NJ Physician Magazine September 2013

JULY 2013 2012 SEPTEMBER Visit us now online at

www.NJPhysician.org

Atlantic NeuroSurgical Specialists Pioneers of Advanced Technologies in Brain, Spine, and Neurovascular Surgery

After more than 50 years ANS Continues as New Jersey’s Leader in Providing Innovative, Supportive and Compassionate Care to Patients and Their Families Also In This Issue: ACO Contracts May Slow Spending, But Quality May Not Improve Physician Lawsuit Against United Healthcare for Failure to Reimburse Allowed to Proceed Aetna Pulls Out of ‘Obamacare’ Health Exchange Affordable Care Model Gets Big Boost with Partnership of Horizon, Barnabas

Princeton Insurance knows New Jersey, with the longest continuous market presence of any company offering medical professional liability coverage in the state.

Now a Medical Protective/Berkshire Hathaway company, Princeton Insurance offers even more resources, strength and innovation to those we insure.

• Measured either by Gross Written Premium or by number of policyholders, Princeton Insurance is New Jersey’s leading healthcare malpractice insurer.

• Serving New Jersey continuously since 1976 and the country since 1899 – the longest track record in the state, the oldest healthcare malpractice insurer in the nation • More than 57,000 New Jersey medical malpractice claims handled • Industry-leading financial strength, with a rating of A+ (Superior) from independent rating agency A.M. Best • Calls handled personally, specialized legal representation, knowledgeable independent agents, 24-hour new business premium quote • Unmatched ability to innovate, create, develop and support new products

Publisher’s Letter Dear Readers, Published by

Welcome to the September issue of New Jersey Physician, reporting on the critical issues to help your practice survive and flourish during these changing times.

Many of you have considered joining an ACO. A new study shows that overall health spending may slow when hospitals and medical groups agree to the new payment model with even one insurer, however the quality of care may not improve for all patients. Quality gains may be limited to patients whose insurer enters into the accountable care contract.

Montdor Medical Media, LLC

Co-Publisher and Managing Editors Iris and Michael Goldberg

Contributing Writers Iris Goldberg Michael Goldberg Melanie Evans Debra C. Lienhardt Joseph M. Gorrell Carol Grelecki Lani M. Dornfeld

The U.S. District Court for the Eastern District of New York recently ruled that a physician and his medical practice entity were not time-barred, under the six year statute of limitations, from bringing suit against United Healthcare for alleged failure to reimburse the plaintiffs the proper amounts for medically necessary procedures.

Keith J. Roberts Kevin M. Lastorino John D. Fanburg Mark Manigan Ed Beeson Dan Goldberg

DOBI has proposed a re-adoption, with amendment, of the regulations governing Third Party Administrators and Third Party Billing Services which expired in 2010 but has continued in effect under the Executive Order. Every TPA doing business in New Jersey must be licensed or registered with DOBI. A TPBS must become certified as well.

Joe Carlson Andrew Kitchenman Beth Kutscher Carrie Stetler

Layout and Design Nick Justus

New Jersey resident’s choices for the Affordable Care Act have changed.

Subtract Aetna from the list, they have decided to withdraw from participation. Add Freelancers CO-OP operating under the name Health Republic Insurance of New Jersey as one of the several options the uninsured and self-insured may choose from when enrollment begins on Oct 1.

Diseases of the brain or spine can be life altering. Whether caused by trauma or disease, they can be significantly fear inducing. Atlantic NeuroSurgical Specialists, this month’s cover story, is the largest private neurosurgical practice in the state. Each member of the group is subspecialized and has trained at some of the most respected programs available. Whether the condition is spine related, brain related and requiring open surgery or a condition treatable with endovascular techniques, the neurosurgeons at Atlantic NeuroSurgical Specialists are equipped to handle the case using the latest and least invasive techniques appropriate to achieve an optimal outcome.

With warm regards,

Michael Goldberg Co-Publisher

New Jersey Physician Magazine

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Contents

Atlantic NeuroSurgical Specialists Pioneers of Advanced Technologies in Brain, Spine, and Neurovascular Surgery

4

After more than 50 years ANS Continues as New Jersey’s Leader in Providing Innovative, Supportive and Compassionate Care to Patients and Their Families CONTENTS

9 10 12 14 15 18 21 24 26

2 New Jersey Physician

ACOs HEALTH LAW UPDATE INSURANCE ISSUES MGMA NEWS HOSPITAL ROUNDS STATEHOUSE RUTGERS ASC NEWS FOOD FOR THOUGHT

Talk to Bollinger about your Professional Liability …

Before entering this room.

• • • •

BROAD COVERAGE FORMS FINANCIALLY STRONG INSURANCE COMPANIES ADVANCED RISK MANAGEMENT SERVICES AND STRATEGIES HIGHLY COMPETITIVE PRICING

With one of the largest professional liability divisions in the region, Bollinger has the expertise and resources to help ensure that your liability threats are properly addressed.

To learn more about how Bollinger can help your practice, contact Brian S. Kern, Esq. 973-921-8497 or Brian.Kern@Bollinger.com

www.Bollinger.com/pro Coverage is subject to meeting eligibility requirements and company approval.

Cover Story

Atlantic NeuroSurgical Specialists Pioneers of Advanced Technologies in Brain, Spine, and Neurovascular Surgery

After more than 50 years ANS Continues as New Jersey’s Leader in Providing Innovative, Supportive and Compassionate Care to Patients and Their Families photography by Michael Goldberg

By Iris Goldberg Anyone who has been stricken with a disorder of the brain or spine knows how drastically life can change as a result. Whether from a life-threatening illness such as a brain tumor or stroke, or from a disabling condition like Parkinson’s disease or something as common as chronic back pain, the life of the patient and that of his or her family may be significantly affected. Obtaining treatment from physicians who are

exceptionally trained and highly skilled can make a dramatic difference in that patient’s ultimate outcome. Choosing a practice that prioritizes the importance of providing its patients with a positive overall experience throughout the course of that treatment can be immeasurably important in terms of helping the entire family progress through the process with greater ease and less anxiety.

Based in Morristown and with additional offices conveniently located throughout New Jersey, Atlantic NeuroSurgical Specialists (ANS) is the largest private neurosurgical practice in the state.

Comprised of a group of sub-specialized neurosurgeons who have been trained at some of the most prestigious programs in the country, ANS is affiliated with the leading local hospitals and major health systems throughout New Jersey.

ANS PHYSICIANS HAVE BEEN TRAINED AT SOME OF THE MOST PRESTIGIOUS PROGRAM THE BARROW INSTITUTE, COLUMBIA UNIVERSITY, CORNELL UNIVERSITY, MASSACHUSETT

The Physicians of ANS Jonathan J. Baskin, MD, FACS Dr. Baskin

John H. Knightly, MD Dr. Knightly is a

fellowship trained spine surgeon who a fellowship trained inPRESTIGIOUS spine surgery and PROGRAMS IN THE ANS PHYSICIANS HAVE BEEN TRAINED AT SOME isOF THE MOST NATION INCLUDING ANS PHYSICIANS HAVE BEEN TRAINED AT SOME specializes OF THEinMOST NATION INCLUDING specializes in complex and minimally invasive minimallyPRESTIGIOUS invasive and complexPROGRAMS IN THE THE BARROW INSTITUTE, COLUMBIA UNIVERSITY, CORNELL UNIVERSITY, MASSACHUSETTS GENERAL AND MOUNT SINAI. ANS PHYSICIANS HAVE BEEN AT OF PROGRAMS IN NATION INCLUDING ANS PHYSICIANS HAVECOLUMBIA BEEN TRAINED TRAINED AT SOME SOMECORNELL OF THE THE MOST MOST PRESTIGIOUS PROGRAMSGENERAL IN THE THEsurgeries.

NATION INCLUDING spine HisMOUNT other specialties include spine surgery, tumors ofPRESTIGIOUS the spine, imageTHE BARROW INSTITUTE, UNIVERSITY, UNIVERSITY, MASSACHUSETTS AND SINAI. ® trauma, Cyberknife guided neurosurgery forPRESTIGIOUS brain tumors, spinal PROGRAMS stereotactic surgery, and ANS PHYSICIANS HAVECOLUMBIA BEENTRAINED TRAINED ATSOME SOMECORNELL OFTHE THE MOST PRESTIGIOUS PROGRAMSGENERAL INTHE THENATION NATION INCLUDING THE BARROW INSTITUTE, UNIVERSITY, UNIVERSITY, MASSACHUSETTS AND MOUNT SINAI. THE BARROW INSTITUTE, COLUMBIA UNIVERSITY, CORNELL UNIVERSITY, MASSACHUSETTS GENERAL AND MOUNT SINAI. ANS PHYSICIANS HAVE BEEN AT OF MOST IN INCLUDING ® stabilization, Cyberknife concussion treatment. surgery, and kyphoplasties.

John H. Knightly, MD Dr. Knightly MASSACHUSETTS is a Igor Ugorec, MD Dr. Ugorec is one of the Jonathan J.INSTITUTE, Baskin, MD, FACS Dr. Baskin THEBARROW BARROW COLUMBIA UNIVERSITY, CORNELL UNIVERSITY, GENERAL AND MOUNT SINAI. THE COLUMBIA UNIVERSITY, CORNELL UNIVERSITY, GENERAL AND SINAI. John H. Knightly, MD Dr. KnightlyMASSACHUSETTS is a Igor Ugorec, MD MOUNT Dr. Ugorec is one of the Jonathan J.INSTITUTE, Baskin, MD, FACS Dr. Baskin

is a fellowship trained in spine surgery and is a fellowship trained MD, in spine surgery and Jonathan J.J. Baskin, FACS Dr. Jonathan Baskin, MD, FACS Dr. Baskin Baskin specializes in minimally invasive and complex specializes in invasive and is aa fellowship trained spine surgery and isJonathan fellowship trained in in spine surgery and Baskin, MD, FACS Dr.complex Baskin Jonathan J.J.minimally Baskin, Dr. Baskin spine surgery, tumors ofMD, the FACS spine, imagespine surgery, tumors ofinin the spine, imagespecializes in invasive and complex specializes in minimally minimally invasive and complex is a fellowship trained spine surgery and is a fellowship trained spine surgery and guided neurosurgery for brain tumors, spinal guided neurosurgery for brain tumors, spinal spine surgery, tumors of the spine, imagespine surgery, tumors ofinvasive the spine, imagespecializes minimally invasive and complex ® specializes ininminimally and complex stabilization, Cyberknife surgery, and kyphoplasties. ® stabilization, Cyberknife surgery, andfor kyphoplasties. guided neurosurgery brain tumors, spinal guided neurosurgery for brain tumors, spinal spinesurgery, surgery, tumors thespine, spine, imagespine tumors ofofthe image® ® stabilization, surgery, kyphoplasties. stabilization, Cyberknife Cyberknife surgery, and andfor kyphoplasties. guidedneurosurgery neurosurgery for brain tumors, spinal guided brain tumors, spinal Ronald P. Benitex, MD Dr. Benitz is a Ronald®®P. Benitex, MD Dr. Benitz is a stabilization,Cyberknife Cyberknife surgery, and kyphoplasties. stabilization, kyphoplasties. fellowshipsurgery, trainedand vascular surgeon specializing fellowship vascular surgeon Ronald Benitex, MD Benitz isis aa Ronald P. P.trained Benitex, MD Dr. Dr. Benitzspecializing in minimally invasive techniques. His specialties in minimally invasive techniques.

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4

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Education at William Paterson University in Wayne, NJ. Education Program ataaWilliam Paterson University in she Wayne, NJ. Medical and Clinical Instructor for the Medical Director Director and Clinical Instructor for theAthletic Athletic Training treatment concussion.

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Dr. Rempsonininconcentrates not only on Dr. Rempson concentrates not onlytoto onthe muscles, bones, tissues, and nervous systems. muscles, bones, tissues, and nervous systems. helps patients who suffer injuries the helps patients suffer injuries musculoskeletal injuries, but onwho the rehabilitation of neurologic musculoskeletal injuries, but on the rehabilitation of neurologic Dr. Rempson concentrates not only on Dr. Rempson concentrates not only on muscles, bones, tissues, andnervous nervoussystems. systems. bones, tissues, and disorders such asmuscles, strokes and brain tumors. disorders such asinjuries, strokes andon brain musculoskeletal but the rehabilitation of neurologic musculoskeletal injuries, but on thetumors. rehabilitation ofon neurologic Dr. Rempson concentrates notonly only on Dr. Rempson concentrates not disorders such as strokes and brain tumors. disorders such as strokes and brain tumors. musculoskeletalinjuries, injuries,but buton onStillerman, therehabilitation rehabilitation neurologic musculoskeletal the ofofneurologic Charles Blair MD Dr. Stillerman’s Charles Blair Stillerman, Dr. Stillerman’s disorderssuch suchasas strokes andbrain brain tumors. MD disorders strokes and clinical interest is intumors. thoracic and lumbar trauma. clinical interest isStillerman, in thoracic and trauma.

Charles Blair MD Dr. Charles Blair Stillerman, MDlumbar Dr.Stillerman’s Stillerman’s Named frequently as one of the Best Doctors in Named frequently asthoracic one of the Best Doctors in clinical interest isisStillerman, in and lumbar trauma. clinical interest in thoracic and lumbar trauma.

Charles Blair MD Dr.Stillerman’s Stillerman’s Charles Blair Stillerman, MD Dr. America in Castle Connolly’s Top Doctors, Dr. America in Castle Connolly’s Top Doctors, Dr. Named frequently as one Best Doctors in Named frequently asthoracic one of of the the Best Doctors in clinicalinterest interest in thoracic and lumbar trauma. clinical isisin and lumbar trauma.

Stillerman has written and lectured extensively Stillerman written andofof lectured extensively America in Castle Connolly’s Top Doctors, Dr. America inhas Castle Connolly’s Top Doctors, Dr. inin Named frequently one theBest Best Doctors Named asasone the Doctors on spinal disorders, spinalfrequently injuries, and specifically on thoracic

most highly regarded neurointensivists in the most highly regarded the Igor MD Ugorec Igor Ugorec, Ugorec, MD Dr. Dr.neurointensivists Ugorec isis one one of ofinthe the country.

His expertise invaluable to ANS and Scott Myer, MD Dr. isMyer is a fellowship country.

His expertise is invaluable to of ANS and most highly regarded neurointensivists the most highly regarded neurointensivists in the Igor Ugorec, MDDr. Dr. Ugorec ofin the Igor Ugorec, MD Ugorec isisone the our patients. trained spine surgeon.

His areas ofone clinical our patients. country.

His is invaluable and country.

His expertise expertise isneurointensivists invaluable to toANS ANS and most highly regarded in most highly regarded neurointensivists in the expertise include complex cervical spine the our patients. our patients. country.

Hisexpertise expertise invaluable ANS and country.

His isisinvaluable totoANS and surgery, minimally invasive surgery, David Wells-Roth, MD Dr.spine Wells-Roth has David Wells-Roth, MD Dr.adult Wells-Roth ourpatients. patients. our degenerative spine disease, spinal has specialized fellowship training in endovascular specialized fellowship training in and endovascular David MD Dr. has David Wells-Roth, MD Dr.Wells-Roth Wells-Roth has deformity (kyphosis andWells-Roth, scoliosis), spinal tumors, spinal neurosurgery, cerebrovascular surgery skull base cerebrovascular surgery skull base specialized fellowship training in specialized fellowship training in endovascular endovascular David Wells-Roth, MD Dr.Wells-Roth Wells-Roth has David Wells-Roth, MD Dr. has trauma. Dr. Myerneurosurgery, also maintains a strong interest in neurotrauma surgery, and complex and minimally invasive surgery, andfellowship complex and minimally invasive neurosurgery, cerebrovascular surgery skull neurosurgery, cerebrovascular surgery skull base base specialized fellowship training endovascular specialized training ininendovascular and general neurosurgery. spine surgery.

His specialties include the spine surgery.

His specialties include the surgery, and and invasive surgery, and complex complex and minimally minimally invasive neurosurgery, cerebrovascular surgery skullbase base neurosurgery, cerebrovascular surgery skull treatment of cerebrovascular diseases such as stroke, aneurysms, treatment of cerebrovascular diseases such as stroke, invasive aneurysms, spine surgery.

His include the spine surgery.

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His specialties include theofas the spine surgery.

His the latest spine surgery treatments. board certified byspecialties the American College latest spine surgery treatments. and AVMs using new and innovative technologies as well as the and AVMs using new and innovative technologies as well as the treatment of cerebrovascular diseases such as stroke, aneurysms, treatment of cerebrovascular such as stroke, aneurysms, Osteopathic diseases Family Physicians and her ares of latest spine surgery treatments. latest spineusing surgery treatments. andAVMs AVMs using new andinclude technologies well the and new and innovative technologies asaswell asasthe interest sports medicine and the Edward J.innovative Zampella, MD, FAANS, FACS Edward J. Zampella, MD, FAANS, FACS latest spine surgery treatments. latest spine surgery treatments. treatment of concussion.

Currently, she is the Dr. Zampella’s specialties include surgical Zampella’s specialtiesMD, include surgical Edward J.J. Zampella, FAANS, FACS Edward Zampella, MD, FAANS, FACS Medical DirectorDr. and a Clinical the Athletic management ofInstructor brain andfor spinal tumors, Training management of brain and spinal tumors, Dr. Zampella’s specialties include surgical Dr. Zampella’s specialties include surgical Edward Zampella, MD, FAANS, FACSNJ. Edward J.J.surgery, Zampella, MD, FAANS, FACS Education Program at William Paterson University in Wayne, endoscopic pediatric neurosurgery, endoscopic surgery, pediatric neurosurgery, management of brain and spinal tumors, management of brain andinclude spinal tumors, Dr.Zampella’s Zampella’s specialties include surgical Dr. specialties surgical spinal cord stimulation, intraspinal drug infusion, spinal cord stimulation, intraspinal drug infusion, endoscopic surgery, pediatric neurosurgery, endoscopic surgery, pediatric neurosurgery, management brain and spinal tumors, management ofofbrain and spinal tumors, neurosurgical treatment ofRempson, movement disorders, epilepsy, Joseph MD Dr. Rempson neurosurgical treatment of movement disorders, epilepsy, spinal cord stimulation, intraspinal drug spinal cord stimulation, intraspinal drug infusion, infusion, endoscopic surgery, pediatric neurosurgery, ® endoscopic surgery, pediatric neurosurgery, stereotactic radiosurgery, andin Cyberknife specializes the field of physiatry, surgery.

Dr.which Zampella ® stereotactic radiosurgery, and Cyberknife surgery.

Dr. Zampella neurosurgical treatment of movement disorders, epilepsy, neurosurgical treatment of movement disorders, epilepsy, spinal cord stimulation, intraspinal drug infusion, spinal cord stimulation, intraspinal drug infusion, also has extensive helps experience patients inwho pediatric suffer neurosurgery. injuries to the ® ®neurosurgery. also has extensive experience in pediatric stereotactic radiosurgery, and Cyberknife surgery.

Dr. stereotactic radiosurgery, and Cyberknife surgery.

Dr.Zampella Zampella neurosurgical treatment movement disorders, epilepsy, neurosurgical treatment movement disorders, epilepsy, muscles,ofof bones, tissues, and nervous systems. also has experience in pediatric also has extensive extensive experience in pediatric®®neurosurgery. neurosurgery. stereotactic radiosurgery, andCyberknife Cyberknife surgery.

Dr. Zampella stereotactic radiosurgery, and surgery.

Dr. Zampella Dr. Rempson concentrates not only on alsohas hasextensive extensive experience pediatric neurosurgery. also experience ininpediatric neurosurgery. musculoskeletal injuries, but on the rehabilitation of neurologic disorders such as strokes and brain tumors.

Charles Blair Stillerman, MD Dr. Stillerman’s clinical interest is in thoracic and lumbar trauma.

Named frequently as one of the Best Doctors in America in Castle Connolly’s Top Doctors, Dr. Stillerman has written and lectured extensively on spinal disorders, spinal injuries, and specifically on thoracic and lumbar stabilization.

treatmen and AVM latest sp

neurosur stereotac also has

Since its establishment in 1958 by Henry Liss, MD, ANS has devoted itself to the treatment and management of patients with the full spectrum of neurosurgical disorders, performing surgical procedures involving the brain, spine/peripheral nervous and neurovascular systems.

Treatments and conditions include: • • • • • • • • • • • • • • • • • • • • • • • • • • •

Aneurysm/Neurovascular Artificial Disc Replacement Back and Spine Pain Back and Spine, Complex Surgery Brain and Spine Tumors Brain Endoscopy Brain Mapping Brain Stimulators Cranium, Minimally Invasive

Neurosurgery Endovascular Neurosurgery Essential Tremor/Parkinson’s Facial Pain/Trigeminal Neuralgia Functional neurosurgery Head Injury Hydrocephalus Kyphoplasties Minimally Invasive Spine Surgery Neck Pain Neuro-Oncology Pain Management Peripheral Nerve Disorders Physiatry and Rehabilitation Medicine Pituitary Disorders Radiosurgery Seizure Surgery Spasticity Stroke Treatment

(For detailed information on each, visit www.ansdoc.com) At ANS the goal is to provide patients with access to a multidisciplinary and comprehensive approach to the surgical and in many cases, non-surgical treatment of disease. Besides its mission to provide excellent neurosurgical care, utilizing the most advanced technologies, the fundamental philosophy at ANS is to ensure that every patient has an exceptional experience that includes open, direct and supportive interaction with clinicians and in fact, with each staff member involved in his or her care.

Thomas J. Wood, BS RT CIT is Director of Marketing / Outreach / Education at ANS. He shares the somewhat unique ideals upheld at ANS that separate it from a number of other practices. “We want people to know that surgery is the

last option here,” Mr. Wood emphasizes.

We have a huge network of specialties, including physical therapy and pain management that we can try before surgery. And we’re known for this.

That’s why we are so busy,” he adds. “If you come here for treatment, it doesn’t necessarily mean that you will end up having surgery.”

Another interesting and unique piece of information that Mr. Wood would like to share with referring physicians and prospective patients is that ANS runs one of the largest brain tumor support groups in the state. “We started the ANS Center for Hope Foundation about a year ago with eight brain tumor patients,” Mr. Wood relates. “We now have over fifty or more attendees at each monthly meeting,” he adds. Mr. Wood goes on to explain that the meetings are not only for ANS patients. All brain tumor patients are welcome.

“Hope means different things for different people. Yes, it can be hope for a cure but in many cases that doesn’t happen. So, there can be hope that you won’t suffer or hope that family members won’t have to watch you suffer, or, perhaps hope to tolerate chemotherapy without feeling too ill. So, hope for everyone is different and that’s what the name refers to,” Mr. Wood points out. All of the information concerning the Center for Hope Foundation is available at www.speakingofhope.com, the website designed by ANS for patients and their families.

Certainly one of the most unique and impressive facts about ANS is that the neurosurgeons in its endovascular division treat the largest number of ischemic and hemorrhagic strokes statewide, having affiliation with the three major comprehensive stroke centers in New Jersey. All three centers receive patients who can be transported from any of the facilities within each of their own health systems. As a result, the vast majority of stroke victims within the state can have access to the experienced endovascular neurosurgeons at ANS who are on call 24/7. Utilizing the most advanced technologies and techniques, the ANS surgeons quickly determine the precise location of the stroke, its cause and resulting damage in order to initiate the appropriate treatment as soon as possible. In a great number of cases,

this is accomplished before damage is irreversible.

Ronald Benitez, MD, President of ANS and Director of the Endovascular Division, has taken over the reigns recently to guide the group and continue its success during these changing times in medicine. For Dr. Benitez, the first priority has always been the patient. “We must understand that although we treat illness, we are treating the person,” he states. Dr. Benitez shares that the effort spent by ANS to ensure that patients have a great over-all experience, helps patients to feel supported throughout their treatment.

Dr. Benitez “We created the largest private practice in the state but we still keep those oldtime values ever-present in all we do,” he informs. With expertly-trained physicians from the most elite programs in the country, Dr. Benitez explains that ANS can offer its patients the highest level of subspecialized expertise.

“We use a collaborative approach in everything we do from the minute a patient enters our offices,” Dr. Benitez emphasizes. “We know neurosurgery is very scary, so we make sure to give our patients the answers they need and offer them next generation treatments,” he elaborates. “ANS is so successful because we go the extra mile for our patients to make certain each person gets the best treatment possible, even if surgery is not an option.”

ANS neurosurgeon Kyle T. Chapple, MD sub-specializes in endovascular neurosurgery, minimally invasive, complex spine surgery and also neurovascular skull base surgery. His specialties include the treatment of cerebrovascular diseases such as stroke, aneurysms and arterial venous malformations (AVMs).

“We are uniquely situated with the September 2013

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amount of people we have doing this, to be on call twenty-four hours a day – seven days a week,” Dr. Chapple reports, referring to the other neurosurgeons at ANS, in addition to himself, that are specialty trained in the treatment of cerebrovascular diseases. In fact, Dr. Benitez and Dr. Chapple, along with David Wells-Roth, MD are often called upon by physicians and hospitals statewide to intervene on some of the most complex endovascular and vascular neurosurgical cases.

Dr. Wells-Roth makes a point of emphasizing the significant advantages for stroke patients who are treated by the physicians of ANS. “There are not many places in New Jersey that have the infrastructure to treat strokes on an emergent basis 24/7,” he mentions.

Additionally, the volume of stroke patients treated by ANS throughout the state provides the ability to access the latest technology available.

For example, for the past six months, Dr. Chapple and his colleagues at ANS have been amongst the first endovascular neurosurgeons to use a newly FDAapproved device that can actually remove the clot from the blocked artery.

A stent retriever is deployed inside of the clot, expands to open the clot and re-establish blood flow and then, grips the clot and pulls it out. “It’s remarkable how well this device re-opens vessels, how much clot we can get out and how successful these procedures are now becoming,” Dr. Chapple exclaims.

Once deployed inside the clot, the stent retriever expands to open the clot and reestablish blood flow.

Then, it grips the clot and pulls it out.

that distinguish it. He shares how ANS has evolved over the years, becoming more sub-specialized with each of the neurosurgeons – all with advanced specialty training - to join. “This is really the great thing about our practice,” Dr. Zampella emphatically states. “We see the patients and make sure they are directed to the appropriate physician.”

Dr. Zampella sub-specializes in the surgical management of brain and spinal tumors, spinal cord stimulation, intraspinal drug infusion, neurosurgical treatment of movement disorders, epilepsy, stereotactic radiosurgery and Cyberknife® surgery.

He co-chairs the ANS Center for Hope Foundation along with Brian Beyerl, MD, FACS, who also specializes in brain tumor treatment and Cyberknife® surgery.

Dr. Chapple performs an aneurysm repair using a surgical microscope.

A hemorrhagic stroke, that results from a ruptured aneurysm, although less common than an ischemic stroke, is also emergent. Dr. Chapple, Dr. Benitez and Dr. Wells-Roth are specialty trained to treat the aneurysm in the endovascular suite from inside the blood vessel by filling it with special coils, or by taking the patient to the OR and doing an open craniotomy. During the open procedure a clip is placed across the blood vessel.

“Although things are evolving, it still is a rarity to find neurosurgeons that are able to do both,” Dr. Benitez states, reiterating that ANS is uniquely equipped to offer exceptional care.

Edward J. Zampella, MD, FAANS, FACS is one of the two most senior members of ANS and as such is well-suited to discuss the aspects of the practice

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The aneurysm is exposed.

Another unique specialty ANS offers is deep brain stimulation (DBS) for Parkinson’s disease. “This makes an enormous difference in patients’ lives,” Dr. Zampella states. He would like neurologists and other physicians in New Jersey with Parkinson’s patients to know about DBS, which uses a surgically implanted neurostimulator to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal signals that cause tremor and other symptoms of Parkinson’s disease.

“This technology is greatly underutilized,” he says, alluding to the preference amongst many physicians to treat the symptoms of Parkinson’s with oral medications.

“Although medications do work in the early stages, there comes a time that the side effects of the medications make them more problematic than beneficial,” Dr. Zampella asserts. “There is a huge population of patients out there who would be eligible to benefit from this procedure,” he emphasizes.

Dr. Zampella While discussing his own specialized skills, Dr. Zampella again shares the diversity of specialization within ANS. “I think what makes us great is that we have experts in every area of neurosurgical practice,” he offers. “And when patients come here they will be referred to the physician who is the expert on their particular condition.”

Specialty trained in complex and minimally invasive spine surgery, ANS neurosurgeon, John J. Knightly, MD shares some of the specialized treatment services available at ANS from his perspective. “We do the complete breadth of spine surgery, from simple disc-type operations all the way up to complex scoliosis and tumor work and trauma work, as well,” Dr. Knightly shares.

During an open procedure, a clip is placed across the blood vessel.

“There are very few things in our chest of tools that we don’t have to offer,” he continues.

“Where we really excel is from a diagnostic standpoint,” Dr. Knightly adds, mentioning that a great many people have degenerative changes in their back that may not be responsible for the pain they are having. “Back surgery has gotten a bad reputation which is welldeserved because people are having the wrong procedures done at the wrong time for the wrong indications,” he strongly asserts. “Our mantra here is – ‘make sure the symptoms match the physical findings and match the x-ray findings.’ Then you can craft an appropriate treatment regimen for the patient,” Dr. Knightly states. “We pride ourselves on being diagnosticians first and proceduralists second,” he reports.

In fact, as Dr. Knightly explains, at ANS, many times surgery is not the answer and other, more conservative treatment modalities are utilized. Even when a procedure is indicated, in most cases Dr. Knightly would much prefer starting

with one that is minimally invasive. “We can always do a bigger operation but we can’t undo a big operation. Once you perform a fusion on a patient, you have changed the mechanics in the back forever,” he says, adding that between 80 and 90 percent of the spine procedures Whether less invasive or open spine surgery is required, the advanced sub-specialty training received by Dr. Knightly and the other fellowshiptrained spine surgeons: Jay Y. Chun, MD, PhD, Jonathan J. Baskin, MD, FACS, Charles Blair Stillerman, MD, FACS and Scott Meyer, MD - plus access to the latest technologies, translates into the best possible outcomes. Dr. Meyer, for example, in addition to his expertise in complex and minimally invasive spine surgery, has extensive clinical experience in treating adult spinal deformity (kyphosis and scoliosis).

Dr. Meyer shares that in most cases he spends up to a year or longer with patients overseeing non-surgical treatments such as physical therapy, oral medications and injections in order to avoid surgery.

Dr. Knightly and Dr. Chun.

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“I really enjoy this extended period of time because I get to know the patients very well,” he offers. When, however, a surgical procedure to correct a spinal deformity becomes necessary, Dr. Meyer makes every effort to choose an approach that is as least invasive as possible.

to correct a deformity or other resulting problem. “I find these cases to be very challenging and also rewarding,” Dr. Meyer shares. In fact, he, Dr. Knightly and the other spine surgery specialists at ANS often treat patients who have had unsuccessful procedures elsewhere.

“It depends on what the goal of the surgery is,” Dr. Meyer says, regarding how to determine whether a procedure can be done minimally invasively or if an open surgery is necessary. Of course, the priority is to eliminate pain that has resulted from the deformity and restore a better quality of life. “Sometimes, when a patient has a mild scoliosis, instead of a large, open surgery to decompress the nerve, I can do a minimally invasive nerve root decompression,” he explains, adding that this is accomplished through a small tube. “This spares a lot of the midline structures so that the scoliosis curve doesn’t get worse,” Dr. Meyer elaborates.

It is important for prospective patients and referring physicians to understand the mission that has emerged at ANS over time, in terms of how its patients are treated. It is the philosophy that has become the foundation upon which ANS stands and what truly distinguishes it from other practices. “Every one of the 52 people who are employed here is taught that the patient comes first, before any of the business issues,” states Maryann F. Gomez, Director of Operations at ANS. In addition to her focus on practice management and development, Ms. Gomez has spent the past 15 years making sure patients know that regardless of which insurance they have or what their financial situation is – the priority at ANS is to provide them with whatever treatment is necessary to ensure the best possible outcome.

“If a patient needs a bit more than this, there are other minimally invasive ways to correct the deformity,” informs Dr. Meyer.

For example, he discusses Extreme Lateral Interbody Fusion (XLIF). This procedure entails having the patient lying on his or her side. Dr. Meyer goes behind the abdomen to the lateral part of the spine and inserts an intervertebral device that straightens the spine. This provides improved intervertebral body height and improved neural foraminal height for patients with scoliosis. Dr. Meyer also points out, that with the XLIF, if a subsequent posterior procedure becomes necessary, often there will be less work for him to do.

Although most spinal deformities are degenerative, sometimes a patient can develop a deformity as a result of a prior back surgery. At times, Dr. Meyer sees patients who were previously treated by other surgeons. Often, they require a revision of a fusion or other procedure

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Unfortunately, in order to have the ability to do just that, the physicians of ANS felt compelled to withdraw from some of the insurance networks that were tying their hands by refusing to cover, or substantially reducing coverage for certain crucial clinical services. Especially for the critically ill, such as those with malignant brain tumors, or tumors of the spine, restricting how they could be treated was unacceptable.

So that the neurosurgeons at ANS can provide care to those who desperately need it, Ms. Gomez and the expert staff of billers and certified coders at ANS work tirelessly, especially for those out

Dr. Baskin of network patients, to overcome the financial obstacles.

While ANS does participate with Medicare, Medicaid, Beech Street, Multiplan and QualCare, Ms. Gomez explains that often patients with other major insurance plans are unaware that their carriers do have arrangements with Beech Street and Multiplan, usually indicated by a small logo on the back of the card that can be implemented.

Even when patients are totally out of network, the insurance experts at ANS negotiate extensively with the company in question in an effort to obtain some reimbursement.

When a balance remains, ANS sets up individuallydesigned payment plans with their patients that are structured specifically for each person’s financial situation.

“To be able to tell patients to come here because our physicians are the best is not something we take lightly,” Ms. Gomez says. “You have to live up to that.”

For more information about Atlantic Neurosurgical Specialists call (973) 285-7800 or visit www.ansdocs.com

ACOs

Reform Update: ACO contracts may slow spending, but quality may not improve, says study

By Melanie Evans As accountable care organizations proliferate, a new study suggests that overall health spending may slow when hospitals and medical groups agree to the new payment model with even one insurer. That's good news for proponents of accountable care, who hope to see a change in healthcare financing lead to a fundamental change in healthcare delivery.

Now the bad news: The quality of care may not improve for all patients.

Quality gains may be limited to patients whose insurer enters into an accountable care contract, the study found. Results, published in the Journal of the American Medical Association, point to potentially uneven progress on two primary aims of the 2010 health reform law: slowing the nation's escalating healthcare costs and improving its erratic quality. The law includes the launch of an accountable care program under Medicare that has expanded to include about 250 organizations and is scheduled grow further in January.

More Policy Articles The finding that did not surprise doctors involved in accountable care research and operations.

“It does make sense,” said Dr. Richard Parker, chief medical officer of Beth Israel Deaconess Care Organization, Boston, an accountable care organization that includes the Beth Israel Deaconess Medical Center.

The study analyzed healthcare spending and quality for Medicare patients treated by providers participating in a Massachusetts Blues commercial accountable care contracts. The Blues contracts, first introduced in 2009, include incentives to control spending and meet quality target, and data published in Health Affairs last fall found a drop in spending (3.3% for the second year) and better quality.

Results for Medicare patients during the same period show a drop in spending (3.4% in year two) compared with projected spending based on trends from a control group.

But quality gains were confined to two cholesterol screening measures for diabetics and heart disease patients. The researchers look at seven quality measures.

The cost and manpower needed to create programs that improve quality can also limit their enrollment, Parker said. Accountable care provides financial incentives for such investments, but those incentives are limited.

Doctors have an easier time reining in costs, said Parker. For example, doctors may reduce spending by more judicious use of some commonly overused laboratory or imaging tests.

Dr. J. Michael McWilliams, an assistant professor of healthcare policy and medicine at Harvard University and one of the study's three authors, said information technology has also helped to make changes in delivery that slow spending more broadly than targeted interventions for patients with gaps in care or complex medical needs.

McWilliams, also a practicing physician at Brigham and Women's Hospital, said an example of more systemic, cost-savings strategies might be electronic medical records that now contain alerts when doctors order an overused test, such as imaging for low-back pain.

Declines in spending for imaging, minor outpatient procedures and office visits accounted roughly one-third of the spending slowdown among Medicare patients cared for by the providers in the Blues accountable care organization contracts.

Such technological interventions “don't discriminate based on insurance,” McWilliams said.

Blue Cross Blue Shield of Massachusetts officials were also unsurprised by the results.

Patients outside the accountable care contract, such as those enrolled in Medicare, do not have the benefit of data analysis the insurer provides to improve quality, said Dana Gelb Safran, senior vice president for performance measurement and improvement for Blue Cross Blue Shield of Massachusetts.

Monthly data provided by the Massachusetts Blues to doctors with accountable care contracts helps physicians quickly identify patients who need follow up or further care, she said. Access to timely data allows doctors to spot gaps in care that can undermine quality.

The insurer's internal data underscores the value of the data. Blues members not included in accountable care contracts, those in preferred provider organizations, have not seen the same quality gains as Blues members in health maintenance organizations who are included in the contracts. To remedy that gap, the insurer is moving this year to provide data to PPOs and starting in January will introduce financial incentives for PPOs tied to quality and spending.

Rising costs, the ACA and employers Employers, responding to the Patient Protection and Affordable Care Act and rising healthcare costs, have made news in recent weeks with changes to workers' health benefits. Modern Healthcare's Rachel Landen reported in this week's magazine on some of the latest employers, such as the University of Virginia and Penn State, to announce new coverage restrictions for workers' spouses and incentives for wellness programs. The ACA allows employers to increase the incentives for wellness programs starting in 2014.

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Health Law Update

HEALTH LAW Update CMS Reduces Payments to Hospitals with High Readmission Rates

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule updating Medicare payment policies for fiscal year 2014, including a policy under the Hospital Readmissions Reduction Program (HRRP) that reduces regular payments to hospitals with high readmissions rates by up to two percent. Established under the Affordable Care Act and implemented by CMS in October 2012, the HRRP applies to discharges on or after October 1, 2012. The program reduces payments to hospitals with high 30-day readmission rates for acute myocardial infarction, heart failure and pneumonia patients. The final rule increases the maximum reduction from one to two percent for FY 2014.

The two percent reduction in regular payments to hospitals will result in a total decrease of approximately $227 million in payments for FY 2014. Over 2000 hospitals across 49 states will receive reduced payments for a year starting on October 1, 2013, with 18 hospitals receiving the maximum reduction of two percent and 154 hospitals receiving a reduction of one percent or more. Among the top ten New Jersey hospitals receiving reductions are Liberty Health-Jersey City Medical Center (2%), Saint Michael’s Medical Center, Newark (1.66%), Palisades Medical Center, North Bergen (1.48%), St. Joseph’s Regional Medical Center, Paterson (1.45%), Christ Hospital, Jersey City (1.37%), Raritan Bay Medical Center, Perth Amboy (1.37%), Kimball Medical Center, Lakewood (1.31%), Underwood Memorial Hospital, Woodbury (1.25%), Kennedy University Hospital, Stratford (1.19%) and Hoboken University Medical Center, Hoboken (1.18%).

For more information, contact: Debra C. Lienhardt | 973.364.5203 | dlienhardt@bracheichler.com Joseph M. Gorrell | 973.403.3112 | jgorrell@bracheichler.com

CMS Finalizes Changes to Hospital Inpatient Guidance, With 2-Midnight Rule The Centers for Medicare & Medicaid Services (CMS) recently released additional guidance regarding inpatient hospital admissions.

In the past, CMS used 24 hours as the standard for determining reimbursement for hospital stays. Under CMS’s revised criteria, a hospital stay must generally encompass at least two midnights in order for the stay to be considered an inpatient hospital stay.

The CMS rule provides that services designated on the Outpatient Prospective Payment System (OPPS) Inpatient-Only list as inpatientonly will continue to be appropriate for inpatient hospital admission and payment under Medicare Part A. However, surgical procedures, diagnostic tests, and other treatments will be deemed appropriate for inpatient hospital admission when the physician expects the patient to require a stay that crosses at least two midnights. If an unforeseen circumstance, such as death or transfer, results in a shorter stay, the patient may still be considered to be appropriately treated on an inpatient basis.

For purposes of determining whether the two-midnight benchmark will be met, the physician should account for time the patient spends as an outpatient for services such as observation services or treatment in the emergency department. The Medicare reviewers will generally consider stays that are less than two midnights to be inappropriate inpatient hospital admissions and will be subject to further review.

The time spent as an outpatient will not be counted toward whether the two-midnight benchmark is met but will be considered during the medical review process when evaluating whether a stay shorter than two midnights is appropriate for payment as an inpatient hospital stay under Medicare Part A. For more information, contact: Carol Grelecki | 973.403.3140 | cgrelecki@bracheichler.com Lani M. Dornfeld | 973.403.3136 | ldornfeld@bracheichler.com

Physician Lawsuit Against United Healthcare for Failure to Reimburse Allowed To Proceed The U.S. District Court for the Eastern District of New York recently ruled, in Josephson v. United Healthcare Corp., E.D.N.Y., No. 2:11-cv3665, 7/24/13), that a physician and his medical practice entity were not time-barred, under the six-year statute of limitations, from bringing suit against United Healthcare for alleged failure to reimburse the plaintiffs the proper amounts for medically necessary procedures. The plaintiffs were parties to a class action that asserted the same claims against United Healthcare, but filed a new action shortly after opting out of the class.

The physician is an ear-nose-throat physician specializing in endoscopic sinus surgery. Ingenix Inc., a United Healthcare subsidiary, developed and sold a database that helped insurers determine the usual, customary, and reasonable rate (UCR) for medical services.

Under its agreements with members, if a United Healthcare member seeks medically necessary treatment from an out-of-network provider, such as the physician plaintiff, United Healthcare is obligated to reimburse the member or provider the UCR for the services

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rendered. The plaintiffs alleged that Ingenix manipulated the data in the database that governs UCR determinations, leading to lower UCRs, which in turn caused the plaintiffs to be underpaid for services rendered.

The plaintiffs were originally part of a class action filed against United Healthcare on March 15, 2000 alleging falsified UCRs. The plaintiffs opted out of the class action in 2010 to pursue their individual claims. On March 3, 2011, the plaintiffs commenced the present action against United Healthcare. United Healthcare argued to have the suit dismissed on the basis that the claims were timebarred by a six-year statute of limitations. However, the court ruled against United Healthcare, ruling the claims were tolled during the period when the plaintiffs were parties to the class action. Therefore, the suit will be allowed to proceed.

For more information, contact: Joseph M. Gorrell | 973.403.3112 | jgorrell@bracheichler.com Keith J. Roberts | 973.364.5201 | kroberts@bracheichler.com

DOBI Proposes Readopted Regulations for Third Party Administrators and Third Party Billing Services The New Jersey Department of Banking and Insurance (DOBI) has proposed a re-adoption, with amendment, of the regulations governing Third Party Administrators (TPA) and Third Party Billing Services (TPBS), which expired in 2010 but has continued in effect under Executive Order. A TPA is a person or entity that processes and pays health or dental claims on behalf of an insurance company or other payer without the assumption of risk. A TPBS is a person or entity that is paid by a health care provider to process claims or claim payments on behalf of the health care provider, and that is not an employee, affiliate or subsidiary of the health care provider.

Under New Jersey law, every TPA doing business in New Jersey must be licensed or registered with DOBI, and every TPBS doing business in New Jersey must be certified by DOBI. The proposed readoption sets forth the procedures for a TPA to become licensed or registered and for a TPBS to become certified. If adopted as proposed, temporary TPA and TPBS registrations will no longer be available. In addition, DOBI may request additional information from TPA and TPBS applicants, and the failure to provide that information within 45 days will be considered a withdrawal of the application. Also, the readopted regulations would provide more detailed rules regarding what information TPAs and TPBSs must make available to DOBI for inspection. Finally, the readopted regulations would clarify the financial reports that a TPA or TPBS must provide to DOBI on an annual basis.

For more information, contact: Carol Grelecki | 973.403.3140 | cgrelecki@bracheichler.com Kevin M. Lastorino | 973.403.3129 | klastorino@bracheichler.com

New Jersey Bills May Impact Providers A3717 (analogous to S2492), an act concerning the submission of certain mental health records to the federal National Instant Criminal Background Check System, was signed into law on August 8, 2013. The law requires certain mental health records required by federal law to be submitted to the National Instant Criminal Background Check System (NICS).

S1253 (analogous to A1665), an act concerning health care coverage for mental health services and alcoholism and other substanceuse disorders and revising parts of the statutory law, was absolutely vetoed by Governor Christie. The bill would have required state health benefit programs provide coverage for non-biologically based mental health disorders, including alcoholism.

S2100 (analogous to A3133), passed the Senate on August 19, 2013. The act would expand the definition and licensure requirements for health care service firms and require health care service firms to obtain accreditation. In addition, the bill would require companion services to be provided only by health care services firms or licensed home health agencies.

S2842 (identical to A4241), an act concerning medical marijuana, was conditionally vetoed by Governor Christie on August 19. 2013.

On the same day, the Senate voted to approve the conditions, including, in part, a requirement that two physicians provide approval before a minor obtains medical marijuana.

S2916 was introduced to the Senate on July 29, 2013. The bill would require Federally Qualified Health Centers (FQHCs) to provide services at times and locations to ensure availability and accessibility, provide emergency medical services, and establish arrangements with other providers for emergency care when the FQHC is closed.

S2923 (analogous to A4304 introduced in June) was introduced in the Senate and referred to the Senate Commerce Committee on July 29, 2013. The bill would revise the “Physical Therapist Licensing Act of 1983� by expanding the scope of practice of physical therapists.

For additional information, contact: John D. Fanburg | 973.403.3107 | jfanburg@bracheichler.com Mark Manigan | 973.403.3132 | mmanigan@bracheichler.com September 2013

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Insurance Issues

Insurance Issues

Aetna pulls out of 'Obamacare' health exchange

By Ed Beeson and Dan Goldberg Aetna announced today that it no longer plans to offer health insurance on the new health care exchanges established by the Affordable Care Act. The announcement comes just weeks before hundreds of thousands of New Jerseyans will begin enrolling.

"This decision was not made lightly and it is important to note that our existing business in the state is not impacted," said Susan Millerick, a spokeswoman for the health insurance company. "We came to this decision as part of our ongoing review of Aetna’s overall company strategy, including the impact of the Coventry acquisition which closed in May, after the original exchange filings were submitted for both companies. We are taking a measured, multi-year approach to exchanges and we will continue to assess our ability to participate on NJ's exchange in 2015 and beyond."

That leaves three options for New Jerseyans to choose from when enrollment on the new exchanges begin Oct. 1 — Horizon Blue Cross Blue Shield, AmeriHealth New Jersey and Health Republic Insurance of New Jersey.

The exchange is a marketplace where private insurance companies will offer health insurance options. Most of New Jersey's uninsured population will qualify for federal subsidies to help them purchase insurance from the exchange. Enrollment begins Oct. 1 and runs through March 31. Coverage begins Jan. 1.

Aetna serves 1.7 percent of the state's individual health insurance market, behind United Health, Amerihealth and Horizon, according to data kept by the Department of Banking and Insurance. It plays a bigger role among small employer health plans, capturing about 13 percent of the market between two units.

Joel Cantor, director of the Center for State Health Policy at Rutgers University, said there’s a potential impact on premiums if the health market is dominated by one carrier. Less competition also could put less pressure providers to cut medical costs. But he did not see Aetna’s departure as too big shake-up overall.

“I don’t see a huge negative consequence.," Cantor said. "More competition is better but I don’t think consumers will notice higher prices. They will notice less choice."

He said it would be “a little premature” to see an insurer pulling out of the exchange at this point as a sign of failure in the Affordable Care Act. But insurers that sign up for the exchange are taking a calculated gamble. There is no way to know how many people will enroll.

Joining the exchange requires a large technological investment by the carrier, which might not be worth making if not enough people sign up for the plans they offer.

“There’s going to be quite a long shakeout period,” Cantor said.

Freelancers CO-OP given green light from N.J. to operate insurance plan under Obamacare

By Dan Goldberg The Star-Ledger Freelancers CO-OP of New Jersey has been given the go-ahead to compete for consumers on the new federal health insurance exchange being rolled out this fall.

The insurance plan, called Health Republic Insurance of New Jersey, will be one of several options the uninsured and self-insured can choose from when they begin enrolling on Oct. 1.

The Affordable Care Act, also known as Obamacare, requires almost every American to either purchase insurance or pay a fine.

“HRINJ is anxious to offer quality health insurance to New Jerseyans through a positive and innovative health insurance experience,” said James Martin, executive director and CEO of Health Republic.

Co-ops are health insurance companies that are essentially run by consumers. It’s the same concept as a farm or dairy co-op, only applied to a health insurance company. Health Republic will have a majority of its board of directors made up of its own customers. This, the company claims, allows them to be more nimble and provide better customer service than a large health insurance company.

But it also presents the challenge of creating a new business in a saturated market. Freelancers CO-OP will compete on the exchange with large players such as Horizon and AmeriHealth New Jersey. None of the companies have announced their rates, but those are expected to be released in coming weeks.

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The Affordable Care Act, seeking to stimulate competition, provided billions of dollars in loans for co-ops like Health Republic, which received $107 million. The loan program has caused consternation among House Republicans wary of these companies’ ability to repay the money.

Darrell Issa (R-Calif.), chairman of the House Oversight and Investigations Committee, has asked if co-ops such as Health Republic will be able to attract enough customers to remain viable, and enough revenue to meet expenses and pay claims.

“New Jersey consumers should absolutely be concerned,” said Ali Ahmad, a House Oversight and Government Reform Committee spokesman. “When co-ops default, taxpayers lose but so do consumers who purchased coverage through the co-op.”

Cynthia Jay, director of marketing and strategic outreach for Health Republic said yesterday the company will be profitable in three years and intends to repay the loan.

“The release of the loans was based on a stringent application process,” she said.

The company plans to enroll 20,000 members in 2014 and 40,000 by 2016, Jay said.

Health Republic has been approved by the New Jersey Division of Banking and Insurance, which requires a detailed feasibility plan, including a marketing strategy and funding source.

The Newark-based company has also partnered with Qualcare, which has a network of 28,000 providers. That will give Health Republic a head start on spreading the word to consumers looking to purchase a health plan.

The company still needs federal approval to be listed as a qualified health plan on the exchange and that application is pending. If that is obtained, Health Republic plans to offer health insurance products on the company website and through a selective network of insurance agents and brokers.

Visit us now online at www.NJPhysician.org

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MGMA News

MGMA News

In this Issue:

• MGMA comments on proposed 2014 Medicare physician fee schedule • How will ACA exchange implementation impact your practice?

• MGMA responds to CMS request for comments on the potential release of Medicare physician data • Free webinar offered on revised 1500 form MGMA comments on proposed 2014 Medicare physician fee schedule MGMA recently submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the proposed 2014 Medicare physician fee schedule (PFS). The proposed rule, released July 19, is expected to be finalized in November.

Along with other recommendations to the agency, MGMA advocated for CMS to: • Address the burdensome and complicated nature of the multiple Medicare quality reporting programs and allow physicians to meet criteria by reporting through a single program • Withdraw a proposal to cap payment for 211 services where the physician fee schedule nonfacility payment is higher than the total payment to furnish the same service in a facility setting • Withdraw a proposal to increase the number of required PQRS measures from three to nine • Finalize complex chronic care management services but reconsider the complexity of the proposed requirements to furnish the services • Withdraw a proposal to expand the 2016 value-based payment modifier program to groups of 10 or more eligible professionals • Work with Congress to address the projected 24 percent cut in physician payments by permanently fixing the broken Medicare sustainable growth rate formula and replacing it with a more stable and predictable payment update mechanism As a member benefit, MGMA provides a comprehensive analysis of the proposed 2014 Medicare PFS. Members with questions about the proposed rule or MGMA's comments are encouraged to contact the government affairs department at 202-293-3450 or by email at govaff@mgma.com.

How will ACA exchange implementation impact your practice?

As the ACA exchange enrollment period approaches, MGMA is conducting research to better understand the impact of the Affordable Care Act (ACA) exchange implementation on practices. ACA health insurance exchanges are scheduled to open for enrollment on Oct. 1 with coverage effective as early as Jan. 1, 2014. As states and the healthcare industry prepare for the ACA exchanges, there is considerable variability across the country regarding readiness for the upcoming deadlines and where private payers are in the process of contracting with providers for these ACA exchange products.

This brief poll focuses on how practices are preparing for ACA exchanges and what factors are taken into consideration when determining whether a practice contracts with an ACA exchange product.

Your feedback is vital! Please take 5-10 minutes to complete this questionnaire.

MGMA responds to CMS request for comments on the potential release of Medicare physician data On Sept. 5, MGMA, along with the American Medical Association and 95 other medical associations, sent a letter to the Centers for Medicare & Medicaid Services (CMS) in response to their request for comment on the potential release of Medicare physician claims data. This request comes after a Florida district court lifted an injunction that previously prohibited the Department of Health and Human Services from disclosing this data. As a result of this ruling, entities may now submit Freedom of Information Act (FOIA) requests seeking access to Medicare physician reimbursement information, which CMS will evaluate on a case-by-case basis. In light of this change, CMS is looking for input on potential modifications to its current data release policy.

In the letter to CMS, we expressed support for the appropriate use of Medicare claims data to inform and improve the quality of patient care, while also safeguarding against potential abuses that could negatively impact healthcare outcomes or diminish the privacy of Medicare physicians and patients. To address these concerns, we state our support of the protections currently available under the Affordable Care Act (ACA) and implementing regulations, which ensure that disclosures are appropriate and include certain procedural safeguards such as appropriate risk-adjustment procedures and specified attribution methods for any public reports utilizing the information. Lastly, the letter encourages CMS to partner with physicians and stakeholders to develop policies that will promote the reliable and effective use of this information.

14 New Jersey Physician

Free webinar offered on revised 1500 form The Workgroup for Electronic Data Interchange (WEDI), a federal advisory group to the Department of Health and Human Services, is offering a webinar on Sept. 17 focused on the professional paper claim form, known as the 1500 claim form. The 1500 claim form has been updated to accommodate the reporting needs for ICD-10 and aligns with requirements in the 837P electronic claim.

MGMA is a member of WEDI and serves on its board of directors. There is no charge to participate in this webinar.

This program will walk through the key changes and discuss the efforts needed to implement the updated form. The first part of this webinar will describe the update and approval process, provide detailed information about each change, explain the transition timeline and provide an overview of the steps practices need to take now. The second half of the webinar will review one practice management vendor's work to implement changes for the new claim for

Hospital Rounds

HOSPITAL ROUNDS RWJF backs publication of Medicare physician data

By Joe Carlson The Robert Wood Johnson Foundation has joined the entities urging the CMS to publish the Medicare earnings and de-identified clinical data of individual physicians. But the foundation stopped short of calling for widespread public release to any interested party.

In recent years, the CMS has published several datasets for the first time, including average hospital charges for common Medicare treatments and the prescribing patterns of doctors in Medicare's drug-benefit program. Now a ruling this year in a 34-year-old lawsuit is prompting the agency to consider releasing a long-sought dataset that would show how individual doctors care for and are paid to treat patients on Medicare.

The CMS is accepting public comments on the question until early next month. The request for comment on the topic says public interest in the information has increased given the major expansion in the Medicare program and the greater impact of fraud, waste and abuse on the program.

Proponents of publishing the dataset say it could be used to ferret out unusual activity that could point to fraud and to inform patients about which providers have enough experience with specific procedures to be considered reliable. The chief barrier is physician privacy—specifically, that showing how much individual practitioners earned from Medicare could violate their privacy rights.

Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, urged the agency to find a way to protect physician privacy while putting the data in the hands of “entities that are reasonably experienced with handling data and will partner with CMS in the common goal of achieving high-value care in the public and private sectors.”

Her letter cited several examples of research initiatives that pool data to analyze cost and use trends in healthcare that could become more effective if they had Medicare statistics on individual doctors. She noted that the CMS could address physician concerns by producing private reports for doctors that could be fact-checked before public release.

This month the Association of Health Care Journalists submitted comments calling for full public release of the data.

“The value of such information to the public far outweighs any privacy claims of physicians,” says the letter signed by Executive Director Len Bruzzese (PDF). “As long as patient confidentiality is protected, we see no reason why taxpayers should not know how individual physicians are spending public dollars.”

The American Medical Association and the Florida Medical Association have fought to block any such release for decades, starting with a lawsuit in U.S. District Court in Jacksonville, Fla., that resulted in a 1979 permanent injunction barring the data from becoming public.

On May 31, a federal judge tossed out the 34-year-old order, but handed the Obama administration a new legal question at the same time: Should the privacy exceptions in the Freedom of Information Act bar the release, now that the Florida injunction no longer applies?

The CMS has not announced a timeline for resolving the issue.

September 2013

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Affordable-Care Model Gets Big Boost with Partnership of Horizon, Barnabas Andrew Kitchenman

Agreement between state’s largest health plan and biggest healthcare delivery system points to potential of coordinated care.

Dr. Anthony Slonim, chief medical officer and executive vice president of Barnabas Health A new partnership bringing together the state’s largest health insurance plan and its largest healthcare delivery system signals a new focus on coordinating the care of elderly patients in New Jersey.

The accountable care organization (ACO) announced by Horizon Blue Cross Blue Shield of New Jersey and Barnabas Health is a landmark event in the growth of the new approach to healthcare delivery in which insurers pay providers to better coordinate care in order to reduce unnecessary tests and treatments while aiming to have no drop-off in the quality of care.

The ACO arrangement between the two health giants is scheduled to begin September 1 for patients covered by Horizon’s Medicare Advantage plan, a private health plan that provides Medicare services.

“What we know is we need to enhance the communication among and between all parties who work to advance healthcare for patients,” and the ACO puts the system in position to do that, said Dr. Anthony Slonim, Barnabas’ chief medical officer and executive vice president. “When you have the largest delivery system and the largest payer working together to solve challenges, only good can come from that.”

Slonim described the ACO as a way “to think differently about the way we provide care to populations of patients,” with “populations” being the operative word. Instead of measuring the health outcomes of individual patients, the ACO will measure whether it is providing needed services to entire groups.

Slonim said he hopes patients will experience “a new and improved level of service,” including getting more feedback from Barnabas staff about how the patients can participate in their own care. For example, when a patient is hospitalized with a chronic condition, the Barnabas staff will be paid under the ACO to help the patient schedule appropriate care after being released.

Slonim said providing the increased level of service “will take thinking and coordination and perhaps staff member education.”

Another key feature of ACOs is that providers will share in savings that result from the coordinated approach.

Horizon Vice President Jim Albano, who oversees Horizon Health Innovations and network management, said in a statement that the arrangement underscores the companies’ mutual desire to transform care delivery.

“Collectively, these accountable care innovations inject a new level of collaboration and quality standards into our health delivery system and help remove wasteful, unnecessary costs,” he said.

A Horizon spokesman said the ACO is part of a broader “patient-centered” approach that is transforming the company’s payment structures from fee-for-service, in which providers are paid for each service they provide, to “pay-for-value.”

He said Barnabas and its doctors are taking on more accountability, since their pay will depend in part on whether outcomes improve while costs are controlled.

“Simply put, Horizon wants to reward the health care leaders who deliver better outcomes and more efficient health care to our members,” Horizon spokesman Thomas Vincz said.

The ACO is Horizon’s fifth announced over the past 12 months, and the company plans to continue to expand its patient-centered programs with providers, Vincz said.

In July, Horizon announced that it saw benefits in 2012 from its patient-centered medical home program its patient-centered medical home (PCMH) program, which – similar to ACOs – include payments for increased care coordination.

Participants in the program had a 3 percent higher rate of breast-cancer screenings, an 11 percent higher rate of pneumonia vaccinations, a 23 percent lower rate of hospital inpatient admissions, a 12 percent lower rate of emergency room visits, and a 9 percent reduction in the cost of care for diabetic patients.

Horizon officials see these results as boding well for the Barnabas ACO. “Patient-centered primary care is the core foundation for both PCMH and ACO programs,” Vincz said.

Barnabas was approved by the federal Centers for Medicare and Medicaid Services for a separate ACO in July 2012. Slonim said the healthcare system has been building the infrastructure for that ACO over the past year but it’s too early to measure results.

Seven N.J., Pa. systems form alliance to focus on population health management

By Beth Kutscher Seven systems that include 25 hospitals in New Jersey and Eastern Pennsylvania have formed an alliance to build expertise in population health management and capitalize on economies of scale without the complications of merging assets.

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Known as AllSpire Health Partners, the network's organizations have combined revenue of $10.5 billion. The systems are the latest to band together in an arrangement that the participants believe will deliver the benefits of scale without giving up their independence.

In July, more than 20 hospitals in central and south Georgia formed Stratus Healthcare, a consortium that now includes about 2,000 physicians and more than 18,700 employees.

Earlier that month, three systems in the Philadelphia area similarly formed a limited liability corporation to gain population health management expertise. The systems will focus first on managing healthcare benefits for their combined 32,000 employees.

But Dr. Ron Swinfard, president and CEO of the Lehigh Valley Health Network in Allentown, Pa., and an AllSpire board officer, said the group is not jumping on a bandwagon and had been in discussions for “quite some time.”

“We've chosen our partners wisely,” he said.

Members of AllSpire Health Partners also include Atlantic Health System, Morristown, N.J.; Hackensack (N.J.) University Health Network; Lancaster (Pa.) General Health; Meridian Health, Neptune, N.J.; Reading (Pa.) Health System; and WellSpan Health, York, Pa. Karen Kessler, chairwoman of the boards of trustees at both Atlantic and AllSpire, said each of the systems has explored acquisitions in its respective market—but the goal wasn't a merger. AllSpire's focus is on sharing best practices, managing healthcare in the region and harnessing the group's collective purchasing power.

“I think that we recognize that we're at the forefront of what will probably be a growing trend,” she said. “Those that try to go it alone are really at a disadvantage.”

Each of the systems will make a “seven figure” contribution to the new limited liability company, Kessler said, adding, “This is serious.”

Although the participants will retain their existing relationships with group purchasing organizations, one element of the alliance will be joint purchases, for example pharmaceuticals and health information technology.

But the main thrust of the alliance is the “triple aim”: better care for patients, better care for populations and lower costs.

Like the alliance in Philadelphia, AllSpire will start with the systems' own employees as the “training wheels” to gain expertise in population health management, Swinfard said. Members will also share their individual efforts with care coordination, including Lehigh Valley's continuing care teams and robust home health network at Lancaster General.

“That kind of scale makes us unique,” Kessler said. “We have a very diverse patient base. And I think that's going to be very valuable and an asset as we move forward.”

Friendly, Compassionate Staff to Serve the Urban Patient The Smith Center for Infectious Diseases and Urban Health was developed to address infectious diseases in the inner city.

This non-profit center, which is initially focusing on HIV, recognizes that inner city patients face many unique challenges in their daily lives. These challenges interfere with treatment of infectious diseases and foster an environment where infectious diseases are easily spread.

When you treat a person with HIV, you greatly reduce the chances of transmission and treat the whole community. In the past 10 years there have been incredible advances in HIV treatment. We at the Smith Center believe that by using novel approaches we can rid New Jersey of HIV. We have designed programs to incentivize patients to continue their medications. We have created a personal atmosphere, where each patient is known by her or his first name. We work with our patients to ensure that we are providing the best service possible.

Dr. Stephen Smith - named a Top Doctor of New Jersey by Castle Connolly 310 Central Avenue, Suite # 307 • East Orange, NJ 07018 Phone: 973-809-4450 Fax: 973-395-4120 • www.smithcenternj.org

September 2013

17

NEW JERSEY STATEHOUSE Statehouse

Student loan forgiveness to keep doctors in N.J? It could happen

By Dan Goldberg In an effort to decrease New Jersey's physician shortage, the state Senate Education Committee on Thursday passed a bill that would forgive student loans for doctors who work in under-served areas of New Jersey for at least 10 years.

The bill, which now moves to the full Senate, is sponsored by State Sen. Robert Singer (R-Ocean) and based on a 2010 recommendation from the New Jersey Council of Teaching Hospitals, which predicted the state will be short 2,800 family doctors and specialists by 2020 unless the state becomes a more appealing place to open a practice.

Loan forgiveness was a "top factor" in choosing where to practice, the council's report found.

“By providing these incentives we can attract more doctors to needed specialties and assure New Jersey residents aren’t left with insufficient care,” Singer said. “With a growing demand for doctors and predicted shortage in many specialties in the next decade we have to act now to attract the best-trained physicians.”

Singer acknowledged it was very unlikely the bill would become law this legislative session, but said the point was to begin a debate over how to keep doctors from fleeing the state.

"This starts the discussion and helps me mold a better piece of legislation," Singer said. The Senator added that in the next legislative session, he'd like to add incentives for doctors in under-served areas to hire new physicians. These incentives, Singer said, could take the form of tax credits, which would help offset the cost of salary and additional malpractice insurance.

The state has a significant shortage of primary care physicians, said Deborah Briggs, President and CEO of the New Jersey Council of Teaching Hospitals. Because of that, she said, patients are more likely to seek specialist care, which is far more expensive and raises the costs of medical care for everyone.

Briggs said other states are being far more aggressive when it comes to courting medical students.

"New Jersey is really behind the eight ball," she said.

For example, New York put in place a loan-repayment program that awarded $11 million to doctors — in needed specialties — to repay medical school loans in exchange for a five-year commitment to work in under-served communities. An additional $11 million was set aside to help physicians expand or establish medical practices.

The Advisory Graduate Medical Education Council, in consultation with the New Jersey Council of Teaching Hospitals, would determine which specialties are projected to have a significant shortage. Underserved areas are those which have been ranked by the Commissioner of Health and Senior Services on the basis of health status and economic indicators.

“Perhaps more significantly, the demand for doctors is increasing because of the growing population of seniors,” Singer concluded.

“It takes years to train a physician so we need to begin now because as the baby boom generation begins to retire we need to ensure that we have enough doctors to care and provide for everyone’s medical well-being.”

Visit us now online at www.NJPhysician.org 18 New Jersey Physician

Where does insurance fraud end in New Jersey?

NJInsuranceFraud.org

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RUTGERS

Rutgers

Rutgers Nursing Schools Aim to Transform Urban Health Care

Mobile health care program and community wellness center team up to dramatically expand reach

By Carrie Stetler One Rutgers, A World of Discovery The new Rutgers, combining nearly 250 years of academic excellence with a renewed commitment to medical education, is inspiring faculty, students and staff to form innovative partnerships in academic research and public service. In an online series, Rutgers Today examines the new ways that members of the university community are collaborating, across a wide range of disciplines, to better meet the needs of the people of New Jersey and beyond.

– The Editors It’s Cindy Sickora’s job to make sure that every weekday, the Rutgers School of Nursing’s health care van is there to help the people who need it. Its patients, mostly from Newark, are elderly residents in buildings without elevators, gunshot victims in need of follow up care, and children booked for vaccines in a city with one of the nation’s lowest vaccination rates.

Many are public housing residents with no health insurance or primary care doctor. Although the traveling clinic treats more than 1,500 patients a year, the city’s need for affordable, accessible health care is overwhelming.

Sickora, an associate professor at the Rutgers School of Nursing, part of the former University of Medicine and Dentistry of New Jersey, was searching for a way to reach more people.

She found it when she met Suzanne Willard.

On the other side of Newark, Willard had opened FOCUS Wellness Center last fall on Broad Street. The wellness center is part of the Rutgers College of Nursing, which was founded at the university in 1955.

Both began working together as Rutgers was preparing to integrate with most of the schools, centers and institutes that made up UMDNJ. Their new partnership allows both facilities to share resources and serve patients far better than they could on their own.

For instance, the center has a social worker on staff for patients with mental health needs. The mobile clinic, which has no social worker, can now refer patients to the center.

“We have the potential to help a whole lot of people,’’ says Sickora, who directs the School of Nursing’s community health program.

“Our mobile clinic can make inroads in educating people to use FOCUS, which could be a health care hub, especially for areas of the city we don’t cover.”

Nurses have a reputation for cutting through red tape and getting things done, says Willard, associate dean of Rutgers College of Nursing advance practice program.“There is a solidarity among nurses,’’ Willard says.

The center’s first patient was a referral from Sickora. Because mobile clinic staff couldn’t provide gynecological exams at the time, they sent her to FOCUS. “Cindy said, ‘I’ve got someone who’s had problems accessing services and your center would be perfect,’’’ recalls Willard.Days after the visit, mobile care nurses checked in on her at home to make sure her symptoms had subsided.

Newark has one of the most underserved populations for basic health care in the United States. Many residents, who lack reliable transportation, must take multiple buses to see a primary care doctor, if they have one at all. Some wait days, even weeks, for appointments. Others are prescribed expensive medication they can’t afford.

Studies show that nurse-managed care can be just as effective as physician-administered care, according to Willard and Sickora.

Nurse-managed care is especially successful at providing treatment continuity – as well as a personal touch – at a much lower cost.

“Our approach is more holistic,’’ says Willard. “Nurses look at patients and think of their overal ability to improve health outcomes, that’s how we’re wired. We ask, ‘What do I need to do to help them take care of themselves when they leave?’ We want to keep them out of the emergency room.”

The FOCUS Wellness Center, funded with federal and local grants, is designed to meet the multifaceted needs of patients who are often grappling with mental health issues and neighborhoods filled with violence, aggravating conditions that are common throughout inner cities: diabetes, hypertension and asthma.

Willard recalls one patient who said her father had been murdered when she was 7. “I thought, ‘How can you just treat the physical symptoms with a patient whose father was killed in front of her when she was that young?’ We have a lot of case histories like that,’’ Willard says.

The FOCUS staff includes a licensed clinical social worker in addition to students and faculty from the College of Nursing, School of Social Work and the Rutgers’ Ernest Mario School of Pharmacy.

September 2013

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As word has begun to spread about the Broad Street center, more walk-ins have been arriving and many have returned. “They tell us, ‘You actually treat us like people,’’' says Willard. That hasn’t always been their experience. … Once you form an emotional attachment, they come back.”

Sickora’s staff also has formed bonds with patients since her program, otherwise known as the New Jersey’s Children’s Health Project, began in 2007 with major support from the nonprofit Children’s Health Fund - a national organization co-founded by singer Paul Simon to help children living in poverty.

The nursing school’s mobile clinic is part of a larger network, based on a pioneering health care model, in which residents work closely with nurses, says Sickora. The nerve center of the program is Rutgers’ Jordan and Harris Community Health Center, headquartered at the Hyatt Court public housing complex in Newark. It’s staffed by two nurses who make house calls to shut-ins and serve as liaisons between patients and outside health care providers. They also refer patients to the mobile clinic, which makes additional stops in Newark at La Casa De Don Pedro Community Center, serving low-income Hispanic residents, and the Covenant House for homeless youth.

Community health workers in Sickora’s program are trained to pinpoint residents in need, schedule appointments and coordinate follow up care. “They knock on doors, they’ll say, ‘We need to make sure the babies get their measles vaccine.’ They’re the reason we’re able to see so many patients,’’ says Sickora, who partnered with Hosseinali G. Shahidi, an emergency medicine specialist at Rutgers New Jersey Medical School, when she applied for funding.

Sickora and her staff, which includes nursing students, have worked hard to form relationships with residents, many of whom rely on them to treat chronic conditions.

During a recent physical exam, Andrew Jackson, a resident of Terrell Homes, was diagnosed with high blood pressure. Since his Medicaid was cut off last year, he’s made weekly visits for checkups and advice. “They tell me to go slow on the salt,’’ says Jackson, 42.

No other mobile health care program in the nation, according to Sickora, uses the community health worker model, which she believes can be a valuable source of data. Researchers from the nursing schools are already involved in evaluating programs.

Says Sickora, “We’re really asking the question: Can we change health care for underserved populations?”

Multiple Sclerosis Appears to Originate in Different Part of Brain Than Long Believed Rutgers professor’s advanced analysis could let therapy start earlier and lead MS research in new directions The search for the cause of multiple sclerosis, a debilitating disease that affects up to a half million people in the United States, has confounded researchers and medical professionals for generations. But Steven Schutzer, a physician and scientist at Rutgers New Jersey Medical School, has now found an important clue why progress has been slow – it appears that most research on the origins of MS has focused on the wrong part of the brain.

Look more to the gray matter, the new findings published in the journal PLOS ONE suggest, and less to the white. That change of approach could give physicians effective tools to treat MS far earlier than ever before.

Until recently, most MS research has focused on the brain’s white matter, which contains the nerve fibers. And for good reason: Symptoms of the disease, which include muscle weakness and vision loss, occur when there is deterioration of a fatty substance called myelin, which coats nerves contained in the white matter and acts as insulation for them. When myelin in the brain is degraded, apparently by the body’s own immune system, and the nerve fiber is exposed, transmission of nerve impulses can be slowed or interrupted. So when patients’ symptoms flare up, the white matter is where the action in the brain appears to be.

But Schutzer attacked the problem from a different direction. He is one of the first scientists to analyze patients’ cerebrospinal fluid (CSF) by taking full advantage of a combination of technologies called proteomics and high-resolution mass spectrometry. “Proteins present in the clear liquid that bathes the central nervous system can be a window to physical changes that accompany neurological disease,” says Schutzer, “and the latest mass spectrometry techniques allow us to see them as never before.” In this study, he used that novel approach to compare the cerebrospinal fluid of newly diagnosed MS patients with that of longer term patients, as well as fluid taken from people with no signs of neurological disease.

What Schutzer found startled one of his co-investigators, Patricia K. Coyle of Stony Brook University in New York, one of the leading MS clinicians and researchers in the country. The proteins in the CSF of the new MS patients suggested physiological disruptions not only in the white matter of the brain where the myelin damage eventually shows up. They also pointed to substantial disruptions in the gray matter, a different part of the brain that contains the axons and dendrites and synapses that transfer signals between nerves.

Several scientists had in fact hypothesized that there might be gray matter involvement in early MS, but the technology needed to test their theories did not yet exist. Schutzer’s analysis, which Coyle calls “exquisitely sensitive,” provides the solid physical evidence for the very first time. It includes a finding that nine specific proteins associated with gray matter were far more abundant in patients who had just suffered their first attack than in longer term MS patients or in the healthy controls. “This evidence indicates gray matter may be the critical initial target in MS rather than white matter,” says Coyle. “We may have been looking in the wrong area.”

22 New Jersey Physician

According to Coyle, that realization presents exciting possibilities. One, she says, is that patients who suffer attacks that appear related to MS could have their cerebrospinal fluid tested quickly. If proteins that point to early MS are found, helpful therapy could begin at once, before the disease can progress further.

Coyle says Schutzer’s findings may also lead one day to more effective treatments for MS with far fewer side effects. Without specific knowledge of what causes multiple sclerosis, patients now need to take medications that can broadly weaken their immune systems. These drugs slow the body’s destruction of myelin in the brain, but also degrade the immune system’s ability to keep the body healthy in other ways. By suggesting an exciting new direction for MS research, Schutzer and his team may have set the stage for more targeted treatments that attack MS while preserving other important immune functions.

Schutzer sees an even broader future for the work he is now doing. He also has used advanced analysis of cerebrospinal fluid to identify physical markers for neurological ailments that include Lyme disease, in which he has been a world leader in research for many years, as well as chronic fatigue syndrome. He says, “When techniques are refined, more medical conditions are examined, and costs per patient come down, one day there could be a broad panel of tests through which patients and their doctors can get early evidence of a variety of disorders, and use that knowledge to treat them both more quickly and far more effectively than is possible now. “ This research was funded by the National Institutes of Health.

September 2013

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ASC NEWS

ASC News

On September 10, the Surgery Center Coalition held their first major educational meeting, celebrating their 10th anniversary. This all day event offered speakers covering many aspects of Ambulatory Surgery Center management, including Infection Control, Pharmacy, OSHA, Insurance, Etc.. Speakers included Marie Kassai, Sherry Mohamed, Eileen Kreiling, Mike Corbett and Mike Dye. Sponsors included the legal firm of Wilentz, Goldman and Spitzer, with healthcare attorney Michael Schaff presenting the opening remarks. This first event was a huge success, with a large turnout and valuable information received. Our congratulations to Marcie and Dorcy, this event was a huge success.

24 New Jersey Physician

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NEW JERSEY PHYSICIAN 2014 cover stories Create an awareness of your practice or hospital program Generate physician referrals Share innovative technologies and procedures Enhance your website with a PDF of your story Receive reprints of your story for use as brochures Our 2014 cover story search is now in progress.

We are looking for 12 exciting specialty practices or hospital programs to share with our audience of over 30,000 physicians and healthcare executives.

If you would like your practice to be one of the 12 featured in 2014, contact Iris Goldberg for information about this unique opportunity.

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Food for Thought

Montclair, New Jersey

By Iris Goldberg I’ve finally reached the stage in life when birthdays are no longer to be dreaded. My priorities have adjusted quite well so that another wrinkle or arthritic spasm is merely a reminder that every day is to be treasured.

For Michael and me, our free time is best spent with family and friends and as I’ve written many times before, usually a great meal. This year my birthday fell on a Sunday and we started the day by driving into Manhattan to see dear friends who were in from Arizona to welcome their new grandson. We met in Soho and shared a fabulous breakfast and much animated conversation.

Later in the day, our children and fifteen-month old granddaughter, along with two more very special friends, came to our house for a steak dinner a la Michael, followed by a decadent ice cream birthday cake and of course, a chorus of “Happy Birthday.” I received some really touching cards and lots of hugs and kisses. Like I said, birthdays are not to be dreaded.

The evening before my birthday was a rare opportunity for Michael and I to spend some time alone. We decided to have dinner for two in Montclair at Aozora, which is famous for a blend of Japanese and European cuisine. Although the sushi is known to be top-rate, we were eager to sample some of Aozora’s other options.

I was intrigued by the quail appetizer. I had eaten quail at some Shanghai Chinese restaurants and had always enjoyed it. The quail at Aozora is roasted and served with soba noodles in a clear broth. I mistakenly expected the crispy quail I was familiar with and did not enjoy picking at the soft tiny bird lying on my plate. With such tempting alternatives, as duck spring roll, seared tuna and salmon carpaccio, I really made the wrong choice.

Michael was much happier with his selection of Hamachi Kama, which is grilled yellowtail collar served with ponzu sauce and plum salt. He savored the freshness of the fish and the delicate flavor of the sauce.

Next came the entrees. I chose a steamed red snapper with fresh herbs over delicately sliced potatoes. The fish was tender and flavorful although the portion was so generous that I could not eat it all.

Michael really enjoyed his seared duck breast in berry sauce served over mashed sweet potato, with duck spring roll and baby bok choy. He had absolutely no problem cleaning his entire plate.

Since it was almost my birthday, we both felt completely justified ordering warm flourless chocolate cake to share for our dessert. While we lingered over our cake and coffee at our window table, we gazed outside at the hustle and bustle of Bloomfield Avenue on that busy Saturday night.

As I ended one more year of life, I was grateful for the quiet dinner just shared with the person who has accompanied me throughout most of the journey thus far and so looking forward to the festivities tomorrow would bring.

Aozora is located at 407 Bloomfield Avenue, Montclair, NJ 07042 (973) 233-9400

26 New Jersey Physician

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