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Californias rural seniors are considerablymore likely to be overweight and unhealthythan their urban counterparts, according to anew study by the UCLA Center for Health

Policy Research.Using data from the California Health

Interview Survey,UCLA researchersconcluded that thestates 710,000rural seniorsexperience far moreisolation than thosewho live in the cities,often diminishingtheir opportunities toexercise and purchasehealthier foods.

As a result,elders living in ruralareas are more than10% more likely to beobese than thosewho live in citiesand suburbs, andabout 15% morelikely to besedentary. At the same time, rural seniors alsohave rates of food insecurity about 60% higherthan their suburban counterparts, althoughcity dwellers experience higher rates of foodinsecurity.

"The countryside can have an isolating

effect," said Steven P. Wallace, the Center'sassociate director and a co-author of the study"When even a trip to the grocery store is asignificant drive, seniors can become trapped

in their houses."According to the UCLA data, rural elders

suffered from heartdisease and weremore likely to suffera serious fall that

could lead to injuriesat significantly higherrates than their urbanand suburbancounterparts.

The study made avariety ofrecommendations.

Among them:

Improve access tomedical providers in

rural areas,including thepayment ofincentives forphysicians to

practice in such regions

Rural communities should keep bettertrack of federally-designated health

July 11-12

June 17-19

Calendar

16 June 2011

June 20-24

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.

www.lakesidecommunityhealthcare.com

California Edition

Rural Seniors In Healthc are BindIsolation Lea ds to Ob esity And Chronic Cond itions

Continued on Next Pag e

Heart Disease Diabetes Falls

12.9

16.1

20.9

14.6

19.4

22.8

16.418.5

25.1

Rural Urban Suburban

Percentage of California seniors with health conditions,by region. Source: UCLA

http://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://tcbi.org/index.php?conference=hu2011http://hia.berkeley.edu/http://hia.berkeley.edu/http://hia.berkeley.edu/http://hia.berkeley.edu/http://hia.berkeley.edu/http://hia.berkeley.edu/http://hia.berkeley.edu/http://hia.berkeley.edu/http://hia.berkeley.edu/http://www.healthwebsummit.com/2011medi-cal.htmhttp://www.healthforum.com/healthforum/html/conferences/11Summit/Summit_home.htmlhttp://www.healthwebsummit.com/2011medi-cal.htmhttp://tcbi.org/index.php?conference=hu2011http://hia.berkeley.edu/

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8/6/2019 Payers & Providers California Edition Issue of June 16, 2011

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Page 3Payers & Providers

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(877) 248-2360, ext. 2

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NEWS

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At first glance, it appeared Hoag MemorialHospital Presbyterian had had its taxexemption revoked last week by the InternalRevenue Service.

The Newport Beach hospital was listedamong more than 30,000 non-profitorganizations in California that had had its tax

exemption automatically revoked for not filingannual reports for three years in a row.

An IRS official confirmed the revocationthis week, but would not comment on specificrevocations as a matter of policy.

However, Hoag had regularly filed 990Form tax returns, according to public records.Moreover, the employer identification numberlisted with the revocation did not match theone used by the 498-bed hospital on its taxreturns.

It turned out that the revocation had beenfor a self-insured dental insurance trust Hoaghad discontinued for employee use back in

Nurses Co st Hospita ls$98K A Yea r Apie c e

The average cost of a hospital-based nurse is $98,000 a year,

according to a new survey byKPMG.KPMG surveyed more than

120 hospital chief executiveofficers for the survey. Of thedirect costs, $55,739 is tied towages, while the rest is connectedto lost productivity, employertaxes, vacation, recruitment andinsurance costs. The overallaverage attrition rate for the vastmajority of respondents was in the10% to 20% range.

Payment for overtime wagesfor nurses averaged four hours perweek. And 65% of the CEOs saythey use traveling nurses,

primarily for seasonal needs andto address local nursing shortages.The survey did not provide

specific data for California orother portions of the country.

IEHP Character WinsAd vert ising A wa rd

Super Nutricia, a superhero-oriented advertising campaigncreated by San Bernardino-basedInland Empire Health Plan in2009 to combat obesity, receivedtop honors from the American

Advertising Federation.The Gold AddyAward wasfrom the AAFs Inland Empirechapter.

A Latina character dressed ina yellow costume, Super Nutriciaencourages children to take apledge to stop eating junk foodand eat more fruits andvegetables.

Super Nutricia is amongseveral superhero characters IEHPhas developed to promotehealthier living for its Medi-Caland Healthy Families enrollees.

members of the Baby Boomer generation areexpected to enter Medicare every year in the14 state where WellPoint operates between

now and the year 2030.The price WellPoint paid for entre intothis market is steep: about $15,000 per life tobuy CareMore more than double theindustrys typical purchase price and farmore than the $3,000 or so per life WellPointtypically paid to acquire health plans in the1990s and early last decade.

WellPoint acquired an attractivebusiness that has grown substantially in thepast few years, but they paid up to do it,Citibank analyst Carl McDonald wrote in aresearch report released last week analyzingthe deal.

"In the last five years we have workeddiligently to create and demonstrate theCareMore model can produce superior

clinical andfinancial results in diversemarkets," said CEO Alan Hoops an old hand

at managed care, having helped launchPacifiCare, one of the states first healthmaintenance organizations, in the 1970s. "Weare excited about the opportunities tocombine our capabilities with the marketpresence nationwide of WellPoint and expandthe CareMore model within WellPoint'smarkets."

The deal is expected to close by the endof 2011, and is subject to both state andfederal regulatory review, WellPoint said in aprepared statement.

Hoag Seemed To Lose ExemptionIRS Names Hospita l, But Denta l Plan Wa s Revoked

the late 1990s, according to hospitalspokesperson Andrea Burgess.

Burgess added that Hoag had regularlyfiled paperwork with the IRS for the dentalplan.

Hoag was not the only California hospitthat appeared on the revocation list. Other

facilities included Barstow CommunityHospital, California Hospital Medical Centein Los Angeles and Pacific Hospital of LongBeach.

Pacific and Barstow had converted to foprofit ownership in recent years, andCalifornia Hospital affiliated with CatholicHealthcare West, which files a single taxreturn for every hospital in its system.

Typically, the only time the IRS revokes tax exemption for a not-for-profit hospital is it coverts to a for-profit, according to Jim Lotexecutive vice president of the HospitalAssociation of Southern California.

CareMore (Continued from Pag e Two)

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8/6/2019 Payers & Providers California Edition Issue of June 16, 2011

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Payers & Providers PageOPINION

Using Reform To Drive Job CreationPPACA Has Provisions For Physic ian, Nurse Inc ent iv

Jim Lott is the executive vice president of th

Hospita l Assoc iation of Southern California.

Op- ed subm issions of up to 600 words are

welc ome d. Please e-ma il proposals to

ed itor@pa yersandp rovide rs.co m,

For all the debate about whether the PatientProtection and Affordable Care Act shouldproceed full steam or be repealed post haste,some of its lesser-known provisions confrontwhat is a growing crisis in healthcare: apersistently shrinking number of doctors andnurses.Although the Great Recession haseliminated many of the signing bonuseshospitals had to hand out to recruit newemployees, the crimped economicenvironment masks the fact that the U.S.population is becoming older andsicker. Physicians and nurses are as

intertwined with this demographictrend as everyone else.Hundreds of thousands of thesecritical professionals plan to retire inthe next decade including up to athird of physicians and about 20% ofthe nurses.Meanwhile, younger physiciansdo not want to put in 18-hour dayslike the previous generation,particularly in already short-handedspecialties such as primary care. In whatappears to be an inverse of the law of supplyand demand, it is among the lowest-paying

specialties in medicine, making it morechallenging to pay off the $150,000 or more instudent loans required to complete medicalschool. Although many organizations helpnewly minted doctors pay off their studentdebt, there are simply not enough professionalschools extant to keep up with demand.The only specialty that pays less thanprimary care is geriatric medicine, andgovernment studies suggest the U.S. will need36,000 more of these specialists by 2030.Add to this demographic time bomb thehissing fuse of healthcare reform. Thirty-twomillion Americans including as many as 6

million Californians are expected to receiveinsurance coverage within the next three years.While reform will provide a badly neededfinancial boost to the healthcare system, itmeans that a group that predictably soughtcare in emergency rooms will soon need theirown cadres of primary care physicians andspecialists.Fortunately, an anticipation of this wasbaked into the reform legislation PresidentObama signed into law last year. The ACA will

spend hundreds of millions of dollars to widethe primary care safety net.Many of the financial inducements withinACA are aimed directly at primary carephysicians, who will receive higher Medicarepayments, as well as bonuses for practicing irural areas. The National Health Services loarepayment program was also expanded. TheNHS offer loan repayments of up to $170,000physicians who choose to serve for five yearsand total repayment for those who serve for syears or more. Obtaining such financial freed

in a relatively short period of timecould prove an attractive inducem

to primary care, rather than pursuihigher-paying specialties such asradiology and orthopedics.Moreover, the ACA also allowsthe re-provisioning of vacant slots medical residents, allocating morethem for primary care. And the U.Department of Health and HumanServices will fund teaching healthcenters to offer primary careresidencies in non-traditional

settings, such as outpatient clinics.The ACA also sets aside $50 million toexpand the number of primary care clinics

managed by nurse practitioners, who areallowed to tend to patients and prescribe druunder a physicians close supervision. This wdirectly address the nursing shortage, but theenhanced availability of such positions whusually pay six-figure salaries and often provedeeply satisfying to those who hold them could draw more people into the nursingprofession.None of these measures will cure thechronic shortage of healthcare professionals their own. But its a start, and one that is likelaccelerate as more provisions of the ACA areimplemented. Should the U.S. Supreme Cou

invalidate ACA, it will spell grim news not onfor healthcare delivery, but for those chargedwith delivering it.

B Jim Lott

8/6/2019 Payers & Providers California Edition Issue of June 16, 2011

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

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

will do it for a lot less.Employment listings begin at just $1.65 a word

Ca ll (877) 248-2360, ext. 2

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Or visit: www.payersandproviders.com

HEALTH PLAN MEDICAL DIRECTOR (Los Angeles)

Physician licensed by the State of California, with board certification in primary care or medical subspecialty.Have five (5) years of Medical Director experience in a managed care setting, such as a HMO or IPA/Medical Group.Medical oversight and physician liaison in the areas of: Utilization review, credentialing, quality improvement, peer review, casemanagement, and disease management.

Works under the direction of the CMO to ensure the delivery of high quality and efficient care for all members. ProvideAdministrative Management of patient care with specific responsibility to provide direction and assistance in achieving optimal

medical performance in an effi

cient manner. To participate and lead in the review of all inpatient admissions. Direct and reviewall inpatient utilization activity at hospitals by interfacing with the clinicians and UR nurses. Oversee the review process of priorauthorization (medical and pharmacy) requests in a timely manner. All denials must be individually reviewed and signed by theMedical Director or physician reviewer.

HEALTH PLAN, MANAGER, MEDICAL MANAGEMENT (So. California)

Graduate from an accredited RN program with three or more years of recent acute hospital nursing experienceThree or more years of recent managed care utilization management and case management experienceThree or more years of staff supervision/management experience. The Manager of Utilization and Case Management is responsibfor the day to day operations of the utilization and case management department, including the Medi-Cal and Medicare Programstaff. The Manager of UM /CM collaborates with the Director of UM/CM and the Team Leader and with the staff Medi-Cal WaiveCase Management Programs to promote continuity between programs, teamwork and collaboration.

Maintains effective administration of UM and CM functions. Coordinates staff schedule to assure effective coverage of UM andCM functions, including after hours, weekends and holiday coverage by Nurse Advice. Trains, implements and evaluates UM anCM policies and procedures, guidelines and action plans. Monitors and evaluates through monthly quality assessments theperformance of the Case Management and Utilization Management staff against established productivity and quality guidelines.

Provides timely educational feedback to staff on performance Assists the Director of UM/CM to ensure the programs are compliato DHCS contractual and regulatory requirements for Medi-Cal and to CMS regulations for Medicare.

Please Contact:Executive Search & Placement

Sonia Varian at 818.707.7118, or espsonia@pacbell.net

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

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