NJAHU State of the State 2012-Healthcare Symposium

Savoy Associates

Wendy Ebner, Pres., NJAHU

4 AAA Drive, Suite 205

Hamilton, NJ 08691

Dear Wendy,

I am an independent broker working through Savoy Associates, as well as being an RIA and I have specialized in working directly with the independent physicians and State and Local County Medical Societies in New Jersey for the last three decades, and I am deeply concerned about our collective industries.

I was in attendance at the aforementioned Symposium and I was particularly interested in the session pertaining to Accountable Care, with Drs. Tallia & Popiel and Messrs. Forrester and Berardo.

Regrettably, we were not offered the opportunity to ask any questions but I would very much appreciate your intervention in communicating with the panel to obtain their respective responses to the following questions:

  • I recall Mr. Aron, our moderator, calling upon Dr. Popiel to provide the audience with a brief description of what ACO, Accountable Care Organizations, are and his response was essentially to inform us that it was the method to be used to determine the reimbursement to the physician, which would be based upon the health of the population/patients under his/her care.

    Given that understanding, I would like to know how the pricing could possibly be determined, as it would necessarily have to be differentiated by locality, i.e., town, city, state, etc. and who would be setting the reimbursement rates, the carriers, State Insurance Department, the Federal Government?

  • If the pricing/reimbursement becomes too diverse, i.e. more favorable reimbursements in “better/more affluent geographic areas”, how will the potential physician migration to the possibly higher reimbursement areas be controlled and who will be left to service the lower reimbursement/higher needs areas, potentially the very people who the Healthcare Reform was to assist, those with lesser means and worse projected outcomes, i.e. lower reimbursements.

    This begs the question of how end of life issues may be handled, as it may pertain to “the bottom line”.

    Could you please address this issue, as well as who will be making the important final testing decisions that may not only assist those in need of critical care but what funds, time and/or testing will be allocated in an effort to maintain a healthy life style.

  • Attentively listening to Dr. Popiel’s explanation of ACO’s, he indicated that the physician/caretaker would ultimately be held responsible for the life results of the patience care.

    I was able to catch up with Dr. Popiel immediately following the presentation and, in addition to the above questions, I asked him how the elongation of the Risk of Malpractice would be assessed, as I have personally known of my own physician clients who were caught up in malpractice issues from many previous years ago when they were residents, for which they had very little, if any, involvement, that resulted in significant malpractice pricing issues, particularly for certain specialties like Ob/Gyn, Neurology etc..

    Much to my surprise, Dr. Popiel informed me that they have not yet even addressed this issue.

    Other than the obvious concern for the physician, this unanticipated cost could be astronomical, particularly in light of today’s extraordinarily litigious society, driving even more physicians/caretakers out of the market and exponentially increasing the costs of Healthcare for all.

    How can this very important pricing issue be non-addressed? My cynical thought process leads me to an obvious but hopefully non-negotiable answer that would leave the Federal Government in charge of all Healthcare, God Forbid!

Your kind and empowered assistance in seeking the panel’s responses would be much appreciated and hopefully passed along to the members of the NJAHU and the associated concerned.


Michael G. Kirwan, CLU, ChFC, RIA

Registered Investment Advisor