30 September 2010
California Edition
Calendar State Reaps Primary Care Largesse
Wins $32M From HHS For Service Expansion, Training
October 7-8
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October 25-27
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published in the Calendar section,
space permitting.
California was among the biggest winner of
hundreds of millions of dollars worth of
grants from the federal government this
week to expand the workforce of primary
Hospitals, clinics and community
colleges received more than $32.2 million
of the program money, which was
announced by the U.S. Department of
Health and Human Services on Tuesday.
Only New York received more: $32.4
million.
HHS officials say the money, which
will be doled out over a five-year period,
will be used not only to generate more
healthcare jobs, but to attempt to refocus
healthcare delivery on primary and
preventive care.
“Investing in our primary care
workforce will strengthen the role that
wellness and prevention play in our
healthcare system. With these grants,
Americans from all backgrounds will have
new opportunities to enter the health care
workforce,” said Health and Human
Services Secretary Kathleen Sebelius.
Providers throughout the state say they
will be using the money to care for more
patients, or expand residency programs to
ensure the workforce has more primary
care physicians.
St. Mary Medical Center in Long Beach
received a grant for $1.92 million. It will
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use the money to expand its primary care
residency program by nearly 20%, from
32 to 38 slots, beginning in 2011.
Residents begin the three-year program
after their third year at the UCLA David
Geffern School of Medicine.
“We’re very pleased. It’s a program
the community both needs and deserves,”
said Drew Gagner, St. Mary’s vice
president of campaigns.
According to St. Mary’s data, the
western central portion of Long Beach has
experienced a chronic shortage of
healthcare professionals, even though
more than half of its residents practice
within the vicinity when they finish their
training.
“We have a large foreign-born
population that’s underserved, and
hopefully if we can give these residents
the right kind of experience in their
training, we can convince more to stay,”
Gagner said.
Among the biggest winners of overall
grant money was the University of
California system, which received nearly
$14 million. The UC San Francisco
campus received $5.34 million in three
separate grants.
Continued on Next Page
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In Brief
Physician Sues Anthem
Over Network Access
Anthem Blue Cross of California
has spent years tangling over
accusations it dropped enrollees
when they become ill. Now a
similar charge is coming from a
provider.
Los Angeles physician Jeffrey
Nordella filed suit in Los Angeles
Superior Court on Aug. 24,
claiming Anthem refused to allow
him to participate in their network.
He claimed in the suit that Anthem
is restricting its provider network
primarily to increase profits.
Nordella claimed that he was
refused entry into its network
because Anthem stated there was
no need for his services, even
though his urgent care practice in
Porter Ranch was only one of three
within a 10-mile radius and he was
a prior Anthem Blue Cross network
physician. He claimed that the
refusal was a violation of state and
federal “any willing provider” laws
and is financially damaging his
medical practice.
The suit seeks damages for
violation of due process
procedures, tortious interference
and unlawful business practices.
OSHPD Grants $2.7M In
Brown-Song Funds
The Office of Statewide Health
Planning and Development has
awarded $2.7 million in training
grants to 25 hospitals and medical
groups statewide to fund their
family practice residency training
programs.
The grants range in size from
$51,615 to $206,460. Recipients
include Harbor-UCLA Medical
Center, White Memorial Medical
Center in Los Angeles, Long Beach
Memorial Medical Center and
Continued on Page 3
NEWS Page 2
Grants (Continued from Page One)
Of that money, $1.5 million will be track record in training primary care
used to expand Glide Health Services, a physicians who tend to work in
nurse-managed primary care center in community clinic settings serving
San Francisco’s impoverished Tenderloin underserved populations after graduating,”
District. Glide’s center, which is staffed said Kevin Grumbach, M.D., a UCSF
with a combination of nurse practitioners professor and chair of the university’s
and visiting physicians, has about 3,400
regular patients. The money will be used
family medicine program.
Children’s Hospital & Research Center
to expand the patient base by another of Oakland received $3.84 million. The
750. money will be used to train an additional
“I’m definitely going to be able to 20 pediatric residents over next five years.
increase my internal medicine and The grants were not restricted to just
support staff,” said Patricia Dennehy, the University of California and teaching
Glide’s director and a member of the hospitals. The Riverside Community
UCSF nursing school faculty.
College District received $2.1 million to
The remainder of the money will be expand its physician assistant training
used to train an additional 20 residents in program, while the University of Southern
UCSF’s family medicine and primary care California received $704,000 for the same
residency programs. objective.
“Both programs have an excellent
The Grant Recipients
Nursing/Nursing Care/Home Aids/Physician Assistants
Western Center for Health Sciences $1.056 million
UCSF $1.49732 million
Tides Center $1.459 million
University of Southern California $744,000
Riverside Community College $2.1178 millon
Samuel Merritt College $1.23 million
Sacramento College $749,960
Primary Care Residency Expansion
UC Davis $1.92 million
UCSD $2.88 million
UCLA $1.92 million
St. Mary’s Medical Center, Long Beach $1.92 million
Children’s Hospital & Research Center, Oakland $3.84 million
UCSF $3.84 million
UC System $1.92 million
Workforce Grants
San Diego Workforce Partnership $5 million
California Employment Development Department $150,000 (Source: HHS)
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In Brief
Santa Rosa Family Medicine.
According to OSHPD, the
funds are used to develop new
curriculum, develop clinical
training sites and other expenses
excluding tuition. The agency
estimates it costs $150,000 to train
a single resident.
Grants, awarded for residency
training through OSHPD’s Brown-
Song program have totaled $21
million since it was initiated in
2003.
Blue Shield of
California Awards
$24.7 Million
San Francisco-based Blue Shield of
California has awarded $24.8
million in incentive bonuses to
medical groups and physicians in
its provider network.
Blue Shield is granting $13
million through the Integrated
Healthcare Association’s P4P
program. Another $7 million will
be awarded through its own
performance improvement rewards
program, which focuses on
managing ER and inpatient
resources and generic drug
utilization. An additional $4.8
million was granted in the form of
other incentives.
Jones: Medi-Cal
Drawdown Near
A fee program that will allow
California’s hospitals to draw down
an additional $3.2 billion in Medi-
Cal funding should be operational
by early next month, according to
Assemblyman Dave Jones, D-
Sacramento.
Jones’ office said that the CMS
has been satisfied about all major
issues surrounding the fee. Jones
authored key pieces of legislating
authorizing the fee and how it
should be implemented.
NEWS
Blue Shield ACOs May Go Statewide
Plans to Build on Success of Sacramento Pilot
The success of an accountable care
organization pilot program in Sacramento
overseen by Blue Shield of California has
prompted the San Francisco-based insurer to
consider expanding it statewide.
The ACO pilot, launched earlier this year
in conjunction with Catholic Healthcare
West and Hill Physicians Medical Group, has
resulted in a 4% reduction in hospital
admissions, a 9% decrease in average length
of stay and a 24% drop in readmissions,
translating to a $14 million annual savings.
The 38,000 participants are retired
government workers who receive their
coverage from the California Public
Employees Retirement System.
The numbers, presented at last week’s
Healthcare Financial Management
Association in Long Beach last week, were
initially questioned by a Hill Physicians
spokesperson, but ofcials at both Blue
Shield and CalPERS conrmed the data this
week.
Blue Shield and the providers have
invested in a network of electronic medical
records and such practices as providing full
Kaiser Opens Much Of EMR System
Release of CMT to Help on Meaningful Use Regs
Oakland-based Kaiser Permanente has
opened up the technology that helps operate
its elaborate electronic medical record
system to other developers.
The donation of the technology, known
as the Convergent Medical Terminology, was
made to the International Health
Terminology Standards Development
Organization. It will be distributed in the
United States through the U.S. Department
of Health and Human Services.
CMT essentially governs and knits
together Kaiser’s EMR system, known as KP
HealthConnect.
“This donation...from Kaiser Permanente
addresses that critical need by making it
easier for health professionals and patients to
create standardized data in electronic health
records,” said Health and Human Services
Secretary Kathleen Sebelius. “It can help
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Page 3
prescriptions upon discharge, something few
insurers are willing to pay for.
“$14 million in savings is a lot of success,
even when we’re doing it in a clunky manner,”
said Juan Davila, Blue Shield’s senior vice
president of network operations, adding that
some changes to clinical processes in the ACO
have yet to be fully rened. “Our goal is to
expand it.”
Davila said that the ACO would likely
expand into the San Joaquin Valley in the rst
part of 2011, involving more CHW hospitals.
“That’s a slam dunk,” he said.
A CHW spokesperson declined comment,
but conrmed that it was in negotiations with
Blue Shield.
However, Davila said Blue Shield is also
in talks with medical groups such as Gemcare
and PrimeCare in the Inland Empire, and
hospital operators such as the Providence
network in the Los Angeles area, Adventist
Health and Tenet Healthcare.
“We hope to have four to six ACOs up
and live by the end of next year, depending on
discussions, and 20 by 2014,” he said.
physicians provide better evidence-based
care, while directly supporting the
administration’s investment in bringing
information technology to healthcare.”
The donation of CMT is also hoped to
expedite the development of EMR systems
and meaningful use compliance in smaller
practices and hospitals, according to a joint
statement issued by Kaiser and HHS.
“This will support efcient patient care, as
well as the production and export of
standardized data needed to support quality
assessment, decision support, exchange of
data for patients with multiple healthcare
providers, and public health surveillance,” the
statement read.
A dollar value of the donation was
unknown. Kaiser spokespersons did not
immediately respond to phone calls and e-
mails seeking comment.
Payers & Providers
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OPINION Page 4
The Looming Apocalypse Of Reform
Historic Law Contains Nothing But Epic Burdens For All
Democrats were urged to vote for Physicians and Surgeons,[ http://
healthcare reform as a smart political move. www.jpands.org/vol15no3/orient.pdf] I used
In time, they thought, people would come colored sticky notes for the various features of
to love the new benefits. the bill: taxes, regulations, punishments,
As people find out what’s in the bill, favors to special-interest groups, and social
Families USA has been suggesting a new engineering. There are no “patient
message: The bill isn’t perfect, but we’ll protections” and nothing that makes care
improve it. Forget about the extravagant more affordable. There are only ways of
claims of reducing medical costs and the shifting the increased costs to other people or
federal deficit: “Keep claims small and taxpayers.
credible.” Features that most Americans will
At the Pima County hate include billions of new tax
Medical Society, there’s a reporting forms (including 1099s for
mood of impassive the sandwich shop), more crowded
resignation. The society is emergency rooms, fewer available
making a deal with a doctors, loss of medical privacy,
business group to help more marriage penalties, and lots of
doctors survive—and to new taxes—either because you are
help the society slow the defined as “rich” or because you are
loss of disenchanted paying the taxes that “rich”
members. businesses such as medical device
Small medical practices manufacturers pass along to you.
won’t be able to afford the There are things in the bill that
crushing new “compliance” some people will like: federally funded
requirements, say the society’s By Jane abortions; lots of multiculturalism;
leaders. They have three years to M. Orient, national servitude for doctors;
figure out what they are going to M.D. acceptance of death by dehydration or
do. The alternative to closing or starvation; thousands of new jobs for IRS
merging is, in this view, to agents and bureaucrats; millions of
outsource responsibility for studying the unwilling new customers for managed-care
new rules, collecting the documentation, schemes and federally certified computer
and filing reports. systems; and grants for developers of medical
Patients have no cause to celebrate cookbooks, ineffective smoking cessation
either. Sure, more people will be covered— aids, or politically correct “counseling” or
by Medicaid. And by unemployment “education” programs.
benefits. As employers look at the cost of This misbegotten child has been
“minimum essential coverage” or penalties conceived and implanted, but it has a lot of
such as $3,000 per employee if any worker growing to do before it matures around 2014
qualifies for subsidies, there will be fewer —in the course of which it will suck the
hires and more pink slips. Especially economy dry while displacing the
around the thresholds of the 201st, 101st, professionals and institutions devoted to
or 51st employee, where new requirements caring for the sick. We need to starve it of
based on “business size” kick in. funding, disown it, repeal it, enjoin it, and
Small businesses may have been excited nullify it on the state and individual level.
about the 35% tax credits touted on a
postcard sent at taxpayer expense. But if Dr. Jane M. Orient is a physician practicing in
they did the math or used the National Tucson, Ariz. and executive director of the
Federation for Independent Business Association of American Physicians and
Internet calculator, they probably figured Surgeons.
out that they didn’t qualify.
In reading the 906 pages of statutory
Op-ed submissions of up to 600 words are
language, in order to write an article welcomed. Please e-mail proposals to
entitled “ObamaCare: What’s in It?” for the editor@payersandproviders.com,
fall 2010 issue of the Journal of American
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

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