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Calendar

14 June 2012

E-Mailinfo@payersandproviders.comwith

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

California Edition

In January 2010, JFK Memorial Hospital inIndio attained a dubious achievement: fouradministrative penalties issued by theCalifornia Department of Public Health in

one day for endangering the safety and lives ofpatients.The regulator was allowed to levy such

penalties after the signing of SB 1312 into lawin 2006. It had been pushed through theLegislature amid mounting concerns aboutpatient safety, spurred by media coverage ofserious medical errors such as wrong-sidedsurgeries.

The CDPH began administering penaltiesand nes in 2007. Another law toughened thenes for second and subsequent penaltiesbeginning in 2009.

JFK received the penalties for issues

involving training deciencies for on-

oornursing staff.

In one case, the skills gap led to a two-day-old baby dying from an infection. He hadnot been properly treated given his symptoms.

In another case, eight emergency roomnurses did not have proper certications towork in that department. That lapse wasdiscovered after another infant was notproperly treated for a fever that approached106 degrees.

More than two years after the $100,000 inpenalties were levied by the CDPH and nearly

four years after the patient death, JFK has yetto pay the nes. All four of its administrativepenalties are under appeal, records show.

JFK spokesperson Linda Evans declined to

comment on the matter, citing the ongoinglitigation.JFK is one of 23 hospitals in California

appealing 28 total administrative penalties andabout $1.84 million in nes, according to dataprovided by the CDPH. That represents about13% of the 224 penalties levied to date andnearly 25% of the nes.

Altogether, the agency has collected $5.9million in nes from 179 administrativepenalties.

Under state law, appeals to administrativepenalties are handled in the same way as achallenge to a hospitals operating license: via

the Of

ce of Administrative Hearings andAppeals.That agency sets a hearing date in front of

an administrative law judge. Hearings arecalendered up to six months after a request ismade.

A legal decision can take months more tobe handed down by the hearing judge. TheCDPH reserves the right to revise it, ask formore written arguments, or even reject it andrequest a new hearing.

July 19-21

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Hospital Safety Appeals In LimboTo Date, a Single Administrative Penalty Case Heard

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Payers & Providers Page 2

Top Placement...Bottomless Potential

Advertise Here

(877) 248-2360, ext. 2

In Brief

Consumer WatchdogFiles Suit Against Blue

Shield On PlanClosures

Santa Monica-based advocacy groupConsumer Watchdog has led a classaction suit against Blue Shield ofCalifornia, claiming the SanFrancisco-based insurer issystematically forcing its older andsicker enrollees into bare-bone high-deductible policies.

The suit, led in San FranciscoSuperior Court by ConsumerWatchdog and the Watley Kallas lawrm, claims Blue Shield shuts downolder plans and compels its enrolleesto take new policies with lesscoverage at a higher price. ConsumerWatchdog refers to the practice as thedeath spiral.

Consumer Watchdog alsoalleges that the suit violates a 1993state law that requires insurers topool members into another plan ifthey

According to the suit, BlueShield is accused of plans to closeeight managed care policies and 23preferred provider policies by July ofthis year without offering enrolleescomparable coverage.

In a statement, Blue Shield saidthe allegations were false and that itwould ght the suit.

CalTAF Starts Legal

Referral Service

The California Treatment AdvocacyFoundation has begun a legal referralservice for individuals who havesubstance abuse problems but cannotobtain coverage from their insurers.

People seeking a referral cancontact the agency via a toll-freenumber and receive a freeconsultation. That can include a

Continued on Page 3

NEWS

An adverse ruling may also be appealedby a hospital for a review in civil court, which

can take months longer.The resulting process can be downrightglacial, say members of the healthcare legalcommunity.

Theyre really slow to respond, saidMichael Dowell, a partner with the LosAngeles rm ofHinshaw & Culbertson, of theCDPH. Theyre really careful and they try tocarefully investigate each matter.

Some cases stretch back to among the rstpenalties levied ve years ago. AdventistFeather River Hospital in Paradise has twopenalties under appeal from 2007.

The state has no budget to handle

appeals, said Mark A. Kadzielski, a partnerin the Los Angeles ofce ofFulbright &Jaworski.

Citing attorney client privilege, Kadzielskideclined to say which hospitals herepresented. However, other members of thehealthcare legal community conrmed hisrm represents most of the hospitals appealingpenalties.

Its a cumbersome, unwieldy, expensiveprocess. The state has to get the case assignedan administrative law judge. Someone has to

Appeals (Continued from Page One)

MEET OUR READERS

Need to promote a conference? Your brand? Payers &Provider!se-mail list for all editions is available for youmarketing needs. Reach out to more than 12,000healthcare professionals who read our publications. Caour advertising director Claire Thayer at (503) 226-985or e-mail her at clairet@mcol.com.

Hospitals That Have Appealed Administrative Penalties

1. Alameda Hospital, Alameda2. Brotman Medical Center, Culver City3. Chapman Medical Center, Orange4. Coastal Communities Hospital, Santa

Ana5. Emanuel Medical Center, Turlock6. Adventist Feather River Hospital,

Paradise (two penalties)7. JFK Memorial Hospital (four penalties)8. Kaiser Permanente (two hospitals)9. Kaweah Delta Medical Center, Visalia10. Lucile Salter Packard Childrens

Hospital, Palo Alto

11. Mercy San Juan Medical Center, Carmicha12. Mills Peninsula Medical Center, Burlingam13. Misson Hospital Regional Medical Center,Mission Viejo (two penalties)14. Placentia Linda Hospital, Placentia15. Scripps Green Hospital, La Jolla16. Scripps Memorial Hospital La Jolla17. St. Bernardine Medical Center, SanBernardino18. St. Helena Hospital, Clearlake19. St. Jude Medical Center, Fullerton20. Sutter Davis Hospital21. UCLA Medical Center

Source: CDPH

budget for the cost of the hearing because involves expenses that the state has to incu

and they have to have legal counsel in theCDPH to allocate some of their time for thehearings, Kadzielski said. And of course,those in-house lawyers are very busy doingother things.

According to CDPH ofcials, a singleadministrative hearing has been held since2007.

(We) do not have any control over whthese hearings take place, said Debby Rogthe agencys deputy director for healthcarequality. It varies depending on the compleof the case.! The unknown factor is howquickly OAHA can schedule the hearing.

As an alternative, Kadzielski claimed thCDPH has focused on publicizing such casthrough news conferences and press releasembarrassing hospital operators to the poinwhere they would prefer to pay the penaltyand move on, even though an appeal candelay payments for years.

Thats how the state has collected(nearly) $6 million. The L.A. Times publisheyour picture on the front page. Youve been

Continued on Next Page

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Page 3Payers & Providers

Longer ALOS!*

Advertise Here

(877) 248-2360, ext. 2

*For our ads, not your hospital

In Brief

review by an attorney to determinefurther legal action.

CalTAF ofcials indicated thatmany health plan enrollees are havingtrouble accessing treatment forsubstance abuse issues. According toa recent survey by the CaliforniaOfce of the Patient Advocate, only

13% of those enrolled in the stateslargest HMOs received treatmentwithin 30 days of a substance abusediagnosis.

Despite the fact that mosthealth insurance policies written inCalifornia already contain someprovisions for substance abusetreatment, the system clearly isntworking as it should, said CalTAFExecutive Director Phillip Greer.Many insurers continue to imposeunreasonable deductibles and co-payments or impose care guidelinesthat keep patients from receivingtreatment at the level of intensity orfor an amount of time that is

universally accepted as necessary.Our legal referral service is there forpeople who have been unfairlydenied treatment.

Kaiser Names ChiefDiversity Officer

Ronald Copeland, M.D., has beennamed senior vice president and chiefdiversity ofcer for Oakland-basedKaiser Permanente.

Copeland, who is currentlypresident of Kaisers medical group inOhio, assumes the new position on

Jan. 1. He will lead KaiserPermanente's diversity efforts tofurther create and sustain a culturalcompetencyexpand supplierdiversity efforts, reduce healthdisparities within diverse andunderserved populations, and achievemarket growth across diversepopulation segments, read a preparedstatement.

Copeland, a graduate of theUniversity of Cincinnati MedicalCollege and a veteran of the U.S. AirForce Medical Corps, has been withKaiser since 1988 and has been in hiscurrent position since 1998.

Oakland-based Kaiser Permanente haspledged $1 million in an attempt to increasediversity among physicians.

The grant, made to the National MedicalFellowships organization, is focused on

increasing the number of African Americanand Latino physicians.Kaiser Permanente understands the

importance of having a health care workforcethat will reect the diversity of our ever-evolving population, said Yvette Radford, avice president for external and affairs forKaisers Northern California region who alsosits on the NMF board. We recognize thatthere are insufcient numbers of African-American and Latino medical students, andour support for NMF is one way to helpaddress this important issue.

NMF was founded in the 1940s to address

barrier that were preventing people of colfrom becoming physicians, as most medicaschools during that era were segregated.Although many of those barriers have fallethe intervening decades, the demographic

have not changed as dramatically.According to data from the AmericanMedical Association, African-Americanscomprise 14% of the U.S. population but o4% of physicians. Latinos comprise 16% othe population, but 5% of physicians.

In a statement, Kaiser noted that manypatients select their own physicians based their own ethnic background because thea high level of condence that the physiciawill understand the patient's uniquehealthcare needs.

This will have a positive impact onhealth outcomes and provide equitable ca

our communities.

Kaiser Funding Physician Diversity$1 Million Pledge Toward More Doctors of Color

STORIES OF ONE HIGHLY LITIGIOUS PHYSICIAN

$149

Call (877) 248-2360, ext. 2 to order

OR CLICK HERE

Appeals (Continued from Page Two)

humiliated and shamed, so you cut a check,he said.

Among those hospitals appealing

decisions, many either negotiate an outrightdismissal of the penalty or a reduced ne,according to Kadzielski.

The CDPH was unable to producerecords of the outcome of administrativepenalty appeals as of presstime.

Along with the penalties, hospitals agreeto take corrective actions to ensure the safetymishaps do not repeat themselves. In the JFKmatter, management agreed to more rigoroustraining of its nurses and agreed not to allowmedical staff to burden them with their ownresponsibilities, records show.

CDPH spokesman Ralph Montano said

such changes are negotiated before thepenalty is levied and the ne issued.

We have fully veried (the hospitals)

plan of correction long before anything elsehappens, he said.In the meantime, a year or more has oft

passed before the CDPH announces anadministrative penalty and ne.

Among the most recent group of 13penalties and nes announced last week, mof the incidents occurred in 2010, accordingto records.

The (nes) dont do anything to x theproblem, because it was xed long before,Kadzielski said. He compared to situation tobeing ticketed for speeding but not receivingthe citation in the mail until years later.

https://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htm

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Payers & Providers PageOPINION

The True Conceit Of The CathedralPatients Dont Want Pianos They Want Quality

Jessie C. Gruman is founder and president

the Center for Advancing Health.

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

EDI Software Engineer III - Ashland, OREDI Software Engineer Level III at Plexis Healthcare Systems in Ashland, OR

Plexis Healthcare Systems is seeking an experienced EDI Software Engineer for production development, Integration, and Sales Support.

POSITION PURPOSE:

This position is responsible for the coordination, development and delivery of software products created by Plexis to maintain and improve

on existing functionality, and incorporates new processes into the code base. This includes handling a wide variety of situations and conicts

involving the functional and implementation specs as well as coding the functionality outlined in the functional specications. Takes direction

from lead Software Engineers; as well as contributing to the team in a constructive manner.

ESSENTIAL FUNCTIONS AND BASIC DUTIES:

Develop enterprise level applications in Microsoft.NET, Windows, NHibernate, C# and MS SQL Server.

Leverage his/her knowledge of object-oriented, Windows based development and advanced modeling techniques to implement scalable,

multi-tiered applications.

Present demonstrable experience in systems development tools and methodologies including Agile, SCRUM, Extreme Programming (XP) &

UML modeling.Write SQL code (stored procedures, triggers, views, etc.) as part of a project team to implement functional requirements ensuring

correctness and optimized performance.

Conduct Code Reviews and assist Management in establishing Standards and Best Practices.

Analyze and mature existing solutions.

Analyze troubleshoot program code to isolate and correct errors.

Collaborates with cross functional teams to analyze customer requirements and create technical specications and/or design documents for

new applications.

Create technical documentation for internal and external clients that accurately describe the conguration of technology utilized to implement

a development solution.

Create estimates of development tasks to be used for project scheduling.

Analyze and troubleshoot existing program code to isolate and correct errors.

Solves complex, analytical problems Understands the use of industry tools and technology and how their implementation affects project

goals.

QUALIFICATIONS:5+ years of experience in the development and implementation of Client Server & Windows based applications

High-level experience in the following: X12 Implementation Specication terminology and usage, C#, XML, Visual Studio, Visual Studio

UnitTest functionality, MS SQL, Windows Workow, NHibernate and Service Oriented Technology Methodologies. Advanced knowledge with

large scale development of enterprise systems.

Experience with Object Oriented Analysis and Design as well as Object Oriented Design Patterns.

Advanced knowledge in using best practices to perform software design, leveraging the methodologies of software systems analysis,

design, testing.

Experience creating technical documentation.

Experience creating UML and implementing Object-oriented design patterns.

Experience with reverse engineering and refactoring of systems.

Advanced knowledge of SQL Server tools (Management Studio, Conguration Manager, SQL Server Integration Services)

Advanced knowledge of database design, writing queries, triggers and stored procedures on SQL Server

Deadline driven accountability

Excellent communication and management skillsMENTAL ACTIVITIES AND REQUIREMENTS OF THIS POSITION:

EDI Software engineering functions are efcient, effective, and conducted in accordance with department policies and procedures, and with

applicable laws

Engineering policies and procedures are regularly reviewed and followed.

Management is appropriately informed of any signicant problems

Suggestions for improved efciency and effectiveness are provided

Required reports and records (including time entry) are accurate and timely

Good communication and effective working relations exist with related departments

The company's professional reputation is projected in all documentation

Successfully prioritizing tasks and meeting project deadlines

Working independently when required

Working successfully in a team environment

This is an immediate opening.

Only fully qualied individuals will be considered. For more information about our company, please visit www.plexisweb.com.

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

MEDICAL DIRECTOR

Coast Healthcare Management has been providing man-agement services to Medical Groups and IPAs since 1986.Coast has an excellent opportunity for an experiencedMEDICAL DIRECTOR with a strong UM and managedcare background who can lead all aspects of clinical opera-ions. The ideal candidate will have demonstrated success-

ful implementation of process improvement; the ability tooversee patient care through Hospitalist and case man-agement programs; the ability to manage ER utilization;and the knowledge and ability to manage global risk. Werequire superior interpersonal and conflict resolution skillswith the ability to articulate the goals and objectives of the

organization throughout the provider network; an under-standing of financial systems, business strategies, and thedevelopment of an integrated healthcare delivery networkfounded in quality with a commitment towards service andexcellence. Candidate should be a board certified physicianwith at least 5 years clinical practice experience along with5 years experience in a managed care clinical position anddocumented leadership capabilities. This position offers acompetitive salary and incentive package.

DIRECTOR OF FINANCIAL OPERATIONS

The DIRECTOR OF FINANCIAL OPERATIONS will reporto the CEO and be involved in all aspects of financial man-

agement and operations. Candidate must be a proveneader with an exceptional understanding of managed

care finance, delegated activities, health plan contracting,DOFRs, claims, reimbursement methodologies, risk poolreview and reconciliation and financial review and analysis.n addition the candidate must possess excellent oral and

written communication skills; ability to utilize an analyticaland systems approach to work and be a team builder. Thedeal candidate will be a strategic and innovative managerwith a Masters degree in business, or CPA with at least 5-7years experience in IPA/Group management.

IPA MANAGER

The IPA MANAGER will provide services and support ofPA operations with regard to providers and contract-ng with the ability to assist in contract financial analysis.This position requires extensive knowledge and experiencewith a variety of compensation methodologies. Candidateshould have a Bachelors degree in health care, business orrelevant domain and a minimum of 3-5 years experience inmanaged care, HMO contracting and/or operations.

nterested candidates should send their resumes in confi-dence to: kathryn.hogan@coasthealthcare.net

Please send resume to AllCare,

3320 Tully Rd., Ste. 1 Modesto, CA 95350,

or fax to 209-338-5657.

Attn: Human Resources/Information Technolog

AllCare IPA

MANAGER OF INFORMATION TECHNOLOGY

AllCare IPA is currently accepting resumes for an

experienced Information Technology professional.Qualified candidates should have experi-

ence in the healthcare industry, have a

thorough understanding of HIPAA/HITECH

regulatory requirements, and the following:

MS Windows 2008, Active Directory, DNS

WSUS, WDS, MS Exchange 2010, MS SQL

2005/2008, MS Windows 7, MS Office 2010

VMware vSphere 5, Equa llogic iSC SI SA Ns,

Crystal Reports XI, Trend Antivirus, firewalls

cisco switching & routing, Telecommunications

(T1, Broadband, Nortel Phone System), VPN and

colocation, backup-to-disk and disaster recovery

document management solutions, Xerox multi-

function printing/scanning and HP stand alone

printers, digital fax servers, and electronic sub-

mission of claims/authorizations. Strong skills inAccess and SQL are desired. Previous experi-

ence with EZ-CAP is a plus.

AllCare IPA, established in 1989, is a dynamic

managed care company with in excess of 500

physicians coordinating the care for tens of thou-

sands of local residents for the majority of major

health plans.

Al lC are of fe rs a compet it iv e salar y pac ka ge

including fully paid employee health, vision, den-

tal, LTC, and employer matched 401K with imme-

diate vesting.

7/31/2019 Payers & Providers California Edition Issue of June 14, 2012

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Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

It costs up to $27,000 to fill a healthcare job*

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*New England Journal of Medicine, 2004.

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