Recently drafted emergency rules could keep New Jersey's physician-owned ASCs and their physician-owners on the right side of the law.

In the wake of a state superior court ruling, which strictly upheld New Jersey's anti-self-referral law, the state Board of Medical Examiners adopted emergency rules on Jan. 9 that maintain the legality of physicians who refer patients to ASCs in which they hold a financial interest, as long as certain conditions are met.

The rules eliminate ASCs' concerns that facility fee billing for its physician-owners' referrals would be construed as insurance fraud under the court's ruling.

The rules should take effect once Gov. Jon Corzine issues a written agreement with the board that an emergency situation exists, and are scheduled to remain in effect for up to two months.

The court's ruling in Nov. 2007 was the unexpected outcome of a lawsuit between an insurer and a Wayne, N.J., surgical facility over disputed claims. The insurer objected to reimbursing procedures by in-network surgeons at their out-of-network, physician-owned center.

The court dismissed the insurer's complaints but held that physicians who refer patients to ASCs in which they have ownership interest are in violation of the Codey Law, a 1991 state statute that prohibits self-referral. The court further rejected the Board of Medical Examiners' 1997 advisory opinion that physician-owners' ASC referrals were in many cases permissible. The ruling put the continued operation of, and insurers' reimbursement to, the state's 200 physician-owned ASCs into question.

The emergency rules don't regulate in- or out-of-network fees, mandate disclosure of a facility's ownership on insurance claims and don't require that facility fee bills be provided to patients. They are, however, limited to ASCs owned by physicians and hospitals, excluding those of third-party, non-physician ownership.

David Bernard

Patients who have undergone a colonoscopy can encourage others to do the same by allaying fears and misconceptions of the procedure, say researchers at the University of Pennsylvania School of Medicine in Philadelphia. In a study that appears in the January issue of the Journal of General Internal Medicine, the researchers discovered colonoscopy patients were twice as likely to keep their first appointment after a telephone conversation with a peer coach than patients who learned about the procedure from educational literature or those who received no educational or peer support.

Barbara J. Turner, MD, MSEd, professor of medicine and director of Penn's General Medicine Physician Scientist Fellowship says this is one of the first studies to show that patients can help other patients overcome barriers to undergoing the tests that can prevent deadly diseases. Her research team says less than 60 percent of patients over the age of 50 have undergone a colonoscopy in the past 10 years. About one-third of patients who do schedule appointments end up canceling because of unanswered questions about the procedure.

Dr. Turner and her team organized a training program for five peer coaches who had undergone a colonoscopy. They learned communication strategies, the biology of colorectal cancer, screening modalities and potential barriers to the procedure. The coaches then called patients two weeks before appointments. Nearly 70 percent of those who received support from a peer coach kept their appointment, compared to the 58 percent who presented after receiving only educational brochures and the 48 percent who showed up after having refused educational support.

Penn researchers note that 80 percent of patients who received support from peer coaches said the information and support was "very helpful." Most said they appreciated hearing from patients who could relay first-hand experiences.

Daniel Cook

In a tribute to HBO's hit TV series The Sopranos, Three Rivers Endoscopy Center's annual Christmas card reads, "Let us whack your polyps before they whack you."

For the past few years, the GI center in suburban Pittsburgh has sent its patients a whimsical Christmas card reminding them to have a colonoscopy. You can view the last few Chistmas cards on the center's Web site.

Dan O'Connor