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Moderator: There is emerging evidence thatgreen healthcare can add to an organizationsbottom line. But typically such initiativesrequire a substantial upfront investment, and it

can take years to reap a return. How do youconvince decisionmakers to take that leap?What works in terms of an argument?Gary Cohen:There areimmediatesavings inenergyreduction andwaste reductionwithout any upfrontinvestment. Justreprocessing

medical devicesis savingshospitalsmillions ofdollars per year.In terms ofgreen building,hospitals arebuilding highperformancebuildings with less than 2% rst cost, andsignicant cost savings during the life of thebuilding.Kathy Gerwig:

We actually don't typically make large upfrontinvestments on sustainability initiatives. Oursolar and fuel cell arrangements have a thirdparty that owns the installations and energy,and we commit to buying the energy at ratesthat are favorable to what we'd be payingthrough traditional channels. That way our costsare either neutral or we realize a savings.Additionally, for new facilities or majorrenovations, if sustainability measures areplanned into the design, we realize cost savingswhile building environmentally sound facilities.I

Gil Friend:Well, there's a lot of context behind thatquestion, but also some assumptions. Yes,people often assume that "typically suchinitiatives require a substantial upfrontinvestment" but that's not always the case.Sometimes it's a small investment, sometimesnone. For example, a recent Kaizen event at

our clientSunPower foundways to reduceelectricityconsumption20% at nocapital cost. Wend that it'soften moreuseful to talk in

terms of % ROIrather than yearsto payback.Three years cansound like along time, butit's better than33% per yearROI --handsome

returns in any economy.Gary Cohen:Practice Greenhealth, our membershiporganization, just signed an agreement with

Citi to offer similar no upfrontnancing forrenewable energy based on the KP

experience. This model especially works instates with tax breaks for renewables.Kathy Gerwig:Kaiser Permanente has two ways we embedsustainability into our supply chain. First,through an environmentally preferablepurchasing program that has been in place foryears. That communicates our intent to themarketplace.

A Discussion On Green HealthcareIndustry Leaders Talk About Returns on Investment

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May 2-5

May 10-13

Calendar

April 2011

May 16-17

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National Edition

Participants

1. Gary Cohen, co-executive director, Health

Care Without Harm, Boston.

2. Kathy Gerwig, Vice President,

environmental stewardship, Kaiser

Permanente, Oakland, Calif.

3. Gil Friend, CEO, founder, Natural Logic,

Berkeley, Calif.

Date of Roundtable: April 12, 2011

Moderator: Ron Shinkman, Publisher, Payers &

Providers

Technical Oversight: David Bronstein, MCOL

Continued on Page 2

E-Mailinfo@payersandproviders.comwith the details of your event,or call (877) 248-2360, ext. 3.

It will be published in theCalendar section, space

permitting.

http://www.wcbf.com/quality/5107/http://www.wcbf.com/quality/5107/http://www.wcbf.com/quality/5107/http://www.wcbf.com/quality/5107/http://www.wcbf.com/quality/5107/http://www.wcbf.com/quality/5107/http://www.wcbf.com/quality/5107/http://www.wcbf.com/quality/5107/http://www.wcbf.com/quality/5107/http://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1http://www.globalmediadynamics.com/upcoming-events/retiree-healthcarehttp://www.wcbf.com/quality/5107/http://www.wedi.org/forms/meeting/MeetingFormPublic/view?id=11917000006F1

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Payers & Providers

Gil Friend:Third, I'd suggest that organizations notsubject environmental/sustainabilty

investments to a higher hurdle rate than otherinvestments. SAP for exapmle has gone theother way, committing to fund anysustainability inevstments with shorter thanve year payback.Kathy Gerwig:Second, we introduced a sustainabilityscorecard that requires suppliers of medicalproducts to disclose, at the point of bid and atthe product level, various harmful chemicalsin their products and safer alternatives.Moderator:Is the patient community aware of theenvironmental footprint of their providers? If

not, what can you do to educate them? Arethere some parts of the country that are moreamenable or resistant to green healthcareinitiatives?Gary Cohen:HCWH was able to educate the general publicyears ago that healthcare was the largestsource of dioxin emissions adn alsoresponsible for 10% of all mercury airemissions. Hospitals responded by phasing outboth. The public does not realize yet howsignicant the carbon and toxics footprint ofhealthcare is.Kathy Gerwig:

Rather than talking about the environmentalfootprint, we talk about total health. Thatmeans high quality healthcare, and also howwe can support healthier communities. Wealso inform members about environmentalcontributors to disease.Moderator:A followup on that, Gary, you noted that theburning of medical waste has been reduceddrastically in just the past 15 years. Is most ofthat waste being recycled now? Or is it beingdisposed of in another manner?Gary Cohen:A lot of waste is being reduced in volume

through reuse and recycling. And bettersegregation. More waste is being treatedthrough sterilization techniques, rather thanburning. The biggest winner on waste inhealthcare is reprocessing medical devices,which allows what were called single usedevices to be sterilized and resold back tohospitals at 50% of the cost. Medicalmanufacturers actively resist and underminethis practice, but it is becoming widespreadthoughout healthcare.

Page 2

Kathy Gerwig:At KP, we have long relied on autoclaving(steam sterilizing) bio-hazardous waste excep

that which must by law be incinerated.Additionally we divert about 31% of our totawaste volume from the landll throughrecycling. To illustrate Gary's point, at KP lastyear we reprocessed 376,000 devices,reduced waste by 274,000 pounds and saved$7.7 million in purchasing costs.Moderator:Gil, your company works both in and out ofthe healthcare industry. Can you delineatesome of the specic environmental needs andgoals of the healthcare industry versusventures outside of healthcare? How does thesupply chain network in healthcare differ

versus, say, the food industry?Gil Friend:(The most interesting question with regard to"waste" isn't "what's the best way to dispose oit" but rather "how can we prevent it frombeing generated in the rst place" -- whichpoints to both the sort of purchasing practicesthat Kathy was discussing (since purchaseslargely determine potential waste) as well asoperational procedures at facilities.At one level, we see sectors as more similarthan different. Even though everyone feelsunique, every client buys energy andmaterials, and produces intended results

(products & services) and unintended results("waste" of all kinds -- not just physical wasteSo we always start with a "metabolic"approach that helps an organizationunderstand how it does and doesn't add valuto its resource ows.Moderator:Gary, you have noted that the OR is one ofthe biggest cost centers that a green initiativecan concentrate on. Is it fairly easy to get buyin from physicians, or is that a challenge? Ifso, what can you do to win hearts and mindsGary Cohen:Practice Greenhealth also has a program

called Greening the OR which is aiming tochange purchasing and waste and energypractices, which is where the greatest waste ia hospital occurs. We need to show safetyrst, equivalent performance, thenenvironmental savings, in that order. Havingphysicians involved in purchasing andvalidation efforts is important. Nurses areeven better since they are more active changeagents in their hospitals.

Trinity Health Will Pay$100 Million For Loyola

Hospital Purchase

Loyola University Chicago stands togain $100 million from the sale of itsmedical complex in the westernsuburbs, announced in March. (Payers& Providers, 8 March 2011, p. 2)

The purchaser of the universityshealth complex, Trinity HealthCorp., of Novi, Mich., willdramatically reduce payments tothe university. Between 2003 and2008, the medical complex paid anaverage of $31.9 million a year to

the university, as a subsidy to themedical school. Going forward,Trinity will pay $22.5 million ayear.

The Loyola University HealthSystem has been a money drain to theuniversity since 2004. In 2009 it lost$37 million on operations and in2010, $7 million, according to CrainsChicago Business.

With the transaction, some $350million in debt will go off theuniversitys books but will stay withthe hospital system. The university hashad to make occasional advancepayments to the hospital to avoid anancial squeeze.

Trinity and Loyola have agreed toput in $75 million each to construct anew research facility at the medicalcenter in Maywood, Ill.

Aetnas WilliamsReceives $72 Million

Exit Package

Ronald A. Williams, who recentlyretired as CEO ofAetna Inc., received$72 million in compensation in 2010,according to a report in the HartfordCourant.

The main form of payment was$50.4 million for the exercise of stockoptions that were granted in 2001. Hereceived $1.1 million in salary, $2.75million in incentive pay, plus $2.3million in pension value.

Williams, 61, stepped aside as CEOat the end of November. He remainedchairman of the board until last week.Information about his compensationwas included in documents led withthe Securities and ExchangeCommission last week.

Continued on Page 3

In BriefRoundtable (Continued from Page One)

NEWS

Continued on Next Page

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Page 3Payers & Providers NEWS

In Brief

Aetna has 18.9 million peopleenrolled in its health plans and hadrevenues of almost $38 billion in2009.

InsuranceCommissioner Joins

Sutter HealthWhistleblower Suit

California Insurance CommissionerDave Jones has joined a civilwhistleblower lawsuit againstSacramento-based hospitaloperator Sutter Health.

The suit, which dates to 2009and was filed in SacramentoCounty Superior Court, wasoriginally filed against Sutter andbilling intermediary Interplan byRockville Recovery AssociatesLimited, which inspects billings forpotential fraud.

The suit claimed that Suttershospitals routinely overbilledinsurers for anesthesia services.Typically, hospitals charge nominalfees for such services to cover thecost of its anesthesia technician,while the anesthestiologist submitsa separate bill.

However, Sutter billed as

much as $5,000 per procedure.and in some instances allegedlybilled for anesthia services whenno anesthesia was used.

"We believe the amount of thefraudulent charges is in thehundreds of millions of dollars, ifnot more," said Jones, who used hisauthority under the CaliforniaInsurance Frauds Prevention Act tointervene.

SCAN Health PlanNames New Medical

Director

California-based MedicareAdvantage insurer SCAN HealthPlan has named Raymond L. Chan,M.D. as its medical director.

Chan previously served asdirector of clinical services andquality for Hil Physicians MedicalGroup in San Ramon, and was amedical director for Health Netand Private Healthcare Systems.

Gil Friend:We need to show safety rst, equivalentperformance, then environmental savings, in

that order. Absolutely. And sometimes BETTERperformance. People often assume thanenvironmental benet has to come at theexpense of performance; demonstrably not so.Moderator:I also want to talk about food. Some hospitalshave been focusing on healthier selections fromlocally-sourced businesses. However, a lot ofhospitals are reliant on the Sodexhos and otherlarge institutional providers to run their patientfood service, cafeterias, etc. Have those largervendors been able to adapt and make greenerfood selections and waste disposal?Kathy Gerwig:

The institutional food suppliers have beenengaged by the large systems including KP toshift to healthier and sustainable food. Last yearwe purchased 100 tons of sustainable food forpatients, and we host 39 on-site farmersmarkets. Our goal this year is for 15% of ourannual food (expenditures) to be on sustainablefood. We are already achieving that goal YTD.Gary Cohen:On the food issue, the national suppliers have amodel that is not built on local and regionalsuppliers. They are being pressured to changetheir model due to concerns about food milesand support for local agriculture. Hospitals are

also realizing that they can support sustainableagriculture as a disease prevention strategy andcommunity benet.Moderator:Kathy, I noticed that you promote the use of e-mail with providers to cut down on ofce visitsand car trips. However, outside of Kaiser, thereis still some resistance by doctors tocommunicate by e-mail, particularly in somesmaller and medium-sized practices. Is Kaiserpromoting this change with providers outside ofits system? Do you have any tips on how toencourage providers to be more e-mail friendly?Kathy Gerwig:

We've found that our members and patients arevery excited about using technology tocommunicate with their doctors, to get Rxrells, to receive lab results, etc. I suggest tothose providers who are resistant to e-mail tothink about how better communication withtheir patients can support better compliancewith physician instructions and better outcomes.Moderator:Thanks! Can all of you talk about some of theretro-commissioning that can be performed toimprove a hospital or clinics bottom-line

operations?Kathy Gerwig:Getting all of a building's systems to work

optimally is foundational to energy efcienAnd every kilowatt saved is money in thebank.Gary Cohen:Many of the hospitals we work with use retcommissioning as the low hanging fruit onenergy reduction strategies, then go on toother strategies. That includes energy auditsupgrading boilers and chillers; changing oulights; tightening up air and water owsystems. Advocate Healthcare is Chicago hcheck list of 200 interventions that everyhospital needs to work on.Kathy Gerwig:

Commissioning is more than an energy audImagine complex building systems where apump here is set in a way that conicts witother equipment over there, and both areusing more power than needed.Understanding all of a building's systems, hthey interrelate, and how to optimizethem...and maintain that optimalperformance...is what commissioning is abModerator:Last question for everyone: can you allprovide some tips for healthcare planners/managers when dealing with and choosing green contractor or consultant to perform

work?Gil Friend:You need someone who plays well withothers. A contractor who is comfortable ancapable working in integrative process, witarchitects, builders, electrical, mechanical other contractors working together, rather tjust lobbing designs & documents from onethe other. It takes a certain skill to coordinathis process -- and sometimes a bit moreupfront work -- but pays big dividends inproject time, performance and economics.Gary Cohen:See if they have an integrated vision,

especially around sustainable design. See ifthey have a strong track record; see if otherthe healthcare eld can validate theirperformance.Kathy Gerwig:We look for evidence that they've contributo sustainability in real ways. Most businesstoday have statements about being green, bit is important to see actual results and proothat they're engaged in projects that reap reresults.

Roundtable (Continued from Page Two)

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Payers & Providers PageVITALS

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On April 15, the Republican-controlled U.S.

House of Representatives voted to endMedicare for Americans who are currentlyunder the age of 55. No Democrat voted infavor of the plan.

For those tens of millions affected, and forall future generations, the Republican plan endsMedicare and "privatizes" health care forAmerican seniors. The plan, if acted upon,would create a voucher system in place ofMedicare. The U.S. governmentwould assign approximately$8,000 to purchase private healthinsurance for each senior once heor she turned 67 years of age.

Under the Republican plan,the average senior would see theirout-of-pocket health care costsdouble to $12,150 per year notincluding co-pays.

There would be no moregovernment lifetime coverage. Ifyou could not afford a private healthcarepremium because you had a preexistingcondition (for example, high bloodpressure, diabetes, breast cancer) youdhave to nd the money to pay whateverpremium the private marketplace wouldcharge. The government, under the Republican

plan, would not even limit the amount theprivate market could charge. If you could notafford to purchase a private health insuranceplan at the age of 67 or older youd beuninsured.Imagine the suffering, pain and terror for thosetens of millions of seniors under thosecircumstances. Where would they turn?

Yes, the United States has a $1.4 trillionannual decit and a $14 trillion national debt.But what are the best and fairest ways to dealwith those extremely serious problems?

The Republican plan is at best a misguidedapproach to solving our nations common

problems. At worst, the Republican plan reectstheir undiminished zeal to "shrink" governmentby eliminating programs most Americans relyon, including Medicare. As a result, however,this would hurt the middle class and mostAmericans, leaving only the rich and super-richto be assured of a good education for theirchildren and affordable healthcare for them andtheir children.

Remember that the median income forseniors in America in 2009 was $19,167; with

most seniors having at least one chronic

condition and many having multiple chronicconditions. Can you imagine the premiumstheyd have to pay?

Medicare was created in 1965 preciselybecause the private market failed to provideseniors with affordable and quality health carBefore Medicare, nearly half of American senhad no health insurance, and nearly 35 percelived in poverty. We must not end Medicare. T

many American seniors would suor die prematurely if we did.

As for our extremely importdecit and debt problems, I beliethat all options should be on the

table, with sacrices shared by aaccording to assets owned andannual income. That means that tfollowing items must be considermaking additional cuts in spendiincluding defense; reducing incoand capital gains tax deductions

earnings over $350,000 per year; reformour tax code to prevent individuals andcompanies from avoiding all tax liabilitieliminating subsidies to Americas richefamilies; reducing or eliminating subsidto agribusiness, big oil and gas; ending o

proportionately scaling back the Bush tax cuts

for the wealthiest Americans; and, additionalcost control measures to the healthcare reformlaw, including a public option.

Forcing seniors and the middle class bear a disproportionate burden in solving ournations scal crisis is, in my opinion, unfair aunnecessary. The better, more typically Ameriway to address our common problems is withshared sacrice and fairness. Medicare is anessential and successful American program thhas worked extremely well for the past 46 yeaIt makes possible a longer and healthier life fomillions of our seniors. It is, also, often thedifference between life and death. We must n

end Medicare.

We Must Keep The Medicare ProgramThe Republican Proposal is Unfair and Benefits Nobod

Op-ed submissions of up to 600 words are

welcomed. Please e-mail proposals to

editor@payersandproviders.com, or call (877

248-2360, ext. 3.

Rep. Steve Rothman is a Democract serving N

Jerseys ninth district in the House of

Representatives.

By

Rep.

Steve

Rothman

8/7/2019 Payers & Providers National Edition, April 2011

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Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

HEALTHCARE CONSULTING OPPORTUNITY

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The Project Manager will have a high degree of direct client interaction, be responsible for managing multiple projects,and participate in the business development and sale of consulting projects.

Responsibilities include preparing and managing projects to include: strategic plans and feasibility studies for a range ofpost acute providers, such as long term acute care hospitals, rehabilitation hospitals, skilled nursing facilities, and assistedliving communities. In addition the Project Manager will be involved with PACE (Program for All-Inclusive Care for theElderly), as well as health care reform planning projects and operational reviews.

The position requires a Masters degree in business or related eld and a minimum of 5 years of consulting and/ orhospital, post acute or managed care planning or operational experience. Prior consulting experience in long-term/acutecare preferred. Health Dimensions Group is based in Minneapolis, MN, but this position may be home based and workfrom any location as the job will require substantial travel to work with clients throughout the nation.

Health Dimensions Group is a values driven organization and offers a competitive wage and benet package. Please sendresume to: hrinbox@hdgi1.com.

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