While New Jersey has been trending upward lately with its attitude towards businesses, it still ranks towards the bottom when it comes to regulations, taxes and a host of other red tape issues. Being a physician in New Jersey also means being a small business owner and subject to the many difficulties that other small business owners face. One of the glowing differences to being a physician/small business owner is the internal and external pressures of caring for the lives of others. Many of the external pressures are driving current and future doctors away from our state.
The February 6 article entitled “N.J. faces growing shortage of doctors due to med school costs, insurance concerns” brings to the forefront a problem that physicians have known about for years. Newly trained physicians are fleeing because of the overall practice environment. We live and work in a state with the lowest reimbursement for treating a Medicaid patient, yet the highest cost of living and a growing population under healthcare reform. The litigious environment coupled with the costs of defensive medicine are other detractors in retaining the best and brightest future physicians that we train here in the Garden State.
Suggestions for state tax forgiveness, loan repayment, and possible income guarantees for the first 3-5 years of practice are okay, but are not the optimum way to get resident physicians to stay here. And since we as physicians understand that a legislative overhaul of the entire tort system is unrealistic, we do believe that there are several key components that, if updated, can help make New Jersey more appealing for young doctors to open a practice.
In New Jersey, the statute of limitations (or time frame in which one can bring a claim against a physician) for medical malpractice is a moving target. The timeframe for bringing a suit does not begin until the time a patient can reasonably discover that a medical injury has occurred. Good lawyers can use this standard to extend the timeframe for bringing claims for many years. This uncertainty leads to higher premiums as insurance underwriters must prepare financially for long term exposure to liability claims.
Another safeguard for physicians is the requirement of an Affidavit of Merit. Until recently, physicians believed the law required a physician in the same specialty (a doctor doing the same type of work and familiar with the standards of care exercised by similarly trained physicians) to certify that the physician being sued may have committed malpractice. This law is needed to weed out suits that are frivolous or where a poor outcome may have occurred through no fault of the physician. The same specialty requirement is necessary as medicine becomes increasingly more complex. An exception in the law allows plaintiff’s lawyers to work around this requirement and use physicians without the same training as the defendant physician. This exception greatly diminishes the protection of this case screening mechanism and allows non-meritorious cases to proceed.
Finally reform is needed to enforce standards experts can use when testifying in a medical malpractice case. Medical cases rely heavily on paid experts for both plaintiffs and defense lawyers. While there are standards in place for the content of an expert’s testimony, physicians rarely face discipline for unsupported testimony. Creating strong disincentives and penalties for individual expert witnesses that offer testimony that does not meet legal standards would prevent abuse and resolve matters more expeditiously for all involved.
Most physicians enter the profession because they have an intrinsic desire to help people. They spend hundreds of thousands of dollars and years of their lives dedicated to studying the art and science of medicine and have a real fear that it can be all taken away in an instant. New Jersey has a chance to regain its popularity amongst physicians by taking proactive steps to enhance the business climate in order to retain our future doctors.
Donald J. Cinotti, MD
Medical Society of New Jersey
Resolutions must be submitted to MSNJ by March 1, 2011. Resolutions will be submitted by individuals to their county societies. The county societies then will determine which resolutions to submit for consideration by the HoD. Emergency resolutions will be accepted from county societies and the BoT, in writing, via e-mail, to firstname.lastname@example.org by April 22, 2011 and will be posted on the MSNJ web site.
Reference Committee(s) hearings will take place via conference call on April 13 and 14, 2011. Anyone wishing to discuss a resolution rather than responding in writing will be given the opportunity at this time. The Reference Committee(s) report(s) will be sent to the county executives and the Board of Trustees via e-mail and will be posted on the MSNJ web site by April 21, 2011.
The MSNJ Nominating Committee will meet on Sunday, February 27 at 12:00 P.M. The nominating committee will recommend candidates. If you are interested in running for any elected office please contact your county medical society to express your interest.
New this year, MSNJ will elect a Speaker and a Vice Speaker. Previously, these positions were appointed by the President. A bylaw amendment approved by the House of Delegates last year now requires these positions to be elected. Terms are one (1) year and the positions are elected annually.
For more annual meeting and election information click here.
President Obama issued an Executive Order on January 18 asking all Government agencies to improve the balance between projected costs and benefits of federal regulations. The Executive Order directs agencies to complete a “retrospective analysis of rules that may be outmoded, ineffective, insufficient or excessively burdensome and to modify, streamline, expand or repeal them in accordance with what has been learned.”
The American Medical Association believes this is an opportunity to provide the federal government with feedback on regulations that create the greatest administrative burden for physicians. To that end, the AMA has developed a short survey to help develop a list of rules and regulations that increase physicians’ administrative costs or interfere with patient care, without a significant benefit to patients or the Government. Survey results will be used to advocate against the identified rules that cause administrative and paperwork hassles, take time away from patient care, and do nothing to advance quality.
MSNJ urges all members to take the survey and to forward it to other physicians. The survey closes on Monday, February 28. If you have questions about the survey, contact email@example.com.
As a result of a limited scope examination, the New Jersey Department of Banking & Insurance (DOBI) and Horizon have entered into a consent order which requires the insurer to pay a penalty in the amount of $500,000. The consent order addresses Horizon’s payments made when it was the secondary insurer to Medicare and its practice of pending claims to determine whether there was a pre-existing condition.
In addition to the $500,000 penalty Horizon has been ordered to reprocess claims where it paid secondary to Medicare and DOBI estimates that this will result in payments of over $5 million to providers and members. These payments will include 12% interest, the statutory amount due when claims are not processed timely. In addition, DOBI established a de minimus repayment amount that may be paid to the state, rather than to the provider or member, and it estimates that this will result in a payment of approximately $1.3 million.
On the issue of pending claims to determine whether there was a pre-existing condition, Horizon has been ordered to disgorge to the State the amount of interest underpaid on claims that were ultimately paid. DOBI estimates this amount of be $1.3 million.
MSNJ and our members have a record of complaints to DOBI concerning Horizon’s practice of routinely pending claims to make a determination on pre-existing conditions. However, MSNJ was unaware of this pending enforcement action. We are taking steps to secure the underlying limited scope examination report and the plan required to address the aged claims for pended pre-existing condition review. MSNJ will also seek information on the revised policy on processing claims secondary to Medicare. While we applaud the work of DOBI to address these two claims payment issues we are concerned about the de minimus amounts to which providers are entitled being directed to the state. We also believe that physicians should be fully entitled to interest amounts when Horizon wrongfully pended payment during pre-existing condition review. It is unclear how that amount will be established without further information which MSNJ is currently seeking.
MSNJ will keep members apprised of developments on the implementation of the consent order and our ongoing efforts to ensure that physicians are made whole for these wrongful claims processing practices.
New Jersey Monthly’s annual survey of physicians is underway. This is the only survey that is mailed to all doctors in active practice in New Jersey rather than relying on the opinions of a smaller group of doctors or a national poll.
The magazine has asked the Medical Society of New Jersey for its assistance in encouraging members to participate.
You should already have received a ballot in the mail. If not, contact the polling company, Leflein Associates of Ringwood, New Jersey, at 973-728-8877.
Or better yet, vote online at www.entersurvey.com/topdocs
You will be asked to enter your medical license number before entering the site to vote. (To be eligible to vote, you need to have been licensed at least five years in the state.)
THE DEADLINE FOR VOTING HAS BEEN EXTENDED UNTIL FRIDAY, MARCH 4TH.
Inclusion on the list is completely unrelated to advertising. The list is “locked down” before any solicitation of advertising, and a variety of methods are employed by the polling company to prevent ballot-box stuffing.
The results will be published in the November issue of New Jersey Monthly.
FRAUD & ABUSE: Federal Government Increases Prosecutions
The United States Department of Health & Human Services (HHS) and the Department of Justice joined forces to recover a record $4 billion for fraudulent activity in 2010. In addition to the federal government’s enhanced enforcement activity the Affordable Care Act contains new compliance requirements and enforcement tools that will trickle down to the states.
Last week, HHS, the Centers for Medicare & Medicaid Services (CMS) and the Office of the Inspector General filed final rules under the new law that will govern Medicare, Medicaid, and SCHIP programs. Read the press release announcing the rules and the fraud and abuse program report.
TORT REFORM: MSNJ Supports Federal Legislation
Last week, MSNJ joined the AMA, other state medical societies, and specialty organizations in a letter to Congressman Phil Gingrey, MD, supporting H.R. 5, the “Help Efficient, Accessible, Low-Cost, Timely Health (HEALTH) Act of 2011.” The bill promotes speedier resolutions to medical malpractice suits and limits non-economic damages. It would not supercede more effective state medical liability tort reform laws. MSNJ will continue tort reform initiatives in New Jersey.
PHYSICIAN OUTREACH RECRUITMENT
Four MSNJ physicians received an award from the AMA’s Physician Outreach Recruiting Program for their outstanding efforts in recruiting new AMA members for 2010:
Peter Carmel, MD
Michael Goldrich, MD
Charles Moss, MD
Niranjan Rao, MD
Read more about the Program on the AMA website.
This week, MSNJ requested in a letter to Horizon that it not reissue a payment policy that limited payment to one unit of radiopharmaceuticals used during nuclear stress tests. The Horizon payment policy was addressed in a class-action compliance dispute filed by our members. The Compliance Dispute Resolution Officer issued an opinion finding that Horizon’s changed payment policy violated the national class-action settlement agreement by failing to give 90 days notice of the material change. All cardiologists in New Jersey who were reimbursed for only one unit when two were used, one at rest and one under stress, will be paid for both units as a result of this compliance dispute.
It is our understanding that Horizon is currently considering whether to reissue the payment policy with the required notice. Since the payment policy at issue is contrary to CPT®, HCPCS, and NCCI guidelines, CMS payment policies, and coding and reimbursement guidance from all the affected specialty societies, MSNJ has requested that Horizon not reissue the payment policy. The payment policy is an outlier from all other payers and will add to the administrative burden of practices that have to distinguish between payers on this issue. The affected specialty societies also sent a letter to Horizon. MSNJ is pleased to work with our members and the affected specialty societies to continue to support this ongoing effort.