From the President
From the Statehouse
From the Legal Counsel
Important
Grassroots Call to Action
FROM THE PRESIDENT...Hakan M.
Kutlu, MD
Dear Friends & Colleagues:
It’s incredible how time flies (…a sure sign of age, no doubt)
but a year has passed since our last annual meeting and my term
draws to a close. I look back upon this year and see a number
of significant improvements which were made within the NJSPS.
One of the biggest changes and driving factors in these
improvements was our change in management… the added energy,
enthusiasm and professionalism of B. Lynch Associates has taken
our society “to the next level”. We are much more actively
involved with the NJ political scene and have our fingers on the
pulse of the events so that we can not only react to proposed
legislation but can be more proactive. The planned formation of
our political action committee will also aid in this endeavor.
We have become more communicative with our members through this
monthly newsletter that you are currently reading and have
updated our website to be more interactive and provide useful,
current information. We have also offered top notch speakers
from our specialty over the past year including Drs. Spinelli,
Matarasso, Constantian, Young and Eaves and look forward to
seeing Drs. Hall-Findley and Krizek on April 4th.
One of our own – Rick D’Amico – just completed his term as ASPS
president further adding to the standing of our state society.
Our fiscal standing is stable and we look forward to having
continued vendor support at our meetings as well as expanding
our membership rolls with new members.
I believe our state society is stronger and more relevant to its
members than ever… I look forward to continuing to work with our
incoming president Greg Borah in the future and thank the many
members of the executive committee for their support over this
past year.
2009 ANNUAL MEETING --- Saturday, April 4th
Elizabeth Hall - Findlay, MD, FRCSC from Banff Plastic Surgery
will present two great talks:
1.
Anatomy and Breast Aesthetics - Surgical Planning Principles
2. Breast Reduction Using the Medial Technique
Thomas Krizek, MD from the University of South Florida will be
the LoVerme Lecturer.
Don't Miss Out...Full brochure on
www.njsocietyofplasticsurg.org
ALSO: Concurrent program for clinical/administrative staff.
From the Statehouse...Beverly
J. Lynch
The Legislature has recessed for its traditional budget break,
and will reconvene in May. The only activity during the month of
April will be conducted by the Senate and Assembly Budget
Committees who will hear from all the Commissioners as they
present their Department’s budgets.
During the month of March, I continued work on the patient
safety legislation. You may recall, from past newsletters, that
we testified on the Senate version, S-2471, in the Senate Health
Committee. During that testimony, we voiced numerous concerns,
particularly with the provision that prohibits payment to
physicians who admit they caused one of the designated
hospital-acquired conditions.
The Senate version was released from committee, and was poised
for a full Senate vote. At the last minute, it was remanded back
to the Senate Health Committee and, on March 10, and further
amended to:
-
add
discoverability protection; and
-
establish a
collaboration between the Commissioners of Health and Senior
Services and Banking and Insurance and the Director of the
Division of Consumer Affairs in the Department of Law and
Public Safety to develop standards for health care providers
and third party payers to implement the billing prohibition
provisions.
Following adoption of these additional amendments, S-2471 passed
the full Senate on March 16, 38 to 0.
On March 9, the Assembly Health Committee had a “for discussion
only” hearing on the measure on its version, A-3633. I have
excerpted my testimony below which I delivered on the bill:
Thank you for the opportunity to speak on A-3633.
First, we're confused as to why the physicians were only
recently included in the discussions -- that apparently took
place over the course of a year - as this measure was drafted.
This is a major piece of legislation – with new standards not
found in any other state in the nation – and far reaching
negative implications for the medical community and the patients
they serve.
We urge you to move slowly and deliberately as the bill
progresses -- to make sure the intent of the legislators is in
fact what the bill says.
We are very familiar with the Centers for Medicare and Medicaid
Services and the work at the federal level to limit or eliminate
payment to hospitals and physicians for so-called “never events”
and hospital acquired conditions.
Our colleagues at the national level have been at the table with
CMS working on these provisions.
There are currently three “never events” for which physicians
are not paid for their Medicaid and Medicare patients. These
include surgery on the wrong patient, wrong body part or wrong
site.
We have no argument at all that these “never events” should
rightly penalize the physician.
This bill seeks to expand this penalty – in the form of
non-payment – to 8 other “hospital acquired conditions”
currently found on the CMS list. Things like “falls and trauma”
and “catheter-associated infections.”
The problem we have with this penalty is that it’s very
difficult to attribute these “conditions” to the attending
physician.
Physician payment for conditions outside the three “never
events” is an area that is being explored by CMS and others, but
it is not ready for prime time.
Physicians regularly attend “morbidity and mortality”
conferences, usually weekly, where each physician discusses
complications on his or her patients, most of which are
inevitable. In effect he “admits” on many patients having had a
part in the evolution of events that include the complication.
Currently, the proceedings of M&M conferences are legally
protected information. We are gravely concerned over how this
bill will impact frank discussions of complications and adverse
events after surgical procedures – which is a common and
necessary part of good quality improvement in all hospitals.
Physician attribution is very difficult to assess in a hospital
setting where so many staff have hands on responsibilities with
the patient.
When this bill was heard in the Senate, the Senate Health
Committee approved amendments that establish that physician will
not be penalized unless he or she admits that the fault was
theirs.
Does this bill impact physicians who are 100% responsible for
the adverse event? What if he or she is only 10% at fault – and
the hospital or staff is 90% at fault?
What about the ancillary physician support? If an orthopaedic
surgeon admits to being 100% at fault for a fall following
surgery, is the anesthesiologist or radiologist reimbursement
affected?
This bill would not only prohibit payment to the attending
physician who “caused” the hospital-acquired condition, it would
also expand the non-payment to the private sector payers – not
just Medicaid and Medicare.
This is also precedent setting legislation found no where else
in the country.
We can’t give the private carriers -- who are already eager to
find any reason to delay or halt physician payment – any new
excuse to do so.
I know you agree that we need not penalize those who treat the
most vulnerable, with the least access to preventive care.
And of course, we all know that the trial lawyers will be
chomping to get their hands on any reporting so they can swoop
in with med mal lawsuits. We understand there are amendments
being prepared that provide safeguards on the discoverability of
the reporting….this is critical so it doesn’t further exacerbate
New Jersey’s tenuous medical liability environment.
We respectfully request that you continue to work with us on
this important legislation to ensure that the “patient safety”
legislation truly improves the care of patients. In its current
form, we disagree.
Chairman Herbert Conaway, MD, and the members of his committee
listened intently to the various testimony, and appeared,
through their verbal responses and questions, to agree with many
of the concerns we addressed. No official action on the bill was
conducted. We will continue to work on this issue as the session
continues.
Stay tuned.
Legal Report...Kern
Augustine Conroy & Schoppmann, P.C.
Governor Corzine Signs Legislation Amending Facilities Licensing
Law and Codey Law
Governor Jon Corzine today signed into law Senate Substitute for
S787 (S787). The new law requires immediate attention by
one-room surgical practices, existing licensed ambulatory
surgery centers, and those planning to open a surgical center.
The law contains important timeframes governing the ability to
offer or continue to offer ambulatory surgery services.
The law revises the States Health Care Facilities Licensing law
to require that single operating-room surgical practices that
are operational as of today become registered with the
Department of Health & Senior Services (DHSS) within one year of
today, which means the deadline for registration is March 23,
2010. Registration must be renewed annually thereafter. A
surgical practice that has not commenced operations as of today
but which, no later than September 19, 2009, files its plans,
specifications, and required documents with the municipality in
which it will be located, must register with DHSS prior to
commencing services.
The law prohibits DHSS, as of today, from issuing new
registrations to surgical practices and new licenses to ASCs,
with certain exceptions, including a surgical practice that is
required to be registered and meets the laws registration
requirements and timeframes set forth above.
The prohibition on new registrations does not apply to a
transfer of ownership of an existing surgical practice if DHSS
approves the qualification of the new owner(s) and approves the
transfer. Exemption is also made in the case of a surgical
practice which relocates the surgical practice, the relocation
is within 20 miles of the surgical practices current location
(or is a relocation to a Health Enterprise Zone), there is no
expansion in the scope of services provided at the new location
from that of the current location, and DHSS approves the
relocation. Note that ASCs are subject to a similar licensure
ban and exemptions, except that a new ASC that is owned by a
hospital or a medical school or is owned jointly by a hospital
and one or more other parties is exempt from the licensure ban.
S787 requires that all surgical practices, as a condition of
registration, obtain certification from CMS as an ambulatory
surgery center provider or accreditation from an accrediting
body recognized by CMS. Thus, that process must be commenced
immediately for those facilities that do not have one of the
required credentials. Currently, there are four CMS approved
national accreditation organizations for ASCs: the Joint
Commission
http://www.jointcommission.org/, the American Association
for Accreditation of Ambulatory Surgery Facilities
http://www.aaaasf.org/, the
Accreditation Association for Ambulatory Health Care
http://www.aaahc.org/, and
the Healthcare Facilities Accreditation Program of the American
Osteopathic Association
http://www.hfap.org/.
All currently licensed ASCs also are required to obtain
accreditation from a CMS-recognized accrediting body as a
condition of DHSS licensure. Those facilities have until March
23, 2010, to comply with this requirement.
The DHSS is directed to issue regulations specifying the
registration process for surgical practices and may charge a fee
for the registration. S787 imposes specific reporting
requirements for a registered surgical practice, including
number of patients by payor, number of Medicaid-eligible and
medically indigent patients, number of new patients accepted,
and number of physicians, physician assistants, and advance
practice nurses providing services at the surgical practice. The
registrant must also submit the names and addresses of all
owners of the surgical practice. Because surgical practices
would be registered rather than licensed as an ambulatory care
facility, they would not be subject to the states ambulatory
care facility assessment (the gross receipts tax). What remains
unclear with enactment of S787 is whether registration qualifies
a surgical practice to bill a facility fee if it is accredited
but not Medicare certified.
S787 provides that referrals to a registered surgical practice
or licensed ASC by a physician owner are exempt from the states
self-referral ban if the referring physician personally performs
the procedure, remuneration to the physician owner is directly
proportional to his or her ownership interest, all clinical
decisions are made by practitioners (not by non-practitioner
owners), and disclosure of financial interest is made to
referred patients. Those requirements go into effect on the
first day of the 12th month following today's enactment. In
addition, the law provides that referrals made to a surgical
practice or licensed ASC prior to today and those made during
the twelve-month period after today are deemed to comply with
the states self-referral law, but only if the referring
practitioner personally performed the procedure and the surgical
practice meets the definition of a surgical practice. The laws
existing self-referral exemption for lithotripsy services and
radiation therapy pursuant to an oncological protocol will now
end except for those already holding a financial interest in
such services as of today or who acquire such an interest by the
first day of the twelfth month after enactment.
Persons with questions about the new law should contact Bob
Conroy, at Kern Augustine Conroy & Schoppmann, P.C.,
908-704-8585.
IMPORTANT
Grassroots CALL TO ACTION
YOUR ACTION NEEDED NOW TO SAVE CRITICAL CLEFT FUNDING
Issue
The proposed FY 2010 NJ State budget includes a significant cut
to the funding of cleft palate surgery.
Background
Since 1979, the State has worked with the New Jersey Federation
of Cleft Craniofacial Programs provide services to children with
special needs in a family centered, comprehensive and
coordinated fashion. In the late 1980s, the Legislature and the
NJ Department of Health and Human Services added a line item
specific to cleft-craniofacial care in the state budget. Without
that line item, the type of care provided to the children of New
Jersey would be non-existent. The current line item is $707,000
and it is facing a proposed reduction of $36,000 for FY2010.
Action Needed
Your calls and emails are needed immediately to stop this
critical budget cut. We are not asking for additional funds
(even though the funding hasn’t been increased in years!). In
light of the state’s fiscal situation, we are only asking that
the funding be maintained.
Email or call today!
And the members of the Assembly Budget Committee
Assemblyman Louis D. Greenwald (D6) — Chair,
AsmGreenwald@njleg.org;
856-435-1247
Assemblyman Gary S. Schaer (D36) — Vice Chair,
AsmSchaer@njleg.org;
973-249-3665
Assemblyman John J. Burzichelli (D3);
AsmBurzichelli@njleg.org; 856-251-9801
Assemblyman Joseph Cryan (D20);
AsmCryan@njleg.org;
908-624-0880
Assemblyman Gordon M. Johnson (D37);
AsmJohnson@njleg.org;
201-541-1118
Assemblywoman Nelida "Nellie" Pou (D35);
AswPou@njleg.org;
973-247-1555
Assemblywoman Joan M. Quigley (D32);
AswQuigley@njleg.org;
201-217-4614
Assemblyman Joseph R. Malone, III (R30);
AsmMalone@njleg.org;
609-298-6250
Assemblywoman Alison Littell McHose (R24);
AswMcHose@njleg.org;
973-300-0200
Assemblyman Declan J. O'Scanlon (R12);
AsmOScanlon@njleg.org;
732-933-1591
and the members of
the Senate Budget and Appropriations Committee
Senator Barbara Buono (D18) — Chair,
SenBuono@njleg.org;
732-205-1372
Senator Paul A. Sarlo (D36) — Vice Chair,
SenSarlo@njleg.org;
201-804-8118
Senator Stephen M. Sweeney (D3);
SenSweeney@njleg.org;
856-251-9801
Senator Shirley K. Turner (D15);
SenTurner@njleg.org;
609-530-3277
Senator M. Teresa Ruiz (D29);
SenRuiz@njleg.org; 973-484-1000
Senator Brian P. Stack (D33);
SenStack@njleg.org;
201-330-3233
Senator Joseph F. Vitale (D19);
SenVitale@njleg.org;
732-855-7441
Senator Sandra B. Cunningham (D31);
SenCunningham@njleg.org;
201-451-5100
Senator Dana L. Redd (D5);
SenRedd@njleg.org; 609-292-5215
Senator Anthony R. Bucco (R25);
SenBucco@njleg.org;
973-627-9700
Senator Philip E. Haines (R8);
SenHaines@njleg.org;
609-654-1498
Senator Steven V. Oroho (R24);
SenOroho@njleg.org;
973-300-0200
Senator Kevin J. O'Toole (R40);
SenOToole@njleg.org;
973-237-1360
Senator Joseph Pennacchio (R26);
SenPennacchio@njleg.org;
973-984-0922
Senator Marcia A. Karrow (R23);
SenKarrow@njleg.org;
908-782-5127
Suggested message
points
-
As a New
Jersey Plastic Surgeon – and on behalf of our patients
throughout the State -- we ask you to restore the $36,000
proposed cuts to the cleft-craniofacial program line item in
the FY 2010 budget.
-
This program
is critically important to the children who are born with
cleft lips and palates and other craniofacial deformities
and would otherwise go untreated.
-
This is
especially needed as we face decreased reimbursement levels
from third party carriers and further reductions in the
types of services we can provide.
-
The technology
and surgical techniques available to children with clefts in
today’s world is limitless and enables the majority of these
individuals to become tax paying and functional members of
society.
-
The continued
financial support from the Adminstration and Legislature is
needed to maintain the programs now serving the residents of
New Jersey.
The Legislature
and the Administration is in the middle of budget debate and are
determining the fate of this program today! Please make your
calls or send your emails now.
Questions? Call Beverly Lynch, NJSPS, at 609-392-7553 or email
blynch@blynchassociates.com
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