Chairman McKeon and Members of the Committee,

Thank you for the opportunity to answer questions many of you had during the hearing last week, specific to  emergency department care and how patients are currently protected from out of network emergency bills.

I am Dr. Margie Langer, a board-certified emergency   medicine physician and President of the NJ Chapter of the American College of Emergency Physicians.  I currently practice in an emergency department in Passaic County and prior to that I practiced in Essex County.  I am an Emergency Department Director responsible for the administration of the Emergency Department and the clinical care of patients in their time of greatest need and vulnerability.  I am here today hopefully to answer questions, specific to the staffing, network participation and billing of Emergency Departments (EDs). I hope you can indulge me slightly because it seems there is some basic Emergency 101 needed to understand who is providing care and submitting claims in an ED.   

Final Days of the 2016-2017 Legislative Session

SURPRISE COVERAGE/OON BILLING BILL STALLS

NJ MEDICAL SCRIBES AS PMP DELEGATES

NJPMP DATA TO BE SHARED WITH EDIE

ED EXEMPTION TO CHECK THE PMP PRESERVED – MANDATE DELAYED

New Jersey has a new Governor. Governor Phil Murphy was sworn into office with Lieutenant Governor Sheila Oliver at the War Memorial in Trenton today, January 16, 2018. The Executive and Legislative Branches are now all majority held by democrats. 

NJ-ACEP continues to represent the interests of emergency medicine and work with other specialist societies through the Access to Care Coalition and actively oppose the Out of Network Legislation (S-1285), sponsored by Senator Vitale.  Trenton is in the middle of a fierce Budget battle with a July 1 deadline and the Out of Network legislation has become tangled in this year's budget and other politically charged issues, once again, including Governor Christie and Senator Vitale's proposal to take $300 Million in Horizon's surplus for opioid addiction treatment (among other reforms for transparency within Horizon's organizational structure).

We learned late Friday night that S-1285, the OON Transparency/Disclosure/Arbitration legislation, would be added to the Senate Budget and Appropriations Committee for Monday without public notice and NJACEP leadership reached out to members of the Committee over the weekend, as did NJ-ACEP's lobbyist and the Coalition in advance of the hearing.  S-3299, the OON Transparency/ Disclosure-only legislation sponsored by Senators Sarlo (D) and Oroho (R) and supported by NJ-ACEP and the Coalition was also scheduled for the same hearing on Monday.   Putting both these bills on the committee agenda at the same time was a compromise by the sponsors and Senate leadership.  S-3299 addresses transparency and disclosure without setting prices or dispute resolution.

S-3299 was unanimously approved by the Committee Monday with support from the Coalition, individual specialty societies, and NJHA.  And, although 5 Republicans and Chairman Sarlo (D) abstained on the vote for S-1285, the balance of the democrats, some expressing reservations, supported S-1285 and it was approved by the Committee.  NJHA and the physician community all opposed S-1285.  NJHA had previously supported this measure and their Board last week withdrew its support.

•  NJPMP’s Interstate Data Sharing now includes:  PA, MA, NH, ME and WV.

•  Expands patient history searches to two years of patient’s prescription records.

•  Automatically converts dosages of commonly-prescribed opioids of differing potency, such as codeine, fentanyl, and oxycodone, into a standard value known as “morphine milligram equivalents” (MME).  

OPIOID PRESCRIBING AND RESOURCES 

The State has created a webpage with all the information you need on the new opioid prescribing laws, as well as links to key resources including a sample one-page pain management agreement and FAQs on the law.

Click READ MORE for description of the bill

Thank you to Dr. Jenice Forde-Baker who testified during the Senate Health Committee hearing on the ED PMP exemption bill on Monday, May 14. She did a great job explaining the need for ED exemption and answered the questions posed.  NJ-ACEP continues to fight this bill. Click READ MORE to view her testimony.

NEW JERSEY CHAPTER, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS EMERGENCY DEPARTMENT OPIATE PRESCRIBING GUIDELINES

1. Emergency department providers are committed to addressing the analgesic needs of all patients presenting for care.
2. Chronic pain syndromes are best managed by physicians with an ongoing relationship with a patient in an outpatient office environment.
3. Emergency department providers should consult the Prescription Monitoring Program (PMP) before writing opioid prescriptions.
4. Physicians should prescribe the lowest effective dose for the shortest possible duration for pain severe enough to require opioids.
5. Emergency department providers should not replace prescriptions for controlled substances that were lost, destroyed, stolen, or finished prematurely.
6. Unless otherwise clinically indicated, Emergency Department providers should not prescribe long-acting or controlled release opioids, such as OxyContin® or fentanyl patches.
7. When opioid medications are prescribed, the Emergency Department staff should counsel the patient regarding risks of opioid therapy, proper storage, and administration.
8. Clinically appropriate administration and prescription of opioids should be provided to patients with cancer pain.
9. Hospitals, in conjunction with emergency department personnel, play a key role in ensuring responsible opioid administration and prescribing. As such hospitals should:
   • Support emergency department practices to provide the most appropriate management to patients with chronic pain.
   • Develop care plans for patients who frequently visit the emergency department for evaluation of acute exacerbations of chronic pain. Coordination should involve the emergency department, hospital, and the primary care provider treating the patient’s pain‐inducing condition. Such care plans may include patient‐specific policies or treatment plans. Screening for brief intervention and referrals to treatment programs for patients who are at risk for developing, or who actively have, substance abuse disorders may be appropriate for these patients.
   • Recognize that parenteral administration of opioids is generally not in the best interest of a patient with an exacerbation of a chronic pain.

Click here to download document.