!!!"#$#!%&!'(&)*+!,!'*-./0)*+ !'1%2/+3/456 !778 As the California Legislature ended its regular session earlier this week, it passed bills that broke both ways for the hospital industry while killing a potential law that could have curbed increases in healthcare premiums. The Assembly passed AB 1653 77-0 on Monday after it was passed by the Senate last week, sending it to Gov . Arnold Schwarzenegger’s desk for his signature. That bill provides structure for a fee to be imposed on hospitals that would allow them to draw more Medi-Cal matching funds from the federal government, pending a final approval by the Centers for Medicare and Medicaid Services . Hospitals are expected to receive $2.6 billion, while the state would receive $560 million earmarked to boost healthcare coverage for children. The Legislature also passed SB 1240, which requires an annual audit of all lease agreements between private hospital operators and hospital districts; imposes limitations on how district assets may be spent and eliminates the use of operating losses as credits toward the purchase of a district hospital. Sponsored by the California Nurses Association , that bill was in response to allegations against Sutter Health in its operation of district hospitals in Marin and Alameda Counties. Sutter is currently embroiled in litigation with both districts. Although a Schwarzenegger spokesperson did not respond to an inquiry as to his position on the bills, he is considered almost certain to make AB 1653 a law. “This solves a lot of funding problems for both hospitals and the state, so there is no reason for the governor to veto it,” said J an Emerson , vice president of external relations for the California Hospital Association . Meanwhile, a bill that would have required regulatory approval before health insurers could increase rates died on the Senate floor. AB 2578 went down after 17-17 and 16-19 votes on Aug. 30 and Aug. 31, with several lawmakers wavering on their votes at the last minute. “Nay” votes by Democratic Senators Lou Correa , Ron Calderon, Roderick Wright and abstentions by four other Democrats during the Aug. 30 tally were blasted by the Santa Monica-based advocacy group Consumer Watchdog , Last-Minute Winners, Losers On Bills Hospital Fee Bill Passed; Insurers Win on Rate Curbs 9:;<!8(2/=-*4/(!:(22!8-4=)*)4>)?!7-45! @)(>3!9&(AA?!BC0(A)+!-4!D;986! 3)(2A3>(*)!+A/E121+?!FGHIJFKHI? L)5/+A)*!M42/4)N 3AACNOOPPP?3=E(J>(=(22>-4=?-*5O *)5/+A)*?2(++- ;)0/>(2!D).)2-CE)4A!QC)>/(2/+A+! <441(2 ! 9)(2A3>(*)!8-4=)*)4>)?!R4>-*)!(A! S&44! 9-A)26!7(+! T)5(+?!D/+>1++/-4!-=!3-P! *)=-*E! P/22!(==)>A!A3)!).-21A/-4!-=!A3)! 3-+C/A(2!(40!C3&+/>/(4!%1+/4)++!E-0)2+?! FGHIJF$6$HI?! L)5/+A)*!M42/4)N 3AACNOOE0+>-4+12A/45?>-E September 8-9 September 19-21 Calendar2 September 2010 September 22-24 Q)>-40! <441(2!;3)(2A3!U)AP-*V/45! 8-4=)*)4>)?!W-P4!(40!8-14A*&!9-A)26!Q(4! D/)5-?! <!0/+>1++/-4!-=!3-P!E-%/2)! (CC2/>(A/-4+!(*)!>3(45/45!3)(2A3>(*)?! FGHI? L)5/+A)*!M42/4)N 3AACNOOPPP?E-%/3?-*5OE))A/45+O 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. Continued on Next Page California Edition HEALTHCARE’S BEST ADVERTISING V ALUE ] PA YERS & PROVIDERS reaches 5,000 hospital, health plan and non- prot executives statewide. There is no better venue for marketing your organization or conference, or recruiting new staff. LEARN MOREHERE OR CALL (877) 248-2360, ext. 2
Transcript
8/8/2019 Payers & Providers – Issue of September 2, 2010
As the California Legislature ended itsregular session earlier this week, it passedbills that broke both ways for the hospitalindustry while killing a potential law that
could have curbed increases in healthcarepremiums.
The Assembly passed AB 1653 77-0 onMonday after it was passed by the Senatelast week, sending it to Gov. ArnoldSchwarzenegger’s desk for his signature.That bill provides structure for a fee to beimposed on hospitals that would allowthem to draw more Medi-Cal matchingfunds from the federal government, pendinga final approval by the Centers forMedicare and Medicaid Services. Hospitalsare expected to receive $2.6 billion, whilethe state would receive $560 million
earmarked to boost healthcare coverage forchildren.
The Legislature also passed SB 1240,which requires an annual audit of all leaseagreements between private hospitaloperators and hospital districts; imposeslimitations on how district assets may bespent and eliminates the use of operatinglosses as credits toward the purchase of adistrict hospital.
Sponsored by the California NursesAssociation, that bill was in response to
allegations against Sutter Health in itsoperation of district hospitals in Marinand Alameda Counties. Sutter is currentlyembroiled in litigation with both districts.
Although a Schwarzeneggerspokesperson did not respond to aninquiry as to his position on the bills, heis considered almost certain to make AB1653 a law.
“This solves a lot of funding problemsfor both hospitals and the state, so there isno reason for the governor to veto it,” said Jan Emerson, vice president of externalrelations for the California HospitalAssociation.
Meanwhile, a bill that would haverequired regulatory approval before healthinsurers could increase rates died on the
Senate floor. AB 2578 went down after17-17 and 16-19 votes on Aug. 30 andAug. 31, with several lawmakers waveringon their votes at the last minute.
“Nay” votes by Democratic SenatorsLou Correa, Ron Calderon, RoderickWright and abstentions by four otherDemocrats during the Aug. 30 tally wereblasted by the Santa Monica-basedadvocacy group Consumer Watchdog,
Last-Minute Winners, Losers On BillsHospital Fee Bill Passed; Insurers Win on Rate Curbs
The Marin Healthcare District suedSutter Health last week, accusingthe Sacramento-based hospitaloperator of taking more than $120
million over the last four years itoperated Marin General Hospital inGreenbrae under contract with thedistrict.
In addition to demanding themoney, the suit also claims that theboard that oversaw hospitaloperations did so in an operationalconflict of interest, and that Sutter’sactivities in the Greenbrae areawere detrimental to the hospital’soperations.
Sutter’s lease with Marinended on June 30, five years earlyas the result of other litigation overthe hospital’s control. The suitclaims that Sutter began taking out
huge chunks of revenue from thehospital as it became clear thelease was going to be terminated.
“Sutter utterly ignored itsfiduciary responsibility to MarinGeneral and instead chose to lineits own pockets with the Hospital’sreserves,” said Marin attorneyJames J. Brosnahan. “It’simproper, immoral andreprehensible conduct by acompany that was trusted tomanage this vital communityresource.”
Sutter has not commenteddirectly on the suit, which was filedin Marin County Superior Court.Published reports quote Sutterofficials as saying the suit has nomerit.
.
Hoag ReopensRenovated Facility
The shuttered Irvine Regional Medical
Continued on Page 3
NEWS
Building on considerable success in securing
recuperative care and housing for homelesspatients after they’re discharged from OrangeCounty’s hospitals, two Southern Californiafoundations will replicate the program in LosAngeles County starting next month.
The Los Angeles-based National HealthFoundation and Irvine-based IlluminationFoundation will start small: homeless patientswill receive recuperative care at a yet-to-be-named motel in the Mid-City area of LosAngeles while social workers help them ndtransitional or permanent housing. The staff will be a mixture of paid professionals andgraduate students from the University of
Southern Calfornia and Alliant University.Of cials say the 20-bed site will be one of at least four countywide to assist withhomeless patients. Other recuperative care“pods” are expected to open in Long Beach,the South Bay and the San Fernando Valley.Each will have a nurse and case manageronsite.
The program not only helps the homeless,but addresses what has been a public relationsproblem for Southern California hospitals,which discharge about 6,000 homelessinpatients a year. Following media scrutinyabout the “dumping” of homeless patients, the
City of Los Angeles made it a misdemeanor in
2008 to discharge a homeless patient onto thstreet.In January, NHF and Illumination
launched a similar program in Orange County(Payers & Providers, 1-21-10). Dischargedhomeless patients stay in a Costa Mesa motelunder the supervision of a nurse while socialworkers nd them appropriate benets andhousing. The costs of $200 per patient per dayare borne by the hospitals.
Of the 105 patients that have beenreferred for recuperative care, more than 60%have been placed in housing, according toIllumination Foundation Executive Director
Paul Leon. Leon noted that many of the OrangeCounty patients had chronic conditions thatentitled them to state disability payments of $800 to $1,400 a month – enough to securehousing in a board and care or a sober livingfacility. Getting them qualied for suchprograms was virtually impossible prior to therecuperative care program.
“It’s far easier to get them stable fundingbecause they’re at one place for a period of time,” Leon said. “Before, they were just
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Homeless Patient Program ExpandsSuccessful in Orange County, it Moves Northward
Bills (Continued from Page One)
which claimed they were influenced bymore than $187,000 in campaigncontributions from health insurers since
2007.“Too many state senators have
refused to buck the industry that has linedtheir campaign chests,” said ConsumerWatchdog President Jamie Court, who
added the legislation should become aballot measure.
However, another bill, SB 1163, whic
would require independent actuarialreview of request rate increases that woulhave to be made available to the public,was passed by both houses and sent toSchwarzenegger for his signature.
Center reopened on Wednesday as154-bed Hoag Hospital Irvine, thesecond acute care facility operated byNewport Beach-based HoagMemorial Hospital Presbyterian.
Hoag invested $84 million inrefurbishing the facility, which hadpreviously been operated by for-prot
chain Tenet Healthcare. The Dallas-based Tenet shut down the hospital in
January 2009, just weeks before itslease of the facility from a LongBeach-based real estate investmenttrust ended. Hoag now holds a long-term lease on the property.
The revamped hospital boastsstate-of-the-art radiology andorthopedics centers. It employs a staff of 900.
Kaiser DermatologistStars in System’s New
Commercials
A new series of televisionadvertisements featuring thecontinuity of care for a KaiserPermanente patient stars one of thehealthcare systems’ physicians. Linda Davis Tolbert, M.D., is adermatologist who practices atKaiser’s South Los Angeles facility.She plays the physician overseeingthe care of another “Linda” – afictional patient provided withprenatal care, an improved dietand vaccinations, among othertreatments.
A Kaiser spokesperson saidthe 49-year-old Tolbert, a graduateof Howard University MedicalSchool who also holds a lawdegree from SouthwesternUniversity School of Law in LosAngeles, was recommended for thecommercials by the South LosAngeles medical director.
The 30-second and 60-secondspots will begin airing in eightstates on Sept. 6.
These are among the ways healthcarefraud is committed in Southern California,which U.S. Attorney General Eric Holder declared a “hot spot” for such activities at asummit held in Los Angeles last week.
“Healthcare fraud tends to be viral and
regional, and this is one region where it hasbeen focused,” Holder told reporters at theHealth Care Fraud Prevention Summit at LosAngeles City College.
Of cials at the summit suggestedSouthern California’s urban sprawl and apresence of Eastern European and Armenianorganized crime rings were among the reasonfor the concentration of fraud in the region.
Holder, along with Health and HumanServices Secretary Kathleen Sebelius,discussed at the summit how their twoagencies are combating fraud.
Last year, DOJ and HHS of cials formed
a joint strike task force called the Health CareFraud Prevention and Action Task Force(HEAT). HEAT uses a variety of methods,including educating senior citizens to betterspot fraud, and working closely with locallaw enforcement agencies. Since HEAT wasformed, it has secured nearly 600 criminalconvictions and recovered $2.5 billion,according to Holder – a roughly 30%increase in asset returns.
Individuals whose frauds exceeded $1
million are receiving enhanced sentences, antheir assets are being more aggressivelyseized. “We’re taking Lamborghinis, Maseratiand beachfront mansions,” said HankWalther, deputy chief of the Department of Justice’s fraud section.
Sebelius said her agency has ratcheted upscrutiny of Medicare contractors, requiringthem to resubmit their credentials and
forbidding the use of post of ce boxes foraddresses or cell phones as business numbersHHS is also using such technologies asGoogle Earth to determine if durableequipment companies are actually doingbusiness where they claim they are.
A Government Accountability Of ce Study released last year indicated that homehealthcare billings were often inated, andthat the addresses for many home healthcareagencies – particularly in the L.A. area – werenonexistent. Sebelius claimed it would beharder to maintain such shams.
“The days when you could just hang ashingle over a desk and start submitting claimare over,” she said.
The day before the Aug. 26 summit, 268-bed Saint John's Health Center in SantaMonica agreed to pay $5.25 million to settleclaims it had inated charges to Medicare forcare provided on "outlier" patients. AndreBirotte Jr., U.S. Attorney for the CentralDistrict of California, cited the settlement in aspeech he made at the summit.
moving all around, oftentimes right back tothe hospital because they never had a chanceto recuperate.”
Patients stay an average of just under 10days before they’re placed elsewhere. That isfar better than the 30-day average stay thatoccurred when the NHF conducted a two-year pilot program with the Los Angeles-based JWCH Institute in conjunction with ahomeless shelter in Bell. That program endedlast March.
Leon credits the shorter length of stay toclose coordination between the recuperativecaregivers, hospitals and social workers. It
also makes the costs far more palatable tohospitals, according to Kelly Bruno, NHF’svice president of programs.
“We’ve already been approached by 10hospitals in the last couple of days,” saidBruno, who added that most facilities in thecounty have yet to be formally notied of theprogram.
Along with NHF funding, KaiserPermanente’s Southern California division isproviding the L.A. County program with a$50,000 grant. The California Endowment islikely to grant another $100,000, according toLeon.
Homeless (Continued from Page Two)
AG Holder: L.A. Is Fraud “Hot Spot”DOJ Teams With HHS to Combat Illegal Activity
8/8/2019 Payers & Providers – Issue of September 2, 2010
There is a fleeting scene in Joan Didion’s memoir “The Year of Magical Thinking,”when she asks a hospital physician abouther gravely ill daughter experiencingsepsis. The doctor brushes her off becausehe considers sepsis a “clinical term” andnot a diagnosis.
Technically, he was correct, but themassive organ failure characterized bysepsis has up to a 60%mortality rate. Anyone whoseloved one is in the hospitalhas a right to be concerned
about it. Any physician askedabout it shouldn’t parse words.Didion is perhaps the
greatest essayist produced byAmerican letters in the pasthalf-century. I still get a thrillwhenever I introduce her workto my writing students, eventhough some of her best workwas published in the early1960s.
Nonetheless, there are fewphysicians who would claim ause for her. Didion’s territory is that of
emotions, of trying to get into someone’shead and figure out how they or theprevailing culture makes them think andact. If a physician gets into someone’shead, it is strictly to make repairs.
That may be changing.Since the late 1980s, the prestigious
Mount Sinai School of Medicine hasadmitted 35 students each year who studyhumanities rather than hard sciences inundergraduate school. In fact, thenotoriously difficult MCAT exam is notrequired for these students.
Those accepted are given a crash
course on chemistry during a summersession, but essentially are educated asphysicians without the supposition thatthey are inclined to be cut-and-driedscientists. Most of the students are fromelite schools (read: Ivy League) withgrade-point averages approaching 4.0. Inother words, these med students are noless academic superstars than theircounterparts steeped in the hard sciences.
Although the American Association of Medical Colleges reports that about two-thirds of medical school applicants still
did their undergraduate studies in the hardsciences, the Mount Sinai example is hardan outlier. More than 40% of the studentscurrently accepted at the University of Pennsylvania’s School of Medicine arehumanities graduates. “They've got to behappy and have a life outside of medicineAdmissions Director Gail Morrison toldNewsweek in 2007. “Otherwise they'll ge
overwhelmed. We need wholepeople.”The consensus is that someone wis schooled in humanities is like
be more holistic in their thinkingand therefore more likely to keeptheir patients’ needs in mind. Mosuch graduates also go into primcare fields, which are woefullyshorthanded.It’s more important than ever tha
the field of medicine be populated wbroad thinkers. Healthcare inflationconsistently runs triple the average ofinflation in this country. I cannot helpbut think that trend is exacerbated inby clinicians who think in purely
scientific terms and automatically refer
patients to surgeries and other expensivetreatments without considering cheaper anless invasive alternatives that could lead tsimilar outcomes.
Moreover, a doctor who’s read some JDidion back in the day might think twiceabout automatically dispensing a flip remawhen communicating with a concernedfamily member. If they’re more at ease witthe physician, they and their loved ones mbe less inclined to opt for the desperate “tat all cost” approach that signifies most enof-life care. Such an approach is hideouslexpensive, almost always futile and usuall
brings satisfaction to no one. A hospitalmedical staff versed in more than justnumbers might be able to tackle this ever-looming obstacle to bringing rationality tohealthcare’s bottom line.
OPINION
Healing Outside Of The Science BoxRecruiting Humanities Majors Could Improve Care
