Frequently Asked Questions
Questions and answers on the EHR Demonstration [April, 2008]
Are there certain sections of the Medicare Waiver Demonstration Application that do not need to be completed?
Applicants are not required to fill out the following sections of the application: Performance Results, and Payment Methodology & Budget Neutrality. The Payment Methodology & Budget Neutrality sections of the application are not required because CMS is not providing any funds to community partners as part of this demonstration initiative. There is also no need to provide, as part of the “Medicare Waiver Demonstration Applicant Data Sheet,” the Medicare Provider number, as the community partners will not be providing any Medicare services to Medicare beneficiaries, nor the Employer Identification Number. In addition, under the Organizational Structure & Capabilities section of the application, applicants do not need to provide copies of applicable Federal and State licenses, provide financial statements or audit opinions, indicate if the applicant is a Medicare provider in good standing, or describe any other applicable accreditation, credentialing, and/or certification processes and results. However, applicants must include, as part of this section, detail regarding the entities that will be part of the community partnership (if multiple stakeholder organizations are involved); how, specifically, each will support CMS in outreach, education and physician practice recruitment efforts (newsletters, mailings, etc.); and the resources they will provide (e.g., staff, meeting space). The application must also provide the lead contact for the proposed community partner organization(s); we will expect this individual to be accountable for the activities of the community partner. Contact information for this individual must be provided.
What will selected community partners be expected to do?
Community partners will assist with education, outreach activities, and recruitment of all potentially-eligible physician practices in the defined site. (See the response to the question above for examples of such activities.) Community partners will also collaborate with CMS on an ongoing basis in an effort to assist us in achieving our goal of leveraging the combined forces of private and public payers to drive physician practices to widespread adoption and use of EHRs. As such, we are seeking organizational entities that have the necessary infrastructure and a strong commitment to advancing the adoption and use of EHRs and are capable of supporting CMS in these activities.
When will CMS start recruiting physician practices in the selected communities?
CMS will start recruiting physician practices in the four Phase I communities in the fall of 2008. Practices in the remaining eight communities (Phase II) will be recruited the following year (fall 2009).
How will CMS select physician practices in the communities? Will the community partner be able to determine which physician practices are selected?
Physician practices that are interested in participating in the demonstration will be asked to complete and submit an application form developed by CMS. The application period for practices located in communities identified as being part of the Phase 1 implementation will begin in the fall 2008, after the selection of sites and community partners. The application period for practices located in Phase 2 sites will begin one year later, in the fall 2009. CMS will review all applications and be solely responsible for all decisions regarding physician practice eligibility and selection to participate in the demonstration. Eligible practices will be randomly assigned to either a treatment or control group. Community partners will not determine which practices are selected to participate in the demonstration or which practices are assigned to the treatment or control group.
You are recruiting 200 physician practices in each community, but only 100 will be eligible for incentives. What is expected of the 100 practices that won’t be eligible for incentives? Why can’t all the physician practices receive incentives?
In order to determine the effectiveness of the financial incentives on the adoption of EHRs and the impact on the quality of care, this demonstration incorporates a “randomized” design whereby half of the practices will be eligible to receive the incentive and the other half will not. Practices that apply to participate in the demonstration are equally likely to be randomly assigned to the demonstration “treatment” group or to the control group. Therefore, the only way for a practice to enjoy the benefits of financial incentives under this demonstration is to apply to participate and possibly be assigned to the treatment group. While it is true that control group practices will not be eligible to receive financial incentives under the demonstration, neither treatment nor control group practices are restricted in any way from participating in other incentive programs that we hope the presence of this demonstration will encourage. In addition, the demonstration will place no reporting requirements on control group practices. In order to earn incentives under the demonstration, treatment group practices will be required to submit clinical quality data in years 2 through 5 and complete an annual Office Systems Survey (OSS). Control group practices will only be asked to complete the OSS at the end of years 2 and 5 and will be given a modest payment for the time required to complete the survey. Control group practices will not be required to submit any clinical quality data. Thus, while the potential direct benefits may be less, there will be minimal, if any, burdens on control group practices. More importantly, if this program is successful, it may provide a model for future Medicare policy or similar incentive programs outside of Medicare. However, the success of this initiative cannot be measured without an appropriate and rigorous evaluation design, which requires a randomized control group for the purpose of comparing outcomes. By participating as part of the control group, practices will provide a valuable contribution towards the possible long-term impact of this demonstration and future programs.
For detailed FAQ section on the EHR Demonstration please refer to website: http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_pv=4.988
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Fingerprinting and criminal background checks of healthcare workers [June 13, 2007]
Are physicians required to be fingerprinted and to undergo criminal background checks? Why? Who else must meet this requirement?
The “Health Care Professional Responsibility and Reporting Enhancement Act” requires all healthcare professionals licensed in the state of New Jersey to be fingerprinted and to undergo a criminal background check. The original legislation was passed in 2002 with overwhelming bipartisan support. It subjected all healthcare professionals to criminal background checks. Since then, all new licensees have been subject to the criminal background check. The legislation was amended in May of 2005 to extend the background checks to renewing licensees if they had not previously been required to undergo the check.
Many practicing physicians have already undergone the Criminal History Record Background Check process for the Division of Consumer Affairs (dca) and, therefore, will not be required to complete the soon-to-be-released Certification and Authorization (c&a) form. All background checks will be conducted only once.
While many of our members view this regulation as a hassle and an invasion of privacy, we feel that it is important to clarify that this legislation is not intended to “target” physicians, but, rather, was enacted as a broad-based public safety measure. It extends the requirements to all healthcare professionals who are in contact with patients. Fingerprints and background checks have become de rigueur for many professionals, including lawyers and teachers. Many municipalities and non-profit organizations are requiring them for volunteers, such as coaches for recreational sports teams.
The reason that members have only begun to hear about this 2005 requirement is dca’s tardiness in sending out letters and the c&a form to all its licensees. They began in 2005 with nurses, anticipating that it would take up to four years before all licensees received further notification about the next step of the background check. There is no obligation on the part of physicians until they receive the c&a form. Regulations concerning dissemination of criminal history–record information prohibit the sharing of the material for any reason other than the authorized and intended use.
MSNJ believes that this legislation brings all healthcare providers up to a single standard of background checks. For more information, go to: www.state.nj.us/lps/ca/chbcfaq.htm where you can find answers to frequently asked questions.
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Starting a practice
Where can I get information on starting my own practice?
By law, licenses and certificates are required from the following three agencies:
- New Jersey Board of Medical Examiners, 140 East Front Street, 2nd Floor, Trenton NJ 08608, 609.826.7100, or www.state.nj.us/lps/ca/medical.htm.
- Controlled Dangerous Substance Registration, Department of Law & Public Safety, Drug Control, P.O. Box 45022, Newark NJ 07101, 973.504.6545.
- In addition, the law requires physicians to register their medical license with the County Clerk in the physician’s county of residence.
If you need more assistance, contact your county medical society. The address and telephone number of your county medical society can be found on our web site by clicking on County Medical Societies, under About MSNJ.
The American Medical Association (AMA) offers a primer titled “Starting a Medical Practice.” Contact the AMA at www.ama-assn.org.
You also may wish to obtain the services of a practice management agency or a health law expert.
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OUTSIDE OF THE HOSPITAL DO NOT RESUSCITATE (DNR) ORDERS
A. This important document is a physician’s order or directive addressed to your emergency medical responders indicating the
predetermined request by the patient (or the patient’s guardian or surrogate) to withhold CPR and other end-of-life resuscitative
treatments once breathing and/or heart beat have ceased. It is the patient’s directive to be allowed to die without emergency
intervention.
A. NO. “Living Wills” are a form of Advance Directive written by the patient. Because Living Will documents discuss the patient’s
wishes under certain circumstances in the future, the New Jersey law requires emergency medical treatments to be rendered until
such time as the document can be read and interpreted by a physician. Usually the patient will be transported to a hospital where
a physician will determine what the patient’s wishes are and will determine any withholding of treatments based upon those
wishes when there has been sufficient opportunity for a diagnosis and prognosis of the patient’s present condition.
NO. A person who has a DNR order will not be resuscitated in the event breathing and/or heart beat have stopped; however,
they will be treated for all other medical emergencies.
A. NO. If you or a household member have a DNR order, you should feel free to call 9-1-1 in the event of a medical emergency.
Once the emergency responders arrive at your home, they will assist you in handling any medical emergency in the appropriate
manner. However, if the patient has died, they will not begin CPR or any other resuscitative efforts.
A. NO. It is a protocol developed as a statewide guideline for EMS in the event that a patient at home does not wish to be
resuscitated at the time of death. The protocol has been supported and promoted through the appropriate State agencies as well
as other professional groups and is a reflection of the most recent American Heart Association standards of care regarding
end-of-life decision making and resuscitation. CPR and DNR are both standards of care promulgated through practice and
protocol in the State of New Jersey.
A. Anybody can sue anyone for anything in our society. However, if a patient has a valid NJ Out-of-Hospital DNR order and you
administer CPR you also run the risk of being sued for violation of the patient’s rights. This is perhaps a greater risk. These
protocols and the OOH DNR form would provide you with a credible legal defense in the event someone did attempt to sue.
A. The patient’s physician controls the completion of the DNR order. While the possibility of “nefarious” dealings can never be
100% eradicated, the likelihood of a person using a document that is going to be seen, copied and entered into a medical record
is minimal. Most patients with DNR orders are cared for in the home by family members who can provide identification. To
date, no incident has surfaced anywhere nationwide indicating the fraudulent use of a DNR order to cause harm to someone.
A. NO. The bracelet in New Jersey is optional. You can have just the paper form (as many photocopies as needed), or you can have
both the form and the bracelet. EMS will honor either the paper form or the bracelet. The bracelet is an orange and white striped
plastic band (similar to hospital ID bands) marked with NJ EMS Alert – No CPR and contains the patient’s name and the name
of the ordering physician. It is convenient for use on patients who may be transported often for treatments such as dialysis, and
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Frequently Asked Q & A
want the protection of their DNR order in all settings
A. YES. It is helpful to have the out-of-hospital DNR form to give to the EMS transport personnel who transport patients by ambulance
from one health care setting to another. It is easily recognizable by EMS and protects the patient during the ambulance
transport. It also serves as an alert to the receiving facility that the patient has a DNR order and, if he/she were admitted to a
new facility, would require the DNR order to be re-written. Relying solely on verbal communication from the nursing home
staff to EMS puts the patient at risk of having their wishes not followed
A. YES. DNR orders are not written conditioned upon the “cause” of death. DNR orders are written when CPR is considered to be
inappropriate for the patient based upon the patient’s current underlying disease and condition. This underlying disease (such as
cancer) remains the same regardless of the cause of death and warrants the honoring of a DNR order.
A. There are a variety of very reasonable and valid reasons why families of “dying” patients call “9-1-1”.
- (1) Families, even if educated by hospice caregivers about not calling 9-1-1 at the time of death, may panic at the time of
the event. Remember, death does not occur instantaneously, but may manifest itself through symptoms such as
difficulty breathing, seizure activity, and other sudden and disturbing precipitating events. When families call for help,
they often don’t realize that the patient is actively dying.
- (2) It is critical to remember that “dying” patients who have DNR orders are still entitled to all other appropriate care.
They may have a prognosis that will allow them to live for a year or more. During that time, they may suffer from a
fall, bleeding, or any other acute reversible process that requires treatment. For comfort and palliation, the
patient may need treatment and transport by EMS.
A. YES. New Jersey is not unique in developing a mechanism for the identification of DNR orders outside of medical facilities.
Therefore, if a DNR identification from another state is presented to EMS in New Jersey with a request to honor it, and if there
is no reason to believe that it is not valid, EMS personnel should honor the DNR in good faith.
A. YES. The New Jersey protocol for out-of-hospital DNR does not replace other mechanisms within health care facilities (hospitals
and nursing homes) to identify patients who have DNR orders. Therefore, if a DNR order is presented to EMS by the health
care facility on a different form with a request to withhold CPR, and if there is no reason to believe that the form is not valid,
EMS personnel should honor the DNR order in good faith.
A. YES. There is no age restriction on the use of DNR orders. DNR orders may be appropriate for patients of any age who are
near the end of life.
A. YES. In the long term care environment (institutionalized elderly care), an advanced practice nurse (APN) can sign DNR (and
Do Not Hospitalize) orders, in consultation with the attending physician.
A. NO. A living will is important, but in order for your wishes for no resuscitation to be implemented, the physician must sign the
DNR form.
Guidelines for Healthcare Professionals, Patients and Their Families
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Medical-waste disposal
How can I find a reliable medical-waste disposal company?
A list of New Jersey Department of Environmental Protection (NJ DEP) commercial regulated medical-waste disposal companies, along with dep numbers and phone numbers, can be found on the NJ DEP’s web site.