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

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

MSNJ Legislative & Regulatory Update – March 22, 2013

From Trenton: Assembly Action:
On Thursday, the Assembly passed a bill that requires physicians to complete survey as condition for biennial registration with Board of Medical Examiners and requires board to maintain and disseminate survey data as appropriate. S. 1336 aims to address workforce shortages and now heads to the Governor’s desk.

The Assembly on Thursday voted on S. 2082, the “Opioid Antidote and Overdose Prevention Act,” which provides immunity from civil and criminal liability and professional discipline for health care professionals who prescribe or dispense naloxone or any similarly acting drug approved for the treatment of an opioid overdose. It provides immunity from civil and criminal liability for other persons who administer such a drug in an emergency to an individual who the person believes in good faith is experiencing an opioid overdose. A health care professional prescribing or dispensing an opioid antidote to a patient would be required to ensure that the patient receives overdose information, which is specified in the bill, and could fulfill this requirement by maintaining a written agreement for the provision of such information with a community-based organization, substance abuse organization, or other organization which addresses medical or social issues related to drug addiction.  MSNJ and the AMA support this bill.

Senate Action:

The Senate passed mental health parity legislation on Monday. S. 1253, sponsored by Chairman Vitale, requires SHBP and SHEBP to cover treatment for alcoholism, other substance-use disorders, and non biologically-based mental illnesses under same terms and conditions as for other diseases or illnesses. MSNJ supports this bill. The Assembly has not yet considered the bill.

Also on Monday, the Senate passed A. 3080, sponsored by Chairman Schaer, which requires health benefits coverage for refills of prescription eye drops under certain conditions. MSNJ supports this bill which now heads to the Governor’s desk.

Gubernatorial Action:

This week, Governor Christie signed a scope of practice bill that MSNJ worked on intimately.  S. 555 removes from a genetic counselor’s scope of practice interpreting such laboratory tests and other diagnostic studies and clarifies that genetic counseling includes identifying, coordinating, and explaining the clinical implications of genetic laboratory tests and other diagnostic studies and their results.  The bill also adds to the scope of practice integrating genetic laboratory test results and other diagnostic studies with personal and family medical history to assess and communicate risk factors for genetic or medical conditions and diseases.  Current law provides that the provisions of the “Genetic Counselor’s Licensing Act,” shall not apply to a person licensed by the State to practice medicine and surgery when acting within the scope of the person’s profession and doing work of a nature consistent with the person’s training, so long as the person does not hold himself out to the public as a genetic counselor.  The bill provides that the act shall not apply to a person licensed by the State to practice medicine and surgery, so long as the person does not hold himself out to the public as a licensed genetic counselor.

New Jersey’s Fiscal Year 2014 Budget

The Legislature has begun its budget hearings, taking testimony from members of the public. In the Assembly hearing on health issues, over 30 people testified with concerns on funding for hospitals, mental health programs and other items.  MSNJ will remain engaged in the budget process, particularly Medicaid Expansion. Read MSNJ’s policy statement on Medicaid expansion.

From Washington: House Committees Continue their Work on SGR Repeal & Replacement
The AMA recently provided in-put to the House Committees on Ways & Means and Energy & Commerce proposal to repeal Medicare’s flawed sustainable growth rate (SGR) formula and replace it with physician-driven quality and payment methodologies. Key points included:

• Phase I: Permanent repeal of the SGR and statutorily-defined rates based on the Medicare Economic Index (MEI) for three to five years
• Phase II: Fee schedule updates based on meaningful, physician-endorsed measures of care and clinical improvement; reduced reporting burdens; timely access to quality performance scores
• Phase III: After several years of risk-adjusted quality-based payments, physicians who perform well would earn additional payments based on efficiency; duplicate programs and reporting requirements would be eliminated.

Other in-put included:

• a “Provider Shield Act” so that reporting would not be used as evidence in tort actions;
• private contracting without penalty to physicians and patients to ensure patient choice and access to care.

MSNJ’s ‘News From Trenton’

News from Trenton

AMA National Advocacy Conference (NAC)

This week, Mary F. Campagnolo, MD, MBA and John Poole, MD, along with MSNJ CEO Larry Downs and COO and Senior Manager, Legislation, Mishael Azam, attended the AMA’s National Advocacy Conference. They heard from national leaders, including Secretary Sebelius, on federal budget issues, SGR reform and GME changes. They also met with staff for key members of the New Jersey Congressional delegation to discuss SGR and other reforms. A House Energy and Commerce held a hearing on Thursday entitled, ‘SGR: Data, Measures and Models; Building a Future Medicare Physician Payment System.’ MSNJ will keep members apprised of these issues. Read more.

Tanning for Minors
On Thursday, the Assembly took a final vote on a bill that would (1) permit a tanning facility operator to allow minors who are at least 14 years of age to use a tanning facility for spray tanning and (2) permit a minor who is at least 17 years of age to use a tanning bed in a tanning facility, provided that the minor’s parent or guardian is present at the tanning facility for the initial consultation. Tanning facility operators must also post notice of the law in conspicuous view near the reception area. The bill now heads to the Governor’s desk.

Gun Control Measures
The Assembly Law and Public Safety Committee on Wednesday heard over 20 bills on gun control. MSNJ weighed in on a mental health bill and successfully sought amendments to protect physicians. The amended bill requires licensed medical professionals in this State to report to the Attorney General when, in their reasonable professional judgment, a patient they are treating is likely to engage in conduct that would result in serious harm to that patient or others. As amended, the bill clarifies that the licensed practitioner who discloses such a privileged communication in is immune from civil liability in regard to that disclosure. The goal of the bill is for the AG to seize weapons from such patients, if appropriate. The bill leaves in place current immunity for physicians from civil liability for a patient’s violent act against another person or against himself. The bill also leaves in place duty to warn requirements and immunity if the duty is upheld. The bill heads to the floor for a full vote but has not yet been considered by the Senate.

Child Privacy
In the Assembly Education Committee, MSNJ supported protections of child privacy. Current law states that, a school district must receive prior written informed parental consent before it administers to students any academic or nonacademic survey, assessment, analysis or evaluation which reveals information concerning:

1. political affiliations;
2. mental and psychological problems potentially embarrassing to the student or the student’s family;
3. sexual behavior and attitudes;
4. illegal, anti-social, self-incriminating and demeaning behavior;
5. critical appraisals of other individuals with whom a respondent has a close family relationship;
6. legally recognized privileged or analogous relationships, such as those of lawyers, physicians, and ministers;
7. income, other than that required by law to determine eligibility for participation in a program or for receiving financial assistance under a program; or
8. social security number.

The bill would loosen parental control requirements by only requiring consent if participation in such surveys is required by the school. If the survey is voluntary, only written notice is required. But, voluntary surveys may not request the student’s political affiliation, sexual behavior and attitudes or social security number.

MSNJ News Roundup – January 4, 2013

Medicare Fee Cut Averted Through 2013; Sequester Cut Delayed for Two Months On January 1^st Congress passed the American Taxpayer Relief Act  and successfully averted the average 26.5% cut in the Medicare physician fee schedule The act dodges the scheduled fee cut due to the sustainable growth rate (SGR), but does not repeal the flawed formula. The 2% sequestration cuts to Medicare payments have also been delayed, but for only two months. MSNJ and our members actively lobbied our congressional delegation to stop the Medicare fee cut, repeal the SGR and replace it with new payment models that will be sustainable. This action stops the fee cut and allows a year for the repeal and replacement of the SGR. While we are thankful that Congress prevented the drastic cut in fees, MSNJ still believes that a permanent fix to the SGR is necessary and overdue. See Senator Menendez’s response to MSNJ’s request that the SGR be repealed. We will continue our efforts to repeal the SGR.

This $25 billion band-aid was offset by assorted provisions. Thankfully, as advocated by MSNJ and the AMA, the increase in Medicaid payments to primary care providers and funds for preventive services remain untouched. Unfortunately, the offsets will have a negative impact on payments for advanced imaging services and will extend the statute of limitations on recoupment to 5 years. In addition, the act takes back unobligated funds for health insurance co-ops as a cost savings. Existing obligations will be honored.

For details on Medicare and other health provisions contained in the American Taxpayer Relief Act, visit the AMA’s website.

2013 Medicare Fee Schedule- Billing Update & Participation Deadline Extension
Many members have questions about billing Medicare, now that the cut has been averted. Although the fee cut has been prevented, it is an average, not applicable to each CPT code and there may be other changes affecting the 2013 Medicare fee schedule, besides the SGR. While the SGR cut has been delayed until after December 31, 2013, Relative Value Unit (RVU) changes will be different from last year, thus changing the 2013 fee schedule for certain CPT codes–either up or down.

We have asked for implementation information from Novitas (New Jersey’s Medicare Contractor). So far, there is no official Novitas position, but CMS published notice indicating that it is updating the 2013 Medicare Physician Fee Schedule. CMS also noted that the Medicare contractors may hold claims until January 15, 2013, while they test and implement the fee schedule. This falls within the prompt pay timeframe.

CMS will give Novitas until January 23, 2013 to post the updated fee schedule on its website.  As of today, the Medicare fee schedule posted on the Novitas website still reflects the scheduled fee cut. In the meantime, we recommend that members hold claims until Novitas posts the corrected 2013 fee schedule. If a practice uses the wrong fee schedule and bills Medicare less than the new fee schedule amount, Medicare will pay the lesser of the two fees and will not reconsider the claim. CMS has also extended the deadline for changing participation status to February 15, 2013. We will notify members, once additional information is received from Novitas.

First HIPAA Breach Settlement Involving Fewer than 500 Patients Announced
The U.S. Department of Health and Human Services (HHS) recently announced a resolution agreement in which the Hospice of North Idaho (HONI) agreed to pay $50,000 for potential HIPAA violations involving less than 500 patients. This is the first settlement involving a breach of protected health information (PHI) of fewer than 500 patients.  HONI also agreed to a corrective action plan (CAP) that requires HONI to notify HHS of any violation of HONI’s privacy and security policies within 30 days of the breach for two years after the date of the resolution agreement. As part of the CAP, HONI must include a description of the events leading up to the breach, a copy of the policy violated, and a description of the corrective actions taken.

The investigation was prompted by HONI’s submission of a breach report to HHS, a requirement under the HITECH Act. A HONI laptop containing electronic PHI was stolen, putting the privacy of 441 patients at risk. After investigation, HHS found that HONI did not perform necessary risk analysis and failed to establish adequate policies and procedures regarding the security of laptops and other mobile devices containing PHI. These inadequacies were in direct violation of the HIPAA Security Rule.

In its article, New Year, Same Old Health Data Breaches, FierceHealthIT noted that security risks continue to be a problem for the healthcare industry and listed several recent cases of PHI security breaches. HHS recognized that physician education is essential to reduce the frequency of such breaches.  In response, HHS developed an educational initiative, Mobile Devices: Know the RISKS. Take the STEPS. PROTECT and SECURE Health Information, to assist physicians with HIPAA compliance when using laptops, smart phones, and tablets. Members are encouraged to review the HHS materials and to take the appropriate steps to protect electronic PHI contained in laptops or other mobile devices.

Congress Must Act to Avert Medicare Fee Cuts Before January 1

The annual rite of organized medicine seeking congressional action to avert steep Medicare fee cuts before January 1 is upon us. However, this year is different. Not only is a 27% fee cut scheduled to occur because of the flawed SGR formula, but physicians will also be subject to an additional 2% fee cut under the sequestration. Next week Congress and the President will return to Washington to face the fiscal cliff, in addition to resolving the annual Medicare fee issue. In anticipation of this, MSNJ joined virtually all of organized medicine to support SGR Transition Principles in personal letters to the New Jersey delegation. We previously gained the personal support of many of our delegation. (See MSNJ e-News dated February 16, 2012). Members are asked to watch for a strategically timed grass-roots “call to action” on this issue.

President Signs Medicare Fee Law as Part of Payroll Tax Extension

Last week, we reported that Congress failed to repeal Medicare’s sustainable growth rate (SGR) formula, but voted to avert the scheduled 27% fee cut in 2012 that is the consequence of the flawed Medicare payment formula. In doing so, Congress missed an historic opportunity to offset the growing cost of funding the SGR shortfall by offsetting the costs with excess spending projected for the conflicts in Afghanistan and Iraq. Instead, Congress adopted the proposal of the congressional conference committee.

Failure to address the SGR in the way proposed by AMA, MSNJ, and virtually all of organized medicine will:

• cost $20 billion to stave off the cuts for ten months;
• add another $25 billion to the cost of eliminating the SGR; and
• result in an estimated payment cut of 32% in 2013.

The House voted 293-132 in favor of the conference committee’s proposal. The Senate voted 60-36 in favor of the proposal. President Obama signed the law on February 22. We are disappointed that resolution of the Medicare physician payment issue has been postponed until after the election.

MSNJ appreciates the support that we received from our representatives, among them: Congressmen Leonard Lance (R-7), Frank Pallone (D-6) and Scott Garrett (R-5) and Representative Rush Holt (D-12). A March meeting with Representative Jon Runyan (R-3) is anticipated. We will continue our efforts to repeal the SGR.

Conferees reach agreement on short-term SGR patch; AMA & MSNJ express deep disappointment

A message from the AMA:

While some details are still being finalized, it is being reported from Capitol Hill that conferees have reached agreement on extending the payroll tax holiday, unemployment insurance benefits, and current Medicare physician payment rates for the next 10 months, through the end of 2012.

In lieu of the 27.4 percent physician payment cut scheduled to take effect on March 1, a payment freeze will be effective through the end of the year.  The cost of this short-term patch was reportedly offset through reductions in a number of health care programs, including Medicaid disproportionate share payments to hospitals, Medicare bad debt payments to hospitals, federal Medicaid payments to Louisiana, and the prevention fund created by the Affordable Care Act.  Other expiring Medicare policies were also extended through the end of the year, including the “floor” on geographic adjustments to the physician work component of the Medicare fee schedule, the therapy cap exemption process, and ambulance add-on payments.  Two policies—Section 508 hospital and special pathology payments—will be phased out, and mental health add-on payments and pay increases for bone density scans have been eliminated.

Assuming this agreement secures sufficient support, it could be voted on by both the House and Senate by the end of the week.

The AMA issued the following statement as details of this agreement began to emerge, attributable to AMA President Peter W. Carmel, MD:

“The House and Senate conference committee agreement averts a 27 percent cut on March 1, but it represents a serious missed opportunity to permanently replace the flawed Medicare physician payment formula and protect access to care for military families and seniors. People outside of Washington question the logic of spending nearly $20 billion to postpone one cut for a higher cut next year, while increasing the cost of a permanent solution by about another $25 billion.

 “Congress had an opportunity to permanently end this problem, which is the sound, fiscally prudent policy choice. We appreciate efforts by members of Congress on both sides of the aisle who publicly supported a framework for a permanent end to this perennial problem. We are deeply disappointed that Congress chose to just do another patch – kicking the can, growing the problem and missing a clear opportunity to protect access to care for patients. Shortly after the coming elections, access to care for seniors and military will again be threatened by an even larger cut, and members of Congress will need to take swift action to end the broken formula.”

MSNJ Meets with Congressman Pallone on the Repeal of SGR

This week, Larry Downs, MSNJ’s CEO and General Counsel, met with Congressman Frank Pallone to discuss a repeal of Medicare’s sustainable growth rate (SGR) which results in annual Medicare fee decreases to physicians. Congressman Pallone is a member of the Energy & Commerce Committee, and Ranking Member of the Health Subcommittee which shares jurisdiction over Medicare with the Ways & Means Committee.  We are pleased to report that Congressman Pallone supports our efforts to repeal the SGR. Read MSNJ’s letter to Congressman Pallone.

MSNJ, the AMA, and organized medicine are urging Congress to seize upon this historic opportunity to use funds in the Overseas Contingency Operations (OCO) to pay for the elimination of the SGR. OCO is the discretionary fund for Afghanistan, Iraq and similar conflicts. Using OCO funding as an offset is appropriate because these conflicts are winding down significantly, but the Congressional Budget Office cannot downwardly adjust the OCO spending estimate over the next ten years until the next (FY2012) Defense Appropriations bill is passed. Read more about the rationale to use OCO funds to offset the SGR elimination which would pay for the accumulated cost of repeal. The current cost is approximately $300 billion. Congressman Pallone agrees that using OCO funds is an appropriate solution and will advocate for this. On behalf of physicians at large and our members who treat our senior population, we express sincere thanks for this support.

MSNJ also signed a letter authored by the AMA to members of the conference committee on payroll taxes, unemployment insurance and physician payments, urging it to repeal the SGR. The AMA reports that during the first public meeting on January 24 virtually all statements addressed the payment crisis and several members called for the permanent repeal as part of the final conference committee package. MSNJ will continue to meet with our delegation. Meetings with Congressmen Leonard Lance (R-NJ, 7th district) and Jon Runyan (R-NJ, 3rd district) have already been scheduled.