payers & providers california edition – issue of april 21, 2011

8/7/2019 Payers & Providers California Edition Issue of April 21, 2011

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Utilization and volume data released by theOfce of Statewide Health Planning andDevelopment shows that the rate of cesareansections continues to rise at the states

hospitals, while intensive cardiac proceduresare continuing a years-long decline.

Californias hospitals performed136,196 C-sections in 2009, down about 2%from 2008. However, the rate per 100 birthsincreased to 29.8 from 29.2. The rate was 27.1per 100 births in2005, whenOSHPD rst beganreleasing data. Theagency considersC-sections as apossiblyoverutilized

procedure,although thestatewide rate isstill lower than thenational rate ofabout 31 per 100births.

The C-section rate among Los Angeles Countyhospitals is much higher than the statewideaverage, at nearly 35 per hundred births.Several facilities perform C-sections well overhalf the time. At Los Angeles CommunityHospital, a small facility in East Los Angeles

owned by the for-prot chain Prospect

Medical Holdings, 67.5 out of 100 births in2009 were delivered via c-section. Aspokesperson from the organization did notreturn a phone call seeking comment.

Although C-sections are generallyconsidered a safe procedure, they oftenrequire blood transfusions and sometimesadmission to the intensive care unit, drivingup costs and the risks for complications. Risksalso rise when a C-section is performed

multiple times. Asubsequent vaginalbirth after a C-section occurs inonly eight per 100births, according toOSHPD data.

State and hospital

ofcials were atodds as to what isdriving up the c-section rate. JosephParker, manager ofOSHPDs healthoutcomes center,suggested that

scheduling on both the parts of patients andphysicians played a hand.

More women are scheduling their c-sections in advance so they can plan theirparenthood better, there are probably certain

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May 4-7

May 11-13

Calendar

21 April 2011

June 3-5

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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.

www.lakesidecommunityhealthcare.com

California Edition

Ups, Downs For Hospital ProceduresC-Section Rate Rises While CABGs, PTCAs Decline

Continued on Next Page

C-Section Rates For Selected Hospitals(Per 100 Births in 2009)

Kaiser South Sacramento Medical Center 18.1

Riverside County Regional Medical Center 20.4

Mercy Medical Center Redding 28.7

Kaweah Delta Medical Center 34.1Scripps Memorial Hospital La Jolla 37.4

Community Hospital of San Bernardino 44.7

Memorial Hospital of Gardena 46.3

Bellflower Medical Center 52.4

(Source: OSPHD)
http://www.hasc.org/ps.events.cfm?ID=942http://www.hasc.org/ps.events.cfm?ID=942http://www.hasc.org/ps.events.cfm?ID=942http://www.hasc.org/ps.events.cfm?ID=942http://www.hasc.org/ps.events.cfm?ID=942http://www.hasc.org/ps.events.cfm?ID=942http://www.hasc.org/ps.events.cfm?ID=942http://www.hasc.org/ps.events.cfm?ID=942http://www.hasc.org/ps.events.cfm?ID=942http://www.capg.org/conference2011/register.htmlhttp://www.capg.org/conference2011/register.htmlhttp://www.capg.org/conference2011/register.htmlhttp://www.capg.org/conference2011/register.htmlhttp://www.capg.org/conference2011/register.htmlhttp://www.capg.org/conference2011/register.htmlhttp://www.capg.org/conference2011/register.htmlhttp://www.capg.org/conference2011/register.htmlhttp://www.capg.org/conference2011/register.htmlhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttp://www.cmanet.org/events/detail/?event=california-health-care-leadership-academyhttp://www.hasc.org/ps.events.cfm?ID=942http://www.capg.org/conference2011/register.html


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Payers & Providers Page 2

Top Placement...Bottomless Potential

Advertise Here

(877) 248-2360, ext. 2

In Brief

DOI CommissionerJones Joins

Whisleblower SuitAgainst Sutter Health

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 nominal

fees for such services to cover thecost of its anesthesia technician,while the anesthestiologist submitsa separate bill.

However, Sutter billed asmuch 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 usedhis authority under the CaliforniaInsurance Frauds Prevention Act tointervene.

A statemet issued by Suttersaid this case is without merit andthat our anesthesia charges areappropriately billed. We intend tovigorously defend this matter.

OSHPD Awards $2.7Million To Nursing

Programs

The Office of Statewide HealthPlanning and Development awared

Continued on Page 3

NEWS

OSHPD Data (Continued from Page One)

incentives on the part of physiciansalso...such as for planning (their schedules),he said.

Ofcials with the California HospitalAssociation and Citrus Valley HealthPartners, a hospital operator in the SanGabriel Valley, suggested that lack of prenatalcare is driving the rates upward. This might beexacerbated in Los Angeles County, wherepoverty rates are higher than in other urbanregions of the state.

We have a lot of mothers who do notget good prenatal care, a lot of the Medi-Calpopulation, and some who have no access toprenatal care at all, said Tracy Dallarda,Citrus Valleys senior vice president ofcommunications. Citrus Valleys 325-bed

hospital in West Covina performs a C-sectionfor every 47 out of 100 births, among thehighest rates for a high-volume facility inCalifornia. Dallarda added that the hospital

system has rigid criteria for evaluatingexpectant mothers for c-sections.

While the C-section rate continued

upward, volumes for complicated cardiacprocedures such as coronary artery bypassgrafts and coronary angioplasties continued todecline. The number of CABG procedurestotaled 17,105 in 2009, down from 17,985 in2008 and 21,295 in 2005, a 20% drop in lessthan ve years. Angioplasties declined 4.2%in 2009, to 50,514 versus 52,935 in 2008. Atotal of 60,414 were performed in 2005 anoverall drop of 17%.

OSHPD and hospital ofcials credit thdrop to the use of medications such as bloodthinners.

Some of these interventional therapie

have similar outcomes to surgery, and farfewer risks for complications such as strokes,Parker said.

CEO/COO/CFO COMPENSATIONPAYERS & PROVIDERS EXCLUSIVE WHITE PAPERCOMPENSATION ON MORE THAN 300 OF CALIFORNIAs

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Continued on Next Page

SCAN Incentivizes Medical Groups$5 Million Set Aside; Plan to Emulate CMS System

SCAN Health Plan has committed $5 millionover the next two years as incentives to its

contracting medical groups to improve thequality of healthcare delivery, and hasestablished a rating system that mirrors oneemployed by the Medicare program.

This is really all about improving patientcare and making healthcare more responsiveand accessible for our members, saidTimothy Schwab, M.D., SCANs chief medicaland informatics ofcer. The Long Beach-basedMedicare Advantage plan has about 130,000enrollees in California and contracts withabout 50 medical groups.

Schwab said SCAN would emulate theve-star rating system used by the Centers

Medicare and Medicaid Services to evaluaproviders. It is requesting that its medicalgroups select at least one CMS qualitymeasure and build a program aroundimproving it.

The providers can have an impact in delivery of care, such as specic diseasemeasures like diabetes, osteoporosis, Schwsaid. Or they could improve preventative
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Page 3Payers & Providers

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SCAN (Continued from Page One)

Long Beach-based Medicaid managed careplan Molina Healthcare posted a strongearnings gain for the rst quarter of 2011,although company ofcials warn that budgetstrictures in certain states could impinge onfuture earnings.

Molina reported net income of $17.4million for the quarter ending March 31, up61% from $10.6 million for the rst quarterof 2010. Revenues were up 13.7%, to $1.1billion from $966.7 million.

Company ofcials attributed the growthto better cost controls inpatient utilizationwas reduced 7% while pharmaceutical costswere kept at and expansion in the Texasmarket, where Molina won a Medicaidcontract in February to service enrollees inthe Fort Worth area.

We exceeded the solid start weintended for achieving the nancialguidance we had provided for this year, saidMolina Chief Executive Ofcer J. Mario

$2,724,000 to 19 programsstatewide that educate registerednurses.

The awards, which rangedfrom $48,000 to $365,000, wentto a combination of public andprivate universities and

community colleges.The money was madeavailable through the Song-BrownHealth Care Workforce TrainingProgram, which is aimed atincreasing the number ofhealthcare workers in rural andother medically undersvered areasin California. The program isadministered by OSHPD, whilefunds are collected via feesimposed on hospitals and otherhealth facilities. Awards aredecided in conjunction with thethe California Health DataPlanning Fund.

As funding opportunities for

nursing programs diminish, theSong Brown program increasinglyplays an important role insupporting a skilled, culturallycompetent nursing workforce,said OSHPD Director DavidCarlisle, M.D.

SCAN Names ChanMedical Director

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

director.Chan previously served as

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

Dr. Chan brings with him animpressive history ofunderstanding the needs ofseniors and in trying to make thehealthcare system work better foreveryone, said Timothy Schwab,M.D., SCANs chief medicalofficer.

care measures, such as inuenzavaccinations or other areas of diseaseprevention.

Schwab added that the groups couldalso be graded on the overall infrastructureof care, such as whether specialty care isprovided for particularly frail patients.

The money earmarked for this year willfocus on funding the improvements, whilepayments made in 2012 will be based onoverall outcomes. Schwab said the funds

would be paid based on overall patientrepresentation. A group that provides care for20% of SCANs enrollees, for example, couldreceive up to 20% of the funding, or $1million.

Weve gotten a lot of traction from our(medical) groups so far, Schwab said.Theyre interested not so much in the dollars,but in the way the Medicare program will bepaying Medicare Advantage plans to delivercare in the future.

Molina Reports Strong EarningsPlan Demurs On Increasing 2011 Guidance

Molina, M.D., during a conference call earlierthis week.

Overall enrollment in the 10 statesMolina operates in reached 1.65 million forthe quarter, up from 1.48 million for the rstquarter of 2010 and 1.61 million at the end ofcalendar 2010. However, Californiaenrollment stood at 347,000 at the end of thequarter, down from 353,000 during the rstquarter of last year.

Molina reported net income of 56 centsper share for the quarter, and forecasts netearnings of $2.20 a share for calendar 2011.However, company ofcials were hesitantabout expanding that estimate further.

Budgets in every state in which theCompany operates its health plans are indecit and are likely to remain so throughstate scal year 2012, the company said in astatement. Given this uncertainty in the rateenvironment, any adjustment to our guidanceis unwarranted at this time.
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Payers & Providers PageOPINION

Providers Get A Drug Program LifelinExpansion of 340B Will Cut Costs For Hospitals, Clini

Henry Loubet is Chief Strategy Officer for

Keenan. He is a member of the Payers &

Providers editorial board.

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

778@!A4!(441(2!/40/./01(2!+1%+B*/>C/-4!/+!DEE!(!&)(*!

FD$GE!/4!%12H!1>!C-!$#!+1%+B*/%)*+I@!^-++!]-20%)*56!(&)*+(40>*-./0)*+@B-: Op-ed submissions of up to 600 words are

welcomed. Please e-mail proposals to

[email protected],

If you have ever taken the time to read ahospital bill, you will have no doubt noticedcertain things beyond the usually mind-bending bottom line. First, they are about assimple to understand as a calculus problemwritten in Roman numerals.

Second, at some point most people noticeone particular line and say to themselves Howcome that single pill costs asmuch as an entire prescription Iget at a drug store?

The question about drugprices could soon be asked farless often through the expansion

of the federal 340B prescriptionmedication discount programenacted just a few months ago.

Originally passed in 1992as part of the Veterans HealthCare Act, the 340B programoffered a signicant wholesalediscount on pharmaceuticalpurchases to certain hospitalsand federal qualied healthcenters (FQHCs). But in 2010,the Affordable Care Act (part ofthe federal healthcare reformpackage) expanded the program,

allowing more facilities around the nation toparticipate.

Currently, most hospitals are able topurchase drugs at about a 15% to 20%discount. The expansion of 340B will raise thatdiscount to 51%. Studies show that that couldmean annual savings of $2 and $5 million for atypical 200-bed hospital.

The broadening of the program means thatsuch facilities as specialty hospitals (freestanding cancer hospitals, for example), ruralhospitals, and a broad range of smallerfacilities (such as health centers for thehomeless) are now eligible to participate.

Additionally, off-site pharmacies owned byany of the qualifying facilities may now takeadvantage of the program. Also, as in the past,all FQHCs, hospitals with a disproportionateshare of Medicaid patients and childrenshospitals may participate. All of the facilitiesmust be non-prot.

In the current climate of what can only bedescribed as shifting uncertainty!in regards tohealth care policy and nances, the expansionof 340B will certainly provide a modicum of

stability and a real savings for both hospitals patients.!

So, whats the catch? There really isnt oHowever, 340B can be a rather complicatedprogram to initialize and manage. Like thatcalculus problem, 340B has a signicantnumber of regulations attached and even theprocess of eligibility determination can be qu

daunting for the uninitiated.Therefore, it is crucial that

healthcare facility considerinjoining 340B do its homeworand know exactly what will bexpected of it and its personn

from the very beginning. It isstrongly recommended that afacility nd an experiencedoutside partner who has beethere, done that.

Step one must be a review the eligibility criteria there no point to investing time andenergy in trying to join 340B there is no hope of it actuallyhappening.

Step two needs to be thecreation of protocols andprocedures as to exactly how t

program will be implemented. For example,program does allow for the offering ofprescription discounts directly to the public aoff-site facility controlled pharmacies butdeciding whether or not you want to beinvolved in that aspect has to made early in tprocess.

Step three is ensuring continuingcompliance once the program is in place. Aswith most federal programs, ensuring andproving regulatory compliance can bechallenging.

While 340B can seem daunting, whenexecuted properly the benets can be truly

signicant and improve both patient care andhealthcare facilitys bottom line.

By Henry Loubet


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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

COPE Health Solutions is a leading health care corporation based in Los Angeles,California. Our mission is to help our clients achieve visionary, market-relevant healthcare solutions. Our vision is for our clients to be recognized for their best practices inworkforce development and clinical integration.

SENIOR PROJECT MANAGERClinical Integration Solutions

The Senior Project Manager will be responsible for all activities related to ClinicalIntegration Solutions (CIS). He/she will be responsible for project planning andimplementation on internal and external projects for Clinical Integration Solutions, whichmay include working with the Regional Safety Net ACO, Camino de Salud Network,Provider Practice Redesign and Care Transitions & Coordination.

Required Skills and Experience: M.P.H., M.B.A., or M.H.A. required; minimum 5 yearsProject Management experience with specific experience in the healthcare industry; andProject Management Professional (PMP) certification preferred.

PROJECT MANAGERClinical Integration Solutions

The Project Manager is responsible for managing major tasks on internal and externalprojects for Clinical Integration Solutions, which may include working with the Caminode Salud Network; Provider Practice Redesign (one component of Clinical IntegrationSolutions designed to expand access to specialty care services); Care Transitions &Coordination; and Translational Research.

Required Skills and Experience: B.A. or B.S. degree; skill set related to effective projectmanagement, including strong work ethic, attention to detail, time management, abilityto prioritize, problem solving, adaptability, and willingness to learn; and prior experiencewith health care operations or research preferred.To apply for a position or for more information about COPE Health Solutions, pleasevisit our website at: http://copehealthsolutions.org/careers .


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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

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7/7

Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

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payers & providers california edition – issue of april 21, 2011

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