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New Jersey Physician Magazine
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Also in this Issue• CareCore Assures NYS Attorney General of Discontinuance of
Restrictive Practices
• Medical Marijuana Could Be Available by Late Spring
• NJACO Pilot Bill Approved by Senate Budget and Appropriations
Sabatino Ciatti, MD, Advanced Dermatology, Mohs & Laser Surgery Center, PASpecializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer
m a r c h 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
Contracting
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Respect
Publisher’s Letter
Dear Readers,
Welcome to the March issue of New Jersey Physician, the only publication advocating
for the state medical community.
We usually focus exclusively on New Jersey medical matters, but I couldn’t resist
crossing over to our neighbor to the east when it involves CareCore getting into trouble.
Seems CareCore preferred its radiologist owners in network decisions while refusing
to contract with qualified physicians and physician groups for some or all of the
modalities they offer. The NYS OAG alleged this is a violation of the Sherman Act which
has resulted in CareCore having to purchase the full ownership interests of each of its
radiologist owners.
“Staggering high medical malpractice rates” are being blamed for an alarming loss of
physicians statewide. Senator Jennifer Beck and Assemblyman Declan O’Scanlon have
introduced legislation that is designed to reform medical malpractice laws. They claim
that allowing med-mal companies to increase rates to physicians when a suit is brought
against a medical professional regardless of the outcome of the case is akin to a judge
handing down a sentence before the verdict is in. The bill simply aims to change the
ability to raise insurance rates to the point after a decision is reached in the case.
I know I’ve said this before, but perhaps this time it is real. Medical Marijuana could be
available by late summer. The unique delivery model, the strictest in the country, has
been agreed upon and dispensary sites have been chosen.
We’ve had the unique privilege of watching masterful surgeons at work in the past seven
years and I always enjoy presenting another to our readers. Dr. Sabatino Ciatti, one of
the few fellows trained through the distinguished American College of Mohs Surgery, is
not only a thorough and accurate remover of cancerous facial tissue, but one of the most
competent reconstruction artists when it comes to restoring the damage caused by the
removal of the tumor. What makes watching these surgeries even more fascinating is that
the entire process can be done in a single visit.
With warm regards,
Iris GoldbergPublisher
New Jersey Physician Magazine
Published by Montdor Medical Media, LLC
Publisher and Managing EditorIris Goldberg
PhotographerKen Alswang, At Home Studios
Contributing Writers Harlene Stevens, CPAIris GoldbergJohn Fanburg, Esq.Kevin Lastorino, Esq.Michael GoldbergDerek DeliaLouise B. Russell
New Jersey Physician is published monthly by montdor medical media, LLc.,PO Box 257Livingston NJ 07039Tel: 973.994.0068Fax: 973.994.2063
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Physician, please contact Iris Goldberg at
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2 New Jersey Physician
Contentsm a r c h 2 0 11
Sabatina Ciatti, MD
Advanced Dermatology, Mohs & Laser Surgery Center, PASpecializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer
COVER PHOTO: Sabatino Ciatti, MD of Advanced Dermatology, Mohs & Laser Surgery Center, PA
CONTENTS
10
Health Law Update
11
Statehouse
16
Finance
An Action Plan for 2011Practical suggestions to help you increase practice revenues, decrease costs and develop an action plan for 2011.
18
Food for Thought
Corso 98 Montclair, New Jersey There are those rare occasions when you come upon a restaurant that you’ve never been to, take a chance and hit the jackpot.
20
Events
Inaugural Meeting of the NJ Women in HealthcareNew Jersey Physician recently met with Debra Lienhardt, Esq. to discuss the New
Jersey Women in Healthcare.COVER STORY
4
COVER PHOTOS BY KEN ALSwANG, AT HOME STuDIOS
March 2011 3
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]
CLIENT: Argent Professional Insurance Agency, LLC Scott Parker - (908)769-7400, [email protected]
BLEED SIZE: 7-1/4 x 5-1/16 TRIM SIZE: 7 x 4-13/16 COLOR: 4/process color
DESIGN: JSM Concepts, Inc., John Malinowski - (516) 379-8221 [email protected]
The Professional Liability Specialists130 Technology Drive, Warren, NJ 07059 • (877)769-1999
Learn more about our commitment to physicians, and read important news and articles at www.insuranceagent.com
Argent Professional is the leading regional medical professional liability insurance agency, and specializes in writing physicians, large groups, ASCs and other healthcare facilities.
Our knowledge, expertise and access to all of the major NJ markets helps to ensure our clients find the best possible coverage at the lowest available rates.
Agents for:
4 New Jersey Physician
Cover Story
In 1941 Frederick E. Mohs, MD published results he
obtained after removing basal cell cancers from 440
patients using a novel technique which he called
“chemosurgery.” In its original form the technique
involved applying a 20% zinc chloride paste directly to
the skin of the patient for fixation of tissue. Then the skin
in question was surgically removed by serial excision
in thin layers of tissue with microscopic control of the
tissue margins. The layers were color-coded with dyes.
Dr. Mohs created a unique mapping system that allowed
him to orient the excised, color-coded tissue back to
the patient. Astonishingly, 99% of primary cancers and
95-96% of recurrent cancers were cured.
Although extremely successful, chemosurgery, in its
original form, could be painful and the entire process
sometimes took days to be completed. In the 70 years
since Dr. Mohs first introduced the technique, it has
been significantly refined and improved. In 1953 the
need for zinc paste was eliminated and surgeries were
performed using the “fresh tissue” technique. More
recently, the development of cryostats to freeze and
cut tissue and the use of automatic staining machines
significantly assist in the processing of tissue samples
from the increasing number of skin cancer patients.
Throughout all of the technical improvements and
refinements of Dr. Mohs’ technique, his original
principle of surgically removing skin cancer in layers
with microscopic guidance to ensure that the tissue left
behind is cancer-free, is still upheld. The color-coded
mapping of excised specimens and their thorough
microscopic examination remains the focal point of the
procedure, now called Mohs surgery. Today, with the
use of local anesthetics, tissue is excised, processed
and immediately examined. For a majority of patients,
the entire process, including reconstruction, can be
completed in one visit.
By Iris Goldberg
Sabatino Ciatti, MDAdvanced Dermatology, Mohs & Laser Surgery Center, PASpecializing in Mohs Micrographic Surgery for the Most Effective and Precise Removal of Skin Cancer
p Dr. ciatti is one of only 900 mohs surgeons to receive fellowship training through the american college of mohs Surgery
March 2011 5
Sabatino Ciatti, MD, of Advanced Derma-
tology, Mohs & Laser Surgery Center, PA,
is one of a relatively limited number of Mohs
surgeons (about 900) to receive fellowship training
through the distinguished American College of
Mohs Surgery, of which Dr. Mohs, himself, served
as its first President. As such, Dr. Ciatti received
advanced training and has developed significant
expertise in cutaneous oncologic surgery
encompassing the removal of skin cancer, the
histopathologic interpretation of tumors and the
reconstruction of post-surgical defects.
Dr. Ciatti performs Mohs surgery for the treatment
of non-melanoma skin cancers, primarily basal
cell and squamous cell carcinomas. The
surgery is performed at his Westfield office or
his satellite office in Morristown. It is important
to note that Dr. Ciatti does not use Mohs surgery
to treat melanoma skin cancers but instead,
wide excision with permanent sections. “It is
controversial as to whether or not melanomas
should be treated with Mohs surgery,” Dr. Ciatti
shares. “My opinion is that they are very difficult
to interpret with frozen sections, which is how
Mohs tissue sections are processed. Melanomas
are best interpreted using permanent paraffin
sections and sometimes, special stains or
immunostains. You don’t want to make a mistake
on a melanoma and miss it,” he emphasizes.
“The difference between the non-melanoma
skin cancers and the melanomas is that if a
non-melanoma comes back, it is usually local.
If a melanoma skin cancer comes back, it could
have distal metastases,” Dr. Ciatti warns. He
goes on to explain that melanomas, therefore,
require a larger margin of excision because of
the potential threat a recurrence would pose.
“With Mohs surgery we want just the opposite.
We are trying to get the smallest margin possible
in order to preserve normal tissue and avoid
cosmetic disfigurement,” Dr. Ciatti states.
This is one of the main reasons to have Mohs
surgery. If the cancer is in an area where it is
important to preserve as much healthy tissue as
possible for maximum functional and cosmetic
result, such as eyelids, nose, ears, lips, fingers
or toes, Mohs surgery is the most appropriate
treatment modality.
Mohs surgery is also the treatment of choice if
the cancer is large, if its edges cannot be clearly
defined or if it was treated previously and has
recurred. With the Mohs micrographic surgical
technique, Dr. Ciatti relies on the precision and
accuracy of the microscope to trace skin cancer
down to its roots in order to ensure that it has
been completely removed.
p Dr. ciatti begins mohs surgery by marking the surgical site
OVERVIEW of the MOHS SURGERY PROCESSStep 1: After local anesthesia has been injected, the
visible part of the tumor is scraped to better define
the margin.
Step 2: A thin layer of tissue is removed around the
scraped skin and divided into sections. It is placed
on a reference map of the surgical site to maintain
correct orientation of the tissue.
Step 3: Dr. Ciatti color codes each of these sections
with dyes and makes reference marks on the skin to
show the source of each section. This is all carefully
diagrammed on the map.
Step 4: A technician freezes the tissue. It is then cut
into thin slices, placed on glass slides and stained by a
series of special tissue stains to distinguish malignant
from benign cells.
Step 5: Dr. Ciatti examines the undersurface and
edges of each section under the microscope for
evidence of cancer at any of the tissue margins.
Step 6: If cancer cells are found under the
microscope, Dr. Ciatti marks their location onto the
map and returns to the patient to remove another
layer of skin – but only from precisely where the
cancer cells remain.
Step 7: The removal of each layer requires
approximately 15-20 minutes. The removal process
is complete when there is no longer any evidence of
cancer remaining in the excised tissue.
6 New Jersey Physician
Once the Mohs procedure is completed, the
patient is left with a surgical wound (defect) that
can be treated in one of several ways, depending
upon each individual case. Some wounds will
heal by spontaneous granulation which involves
letting the wound heal by itself. Dr. Ciatti
explains that there are some areas of the body
where nature will heal a wound as nicely as any
further surgical procedure.
In most cases, however, Dr. Ciatti will perform a
reconstructive procedure. For small lesions, he
often closes the wound with sutures, loosening
or undermining the adjacent skin as necessary
and suturing the edges together. Larger defects
often require a flap or graft. To develop a flap,
Dr. Ciatti is able to mobilize tissue from a site
adjacent to the wound and then bring that tissue
into the wound, securing it with sutures. With
both simple side-to-side closures and more
complex flaps, Dr. Ciatti utilizes plastic surgery
techniques to conceal the scar within natural
facial contours or wrinkle lines.
Sometimes there is not enough tissue adjacent
to a large wound to create a flap. In these cases
a graft may be used. Dr. Ciatti takes tissue from
a donor site, such as the back of the ear and
sutures that donor skin onto the wound. The
donor site, in most cases, is also sutured.
Rarely, a patient will require more extensive
reconstruction, such as a significantly larger
graft or flap. These procedures typically involve
sedation/general anesthesia and are best done
in an operating room setting for the comfort and
safety of the patient. Generally, Dr. Ciatti plans
this ahead of time and has arranged for these
individuals to have a consultation with one of
several physicians who are skilled in performing
various reconstructive procedures. In this way,
the Mohs surgery and the reconstruction can
be coordinated so that they are both performed
within a 24-hour period.
Patients who undergo Mohs surgery can expect
the highest cure rate of any method (97-99%),
even if other methods have failed. As the most
exact and precise method of tumor removal, it
minimizes the chance of re-growth and lessens
the potential for unnecessary scarring and
disfigurement.
A sizeable number of Mohs patients are
elderly. Some are in their eighties and nineties.
Many would have difficulty obtaining medical
clearance for surgery with general anesthesia.
Mohs surgery is ideal for these patients because
it is done with local anesthesia only. “We’re
removing a lot of tumors that would be left
untreated if the patient had to go to the OR and
have general anesthesia,” Dr. Ciatti offers. Also,
having the procedure performed in an office
setting as opposed to a hospital is much less
stressful, especially for the elderly.
Another significant advantage of Mohs surgery
is its cost-effectiveness, particularly as the
incidence of skin cancer continues to rise.
Recent data show that there are 3.5 million non-
melanoma skin cancers diagnosed in the U.S.
every year. As health care dollars continue to
shrink and many patients are faced with lack of
insurance or higher deductibles, it is important
to keep cost in mind.
Although more expensive than a standard
excision, Mohs surgery offers savings on
several levels. First, because the likelihood of
recurrence following Mohs surgery is less than
1-3%, additional and possibly more extensive
surgeries to retreat the same cancer are
avoided. Also, since the tissue is processed
and clean margins are verified at the time of
surgery, there is no additional expense to re-
excise an area because tissue was processed
by an outside laboratory where positive margins
were subsequently found. Finally, because the
procedure is performed in an office setting, the
expense of facility fees and general anesthesia
is avoided.
In addition to these benefits of having Mohs
surgery, Dr. Ciatti shares what is perhaps, the
most convincing reason to opt for the Mohs
procedure. He explains the difference between
Mohs surgery and having a routine excision
performed without Mohs surgery. “If you were
to just do an excision you would be sending that
p a thin layer of removed tissue is placed on a reference map. Dr. ciatti color codes each of these sections with dyes.
p a technician freezes the tissue and cuts it into thin slices. Those are then placed on slides and stained to distinguish malignant from benign cells.
March 2011 7
tissue out for analysis. Because the tissue would
be sent out you would need a larger margin,
typically about 4 or 5 millimeters to ensure clean
margins,” explains Dr. Ciatti.
He relates that the wound would then be
sutured and the tissue would be sent out for
pathology. “If those margins weren’t found to
be clear, the procedure would have to be done
all over again but you wouldn’t know that for a
week to ten days. If the margins were clear, you
might have taken too much tissue and therefore,
created a larger and less desirable incision than
necessary,” Dr. Ciatti proclaims.
If a surgery center or operating room is utilized
for excision and reconstruction, time becomes a
huge factor. In an operating room setting frozen
sections can be obtained but they are processed
differently than Mohs sections. Only a partial
representative section is analyzed in order to
allow the surgeon to have a result within 20-
30 minutes. This is necessary because an OR
cannot be held up indefinitely as other surgeries
are scheduled.
Dr. Ciatti reports that in 85-90% of cases the
results are correct. In 10-15% of cases, however,
he explains that once the more extensive
post-operative analysis is done on the entire
specimen, it is found that the margins are not
clean. Dr. Ciatti continues, “At this point again,
the patient is home and has been reconstructed
and you have to call him or her to come back
in.”
Once this situation occurs, it becomes
challenging to repeat the procedure and derive
an optimal cosmetic result. Dr. Ciatti sees
patients who unfortunately did not have Mohs
surgery initially and now must undergo Mohs
surgery with him to remove the remaining
cancer. Dr. Ciatti discusses the problem. “You
now have to go back and you don’t know exactly
where to go back so you have to go back along
the entire incision,” he shares.
Dr. Ciatti goes on to further explain that in some
reconstructions where a flap of skin has been
taken from one side, placed over the defect
and sutured in place, the entire flap has to be
removed in order to go back and remove the
residual cancer. “Now a huge defect is created,”
relates Dr. Ciatti, pointing out the obvious fact
that if Mohs surgery had been done in the first
place, this could have been avoided.
Mohs surgery eliminates the possibility of
unknowingly leaving some of the cancer
behind. “We process the tissue in the office at
the time of surgery, so there is no suturing done
until we know that the tumor is out,” Dr. Ciatti
emphatically points out. He explains that the
tumor is mapped in quadrants (superior, inferior,
medial, lateral). As the tissue is analyzed, if there
are positive margins, Dr. Ciatti knows exactly
where to return. “If the margin is only positive
in one quadrant, then we only go back to that
quadrant,” he says.
“We start with only a one or two millimeter
margin in a circular fashion. The whole idea is to
keep that defect as small as possible,” Dr. Ciatti
reiterates. He shares that minimizing the defect
makes all the difference in reconstruction or in
allowing the wound to just heal on its own. This
is especially important for the head and neck
where a good cosmetic result is a primary goal.
“When you’re dealing with the eyelid, the lip, the
tip or rim of the nose, the ears – these are areas
where minimizing the amount of tissue removed
is very important,” Dr. Ciatti explains. “The
larger the defect, the less likely you will be able
to reconstruct that defect using adjacent tissue
or to allow the defect to heal by spontaneous
granulation. Size matters because the wider the
defect gets, the more extensive and complicated
the reconstruction becomes,” he strongly states.
The skill with which Dr. Ciatti performs Mohs
surgery and the exceptional cosmetic results
he is able to achieve with his reconstructive
techniques have not gone unnoticed. Many
patients come to him through referrals from
other physicians, particularly dermatologists.
Still others have heard about or seen the quality
of Dr. Ciatti’s work through a friend or relative
that he has treated.
p Dr. ciatti examines the undersurface and edges of each section for evidence of cancer at any of the tissue margins
8 New Jersey Physician
p here, a mohs procedure involving a large portion of the patient’s cheek shown from start to finish. Dr. ciatti excises the tumor in layers until margins are clear and reconstructs the defect during one visit.
p another mohs surgery is shown from exicision to reconstruction. On photos far right here and above, the superb quality of Dr. ciatti’s cosmetic closures is evident.
Robert Marinaro, MD has a busy dermatology
practice in Morristown and is one the many
physicians who refer patients that are Mohs
surgery candidates to Dr. Ciatti. “Not only is he
a superlative Mohs surgeon but his cosmetic
closures are on par with the best I’ve ever seen,”
Dr. Marinaro shares, when asked why he sends
his Mohs patients almost exclusively to Dr. Ciatti.
Dr Marinaro goes on to relate the positive
feedback he receives from patients, without
exception, regarding Dr. Ciatti’s skill and the
caring attention shown by Dr. Ciatti and his
entire staff. Dr. Marinaro and his own staff are
often amazed when patients return, some having
had extensive Mohs procedures, at the excellent
results Dr. Ciatti is able to achieve with his
cosmetic closures.
Undoubtedly, the fact that Dr. Ciatti has
consistently been performing Mohs surgery
and reconstruction for many years with great
success is the reason he has become a highly
regarded expert in the particular surgical and
reconstructive techniques associated with
this procedure. Besides his great skill, there is
something else that sets him apart. His kindness
and compassion and that of his entire staff, have
earned the gratitude and loyalty of countless
patients throughout the years.
Ms “V” has had nine basal cell cancers removed
by Dr. Ciatti. “He is an absolute artist!” Ms V
exclaims. She wants to emphasize the fact that
patients who undergo their Mohs procedure
with Dr. Ciatti do not then need to see a
plastic surgeon. She describes one particular
time when she had an extensive procedure to
remove a lesion on her forehead over one of her
eyes. She relates that when Dr. Ciatti finished
suturing, she looked as if she had been in a fight.
To her amazement, when she returned to have
the sutures removed, not only was the bruising
gone but there was no visible scar whatsoever.
“Not only is he amazing as a doctor but I have
to say that he is amazing as a person,” shares Ms
V. She continues, “He is wonderful and his staff
is too. They are absolutely phenomenal.” Ms V
goes on to relate that after nine procedures she
feels very much “at home” whenever she is at Dr.
Ciatti’s office. In fact, her experience is always
enjoyable. She and Dr. Ciatti share their mutual
love of baseball. “He doesn’t rush to do things –
he takes as much time as is necessary - and I’ve
never felt any pain,” Ms V is eager to add.
Another long-time patient is Ms “L.” Dr. Ciatti has
performed Mohs surgery and reconstruction
on numerous basal and squamous cell cancers
located in different areas on her face, including
her nose, forehead and lip. When asked, during
a telephone interview, if her face was marred as
a result, she replies without hesitation that no
one would be able to notice anything unusual
because of Dr. Ciatti’s skillful work.
“He is one of the best doctors I know of. He
has an eye for zeroing in on cancer. Never once
has he said that he thought I had cancer when I
did not,” Ms L reports. “His staff is the greatest,”
she wants to share as well. She talks about their
kindness and gratefully remembers one of Dr.
Ciatti’s nurses tightly holding her hand while the
local anesthetic was being injected.
Although Ms L is predisposed to skin cancer and
at 80 years old certainly has had more than a
fair share of Mohs procedures, she is extremely
positive and very thankful that she has Dr. Ciatti
taking care of her. “You can’t ask ‘why me?’ But
when you have an expert like Dr. Ciatti, you
know you’re in good hands,” Ms L says with
conviction. Her next statement is a window into
the type of warm, comfortable and good-natured
relationship Dr. Ciatti develops with his patients.
“And besides,” Ms L confides with a lilt in her
voice, “I bribe him with chocolate.”
As our population continues to age and as skin
cancer becomes more prevalent, skilled Mohs
surgeons will be in even greater demand than
they are today. For many referring physicians
and patients in New Jersey who are dealing
with skin cancer presently, Dr. Ciatti offers his
expert surgical and reconstructive skills and a
caring and compassionate manner. Those who
are training to become Mohs surgeons would do
well to follow his example.
Dr. Ciatti’s locations are: • 240 E. Grove Street, Westfield NJ 07090
(908) 232-7235• 20 Community Place, Morristown NJ 07960
(973) 538-1560
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10 New Jersey Physician
Health Law Update
CareCore Assures NYS Attorney General of Discontinuance of Restrictive Practices; Will Buy-Out Radiologist OwnersBy John Fanburg, Esq. and Kevin Lastorino, Esq.
CareCore National LLC, a radiology benefits management company
owned and controlled by radiologists, and the Office of the Attorney
General of the State of New York (OAG), entered into an assurance of
discontinuance requiring CareCore to refrain from conduct that restrains
trade in the market for specialty health services providers.
The assurance stems from the OAG’s investigation into complaints
that CareCore, which contracts with managed care organizations to
provide radiology utilization management and manage networks of
outpatient radiology practices, preferred its radiologist-owners in
network decisions and refused to contract with qualified physicians and
physician groups for some or all modalities that they offer. The OAG
alleged that CareCore’s business practices constitute a violation of New
York law. A month earlier, a jury verdict in Stand-Up MRI v CareCore
National, EDNY Case No 08 Civ 2954 (LDW) (ETB) concluded that
CareCore violated the Sherman Act by denying competing radiologists
from joining CareCore-managed networks.
In lieu of commencing a special proceeding, the OAG accepted
CareCore’s assurance that it will use its best efforts to purchase at fair
market value, within 210 days, the full ownership interests of each of its
radiologist owners. The assurance also requires CareCore to establish
an appeals process for providers that have been denied membership in
a network and provides guidelines by which CareCore must make New
York network contracting determinations going forward.
HealtH lawUpdateProvided by Brach Eichler LLC, Counselors at Law
Surgical Care Affiliates (SCA), one of the country’s largest providers of
specialty surgical services, announced today it has entered into a joint
market development agreement with the Saint Barnabas Health Care
System (SBHCS), New Jersey’s largest integrated health care delivery
system.
Under the terms of the agreement, SCA and SBHCS will work together
to acquire ownership interests in physician-owned ambulatory surgery
centers in northern and central New Jersey, with SCA providing day-to-day
management services.
“We look forward to building an exceptional network of surgery centers in
New Jersey,” said Barry Ostrowsky, President and Chief Operating Officer
of the Saint Barnabas Health Care System. “Combining SCA’s operational
platform and the strength of our System will present a compelling
opportunity for our physicians, patients, and payors.”
Andrew Hayek, President and Chief Executive Officer of SCA, said, “We
are honored to be selected to enter into this relationship with the Saint
Barnabas Health Care System. The strength of our clinical programs was
a critical factor in this decision. We believe this relationship will improve
healthcare in New Jersey, and further position SCA as the partner of
choice for health systems and physicians.”
About Surgical Care Affiliates:SCA’s vision is to be the partner of choice for physicians, hospitals, and health systems in developing and operating ambulatory surgery centers and surgical hospitals across the country. SCA operates 125 ambulatory surgery centers and surgical hospitals, in partnership with approximately 2,000 physicians and 20 not-for-profit health systems across the country. SCA’s clinical systems, efficiency programs, benchmarking process, and training programs create measurable advantage for surgical facilities – clinically, operationally, and financially.
About Saint Barnabas Health Care System:The Saint Barnabas Health Care System is the largest integrated healthcare system in New Jersey, providing treatment and services for more than two million patients each year at over 50 facilities. The system’s 18,200 employees, 4,600 physicians and 445 residents and interns are united in their mission to deliver the highest quality of care in the best possible environment. For more information on Saint Barnabas, visit www.saintbarnabas.com.
Surgical Care Affiliates, Saint Barnabas Health Care Announce Agreement
March 2011 11
Statehouse
NEW JERSEYSTATEHOUSE
Beck’s Medical Malpractice Bill Passes Assembly CommitteeThe Assembly Health and Senior Services Committee today passed
S-760/A-1982, a bill sponsored by Senator Jennifer Beck in the Senate and
by Assemblyman Declan O’Scanlon in the Assembly. The legislation is
designed to reform the medical malpractice laws in New Jersey that are a
major cause of a physician shortage in the State.
“The New Jersey Council on Teaching Hospitals has reported that New
Jersey is losing physicians at an alarming rate,” said Beck, who was on
hand to testify at today’s hearing, “and this is attributed in large part to
New Jersey staggeringly high medical malpractice insurance rates.
These high rates are a reflection of New Jersey’s malpractice laws, which
unfortunately permit suits to be brought against medical professionals
with little discretion. This bill simply aims to put in place reasonable
restrictions on what may be considered in a malpractice law suit and how
insurers may react to those suits.
“Currently, New Jersey allows malpractice insurance providers to
increase rates when a suit is brought against a medical professional,” Beck
continued, “regardless of the outcome of the case. That is akin to a judge
handing down a sentence before the verdict is in. This bill would change
that so that only in the case that a settlement is made that a customer’s
rate may be increased.”
The bill will also requires that a malpractice action against a health care
provider shall be commenced within two years after the plaintiff or patient
discovers the injury, but not more than four years after the alleged act;
that only licensed medical professionals may be permitted to give expert
testimony on the standard of practice in a malpractice case; and that
physicians licensed in the State of New Jersey shall not be liable for civil
damages in the case of rendering treatment in good faith, as a volunteer
at a clinic or other health care facility.
Medical Marijuana Could Be Available by Late SummerA half-dozen alternative treatment centers across New Jersey could be
legally selling marijuana to patients with certain medical conditions by late
summer, state Health Department officials said Monday. The centers were
culled from 35 applications from 21 nonprofit entities, the officials said.
Under proposed state regulations, each treatment center would grow
and sell up to three strains of marijuana. The pot would be available
only to patients with certain conditions, including multiple sclerosis and
glaucoma. Patients say it can ease symptoms such as pain and nausea.
Home delivery, as the proposed regulations currently stand, would not
be allowed.
Some groups that were considering applying said they didn’t because the
proposed rules were too onerous - for instance, limiting the potency of the
legal pot, which none of the 13 other states that have legalized medical
marijuana has done.
Most of the winners came from outside the close-knit group of the most
public advocates for legalizing medical marijuana.
Devon Graf, the Health Department’s director of legal and regulatory
compliance, said the successful applicants are a mix of big and small
operations.
“It was pleasant to see that there are some little-guy, some small-business
providers in there,” Graf said.
He said the winners had strong financial backing and had secured
preliminary approvals for their locations from local zoning boards and
town governments and prepared training manuals for employees.
The applicants were required to show they had plans for security, quality
control, and other aspects of the businesses.
Some have strong ties to hospitals. One of the successful applications
was Compassionate Care Centers of America Foundation, which will
work with Meadowlands Hospital. The group’s facility in New Brunswick
was approved.
“We are grateful to Gov. Christie’s administration that [Health]
Commissioner [Poonam] Alaigh is a visionary who has devised a medical
model that will ensure much needed relief to patients suffering serious
debilitating conditions in a safe, strict, and appropriate manner,” said Raj
Mukherji, a spokesman for the group.
The group’s application says it expects to spend $4.5 million a year to
operate the facility.
Peter Rosenfeld and his organization, Compassion Collective of Camden
County, applied to run a center in Pennsauken but did not get a license.
“The process, I would characterize as interesting,” he said. “They gave
us six business days from the announcement to the day it had to be
12 New Jersey Physician
NEW JERSEY STATEHOUSE submitted. It was a little hard to figure out which way they were heading.”
The successful applicants are in the populous corridor between the New
York City and Philadelphia areas.
They are the Breakwater Alternative Treatment Center Corp., in Manalapan;
Compassionate Care Centers of America Foundation, in New Brunswick;
Compassionate Care Foundation Inc., in Bellmawr; Compassionate
Sciences Inc., with a facility planned in Burlington or Camden County;
Foundation Harmony in Secaucus; and Greenleaf Compassionate Center
in Montclair.
Roseanne Scotti, New Jersey director of the Drug Policy Alliance, said the
regulations would be better if they included a home-delivery option for
far-flung patients.
“We’re a little concerned there’s nothing in Atlantic County,” she said.
State Sen. Nicholas Scutari, a Democrat from Linden, has called
for lawmakers to nullify the proposed regulations from Christie’s
administration.
Scutari says the regulations fall short of the Legislature’s intent when
it voted 14 months ago to allow medical marijuana. He said Monday
he wanted to negotiate changes to the regulations with Christie’s
administration.
NJ ACO Pilot Bill Approved by Senate Budget and AppropriationsA bill sponsored by Senators Joseph F. Vitale and Jim Whelan which
would establish a three-year pilot program in the Department of Human
Services in order to make sure Medicaid recipients have access to quality
health care was approved by the Senate Budget and Appropriations
Committee by a vote of 7-5.
“Under the current health care delivery and payment structure, Medicaid
recipients are often unable to access high-quality, cost-effective health
care,” said Senator Vitale, D-Middlesex, and Vice Chair of the Senate
Health, Human Services and Senior Citizens Committee. “As a result, we
pay more money for less-than-stellar results in terms of positive patient
outcomes. It’s time that we move away from the existing system which
puts vulnerable New Jerseyans at a disadvantage to receive high-quality
care, and begin to invest State resources in a smarter, cost-effective model
of health care for Medicaid enrollees.”
“This bill is about spending State health care dollars smarter, and
improving care for people who depend on our State’s health care safety
net for access to medical services,” said Senator Whelan, D-Atlantic, and
a member of the Senate health panel. “Right now, we lack the objective
evaluation and cost-effective protections to make sure that we’re getting
the biggest bang for our buck, and providing the best care possible for
people enrolled in the Medicaid system. It’s time that we do better for
New Jerseyans in need.”
The bill, S-2443, would create the “Medicaid Accountable Care Organization
Demonstration Project” to ensure that Medicaid recipients in New Jersey
have access to high-quality, cost-effective medical care. The bill would
establish a demonstration project within the Department of Human
Services to increase access to primary care, behavioral health care, and
dental care by Medicaid recipients in a particular region. The bill would
also improve the quality of health care by establishing objective metrics
and relying on patient experience, and would reduce unnecessary and
inefficient care without interfering with a patients’ access to the health
care providers and services they need to stay healthy.
The bill would authorize Accountable Care Organizations (ACOs),
defined as nonprofit corporations, to provide coordinated, high-quality
care to Medicaid recipients in a municipality or defined geographic
region with more than 5,000 Medicaid recipients. If the program proves
successful in lowering costs and improving care, the sponsors said they
would consider working with the Department to establish a permanent
program.
“As part of the federal health care reform law, states have been given
the authority to empower ACOs to provide coordinated, high-quality,
cost-effective health care to Medicaid recipients,” said Senator Whelan.
“Frankly, we’re flying blind right now in terms of the level of care available
to Medicaid recipients, and it’s time to try something new to create a
high-quality standard of care that allows us to achieve the best patient
outcomes at a fraction of the current price. By shifting to a smarter model
of care, we can maximize the impact of our health care investment.”
“Whether it’s FamilyCare or the medical home pilot program, New Jersey
has been a laboratory for best practices in administering and delivering
health care for New Jerseyans in greatest need, and the Medicaid ACO
Demonstration Project is another step forward in better health care at less
cost to the State’s taxpayers,” said Senator Vitale. “We recognize that we
have a responsibility to provide quality care for people who depend on
Medicaid, and we have to stretch limited health care dollars as far as they
will go. By moving to an ACO model of delivering health care services,
we can achieve both, and will once again set New Jersey up as a national
model for other states to follow.”
The bill now heads to the full Senate for consideration.
Assembly Passes Measure to Improve Emergency Medical Services In New JerseyConaway/Fuentes/Evans/Quigley Bill Aims to Boost Delivery of Urgent Care
The full Assembly on Monday approved a measure sponsored by
Committee Chairman Herb Conaway, Jr., M.D., and Assembly members
Angel Fuentes, Elease Evans and Joan Quigley to improve the quality and
delivery of emergency medical services in New Jersey.
“Emergency medical services are among the most fundamental functions
we can provide as a government,” said Conaway (D-Burlington/Camden).
“We need to overhaul our system in order to improve efficiency and
ensure compliance with applicable standards of pre-hospital care. This
bill recognizes the important work of emergency volunteers by providing
March 2011 13
NEW JERSEY STATEHOUSE free licensing and background checks as a condition of service.”
According to a 2007 report that was issued after a comprehensive analysis
was conducted at the behest of the Legislature, New Jersey’s two-tiered
EMS system is in a “state of near crisis” due to the system’s financial
structure, decline in volunteer membership, lack of comprehensive
legislation and a weakened Advanced Life Support (ALS) system. The
bill (A-2095), approved by a vote of 44-31-3, incorporates many of the
recommendations from the report.
“This legislation would institute various measures that will revolutionize
services, making them more efficient and effective, while streamlining the
system to save taxpayer dollars,” said Fuentes (D-Camden/Gloucester).
Under the direction of the Commissioner of Health and Senior Services,
the Office of Emergency Medical Services in the Department of Health
and Senior Services (DHSS) would serve as the lead state agency in
overseeing emergency medical services to ensure the continuous and
timely availability and dispatch of basic and advanced life support through
ground and air, adult and pediatric triage, treatment and transport and
emergency response capabilities.
The bill would consolidate numerous groups, task forces and advisory
boards, into one governing body - the Emergency Medical Care Advisory
Board (EMCAB) - to advise DHSS on pre-hospital issues, medical care and
the establishment of provider standards.
Furthermore, the bill would create a number of subcommittees under
EMCAB, including one charged with exploring shared services and
consolidation in order to make recommendations for municipalities and
counties to consolidate EMS services.
The bill would also require a minimum of one emergency medical
technician (EMT) as the standard of care for every ambulance in the state.
DHSS would also be responsible for arranging advanced life support
services in response to 9-1-1 calls statewide.
“This is an important measure because it provides a uniform standard for
responding to emergencies and treating and transporting patients. The
ultimate goal is to ensure proper care for all of our residents,” said Evans
(D-Passaic/Bergen).
“This bill will enhance professionalism, transparency and coordination of
the state’s EMS system, making patients the ultimate priority,” said Quigley
(D-Hudson/Bergen).
The bill would also require paramedics, EMTs, and emergency medical
responders to obtain a license from DHSS and undergo a criminal history
background check as a condition of licensure or other authorization to
practice.
The commissioner would also have the authority to revoke the license for
violation of certain laws and regulations.
Despite the political uncertainty around national
health reform, New Jersey is moving forward with
a major innovation in its Medicaid program. By
authorizing the formation of Medicaid Accountable
Care Organizations (ACO’s), the state will take a
leadership role in the struggle to contain Medicaid
costs without disenrolling patients or withholding
beneficial care.
ACO’s are the latest big idea in health reform. They
are networks of physicians, hospitals, and other
providers that work together to improve quality
of care and reduce expenditures for a defined
patient population. The purpose is to achieve three
interrelated goals:
• Improve objectively measured health care
quality and patient safety
• Improve patients’ experiences with care
• Achieve savings large enough to be shared by
health care providers and payers
On the surface, the ACO idea looks a lot like old
fashioned managed care with the image of HMO’s
telling providers how to practice medicine. The
key difference is that ACO’s are designed to be
more “bottom up” than “top down”. Providers form
ACO’s voluntarily, set their own rules for organizing
care, and establish a plan to share savings.
By authorizing Medicare to contract with ACO’s,
the Affordable Care Act (ACA) will encourage
the expansion of ACO networks throughout the
nation. But in the current political environment,
implementation of the ACA, or at least some
of its provisions, has become highly uncertain,
presenting a challenge for states that must lay the
groundwork for implementing health reform by,
for example, establishing procedures to expand
Medicaid enrollment. One thing that is very certain
is that, with or without federal health reform, states
must find solutions to the enormous budgetary
problems associated with rising Medicaid costs.
Pending legislation in New Jersey shows that states
do not have to wait for the politics of national
health reform to work themselves out. On January
6, a bill to create a demonstration project for
Medicaid ACO’s was introduced in the New Jersey
State Legislature. Under the bill, New Jersey’s
Department of Human Services would certify as
ACO’s nonprofit coalitions of local health care
providers who organize themselves to improve
care for a defined population of at least 5,000
Medicaid enrollees. A defined population might
Medicaid Accountable Care OrganizationsOpportunities for State Cost ControlSubmitted by Derek Delia and Louise B. Russell
14 New Jersey Physician
include Medicaid enrollees living in a city or
cluster of smaller municipalities.
Certified ACO’s would have to meet specific
requirements for health care quality and outcomes
and, in fee-for-service Medicaid, would be eligible
to share in savings from care improvements.
The bill would also permit Medicaid HMOs to
engage with certified ACO’s. The demonstration
projects would be subject to annual evaluation.
If successful, they would open the door for
expanding the Medicaid ACO concept across
New Jersey and the nation.
The approach in New Jersey stands in stark
contrast to approaches currently contemplated in
other states. Arizona is attempting to address its
budget woes by disenrolling 280,000 beneficiaries
from Medicaid. Florida’s newly elected governor
has expressed interest in requiring more Medicaid
beneficiaries to move from traditional Medicaid
into Medicaid HMO’s. Unlike the New Jersey
reform, these approaches have a distinctive
“been there, done that” feel to them. They also fall
into the “top down” category mentioned above
where payers impose new requirements without
any input from patients and providers.
In contrast, the New Jersey effort was initially
proposed by a coalition of medical providers from
the city of Camden. The Camden Coalition was
designed to better organize care for low-income,
complex patients in Camden, one of America’s
poorest cities. (Readers of the New Yorker magazine
may recall Atul Gawande’s profile last month of Dr.
Jeffrey Brenner, who leads the Camden Coalition.)
The Coalition, whose work has been supported by
philanthropic grants and donated services, seeks
to sustain its efforts by forming a Medicaid ACO,
which would use the savings from reduced costs
to sustain and expand patient services.
A clever element of the New Jersey reform is
that it allows the state to take full advantage of
federal health reform without being contingent
upon it. For example, lessons learned from the
Medicaid ACO experience will place New Jersey
stakeholders ahead of the curve, as they consider
the formation of Medicare ACO’s encouraged by
federal reform. In addition, Secretary of Health
and Human Services (HHS) Kathleen Sebelius
recently wrote a letter to state governors inviting
them to collaborate with HHS to find ways of
containing Medicaid’s costs as it prepares to add
millions of new enrollees. Her letter emphasizes
care coordination and innovations in health care
delivery similar to the path that New Jersey is
taking. This will leave the state well positioned
to take advantage of federal assistance for
implementation and surveillance of Medicaid
innovations. But even if federal efforts stall, New
Jersey’s Medicaid ACO efforts can move forward
on their own.
ACO’s in Medicaid are also likely to avoid
some of the thornier issues that have been
raised about ACO’s in general and ACO’s that
contract with private insurers in particular. First,
a large ACO might have so much consolidated
market power that it could command large
reimbursement increases, offsetting any savings
from improved efficiency. Second, ACO’s achieve
their efficiencies largely by creating incentives to
avoid expensive services that are preventable,
marginal, or downright unnecessary. Of course,
one person’s unnecessary service is another
person’s profit margin. Providers who see their
profit margins decline will have every incentive
to argue that their services really are needed
and the so-called efficiencies are illusory. As
the readers of this blog well know, it is not hard
to generate political outrage over reductions in
medical services (regardless of their effectiveness,
appropriateness, or safety).
Medicaid ACO’s, in contrast, raise fewer concerns
about market power. In fee-for-service Medicaid,
reimbursement rates are set by the state, leaving
no room for providers to raise prices. Although
Medicaid HMO’s do negotiate reimbursement
rates, the HMO’s cannot spend beyond the
limited amount that Medicaid allocates to them to
pay for patient care.
In addition, most providers, especially those who
provide the most expensive forms of care, do
not build their profits on maximizing Medicaid
volume. On the contrary, many providers do not
even accept Medicaid patients because payment
rates are usually too low to be profitable. As a
result, the pushback against reducing avoidable
services in a Medicaid ACO is likely to be much
less intense.
A great deal of work still lies ahead for New
Jersey’s Medicaid ACO’s. This includes the
final passage of legislation and several years
of implementation. But as the process unfolds,
lessons learned will be important not just for
New Jersey but for all states struggling to serve
their Medicaid populations well and in a fiscally
sustainable way.
ART#: 187321_NJS_NJPM.inddPUBLICATION: NJPMSIZE: 4.75x4.8125D: sd
The State of New Jersey
EEO/AA
State of New Jersey
Department of Health and Senior Services
Deputy Commissioner Public Health Services
This key management position, which reports directly to the
Commissioner of Health and Senior Services, will provide leadership for
planning, policy implementation, budgeting, and executing the goals
and mission of the department as it relates to the assigned areas of
responsibilities: The Divisions of HIV/STD/TB Services; Family Health
Services; Epidemiology, Environmental and Occupational Health Services;
Public Health Infrastructure, Laboratories and Emergency Preparedness.
Successful candidate must be a licensed physician.
For a full description of the position, including the education and
experience requirements, and addresses for filing either via electronic or
hard copy visit: www.nj.gov/health/jobs.
NEW JERSEY STATEHOUSE
March 2011 15
HELP SAVE THE PRACTICE OF MEDICINE!CALL 888-806-5362
OR VISIT OUR WEBSITE AT WWW.NJPHYSICIANS.COMFOR MEMBERSHIP INFORMATION
NJ_Ad2.indd 1 1/8/10 10:23 AM
16 New Jersey Physician
How often have you heard a physician say,
“Medicine is the easy part. It’s everything else
about running the office that is stressful,” or “I went
to medical school to practice medicine; I am not a
business person.” I hear similar statements from
my clients time and time again. The goal of this
article is to provide some practical suggestions to
help you increase practice revenues, decrease
costs and develop an action plan for 2011.
• Analyze your fee schedule. When was
the last time you increased your fees? Many
physicians feel guilty about increasing fees
in light of these difficult economic times.
However, most practices have experienced
increased labs, medical supplies, payroll and
general overhead especially with employee
costs. A modest fee adjustment once a year is
preferred over a significant hike in fees every
couple of years. For those practices whose
fees are regulated by PPOs or managed care
plans, remember that the fees you submit
on medical claims are factored into future
contracted fee schedules. So submit your full
fees to all insurance carriers and adjust the
contracted write-offs when posting payments
to patients’ accounts as required by the EOBs.
• Perform a monthly analysis of your
collection percentages. Do you know
how your practice is being paid by your top
5-7insurance companies on your top 20-25
procedures? Your office manager should be
aware of frequent denials and resolutions to
determine if they are being resolved or written
off as an adjustment? Incorporating some
monthly practice statistical calculations when
performing the monthly bank reconciliation
is crucial to monitoring current vitals of the
practice’s revenue cycle.
• Conduct a “patient service review”
and look for those patients who may require
medical treatment, or are due for annual
physical exams.
• Analyze your accounts receivable with
special attention to accounts that are 90 days
or more past due. All insurance claims past 90
days should be researched. I have found that
in practices where the 90 day plus accounts
receivable are over 20%, there may be collection
issues, which are hindering prompt payment.
It is important to look at days in accounts
receivable by payer, not just the practice as a
whole. Sometimes the insurance company is
waiting for information from the patient. Reach
out to overdue accounts with a personal phone
call and try to work out payment arrangements.
If the accounts are deemed uncollectable,
consider sending them to collection or to small
claims court if appropriate. After all options
have been exhausted, consider writing off the
uncollectable accounts so that your accounts
receivable total is accurate.
• Evaluate the growth of your practice.
Run a demographics report of collections and
new patients. Is your practice growing? If it is
not growing to your satisfaction, now may be
the time to engage in or ramp up internal and
external marketing.
• Update your website. The majority of my
medical clients have a website, but many have
not updated it since inception. Do you have
any promotions or new services you now offer
in your office that patients may not be aware
of? (i.e., cosmetic procedures or supplements
for retail).If so, those promotions should also
be highlighted on your home page.
• Analyze your overhead costs as
compared to the prior year. Do you
anticipate your overhead costs changing in
2011? Are there any practice costs that can be
cut this year? I have seen practices reduce their
telephone bill by over 50% simply by using the
same vendor for both phone and internet.
• Review your HIPAA compliance procedures.
Just because you do not hear as much about
HIPAA compliance does not mean you can
relax privacy and security measures. Review
and revise your HIPAA policies and procedures
as necessary. Make sure that all employees are
familiar with your policies and procedures and
have had a chance to ask questions. Document
employee training updates, and make sure that
all patients sign their own HIPAA forms once
they turn 18 years of age (or the age of majority
in your state, if younger than 18).
• Consider initiating your Electronic Medical
Records (EMR) research and selection
process. Electronic medical records promote
better communication between patients,
doctors and specialists, with the overall goal
of better patient care, as well as to improve
office management efficiency. In addition,
successful EMR implementation can lead to
financial incentives for your practice. For more
information regarding EMR selection send an
email to [email protected] with “EMR
Selection Guide” in the subject line.
• Take an inventory your medical supplies.
Expired supplies should be discarded. Review
your ordering procedures with staff so as to
minimize waste.
• Scrutinize payroll costs, which are typically the
largest expense in a medical office. Analyze
employee performance and revise hours as
necessary. Limit overtime hours for employees
(other than physicians), which typically must
be paid at time and a half. Review health
An Action Plan for 2011By Harlene S. Stevens, CPA – Nisivoccia LLP
Finance
March 2011 17
By Harlene S. Stevens, CPA – Nisivoccia LLP
insurance costs, which have increased
dramatically in recent years. If you pay at least
50% of your employees’ health insurance you
may be entitled to a health care credit on your
tax return. Update and revise your employee
manuals if needed.
• Provide each employee with at least one
written performance review annually.
For a copy of a very basic performance review
send an email to [email protected]
with “Performance Review” in the subject line.
• Conduct regular staff meetings. I prefer
monthly lunch meetings. These meetings
should be scheduled for a set amount of time
(i.e., one hour) and have a specific agenda.
One purpose for having regular staff meetings
is to build a sense of “team” by keeping all
staff informed of practice-related issues and
providing practice managers an opportunity to
show staff they are appreciated. When staff feel
appreciated they often display more energy
and enthusiasm at work.
• Maximize your retirement contri-
butions by saving early in the year.
I recommend physicians open a separate
account to accumulate earnings that they
intend to use to fund retirement plans and pay
taxes at year end.
• Set up appointments with your
accountant, attorney, and financial
advisor to be sure that your business plan
and personal finances are in sync for 2011.
By utilizing these guidelines early in the year,
you should develop an action plan that you are
comfortable with and one that should enhance
the financial health of your practice.
Princeton Insurance knows New Jersey, with the longest continuous market
presence of any company offering medical professional liability coverage in the state.
Leadership: Over 16,000 New Jersey policyholders
Longevity: Serving New Jersey continuously since 1976
Expertise: More than 55,000 New Jersey medical malpracticeclaims handled
Strength: Over $1 billion in assets and $335 million in surplus as ofSeptember, 2010
Service: Calls handled personally, specialized legal representation,knowledgeable independent agents, in-office visits by ourskilled risk consultants
Knowledge: New Jersey-specific knowledge and decades of experience
Innovation: Three corporate options, gap coverage, specialty reports,practitioner profiles, office practice toolkits
Harlene S. Stevens, CPA, Supervisor is a leader of the Nisivoccia LLP Healthcare Segment, which concentrates in providing services to physician and dental practices. The Company is a multi-dimensional CPA firm with offices in Mt .Arlington and Newton, New Jersey. The firm offers traditional tax, account-ing, audit and business advisory services. Contact her at [email protected] or 973-328-1825.
18 New Jersey Physician
Food for Thought
Every now and then a dinner out becomes an unexpected experience,
especially when it’s your first time at a particular restaurant.
Sometimes, a place has been highly recommended and ends up
being a huge disappointment. We’ve all been there. Then there are
those rare occasions when you come upon a restaurant that you’ve
never been to, take a chance and hit the jackpot. That’s exactly what
happened last night when Michael and I had the pleasure of sampling
the contemporary Italian cuisine and the hospitality provided at
Corso 98 in Montclair.
From the moment we entered this storefront, family-owned BYO on
Walnut Street, we were treated royally. We were shown to an elegantly
set table for two in a cozy nook by the window. That’s definitely
my favorite type of seating when we are dining alone. Even an old
married couple like us appreciates the romantic ambience that is
created. In fact, the entire place is beautifully decorated and arranged
so that every table is situated to allow for a warm and comfortable
dining experience. The lighting is soft and the music (Italian as well),
is definitely in the background and not at all distracting. Actually, it
was the perfect accompaniment to the food and the atmosphere.
The menu at Corso 98 offers an ample selection of salads, appetizers,
seafood, pastas, fine meats and cheeses which showcase classic
Italian dishes that are creatively prepared and presented. There is
also a separate menu featuring the specials of the day. This is what
Michael and I focused on since there were a number of intriguing
choices. We decided to share two of the tempting appetizers.
First, we had a frisse salad served with beets stuffed with feta cheese,
garnished with grapes and walnuts and finished with an orange
vinaigrette. Our server was kind enough to have this divided in
the kitchen. The presentation was a lovely arrangement of colors
and textures. I found the beets and feta cheese to be a winning
combination.
Once our salads were done our server placed the impressive bowl
of Vongole con Ceci between us. This was fresh little neck clams
steamed in roasted garlic in a saffron scented tomato-herb broth with
chick peas and a few slices of toasted bread for dipping on top. Dip
we did as the broth was heaven with just the right amount of clam
juice. Also, the clams were fresh as could be. We really enjoyed this
dish.
At this point I must comment on the exemplary service we received.
Every need was anticipated yet our server did not hover or interfere
By Iris Goldberg
Corso 98Montclair, New Jersey
p Grilled rack of lamb is one of the most elegant ways to serve the traditional specialty.
p Puff-pastry-wrapped Brie with shaved pears, mango, strawberry flower, and cranberry-watermelon-pineapple reduction.
March 2011 19
with our enjoyment of the food or each
other. When we did have an opportunity
to speak with him, we couldn’t help but
appreciate his warm demeanor and his
quick sense of humor.
Now for the main course. Michael
immediately decided on Risotto con
Gamberi, Salsiccae e Piselli, which
is slowly simmered Arborio rice with
brown butter-seared shrimp, roasted
Italian sweet sausage, tomato, pecorino
Romano cheese and early spring green
peas. I can always tell by the look on his
face if Michael is enjoying his meal. His
eyes, which have always revealed to me
exactly how he is feeling at the moment,
were smiling.
After a bit of deliberation, I went for the
Osso Buco, which is a long-time favorite
of mine. I was not disappointed. The
veal shank was cooked to perfection,
slowly braised, making it tender as can
be. It was served in a rich and flavorful
tomato-vegetable red wine demi-glace
over risotto Milanese. A small fork was
provided to reach the succulent marrow
within the large bone and I am sure not
a spec was left after I was done.
Although we often skip dessert, things
were going so well that we decided to
indulge ourselves. We ordered some
pistachio gelato and a piece of Italian
ice box cake which consists of layers
of graham crackers with chocolate
pudding, topped with whipped cream
and fresh strawberries. Yes, it was as
scrumptious as it sounds.
As we were lingering over coffee
and waiting for our credit card to
return, Executive Chef, Darek Haupt
approached our table. He graciously
asked if we had enjoyed our meal. We
ended up in a long conversation about
his extensive training, including studying
at the CIA and his mastery of the art of
Italian cooking, which has become his
passion. He shared that he is going to be
a contestant on an upcoming episode of
“Chopped,” which has become quite a
popular TV show amongst food channel
watchers.
He also told us about a special private
luncheon that would be served at Corso
98 on the Sunday that was approaching. It
was for notable professionals (including
physicians) within the community
and was to showcase the dishes from
Abruzzo, an area east of Rome on the
Adriatic Sea, where co-owners and
brothers, Elio and Corradino Suriano
were born. Here is the menu:
Sunday, March 27, 2011
BACALA FREDDITraditional salt cod salad with chick peas, celery, shaved garlic, cerignola olives, capers, hot cherry peppers, lemon, flat leaf parsley and extra virgin olive oil
CHITARRA LAMB RAGUFresh chitarra pasta made by Mama Suriano with slow-braised lamb, carrots, celery, shallots, tomatoes and herbs
FRISEE SALADFrisee lettuce, fresh fennel, blood oranges, roasted skinless almonds, red grapes and a light citrus vinaigrette
CHOICE OFPrime center cut pork chop grilled with broccoli rabe, roasted potatoes, hot cherry peppers and a tomato-herb demi-glace
– OR –Pan seared fresh Alaskan salmon with roasted tomato, rosemary-goat cheese polenta, citrus scented arugula and an orange-basil reduction
DESSERTOrange mascarpone tartlets with macerated Grand Marnier strawberries and a warm espresso-dark chocolate sauce
In case you haven’t realized by now, I
would definitely recommend Corso 98
for an intimate dinner for two, a large
group or a special celebration. The food
is fantastic and the service is top-notch.
No effort is spared to make you feel
welcome. In fact, we plan to return very
soon. Perhaps we’ll see you there.
Corso 98 is located at 98 Walnut Street,
Montclair NJ 07042. (973) 746-0789
p Pan-roasted Prince Edward Island mussels with Pinot Grigio butter sauce, roasted garlic cloves, croutons, and roma tomatoes.
p Juicy roasted salmon with whipped potatoes, wilted spinach, roasted peppers, pancetta, and grilled fennel.
p herb-crusted Georges Bank flounder over roasted sweet cubanelle peppers, surrounded by a spicy puttanesca sauce.
p Zucchini blossoms stuffed with prosciutto and fresh mozzarella over a citrus beurre blanc.
p handmade pasta chitarra alla mamma with Bolognese sauce.
20 New Jersey Physician
Events
Recently, New Jersey Physician had the pleasure of
attending the first meeting of New Jersey Women
in Healthcare. Founded by Lani M. Dornfeld, Esq.,
Carol Grelecki, Esq., and Debra Lienhardt, Esq., all
of the healthcare division of Brach Eichler, this very
well attended event mixed significant speakers
from the state healthcare field with lunch and a
wine tasting. The audience was most enthusiastic
and felt this type of networking event was a
long time in coming and was most appreciative
someone had taken the initiative to put it together.
New Jersey Physician recently met with Debra
Lienhardt, Esq. to discuss the association.
NJP: Can you give us a brief history of
how the association was born?
DL: My partners, Lani and Carol, and I have
been practicing in the health care group of Brach
Eichler and representing health care providers and
institutions for a number of years. In such capacity,
we have been counseling a large and growing
number of women in the health care field, including
physicians, other practitioners and key executives
of hospitals, ambulatory surgery centers, nursing
homes, and other facilities and organizations. We
realized that there was no existing forum for these
professional women to get together, network and
share ideas. Therefore we developed the New
Jersey Women in Healthcare association and have
been working since the beginning of the year to
put together the inaugural event. Brach Eichler,
the leading health law practice in New Jersey,
always looks for ways to support the health care
community and was delighted to sponsor and
promote the event.
NJP: What are the goals that you and
your partners would like to see reached
by the group?
DL: Our goals are clear. NJWH expects to grow
and provide a forum for women to come together
and address shared interests and concerns. It
will provide information regarding the health
care industry and national and local trends and
foster strong professional networks. This event
was our first. Based on the level of enthusiasm
from the women who attended-as well as the
disappointment from the women who didn’t-we
will be creating additional programs aimed at
achieving these goals for women leaders in health
care.
NJP: Can you discuss the difficulties faced
by women in health care previously and
currently? Has this changed and where
do you see it going? What can the group
do to lessen this problem and how can
this be done?
DL: Although women have always played a large
role in the provision of health care and the health
industry generally, with respect to key leadership
and executive positions, it was largely male
dominated. In recent times this has changed and
female colleagues are being recognized for their
achievements. However, in order to ensure that
this continues, we, the women leaders in health
care, need to focus on building professional
relationships and using those resources. We
hope that through the efforts of NJWH, we can
begin offering the growing number of women in
the health care community a way to join together,
share information and ideas and reach their
professional goals.
New Jersey Physician DiscussesThe Inaugural Meeting of the New Jersey Women in Healthcare with Debra Lienhardt, Esq. of Brach Eichler
A full-day program followed by a networking cocktail reception offering presentations and panel discussions by industry leaders on the latest ASC developments.
• What is Your ASC Worth?
• Latest Regulatory Developments from Washington and Trenton
• ASC Mergers, Acquisitions and Consolidations
• Key Insights from New Jersey Insurance Industry Leaders
• Hospitals Getting Into the Game
• Analysis from Key New Jersey Government Officials
• PIP, Out-of-Network and Other Reimbursement Issues
The 3rd Annual
NJ ASCReviewA timely seminar on the latest regulatory and business developments affecting the New Jersey ambulatory surgery centers. This seminar provides an opportunity for more than 300 national and statewide ASC leaders to come together and discuss the latest and hottest issues affecting the industry.
Wednesday | April 27, 20118:00 – 9:00 a.m. Registration and Networking Breakfast
9:00 – 4:00 p.m.Program
4:00 – 6:00 p.m.Networking Cocktail Reception
The Palace at Somerset Park Somerset, NJ
For sponsorship opportunities or to attend the event, please contact Alan Levine at [email protected] or 973-364-8389
Mark Manigan Program Chair
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