HAMILTON, NJ -- At the organization's first annual Healthcare Leadership Summit, Senate President and former Governor Richard Codey urged members of NJ Physicians to get more involved in the political process.
 
"Doctors love to talk about politics but rarely get involved in politics," Codey told the group of assembled physicians, state legislators, and representatives of business, labor, healthcare, the pharmaceutical industry and the legal community.
 
NJ Physicians, an organization representing some 1,100 New Jersey doctors, presented its first annual Healthcare Leadership Summit on April 14 to discuss the future of healthcare in New Jersey.
The summit was held at the Hilton Garden Inn Hamilton.
 
During a question and answer session, Governor Codey and Assembly Majority Leader Bonnie Watson Coleman both said that requiring more New Jerseyans to hold health insurance is imperative to improving quality of care in the state, as well as efficiency.
 
About 1.4 million people in the state -- 15 percent of residents -- lack health insurance.
 
Later in the program, a panel discussion focused on current issues underscoring the conflict between physicians and managed care organizations.
 
Much of the discussion focused on "step edits" -- requirements by managed care companies for doctors to prescribe certain drugs prior to prescribing other, more costly, pharmaceuticals -- and the increasing burden posed by insurance company pre-certification and pre-authorization requirements.
Commissioner Steven Goldman of the Department of Banking and Insurance urged the NJ Physicians members to look for better ways of communicating with insurance companies as a way of resolving issues of step edits, pre-certifications and pre-authorizations. Commissioner Goldman also urged greater use of the Internet or other electronic systems to more efficiently handle pre-authorizations and pre-certifications.
"I think it's highly unlikely we are going to move back to pure indemnity plans in this country, so I think that this sort of tension which clearly does exist ... in fact will continue to exist," he said. "The principle difficulty that I've seen since I have been commissioner is an enormous lack of communication generally between the physician community and the insurance community."
John Ciccone, MD, a cardiologist from Essex County and a member of NJ Physicians' Leadership Council, said the growing use of step edits and pre-certifications represent improper interference with a doctor's sound patient care decisions and are a growing threat to patient safety.
For example, Dr. Ciccone said he has been forced to change a patient's prescription based on the insurance company's demands. "For financial reasons, and purely financial reasons, you're asked to change the treatment plan that has been successful for that patient," he said.
He said the practice puts patients at unnecessary risk of adverse side effects, increases administrative costs for the doctor and confuses patients.
"Let's remember who is managing the care. It's not the insurance company. The insurance companies are managing the costs. The physicians are managing the care," Dr. Ciccone said. "If managed care was designed to save money for the healthcare system, it's done a pretty poor job," he added, noting that nationwide healthcare expenses rose from about $740 million in 1990 to more than $2 trillion.
Assemblywoman and Health and Senior Services Committee member Linda Greenstein, who also participated in the panel discussion, said she does not believe that doctors should remain liable for cases in which medical decisions are overridden by the insurance company. "I realize that would be a radical break," she said. "But I intuitively don't think the doctor should be liable."
 
Panelist Jill Young, DO, an anesthesiaologist, cited a recent attempt by a managed care company to end the practice of providing anesthesia to people undergoing colonoscopies as an example of how interference with a patient's medication plan can be a slippery slope to other restrictions.
 
NJ Physicians is an organization created in late 2007 by six doctors concerned about the quality of medical care and the future of the practice of medicine.   Six months after launching, the organization's membership has risen to approximately 1,100 of the state's doctors.