The Alliance for Quality Care, Inc. is a coalition of healthcare providers, including the ASC, orthopedic surgery, pain management, and neurosurgery communities (the "Alliance"). Formed in the fall of 2005, the Alliance has identified and worked vigorously on many challenges facing the provider community. Please see our 2007 Agenda page for more details.
The Alliance has developed, and continues to develop, regulatory, legislative, political, and legal strategies to deal with these challenges. The Alliance has made a difference over the past year and intends to capitalize on the organizational and political momentum it has created.
JANUARY 23, 2010
Yesterday Governor Christie released his transition team subcommittee
reports to the public. Of particular interest are the reports submitted by
the DOBI and Health subcommittees. As you know, I was asked by Governor
Christie to serve on the Health Subcommittee and honored to do so.
While bound by confidentiality restrictions, now that the reports have been
made public I can update you. The reports deal with a number of topics, but
of immediate interest is the unfair treatment of out-of-network ("OON")
providers and ambulatory care facilities. Brach Eichler will be
distributing a more in-depth analysis of these reports in a couple of days,
but we wanted to reach out for you as soon as we could on some important
It would be unprofessional to discuss the process pursuant to which the
analysis on these issues came about and potentially disrespectful of the
hard work that the committee and its chair put in. I was very impressed by
the professionalism with which the business of the committee was conducted
and the dedication of its members, staff and chair. However, I could not
countenance, in any form or fashion, the analysis of OON providers and
ambulatory care facilities contained in the report. The resemblance which
it bears to the positions of the insurance and hospital industries is too
strong. Suffice it to say that I requested that my name be removed from the
report, which request was graciously granted by the committee chair.
Further, Governor Christie has been made aware of my concerns.
The Health report identifies as one of the three major factors causing the
poor financial condition of NJ hospitals "the proliferation of ambulatory
care and ambulatory surgery centers in competition with hospitals without
any obligation to care for the uninsured" and that ambulatory care
facilities have "siphoned paying patients away from hospitals." The Health
report also identifies as significant healthcare policy issues "leveling the
playing field" and "the out-of-network problem." Upon reading these two
phrases we at Brach Eichler think of leveling the playing field between
healthcare providers and insurance companies and, regarding "the OON
problem," the various threats (both in terms of insurance company business
practices and regulatory schemes) to the right and ability of providers to
go OON -- and survive OON. Very few healthcare providers, and virtually no
small healthcare providers, possess any leverage to negotiate rates with
insurance carriers. The only leverage is to not participate. When we hear
"OON problem" we think about any reduction or tampering with this precious
and exceedingly limited leverage.
Unfortunately, the Health report goes in another direction and makes the
following recommendations to the Governor: (i) DOH should explore capping
OON charges and prohibiting waiver of co-payment amounts; (ii) ambulatory
care facilities should have the same regulatory requirements as hospitals;
(iii) ambulatory care facilities should have to report cost and quality data
similar to hospitals; (iv) list prices charged to uninsured patients should
be made public; and (iv) the ambulatory care facility assessment should be
increased. The report fails to mention anything positive about ambulatory
care facilities, patient freedom of choice, or the fact that physicians
provide charity care services without recompense every day, etc., etc.,
The DOBI report was equally anti-OON. The DOBI report noted "the explosion"
of ASCs in the state and that "providers moving OON will put inordinate
strain on the healthcare market place." The report also knocked the
recently enacted assignment of benefit legislation, noting that the new law
"will leave no incentive for providers to remain in-network, as higher rates
will be guaranteed." If only that were true. There was no analysis in the
report of in-network provider reimbursement levels or what percentage of
providers are actually OON, let alone any discussion or consideration of the
overall provider environment in New Jersey versus other states.
The DOBI report also admonishes the new administration to be "vigilant of
Legislative initiatives to redefine how the the [PIP] fee schedule is
calculated." We can tell you there will be no such attempt that we are
aware of. There will be an attempt, however, to get DOBI to calculate fees
as currently required by law.
Transition committees play an important role in the transition of governing
from one administration to another and I was honored to be part of the
process. However, they do not serve in a policy making capacity. That
function rests with Governor Christie and the Legislature.
The Christie campaign was very fair, open minded and interested in what the
provider community's issues were. I was and continue to be very impressed
by the these folks and how they handle themselves and conduct business.
Over the last couple of years the provider community has worked hard, with
some success, to advance its agenda and to retard the agenda of those trying
to harm us. That hard work must and will continue. With a new Governor and
new leadership in the Legislature the transition committee reports serve as
a reminder that the interests adverse to ours are significant and far
reaching. We remain optimistic, however, that Governor Christie, Senate
President Sweeney, Speaker Oliver and the rest of the leadership in the
Legislature will maintain open minds and a continued willingness to "hear
our case." In this regard we look forward to continuing the fight, side by
side with you.