payers & providers california edition – issue of november 10, 2011

8/3/2019 Payers & Providers California Edition – Issue of November 10, 2011

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November 15-17

November 14-16

Calendar

10 November 2011

November 29

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

published in the Calendar section,space permitting.

California Edition

CHA Pulls Out Of CHART InitiativeQuality Measurement Program’s Future in Question

The California Hospital Association haswithdrawn its support for the CHARThealthcare quality program, a dramatic movethat raises questions about the future of the

landmark initiative.The California Hospitals and AssessmentReporting Task Force was launched in 2004,and is one of the rst coordinated efforts toreport on the quality of care in a state’shospitals. More than 240 facilitiesrepresenting nearly 90% of the inpatient bedsstatewide report on various facets of thequality of care they deliver, including infectionrates, treating heart attack victims andmaternity care. The data and analysis is postedfor consumers on the Calhospitalcompare.org.website. CHART has been supported by everymajor hospital system, health plan and

purchasing group in California.However, interviews with industryobservers suggested that hospitals had begunto chafe about compiling and submitting datafor CHART as other quality reportinginitiatives have launched and demanded theirown information. They include the Centers forMedicare and Medicaid Services’ HospitalCompare initiative, as well as the JointCommission and the Of ce for StatewideHealth Planning and Development.

Participating hospitals had beencommunicating with CHART for months abouthow to better standardize the reporting

process, according to CHA of cials, but noconsensus could be reached. As a result, theCHA board voted unanimously late last monthto withdraw its support for the program.

“As CHART evolved, we did really wellon the public reporting, but we have not doneas well (regarding) standardizing the format forinformation and decreasing the amounts of data being asked for,” said Debby Rogers, theCHA’s vice president of quality and emergencyservices.

Rogers added that the CHA’s decision islikely to prompt its member hospitals towithdraw from CHART – a move that wouldall but end the initiative because the lobbyinggroup represents virtually every participant.

However, CHART Executive DirectorBruce Spurlock, M.D., said the organization

was still mulling its options and that its 19-member board will meet in mid-December todecide how to move forward.

“I haven’t heard directly of anyoneleaving,” Spurlock said of the hospitals. “Wehave had a lot of questions about where we gonext.” Kaiser Permanente, one of the largesthealthcare systems in California and a major

Continued on Next Page

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In Brief

CDPH Fines NursingHome $75,000

The California Department of PublicHealth has issued a AA citation and a

$75,000ne – the most severepenalties – against the Crystal Ridge

Center in connection to the death of a patient at the Grass Valley facilityearlier this year.

The patient, who was receivinghospice care and had a history of being unable to hold himself upright,fell out of a mechanical lift chairbeing used to extract him from abathtub.

Only one nursing home staff member was operating the lift at thetime of the accident, even though itrequired two people to operate itsafely.

The patient suffered two

fractured neck vertebrae and a nine-inch-long gash on his head. Thefractures led to respiratory problemsand his death four days later.

A CDPH probe concluded thatthe facility had not properly trainedstaff on using the lift chair.

USC Pharmacy SchoolOpens Center To Study

Regulatory Issues

The University of SouthernCalifornia’s School of Pharmacy hasopened a new research centerexpected to focus on bringingmedical products to the market in amore timely and ef cient manner.

The International Center forRegulatory Science will explore waysto bring new products to themarketplace more rapidly in anincreasingly complex regulatoryenvironment, while also ensuringtheir safety. Its formation is partly in

Continued on Page 3

NEWS

Kaiser Permanente’s hospitals and health planreported a loss for the quarter ending Sept. 30,even as the Oakland-based healthcare giantcontributed more than $17 million tocommunity organizations during that period.

Kaiser lost $45 million for the quarter,compared to net income of $364 millionduring the third quarter of 2010. Systemof cials attributed the dramatic shift inearnings to declines in the nancial marketthat affected its investment portfolio. Its net

non-operating loss was $365 million,compared to a $268 million gain during thethird quarter of 2010.

Revenues for the quarter were $11.9billion, up 8% from the $11.1 billion reportedin the year-ago quarter. Revenues for the rstnine months of 2011 reached $35.8 billion,up 8.1% from the $33.1 billion in revenueduring the rst nine months of 2010.

Kaiser’s patient health record system, MyHealth Manager, has received heavy use from

its enrollees during 2011. To date, they havereceived more than 52 million laboratoryresults and lled more than 7 millionprescriptions online and sent more than 9million e-mails to their physicians.

“Through our investment in the tools aprocesses that support patient-centered careand through our commitment to continuousimprovement, we are nding new andinnovative ways to support total health andimprove care outcomes and affordability,” sa

Kaiser Chief Executive Of cer GeorgeHalvorson.

Meanwhile, Kaiser reported that it haddisbursed $17.3 million in grants tocommunity organizations throughout thecountry during the third quarter. Among therecipients in California were the Los AngeleCounty Department of Public Health, whic

Kaiser Reports Loss For The Quarter

Investments Blamed; Distributes $17.3M in Grants

Continued on Next Page

CHART (Continued from Page One)

nancial supporter of CHART, echoedSpurlock.

“We are reviewing the situation and

working with CHART and its constituents tond a solution that meets the needs of KaiserPermanente members, customers, and thecommunity for useful information,” Kaiser saidin a statement.

The California Health Care Foundation, aphilanthropic organization that wasinstrumental in forming CHART, said in astatement it was engaged in “internal

discussions and will be participating in theupcoming...meeting.”

It remains to be seen whether nancial

support for CHART would continue in thewake of CHA’s action. Most of its operatingfunds come from contributions fromparticipating hospitals, health plans and gropurchasers. Spurlock would not disclose itsannual operating budget.

“It’s hard to predict what’s going tohappen next,” he said. “I really do have to sathe crystal ball is a little cloudy.”

Thursday, Nov. 17, 2011 10 A.M. P

The New Deal: Private Equity In Healthcare M&! Please join Shane Passarelli, senior vice president of the Healthcare Finance Group, ! James Unland, President of the Health Capital Group, to discuss the movement of! private equity funds into the acquisition of hospitals and where this trend may be leading

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NEWS

In Brief

response to budgetary cutbacks at theU.S. Food and Drug Administration,which has been slowing the approvalprocess for new pharmaceuticals andmedical devices. However, centerof cials said they would work withFDA counterparts in other parts of theworld.

“The new International Centerfor Regulatory Science furthersolidies USC's commitment totransnational collaboration focusedon the safety and effectiveness of medical products, practices, anddevices that enhance the well-beingof our global community,” said USCprovost and Senior Vice President forAcademic Affairs Elizabeth Garrett.

Children’s Hospital LosAngeles Receives$600,000 CancerResearch Grant

Cancer researchers at Children’sHospital Los Angeles and the USCKeck School of Medicine havereceived a $600,000 grant from the VFoundation to conduct research todevelop a method of combating themost common form of cancer inchildren.

The scientists will focus on theuse of an engineered protein that canbe used in amplifying the effects of treating chemotherapy-resistantversions of the cancer, known as B-lineage acute lymphoblasticleukemia, or ALL.

“The translational research grantfrom the V Foundation will enable usto fully develop a therapeuticinnovation that can have a signicantpositive impact on the survival andquality of life of children diagnosedwith aggressive leukemias,” said FatihUckun, M.D., who heads Children’stranslational research in leukemiateam and will serve as principalinvestigator in this effort.

The V Foundation, named afterthe late college basketball coach JimValvano, made nine such researchgrants in 2011.

received $200,000 to create a healthy eatingand living initiative in 10 communities withhigh rates of childhood obesity. The

Partnership for Children and Health inNorthern California received $75,000 forsummer learning and enrichment programs

for low-income children.“There are tremendous programs and

initiatives underway in local communities tha

are addressing immediate healthcare needs,”said Raymond J. Baxter, a Kaiser senior vicepresident.

Researchers say the level of overweight andobese children in California dropped slightlyduring the past several years, although the

state is still facing an enormous challenge inkeeping the issue under control.

The proportion of children classied asoverweight or obese dropped 1.1% between2005 and 2010, according to a new report,“A Patchwork of Progress,” prepared jointlyby the UCLA Center for Health PolicyResearch and the California Center forPublic Health Advocacy. However, 31 of thestate’s 58 counties experienced an uptick inpercentages of overweight children.

Overall, the proportion of children thatwere overweight or obese in California in2010 stood at 38% – about triple the levels of

the 1970s. That compares to 38.4% in 2005.Ten of California’s counties had levels of

children overweight or obese that exceeded43%. Most contained large numbers of ruraland low-income communities. ImperialCounty had the highest level, with 46.9%,closely followed by Colusa County at 45.7%.Although Imperial’s rate dropped slightlybetween 2005 and 2010, Colusa’s grew bymore than 5%.

The lowest proportions of obese andoverweight children were predominantly in

counties in the far North of the state. Theaf uent Marin County in the Bay Area had thelowest overall rate at 24.9% in 2010, but had

increased 5.5% from 2005. By contrast, PlaceCounty had a rate of 25.8% in 2010, the thirdlowest in California and a drop of 5% from2005. El Dorado County had a rate of 25.7%,down 3.1% from 2005. Trinity County had thebiggest overall decrease, declining to 26.7%in 2010 from 37.6% 2005, an overall decreasof more than 10%.

Los Angeles County, which containsnearly a third of the state’s population, had anoverall overweight and obesity rate of 41.6% about ve percentage points higher than othemajor metropolitan areas.

Researchers suggested that the patchwork

declines were attributed to bans on sugarydrinks on school campuses beginning in 2004and a greater emphasis on healthier foods."Increased awareness and a growing array of school and community policies and programsare beginning to have an impact,” saidCCPHA Executive Director Harold Goldstein“But in light of the huge number of countieswhere childhood obesity rates continue toclimb, our efforts must continue and evenexpand, especially in those areas where wenow know children are most at risk."

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Some Light At End Of Obesity TunneUCLA Study Reports Some Stabilization in Californi

Kaiser (Continued from Page One)

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Payers & Providers PageOPINION

The Tough Path To Addiction CareInsurer Practices Create Huge Barriers to Access

Phillip Greer is the executive vice preside

the recently formed California Treatment

Advocacy Foundation.

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Op-ed submissions of up to 600 words ar

welcomed. Please e-mail proposals to

[email protected]

The Patient Protection and Affordable Care Actwas established to help make qualityhealthcare more available and affordable to allAmericans. But when those in the system itself pose the greatest barriers to care, somethinghas gone terribly amiss. Sadly, that is thesituation here in California.

In an attempt to increase prots,California’s insurance companies continue toimpose barriers that reduce access to much-needed chemical dependency treatment fortheir policyholders. In the past they did this byselling policies with deductibles and co-payments that were much higher

than for any other illness. Tocombat that, Congress passed theWellstone Dominici Equity Act in2008. Yet insurers continue toimpose unreasonable deductiblesand co-payments for small groupsand individuals or sell planswithout any chemical dependencybenets at all.

To this shenanigan, insurancecompanies have added “careguidelines,” which they claimrepresent “best practices.” But whatthey do in reality is deny patientsfrom receiving treatment at the levelof intensity or for an amount of timethat is universally accepted asnecessary. By ignoring guidelines of both the Substance Abuse and Mental HealthServices Administration (SAMHSA) and theAmerican Society of Addiction Medicine(ASAM), these insurance companies havemade a mockery of the system.

The Knox-Keene Act requires plans be“fair and reasonable,” but insurers are beinganything but when they exclude massivenumbers of patients from treatment. This yearone insurance company “updated” itsguidelines for residential chemicaldependency treatment by establishing as aprerequisite that the patient must, in additionto severe chemical dependency symptoms,have a serious medical complication or aserious psychiatric disorder. Theserequirements y in the face of SAMHSA andASAM as well as California regulationsgoverning licensure of residential chemicaldependency treatment centers.

To make matters worse, providers aregagged by the insurance companies who

refuse to contract with or refer patients toanyone who “causes trouble” by not adheto care guidelines. One well-known Califoprovider was recently denied a contract bylarge insurer after advising a patient to seelegal advice to assist in overruling herinsurance company’s denial of care.

California is not alone in this struggle,and fortunately other states are doingsomething about it. Pennsylvania’s Drug aAlcohol Insurance Law (Pennsylvania Act of 1989) requires most group health insuraplans to include coverage for addiction

treatment. The only prerequisite

certication and referral by alicensed physician or a licensedpsychologist. The Act also requmost group health policies toinclude mandated minimumbenets for treatment of alcohoand drug addiction. These incluseven days of detoxication peyear, 30 days of non-hospitalresidential rehab per year, and day per year of full-session visitoutpatient or equal partialhospitalization visits.

It is time for California to do same.

What kind of a nation are wewhen providers can be silenced,patients can be denied lifesaving

care, and the wellness of whole families cabe jeopardized all so insurance companiescan record huge prots? Can we really besurprised then when much of the public halost trust in our healthcare system? We are better society than that. Now it is time toprove it.

All individuals should have access to tright treatment, in the right setting, at the rtime. It is our belief that only throughinsurance reform, either voluntary ormandated, can barriers to care be eliminatso that individuals can get immediate andaffordable access to the treatment they nee

ByPhillip Greer



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payers & providers california edition – issue of november 10, 2011

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