New Jersey Patient Care & Access Coalition Spring 2019 PRESIDENTS’ LETTERS the current Commissioner of has been the true friendships Health, Shereef Elnahal, at our that I have built with elected annual meeting in 2018. We officials such as Governor were successful for the very first Richard Codey, Assembly time in having one of our Health Committee Chairman members, Dr. Alex Gellman, Dr. Herb Conaway, Assembly appointed to the Board of Republican Leader Jon Medical Examiners by Governor Bramnick, and others. Christie. We submitted formal comments to the United States None of our success over the Preventive Services Task Force past four years could have on their recommendations on been achieved without the Dr. Alan Krieger Immediate Past President prostate cancer screening. And it team we have assembled to Dear NJPCAC Member: was during my tenure that guide us. I am particularly NJPCAC expanded beyond grateful to Mary Beth Guilbert For the past 4 years, it has been urological practice and included and Kelly Snyder who make my privilege and honor to serve other independently practicing sure things get done. They you as President and Chairman physicians and became the true truly are the backbone to of the New Jersey Patient Care voice for independently NJPCAC. and Access Coalition. I am practicing physicians in New proud of the successes during Jersey. I will stay involved as Vice that time, particularly in Chairman now, but rest enabling New Jersey to become Easily, however, the most joyful assured, the Coalition is in the just the second state in the part of serving the Coalition has very capable hands of our new nation to modernize its self- been the friendships that have President and Chairman, Bob referral law to enable been created with many of you. Gialanella from Allied physicians in independent The Coalition has given me the Digestive Health. I wish him practice to participate in opportunity to know many of every success. alternative payment models. you outside of our clinical world and I treasure these new Best personal regards, We were the first physician relationships and hope they organization or group to host endure. An unexpected bonus Alan P. Krieger, MD The New Jersey Patient Care and Access Coalition (NJPCAC) exists to promote and protect the Immediate Past President high quality, cost-effective and integrated care furnished by physicians in independent medical practices and other non-hospital settings throughout the State of New Jersey. NJPCAC’s membership includes more than 200 practicing physicians and scores of additional healthcare professionals, including urologists, gastroenterologists, radiation oncologists, pathologists, nurses and administrative staff, who have come together to educate policy makers, regulators, insurers and other key stakeholders, including patients and peers about legislative and regulatory changes that could adversely affect the quality and accessibility to care provided to patients in New Jersey and those that could advance care in New Jersey. Spring 2019 – Page 2 As this newsletter is being distributed, we continue to work with senior Horizon officials in the hopes of having the MND ultrasound policy rescinded. (You can read more about this issue on pages 4 and 5.) Please do not hesitate to reach out to me directly should there be any concern you have for which you think NJPCAC might be helpful. Together we can make New Jersey a little better place to conduct the business of health care for the patients we serve. Robert J. Gialanella M.D. President & Chairman Sincerely, Dear NJPCAC Member, Thank you for the trust and confidence you have placed in me as the new President and Chairman Robert J. Gialanella M.D. of the Coalition. Alan Krieger is a tough act to President & Chairman follow, but I will work diligently to achieve some measure of success in these difficult and changing times for physicians. NJPCAC Elects New Officers for 2019 at Annual Meeting As Gilda Radner’s Emily Litella character on Saturday Night Live used to say, “It’s always The New Jersey Patient Care and Access something.” That is never more true than in the Coalition Board of Directors met on March 7th world of healthcare, especially for physicians in New Brunswick. The Coalition elected the and our staff. following slate of officers for 2019: I am both mindful and grateful that the New . Dr. Robert Gialanella, Allied Digestive Jersey Patient Care and Access Coalition is one Health, President and Chairman more tool we have at our disposal to keep an eye . Dr. Alan Krieger, New Jersey Urology, Vice out for dangers and opportunities and, more Chairman importantly, to use our collective strength to . Dr. Pat Ciccone, The Stone Center of New forge solutions. Jersey, Treasurer . Dr. Steve Orland, Urology Care Alliance, Rarely has that been more evident than in the Secretary surprise announcement from Horizon on its . Ms. Kelly Snyder, The Stone Center of New policy to impose Medical Necessity Jersey, Assistant Treasurer Determinations (MND) on various ultrasound services that are so critical to our care in gastroenterology and urology practices. Our Coalition came together quickly to fight for and protect the patients we serve and we were able to get a quick and very necessary delay in the implementation of the policy. Spring 2019 – Page 3 ------ The full Board of Directors voted unanimously Mr. Rubin shared that Horizon was very to amend Section 2.7 of the NJPCAC Bylaws to appreciative of the outreach and, through its in- provide that each NJPCAC member entity shall house counsel, was committed to working with receive two seats on the NJPAC Board of NJPCAC on development of the proposed Directors. regulations. Since that meeting, NJPCAC has continued to serve as a resource to the The following slate of 12 individuals was elected Department of Health as it develops proposed to serve on NJPCAC’s Board of Directors for regulations to implement certain aspects of the 2019: Codey Act amendments. That work is ongoing. Drs. David Chaikin and David Taylor, Mr. Rubin also discussed efforts in New Jersey Garden State Urology and in other states to eliminate Maintenance of . Dr. Pat Ciccone and Ms. Mary Beth Guilbert, Certification (MOC) as a requirement for The Stone Center of New Jersey licensed physician in various specialties, . Drs. Ben Fand and Ken Ring, Premier including urology and gastroenterology. Urology Group . Drs. Nadeem Baig and Bob Gialanella, In New Jersey, Senator Robert Gordon Allied Digestive Health introduced S.2141 on March 5, 2018 to prohibit . Drs. Alan Krieger and Adam Perzin, New the State Board of Medical Examiners (BME) Jersey Urology from requiring a physician licensed by the State . Dr. Steve Orland and Mr. Alan Plotkin, and in compliance with the requirements of the Urology Care Alliance BME regarding biennial registration to secure MOC as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in the State. Mr. Rubin noted that approximately a dozen States in the country have already passed anti- MOC legislation and another dozen, including New Jersey, are considering similar legislation. The Board voted to make MOC a top legislative NJPCAC Counsel Howard Rubin provided an initiative for 2019. overview of NJPCAC’s efforts to assist the Department of Health (DOH) in its development Mr. Sico gave an overview of New Jersey’s new of regulations to implement key aspects of the Out-of-Network Consumer Protection Act that Codey Act amendments that were enacted in Governor Murphy signed into law on June 1, summer 2017 and took effect in early 2018. 2018. As Mr. Sico noted, the law became effective August 29, 2018, and gives Mr. Rubin reported on a positive meeting that responsibility for promulgating regulations to Dr. Krieger, Dr. Gialanella, NJPCAC lobbyist implement the law to three state departments: Don Sico and Mr. Rubin attended with The Department of Banking and Insurance, The leadership at Horizon BlueCross BlueShield of Department of Health and The Department of New Jersey on March 6, 2019, to discuss Law and Public Safety through its Division of NJPCAC’s collaboration with DOH in framing Consumer Affairs and the Board of Medical proposed regulations designed to implement the Examiners. 2017 Codey Act amendments. Spring 2019 – Page 4 ------ As of early March 2019, none of those NJPCAC Works to Rescind Departments had proposed regulations designed to implement the OON law. NJPCAC is Horizon Ultrasound Policy working with a broader coalition of provider organizations to provide input into the regulatory Since it first learned in late April of a surprise process. announcement by Horizon Blue Cross Blue Shield to implement a new policy to impose In addition, NJPCAC is closely monitoring a Medical Necessity Determinations (MND) on lawsuit filed by the New Jersey Spine Society in various ultrasound services, the New Jersey December 2019 challenging the legality of the Patient Care and Access Coalition has been OON law. working virtually non-stop to reverse this ill- advised decision. NJPCAC Leadership Meets with The new Horizon program requires a referring Assembly Health Committee physician to obtain an MND for a variety of Chairman on Key Issues obstetric and non-obstetric ultrasounds (the “MND Program”). NJPCAC believes that this MND requirement is a first-of-its-kind in the NJPCAC President and Chairman Dr. Bob State—at least outside of the Medicaid program. Gialanella, Vice Chairman Dr. Alan Krieger, Counsel Howard Rubin and lobbyist Don Sico NJPCAC further believes that the MND Program met with Dr. Herb Conaway, Chairman of the will harm patients with serious urologic and Assembly Health and Senior Services gastrointestinal conditions by creating Committee on April 29th in New Brunswick. unnecessary delays in patient care and increased patient costs, while imposing significant burdens on the physician practices that order ultrasound services.