Two state regulatory proposals will have a direct impact on virtually every member of MSNJ and physicians practicing in New Jersey. DOBI’s re-proposed regulation on managed care contracts is the culmination of seven years of MSNJ work, beginning with the passage of the managed care reform law in 2006 and the settlement of national class-action lawsuits with the major healthcare insurers over the past decade. One element of managed care reform is regulations that will legally bind healthcare insurers to fair contract principles with participating physicians. MSNJ has tirelessly spearheaded this initiative, meeting with representatives at the highest level of both DOBI and the Governor’s Office. This has caused the re-proposal to be released for comments.
Similarly, DOBI re-proposed regulations governing the personal injury protection (PIP) program in New Jersey when MSNJ expressed concerns over the comprehensive rule proposal. This has already resulted in the removal of the proposed workers compensation managed care organization (WCMCO) network. DOBI also removed 117 of the CPT codes of concern for spinal surgeons and neurosurgeons, permitting these codes to be paid at usual, customary and reasonable (UCR) rates until further study can be concluded.
MSNJ will file comments on the “fair contract” rule proposal and PIP rule proposal by the due date of April 21, 2012. Any member with questions or suggestions for comments should contact Melinda Martinson, MSNJ Assistant General Counsel, at (609) 896-1766, ext. 258.
A pending federal rule proposal will impact physicians nation-wide: CMS has proposed changes to the Medicare program’s overpayment recovery program which would permit the federal government to “look back” for a period of ten years on alleged overpayments. MSNJ has a long history of objecting to unreasonable overpayment recovery requests which includes meeting with representatives at the highest level of Aetna in Hartford, Connecticut, and urging both the AMA and the Physician Advocacy Institute (PAI) to make overpayment recovery issues a national priority. MSNJ is considered a national leader on this issue. Read PAI’s whitepaper.
We will work with the AMA on this issue and will file comments in opposition to the proposed expansion of the Medicare overpayment recovery program. Comments on the Medicare proposal are due on April 16.
Diane Calello, MD, represented the Medical Society of New Jersey at a press conference held in Trenton on Wednesday, February 29 as Attorney General Jeffrey S. Chiesa announced a comprehensive statewide ban on all types of synthetic marijuana, which was issued by the Division of Consumer Affairs. According to reported data, between 2010 and 2011 the number of synthetic marijuana exposures reported to poison control centers jumped by an alarming rate of 139 percent nationwide and 711 percent in New Jersey alone. A recent nationwide study funded by the National Institute of Drug Abuse shows synthetic marijuana is the third most commonly abused drug by American high school seniors, after marijuana and prescription drugs.
Dr. Calello is a medical toxicologist at the New Jersey Poison Information and Education System in Newark, NJ, and an attending physician in the Emergency Department at Morristown Medical Center/Atlantic Health System. She spoke on the effects of synthetic cannabinoids and the serious risk they pose to public health and safety.
This week, the New Jersey Supreme Court published its opinion in Kendall v. Hoffman-LaRoche, its latest interpretation of the discovery rule in New Jersey. MSNJ filed an amicus brief in the case because the state courts’ expansion of the two-year statute of limitations for personal injury lawsuits through the discovery rule is of great concern to physicians in the state of New Jersey. We are disappointed that the state’s highest court has again adopted an expansive view of “when the patient knew or should have known” that her injuries were related to the use of Accutane.
MSNJ’s participation in the case is part of our legal advocacy initiative to restrain further inappropriate extension of the statute of limitations. We believe that an expansive interpretation of the discovery rule has a direct impact on the cost of practicing medicine through increased professional liability premiums. The opinion sharpens our resolve to achieve tort reform through legislation.
Last week, MSNJ joined the AMA and virtually all of organized medicine in comments requesting significant changes to the proposed rule implementing the “Sunshine Provisions” in the Patient Protection and Affordable Care Act (PPACA). PPACA requires pharmaceutical and medical device manufacturers to report on transfers of value to physicians and teaching hospitals. Among the most controversial requirements is one that gifts (including food) of less than $10 be aggregated and reported if they exceed $100 in a year. The physician community is concerned that the proposed regulations are even worse, allowing aggregated amounts to be attributed to practices or entities rather than attributing the actual amount to an individual who directly received value. We believe that the amount of reporting will result in misleading information, shedding little light on actual physician-manufacturer interactions, and imposing burdensome record keeping time and expense on physicians. We have asked that any reporting obligation be delayed until a final rule is issued.
Another controversial requirement in the rule proposal relates to the requirement that indirect transfers through certified and accredited CME be reported. However, Congress excluded CME from reporting because of the strict regulations already in place governing industry relationships. MSNJ is recognized by the Accreditation Council for Continuing Medical Education (ACCME) to accredit intrastate continuing medical education (CME) providers in our state. Our Committee on Medical Education oversees and administers the CME accreditation program. Because the proposed rule would be burdensome and unnecessary MSNJ’s Committee on Medical Education submitted comments to CMS.