Payers & Providers – Issue of July 15, 2010

8/9/2019 Payers & Providers Issue of July 15, 2010

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Californias providers are breathing a sighof relief as the U.S. Department of Healthand Human Services has issued lessstringent meaningful use rules for

hospitals and physicians to receivefinancial incentives to ramp up their usageof electronic medical records and relatedapplications.

The HHS received more than 2,000comments on its interim final rules thatwere released earlier this year, many fromphysician organizations and hospitals.

We have sought and receivedextensive input from the healthcarecommunity, and we have drawn on theirexperience and wisdom to produceobjectives that are both ambitious andachievable, said David Blumenthal, M.D.,

the national coordinator for healthinformation technology.The California Hospital Association

lauded the relaxation of a guideline thatwould have originally required all hospitalsto meet 23 specific requirements in orderto qualify for incentive payments that willbe dispensed beginning next year. Now, thehospitals have to meet 19 guidelines.Fourteen of those are mandatory, alongwith five others from an additional list of10.

Moreover, critical access hospitals those facilities at least 25 miles away from

the nearest acute care facility and less than25 beds in size may also qualify for

incentive payments. They were previouslyexcluded.

In another big change, hospitals andphysicians have to use computerphysician order entry for 30% ofmedication orders. Thats down from theprevious mandate of 80%.

Were pleased with the changes. Werequested more flexibility, and generallyreceived it, said Pam Lane, a CHA vicepresident in charge of healthcareinformatics.

The California Association ofPhysician Groups mostly concurred withthe CHA. Physicians, for example, nowhave to meet 20 criteria, 15 of which aremandatory and five out of a group of 10.Thats down from a previous mandate of

25 objectives.However, most physicians have toapply for incentive payments individually,even if they practice within a group.

They built this on the old cottageindustry model. However, large groupsare where its at. The fact that a medicalgroup cant apply as an entity, but ahospital can is silly, said WilliamBarcellona, CAPGs vice president ofgovernment affairs. He added thatCongress may be lobbied to draftappropriations-oriented legislation that

Mostly Winners For Meaningful UseHospital Like Final Rules; Medical Groups Want More

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July 25-28

July 22-24

Calendar

15 July 2010

July 19-21

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[email protected]

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

published in the Calendar section,space permitting.

Continued on Next Page

www.lakesidecommunityhealthcare.com

California Edition

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Payers & Providers

would relax the individual physicianrequirement.

Although the guidelines are less

stringent than what the HHS originallysought, the rules drafted by the agency areso lengthy 864 pages that it is likely totake weeks for providers to fully assesswhat compliance will mean, Lane said. Andthe dense reading the rules represent doesnot even include a second set of rulesissued by HHS this week specifying theacceptable hardware and softwareapplications currently being pored over byrelevant industry vendors.

Page 2

The HHS will dispense as much as$27 billion in incentive payments over thnext decade. Its part of the Health

Information Technology for Economic anClinical Health (HITECH) Act of 2009, astimulus program intended to speed upthe adoption of advanced informationtechnology among hospitals andphysicians. Individual physicians can earas much as $107,350 from Medicare andMedicaid in meeting all the rules, whilehospitals can earn millions. Conversely,providers that dont update their systemswill begin facing payment cuts fromfederal programs beginning in 2015.

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In Brief

Molina Healthcare toExpand into Wisconsin

Long Beach-based MolinaHealthcare Inc. has expanded itsoperations in the Midwest,

acquiring a Wisconsin-basedMedicaid managed care insurer.Molina will pay about $16

million for Abri Health Plan, basedin the Milwaukee suburb of WestAllis. Abri has about 16,000enrollees in 23 counties, primarilythrough Badger Care, WisconsinsMedicaid managed care plan. Abrirecently won a contract that will gointo effect during the third quarterof 2010 that will further expand itsenrollment.

The deal will expand Molinasmarket presence in the Midwest tofour states. It currently operates inOhio, Missouri and Michigan.

Once this transaction closes,our company will provide healthplan services in ten Medicaidmarkets throughout the country, wewill be further diversified, and ourWisconsin health plan will havesignificant potential for futuregrowth, said Molina HealthcareChief Executive Officer J. MarioMolina, M.D.. The plan has 1.5million enrollees nationwide.

Kaiser Links ChildhoodObesity to Esophogeal

Disorder

Extremely obese and obese childrenrun a much higher risk ofgastroesophageal reux disease thantheir thinner counterparts, according toa study by Kaiser Permanenteresearchers of its Southern Californiaenrollees.

Kaiser studied the electronicmedical records of more than 690,000enrollees between the ages of 2 and 19

Meaningful Use (Continued from Page One)

Continued on Page 3

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DMHC Resurrects Solvency BoardShift From Medical Groups Toward Impact of Reform

The Department of Managed Health Care hasrevived its Financial Solvency Standards Boardafter a nearly four-year hiatus, ostensibly tostudy and report on how healthcare reformwill affect California.

The board was originally convened in 1999to create solvency standards for the states risk-bearing medical groups after two largerentities, HealthPartners and KPC, collapsed ina spectacular fashion, leaving thousands ofpatients with gaps in their continuity of care.

The board will again revisit nancialsolvency of the states more than 200 medicalgroups, according to Grant Cattaneo, ahealthcare consultant in Northern Californiaand a holdover from the prior board.

Im not sure if they (the DMHC) has beenletting things go in terms of solvency, and Iwant to hear from the medical groups aboutthat, Cattaneo said.

However, the FSSB will also study conceptsbeing pushed by the Obama Administration in

the wake of sweeping healthcare reformssigned into law earlier this year. Included armedical homes, bundled payments,accountable care organizations andhealthcare exchanges.

Federal healthcare reform is creating newscal models of health care that will needmuch thought and the DMHC has been

working to proactively address its implicatiofor the California healthcare landscape,trends, and regulations, said DMHC DirectCindy Ehnes. It is imperative that weunderstand and inuence the impact on ourstates delivery system and health careproviders, many of whom are alreadystruggling due to the economic situation.

William Barcellona, a deputy director atDMHC between 2001 and 2005 and now avice president with the California Associatio

Continued on Next Page
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Page 3Payers & Providers

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NEWS

In Brief

in its health plan in SouthernCalifornia between 2006 and 2008.Researchers determined that childrenwho are extremely obese have a 40%higher chance to suffer GERD than dochildren of a normal weight, whilethose who are moderately obese havea 30% greater chance of contracting

the condition.GERD is characterized by the

liquid contents of the stomach owingback into the esophagus. Thecondition can lead to coughing,asthma and an inamed larynx. If thecondition persists for years, it can leadto a precancerous state in theesophagus, and eventually esophagealcancer. Up to a quarter of the childrenin the U.S. may be affected by thecondition, with increasing obesityrates a contributing factor.

The takeaway message of ourstudy is that GERD now also is one ofthe conditions associated withchildhood obesity," said study co-

author Corinna Koebnick, a Kaiserresearch scientist. Beyond counselingfor weight loss, obese children whoreport symptoms of GERD may needto be treated for the underlyingreasons to help avoid persistence ofGERD into adulthood and to preventits complications.

The study was published in themost recent issue of the InternationalJournal of Pediatric Obesity.

CHW Exec To HeadAdvocacy Group

Californians for Patient Care has

named former Catholic HealthcareWest executive Carmella Gutierrezas its president.

The 44-year-old Gutierrezpreviously served as a publicaffairs director at CHW. She hadprevious experience as a regionalaffairs manager in the U.S.Department of Health and HumanServices.

The Sacramento-based CPCadvocates on behalf of the states 8million uninsured.

More Delays For Palmdale RegionaHospitals Projected Opening Now Two Years Lat

The end of 2010. Maybe.Thats the latest projected opening date

for Palmdale Regional Medical Center, oneof few hospitals built in California during thepast decade from the ground up.It looks hopeful for this year, but the bottomline is that we dont have any idea, said

Julie Montague, spokesperson for LancasterCommunity Hospital, a nearby facilitywhose management will oversee the newhospital once it begins operations.The project, undertaken by Pennsylvania-based for-prot hospital operator UniversalHealth Services, has been bedeviled byconstruction-related delays that now totalnearly two years and counting. The hospitalis planned for 127 beds at opening, with aneventual expansion to 239 beds. It wasoriginally scheduled to open in late 2008.Payers & Providers reported in April that theOfce of Statewide Health Planning and

Development (OSHPD) could have issued acerticate of occupation for the hospital asearly as late spring. However, that timetablehas vanished, according to both Montagueand OSHPD ofcials.

Montague noted that the current delayscenter on inspections of the hospitals dropceilings and its re-suppression system, bothof which are being undertaken by OSHPD.Project planners previously had to replacesome 160 windows due to leaks.In an e-mailed statement, OSHPD

spokesman David Byrnes said that a schedis difcult to project until the re damper issis resolved. He noted there were issues interms of how the re suppression system wainstalled and functions.Byrnes did add that most other issues suchthe leaky windows have been resolved, bu

that the

re suppression issue is particularlychallenging. The mitigation work could besubstantial, he wrote. Identifying andresolving the issue in one of our highestpriorities.

Sources have told Payers & Providers thUniversal is using a building contractor andarchitect that have never worked on a hospiin California before, and are thereforeunaccustomed to working with OSHPD, whplanning and certication processes areformidable.

A Universal manager overseeing theconstruction project did not respond to a

phone call and e-mail requesting comment.Palmdale Regional Medical Centers openindoes not represent the only difculty Univehas had with Californias regulators. Its two-hospital Southwest Healthcare System camclose to losing its certications to receiveMedicare and Medi-Cal funding earlier thisyear due to persistent quality-of-care probleat its facilities. It is working on implementincorrective plan to improve Southwestsoperations.

of Physician Groups, believes that reform willbring new pressures on medical groups.

Were not moving patients out of dead

medical groups, but theres going to be a lot ofchange, he said. In particular, a hugeexpansion of Medi-Cal patients will put aburden on a lot of groups to treat them whileaccepting razor-thin operating and protmargins.

The DMHC is going to have to keep amuch closer eye on solvency in thatsituation, Barcellona said.

The board last met in October 2006. Threeof its eight members served during the boardsprevious incarnation: Cattaneo; Keith Wilson,M.D., chief executive ofcer of the Talbert

DMHC (Continued from Page Two)

Medical Group in Costa Mesa; and EdwardCymerys, senior vice president and chiefactuary ofBlue Shield of California.

The new appointees include LarrydeGhetaldi, M.D., head of the Santa Cruzdivision of the Palo Alto Medical FoundatioAnn Pumpian, chiefnancial ofcer of ShaHealthcare; Dave Meadows, vice presidentCalifornia health programs for Health Net;Tom Williams, Executive Director of theIntegrated Healthcare Association; and RickShinto, M.D., president and chief executiveofcer of IPA operator Aveta, Inc.


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Payers & Providers Page

Most hospital information systems aredesigned with an emphasis on dailyoperations. The electronic medical recordsystem is used primarily to care for thecurrent clinical needs of the patientpopulation. Over time, hospitalinformation systems compile tremendousamounts of clinical data, however, thisinformation is rarely given acomprehensive, retrospectiveanalysis to spot long-termtrends. Medical executiveswant at-a-glance, dashboard

information to gaugeorganizational performance,but they also need root-causeanalyses of longer-term trends. !

Data mining technology isnow being used to providereports across varioushealthcare data sets includingpharmacy, lab, admission/discharge and medicaltranscripts.! It has been used for manyyears by business and government toanalyze trends in massive blocks ofdata such as airline passenger records,

census data and supermarket scannerinformation. !By applying algorithms, association

rules and regression analysis to identifypatterns and meanings, hospitalexecutives can spot trends that wouldotherwise be hidden

Traditionally, when the hospital ITdepartment is asked to answer specificbusiness questions, too often its staffresponds with raw files endless rows ofundigested numbers.! With data miningtools in place, it is possible to transformthe filing cabinet into a smart

information repository which can provideactionable reports for clinical andbusiness decisions. !

For example, most California hospitalshave Pharmacy and TherapeuticsCommittee guidelines on reduced use ofantibiotics. Hospital leaders want to knowhow well the guidelines are beingfollowed. Now, data mining software canevaluate antibiotic usage across severaldepartments or different facilities.. !!

In a similar manner, many hospitals

would like to track the productivity of theclinical pharmacists, who have theresponsibility of monitoring a patientschanging lab results and adjusting hismedication accordingly. By analyzing druorders, lab results and pharmacistintervention documentation, advancedsoftware can report on how individualpharmacists performed in meeting this tashow they contributed to meeting other qu

metrics. !In California, hospitals arerequired to report healthcare

acquired infections (HAIs).However, making thedifferentiation betweenhealthcare-acquired versuscommunity-acquired infectiocan be very time consumingbecause it involves reviewinmany data points in a patienclinical profile.! Advanced d

mining software can calculatproper HAI rate and create comparor benchmark reports. !Another capability provided by thisadvanced software is automatic

surveillance for infection control. Ithe past, infection control practitioners suas pharmacists or epidemiologists had tomanually review hundreds of patient medrecords to identify at-risk individuals. Nowsoftware can enable automatic surveillancthe entire patient population and quicklyidentify individuals requiring attention. !

One of the key trends in healthcarereform is more transparency, meaning moreports for consumers and regulators. Datmining is the next, evolutionary step inhospital information systems. It can helpprepare the basic reports and provide a

valuable analysis of the trends behind thedata. !

OPINION

Healthcare Gold From Data MiningLong Used Elsewhere, it Can be a Boon For Hospita

By

Chun

Wong

Chun Wong is chief executive officer of

Asolva, a Los Angeles-based firm that

designs streamlining software for a varie

of businesses.

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Op-ed submissions of up to 600 words a

welcomed. Please e-mail proposals to

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

VENTURA COUNTY HEALTH CARE SYSTEM is a new organization in Ventura County, CA with ofces locatedin Oxnard. This new agency is building its organization starting at the top. There are immediate openings in thefollowing areas, with other management-level positions being announced soon. All employees will work for RegionalGovernment Services, assigned to the Ventura County Organized Health Care System. For more and specic details,go towww.rgs.ca.gov/jobopportunities.

CHIEF EXECUTIVE OFFICER Salary up to $200,000; apply with a resume and cover letter byJuly 18, 2010 [email protected]. 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 staffto achieve the organization's philosophy, mission, strategy, annual goals, objectives, and nancial targets. This is a keyrole in developing metrics to measure performance; serves as a liaison with the public, governmental organizations,afliated organizations, and other stakeholders. Appropriate education with at least 10 years of progressively moreresponsible executive level experience, in health care or managed care.

CHIEF MEDICAL OFFICER Salary up to $200,000; apply with a resume and cover letter byAugust 18, 2010 [email protected]. This position is the principal manager of medical care, and is responsible for theappropriateness and quality of medical care delivered and for the cost-effectiveness of service utilization. MD/DOdegree from an accredited program preferably in a primary care specialty; minimum two years experience in amanaged care plan preferred with duties comparable to those listed in the brochure, and experience administeringmedical programs. Board certied 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 caredelivering systems and philosophy; and meets all criteria required of particular physicians, including a local medicallicense.

CHIEF FINANCIAL OFFICER Salary up to $175,000; apply with a resume and cover letter byAugust 4, 2010 [email protected]. The CFOs 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 cashowpurchasing, invoices, and expenses; and meet the requirements of contracted entities, and state and federal governmen

regulations. It reports directly to the Chief Executive Ofcer and partners with department directors on strategic andtactical matters relating to budget management, cost benet 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 organizations operations, and protection of organizations assets. This positionprovides both operational and programmatic support, supervises the nance unit, and is the organizations chiefnancial spokesperson. Appropriate education, and completion of 10 years of progressively more responsibleexperience in nancial accounting and reporting for a health care organization, with at least 5 years at an executivelevel with a proven track record of successful nancial management in healthcare, managed care insurance, ornancial services.

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Payers & Providers – Issue of July 15, 2010

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