The New Jersey State Society of Anesthesiologists, Inc. is an organization of physicians dedicated to upholding the highest standards of the profession of anesthesiology and committed to serving as an advocate for anesthesiologists and their patients.
Statement of Policy
The New Jersey State Society of Anesthesiologists is the recognized component society of the American Society of Anesthesiologists, Inc. in the State of New Jersey. The New Jersey State Society of Anesthesiologists was incorporated in 1961 as a voluntary, non-profit association of physicians interested in the practice of anesthesiology. Membership is a privilege, not a right. Individuals are entitled membership by virtue of licensure certification or other means. As stated in its bylaws, the society was formed for the following purposes:
- To advance the science and art of anesthesiology.
- To stimulate interest and promote progress in the scientific and educational aspects of the specialty of anesthesiology.
- To seek the betterment of the individual member of this society, and to protect his or her interests within the structure of the bylaws of this society and of the American Society of Anesthesiologists.
- To uphold, adhere to and promote the aims, principles and purposes of the American Society of Anesthesiologists as set forth in the bylaws of that organization.
The NJSSA recognizes the “Principles of Medical Ethics” of the American Medical Association as the basic guide to the ethical conduct of physicians. The NJSSA also recognizes the practice of anesthesiology as the practice of medicine.
History of NJSSA
In 2005 the ASA celebrated the 100th year anniversary of organized anesthesiology. The ASA traces its roots to Long Island anesthesiologists who organized in 1905. The celebration was scheduled to be held in New Orleans but was cancelled because of hurricane Katrina. Instead the 100th Centennial celebration was held in Chicago in October 2006.
The NJSSA was established in 1948 and was incorporated under Title 15 Corporation and Associations not For Profit on July 28, 1961.
The office of the NJSSA was located at 24 Pennington Street in the city of Paterson, county of Passaic and state of New Jersey. The name of the registered agent was James Toombs, MD, 200 Lincoln Ave., Ridgewood, New Jersey.
The first five trustees were:
- G.L. D’Alessandro, MD (United Hospitals)
- G.T. Henderson, MD (St. Peter’s Hospital)
- J.R. Toombs, MD (Paterson General)
- A. Dear, MD (Beth Israel Newark)
- N. Palma, MD (Paterson General)
During World War II, physicians received a crash course in Anesthesiology and were sent overseas. In 1948 there were but a handful of residency trained anesthesiologists. The American College of Anesthesia offered certification by exam until 1982. Most providers were family practitioners who administered anesthesia part time. Others had learned by serving a preceptorship in the operating room. These various providers came together to meet at restaurants including The Newarker at the old Newark Airport and Stouffers located where the Short Hills Mall now stands.
By 1957 only 16% of anesthetics were administered by residency trained anesthesiologists. Yet jobs were hard to find in New Jersey. The non-boarded anesthesiologist resented the Board Certified anesthesiologists. Large hospitals were staffed by the G.P. / anesthesiologists who referred their surgical cases and received from the surgeon the right to administer the anesthesia. “Stables” of CRNA’s were common as well as unlicensed foreign doctors.
Many insurance companies failed to recognize the new specialty. Blue Shield had a fixed fee schedule including $15.00 for labor and delivery and $35 for a cholecystectomy. It was not the best of times but the result was the need for anesthesiologists to band together for the common good. The NJSSA met those needs!
In 1963 the Director of District V was Nicholas Palma, MD from Paterson General Hospital who is credited with establishing the first recovery room in New Jersey. His partner was James Toombs, MD and their small office across from Paterson General became the NJSSA headquarters. Dr. Toombs followed Dr. Palma as Director. In order, Dr. A. Lucas, Dr. G. Shapiro, Dr. R. Moore and Dr. J. Tyler have served as Directors District V of the ASA. Dr. K. Mirsky is the current District Director.
As the membership grew, the office was moved to 2424 Morris Ave, Union, N.J. the home of the Academy of Medicine with Linda Bartolo managing all Society’s business. The year was 1974. In 1979 the office was moved to Lawrenceville, in 1993 to Princeton Junction, in 2000 to the Medical Society Building at 2 Princess Road in Lawrenceville, in 2002 to 3 Regent Street in Livingston and in 2006 to our current address at 26 Eastmans Road in Parsippany. Linda Bartolo has served as the Executive Director of the Society for the past 32 years. In 1990 Dr. Ervin Moss became Executive Medical Director of the NJSSA, the only practicing anesthesiologist to hold such a position within the ASA.
The NJSSA was proactive in the 70s and 80s in the economics of anesthesiology attempting to gain recognition of the specialty, which was undervalued as to reimbursement. It supported the concept of the ASA RELATIVE VALUE GUIDE and argued against the use of a percent of a surgeon’s fee, which was then used by most insurance companies. The NJSSA was named in the Federal anti-trust action against the ASA because of the use of the ASARVG. The ASA spent millions to defend the use of the RVG and won the case.
In 1970 Medicaid based its fees for anesthesia on a 1956 Blue Shield Plan. Prudential Insurance had been awarded the Medicaid contract. All attempts to gain information from Medicaid which included political pressure from Blue Shield were unsuccessful. In 1975 the NJSSA sued the State of New Jersey based on below market value of our services. The Courts ruled against the NJSSA stating that the doctors of New Jersey could better care for the poor than the State of New Jersey. Unfortunately Medicaid fees for anesthesia are still amongst the lowest in the United States as of today despite a budget increase promised for 2002 as a result of a Coalition formed by our Lobbyist. At present, fee for service fees are $9.30 per unit. As Medicaid switched to HMOs the NJSSA lead the protests that the HMOs did not increase reimbursement to doctors despite State Medicaid premiums based on 80% of commercial rates. Even under the promised increase in HMO payments, there is no mechanism in place to force the HMOs to pass increases on to doctors.
In 1975 the NJSSA created a Negotiations Team. Dr. Ervin Moss, Executive Medical Director, attended the AMA Training Program on Negotiations and formed a team consisting of Dr. A. Lucas and Dr. J. Woolwich. The team brought equality to the table, which resulted in increases in anesthesia reimbursement and respect from the insurance industry.
In the mid 1970s a malpractice crisis arose in New Jersey with the withdrawal of the carrier. The State of New Jersey failed to act and as a result the Medical Inter Insurance Exchange was created by doctors who funded the company by investing $7500 in bonds that later were reimbursed. Once the Insurance Commissioner realized the doctors were going to form their own company, it created a company that did not require a bond thus draining some doctors out of MIIX. In general, anesthesiologists supported MIIX. Unfortunately, due to over expansion and poor management MIIX failed and was not allowed to write policies in New Jersey since the early 2000’s. A limited fund of money is available to settle outstanding claims. Once this money is used the State Reinsurance Fund will pay out a maximum of $300,000. A New Jersey Court has ruled that the doctor can be liable from personal assets, for awards above $300,000. A new company was created out of the ashes of MIXX and is called MIIX Advantage.
In 1976 the membership of the NJSSA in a Statement of Policy voted to set a ratio of one anesthesiologist supervising no more than two CRNAs. Despite the allowed Medicare ratio of 1 to 4. the 1 to 2 ratio is being followed in the majority of case. Recently we have had an invasion of Anesthesiologists from Pennsylvania and Florida that have taken over facilities in New Jersey and are using 1 to 3 and 1 to 4 ratios. The 1 to 2 ratio is more than 30 years old and, in my opinion has become a standard of care in New Jersey despite not being a regulation or law.
The crisis in malpractice had been created by huge jury awards in malpractice cases. To address this issue the NJSSA decided that its attention should be on Risk Management, Patient Safety and Quality Care. The concept being that not having tragic incidents, the trial lawyers would have no basis of claims. In 1984 it identified the dangers of Office Based anesthesia as a result of the death of a 16-year-old during an abortion. This awareness was put in writing to the Board of Medical Examiners which marked the beginning of a struggle to regulate offices that has not reached full fruition in 2006 despite passage of the Regulations in 1998. Malpractice premiums have decreased in the last 15 years. In 1989, $18,000 would buy 1m/3m. Today this same amount would buy 2m/4m, when available.
From 1985 to 1989, a year before the creation of the Anesthesia Patient Safety Foundation, a committee of the NJSSA met with the New Jersey State Department of Health to formulate hospital and surgicenter Regulations. This Regulation requires the Chief of Anesthesia to be Board Certified or a Fellow of the College by exam before 1982. It defined obsolete machines and required 50% of all anesthesia machines to be replaced within 6 months. Monitoring including oximetry and end tidal PCo2 were mandated as well as a reporting mechanism. Staffing was defined and nurse anesthesia providers were required to be under physician supervision. In 2000 the Regulations were revised to include a difficult airway cart and ACLS and PALS when indicated for all anesthesiologists.
From 1990 to 1998 the NJSSA actively pushed the New Jersey Board of Medical Examiners to pass Office Based Surgery and Anesthesia Regulations. The Regulations were passed in 1998 except for one paragraph dealing with alternate privileging which was blank. As a result of lobbying by those who did not want the required hospital privileges, the Board of Medical Examiners offered an alternate pathway to privileging by the BME. As soon as the OBA regulations were passed the NJANA (CRNAs) files a suit against the BME for dictating nursing practices by requiring that general anesthesia in offices be supervised by an anesthesiologist. This was, and is the requirement in hospitals and Ambulatory Surgery Centers. The lower court ruled that the case was not “ripe” because the Regulation was incomplete without the alternate privileging section. The BME knew that there was a law suit down the road and did not complete the paragraph until 2002 at which time the CRNAs lost in the lower court and appealed in the Appellate Court and lost 3 to 0. In May of 2005 the case was heard by the New Jersey Supreme Court. Their decision was with the BME, in that the Regulations addressed how doctors should practice, not nurses. It also declared that Anesthesiology is the practice of Medicine and that the education of an MD is superior to that of a nurse. One day before the trial, Dr. Moss received the ASA’s Second Governmental Award along with Senator Bill Frist in Washington. The following May 2006, Dr. Moss received Samba’s Distinguished Service Award for his work in patient safety.
Unfortunately the alternate privileging process was outsourced and as of December 2006 the applications have not been completely processed leaving the possibility that surgeons could still perform procedures in their offices that they are not privileged to perform in hospitals. This represents a public danger and requires constant pressure from the NJSSA. Nevertheless the office regulations have become the benchmark and have been used as a model by other states. Total number of years spent on the project is 22.
The NJSSA has not only acted in the interest of its membership but has acted as a patient advocate on fee complaints. The membership voted a Statement of Policy, which addressed obstetrical epidural billing. It limited the charges to base units plus time units spent in direct contact with the patient. In another Statement of Policy the requirement that an epidural for OB not be administered without the presence of the Obstetrician and that once the epidural is in place an Obstetrician must remain in house.
Besides its role in the increase in patient safety and the economic betterment of its membership, the NJSSA provides CME credits through lectures at our annual meeting each year.
New Jersey is unique in that there are no rural hospitals. All hospitals have anesthesiologists on staff. No patient in New Jersey is more than 20 minutes away from a trauma center by helicopter. There are about 400 nurse anesthetists in New Jersey with about 50% of hospitals and Surgicenters utilizing the anesthesia care team. There has been a drain on manpower because of the number of offices providing surgery and the decrease in Surgicenters. In addition the drop in Residents during the mid 1990′s and the increase in Residents from overseas will result in a further drop in anesthesia providers in the next decade. The recent failure of the Congress to fund fairly teaching of residents in a ratio of 2 to 1 attending, will cause further closing of residency programs. The future will find CRNAs graduating at twice the number as physician anesthesiologists.
At present the NJSSA has 970 active members, 19 affiliate members, 82 resident members, and 134 retirees for a total of 1205. The Advocacy and Management Group provides office management. The NJSSA retains an attorney and a lobbyist.
The NJSSA has 10 delegates and 10 alternates to the ASA House of Delegates, a Director and an Alternate Director. Dr. Roger Moore was the first anesthesiologist from New Jersey to become President of the ASA for 2008-2009.
The New Jersey State Society of Anesthesiologists may be reached:
Phone: 609-528-7392 Fax: 609-392-2664
Ervin Moss, MD
Former Executive Medical Director