!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456 !778 A Los Angeles non-prot group that succeeded in persuading California’s hospitals to change their charity care policies nearly a decade ago has taken on a new cause: adult day care facilities. The founder of the Consejo de Latinos Unidos claimed that broad abuses are occurring within the adult day care system, which provides care for many individuals with disabilities. Consejo Executive Director K.B. Forbesdeclined to provide speci c details, but said that evidence has been submitted to his organization that both physical abuse and neglect of clients at adult day care providers may be signi cant. “We believe it is broad,” said Forbes, whose organization helped the families ofeight developmentally disabled adults le suit against the operators of an El Monte day care center earlier this week. In that case, a former employee of the center – now known as New Day but formerly known as Healthy Start – pleaded guilty in January to charges of sexually molesting three female clients. However, the lawsuit claims that other clients were physically abused and neglected. Forbes also charged that in the case of the sexual molestations, New Day’s operators conspired to keep charges of abuse secret, and red an employee in retaliation for notifying law enforcement. In published reports, New Day ofcials say they have xed operationa l issues at its center and called the Consejo’s actions a “witch hunt.” The Consejo made national headlines early last decade when it accused hospitals ofputting undue pressure on patients who were uninusred or underinsured to pay their bills. The Consejo’s actions eventually led to several hospital chains agreeing to provide charity care to patients with much higher levels of income than in the past, policies that have since been adopted by virtually every hospital in California. Such policies are now usually posted in hospital emergency rooms and other parts of the facility. Forbes said he wants the owners and operators of the New Day center investigated, as well as the of the East L.A. and Pomona Regional Centers, which are operated by the California Department of Developmental Services . There are 21 such centers statewide, and make client referrals to adult day care operators such as New Day. Nancy Lungren, a spokesperson for the California DDS, said that all reports of abuse at adult day care centers are investigated as a matter of course and that protections are provided to whistleblowing employees. She added that corrective actions had been issued to New Day to undertake. 8(2/9-*4/(!:-;/)<&!9-*!=)(2<3;(*)! ><<-*4)&+6!>441(2!?))</45@!A)**(4)(! B)+-*<6!B(4;3-!'(2-+!C)*0)+@!D-;1+!-4! 4)E!3)(2<3;(*)!2(E+!(40!-<3)*! 0).)2-FG)4<+@!HIJIKHLII@ 82/;M!=)*)!D-*!?-*)!N49-*G(</-4 >>'8!>441(2!8-49)*)4;)@!7-45!O)(;3! 8-4.)4</-4!8)4<)*@!HLPI@!>4!)Q(G/4(</-4! -9!2)5(2!<*)40+!(40!/++1)+!/4!<3)!%/22/45R ;-0/45!+);<-*@ !HLPI@ 82/;M!=)*)!D-*!?-*)!N49-*G(</-4 April 3-6 April 8-10 Calendar24 March 2011 March 24-25 =)(2<3;(*)!D/4(4;/(2!?(4(5)G)4<! >++-;/(</-4!S-*<3)*4!8(2/9-*4/(!83(F<)*! >441(2!:F*/45!8-49)*)4;)@!:3)*(<-4! T*(40!=-<)26!:(;*(G)4<-@!B)9-*G!(40!/<+! )99);<+!-4!3)(2<3;(*)!9/4(4;)!/+!(G-45!<3)! <-F/;+@!HUIKHVII@ 82/;M!=)*)!D-*!?-*)!N49-*G(</-4 E-Mail [email protected]with 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 Group Takes On Care For Disabled Consejo Claims Abuse, Neglect is Commonplace Continued on Next Page
Transcript
8/7/2019 Payers & Providers California Edition – March 24, 2011
A Los Angeles non-prot group that succeededin persuading California’s hospitals to changetheir charity care policies nearly a decade agohas taken on a new cause: adult day care
facilities.The founder of the Consejo de Latinos
Unidos claimed that broad abuses areoccurring within the adult day care system,which provides care for many individuals withdisabilities.
Consejo Executive Director K.B. Forbes declined to provide specic details, but saidthat evidence has been submitted to hisorganization that both physical abuse andneglect of clients at adult day care providersmay be signicant.
“We believe it is broad,” said Forbes,whose organization helped the families of
eight developmentally disabled adults le suitagainst the operators of an El Monte day carecenter earlier this week.
In that case, a former employee of thecenter – now known as New Day but formerlyknown as Healthy Start – pleaded guilty inJanuary to charges of sexually molesting threefemale clients.
However, the lawsuit claims that otherclients were physically abused and neglected.Forbes also charged that in the case of thesexual molestations, New Day’s operatorsconspired to keep charges of abuse secret, andred an employee in retaliation for notifying
law enforcement.
In published reports, New Day of cialssay they have xed operational issues at itscenter and called the Consejo’s actions a“witch hunt.”
The Consejo made national headlinesearly last decade when it accused hospitals of putting undue pressure on patients who wereuninusred or underinsured to pay their bills.
The Consejo’s actions eventually led toseveral hospital chains agreeing to providecharity care to patients with much higherlevels of income than in the past, policies thathave since been adopted by virtually everyhospital in California. Such policies are nowusually posted in hospital emergency roomsand other parts of the facility.
Forbes said he wants the owners andoperators of the New Day center investigated,
as well as the of the East L.A. and PomonaRegional Centers, which are operated by theCalifornia Department of DevelopmentalServices. There are 21 such centers statewide,and make client referrals to adult day careoperators such as New Day.
Nancy Lungren, a spokesperson for theCalifornia DDS, said that all reports of abuseat adult day care centers are investigated as amatter of course and that protections areprovided to whistleblowing employees. Sheadded that corrective actions had been issuedto New Day to undertake.
Many small business owners inCalifornia are unaware of generalprovisions of the Patient Protectionand Affordable Care Act, accordingto a new survey by an Francisco-based not-for-profit group PacificCommunity Ventures.
Although 43% of the smallbusinesses surveyed said theywould offer insurance to theiremployees after learning of taxcredits offered to do so, 48% saidthey had been unaware of suchincentives.
Moreover, nearly two-thirds of small business owners – 62% –have not heard of the health
insurance exchanges set to beginoperating in 2014. However, 55%said they would participate onceprovided basic information abouttheir functions.
Among the survey’s 802participants, 45% identifiedthemselves as Republicans, 26% asDemocrats and 21% as politicallyindependent. Recent nationalsurveys show more than 80% of Republican favor the repeal of federal healthcare reform.
Half of the business ownerssurveyed had two to nineemployees, and half had 10 to 19employees.
"This survey shows thetremendous opportunity to furtherinform small business owners aboutthe healthcare act's core benefitsavailable to help them offerinsurance," said Pacific CommunityVentures Executive Director BethSirull. "Armed with thisinformation, small businesses willplay a vital role in covering greatnumbers of uninsured workers.”
Continued on Page 3
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Consejo (Continued from Page One)
However, Forbes noted the lawsuitagainst New Day was a start of what wouldbe a campaign against alleged abuses at other
organizations.“You know my M.O. This will eventually
grow,” he said.
A study released today by the Sacramento-based advocacy group Health Access estimates that the $6.4 billion in cutsproposed by Gov. Jerry Brown to the Medi-Cal, Healthy Families and other healthcareprograms will cost the state’s healthcaresector a minimum of 42,000 jobs.
In addition to those forecast job losses,Health Access also estimated that the cutswould also result in lost economic activitytotaling more than $2.7 billion.
“Combined with the other cuts proposedby the Governor, this will compound theeconomic downturn instead of reversing it,”the report said. It added that healthcare wasthe only job sector that grew in California in2009.
In trying to close a budget decit
approaching $27 billion, Brown’s budgetproposal calls for cuts in payments toproviders, a cap of 10 physician of ce visitsper enrollee per year, as well as theimposition of co-payments for ER visits,hospital admissions and prescription limits.
Brown has also proposed the eliminationof coverage for adult day care in the Medi-Calprogram. Health Access claims would lead tothe loss of at least 7,500 jobs at thosefacilities.
Cuts are also proposed to the HealthyFamilies program, which provides healthcare
coverage to children in lower incomehouseholds that do not qualify for Medi-Cal.
Health Access noted that the cuts – andpresumably job losses – will be much deeperif Brown’s proposals to extend about $12billion worth of various taxes are not placedon the ballot as voter initiatives later this year
Brown so far has been unable to reach anagreement with Republican lawmakers toplace the tax extensions on the ballot for aspecial referndum in June. He is now seekinga signature campaign by voters to approve theplacement of the referendum directly. Such areferendum would be scheduled forNovember, and would constitute a taxincrease rather than an extension.
In addition to the additional cuts if thetaxes are not green-lighted by voters, the
report noted that “these estimates also do notattempt to quantify the damage to California’slong-term economic growth of cuts toprograms that help sick and injured workersreturn to work, or the impact of hundreds of thousands of children going without healthcoverage, and the nearly one million childrenbeing denied eye glasses and other visionservices.
“The Governor’s proposed healthcare cutare bad for jobs, bad for California’s families,and bad for California’s economy,” the reportconcluded.
Cuts Could Cost Healthcare JobsGroup Says Budget Puts 42,000 Positions at Risk
Anthem Blue Cross of California isteaming with Sharp CommunityMedical Group and Sharp Rees-Stealy Medical Centers to launchan accountable care organizationpilot project.
Enrollees in Anthem’s PPOproducts in the San Diego area thatalready receive much of their carefrom the participating physiciansare candidates for enrollment inthe project. About 17,000 suchenrollees are eligible, officialssaid.
“PPO patients will now havethe opportunity to have theirpersonal doctor helpthem navigate the often-confusingarray of health care options andbetter coordinate their care,” saidJohn Jenrette, M.D., CEO of theSharp Community Medical Group.
Anthem is involved with asimilar pilot project incollaboration with medical groupsin Orange County.
Huntington MemorialReceives Nursing
Magnet Designation
Pasadena-based HuntingtonMemorial Hospital has received a“magnet” designation from theAmerican Nurses CredentialingCenter.
Huntington is only among 5%of the nation’s hospitals thatreceive such a designation, whichrecognizes the facility for itsexcellence in nursing.
"This is the highest honor aU.S. hospital can receive for itsnursing program and our nurseshave worked tirelessly to achievethis accomplishment," said BonnieKass, Huntington’s chief nursingexecutive.
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Anthem Blue Cross of California on Mondayannounced a curtailment and delay of double-digit rate hikes that were to be imposed on itsindividual policyholders this spring – just daysafter Blue Shield of California cancelledsimilar scheduled hikes.
The plan’s original 16.4% averagepremium increase for its roughly 600,000individual policyholders was set to go intoeffect on June 1. Instead, it has reduced thatrate hike to an overall average of 9.1% – areduction of roughly 45% – and will movethat increase back to July 1. Planned increasedin deductibles and co-payments were also
moved back from next month to January 2012.Anthem did so at the behest of California
Insurance Commissioner Dave Jones.Although Jones has no power to cancel suchrate hikes, he has been critical of health plansputting pressure on individual policyholderswith such steep increases.
Jones said he was pleased by the action,estimating that the change would save Anthempolicyholders about $40 million. However, hereiterated that his of ce has receivednumerous complaints about rate hikes, andadded that he has no power to regulate rates –something he would like to change.
"Health insurers still hold all the cardsand consumers remain at their mercy,” Jonessaid. He reiterated support for a bill currentlypending in the Legislature that would give hisof ce and the Department of Managed HealthCare power to regulate premium increases.
Anthem’s action was not as drastic as BlueShield of California, which last weekannounced the cancellation of a plannedrate hike this spring and the imposition of no further increases on its 193,000policyholders for the remainder of 2011.
Like Blue Shield, Anthem of cialsblamed rising medical costs for the need toimpost rate hikes, and suggested otherparties need to take some responsibility forfor the trend.“We are pleased with the resolution of thismatter, but feel all stakeholders in thehealthcare market in the state must do mor
to control the unrelenting rise of underlyinghealth are costs,” said Anthem Blue Cross oCalifornia president Pam Kehaly. “We planto be an active participant in helping forgethat dialogue and bringing together themajor healthcare players to nd the bestsolutions for California consumers.”
Anthem said it lost $110 million on itsindividual policyholders in California lastyear, and projected more losses for 2011even if it had implemented its originalincreases.
Consumer advocates remained waryabout Anthem’s actions. Michael Russo, an
attorney for the California Public InterestResearch Group, called the pullback a“reprieve for consumers,” but noted “analmost 10 percent hike will still be hard formany to afford. And Anthem enrollees haveto be worried about what will happen nextyear.”
Anthem Dials Back Rate HikesMove Comes Days After Blue Shield Cancellation
It was reported in the March 17 edition of Payers & Providers that both L.A. Care Health Plan and
HITECH-LA, its affiliated regional health information organization, were providing $2 million in fund
providers for EHR development. Registration with HITECH-LA is required in order to be eligible toreceive the funds, but L.A. Care is the conduit.
Just a generation ago there was little sciencebacking the practice of nursing. Nurses relied,as they always had, on folklore,!instinct, andnally trial and error. Thankfully, for theprofession itself and, most importantly for thepatients, that has changed.Today, the practice of nursing is beingexcitingly redened. Critically importantclinical research is takingplace at premier nursingschools across the country,and these collective effortsare helping to transform thenursing vocation that will
make immeasurable impacton the nation’s health.!
The timing couldn’t bebetter. Society is aging andconsumer expectations havenever been higher. With theearly stages of healthcarereform beginning to takehold, ACOs beginning toemerge and transparencybecoming the new norm,healthcare itself is going throughits own transformation.!!!!!!One of nursing’s distinct characteristics has
always been found in its focus on caring forand improving the quality of life of patientsand their family members -- not just in thehospital but in the home and in the communityas well. This is often done through educationand other behavioral interventions, with anemphasis on prevention. It is no surprise thenthat the vast majority of nursing research beingconducted across the country could beclassied as science aimed at affectingbehaviors that will improve health outcomes.!!!!!!Such is certainly the case at the UCLASchool of Nursing. Last month, four membersof our faculty presented important ndings at
the annual research conference of theOncology Nursing Society. Other members onour faculty are conducting important researchin the elds of geriatrics, cardiovascular healthand enhancing the health of vulnerablepopulations with a focus on such areas asasthma and childhood obesity. And that’s onlypart of the picture.!!!!!!Among other things, the school’s facultyincludes nearly a dozen basic scientists. Someare nurses prepared in the biological sciences
–!neuroscience, physiology or genetics. Otheare non-nurses, from an engineer studying linbetween brain changes, depression andphysiology to a physician studying HIV/AIDSThe school also boasts a group of nurses andnon-nurses who are biobehaviorists. Thesefaculty members marry the behavioral and thbiological. With ample opportunities to
exchange ideas and forgecollaborations, the school’researchers are addressingimportant health challengeand pushing the scienticfrontiers as never before.
!!!!!!While the UCLA Schoof Nursing is at the forefroin these efforts, we are notalone. From Yale to JohnHopkins and fromGeorgetown to the Univerof Virginia, nursing schoolacross the country are doiremarkable work and mak
vital contributions toward thiseffort. These nursing schools anothers like them are focusing osuch areas as disease preventio
pain management, improving quality of life, palliative and end-of-life care. They are helpito build the scientic foundation for clinicalpractice and developing knowledge that willone day lead to disease prevention and thebetter management of symptoms caused byillness.!!!!!!Nurses have long been among the mostrespected and revered of all healthcareprofessionals. They are the comforting voice;helping hand; the patient ally. This is a positiowe hold dearly and a responsibility we cherisBut today’s nurse researchers are makingcontributions in the lab and scienticcommunity as well, and that makes it time fohealthcare leaders across the country to take fresh new look at the nursing profession and the contribution these nurses can make.!
By Courtney H.
Lyder
8/7/2019 Payers & Providers California Edition – March 24, 2011
