Payers & Providers – Issue of June 10, 2010

8/9/2019 Payers & Providers Issue of June 10, 2010

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Just weeks after President Barack Obamaissued an executive order to start theprocess of abolishing discrimination againstsame-sex couples in acute care andoutpatient settings, Oakland-based KaiserPermanente became the first inpatientprovider in the country to adopt acomprehensive policy addressing the issue.

Meanwhile, a survey of other hospitals inCalifornia show policies that have yet to beupdated, or are unavailable.

Kaiser updated its 19-point Patient Bill ofRights on June 7 to allow patients to choosewhomever may visit them in its hospitals,and to enjoy all the rights without regard tosexual orientation.

As a result, Kaiser was recognized earlierthis week as the only hospital operator in

the country to achieve a perfect score onthe Healthcare Equality Index (HEI), anannual survey of patient rights policies athospitals. The survey is administered by theWashington-based Human RightsCampaign Foundation (HRC) and the Gayand Lesbian Medical Association.

Kaiser Permanente is deeply committedto providing equitable, compassionate andhigh-quality care to our lesbian, gay,bisexual and transgender patients and theirfamilies, a level of care that is standardacross our diverse patient population, saidGeorge Halvorson, M.D., Kaisers chief

executive officer and chairman.

According to Human Rights Campaignofficials, Kaiser has been working closelywith the compilers of HEI over the pastseveral years to improve its score.

Weve identified model language (forproviders) and Kaiser has continued tomeet the bar as we have raised it, goingall the way to the top in terms of non-discriminatory patient policies, said TomSullivan, deputy director of the HRCsfamily project. He added that he hopedKaisers move would prod other hospitalsto do the same.

Sullivan noted that ambiguouslanguage in individual patients bill ofrights can often leave enforcement ofpolicies to individual hospitalemployees, who may move to ban a

member of a gay or lesbian couple fromvisiting their partner while they are beingtreated.

Data for the HEI is either providedvoluntarily by the hospitals, or isgathered by researchers. According toSullivan, just 30 of the nations 200largest hospitals voluntarily provideddata for the latest survey. Little more thanhalf of the hospitals surveyed usedlanguage in their bill of rights that

Kaiser First To Equalize Patient RightsNew Policy Lauded By LGBT Group; Others Lag

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June 23

July 9

Calendar

10 June 2010

June 13-16

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

published in the Calendar section,space permitting.

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Payers & Providers

addressed discrimination against gay andlesbian patients.

On April 15, President Obama issued an

executive order meant to ban suchdiscrimination altogether, but also askedthe U.S. Department of Health andHuman Services to draft regulations, aprocess that could take years to complete.Sullivan suggested that many institutionsmay be waiting for the regulations to befinalized before officially changing theirpolicies.

Although exclusions of same sexcouples are relatively rare nowadays, itwas commonplace well into the 1980s,often aided by blood relatives whoresented having gay or lesbian family

members, and sometimes leading to aseparation even as a loved one died.Isolated incidents of exclusion do stilloccur.

Community Medical Center in Fresnoagreed to change its policies and undergostaff training after emergency roompersonnel excluded Teresa Rowe fromvisiting her partner, Kristin Orbin, whileundergoing treatment for an epilepticseizure in May 2009. Orbin claimed she

Page 2

was overmedicated as a result of theseparation.

The HEI surveyed 47 hospitals in

California (28 of which were Kaiserfacilities). It listed Community MedicalCenter as unknown when it came to itspolicies regarding same sex couples. Ahospital spokesman did not return a callseeking comment.

Los Angeles County-USC MedicalCenter, St. Mary Medical Center in LongBeach, and UC San Diego MedicalCenter were listed as not having specificpolicies that permitted visitation forsame-sex couples.

Scoring an unknown regarding theirvisitation policies were UCLA Medical

Center, San Pedro Peninsula Hospital,San Francisco General Hospital, the V.A.Medical Centers in Los Angeles and PaloAlto, Cedars-Sinai Medical Center, LomaLinda University Medical Center,Huntington Memorial Hospital inPasadena, California Pacific MedicalCenter, UC Davis Medical Center andScripps Mercy Hospital and SharpMemorial Hospital, both in San Diego.

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In Brief

Court Prohibits One-Day Nurses Strike

The University of California wassuccessful in obtaining a temporaryrestraining order against 11,000 nursesfrom striking at ve UC hospital

campuses today.San Francisco County Superior

Court Judge Peter J. Busch sided withattorneys representing the UC systemwho had argued that the strike wouldendanger public safety. Buschstemporary restraining order remains ineffect until June 18, at which point hewill hear arguments about whether ornot to grant a permanent injunction.

Represented by the CaliforniaNurses Association, the nurses hadplanned to strike with 12,000 othernurses in Minnesota, making it thelargest walkout of nurses in U.S.history. The temporary restraining orderdoes not affect planned walkouts at

three non-UC hospitals in the LosAngeles area.

The nurses claim that the hospitalshave kept their stafng at levels thatare too low to guarantee patient safety.CNA ofcials say they will stage non-strike rallies at the hospitals instead.

All the resources the University haswasted trying to silence the nurses willdo nothing to solve the stafng crisis atUC hospitals, and nurses will not restuntil their concerns are addressed,said CNA negotiator Beth Kean.

Kaiser: Norcal HeartAttacks in Decline

The number of heart attacks amongKaiser Permanentes membership inNorthern California have declined by24% since 2000, according to a studyundertaken by the organization andpublished in the New England Journalof Medicine.

Kaiser (Continued from Page One)

Continued on Page 3

NEWS

HMO Complaints Up More Than 7%Kaiser Experiences 16% Increase; IMRs Go Down

Consumer complaints led against healthmaintenance organizations with theDepartment of Managed Health Careincreased 7.4% in 2009, a rise the agencyattributed to greater nancial stressexperienced by policyholders.

A total of 4,397 complaints were resolvedby DMHC last year, up from 4,076 in 2008.Virtually all of the complaints 4,274 were

led against large health plans, those withenrollments of more than 400,000 lives.

The largest year-to-year increase incomplaints was against Oakland-based KaiserFoundation Health Plan. A total of 1,809complaints were lodged against the insurer,up 16.2% from 2008, even though its overallenrollment was down 5.2%. San Francisco-based Blue Shield of California received 799complaints, up 15.6% from the 675 it

received the year before, even though itsenrollment was down 4.7%.

Although Anthem Blue Crossof Califoris by far the most penalized insurer by theDMHC (Payers & Providers, May 27, 2010),complaints declined 10.7%.

DMHC spokeswoman Lynne Randolphattributed the increase in part to theincreasingly complexity of the health plans,

and escalating cost-shifting.There are more higher-deductible plan

more tiered co-payments for prescriptions, aconsumers may have difculty understandinthat, Randolph said, but added that changein physician networks may also be to blame

Complaints about benets and claims romodestly, but grievances regardingcoordination of care issues were up 22.7%.

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Page 3Payers & Providers

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NEWS

In Brief

In addition to the decline in overallheart attacks, the number that inictedpermanent damage to the heartdeclined by 62%, according to datafrom the Kaiser Permanente Divisionof Research.

Researchers attributed the declineto more accurate electrocardiograms

that are able to assess the risk ofpatients having heart attacks, as wellas the detection of elevated levels inthe body of troponin, a substance thatcan signal a coming heart attack andits severity.

This research provides newinsights into the changing landscapeof heart attack incidence andassociated outcomes in thecommunity, said Alan S. Go, M.D.,director of the ComprehensiveClinical Research Unit at the KaiserPermanente Division of Research inOakland. Go was the studys leadinvestigator.

Kaiser examined the medical

records of more than 46,000 memberswho were hospitalized for heartattacks between 1999 and 2008.

Four CaliforniaHospitals Win Premier

Quality Award

Four California hospitals werenamed winners of the PremierHealthcare Alliances Award forQuality.

The facilities are St. Josephs

Medical Center in Stockton,Providence Little Company ofMary Medical Center in Torrance,Mercy General Hospital inStockton, and Palomar MedicalCenter in Escondido.

The hospitals were cited fortheir high scores in quality andefficiency, with a focus onmorbidity, mortality andcomplications. Twenty-onehospitals and systems nationwidereceived the award..

DMHC (Continued from Page Two)

UCLA, LAC To Study Health ImpactsWill Use $300K Grant On Transportation, Water Issues

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However, the number of independentmedical reviews conducted were down9.3%, a drop Randolph attributed to a spateof ER and urgent care coverage complaintsthe agency handled in 2008.

Kaiser spokesman Jim Anderson saidthe percentage of complaints per Kaiserenrollees 3.2 per 10,000 was too smallto attribute to a trend.

We take every complaint seriously, butwe also need to put them into perspective,he said. Anthony Wright, executive director ofHealth Access, a Sacramento-basedconsumer advocacy group, believes thecomplaints may have rose because of more

media coverage of insurance-related issues,particularly in the wake of national healthcarereform.

Those complaints are part of the reasonwe had reform, and the statistics suggest weneed to continue to have a feedback loop, hesaid. Wright added that the DMHCs telephonehotline is particularly easy for consumers touse.

Randolph is not making any predictions,but she does believe consumers will havequestions regarding their coverage as reformsare enacted in the coming years.

We do want to present ourselves as aresource, she said.

The UCLA School of Public Health and theLos Angeles County Department of PublicHealth have jointly received a $300,000grant from the Pew Charitable Trusts andRobert Wood Johnson Foundation to studythe health-related impacts of two majorissues confronting Angelenos publictransportation and water conservation.

The grant among six announced torecipients nationwide earlier this week wasprovided by the Health Impact Project (HIP),a collaboration between Pew and RWJF todiscover how public policy may impactcommunity health. A statement issued by HIPsaid the projects are at the forefront of aburgeoning movement in the United States toensure health is considered in sectors that donot traditionally factor it into their decisionmaking.

UCLA and L.A. County researchers willstudy how a proposed extension of the Metro

Line subway or similar projects down WilshBoulevard may affect residents and workers the area, and how water conservation effortsamong municipalities in the Los Angelesregion may affect public health. Thetransportation study is scheduled to bereleased in mid-2011; the water report inmid-2012.

Although costly and extensiveenvironmental impact reports are required bvarious agencies as part of any subwayconstruction project, UCLA Health AssessmProject manager Brian Cole said the reportbeing undertaken here would study softerhealth aspects. Among them: how people wwalk through the Wilshire corridor for exercor errands would have their health affected construction barred them from doing so. Thewater study would examine the pluses andminuses of different alternatives to reducingwater consumption, he said.
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Payers & Providers Page

The passage of national healthcare reformhas given clear indication of a policy shiftin how the Centers for Medicare andMedicaid Services (CMS) will relate tohealthcare providers and markets.Through the development of accountablecare organizations (ACOs) and on asmaller scale, bundling arrangements(i.e., where both the hospital andprofessional components are paid to thehospital in a single payment from CMS),CMS is signaling a shift away from an allprovider/all services available model to a

model more regional and more selectivein certain areas of clinical care. !While the ultimate future model for

acute care providers and large medicalgroups may be to achieve ACO status,which is to provide all the healthcareneeds to a defined population, a less riskyfirst step is to increase an organizationsabilities and competencies by firstexpanding its current service lineapproach to integrate the medicalprofessional components into thepricing and cost structure of theorganization.!The recent demonstration projectsapproved by CMS give those in the acute

care space an opportunity to developthese models. Last year, CMS approvedfive Acute Care Episode (ACE)demonstration projects for two servicelines cardiac and orthopedics (28cardiovascular and 9 orthopedic DRGs) and promises to expand them for otherclinical services very soon.!Those early adopters successful in

winning these designations may bepositioned as a preferred provider withMedicare that could shift substantial

market share for both Medicare as well ascommercial insurance populations.! Thisin turn may positively influence anorganizations profitability through the useof excess capaci ty.! For the first time, highquality and low cost will result in a shiftof market share at a large scale. !As organizations begin to considerundertaking a bundling strategy, forward-thinking CEOs should bear in mind thefollowing key issues:!!

A broader strategic end-game.! Bundpayment is one of several models of cadesigned to achieve enhanced quality areduced costs, like those associated witreadmissions and unnecessary use ofresources. It can be an early stepping stto more comprehensive models such asaccountable care organization. It is helto assure those in the organization of abroader vision of the future and the rolebundled payments in driving the valueproposition.

!Management, board, and physicianeducation and buy-in. The CEO must

educate the organization, board, andmedical staff leaders to create consensubefore moving ahead.! Shifting to bundpayments is a drastic change, and buy-from all is critical to success.

Quality-focused medical staffleadership. The organization must medical staff leaders who arepassionate about quality and arewilling to change their practices

relationship to the market (i.e., give up

their independence) in order to proviimproved care and a superior patientexperience.

Flexibility in engaging physicians. CEconsidering bundled payments should bprepared to let go by exploring new wof engaging physicians, such as throughmanagement arrangements with the serline medical staff leadership.

Perseverance.! Change of this magnitudis daunting and requires tenacity from tCEO.! The CEO must believe firmly thatmoving to bundled payments is the righdecision for the organization, medical and community.!!!!!

OPINION

Keeping An Eye Out For Sea-ChangNew Demonstration Projects Signal Shift in CMS Polic

By

Robert

Minkin

Robert Minkin is a senior adviser with Th

Camden Group, a hospital and medica

group consulting firm in El Segundo.

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Op-ed submissions of up to 600 words a

welcomed. Please e-mail proposals to

[email protected], or ca

(877) 248-2360, ext. 3.
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6
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Payers & Providers – Issue of June 10, 2010

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