VOLUME 5, ISSUE 6 JUNE 2010 Health Care Reform’s Big Impact on HR By Judd H. Lees By KoKo Huang es effective as of June 23, 2010 are Williams Kastner Williams Kastner directed at the nature of the health insurance offered by employers who self-insure or participate in group health plans. Group plans offering dependent coverage must continue coverage to children up to the age of 26 even if they are married, and must not exclude par- ticipants under age 19 with pre- existing conditions. In addition, the Act eliminates lifetime or an- nual limits on the dollar value of benefits as well as the ability to re- Please see> Reform, P4 Inside This Issue Health Care Reform’s Big 1 Impact on HR Few people have read all 3,000- and prepare for the changes ahead. plus pages of the recently enacted Healthcare Administration: The Grandfathered Plans. At the out- Patient Protection & Affordable New Excise Tax Penalties: 8 set, it should be noted that in or- Compliance is Your Best Defense Care Act (Act) and the ensuing der to deliver on presidential Health Care and Education Rec- promises made during the health Healthcare Law: Social Media: 10 onciliation Act of 2010, but no New Opportunities and Headaches care debate, the Act provides for one doubts the compliance head- no changes for enrollees in group Healthcare Insurance: Your Best aches these contentious pieces of health plans or health insurance HR Tool: Employment Practices 14 legislation will present for human Liability Insurance in effect on the March enactment resource personnel for years to date, with some minor exceptions. Healthcare Administration: Is come. This article discusses the The same grandfathering applies There Really a Nursing Shortage 16 broad brushstroke requirements in Washington State? to plans provided by union collec- under the health care legislation tive bargaining agreements in ef- which will go into effect on vari- Career Opportunities 18 fect in March 2010. ous dates over the next several Plan and Hospital Financial Informa- years, and provides guidance for Immediate Changes to Employer tion Available at www.wahcnews.com HR personnel to both understand Health Care Plans. Several chang- Letter from the Publisher and Editor Publisher and Editor Dear Reader, David Peel Managing Director In February 2010, the Facebook social network- Elizabeth Peel ing web site surpassed 400 million users. Incred- Contributing Editor ibly, this was an increase of 225 million in just Nora Haile one year! Advertising The Washington Healthcare News recently inte- Jennifer Sharp grated our web site into the Facebook platform, Business Address joining 250,000 web sites that have already done 631 8th Avenue Kirkland, WA 98033 so. You can connect with us on Facebook by vis- Contact Information iting www.wahcnews.com, clicking on the blue Phone: 425-577-1334 “join us on Facebook” icon and then selecting Fax: 425-242-0452 Like at the top of the page. E-mail: email@example.com Why join us on Facebook? There are several reasons: Web: wahcnews.com • Our “Discussions” page allows immediate engagement in dialog with TO GET YOUR COPY other healthcare leaders based on topics you create or choose. If you would like to be added to the dis- tribution, go to our web site at www. • You can choose to be notified when our content changes. wahcnews.com, click on the “sub- • We provide links to healthcare management articles beyond those pre- scribe” tab at the top of the page and en- sented on the Washington Healthcare News web site. ter all information requested. Be sure to let us know whether you want the hard • We will be enhancing our Facebook page on an ongoing basis. We copy or the web version. hope to offer our job board and Consultant Marketplace at some point LETTERS TO THE EDITOR in 2010. If you have questions or suggestions We look forward to seeing you on Facebook! regarding the News and its contents, please reply to firstname.lastname@example.org. David Peel, Publisher and Editor www.ubcinc.org NEED RETURN TO WORK? PAIN TREATMENT? CLAIM RESOLUTION? LOWER CLAIM COSTS? Use our interdisciplinary rehabilitation experience • Return-to-Work / Pain Management * • Work Hardening * * CARF accredited • Physical Capacity Evaluations • Opioid Detoxi cation • Psychological Counseling & Services Make a Referral online or call our Intake Coordinators Today to Schedule an Evaluation Redmond, WA 425-644-4100 | Everett, WA 425-513-8509 | Puyallup, WA 253-445-8663 | UBC Toll Free 877-302-7132 -2- A Common Sense Approach to Employee Benefits At Stoel Rives, we understand that your We place a premium on technical expertise benefits and compensation program doesn’t – each member of our Employee Benefits exist in a vacuum. It intersects with your tax team practices exclusively in employee accounting, employee retention, financial benefits and executive compensation. But projections and much more. 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Headquartered in Our systematic and disciplined approach to the complexities of managing investment portfolios gives us a unique ability to Redmond, WA develop customized solutions that integrate investment Prime Advisors, Inc.® strategy with the operational demands of hospital associations, 22635 NE Marketplace Drive, Suite 160 insurance companies and health plans. Redmond, WA 98053 For more information contact Patrick Tuohy at (860) 331-3050 or WWW.PRIMEADVISORS.COM Patrick.Tuohy@primeadvisors.com < Reform, from P1 ry explanation of benefits and, by June 23, 2010 is the establishment scind participant coverage except 2014, must offer at least an “essen- of a temporary reinsurance pro- in cases of fraud or an intentional tial health benefits” package which gram for early retirees receiving misrepresentation. Other changes includes ambulatory patient ser- health insurance coverage from include application of nondiscrim- vices, emergency services, hospi- former employers until Medicare ination rules which previously ap- talization, maternity and newborn kicks in. Since the new state-cre- plied only to self-insured group care, mental health and substance ated health insurance exchanges health plans. New private plans use, prescription drugs, rehabilita- discussed below will not come will also have to fully cover pre- tive services and devices, laborato- into existence until 2014, this vol- ventative care services without co- ry services, preventative and well- untary reinsurance program will payments. By 2010, group health ness care, and pediatric services. reimburse participating employ- plans and insurers must prepare Early Retiree Benefits. Another ers 80 percent of their per-em- and distribute a standard summa- change which will take place on ployee costs between $15,000 and $90,000 a year in order to entice employers to offer health insur- ance to retirees between the ages Good Medicine Has Its of 55 and 64. State-created Exchanges. The pri- Rewards: $184 Million mary vehicle for opening up health care to the estimated 32 million people who are currently unin- sured will be the establishment of American Health Benefit Ex- changes by states in 2014. These We have returned $184 million to our exchanges must include Small members through our dividend program. Business Health Options Programs 5% For more than two decades, our member or “SHOPs” to assist small-group dividend for market employers to provide qual- physicians in Washington have benefited from ified health plans to their employ- Washington our strength. As a leading carrier in the state, ees. The Doctors Company’s 2010 dividend is made members Free Rider Penalties. The piece of possible by the excellent claims experience of our the legislation drawing the most in 2010. members and the commitment we’ve made to advance, attention is the mandate that, by protect, and reward the practice of good medicine. 2014, employers with more than 50 full-time employees (FTEs) pro- vide health insurance coverage or face a so-called “free-rider” penal- To learn more about The Doctors Company’s ty of $2,000 per full-time employee medical professional liability program in Washington, (although the penalty is reduced by including the member dividend program, call 30 FTEs). “Full-time employees” are those working an average of at (877) 673-2101 or visit us at www.thedoctors.com. least 30 hours per week; part-time hours are aggregated on a monthly basis and divided by 120 to deter- mine FTEs. Qualifying employer health insurance coverage must be “affordable” and provide coverage www.thedoctors.com of medical expenses with an actu- arial value of 60 percent. “Afford- -4- Volume 5, Issue 6 able” coverage is defined as that has been voiced that vouchers will Accounts (FSAs) will no longer be costing no more than 9.5 percent drive up health care premiums by eligible for reimbursement for the of the employee’s modified gross pushing younger, healthier em- purchase of nonprescription over- income. ployees to opt out in order to pur- the-counter drugs. In addition, Major Employers. By January 1, chase cheaper insurance through the tax on nonqualified medical 2014, employers with more than the regulated exchanges. expense distributions from HSAs 200 FTEs offering more than one HSA and FSA Changes. By 2011, will increase from 10 to 20 percent health plan will be required to au- employers will need to disclose effective 2011. By 2013, annual tomatically enroll any new full- the value of the health care ben- contributions to health FSAs will time employees in one of the plans efits provided on employee W-2 be capped at $2,500. and offer these employees notice forms. Employees enrolled in Whistleblower Protection. As and the opportunity to opt out. popular Health Savings Accounts This opt out written notice must (HSAs) and Flexible Spending Please see> Reform, P6 contain clear language describing employee options in state-created health care exchanges as well as (800) 467-5281 eligibility for a premium tax credit. www.fchn.com Small Business Tax Credit. Small employers with 25 or fewer FTEs with annual average wages of $50,000 or less will receive a tax credit to purchase health insurance for their employees. A qualifying employer must contribute at least 50 percent of the total premium cost of a qualified plan in order to be eligible for a tax credit of up to 35 percent of the employee’s pre- mium. A full credit will be avail- able to smaller employers with 10 or fewer employees who have an- nual average wages of $25,000 or less. Free-choice Vouchers. The legis- lation also requires that employ- ers offer free-choice vouchers beginning in 2014 to low-income employees in order to allow them to purchase health insurance cov- erage through one of the state ex- changes. Employees will qualify for the vouchers if their income is four times below the federal PPO Network poverty level. The dollar value of the free-choice vouchers must Medical Management equal what the employer would Third Party Administration have paid to cover these low-wage Employee Assistance Program employees under the most gener- ous group plan option. Concern -5- < Reform, from P5 was a “contributing factor” in the well-deserved raise. adverse action by the employer. employers and, more important- The employer, in turn, must prove ly, their HR personnel stumble Judd H. Lees is a Member in the “by clear and convincing evidence through the various requirements Seattle office of Williams Kastner. that it would have taken the same under the health care legislation, He has 30 years of experience adverse action in the absence of they should be aware that em- practicing labor and employment the protected conduct.” ployees have been incentivized to law, and currently serves as Chair ensure employer compliance with As a result, HR personnel will of the firm’s Labor & Employment the health care legislation. The be carefully monitored not only Practice Group. Judd represents law prohibits discrimination or re- by the government but by em- both unionized and nonunion- taliation by an employer against ployees as they steer through the ized employers in the private and myriad requirements of the new public sector, including clients in an employee who (1) reports or is health care legislation. Whether the construction, manufacturing about to report possible employer the health care legislation will and the transportation industries violations of the Act; (2) testifies achieve its ultimate goal of ex- before federal and state agen- about or assists authorities with an tending health care coverage to cies, including the Department of investigation under the health care those who are currently not cov- Labor, National Labor Relations legislation; or (3) objects to or re- ered and, more importantly, make Board and the Washington State fuses to participate in any activity, it more affordable, will be any- Department of Labor and Indus- policy, practice or assigned task body’s guess. However one thing tries. he or she reasonably believes to violate the health care legislation is certain. The employee benefit KoKo Huang is an Associate in the or any rule or regulation under it. aspects of the HR job description Seattle office of Williams Kastner. The employee need only demon- suddenly got a lot more compli- Her practice focuses on employ- strate that the protected conduct cated. It’s time to ask for that ment law and general litigation. -6- smart efficient seamless administration for CAM benefits the authority in complementary and alternative medicine services for health plans and employer groups since 1989 taylor gregory broadway architects We are a diverse team of design professionals. Our talent and approach are geared toward creating logical solutions for the complex needs of our healthcare clients. SERVICES Feasibility Study Facility Analysis Master Planning Design Development Programming Construction Oversight Architectural Design Site Analysis FACILITIES ASC Design Fitness Center Design Sleep Lab Design Hospital Design Multi-Practice Clinic Hospital Remodel Specialty Clinic Imaging / Radiology Sole Practice Clinic ER / ICU Design 21911 76th Ave W. Suite 210 Medical Oﬃce Buildings Edmonds, WA 98026 Building Spaces for T: 425.778.1530 F: 425.774.7803 Health and Healing www.tgbarchitects.com Healthcare Administration Washington Healthcare News | June 2010 | wahcnews.com The New Excise Tax Penalties: Compliance is Your Best Defense By Susan Smith, SPHR compliance – be it TPA, HMO, costs $100 per affected person Director, Human Resources & insurance company or plan spon- per day, or if more than one per- Compliance Healthcare Management sor/employer – must self-report son is affected by the failure, $200 Administrators each non-compliance instance per day. For instance, if a family Those of us who work in the group and proactively pay the associated doesn’t receive their COBRA elec- health benefits arena are quite fa- penalties (26 CFR part 54, sections tion notice in a timely manner, the miliar with the many federal laws 4980b and 4980d). The reporting excise tax penalty is $200 per fam- regulating employer sponsored entity must use the new IRS re- ily member, per number of days of group health plans – COBRA, porting form 8928 (created specifi- non-compliance. On a wry note, mental health parity, HIPAA, cally for this purpose) and file it at the IRS does indicate the maxi- GINA, the Newborns’ and Moth- the same time as their other federal mum penalty in any one year for a ers’ Health Protection Act, and Mi- tax forms. TPA, HMO or insurance company chelle’s Law, to name a few. Each Reportable non-compliance inci- is $2 million USD. places requirements on the group dents subject to excise tax penalty What about waivers? Under the health plan to provide coverage include failure to: new reporting regulations, the pos- or continue coverage, or provide • Satisfy COBRA continuation sibility of a partial or full waiver notice, special enrollment rights coverage requirements; exists in the following instances: or protection from discrimination due to genetic information or the • Comply with HIPAA limita- • If the plan did not, and by ex- presence of a health factor. Com- tions on pre-existing condi- ercising reasonable diligence pliance failure with any of these tion exclusions, certificates of would not have known of the laws’ highly specific requirements creditable coverage, or special non-compliance. carries a per person, per day pen- enrollment rights; • If the non-compliance was due alty burden for non-compliance • Provide coverage for the man- to reasonable cause and not instances. However, historically dated minimum length of hos- willful neglect, and the failure no mechanism has existed for the pital stays in connection with was fully corrected and the af- reporting or payment of a non- childbirth for mothers and fected persons “made whole” compliance penalty, other than as newborns; within 30 days of discovery. the result of a lawsuit or an IRS or • Provide parity in mental health • If the excise tax would be ex- DOL audit. Until now. benefits and substance use dis- cessive relative to the nature of On September 8, 2009, the IRS is- order benefits ; the non-compliance. sued final regulations that became • Make comparable HSA con- Unfortunately, as of this writing, effective for tax years beginning tributions for all participating there is no guidance on how a plan January 1, 2010, regarding new employees; would apply for the waiver, and employer sponsored group health • Exercise non-discrimination the IRS reporting form 8928 does plan reporting obligations. Annu- regarding eligibility to enroll not include the option to provide ally, every group health plan must or premium contributions as an explanation for the non-compli- determine if any non-compliance required due to genetic infor- ance. incidents reportable under the federal mandates occurred. If so, mation or health factors. While the new reporting require- the party responsible for the non- Each incident of non-compliance ments are too detailed to elaborate -8- Volume 5, Issue 6 on in this article, the basics are also assist HMA clients with Plan insured employers a full comple- here. To protect your plan, start compliance questions and issues. ment of benefit products and ser- a proactive discussion with your HMA currently administers over vices. Contact: 800.869.7093, or broker or Third Party Administra- 600 benefits plans and offers self- email@example.com. tor to identify and address any po- vertical tential problem areas. If you’re an HMA client, be at ease. We’ll be working with you to ensure your plans are fully compliant so the excise tax penalty is avoided. Five Preventive Next Steps 1. Self-funded? Work with your broker or TPA to identify each new reporting requirement mandate and how it applies to your plan. 2. Ensure your plan document not only accurately reflects the mandated coverage or require- ments, but also is administered Legal strategies for the accordingly. healthcare challenges ahead. 3. Develop an Action Plan to ad- dress steps that help ensure continued compliance, identify Your healthcare business is operating in an increasingly complex time lines to meet each man- environment. Miller Nash’s team of healthcare attorneys have the date, and guide your plan’s ad- knowledge and depth of experience to successfully address the ministration. unprecedented challenges and expanding responsibilities you face. 4. Implement strong audit proce- Please contact Bob Walerius | firstname.lastname@example.org dures to assure near-immediate identification of all failures. Regulatory Compliance | Board Governance | Medical Staff | Fair Hearings Mergers & Joint Ventures | Physician Recruitment & Contracting | HIPAA Privacy Laws 5. Develop policies and proce- Health Information Technology | Physician Credentialing | Stark/Fraud & Abuse Litigation & Dispute Resolution Business Formation & Transactions dures that assure corrective Labor and Employment | Real Estate action for discovered failures occurs within the 30 day cor- seattle rection window. Document vancouver carefully! Show what you dis- portland covered and when, as well as central oregon TEL 206.622.8484 the remediation steps. Susan Smith has over 25 years experience in the employee ben- efits field, and is the Director of Human Resources and Compli- ance at HMA, a third party ben- efits administrator based in Bel- levue, WA. She and her team are responsible for HMA’s legal and Visit wahcnews.com for current career opportunities legislative compliance, and they -9- Healthcare Law Washington Healthcare News | June 2010 | wahcnews.com Social Media: New Opportunities and Headaches By Leslie Bottomly By Kathy Feldman to this general rule. Partner Partner Ater Wynne LLP Ater Wynne LLP For example, in union and non- union workplaces, an employer may not interfere with an em- ployee’s right to organize under the National Labor Relations Act, may not retaliate against a whistle- blower or because the employee asserts his or her employment- related rights (for example, asking to be paid overtime) and may not discriminate against an employee because of his or her race, religion, age or other protected status. Any time an online posting touch- es upon these potential risk fac- tors, the employer must evaluate the risk before terminating or dis- New technology and social me- ees on Twitter, blog postings, or ciplining the employee. Although dia opportunities have opened a an objectionable and disrespect- Facebook pages. A worker may Pandora’s Box for employers and ful tweet may not initially appear express dissatisfaction with work, HR professionals. At work and to implicate these concerns, closer pay, a manager or coworkers, post at home, employees can access e- consideration might show that the unprofessional photographs or mail, the Internet, and social net- employee postings touch upon po- reference getting drunk or being working sites such as Twitter and tentially protected issues. hung over at work. Perhaps more Facebook, allowing them to work disconcerting is an employee dis- For example, an employee may, in more efficiently and communicate closing confidential employer in- a moment of frustration, post that more broadly. But it also creates a formation. “my manager sucks and my com- range of legal, moral and ethical pany sucks. The room I work in For private (non governmental) dilemmas for employers as they is too cold, and they are so cheap and non-union employers who strive to balance the legitimate they don’t even pay us for the time need to know what is happening have engaged employees on an at- it takes to get into our uniforms in the workplace with employee will basis, the default presumption once we get to work. Me and my rights to privacy. is that an employee can be termi- co-workers are signing a petition nated for any reason or no reason, to complain.” A posting such as Can You Fire Someone Because and certainly for disparaging the of Online Conduct? this should be analyzed to deter- employer or its products, goofing mine whether the employee may Given the prevalence of online off at work, being drunk at work, have a claim as a whistleblower activity, employers routinely dis- or for similar activities frequent- or under the applicable wage and cover objectionable conduct or ly tweeted or blogged about. communications by their employ- However, there are exceptions Please see> Social, P12 -10- healthcare marketing reform In a Social Media world, old marketing tactics don’t work for patient recruitment. Only 58% of patients trust their doctors, and only 13% of consumers trust advertising. Interestingly, 76% trust peer recommendations.* We’ve been studying these trends carefully, responding with campaign strategies that help you launch new clinics, attract new patients, and increase doctor referrals faster than ever before. Now we’re also building the online communities that get people talking about your healthcare brand, and recommending it to others. Can we help you? palazzo *2009 Edelman Trust Barometer Contact Richard at 206.328.5555 ext. 203 | www.palazzo.com CellNetix palazzo Washington Healthcare News > HPH4C > Distribution Date: 10.19.09 > 9.29.09 Pathology & Laboratories Breaking Traditions... ...Creating new pathology standards for physicians and their patients • Bar-coding system slashes error rates and improves patient safety • 44 in-house pathologists with expertise in 29 sub-specialties • 100% physician and employee owned: Local pathologists, local relationships, local jobs To learn more please visit www.cellnetix.com or call (866) 236-8296. < Social, from P10 to articulate fair and uniform stan- Develop a Social Media Policy dards by which to evaluate online Although social media policies are hour laws or under the union-or- information about job candidates. in the news, relatively few com- ganizing laws (the National Labor An employer may take steps to panies actually have implemented Relations Act). screen the hiring decision-maker them. A recent Ethics and Work- Vetting Job Applicants On Line from protected class information place Survey by Deloitte LLP embedded in social media. Em- showed that only 17 percent of Employers also must be careful in ployers can do this by outsourc- accessing job applicants’ online employers have policies in place ing the task to a third party with to examine and minimize potential communications. Viewing person- instructions to screen out protected al web pages or blog posts to learn risks to reputation related to use of class information (or instructions social media. At the same time, al- of a potential employee’s judg- to just provide information on lim- ment or reputation may seem like a most half of employees surveyed ited criteria, e.g., evidence of ille- stated that they regularly visit one way to avoid hiring mistakes, but it gal activity). puts employers at risk of exposure or more social media sites four or to information about an applicant’s As an alternative, the employer can more times per week. More than protected class. designate a “neutral” individual in- 53 percent of employees stated that ternally to research the candidate’s “social networking pages are none It would not be unusual to learn social networking information, of an employer’s business.” from a candidate’s blog or Face- screen out protected class infor- A social media policy (and/or relat- book page, for example, that the mation, and provide the remaining ed training) can help educate em- candidate is a minority (which may data to the decision-maker. ployees on why it sometimes is the not be obvious from having met employer’s business to know what the individual), a union activist, Employers who use social net- working as a screening tool an employee is doing or saying on- of a particular religion, planning line. Well thought-out policies and to have children, has a disability should consider developing a policy on this practice in order to procedures may pay off by saving or has filed workers’ compensa- the employer time and expense of tion claims. Even if the employer ensure consistent treatment and respond to discrimination claims. unwanted litigation in the future. does not base its hiring decision on these criteria, which would be Such a policy should articulate illegal, simply learning such in- the legitimate business reasons Leslie Bottomly (Portland, OR) formation renders the employer for the inquiry, describe the cri- and Kathy Feldman (Seattle, WA) more vulnerable to discrimination teria that will be considered, and are partners in Ater Wynne LLP’s claims. articulate information that will be Labor and Employment Group. disregarded if learned during the Contact them at lgb@aterwynne. Employers are struggling with how process. com or email@example.com. The Consultant Marketplace, located on the Washington Healthcare News web site, is where over 60 companies that specialize in providing services or products to healthcare organizations are found. When using external firms, doesn’t it make sense to use those that specialize in healthcare? Visit wahcnews.com/consultant to learn more. -12- 30 30 ●● // ●● ●● Fraud Audits Medicare & Medicaid: Fraud Audits Medicare & Medicaid: ●● RAC Audits: Training/Response Plan RAC Audits: Training/Response Plan ●● Appeals & Supreme & Superior Appeals & Supreme & Superior Court Cases Court Cases ●● ●● Strategic Planning Strategic Planning Play With A Winning Play With A Winning Reimbursement Team Reimbursement Team www.FCAWreimbursement.com www.FCAWreimbursement.com FCAW@FCAWreimbursement.com FCAW@FCAWreimbursement.com Healthcare Insurance Washington Healthcare News | June 2010 | wahcnews.com Your Best HR Tool: Employment Practices Liability Insurance By Janet Jay the event of an employment claim. vided by some EPL policies that Agency Sales & Service Representative can help you navigate through Physicians Insurance Agency What special features should I look for? routine human resources events such as hiring, granting time • Definition of insured: Does off, taking disciplinary action, your policy cover only claims and terminating an employee, brought against the entity, while keeping you informed or does it also include those of federal and state laws. Ad- brought against your employ- ditionally, you can find online ees, directors and officers, or training programs for you and even the independent contrac- your staff on a variety of hu- tor who is working exclusively man resource topics. for you? • Access to Live Support: Do you • Third-party coverage: This have a question that needs an coverage can protect you from immediate answer or that you a covered cause of action filed can’t find in the human resourc- by any non-employee, includ- es toolkit? Having access to live ing an outside vendor (such as support can save you time and the delivery or cleaning per- money on attorney fees when son) who is working in your Times are tough, and it’s difficult you need to know what to do in office. to find a job. So, when you termi- an unusual situation. nated that employee last month, • Coverage for state-approved peer review claims: If you’ve Can you give an example EPL she may be looking for any reason claim scenario? A newly hired to come after you and put a few filed and received state approv- al on your peer review plan, Clinical Director of Occupational bucks in her pocket. Luckily, you Therapy at a rehab facility was have a good Employment Prac- this coverage can protect you if one of your healthcare provid- demoted after just a few months’ tices Liability (EPL) policy to help employment because of her in- guide you – and to provide cover- ers files suit against your group in response to action you’ve ability to get along with doctors age in case there is a claim. and staff. A new therapist position taken within the guidelines of What does an EPL policy cover, your peer review plan. was created especially to accom- and why do I need it? All EPL modate her, but this was not satis- policies cover for employment- • Wage and Hour Defense Op- factory, and her performance did related claims. Covered claims can tion: This feature provides not improve. She was counseled include allegations such as harass- coverage for claims alleging repeatedly for her resistance to or ment, wrongful termination, hos- violation of a federal, state, outright refusal to utilize the rec- tile work environment, failure to or local wage and hour law or ommended therapies and splinting hire or promote, wrongful demo- regulation. Such allegations procedures. She was then made a tion, negligent evaluation, depri- could include failure to provide “floater” at various rehab facilities vation of career opportunity, retali- mandatory breaks or to pay for but at once began generating com- ation, wrongful discipline, etc. An overtime hours worked. plaints from doctors and nursing EPL policy provides coverage and • Human Resource Toolkit: This staff at each location for her poor security for a business owner in is an invaluable resource pro- attitude and working habits. Fi- -14- Volume 5, Issue 6 nally, she was given an “Immedi- ate Action Needed” written warn- ing regarding her refusal to follow doctor’s orders and was counseled We believe a great lawyer is a creative that one more complaint would re- thinker who helps employers build and sult in termination – and it did. The therapist immediately filed a law- protect their business while empowering suit alleging wrongful termination their workforce. That’s our approach. for her having refused to provide At Ater Wynne we do more than give “unnecessary” patient services that legal advice. We give you confidence in might have constituted “Medicare your hire power. Contact Kathy Feldman, fraud.” Insurance covered $86,775 Seattle, or Stacey Mark, Portland. in defense costs. Are you looking for an EPL poli- cy for your group? Physicians In- Suite 1501 601 Union St. Suite 900 1331 NW Lovejoy St. surance Agency offers a packaged Seattle, WA 98101 Portland, OR 97209 206-623-4711 503-226-1191 EPL policy that can provide all of the above features and is tailored P O RT L A N D S E AT T L E M E N LO PA R K S A LT L A K E C I T Y aterwynne.com specifically to the needs of the medical office. For specific terms and exclusions, it’s important to refer to your actual policy. For more information and an EPL ap- plication, contact Janet Jay at (206) 343-7300 or 1-800-962-1398. Visit wahcnews.com for current career opportunities Dorsey Helps Healthcare Companies Get to the Heart of the Issue Our Healthcare Group helps clients, from health care providers to insurers and life science companies, manage the complex issues that affect the health care industry. From implementing compliance programs to providing tax-exemption advice to structuring complex transactions between providers, our expertise helps clients achieve their goals. According to Modern Healthcare magazine, Dorsey completed the largest transaction in the managed care industry in 2008 for two companies that serve more than two million people across 21 states with an estimated transaction value of $930 million. Please contact Ron Lahner at (206) 903-2455 or firstname.lastname@example.org for more information. Dorsey & Whitney LLP · Columbia Center 701 Fifth Avenue · Suite 6100 Seattle, WA 98104-7043 www.dorsey.com -15- Healthcare Administration Washington Healthcare News | June 2010 | wahcnews.com Is There Really a Nursing Shortage in Washington State? By Linda Tieman RN MN FACHE supply and demand research in- morbidities and takes 5-10 medi- Executive Director dicated that simply to keep up cations. Older patients have more, Washington Center for Nursing with expected demand, we should longer office visits, more hospital have added 400 new positions this admissions with longer lengths-of- past Fall to our nursing schools in stay, and more needs for support Washington.1 Organizations are (read “more nursing care in all set- clamoring for nurse managers, tings” and “more career opportu- and Chief Nurse Executive turn- nity”). over is high. The average age of What’s been done to date? WA’s RN is 48.5 (46 nationally), and the average faculty member • The Master Plan for Nursing is over 50. Schools cannot recruit Education in Washington State or retain faculty due to workload is focused on ensuring that we and compensation disparities. Our have an educational system overall state unemployment hov- that provides a futuristic nurs- ers around 9.5%. The recent nurs- ing education for increasingly ing workforce shortage and that complex needs, so that our ahead, is caused by demographic population has the required changes, unlike shortages of the care. past. Healthcare organizations that The current economic conditions • The Rural Outreach Nursing have done their own workforce have altered many working nurs- Education program (RONE), analyses know that RNs in the Op- es’ plans to retire or reduce work bringing nursing education erating Room comprise the oldest hours. In 2007, approximately 80 to incumbent rural healthcare segment of their RN workforce of our nurse educators indicated employees, accepted its second and will retire first. As the econ- that they planned to retire in the class in January, and a third is omy improves, others will follow, next year; few have done so. Em- planned. or at least reduce work hours. ployers report that vacancy rates • A preliminary analysis of fac- for RN positions are lower than The forecast from our state Fore- ulty workload was completed, in many years. Hiring of new RN casting Division is chilling: the providing baseline information grads this June is projected to be percentage of our population over for making changes to the edu- better than in 2009 but still low. 65 will continue to grow dramati- cator role. Is it time to finally focus on issues cally, with the elderly population other than the nursing shortage? composing 20% of our total popu- • Transition-to-Practice plan- lation by 2030.2 Also, 2010 is the ning guides for organizations Not so fast! All of our schools of year that the proportion of our na- that do not yet have programs nursing continue to report being tional population turning 65 esca- for new graduates are being full and unable to accept more lates dramatically, making more developed. qualified applicants for the pre- individuals automatically eligible licensure programs. Our best data • Community College nurse for Medicare. tell us that approximately 750 educators are working to mini- more individuals might have been It’s been reported that the aver- mize unnecessary variation in admitted if we had capacity; our age Medicare patient has 3-5 co- pre-requisites, thus streamlin- -16- Volume 5, Issue 6 ing students’ experience. ington, now? The economic down- reached at 206-787-1200. turn has tipped the scales towards • Washington’s Campaign to the supply side. But as our econo- Champion Nursing in America 1 “Washington State Registered my warms up, the older population team3 is learning about other Nurse Supply & Demand Projec- increases, and healthcare reform states’ successes redesigning tions:2006-2025” Skillman et al. WWA- impact is realized, an imbalance to nursing education and bringing MI Center for Health Workforce Stud- the demand side will occur, quick- ies. June 2007. that info to Washington. ly. Educational funding, innova- 2 “Forecast of the State Population” No- • Regional meetings of stake- tive curricula, public-private part- vember 2009 Forecast. Office of Finan- holders will be sponsored by nerships, and support for students cial Management Forecasting Division, WCN in the second half of are critical to our state’s health and State of Washington. Pp8-9. 2010 to find agreement on the prosperity. 3 The CCNA is a collaboration of the knowledge, skills and attri- Robert Wood Johnson Foundation & butes nurses need at graduation AARP, focused on transforming Nursing and throughout their careers. Linda Tieman is the Executive Education in America and includes the following individuals: Gladys Camp- • Diversity in the nursing stu- Director of the Washington Cen- bell, NWONE; Karen Heys, Everett dent and nursing faculty popu- ter for Nursing in Seattle, WA. CC; Anne Hirsch, WSU; John Lederer, lations is receiving additional The mission of the Washington HECB; Andrea McCook, WCN; Pau- focus from WCN. Center for Nursing is to contrib- la Meyer, NCQAC; Eleni Papadakis, ute to the health and wellness of WTECB; Dixie Simmons, SBCTC; Di- • Incumbent worker education is ane Sosne, SEIU Healthcare 1199 NW; Washington State by ensuring expanding. Charleen Tachibana, Virginia Mason that there is an adequate nurs- Medical Center; Barbara Trehearne, All of this work is focused on the ing workforce to meet the current Group Health Cooperative; Sally Wat- future of Washington’s health. Is and the future healthcare needs kins, WSNA; Linda Tieman WCN there a nursing shortage in Wash- of our population. She can be (Lead). -17- Career Opportunities To advertise call 425-577–1334 To advertise call 425-577–1334 To advertise call 425-577–1334 Visit wahcnews.com to see all Visit wahcnews.com to see all Visit wahcnews.com to see all available jobs. available jobs. available jobs. Chief Operating Officer Under the general direction of the CEO, the COO Executive Medical Director will be responsible for the oversight of CenCal The Children’s Hospital at Providence in Anchor- Health’s day-to-day operations including the age, AK is recruiting for an experienced physician leadership and operational implementation of leader to serve as its new Executive Medical Direc- new business plans and programs as directed by Administrator & tor. Position is responsible for the overall opera- tional, financial and business effectiveness of The the CEO. Additional responsibilities include the oversight of Provider Services provider contract Practice Manager Children’s Hospital at Providence. Accountabilities negotiation functions, Information Technology Valley Orthopedic Associates a division of Proliance include: formulate strategy, implement strategic Department, Quality and Decision Support De- Surgeons, Inc is seeking a clinic administrator. VOA is a plans, develop and ensure attainment of operating 17 physician orthopedic practice with 4 locations in the goals and objectives consistent with the strategic partment, and coordination of the Chief Medical south King County Area including an ASC and Full Body objectives and policies established by PAMC and Officer’s role regarding clinical input needed by MRI. In addition, VOA is electronically automated and TCHAP. Will oversee recruitment of physicians to other departments. has state of the art digital imaging, PACS, and EMR. TCHAP and manage $130 million facility expansion QUALIFICATIONS: Bachelor’s Degree. MBA, The successful candidate will possess excellent com- project that will kick off in 2010. Excellent compen- MPH, or related post-graduate degree. Ten- munication skills, superior analytical skills, a strong sation package, including relocation assistance. plus years of senior management experience in sense of leadership and professionalism. In addition, Amazing quality of life in Alaska’s largest and most a managed-care organization with at least five this person will have experience in identification and modern city. resolution of workflow problems, optimization of rev- years of direct-reporting for the following depart- Requirements: enue cycle, and the ability to coalesce a strong team to ments: Provider Contracting, Claims, and Infor- lead this practice into the future. A minimum of 3 years Advanced graduate training in health or business mation Technology. Experience with Medicaid of experience in operations for a physician group prac- administration: at least five years of experience in programs and their regulations, guidelines, and tice and a Bachelor´s Degree is necessary. A Master´s health care; and at least five years of high-level standards.(Knox Keene and CMS Regulations) Degree is preferred. If you have reached your growth leadership experience. Must be a board-certified potential in your current position and your professional Additional Key Functions and Responsibilities Pediatrician or Pediatric Subspecialist physician desire is to combine creative thinking and solid mana- and Competencies, Skills and Attributes avail- gerial skills within an innovative private practice group (M.D. or D.O.). able for review at www.cencalhealth.org setting, we look forward to hearing from you. CMPE or Contact: FACMPE designation is a plus. Apply online at www.cencalhealth.org or Con- Cindy McCasker tact Debbie Horne, Director of Human Resourc- Please send resume to: paul@themanagementtrust. (503) 216-5469 Direct (866) 504-8178 Toll Free com Cindy.email@example.com es at firstname.lastname@example.org Founded in 1936, The Vancouver Clinic is a multi-specialty clinic located in Vancouver Washington, just north of Port- land Oregon. The Clinic is a privately held, physician-owned clinic, with over 700 staff members and 190 providers. The Clinic is one of the region’s principal health care providers, offering extensive services to our patients. We are currently seeking the following key positions. Clinic Manager We are looking for an energetic, experienced professional to lead a team of staff providing compassionate medical care. Must have excellent communication and problem solving skills. The manager will work through supervisory staff to over- see the daily operations of specialty departments such as ENT, Orthopedics, Podiatry, Surgery, urology and our Special Procedures Suite. The successful candidate will have approximately 5 years of previous medical experience, preferably in an ambulatory care setting. Prefer those with a Bachelors degree or equivalent combination of education and experience. RN-Supervisor-Oncology/Infusion We are seeking a Nurse Supervisor to provide the best for our patients and leadership for our staff. Prefer those who are Certified Oncology with clinical leadership experience. Must thrive in a fast-paced environment, be detail oriented, and be able to handle sensitive situations with diplomacy and tact. We offer a competitive wage and benefits package. Clinical Operations Specialist - RN Would you enjoy a position where you will serve as a resource and facilitator to identify clinical improvement opportuni- ties and subsequent process improvements? Do you enjoy educating others? Be our site clinical educator and trainer for new and existing staff and assure standardization of care and the clinical environment. Looking for nurse with experience leading quality and safety initiatives and ability to manage multiple projects in varying stages. To apply for any of these positions visit www.tvc.org or call 360-397-3273 for information. -18- Volume 5, Issue 6 Career Opportunities To advertise call 425-577–1334 To advertise call 425-577–1334 To advertise call 425-577–1334 Visit wahcnews.com to see all Visit wahcnews.com to see all Visit wahcnews.com to see all available jobs. available jobs. available jobs. Admitting Manager Southern Coos Hospital on the beautiful south coast of Oregon has an opening for an Admitting Manager. This is a new position CARE Project Manager and will provide the successful candidate an opportunity to help Practice Advisor us consolidate our patient admitting resources to improve train- The Daughters of Charity Health System will launch UW Physicians seeks to fill its Practice Advisor position ing, performance monitoring, collections, and customer service. a nursing initiative to reduce sepsis mortality rates by This position is responsible for supervision and coordination of reporting to the Director of Physician Services and Perfor- 25% annually. DCHS is seeking a results-oriented ex- all operational activities within the Admitting Departments, which mance Improvement. perienced CARE Project Manager who will be respon- includes the Patient Service Coordinator and switchboard / pbx The Practice Advisor interfaces with UW Physicians’ key functions. This would involve point of service collections, compli- sible for guiding staff nurses through a pre-established ance, medical necessity, authorizations & referrals and a good leadership development program. He/she will also work partners to provide professional benchmarking, analysis and understanding of all insurance regulations. Excellent people and closely with project consultants that are national experts performance management strategies as they relates to mem- communication skills are needed to coordinate the admitting pro- in leadership development. The initial project is the de- ber physicians’ practices. cess with physician, nursing & other hospital staff. This position velopment of nursing councils focused on early recog- Collaborating in enterprise-wide quality and performance recruits, orients, trains, evaluates and monitors on the job per- nition of sepsis and reduction of sepsis mortality. The improvement initiatives, the Practice Advisor is a liaison be- formance of department personnel. This is a “working manage- ment” position and the manager is expected to work in any area ultimate goal is to develop front line nurses as change tween UW Physicians and individual clinical departments. of the department in addition to supervisory functions. agents for quality. This position will be primarily located Qualifications: at St Francis Medical Center and St Vincent Medical Educational Requirements/Qualifications: Bachelor degree required, preferably in business, mathemat- Center in the Los Angeles area and may include tele- ics, industrial engineering, health administration, or other phonic and occasional site visits to DCHS San Francis- Bachelor’s Degree required. Certified Healthcare Financial Pro- relevant process-oriented or analytical discipline; Master’s co Bay Area Hospitals. This is a dynamic new position fessional (CHFP) is a plus. Minimum 5 years experience with degree in business or health administration preferred; Two increasing responsibilities in a healthcare admitting, patient ac- that is funded for 30 months. years experience working with physician billing and reim- counting, or other related medical environment. Demonstrates Requirements: Degree in nursing required. Equivalent bursement and/or medical clinic management; Professional proficiency in Microsoft Office (Outlook, Word and Excel) ap- plications is required. Must be familiar with Federal HIPAA and experience is 5 or more years in a health care project medical coding certification helpful, Professional billing soft- EMTALA regulations and patient confidentiality requirements. management role. Experience in quality improvement ware experience and Epic knowledge preferred; Knowledge Knowledge of procedures of third party payers and fiscal interme- and/or project management desired. Comfort level with of ICD-9 and medical documentation requirements including diaries and compliance rules and regulations is required. Proac- clinical data/data management and Microsoft Excel. Teaching Physician guidelines; Knowledge of professional tively prioritizes needs and effectively manages resources. Com- billing/revenue cycle management. municates clearly and concisely. Oversees the development, Additional Roles and Responsibilities available for re- deployment and direction of complex programs and processes. view at www.dochs.org/careers A detailed job description available at website. Guides staff toward desired outcomes, setting high performance Application Process: standards and delivering quality service To apply or learn more, contact Nancy Carragee, RN MS, Director, Quality at 650-917-4521. Please submit cover letter and resume. To apply, visit website: This is a full time position of 40 hours a week with competitive http://uwmedicine.washington.edu/Global/Employment/UW- benefits. For more information go to www.southerncoos.org. or We offer excellent salary ($114 to $190 annually de- Physicians/Pages/default.aspx email email@example.com or call 541.347.4515. EOE. pending on skills, education, and relevant experience). UW Physicians. Equal Opportunity Employer M/F/D/V PeaceHealth Dedicated to Exceptional Medicine and Compassionate Care Located in Southwest Washington State, Regional Director, PeaceHealth’s St. John Medical Center Contracts includes a 200-bed acute care medical Primary financial center and PeaceHealth Medical Group, PAIN Physician in negotiator for a 100+ clinician multi-specialty practice. revenue contracts Portland, Oregon We are a mission and values-oriented needed. Develop Unique opportunity for a board certified phy- faith-based nonprofit healthcare system. sician with experience in the non-invasive and implement management of chronic pain. We want to share our excitement with contracting strategy. Join our multidisciplinary team of professionals you! We offer a competitive salary and Requires min. 5 in a free-standing medical rehabilitation clinic where our emphasis is on functional return to comprehensive benefits package. For a years related work, home and community. We are CARF ac- complete job description and online experience in the credited and located in SW Portland with conve- nient access to abundant public transportation, application, visit: healthcare finance freeways, acres of parks and the thriving down- www.peacehealth.org/careers industry in a town core. contracting Please contact: Kathy de Domingo Curious seekers contact: capacity. 503.292.0765 DTroyer@peacehealth.org, progrehab.com 360-636-4106. -19- Prsrt Std US Postage Paid Olympic Presort Over 11,000 healthcare leaders on the West Coast receive Healthcare News publications each month. As a healthcare organization, doesn’t it make sense to target recruiting to the people most qualified to fill your jobs? To learn about ways the Washington Healthcare News can help recruit your new leaders contact David Peel at firstname.lastname@example.org or 425-577-1334.
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