Save
the Date
From the President
From the Legal Counsel
From the Statehouse
SAVE THE DATE!
April 4,
2009
2009 Annual Meeting, Forsgate Country Club, Jamesburg, NJ
******New this year: Administrative/Clerical Track******
Brochure will
be mailed and emailed soon!
FROM THE PRESIDENT...Hakan M.
Kutlu, MD
Dear Friends & Colleagues:
New year, new president, same mess...as the downward economic
spiral continues. Local hospitals are scrambling to make up for
cuts in charity care reimbursement with layoffs and decreased
services offered to their communities. We see it in our own
practices with decreased aesthetic surgeries and an increase in
the number of uninsured patients as people lose their jobs and
health insurance coverage. While our new president appears to
have hit the ground running in providing bailouts to the
financial and auto industries, we have not heard much regarding
healthcare reforms.
Meanwhile on the local front we are involved with efforts to
pass legislation to deny payments for "hospital acquired
conditions". In essence they are trying to "legislate away"
post-operative and other known complications that occur while treating patients
for a variety of conditions. We are conveying our concerns to
the legislators through our lobbyists and larger state medical
society and other subspecialty groups.
On a positive note, we are looking forward to our annual spring
meeting on April 4 at the Forsgate Country Club where we will
have Dr. Elizabeth Hall-Findley as our guest speaker along with
an entirely new program that will be running concurrently for
our nurses and administrative staff -- thanks to the efforts of
Drs. Chris Godek and Greg Grecco. If there are any specific
issues you would like to have addressed either at our spring
meeting or prior, please contact me.
Legal Report...Kern
Augustine Conroy & Schoppmann, P.C.
United HealthCare Settlement Reached
United HealthCare has agreed to enter into an Assurance of
Discontinuance with New York’s Attorney General, under which it
will pay $50 million to fund the creation of a new and
independent UCR database to replace the old databases
promulgated by Ingenix, a wholly-owned subsidiary of United
HealthCare. Those databases are considered to be inherently
flawed, but are used by many insurers to set UCR rates for
out-of-network services. United HealthCare also agreed to
establish a $350 million settlement fund from which their
insured members and out-of-network providers who were adversely
affected by the payor’s use of the Ingenix database will be
entitled to make claims for reimbursement.
New Jersey Proposes New Computer Security Requirements
When the NJ Division of Consumer Affairs adopted its rule
implementing NJ’s Identity Theft Prevention Act, it received a
deluge of comments expressing concern with the onerous computer
security requirements of the proposed rule. As a result, the
Division delayed implementation of those provisions. The
Division has now issued newly drafted computer security
requirements as a “pre-proposal” to give the public time to
comment (by February 13th). The proposal eliminates several
security requirements, including mandated encryption, password,
and anti-virus software requirements. It also amends the
security breach notification requirements, including replacing
the specific duty to mitigate damages resulting from a security
breach with a requirement to make reasonable efforts to prevent
further breaches. In addition, the requirement to have in place
a comprehensive written information security program would not
apply to a business required to comply with a federal regulatory
scheme (presumably including the HIPAA security rule) that meets
the NJ rule’s physical, administrative and technical safeguard
requirements. The pre-proposal can be viewed at:
http://www.state.nj.us/lps/ca/proposal/dcapro121508.htm.
ICD-10 and Updated Electronic Transaction Standards Rules
Adopted
The U.S. Dept of Health & Human Services has issued the final
rule replacing the current ICD-9-CM with the greatly expanded
ICD-10 code sets for the reporting of health care diagnoses and
inpatient procedures, with an implementation date of October 1,
2013, two years later than initially proposed. A second final
rule was also adopted, issuing updated standards for electronic
health care transactions, effective January 1, 2012. The new
code sets are intended to improve claims processing and payment
and support Medicare’s initiatives such as quality reporting,
pay-for-performance, bio-surveillance, and anti-fraud and abuse
activities, while the updated transaction standards are designed
to provide the framework needed to support the ICD-10 codes.
NJ Family Leave Insurance Act Takes Effect
The Family Leave Insurance Act, enacted in May 2008, became
effective January 1, 2009, which is the date employers begin
withholding taxes from their employees’ salaries to fund the new
benefit (there is no employer contribution). The new law itself
does not entitle employees to take family leave but only
provides monetary benefits for employees. It provides up to 6
weeks of monetary benefits for the care of a newly born or newly
adopted child or of a family member with a serious health
condition. Employees may be entitled to leave rights under NJ’s
Family Leave Act (which applies to employers with 50 or more
employees) or the federal Family & Medical Leave Act. However,
the new insurance benefit law applies to all employers who are
subject to NJ’s Unemployment Compensation Law. Qualified
employees can apply for and begin receiving the benefits
beginning July 1, 2009. For more information on employer
requirements and employee rights under this and state and
federal leave laws (which also were amended effective January
1st), see the following website:
http://lwd.state.nj.us/labor/fli/fliindex.html.
ABN Note: Beginning March 3, 2008, physicians were allowed to
use Medicare’s revised Advance Beneficiary Notice (ABN),
CMS-R-131, for all situations where Medicare payment is expected
to be denied. As of March 1, 2009, the old form ABN-G will no
longer be valid.
From the Statehouse...Beverly
J. Lynch
Important Patient Safety Bill Debated
On Monday, January 26, the Senate Health and Human Services
Committee considered a new bill, S-2471, sponsored by Senators
Vitale, Sweeney and Weinberg, that seeks to improve patient
safety and reporting of medical and hospital errors. It is
modeled after the work of CMS and others at the national level,
who are currently prohibiting payment to hospitals and
physicians for so called “never events,” such as surgery on the
wrong patient, body site or body part, and reduced payments to
hospitals for a specific list of “hospital acquired conditions.”
I have had numerous conversations with the bill’s sponsors, and
my physician lobbyist colleagues, about the concerns we have
with the bill. In the original language, the attending physician
could be held accountable for causing the hospital acquired
conditions, and would not be reimbursed. We pointed out the many
problems associated with this concept – and how difficult it is
to attribute the cause of the condition to the physician, when
so many people touch a patient in a hospital setting.
Based on our concerns, the sponsor amended the bill. I have
cut/pasted the section that impacts the physician community
below. But, here is a simplistic explanation of what this bill
seeks to do:
If a physician admits/acknowledges that he/she caused one of the
8 hospital acquired conditions (HACs), developed by CMS and
others nationally, then that physician can not bill CMS (for
Medicaid and Medicare patients) or a third party payer (if
private pay) or the patient him/herself (if self pay). The list
of 8 HACs are:
1. pressure ulcer stages III and IV;
2. falls and trauma;
3. surgical site infection after bariatric surgery for obesity,
certain orthopedic procedures, and bypass surgery (mediastinitis);
4. vascular-catheter associated infection;
5. catheter-associated urinary tract infection;
6. administration of incompatible blood;
7. air embolism
8. foreign object unintentionally retained after surgery.
Additionally, as is currently the practice with CMS, there would
physician non-payment for:
Wrong surgical or other invasive procedures performed on a
patient; Surgical or other invasive procedures performed on the
wrong body part; and Surgical or other invasive procedures
performed on the wrong patient.
Remember - the physician must admit wrong doing in order for any
non-payment to be assessed. If the physician does not admit
wrong doing, the physician is paid as always.
Here is the exact language now found in the bill:
"2b. A physician licensed by the State Board of Medical
Examiners pursuant to Title 45 of the Revised Statutes, who
acknowledges responsibility for causing a condition for which a
hospital is prohibited from obtaining payment from a patient or
any third party payer pursuant to subsection a. of this
section*, shall not charge or otherwise seek to obtain payment
from a patient or any third party payer for costs associated
with the condition."
[*"subsection a. of this section" refers to the CMS list above]
We testified that the bill still lacks the discoverability
safeguards so the non-billing doesn't become a med mal
incident. The legislators agreed and this language will be
added to the Assembly version. We also asked to be included in
future discussions as the bill progresses.
The bill was released from committee and moves to the Senate
floor.
Please give me your feedback as to this new version of the bill
- we're eager to receive comments from the physician community
and will be providing them directly to the legislators involved.
Back to News
