Hospital Must Divest Merged Physician Practice
An appellate court has affirmed a lower federal court decision that requires St. Luke's Hospital in Idaho to divest its acquisition of a significant physician practice. The 9th Circuit Court of Appeals in St. Alphonsus Medical Center v. St. Luke's Health System found that the hospital and physician practice merger might result in better patient care, but was satisfied that the merger would result in less competition in the marketplace. The appellate court recognized the laudable goal of better efficiencies, but found that efficiencies alone were not sufficient to overcome the anticompetitive impact of the merger. Read more.  

Congress Passes Suicide Prevention Law-Includes Loan Forgiveness for Psychiatrists
President Obama has signed legislation that will address the suicide epidemic among soldiers and veterans. The law requires the VA to have suicide prevention programs and to make suicide prevention information more available to veterans. In addition, it establishes a pilot program that will include loan forgiveness for a number of psychiatrists who work for the VA. 

February 28: Last Day to File PQRS Informal Review and EHR Attestation. 

Anthem Data Breach Potentially Affecting Horizon BCBSNJ and Amerigroup New Jersey Inc. Policyholders

Anthem advised that the following consumers may have been affected by their data breach last month:

• Current policyholders of Horizon Blue Cross Blue Shield of New Jersey and past policyholders of those plans who accessed services out of state dating back to 2004
• Current policyholders of Amerigroup New Jersey Inc. and past policyholders dating back to 2004

Read more. 

Drug Abuse

Hospital Staffing

The Senate Heath Committee held a hearing on S.1183, which would establish minimum registered professional nurse staffing standards for hospitals and ambulatory surgery facilities and certain DHS facilities. The NJ State Nurses Association and Health Professionals and Allied Employees support the bill, while NJHA opposes it. MSNJ has not taken a position on this bill.  

End of Life

The Senate Health Committee has passed S.2435, which requires Medicaid to cover advance care planning. Two other states cover such services. MSNJ is monitoring this bill. Read press coverage.

Medicaid Fraud

Child Health

The Assembly has passed A.3435, called the "Boys & Girls Clubs Keystone Law," which permits minors to give consent for behavioral health care for the treatment of mental illness or emotional disorders.  The bill provides that the minor's consent to treatment under the supervision of a physician, an individual licensed to provide professional counseling, including, but not limited to, a psychiatrist, licensed practicing psychologist, certified social worker, licensed clinical social worker, licensed social worker, licensed marriage and family therapist, certified psychoanalyst, licensed psychologist or licensed clinical social worker, an advanced practice nurse, or in a health care facility would be valid and binding as if the minor had achieved majority. Read more. 

Drug Substitutions

The Assembly Health Committee held a hearing on A.2477, which attempts to create rules regarding the dispensation of biosimilars as interchangeable for biologics. Though there are no biosimilars on the market yet, the FDA has created a pathway for approvals of biosimilars, so the pharmaceutical industry hopes to have parameters for substitutions (physician and patient notice). New Jersey already has drug substitution laws and notice requirements, but they do not apply to biologics. Bills are being introduced in most states. The Association of Health Plans and pharmacy benefits management companies oppose the bill if it hampers substitution in favor of more costly "brand" biologics unless a prescribing physician prohibits substation.  Many pharmaceutical companies support the bill. MSNJ is neutral on this bill, as are many other state medical societies, but monitoring it very closely. Read the AMA letter supporting physician prescribing discretion. Read more.  

Vaccines

MSNJ HOD Resolutions

In preparation for MSNJ House of Delegates on Friday, May 1, 2015, enclosed are the guidelines for resolution submission, writing and due dates. Please submit all resolutions via resolutions@msnj.org or fax 609-896-1347.

Resolutions may not be submitted to MSNJ directly by individuals, and resolutions must come from county societies or the MSNJ Board of Trustees. Resolutions submitted directly to MSNJ by an individual member will be forwarded to that member's county society for action. The county societies will determine which resolutions to submit for consideration by the HOD.  All resolutions need to have the submission form attached to the resolution.

• March 16, 2015 - Resolutions due from counties
• March 27, 2015 - Resolutions posted on MSNJ website
• April 3, 2015 - Comments and recommended changes on resolutions due from counties
• April 7, 2015 - Reference Committee Webinar 6 - 9 pm - Register (Session 1 HOD)
• April 24, 2015 - Reference Committee Report posted on MSNJ website
• May 1, 2015 - MSNJ HOD

NJ Department of Human Services Commissioner Resigns

Top Doctors 2015: Make Your Voice Heard in New Jersey Monthly by Sunday, March 1
New Jersey Monthly's annual survey of physicians is underway. This is the only survey that is mailed to all doctors in active practice in New Jersey rather than relying on the opinions of a smaller group of doctors or a national poll. MSNJ encourages all members to participate. Vote online by Sunday, March 1. You will be asked to enter your medical license number before entering the site to vote. The list is "locked down" before any solicitation of advertising, and a variety of methods are employed by the polling company to prevent ballot-box stuffing. The results will be published in the November issue of New Jersey Monthly and is searchable throughout the year at www.njmonthly.com.

There is still time to submit 2014 PQRS data and avoid the penalty in 2016! Marcy Le, Medical Software Trainer at STI Computer Services, MSNJ corporate partner, will present a free webinar "PQRS Reporting Simplified." Learn about the program and how to avoid the penalty. This webinar will be presented on the following dates:

• February 27 at 9:00am - Register
• March 3 at 12:00pm - Register

ICD-10: Only 223 Days Away!

October 1, 2015 is the deadline to transition to the ICD-10 code set. MSNJ encourages all physicians to begin preparing for implementation by working with software vendors and testing their systems. View resources on MSNJ's website. Register for upcoming ICD-10 Webinar Workshops. Participate in NJ DOBI's ICD-10 Readiness Survey.

Coming Soon: Ask an Expert from SuperCoder.com

MSNJ members will soon have free access to a new coding benefit through MSNJ's website. Our Practice Management Section will soon feature coding tools powered by SuperCoder.com including the very popular Ask an Expert. Ask an Expert is a forum-style Q&A that allows coders and billers to submit questions and get answers from AAPC or AHIMA certified coders that include supporting information and explanation. Stay tuned to e-News and the MSNJ website for more information, as we roll out this new benefit.

NJ DOBI Standard ICD-10 Readiness Survey

The New Jersey Department of Banking and Insurance (DOBI) ICD-10 Implementation Task Force, which MSNJ participates in with NJHA and many New Jersey payors and hospitals, is conducting a standardized ICD-10 Readiness Survey to collect information regarding your ICD-10 readiness. We are looking for solo and small practices in particular to take the survey. Please take this opportunity to tell us where you are in the transition process. Take the survey! 

February 28 Deadline: EHR Attestation for Eligible Professionals

Eligible Professionals (EPs) participating in the Medicare EHR Incentive Program have until February 28 to attest to meeting meaningful use of the data collected during their 2014 reporting period. The attestation includes the 2014 Certified EHR Technology (CEHRT) Flexibility Rule options. Starting January 1, 2015, penalties were applied for Medicare EPs that did not successfully demonstrate meaningful use in 2013 and did not receive a 2015 hardship exception. Medicare EPs that did not successfully demonstrate meaningful use in 2014 and do not receive a 2016 hardship exception will have payment adjustments applied beginning January 1, 2016. Read the payment adjustment tipsheet for more information.

Please Note: You must attest to demonstrating meaningful use every year to receive an incentive and avoid a Medicare payment adjustment.

Medicaid EHR Incentive Program participants should refer to their state's deadlines for attestation information. 

February 28: Last Day to File a 2014 PQRS Informal Review

Physicians that believe they received a PQRS penalty letter in error from CMS have the ability to verify the information and request an informal review using the PQRS Look Up tool from now through February 28.

An informal review may be requested if:

• A practice's PQRS feedback report indicates that the physician or group practice did not earn the PQRS incentive payment when they believe they should have
• A practice believes the PQRS payment amount was incorrect
• A practice received a notification in error from CMS indicating the physician or group practice did not successfully participate in 2013 PQRS and will receive a 2015 PQRS payment adjustment

Important 2014 PQRS Data Submission Deadlines

There is still time to avoid the 2016 Medicare payment penalties by participating in PQRS for 2014. The following reporting methods are still available:

• Until February 28, 2015:
• EHR direct or data submission vendor that is Certified EHR Technology
• Qualified Clinical Data Registries (QCDRs) (using QRDA III format) reporting for PQRS and the Clinical Quality Measure component of meaningful use for the Medicare EHR Incentive Program
• Until March 20, 2015:
• Group Practice Reporting Option Web Interface
• Until March 31, 2015:
• Qualified registries
• QCDRs (using XML format) reporting for PQRS only
• Maintenance of Certification Organizations

View February's Coding Tip of the Month for information on the use of E codes in ICD-10 for Endocrine, Nutritional, and Metabolic Diseases (E00-E89).