Physician AdvocateVolume 9, Issue 1

Inside: ‘MSNJ News & Notes,’ Superstorm Sandy Grant and Updates from NJ-HITEC; MSNJ’s New Website and Online Physician Community Launch; Op-Ed Regarding EMR Technology

MSNJ Provides $350,000 in Grant Funding for Local NJ Physicians Impacted by Superstorm Sandy

Story on page 3

(from left) MSNJ President Mary F. Campagnolo, MD, MBA with grant recipients Harry L. Larkin, MD and James Suddeth, MD of Island Medical Professional As-sociation in Ship Bottom, NJ.

Page 2Page 2 Medical Society of New Jersey’s Physician Advocate Magazine

MSNJ CEO & General CounselLawrence Downs, Esq.

@lawrencedowns

msnj.wordpress.com

facebook.com/msnj1766

Get connected to MSNJ!

OFFICE

COrNEr

I am proud to announce the launch of MSNJ’s new database, website and online physician communties, powered by Socious. More than a year of planning,

research and time has gone into this change and we are excited to present all the new options and features to you, our members.

Accurate data on our MSNJ member physicians is important to our organization. It is also important to our members. The physician profile section of our website is the most visited part of msnj.org.

As New Jersey residents begin to purchase insurance through 'insurance exchanges" in 2014 they will need accurate information on the types of plans you participate with. Those seeking independent, physician verified information will look to our website for guidance. We believe this valuable service will help you promote your practice.

Our new database allows you as a member to update your profile directly and add additional information about

your practice. The new database will allow you as a member to actively participate in discussion forums, connect with other members in your local area or specialty.

You also can also incorporate photographs, certifications and qualification so potential patients can connect with you. Are you accepting new patients? Are you participating with a new insurer or have you recently left a network? Changed addresses? You can update your profile and data in an easy secure way.

Check out the all-new msnj.org and log in to see everything now available to you. To sign in for the first time, click ‘log in’ and then ‘Username and/or Password Help.’ Type the e-mail address you receive e-News to, and it will send you a temporary password to get started.

As always, the staff is here to help with this transition and any questions you may have. We welcome suggestions as well! E-mail us at info@msnj.org or call the Member Resource Center at 609-896-1766.

Continued on page 4

Medical Society of New Jersey’s Physician Advocate Magazine Page 3

MSNJ Provides $350,000 in Grant Funding for Local NJ Physicians Impacted by Superstorm Sandy

The Medical Society of New Jersey and the Institute of Medicine & Public Health of NJ have established a fund to assist physi-

cian practices that were damaged by Hurricane Sandy.

Frank Matteace, MD of Pronto MedCare in Toms River, NJ and Harry L. Larkin, MD and James Suddeth, MD of Island Medical Profes-sional Association in Ship Bottom, NJ are the first medical practices to receive assistance through the fund.

“The impact of Hurricane Sandy is unprec-edented in New Jersey and many of our phy-sicians are struggling to rebuild,” said Larry Downs, CEO of the Medical Society of New Jersey. “MSNJ and IOMPH are pleased yo assist these medical practices to continue to meet the healthcare needs of their community.”

Funds are available to physicians in Atlantic, Ocean, Monmouth, Burlington and Hudson counties. The grants can be used many ways including relocating or rehabilitating the physi-cians’ medical offices, replacing equipment, rebuilding patient records and payment of tem-porary operating expenses.

Support for the program was provided by the Physicians Foundation, a non-profit organiza-tion that seeks to advance the work of practic-ing physicians and help facilitate the delivery of healthcare.

“Our goal is to give physicians the resources and support they need to reestablish healthcare delivery in affected areas,” said Dr. Alan Plum-mer, Physicians Foundation board member and chair of the Grants committee.

“We feel a responsibility to help physicians in New York and New Jersey who were impacted by Hurricane Sandy rebuild their practices, so they can focus on caring for their patients and pro-viding the best quality medical care available.”

Medical practices may apply for funding by visit-ing www.msnj.org.

(from left) MSNJ President Mary F. Campagnolo, MD, MBA with grant recipient Dr. and Mrs. Frank Matteace of Pronto MedCare in Toms River, NJ.

Page 4Page 4 Medical Society of New Jersey’s Physician Advocate Magazine

Super Storm Sandy may have taken down power lines and left many areas

of New Jersey in the dark, but EHR technology proved its value during the roughest hours following the storm’s destruction. This is especially true for those physicians who were prepared.

"Hurricane Katrina helped to start moving people toward EHRs," explains Bill O'Byrne, executive director of NJ-HITEC, New Jersey’s Regional Extension Center and a national leader in providing EHR guidance to healthcare practitioners. "

Patients’ entire medical histories were wiped out during that storm, and there was no way to ever get those back. One of our jobs before this storm was to help our over 7,200 docs keep their information safe because information doesn't mix well with water."

NJ-HITEC sent out a "disaster recovery precaution" checklist to all of its members detailing

options for how to back up and protect medical information in the lead-up to the storm. The document made suggestions such as backing up medical records on external drives and removing the drives from the office so records exist in more than one location. Here is the checklist that NJ-HITEC shared with its members:

• Be sure all patient data is backed up at a remote location. The backed up patient records should be accessible via the web from alternate care delivery sites, if necessary.

• Make sure adequate and appropriate privacy and security measures are employed at the back-up remote location.

• Once you have completed the system back up, shut down your system in an orderly fashion by using a battery back-up setup before any anticipated change in climate and/or predicted storms.

• Remove all previous backup files from the danger zone.

• If there is no time to perform a system back up, if possible, remove the server and monitors to a safe location and proceed to perform the

system back up.• Move your modems and

routers off the floor and place them in a higher position. You can also take them with you, if appropriate.

• Take all written system policies, procedures, and training materials out of the office

• Notify your EHR vendor since you may need assistance before or after, if your practice is impacted by the emergency. Your vendor may provide tips on how to alleviate or lessen any potential damage to your EHR system.

• Keep an up-to-date staff roster of cell phone numbers and emails for continuous communication during an emergency situation. Your staff may also be able to help by providing information about other equipment that you may need to move or shut down.

• Prepare an emergency manual paper back up plan with clear policies and procedures for capturing the patient’s data while your EHR system is down. Once you are able to access your

Super Storm Sandy Disrupted Power, but Not the Value of EHR Technology

By Denise Anderson Ph.D.NJ-HITEC Director of Strategic Initiatives

Continued on page 12

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Page 6Page 6 Medical Society of New Jersey’s Physician Advocate Magazine

The information age continues to move briskly with new innovative

technology being introduced almost on a daily basis. Beginning with the advent of the personal computer and the creation of the Internet by 1995, there has been no looking back.

Many industries have been and continue to be transformed by information technology, like banking and travel, to name a few. Moreover, we have all benefited from ease of communication, clarity of transactions, and data streams that make us more effective and our businesses more cost efficient.

So why has it taken the healthcare industry so long to make the transformation to the information technology age? Fear of change, apathy, lack of capital, questions about ROI, the sheer complexity of the task, and the idea that someone else will do it for us are some of the more common reasons cited to explain the delay.

More importantly, why is the idea of using computers to manage our healthcare industry now becoming a priority? Because of one man’s vision in the position to make it happen, supported by a critical mass and the shear financial need with the help of Congress.

This man is President Barack Obama. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, providing $19.2 billion in funding, was clearly established to provide doctors with financial incentives to cover the costs of EMR adoption and to stimulate its use to improve the quality and reduce the costs of healthcare for our patients with the goal of 90 percent of doctors using EMR systems to full Meaningful Use by 2019.

I see it as the healthcare industry bail out to help us out of the hole we have dug ourselves into,- operating within a fragmented, nonintegrated, non-accountable system, with no health information exchange occurring and a costly payment system fraught with fraud and abuse.

In NJ, the 2009 HITECH Act provides us with a huge advantage over many other states, a Regional Extension Center (REC) namely the New Jersey Health Information

Technology Extension Center (NJ-HITEC).

NJ-HITEC has funding to help physicians in NJ to adopt, implement, and update EMRs systems into their offices and into their work flows in a way that allows the physician to quality for significant incentive payments from the federal government, up to $63,730 over the next few years.

The fact is that NJ-HITEC as already helped numerous physicians receive their first installments of the incentive payments. Were you or your group among them? If not what are you waiting for?

These incentive payments are being timed out and are not available indefinitely. In fact, the incentives will expire, and penalties of up to five percent in the reduction of federal reimbursements will begin in 2015. You still have time, but the incentives are already being reduced.

The requirements needed to achieve Meaningful Use recognition are very consistent with what most physicians want for their community of patients - improved care coordination, the engagement of patients’ and their families in healthcare decision making, improved population and

What Meaningful Use of EMR Technology Means to NJ Physicians

By Thomas R. Ortiz, MD, FAAFP- Medical Director, NJ-HITEC

Page 7Medical Society of New Jersey’s Physician Advocate Magazine Page 7

public health, an improvement in outcomes, and the reduction in healthcare disparities among populations of patients as well as the assurance of security and privacy maintaining the sanctity of the doctor patient relationship.

There are a number of distinct benefits of becoming a Meaningful User of an EMR system in practice as part of the daily work flow once transitioned. These benefits include:

• Easy retrieval and access to a patient’s individual health record, related reports, and clinical information with no more lost charts;

• No more transcription service;

• Enhanced and legible notes integrated and accessible to you and your healthcare delivery team from anywhere;

• Efficiencies through better communication, coding, and compliance alleviating the need for personnel to manage paper charts that in turn decreases costs and improves cash flow;

• Improved tracking of critical clinical data results, referral consultation reports, and clinical trends over time from diverse sources; and

• Better quality results among your patients that is measureable.

The data generated by your EMR system about the health status

of your patient as an individual and as an attributed member of your overall patient population is probably the most important benefit of effectively using an EMR.

A vetted system, with adequate practice management and clinical quality measures capability provides you with the foundation to become a Patient Centered Medical Home (PCMH) and is the gateway by which you can participate in a variety of pay for performance or gain sharing types of value based payment

contracts with the government or commercial insurance companies providing enhanced payments and bonuses.

In addition, the innovations of E-prescribing and lab reporting will save you hours of time and change your lifestyle by freeing up your time for family or other activities. The billing systems also become real time and automatic eliminating mistakes on both ends of today’s paper trail, providing the ability for better complex coding thus enhancing cash flow and revenue generation.

For communication with the emerging local Health Information Exchange (HIE) electronic

provider networks, Meaningful Use of an EMR system will be key to receiving this data from local hospitals and ERs.

Statistics reveal that of the 30,000 doctors in NJ only 25 percent have adopted an EMR system; of the 111 hospitals, only 57 percent have adopted EMRs; however all 20 FQHCs have adopted an EMR system. Moreover, of the 5,800 eligible physicians and 57 eligible hospitals, the feds, with the help of NJ-HITEC and through the Medicaid and Medicare incentive programs, have already paid out over $130 million in incentive funding in NJ to date.

How much of that did you get?

The point of these facts is that it just doesn’t make any business or financial sense to put off

adoption, implementation, or an upgrade of a certified EMR system.

The decision to make the transition takes serious thought, planning, and a good financial due diligence to be done correctly to avoid serious errors and omissions.

There is a 20 percent failed installation rate that can occur for a multitude of reasons. Some of the reasons include: technology failure due to incompatibility of systems; financial miscalculations that fail to include costs of training, interfaces, licenses, or maintenance fees in the budget;

Continued on page 8

“ The feds ... have already paid out over $130 million in incentive funding in NJ to date. ”

Page 8Page 8 Medical Society of New Jersey’s Physician Advocate Magazine

and the most common, user dysfunction by reluctant, poorly motivated doctors and staff members.

This can all be avoided with proper planning and due diligence. Any system purchased today needs to be CCHIT or ONC certified to qualify to be eligible for Meaningful Use incentive payments. Decision making criteria needs to be established including: identifying functions, work flow operations, implementation, data conversion, training, disruption of patient and cash flows, ROI analysis, and scalability of the system.These factors have to be carefully considered before a system is purchased.

Many practices spend thousands

of dollars on management and EMR consultants to walk them through this process. Fortunately, for us in NJ, we have NJ-HITEC, our REC, that has experienced personnel, resources, and tools to assess your practice needs, identify the gaps in your workflow to assist you in the process of achieving Meaningful Use as well as provide you with the up to date tools to assess which EMR system best satisfies your practice’s needs.

Further, health informatics, work flow processes, the retrieval of the required Critical Quality Measures (CQMs) and MU requirements are part of the next phase after implementation of your system.

With so many benefits of successfully implementing

an EMR system including short and long term financial incentives, better patient case management, and the ability to be part of the larger solution to healthcare delivery in New Jersey and America, why haven’t you began the process? If you have, congratulations and welcome to a new generation of computing in healthcare.

For more information about NJ-HITEC, please visit our website at www.njhitec.org, call 973-642-4055 or email info@njhitec.org.

About The Physicians Foundation

The Physicians Foundation is a nonprofit 501(c)(3) organization that seeks to advance the work of practicing physicians and help facilitate the delivery of healthcare to patients. It pursues its mission through a variety of activities including grantmaking, research, white papers and policy studies. Since 2005, The Foundation has awarded numerous multi-year grants totaling more than $28 million. In addition, The Foundation focuses on the following core areas: physician leadership, physician practice trends, physician shortage issues, and the impact of healthcare reform on physicians and patients.

As the healthcare system in America continues to evolve, The Physicians Foundation is steadfast in its determination to strengthen the physician-patient relationship and assist physicians in sustaining their medical practices in today’s practice environment. For more information, visit www.PhysiciansFoundation.org.

Continued from page 3

Continued from page 7

Dr. Masucci found a better way.“ The power of a web-based network like athenahealth is that

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which is our ultimate goal.

Here’s what he did.After 30 years running a solo pediatric practice, Dr. Peter E. Masucci found a better way to manage his practice.

Now, he spends more time with patients than ever and he’s getting paid the money he’s owed — when he’s owed it.

With athenahealth’s integrated web-based billing, practice management, and electronic health record services, he’s been able to:

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* Dr. Peter E. Masucci participates in athenahealth’s National Showcase Client Program. For more information on this program, please visit www.athenahealth.com/NSC.

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Find that elusive work/life balance he’s been Find that elusive work/life balance he’s been

Here’s how he did it. Low-cost, web-based, CCHIT-certifi ed

Here’s how he did it.

health record services, he’s been able to:

Reduce Days in Accounts Receivable by 65%

Increase the percentage of claims paid at their contracted rate from 62% to 99%their contracted rate from 62% to 99%

Find that elusive work/life balance he’s been Find that elusive work/life balance he’s been searching for

Reduce Days in Accounts Receivable by 65%

Increase the percentage of claims paid at Increase the percentage of claims paid at their contracted rate from 62% to 99%

Reduce Days in Accounts Receivable by 65%

Here’s how he did it. Low-cost, web-based, CCHIT-certifi ed

software

Reduce Days in Accounts Receivable by 65%

Increase the percentage of claims paid at their contracted rate from 62% to 99%

Find that elusive work/life balance he’s been searching for

Here’s how he did it.

Page 10Page 10 Medical Society of New Jersey’s Physician Advocate Magazine

MSNJ News & Notes

Congratulations to our 2012 Dues Renewal iPad Contest Winners!

• Franklin J Frasco, MD - Monmouth County

• Joseph P. Costabile, MD - Camden County

• Michael B. Silber, DO - Hunterdon County

Renew Your Dues Through 2013 Today!

You now have the option to pay your dues in monthly installments. Contact us at info@msnj.org to set up your account. Monthly service fees apply.

• DeCotiis, FitzPatrick & Cole, LLP

• HEFCU• Sun National Bank• Giordano Halleran &

Ciesla • CohnReznick LLP

• Liberty Mutual• Cape Medical Billing • Valley National Bank • Two River Community

Bank • Buyer's Edge Inc.

Coding Questions? If you would like your coding question addressed in an upcoming edition of e-News or you have a coding question specific to your practice, please email your questions to the MSNJ Member Resource Center at info@msnj.org.

We will work with a certified professional coder to help answer your questions.

Congratulations to MSNJ President Dr. Mary

Campagnolo - One of South Jersey Magazine's

Featured "Women of the Year"

Is there an MSNJ member physician you’d like to see

recognized? E-mail bbarry@msnj.org with the information and look for the mention in the next edition of Physician

Advocate.

Thank you to our corporate partners who offered help and resources in the aftermath of Hurricane Sandy:

Save the Date: MSNJ’s Annual Meeting!May 17-18, 2013

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EHR system again, scan that patient data immediately into his/her file and run your billing processes.

• Invest in an adequate generator.

NJ-HITEC asked its members to share their Super Storm Sandy stories to assist other providers who are in the process of an implementing an EHR system or want to formalize their preparedness plan.

“We lost power for eight days. The bad news was that I could not use the EHR system even though we have a generator. Our practice has a network of 38 EHR workstations that needed too much power for the generator to handle. The good news is that we didn’t lose any data or files and all of the lab work downloads remained in the system when power was restored,” explains Dr. Thomas R. Ortiz.

In the last few days of the outage and during the daylight hours, the practice implemented its emergency back-up manual paper system, treating walk in and urgent patients with acute problems.

In addition, the doctors were

able to write prescriptions for medications and call pharmacies for refills. They were also able to power the phone system by the generator to answer calls.

Forest Hills Family Health Associates has a local area network powered by an onsite server. In the situation of a power loss, the battery back-up system allows for an orderly shut down of the server. To continuously protect patient data, the EHR system is equipped with an automated backed up system that backs up the database every 15 minutes to an off-site server location, so all of the patient information is stored securely.

Dr. Muthu R. Arunachalam is a solo practitioner specializing in geriatric medicine. Consequently his patients are frequent visitors to the hospital. He is affiliated with both Mountainside Hospital in Montclair and St Barnabas Medical Center in Livingston. In the aftermath of Super Storm Sandy, he had authorization from both hospitals to treat his patients at their facilities. Utilizing cloud technology, Dr. Arunachalam was able to access to his patients’ medical records through his smart phone.

“We had no power in our office so I was unable to see patients. Without my staff in the office, it

would have been very difficult for me to treat my patients. I would have had to go to my office, copy their charts, and bring them to the hospital. Instead, with EHR technology, through my smart phone, I could access my patients’ charts, check their medical histories, medications, allergies, etc. I felt very connected during this time of disaster,” explains Dr. Arunachalam.

The ability to log in and obtain patient data anywhere and anytime is invaluable. Dr. Arunachalam adds, “The initial stages of implementing an EHR system is challenging and time consuming.

But once the patient’s record is in the system, the process gets easier. EHR technology gives you freedom as a physician with the ability to review a patient’s medical history within minutes.”

The Sunday before Super Storm Sandy, Dr. Firpo E. Guerrero’s staff called their scheduled patients to check in on them and to let them know that the practice would be closed on Monday and possibly Tuesday.

On Wednesday, they were able to see patients because the practice has a natural gas generator that

Muthu R. Arunachalam, MDGeriatric & Primary Care Center - Livingston, NJ

Thomas R. Ortiz, MD, FAAFP Forest Hill Family Health Associates, PA – Newark, NJMedical Director, NJ-HITEC

Firpo E. Guerrero, MDEssex Gastro Associates - Newark, NJ

Continued from page 4

Page 12Page 12 Medical Society of New Jersey’s Physician Advocate Magazine

powered its EHR system, lights, phones, and heat - everything that runs on electricity in the office. Once the generator was powered up, all of the patient records were accessible. No patient files or patient data was lost.

“The best advice I can give my colleagues with regard to preparing for a storm or any other type of disaster, is to continuously back up your files, invest in a generator, and select an IT company that is customer service focused to answer all your questions and walk you through any problems,” explains Dr. Guerrero.

He adds, “The biggest challenge of implementing EHR technology was to get the 20,000 paper records scanned into our EHR system. The second key challenge is that anytime you implement a new system, it slows you down. “

“In turn, I saw less patients and worked longer hours until I learned how to use the technology effectively. Overall, it took about two months. However, the benefits are amazing - more than one person can view a chart; we don’t spend hours looking for a patient’s chart; and lab results and tests are delivered electronically.”

“Additionally, if a doctor calls me for information or has a question about one of my patients, I don’t have to put him or her on hold and ask my staff to find the chart. I ask for the

patient’s date of birth and I can pull up chart in seconds.”

The moral of these stories is that no patient records were lost or damaged because of Super Storm Sandy. Patient records were secure and accessible despite the flooding and loss of electrical power. These providers demonstrated the usefulness, efficiencies, and effectiveness of EHR technology.

Super Storm Sandy left a trail of devastation in its wake touching on all aspects of our lives. For medical community, it clearly emphasized the important role that Health Information Technology (IT) plays in improving the delivery of quality healthcare under the worst of conditions.

“NJ-HITEC is even more committed to our mission of supporting New Jersey providers in implementing EHR technology into their practices. We have expanded our reach to specialists, in addition to our primary care providers, currently assisting over 7,200 members,” states O’Byrne.

“And we will not stop until all New Jersey providers are connected electronically to their patients.”

To become a member of NJ-HITEC or for more information, on all of its services, call 973-642-4055, email info@njhitec.org, or visit www.njhitec.org.

CMS Will Accept Hardship Exemptions for 2013 erx Payments for Providers Affected by Hurricane Sandy

NJ-HITEC and Senator Robert Menendez combined efforts to assist NJ providers who were affected by Hurricane Sandy in requesting CMS to provide a waiver for eRx Payment Adjustments. The efforts paid off as CMS has granted that waiver.

At Senator Robert Menendez’s suggestion, CMS is considering hardship exemptions to the eRx Payment Adjustments to providers impacted by SuperStorm Sandy. The impacted Eligible Professionals should file their hardship exemption via the Quality Reporting Communication Support page at www.qualitynet.org.

From there, the EPs can create their hardship exemption request and in the justification portion of the hardship outline state that they were unable to eRx due to Hurricane Sandy.

If the EPs have any questions on filing their hardships, they can also always contact the CMS Help Desk at 1-866-288-8912 or via email at Qnetsupport@sdps.org.

Page 13Medical Society of New Jersey’s Physician Advocate Magazine Page 13

vs Inaction

We understand the differenceThe Litigation Center of the American Medical Association and the State Medical Societies fights to protect doctors and uphold the highest standards of patient care.

In courtrooms across America, we are achieving legal victories that preserve the rights of physicians, promote public health and protect the integrity of the profession.

Whether we are challenging managed care organizations’ payment practices or preserving the autonomy of the hospital medical staff, one thing remains constant: The Litigation Center is an active force fighting for physicians’ rights.

Learn more on how The Litigation Center can help you: www.ama-assn.org/go/litigationcenter

Membership in the American Medical Association and the Medical Society of New Jersey makes the work of The Litigation Center possible.

Join or renew your memberships today.

IN ACTION

The Litigation Center is proud to have Lawrence Downs, Medical Society of New Jersey CEO, serve on its executive committee.

www.ama-assn.org www.msnj.org

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