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2014 Message from MSNJ President, Ruth Schulze, MD

MSNJ –HAPPY 2014!

As we begin a New Year, it seems like a perfect time to look back on 2013 and all that MSNJ has been doing.  At my inaugural last May, I suggested 5 initiatives as part of our strategic plan:

  1.                 Outreach for Hospital Staff and Large Group Membership
  2.                 Increased Student Participation
  3.                 Community Partnership
  4.                 Quality Certification for Medical Liability Insurance Reduction
  5.                 Coalition Building with Specialty Societies

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While we have made progress in all these areas, our mission and battles continue.  But isn’t that a prime reason for MSNJ’s existence- to defend physicians in their professional battles – to be the representative voice of the physician community- to be the watchdog protecting the back of the medical profession.

Scope of practice, out-of-network payments, maintenance of certification, insurance network adequacy, physician exclusions, SGR repeal, ICD-10 conversion, medical liability reform and the prevention of bad legislation are all on MSNJ’s daily “to do “ list.

The MSNJ BOT was recently asked a visioning question at our November board retreat:

If there were no financial or staffing constraints, “I would like my medical society to….”

Board members consistently answered; Increase Effective Communication, Redefine Membership Options, Partner with Community Groups & Organizations, Promote Quality Medicine, Rebrand MSNJ, Create a Public Relations Campaign, Recapture Physician Esteem and ultimately, Increase MSNJ Relevance to Physicians.

These issues are of critical importance to NJ physicians, but interestingly, they are also the same issues which our neighboring states are tackling as well.  Physicians everywhere are struggling with similar issues and feeling equally frustrated and threatened by our flawed medical system.  So much of the daily practice of medicine seems like a fight- insurers, lawyers, legislators, administrators and sometimes even colleagues are all attacking us.  This onslaught has made many physicians jaded and negative. We, the entire physician community, need to recapture the positive side of medicine and reaffirm the healing aspect of our profession.

To that end, I have asked the MSNJ Foundation to help establish a physician led community outreach program targeting adolescent and young adult multicausational  health problems. This public health initiative is modeled after a similar program in Delaware entitled “OBVIOUS”.  I look forward to sharing more details as this program takes shape over the next months.  MSNJ is also introducing a “Women in Medicine” discussion series and CME program this March with a follow-up “Collaborative Health Team” event anticipated for the fall of 2014.  We are also facilitating scheduled quarterly meetings of all specialty societies so that the “Medical Voice” of NJ physicians can be one of unity and well-being.

Such programs are just the beginning of our campaign to revitalize our society and create,

“ The New MSNJ – The Voice of NJ Physicians”.

In February, the BOT will meet for Part 2 of our yearly retreat to establish our 2014 organizational strategic plan.  While there are less than 5 months left in my presidency, our collective mission has no endpoint.  MSNJ’s mission is not a destination but rather an ongoing journey.  Just as in 1766, MSNJ as  the physician voice, is speaking to protect our profession and promote the betterment of public health.  Individually our physician message is important but only heard by a select few.  Together, our physician voice can be powerful ,so let’s “Get Loud” in 2014 as MSNJ becomes “The Physician Voice” in NJ.

– Ruth Schulze, MD
MSNJ President

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MSNJ Legislative Update: May 10, 2013

Pediatric Respite Care Facilities

The Assembly Regulated Professions Committee unanimously approved A. 3558 which will provide a license for pediatric respite care facilities.  A pediatric long-term care facility is not required to seek a dual license under this bill.  MSNJ took no position on this bill, but recognizes its potential to help families deal with pediatric illnesses.

Mental Health Coverage for Alcoholism & Substance Abuse Disorders

The Assembly Health Committee passed A. 1665/S. 1253, which would revise statutory mental health coverage requirements and require all health insurers and SHBP to cover treatment for alcoholism and other substance-use disorders under the same terms and conditions as for other diseases or illnesses. MSNJ has supported mental health parity measures, including this one, for years. The bill is particularly important in light of the focus on mental health issues related to gun violence.

Influenza Vaccinations for Healthcare Workers

The Assembly Health Committee passed A. 2172, which would require that a healthcare facility annually offer on-site or off-site influenza vaccinations to its health care workers, and they would be required to receive an influenza vaccination, but would be permitted to present acceptable proof, including an attestation by the health care worker, of a current influenza vaccination from another vaccination source, or sign a written declination statement. The bill is poised for full votes in both houses; the Governor vetoed the bill last year. MSNJ supports the bill.

Prescription Drug Donation Repository Program

The Assembly Health Committee passed A. 2188/A. 3964, which would establish a prescription drug donation repository program in the Department of Health (DOH).  This program will provide for the donation of unused prescription drugs and supplies by persons, health care facilities, and pharmacies to a central repository for redistribution to authorized medical facilities and pharmacies in order to re-dispense these medications, which would otherwise be destroyed, for use by individuals who meet eligibility criteria specified by the Commissioner of Health. MSNJ supports the bill, as it is in line with our goal to reduce abuse and diversion of drugs, particularly opioids.

Limitation of Settings for Certain Surgeries

The Senate Health Committee approved S. 2079, sponsored by Senator Richard Codey, which would limit settings where certain surgeries may be performed.  Under the bill, a physician may only perform any of the following procedures in an office or facility that is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or The Joint Commission: a liposuction procedure that involves more than 750 cubic centimeters of aspirate; a procedure that utilizes a breast implant; or an aesthetic truncal contouring procedure that involves the excision of skin. This bill is supported by plastic surgeons, but opposed by dermatologists. MSNJ opposes the bill on the principle that clinical matters of such specificity should not be legislated.

Medicaid Expansion

The Senate Health Committee also passed S. 2644, sponsored by Senators Joseph Vitale, Nia Gill and Loretta Weinberg, which would expand Medicaid eligibility pursuant to the federal Affordable Care Act.  The bill essentially is the legislative version of the Governor’s decision to expand Medicaid eligibility under the ACA.  MSNJ’s position on expansion can be found here.

Value Based Benefit Design for Chronic Health Conditions

The Assembly Appropriations committee passed A. 1214, which establishes a pilot program to utilize value-based benefit design in the State Health Benefits Plan to increase health benefits coverage for certain employees concerning chronic health conditions.  The coverage design will utilize explicit financial incentives to increase the employee’s interaction with appropriate health care providers, and encourage use of those health benefits that specifically relate to the employee’s chronic health condition.  MSNJ is monitoring this bill, which mirrors the goals of ACOs and other new payment models that focus on outcomes.

Health Benefit Mandate for Breast Imaging Services

The Assembly Appropriations committee also passed A. 2022/S. 792, which contains an insurance mandate for certain tests following mammograms and requires certain notice about risk factors. 

The bill requires health insurers to provide health benefits coverage for additional testing deemed medically necessary by a patient’s health care provider, of an entire breast or breasts, after a baseline mammogram examination, if the mammogram demonstrates extremely dense breast tissue, if the mammogram is abnormal within any degree of breast density including not dense, moderately dense, heterogeneously dense, or extremely dense breast tissue, or if the patient has additional risk factors for breast cancer.  Additional risk factors include, but are not limited to, family history of breast cancer, prior personal history of breast cancer, positive genetic testing, extremely dense breast tissue based on the Breast Imaging Reporting and Data System, or other indications as determined by the patient’s health care provider. The bill also requires providers of mammography services to include information on breast density in mammography reports sent to patients and physicians, if a patient’s mammogram demonstrates extremely dense breast tissue based on the Breast Imaging Reporting and Data System.  The bill provides that the information on breast density must include the following statement:  “Your mammogram shows that your breast tissue is extremely dense as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology.  Dense breast tissue is very common and is not abnormal.  However, extremely dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for cancer.  This information about the result of your mammogram is given to you to raise your awareness.  Use this information to talk to your health care provider about this and other risks for breast cancer that pertain to your personal medical history.  A report of your results was sent to your physician.”

MSNJ was engaged in improving the bill along with radiology and ob/gyn specialty societies, so that it reflects clinical realities and current practices.  Insurance providers and business groups oppose the bill.

Regulations Adopt MSNJ Suggestions for Collaborative Practice with Pharmacists

MSNJ has advocated for changes to the regulatory proposals which would allow collaborative practice agreements between physicians and pharmacists over the last two years. On February 4 the State Board of Medical Examiners and State Board of Pharmacy adopted regulations that addressed many of our concerns. The boards clarified in the preamble to the adopted regulations that “pharmacists do not have prescriptive authority” and may not engage in therapeutic interchange without the express consent of the physician and patient. [44 N.J.R. 213(b), Response to Comment 6].  Specific provisions for which MSNJ advocated include:

  • Pharmacists may modify, continue or discontinue drug therapy, but may not initiate;
  • Collaborative practice arrangements are limited to individual pharmacists (and may not be with a pharmacy or a chain);
  • There must be a bona fide relationship for a physician and pharmacists to enter into a collaborative practice arrangement;
  • The pathways for pharmacists to participate in collaborative agreements has been better defined; a voucher of 2,000 hours of training is not sufficient;
  • Covering physicians and pharmacists must meet the same standards as the individuals entering into the arrangements;
  • Specific conditions/diseases must be specified in the collaborative agreement; and
  • Pharmacists must complete ten hours of continuing education on the specific disease states or conditions covered by the collaborative agreement which may require more than the minimum 30 hours, biennial,  of continuing education depending on the number of conditions/disease states covered; physicians may customize the disease specific training required for the treatment of his/her patients.

MSNJ appreciates the careful consideration given to our concerns and the responsiveness of the Boards of Medical Examiners and Pharmacy to our comments.

MSNJ Leads Rule-making that Directly Impacts Physicians

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.

MSNJ Joins AMA in Sunshine Law Concerns

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.

Proposed Rulemaking—PIP and Managed Care Contracts

This week, the New Jersey Department of Banking & Insurance (DOBI) proposed two significant regulations that are of interest to our membership.

MSNJ and many other physicians, practices, and specialty organizations filed comments on DOBI’s proposed comprehensive personal injury protection (PIP) regulations. DOBI has re-proposed certain key provisions in an effort to respond to the meritorious comments. In particular, MSNJ asked that the fees for spinal surgeons and neurosurgeons be re-examined in light of the shortage of these specialists and the amount of the fees. DOBI has responded by removing from the fee schedule 117 of the CPT codes of concern, permitting these codes to be paid at usual customary and reasonable (UCR) rates until further study can be concluded. MSNJ also asked that the proposed workers compensation managed care organization (WCMCO) network entity be removed from the proposed new regulatory framework. DOBI has responding by removing WCMCOs as network providers.

MSNJ has advocated for rulemaking on managed care contracts for over five years. Our effort has been focused on leveling the playing field and creating a “fair contract” environment between healthcare insurers and physicians. DOBI worked diligently with all affected stake-holders and publication of proposed fair contract regulations was imminent when Governor Christie signed Resolution One, the red-tape reduction initiative, which had the impact of holding regulations. With the cooperation of Governor Christie’s administration and DOBI, those proposed rules on managed care contracts were released this week. The proposed regulations appear to incorporate many of our desired provisions and we will work to ensure that the adopted “fair contract” regulations benefit our members.

Comments on the proposed PIP and managed care contract rules are due on April 21, 2012.

MSNJ Objects to Expansion of Chiropractors’ Scope of Practice

On January 20, 2012, MSNJ filed comments in opposition to the New Jersey Board of Chiropractors proposed regulations that would expand chiropractors’ scope of practice by allowing them to perform pre-participation screens—medical examinations of students, clearing them for sports and intramural activities. While the New Jersey Legislature previously expanded the chiropractors’ scope of practice, it specifically considered and deliberately declined to include pre-participation screens in the enabling legislation. MSNJ is confident that the legislature said what it meant and did what it said. We believe that inclusion of pre-participation screens was in error and that the Board of Chiropractors will remove this unauthorized scope of practice expansion from the regulations.

This effort is part of MSNJ’s initiative to protect the profession of medicine and ensure that any expanded scopes of practice are medically appropriate and well-defined. MSNJ will continue to monitor the rulemaking and will keep members apprised of any developments. Read MSNJ’s comments in their entirety.