks. Just about everyone has taken a hit in order to have our federal government reach a compromise solution to a budget. Medicare Advantage plans, which are services administered by private for-profit or non- profit providers that offer additional services beyond traditional Medicare, will be receiving a planned reduction in the reimbursement rates the government pays. CMS announced the surprised rate cuts of 2.3 percent, meaning it would pay health care providers 2.3 percent less for providing services to patients. Additionally, the new federal budget calls for charging wealthy Medicare beneficiaries more for physician and prescription drug coverage. The spending framework also raises costs for people who join Medicare in 2017 or later for some services and levies surcharges on beneficiaries who buy comprehensive health insurance plans to supplement their Medicare coverage. Finally, as of April 1 of this year, healthcare providers will suffer a two percent reduction across the board in their Medicare payments. This reduction is far reaching and will have impact on all providers under Medicare Part A, B, C and D. There will also be an impact on incentive payments for meaningful use of electronic health records. Hospitals and insurers have traditionally been adversaries in payment negotiations, but that line could soon be blurred in South Jersey where Cooper University Health Care is purchasing 20 percent of AmeriHealth New Jersey. According to some, it’s not just a question of blurring a line, it’s a matter of crossing one. The agreement requires the approval of state regulators and could raise concerns about violating antitrust laws.

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Co-Publisher and Managing Editors Iris and Michael Goldberg Contributing Writers Iris Goldberg Michael Goldberg Samuel C. Berger Vanessa Torres Andrew Kitchenman Melinda Caliendo Matt Cover Mark Manigan Keith J. Roberts John D. Fanburg Carol Grelecki Joseph M. Gorrell Rachel Landen Associated Press Layout and Design Nick Justus

New Jersey Physician is published monthly by Montdor Medical Media, LLC., PO Box 257 Livingston NJ 07039 Tel: 973.994.0068 F ax: 973.994.2063 For Information on Advertising in New Jersey Physician, please contact Iris Goldberg at

Many of us will suffer joint or musculoskeletal injuries in our lives, whether it is the young athlete, the weekend warrior or a senior citizen. When this happens we try to receive the most effective treatment possible to return to a normal, active life. Richard R. Rosa, MD and Jason P. Garcia, MD of Advanced Orthopaedic and Joint Replacement Center are frequently called in, offering comprehensive care and highly-individualized treatment options. Dr. Rosa, who was fellowship-trained at the Hospital for Special Surgery,specializes in joint replacement and treating sports injuries. Dr. Garcia, received fellowship training in sports medicine and arthroscopic surgery and concentrates on repair and reconstruction of shoulders and knees as well as shoulder replacement. When the moment comes that puts you or a patient in a situation requiring orthopaedic care, we highly recommend this group to help get you moving again.

973.994.0068 or at igoldberg@NJPhysician.org Send Press Releases and all other information related to this publication to igoldberg@NJPhysician.org Although every precaution is taken to ensure accuracy of published materials, New Jersey Physician cannot be held responsible for opinions expressed or facts supplied by its authors. All rights reserved, Reproduction in whole or in part without written permission is prohibited. No part of this publication may be reproduced or transmitted in any form or by any means without the written permission from Montdor Medical Media. Copyright 2010.

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Contents

Richard A. Rosa, MD and Jason P. Garcia, MD

Advanced Orthopaedic and Joint Replacement Center

4

Pioneering the Latest Technology to Keep Patients on the Move CONTENTS

9 10 12 15 19 21 24 2 New Jersey Physician

STATEHOUSE NJ HITEC NEW JERSEY HEALTH NEWS FEDERAL HEALTHCARE NEWS HEALTH LAW UPDATE BITS AND PIECES FOOD FOR THOUGHT


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Cover Story

Richard A. Rosa, MD and Jason P. Garcia, MD Advanced Orthopaedic and Joint Replacement Center Pioneering the Latest Technology to Keep Patients on the Move

photography by Michael Goldberg

By Iris Goldberg Whether it’s the young athlete, the middle-aged “weekend warrior” or the senior citizen, people at every stage of life can fall victim to joint and musculoskeletal disorders. When this happens the quality of life can be significantly compromised and the goal is to get the most effective treatment available in order to resume normal activities as soon as possible. For patients of all ages in and around Essex County, Advanced Orthopaedic and Joint Replacement Center (AOC), located in West Orange, offers comprehensive care and highlyindividualized treatment options for the entire gamut of orthopaedic conditions, including but not limited to:

ligaments, for example, is particularly gratifying for him because he has been involved in sports throughout his life. Dr. Rosa received his undergraduate education on a full track scholarship, where he was co-captain of the track team and has participated in athletics ever since. “I’m an avid sports fan and sports enthusiast and over the years I’ve been on the sidelines for multiple teams – football and lacrosse, for example,” he continues. In fact, presently, Dr. Rosa is the team physician for the Georgetown University rugby team, traveling down on weekends during the spring and fall.

• General orthopaedics • Sports-related injuries

experienced hip and knee surgeons to share research and discuss the latest advancements in hip and knee replacements. Also, there is a strong focus on what the trends will be going forward. Dr. Rosa has also had a major involvement in the development and design of knee and hip replacement systems. He has actively participated with some of the companies that manufacture the prostheses which are implanted. He was the primary designing surgeon for a major unicompartmental partial knee replacement system, a minimally invasive alternative to total knee replacement surgery for appropriate patients and he continues to act as a consultant for partial and total knee replacement systems. Joining Dr. Rosa in practice in 2007, Jason P. Garcia, MD was born and raised in New Jersey, receiving his medical degree and completing a residency in orthopaedic surgery at UMDNJ-New Jersey Medical School. He then attended the University of California, San Diego, where he completed fellowship training in sports medicine & arthroscopic surgery. During that time, Dr. Garcia participated in the care of the San Diego Padres baseball team as well as Division I college teams.

• Running problems • Arthritis management • Arthroscopic knee surgery • Arthroscopic shoulder surgery • Total knee replacement surgery • Total hip replacement surgery • Unicompartmental partial knee replacement surgery • Total shoulder replacement surgery • Rotator cuff treatment Richard A. Rosa, MD, with nearly three decades of practical experience, received his fellowship training at the Hospital for Special Surgery in New York, where he specialized in joint replacement. Dr. Rosa’s expertise in joint replacement includes knees, hips and shoulders. “Half of my practice is joint replacement and half is sports injuries and other orthopaedic problems,” Dr. Rosa shares. He goes on to explain that treating sports injuries, most commonly performing arthroscopic shoulder and knee surgeries to repair rotator cuffs or anterior cruciate ligaments, for example, is particularly

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Dr. Rosa’s expertise in joint replacement includes knees, hips & shoulders. In terms of his work in joint replacement surgery, Dr. Rosa emphasizes the importance of being at the forefront of the most current technology. As a charter member of the AAHKS (American Association of Hip and Knee Surgeons), Dr. Rosa meets annually with a group of about 1000 of the nation’s most

Dr Garcia specializes in arthroscopic treatment of shoulder and knee disorders.


“Basically, my specialty is sports medicine – arthroscopic treatment of shoulder and knee problems, including anatomic ACL reconstruction, meniscal repair, shoulder reconstruction, including instability or repairing dislocations as well as rotator cuff repair and other types of arthroscopic surgery,” Dr. Garcia shares. In addition to his expertise in arthroscopy, Dr. Garcia specializes in open surgery for shoulder replacements, including partial, total and reverse shoulder replacements. Also, during his residency training at a level I trauma center, Dr. Garcia received a great deal of experience in trauma surgery and now treats patients with injuries such as complex fractures, repairing them with advanced surgical techniques. In terms of arthroscopic shoulder repair, especially, Dr. Garcia emphasizes the benefit of the advanced training he received. “Advances in arthroscopic shoulder surgery have been rapidly changing over the last decade. My fellowship training in arthroscopy and sports medicine has made me very comfortable treating complex shoulder and knee conditions, whereas classically, they have been treated through an open approach,” he states. Although Dr. Garcia performs a high volume of surgical procedures to treat sports-related injuries, he is a strong believer in the conservative, non-surgical management of sports injuries whenever possible. Dr. Garcia also prioritizes educating young athletes on preventing injuries from occurring in the first place. “We focus on core strengthening, on the biomechanics of the throwing motion, on pitch counts, for example,” he mentions. Dr. Garcia is passionate about helping young sports participants (and their parents) understand the importance of learning how to protect their joints by using them correctly and not subjecting them to overuse. When surgical intervention is necessary after an injury or to alleviate the disabling symptoms that can be caused by the process of aging, patients who are treated at AOC find that Dr. Rosa and Dr. Garcia utilize the most current technology in order to achieve optimal results with the least invasive approach possible in each case. For example, Dr. Rosa discusses the advantages of unicompartmental partial knee replacement surgery as a less invasive alternative to total knee

Today, Unicompartmental knee replacement systems are created specifically for each patient. replacement in patients with arthritis in only one compartment in the knee, usually the medial. “Although historically, unicompartmental knee replacements have been around since the late 70s or early 80s, in the beginning the technology and the patient selection weren’t all that great,” Dr. Rosa reveals, explaining why most orthopaedic surgeons chose not to get involved with the procedure at that time. Dr. Rosa himself eventually became instrumental during the late 90s, in designing a unicompartmental knee system that was significantly better. Today, much like the total knee replacements he does, Dr. Rosa implants computer-generated partial knee prostheses that are created specifically for each patient. “Over the years as technology has developed and especially now that we do it using smaller incisions, it’s a very attractive alternative for some patients because it involves a much shorter and easier recovery. For example, someone in their 50s who has arthritis of the knee in only one compartment is a great candidate. Hopefully, this patient can get 10 to 20 years out of it and then we can go to the total knee replacement, if necessary,” he continues. “For someone who is in the older age group with primarily unicompartmental disease, this should theoretically last for the rest of his or her life,” Dr. Rosa adds. Like the arthroscopic surgeries done by Dr. Rosa and Dr. Garcia, unicompartmental knee replacement is also done on an outpatient basis at the impressive Short Hills Surgery Center. During the procedure, Dr. Rosa uses small incisions to gain access to the affected compartment. Damaged cartilage and bone tissue are gently removed from the surfaces of the tibia and the femur in the arthritic area. The surfaces are then prepared

Unicompartmental partial knee replacement involves minimal blood loss and is associated with a lower rate of complications than total knee replacement surgery. for the implantation of the prosthetic components which are specifically sized to each patient’s joint. The prosthesis takes the place of the damaged area of the knee, leaving the other compartments intact. Unicompartmental partial knee replacement involves minimal blood loss and is associated with a lower rate of complications than total knee replacement surgery. Most patients can expect to return to their normal activities within a matter of weeks. Another example of state-of-the art technology incorporated by Dr. Rosa and Dr. Garcia is arthroscopic rotator cuff repair. Traditionally, when a patient sustained a rotator cuff tear that required surgical repair, an open procedure was performed, during which an incision was made over the outside of the shoulder. The muscle beneath the skin was separated to expose the rotator cuff, which was then inspected and repaired. This method is associated with blood loss and a significant amount of post-surgical pain that can persist even after the rotator cuff has healed. Most recently, innovative techniques have been developed to perform the repair with arthroscopic instruments. Small incisions of approximately one centimeter are made, through which April 2013

5


Dr. Garcia views the monitor during arthroscopic rotator cuff repair.

the smaller instruments are manipulated while the surgeon views the rotator cuff on a monitor. Dr. Garcia provides some information about the newer, less invasive technology and specifically how the procedure is done. “Arthroscopic rotator cuff repair is probably the most common procedure I do,” Dr. Garcia reports. “This basically involves repairing the tendon through about three little incisions, using suture anchors, which are small absorbable screws that go into the bone. The tendon can then be sewn and repaired to bone. I use something called a double row rotator cuff repair technique as compared to a single row technique because we’ve found that the results are more favorable in terms of tendon healing. Also, the biomechanics of the double row repair are more stable than with the single row technique, which may translate into a better clinical outcome,” he explains. Besides arthroscopic rotator cuff repairs Dr. Garcia performs all shoulder reconstructions as arthroscopic outpatient procedures. “I do all my reconstructions arthroscopically – dislocated shoulders, bankart repairs,

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Double row rotator cuff repair is preferred by Dr. Garcia who has found it to be more stable than the single row technique.

torn labrum, SLAP (superior labral anterior to posterior) tears, which are quite common in throwing athletes – all these are done with an arthroscopic approach,” Dr. Garcia elaborates. “The arthroscopic approach allows me to perform a more comprehensive analysis of the joint and the recovery is much faster when compared to traditional open approaches,” he adds.

significantly over the last ten years, in terms of improved design, improved surgical technique and improved instruments,” remarks Dr. Rosa. Perhaps the most exciting advancement has been the development of the iTotal CR knee replacement system, the first FDAcleared total knee replacement system that is specifically manufactured for each individual patient.

While Dr. Rosa and Dr. Garcia employ arthroscopic surgical techniques whenever possible to replace a traditionally “open” procedure, there are situations that do require a somewhat more invasive approach. In these cases, the so-called MIS (minimally invasive surgery) approach is utilized.

“With the computer-designed, patientspecific implant we are actually making an implant that matches each individual patient’s anatomy exactly,” Dr. Rosa emphasizes. Dr. Rosa was the first surgeon in New Jersey to implant this knee. “At the time that I did it, there were probably only a dozen surgeons nationwide that were starting to do it,” he relates. In addition to pioneering its use, Dr. Rosa is pleased to serve as a physician-consultant to the manufacturer and has participated in providing feedback to aid in the design of this this innovative system.

Certainly total joint replacement is one example and as Dr. Rosa relates, over time technology in this area continues to evolve. Now, smaller incisions and less involvement of surrounding tissue provide optimal results for their patients who undergo total joint replacement surgery. To exemplify this, Dr. Rosa begins by sharing information regarding the many total knee replacement surgeries he performs. “Knee

technology

has

improved

Dr. Rosa performed that first procedure at Saint Barnabas Medical Center in Livingston, where he serves as the Medical Director of its Joint Institute. The patient was an electrician who had previously been significantly overweight


an exact fit. In addition, the system minimizes the amount of bone removed, thereby preserving the patient’s own bone as much as possible. The implant is made to fit each individual precisely, without the sizing compromises common with traditional systems. Other total knee replacement systems require the surgeon to cut bone and balance the ligaments to fit the implant instead of using an implant that was specifically created to fit the patient.

The iTotal CR system creates a computer generated knee prosthesis that matches the patient’s anatomy specifically. It includes a customized implant as well as surgical guides, single-use disposable surgical instrumentation that is personalized for each patient to ensure an exact fit.

and also had spent a great deal of his working time on his knees. As a result both knees suffered progressive deterioration until the pain became so intense that he was unable to participate in any of the activities he once enjoyed. Dr. Rosa is delighted to report that after receiving the iTotal CR knee replacement, the patient was overjoyed, regaining the mobility and endurance that he once had.

Here, customized implant has been placed within the knee.

Dr. Rosa goes on to explain why the results with this system are so positive. Besides a computer-generated surgical guide that provides anatomic cuts, a feature offered by most total knee replacement systems, the iTotal CR system creates a computergenerated knee prosthesis that matches the patient’s anatomy specifically. A CT scan of each patient’s knee is converted to a 3D model which is used to design a unique, customized implant as well as the surgical guides and also, single-use, disposable surgical instrumentation that is personalized for each patient to ensure

“One of the biggest advantages of this system is that the ligaments are automatically balanced since everything is computer-generated, so it has a much more natural feel,” Dr. Rosa points out. “Overall, I’ve seen my patients do much better more quickly with this design,” he is pleased to report. Regarding the numerous total hip replacement surgeries performed by Dr. Rosa, he is pleased to share that the technology for that procedure has improved over the years as well. In fact, he was the primary investigator in this area when the ceramic hip replacement was being evaluated by the FDA, performing some of the 1800 hip replacements nationally that used the ceramic prosthesis before its eventual approval. Today, Dr. Rosa incorporates the most current technology, implanting a device

Dr Rosa performs hip replacements with smaller incisions and preservation of more surrounding tissue.

April 2013

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with a larger femoral head. “This implant, which is metal on polyethylene, is more inherently stable and virtually eliminates the risk of dislocation,” he states. Also, while hip replacement surgery has traditionally been performed through a posterior approach, Dr. Rosa has received specialized training in the anterior approach, and selects it for appropriate patients. “The advantage to this approach is obviously that patients are able to get up and walk much more quickly,” Dr. Rosa mentions. However he reiterates that not every patient will be a candidate for this. Additionally, Dr. Rosa explains that even his posterior hip replacements are now modified, being performed as MIS, with smaller incisions and preservation of more surrounding tissue. “Besides using small incisions, minimally invasive procedures do less damage beneath the skin and that’s what I do with all of my joint replacements. I use a very small approach,” he emphasizes.

Platelet –rich plasma (PRP) injections which contain a concentration of platelet cells extracted from the patient’s own blood sample, have been found to be helpful in treating arthritis when injected directly into the affected joint.

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Unless a patient arrives at Advanced Orthopaedic and Joint Replacement Center with a problem for which a surgical solution is clearly indicated, whenever possible, Dr. Rosa and Dr. Garcia employ the full gamut of non-operative treatments such as medications, nutritional supplements, physical therapy, braces, injections, etc.

performed under ultrasound guidance to ensure accuracy, which may improve outcomes,” he specifies.

Platelet-rich plasma (PRP) injections, for example, are administered to appropriate patients in order to promote healing of tendons in the elbow, knee, ankle and shoulder. “If a tendon is not healing, by adding the platelet-rich plasma, which is rich in growth factors and healing cells, you can try to stimulate a healing response naturally, Dr. Garcia explains.

Both Dr. Rosa and Dr. Garcia emphasize the importance they place on staying at the forefront of technological advancements in order to provide their patients with the highest level of care and treatment. Equally important at Advanced Orthopaedic and Joint Replacement Center is making each and every patient know that they are special. “In an era where things have become so mechanized, we pride ourselves on treating everyone as we would want our own family member to be treated,” Dr. Rosa says. This is true for everyone on staff and patients make it a point to tell me how pleased they are with the experience they’ve had here,” he happily shares.

He further mentions that PRP, which is a concentration of platelet cells extracted from the patient’s own blood sample, has been reported in some studies to be helpful in treating arthritis by injecting it directly into the affected joint. This would be particularly appropriate for a young person, possibly an athlete with arthritis of the knee, for example, who is not yet of the age for replacement surgery. “We incorporate the use of ultrasound, as a non-invasive diagnostic tool, without subjecting the patient to harmful radiation,” Dr. Garcia mentions. “All joint and tendon injections are

“It’s still under investigation but PRP has been found to be as effective as hyaluronic acid in some cases,” Dr. Garcia shares. “This is very progressive and not available everywhere but we are one of the practices offering it,” he notes.

Advanced Orthopaedic and Joint Replacement Center is located at 741 Northfield Avenue, Suite 200, West Orange, NJ. For more information or to make an appointment, please call (973)736-9980 or visit www.aocenter.org

At Advanced Orthopaedic and Joint Replacement Center, all joint and tendon injections are performed under ultrasound guidance to ensure accuracy.


Statehouse

NEW JERSEY STATEHOUSE Pending New Jersey Legislation Addresses Lack of Health Insurance

By Samuel C Berger, PC The Affordable Care Act (ACA), sometimes known as "Obamacare," passed the U.S. Congress two years ago. Many of its provisions have only just begun to take effect, and some will not take effect for several more years. One of its requirements is for each state to establish a health insurance exchange, which would allow, but not require, consumers to purchase health insurance in an open market system. The federal government will establish exchanges in any states that do not set up one of their own. Several people have recently published op-eds in New Jersey newspapers encouraging the state to set up an exchange. It could benefit small businesses by removing some of the burden of providing health insurance to employees. According to New Jersey Newsroom, 1.3 million New Jersey residents, about 1 in 7 of the state's population, lack health insurance coverage. The total number of uninsured residents in 2010 was fifty percent higher than the number in 2000. This rate is much higher than the rate of increase nationwide. Increasing premiums are generally blamed for people's growing inability to afford insurance. Most people depend on employer-provided health insurance, as premiums tend to be much higher for insurance purchased directly by a consumer. Such a widespread lack of health care coverage can have a broader impact on a state's economy, as people cannot work due to health problems but cannot afford health care. This can lead to foreclosures and even business failures.

The ACA introduced a number of provisions to improve people's access to health insurance coverage. Many of these provisions, like the insurance mandate requiring people to purchase health insurance, have proven controversial and are the subject of court challenges. The law has had positive impacts on many people, though. The Philadelphia Inquirer reports, for example, that over 130,000 young adults in New Jersey and Pennsylvania, age 26 or less, may now obtain health insurance through plans held by their parents. This can lead, unfortunately, to increased costs for employers, as family-plan premiums are generally higher than plans covering one person or a married couple. The proposed New Jersey Health Benefit Exchange Act would give consumers and small businesses the ability to shop for coverage plans that are better customized to their particular needs. According to bill sponsor Ruben J. Ramos, Jr., an Assemblyman from New Jersey's 33rd District, this system can save money for everyone involved, including the government, consumers, and employers. To ensure that the exchange runs smoothly without conflicts of interest, the Health Benefit Exchange Act establishes strict guidelines for its governance. The governor and the state Legislature participate directly in selecting exchange commission members, ensuring the government's accountability for the exchange commission's performance. Individuals working directly in health care in insurance or hospital administration, or as a practicing physician, cannot serve on the commission. The commission will have an advisory board made up of "interested stakeholders," which includes small business owners. April 2013

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NJ Hitec

The Benefits of a Patient Portal

By Vanessa Torres NJ-HITEC Meaningful Use Specialist

The Stage 2 Meaningful Use rules quickly approaching and go into effect on January 1, 2014. The first quarter of 2013 is already history so Stage 2 is just around the corner. One of the key requriements of Stage 2 Meaningful Use is that providers will have to implement and offer a patient portal in 2014. CMS removed some MU measures and replaced them with the patient portal access requirement for Stage 1 and Stage 2. NJ-HITEC Meaningful Use Director, Bala Thirumalainambi, explains, “The focus is shifting toward the patient in Stage 2. Providers should be thinking about patient portals and what works best for their patient population. Every year the MU process sets the bar little higher. The reality is before we know it, 2014 will arrive and the new requirements will kick in. It’s always best to plan ahead.” The key is that for Stage 1 in 2014, the providers must facilitate the portal in order to be compliant. The rule does not require the patients to get on the portal and use the information; it is just about providing them access. But in Stage 2, five percent of the patients will have to get on the portal and access their information. The questions below provide information about the value of a patient portal: What is a patient portal? A patient portal is a secure online website that gives patients 24 hour access to their personal health information as well as their medical records. What are the benefits of a patient portal? Patients who have access to their personal medical records through a patient portal are more active and involved in their own health care, as well as accessing family members health information which can help take care of them more easily. Patient portals offer self-service options that can eliminate phone tag with providers and even save trips to doctor’s offices. Patient portals are also beneficial to providers and the healthcare team. What can be done using a patient portal? Provided there is internet access, patients can securely view and print portions of their medical records, including doctor visits, discharge summaries, medication, immunizations, allergies, and most labs results. Other features of a patient portal may be: •

Exchanging secure email with the healthcare team.

Requesting prescription refills.

Scheduling non-urgent appointments.

Checking benefits and coverage.

Updating contact, demographic, and insurance information.

Make payments.

Downloading or completing intake forms.

Referrals to specialty services.

A patient portal may also allow access to parents on behalf of their children or other family members. What are the benefits of a patient portal to the practice? The benefits of a patient portal to a doctor’s practice include: •

Efficient communication for patients and medical staff.

Patients are able to take better care of themselves.

Allows time for providers to focus on critical patients.

Reduces misunderstandings and errors.

Allow providers to meet the requirements of Meaningful Use:

Meaningful Use Stage 1

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Patient electronic copy

Clinical summaries

Lab results

Patient reminders

• Provide patient timely electronic access to their health information (including lab results, problem list, medication list, medication allergies) •

Patient education

Meaningful Use Stage 2

Provide patients the ability to view online, download, and transmit their health information

Clinical summaries

Lab results

Patient reminder

Patient education

Use secure electronic messaging to communicate with patients on relevant health information

Imaging results

Moreover, staff will be more productive with happier patients and providers alike. Health care providers need to more actively engage patients by providing them with the capability to electronically view, download, and transmit relevant information from their provider’s Electronic Health Records (EHRs) and this can be achieved through a patient portal. NJ-HITEC has created multiple strategies to tackle this requirement and is planning to roll them out to our member providers in 2014. For more information or to becme a member of NJ-HITEC, please call 973-642-4055, email at info@njhitec.org, or visit www. njhitec.org.

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New Jersey Health News

In Acquiring Share of AmeriHealth, Cooper Crosses Hospital-Insurer Divide Expert raises concerns that alliance could be viewed as violating antitrust laws

By Andrew Kitchenman, Hospitals and insurers have traditionally been adversaries in payment negotiations, but that line could soon be blurred in South Jersey, where Cooper University Health Care is purchasing 20 percent of AmeriHealth New Jersey. And to some, it's not just a question of blurring a line, it's a matter of crossing one. According to Uwe Reinhardt, a Princeton University economist, the agreement, which requires the approval of state regulators, could raise concerns about violating antitrust law. He noted that while serving as part-owner of AmeriHealth, Cooper would be in a position to treat AmeriHealth more favorably than other insurers. “That could put [rivals] at a competitive disadvantage,” Reinhardt said. An AmeriHealth spokeswoman said that the company would not receive favorable treatment and wouldn’t have access to other insurers’ rates when it sets its prices. Officials with both the Camden-based hospital and the Cranbury-based insurer said that current patients wouldn’t see a difference in services, but indicated that the partnership would allow them to reduce patients’ medical costs through closer coordination of care. AmeriHealth also intends to offer specially priced plans that will reduce copayments when patients use Cooper and its doctors instead of other area providers. Cooper Chairman George Norcross said AmeriHealth was an attractive partner since it is the only insurance company that is based solely in New Jersey. “It’s large enough but yet small enough to be a participant with healthcare systems, and it’s innovative enough and forward-thinking enough,” to be a suitable partner, said Norcross, a leading political powerbroker in South Jersey. The agreement would make Norcross an even larger figure in the healthcare world. As executive chairman of Conner Strong & Buckelew, he already a major insurance broker and consultant. The partnership will be based on a model similar to accountable care organizations, in which an insurer attempts to compensate providers for how well they perform and keep costs down, rather than for each service they provide. The model “is designed to enhance communication with patients and among providers and give patients easier access” to doctors, according to the statement announcing the agreement. Cobranded AmeriHealth-Cooper insurance plans will be available in 2014, with a goal of making them available on the state’s health benefit exchange in 2015, AmeriHealth President and CEO Judith L. Roman said. She expects many individuals and small groups that currently go without insurance to buy plans through the partnership. Both Norcross and Roman said they hope that AmeriHealth builds similar partnerships with other hospitals elsewhere in the state. “This is just the beginning,” Norcross said. Roman said the agreement would offer various options in South Jersey, including opportunities for employers to choose commercial insurance and to self-insure. Both Roman and Norcross highlighted the importance of having a patient served by a group of doctors who are coordinating care, known as a patient centered medical home. Roman said patients would benefit from aligning the incentives for hospitals, doctors and health plans. She said the goals of the agreement are to improve patient outcomes and member satisfaction while reducing the use of the hospital for inpatient and emergency-room visits. Norcross said the agreement could mark the end of the traditional sparring between insurers and hospitals. “For far too many years, probably decades, there’s been pretty much an adversarial relationship between the payers and the providers, whether they are hospitals or physicians or otherwise,” Norcross said, adding that the ability of patients to choose among providers makes Cooper sensitive to their needs. “We’re a Four Seasons Hotel that happens to provide world-class healthcare, because we’re in a competitive marketplace today.” He said such agreements are well suited to New Jersey, which has few insurers but many hospitals. Reinhardt said the agreement was reminiscent of an unsuccessful trend in the 1990s, in which hospitals and doctors sold insurance directly to employers. This effort was complicated by many doctors’ aversion to alternatives to traditional payment models. While these physician-hospital organizations “didn’t work at that time, it may this time work a little bit better because physicians are more inclined to work for an organization on salary,” Reinhardt said. Reinhardt also questioned the opportunities for savings for AmeriHealth in the agreement. The deal is subject to state Department of Banking and Insurance approval, which is expected in three to six months, according to AmeriHealth officials.

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Hospital’s Plight Spurs Advocates of Greater Fiscal Oversight Increase in number of for-profits adds urgency to calls for more financial transparency

By Andrew Kitchenman, Advocates of requiring more financial transparency by for-profit hospitals say tax liens placed on Meadowlands Hospital Medical Center by the Internal Revenue Service are proving their point. Senate Majority Leader Loretta Weinberg (D-Bergen) said the state must learn more about the financial health of hospitals like Meadowlands, whose owner -- MHA LLC -- faces $4.46 million in federal tax liens after failing to pay unemployment and payroll taxes to the IRS. A bill sponsored by Weinberg last year, S-782, would have required for-profits to file the same financial information as nonprofit hospitals. The bill was conditionally vetoed by Gov. Chris Christie. “Anybody who’s against transparency, you have to be suspicious, your antenna has to go up,” Weinberg said. “What is it you don’t want the public to know?” Christie said in his conditional veto statement that the state must be careful to avoid “over-reaching into the business arena,” while still increasing transparency about hospital finances. Christie instead recommended that state Health Commissioner Mary E. O’Dowd review existing financial reporting requirements and recommend how to make more information available. Officials are conducting that review, according to a Department of Health spokeswoman. The number of for-profit hospitals has been steadily rising since the first two for-profits opened in 2002. Currently, there are seven for-profits operating in the state, along with one set to open this year (HackensackUMC North at Pascack Valley) and two whose sales are pending (Saint Michael’s in Newark and St. Mary’s in Passaic). That growth in the number of for-profit hospitals is what is causing increasing alarm on the part of legislators and the Health Professionals and Allied Employees (HPAE) union. The liens on the Meadowlands were brought to light on March 28 by the HPAE, which represents that hospital’s nurses. The union also questioned the implications of a recent $18 million sale of the hospital’s land, with the hospital leasing the property from the new owner, Rosdev of Montreal, Canada. Union officials, Weinberg and Sen. Joseph F. Vitale (D-Middlesex) all called on the state to appoint a monitor to oversee the hospital’s finances, a move that the state is considering. Weinberg said the murkiness of Meadowlands’ finances calls into question the broader issue of for-profit hospital finances and the state’s oversight of them. Vitale is planning a hearing in May to examine for-profit hospitals. Weinberg said it appears that some hospital conversions to for-profit status primarily serve as real-estate deals, profiting the new owners while leaving the hospitals at greater risk of closure. “I have a lot of questions about how healthcare is delivered in a for-profit,” Weinberg said. “They drop insurance carriers, they drop services.” Some for-profit operators drop out of the networks of insurance companies, allowing them to charge more for services. In addition, some nonprofit hospitals have raised concerns that for-profits have increased pressure on them by dropping less-profitable services. HPAE policy director Jeanne Otersen said state regulation of hospitals hasn’t kept pace with the rapid increase in for-profit operators. “This is exactly why we needed legislation to require transparency for for-profit hospitals,” she said of Meadowlands’ liens. Meadowlands Hospital Medical Center spokesman Bill Maer said the liens “have been paid, or are scheduled to be paid imminently.” He said the focus should be on the hospital’s “record of turning around,” describing the union’s allegations as “another unbridled and recklessly false attack.” The hospital and union also disagree on which measures of patient satisfaction are more accurate, with Maer pointing to a set of scores that are among the highest in the region and Otersen citing below-average scores. The Department of Health has taken the union’s concerns “very seriously,” a spokesman said. It is having ongoing discussions with Meadowlands representatives and has arranged for mediation between Meadowlands and the union this week. Both Weinberg and Otersen said that the issue shouldn’t be framed as a labor dispute, since the liens represent clear evidence of April 2013

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problems with hospital finances, which may reflect underlying problems that could undermine the hospital’s ability to serve the public. “Obviously the liens are not a false scenario,” Weinberg said. “They are what they are. They are factual.” Prime Healthcare of California’s proposed purchase of Saint Michael’s and St. Mary’s has added more urgency to having the state take steps to increase regulation of for-profit hospitals. “If we don’t do this now, I think we lose our capacity to protect not only the patients, who are served by these hospitals, but the taxpayers,” who support all hospitals in the state through various government healthcare programs including charity care, Otersen said. The union has raised concerns about Prime Healthcare. Weinberg questioned when the Department of Health recommendations for increasing financial reporting would be available. Department of Health spokeswoman Donna Leusner said the review has begun. “We have initiated a conversation with hospitals,” she said. “We’ve been meeting with advocates and labor unions. We believe it’s important to hear from all sides.”

Surgical facility bill passes Senate committee again By Melinda Caliendo State Sen. Joseph Vitale's (D-Woodbridge) efforts to get single-room surgical facilities under the same regulatory umbrella as other surgical facilities advanced Monday, as his proposed legislation moved through the Senate's Health, Human Services and Senior Citizens Committee unanimously. Vitale sponsored the same bill in the last legislative session after a study by the New Jersey Health Care Quality Institute authored a report finding many of the one-room facilities in New Jersey had deficient patient safety standards. The bill was pocket vetoed by Gov. Chris Christie because of a 2.95 percent tax assessment on single-room facilities, required by Centers for Medicare and Medicaid Services. "The bill that passed out of committee is in its original form, from last session, which included the assessment that the governor had a concern with, that I shared that concern with," Vitale said. "We're going to try to move the bill along as it is, and try to address that issue. I'd rather not have to apply the assessment, but we may, at the end of the day, not have a choice." "CMS requires that we apply any assessment equally, so the assessment we now apply to multiple suite facilities would have to apply to single-suite facilities, because they're the same, they deliver essentially the same services," Vitale said, adding he would explore the possibility of a waiver from CMS. The legislation would ensure all surgical facilities are licensed and inspected by the Department of Health and Senior Services. Vitale said the bill has the support of the New Jersey Hospital Association and the Quality Institute in addition to his fellow committee members. "They're recognizing not only the importance of the issue, which is making sure that they are properly inspected and licensed, but that we can ensure there's a comfort level on patient safety. The members obviously believe that," Vitale said.

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Federal Healthcare News

FEDERAL HEALTHCARE NEWS

Some seniors would pay more for Medicare benefits in the future under President Barack Obama's budget proposal for the coming fiscal year. The $3.8 trillion White House budget unveiled renews calls for charging wealthy Medicare beneficiaries more for physician and prescription drug coverage. The spending framework also raises costs for people who join Medicare in 2017 and later for some services, and levies a surcharge on beneficiaries who buy comprehensive health insurance plans to supplement their Medicare coverage. "If we want to preserve the ironclad guarantee that Medicare represents, then we're going to have to make some change but they don't have to be drastic ones," Obama said Wednesday when he introduced his budget for fiscal year 2014, which begins on Oct. 1. "They are reforms that keep the promise we've made to our seniors: basic security that is rock-solid and dependable and there for you when you need it." Wealthier Medicare beneficiaries would pay higher premiums for Medicare Part B, which covers physician visits and other outpatient care, and Medicare Part D, the prescription-drug benefit, starting in 2017. That same year, everyone enrolled in Part B would face a higher deductible. People who join Medicare in 2017 or later, and buy supplemental health insurance that covers all or most of their Medicare deductibles and cost-sharing expenses would pay extra for Medicare Part B. According to White House estimates, these and other new changes to Medicare benefits and costs would reduce federal spending by $57 billion over a decade.

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The increased costs for some are balanced by measures that would reduce prescription drug spending for beneficiaries and taxpayers. Obama seeks to close the Medicare prescription drug benefit coverage gap known as the "doughnut hole" by 2015, five years sooner than under current law. The budget also would cut Medicare payments for prescription drugs and speed generic medicines to the market. Although some of the White House's proposals, such as closing the Medicare drug benefit doughnut hole sooner, would be beneficial to people on the program, other parts of the plan would simply shift more health care expenses from the government to senior citizens and the disabled, said Dan Adcock, the director of government relations and policy at the National Committee to Preserve Social Security and Medicare. "The problem is that with seniors already using 20 to 40 percent of their income on health care and you're just going to pile on these additional costs, you know they're going to have to be choosing and picking between what they can afford to buy and what they can't," said Adcock. The negative effects on retirees' finances would be exacerbated by a White House-backed proposal to reduce Social Security costof-living increases, he said.

Obama's proposals to change Medicare benefits and costs are small relative to the overhaul of the program outlined last month by House Budget Committee Chairman Paul Ryan (R-Wis.). Ryan's budget, which the House approved for the third consecutive year, would replace traditional Medicare with a system that would provide beneficiaries with a flat sum of money each year to buy private health insurance. In total, Obama seeks to cut federal health-care spending by $401 billion over a decade, mostly by lowering prices for prescription drugs and reducing Medicare payments to medical providers. Congress would have to approve the budget measures for them to take effect. The White House targets drug companies for $169 billion in spending reductions over 10 years. The proposals include a number of provisions Obama set aside in 2009 and 2010 in exchange for the pharmaceutical industry's support of his health care reform plan, including $123 billion in savings from applying lower Medicaid drug prices to medicines sold to poor beneficiaries on Medicare, which pays higher rates for pharmaceuticals. Obama also would bar brand-name drugmakers and generic manufacturers from striking "pay to delay" deals that postpone the availability of cheaper medicines and shorten the length of time makers of brand-name "biologic" drugs, which are based on living organisms, can market products without generic competition. The budget boosts proposed spending on implementing Obamacare and its health insurance exchanges. Obama also proposes postponing the health care reform law's cuts to Medicaid funding for hospitals that treat uninsured patients.

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Obama Administration Plans to Cut Medicare Advantage Reimbursements

By Matt Cover

Obama administration is planning new cuts to Medicare, a federal regulatory filing reveals, cuts that could mean higher premiums or seniors losing their coverage altogether. The new cuts come in the form of a planned reduction in the reimbursement rates the government pays to insurance companies that operate Medicare Advantage plans, which are services administered by private for-profit or non-profit providers that offer additional services than can be found in traditional Medicare. In a Feb. 15 regulatory filing, the Centers for Medicare and Medicaid Services (CMS) announced the surprised rate cuts of 2.3 percent – meaning it would pay health care providers 2.3 percent less for providing services to patients. CMS said it was cutting payments because it foresaw the overall costs of the Medicare Advantage program shrinking by 3.2 percent, despite the fact that health care costs – the driver of all federal health care program costs – are only rising. Medicare Advantage is like traditional Medicare except that its plans are administered by insurance companies, who are paid a per-enrollee reimbursement fee by the government. If insurance companies can provide care to seniors at less than what the government pays them for it, they make a profit. Medicare Advantage provides coverage for approximately 28 percent of all Medicare beneficiaries, offering them higher-quality services and additional benefits, such as vision and dental care, than the traditional government program at slightly higher cost. The Obama administration already plans to cut the Medicare Advantage program by $200 billion as part of Obamacare. However, the proposed reductions it announced in February are new, and will cut the program in addition to the planned $200 billion in Obamacare cuts, most of which are delayed in 2014.

The new cuts are also scheduled to go into effect in 2014, but as a function of the normal rate-setting process for that year, not a political effort to delay financial pain for seniors past an important election, as apparently was the case with the original Medicare cuts that Obama signed. In its regulatory announcement, the CMS said it was assuming that reimbursement payments in traditional, government-run Medicare will be cut, and cited that as justification for cutting Medicare Advantage. However, while those cuts to traditional Medicare have been set into law for more than a decade, Congress has never allowed them to happen, instituting what is known as the Doc Fix every year, to keep reimbursement payments the same. Senator Marco Rubio (R-Fla.) wrote to the CMS urging them to consider political reality and reverse their planned Medicare Advantage cuts. “This assumption is highly problematic because – even though it almost certainly will turn out to be wrong – it translates into lower funding to support the health benefits of the 14 million Medicare beneficiaries who are currently enrolled in MA [Medicare Advantage] plans,” Rubio wrote on March 8. In other words, if the Obama administration continues with its proposed new Medicare cuts, some or all of the 14 million seniors who get health care through the MA program could be negatively affected, that is, paying higher premiums or possibly losing coverage. April 2013

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This is because the proposed cut could make the program unprofitable for insurers, who would be forced to either stop offering plans or pass the increased costs on to seniors in the form of higher premiums. One health insurance provider told its shareholders that the proposed rate cuts could mean the end of Medicare Advantage all together. “There are going to be some markets that at these rates, if they go the way they’re going, it’s going to be very hard for Medicare Advantage to survive,” Universal American Corp CEO Richard Barasch said in a February 19 conference call with shareholders, the industry publication Health Plan Week reported. “I think it’s going to be sort of a market-by-market, company-by-company exercise,” Barasch said.

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HEALTH LAW Update Health Law Update

MD-Owned Malpractice Insurance Exchange Sued by NJ Physician

A New Jersey physician has filed a class action against physician-owned malpractice insurance exchange Conventus Inter-Insurance Exchange (Conventus). Claims include allegations of fraud, anti-competitive practices and unauthorized debits from the physician’s checking account. The plaintiff alleges Conventus restrained competition among insurers through preventing insured physicians from changing providers, by conditioning the provision of tail coverage on the payment of additional capital contributions upon withdrawal, or forcing physicians to bear the costs of nose coverage. Plaintiff also claims that, while she only authorized Conventus to deduct her initial insurance deposit, Conventus made unauthorized debits from the physician’s checking account for un-noticed capital contributions and premium charges, at times in excess of the amounts invoiced, both throughout her membership and after the physician terminated her membership with the exchange. The proposed class of plaintiffs would include physicians who terminated their membership with Conventus within six years of the filing of the lawsuit, and either were required to pay remaining capital contributions in full before they could purchase tail coverage, or who had their checking accounts improperly accessed by Conventus for premiums or capital contributions or were charged erroneous amounts, before or after terminating membership with Conventus. For additional information, contact: Mark Manigan / 973.403.3132 / mmanigan@bracheichler.com Keith J. Roberts / 973.364.5201 / kroberts@bracheichler.com

CareCore Adopts Practice, Physician and Technologist Quality Standards

CareCore National (CareCore) requires medical imaging providers to complete a form entitled “Professional Physician/Practice Assessment.”  The form is required to be completed initially and every two years thereafter, and must be updated for each practice site if there is a change in ownership, TIN, NPI, physician or technologist staff, address, equipment or services provided at the site. Effective January 3, 2013, CareCore has adopted new quality standards that medical imaging providers must meet in order to be considered for positive contracting recommendations by CareCore to insurance payors. The quality standards must also be met for a medical imaging provider to receive reimbursement for diagnostic imaging exams. For additional information, contact: John D. Fanburg / 973.403.3107 / jfanburg@bracheichler.com Carol Grelecki / 973.403.3140 / cgrelecki@bracheichler.com

CMS Issues Decision Memos Relating to PET Imaging On March 7, 2013, Centers for Medicare & Medicaid Services (CMS) issued a final decision memorandum authorizing Medicare Administrative Contractors (MACs) to make local coverage determinations for positron emission tomography (PET) using FDAapproved radiopharmacueticals for oncologic imaging. PET is used to detect conditions such as cancer, ischemic heart disease and certain neurologic disorders, but is generally not covered under CMS national coverage determinations except for the use of specified tracers. Under the decision memorandum, local MACs may make the determination regarding newly-FDA-approved radioactive tracers. On March 13, 2013, CMS issued a proposed decision memorandum relating to fluorodeoxyglucose (FDP) PET. Under the proposal, except for cancer of the prostate, one FDP PET would be covered by Medicare when used to guide subsequent physician management of anti-tumor treatment after the completion of initial anti-cancer therapy. Coverage for additional FDP PET would be determined by local MACs. CMS is accepting comments to the proposal. For additional information, contact: John D. Fanburg / 973.403.3107 / jfanburg@bracheichler.com Carol Grelecki / 973.403.3140 / cgrelecki@bracheichler.com April 2013

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Medicare Payments Automatically Reduced by Two Percent Beginning April 1, 2013, healthcare providers will suffer a two percent (2%) reduction across the board in their Medicare payments.  Although Congress adopted the recent sequestration to address the federal budget deficit and to avoid the fiscal cliff, Congress failed to address the automatic reduction in Medicare payments that will go into effect.  This reduction is far-reaching, impacting hospitals and other providers under Medicare Part A, licensed professionals and other suppliers under Part B, Medicare Advantage plans under Part C, and Medicare prescription drug plans under Part D.  The reduction in Medicare payments is also expected to impact incentive payments for meaningful use of electronic health records, although Medicaid incentives and low-income and other subsidies will not be affected. For additional information, contact: Carol Grelecki / 973.403.3140 / cgrelecki@bracheichler.com Joseph M. Gorrell / 973.403.3112 / jgorrell@bracheichler.com

OIG Issues Special Fraud Alert Regarding Physician-Owned Distributorships The Department of Health and Human Services Office of Inspector General (OIG) issued a special fraud alert late last month, warning physician-owned entities that they will face additional scrutiny under the federal anti-kickback statute, particularly those entities that sell implantable medical devices ordered by their physician-owners for use in procedures the owners perform. The OIG reiterated its prior guidance and reinforced its long-standing position that physician-owned distributorships (PODs) present conspicuous opportunities for referring physicians to earn profits that could constitute illegal remuneration under the anti-kickback statute, and that PODs are inherently suspect. Questionable features of PODs include: selecting physician-investors for the POD based on their ability to generate referrals or device orders requiring investors who have ceased practicing to divest their interest in the POD distributing extraordinary returns on investments compared to the level of risk involved (generally deemed minimal for investing in a POD) size of POD investment opportunities varying with expected volumes of devices ordered distributions that are made in proportion to volume of referrals or devices ordered, rather than in proportion to ownership interests physician-owners conditioning patient referrals to hospitals or ASCs on their purchases of the POD’s devices PODs that are shell entities that do not conduct appropriate product evaluations, maintain proper inventories, or employ or contract with personnel necessary for operations the POD retaining the right to redeem a physician-owner’s company interests in the event the physician-owner fails to produce a certain volume of referrals or device orders. For additional information, contact: Mark Manigan / 973.403.3132 / mmanigan@bracheichler.com John D. Fanburg / 973.403.3107 / jfanburg@bracheichler.com

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Bits & Pieces

Cooper health system to partner with AmeriHealth By Rachel Landen Cooper University Health Care in Camden, N.J., plans to take a 20% stake in AmeriHealth New Jersey and develop an accountable care model with the health insurer. Cooper and AmeriHealth will create new health plan offerings—including insured, self-insured and Medicare products—aimed at improving the coordination of care and delivering better care at lower costs. The deal is one of several that are blurring the lines between healthcare providers and insurers. Englewood, Colo.-based Catholic Health Initiatives, for example, is developing its own insurance arm. The Detroit (Mich.) Medical Center and Boston-based Partners HealthCare recently acquired insurers. In Georgia, Piedmont Healthcare and WellStar Health System said last December that they planned to launch an insurer within a year.

Cooper recently instituted an employee-centered medical home model for its 9,100 covered employees. The program gives employees with chronic conditions efficient, coordinated and close management of their care to keep them healthier and reduce their costs. As part of the new venture, Cooper also plans to implement the patient-centered medical home model in its primarycare practices in southern New Jersey. Cooper, which is anchored by a 493-bed hospital in Camden, employs more than 500 physicians and has about 100 outpatient offices in southern New Jersey. “Under this new partnership with AmeriHealth New Jersey, Cooper's network of advanced medical specialists and primary care physicians will provide coordinated patient care never seen before in our region,” George Norcross, chairman of Cooper's board, said in a news release. AmeriHealth New Jersey is one of five plans in the state participating in the CMS Innovation Center's Comprehensive Primary Care Initiative, a demonstration project in which private insurers, Medicare and Medicaid programs are paying providers per-month, perpatient fees to compensate them for coordinating care. “We are proud that AmeriHealth New Jersey and Cooper are transforming healthcare by cultivating this innovative partnership with physicians and hospitals in order to manage medical costs, develop low-cost, high-quality products, and enhance the patient experience. This collaboration helps to break down the traditional barriers associated with healthcare by having two organizations work together as one to build an accountable care model—and that is what makes it so exciting,” Daniel Hilferty, president and CEO of Independence Blue Cross, AmeriHealth's parent company, said in the release.

NY, NJ area cardiologist admits record $19M fraud By Associated Press

A cardiologist with offices in New York City and New Jersey has admitted taking part in a scheme that subjected thousands of patients to unnecessary tests and treatment and resulted in $19 million in bogus bills, the largest case of healthcare fraud ever by a practitioner in either state, authorities said. Dr. Jose Katz, of Closter, pleaded guilty Wednesday in federal court to conspiracy to commit healthcare fraud and an unrelated count of Social Security fraud for giving his wife a years long no-show job, making her eligible for Social Security. Katz, 68, was the founder and chief executive of Cardio-Med Services LLC, which had offices in Union City, Paterson and West New York, and Comprehensive Healthcare & Medical Services, which had offices in Manhattan and Queens. The cardiologist falsely diagnosed a majority of his Medicare and Medicaid patients with coronary artery disease and debilitating and inoperable angina so he could treat them, unnecessarily, with enhanced external counterpulsation, or EECP, prosecutors said. The treatment employs the use of pneumatic cuffs to compress blood vessels in the lower limbs to increase blood flow to the heart. Katz even prescribed the treatment in cases in which doing so subjected the patients to risk of injury or death, prosecutors said. April 2013

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From 2005 through 2012, Medicare and Medicaid paid the doctor more than $15.6 million just for his EECP treatments, most of which were fraudulent, the government said. "After years of prominence in his field, Jose Katz will now be remembered for his record-setting fraud," U.S. Attorney Paul Fishman said. From 2006 to early 2009, Katz spent more than $6 million for advertising on Spanish-language television and radio stations, attracting hundreds of patients from New York, New Jersey and Connecticut.

Overall, the government said, he billed Medicare and Medicaid more than $70 million from 2005 through 2012. Prosecutors said he ordered and performed essentially the same diagnostic tests for nearly all his patients. They said he also instructed his non-physician employees to order and perform tests for patients of other doctors working at his offices, even though he had not examined those patients and the other doctors had not ordered them. Katz also was accused of ordering an unlicensed co-conspirator to treat patients. The co-conspirator, who had a medical degree from Puerto Rico but didn't have a license to practice medicine in any of the 50 states, awaits sentencing. Katz, who is free on bail, is scheduled to be sentenced July 23. The healthcare fraud charge carries a maximum penalty of 10 years in prison. Prosecutors said he also faces fines and will be ordered to pay restitution.

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22 New Jersey Physician

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Food for Thought

Peking Duck at

Chengdu 46 Clifton, New Jersey

By Iris Goldberg Many years ago, before he was a magazine publisher within the New Jersey healthcare industry, Michael traveled extensively on behalf of a large international magazine publishing company. Many of his trips were outside of the U.S., to Europe, Asia and South America. Those were exciting but challenging years for us. He would leave and I stayed behind, attending to our children and my work. When he’d return, I thoroughly enjoyed hearing about all of his experiences. As I think back now, I’d have to say that often he spoke most animatedly about the food (no surprise there) that he had sampled in the various countries he visited.

takes pride in the Peking Duck it serves.

While in China, he discovered how different the food served is from what we are accustomed to at most of the Chinese restaurants we have here. In fact, I have written about this in past issues, suggesting a few Chinese restaurants in New Jersey that cater to people of Chinese descent and offer authentic cuisine.

Our server was a delightful man who spoke with us about his life in Hong Kong before coming here. He made a point of showing us the platter containing the duck, skin, scallions, cucumbers, hoisin sauce and pancakes, beautifully arranged, before he constructed each pancake. I am sorry to say I was not brave enough to ask if I could take a picture. Trust me, it was an absolutely lovely presentation!

In Beijing, one of Michael’s most memorable dining experiences was at a restaurant that served the entire meal consisting of some form of duck. The appetizer might have been pickled duck tongue, for example. Next came the tender, succulent duck meat and crispy skin, vegetables and tangy sauce, wrapped in fresh bun pancakes. This was followed by a savory duck soup. When visiting China this was the meal he especially looked forward to. Here, ordering Peking Duck is a gamble. Many times, the skin is too crisp - almost burnt and the meat is dry. Usually the most expensive item on the menu, if the Peking Duck falls short, you really feel cheated. Happily, we discovered one restaurant that

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Chengdu 46 has been around for a while. With a liquor license and a separate bar room, its atmosphere is a bit more festive than other places, although after so many years there’ a bit of a “tired” look that some fresh paint and perhaps new seating would eradicate quite nicely. We had heard about the duck and arrived with the sole purpose of trying it. To make things seem a bit more like Beijing, we started with some fried duck dumplings. They were good but an accompanying sauce would have made them even better.

I must say, the Peking Duck at Chengdu 46 was the best I’ve had. The meat was cooked perfectly and the skin was crisp and flavorful. The hoisin sauce might have been homemade. Even the pancakes, which were not buns but the crepes usually served here, were special. I’m sure it didn’t take Michael back to China but I know he did enjoy this preparation. If you’re planning a trip to Beijing in the near future, wait to have your duck there. If not, take a ride down Route 46. I don’t think you will be disappointed. Chengdu 46 is located at 1105 Us Highway 46, Clifton, NJ 07013. (973) 777-8855


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NJ Physician Magazine April 2013