The Journal

Fall 2009 Vol 9.4

Reflections on Becoming a DO

New HIPAA and Stark Changes Rolled Out

Law Spotlights Hospital Safety Statistics

Top-Notch Billing Bolsters Bottom Line

Regulatory Compliance Insurance Now Available

With over 7,000 physician policyholders, Princeton Insurance is the leading medicalprofessional liability insurance provider in the state – and we have you, the physicians ofNew Jersey, to thank. We appreciate your partnership and are honored that you trust us toprotect your practice.

At Princeton Insurance, we understand choosing a medical professional liability insuranceprovider is never easy. But when you look at all the facts, the choice is clear:

• Our financial strength has allowed us to serve New Jersey physicians continuously for 33years. No other insurer comes close to this record.

• Over the past three decades, we have defended more than 53,000 medical malpracticecases in New Jersey.

• Policyholders benefit from our innovative risk management and patient safety initiatives.

• Underwriting discipline is always a priority – it’s the reason we succeed in a marketwhere others have failed.

Excellence sets up apart from the rest.Thank you for choosing Princeton Insurance.

For more information give us a call at 800.334.0588, or visit us online at www.PrincetonInsurance.com, or contact your independent agent.

for choosing excellence.

©2009 New Jersey Physicians United Reciprocal Exchange

Let ourassets be your

assets. This past year, NJ PURE reported an all-time high of $43 million in assets. This is even more impressive because we did it without the use of agents or brokers and without going through a rate increase for over 5 years. As a not-for-profit physician reciprocal exchange, NJ PURE’s assets are the physician’s assets. That’s why in 2007, NJ PURE returned cash dividends back to our policyholders who were insured with us in 2003. Some groups received up to $11,000 back in dividends. So, isn’t it about time that you started listening to someone other than your agent or broker? Call us today at 1-877-2-NJ-PURE or go online to www.njpure.com.

Admitted Assets 2004 $15,660,955 2005 $25,190,023 2006 $32,830,048 2007 $40,750,382 2008 $43,021,431

THE JOURNAL | FALL 20092

TABLE OF CONTENTSTHE JOURNAL Editorial and Executive Staffs

Executive Editor Robert W. BowenManaging Editor Kristen Bowen

ContributorsLaurie A. Clark Timothy L. HooverMichael S. Lewis Mark E. Manigan

Deborah R. Mathis

Executive OfficersPresident Alan Carr, DO

President-elect Lee Ann Van Houten-Sauter, DOVice President Antonios Tsompanidis, DO

Treasurer Karen Kowalenko, DOSecretary John LaRatta, DO

Immediate Past President Susan Volpicella-Levy, DO

NJAOPS StaffExecutive Director Robert W. BowenBusiness Manager Alice Alexander

Director, Exhibit Services Kristen BowenDirector, Medical Education Lila Cleaver

Director, Marketing& Communications Bonnie Smolen

Office Manager Diana Lennon

The Journal is the official magazine of the New JerseyAssociation of Osteopathic Physicians and Surgeons(NJAOPS). NJAOPS is the sixth largest state affiliate ofthe American Osteopathic Association. NJAOPS representsthe interests of more than 3,500 active osteopathic physicians, residents, interns and medical students. Founded in 1901,NJAOPS is one of the most active medical associations in New Jersey with 12 county societies.

Opinions expressed in The Journal are those of authorsor speakers and do not necessarily reflect viewpoints orofficial policy of NJAOPS or the institutions with whichthe authors are affiliated, unless expressly noted.

NJAOPS/The Journal is not responsible for any statementsmade by any contributor. Although all advertising isexpected to conform to ethical medical standards,acceptance does not imply endorsement by this publication.

The appearance of advertising in The Journal is not anNJAOPS guarantee or endorsement of product or service,or the claims made for the product or service by theadvertiser. When NJAOPS has endorsed a product or program it will be expressly noted.

All advertising contracts, insertion orders, inquiries, correspondence, and editorial copy should be mailed to:The Journal (attention: Executive Editor), NJAOPS, OneDistribution Way, Suite 201, Monmouth Junction, NJ08852-3001. Telephone: 732-940-9000.

The Journal editorial staff reserves the right to edit all articlesand letters to the editor on the basis of content or length.

The Journal (ISSN 0892-0249) is published quarterly (January,April, July, and October) from the executive and editorial officesat NJAOPS headquarters in Monmouth Junction, New Jersey.Periodical postage paid at Monmouth Junction, New Jersey, andadditional mailing offices.

POSTMASTER, please send address changes to The Journalof the New Jersey Association of Osteopathic Physiciansand Surgeons, One Distribution Way, Suite 201,Monmouth Junction, NJ 08852-3001.

Subscription to The Journal is included in NJAOPS membership dues. Non-member subscription is $25.

Designed and printed in the USA by Mastergraphx, Monmouth Junction, New Jersey.

The Journal is printed on environmentally friendly paper. Byusing products with the FSC label you are supporting the growthof responsible forest management worldwide.

AROC 2010 .........................................................................Back Cover

BC Szerlip..........................................................................................15

Brach Eichler .....................................................................................21

Conventus Inter-Insurance Exchange .................................................17

HealthCare Institute of New Jersey ......................................................5

Medical Protective ...............................................................................7

NJ PURE ..........................................................................................1, 3

Pellittieri Rabstein & Altman..............................................................23

PNC Bank............................................................................................9

Princeton Insurance...................................................Inside Front Cover

Professional Liability Insurance Group

of South Jersey ....................................................................................6

ProMutual Group.......................................................Inside Back Cover

University Services Sleep Diagnostic

& Treatment Centers........................................................................24

Woodland Group, The.......................................................................19

Classified Ads ....................................................................................24

President’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4NJAOPS President Alan D. Carr, DO, urges members to have a voice in the legislative process,particularly as high-stakes healthcare issues shape the future of the medical profession.

From the Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6Executive Director Robert Bowen highlights two new initiatives to enhanceassociation communications.

Capital Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Government Affairs and Legislative Counsel Laurie Clark provides an update on a newlaw that makes New Jersey the first in the nation to require hospitals to share specificdetails about their medical errors.

Reflections on Becoming a DO . . . . . . . . . . . . . . . . . . . . . . . . . . . .10In “Reflections on Becoming a DO,” AOA President-elect Karen Nichols, DO, Army medicalofficer turned infectious disease specialist Ginamarie Foglia, DO, and maternal-fetal medicineexpert Joseph Bottalico, DO, bring us back to the basics by sharing their experiences andreminding us about what really matters over the course of a physician’s career.

Managing Malpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18Medical liability insurance expert Timothy Hoover shares the latest product for yourinsurance portfolio: regulatory compliance coverage.

Legal Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Health law specialist Mark Manigan gives the latest news in NJAOPS’ fight against the PIP feeschedule, plus provides updates on the most recent changes to HIPAA and Stark regulations.

The Professional Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22In their debut column, medical practice management experts Deborah R. Mathis, CPA,CHBC, and Michael S. Lewis, MBA, FACMPE, offer tips to enhance your billing processes.

Member News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23NJAOPS welcomes its newest members and highlights physician achievements.

ADVERTISERS INDEX

©2009 New Jersey Physicians United Reciprocal Exchange

NJ PURE is proud to be the only medical malpractice provider in New Jersey to be an approved American Express merchant. American Express has been a long-

standing leader in the world of small business and this relationship will now offer New Jersey physicians a level of confidence and service not available with any other medical malpractice provider. In addition, by using your American Express card to pay for your policy, you can earn amazing rewards from shopping to travel to cash back. NJ PURE has an unwavering commitment to its policyholders. The convenience of American Express and the stability of NJ PURE are unmatched in the industry. To learn more about how you can start using your American Express card or for a quote, call us at1-877-2NJ-PURE or visit njpure.com. We look forward to working with you.

We’re one of American Express’s

newest benefits.®


PRESIDENT’S MESSAGE

Alan D. Carr, DO

Lend Your Voice to Policymakers

Since beginning my term in April, I’ve joined previous presidents inencouraging members to get involved

in the legislative process. Some of us havebeen active for years and enjoy theexperience, while others remain on thesidelines and dread setting foot in thepublic policy arena. The daily headlinesreinforce that health care and politics are increasingly intertwined. Some recentinteractions have reminded me of theessential role those of us on the frontline of patient care can have in the discussion.

In mid-September, I attended a meetingwith health policy representatives from one of the gubernatorial campaigns. Bothrepresentatives are public policy experts butnot specialists in health care. This is verycommon, particularly at the state level. Iflegislators are attorneys or businesspeople,can they be expected to be experts inhealth issues too? Most have a layman’s

level of knowledge. Most have small staffsthat have general public-policy expertise.Those of us attending the meeting wereable to provide firsthand accounts of whatworks and what doesn’t in New Jerseyhealth care. The reality is only a cliniciancan provide a comprehensive account ofthe current condition of patient care.

One interaction in particular from thatevening continues to resonate. Toward theend of the meeting, one of the campaignrepresentatives commented that physiciansare the least-visible stakeholder in the publicdiscussion of health care. It was anobservation, not a criticism, and it confirmedwhat many of us already know: issues thatdirectly affect physicians are being debatedand policy is being decided whetherphysicians participate or not. Politicians,insurers, patient advocates, hospitals andlegal lobbyists are ready to determine therole of physicians in the future of health carewith or without us. And if your seat at thetable is empty, don’t count on anyone elserepresenting you and your patients.

Fortunately, a growing number ofphysicians are becoming engaged in theprocess. Allow me to offer a fewobservations from my own experience:

1. It’s easy and painless. We tell our patients this but we don’t take our ownadvice. I’ve communicated with myelected state and federal officials for anumber of years. As a physician andemployer, I contact them on bills thataffect me and my patients, and it’salways been a positive interaction.They welcome constituent input andwith today’s technology, it’s easier than ever.

2. They appreciate your expertise. As I mentioned earlier, legislators deal witha complete array of issues and none ofus can be an expert in every issue. WhenI call or write, I offer my understandingof the bill and how I anticipate it will

impact my practice and the care of mypatients (their constituents).

3. Understand ‘The Rule of Six.’ Most legislation is passed with little or noinput from the public. One rule ofthumb is that any bill that generatesmore than six constituent comments issignificant and is flagged for additionalattention. Is there any good reason whyevery bill that significantly impacts ourpractices doesn’t get flagged because ofphysician feedback? I’m particularlypleased that the newly redesignedNJAOPS Web site at www.njosteo.comincludes a comprehensive “Government”section including a legislative actioncenter where you can interact withwhat’s going on in Trenton andWashington, D.C.

4. Give thanks. Don’t shy away from thanking a legislator who favorably voteson a bill of interest to you or whoregularly supports pro-physician/patientlegislation: There will be plenty of

others on the opposite side, and positivereinforcement is always welcome.

5. Remain committed to your state professional association and whenpossible support JOPAC. Unlike someother medical associations, our boardmembers are uncompensated and payfull dues like the rest of the membership.Our time is in addition to our financialcommitment. One key commitment isour lobbyist in Trenton, who is one ofonly five lobbyists representing physiciansand one of two lobbyists defendingprimary care.

Shortly after the campaign meeting, Iattended another one on the campus ofUMDNJ–School of Osteopathic Medicine.One of my goals is to energize medicalstudents to become engaged in the politicalprocess early in their careers and tobecome accustomed to championing theirprofessional futures and the needs ofpatients. I was excited by their interest,how many were already active in a varietyof ways, and their willingness to reach outto their classmates in a grassroots effort.

To be clear, my message to medicalstudents and physicians is not “say this” or“vote this way,” but rather, educateyourselves on the issues and thoughtfully,carefully come to your own conclusionsand respond accordingly.

This election season, the stakes are high asthe nation debates the country’s healthcaresystem. Those of us who are fortunateenough to work in the system can offer arare perspective that needs to be included.But make no mistake, the debate will takeplace with or without us, so give yourelected officials the benefit of yourexpertise. Communicate the needs of yourpractice and your patients in a clear andeffective manner, and vote Tuesday,November 3. (Remember, if you’reattending the AOA national conventionyou’ll need an absentee ballot). �

Alan D. Carr, DO, is the 2009–2010president of NJAOPS. He is a board-certified anesthesiologist specializing inpain management.

Politicians, insurers, patient advocates, hospitals and legallobbyists are ready to determine the role of physicians in thefuture of health care with or without us.

A no-cost service connectingqualified New Jerseyansto free – or nearly free –prescription medicines

Rx4NJ is a voluntary partnership formed to help people all across New Jersey gain access to free and low-costprescription medicine programs.

The coalition is led by a wide range of patient advocacy and community organizations and New Jersey’spharmaceutical and medical technology industry.

Click: www.rx4nj.org Call: 1-888-Rx FOR NJ (1-888 -793 -6765)

* Each pharmaceutical company and government program determines the eligibility for its program. Specific guidelines and application processes vary.

1. Call or click.2. Answer a few short questions to determine your eligibility.* Have your age,

income, current insurance and prescriptions in front of you before you callor click.

3. Then you’ll be shown the programs and discounts for which you may qualify.

They Clicked. They Called.

They Got Help.

Have a Patient in Need?


FROM THE EXECUTIVE DIRECTOR

Robert W. Bowen

Enhanced Web Site Expands NJAOPS’ Offerings

At the midpoint of our currentofficers’ terms, we’re pleased toprovide an update on our initiatives.

Under the leadership of President Alan D.Carr, DO, we have been enhancing ourcommunications efforts and expanding ourfocus on practice management beyondthe physician.

NJAOPS OnlineThe newly re-launched NJAOPS Web site,www.njosteo.com, is now available as a24/7 member resource, and we’re alreadyattracting record traffic. New-memberapplications, annual dues renewals andAROC registrations can now be completedonline. Nearly all resource and referenceinformation will be moved to the Web site,offering the information you need whenyou want it. Activities are listed on the

site’s Events Calendar, where you can alsoRSVP for county dinners or meetings.Additionally, archives of The Journal arebeing added in an easy-to-use format.

Have you ever wanted to find the name ofa committee chair or your county delegateto the NJAOPS House of Delegates? All of the association’s leadership is includedon the site. The “Find a DO” feature iscurrently linked to the AOA’s database, but soon we’ll offer our own directory ofNJAOPS members to local patients. Visitthe site and watch for new features.

Professional Practice ManagementOur second presidential initiative expandsthe NJAOPS relationship beyond thephysician to the professional practicemanagement staff—your practice manager,

office administrator, etc. To be a betterresource for improving patient care andpractice performance, we recognize theneed to work with each member of yourteam. Launched this summer, nearly tenpercent of NJAOPS’ member practices havealready registered their staff for this excitingnew initiative, which will includeeducation and resources to improveworkflow. If you haven’t yet registered, you can do so at www.njosteo.com under“Resources, Practice Management,” whereyou will also find a growing number ofvaluable reference links.

Call for Leadership NominationsPresident Carr and the NominationsCommittee have opened a call for 2010nominations. Nominations are beingaccepted for the House of Delegates,Board of Directors, Ethics Committee,Membership Committee, New JerseyOsteopathic Education Committee(physicians and non-physicians), andAOA delegates and alternates. If you areinterested in serving your profession orwant to nominate someone, contactPresident Carr ([email protected])or Nominations Committee Chair LeeAnn VanHouten-Sauter, DO ([email protected]).

2010 Awards NominationsNominations are now open for the 2010NJAOPS awards including Physician of the Year and the Special Service andAppreciation recognitions. The Physician of the Year award is the highest honorgiven to an “osteopathic physician who has provided exemplary service to his orher patients and community while activelyparticipating in NJAOPS leadership.”Nominations may be submitted onlineunder “About Us, Awards.” Forms are alsoavailable for download from the Web siteor by mail or fax by calling NJAOPS at732-940-9000. The last day to submit isFriday, December 18. We look forward torecognizing those members who havemade a particularly notable contribution tothe association and profession. �

Robert W. Bowen is the executive directorof NJAOPS.

The Commons at Brewster • 630 S. Brewster Road, Suite B3 • Vineland, NJ 08361

Over 60 combined yearsexperience in Healthcare

Toll Free: 866.304.9909 Phone: 856.692.7702Fax: 856.691.0059 Email: [email protected]

www.PLIGofSJ.com

Medical Malpractice Insurance Solutions

Specializing in...


CAPITAL VIEWS

Laurie A. Clark

Law Spotlights Hospital Safety Statistics

Abill that identifies hospitals’ track records on a broad range of safety performance issues and

rates of medical errors was recentlysigned into law by Governor JonCorzine. Advocates, such as the AARP,who pushed for the bill’s passage, say it will allow patients to make informedhealthcare decisions and force hospitalsto improve their safety.

The bill, S-2471/A-1264, brings NewJersey requirements in line with federalregulations in effect for Medicare andMedicaid. It makes New Jersey the firststate in the nation to require hospitals toshare details about their medical errors.The law also prohibits hospitals fromcharging patients or their insurancecompanies for certain medical mistakes.

Before the bill’s passage, New Jerseyhospitals had already been required toreport medical errors to the Department of

Health and Senior Services, which issuesan annual performance report on hospitalsin the state. However, the report did notdisclose where the errors were takingplace. Only general data showing thenumber and types of errors that hadoccurred were released.

The 2009 New Jersey Hospital PerformanceReport will be the first to include specifichospital-by-hospital events and rates, andinclude statewide and national comparisonsconcerning 14 indicators:

1.A foreign body left in a patient during a procedure

2. Latrogenic pneumothorax

3. Postoperative hip fracture

4. Postoperative hemorrhage or hematoma

5. Postoperative deep vein thrombosis or pulmonary embolism (excluding obstetric patients)

6. Postoperative sepsis (excluding principal diagnosis of infection, or anydiagnosis of immunocompromised stateor cancer, and obstetric admissions)

7. Postoperative wound dehiscence (excluding obstetric admissions)

8.Accidental puncture or laceration (excluding obstetric admissions)

9. Transfusion reaction

10.Birth trauma/injury to neonates (excluding some preterm infants and infants with osteogenic imperfecta)

11.Obstetric trauma/vaginal delivery with instrument

12.Obstetric trauma/vaginal delivery without instrument

13.Air embolism

14. Surgery on the wrong side, wrong body part, or wrong person, or wrong surgeryperformed on a patient

The law also prohibits hospitals fromcharging or seeking to obtain paymentfrom a patient for costs associated with:

� A transfusion reaction

� An air embolism

� A foreign body left in a patient during a procedure

� Surgery on the wrong side, wrong bodypart or wrong person

� The wrong surgery performed on a patient

The indicators were chosen based on work by the federal Agency forHealthcare Research and Quality and the Centers for Medicare and MedicaidServices. The Department of Health and Senior Services will use data from

procedure and diagnosis codes in hospitalbills to compile the information. Most ofthe indicators listed are risk-adjusted byage, sex, diagnosis and comorbidities, andare externally validated as suitable forhospital quality comparisons.

The 2009 Hospital Performance Report isscheduled for release this fall and will beavailable at www.njosteo.com. Memberswho subscribe to the “NJAOPS Update”will be notified when the report is released.

New Prescription Regulations in WorksPatients on certain medications who arenow required to get a new prescriptionevery 30 days will see an easing of thisrestriction if the governor signs a bill thatpassed both houses in June.

Bill S-2550 /A-3799 would permit physiciansto issue up to three prescriptions for ScheduleII controlled dangerous substances, such asRitalin, allowing a patient to get up to a90-day supply if:

� Each separate prescription is issued for a legitimate medical purpose

� The physician provides written instructionson each prescription (other than the firstprescription if it is to be immediately filled)indicating the earliest date on which apharmacy may fill each prescription

� The physician determines that providingthe patient with multiple prescriptionsdoes not create a risk of abuse

� The physician complies with all other applicable laws and regulations

The bill is not intended to encouragephysicians to issue multiple prescriptions,or to see their patients less frequently whenprescribing Schedule II medications.Physicians must individually determinewhether it is appropriate to issue multipleprescriptions and how often to see theirpatients under these circumstances.

The bill is on the governor’s desk. �

Laurie A. Clark is NJAOPS’ governmentaffairs and legislative counsel. She is alsopresident of LegisServe.

The 2009 New Jersey Hospital Performance Report will be thefirst to include specific hospital-by-hospital events and rates,and include statewide and national comparisons.


of why we chose medicine, the noblest of professions, asour profession.

This issue of The Journalshowcases the advice of threeinspiring leaders in the osteopathiccommunity to the newest membersof the osteopathic profession.Authors include AOA President-elect Karen Nichols, DO, Armymedical officer turned infectiousdisease specialist Ginamarie

Foglia, DO, and maternal-fetal medicine expert JosephBottalico, DO. Each hasdifferent backgrounds and offers different experiences andperspectives. But each brings us back to the basics by sharingexperiences and reminding uswhat really matters: empathy,compassion, dedication,excellence and a fervor forlifelong learning.

We live in a society where sound bites reign supreme and

our headlines—online, broadcast and print—are dominated by debates over healthcare reform,reimbursement issues and scopeof practice struggles. It’s easy forthe spectacle of the media toeclipse our mission of preventingand treating illness, and easingsuffering. It’s at these times thatit’s best to get back to the heart

Becom

ing a DO

Reflections on


Ihave a little test for you. Five questionsper section. Two sections. Tenquestions total. No need to write

anything down. You can give yourselfpartial credit. Let’s see how you do.

1. Name the last three winners of the NCAAmen’s collegiate basketball finals.

2. Name the states that produced the last three Miss Americas.

3. Name the last three Vice Presidents, before Joe Biden. (Sarah Palin doesn’t count).

4. Name three Pulitzer Prize winners, any category, any year.

5. Queen Elizabeth II has four children, name three.

So how did you do? Anyone get 100%?80%? 60%?

Let’s try the next section.

1. Name the first three people you called on September 11, 2001, after 9:45 a.m.

2. Name the first three people who called you that day.

3. Name three people who encouraged you to go to medical school.

4. Name the top three people on your list to call if you have a really tough medical case.

5. Name the top three people you call to help you make major life decisions.

So how did you do on that section? Dideveryone get 100%?

Caring CountsSo what’s the difference? The first section’sanswers were famous people and eventsthat were in the national media for days ifnot months. So why didn’t they make theimpression on your memory that thesecond section’s answers did? Of course,it’s because the first group doesn’t knowyou and doesn’t care about you, just asyou don’t really care about them or youwould have recalled them. The impact ofthe second group is solely based on thefact that they cared enough about you tomake a difference in your life and youcared about them. So that is my whole

message: The essence of being a doctor iscaring for your patients, just as that secondgroup cares for you.

Now I don’t want to shortchange the fact that you have been taught the body of knowledge required to become aphysician. Your excellent performance bystandardized measures and the excellentresidencies you are going to attest to howwell you have learned those lessons. Butwe⎯your faculty, your administration,your profession⎯hope you have learnedmuch, much more about how to care foryour patients.

Caring in ActionHere are a couple of stories to demonstratewhat it means to care for your patients.

I remember well the day that woman cameinto the ER in the tiny hospital where I wascompleting a third-year rural rotation inJoplin, Mo. She was barely walking butwas making it under her own steam. A fewhours later she died of a massive MI. Theexcellent doctor came out to talk to thefamily, whom he had never before met andsaid, “Mrs. X came in very sick with a heartattack. We worked very hard, and I’m sorryto tell you she is deceased.” He kindly shook hands with the husbandand sons and took his leave. The familystood there in stunned silence, and I mustadmit, so did I. Slowly the husband turnedto me and asked, “But is she going to makeit?” I silently shook my head no. The family

didn’t know what the word “deceased”meant. I swore right then and there I wouldlearn good communication skills so thatwould never happen to one of my patientsor their family.

Besides communication, another aspect ofcaring is having empathy. This point hithome in my practice when I entered theexam room to meet a new patient. As Iheld out my hand to shake hers, the patientjumped off the table and grabbed me in abear hug. “You don’t remember me, butyou took care of my mother when she died10 years ago. You came into the room andasked how she was. When she said shewas cold, you got a warm blanket andtucked her in just like a little kid. Sherelaxed and fell asleep. Later that night shequietly passed away. I swore that some dayI’d be your patient because you were sokind to her.” Empathy is a powerful partof caring.

Another aspect of caring is the point of thisnext story. Some of you may have heard ofDaniel Schorr. In my opinion, he is thesenior statesmen of journalists. I recentlyheard him being interviewed. Theinterviewer hadn’t done his homework,and instead of asking something pertinenttook the generic approach of “What is thebest advice you ever received in yourcareer as a journalist?”

“Well,” Schorr answered, “in 1953 I gotmy first big break and went to my senioreditor. ‘What can I do to be a really goodreporter?’ I asked. ‘That’s easy,’ he said.‘You have to be sincere. When youinterview someone you will never find outwhat is really in their heart unless theyrealize you are sincere. And when you arereporting the story, you won’t capture thereader’s attention if you aren’t sincere. Yes,that’s it, sincerity. When you learn to fakethat, you’ll do fine.’ ”

Of course, that doesn’t work. Your patientscan always immediately tell if you truly careabout them. You can’t fake caring. Studieshave shown that patients decide whether ornot they trust a doctor in the first 20 secondsof the visit. No time for faking. Early in yourcareer you will struggle with the problem oflooking too young to be a doctor. That’s aproblem you won’t have as long as youwould like, however. But showing yourpatient that you have the maturity to havelearned how to care will help erase theeffect of your youthful appearance.

The Essence of Being a DoctorBy Karen Nichols, DO, MA

THE JOURNAL | FALL 2009 11


These are just some of the things I havelearned. And the learning keeps going on.There is an old adage that says, “In fiveyears, half of what you have learned isobsolete. The problem is, you don’t knowwhich half.” Winston Churchill put it bestwhen he said, “This is not the end. This isnot even the beginning of the end. This isjust the end of the beginning.”

Forever After…The last point I want to make is thatupon receipt of your diploma you willhave a new last name. Forever after, youwill be a DO. Enjoy it. I have to confessthat I didn’t think I would be usingmanipulation much as an ICU-basedinternist. But my patients demanded total

care, and I learned to measure up totheir expectations. Besides, one of thesecrets of osteopathic medicine is youcan’t be aloof when you are holdingyour patient in your arms, performingmanipulation. It just can’t be done.

Cherish your heritage. It won’t let you down.Join your state and specialty osteopathicsocieties, and join the American OsteopathicAssociation. No one else will advocate foryou as a DO. Support your organizations sothey can be strong and be there for youwhen you need them.

So think back to that little 10-question test.The reasons you knew the answers to thesecond section were varied—maybe for

their communication, maybe for theirsincerity, maybe for their empathy, butall reasons come back to the same point,the point that I want to sum up for youwith a phrase I learned from my crustyold OB/GYN professor and with which Iwill close, “Your patients don’t care howmuch you know, until they know howmuch you care.” �

About the AuthorKaren Nichols, DO, MA is Dean andProfessor of Internal Medicine at MidwesternUniversity’s Chicago College of OsteopathicMedicine and the president-elect of theAOA. This was an abridgement of hermessage to graduating students ofUMDNJ–School of Osteopathic Medicine.

This time around 20 years ago, I wasabout to begin my journey throughmedical school. I was excited,

motivated and also a bit anxious aboutwhat was to come. When I now look backon my experiences, I really didn’t have muchof a clue of what I was getting myself into.But would I do it all over again? Absolutely.

As a child, I started out in life wanting tobe a musician, dancer and athlete. Ipracticed the piano several hours a daywith the plan of becoming an accomplishedpianist. I swam until my muscles ached. Idanced until my parents told me to shut offthe music. (They always knew when I washome by the percussion.)

Then my father became ill with coronaryartery disease and required coronarybypass surgery. I was amazed at how thesurgeons “fixed” my father, prolonging hislife and the time we had with him. Indeed,I truly began to respect the role ofphysician and wanted to be one of them.Wouldn’t it be great to learn somethingnew every day while positively impactinganother’s life? You bet. So I saved themusic, dancing and exercise for the stressrelief I would need to pursue such ademanding profession.

You need to have a vision of where youare going and what is expected from youto achieve the goal of becoming a greatosteopathic physician. My guidanceinitially came from reading the OsteopathicHippocratic Oath. Perhaps, it would begood for you to reflect on this during

your rite of passage today as a reminderof why you are here and where you are going.

The first version of the OsteopathicHippocratic Oath began as a suggestion byFrank E. MacCracken, DO, of California tohis state society in 1838. It was modified in

1954 and has been in use since then. Theoath reads:

“I do hereby affirm my loyalty to theprofession I am about to enter. I will bemindful always of my great responsibility

to preserve the health and the life of mypatients, to retain their confidence andrespect both as a physician and a friendwho will guard their secrets with scrupuloushonor and fidelity, to perform faithfully myprofessional duties, to employ only thoserecognized methods of treatment consistentwith good judgment and with my skill andability, keeping in mind always nature’slaws and the body’s inherent capacity for recovery.

I will be ever vigilant in aiding in thegeneral welfare of the community,sustaining its laws and institutions, notengaging in those practices which will inany way bring shame or discredit uponmyself or my profession. I will give nodrugs for deadly purposes to any person,though it may be asked of me.

I will endeavor to work in accord withmy colleagues in a spirit of progressivecooperation and never by work or by actcast imputations upon them or theirrightful practices.

I will look with respect and esteem upon allthose who have taught me my art. To mycollege I will be loyal and strive always forits best interests and for the interests of thestudents who will come after me. I will beever alert to further the application of basicbiologic truths to the healing arts and todevelop the principles of osteopathy whichwere first enunciated by Andrew Taylor Still.”

That was the traditional oath andmission. Now, perhaps a more modern

To Whom Much is Given, Much is ExpectedBy Ginamarie Foglia, DO, MPH, FACP


interpretation of the Hippocratic Oath byLouis Lasagna, MD:

“I will respect the hard-won scientific gainsof those physicians in whose steps I walkand gladly share such knowledge as ismine with those who are to follow.

I will apply, for the benefit of the sick,all measures that are required, avoidingthose twin traps of overtreatment andtherapeutic nihilism.

I will remember that there is an art tomedicine as well as science, and thatwarmth, sympathy and understanding may outweigh the surgeon’s knife or thechemist’s drug.

I will not be ashamed to say “I know not,”nor will I fail to call in my colleagues whenthe skills of another are needed for apatient’s recovery.

I will respect the privacy of my patients, fortheir problems are not disclosed to me thatthe world may know. Most especially mustI tread with care in matters of life anddeath. If it is given to me to save a life, allthanks. But it may also be within my powerto take a life; this awesome responsibilitymust be faced with great humbleness andawareness of my own frailty. Above all, Imust not play at God.

I will remember that I do not treat a feverchart, a cancerous growth, but a sickhuman being, whose illness may affect the

person’s family and economic stability.My responsibility includes these relatedproblems, if I am to care adequately forthe sick.

I will prevent disease whenever I can, forprevention is preferable to a cure.

I will remember that I remain a member ofsociety, with special obligations to all myfellow human beings, those sound of mindand body as well as the infirm.

If I do not violate this oath, may I enjoylife and art, respected while I live andremembered with affection thereafter. MayI always act so as to preserve the finesttraditions of my calling and may I longexperience the joy of healing those whoseek my help.”

It gets to the meat of it, doesn’t it? This isthe goal to achieve, the vision, if you will.

So, you now are referred to as a“Student Doctor.” What does that mean?What does it imply? I came across anarticle just last month describing therole. It read:

“It’s an inflated title, ‘Student Doctor.’More accurate might be ‘Recent CollegeGraduate Who Spends Her Days Buriedin Books.’ Without her fancy white coat,would you expose intimate details to this

stranger? Would you surrender everynook to foreign hands? Would yousubmit your vulnerabilities to a novice?Or would you balk at the youth standingat the foot of your bed?

Would you question the girl with curlylocks while she feigns a professionalfacade? The girl recently mistaken for ateenager when she ordered a glass of wine?The girl who giggles when she sees a cuteguy? The girl who still cherishes her stuffedanimals? The girl who has lived acomfortable life and may not appreciatewhere you’re coming from, even thoughshe listens intently and desperately wantsto understand your world? What gives herthe right to invade your privacy? To subjectyou to such indignities?1”

Real physicians do not graduate from the paint-by-number model. Instead,

differential diagnoses inform theirquestions; clinical judgments dictatetheir physician examinations. Theymasterfully navigate awkwardinteractions, instill confidence andbalance investigator with healer. Theirart makes them worthy of entry into apatient’s world, and this is where youwill be entering very soon.

So enough of the oaths and literature.Would you like to hear how I got throughthese past 20 years? Here are the pearls:

1. Delayed gratification. Keep your eye on your dream. In time you will self-actualize and blossom into the healeryou want to be.

2. There is no substitute for hard work and dedication. See one, do one, teach one.Proficiency only comes from doing thesame things over and over.

3. Be open to opportunities and take risks.You may find your passion in acceptingan internship or training opportunitythat you would otherwise not haveconsidered. For me, it was the Armyand the CDC.

4. Get sick or be involved with a family member who is sick. Live on the otherside a little. It will make you a moreempathetic physician and inspire you

to treat the person more than thedisease. It may also inspire you to takea certain path in your medical careerlike I did.

5. Expect change in many ways. In you,in how your family and friends see you,in medical practice, in the globalenvironment in which we live, etc.Remember, it is not the strongest or thesmartest individual who will succeed inlife, but the one who is most adaptableto change.

6. Be you and be human. You will never know all of the answers. It’s okay tobe uncertain—that’s what encouragesus to learn more. It’s okay to say “Idon’t know,” just follow-up with theanswer later after careful review ofthe literature.

7. Nurture your support system. Your family, your spirituality, your friends,yourself. Find and cultivate positivestress releasers. You will need them.For in the end, it will be your God,your family and your true friends whowill be the ones to fortify you and makeit all worthwhile. You are their legacyand their hope.

Remember to whom much is given,much is expected. I applaud you for yourefforts thus far. It is only the beginning.Do well. �

About the AuthorGinamarie Foglia, DO, MPH, FACP, isClinical Director of Vaccines at SanofiPasteur. As a Lieutenant Colonel in the U.S.Army Medical Corps, Dr. Foglia led a U.S.Department of Defense program in Kenyainvolving HIV/AIDS research and treatment.She is a 1993 graduate of UMDNJ–SOM.This was an abridgement of her message toincoming students of UMDNJ–SOM.

Reference1. Winer, Rachel A. Physician by Number. JAMA, 8 Jul, 2009; Vol 302, No 2.

Wouldn’t it be great to learn something new every day whilepositively impacting another’s life?

You need to have a vision of where you are going and what isexpected from you to achieve the goal of becoming a greatosteopathic physician.



It is my opinion, but I believe it to beshared by many, that there is no highercalling, no greater privilege, than to be

a physician. I’m sure many of you sharesimilar motivations with your faculty forcareers in medicine. I think it is safe to saythat underlying all of those motivations is afundamental desire to help people.Coupling a humanitarian instinct with thenecessary training in medical science,some of you may even break new groundin the frontiers of medical knowledge.

As I reflect on my own motivations for a career in medicine, it wasn’t justscientific curiosity that drove me butalso a strong desire to help people. It isa very simply stated concept—not verysophisticated but powerful nonetheless.This core value starts you on a journey.Whether you become a clinician, amedical or public health researcher oryou pursue other non-clinical careers,you will be given opportunities to help people in many ways. Frankly,otherwise, what’s the point? While there are many rewards from a career in medicine, the best of them will beintangible. There is no greater privilege.

Physicians in HistoryI believe it is important to study the historyof medicine and recognize the contributionsof those pioneers who came before you. It isalso possible that if you are so inclined, andyou seize opportunities presented to you,one or more of you may someday contributeto the history of medicine.

As a member of the medical profession,you will step into what I like to call, “thelong line of white coats.” (I’m borrowing aconcept here from a famous West Pointgraduation speech.) It is important torealize that you stand on the shoulders ofmany doctors who came before you andwho built the foundation for modernmedical practice. However, try never toforget that you also stand on the shouldersof those who nurtured you and providedsupport for you in so many ways. Thosepeople are your family.

Hippocrates (460-370 BC) was therenowned Greek physician who livedand practiced ancient medicine on theIsle of Cos. He said, “Where there is lovefor humanity so also is there love for theart of medicine.” Hippocrates was aremarkable physician, and although anancient, he possessed many skills that are

important to emulate today. FromGarrison’s classic 1929 History ofMedicine text we learn that:

“…with no other instrument of precisionthan his own open mind and keen senses,(Hippocrates) accomplished his bestdescriptions of disease which are models oftheir time today. To Hippocrates, medicinewas the art of clinical inspection andobservation, and he is the exemplar of aflexible, critical, well-poised attitude ofmind, ever on the lookout for sources oferror, which is the very essence of thescientific spirit. Hippocrates was modest,

never criticized fellow practitioners orinflated his own importance.”1

Another ancient Greek, Herophilus, oncesaid, “…nor love, nor honor, wealth, norpower can give the heart a cheerful hourwhen health is lost.” Centuries later,Coleridge said, “The best inspirer of hopeis the best physician.”

Humanism and science. Learn the science.Develop the art. A patient of a physicianwhom I considered to be a role modelonce said, “He treated me like I was hisonly patient.” Many of you have thefundamentals of the art in your heartstoday, nurtured since childhood by thoseCEOs of medical care for most families:your mothers. A prominent pediatricianwas once told by his wife, “You may be agreat pediatrician, but you'll never be a

mother.” As you hone those humanisticskills, you grow and mature as a physician.Learn the science. Develop the art.

I would like to offer some notable quotesfrom the history of medicine. “Theeducation of most people ends upongraduation; that of the physician requires a lifetime of study” (Karl Marx). Nothingcould be more true. As a physician, youcan be a student forever. After all, many ofus never really wanted to leave college inthe first place! The field of medicine offersa tremendous opportunity to spend the rest of your life learning. It is also criticallyimportant to do so in order to provide the best care possible for your patient.Charcot, the great neurologist of thenineteenth century, said, “Disease is fromof old and nothing about it has changed. It is we who change and we who learn torecognize what was formerly imperceptible.”Charcot also said, “How it is that one finemorning Duchenne discovered a diseasewhich probably existed in the timeof Hippocrates?”

As one studies the history of medicine,with all of the giants that came before us, itis important not to be intimidated. They alllearned to walk before they could run.They all had their noses wiped by theirmothers when they were young. You willbe given an education in the best oftoday’s medical science, and if youintegrate that knowledge with yourcuriosity, your scientific spirit and ahumanistic instinct, you too may appear ina future textbook on the history ofmedicine. Don’t let anyone tell you, youcan’t do it.

Lastly under this topic, I suggest to youthat your education in the history ofmedicine and medical ethics will play avery important role in your professionaldevelopment. History provides avaluable context for the special skillsthat will be imparted to you throughyour medical education.

Physicians in Literature and the MediaI think it is very important to pay attentionto the image of the physician in society,past and present. There are many literaryworks, TV series and yes, even blogs, thatdeal with the image of the physician. It is important to pay attention to thosedepictions and recognize where they camefrom. It is also important to learn what notto do.

Learn the Science. Develop the ArtBy Joseph Bottalico, DO


I’m going to date myself a little bit and ask the generation before you toremember the popular TV series “Marcus Welby, MD.” I once heard anilluminating presentation by a respectedperinatal law attorney and RN fromUMDNJ–Robert Wood Johnson MedicalSchool, Marlene Schwebel. Shereminded us that Marcus Welby wasportrayed as the quintessential caringfamily doctor. He was humanistic andeven paternalistic. He knew his patientsinside and out and was a friend of hisrespected patients and their families. Heknew their roles in their communities. Hewas loved, admired and respected by all.He was patient and kind, soothing in hischoice of words and mannerisms, not tomention his dedication.

Robert Young, the actor who played therole of Dr. Marcus Welby, actuallyreceived letters from the public askingfor medical advice. This illustrates animportant reality in medical practice:While it is so important to know the

science, it is equally important to showthat you care. Learn the Science, Developthe Art.

It has been said that patients care lessabout what their doctors know than howmuch they care. Caring will always drive asearch for missing knowledge, but whencaring is gone, all is lost.

Ms. Schwebel also compared andcontrasted the popular image of the familyphysician in the 60s and 70s, MarcusWelby, with a popular fictional physicianin the media today: Dr. Gregory Houseplayed by Hugh Laurie. Marcus Welbyloved his patients. House “hates patientsbut loves diseases.” Marcus Welby waskind, respectful and caring. House isimpatient, arrogant and bothered by hispatients. House is a brilliant diagnostician,but is that enough? Perhaps we should askourselves where this portrayal of themodern physician came from. Did some ofyour professional progenitors perhapscontribute to this image? You can bet on it.

Literature is filled with depictions ofphysicians, not all complimentary. Theshortcomings of Dr. House follows acenturies-old tradition epitomized perhapsbest by Moliere, the seventeenth-centuryFrench dramatist, who according toGarrison, “had no use whatsoever for themedical profession … having written noless than five comedies that railed against

contemporary French internists who hebelieved to have killed his only son withtheir dreaded antimony.”2 Moliere alsoharbored a lasting grudge himself for theirinability to cure his “consumption” (i.e.,tuberculosis). It is important to keep abreastof the image of the physician in societyand do your share, through your example,to strengthen it.

Medical Education and Medical PracticeYou will be challenged in many waysduring your years in medical school andbeyond. It will require much hard work,many hours of study and sacrifice, and veryimportant and formative interactions withmentors and peers, not to mention patients.You will probably run the full gamut ofemotions from elation to dejection.However, lest we all become members ofthe “Prozac nation,” keep in mind thatthese trials and tribulations—these peaksand valleys in the long journey to becomea physician—are fairly universal. Also, asyou go through your medical educationand careers, you will have many teachers,

some of whom will have earned the title ofmentor. Value them. Some very specialones, often without their knowledge, willbecome your role models.

In medical practice, our style of interactingwith patients is very important. Goodphysicians will take the time to learnsomething unique about their patients and ask not, “How is your blood pressuredoing?” or “How is your blood sugardoing? or “How is your pregnancy going?”Instead, good physicians will ask, “Howare you?” “How is the fishing?” “How isyour mother doing?” If you genuinely care,and hopefully you will, you can andshould show that you care. Patientsimmediately pick up on this. Apologize forrunning late. Apologize for rescheduledappointments. These common courtesiesare important to patients. Always rememberthat how much you care is of tremendousimportance to patients. No matter how busyyou are, take a deep breath, connect withyour patient on a human level, and whenpossible, sit down when you talk to them.Don’t have your hand on the doorknob,and please don’t ever refer to them as “thegallbladder in 312” or “the alcoholic in616.” It’s dehumanizing.

It Takes a TeamEvery physician must acknowledge thereality that they are just one member ofthe healthcare team. Learn to value and respect the input and special skills

B.C. Szerlip Insurance Agency has specialized in supporting the practices of health care professionals for almost 30 years. And now, the health care industry’s trusted source for top-rated malpractice, office property and liability coverage also offers general business and personal insurance.

Using our industry-wide contacts, we offer the most comprehensive coverage at the best possible rates, and provide insight that allows you to make informed decisions. In fact, we maintain our partnership with our clients three times longer than the industry average. It’s no wonder why–we operate with ethics, not profits, as our first priority.

Insurance. Experience.Confidence.

800-684-0876www.bcszerlip.com

While there are many rewards from a career in medicine, thebest of them will be intangible. There is no greater privilege.



brought to your patients by a multitude of health professionals in other fields,especially nursing, social services andcountless specialized technicians,dietitians and on and on. The bestoutcomes are achieved when amultidisciplinary team is brought to bearon medical and psychosocial problemswith overlapping complexities. Physicianscan learn to lead this team and setappropriate examples, but we shouldalways remember that we cannot do italone. Not only do we stand on theshoulders of those who came before us,but we all support each other’s efforts

when joined together in the commongoals of alleviating or preventing sufferingand promoting health.

But please, don’t ever accept beinglabeled as just a generic “provider.” Youwill be a physician. Physicians have anancient and privileged role in society,being entrusted with their patients’ mostprivate and sensitive information. Whatgood physicians provide to their patientsis very special and should not be labeledwith the nondescript term “provider.”Our patients, likewise, are patients, not “clients.” In my opinion, the term“provider” is overly generic, somewhatdemeaning and inappropriate. All of us provide something. Professionals have unique roles that deserve to beacknowledged by the use of their proper titles: doctor, nurse, optometrist,physician assistant and so on. To pushback a little, if you ever receive a letter

addressed, “Dear Provider,” I recommendyou respectfully write back, addressingthe sender, usually a third-party payer, as“Dear Merchant.” Maybe they will getthe idea.

Patient AdvocacyIn addition to our role as healers anddisease prevention specialists, we alsoneed to be patient advocates. Physiciansand other medical professionals makemedical care decisions. Insurancecompanies make reimbursementdecisions. Don’t ever abdicate your roleas a physician to an insurance company.Of course, we all have to work withinthe realities of our patients’ availableresources, but there are many situationswhere you can advocate for your

patients and obtain more resources for their care than would have beenavailable had you not taken that extratime to stick your neck out for them.Don’t back down!

Remember, as physicians we have theresponsibility to base our treatmentdecisions first and foremost on theprinciple of beneficence, or “to dogood,” as well as primum non nocere, or“do no harm.” We should base ourdecisions on the best science available,our compassion for the patient and ourrole as patient advocates.

Volunteerism If you are given the opportunity to giveback to the society that grants you suchspecial privileges, I recommend that youstrongly consider doing so. Thoseopportunities will present themselvesthroughout your career, and some ofthem may be barely recognized. I havehad the privilege of being able toparticipate in a few state and nationalhealthcare activities, and I have to tellyou, you get back more than you give.

However, make sure you also give backto your loved ones—your spouse orpartner, your children, your parents, yourfavorite aunts and uncles, your medicalschool. ”To those whom much is given,much is expected.”

A Few Words about LawyersAll physicians in today's world have to learnabout the intersection between medicalpractice and law. If you want to avoidlawyers, my recommendations are simple:

1.Be the best doctor you can be; and

2. Treat your patients the way you would want to be treated. You don’t sueyour friends.

Balancing Life and ProfessionPut on your white coat and journeytoward the ancient role of the healer, the physician. When does it come off?Ideally, never. But that is not to say youcan’t have a life outside of medicine—you can and should, and it is important

to have a balance between yourprofession and your life. Remember,however, to honor your profession withyour white coat on or off. Don’t bebothered by people asking you formedical advice in social situations. Berespectful. Show people that you care.They are probably asking because theythink highly of you.

I would like to close by voicing mysincere appreciation for being given theprivilege of becoming a physician thatwas granted to me by UMDNJ-SOM andalso for the opportunity to deliver mythoughts to you today. I am bit of anidealist but have also been around longenough to have had that idealismtempered by a healthy dose of realism.Nevertheless, I do believe that startingwith an idealistic mindset is important,and you should always carry some ofthat sentiment with you.

As you journey through your medicalcareer, please always keep in mind theneed to marry humanism with ever-advancing scientific knowledge. Werecognize, of course, that you do nothave to get your name into a medicalhistory book to have a successfulmedical career. Every physician is given

many thousands of opportunitiesthroughout his or her career to make amark on mankind.

Your value will be measured by the livesyou touch, the loads you lift, the hearts yousooth, the hope you restore, the familiesyou rescue, the communities you serve,and maybe if you are so inclined and seizethe right opportunities, the society youbenefit by pushing the boundaries ofknowledge further and further. �

About the AuthorBoard certified in obstetrics/gynecologyand maternal-fetal medicine, JosephBottalico, DO, specializes in maternal-fetalmedicine. He is a member of the firstgraduating class of UMDNJ–SOM. This wasan abridgement of his message to incomingstudents of UMDNJ–SOM.

References1. Garrison, F. (1929). History of Medicine. Philadelphia and London: W.B. Saunders Company, Fourth Edition, page 94.

2. Garrison, F. (1929). History of Medicine. Philadelphia and London: W.B. Saunders Company, Fourth Edition, page 296.

It has been said that patients care less about what their doctorsknow than how much they care.

Caring will always drive a search for missing knowledge, butwhen caring is gone, all is lost.

It is important to keep abreast of the image of the physician insociety and do your share, through your example, to strengthen it.


Conventus.The word is spreading

Frustrated with commercial insurancecompanies, a group of New Jersey private practice physicians formedConventus Inter-Insurance Exchange.Conventus is the only medical profes-sional liability insurance company in NJthat’s 100% owned and 100% governedby its member physicians and managed by insurance experts.

It’s contagious.

Now more than 1,000 members strong,Conventus’ steady growth is the result of…

• a conservative, fiscally responsibleoperating philosophy

• claims handling focused on pro-tecting the professional reputationsof physicians

• a risk management program gearedtoward helping members achieve efficiency and reliability in their practice

• fair and individual underwriting withno profit motive

By physicians. For physicians.

We invite you to do your own examinationof Conventus. We’re confident you’ll agreethat it’s the best course of treatment for aproblem that’s been plaguing New Jerseyphysicians for years.

For more information about Conventus Inter-Insurance Exchange:

Call 1-877-444-0484

Mail us at: [email protected]

Visit us online at: www.conventusnj.com

900 Route 9 North • Suite 503 • Woodbridge NJ 07095

Inter- Insurance ExchangePutting Physicians FirstTM


Never in history have you been undergreater pressure to comply withregulatory and billing guidelines. It

seems that no year goes by without a newcompliance requirement. What’s worse, theissues of compliance, oversight andprosecution have been firmly placed withinthe national healthcare debate.

Many believe the maze of physicianregulation now rivals the complexity of theInternal Revenue Service tax code. Thesheer administrative burden of compliancehas created a new and ever-growingliability exposure to your practice.

The average legal bill to defend a singleregulatory complaint can easily exceed$10,000, excluding any additional fines orrecovery. Even complaints to the Board ofMedical Examiners (BME) can carry a pricetag for legal review. These legal fees, finesand penalties are not usually covered bystandard insurance.

Add to this landscape the fact that theCenters for Medicare and MedicaidServices (CMS), commercial companiesand other government regulators areplacing a growing emphasis on findingfraud and non-compliance. It may leaveyou wondering what you can do to protectyourself and your practice.

Fortunately with a little due diligence,compliance complaints can be insured. In

some cases there is no cost. In others, thecost is relatively low and well worth theinvestment. This makes purchasingregulatory compliance insurance a newrequirement within the reach of every NewJersey physician and a must-have for yourinsurance portfolio.

Insuring BME Actions for FreePatient complaints to the BME are notuncommon. In many cases, they go awaywith little more than a response from thephysician. But be warned, no physicianshould ever respond to a complaintwithout having a legal review of thedocument. Complaints can be a

precursor to a malpractice action andthe response can have impact if anyBME action is taken and the documentthen becomes public.

Defense coverage that protects youagainst legal fees for licensing boardactions can be included under manymalpractice policies at no cost. In fact,some companies automatically includethis extension while others require anendorsed extension of the policy. Usually

there is a limit on the amount of legalfees that are covered, with $25,000being typical. So have your malpracticepolicy evaluated to see if you have thiscoverage included.

Other Actions are Also InsurableHIPAA, Recovery Audit Contractor (RAC),Stark, Emergency Medical Treatment &Labor Act (EMTALA), Red Flag, non-

complaint referral agreements, identitytheft, patient privacy, fraudulent billing:These are words that can strike fear intoyour heart if you are pressed to find thetime to see patients, let alone overseeadministrative functions of your practice.The government has increased spending on

compliance efforts in these areas by 15%every year since 1998.

Physicians are definitely targeted⎯not onlyby the government, but by commercialpayers as well. Contractual fraud litigationin New Jersey is well publicized. And whilemost violations are unintentional errors, theeffort needed to defend these infractions isunchanged. Given this, it’s no surprise thatinterest in finding an insurance product toprotect against these exposures is high.

The good news is that protection fromexposure to the legal costs, fines andpenalties that arise from these regulatoryrequirements is now available to individualphysicians at an affordable cost. Coveragecan be arranged to apply only to newpatient activity or, alternately, to applyretroactively to past events.

A single physician can buy a policy with a $1 million recovery limit for a typicalpremium that ranges between $1,000 and$1,500. Larger groups pay even less but

often have the option to purchase higherlimits. At that price, every physician shouldhave this protection.

Uninsurable ActsFraud and intentional illegal acts are neverinsurable. And recovery of overbilledamounts is not a provision of mostcompliance policies. The coverage intent isusually restricted to removing the defensecost burden and to pay fines and penaltiesfor inadvertent violations. But that alone isa major benefit well worth pursuing.

Regulatory compliance insurance is availableonly through agents. It is not sold directly orthrough malpractice companies. �

Timothy L. Hoover, CPCU, is theHealthcare Practice Leader with theWoodland Group. He can be contacted at [email protected] or 973-300-4216.

MANAGING MALPRACTICE

Timothy L. Hoover, CPCU

Compliance Insurance Now Available

The average legal bill to defend a single regulatory complaint can easilyexceed $10,000, excluding any additional fines or recovery… These legalfees, fines and penalties are not usually covered by standard insurance.

The government has increased spending on compliance effortsin these areas by 15% every year since 1998.

The good news is that protection from exposure to the legal costs,fines and penalties that arise from these regulatory requirementsis now available to individual physicians at an affordable cost.


You shouldn’t have to face the dilemmaof choosing between your practice andyour malpractice coverage. Let our teamof specialists diagnose your specific insurance needs and create a custom solution your practice can live with.

To find out more, contact: Tim HooverThe Woodland Group376 Route 15, Suite 205Sparta, NJ 07871973.300.4216Fax [email protected]

Is your malpractice

coverageputting you

between a rock and a hard place?

www.woodlandgroup.com75 Years of Healthcare Experience.

NowEndorsed by

NJAOPS

10/5/04 1:14 PM Page 1


LEGAL PERSPECTIVES

Mark E. Manigan

New HIPAA and Stark Changes Rolled Out

Medical practices should be awareof some major changes to thehealth information privacy act,

known as HIPAA, which took effect in September.

The new rule requires all HIPAA-coveredentities to notify affected individuals whenthere is a breach of security. The Departmentof Health and Human Services (HHS) andthe media must be notified in cases wherea breach affects more than 500 people.Breaches affecting fewer than 500 peoplemust be annually reported to the HHS.

The rule also requires that physicians’business associates notify the physicianwhen a privacy breach occurs by thatassociate. Now is a good time to reviewagreements with business associates toensure they include a breach notificationclause. Practices should also consideradopting breach notification policies andshould amend HIPAA business associatepolicies and procedures to reflect thesenew requirements. Visit the PracticeManagement Resources page ofwww.njosteo.com for a comprehensiveguide to the HIPAA privacy rule.

Stark Law UpdateNew changes to the physician self-referral law, known as Stark, also wentinto effect on October 1. Stark prohibitsa physician from referring a patient, whoreceives assistance from Medicare orother federal healthcare programs, forcertain designated health services (DHS),to an entity with which the physicianhas a financial relationship, unless anexception applies.

This prohibition has now been extended toarrangements where services are billed bya hospital but are actually provided by aphysician-owned entity under contract withthe hospital. By changing the definition of“entity” to include the person or entity thatperforms DHS, the Centers for Medicareand Medicaid Services expanded the graspof Stark. This change will significantlyaffect physician relationships with hospitalsand their ability to refer patients. Starkrarely applies to ambulatory surgical

centers as most surgical services performedat ASCs are not designated health services.

Also newly prohibited are “per-click” rentalcharges in space and equipment leasesbetween service entities and physicians ifthe charges reflect referred services. Pre-existing leases will not be immune fromsanction, so existing leases should bereviewed to ensure compliance.

PIP Fee Schedule Goes to High CourtThe fight against the drastic cut inreimbursement to physicians throughPersonal Injury Protection (PIP) policiescontinues at NJAOPS with a petition askingthe New Jersey Supreme Court to reviewthe lower court ruling that permitted thePIP fee schedule revisions.

More than three years ago, the Departmentof Banking and Insurance (DOBI) revisedthe PIP fee schedule by adding nearly1,000 CPT codes to the previousschedule’s 92 CPT codes and, for the firsttime, setting a fee schedule for ambulatorysurgery centers (ASCs). The fee scheduleset fees across the board at 115% ofMedicare rates. A legal battle ensued andthe implementation of the fee schedule wasput on hold until this summer when theAppellate Court ruled to adopt the originalfees with one major exception: fees wereincreased to generally 130% of Medicare,with various adjustments in the 130%–800% of Medicare range. ASC fees wereincreased to about 300% of Medicare.

NJAOPS legal counsel has asked the stateSupreme Court to review the decision andinvalidate the fee schedule. We have alsorequested that the court stay the feeschedule pending its review. Furthermore,NJAOPS is aggressively seeking correctivelegislation. In the interim, the fee scheduleapplies to all services other than inpatientservices provided by acute care hospitals.So it is important for physicians to notesome of the schedule’s significant changes.

Under the new regulations, insurers⎯notpractices⎯set the usual, customary andreasonable (UCR) fees for a procedurewhen no corresponding CPT code appears

on the schedule. The insurer determinesthe reasonableness of a practice’s fee bycomparing its experience with that practiceand others. In submitting bills for unlistedservices, physicians must base their fee on a comparable procedure and providedocumentation describing the procedure.However, the insurer determines which CPTcode is appropriate. It’s important to note thatthe use of the Ingenix database in determiningfees is prohibited pending review.

Furthermore, the fee schedule limitsreimbursement for osteopathic manipulations(CPT Codes 98925-98929) to $99 per day.However, a provider may be reimbursed inexcess of the daily maximum by showingthat the treatment required extraordinarytime and effort.

The fee schedule also adopts Medicarestandards when billing for bilateralsurgeries, co-surgeons, assistant surgeonsand multiple procedures. For multiplesurgeries subject to the multipleprocedure reduction, the highest valuedprocedure will be reimbursed at 100% of the eligible charge and additionalprocedures reimbursed at 50%. For co-surgeries, each co-surgeon will now be reimbursed at 62.5% of the eligiblecharge. The need for co-surgeons isdetermined by authorities such asMedicare and not by the physician. Withregard to multiple surgeries, the highestvalued procedure will be reimbursed at100% while contemporaneous procedureswill be paid out at 50% of the eligiblevalue unless the schedule denotes theprocedure as fully reimbursable.

As for ASC facility fees, the scheduleresults in a drastic cut in reimbursementfrom prior amounts. Multiple proceduresperformed at an ASC also will be subject to the multiple procedurereduction, as discussed above. Visit the Practice Management Resources page of www.njosteo.com to review the complete fee schedule. �

Mark E. Manigan is a member of BrachEichler’s Health Law Practice Group,NJAOPS’ general counsel.

A Beacon for Success

Clients have long come to

rely on Brach Eichler for

guidance in navigating the

dynamic changes of the

health care industry.

Our health law attorneys

have provided representation

to private physician practices,

ambulatory care facilities, hospitals,

medical staffs, nursing homes,

physician organizations, home health

agencies and hospices to help them

recognize emerging and evolving trends

within the health care industry and

interpret those realities into successful

business outcomes.

Todd C. Brower [email protected]

Lani M. Dornfeld [email protected]

Burton L. Eichler [email protected]

John D. Fanburg [email protected]

Joseph M. Gorrell [email protected]

Carol Grelecki [email protected]

Kevin M. Lastorino [email protected]

Debra C. Lienhardt [email protected]

Mark E. Manigan [email protected]

Richard Robins [email protected]

Jenny Carroll [email protected]

Deborah Cmielewski [email protected]

Eric Gross [email protected]

Rita Jennings [email protected]

Leonard Lipsky [email protected]

Isai Senthil [email protected]

Edward Yun [email protected]


Welcome to the debut of “The ProfessionalPractice,” a new column to equip practiceswith tools needed to raise office operationsto a higher level of professionalism andpatient care.

Billing is the key to the financial successof every medical practice. Whetheryou are in a solo or group practice,

you have a vested interest in the success ofyour billing operation. When evaluating theeffectiveness of your billing and collectionprocess, there are six important areas to keepin mind. Doing so will allow you to isolateproblems and develop corrective actions.

1. Lag TimeLag time is the time between the date ofpatient service and the date of charge entry.Practices should strive for a date-of-service

lag time of less than 24 hours for officecharges and less than 72 hours for hospitaland surgical charges. Anything more canindicate problems in your practice, such asa backlog of charges in your billing office,which can delay the entire revenue cycle.

Take a look at the issues that are causingyour billing lag time to be excessive. Arethe physicians in your practice givingencounter forms to the billing office beforethe end of the day? If not, set a policy thatrequires them to do so. Think about usingelectronic charge capture devices to reducelag times for hospital charges.

2. Insurance DenialsClean claims drive the cash flow of a practice.Mistakes by your billing office could becausing insurance denials. Front office staffersoften fail to verify insurance information forpatients, billing invalid insurances. Orperhaps there are coding errors or incorrectdemographic and insurance data. Denialsshould be categorized and reviewed dailyto correct the problems. Also review yourprocess of collecting information to assesshow incorrect information is getting on claims.

3. Aged Accounts ReceivableAged accounts receivable (aged A/R)measures the age of the balances due to yourpractice. Typically aged accounts receivableare broken down as insurance balances andpatient/guarantor balances. Aged A/R providesan analysis of how long it takes for claims tobe paid. When run for insurance companies,this tool illuminates which insurancecompanies are taking the longest to pay claims.

For example, Medicare is required to payelectronically submitted claims in 14 days.Therefore, an aged A/R showing 90-day-oldMedicare claims indicates a problem.Claims may be getting rejected during theinitial submission process. These rejectionsshould appear on the reports generated byyour practice management system. Theserejections won’t appear on the Medicare

Explanation of Benefits since they have nottechnically been accepted. The billingreports must be carefully reviewed each dayto ensure that claims have been accepted.

The aged A/R also measures the age of the patient balances due to yourpractice. Studies show that the older apatient balance becomes, the less likelyit is to be collected. Practices shouldprovide patients with a financial policythat sets forth your guidelines on patientresponsibility. A hardship policy shouldalso be adopted so arrangements can be made for patients who are truly infinancial need, ensuring these balanceswill not continue to age.

4. Gross Collection Ratio This ratio is calculated by dividing grosscollections of the practice by gross charges.Be aware if the gross collection ratio for asingle physician is significantly differentfrom other physicians in your practice. Thephysician with the lower gross collectionratio may be providing services that are notbeing reimbursed and likely needs moreeducation on reimbursement issues.

5. Net Collection RatioThis ratio is calculated by dividing netcollection (gross collections minus refunds)by net charges (gross charges minuscontractual allowances). This tells you whatpercentage of every dollar your practice isreceiving after contractual allowances.

As an example, if your practice charges $100for a routine office visit and Medicare’sallowance in 2009 is $66.24, the grosscollection ratio is 66.24%. If the practicecollects only the Medicare payment, but notthe co-payment, it would collect $52.99 andthe net collection ratio would be $52.99divided by $66.24 or 80%. The median netcollection ratio in the 2008 Medical GroupManagement Association (MGMA) CostSurvey for family practice was 98.6%.Practices should strive to be in the high 90th

percentile for their specialty. Aggressivefollow-up on outstanding insurance claimscan help you increase your net collectionratio. Practices need to look at systemic issuesthat are causing delays in claims payments.

6. Days Charges in Accounts Receivable Days charges in A/R measures the turnaroundtime for claims to be paid. You can’t pay billsfor expenses faster than you are getting paid.The median days charges in A/R in the2008 MGMA Cost Survey for family practicewas 42.6 days. This means that on average, ittakes 42.6 days for claims to be paid. As withimproving net collection ratio, the key toreducing days charges in A/R is aggressivefollow-up on outstanding claims.

With so many external factors affecting yourrevenue, it is important to maximize yourinternal billing and collections processes toimprove your accounts receivable efforts. A well-oiled billing operation, whether in-house or outsourced, will improve youraccounts receivable and allow you to focuson patients instead of financial problems. �

Deborah R. Mathis, CPA, CHBC, isShareholder/Director, Healthcare ServicesGroup for Cowan, Gunteski & Co, andMichael S. Lewis, MBA, FACMPE, isDirector, Healthcare Services Group forCowan, Gunteski & Co. They can bereached at (732) 349-6880.

THE PROFESSIONAL PRACTICE

Deborah R. Mathis, CPA, CHBCMichael S. Lewis, MBA, FACMPE

Top-Notch Billing Bolsters Bottom Line

With so many external factors affecting your revenue, it is importantto maximize your internal billing and collections processes toimprove accounts receivable efforts.


MEMBER NEWS

New MembersNJAOPS is pleased to welcome the followingphysicians into new membership this quarter.

Associate Members

� Richard Levandowski, MDFamily Medicine, Lawrenceville

Intern, Resident and Fellow Members

� Wasiu Adisa, DOInternal/Emergency Medicine, Stratford

� Ashley Albers, DOInternal Medicine, Stratford

� Brian Beluch, DOInternal Medicine, Stratford

� Michelle Bermingham, DOInternal Medicine, Stratford

� Michael Bianco, DOInternal Medicine, Stratford

� Shelley Bianco, DOInternal Medicine, Stratford

� Andrew Caravello, DOInternal/Emergency Medicine, Camden/Stratford

� Suvid Chaudhari, DOInternal/Emergency Medicine, Stratford

� Wei L. Chen, DOInternal Medicine, Camden/Stratford

� Wunhuey Cheng, DOInternal Medicine, Stratford

� Drew Chiesa, DOInternal Medicine, Stratford

� Michael Chow, DOInternal/Emergency Medicine, Stratford

� Ann Fernandez, DOInternal Medicine, Stratford

� Amee Garg, DOInternal Medicine, Stratford

� Amir Gerges, DOInternal Medicine, Stratford

� Kevin Gershuny, DOInternal Medicine, Stratford

� Alan G. Ghaly, DOInternal Medicine, Stratford

� Zeina R. Ghayad, DOInternal Medicine, Stratford/Camden

� Jospeh Gambale, DOInternal Medicine, Stratford

� Melissa Green, DOInternal Medicine, Stratford

� Jamie Hung, DOInternal Medicine, Stratford

� Sona Kothari, DOInternal Medicine, Stratford

� Stacey M. Kuhfahl, DOInternal Medicine, Stratford

� Ellen J. Kurkowski, DOInternal/Emergency Medicine, Stratford

� Alan Lucerna, DO, Internal Internal/Emergency Medicine, Stratford

� Patricia Mento, DOInternal Medicine, Stratford

� Megan Merrill, DOUrology, Stratford

� Daniel Merz, DOInternal/Emergency Medicine, Stratford


MEMBER NEWS

Classified

Practices for SaleTwo, long-established medical

practices for sale.Camden: 856-963-8907Lumberton: 609-267-8888Jack Goldstein, DO

Position WantedBoard-certified internist seekspart- or full-time employment inthe central New Jersey area.

267-242-4719

� Thomas Papa, DOInternal/Emergency Medicine, Stratford

� Reynaldo Paraiso, DOOtolaryngology, Livingston

� Vincent G. Peterson, DOInternal Medicine, Stratford

� Derrick Plahn, DOInternal Medicine, Stratford

� Kelly Schiers, DOInternal Medicine, Stratford

� Robert J. Shmuts, DOInternal Medicine, Stratford

� Michael R. Sinkoff, DOInternal Medicine, Stratford

� David Somerman, DOInternal Medicine, Stratford

� Amanda Ann Valvano, DOInternal Medicine, Stratford

� Ramneet Wadehra, DOInternal Medicine, Stratford

� Anthony Wehbe, DOInternal Medicine, Stratford

� Brian Weingart, DOInternal Medicine, Stratford

� Joan Wiley, DOInternal Medicine, Stratford

� Aria Williams, DOInternal Medicine, Stratford

� Julianne Wysocki, DOInternal/Emergency Medicine, Stratford

Life Member

� David Skole, DOFamily Practice (Retired), Margate City

AchievementsNJAOPS is proud to announce the followingachievements and awards earned by our members.

� Frederick G. Meoli, DO, of Cherry Hill, will recieve the Distinguished ServiceAward at the 114th AOA OsteopathicMedical Conference and Exposition inNew Orleans in November. The award,the AOA’s highest honor, will bepresented in honor of Dr. Meoli’soutstanding efforts to further theosteopathic profession througheducation and licensure.

� Craig M. Wax, DO, of Mullica Hill, was recently elected to the physician editorial board of Medical Economics.

� Richard Jermyn, DO, of Stratford, and Millicent Channell, DO, of Stratford,were inducted into the Gold HumanismHonor Society at the UMDNJ –School ofOsteopathic Medicine (SOM) WhiteCoat Ceremony on August 2. Dr.Jermyn is Associate Professor, ActingChair of Rehabilitation Medicine andDirector of the NeuroMusculoskeletalInstitute at SOM. Dr. Channell isAssistant Professor of OsteopathicManipulative Medicine at SOM. Alsoinducted were UMDNJ–SOM studentsEdward Gettings, Felicia Johnson, JoanLee, Xityalichomiha O’Dell; Rana Randand Erin Toller. Membership in thesociety is based on demonstratedexcellence in clinical care, leadership,compassion and dedication to service.

More than 17,000 healthcare professionals in the Northeast depend on medical malpractice insurance from ProMutual Group for protection and peace of mind.

To learn more about ProMutual Group, call us at (800) 225-6168 or visit us online at www.promutualgroup.com.

PROTECT, PREVENT, DEFEND.

ProMutual Group Agents:Michael R. Bernal-SilvaMBS InsuranceBoonton, NJ – 800-347-3417

John BisbeeBoynton & BoyntonRed Bank, NJ – 800-822-0262

Kevin ByrneAcorn Professional ServicesWest Conshohocken, PA – 800-454-2429

Bob CottoneRUE InsuranceTrenton, NJ – 800-272-4783

Mary DonohueBrown & Brown MetroMt. Laurel, NJ – 856-552-6330

Tim HooverThe Woodland Services GroupSparta, NJ – 800-253-1521

Henry S. KaneArgent Professional InsuranceWarren, NJ – 908-769-7400

Steven KlingerProfessional Consulting ServicesLivingston, NJ – 973-597-0400

Shawn KnechtelWiderman & CompanyHaddonfield, NJ – 800-220-3434

Ed LynchHealthcare Risk SolutionsFort Washington, PA – 800-215-2707

Carol MaselliConner Strong CompaniesPhiladelphia, PA – 267-702-1375

Jennifer M. MoserBrown & BrownPhillipsburg, NJ – 908-689-5988

Richard PetryGlenn InsuranceAbsecon, NJ – 609-641-3000

William A. ReillyJoseph A. Britton AgencyMountainside, NJ – 800-462-3401

Rory RineerProfessional Liability AgencyHarrisburg, PA – 800-375-3056

Don RobertsUSI MidAtlanticPlymouth Meeting, PA – 484-351-4600

Patty SchaefferAON/Affinity InsuranceHatboro, PA – 215-773-4600

Kim SoricelliArthur J. Gallagher AssociatesMontclair, NJ – 973-744-8500

Burt C. SzerlipBC Szerlip Insurance AgencyLittle Silver, NJ – 800-684-0876

Robin VoorheesThe NIA GroupSomerset, NJ – 800-669-6330

Eileen YuenBollinger InsuranceShort Hills, NJ – 800-350-8005

Chris ZuccariniCornerstone Professional Liability ConsultantsRadnor, PA – 800-508-1355

101 Arch Street, Boston, Massachusetts 02110 | 1.800.225.6168 | www.promutualgroup.com


April 14 17, 2010 Bally’s Atlantic City– •

The largest physician conventionand exhibition in New Jersey

Atlantic Regional Osteopathic Convention

AROC20 01

Business of Medicine

Geriatrics

End of Life Care

Infectious Disease

Internal Medicine

Law & Order:Medically Speaking

NeurobehavioralDisorders

OMM

Pediatrics

Radiology

Risk Management

Sleep Disorders

Surgery

Also...

Alumni Events

American Red CrossBlood Drive

Basic Life SupportRecertificationfor Clinicians

Practice Managers’Seminars

732-940-9000njosteo.com

Featuring

the country’s

largest regional

osteopathic

exhibit hall

Documents

The Journal