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I want to thank my Joyce, my wife, whose love all these years has been the wind beneath my wings, and to Joyce and my son Adam and daughter Jennifer for bringing some much joy, music and beauty into my life.

So I am sure you are all hoping to hear some good news along with our good meal.

So what has my society done for me lately?   You ask?


Well, I’ll tell you:

The NJ State society, is the oldest professional society in the country, older than the US, with support from the 21 county societies, of which Bergen is the largest county society, has remained the watchdog of medicine in Trenton, in recent years affecting many legislative efforts and initiating 5 successful lawsuits for hundreds of millions of dollars from some of the largest insurers.


MSNJ is crucial in holding the line of erosion of Medicine in this state.


Since its inception in the horse and buggy days, the society has mediated the needs of patients , doctors and government, and the business community, forming at one time insurance companies and meeting many other needs, and fostering many  a good legislation


The society has also sponsored many educational seminars, webinars and other activities:


For instance, In 2009 The Medical Society of New Jersey and the Rutgers Center for Management Development partnered to offer the Rutgers MiniMBA: Strategic Healthcare Management certificate program at a reduced tuition rate.


This certificate program provides MSNJ members with the strategic business skills needed to navigate today’s rapidly changing healthcare environment in thirteen, three-hour sessions, at a 20% discount off the $4,995 tuition.


In 2011, the MSNJ helped pass the assignment of benefits bill, stopped a regulation allowing nurse anesthetists to practice independently of anesthesiologists. Helped pass a bill that allows doctors to refer patients to an ASC in which they have ownership interest.


2011 the society fought for:

Agains Bill S-2707 which will allow an APN to determine cause of death

For Bill A-3378 Out of Network Healthcare Reform Bill

Along with the radiological society of NJ—legislation to provide a tax credit for ASC owners who also provide in-hospital charity care



 MSNJ 's Legal Defense Benefit provides MSNJ members with high quality legal representation at the earliest stage of a legal action; the most critical stage when you’re the target of an investigation.


The MSNJ Insurance Agency (MSNJIA) offers physicians all types of insurance products for their personal and professional lives.


The Lunch & Learn Webinar Series are half-hour web presentations for physicians and practice managers to get up-to-date healthcare information


New Jersey Medicine-online - weekly edition of NJM-online including categorized specialty and subspecialty articles from peer-reviewed journals and a personalized briefing as it relates to how you practice medicine.


MSNJ has a Certified Professional Coder on staff for members to consult with.

That is Important especially when you realize that 30% of physicians recently surveyed by medscape have no savings or funds for retirement.


MSNJ and BCMS have some terrific and dedicated members and staff - Here today, Larry Downs, Chief Executive Officer, brings with him: his leadership, decades of dedicated service and legal expertise


MSNJ presidents: Doctor Niranjan (Bunky) Rao and Dr. Mary Campagnolo, I have witnessed them to be both dynamic and able leaders, have brought many innovation these 2 years—the ACO task force, DOCBookMD, and crucial legislative guidance on the structure of the upcoming insurance exchange in Trenton.


Dr. Ruth Schulze, MSNJ president Elect, a tireless and passionate fighter for physician rights and tort reform who has inspired so many of us.


Dr. Steven Frier, who has been instrumental in writing bylaws for Englewood hospital that are amongst the most protective for physician rights in this county; a long time  Champion for abolishing the death penalty and who gave every physician in this state a free membership to the county and state medical Society.


Dr. John Poole, now treasurer at MSNJ, who as Chairman of the MedAC (Medical Action Committee), has raised $300,000 dollars. Famous for quotes such as “If you’re in medicine, you’re in politics and the best way to predict the future is to create it.” Champion of the dollar-a-day campaign for this year, John’s eloquence in explaining our cause is legendary—he is often quoted, never imitated—and many of his quotes are in the long version of my speech on my web site.


Tim Martin –our lobbyist-- taking over the reigns from his father, this year retiring from 25 years of service to MSNJ and physicians throughout the stated,


Quote from Dr. John Poole:  

“Whether it’s advocating for tort reform, reining in managed care, or fighting unwieldy unwise  legislation that constantly bombard our profession and our patients, our lobbyist and MedAC moneys are working hard for you, being the only state-wide, multi-specialty Physician’s PAC in New Jersey.  It advocates for all physicians no matter what specialty or practice situation."


February 2010--The 2131* Legislative Session, which came to its conclusion 1/’10, was hands down the most productive two year cycle of the last decade. We saw many great achievements, prevented the enactment of potentially harmful policies, and fought hard to secured important amendments to unfavorable legislation, with details on the web site:


Right to Refer legislation, which was critically needed to reverse a court ruling that physicians were in technical violation of the law when treating their patients at their ambulatory facilities despite 17 years of SMBE opinion to the contrary. It was our first order of business last session and Governor Corzine signed it into law last Spring.


After years of debate, an Involuntary Outpatient Commitment law was finally enacted in the summer of 2009, making New Jersey the 43’ state to give its courts such an option. MSNJ, working closely with our partners in the New Jersey Psychiatric Association, successfully persuaded lawmakers to adopt amendments to strengthen the role of physicians in the placement decision.


Following a Drug Enforcement Agency rule revision, MSNJ successfully pursued 30 X 3 Rx legislation allowing physicians to provide 90 days worth of Schedule II CDS when it makes sense for their patients. The new rules go into effect next month and will benefit any number of patients that demonstrate long term stability on certain drug regimens.


Again working with our friends at NJPA and the New Jersey Hospital Association, we worked to achieve the enactment of a Bill Package to Improve Patient Placement for the Mentally Ill by requiring the Department of Human Services to establish procedures for assisting hospitals with patient placement, standardize admission protocols and medical clearance criteria, and perform a statewide needs assessment. The plight of the acutely mentally ill in New Jersey emergency departments is an underreported crisis, and we were proud to be a part of this important effort.

Finally, the true highlight of the 213th was without a doubt the enactment of the Assignment of Benefits bill. When effective, the provisions of this important achievement will prevent insurer payment tactics from driving a wedge between physicians and their patients by requiring out-of-network payment to be sent directly to the provider.


Very Recent Discussions championed by Dr. Brand, president of Essex County society, with Glen Pomerantz, Chief Physician and VP of BCBS are yielding small but important changes in their web access and dealings with physicians.


MSNJ has also worked to make bills better, achieving vital amendments to threats such as the No-Pay Bill, Medical Marijuana legislation, and the expansion of the Scope of Chiropractic.


It’s clear that we are spending too much on health care for too little return.  

Annual per capita expenditures in the US being $3-4000 higher then the most expensive European countries and the health of their citizens is better. Private insurers are using up to 31% of premium dollars for what they call administration and up to $200 billion a year is wasted on defensive medicine and malpractice and up to half of our health expenditures may be curtailed with better life styles and diet.


As physicians we have harped on the destructive power and spiraling cost of malpractice.

We have pointed out the better life styles and smarter diets.

We have fought to preserve health savings accounts and pass legislation that preserve patient choice and health benefits for patients. 


Senate Majority Leader Loretta Weinberg, here today, was for instance instrumental in forcing insurers to abandon a 23 hour limit on hospital stays for deliveries and increased it to a minimum of 48 hours for mothers and their babies.


But we have not come up with enough methods to curb, much less lower the cost of health care; so government and insurers are doing this by rationing care  when they fail to reimburse, discourage investments and starting now by penalizing hospitals for costly infections or frequent readmissions and starting ACO’s


ACO’s – giving a lump sum to physicians and hospitals and other facilities organized to be more cost effective, with the hope they will deliver greater value of healthcare—sounds great on paper but these are still unproven methods, with some hospital systems abandoning them already.   I also worry that medical decisions to forgo surgery, chemo, or a timely discharge will be viewed by suspicious patients  as serving the bottom line of an ACO, instead of then being  recommended because these decisions were medically sound.  ACO’s will undoubtedly ration certain screening procedures, such as colonoscopies, to comply with imperfect guidelines, guidelines which we already know, from cases such as Johns Hopkins, are indefensible in court.  Couple these with the sure knowledge that ACO’s represent new deep pockets -- you can see a feeding frenzy of malpractice lawyers circling around each ACO medical record department.


I am personally disappointed that physicians and hospital entered ACO’s instead of holding out for complete and total Tort reform. Or how about abolishing malpractice in favor of a direct compensation board where all, not just lucrative medical torts, are compensated?  . 

In my view, There will only be one more chance, when ACO contracts come up for renewal in 3 years, for the medical community to stand together, stand together without any stragglers, outliers, high riders or low riders, for the whole medical community to stand together and tell the government - malpractice in its present form, and ACO’s, and health cost containment, cannot co-exist.


And in the meantime, what is a physician to do?


Medicare reimbursement will fall when the SGR gets implemented next year, as more and more insurers lower out of network reimbursements to 130% of Medicare, and in network reimbursement will be cut to well below Medicare? And insurers will yet still charge much higher rates for OON insurance?


Besides buying stock in these insurance companies, what can a physician do to stem the tide of lower reimbursement and higher costs?


Several suggestions can be made:


First, practice defensibly—your carrier will have many specific instructions for you.  Do not practice out of your scope, avoid risky situations and patients, for instance refer chronic narcotic users to pain specialists, attend malpractice seminars often, and document, document, document.  We just had a seminar earlier today--


Second, carefully evaluate, by talking to your colleagues, whether entering meaningful use will actually make you money, or if you are better off just living with the 2-3% medicare penalties that will come starting in 2015.


Third, learn to defend your online reputation – more on this on my website.


Fourth—Take care of yourself. When Dr. Bunky Rao came to VH, as president of the MSNJ, and proposed we follow our own BMI and in other ways Take good care of ourselves, I was concerned it was falling on deaf ears.  Now I take care of a lot of healthcare personnel, and many physicians, and I can tell you, we make bad patients.  Sometimes we even don’t listen to our doctor.   


I am happy to report, Dr. Rajinder Rao, (MSNJ outgoing president, attending today, who started initiative for physicians to heal themselves) that a recent MEDSCAPE survey showed less than  10% of MD’s are obese vs. 60% of Americans—but physicians need to take care of themselves and of each other—we need to cover each other better—good sign-out and clear notes will have an immediate benefit on the health of your covering physician—and for those who don’t type as I do, I paid for the ad for Kate Gladstone, a professional handwriting coach—use her!  and --have that colonoscopy,  have that rectal, do the skin check,  see your GYN, don’t delay, don’t wish problems away, and don’t treat yourself—for heaven’s sake, listen to your doctor !!!


Consider---Seeking to join fellow colleagues in large single or multispecialty groups that will be able to get better reimbursements from insurers and benefit from economy of scale, and, thereby limit your exposure to Medicare and Medicaid, possibly seek to become your own ACO.  This is not a pipedream—this is happening right now,


Consider---Sell practice to hospitals, who are better reimbursed for the same work that you do—just be aware of limitations in your contracts.  


The society will strive to have educational seminars on all these topics and we are building a database to help answer many of these questions—initially this will be on my website, and I hope soon after, will be available through the society.


What else?


My favorite is CONCIERGE MEDICINE—despite dire warnings thousands of concierge practices are thriving.  Whether full concierge models where a physician contracts a large practice to about 5-10% that pay $3-4000 yearly, or the more popular hybrid model, where nothing changes in your practice except that ~ 5% are converted to concierge services that allow then daily walk in hours, free annual physicals and hour long appointments, newsletters, and your personal phone number or beeper.


15 years ago, 5 patients of Lois Copeland, one of our own physicians from PVH, and the AAPS sued the federal government for the right to contract out of Medicare. Several years later congress changed the law to make that very difficult but a growing number of doctors, often aided by the AAPS, are making the transition. 


I believe these trends will continue, as they preserve the doctor patient relationship, preserve quality of care and preserve physician reimbursement. 


Also, full or hybrid concierge, and private Medicare contracting work well with mega-groups, selling to a hospital, or, if you prefer, staying solo and autonomous and small.


I believe that nationwide we are moving towards a two tier system such as is prevalent in much of the world.





In my view these are all viable alternatives.


So what else, you say?


Introducing DocBookMD, a smartphone application designed by physicians for physicians and only available through the MSNJ, exclusively to MSNJ members.

DocBookMD provides physicians on the go an exclusive HIPAA-compliant professional network to communicate, collaborate and coordinate with their colleagues.


• Fast, HIPAA compliant secure messaging

•sending  Vital patient information, X-rays and picturs, right from your phone to

Any  MSNJ colleagues  ... and much more!


Introducing MedXcom—an inexpensive and very sophisticated electronic answering system that is Fast, HIPAA compliant & secure , saves all conversations for 23 years,

 loaded with features, that is growing capabilities rapidly.


Introducing from Drs. Ceryl and our own Vivian Bethala, two brothers who with several other physicians severely affected by the devastation of Katrina, built their own internet physician referral network and are now taking it national


Medical Societies throughout the country are banding together, using social media to rapidly assimilate members and act collectively to multiply their strength,


DOCBookMD , DoctorsElite, and MedxCom are but a few of the new breed of communication tools for society members or doctors only, social media can keep our membership constantly aware of our efforts, our successes, and especially any immediate needs for letter writing, or attendance at crucial meetings.To help this effort, I have discussed with Larry Downs and Julie Lynch, CFO a college internship program that will bring willing hands to help with both paperwork and electronic media integration to all county and state offices that might want to utilize them-- I will be writing and managing the didactic part and  A pilot will be starting in my  office and Bergen county society fall of 2012. Within 1-2 semesters We intend to expand to other counties and add to the cadre of interns at the state society.


The didactic portion of the program will be available on line, and will serve as a primer for society members as well as the interns on over 25 topics of interest to physicians--


This year the state and local counties are looking into ways we can regionalize and reorganize around social media to be more efficient and cut our membership dues to help in this effort, Bergen County will be holding more of its board of trustees meetings in hospitals, instead of its own offices.


Principally, this would save the state and local governments and hospitals and physicians lots of money. 


So I want to thank all the wonderful vendors that helped make this evening possible--- their ads are featured in the commemorative journal and will be featured on my web site. 


I want to thank Larry Downs, Dr. Rajinder Rao, and Dr. Mary Campagnolo for their support, and




Dr. Steve Frier, and all the board members, for their sage advice and support,


Senate  Majority leader Loretta Weinberg, for coming tonight,


I want to thank my friends for sticking with me all these years,


I want to thank Anjanette for handling a 1000 little details,


And I want to thank you all,


So get on the websites, mine and that of the county &  state medical society, get DocBookMD, get MedXcom, get, get going getting us your colleagues as members—tell them there is a good thing going on here –we have terrific and dedicated doctors, and we have terrific and dedicated legislators-- together we can make thinks better !


So eat up, drink and stay late—its BIENERTIME !


Health at a Glance 2011: OECD Indicators - © OECD 2011

Source: OECD Health Data 2011



Source: OECD Health Data 2011

World Bank and National sources for non-OECD countries

Source: OECD Health Data 2011

Source: OECD Health Data 2011