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					                                                                       15 July 2010

                                                California Edition

      Calendar                                     Mostly Winners For Meaningful Use
                                                Hospital Like Final Rules; Medical Groups Want More
           July 19-21                           California’s providers are breathing a sigh                 incentive payments. They were previously
                                                of relief as the U.S. Department of Health                  excluded.
                                                and Human Services has issued less                              In another big change, hospitals and
  ?).)4>3!9441(2!<)(2>3;(*)!R4%-140!            stringent “meaningful use” rules for                        physicians have to use computer
8-4N)*)4;)@!R@?@!B*(4>!<->)26!?(4!C/)5-@!       hospitals and physicians to receive                         physician order entry for 30% of
  S-;1+!-4!/44-.(>/.)!4)M!=*-01;>+!N-*!         financial incentives to ramp up their usage                 medication orders. That’s down from the
 ;3*-4/;!;(*)!:(4(5):)4>!(40!M)224)++!          of electronic medical records and related                   previous mandate of 80%.
        =*-:->/-4@!ETFGHE$6#FG@!                                                                                “We’re pleased with the changes. We
             I)5/+>)*!J42/4)K                        The HHS received more than 2,000                       requested more flexibility, and generally
                                                comments on it’s interim final rules that                   received it,” said Pam Lane, a CHA vice
        3>>=KLL>;%/@-*5L/40)U@=3=V              were released earlier this year, many from                  president in charge of healthcare
           ;-4N)*)4;)WX(31"#$#                  physician organizations and hospitals.                      informatics.
                                                     “We have sought and received                               The California Association of
                                                extensive input from the healthcare                         Physician Groups mostly concurred with
           July 22-24                           community, and we have drawn on their                       the CHA. Physicians, for example, now
                                                experience and wisdom to produce                            have to meet 20 criteria, 15 of which are
9:)*/;(4!<-+=/>(2!9++-;/(>/-4!7)(0)*+3/=!       objectives that are both ambitious and                      mandatory and five out of a group of 10.
 ?1::/>@!A(4;3)+>)*!B*(40!<&(>>6!?(4!           achievable,” said David Blumenthal, M.D.,                   That’s down from a previous mandate of
 C/)5-@!92!B-*)!/+!>3)!D)&4->)!+=)(D)*@         the national coordinator for health                         25 objectives.
            E$6#FGHE$6$FG@                      information technology.                                         However, most physicians have to
             I)5/+>)*!J42/4)K                        The California Hospital Association                    apply for incentive payments individually,
                                                lauded the relaxation of a guideline that                   even if they practice within a group.
      3>>=KLLMMM@3)(2>3N-*1:@;-:L               would have originally required all hospitals                    “They built this on the old cottage
3)(2>3N-*1:L3>:2L;-4N)*)4;)+L$#?1::/>L          to meet 23 specific requirements in order                   industry model. However, large groups
             I)5/+>*(>/-4@3>:2                                                                              are where it’s at. The fact that a medical
                                                to qualify for incentive payments that will
                                                be dispensed beginning next year. Now, the                  group can’t apply as an entity, but a
           July 25-28                           hospitals have to meet 19 guidelines.                       hospital can is silly,” said William
                                                Fourteen of those are mandatory, along                      Barcellona, CAPG’s vice president of
                                                with five others from an additional list of                 government affairs. He added that
?1::)*!8-4N)*)4;)@!Y:%(++&!?1/>)+6!7(D)!        10.                                                         Congress may be lobbied to draft
 O(3-)@!EZFFHEGTF@!9!0/+;1++/-4!-N!2-45H             Moreover, critical access hospitals –                  appropriations-oriented legislation that
   >)*:!(40!>3)![1(2/>&!-N!/>+!0)2/.)*&@        those facilities at least 25 miles away from
                                                the nearest acute care facility and less than
                                                25 beds in size – may also qualify for                                Continued on Next Page
       C)N(12>@(+=UV'*-01;>Q0WFX\                                       NORTHERN & SOUTHERN CALIFORNIA
                                                                        HFMA CHAPTERS
                 E-Mail                                                 20th Annual California Fall Conference with                                        Hyatt Regency Long Beach, Long Beach, CA
   the details of your event, or call                                   Sunday, September 19 - Tuesday, September 21, 2010
  (877) 248-2360, ext. 3. It will be                 Fall Conference
 published in the Calendar section,
          space permitting.

   Payers & Providers                                               NEWS                                                              Page 2

     Top Placement...                                           Meaningful Use (Continued from Page One)
    Bottomless Potential
                                           would relax the individual physician                         The HHS will dispense as much as
                                           requirement.                                             $27 billion in incentive payments over the
           Advertise                            Although the guidelines are less                    next decade. It’s part of the Health
  (877) 248-2360, ext. 2                   stringent than what the HHS originally                   Information Technology for Economic and
                                           sought, the rules drafted by the agency are              Clinical Health (HITECH) Act of 2009, a
                                           so lengthy – 864 pages – that it is likely to            stimulus program intended to speed up
                                           take weeks for providers to fully assess                 the adoption of advanced information
          In Brief                         what compliance will mean, Lane said. And
                                           the dense reading the rules represent does
                                                                                                    technology among hospitals and
                                                                                                    physicians. Individual physicians can earn
                                           not even include a second set of rules                   as much as $107,350 from Medicare and
                                           issued by HHS this week specifying the                   Medicaid in meeting all the rules, while
  Molina Healthcare to                     acceptable hardware and software                         hospitals can earn millions. Conversely,
 Expand into Wisconsin                     applications currently being pored over by               providers that don’t update their systems
                                           relevant industry vendors.                               will begin facing payment cuts from
Long Beach-based Molina                                                                             federal programs beginning in 2015.
Healthcare Inc. has expanded its
operations in the Midwest,

                                               DMHC Resurrects Solvency Board
acquiring a Wisconsin-based
Medicaid managed care insurer.
      Molina will pay about $16

                                           Shift From Medical Groups Toward Impact of Reform
million for Abri Health Plan, based
in the Milwaukee suburb of West
Allis. Abri has about 16,000
enrollees in 23 counties, primarily
through Badger Care, Wisconsin’s           The Department of Managed Health Care has                 the wake of sweeping healthcare reforms
Medicaid managed care plan. Abri           revived its Financial Solvency Standards Board            signed into law earlier this year. Included are
recently won a contract that will go       after a nearly four-year hiatus, ostensibly to
into effect during the third quarter                                                                 medical homes, bundled payments,
of 2010 that will further expand its       study and report on how healthcare reform                 accountable care organizations and
enrollment.                                will affect California.                                   healthcare exchanges.
     The deal will expand Molina’s            The board was originally convened in 1999                 “Federal healthcare reform is creating new
market presence in the Midwest to          to create solvency standards for the state’s risk-
four states. It currently operates in                                                                scal models of health care that will need
                                           bearing medical groups after two larger                   much thought and the DMHC has been
Ohio, Missouri and Michigan.
      “Once this transaction closes,       entities, HealthPartners and KPC, collapsed in            working to proactively address its implications
our company will provide health            a spectacular fashion, leaving thousands of               for the California healthcare landscape,
plan services in ten Medicaid              patients with gaps in their continuity of care.           trends, and regulations,” said DMHC Director
markets throughout the country, we            The board will again revisit nancial
will be further diversified, and our                                                                 Cindy Ehnes. “It is imperative that we
Wisconsin health plan will have            solvency of the state’s more than 200 medical             understand and inuence the impact on our
significant potential for future           groups, according to Grant Cattaneo, a                    state’s delivery system and health care
growth,” said Molina Healthcare            healthcare consultant in Northern California              providers, many of whom are already
Chief Executive Officer J. Mario           and a holdover from the prior board.
Molina, M.D.. The plan has 1.5                                                                       struggling due to the economic situation.”
                                              “I’m not sure if they (the DMHC) has been                 William Barcellona, a deputy director at
million enrollees nationwide.
                                           letting things go in terms of solvency, and I             DMHC between 2001 and 2005 and now a
                                           want to hear from the medical groups about                vice president with the California Association
Kaiser Links Childhood                     that,” Cattaneo said.
                                              However, the FSSB will also study concepts
Obesity to Esophogeal
                                           being pushed by the Obama Administration in                          Continued on Next Page
Extremely obese and obese children
run a much higher risk of
gastroesophageal reux disease than
                                                     NON-PROFIT HOSPITAL CEO SALARIES
their thinner counterparts, according to
a study by Kaiser Permanente
researchers of its Southern California
                                             A PAYERS & PROVIDERS EXCLUSIVE WHITE PAPER
   Kaiser studied the electronic            Analyzes Compensation Of Nearly 120 of California’s CEOs
medical records of more than 690,000
enrollees between the ages of 2 and 19
                                              $149 (Executive Summary) $275 (Summary and Salary Data)
      Continued on Page 3
                                                         Call (877) 248-2360, ext. 2 to order, or CLICK HERE

Payers & Providers                                              NEWS                                                               Page 3

        Longer ALOS!*                                                  DMHC (Continued from Page Two)
           Advertise                        of Physician Groups, believes that reform will        Medical Group in Costa Mesa; and Edward
                                            bring new pressures on medical groups.                Cymerys, senior vice president and chief
 (877) 248-2360, ext. 2                        “We’re not moving patients out of dead             actuary of Blue Shield of California.
                                            medical groups, but there’s going to be a lot of         The new appointees include Larry
   *For our ads, not your hospital
                                            change,” he said. In particular, a huge               deGhetaldi, M.D., head of the Santa Cruz
                                            expansion of Medi-Cal patients will put a             division of the Palo Alto Medical Foundation;
                                            burden on a lot of groups to treat them while
          In Brief
                                                                                                  Ann Pumpian, chief nancial ofcer of Sharp
                                            accepting razor-thin operating and prot              Healthcare; Dave Meadows, vice president of
                                            margins.                                              California health programs for Health Net;
                                               “The DMHC is going to have to keep a               Tom Williams, Executive Director of the
                                            much closer eye on solvency in that                   Integrated Healthcare Association; and Rick
in its health plan in Southern              situation,” Barcellona said.                          Shinto, M.D., president and chief executive
California between 2006 and 2008.              The board last met in October 2006. Three          ofcer of IPA operator Aveta, Inc.
Researchers determined that children
who are extremely obese have a 40%          of its eight members served during the board’s
higher chance to suffer GERD than do        previous incarnation: Cattaneo; Keith Wilson,
children of a normal weight, while          M.D., chief executive ofcer of the Talbert
those who are moderately obese have
a 30% greater chance of contracting

                                              More Delays For Palmdale Regional
the condition.
    GERD is characterized by the
liquid contents of the stomach owing
back into the esophagus. The
condition can lead to coughing,                Hospital’s Projected Opening Now Two Years Late
asthma and an inamed larynx. If the
condition persists for years, it can lead
to a precancerous state in the
esophagus, and eventually esophageal        The end of 2010. Maybe.                               spokesman David Byrnes said that “a schedule
cancer. Up to a quarter of the children           That’s the latest projected opening date        is difcult to project until the re damper issue
in the U.S. may be affected by the          for Palmdale Regional Medical Center, one             is resolved.” He noted there were issues in
condition, with increasing obesity          of few hospitals built in California during the       terms of how the re suppression system was
rates a contributing factor.
    “The takeaway message of our            past decade from the ground up.                       installed and functions.
study is that GERD now also is one of       “It looks hopeful for this year, but the bottom       Byrnes did add that most other issues – such as
the conditions associated with              line is that we don’t have any idea,” said            the leaky windows – have been resolved, but
childhood obesity," said study co-          Julie Montague, spokesperson for Lancaster            that the re suppression issue is particularly
author Corinna Koebnick, a Kaiser
                                            Community Hospital, a nearby facility                 challenging. “The mitigation work could be
research scientist. “Beyond counseling
for weight loss, obese children who         whose management will oversee the new                 substantial,” he wrote. “Identifying and
report symptoms of GERD may need            hospital once it begins operations.                   resolving the issue in one of our highest
to be treated for the underlying            The project, undertaken by Pennsylvania-              priorities.”
reasons to help avoid persistence of        based for-prot hospital operator Universal                 Sources have told Payers & Providers that
GERD into adulthood and to prevent
its complications.”                         Health Services, has been bedeviled by                Universal is using a building contractor and
    The study was published in the          construction-related delays that now total            architect that have never worked on a hospital
most recent issue of the International      nearly two years and counting. The hospital           in California before, and are therefore
Journal of Pediatric Obesity.               is planned for 127 beds at opening, with an           unaccustomed to working with OSHPD, whose
                                            eventual expansion to 239 beds. It was                planning and certication processes are
   CHW Exec To Head                         originally scheduled to open in late 2008.            formidable.
    Advocacy Group                          Payers & Providers reported in April that the               A Universal manager overseeing the
                                            Ofce of Statewide Health Planning and                construction project did not respond to a
Californians for Patient Care has
                                            Development (OSHPD) could have issued a               phone call and e-mail requesting comment.
named former Catholic Healthcare
West executive Carmella Gutierrez           certicate of occupation for the hospital as          Palmdale Regional Medical Center’s opening
as its president.                           early as late spring. However, that timetable         does not represent the only difculty Universal
      The 44-year-old Gutierrez             has vanished, according to both Montague              has had with California’s regulators. Its two-
previously served as a public               and OSHPD ofcials.                                   hospital Southwest Healthcare System came
affairs director at CHW. She had
previous experience as a regional                 Montague noted that the current delays          close to losing its certications to receive
affairs manager in the U.S.                 center on inspections of the hospital’s drop          Medicare and Medi-Cal funding earlier this
Department of Health and Human              ceilings and its re-suppression system, both         year due to persistent quality-of-care problems
Services.                                   of which are being undertaken by OSHPD.               at its facilities. It is working on implementing a
      The Sacramento-based CPC
                                            Project planners previously had to replace            corrective plan to improve Southwest’s
advocates on behalf of the state’s 8
million uninsured.                          some 160 windows due to leaks.                        operations.
                                            In an e-mailed statement, OSHPD

Payers & Providers                                           OPINION                                                     Page 4

 9-21:)!"6!;++1)!"<                         Healthcare Gold From Data Mining
                                          Long Used Elsewhere, it Can be a Boon For Hospitals
 '(&)*+!,!'*-./0)*+!'1%2/+3/456!         Most hospital information systems are         would like to track the productivity of their
    778?!@4!(441(2!/40/./01(2!           designed with an emphasis on daily            clinical pharmacists, who have the
    +1%+A*/=B/-4!/+!CDD!(!&)(*!          operations. The electronic medical record     responsibility of monitoring a patient’s
  EC$FD!/4!%12GH?!;B!/+!0)2/.)*)0!       system is used primarily to care for the      changing lab results and adjusting his
       %&!)I:(/2!(+!(!'JK!               current clinical needs of the patient         medication accordingly. By analyzing drug
 (BB(A3:)4B6!-*!(+!(4!)2)AB*-4/A!        population. Over time, hospital               orders, lab results and pharmacist
            4)L+2)BB)*?                  information systems compile tremendous        intervention documentation, advanced
                                         amounts of clinical data, however, this       software can report on how individual
   @22!(0.)*B/+/456!+1%+A*/%)*!(40!      information is rarely given a                 pharmacists performed in meeting this task or
         )0/B-*/(2!/4M1/*/)+N            comprehensive, retrospective                  how they contributed to meeting other quality
                                         analysis to spot long-term                                   metrics. !
           EO<<H!"FOI"PQ#                trends. Medical executives                                   In California, hospitals are
     /4R-S=(&)*+(40=*-./0)*+?A-:         want at-a-glance, “dashboard”                                required to report healthcare-
                                         information to gauge                                         acquired infections (HAIs).
                                         organizational performance,                                  However, making the
    O$O!U?!V-22&L--0!W(&6!X1/B)!Y        but they also need root-cause                                differentiation between
         Y1*%(4G6!8@!D$Z#Z               analyses of longer-term trends. !                            healthcare-acquired versus
                                            Data mining technology is                                 community-acquired infections
              W)%+/B)                    now being used to provide                                    can be very time consuming
     LLL?=(&)*+(40=*-./0)*+?A-:          reports across various                                       because it involves reviewing
              K(A)%--G                   healthcare data sets including                               many data points in a patient’s
  LLL?R(A)%--G?A-:[=(&)*+=*-./0)*+       pharmacy, lab, admission/                                    clinical profile.! Advanced data
               >L/BB)*                   discharge and medical                                       mining software can calculate the
   LLL?BL/BB)*?A-:[=(&)*+=*-./0)*+       transcripts.! It has been used for many      By       proper HAI rate and create comparison
                                         years by business and government to         Chun or benchmark reports. !
                                         analyze trends in massive blocks of                   Another capability provided by this
          \0/B-*/(2!Y-(*0                data such as airline passenger records,     Wong advanced software is automatic
                                         census data and supermarket scanner                   surveillance for infection control. In
        >3)!8(:0)4!]*-1=                 information. !                                the past, infection control practitioners such
                                            By applying algorithms, association        as pharmacists or epidemiologists had to
  ^-++!]-20%)*56!83(/*:(4!-R!B3)!        rules and regression analysis to identify     manually review hundreds of patient medical
   Y-(*06!7-+!^-%2)+!V-+=/B(2!,!         patterns and meanings, hospital               records to identify at-risk individuals. Now
          T)0/A(2!8)4B)*                 executives can spot trends that would         software can enable automatic surveillance of
                                         otherwise be hidden                           the entire patient population and quickly
  _/:!7-BB6!\`)A1B/.)!9/A)!'*)+/0)4B6!      Traditionally, when the hospital IT        identify individuals requiring attention. !
   V-+=/B(2!@++-A/(B/-4!-R!X-1B3)*4!     department is asked to answer specific             One of the key trends in healthcare
              8(2/R-*4/(                 business questions, too often its staff       reform is more transparency, meaning more
                                         responds with raw files – endless rows of     reports for consumers and regulators. Data
  T)0/A(2!aRR/A)*6!7?@?!8(*)!V)(2B3!     undigested numbers.! With data mining         mining is the next, evolutionary step in
                '2(4!                    tools in place, it is possible to transform   hospital information systems. It can help
                                         the filing cabinet into a “smart”             prepare the basic reports and provide a
   b)/B3!^/A3:(46!T?J?6!\`)A1B/.)!       information repository which can provide      valuable analysis of the trends behind the raw
       9/A)!'*)+/0)4B6!7(G)+/0)!         actionable reports for clinical and           data. !
       8-::14/B&!V)(2B3A(*)              business decisions. !
                                            For example, most California hospitals       Chun Wong is chief executive officer of
    V)4*&!7-1%)B6!83/)R!XB*(B)5&!        have Pharmacy and Therapeutics                  Asolva, a Los Angeles-based firm that
          aRR/A)*6!b))4(4                Committee guidelines on reduced use of          designs streamlining software for a variety
                                         antibiotics. Hospital leaders want to know      of businesses.
    '1%2/+3)*[\0/B-*I/4I83/)R            how well the guidelines are being
           ^-4!X3/4G:(4                  followed. Now, data mining software can
                                                                                          Op-ed submissions of up to 600 words are
                                         evaluate antibiotic usage across several
    )0/B-*S=(&)*+(40=*-./0)*+?A-:                                                           welcomed. Please e-mail proposals to
                                         departments or different facilities.. ! !
                                                                                 , or call
                                            In a similar manner, many hospitals
                                                                                                     (877) 248-2360, ext. 3.

Payers & Providers                   MARKETPLACE/EMPLOYMENT                                                    Page 5

                                                  VENTURA COUNTY
                                                    MANAGED CARE

 VENTURA COUNTY HEALTH CARE SYSTEM is a new organization in Ventura County, CA with ofces located
 in Oxnard. This new agency is building its organization starting at the top. There are immediate openings in the
 following areas, with other management-level positions being announced soon. All employees will work for Regional
 Government Services, assigned to the Ventura County Organized Health Care System. For more and specic details,
 go to

 CHIEF EXECUTIVE OFFICER – Salary up to $200,000; apply with a resume and cover letter by July 18, 2010 at The CEO develops, manages, and leads this new organization. Under the authority of the by-
 laws and the policies of the board, this position implements strategic goals and objectives by leading and directing staff
 to achieve the organization's philosophy, mission, strategy, annual goals, objectives, and nancial targets. This is a key
 role in developing metrics to measure performance; serves as a liaison with the public, governmental organizations,
 afliated organizations, and other stakeholders. Appropriate education with at least 10 years of progressively more
 responsible executive level experience, in health care or managed care.

 CHIEF MEDICAL OFFICER – Salary up to $200,000; apply with a resume and cover letter by August 18, 2010 to This position is the principal manager of medical care, and is responsible for the
 appropriateness and quality of medical care delivered and for the cost-effectiveness of service utilization. MD/DO
 degree from an accredited program preferably in a primary care specialty; minimum two years experience in a
 managed care plan preferred with duties comparable to those listed in the brochure, and experience administering
 medical programs. Board certied in specialty and a minimum of 5 years clinical/medical practice experience;
 knowledge of QI and UM resources management procedures; experience with and acceptance of managed health care
 delivering systems and philosophy; and meets all criteria required of particular physicians, including a local medical

 CHIEF FINANCIAL OFFICER – Salary up to $175,000; apply with a resume and cover letter by August 4, 2010 to The CFO’s responsibilities include the nancial analysis, budgeting, productivity,
 benchmarking, reimbursement cost analysis, managed care risk report and analysis. The CFO must perform nancial,
 business, and strategic goals; nancial analysis, budgeting, productivity, benchmarking, reimbursement cost analysis,
 and managed care risk reporting and analysis; improve organizational productivity and cost-control; manage cash ow,
 purchasing, invoices, and expenses; and meet the requirements of contracted entities, and state and federal government
 regulations. It reports directly to the Chief Executive Ofcer and partners with department directors on strategic and
 tactical matters relating to budget management, cost benet analysis, forecasting, and securing of new funding sources;
 is responsible for providing nancial leadership and nancial management in business planning, accounting,
 budgeting, scal management of organization’s operations, and protection of organization’s assets. This position
 provides both operational and programmatic support, supervises the nance unit, and is the organization’s chief
 nancial spokesperson. Appropriate education, and completion of 10 years of progressively more responsible
 experience in nancial accounting and reporting for a health care organization, with at least 5 years at an executive
 level with a proven track record of successful nancial management in healthcare, managed care insurance, or
 nancial services.

Payers & Providers        MARKETPLACE/EMPLOYMENT                                  Page 6

              It costs up to $27,000 to fill a healthcare job*

                                                     will do it for a lot less.

             Employment listings begin at just $1.65 a word

                        Call (877) 248-2360, ext. 2
             Or e-mail:

                     Or visit:
                         *New England Journal of Medicine, 2004.

                                                                    can help.
            We publish advertisements for those seeking
                           new career
                 opportunities for just $1.25 a word.

               If you prefer anonymity, we’ll handle all
                   responses to your ad. Discreetly.
                  Call (877) 248-2360, ext. 2, or e-mail


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