The New Jersey State Spine Society (NJSSS) is composed of spine surgeons with the mission of protecting patient access to high quality spine care in New Jersey. Major issues have arisen from proposals by Horizon Blue Cross and Blue Shield of New Jersey and Cigna that will dramatically reduce reimbursement rates for spine procedures.
Dr. Mitchell Reiter, President NJSSS, has called for an emergency meeting to be held on on February 15, 2012 at the Sheraton Tara Hotel, 199 Smith Road, in Parsippany, New Jersey (click here for map and directions) to collect input and activate spine surgeons in New Jersey to address this direct and specific attack on spine procedure reimbursement.
Details for the meeting are provided in Dr. Reiter’s letter:
New Jersey State Spine Society
Wednesday, February 15, 2012
The New Jersey State Spine Society has been revived! Many NJ spine surgeons (a total of 130) contributed to the NJSSS in 2008 when we faced a potential socioeconomic emergency. The asking price at that time was $1000. This show of unity among our membership was immensely helpful in allowing the goals of the organization to be achieved.
Many of the NJ spine surgeons have asked what was done with this money. It was placed in to a political action committee account (the NJ SpinePAC) where it remained, untouched, for 3 years. At the time it was donated, in 2008, the strong support of our state’s spine surgeons was apparent to everyone. Most importantly, this included politicians and policy makers.
We are faced with another impending emergency at this time. The ability to practice in the manner to which we have become accustomed is coming under fire. There are forces which are threatening the current out-of-network providers of spine surgery in New Jersey. This situation, if allowed to occur, could turn New Jersey into Pennsylvania or Massachusetts. In those states, spine surgeons have difficulty earning a fair living and patients have a very difficult time with access to spine surgical care.
The NJSSS has an Executive Committee of 11 members, each of whom has donated a minimum of $5,000 to the SpinePAC in 2011. The reason for these donations is to provide the funding to exert the necessary sphere of influence for our collective voices to be heard.
Recently, the PIP fee schedule was to be overhauled. Many spine codes were to be included. The proposed PIP fee schedule threatened to make caring for motor vehicle accident victims financially untenable for many NJ spine surgeons. The leadership of the NJSSS has worked continuously for the past 6 months to attempt to prevent an unacceptable fee schedule from being implemented. While the final result has not yet been realized, we are confident that significant progress has been made toward reaching a satisfactory solution which will be acceptable to both NJ spine surgeons and our patients.
The goal of the NJSSS is to provide access-to-care for the patients in New Jersey who require our services. Patients should be free to choose the spine surgeon who will provide their care. For the past 3 decades, this has mostly been true. We pledge to work hard to maintain this freedom of choice which has made New Jersey one of the best states in America if spine care is needed.
In 2011, the NJSSS secured the lobbying services of Rocco F. Iossa, Esq., who is the founder and managing partner of State Street Partners, LLC. Rocco’s website details his exemplary credentials:
State Street Partners >
Attached to the end of this report is the 2011 NJSSS Legislative Summary prepared by our lobbyist, Rocco F. Iossa, Esq. In this report, the actions of our legislative bodies are evaluated as they apply to the NJSSS. Please review this carefully.
In 2011, it became clear that lobbying was necessary to preserve our interests. Rather than have policy makers change the practice of medicine, in general, and spine surgery, in particular, we have chosen to pro-actively work hard to prevent adverse decisions before they become laws or regulations. As has been evident from the inactions of our fellow spine surgeons in a number of our neighboring states, inaction can and does lead to regrettable decisions which become virtually impossible to turn back.
The current crisis is predicated on the ideas of some influential individuals in New Jersey to change the manner in which out-of-network billing for spine surgery is performed. As spine surgeons, we have the ability to practice either “in-network” or “out-of-network” to deliver the best spine surgical care to our patients. Likewise, our patients have the opportunity to choose whether to stay in-network or go out-of-network for their care. This system is the best, fairest, and most reasonable way for high-quality spine care to be delivered.
The purpose of the emergency meeting of the NJSSS on February 15, 2012 is to unite all spine surgeons in New Jersey behind a common goal. At some point in the near future, all spine surgeons in New Jersey will be asked to help the society flourish by providing a contribution to the SpinePAC. What you can be assured is that each and every member of the NJSSS Executive Committee is committed to this cause. Each and every Executive Committee member has reached into his own pocket and written a check, for a minimum of $5,000, to help resurrect the society.
We need every spine surgeon in New Jersey to help us in this effort to maintain the ability to practice in the manner to which we have been accustomed. Please attend the meeting on Wednesday evening, February 15, 2012 from 7:30 pm – 9:30 pm at the Sheraton Tara Hotel in Parsippany, New Jersey. This meeting will be informational and will be an opportunity to meet with like-minded individuals who are interested in preserving our current practices. I encourage each of you to forward this invitation to any spine surgeons (orthopaedic surgeons or neurological surgeons) you know and ask them to attend.
There is no fee for attendance. We want to get the message out. We will be asking for help in the foreseeable future, but at this time, we are just looking to have a strong showing to get as many of us together as possible to “rally the troops”. If we don’t act proactively over the next year, we risk having everything we have worked so hard to develop fall apart. The list of the Executive Committee members, with their e-mail addresses, is included in the appendix following this message. Please feel free to contact any one of us with your questions or concerns. I sincerely hope to see each of you at the next NJSSS meeting on February 15.
Robert F. Heary, MD
Professor of Neurological Surgery
UMDNJ-New Jersey Medical School
Newark, New Jersey
NJSSS Executive Committee
Robert F. Heary, MD
Steve Reich, MD
Mitchell Reiter, MD
Roy Vingan, MD
James Dwyer, MD
Dante Implicito, MD
Jack Knightly, MD
Michael Vives, MD
Steve Paragiodakis, MD
Orin Atlas, MD
Paul Vessa, MD
2011 was an active year for the NJSSS. Several bills or regulatory initiatives were introduced or proposed by the NJ Legislature or Department of Banking and Insurance (DOBI). Members of the NJSSS were actively engaged in the legislative activities as well as the regulatory initiatives proposed by DOBI.
A. LEGISLATIVE ACTIVITY.
A-3378 (Schaer)/S-2583 (Vitale).
In October of 2010 Assemblyman Schaer, Chairman of the Assembly Financial Institutions and Insurance Committee, introduced the “Healthcare Transparency and Disclosure Act.” This bill, makes various changes to the administration of health benefits plans, regarding: (1) out-of-network payment collection responsibilities by physicians and health care facilities under insured and self-funded health benefits plans; (2) certain consumer disclosures by physicians, health care facilities and health plan providers; and (3) eligibility for participation in health insurance plan networks.
The bill requires physicians and health care facilities delivering out-of-network services to make a good faith and timely effort to collect each covered person’s liability, including any deductible, copayment, or coinsurance owed by the covered person to the physician or health care facility pursuant to the terms of the covered person’s health benefits plan. The bill provides that a good faith and timely effort to collect means three good faith attempts to collect.
The bill also requires the physician and facilities to retain and make available for inspection by the Department of Banking and Insurance, all records relating to any attempt to collect a covered person’s liability for at least seven years following the date on which the record is made.
The bill allows a carrier or entity providing a self-funded health benefits plan, if the carrier or entity determines that a physician or facility has committed a pattern of violations of section 3 of the bill concerning waivers of payment by a covered person, to exempt the physician or facility from the provision of law which gives an out-of-network health care provider the right to receive payment for reimbursement directly through an assignment of benefits. Under the bill, the carrier or entity is required to notify the physician or facility 30 days in advance of exempting the physician or facility and the exemption is not permitted to exceed a period of one year from the date of the notification. The bill further provides that a determination imposing the exemption may not be made until six months after the effective date of this bill.
This bill requires physicians and health care facilities, when scheduling an appointment with a covered person, to disclose whether the health care services are in-network or out-of-network with respect to that person’s health benefits plan and that there may be a financial responsibility of the covered person, including applicable deductibles, copayments and coinsurance. The bill also requires the facility or physician, if providing out-of-network services, to provide to the covered person, in a clear and understandable manner and in the terms the covered person typically understands, the following: (1) a description of the procedure; (2) an estimate of the costs charged by the physician or facility for those services; and (3) a notice to contact their insurance carrier for further consultation on the costs of the procedure.
The bill also amends the “Health Care Quality Act” by adding to the current policies governing when a health insurance carrier can remove a health care provider from a provider network. The bill provides that the carrier shall not terminate participation of the provider based on a determination that the provider referred a covered person to an out-of-network health care provider.
This bill was moved very quickly through the Assembly Committee and passed the NJ General Assembly on January 10, 2011. At that time the bill was referred to the NJ Senate for consideration. At the time there was an identical bill introduced in the NJ Senate by Senator Vitale. Members of the NJSSS quickly mobilized and were able to prevent the bill from gaining approval in the Senate. Our Society met with Senator Vitale as well as the Governor’s Office of Policy and Office of Chief Counsel and were able to persuade each that this bill would have a negative impact on the quality of care in the state of New Jersey. Without gaining approval in the Senate in the then-current legislative cycle, both bills, A-3378 and S-2583, were terminated and have no further effect.
Unfortunately, both Assemblyman Schaer and Senator Vitale have re-introduced these bills in the new Legislative Session that began January 10, 2012. The new bills, A-245 and S-848, will be referred to committee in the coming weeks. Thus a major battle for our society during the 2012-13 legislative cycle will be to to preserve our current out-of-network privileges.
On August 1, 2011 the Department of Banking and Insurance (DOBI) issued Proposed Changes to the PIP Fee Schedule. Under the proposed fee schedule reimbursement for spine surgeons would have been dramatically decreased by as much as 50%. This would have had a negative impact on the delivery and quality of spine care to MVA victims in the state of New Jersey. Spine surgeons may opt to no longer cover emergency on-call at multiple hospitals or they may choose to only cover the one in three nights required by federal law. The result of these proposed regulations would be that access to care would be dramatically decreased.
Members of our Society quickly mobilized on this issue and had several meetings with regulators on this issue. Our Society met with the Governor’s Office on several occasions, including the Office of Chief Counsel and the Office of Policy, as well as senior staff at DOBI. The result of our meetings was that the department may not be including spine codes in the proposed fee Schedule. Although the process is not concluded we view our efforts on this issue as being highly successful.
The Proposed Fee Schedule is due to be released on February 21, 2012. At that point, a new 60-day comment period will begin and we will have to work hard to maintain our current position with the department.
The 2011 Legislative Summary was prepared for NJSSS by our lobbyist, Rocco F. Iossa, Esq.