Archive | March 2015

Doctor’s Day: N.J. Doctors Work to Keep Care Accessible – Urge New Jersey Senators to Vote in Favor of Legislation

By: Lawrence Downs, Esq.

Doctors want to help people. That’s what drives them; that’s what gives them satisfaction and purpose. And that’s what they spend their lives doing.

For more than a decade, however, physicians have faced rising barriers to caring for older patients. Due to flaws in the Medicare system – the federal health insurance program for seniors – growing numbers of physicians simply cannot afford to treat Medicare patients, and seniors are increasingly struggling to access medical care.

But across New Jersey and nationwide, caring doctors are stepping forward to help. They’re strongly supporting legislation that would ensure seniors access to physicians in their communities.

The problem is not new: Congress has enacted 17 temporary patches over the past 12 years to address Medicare’s faulty “Sustainable Growth Rate” (SGR) formula – which determines physician payment rates each year. (Ironically, the $170 billion price tag on these patches has already exceeded the cost of simply freezing payment rates for the next 10 years, estimated at $137 billion by the American Medical Association.)

But now, there’s a real chance for a permanent – and less costly – repair: Congress has introduced, and the House has already voted on groundbreaking legislation that would eliminate the SGR and provide real solutions to ensure seniors’ access to good care.

After many years with little consensus, we finally have a bipartisan, bicameral bill, and the vital support of key stakeholders including patient organizations, policy think tanks, and advocacy groups across the political spectrum.

The Medical Society of New Jersey is one of more than 600 national and state physician associations that vigorously support the legislation, known as the “SGR Repeal and Medicare Provider Payment Modernization Act of 2014” (H.R. 1470 / S. 810).

Since the House has already taken historic action, we encourage New Jersey Senators Menendez and Booker to vote in favor of this legislation when the Senate returns on April 13, so it can be sent to the president’s desk for signature.

If nothing is done, the problem will only worsen. Today, with the baby boomers hitting retirement age, 10,000 Americans are enrolling in Medicare each day. In New Jersey, 1.4 million people currently rely on Medicare; nationally, the total is about 50 million.[i] The flawed SGR also affects the care of 10 million veterans and active-duty military personnel enrolled in Tricare, the health care program for armed-services members and their families.

Physician members of MSNJ urge everyone’s strong support of the SGR Repeal Act, to help ensure care for some of our most vulnerable citizens. For more information, including links to contact Congress, please visit, scroll to “News” and click on “SGR Repeal.”

Time is running out; please act now.

[i] Kaiser Family Foundation, Total Number of Medicare Beneficiaries (2012). Accessed March 24, 2015

Insurers Release Study on Out of Network Costs

Yesterday Horizon Blue Cross released the results of a study it paid for that concludes that insurers are paying too much to physicians and hospitals that don’t participate in its network. Horizon also suggested it could lower premiums if NJ’s important consumer protections were repealed.

Horizon is a financial juggernaut. The company made $214 million net of expenses in 2013 according to its published financial statements, that’s $10 million better than they did in 2012. The company (a non-profit) has reserves over $2.5 billion. It seems they have some room to lower premiums now.

What Horizon failed to say is that they have the ability to contract with all physicians and hospitals in the state, but they choose not to. New narrow network plans exclude physicians that want to treat patients. So in effect Horizon is contributing to the problem they seem so desperate to fix.

Dialog on the financing of healthcare in NJ is sorely needed. But the laser focus on out of network payments is unfounded.