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Payers & Providers – Issue of January 27, 2011

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  • 8/7/2019 Payers & Providers Issue of January 27, 2011

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    When Mitchell H. Katz, M.D., made one ofhis rst public appearances after assuming thehelm of the Los Angeles County Departmentof Health Services earlier this month, he

    possessed features never seen by hispredecessors: a multi-day growth of beard,green khakis, tennis shoes, aloose tie and a blue blazerwhose vents were resolutelypinned together.

    And while Katzspresentation at the CaliforniaEndowment on Mondaybegan with his hugging itsPresident Robert K. Ross,M.D., before taking thepodium, he nonetheless laidout an agenda that was

    anything but mellow: hewants to remake the nations second-largestpublic health system and overcome thesometimes rigid bureaucracy that likely playeda role in keeping the post vacant for nearlytwo years.

    Is there a structural reason that LosAngeles County cant have the best safety netsystem in the country? Katz asked theaudience, primarily members of the LosAngeles Chamber of Commerce. The answeris no. The point is, we have to gure outwhere we want to go.

    Katz, appointed by the L.A. County Board

    of Supervisors in December, began his new

    job on Jan. 3, and is paid an annual salary of$355,000. He had been the Supervisorsunanimous pick to replace Bruce Chernof,M.D., who left the post in May 2008.

    The 51-year-old Ivy League-trainedphysician had been head of the San Francisco

    Department of Health since1997. He has been widelylauded for establishingHealthy San Francisco, thenations rst universal publichealth insurance plan.While Dr. Katz hasexperience in running a majorurban public healthcaresystem, he also has the visionand passion to steer the L.A.County Department of Health

    Services to meet thechallenges and opportunities posed bynational health reform, said Los AngelesCounty Supervisor Zev Yaroslavsky.

    Katz, who spoke for only 15 minutes butelded questions from the audience for aboutan hour, laid out his plans for DHS in thecoming months and years.

    He observed that the recently approvedMedi-Cal waiver and impending federalhealthcare reform which are expected to addmillions of Californians to the Medi-Cal rollsand could have Medi-Cal managed care plans

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    February 24-25

    February 23

    Calendar

    27 January 2011

    February 9

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    [email protected]

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

    published in the Calendar section,space permitting.

    Continued on Next Page

    www.lakesidecommunityhealthcare.com

    California Edition

    Katz Outlines Remaking Of LAC DHSVows to Overhaul Healthcare Delivery And Culture

    Mitchell H. Katz, M.D., speaking

    Monday in Los Angeles.

    http://www.calhealthplans.org/events/index.cfmhttp://www.calhealthplans.org/events/index.cfmhttp://www.calhealthplans.org/events/index.cfmhttp://www.calhealthplans.org/events/index.cfmhttp://www.calhealthplans.org/events/index.cfmhttp://www.calhealthplans.org/events/index.cfmhttp://www.calhealthplans.org/events/index.cfmhttp://www.calhealthplans.org/events/index.cfmhttp://www.calhealthplans.org/events/index.cfmhttp://merage.uci.edu/Events/merage/2011HCFC/http://merage.uci.edu/Events/merage/2011HCFC/http://merage.uci.edu/Events/merage/2011HCFC/http://merage.uci.edu/Events/merage/2011HCFC/http://merage.uci.edu/Events/merage/2011HCFC/http://merage.uci.edu/Events/merage/2011HCFC/http://merage.uci.edu/Events/merage/2011HCFC/http://merage.uci.edu/Events/merage/2011HCFC/http://merage.uci.edu/Events/merage/2011HCFC/http://www.hasc.org/briefs.cfm?resID=256278http://www.hasc.org/briefs.cfm?resID=256278http://www.hasc.org/briefs.cfm?resID=256278http://www.hasc.org/briefs.cfm?resID=256278http://www.hasc.org/briefs.cfm?resID=256278http://www.hasc.org/briefs.cfm?resID=256278http://www.hasc.org/briefs.cfm?resID=256278http://www.hasc.org/briefs.cfm?resID=256278http://www.hasc.org/briefs.cfm?resID=256278http://www.healthwebsummit.com/green020411.htmhttp://www.healthwebsummit.com/green020411.htmhttp://merage.uci.edu/Events/merage/2011HCFC/http://www.calhealthplans.org/events/index.cfmhttp://www.hasc.org/briefs.cfm?resID=256278
  • 8/7/2019 Payers & Providers Issue of January 27, 2011

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    Payers & Providers Page 2

    Top Placement...Bottomless Potential

    Advertise Here

    (877) 248-2360, ext. 2

    In Brief

    IHA Wins RWJF GrantFor P4P Enhancement

    The Oakland-based IntegratedHealthcare Association has been

    awarded a $281,000 grant from theRobert Wood Johnson Foundationto work with the Santa Monica-based RAND Corp. to create anadvanced program to better gaugethe quality of healthcare delivery.

    The new program, focused onpay-for-performance programs, willattempt to estimate a physiciangroups total cost of delivering care.It is intended to enhance IHAscurrent pay-for-performanceprogram.

    Building on the foundation ofour pay for performance program,this effort will merge both qualityand cost measures to create a more

    comprehensive view ofperformance, said IHA ExecutiveDirector Tom Williams. Carefullyconstructed, the results will enablephysician groups to differentiatethemselves and for health plans tomake value based contractingdecisions that benefit consumersand reward high-performingproviders.

    A statement issued by the IHAsaid that the enhanced programshould be ready to deploy by 2012.

    Kaiser To Deploy Fuel

    Cell Techonolgy AtFacilities

    Kaiser Permanente has entered intoan agreement with Sunnyvale-basedBloom Energy to install fuel cells atseven of its facilities in Californiaby the end of this year.

    The cells are expected togenerate four megawatts ofelectricity combined, and reduce

    Continued on Page 3

    NEWS

    Katz (Continued from Page One)

    competing for new enrollees on the state-runinsurance exchange would change the rolesand perceptions of safety net providers.

    The safety net will be functioning as asystem of choice, not a system of the lastresort, he said.

    As a result, Katz discussed assigningpatients who enter the county system tospecic hospitals or clinics, along the lines ofpatient-centered medical homes. He notedthat under the Healthy San Francisco plan,enrollees are required to pick a clinic toreceive their primary care.

    You were accountable for choosing aclinic for your care, he said, noting that oneof the primary picks here for indigent care the emergency room at Los Angeles County-

    USC Medical Center, was not appropriate.In responding to a question from anurses union ofcial, Katz said he wanted toreduce some of the authority physicians havein DHS and share more of it among nursesand other allied healthcare professionals.

    Registered nurses are the glue of anyhealthcare system...the notion that a doctorleads treatment is wrong, said Katz, whoadded that nurses often are in far closercommunication with the patient. A high-performing system is one that is multi-professional.

    However, Katz also conceded that hisearly proposals have already run up againstthe near-legendary force of the county

    bureaucracy.My staff has told me that proposals Ihave made that would improve quality andnot cost any more would not work, he said.Ive been told the (Los Angeles) CountyCounsel wont let us, the unions wont let us,and the board (of Supervisors) wont let us.He added that the notion of moving forward isperceived by some as foolish.

    Instead, Katz said he would remake hisagencys outlook.

    A cultural change is the single biggestthing I have to do at DHS, he said.

    Katz is already mounting another cultura

    challenge toward the attachment Angelenoshave for their cars. He bicycles daily to andfrom from his mid-Wilshire apartment at thePark La Brea complex to his ofcedowntown. Its a one-way trip of nearly eightmiles in often heavy trafc, and likely explainmany of his wardrobe choices.

    He has found 6th Street to be a goodway to go, said DHS spokesman MichaelWilson, although he added that Katz hasalready complained of several near misseswith motorists. How he fares in potential job-related collisions remains to be seen.

    The Department of Managed Health Careheld a press conference in November toannounce that it had ned seven health plans$4.85 million for failure to pay providerclaims and answer their complaints in atimely manner.

    However, nal settlement letters posted

    on the agencys website in recent days showthat the regulator provisionally reduced thenes levied against ve of the plans, some bymore than half.

    To date, the DMHC reduced the nes known as administrative penalties by $1.3million, an overall reduction of nearly 27%. Aletter of agreement has yet to be posted forWoodland Hills-based Health Net, whichwas ned $750,000.

    A DMHC spokesperson said the nesannounced in November were initialpenalties, which could return to the full

    amount with a back ne if the plans do notshow full compliance during their next routineaudits, which would occur within 18 months.

    The biggest beneciary was Anthem BlueCross of California. Originally ned$900,000, the sum was reduced to $500,000,a 55% reduction. Aetna had its ne cut in

    half, to $150,000 from $300,000.UnitedHealth/PaciCare had its ne reducedto $500,000 from $800,000. Blue Shield ofCalifornia had its ne reduced 33%, to$400,000 from $600,000.

    Kaiser Foundation Health Plan had itsne reduced to $500,000 from $750,000, andreclassied as a contribution to DMHCsManaged Care Fund.

    The letter to Kaiser indicated the healthplan was willing to ght the violations the

    Continued on Next Page

    DMHC Reduces Many PenaltiesFines Levied in November Cut By More than $1M

  • 8/7/2019 Payers & Providers Issue of January 27, 2011

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    Page 3Payers & Providers

    Longer ALOS!*

    Advertise Here

    (877) 248-2360, ext. 2

    *For our ads, not your hospital

    NEWS

    In Brief

    the use of fossil fuels at the sites byslightly more than a third. Theywill initially be operated on naturalgas, although they may be operatedon methane gas derived fromlandfills or manure.

    "Kaiser Permanente recognizesthe health of the environment

    directly affects individual andcommunity health," said KathyGerwig, vice president andenvironmental stewardship officerat Kaiser Permanente. "Byexpanding the use of cleanerenergy technologies such as fuelcells, we're demonstrating ourcommitment to greening ourenergy portfolio and reducing ourcarbon footprint."

    Wright Joins Payers &Providers Editorial

    Board

    Anthony Wright, the executivedirector of Oakland-based HealthAccess California, has joined theeditorial board ofPayers &ProvidersCalifornia edition.

    The addition of Wright, who isbased in Sacramento, makes himthe second Northern California to

    join the editorial board.Established in 1987, Health

    Access has advocated on a varietyof health issues for consumers inCalifornia, particularly theexpansion of healthcare coveragefor its more than 8 million

    residents who lack insurance.Wright, who previously servedon the staff of Vice President AlGore, has headed Health Accesssince 2002. He is a graduate ofAmherst College.

    Anthony is one of the mostdistinguished and measured voicesfor advocacy in California, and Iam extremely pleased that he is

    joining the board, said Payers &Providers Publisher Ron Shinkman.His contributions to the op-edpage will lay out specific advocacyissues to a policy-orientedaudience.

    We want to set the record straight about anopinion article that unfairly charged theOfce of Statewide Health Planning andDevelopment (OSHPD) with holding uphospital construction projects in California (IsOSHPD an Obstacle to Growth?, Jan. 20). Itssimply not accurate to say that the state isimpeding growth when billions of dollars inprojects have been approved but are stalledbecause of inaction by hospital builders, notanything the state has done.

    Unsafe hospital buildings can kill peopleduring earthquakes. Further, these buildingsare expected to withstand an earthquake sothat they can remain open to treat the injuredduring such a disaster. We will continue toinsist that hospitals buildings are built to savelives, and we are doing everything in ourpower to expedite the state approval process.

    OSHPD has implemented numerousenhancements, such as expedited plan reviewprocedures, launched a Web-based trackingsystem, implemented urgency regulationsallowing hospitals to take advantage ofalternative seismic compliance options, andworked collaboratively with entitiesauthorized to use the Design-Build model as amethod to speed project delivery. !Over $5.5billion of OSHPD approved projects are

    currently under construction. !More than $3billion in hospital projects have also beenapproved by OSHPD, and they wouldcertainly generate jobs and help revitalizecommunities, but for reasons completelyoutside the states control, these projects sitidle. !!Further, OSHPDs efforts can onlyaddress half of the length of time it takes toapprove a plan, as plans are typically with thbuilders design team 50%-60% of the timeduring the plan review process. Design teamneed to hold up their end of the bargain aswell, returning plans back to OSHPD in atimely way so we can turn them back arounas quickly as possible.

    We stand by our record of assistinghospitals to design and construct buildingsthat will ensure public safety in California,which has the most active and heavily

    populated seismic zones in the nation. Wehope that hospitals will take steps tocommence construction of the projects thathave already been approved, and continue twork in partnership with us to move plansforward quickly and effectively.

    David M. Carlisle, M.D., PH.D.Director, Ofce of Statewide Health

    Planning & Development

    COO/CFO COMPENSATION

    A PAYERS & PROVIDERS EXCLUSIVE WHITEPAPER

    COMPENSATION ON NEARLY 200 OF CALIFORNIAsHEALTHCARE COOs & CFOs NOW AVAILABLE

    Report is $149. Report and Salary Data is $275.

    Call (877) 248-2360, ext. 2OR

    CLICK HERE to Order

    LETTER TO THE EDITOR

    DMHC (Continued from Page Two)

    DMHC claimed it had committed, and thatthe settlement was reached in the bestinterests of both parties to avoid theuncertainty and expense of an administrative

    hearing.The letters to the other plans indicated the

    DMHC acted on its own to reduce the nes.A Kaiser spokesperson said the plan wouldcomply with the objectives set forth by theDMHC.

    Only Cigna agreed to pay its full ne of$450,000.

    https://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htm
  • 8/7/2019 Payers & Providers Issue of January 27, 2011

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    Payers & Providers Page

    As the CEO of a small Los Angeles Countyhospital who has dealt in the past with theOffice of Statewide Health Planning andDevelopment, I read Jim Lotts recentopinion Is OSHPD an Obstacle toGrowth? with great interest. Mr. Lottsastute recap of both the potential behind SB1953s initial design and the correspondingshortcomings in its deploymentwas in my opinion insightful.

    However, to cast the blameentirely on OSHPD is notnecessarily fair, especially when

    it comes to state-mandatedseismic safety standards. Inmarshaling all Californiahospitals in the direction of SB1953, OSHPD has been chargedwith a Herculean task, which hasbeen compounded by our currenteconomic climate. With suchresponsibility thrust upon theshoulders of an underfunded,understaffed department, efficiencywas certainly never a priority in theminds of its makers. Furthermore, asimportant as this role may be, upon

    reflection it stems in large part from thefear generated by a high-profile tragedy andthe arguable overreaction of statepolicymakers and popular media. Too oftenafter these events the course of healthcareshifts its aim away from the big picture todwell on anomaly, often to the detriment ofboth patients and providers.

    To be certain, the isolated events thatcapture our attention are often devastating,tearing apart families, communities, evencities. In early January an angry, disturbedyoung man killed six with his gun. Some ofthe victims were high profile and others

    were tragically young. As the fallout fromthis shooting captured the nationsspotlight, significant focus centered onepisodes of unidentified bipolar disorderand schizophrenia. Mental health expertstrumpet the warning signs of illness leadingto such a violent event much likeCalifornians speak of The Big One, eventhough less than 0.004% of the U.S.population is likely to die from firearmseach year. When this occurs, the spotlightis shifted away from more prevalent threatssuch as diabetes, obesity, and heart disease,

    though the aftereffects on the families ofthose who die from these understated killeare no less devastating.

    Similarly, when fear of catastrophe sethe tone for policy, funding is often funneaway from its most deserving targets. The for SB 1953 came about after a 6.7 magniearthquake in Los Angeles County, Califor

    killed 72 people in January 199Seventeen years later, hospitalacross California are spendingtheir part of the estimated $90$120 dollars to ensure they me

    the seismic safety requirementmandated by the state legislaturegardless of their day-to-dayfiscal health. While theNorthridge Earthquakeunquestionably causedtremendous damage to SoutheCalifornia, the proposed price

    when broken down runs about $1.billion per fatality.As an administrator, it is confusingme that Americas healthcare is so

    often dictated by the aftereffects of anaberrant, high profile tragedy, while more

    subtle yet more prolific killers go largelyunpublicized as their cures remainunderfunded and their victims die withoufanfare, or essential earmarked funds arererouted to assuage tomorrows fears.Certainly seismic compatibility is a goalworth attaining, but in these troubledeconomic times as hospitals both large ansmall struggle to keep their doors open to dependent public, it certainly does not huunderstand the origins of this expensiveoverhaul, and question whether these fundwould be better spent on preserving thequotidian rather than planning for a possi

    catastrophe. By 2015 all functioningCalifornia hospitals should be prepared fothe Great Shock, but how many will remato be left standing, regardless of the whimmother nature?

    OPINION

    Our Fear-Driven Regulatory RealmOne Event, Not Day-to-Day Reality, Pushed SB 195

    By Craig

    B. Garner

    Craig B. Garner is the chief executive office

    of Coast Plaza Hospital in Norwalk.

    9-21:)!;6!1%2/+3)0!).)*&!?31*+0(&!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!

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    FD$=E!/4!%12G!1>!C-!$#!+1%+B*/%)*+H@!^-++!]-20%)*56!(&)*+(40>*-./0)*+@B-:

    Op-ed submissions of up to 600 words are

    welcomed. Please e-mail proposals to

    [email protected],

  • 8/7/2019 Payers & Providers Issue of January 27, 2011

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    MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

    MEDICARE COMPLIANCE ADVISOR - ensures that L.A. Care and its subcontracted provider network is compliant with all Centerfor Medicare &!Medicaid federal regulatory requirements. This is achieved by participating in the annual PPG and quarterly auditsworking with internal and external staff to correct performance deciencies, identifying internal areas for improvement, serving a

    the compliance contact with Plan Partners for member grievance oversight, provider services oversight, and interpreting CMS/SNPProgram requirements for L.A. Care. !Additionally, this individual is a resource to internal staff on compliance matters relating toCMS/SNP standards, including, but not limited to, marketing materials, grievances and appeals, member rights issues, and claimsadjudication.! Responsible for performing internal audits, monitoring for implementation of corrective measures, and interpretationof CMS requirements. !Working knowledge of federal and state requirements is required, as well as highly developed analytical skilland excellent verbal and written communication skills.!

    For complete job description, qualications/requirements, visit our website: www.lacare.org

    To apply, email resume with salary history and requirement to: [email protected] referencing Payers & Providers Ad

    MANAGER, BUSINESS ADVISORY SERVICES

    The Camden Group has been providing business advisory and management services to the healthcare industry exclusivelysince 1970. We have served more than 1,000 clients nationwide. Due to our growth, the following opportunity is available inour Los Angeles ofce:

    Will prepare and manage the following types of projects: strategic plans, physician-hospital alignment strategy (e.g., ACO,clinical integration, bundle payment), service line development, and demand forecasts for presentation and collaboration withthe executive team members of hospitals, physician groups, and other healthcare organizations. The successful candidate willhave a high degree of direct client interaction, be responsible for managing projects, participate in the business development

    and sale of consulting projects, and use their time in a billed-hours environment. Masters degree in business or related eld, 8years of consulting or hospital-based planning experience required. Los Angeles.

    All of our positions require prociency with Microsoft Ofce software, the ability to work well with individuals at all levels ofan organization, and excellent analytical, written, and oral communication skills. Based in Los Angeles, with work locally andthroughout the nation. Comprehensive compensation packages offered.

    Contact Information:

    Miriam Lupercio, Human Resources

    [email protected]

    www.TheCamdenGroup.com

  • 8/7/2019 Payers & Providers Issue of January 27, 2011

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    Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

    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

    Call (877) 248-2360, ext. 2Or e-mail: [email protected]

    Or visit: www.payersandproviders.com

    *New England Journal of Medicine, 2004.

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    T)!$)5!@#-3!3)!2&)2)'%!)&!2#&3+9+2#3%!+-!#!C535&%!4)5-,3#67%!8-3%]+*%S!"#&3+9+2#3+)-!+'!%-3+&%7$!)-7+-%I!@+3;!#!9)BB+3B%-3!)C!-)!B)&%!3;#-!)-%!;)5&:!/#77!4)-!M;+-AB#-!#3!VWWE

  • 8/7/2019 Payers & Providers Issue of January 27, 2011

    7/7

    Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

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