Payers & Providers – Issue of October 28, 2010

8/8/2019 Payers & Providers Issue of October 28, 2010

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Most of Californias 430 acute care hospitalspaid the rst round of self-imposed fees earlierthis month to the Department of Health CareServices in order to draw down as much as

$3.2 billion in additional funding from theMedi-Cal program. However, the DHCSindicated supplementary Medi-Cal paymentsmade to the hospitals fell short due to a handfulof stragglers.

According to DHCS spokesperson AnthonyCava, about 20 hospitals have failed to makeall or part of the rst fee payment, which wasdue on October 8. Altogether, the agencycollected $722 million in fees, out of anexpected $770 million.

The rst round of supplemental paymentswent out on Oct. 25 and totaled $885.5million, but was slightly less than projected due

to the shortfall, Cava said.Cava declined to disclose the names of the

hospitals that did not make payments.The fee, which applies retroactively from

the spring of 2009 and expire at the end of thisyear, is being used to draw down Medi-Calmatching funds from the federal government.The fee also takes advantage of last years $700billion stimulus program, which temporarilyaltered the matching funds formula to theadvantage of providers.

Jan Emerson-Shea, vice president ofexternal relations for the California HospitalAssociation, said many of the delinquent

facilities are not members of the lobbying

organization and may also be facing nancialissues.

Of those that did not pay the fee, a fewof them are in bankruptcy and some others

are non-CHA members - thus they may nothave been prepared for the program,Emerson-Shea said in an e-mail response.Only CHA members received all of ourcommunications on this program - which hasbeen quite extensive.

Emerson-Shea added that the CHAconsidered the overall compliance rate to begood.

Those hospitals unable to pay the feeswill be dealt with in a variety of ways. If thehospitals nancial condition is relativelystable, the fees may be withheld out of thehospitals owed Medi-Cal payments. More

leniency will be provided if the hospital is ina precarious nancial state.

If a hospital contacts DHCS and candemonstrate cash ow issues, DHCS willwork with the hospital on a case-by-casebasis to prevent access issues, Cava said. Insome cases withholds (will be) limited to theamount of the supplemental payment.

DHCS is also imposing interest paymentsof 10% per year on any delinquent fees,according to Cava.

Not all hospitals are beneting from thefund drawdown. Nineteen hospitals and two9441(2!8(2/:-*4/(!;1*(2!(*)!

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Payers & Providers Page 2

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In Brief

UC Hospitals Move ToBetter Coordinate Care

The five hospitals operated by theUniversity of California haveopened up a center to bettercoordinate care and quality.

The Center for Health Qualityand Innovation will be based at theUC systems headquarters inOakland, although initiatives willbe conducted on the campuses ofall the hospitals. It will act asclearinghouse for best practicesthat may be used throughout thesystem. Its chairman is by JohnStobo, M.D., UC senior vicepresident for health sciences andservice. Terry Leach, UC managerof health policy, will serve as itsexecutive director.

This center will help connectthe best and brightest UC minds sowe can spread the most effective

innovations throughout the system,provide Californians with betterhealth care and be a leader indelivering health reforms, Stobosaid.

The center will initially befunded from $1 million from eachof the UC hospitals, derived fromthe recently enacted statewide feeprogram to drawn down additionalMedi-Cal funding

CDPH Fines Two NursingHomes $190K

The California Department of

Public Health has levied maximumpenalties against two San JoaquinValley nursing homes forinadequate care that led to thedeaths of two patients. Browning Manor ConvalescentHospital in Delano was fined$100,000 for a 2009 patient death,while Gramercy Court NursingHome near Sacramento was fined$90,000.

Continued on Page 3

NEWS

Fee (Continued from Page One)

hospital systems about 10% of the statestotal acute care facilities are obligated topay the fee but not receive supplementary

payments. Ofcials say most of those facilitiesare in relatively prosperous regions of the statewith low volumes of Medi-Cal patients.

L.A. Care Health Plan announcedWednesday it will spend $600,000 to helptransform 11 community clinics throughoutLos Angeles County intopatient-centered medicalhomes.

The expeditures inthe form of grants andpayments to a consultingrm is part of a two-yearpilot project to help theclinics move fromproviding episodic care to

walk-in patients toongoing primary care tomembers of thecommunity. The clinicsthemselves are relativelysmall, and are located primarily in suburbanor exurban areas of the county. They have acombined 270,000 patient visits a year. Oftheir 85,000 total patients, about 30,000 are

enrolled in L.A. Care, which covers primarilyMedi-Cal and Healthy Family enrollees.

L.A. Care ofcials say the transition to apatient-centeredmedical home hasmostly been oneachieved by largerfacilities with moremeans at theirdisposal, and thegrants are intended togive smaller clinics achance to get into the

game.Early adopters the medical homemodel are mainlylarge medical groups

or integrated delivery systems, which represenless than 10% of the physician practices in the

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Correction

It was reported in early editions of the Oct. 21 issue of Payers & Providers that the Calfiornia HospitalAssociation did not support SB 608. CHA supported that bill, but did not sponsor it. It was also reported that

CHA would draft new seismic extension legislation immediately. CHAs decision to do so is pending

publication of the most rescent results on hospital seismic compliance in early 2011.

Medical Home Pilot For L.A. CountyL.A. Care Funds Initiative For Community Clinics

Grant Recipients

Antelope Valley Community Clinic

Community Health Alliance of Pasadena

El Proyecto del Barrio

South Bay Family Health Center

The Childrens Clinic

Watts Healthcare Corp.

Clinica Familiar De Los Latinos

Kids and Teens Medical Group

A Diop Family Care Medical GroupUSC Family Medicine Clinic

Source: L.A. Care

Continued on Next Page
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Page 3Payers & Providers

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NEWS

In Brief

Both facilities received AAcitations from CDPH the mostsevere penalty the agency maylevy.

Anaheim General

Recertified by CMSMore than a year after beingdecertified a year from theMedicare and Medi-Cal programsby the Centers for Medicare andMedicaid Services, AnaheimGeneral Hospital has beenrecertified to receive suchpayments.

CMS notified the hospital ofits recertification after it made twounannounced inspections earlierthis year. It had been decertified in

July 2009.As far as we know, we are

one of only a very few hospitals in

the U.S. that have successfullybeen recertified by CMS afterlosing their certification, saidAnaheim General Chief ExecutiveOfficer Tom Salerno. Mosthospitals facing similar challengeshave closed. We have kept ourdoors open and continued toprovide quality care to patients aspart of our commitment to thiscommunity.

CAPG, Health AccessSolutions Enter

Partnership

Foster City-based Health AccessSolutions, which markets a Web-based care coordination platform,has entered into a partnership withthe California Association ofPhysician Groups to promote itsproducts to CAPG membership.

CAPG President Donald Cranesuggested that use of the HealthAccess Solutions platform could beused by providers to help theirinstitution become an accountablecare organization

Long Beach-based Medi-Cal managed careplan Molina Healthcare has been grapplingwith cost-control issues over the past year, butits third-quarter earnings suggest it has gainedthe upper hand.

For the quarter ending Sept. 30, Molinaposted net income of $16.1 million, or 57

cents per share. Thats compared to thirdquarter 2009 earnings of $8.56 million, or 33cents per share, a 47.1% gain.

Revenue was also up considerably for thequarter, to just over $1 billion, compared to$916.5 million for the year-ago quarter, up11.9%.

During the third quarter, we maintainedour focus on medical costs and benetedfrom enrollment and revenue growth. Ouryear-to-date performance demonstrates thatwe continue to make progress in improving

our operations while investing in expansioninto new markets and new programs, saidMolina Chief Executive Ofcer J. MarioMolina, M.D.

Molina has pulled ahead of 2009 for theentire year to date. It reported net income of$37.3 million, or $1.39 per share, compared

to net income of $35.3 million, or $1.36 pershare, during the rst nine months of 2009.A year ago, the plan was being battered

by claims related to treating the H1N1inuenza virus, but that has since abated.Molinas medical loss ratio for the quarter wa84.2%, compared to 86.7% in the thirdquarter of 2009. Its year-to-date MLR is85.1%, compared to 86.5% in 2009.

Total membership in Molina was justunder 1.6 million, compared to 1.4 million ayear ago.

Molina Reports Quarterly EarningsExpenses Under Control, It Pulls Away From 2009

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Medical Home Pilot (Continued from Page Two)

nation, said Elaine Batchlor, M.D., L.A.Cares chief medical ofcer and a member ofthe Payers & Providers editorial board. L.A.Care is committed to helping small practicesand safety net clinics, which serve themajority of Americans, redesign how theydeliver care to achieve better outcomes,higher patient satisfaction and more efcientuse of resources.

Along with the clinic grants, L.A. Care isalso paying up to $400,000 to Qualis Health,a Seattle-based rm that focuses onhealthcare quality initiatives. Qualis beat outthree other bidders for the project, accordingto L.A. Care ofcials.

According to L.A. Care Medical Director

Alexander Li, M.D., Qualiss jobs is to havethe clinics meet the medical-home guidelinespromulgated by the National Committee on

Quality Assurance. That includes the use ofelectronic health records, effectivecoordination of care and communicationbetween doctor and patient, among othercriteria.

Although the rst phase of the pilot is forthe clinics to undergo an internal study of thereadiness as medical homes, some datasuggests their staffs have their work cut our fothem. Of the 11 clinics, only four have EHRsinstalled, according to Li.

This is going to be worthwhile as a longterm investment, he said.
http://www.payersandproviders.com/publications/pandpadkit.pdfhttp://www.payersandproviders.com/publications/pandpadkit.pdfhttp://www.payersandproviders.com/publications/pandpadkit.pdfhttp://www.payersandproviders.com/publications/pandpadkit.pdf


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Payers & Providers Page

Its easy to say that all electronic healthrecord (EHR) implementations go smoothlyfrom day one, but, in fact, there is typicallyno day one.

Once the decision has been made bypractice leaders to implement an electronichealth record, many practice leaders startto worry about how to actually implementthe EHR success fully. The primary concernfor most practices during implementation isfinding a way to avoid disturbing thephysicians who are providingcare and maintaining the

practices administrativefunctions.Implementing an EHR

means change, and change canbe challenging. Change isespecially challenging when weare not prepared for it. But, byfollowing a few simple tips,every practice leader canensure that the implementationof their EHR will go smooth,not south.

1. !Keep your eye on goodpatient care.!For example,scanning cant back up becauseproviders need to trust that theelectronic record has the information theyneed to make good medical decisions.

2. !Listen to feedbackand use it. Dontscrap the project if you get negativefeedback, but use your management skillsto change the process.!

3. !Evaluate your financial position.!Youcant go into a project like an EHR purchaseand implementation without a financialplan.!Make sure you understand yourpractices tolerance for debt.!Set up aninternal payment schedule and determine

your go-live date by how much time youllneed to prepare financially.!4. !Look at overall benefits in a big

picture, be realistic with the practicesowners on implementation, and focus onthe end results and cost savings.

5. !Go into the process because it is thenext transition in your practices design:Youll be able to get more completeinformation from several locations and,most importantly, you will be prepared forelectronic quality measurement which maybe the foundation of payment structures in

the near future.6. !Make sure all physician leaders in y

practice are on board.!They may havereservations, but they must agree to commto the change process.

7. Put the right people in projectleadership positions. Base your decisions basic knowledge, an interest in the projecdesire to learn and grow, a positive attitudtoward change and the ability tocommunicate and work well with others.

8. Provide resources and time. Donstarve your EHR implementation.

Make sure your staff has theresources they needtraining,hardware, space and support. Keethese commitments in mind as yocreate your financial plan.9. Focus on small success first.!Asmall success, for example, was timplementation of the e-prescribmodule: the clinical advantages wapparent and it gave everyone apositive start to a major change iwork flow.

10.! Dont overreact toproblems.!Practice leaders musteliminate always and never fromtheir vocabulary.

11. Dont implement other major chaat the same time as you implement anEHR.!Clear the decks of other significantprojects before the implementation.

12. Leaders must be visible. Thepractices leadership must be present andavailable during the first two weeks of EHimplementation.

13. Focus on training. Train a core growell in advance of staff.!Make sure stafftraining is consistent and that staff leadersavailable to others.!Encourage and allow tfor practicing on the system before the godate.

14. Have fun with the project.!This is new way of doing work.!

OPINION

EHR Implements For Non-DummiesFollowing Fourteen Key Rules Will Create Harmon

By Tony

Ryzinski

Tony Ryzinski is senior vice president of

marketing at EHR vendor Sage Healthcare.

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Op-ed submissions of up to 600 words are

welcomed. Please e-mail proposals to

[email protected],


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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

SENIOR DIRECTOR, MANAGED CARE ANALYTICS

(San Francisco, CA)

Catholic Healthcare West, headquartered in San Francisco, CA, is a system of 41 hospitals and medical centers in California,Arizona, and Nevada. Founded in 1986, it is the eighth largest health system in the nation and the largest not-for-protprovider in California. CHW is committed to delivering compassionate, high-quality, affordable health care services withspecial attention to the poor and underserved. The CHW network of nearly 10,000 physicians and approximately 54,000

employees provides health care services to more thanve million people annually.

We are currently seeking a dynamic leader for the position of Senior Director, Managed Care Analytics. This position isresponsible for the overall leadership and management of CHWs Analytics & Application Team (16 FTEs) to support over $3billion in managed care negotiations across CHWs 40+ acute care hospital, afliate physician groups, joint ventures andother business development projects throughout California, Arizona & Nevada. This position will innovate and developreimbursement rate structures to maximize CHWs reimbursement and operating margins. In addition, the Senior Directorwill provide leadership of the statewide development and implementation of accurate, timely analyses and proposals inpreparation for, during, and after payer negotiations.

QUALIFICATIONS

Bachelors degree. Masters degree preferred. Equivalent experience and record of accomplishments may be considered.

Minimum of ten years progressive responsibility in the healthcare environment. A thorough senior practitioner'sunderstanding of the healthcare industry, managed care, fee-for-service reimbursement structures, nancial modeling,capitation, and knowledge of relevant federal and state regulations is mandatory.

SPECIFIC KNOWLEDGE AND SKILLS

Comprehensive, advanced knowledge of healthcare managed care principles High degree of advanced analytical and problem solving skills with specic application to hospital, medical and

actuarial data Advanced capitation and capitation management skills, including a working knowledge of actuarial analysis and

risk evaluation methodologies, calculating and evaluation reimbursement rates, and forecasting effect on revenuesand expenses

Must be able to effectively function in situations involving high-level negotiation activities and possess effectivenegotiating skills

Knowledge of legal principles and regulatory requirements relating to managed care risk and fee-for-servicecontracting

Comprehensive knowledge of healthcare market and hospital operations Advanced knowledge of hospital nance and accounting, including cost accounting principles and operations Knowledge of MSDRGs, APCs and other coding methodologies as they apply to managed care

Apply online: www.chwcareers.org or email your resume to Lori Burt:[email protected]


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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

SENIOR MEDICARE COMPLIANCE ADVISOR - Along with the Compliance Ofcer and Privacy & Information Security Ofcerserves as the focal point for all Medicare Advantage compliance activities. Coordinates and communicates all assigned Medicare

Advantage compliance activities internally and with L.A. Care's contracted provider network. Along with the Compliance Ofcer, iL.A. Care's liaison with Centers for Medicare & Medicaid Services (CMS) and other federal agencies concerning L.A. Care'Medicare Advantage product(s). Ensures that L.A. Care and its subcontracted provider network is compliant with all CMS federaregulatory requirements. This is achieved by working with internal and external staff to correct performance deciencies, ensuringstaff are aware of CMS reporting requirements and reports are submitted to CMS identifying internal areas for improvementResponsible for performing internal audits, monitors implementation of corrective measures, and interpretation of CMS requirementsWorking knowledge of federal and state requirements is required, as well as highly developed analytical skills and excellent writtenand verbal communication skills.

For complete job description, qualications/requirements, visit our website: www.lacare.org

To apply, email resume with salary history and requirement to: [email protected] referencing Payers & Providers Ad

ASSOCIATE MEDICAL DIRECTOR FOR CLINICAL INTEGRATED SOLUTIONS(Los Angeles, CA)

The Associate Medical Director for COPE Health Solutions Clinical Integration Solutions service line will serve as theDirector of the Camino de Salud Network and Product Leader for Provider Practice Redesign. The Associate Medical Directorwill play a key role in launching the Provider Practice Redesign product into other marketplaces outside of the Camino deSalud, Long Beach, and Westside/South Bay Networks.

Provider Practice Redesign (PPR) is one component of Clinical Integration Solutions, designed to expand access to specialtycare services within the community.

Camino de Salud Healthy Road Network is a public-private partnership between LAC+USC Healthcare Network, fourprivate hospitals, numerous community clinics and private physician ofces, Keck School of Medicine at USC, and the USCSchool of Pharmacy.

QUALIFICATIONS

M.D. with a non-restricted license and board certication

Minimum 2 years of full-time experience in practice (not including residency training) in one or more of the following:private physician practice, hospital-based practice and inpatient care.)

Masters degree is strongly preferred

Procient in Microsoft Ofce Programs (Outlook, Word, Excel, Access and PowerPoint) and experience with Internetresearch.

To apply and learn more visit: www.copehealthsolutions.org/careers


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Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

DIRECTOR, BUSINESS DEVELOPMENT(West Covina, CA)

The Director will work in tandem with another Director of Business of Development to support the client, Citrus Valley HeaPartners, the project lead, and the project team in the design and development of strategic initiatives and businessdevelopment projects by providing information, recommendations, consultation and management services in the areas ofClinical Integration, Physician Alignment, Service Lines, Facility and Capital Planning, Government Relations and Advocacyand Research and Teaching Opportunities.

QUALIFICATIONS

Masters degree (MBA, MPH, MHA or similar degree)

5-15 years of work experience in business development and/or strategic planning in a healthcare setting

Strong understanding of physician-hospital relations Procient in Microsoft Ofce Programs (Outlook, Word, Excel, Access and PowerPoint) and experience with Internet

research.

Ability to work collaboratively and effectively while handling multiple projects on various timelines in an extremely fast-paced environment

Ability to travel (as required)

Strong understanding of the health care industry, analytical thinking skills and a strong and dedicated work ethic

To apply and learn more visit: www.copehealthsolutions.org/careers

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

will do it for a lot less.

Employment listings begin at just $1.65 a word

Call (877) 248-2360, ext. 2Or e-mail: [email protected]

Or visit: www.payersandproviders.com

*New England Journal of Medicine, 2004.


8/8

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Payers & Providers – Issue of October 28, 2010

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