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New Jersey Physician Magazine
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Also in this Issue• CMS Releases Proposed Rules for 2012 Medicare Payments
• Medicaid RAC Program is Underway in New Jersey
• New Jersey Durable Power of Attorney Laws
University Orthopaedic Associates, LLCWith the Opening of its Brand New All-Inclusive Facility, UOA Offers One-Stop Comprehensive Care and Treatment
a u g u s t 2 0 11
www.HNManagement.com973-660-9334/ext 125Located in Florham Park, NJ
HEALTH NETWORKM A N A G E M E N T
A Full Service Billing, Collection and Practice Management Company
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Publisher’s Letter
Dear Readers,
Welcome to the August issue of New Jersey Physician, the state’s only publication
serving the medical community.
This month we feature University Orthopaedic Associates as our featured
practice. Began in 1972 with three physicians, and now with fifteen, the very
large, sub specialty practice, offering patients the entire gamut of non-surgical
and surgical treatment is about to move into a new, comprehensive facility with
its own ASC, Physical Therapy Center, and fully equipped, state-of-the-art imaging
center, offering patients one stop care without the need to leave the building.
Hackensack University Medical Center has announced the formation of an ACO.
The employees of HUMC will pilot the attempt at accountable care through its
self-insured employee health plan.
The ProMutual Group, a leading provider of medical professional liablility
insurance has announced the launch of its new name and brand. Now to be
known as Coverys, the change reflects the continued integration of the member
companies within ProMutual Group, including recently acquired Fincor Holdings
and its subsidiaries. In the same vein, the “Saint Barnabas Health Care System”
has rebranded itself into “Barnabas Health”.
New Jersey’s Durable Power of Attorney Laws are most confusing. We have
included a summation of the laws along with additional information that each of
our readers should be aware of in dealing with such patient issues as power of
attorney, and other advanced directives for Health Care.
The Department of Health and Human Services has announced draft guidelines
for states to follow in crafting state-run insurance exchanges. The ACA mandates
states to offer a competitive marketplace for consumers and small businesses to
compare and purchase health insurance. This is required to be in effect by Jan 1,
2014.
Finally, we ask you to excuse the lateness of our current issue. Hurricane Irene
slowed everything down including our ability to get to interviews and surgical
photo shoots, as well as our ability to function without power. We will be doing
our best to get back on schedule as promptly as possible.
With warm regards,
Michael GoldbergCo-Publisher
New Jersey Physician Magazine
Published by Montdor Medical Media, LLC
Co-Publisher and Managing EditorsIris and Michael Goldberg
Contributing Writers Iris GoldbergMark Manigan, Esq.Debra Lienhardt, Esq.Joseph Gorrell, Esq.Kevin Lastorino, Esq.Carol Grelecki, Esq.John Fanburg, Esq.Lani Dornfeld, Esq.Caren Malone
New Jersey Physician is published monthly by Montdor Medical Media, LLC.,PO Box 257Livingston NJ 07039Tel: 973.994.0068Fax: 973.994.2063
For Information on Advertising in New Jersey
Physician, please contact Iris Goldberg at
973.994.0068 or at [email protected]
Send Press Releases and all other information
related to this publication to
Although every precaution is taken to ensure
accuracy of published materials, New Jersey
Physician cannot be held responsible for opinions
expressed or facts supplied by its authors. All
rights reserved, Reproduction in whole or in part
without written permission is prohibited.
No part of this publication may be reproduced or
transmitted in any form or by any means without
the written permission from Montdor Medical
Media. Copyright 2010.
Subscription rates:
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Advertising rates on request
New Jersey Physician magazine is an
independent publication for the medical
community of our state and is not a publication
of NJ Physicians Association
2 New Jersey Physician
CONTENTS
11
Statehouse
More information on Durable Power of Attorney Laws
12
Health Law Update
16
Hospital Rounds
18
Food for Thought
Serenade Chatham, New Jersey
20
Coverys
ProMutual Group rebrands as Coverys
Contents
University OrthopaedicAssociates, LLC
With the Opening of its Brand New All-Inclusive Facility, UOA Offers One-Stop Comprehensive Care and Treatment
COVER STORY
4
Call for NomiNatioNs
New Jersey Physician Magazine invites all medical practices to submit nominations for cover stories.
Practices should include a brief description of what makes the practice special.
Please contact the publisher Iris goldberg at [email protected]
August 2011 3
4 New Jersey Physician
Back in 1972 University Orthopaedic
Associates, LLC (UOA) began with two
physicians and a mission to provide the
most current, technologically advanced and
personalized healthcare services available.
This month, UOA welcomes the fifteenth
orthopaedic surgeon to join its multi-faceted,
subspecialty-trained team. Also, honoring
the mission that began nearly four decades
ago, University Orthopaedic Associates is
preparing to move into its beautiful, newly
constructed, comprehensive facility that
will allow patients to travel to just one
destination and receive a full circle of
integrated orthopaedic care.
Affiliated with Robert Wood Johnson
University Hospital, Saint Peter’s University
Hospital, Jersey Shore University Medical
Center and University Medical Center at
Princeton, the surgeons of UOA specialize
in the entire spectrum of non-surgical and
surgical orthopaedic care and treatment,
including:
• sports medicine• arthroscopic surgery• surgery of the hand and upper extremity• surgery of the foot and ankle• surgery of the spine• surgery for traumatic injuries• joint replacement surgery
In addition to the pursuit of excellence in
orthopaedic treatment, the surgeons of
UOA are deeply committed and involved
in the training of medical students and
residents at their affiliated hospitals, as
well as clinical and bench research. The
promotion of community health and well-
being is another priority at UOA and is
accomplished through participation with
numerous organizations throughout the
state. Also, the physicians of UOA serve as
the orthopaedic consultants for the athletic
teams at Rutgers University, Princeton
University, Rider University and US Rowing,
as well as numerous high school teams.
With the upcoming Fall opening of its
impressive 62,000-sq.-ft. state-of-the-art
facility in Somerset County, University
Orthopaedic Associates is positioned
to provide one- destination treatment to
orthopaedic patients from many locations
throughout the state. Housed within the new
building will be three high-tech equipped
ambulatory surgical suites to accommodate
the many same day, minimally invasive
procedures performed by the surgeons of
UOA.
Also on site, complete orthopaedic
diagnostic imaging services including
x-ray, MRI, ultrasound and dexa scanning
will simplify the lives of patients, who no
longer will need to travel from facility to
facility in order to receive diagnosis and
treatment. For patients with osteoporosis,
a certified Nurse
Practitioner, with
ISCD accreditation,
is on staff to assist
with the screening
and treatment
regimen of each
individual patient.
Modern, fully
equipped occupa-
tional and physical
therapy centers,
staffed with highly
skilled professionals,
are included in the
new facility as well.
For surgical patients,
therefore, diagnosis,
surgical treatment
and post-surgical
rehabilitation are all
accomplished under
one roof. This set-up
allows for hands-on,
personalized care
Cover Story
University Orthopaedic Associates, LLCWith the Opening of its Brand New All-Inclusive Facility, UOA Offers One-Stop Comprehensive Care and Treatment By Iris Goldberg
Michael P. Coyle, MDHand & Upper Extremity
Aman Dhawon, MDSports Medicine
Carlos A. Sagebien, MDTrauma
August 2011 5
that is more efficient through better com-
munication amongst all caregivers because
each is in-house.
Setting UOA further apart from other
practices, the new facility has a comfortable
learning center at which seminars for
medical students and residents will be
conducted. The learning center will serve
patients and the community such as primary
care physicians and athletic trainers as
well. There, pre-surgical sessions will be
conducted to answer questions patients have
about upcoming procedures. The sessions
will also help patients understand what will
be expected of them during their course of
treatment. Outcomes are always improved
when patients are aware of the commitment
they need to make prior to undergoing a
surgical procedure. In this way, there are no
surprises afterwards and patients can play an
active role in the recovery process.
Of course, the most important asset of
any medical practice is the expertise of
its physicians. At University Orthopaedic
Associates, all of the surgeons treat
general orthopaedic conditions affecting
adult, adolescent and pediatric patients.
Each, however, has also been fellowship
trained in one of the subspecialty areas of
orthopaedic care. New Jersey Physician had
the opportunity recently to meet with some
of the UOA surgeons in order to learn about
the innovative developments within each of
their specialties.
One of the original founders of University
Orthopaedic Associates was Joseph
Leddy, MD, who is presently retired. Dr.
Leddy sub-specialized in surgery of the hand
and upper extremity. It is a great source of
pride for the practice and most certainly for
Dr. Leddy that his son, Timothy P. Leddy,
MD, is currently one of the hand and upper
extremity specialists at UOA. “It was a really
unique and wonderful experience for me
to train under him when he was one of the
professors here and also to join with him in
practice here for the few years before his
retirement,” Dr. Leddy happily remembers.
Like his dad before him, one of the
complex procedures Dr. Leddy performs is
delicate surgery on infants with congenital
differences of the hand. He relates a current
case involving two sisters who were born
with thrombocytopenia-absent radius (TAR)
syndrome. Originally operating on the sisters
as infants, Dr. Leddy recently operated on
one of the sisters now that she is sixteen.
Besides all of the innovative hand and upper
extremity surgeries Dr. Leddy performs as
an orthopaedic subspecialist at UOA, he
receives immeasurable gratification from
the work he does with Health Volunteers
Overseas. This program sends specialists
to other countries to impart expertise
and also to learn from their international
counterparts. Dr. Leddy serves as a site
director for hand surgery in Peru, where
there is a need for access to technological
developments in the most sub-specialized
areas of orthopaedics.
In terms of the imminent opening of UOA’s
all-inclusive new facility, Dr. Leddy looks
upon this as the appropriate next step in
the evolution of the practice, which has
continually grown in size as well as expertise
since his dad helped found it almost forty
years ago.
Along with the elder Dr. Leddy in 1972,
the original foundation of the practice
included Joseph Zawadsky, MD, who
is also retired, and Michael P. Coyle, Jr.,
MD. Today, Dr. Coyle, who specializes in
surgery of the hand and upper extremity,
is the senior staff member of University
Orthopaedic Associates. Dr. Coyle has
witnessed the evolution of UOA firsthand
and believes the opening of the new facility
will be another positive development. “This
is going to streamline things for us,” he
says. We will be doing basically the same
things we’ve done in the past, but probably
much more efficiently for the patient,” Dr.
Coyle foresees. Fortunately for patients
and also colleagues at UOA, who can avail
themselves of his considerable experience,
Dr. Coyle has no immediate plans to retire.
John Delgado, MDTrauma
Charles J. Gatt, MDSports Medicine
Mark S. Butler, MDFoot & Ankle/Trauma
Christopher Doumas, MDHand & Upper Extremity
Stephen Cook, MDSpine
David Harwood, MDJoint Replacement
David R. Polonet, MD Trauma
Timothy M. Hosea, MDSports Medicine
Gino Chiappetta, MD Spine
Timothy P. Leddy, MDHand & Upper Extremity
Jeffrey R. Bechler, MDSports Medicine
James T. Monica, MD Hand & Upper Extremity
6 New Jersey Physician
Working with Dr. Leddy and Dr. Coyle in
hand and upper extremity surgery is one of
UOA’s newest members, James T. Monica,
MD, who has specific fellowship training in
shoulder surgery as well as in hand and upper
extremity surgery. “Ailments of the shoulder,
elbow, and hand are incredibly common. It’s
a privilege to use my subspecialty training
to help my patients,” Dr. Monica expresses,
referring to the innovative upper extremity
procedures that he is able to perform.
Dr. Monica describes reverse total shoulder
replacement surgery for people who have
severe arthritis and who also have rotator cuff
tears that are irreparable. This would also be
appropriate for a young person with a tear
that could not be repaired in the traditional
manner. In this innovative procedure that
has not yet become commonplace, the
socket and ball are switched. A metal ball is
attached to the shoulder bone and a plastic
socket is attached to the upper arm bone.
This allows the patient to use the deltoid
muscle instead of the torn rotator cuff to lift
the arm.
Another cutting edge procedure performed
by Dr. Monica is the Latarjet procedure,
which is used for stabilizing shoulders that
suffer repeated dislocations. The procedure
involves transfer of the coracoid with its
attached muscles to an area in front of the
socket (glenoid) that is deficient, thereby
replacing missing bone and preventing
further dislocations.
He also shares information about a
neurotization procedure to transfer healthy
nerves from one part of the upper extremity
to nerves that are no longer functioning,
usually as a result of traumatic injury. Dr.
Monica explains that the patients in question
often have no bicep or deltoid function,
preventing them from lifting or flexing the
arm. Neurotization, which takes redundant
healthy nerve, and brings it over to the nerve
that feeds the deltoid or biceps, will help
muscle with damaged nerves to eventually
regain their function.
Also fellowship trained in hand and upper
extremity surgery, Christopher Doumas,
MD, has been with UOA for almost five years.
Dr. Doumas spends much of his time in UOA’s
Monmouth County satellite office, located
in Wall, N.J., and also serves as Director of
Hand Surgery at Jersey Shore University
Medical Center. “I really like the academic
side of this practice,” Dr. Doumas mentions,
as one important reason he decided to join.
He is involved in researching bio-mechanics
and feels that being a member of UOA will
give him the opportunity to continue that
pursuit.
Dr. Doumas, who specializes in minimally
invasive nailing of clavicle fractures and
arthroscopic triangular fibrocartilage (TFCC)
repairs, published two chapters on wrist
fractures last year. He is currently developing
a new TFCC ligament reconstruction
procedure that is less invasive. Dr. Doumas
is passionate about helping people and
chose his profession in order to have the
opportunity to do just that. In fact, Dr.
Doumas is willing to donate his services to
those in need. He spent time in Haiti, for
example, to treat victims of the devastating
earthquake there.
p Dr. Harwood begins hip replacement as residents look on
August 2011 7
University Orthopaedic Associates spine
surgeons include Stephen S. Cook, MD and
Gino Chiappetta, MD. Joining the practice
in 2005, Dr. Chiappetta treats patients with
disorders of the spine caused by illness
or injury. Dr. Chiappetta is gratified to be a
member of UOA for many reasons. One of
the most significant for him is its affiliation
with academic medical centers like Robert
Wood Johnson University Medical Center,
which is a Level I trauma center, and also
Jersey Shore University Medical Center,
which is Level II.
“We get referrals of patients with complex
spinal cord injuries, spinal traumas, spinal
cord tumors and also those who need
revisions of prior surgeries. In terms of being
here, we have the resources at the hospital
as well as the surgical skills to handle any
high-level, complex case,” Dr. Chiappetta
shares.
For example, Dr. Chiappetta cites an
upcoming case of an adult scoliosis patient
who requires revision of a past surgery
performed by another spine surgeon. Dr.
Chiappetta is also the first spine surgeon to
perform both cervical and lumbar artificial
disc replacement surgery at Robert Wood
Johnson University Hospital.
In addition to these extraordinary complex
procedures, Dr. Chiappetta utilizes the most
current technology for those procedures
that are somewhat more commonplace,
such as cervical and lumbar spine fusions.
For instance, appropriate patients might
opt for a lumbar fusion that is done using
the minimally invasive Extreme Lateral
Interbody Fusion (XLIF) technique of
approaching from the side of the patient as
opposed to anterior or posterior entry. In
fact, with the opening of UOA’s new facility
and its three state-of-the-art operating suites,
Dr. Chiappetta looks forward to performing
many minimally invasive spine procedures
there.
UOA’s joint replacement specialist is David
A. Harwood, MD. Dr. Harwood shares some
of the innovative joint replacement surgeries
which he performs. For many younger, more
active patients, traditional hip replacement
surgery is not the best option because there
are limitations to the activities that can be
resumed afterwards. For these individuals,
Dr. Harwood performs computer-assisted
Birmingham hip resurfacing. Unlike total hip
replacement, which requires removal of the
femoral head and the insertion of a hip stem
down the shaft of the femur, hip resurfacing
preserves the femoral head and neck. Dr.
Harwood shaves only a few centimeters of
bone around the femoral head and shapes
it tightly to fit the Birmingham hip implant,
not unlike fitting a cap for a tooth. The
vast majority of patients who undergo this
procedure can eventually resume their
active lives without limitation.
Dr. Harwood is most excited about a knee
replacement procedure he has recently
incorporated that is practically bloodless.
With the benefit of remarkable new
technology developed by Smith & Nephew
that uses MRI and x-ray images to custom-fit
surgical instruments to each patient’s unique
anatomy, Dr. Harwood can merely snap the
computer-mapped, customized implant on
the end of the femur, saving countless steps
required in the traditional procedure. He
explains that before, a big hole was made
in the femur bone for a rod to hold the jig
needed to make the cuts. This created a
great deal of blood loss. Now with this less
invasive, computer-mapped approach,
besides experiencing less blood loss,
patients require less time under anesthesia
and have a lower risk of infection.
Combining patient-matched technology
with technology also developed by Smith &
Nephew that extends the life of the replaced
knee allows Dr. Harwood to provide optimal
results for patients of all ages. With implants
created by using a combination of materials
that have been tested to simulate 30 years of
wear performance, Dr. Harwood explains
that even patients in their 30s and 40s can
now undergo knee replacement surgery
without worrying about another procedure
10 or 15 years down the road.
Like his colleagues at UOA, Dr. Harwood
is looking forward to the opening of the
new facility. “There’s going to be plenty of
parking, plenty of comfortable places to wait
and even a coffee shop where patients can
grab a bite,” Dr. Harwood shares. He further
reveals there will be accessibility not only
for handicapped people in wheelchairs,
p the incision in the hip is relatively small allowing for less blood loss
8 New Jersey Physician
but also for patients on stretchers who
come by ambulance. “It has been very well
thought out,” he adds, wanting to credit
those at UOA who have spent a great deal
of time working on all of the details that will
definitely set their facility apart from others.
UOA’s comprehensive trauma specialists
include Carlos A. Sagbien, MD, Mark
S. Butler, MD, David R. Polonet, MD,
and John M. Delgado, MD. In addition
to treating patients who have been
involved in a traumatic event resulting in
an orthopaedic injury, many are involved
in various research projects. In fact, at the
42nd Eastern Orthopaedic Association
meeting taking place in Williamsburg, VA,
this coming October, Dr. Sagebien and Dr.
Harwood are presenting the protocol they
developed to reduce blood loss in total knee
replacement surgery, as described above.
Dr. Sagbien points out the fortunate timing
of this less invasive knee replacement in
terms of the opening of UOA’s new facility
- complete with ambulatory surgical suites.
“In the near future, there is a high likelihood
that for the right patient at the right age,
same day knee replacement surgery will be
performed at our new facility,” he predicts.
Additionally, Dr. Sagbien is currently
conducting research on bisphosporate-
related femur fracture in patients with
osteoporosis who have been on medications
like Fossomax for extended periods of time.
He reiterates the importance of screening
patients and monitoring their medications
to prevent serious side effects. Again, the
new facility, with dexa scanning on site
and a dedicated NP, will be instrumental in
providing patients who have osteoporosis
the highest level of care.
Whether it’s for the “weekend warrior” or
the serious athlete, University Orthopaedic
Associates offers the most innovative
and effective sports medicine treatment.
Jeffrey R. Bechler, MD, Charles J. Gatt,
MD, Timothy M. Hosea, MD, and newest
member Aman Dhawan, MD, ensure that
patients can “get back in the game”.
p Dr Harwood prepares to fit the prosthetic hip into place
p Dr gatt begins shoulder arthroscopy by marking the incision site.
August 2011 9
p Dr. gatt trains an orthopaedic surgical resident during shoulder surgery. Dr gatt and his colleagues at uOa feel that keeping current with the latest technology in orthopaedic surgery is imperative to properly educate those who are in training.
Dr. Hosea specializes in sports medicine at
UOA and also serves as the team physician
of US Rowing and Rutgers University. Dr.
Hosea shares his work on a novel surgical
system for one-step repair of damaged
articular knee cartilage for patients between
the ages of 18 and 55. Dr. Hosea was one of
only five specialists nationwide and the only
one in New Jersey to initially collaborate
on a clinical trial to evaluate the safety and
effectiveness of the Cartilage Autograft
Implantation System (CAIS™) as compared
to microfracture, which is the traditional
surgical approach. Microfracture repairs
have been shown to not hold up well over
time. CAIS™ involves removal of a small
sample of healthy cartilage from a non-
weight or low-weight bearing area of the
patient’s own damaged knee. That cartilage
is then broken up and combined with an
absorbable material (scaffold) on which
cells can grow. This scaffold is implanted at
the damaged site to promote healing.
Dr. Hosea and the research team followed
a group of 29 patients with damaged knee
cartilage, randomly assigning the participants
to either the CAIS™ or microfracture group.
Patients’ progress was monitored for two
years using standardized assessment tools
and MRI imaging. The results, published
this past June in the American Journal of
Sports Medicine, found CAIS™ to be a “safe,
feasible and effective method that may
improve long-term clinical outcomes” for
patients with damaged knee cartilage. Since
that pilot study, the FDA has now expanded
the program to include 300 patients.
Along with the other UOA surgeons, Dr.
Hosea feels fortunate to be a member of a
practice that embraces academic pursuit.
“We try to set a good example for our
residents and medical students so they see
that you have to continue to grow,” Dr. Hosea
relates. “You can read your journals and go
to meetings, but you should be involved
at the cutting edge of things. Our practice
reflects this with our team of orthopaedic
specialists, who are the ‘best of the best’
from throughout the country. For example,
our newest sports medicine physician, Dr.
Aman Dhawan, completed his fellowship in
sports medicine and shoulder surgery at the
prestigious Rush University Medical Center.
That’s where I think we like to see that our
group is at—we always want to be at the
cutting edge of orthopaedics in New Jersey,”
he emphatically states.
Charles J. Gatt, Jr., MD, is also a sports
medicine surgeon at UOA and serves as
Chairman of the Department of Orthopaedics
at UMDNJ. Dr. Gatt is in total agreement
with Dr. Hosea and the other surgeons at
UOA regarding the obligation they have
to teach and set an example for medical
p Close up of shoulder arthroscopy as shown on the monitor
10 New Jersey Physician
school students and those who are in an
orthopaedic surgery residency program.
“Everyone at University Orthopaedics,
including myself, is a faculty member at
Robert Wood Johnson Medical School. With
that responsibility there is a direction of the
practice that keeps us at the cutting edge
of orthopaedics,” Dr. Gatt states, unaware
that Dr. Hosea voiced the same sentiments
only moments before. Dr. Gatt feels that it is
only by keeping current with all of the latest
technologic developments in orthopaedic
surgery that he and his colleagues at UOA
can properly educate those who are in
training.
As part of his residency teaching, Dr. Gatt
is also quite involved with basic science
research. As such, he has been funded by
the NIH and the Department of Defense to
develop a tissue-engineered replacement for
the meniscus. Perhaps the most common
procedure in orthopaedic surgery is a partial
meniscectomy, which is the removal of a torn
meniscus. However, at present there is no
replacement available on the market. Dr. Gatt
is far enough along in this research that he is
able to predict that clinical trials can begin
in as little as two years. Equally exciting, Dr.
Gatt is also working on a tissue-engineered
ACL replacement. Currently, the ligament
is rebuilt by taking part of the patella or the
hamstring. When this replacement device is
approved, hopefully within five years or so,
post-surgical pain that commonly occurs
at the site of the harvested tissue will be
eliminated and the entire recovery process
will be hastened.
As sports medicine specialists, Dr. Gatt and
his colleagues at UOA are concerned about
the welfare of the young athletes whom
they treat as well as those throughout the
state. In particular, Dr. Gatt refers to stress
fractures which are common in adolescents.
Very often pediatricians or primary care
physicians will advise these youngsters
to abstain from sports participation for a
month or six weeks until the fracture heals.
Dr. Gatt explains that in most cases activity
modification is a better approach. While
he will recommend limitations on practice
sessions, Dr. Gatt’s treatment methods allow
the patient to “stay in the game”. In an effort
to educate PCPs, trainers, parents and young
athletes, Dr. Gatt and other sports medicine
experts have created an Internet data base
that shares correct information for a variety
of stress fracture situations.
Whether for a infant with a congenital
difference, an adolescent or adult athlete
with a sport-related injury, a weekend
warrior, a victim of a traumatic event, or a
person who is merely experiencing the wear
and tear of an active life, the sub-specialized
surgeons at University Orthopaedic
Associates continue to offer comprehensive,
cutting-edge care and treatment. In fact,
throughout the almost 40 years since its
inception, UOA has developed life-long
relationships with patients, providing care as
the situation warrants. With the opening of its
magnificent, all-inclusive facility, University
Orthopaedic Associates has a new home
at which patients will receive the highest
level of integrated orthopaedic healthcare
services available.
For more information about UOA and
its office locations or to schedule an
appointment, call 732-545-0400 or visit
www.uoanj.com.
p the soon to be new home of university Orthopeadic associates, where patients will be able to receive all inclusive care and treatment.
August 2011 11
Statehouse
NEW JERSEYSTATEHOUSE
New Jersey Durable Power of Attorney LawsMore Information on Durable Power of Attorney Laws
Specific Powers, Life-Prolonging Acts
Decisions to accept or refuse treatment,
service, or procedure used to diagnose,
treat, or care for a patient’s physical or
mental condition including life-sustaining
treatment. Includes decisions on acceptance
or rejection of services of particular physician
or health care provider or transfer of care; on
the use of any medical device or procedure,
artificially provided fluids and nutrition, drugs,
surgery or therapy that uses mechanical or
other artificial means to sustain, restore, or
supplant a vital bodily function and thereby
increase the expected life span of a patient;
does not include provision of comfort care or
alleviation of pain.
Legal Requirements for Durable
Power of Attorney
(1) Competent adult; (2) signed; (3)
dated; (4) 2 witnesses who shall attest that
declarant is of sound mind and free of duress
and undue influence or notarized or other
person authorized to administer oaths. May
be supplemented by video or audio tape
recording; (5) directive implemented when
determination of lack of decision-making
capacity is documented and confirmed by
physicians.
Revocation of Durable Power
of Attorney
Revocable by (1) oral or written notification;
(2) execution of subsequent directive; (3)
divorce revokes former spouse’s designation
as representative. Patient’s clearly expressed
wishes take precedent over any patient’s
decision or proxy directive.
Validity from State-to-State
Effective if executed in compliance with New
Jersey law or the laws of that state. Effective if
executed in a foreign country in compliance
with that country’s laws or the laws of New
Jersey and is not contrary to public policy of
New Jersey.
If Physician Unwilling to Follow
Durable Power of Attorney
Unwilling physician should act as soon
as practicable to effect an appropriate,
respectful and timely transfer care and to
assure patient is not abandoned or treated
disrespectfully.
Immunity for Attending Physician
No civil, criminal, or professional liability
for any physician acting in good faith and
pursuant to this act.
Is your practiceweathering the storm?
The healthcare business environmentcontinues to be increasingly turbulent.
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12 New Jersey Physician
Health Law Update
Reducing the Gap: OIG Permits Waiver of In-Patient Deductible
HealtH lawUpdateProvided by Brach Eichler LLC, Counselors at Law
In a recent Advisory Opinion (11-09), pub-
lished in near identical form to an opinion is-
sued in 2009, the Office of Inspector General
(OIG) of the Department of Health & Human
Services stated that it does not object to an
arrangement whereby a company licensed
to provide Medigap policies contracts with
hospitals to reduce or eliminate the Medi-
care in-patient deductible. This deductible,
which would otherwise be covered under the
Medigap plan, would be reduced up to 100%
when an insured is admitted to an in-network
hospital participating in a preferred provider
organization (PPO). The Medigap provider
would pay the PPO an administrative fee each
time it receives this discount from an in-net-
work participating hospital. Further, the sav-
ings would be shared with the policyholder in
the form of a $100 premium credit.
While the Anti-Kickback Statute prohibits re-
muneration in the form of waivers of Medicare
cost-sharing amounts, regulations provide a
safe harbor for inpatient deductibles when
they are part of an arrangement with an in-
surer. Further, the law provides a statutory
exception for differentials in coinsurance and
deductibles as part of a benefit plan design,
thus allowing for the premium credit.
Medicare Fraud Scheme Foiled: New Jersey Man Admits Posing as Doctor and Treating Elderly Patients
New Physician Assistant Rules Adopted in Part and Rejected in Part
On July 11, 2011, Patrick Lynch of Toms River,
New Jersey pled guilty and admitted to unlaw-
fully treating patients, prescribing medicine
and ordering procedures while posing as a
licensed physician. Pursuant to documents
filed in the case and statements made during
the guilty plea proceeding, Lynch created Vis-
iting Doctors of New Jersey to provide medical
care for elderly home-bound patients in the
Monmouth and Ocean County areas. Since
Lynch was neither a licensed physician nor
a nurse practitioner, he hired licensed indi-
viduals to conduct patient visits. When Lynch
failed to pay the licensed physicians and nurse
practitioners, they quit. Subsequently, Lynch
continued to carry on the business by pos-
ing as the licensed professionals, using their
names and government-issued identification
numbers to write prescriptions and submit
billings to Medicare. Sentencing (including
determinations of possible jail time, monetary
penalties and restitution) is scheduled for Oc-
tober 17, 2011.
Last year, the New Jersey State Board of Medi-
cal Examiners (BME), in consultation with
the Physician Assistant Advisory Committee,
proposed two amendments to N.J.A.C. 13:35-
2B, concerning physician assistants (PAs).
The first amendment would have allowed PAs
to refer patients to health care practitioners,
facilities and other appropriate agencies and
resources in the community, instead of “fa-
cilitating the referral” of such services. This
amendment was rejected by the BME and
was, therefore, not adopted.
The second amendment, which has been ad-
opted by the BME and was effective as of July
5, 2011, provides for the supervisory ratio of
four PAs to one physician in all settings at any
given time. Under prior BME rules, in a pri-
vate practice setting, the supervisory ratio was
two PAs to one physician, and in all other set-
tings, the ratio was four PAs to one physician.
August 2011 13
Health Law Update
Medicaid RAC Program is Underway in New Jersey
CMS Releases Proposed Rules for 2012 Medicare PaymentsThe Centers for Medicare & Medicaid Services
(CMS) recently published proposed rules for
Medicare payments in calendar year 2012 for
physician services, outpatient hospital and
ambulatory surgery services, and home health
agency services. Comments to the proposed
rules must be submitted to CMS by August
30, 2011, and the final rules will be published
sometime in November 2011. The following
summarizes some of the key proposals:
Physician Fee Schedule:
• Unless Congress enacts legislation
otherwise, reduces Medicare payments by
29.5% due to the Sustainable Growth Rate
(SGR) formula imposed under the Balanced
Budget Act of 1997
• Expands the Multiple Procedure Payment
Reduction (MPPR) policy – which currently
reduces payment for the “technical
component” associated with certain
procedures performed on the same patient,
on the same day and in the same setting – to
include a 50% reduction in payment for the
“professional component” for CT, MRI and
ultrasound services
• Provides criteria for performing health risk
assessments as part of the annual wellness
visit
• Updates the Physician Quality Reporting
System (PQRS), the e-Prescribing incentive
program (eRx), and the Electronic Health
Records (EHR) incentive program
• Provides for quality and cost measures for
a new value-based modifier (VM) that will
reward physicians for providing higher
quality and more efficient care. Under
this proposal, CMS would use calendar
year 2013 data for purposes of adjusting
payments in calendar year 2015
Hospital Outpatient Prospective
Payment System:
• Increases Medicare payments by 1.5% for
hospitals publicly reporting data on 23
quality measures, and decreases Medicare
payments by 0.5% for hospitals not
submitting such data
• Increases the number of quality measures
that must be reported under the hospital
quality reporting program; nine new
measures would be added in 2012, and one
new measure would be added in 2013
• Proposes a new independent review
process to determine the appropriate
level of physician supervision needed for
outpatient therapeutic services
Ambulatory Surgery Services:
• Increases Medicare payments by 0.9%. This
takes into account the Consumer Price Index
for Urban Consumers (a 2.3% increase), as
well as the productivity reduction under the
Affordable Care Act (a 1.4% decrease)
• Proposes eight quality measures for
implementing a quality reporting program
for ASCs in 2014; ASCs that do not report
quality measures would receive reduced
Medicare payments
Home Health Agency Prospective
Payment System:
• Reduces Medicare payments by 3.35%. This
takes into account the market basket and
wage index updates (a 1.5% increase), as
well as the prospective payment system rate
reduction (a 5.06% decrease) in response
to increases in aggregate case-mix due to
billing practices rather than changes in the
health status of patients
• Revises the case-mix system, including
the exclusion of two hypertension codes
and lowering payments for high therapy
episodes
• Allows greater flexibility, in acute care and
post-acute care settings, for a physician to
satisfy the requirement of having a face-to-
face encounter before certifying that the
patient is eligible for home health benefits
On July 7, 2011, the New Jersey Medicaid
Fraud Division, in association with the Divi-
sion of Medical Assistance and Health Ser-
vices (DMAHS), implemented the Medicaid
Recovery Audit Contractor (RAC) program.
Additionally, DMAHS is expected to issue a
provider alert to introduce the choice of HMS
Government Services as New Jersey’s Medic-
aid RAC.
The Centers for Medicare & Medicaid Services
(CMS) has yet to issue final regulations gov-
erning the Medicaid RAC program. CMS has,
however, advised states that they can proceed
with implementation. New Jersey has chosen
to move forward utilizing the proposed Med-
icaid RAC rules and the structure of the Medi-
care RAC program as the basis for the Medic-
aid RAC program.
14 New Jersey Physician
Health Law Update
SHOP and Exchange - Adding Up the Change in a State-Run Insurance MarketProgressing toward putting America’s
healthcare system overhaul into
action, the Department of Health &
Human Services (DHHS) announced
draft guidelines for states to follow
in crafting state-run insurance
exchanges. The Affordable Care
Act (ACA) mandates that states
offer a competitive marketplace for
consumers and small businesses
to compare and purchase health
insurance. States will host two
exchanges - one for individual
consumers and one available for
small businesses. States are required
to go live by January 1, 2014.
Standards that employers must meet
to participate in SHOP (Small Business
Health Options Program), standards
for establishing an exchange, basic
functions of an exchange and health
plan participation criteria have each
been illuminated as key areas by
DHHS. For instance, health plans
offered on the exchange must be
certified as Qualified Health Plans
(QHP), which must meet minimum
standards stipulated by the ACA
and the proposed rules in order to
participate. Small businesses will
be eligible to receive tax credits for
insurance purchased on exchanges
for employees.
To reduce administrative duplication
of efforts, states will be permitted to
partner with the federal government,
or states can develop their own
exchanges in conformance with
federally-mandated rules. The
proposed rules allow states to select
whether to have the insurance
exchanges run by a non-profit in
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has offered grants, and 48 states – including New
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insurance exchanges. Presently, Rutgers University
is examining implementation strategies for New
Jersey, in a project commissioned by Governor
Christie. DHHS is accepting comments to the
proposed rules until September 24, 2011.
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16 New Jersey Physician
Hospital Rounds
New Chief Medical Officer Named at The Cancer Institute of New Jersey Montgomery Township Resident Tapped for Leadership Post
Children’s Hospital of New Jersey at Newark Beth Israel Medical Center First in NJ to Place Pulmonary Valve via Catheter-Based Procedure
A Belle Mead (Somerset County) resident has
been named the new chief medical officer
at The Cancer Institute
of New Jersey (CINJ).
Deborah L. Toppmeyer,
MD, an associate professor
of medicine at UMDNJ-
Robert Wood Johnson
Medical School, was recently appointed by
CINJ Director Robert S. DiPaola, MD. CINJ is a
Center of Excellence of UMDNJ-Robert Wood
Johnson Medical School.
Dr. Toppmeyer joined CINJ in 1995 from the
Dana Farber Cancer Institute at Harvard
Medical School. She is an expert in breast
cancer, breast cancer genetics and the design
and implementation of clinical trials that offer
promising new therapies targeted to specific
types of breast cancer. As chief medical officer,
she will be responsible for compliance with
all clinical medical policies, regulations and
clinical performance standards of the state, the
federal government, and accrediting bodies.
She will have oversight and responsibility for
all of CINJ’s clinical objectives and serve as
CINJ’s ultimate authority on medical issues.
Through her role as director both of CINJ’s
Stacy Goldstein Breast Cancer Center and of
the LIFE (LPGA pros In the Fight to Eradicate
breast cancer) Center, Toppmeyer helps
patients navigate through treatment options
while encouraging enrollment in clinical
trials. She is also the chief of solid tumor
oncology at CINJ.
“Over the past 16 years, Dr. Toppmeyer has
played an integral role in the advancement and
success of CINJ. As a renowned researcher
and clinician, Dr. Toppmeyer has drawn upon
and shared that wealth of experience in order
to successfully meet the needs of patients
while growing CINJ clinic operations and
clinical trial accrual. I have every confidence
that in her new role, she will help move CINJ
forward in an even greater capacity,” noted Dr.
DiPaola, a professor of medicine at UMDNJ-
Robert Wood Johnson Medical School.
Toppmeyer is the author or co-author of
more than 40 publications and serves on the
editorial board of the journal Clinical Cancer
Research. She also serves as a core member
for the Breast Committee of the Eastern
Cooperative Oncology Group, which is one
of the nation’s largest clinical cancer research
organizations that conducts clinical trials in all
types of adult cancers.
New Jersey’s first transcatheter pulmonary
valve was placed on August 18 at Children’s
Hospital of New Jersey at Newark Beth Israel
Medical Center. The 14-year-old young man
from Jersey City with congenital heart disease
who received the device went home the
following day and was able to avoid having
what would have been the fourth open heart
surgery in his lifetime.
Thanks to advances in medical and surgical
care, most children with congenital heart
defects are surviving into adulthood. In
fact, today, there are more adults living with
congenital heart disease (500,000) than
children diagnosed with congenital heart
defects. These heart defects require treatment
from a collaborative team of adult and
pediatric cardiac specialists as the child grows
into an adult.
“The transcatheter pulmonary valve allows
patients to undergo a much less invasive
procedure that improves the flow of blood
from the heart to the lungs,” said Rajiv Verma,
MD, Director of the Children’s Heart Center
at The Children’s Hospital of New Jersey at
Newark Beth Israel Medical Center, who, along
with Marc Cohen, MD, Chief of Cardiology at
Newark Beth Israel Medical Center, placed the
first Melody valve in the state.
In children born with certain kinds of heart
defects, the blood vessel leading from the
heart to the lungs and the valve, known as a
conduit, are surgically constructed early in
the child’s life. “These conduits can have a
limited lifespan and typically require repair or
replacement as the patients grows,” noted Dr.
Verma. “The device allows us to replace the
pulmonary valve in the conduit without the
long recovery and risks associated with open
heart surgery.”
Placement of the Melody transcatheter
pulmonary valve, approved by the FDA in
2010, requires the expertise of pediatric and
adult cardiologists, an experienced cath
August 2011 17
Hospital Rounds
lab team of physician assistants, nurses and
technicians, as well as an available on-site
pediatric cardiac surgery team.
The Melody valve is placed with a catheter
that is inserted into a vein in the leg and
guided up into the heart. “The anatomy of
each heart affected by congenital disease
is unique and by the time these patients are
young adults, they have undergone multiple
heart surgeries,” said Dr. Cohen. He compares
the challenge of guiding a catheter through
such hearts to driving along a highway that is
under construction with detours, blockages
and obstacles.
Once deployed, the valve begins to function
immediately and the patient can resume
normal activities within a few days. In
comparison, full recovery from open heart
surgery can take several months.
N.J.’s Hackensack University Medical Center announces ACOHackensack (N.J.) University Medical
Center said its employees would pilot the
organization’s attempt at accountable care, a
payment model that has gained proponents
since the passage of the 2010 health reform
law. The 703-bed hospital said in a news
release that its self-insured employee health
plan called the Hackensack Physician
Alliance would provide the patients needed
for Hackensack’s new accountable care
organization, a limited liability company
Hackensack joins a growing number
of hospitals launching private-market
accountable care efforts. A recent Modern
Healthcare survey of accountable care
organizations found roughly one dozen such
initiatives in various stages of development
across the U.S. The Patient Protection and
Affordable Care Act included a provision for
Medicare to offer accountable care contracts—
which offer financial incentive to providers
that meet quality and cost-control targets—as
early as 2012. Recently proposed Medicare
ACO rules drew criticism from providers, who
argued that the financial risks of forming an
ACO according to the proposed regulations
outweighed possible incentives.
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18 New Jersey Physician
Food for Thought
I have consistently found that when you visit
a restaurant that has been touted by review-
ers or by personal acquaintances, it never
lives up to its reputation. I think Serenade
has fallen victim to this. Located in quaint
Chatham, Serenade is the type of place that
is often selected for a special occasion. In
fact, before our visit this past month, the last
time we were at Serenade was for a “mile-
stone” anniversary celebration. At that time
we opted for the wine sampling meal at
which each course is paired with an appro-
priate and presumably notable wine.
I remember enjoying the anticipation of each
course and the accompanying wine. We
found all of the wines selected to be won-
derful but we were disappointed in the small
amount offered in each glass, especially in
light of the price charged. That evening we
did enjoy our food but we would have pre-
ferred sitting in the room with the fireplace
(our anniversary is in December) but in-
stead sat at a table in another room that was
far less romantic. We had our backs to the
wall and were separated from any of the oth-
er tables in what I can only describe as an
alcove in that outer eating area.
Nevertheless, one mid-week August evening,
spent from a hectic work schedule and the
endless number of last-minute details associ-
ated with our daughter’s upcoming wedding,
Michael and I felt entitled to a somewhat
decadent reward and so, decided to give
Serenade another go. I must say, without the
pressure of an “event” we were able to judge
our meal more objectively.
This time we were escorted to the room with
the fireplace but of course one would not
SerenadeChatham, New JerseyBy Iris Goldberg
August 2011 19
expect a fire during the summer. Still the ambience was lovely and
we prepared for a relaxing meal. At Serenade a charming sommelier
visits your table to help with the wine selection. Michael is somewhat
of a wine connoisseur and always enjoys these discussions. Finally,
a moderately-priced 2007 Montvac Vacqueyras was chosen. I’ve men-
tioned this before and it is worth repeating – we in New Jersey are
fortunate to have an abundance of BYOs here. Purchasing wine at a
restaurant will be significantly more costly than bringing it in with you.
That being said, we each took a sip of the Rhone and had to agree, it
was splendid.
For our first course Michael chose grilled octopus served with po-
tatoes, preserved lemon, Nicoise olives and olive oil. Octopus is a
favorite for Michael but it must not be overcooked. He took his first
bite and smiled. The octopus was perfectly done. He offered me a bite
and I had to agree it was lovely and not at all rubbery.
I went with an escarole salad that included fava beans, Parmesan
cheese, grilled asparagus and cherry tomatoes in a lemon dressing.
The combination of flavors and textures made for an interesting and
enjoyable first course.
Despite comments I’ve read to the contrary, the service at Serenade
is quite attentive but not overbearing. Our server did not interrupt nor
did he leave us waiting for water refills, etc. I think we sometimes
expect that a so-called “fancier” restaurant will never have an off night
or perhaps an employee who is not at his or her best. We often accept
this more readily at an everyday eatery.
Anyway, back to the food. I really treated myself and selected the rack
of lamb for my entrée. It is one of my favorite dishes and since I have
been watching what I eat very carefully in anticipation of my appear-
ance as “Mother of the Bride,” I needed to indulge myself a bit. I was
not disappointed. The lamb, which was served with a variety of local
beans, heirloom tomato broth and couscous roulade, was cooked
just as I like – medium rare. The sides were a good accompaniment.
I especially enjoyed the flavorful couscous. The wine Michael had
selected paired perfectly as well.
Michael had a hard time choosing his dish. He kept vacillating between
the calf’s liver which he hasn’t had in years and the hanger steak. Decid-
ing on the lesser of two evils, health-wise, he opted for the steak. He or-
dered this rare and that’s exactly how it came. On the side was a grilled
potato puree, summer ratatouille, artichokes and Spanish chorizo. He
enjoyed his meal and commented that the chorizo was a novel and
surprisingly appetizing accompaniment to the beef. He too was pleased
with his wine choice as a great complement to the food.
Of course Serenade has a scrumptious dessert menu which we
glanced at briefly, not wanting to be tempted. We settled for coffee
and the last sips of the delicious wine before heading back to the
real world. People can say what they want. For us Serenade provided
a much needed and certainly delightful evening that wasn’t at all a
special occasion when it started but somehow ended up that way.
Serenade is located at 6 Roosevelt Ave. (Main Street) in Chatham, NJ
(973) 701-0303.
p Leek, Potato and Zucchini Pancakes With Baby Lettuces p tomato salad with toasted Mozzarella Croquettes
20 New Jersey Physician
Boston, MA (July 25, 2011) – Effective today,
ProMutual Group, a leading provider of med-
ical professional liability insurance, is proud
to announce the launch of its new name and
brand, Coverys. This change is part of the
continued integration of the member com-
panies within ProMutual Group, including
recently acquired FinCor Holdings, Inc. and
its subsidiaries, and is representative of the
enterprise’s now national reach. Accompa-
nying the new name and logo is a new web-
site, which will streamline communication
between Coverys member companies and
the public.
“We believe the new name, Coverys, will bet-
ter position the member companies as an
integrated whole and will better reflect the
services we offer,” said Richard W. Brewer,
president and CEO of Coverys. “The enter-
prise is now strengthened with expanded
geographic, product and policy diversity as
well as an enhanced ability to share exper-
tise and best practices – we feel it is impor-
tant to communicate this via our brand. The
Coverys organization will continue to be a
strategic thought leader and forward-think-
ing partner for our policyholders, now and
in the future. We thank our employees and
policyholders for their continued support
and dedication.”
“This is an exciting and important change
for the organization,” said Gregg L. Hanson,
chief operating officer of Coverys. “We feel
privileged to have the opportunity to reach
and maintain the trust of a broader range of
healthcare professionals and organizations.
Our unwavering dedication to financial sta-
bility, profitable growth and to protecting the
livelihoods of our policyholders remains the
foundation of our organization.”
The name Coverys is loosely derived from
the word “coverage,” which encompasses
the core of the organization’s mission and
value proposition. As the enterprise transi-
tions into its new brand, it will continue to
be aware of healthcare and medical profes-
sional liability reform and proactive in pro-
viding a broad range of the best possible
products and coverages to its policyholders.
The enterprise will emphasize adaptation to
the changing industry via relevant continu-
ing medical education (CME) programs, its
innovative disclosure and apology program,
REACT® (Respond Effectively And Com-
municate Timely), and the highest level of
claims and risk management services. Cov-
erys is committed to delivering on its vision
of outstanding protection, education and pa-
tient safety.
In the last several years, ProMutual Group,
now Coverys, expanded throughout New
England as well as into New Jersey, North
Carolina, Pennsylvania and Virginia via mem-
ber company ProSelect Insurance Company.
In September of 2009, the company acquired
FinCor Holdings, Inc., which provides medi-
cal professional liability insurance and ser-
vices in the Midwest and Pacific Northwest
through member companies MHA Insur-
ance Company, Washington Casualty Com-
pany, FinCor Solutions and the Risk Manage-
ment and Patient Safety Institute. As a whole,
Coverys member companies insure more
than 20,000 healthcare professionals as well
as nearly 500 hospitals, health centers and
clinics in 22 states from coast to coast. The
legal names of the Coverys member compa-
nies will not be changing at this time.
For more information about Coverys, visit
www.coverys.com. To schedule an inter-
view with a Coverys representative contact
Katharine Gould, public relations specialist,
at (617) 946-8665 or [email protected].
101 Arch Street, P.O. Box 55178
Boston, MA 02205-5178
Phone: 617.330.1755
Toll Free: 800.225.6168
Fax: 617.330.1748
www.coverys.com
About Coverys (formerly ProMutual Group)
Coverys is one of the top 10 medical profes-
sional liability insurance providers in the coun-
try based on direct written premium. Coverys
member companies insure more than 20,000
physicians, surgeons, dentists, certified nurse
midwives and allied healthcare providers as
well as nearly 500 hospitals, health centers and
clinics in 22 states from coast to coast. Coverys
has net admitted assets in excess of $3.0 bil-
lion as of December 31, 2010. Coverys member
companies Medical Professional Mutual Insur-
ance Company, ProSelect Insurance Company,
MHA Insurance Company and Washington
Casualty Company have a Best’s Rating of A-
(Excellent). Other Coverys member companies
include FinCor Solutions, a multi-line insurance
agency, and the Risk Management and Patient
Safety Institute, which focuses on clinical risk
reduction, quality patient outcomes and edu-
cation. Coverys as a whole is acknowledged
as a leader in providing risk management and
claim services to the healthcare community,
and it offers risk management consultations
and educational activities to healthcare provid-
ers across the country. For more information on
the enterprise and its member companies, visit
the Coverys website at www.coverys.com.
Press Release
ProMutual Group Rebrands as Coverys Launches New Name, Logo, Website
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*
*Wednesday, May 5, 2010