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California was among the biggest winner ofhundreds of millions of dollars worth ofgrants from the federal government thisweek to expand the workforce of primary

caregivers.Hospitals, clinics and community

colleges received more than $32.2 millionof the program money, which wasannounced by the U.S. Department ofHealth and Human Services on Tuesday.Only New York received more: $32.4million.

HHS officials say the money, whichwill be doled out over a five-year period,will be used not only to generate morehealthcare jobs, but to attempt to refocushealthcare delivery on primary andpreventive care.

Investing in our primary careworkforce will strengthen the role thatwellness and prevention play in ourhealthcare system. With these grants,Americans from all backgrounds will havenew opportunities to enter the health careworkforce, said Health and HumanServices Secretary Kathleen Sebelius.

Providers throughout the state say theywill be using the money to care for morepatients, or expand residency programs toensure the workforce has more primarycare physicians.

St. Mary Medical Center in Long Beach

received a grant for $1.92 million. It will

use the money to expand its primary careresidency program by nearly 20%, from32 to 38 slots, beginning in 2011.Residents begin the three-year program

after their third year at the UCLA DavidGeffern School of Medicine.

Were very pleased. Its a programthe community both needs and deserves,said Drew Gagner, St. Marys vicepresident of campaigns.

According to St. Marys data, thewestern central portion of Long Beach hasexperienced a chronic shortage ofhealthcare professionals, even thoughmore than half of its residents practicewithin the vicinity when they finish theirtraining.

We have a large foreign-born

population thats underserved, andhopefully if we can give these residentsthe right kind of experience in theirtraining, we can convince more to stay,Gagner said.

Among the biggest winners of overallgrant money was the University ofCalifornia system, which received nearly$14 million. The UC San Franciscocampus received $5.34 million in threeseparate grants.

State Reaps Primary Care LargesseWins $32M From HHS For Service Expansion, Training

8(2/9-*4/(!'*/:(*&!8(*)!;++-

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In Brief

Physician Sues AnthemOver Network Access

Anthem Blue Cross of Californiahas spent years tangling overaccusations it dropped enrolleeswhen they become ill. Now a

similar charge is coming from aprovider.

Los Angeles physician JeffreyNordella filed suit in Los AngelesSuperior Court on Aug. 24,claiming Anthem refused to allowhim to participate in their network.He claimed in the suit that Anthemis restricting its provider networkprimarily to increase profits.

Nordella claimed that he wasrefused entry into its networkbecause Anthem stated there wasno need for his services, eventhough his urgent care practice inPorter Ranch was only one of threewithin a 10-mile radius and he was

a prior Anthem Blue Cross networkphysician. He claimed that therefusal was a violation of state andfederal any willing provider lawsand is financially damaging hismedical practice.

The suit seeks damages forviolation of due processprocedures, tortious interferenceand unlawful business practices.

OSHPD Grants $2.7M InBrown-Song Funds

The Office of Statewide Health

Planning and Development hasawarded $2.7 million in traininggrants to 25 hospitals and medicalgroups statewide to fund theirfamily practice residency trainingprograms.

The grants range in size from$51,615 to $206,460. Recipientsinclude Harbor-UCLA MedicalCenter, White Memorial MedicalCenter in Los Angeles, Long BeachMemorial Medical Center and

Continued on Page 3

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Grants (Continued from Page One)

Of that money, $1.5 million will beused to expand Glide Health Services, anurse-managed primary care center in

San Franciscos impoverished TenderloinDistrict. Glides center, which is staffedwith a combination of nurse practitionersand visiting physicians, has about 3,400regular patients. The money will be usedto expand the patient base by another750.

Im definitely going to be able toincrease my internal medicine andsupport staff, said Patricia Dennehy,Glides director and a member of theUCSF nursing school faculty.

The remainder of the money will beused to train an additional 20 residents in

UCSFs family medicine and primary careresidency programs.

Both programs have an excellent

track record in training primary carephysicians who tend to work incommunity clinic settings serving

underserved populations after graduating,said Kevin Grumbach, M.D., a UCSFprofessor and chair of the universitysfamily medicine program.

Childrens Hospital & Research Centeof Oakland received $3.84 million. Themoney will be used to train an additional20 pediatric residents over next five years

The grants were not restricted to justthe University of California and teachinghospitals. The Riverside CommunityCollege District received $2.1 million toexpand its physician assistant trainingprogram, while the University of SoutherCalifornia received $704,000 for the samobjective.

The Grant Recipients

Nursing/Nursing Care/Home Aids/Physician Assistants

Western Center for Health Sciences $1.056 million

UCSF $1.49732 million

Tides Center $1.459 million

University of Southern California $744,000

Riverside Community College $2.1178 millon

Samuel Merritt College $1.23 millionSacramento College $749,960

Primary Care Residency Expansion

UC Davis $1.92 million

UCSD $2.88 million

UCLA $1.92 million

St. Marys Medical Center, Long Beach $1.92 million

Childrens Hospital & Research Center, Oakland $3.84 million

UCSF $3.84 million

UC System $1.92 million

Workforce Grants

San Diego Workforce Partnership $5 million

California Employment Development Department $150,000 (Source: HHS)

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Page 3Payers & Providers

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NEWS

In Brief

Santa Rosa Family Medicine.According to OSHPD, the

funds are used to develop newcurriculum, develop clinicaltraining sites and other expensesexcluding tuition. The agencyestimates it costs $150,000 to traina single resident.

Grants, awarded for residencytraining through OSHPDs Brown-Song program have totaled $21million since it was initiated in2003.

Blue Shield ofCalifornia Awards

$24.7 Million

San Francisco-based Blue Shield ofCalifornia has awarded $24.8million in incentive bonuses tomedical groups and physicians inits provider network.

Blue Shield is granting $13million through the IntegratedHealthcare Associations P4Pprogram. Another $7 million willbe awarded through its ownperformance improvement rewardsprogram, which focuses onmanaging ER and inpatientresources and generic drugutilization. An additional $4.8million was granted in the form ofother incentives.

Jones: Medi-CalDrawdown Near

A fee program that will allowCalifornias hospitals to draw downan additional $3.2 billion in Medi-Cal funding should be operationalby early next month, according toAssemblyman Dave Jones, D-Sacramento.

Jones office said that the CMShas been satisfied about all majorissues surrounding the fee. Jonesauthored key pieces of legislatingauthorizing the fee and how itshould be implemented.

Oakland-based Kaiser Permanente hasopened up the technology that helps operateits elaborate electronic medical recordsystem to other developers.

The donation of the technology, knownas the Convergent Medical Terminology, wasmade to the International HealthTerminology Standards Development

Organization. It will be distributed in theUnited States through the U.S. Departmentof Health and Human Services.

CMT essentially governs and knitstogether Kaisers EMR system, known as KPHealthConnect.

This donation...from Kaiser Permanenteaddresses that critical need by making iteasier for health professionals and patients tocreate standardized data in electronic healthrecords, said Health and Human ServicesSecretary Kathleen Sebelius. It can help

physicians provide better evidence-basedcare, while directly supporting theadministrations investment in bringinginformation technology to healthcare.

The donation of CMT is also hoped toexpedite the development of EMR systemsand meaningful use compliance in smallerpractices and hospitals, according to a joint

statement issued by Kaiser and HHS.This will support efcient patient care, awell as the production and export ofstandardized data needed to support qualityassessment, decision support, exchange ofdata for patients with multiple healthcareproviders, and public health surveillance, thstatement read.

A dollar value of the donation wasunknown. Kaiser spokespersons did notimmediately respond to phone calls and e-mails seeking comment.

The success of an accountable careorganization pilot program in Sacramentooverseen by Blue Shield of California hasprompted the San Francisco-based insurer toconsider expanding it statewide.

The ACO pilot, launched earlier this yearin conjunction with Catholic HealthcareWest and Hill Physicians Medical Group, hasresulted in a 4% reduction in hospitaladmissions, a 9% decrease in average lengthof stay and a 24% drop in readmissions,translating to a $14 million annual savings.The 38,000 participants are retiredgovernment workers who receive their

coverage from the California PublicEmployees Retirement System.The numbers, presented at last weeks

Healthcare Financial ManagementAssociation in Long Beach last week, wereinitially questioned by a Hill Physiciansspokesperson, but ofcials at both BlueShield and CalPERS conrmed the data thisweek.

Blue Shield and the providers haveinvested in a network of electronic medicalrecords and such practices as providing full

prescriptions upon discharge, something fewinsurers are willing to pay for.$14 million in savings is a lot of success

even when were doing it in a clunky manner,said Juan Davila, Blue Shields senior vicepresident of network operations, adding thatsome changes to clinical processes in the ACOhave yet to be fully rened. Our goal is toexpand it.

Davila said that the ACO would likelyexpand into the San Joaquin Valley in the rstpart of 2011, involving more CHW hospitals.Thats a slam dunk, he said.

A CHW spokesperson declined commen

but conrmed that it was in negotiations withBlue Shield.However, Davila said Blue Shield is also

in talks with medical groups such as Gemcareand PrimeCare in the Inland Empire, andhospital operators such as the Providencenetwork in the Los Angeles area, AdventistHealth and Tenet Healthcare.

We hope to have four to six ACOs upand live by the end of next year, depending odiscussions, and 20 by 2014, he said.

Kaiser Opens Much Of EMR SystemRelease of CMT to Help on Meaningful Use Regs

Blue Shield ACOs May Go StatewidePlans to Build on Success of Sacramento Pilot

8/8/2019 Payers & Providers Issue of September 30, 2010

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Payers & Providers Page

Democrats were urged to vote forhealthcare reform as a smart political move.In time, they thought, people would cometo love the new benefits.

As people find out whats in the bill,Families USA has been suggesting a newmessage: The bill isnt perfect, but wellimprove it. Forget about the extravagantclaims of reducing medical costs and thefederal deficit: Keep claims small andcredible.

At the Pima CountyMedical Society, theres a

mood of impassiveresignation. The society ismaking a deal with abusiness group to helpdoctors surviveand tohelp the society slow theloss of disenchantedmembers.

Small medical practiceswont be able to afford thecrushing new compliancerequirements, say the societysleaders. They have three years tofigure out what they are going to

do. The alternative to closing ormerging is, in this view, tooutsource responsibility for studying thenew rules, collecting the documentation,and filing reports.

Patients have no cause to celebrateeither. Sure, more people will be coveredby Medicaid. And by unemploymentbenefits. As employers look at the cost ofminimum essential coverage or penaltiessuch as $3,000 per employee if any workerqualifies for subsidies, there will be fewerhires and more pink slips. Especiallyaround the thresholds of the 201st, 101st,

or 51st employee, where new requirementsbased on business size kick in.Small businesses may have been excited

about the 35% tax credits touted on apostcard sent at taxpayer expense. But ifthey did the math or used the NationalFederation for Independent BusinessInternet calculator, they probably figuredout that they didnt qualify.

In reading the 906 pages of statutorylanguage, in order to write an articleentitled ObamaCare: Whats in It? for thefall 2010 issue of the Journal of American

Physicians and Surgeons,[ http://www.jpands.org/vol15no3/orient.pdf] I uscolored sticky notes for the various featurethe bill: taxes, regulations, punishments,favors to special-interest groups, and sociaengineering. There are no patientprotections and nothing that makes caremore affordable. There are only ways ofshifting the increased costs to other peopltaxpayers.

Features that most Americans willhate include billions of new taxreporting forms (including 1099s

the sandwich shop), more crowdemergency rooms, fewer availabdoctors, loss of medical privacy,more marriage penalties, and lotnew taxeseither because you adefined as rich or because youpaying the taxes that richbusinesses such as medical devicmanufacturers pass along to youThere are things in the bill that

some people will like: federally fundeabortions; lots of multiculturalism;national servitude for doctors;acceptance of death by dehydration o

starvation; thousands of new jobs for agents and bureaucrats; millions ofunwilling new customers for managed-carschemes and federally certified computersystems; and grants for developers of medcookbooks, ineffective smoking cessationaids, or politically correct counseling oreducation programs.

This misbegotten child has beenconceived and implanted, but it has a lot growing to do before it matures around 20in the course of which it will suck theeconomy dry while displacing theprofessionals and institutions devoted to

caring for the sick. We need to starve it offunding, disown it, repeal it, enjoin it, andnullify it on the state and individual level.

OPINION

The Looming Apocalypse Of ReformHistoric Law Contains Nothing But Epic Burdens For A

By Jane

M. Orient,

M.D.

Dr. Jane M. Orient is a physician practicing

Tucson, Ariz. and executive director of the

Association of American Physicians and

Surgeons.

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Op-ed submissions of up to 600 words are

welcomed. Please e-mail proposals to

editor@payersandproviders.com,

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

SENIOR MEDICARE COMPLIANCE ADVISOR - Along with the Compliance Ofcer and Privacy & Information Security Ofceserves as the focal point for all Medicare Advantage compliance activities. Coordinates and communicates all assigned MedicarAdvantage compliance activities internally and with L.A. Care's contracted provider network. Along with the Compliance Ofcer, L.A. Care's liaison with Centers for Medicare & Medicaid Services (CMS) and other federal agencies concerning L.A. Care's MedicarAdvantage product(s). Ensures that L.A. Care and its subcontracted provider network is compliant with all CMS federal regulatorrequirements. This is achieved by working with internal and external staff to correct performance deciencies, ensuring staff are awarof CMS reporting requirements and reports are submitted to CMS identifying internal areas for improvement. Responsible foperforming internal audits, monitors implementation of corrective measures, and interpretation of CMS requirements. Workin

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