The Daily Record

Money Flows To GOP From NJ Spine Doctors

State weighing change in PIP reimbursements

Daily Record — Saturday, October 22, 2011

Written by Michael Symons | Statehouse Bureau

TRENTON — Spine surgeons and related medical professionals donated $70,000 to the New Jersey Republican State Committee in late September, as the state insurance department was soliciting testimony about its plan to restrict how much doctors would be paid for treating car-crash victims.

The donations include 10 contributions of $5,000 each from physicians, neurosurgeons, anesthesiologists and a spinal surgery center, all made on Sept. 21. Five days later, the Medical Society of New Jersey Spine PAC made a $20,000 donation — apparently the first since its creation in 2008, according to campaign finance reports — to the Republican state party.

In late September, state officials met with spinal surgeons to discuss their concerns, Division of Insurance director Douglas Wheeler told the Assembly Financial Institutions & Insurance Committee. That meeting was Sept. 28, a week after the physicians' donations were made and two days after the donation from the Medical Society committee.

"Indeed, the department met late last week with spinal surgeons and neurosurgeons at which time they raised some issues, and we instructed them to submit written comments so that they would have the opportunity to address those issues through the formal (Administrative Procedures Act) process," Wheeler told the Assembly panel at an Oct. 6 hearing.

Dr. Robert Heary, a professor of neurological surgery at the University of Medicine and Dentistry of New Jersey's New Jersey Medical School in Newark and president of the New Jersey State Spine Society, said the donations were unrelated to the meeting and his "gigantic concerns" about the proposed rules. He gave $5,000 of his own money; he's also treasurer of the Spine PAC.

"Donations are people's own choices, what they want to do with donations," Heary said.

Department of Banking and Insurance spokesman Ed Rogan said it's not uncommon for stakeholders to meet with department officials during a proposed rule's public comment period. "It happens sometimes," he said.

"That was just part of the process," said Rogan, who said the meeting was requested by the surgeons. "What he did was he asked those groups to submit their issues with PIP as part of the record, and their concerns will be something we review as well."

Wheeler had told the Assembly committee there were many meetings with interested groups while the rule proposal was in development, leading up to its August release.

"These proposed changes were not developed hastily, but rather over the course of several months following dozens of meetings with the wide spectrum of stakeholders — including the medical community, doctors, hospitals, including trauma hospitals, attorneys, both defense and plaintiffs' bars, insurance carriers and agents. ... No group was turned away," Wheeler said.

Insurance companies support the state's plan to establish new rules for how no-fault "personal injury protection" medical claims are handled when people seek treatment for injuries suffered in a car crash. New Jersey Citizen Action and some attorneys and members of the medical professions are opposed.

The proposed rules attempt to limit the use of arbitration to settle disputes between insurers and providers and significantly expand the list of treatments for which reimbursements to doctors are locked in by state rules. Both moves would clamp down on efforts to game the system, state officials say.

Critics of the proposal have cited a five-day limit on the time patients and providers would have to appeal claim denials, reliance on a managed-care style system and reimbursements for some treatments so low that providers would decline to provide care. Efforts to limit fees to lawyers in arbitration cases could hurt patient care, as well, some contend.

"It could be detrimental over time to the quality of care and the availability of care," said Timothy Martin, a lobbyist for the Medical Society of New Jersey.

Heary said the proposed reimbursements for spine surgical procedures are "very, very, very much less" than out-of-network reimbursement rates measured by not- for-profit FAIR Health Inc. He said there are surgeons in states with low reimbursements, such as Pennsylvania, who won't accept car-insurance cases.

"We want our patients if they're in a motor vehicle accident to have the best care from all the spine surgeons, not have limited access to their care due to an insurance fee schedule which does not adequately compensate surgeons for the amount of work, the amount of training, the amount of risk involved in taking care of these critically injured patients," Heary said.

Heary said there are more than 80 acute- care hospitals in New Jersey and 85 neurosurgeons, meaning there already aren't enough to cover the emergency rooms without "voluntary overtime," under w hich doctors cover multiple hospitals or work extra nights. Federal law says neurosurgeons can only be required to be on call once every three nights, and Heary worries the new rules would curb volunteerism.

"If we're going to ask people to do more than they're obligated to do, and ask them to do it for a third or a quarter of the reimbursement that they have been getting, the odds of us having people to continue to do that go down dramatically," Heary said. "If people stop doing voluntary overtime, we develop a health-care crisis and an emergency."

Trauma care isn't covered by the proposed reimbursement caps.

New Jersey Manufacturers Insurance Co., the state's largest auto insurer, has said the proposed rules are significant because they establish reimbursement limits for the first time for spinal procedures, which are common after car crashes and can carry unpredictable and high reimbursement costs.

"The department is appropriately focusing on the most common treatments connected with automobile accidents," said NJM spokesman Eric Stenson. "Obviously the back surgeries they're looking to add would be appropriate to add because they' re common treatments and were omissions we'd seen in the previous medical schedules."

The time frame for public comments to be submitted ended last week. State officials now must pore through and develop responses to more than 10,000 comments that were received, then have until the beginning of August 2012 to make a final decision about the proposed rule.

"Obviously, we don't want to take anywhere near that," Rogan said. " PIP has been a top priority for Commissioner (Thomas) Considine. ... It's an urgent matter for him, so we would like to do it as quickly as possible."

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