An Open Letter to Governor-Elect Christie

December 30, 2009

Dear Governor-Elect Christie:

On behalf of the members of the Medical Society of New Jersey and the nearly 30,000 physicians of the State of New Jersey we respectfully request you appoint a qualified and proven medical doctor to the position of commissioner of the Department of Health and Senior Services.

There has never been a time in our state’s history when having a physician in place to lead the department has been so important.  Our state is faced with on-going public health issues and emergencies.

We are witnessing national health reform and state health reform issues that will have lasting effects on our quality of life and that of our children for years to come.  We have an aging population that requires time and attention.  We are confronted with Medicare and Medicaid challenges and continuous issues relating to health economics and deployment of resources.  A physician must take all of these factors and more, into consideration everyday of their lives.

We realize you and the members of your transition team are challenged with enormous financial burdens and we do not take lightly the tasks at hand relating to the budget. We do, however, know you recognize the important role healthcare providers and healthcare services play in the overall health of the State of New Jersey.  You know the importance of training and retaining the fine physicians who live, work and study in New Jersey.  A physician at the helm of the department will offer the right balance of training, leadership, insight and compassion.

MSNJ feels very strongly about this appointment as does our membership base.

Respectfully,

Michael T. Kornett

Chief Executive Officer

Medical Society of New Jersey, est. 1766

AMA Endorsement of Senate Healthcare Reform Misguided

Statement by Joseph Reichman, MD, President of the Medical Society of New Jersey

The Medical Society of New Jersey is deeply troubled by the recent AMA approval of healthcare reform legislation emerging from the US Senate.  This legislation is significantly flawed and contains very few of the important reforms physicians consider critical to a meaningful overhaul of the US healthcare system.

The Senate measure provides no substantive payment reform.  The AMA and MSNJ have placed a high priority on permanently fixing the flawed Sustainable Growth Rate formula for Medicare payments to physicians.  It is shocking that a bill could gain AMA endorsement without such a fix.  America’s physicians deserve more than unsecured promises from Congress on something as vital as healthcare payment reform. 

Second, the Senate bill expands Medicaid to cover the uninsured. Unfortunately the New Jersey Medicaid Program pays so little for healthcare services that few physicians participate in the program.  Healthcare reform based on Medicaid expansion will leave thousands of New Jersey residents with health insurance that the majority of practicing physicians cannot accept.  It is no fix to roll the uninsured into a program where the cost to the physician to provide care exceeds the amount paid.

Finally, the Senate bill provides very little insurance reform.  New Jersey is dominated by a few large health insurance plans that dominate the market place.  These companies use their market power to increase premiums and force physicians and other healthcare providers to accept poor contract terms and lower payments.  The Senate bill does very little to restrain the monopolistic behavior of these insurance companies.

We have little confidence that the American Medical Association is representing the interests of the practicing physician in New Jersey.  The Medical Society of New Jersey will continue to advocate for meaningful reforms that help practicing physicians care for their patients.

Announcement by Oxford Regarding Changes to Out of Network Payments

Lawrence Downs, General Counsel

In a letter dated December 1, 2009, United Healthcare (Oxford Health Plan) advised physicians that “beginning January 2010 . . .the reimbursement for all services [Oxford Liberty subscribers] receive from out-of-network providers will be calculated as a percentage of Medicare instead of the charge based methodology to which you [the provider] may be accustomed”.   The letter goes on to advise that the percentage is generally set at 140 percent of the published rates allowed by Medicare.

MSNJ has had several inquiries from members regarding the impact of this new policy.  In New Jersey, the normal out-of network benefits do not generally apply in emergency or urgent care situations where the patient has no control over whether he or she receives services from a non-contracted physician.  Moreover, in cases in which a patient requires a level of care that is not available in-network.  In these cases the patient liability is limited to the amount they would pay if the service was performed by a participating physician.  As a result, the insurer will need to pay the physician an amount which causes a balance bill NOT to be issued to the patient.

In addition, some regulated benefit plans (e.g. Small Employer Health policies) generally provide for a level of out-of-network benefit that is greater than 140% of Medicare and not tied to Medicare rates. 

Therefore the new limitation on reimbursements for out-of-network physician services will probably only be applicable to outpatient care. In that instance the physician is free to exercise their right to collect the balance of the fee from the patient.

We understand that the Oxford letter has caused confusion and concern among many members.  We hope this guidance will clarify the consumer protections in place under state law.  If you have questions kindly contact the member resource center at 609-896-1766 ext. 299.

MSNJ responds to NJ Attorney General’s report on Physician Compensation Arrangements with Industry

MSNJ’s President-elect, Donald J. Cinotti, MD issued the following statement on the report and proposed recommendations.  To view the full report and recommendations click here.

“Yesterday, the NJ Department of Law and Public Safety released a report on physician compensation arrangements with the pharmaceutical and medical device industry. The government contends that financial arrangements among physicians and industry ‘threaten to bias medical decision making and compromise patient health.’  Physicians understand the potential conflicts of these relationships and are bound by the Code of Medical Ethics of the American Medical Association that governs the profession’s interaction with these industries.

While the state’s concern about industry influence is laudable, they picked the wrong industry and the wrong approach.

First, medical decision making is influenced predominately by health insurance companies through restricted drug formularies and pharmacy benefit managers. The state offers no recommendations to resolve this conflict of interest. 

We believe physicians should make medical decisions free of influence by any party outside the physician-patient relationship. Physicians have no interest in prescribing a medication that is not covered by the patient’s insurance plan. Physicians are acutely aware that a prescription not filled by the patient is of no therapeutic benefit. 

Second, the state’s physicians are highly disappointed with the recommendations in this report.  The state chooses to regulate 33,000 physicians rather than go after a few large companies.  New Jersey is the only state in the nation that chooses to regulate tens of thousands of individuals and allow large companies to escape scrutiny.”

Burt Eichler, Friend of MSNJ Dies at 76

Burton L. (Burt) Eichler, a member of the law firm BrachEichler L.L.C. and friend of medicine for over 35 years, died suddenly while visiting his son in New Orleans on Thanksgiving Day. 

“Burt defended many physicians over the past 35 years and personally helped the MSNJ organization during some very difficult times recently,” stated Dr. Robert Rigolosi, Treasurer and Past President of MSNJ.  “Because of Burt, the Brach Eichler firm and its current successors will forever be remembered for their contribution to the Medical Society of New Jersey.”

Eichler co-founded the firm of Brach Eichler Rosenberg Silver Bernstein Hammer & Gladstone PC in 1967 in Newark, NJ.  The firm, which had since relocated to East Orange and then Roseland, NJ, later merged with WolfBlock Schorr & Solis-Cohen LLP in 2003.  In April 2009, the Roseland attorneys of WolfBlock formed Brach Eichler after WolfBlock announced its plans to disband earlier last spring.

“The Medical Society of New Jersey (MSJN) is deeply saddened about the loss of Burt and remembers him for the impact he made to physicians in the state,” said Michael T. Kornett, MSNJ’s chief executive officer.

In the early 1970s, Eichler paved the way for the establishment of many New Jersey healthcare “firsts” by shepherding the licensing of the first non-hospital-owned, free-standing dialysis facility,  the first MRI, the first free-standing ambulatory surgical center, and the first lithotripter. He was also the first attorney to represent a medical staff in New Jersey.

Most notable among Eichler’s published opinions was Marsh v. Finley, 160 N.J. Super., 193 (App. Div. 1978), certif. den. 78 N.J. 396 (1978), which allowed physicians engaged in the private practice of medicine to operate a CT scanner.

Other notable decisions in which he played a role were  Desai v. St. Barnabas Medical Center, 103 N.J. 79 (1986); Paul Kimball Hospital Inc. v. Brick Twp. Hospital, Inc. , 86 N.J. 429 (1981); Women’s Medical Center at Howell v. Finley, 192 N.J. Super. 44, certif. den. 96 N.J. 279 (1984); St. Joseph‘s Hospital and Medical Center v. Finley, 153 N.J. Super. 214 (App. Div. 1977); Radiological Society of N.J. v. Sheeran, 175 N.J. Super. 367 (App. Div. 1980) certif. den. 87 N.J. 311; and National Nephrology Foundations v. Dougherty, 133 N.J. Super. 470 (App. Div. 1976).

Eichler earned his L.L.B. from Rutgers University School of Law in 1957 and his B.S. from Ohio State University in 1954. He was a member of the Bars of New Jersey and New York.

“In speaking for all of the physicians in New Jersey, Burt will surely be missed,” added Dr. Rigolosi.