New Jersey Healthcare Blog

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Medicare Solvency: A Continuing Challenge

The Medicare Board of Trustees recently projected that the Medicare program will be insolvent in 2024.  Unfortunately, the news may be even worse than that.  If you read pages 265-267 of the Trustee’s report which is the Actuarial Opinion, there are two (2) critical assumptions being made by the Trustees in order for the Medicare […]

Accountable Care Organizations

Dr. Donald Berwick, Administrator of CMS, has recently written about the potential benefits of Accountable Care Organizations (ACO’s), ( as is set forth in the attached article one of the hurdles facing the provider community is that ACOs will cost millions of dollars that are unlikely to be recouped (at least in the short term). […]

Sustainable Growth Rate

Attached is an article from the American Medical News in regard to the Sustainable Growth Rate (SGR) formula and its application to the Medicare physician fee schedule.  This issue is still on the table and is moving to the forefront again.  The result of the application of the SGR would be a 29.5% cut in […]

Beth Christian Elected Chair of the Health & Hospital Law Section

Beth Christian of our Health Care Department has been elected Chairman of the New Jersey Bar Association’s Health and Hospital Law Section.  This election is clearly a recognition by her peers of her contributions in the legal field of Health Care. Beth joined us in January of 1990.  Prior to that, Beth spent a number […]


At the presentation given by Frank Ciesla, Sharlene Hunt and Beth Christian at the New Jersey Medical Society’s Annual Meeting on Friday, May 13, 2011, in New Brunswick, we discussed the potential impact on fees paid by third party payors to providers in light of the medical loss ratio limitations set forth in the Patient […]

CMS Proposals for Accountable Care Organizations Are Described As Unworkable By Healthcare Organizations

Today’s Associated Press article contains comments from the medical community that the Obama administration’s proposals for Accountable Care Organizations (ACOs) are unworkable.  The American Medical Group Association, which represents entities such as the Mayo Clinic, the Geisinger Health System, the Cleveland Clinic, and Intermountain Health Care (among others) wrote to CMS this week and indicated […]

Regulations Regarding Accountable Care Organizations

The proposed regulations in regard to Medicare Accountable Care Organizations (ACOs) have been issued by the Centers for Medicare and Medicaid Services (CMS).  The position paper of the Internal Revenue Service (IRS) regarding ACOs, the combined position paper of the Federal Trade Commission and the Justice Department in regard to ACOs, and the combined notice […]

CMS Concern Regarding ACOs

The Congressional Quarterly Health Law Daily of May 6, 2011 quoted CMS Administrator Dr. Donald M. Berwick as stating, in regard to the comments regarding the proposed Accountable Care Organizations, “. . .that the Agency is interested in working with providers and wants the program to live up to the potential of transforming medical care,” […]

Medicare Balance Billing

A bill was introduced in the House of Representatives last Wednesday, which would permit physicians to balance bill Medicare patients, between what Medicare will pay and what the physician’s charges are for his services. This legislation is being considered by the House Energy and Commerce Committee, as a potential solution to the issue regarding Medicare […]

Health Centers

The Centers for Medicare and Medicaid Services, as you will see in the proposed regulations published Friday in the Federal Register, is attempting to establish criteria for assuring access to Medicaid services. This proposed regulation has already drawn comments from various state officials as reported on Tuesday, May 3, 2011 in the New York Times. […]

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