Payers & Providers California Edition – Issue of May 19, 2011

8/6/2019 Payers & Providers California Edition Issue of May 19, 2011

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Despite epic budget woes, Gov. Jerry Brownhas exempted the Ofce of Statewide HealthPlanning and Development from agovernment-wide hiring freeze, allowing the

agency to begin addressing a backlog ofapprovals for hospital construction projects.

The exemption by Browns ofce wasgranted earlier this month, according toOSHPD ofcials. It will allow the agency toll 26 positions in its facilities developmentdivision. Two structural engineers will alsocome out of retirement. The hires will expandthe divisions overall employment by about10%.

While it will take some time to recruitand ll the vacancies, these steps will result inOSHPD having the resources needed toreduce OSHPDs plan review time and

construction observation of hospitalconstruction projects, OSHPD spokespersonDavid Byrnes said in an e-mail.

Brown instituted a statewide hiringfreeze in February to address a $25.4 billionbudget decit. It prohibited state agenciesfrom hiring new employees, converting part-time positions into full-time jobs, or usingoutside contractors to make up for theemployee shortfall.

However, Brown is able to grantexemptions based on whether positionsgenerate revenue or compromise public safety,according to his spokesman Evan Westrup. He

declined comment on what prompted the

OSHPD exemption.The new hires will be paid for through

OSHPDs hospital building fund. Thats fundedthrough fees hospital pay to the agency as part

of the permitting and approval process. Thefees are based on a percentage of the value ofeach project.

Browns administration as well as thatof his predecessor Arnold Schwarzenegger had been extensively lobbied to deal with amounting seismic safety compliance issue. InApril, Senator Pro Tempore Darrell Steinberg,D-Sacramento, sent a letter to Health andHuman Services Secretary Diana Dooley,citing the devastating earthquake in Japan theprior month.

We urge you to help unclog thegrowing backlog of hospital construction

projects at OSHPD, Steinberg wrote. Headded that the backlog has grown from $14billion worth of projects in 2005 to more than$22 billion today.

OSHPD, which oversees most aspectsof hospital construction in California, hasbeen subjected to furloughs and cuts inovertime during the current recession.Steinbergs letter noted that the effects of thishave been to reduce the number of employeessupervising construction projects compared tove years ago, even as the number of projectshave grown. Some hospital industry ofcials

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Page 3Payers & Providers

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NEWS

In Brief

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Researchers at Childrens Hospital of LosAngeles and the University of California SanFrancisco have reported a signicantbreakthrough in treating one of the mostcommon forms of pediatric cancer.

The disease is acute lymphoblasticleukemia. Although a majority of sufferers ofthe disease survive, a subgroup is resistant tochemotherapy.

The researchers pinpointed the resistanceto the protein BCL6, which the leukemia cellsuse to stay alive.

We believe this discovery is ofimmediate relevance to patient care, saidMarkus Muschen, M.D., an investigator at TheSaban Research Institute of ChildrensHospital.

Muschen and other researchers found thatan investigative drug developed at the Weill

programs focusing on globalhealthcare issues.

"UCSF is one of the world'sleading academic biomedicalcenters with a very strongreputation worldwide in all of itsschools," Sepulveda said. "This is

a tremendous opportunity to usethatstrength to make a globalimpact."

Sepulveda previously servedas director of special initiativesfor the Bill and Melinda GatesFoundation.

Number OfEmergency RoomsDrop By 30% In Past

Decade

The number of hospital

emergency rooms dropped byabout 30% nationwide during thelast decade, according to a newstudy in the Journal of theAmerican Medical Association.

According to the study, thenumber of ERs nationwide stoodat 1,779 in 2009, compared to2,446 in 1990. Meanwhile, thenumber of ER visits grew by morethan one-third.

Those ERs most likely toclose were those serving largenumbers of poor patients, wereoperated by for-profit chains,were losing money or operating inhighly competitive markets.

The study did not providespecifics on California ERs, butthe state has lost dozens ofhospital emergency departmentsover the past decade.

This suggests market forcesplay a larger role in thedistribution and availability ofcare, Renee Hsia, an assistantprofessor at UCSF and the leadauthor of the study, told the NewYork Times. We cant expect themarket to allocate criticalresources like these in anequitable way.

A new study by Kaiser Permanente SouthernCalifornia researchers has directly linkedchildhood obesity to psoriasis and indirectlyto heart disease.

Kaiser researchers examined themedical records of nearly 711,000 children.They discovered that obese children weremore than 40% more likely to have psoriasis a chronic skin inammation thanchildren of normal weight, while extremelyobese children were nearly 80% more likelyto have the condition.

Teenaged children with psoriasis regardless of weight have elevated

cholesterol and liver enzyme levels of

between 4% and 16%, suggesting they aremore susceptible to developing heart disease.The condition is also linked to metabolicsyndrome, diabetes and other chronicconditions.

"This study suggests a link betweenobesity and psoriasis in children," said leadauthor Corinna Koebnick, a research scientistat the Kaiser Southern Californias Departmentof Research & Evaluation in Pasadena. "Butour study ndings also suggest that the higherheart disease risk for patients with psoriasisstarts in childhood in the form of highercholesterol levels. The study was published

on the website of the journal Pediatrics.

Pediatric Cancer BreakthroughUCSF, Childrens Hospital L.A. Develop Cocktail

Cornell College of Medicine, when used inconjunction with the current anti-leukemiadrug Gleevec, shut down the BCL6 protein,allowing the cancer to be treated withconventional chemotherapy. Researchers havbeen able to cure laboratory mice with theresistant form of leukemia as a result.

The desperate prognosis that exists for subset of (these leukemia) patients mayradically change given these results, said coauthor Ari Melnick, M.D., an associateprofessor of pharmacology at Weill CornellMedical College, who initially developed RIBPI. This opens up the possibility that thecompound may have similar benecial effecin other tumor types.

The ndings of the Childrens Hospital aUCSF research was published in the currentissue ofNature.

Kaiser Makes Child Obesity LinkResearchers Tie Condition to Heart, Skin Diseases
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Payers & Providers PageOPINION

Medi-Cal Has A Big OpportunityNew Waiver Would Expand And Bridge Coverag

Anthony Wright is the executive director of

Health Access. He is a member of the Paye

& Providers editorial board.

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

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

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HEALTH PLAN MEDICAL DIRECTOR (Los Angeles)

Physician licensed by the State of California, with board certication in primary care or medical subspecialty.Have ve (5) years of Medical Director experience in a managed care setting, such as a HMO or IPA/Medical Group.Medical oversight and physician liaison in the areas of: Utilization review, credentialing, quality improvement, peer review, casemanagement, and disease management.

Works under the direction of the CMO to ensure the delivery of high quality and efcient care for all members. ProvideAdministrative Management of patient care with specic responsibility to provide direction and assistance in achieving optimal

medical performance in an ef

cient manner. To participate and lead in the review of all inpatient admissions. Direct and reviewall inpatient utilization activity at hospitals by interfacing with the clinicians and UR nurses. Oversee the review process of priorauthorization (medical and pharmacy) requests in a timely manner. All denials must be individually reviewed and signed by theMedical Director or physician reviewer.

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HEALTH PLAN, MANAGER, MEDICAL MANAGEMENT (So. California)

Graduate from an accredited RN program with three or more years of recent acute hospital nursing experienceThree or more years of recent managed care utilization management and case management experienceThree or more years of staff supervision/management experience. The Manager of Utilization and Case Management is responsibfor the day to day operations of the utilization and case management department, including the Medi-Cal and Medicare Programstaff. The Manager of UM /CM collaborates with the Director of UM/CM and the Team Leader and with the staff Medi-Cal WaiveCase Management Programs to promote continuity between programs, teamwork and collaboration.

Maintains effective administration of UM and CM functions. Coordinates staff schedule to assure effective coverage of UM andCM functions, including after hours, weekends and holiday coverage by Nurse Advice. Trains, implements and evaluates UM anCM policies and procedures, guidelines and action plans. Monitors and evaluates through monthly quality assessments theperformance of the Case Management and Utilization Management staff against established productivity and quality guidelines.

Provides timely educational feedback to staff on performance Assists the Director of UM/CM to ensure the programs are compliato DHCS contractual and regulatory requirements for Medi-Cal and to CMS regulations for Medicare.

Please Contact:Executive Search & Placement

Sonia Varian at 818.707.7118, or [email protected]


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Payers & Providers California Edition – Issue of May 19, 2011

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