Winter 2014

The President’s Corner


Thank you for allowing me the honor of holding the office of President of NJMGMA for 2014 and 2015.  Although I have served in several Board capacities over the past 8 years, holding the top leadership role in the state for medical practice managers is quite a humbling experience.  It is reassuring to know that our organization relies heavily on the experience, enthusiasm and dedication of our Board members, both seasoned and newbie participants alike.  And for that we are ALL grateful.

One of my goals during this tenure will be to continue the progress we have already made in making NJMGMA an organization that is strong in both its membership numbers as well our sense of community and volunteerism.  This membership is nothing without YOU… I challenge you each to get engaged, find your niche and make a difference.

I’d like to share with you about some of the things we are already working on for you.

First of all, I hope you have visited our new and improved NJMGMA website, a work in progress.  We are very excited to have this website become your #1 source for resources, education, advocacy and national topics.  Please browse around the website, kick the tires and let us know what else you’d like to see.  Some of our plans include:

  • a more extensive library of resources for the practice administrator to access; 
  • readily available links to encourage participation with our advocacy efforts at the practice level
  • up to the minute informational pieces, tools and resources.

We have transitioned to new membership software, Member Clicks, which will allow NJMGMA to move into the future; secure in the knowledge that we have a strong informational data base from which we can serve and predict the needs of our membership.  You might receive requests for your information to be updated.  Remember; a data base as only as strong as its data.  Help us to help you!

A commitment to Quarterly half day educational sessions designed to emphasize the MGMA   Body of Knowledge is a major effort this year.  These sessions, offered at a minimal cost of $10 for members and their guests (hot breakfast included) will provide the ongoing, up to date information practice managers need to know. Please encourage your appropriate staff to attend… we guarantee it’s the best educational value around! 

Our PMC has always been our annual “showcase” and this year will prove to be no exception.  Our theme is Surviving the perhaps has never been so true!   The speakers are great, the topics essential to your practice and the networking opportunities designed to be relaxing, fun and flexible.  And let’s not forget the exhibitors providing the key resources for your practice to survive.  Our exhibitors bring so much to NJMGMA, in both financial and educational support. Be sure to check out the video, “PMC 2014”, available in this newsletter. 

Our advocacy efforts continue on the local, state and national level.  I have personally seen the difference we have made, have participated in visits to Capitol Hill and have watched Larry Epstein (NJMGMA Legislative/ External Affairs chair and David Matos, NJMGMA lobbyist) hard at work representing each of our medical practices as we work on the Administrative Simplification bills that sit before the legislature. 

Well, my friends ... that’s some of what NJMGMA and I have in store for you in 2014 on a local level. 

Now, let’s list what our National organization believes are the key issues to watch in 2014… 

  • Medicare payments remain in flux
  • SGR  repeal  and replacement
  • ACA implementation
  • Countdown to ICD 10 transition
  • Expansion of Value Based Payment Modifier
  • Stage 2 Meaningful Use begins
  • Quality reporting program penalties continue
  • Administrative simplification
  • Heightened emphasis on compliance
  • Information about physicians' relationships with drug and device manufacturers and group purchasing organizations (GPOs) will be made public. 

So as you can see, If nothing else, 2014 promises to be a year full of change, change and yes, unexpected change.  And NJMGMA is committed to be there to give you the tools you need to meet these challenges. 

Please feel free to reach out to me or any Board member to discuss your vision for the organization.  And mark your calendar for Atlantic City in May 2014! 

Be well, 

Debbie Puccio RN, CMPE

NJMGMA Leadership Looks to Improve the Status of Health Care Management

Board and Committee Members meet with key NJ Congressional Delegation Members to discuss what is happening on the ground in their communities related to physician services/ medical care.

Trenton, NJ December 5, 2013:  A group of NJMGMA members was recently lead by current board president, Bruce Kramer, and Legislative Chair, Lawrence Epstein to our nation’s capital to discuss the current state of the physician practice and the key regulatory and legislative issues that would change the delivery of services in their practices. The group met with Congressmen Andrews, Pallone, Lance, Frelinghuysen, LoBiondo, and Pascrell as well as representatives from the office of Senator Menendez. 

Burning issues of the day included the current federal physician payment formula, SGR, and the significant impact that a cut in rates would have on their small businesses. Members also discussed how the cumbersome and sometimes duplicate quality reporting data gathering programs have a deleterious impact on the operations of their practice and financial bottom lines. Of course the subject of EMR came forward in every conversation and how this has been extremely impactful to the current workflows of the physician practice in turn leading to increased care times and delays in receiving better care.  The meetings resulted in many of these members signing onto letters circulated in the House of Representatives supporting revision of the SGR formula and proposal of a new methodology for reimbursing physicians.

The group, in discussing the potential cuts in reimbursement and the potential negative impact on the health care delivery for consumers, was impressed by the knowledge of our representatives on these and other issues affecting medical practices: and, were heartened by their interest in assisting the medical community in reaching for solutions to these structural problems which could lead to loss of not just revenue to physicians but possibly loss of employment for the support staffs we all employ. 

The delegation also heard our concerns that cuts in reimbursement with expansion of insurance coverage under the ACA in turn may accelerate the current physicians of NJ leaving medical practice and increasing care access problems as well as create an environment with a shortage of care options for consumers.

All in attendance took away the importance of these and other local initiatives on how they could help sculpt the care delivery system and everyone’s part to play to improve services and equal or lower cost.



If you have not yet registered for the upcoming Practice Management Conference, the time is now.  Not just because this year’s venue has moved to the panache Revel location, but because the lineup of speakers is not to be missed. 

PMC 2014 is a combination of bringing you the opportunities we know have been so well received, as well as offering new exciting programs.  This year we have 2 preconferences to jumpstart your learning experiences here at PMC.

On Wednesday morning, Nate Moore, the AMAZING Excel Guy, returns to do his wildly popular half day preconference helping you do things with Excel you NEVER thought possible. He follows up with more information at a breakout session the very next day.  Because of Nate’s concentrated attention to the participants, this preconference is only offered to the first 25 registrants for PMC until the class is full. So hurry up and see if you score one of these coveted seats.

Later on Wednesday, we will debut a highly interactive preconference on Mergers and Acquisitions:  Everything you want to know but are afraid to ask; led by the experienced professionals Michelle Koury, William Lewis, Michael Schoppman and William Febus. This pre conference, moderated by Larry Epstein, NJMGMA Legislative Chair will provide the participants with the expertise of those who have gone before us, as well as real time discussions of what is happening now in this area of medical practice that is constantly evolving and changing the shape of the world in which we practice.

Kicking off our conference is the extremely important National Update by national MGMA Speaker Jennifer McGlaughlin to let us know what is happening NOW, and what you need to be doing to live our future today.  It is our hope that this highly informative kickoff presentation helps you to plan what breakout sessions you need to attend to polish up your toolkit for the year ahead .

This year we are proud that the MGMA Body of Knowledge has been incorporated into our programming, from Common Pitfalls of EHR Conversion (Information Management), ICD-10 Preparation (Business Operations)  to understanding the importance of Respect in the Workplace (Human Resource Management) and Maximizing Billing Office Efficiencies (Financial Management)This year's slate boast national speakers, Penny Noyse, Meryl Luallin and Dr Paul Marciano as well!

Closing out the conference, the much sought after Shari Harley will send us back to our practices with the ability and knowledge to “Corporate Candor: Say Anything to Anyone.” 

The board and committees are working tirelessly to make sure this year's PMC conference is exciting, entertaining, and educational.  But none of that can happen without you.  So please be sure to register now, and attend May 14th-16th.  

Click here to register now!

Watch our VIDEO to see what’s being said about the PMC 2014!

Evolving Liability for Physicians

Much has been written about the National Healthcare Reform and the poor performance of the website, but I would like draw your attention to an equally pressing and serious issue for our healthcare providers, specifically doctors. 

President Obama’s Affordable Care Act Accountable Care Organizations (ACO’s) have been developed to deliver better care at less cost by better coordinating care.  The premise is a good one, but the actual implementation is not as easy. 

As your readers are well aware, medical malpractice insurance is in place to protect physicians and other health care providers when a patient is dissatisfied with medical outcomes.  In this new world, where each patient knows upfront that the stated goal is lower cost care while simultaneously being of a “higher” quality, the patient’s perception about how medical decisions are being made will be dramatically effected.  There will naturally be tension between cost containment and medical liability.  The potential for medical malpractice liability issues to expand is very real, particularly since providers will now be part of an ACO’s team and will be responsible for full care across all specialties. The possibility of vicarious liability allegations cuts in all directions, ACO to provider, provider to ACO and provider to provider. 

Secondarily, the essence of the Affordable Care Act and the Accountable Care Organizations run against the grain of traditional anti-trust, STARK and self-referral rules.   The new ACO entities are now incentivized to provide a full continuum of care for their patient population.   The act of referring a patient to one of your own facilities has been illegal and litigated in the past with significant consequence to doctors/hospitals.  This issue must be addressed or hospitals, physicians and all other providers will be exposed to devastating financial exposures.  

Lastly, the personal exposure to the Directors and Officers of an ACO can result from a number of unique scenarios.  Discovery under medical malpractice cases could reach into the corporate boardroom, with plaintiffs trying to prove widespread institutional policies that may impede appropriate treatment due to physician compensation formulas and withheld resources.  Additionally, the ACO’s board and management will also be held responsible for the success or failure of the execution of the business plan – meaning delivering “higher quality care” at a lower cost. 

In summary, a new era is fully upon us and with all change there is risk; but, in this case the majority of the exposure is directed at health care providers who are already likely to be strained by an exponentially growing patient base.   The new and evolving provider risks must be carefully addressed.   The blurring of lines between insurers and providers has never been more dynamic, with health insurers buying hospital systems and healthcare providers effectively becoming insurers.  It is imperative that providers have a full understanding of their risks. 

Ron Gillespie
Senior Vice President
Boynton and Boynton

(Boynton and Boynton is the largest writer of medical malpractice insurance in New Jersey). 

IT Vulnerabilities in Your Medical Office Network

It’s quite shocking to learn how many practice managers don't take proactive action to protect their business networks and PHI. Unfortunately, too many assume that their computers are just fine out of the box.  But the fact is, medical office networks are more at risk now than they have ever been in the past.

Many practice management professionals are helped along by the false sense of safety by the many PC manufacturers who now ship computers with a trial version of a consumer grade anti-virus product installed. For many, those constant reminders to register their anti-virus software seem as good as a free pass.  Most end users don't realize that these consumer-oriented anti-virus programs are not suited for the heavy duty protection that a healthcare IT environment requires and, typically, are temporary trial versions that stop working.

Recent research by anti-virus firm Kaspersky suggests that end users and business owners drastically underestimate the threat posed.  In a recent survey, respondents largely believed that there were about 4,000,000-6,000,000 new pieces of malware per year. In fact, security researchers actually identify over 200,000 new malware pieces EACH DAY. 

Now more than ever, healthcare providers must be extra diligent to protect their networks and patients from attacks and attempts to steal PHI. To assist in that regard, what follows are some of the biggest medical office vulnerabilities with thoughts on how you can mitigate the risks. 

Address People Problems
The number one way malware, viruses and hackers penetrate business networks is through exploiting people rather than technology. This encompasses things like employees who download malicious files (knowingly or unknowingly) or those who reuse the same password over and over or on countless sites, including their work-related accounts. This category also includes users and employees with malicious intent, and those who actively go out of their way to hurt your practice.

The best way to curb this problem is to have a strong security and acceptable use policy and to train every employee on it. Require forced, frequent password changes through your server.  Lock down and filter frivolous and unnecessary web browsing and file downloading through web content filtering.  And make sure disgruntled employees are identified and segregated before they can do damage on any IT systems.  (See “Former Rocky Mountain Spine Clinic employee stole patient information”)

Build a Wall Around Your Medical Practice Network
Don’t rely on endpoint protection alone (anti-virus software).  Instead, invest in a strong perimeter security solution such as SonicWALL Comprehensive Gateway Security Suite Bundle to put a shield between your network and the public Internet.

Remember, the HIPAA security rule includes two provisions that require organizations to perform security audits. They are: 

  • Section 164.308(a)(1)(ii)(c), Information system activity review (required):  “implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports."[i]
  • Section 164.312(1)(b), Audit controls (required):  "implement hardware, software, and procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information."[ii] 

Strong perimeter security that allows for auditing and tracking of access to your medical office network dovetails perfectly with the aforementioned HIPAA rules.

Secure and Filter Your Email
Please know that sending email through the Internet is as secure as sending a postcard; in other words, the contents of the email can be viewed and intercepted in transit.  Let me be clear here.  If you are not using email encryption, do not send identifiable patient information (PHI) through email.  These are merely a sample of best practices.  Remember, an ounce of prevention is worth a pound of cure, especially in our extremely regulated and litigious environment. 

Daniel J. Haurey is founder and president at Exigent Technologies, a managed IT and cloud services provider to specialty medical practices.


Planning for the new 3.8% Net Investment Income Surtax

Heads Uncle Sam wins, Tails you lose!

With a new 3.8% tax on “unearned” income beginning in 2013, it’s very difficult to limit your tax to just “ordinary” income tax. If your income is earned, you pay 15.3% Self-Employment (Social Security) tax. If your income is un-earned, you now have the new 3.8% Net Investment Income (NII) tax to pay. 

The S Corporation “loophole”!

Profits from an S corporation are just about the only income that escapes Self-Employment tax as well as the 3.8% NII tax. The S corporation is now an even more attractive form of entity to minimize taxes for owners of medical practices. After paying reasonable compensation to the physicians, the remainder of the profits flow through to physicians’ personal tax returns subject only to income tax, not Self-Employment or NII tax. 

Reduce your Salary!

There are several areas you can address to possibly reduce your overall tax. One such area is compensation. Let’s assume that Dr. Feel Good worked full-time as the manager of his medical practice, which employs several nurses and technicians. The practice earned income of $1 million this year, and he is deciding how much to take as wages. Dr. Feel Good should find out what is the standard of physician compensation for medical practices of his size, specialty and profitability, before making this determination. If he doesn’t, he will be paying Social Security tax on the excess compensation unnecessarily. Even if he’s over the Social Security wage limit ($117,000 in 2014) he still continues to pay the Medicare tax of 2.9% coupled with the new 0.9% Medicare surcharge for high-wage earnings totaling 3.8%. 

Rent too high?

Another area where you might be able to shift income is if you self-rent your building to the medical practice. If your rent is higher than market, you could pay the additional 3.8% NII tax on that excess rent. By reducing your rent to a more reasonable level, you will increase your S Corporation income which is not subject to the additional tax. When was the last time you reviewed the reasonability of your rent? Now is a good time. 

The “Benefit” of high rates

In an atmosphere of high income tax rates, deductions are more valuable. If you are paying higher income tax rates and are also subject to exemption phase-outs, itemized deduction phase-outs, self-employment tax and 3.8% NII tax you could be giving half of your money away to Uncle Sam. This means that contributions to a pension plan will be half financed by tax savings. If you have a plan, consider increasing the contributions. If you don’t, maybe it’s time to set one up. 

To Wrap it up!

In today’s high tax environment, physician- owners should be proactive to keep income taxes down. In addition to the traditional advice to maximize pension and other expenses, shifting income to your S Corp via salary or rent reductions can result in tax savings that will make you feel good. 

BY: Pamela Avraham, CPA, Partner, Urbach & Avraham, CPAs which provides accounting & tax services to medical practices. Pamela may be reached at or 732-777-1158. Firm website is 

Membership News                        

I am very excited to take over the role of Membership Chair for NJMGMA. I have served on the board of NJMGMA in a few capacities over the years but I am most excited about my role as Membership Chair which will allow me to help the organization grow. NJMGMA is New Jersey’s premier practice management organization offering a wide range of education, networking events and up to date information to assist us in our practices and workplace.  Our membership is strong and consists of General Members who are managers and providers from medical practices of all sizes along with our Affiliate Members who bring us industry knowledge which we can use every day in our businesses. 

We have kicked off 2014 with our new management software to help us to offer more sophisticated and relevant communication. Member Clicks helps us better track our membership needs. You should have received an email communication to renew your membership. If you have not renewed yet please sign in to renew at so you can continue to receive the quality benefits that you have enjoyed with NJMGMA in the past. 

NJMGMA continually strives to reach our all practices and interested affiliates. Let us know if you know someone who would like to join or needs additional information.  Please feel free to contact me at if I can answer any questions or help you with NJMGMA. Your support helps us stay strong. 

I look forward to seeing everyone at our upcoming events. 

Ruth Harris, Membership Chair

ACMPE Corner

How many months or years have you been a member of the College?  How long has it been since you said that you were going to take the certification exam or write your Fellowship paper or case studies?  Are you waiting for completion of the building's renovation project?  Or will it be after ICD-10 has been implemented?  Have you postponed taking the exams because you are too busy planning a child's wedding?  Or perhaps, have you resolved to write your paper after Congress resolves the SGR issue?

Every journey begins with a single step.  When will you take yours?  Take a deep breath, put one foot in front of the other and begin.  Build the momentum that will carry you through to your ultimate goal.  ACMPE is always available to help you on the advancement journey.  Know that the rewards, both personal and professional, for achieving the designation of Certified Medical Practice Executive or Fellow in the ACMPE are tremendous.  Your only regret may be that you didn't do it sooner.

The NJMGMA is also committed to assist and recognize those NJMGMA members who partake in this journey of personal growth.  Those State members who pass the certification exams and achieve the CMPE designation are eligible to have their exam fee reimbursed and receive a free registration to the PMC meeting that follows the attainment of their CMPE.  For State members that continue the journey and earn their Fellowship, NJMGMA will pay for their registration to the Annual MGMA meeting where they will receive their Fellowship. 

If you have questions, need assistance or just want to talk about the process, please feel free to contact me at

Edward Gulko, FACMPE, FACHE

ACMPE Forum Rep