Richard Popiel, MD, MBA, is a member of the Medical Society of New Jersey and President and Chief Operating Officer of Horizon Healthcare Innovations. He will be a featured panelist on Wednesday, December 14th at 8:00 am when MSNJ co-sponsors “Innovation through Collaboration: A Healthcare Transformation Forum” along with Horizon Healthcare Innovations & the NJHA. MSNJ recently asked Dr. Popiel to provide us with his vision on how Accountable Care Organization (ACO) and Patient Centered Medical Home (PCMH) models will transform the way care is delivered in New Jersey.
MSNJ: Please tell us how you became interested in the implementation of Accountable Care Organization (ACO) and Patient Centered Medical Home (PCMH) models.
Dr. Popiel: Most health care leaders agree that our delivery system needs to be reformed when it comes to the quality and cost of care. The status quo of the delivery system is not sustainable, and urgent action is necessary to collaborate with others to transform and improve New Jersey’s health delivery system. Horizon Healthcare Innovations, which is a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, is launching programs, like Patient Centered Medical Homes and Accountable Care Organizations, to deliver improved patient care at a lower cost. We feel these patient-centered care models give our delivery system the best opportunity to help all stakeholders achieve the goals of better health and better care at lower costs.
MSNJ: How do you see health care being delivered in New Jersey in the next 3-5 years?
Dr. Popiel: Over the next five years health care stakeholders will begin to work more collaboratively and focus on improving care coordination, preventive and well care, and help empower patients to take control of their own health. In addition, the way health plans and government entities pay providers will move from a volume-based or fee-for-service approach to one where providers are supported to get and keep their patients healthy. Health Information Technology systems to improve care coordination, as well as using new technologies and various communication methods to engage patients will be critical to transforming the delivery system.
MSNJ: What role do you see insurers having in the marketplace?
Dr. Popiel: Health plans play a leadership role in collaborating with providers to improve quality and make health care more affordable. To this end, health plans can facilitate a more integrated and efficient delivery system. Insurers have comprehensive patient data, strong IT systems and the ability to share this valuable information with doctors, hospitals and other providers. This information can be a tremendous resource and give physicians and hospitals timely data to provide higher quality, more coordinated care for their patients. Business as usual is not the solution. Health plans throughout New Jersey and the country need to step up in a collaborative manner and be a catalyst of change.
MSNJ: Will the financial benefit to physicians be better or worse if they sign up to participate in ACOs or PCMHs?
Dr. Popiel: A key component of these new care models, including ACOs and PCMHs, is to pay physicians and other providers for delivering better care at lower costs. Paying doctors for the number of tests ordered or treatments given doesn’t create a healthier New Jersey. Physicians and provider groups that can get and keep their patient population healthy and provide efficient care may financially benefit from participating in these new programs.
Richard Popiel, MD, MBA, is President and Chief Operating Officer of Horizon Healthcare Innovations, a Horizon Blue Cross Blue Shield of New Jersey company. His scope of responsibilities includes managing all aspects of the company, whose purpose is to launch new models of reimbursement and care delivery with network providers. He continues to serve as a member of the Board of Directors of Horizon Healthcare of New Jersey. He is also a member of the Board of the New Jersey Sharing Network (local Organ Procurement Organization), the local chapter of the American Cancer Society and the George Washington University Alumni Association.
Formerly, Dr. Popiel held the position of Vice President and Chief Medical Officer at Horizon Blue Cross Blue Shield of New Jersey. His scope of responsibilities included all medical management activities at Horizon BCBSNJ including Quality and Care Management, Utilization and Pharmacy Management. Dr. Popiel served as the Chair of the National Council of Physician Pharmacy Executives, a Blue Cross Blue Shield Association council comprised of all Chief Medical and Chief Pharmacy Officers. He also served as the Chair of the Chief Medical Officer Leadership Group at American Association of Healthplans (AHIP) and was a member of AHIP’s Board of Directors.
Dr. Popiel earned multiple degrees while attending George Washington University in Washington, D.C., including a Bachelor of Science and Doctor of Medicine. In addition, he earned a Masters in Business Administration from Northwestern University Kellogg School of Management in Chicago. He completed residency training in Internal Medicine and Emergency Medicine as well as fellowship training in Toxicology. He is Board Certified in Internal Medicine.
Thomas Kloos, MD, is a member of the Medical Society of New Jersey and will be a featured panelist on Wednesday, December 14th at 8:00 am when MSNJ co-sponsors “Innovation through Collaboration: A Health Care Transformation Forum” along with the NJHA & Horizon Healthcare Innovation. MSNJ recently asked Dr. Kloos to provide us with his vision on how Accountable Care Organization (ACO) and Patient Centered Medical Home (PCMH) models will transform the way care is delivered in New Jersey.
MSNJ: Please tell us how you became interested in the implementation of Accountable Care Organization and Patient Centered Medical Home models.
Dr. Kloos: Both models allowed for the first time the elements of population management to occur at the physician level, and are developing mechanisms to make sure the patients who are part of your practice are receiving the care they need, rather than just those who show up in your office on any particular day.
MSNJ: How do you see healthcare being delivered in New Jersey in the next 3-5 years?
Dr. Kloos: I see an absolute need to shift to the development of high performing physician networks with greater collaboration among all stakeholders including the patient.
MSNJ: What role do you see hospitals and insurers having in the marketplace?
Dr. Kloos: Hospitals remain an essential part of the equation especially where opportunities exist for quality programs and transitions of care. Insurers, through development of novel collaborative programs with physicians and hospitals, as well as by placing the right financial incentives in place to drive change, can be the catalysts for new models of care delivery.
MSNJ: Will the financial benefit to physicians be better or worse if they sign up to participate in ACOs or PCMHs?
Dr. Kloos: For primary care physicians, there is no doubt it’s a positive, for specialists who become comfortable in partnering in these models there will also be a benefit in maintaining and expanding their referral base and opportunities for other outcome based payment models such as episodes of care, but it will be outcomes and value driven.
Thomas Kloos, MD, serves as President and Chief Executive Officer of Optimus Healthcare Partners as well as President and Medical Director of Vista Health System IPA. He has been involved in all aspects of IPA development and growth since inception in 1995.
As medical director he managed full professional risk contracting and physician performance during the early years of the IPA. As President, he managed conversion to a messenger model IPA, and developed P4P and novel care coordination programs with major payors in the NJ market. Through the IPA he also advocated and supported primary care practices becoming BTE certified and transitioning to Patient Centered Medical Home (PCMH). On the payor side, he serves as Vice President of the Affiliated Physicians Health Plan, a self funded Multiple Employer Welfare Association (MEWA) in New Jersey with 7,000 covered lives which provide health insurance to small and medium sized physician and health related practices. Dr. Kloos is a board certified Internal Medicine practitioner in Warren NJ, NCQA certified in Diabetes Care, and a NCQA recognized Level III PCMH. He graduated from the University of Louisville Medical School in 1979, and Rutgers University in 1975, according to the website www.optimushealthcarepartners.com
The Assembly Health and Senior Services Committee is expected to approve next week a measure that would require the licensure of Single Room Surgical Practices (SRSPs). S-2780, sponsored by Senator Joseph Vitale (D – Middlesex), was amended earlier this year to exempt all SRSPs from the gross receipts assessment currently paid by ambulatory care facilities, exempt CMS certified SRSPs from the “physical plant and functional requirements” in the current Department of Health & Senior Services regulations, and require the Department to promulgate regulations that better reflect the unique characteristics of a Single Room Surgical Practice. Observers expect the Assembly to add additional amendments that would apply a “grandfather” exemption to all existing SRSPs regardless of CMS certification.
Single-room surgical practices are currently defined in the law as a practice which:
- has no more than one room dedicated for use as an operating room which is specifically equipped to perform surgery, and is designed and constructed to accommodate invasive diagnostic and surgical procedures;
- has one or more post-anesthesia care units or a dedicated recovery area where the patient may be closely monitored and observed until discharged; and
- is established by a physician, physician professional association surgical practice, or other professional practice form specified by the State Board of Medical Examiners pursuant to regulation solely for the physician’s, association’s or other professional entity’s private medical practice.
Press Release: American Medical Association
NEW ORLEANS, Nov. 15, 2011 (GLOBE NEWSWIRE) — The American Medical Association (AMA), the nation’s largest physician organization, voted today during the closing session of its semi-annual policy-making meeting to adopt the following new policies:
Guidelines for Health Insurance Exchanges
The AMA today adopted new policies on the health insurance exchanges created by the Affordable Care Act. New policies include AMA support for using the open marketplace model for exchanges to increase competition and maximize patient choice, and the involvement of state medical associations in the legislative and regulatory processes concerning state health insurance exchanges. The new policy also asks the AMA to advocate for the inclusion of actively practicing physicians and patients in health insurance exchange governing structures and for developing systems that allow for real-time patient eligibility information. The policies were adopted as part of a report from the AMA’s Council on Medical Service.
“If they are developed well, health insurance exchanges will provide a new way for millions of Americans to obtain health care coverage from private insurers,” said AMA Board Member Barbara McAneny, M.D. “Physicians and patients should be involved in setting up and governing these bodies to ensure they best meet the health care needs of residents in each state.”
Virtual Medical IDs
New AMA policy encourages the availability of portable medical identification alert systems for patients. Virtual medical identification systems allow emergency medical personnel to access a patient’s medical history and emergency contact phone numbers through a pin number that can be attached to clothing, keys, or stored in a wallet. They allow emergency responders and medical staff in emergency departments immediate access to important health and family contact information for patients who are enrolled in these systems.
“A physician’s ability to obtain health information for patients at the point of care can make a significant difference in providing successfully treatment,” said AMA Board Member Carl Sirio, M.D. “When patients are unable to communicate for themselves, especially in emergency situations, these identification devices can share vital information and may help save lives.”
Stop the Implementation of ICD-10
The AMA House of Delegates voted today to work vigorously to stop implementation of ICD-10 (The International Classification of Diseases and Related Health Problems, 10th Revision), a new code set for medical diagnoses. ICD-10 has about 69,000 codes and will replace the 14,000 ICD-9 diagnosis codes currently in use.
“The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients’ care,” said Peter W. Carmel, M.D., AMA president. At a time when we are working to get the best value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions. The timing could not be worse as many physicians are working to implement electronic health records into their practices. We will continue working to help physicians keep their focus where it should be — on their patients.”
A 2008 study found that a small three-physician practice would need to spend $83,290 to implement ICD-10, and a 10-physician practice would spend $285,195 to make the coding change.
Stop Legal Prohibition of Male Circumcision
Ballot and other legal initiatives have recently been proposed in Californiathat would ban infant male circumcision and penalize any physician who performed it. The AMA voted today to oppose any attempt to legally prohibit male infant circumcision.
“There is strong evidence documenting the health benefits of male circumcision, and it is a low-risk procedure, said Peter W. Carmel, M.D., AMA president. “Today the AMA again made it clear that it will oppose any attempts to intrude into legitimate medical practice and the informed choices of patients.”
The National Ambulatory Medical Care Survey (NAMCS) is conducted by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). The NAMCS is designed to produce national estimates which describe the utilization of ambulatory medical care services in the United States. Findings are based on a national probability sample of visits made by ambulatory patients to community health centers and nonfederal physicians who are in office-based practice and engaged primarily in direct patient care. The data provide insight into ambulatory medical care and stimulate further research on the use, organization, and delivery of ambulatory care.
NAMCS data are used by public health policy makers, health services researchers, government agencies, medical schools, physician associations, epidemiologists, and the print and broadcast media to describe and understand the changes that occur in medical care requirements and practices. The data are disseminated in the form of NCHS reports, journal articles, and downloadable data files. Previously, the NAMCS has provided only national-level estimates. For the first time starting in 2012, NAMCS poses a unique opportunity to produce state-level data as well as national and census divisional estimates. Moreover, your particular state is one among 34 of which NCHS will be able to provide state level estimates. Below are a few highlights of the 2012 NAMCS survey:
- Survey data will now be collected using a computerized instrument; which will simplify data collection activities and reduce data entry errors and omissions, thus improving data quality.
- Sample size has been increased nearly five-fold to allow NAMCS to provide estimates for the top 34 most populated states in the United States.
- Findings will allow physician offices and community health centers at the state level to baseline themselves against national estimates (including 9 Census divisions).
See how NAMCS data is used:
- NCHS 2010 Data Brief: Population Aging and the Use of Office-based Physician Services
- Selected 2009 Summary Tables: Physician and Physician Practice Characteristics
Questions? Feel free to call our toll free number 1-800-392-2862.
A message from the Office for Civil Rights (OCR) in the US Department of Health and Human Services
FIRST NATIONWIDE TEST OF THE EMERGENCY ALERT SYSTEM
Test to Take Place November 9 at 2 p.m. EDT
We need your assistance in notifying everyone about the November 9th nationwide test of the Emergency Alert System. Please help distribute this to all your stakeholders, as far and wide as possible, to ensure the entire community is aware that
As part of our larger efforts to strengthen our nation’s preparedness and resiliency, the Federal Communications Commission (FCC) and the U.S. Department of Homeland Security’s Federal Emergency Management Agency (FEMA) will conduct the first nation-wide test of the Emergency Alert System on November 9th at 2pm Eastern Standard Time.
The national Emergency Alert System is an alert and warning system established to enable the President of the United States, if needed, to address the American public during emergencies. It is another critical communications tool that can protect the public and strengthen our nation’s resiliency. The National Weather Service, governors, and state and local authorities also use parts of the system to issue more localized emergency alerts. The test is an important exercise in ensuring that the system is effective in communicating critical information to the public in the event of a real national emergency.
This national test will help federal partners and EAS participants determine the reliability of the system, as well as its effectiveness in notifying the public of emergencies and potential disasters both nationally and regionally. The test will also provide the FCC and FEMA a chance to identify improvements that are needed to build a new, modernized, and fully accessible Emergency Alert System.
To support the disability community, FEMA has developed a toolkit that will allow you to reach out to your constituents and local partners. The toolkits, attached here in multiple formats, allow you and your organization to quickly disseminate information about this test.
In addition, we’re also releasing two new videos created to support the outreach efforts of our disability community partners. FEMA Administrator Craig Fugate has long been a champion of the whole community and ensuring that FEMA represents the diversity of the people we serve. In one video, Neil Mc Devitt, from FEMA’s Office of Disability Integration and Coordination joins Administrator Fugate in outlining the need for the upcoming Emergency Alert System test and the accessibility challenges posed by the test. The video has American Sign Language, open-captions, and is voiced throughout. We’re also happy to provide a Spanish version of the message with open-captions.
If you have additional questions for FEMA-Office of Disability Integration and Coordination questions, please contact our office at
Office of Disability Integration and Coordination
FEMA Administrator’s Message – http://www.fema.gov/medialibrary/media_records/6407
Spanish Video: http://www.fema.gov/medialibrary/media_records/6408
MNSJ members recognized the increasing number of drug shortages occurring in America and sought the support of the AMA on this issue. AMA has been tracking the issue for some years, but the shortages have now become more common and include vital and life sustaining drugs for which there may be no substitutes. To address this issue MSNJ leadership passed a resolution that will require the AMA to support federal legislation and regulations to address the shortages. The resolution seeks action to ensure continuity of supply of vital and life sustaining medications and vaccines. It aslo seeks penalties for non-compliance. MSNJ will introduce this resolution, as an urgent matter, during the AMA Interim Meeting in November and ask for its action plan at the AMA’s 2012 Annual Meeting.
The President recently executed an Executive Order to address the critical drug shortages in America. With this attention and the advocacy efforts of organized medicine we are confident that the issue will be addressed.
The Medical Society of New Jersey is providing emergency preparedness information for physicians who treat patients with special medical needs. Physicians can assist their patients with special medical needs to prepare for evacuation by referring them to county based emergency medical services in advance of a disaster. Below is a summary of resources.
Mary Goepfert, MPA, APR, CPM, External Affairs Officer, NJ Office of Emergency Management presented at the August 11, 2011, PSP Meeting and her power point Assisting People with Disabilities during Large-Scale Emergencies and Disasters is available on the MSNJ website http://www.msnj.org. As in all situations, planning is the key for the patient and their family.
The special need patients need to have a GO KIT. Listed below are some items that the individual needs to have ready in addition to basic supplies of water, food, flashlight, whistle or bell for alerting other to your whereabouts, batteries, basic first aid supplies and supplies for pets. Another suggestion is having their identification, medical information and personal contacts on a computer thumb drive.
- Identification, medical insurance cards, physician contact information
- Written medical descriptions of the disability and support needs
- Copies of medical prescriptions
- List of personal contacts
- List of allergies and health history
- Medical alert tags or bracelets
- Extra medicine, oxygen, insulin, catheters or other medical supplies used regularly
- Eyeglasses, hearing aids
- Batteries – for adaptive equipment
- A light weight, collapsible wheel chair
Sign up on the NJ Register Ready website. This website collects data on special need individuals to provide information to the emergency response agencies.
Each county in the state has an office on emergency management. Please refer to the following websites for more detail information.
After hearing yesterday that some physicians were having difficulty accessing the CMS Communication Support Page, the AMA was able to work with CMS to secure an extension. The new deadline to file for an e-prescribing hardship exemption is Tuesday, November 8, 2011. The hardship exemption categories include:
- Your practice is located in a rural area without highspeed internet access
- Your practice is located in an area without sufficient available pharmacies for ePrescribing (CMS clarified by providing more examples including disruption of e-prescriptions between physician offices and pharmacies caused by natural disasters).
- You are registered to participate in the Medicare or Medicaid electronic health record (EHR) Incentive Program and you adopted certified EHR technology by October 1, 2011, and did so prior to requesting an exemption.
- You are unable to electronically prescribe due to local, state or federal law or regulation, (CMS clarified that physicians who mainly prescribe narcotics but due to certain limitations cannot submit these prescriptions electronically can apply for this exemption category).
- Limited prescribing (you do not prescribe on a regular basis).
- There were too few opportunities for you to report the ePrescribing measure due to limitations of the measure’s denominator (you do e-prescribe but your electronic prescriptions are not related to qualifying visits/services).
Where to File for a Hardship Exemption
File for a hardship exemption online.
What to Do if You Have Problems Accessing the Hardship Exemption Webpage
CMS and the QualityNet Help Desk has been receiving calls from Eligible Professionals who are having difficulty with accessing the Communication Support Page. After doing some research they found that the problem is related to an issue with the internet browser. CMS is asking eligible professionals to take the step below if they are unsuccessful in accessing the Communication Support Page when trying to submit their Hardship Exemption Request.
After typing in the above link, in the internet browser, select Tools/Internet Options/Advanced. Scroll down toward the bottom and locate the “Use TLS 1.0” choice. Place a checkmark in the “Use TLS 1.0.” Click OK. Attempt to access the site again.
If you still have trouble accessing the site, the QualityNet Help Desk may be reached at 1-866-288-8912 or email at email@example.com from 7am to 7pm CT, Monday through Friday. Due to the high volume of calls that the QualityNet Help Desk has been receiving there may be a waiting period.
MSNJ appreciates the efforts of AMA on the e-prescribing program, particularly with regard to the hardship exemptions.