Assemblyman HERB CONAWAY, JR.
District 7 (Burlington)
Assemblywoman NANCY J. PINKIN
District 18 (Middlesex)
Exempts intraoperative monitoring services rendered during inpatient surgical procedures from physician self-referral restrictions.
CURRENT VERSION OF TEXT
An Act concerning referrals for intraoperative monitoring services and amending P.L.1989, c.19.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.1989, c.19 (C.45:9-22.5) is amended to read as follows:
2. a. A practitioner shall not refer a patient or direct an employee of the practitioner to refer a patient to a health care service in which the practitioner, or the practitioner's immediate family, or the practitioner in combination with the practitioner's immediate family has a significant beneficial interest; except that, in the case of a practitioner, a practitioner's immediate family, or a practitioner in combination with the practitioner's immediate family who had the significant beneficial interest prior to the effective date of P.L.1991, c.187 (C.26:2H-18.24 et al.), and in the case of a significant beneficial interest in a health care service that provides lithotripsy or radiation therapy pursuant to an oncological protocol that was held prior to the effective date of this section of P.L.2009, c.24, the practitioner may continue to refer a patient or direct an employee to do so if that practitioner discloses the significant beneficial interest to the patient.
b. If a practitioner is permitted to refer a patient to a health care service pursuant to this section, the practitioner shall provide the patient with a written disclosure form, prepared pursuant to section 3 of P.L.1989, c.19 (C.45:9-22.6), and post a copy of this disclosure form in a conspicuous public place in the practitioner's office.
c. The restrictions on referral of patients established in this section shall not apply to:
(1) medical treatment or a procedure that is provided at the practitioner's medical office and for which a bill is issued directly in the name of the practitioner or the practitioner's medical office;
(2) renal dialysis; [and]
(3) ambulatory surgery or procedures requiring anesthesia performed at a surgical practice registered with the Department of Health pursuant to subsection g. of section 12 of P.L.1971, c.136 (C.26:2H-12) or at an ambulatory care facility licensed by the Department of Health to perform surgical and related services or lithotripsy services, if the following conditions are met:
(a) the practitioner who provided the referral personally performs the procedure;
(b) the practitioner's remuneration as an owner of or investor in the practice or facility is directly proportional to the practitioner's ownership interest and not to the volume of patients the practitioner refers to the practice or facility;
(c) all clinically-related decisions at a facility owned in part by non-practitioners are made by practitioners and are in the best interests of the patient; and
(d) disclosure of the referring practitioner's significant beneficial interest in the practice or facility is made to the patient in writing, at or prior to the time that the referral is made, consistent with the provisions of section 3 of P.L.1989, c.19 (C.45:9-22.6); and
(4) medically-necessary intraoperative monitoring services rendered during a surgical procedure that is performed as an inpatient hospital service.
(cf: P.L.2013, c.178, s.1)
2. The Board of Medical Examiners shall adopt such rules and regulations, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to carry out the provisions of this act.
3. This act shall take effect immediately.
This bill provides that certain intraoperative monitoring (IOM) services are exempt from the prohibition against physicians referring patients for health care services in which the physician or the physician’s family has a financial interest. IOM takes place during surgery and consists of a technician recording and stimulating various nerves and muscles through leads attached to the patient’s body. The purpose of IOM is to elicit responses from the nerves and muscles to determine if they are functioning normally, thereby helping reduce the risk of neurological damage during surgery.
Current law prohibits physicians from referring patients to health care services in which the physician or the physician’s family has a significant financial interest, but provides certain exceptions in cases where: the financial interest was held prior to a certain date and the physician provides the patient with written disclosure of the financial interest; the procedure is performed in the physician’s medical office and the patient is billed directly by the physician or the physician’s office; the procedure is renal dialysis; or the procedure requires anesthesia and is performed at a surgical practice or ambulatory surgery center, provided certain other conditions are met.
This bill provides that, in addition to these exceptions, the prohibition will not apply to medically-necessary IOM services rendered during a surgical procedure that is performed as an inpatient hospital service. It is the sponsor’s belief that, because IOM services rendered under these conditions are not likely to result in overuse or abuse, and because of the difficulty some hospitals have experienced in locating and retaining qualified IOM service providers, establishing this exception is an appropriate and necessary measure to help improve the provision of health care in New Jersey.