NJPCAC Works to Rescind Horizon Ultrasound Policy

Legislation, Press Releases on June 12th, 2019 No Comments

Since it first learned in late April of a surprise announcement by Horizon Blue Cross Blue Shield to implement a new policy to impose Medical Necessity Determinations (MND) on various ultrasound services, the New Jersey Patient Care and Access Coalition has been working virtually non-stop to reverse this illadvised decision.

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2019 New Jersey Patient Care and Access Coalition Board of Directors Officers Elected

NJPCAC Member News on June 12th, 2019 No Comments

The New Jersey Patient Care and Access Coalition Board of Directors elected its 2019 officers at its annual meeting in New Brunswick on February 7th.

From left: Dr. Patrick Ciccone, Treasurer, Dr. Steven Orland, Secretary, Dr. Robert Gialanella, Chairman, Dr. Alan Krieger, Vice-Chairman.

NJPCAC Awarded $15K Grant from Digestive Health Physicians Association

NJPCAC Member News on June 11th, 2019 No Comments

Thanks to the efforts of NJPCAC Board member Dr. Nadeem Baig, the Coalition was awarded a grant of $15,000 from the Digestive Health Physicians Association (DHPA) for the Coalition’s “ongoing advocacy efforts … to modernize New Jersey’s physician self-referral law.”

The DHPA created its State Health Policy Action Fund “to support legislative and regulatory efforts on the state level.” The DHPA was specifically interested in “the need to modernize state physician self-referral laws to promote access to care furnished in independent gastroenterology practices.”

Dr. Baig applied for the grant on behalf of the Coalition and cited our effort In 2017, to lobby for passage of legislation that made New Jersey one of the first two states in the country to modernize its self-referral law—known as the Codey Act. The Codey Act amendments were enacted into law in Summer 2017 and took effect in early 2018. NJPCAC continues to work with the Department of Health to promulgate regulations for the new law.

The amended Codey Act created a new exception from the self-referral prohibition for referrals made in furtherance of an Alternative Payment Model (APM) submitted to and approved by the DOH.

NJPCAC Leadership Meets with Assembly Health Committee Chairman on Key Issues

Legislation on June 11th, 2019 No Comments

NJPCAC President and Chairman Dr. Bob Gialanella, Vice Chairman Dr. Alan Krieger, Counsel Howard Rubin and lobbyist Don Sico met with Dr. Herb Conaway, Chairman of the Assembly Health and Senior Services Committee on April 29th in New Brunswick.

The group discussed two key issues with the Chairman: Maintenance of Certification and a new ultrasound policy issued by Horizon Blue Cross Blue Shield of New Jersey that will require Medical Necessity Determinations be made in order to obtain reimbursement for ultrasound services.

New Jersey was Right

Legislation, Press Releases on June 12th, 2017 No Comments

New Jersey became the first state in the nation to formally oppose the draft recommendation made by the U.S. Preventive Services Task Force (USPSTF) that healthy men should no longer receive prostate-specific antigen (PSA) blood tests as part of routine cancer screening.  The joint resolution requesting the U.S. Congress to seek the withdrawal of the USPSTF’s dangerous recommendation, which was passed unanimously by the Senate and the Assembly and signed into law by the Governor, was a quick, bold and courageous move that clearly put our State on the side of early detection of cancer and, ultimately,  aving lives.  New Jersey men, especially men with a family history of prostate cancer, as well as the underinsured, men living in rural areas and African Americans, can applaud our legislature and Governor for this triumph.

Now, a new study published on March 15 in the New England Journal of Medicine has proven once again how valuable PSA screening is as a life-saving tool and just how right our leaders were in acting so quickly to seek the withdrawal of the USPSTF recommendation. A follow-up of the European Randomized Study of Screening for Prostate Cancer (ERSPC) confirmed what practicing urologists have known for decades: PSA screening saves lives.

In the study, “Prostate-Cancer Mortality at 11 Years of Follow-up,” PSA screening was shown to reduce the mortality rate of prostate cancer by 29 percent.  The ERSPC, the world’s largest prostate cancer screening study, involved 182,160 men between the ages of 50 and 74 years at entry, with a predefined core age group of 162,388 men 55 to 69 years of age. The trial was conducted in eight European countries. Men who were randomly assigned to the screening group were offered PSA-based screening, whereas those in the control group were not offered screening. The results showed that for all patients, there was a 21% survival advantage, and more importantly, for those with follow-up of more than 10 years, the survival advantage increased to 38%.

New Jersey public policy makers, including Governor Chris Christie, Senators Loretta Weinberg and Joseph Vitale and then-Assembly members Joan Quigley and Alex DeCroce quickly understood the dangers inherent in the USPSTF recommendation against PSA screening.  Senator Weinberg remembered that the USPSTF was the very same task force that, in 2009, recommended against mammograms for women ages 40-49 and against teaching women to do breast self-exams.  Our legislators understood the seriousness of the USPSTF’s latest recommendation and in a show of bi-partisan support unanimously passed the resolution in both houses – sending a clear message to men in New Jersey  who, upon hearing news reports of the USPSTF recommendation, might decide to forego routine PSA screening.

It is important for patients to know that PSA screening is not treatment. It is a simple blood test. There are essentially no risks to screening, and with screening results, patients have the information they need to consult with their families and their doctors to make better informed decisions about their health.

African American men are especially in need of this information as well as those with a family history of prostate cancer. The facts are not in dispute: One in six men will be diagnosed with prostate cancer in his lifetime and this figure increases to one in five for African-American men; and African-American have more than twice the prostate cancer mortality rate of white men.

As Chairman of the New Jersey Patient Care and Access Coalition (NJPCAC), a coalition of nearly 200 practicing urologists and scores of additional healthcare professionals, including radiation oncologists, pathologists, and nurse oncologists from across the state, I understand what is at stake here. We are united in our opposition to this new recommendation and we have good reason. According to the American Cancer Society, approximately 7,840 New Jersey men will be diagnosed with prostate cancer this year. Roughly 1,100 of them will eventually die from the disease. And while that is an unacceptable number and we can do better, it is significantly better than a few short years ago because of PSA screenings.

Few would disagree that the decision on how and when to screen and treat prostate cancer should stay where it has always been: between patients and their doctors. As a physician, I have been trained not to be an alarmist nor to be prone to exaggeration, but I believe that the USPSTF draft recommendation, if finalized, will cause the needless deaths of thousands of men. As the State of New Jersey has unanimously stated, the USPSTF recommendation must be rejected.

Dr. David Taylor is President and Chairman
of the New Jersey Patient Care and Access Coalition. He is also President of
Garden State Urology and practices in Morristown, NJ.

2018 New Jersey Patient Care and Access Coalition Board of Directors Officers Elected

NJPCAC Member News on February 9th, 2017 No Comments

From left: Dr. Robert Gialanella, Vice Chairman, Dr. Abe Horn, Secretary, Dr. Alan Krieger, President and Chairman, Dr. Patrick Ciccone, Treasurer.

The New Jersey Patient Care and Access Coalition Board of Directors elected its 2018 officers at its annual meeting in New Brunswick on February 28th.

Update from Trenton

Legislation, NJPCAC Member News on November 29th, 2016 No Comments

Two of NJPCAC’s priority issues are heating up in Trenton as Legislators tackle an aggressive pre-holiday agenda. The Out of Network issue and the NJPCAC-led initiative to reform New Jersey’s “Codey Act” to allow for value-based/alternative payment model health care are expected to see action. A third issue – Horizon’s OMNIA tiered network product and its impact on hospitals and physicians – has gone dormant. A new issue has also emerged: Horizon’s notice effective December 1, to its reimbursement policy involving site of service differential for surgical CPT codes (10000 through 69999). NJPCAC is in the early stages of deciding how to respond to this new issue. Updates on the Out of Network, Codey Act Reform and OMNIA issues are now available.

Out of Network Bill

Legislation, NJPCAC Member News on November 29th, 2016 No Comments

UPDATE: On Monday, December 5th, the sponsor of the bill, Senator Joe Vitale, Chair of the Senate Health Committee, delayed action on the legislation to give stakeholders more time to reach a compromise.

Brand new coalitions have been created in recent weeks to both support and oppose out of network reform. Horizon Blue Cross Blue Shield of New Jersey is funding one group: “Better Choices, Better Care, NJ” made up primarily of business and labor groups. NJPCAC is participating in another coalition – the “Access to Care Coalition” – consisting of medical providers.

There appears to be general agreement on issues of transparency and disclosure – assuring that patients are told by their Plan or Provider what is covered and what is not prior to a non-emergency treatment. Where the disagreements lie is in how to resolve disputes. Horizon and some labor unions would like to move to an arbitration system that relies on a percentage of Medicare as the benchmark, while NJPCAC and other hospitals and providers are pushing for a system that would recognize fair market value.

Final legislative action on the out of network bill is not expected by the end of the year. However, at least one committee – the Senate Budget and Appropriations Committee – has scheduled a hearing on the matter in December.

NJPCAC members are encouraged to participate in the Medical Society of New Jersey’s “Action Alert” on the Out of Network issue. You can easily contact your own legislators by going here:http://www.cqrcengage.com/msnj/app/write-a-letter?1&engagementId=149533

Codey Act Reform

Legislation on November 29th, 2016 No Comments

UPDATE: An identical bill (A4334) introduced in the Assembly by Dr. Herb Conaway, Chairman of the Assembly Health and Senior Services Committee, was unanimously and favorably reported from that committee on December 5th. The vote was 13-0 with no abstentions and no absent members.

Legislation advanced by the New Jersey Patient Care and Access Coalition to modernize the state’s “Codey Act” to permit alternative payment models and other value-based health care was UNANIMOUSLY and favorably released from the Senate Health, Human Services and Senior Citizens Committee on November 3rd.

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NJPCAC Board Member Dr. Robert Gialanella and NJPCAC Counsel Neal Shah

S2724 (Codey/Vitale) “Requires alternative payment models to register with DOH; permits health care practitioners to refer patients to health care service in which the practitioner has beneficial interest when related to alternative payment model” was amended and approved with a vote of 9-0 with no abstentions and no absent members. The two amendments – one requiring a six-year review of the program by the Department of Health and another to allow physicians to forego registration under programs for which they were already approved by CMS – were supported by NJPCAC and also approved unanimously.

NJPCAC Board Member Dr. Robert Gialanella and NJPCAC Counsel Neal Shah provided testimony to the committee.

An identical bill was introduced in the Assembly by Dr. Herb Conaway, Chairman of the Assembly Health and Senior Services Committee. The bill number in the Assembly is A4334.

It is expected that the Assembly bill will be considered by the Assembly Health Committee in early December. The bills still must pass the full Assembly and Senate and be signed by the Governor before they can become law.

OMNIA Update

Legislation on November 29th, 2016 No Comments

Efforts to reform New Jersey’s network adequacy and plan disclosure laws that were introduced in the Legislature late last year in response to the roll out of Horizon’s new OMNIA tiered network product have stalled and have little hope of enactment. Court cases – one of which NJPCAC participated amicus – have also hit a dead end and there is little likelihood of a court solution. NJPCAC continues to work with Legislators on this important issue to craft a solution.