17 February 2011
California Edition
Calendar
February 22-25
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February 23
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February 24-25
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E-Mail
info@payersandproviders.com with
the details of your event, or call
(877) 248-2360, ext. 3. It will be
published in the Calendar section,
space permitting.
Reform Could Help 70% Of Uninsured
UCLA Study Says Nearly 5 Million May Get Coveage
A large majority of the Californians currently
lacking healthcare insurance could obtain
coverage once key provisions of the Patient
Protection and Affordable Care Act kick in
during 2014, according to UCLA researchers.
The report released earlier this week by
the UCLA Center for Health Policy and
Research indicates that as many as 4.7 million
Californians could gain coverage through
federal healthcare reform, either through
purchasing coverage subsidized by tax breaks
via the health insurance exchanges set to
begin operating in three years, or through the
sizable expansion of the Medi-Cal program.
"Healthcare reform lifts a tremendous
burden off the shoulders of all Californians,"
said E. Richard Brown, a UCLA professor and
the center’s director. “It will be an enormous
relief to anyone who's struggling to pay both
the rent and a medical bill."
The number of uninsured Californians
ranges in ofcial estimates from 7 million to 8
million, but experts agree it has increased at
least 15% since the Great Recession began in
December 2007.
UCLA researchers say 7 million
Californians – slightly more than 21% of the
population – lacked insurance for all or part of
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2009, the largest such number in the United
States. In Los Angeles County and some rural
areas the rate of uninsured approach or top
25%. The UCLA report on reform noted that
the rates of uninsured would likely be higher if
a federal subsidy to provide coverage to laid
off workers had not gone into effect as part of
the stimulus package. That subsidy has since
expired.
According to demographic data compiled
by UCLA via the vast 2009 California Health
Interview Survey, researchers predict that more
than 3 million Californians will be eligible for
Medi-Cal who were not previously eligible.
Another 1.73 million will be eligible for
subsidized coverage through the insurance
exchanges.
UCLA predicts that another 1.2 million
Californians won’t qualify for tax subsidies
due to income guidelines, but would be
eligible to purchase coverage on the
exchanges at full cost.
"The sheer number of Californians
without health insurance underscores the
importance of implementing the healthcare
law successfully," said Robert K. Ross, M.D.,
Continued on Next Page
 Payers & Providers
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In Brief
Kaiser Reports 2010
Earnings
Oakland-based Kaiser Permanente
reported modest revenue gains but
lower net income for calendar
2010.
Kaiser reported revenue of
$44.2 billion, up 4.8% from 2009’s
revenue of $42.1 billion. Net
income was $2 billion, down from
$2.1 billion in 2009. The biggest
dip was in operating income, which
dropped to $1.2 billion last year
from $1.6 billion in 2009, a 2.5%
drop. That number was mitigated in
part by a 33.5% boost in non-
operating net income, to $789
million in 2010 compared to $524
million in 2009.
"Improvement in financial
markets made a contribution to our
overall net income, enabling us to
partially recoup the investment
losses sustained in 2008," said
Kaiser Chief Financial Officer Kathy
Lancaster. "We are pleased that our
financial performance supports our
continued investment in technology
and our facilities.”
Capital spending was up
sharply in 2010, to $2.9 billion,
compared to $2.6 billion in 2009.
In the fourth quarter of 2010 it
reached $1.2 billion, up 33% from
the same quarter in 2009.
Anthem Blue Cross
Gives Grant To Boys
And Girls Club
Anthem Blue Cross of California
has given a sizable grant to the
Boys and Girls Clubs of America in
order to address childhood obesity
and encourage healthier lifestyles.
The grant, which totals
$432,892, will sponsor the clubs’
“Triple Play” program. The program
Continued on Page 3
NEWS
Reform (Continued from Page One)
CEO of the California Endowment, which co-
funded the study.
Potential roadblocks still loom prior to
the full implementation – a federal appeals
court judge last month ruled the entire reform
law was unconstitutional, while another
Liver Cancer Soars For State’s Latinos
Registry Data Indicates Rates Have Nearly Doubled
The state rate of liver cancer among native-
born Latinos has nearly doubled over the last
decade, according to a new report by the
Cancer Prevention Institute of California.
The CPI employed data from the California
Cancer Registry and the recently updated
California Health Interview Survey data. it
examined more than 3,700 cases of Latino
males diagnosed with liver cancer between
1988 and 2004, more than 1,600 cases of
Latinas diagnosed with the disease. More than
12,000 cases among Asian and Latino
populations were studied overall.
The study’s ndings were grim: liver
cancer rates among U.S.-born Latino males
have soared 87% since the 1990s, while the
rate among U.S.-born females jumped 83%.
That compares to increases of 31% among
Latino males born outside of the U.S. and 29%
among foreign-born Latino females.
By contrast, the liver cancer rates among
the Asian populations were higher among
those in the foreign-born groups versus the
native born, which researchers attributed to
hepatitis b being endemic in Asia. Moreover,
the number of case diagnosed were a fraction
IHA Wins $2.9M Grant From AHRQ
Money Will Test Bundled Payments For Some Care
The Integrated Healthcare Association has
received a three-year, $3.9 million grant from
the U.S. Agency for Healthcare Research and
Quality to implement and study bundled
payment for certain episodes of care.
The Oakland-based IHA will work with
medical groups, health plans and hospitals
throughout California. Payments will be
bundled for hip replacement surgeries,
cardiac catheterizations with a stent and
certain knee arthroscopic procedures.
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 2
judge ruled in December that the mandate to
purchase insurance was also unconstitutional.
The ultimate durability of the
healthcare reform law will almost certainly be
decided in the coming years by the U.S.
Supreme Court.
compared to those among the Latino
populations.
Researchers attribute the dramatic
increase of the often terminal condition to
stark differences in lifestyle for Latino males in
California versus Mexico and Central America.
“The fact that the cancer rates differ by
birthplace mean that the causes are not
genetic,” said Ellen Chang, the CCPI
researcher who led the study.
Chang noted that the cancer data was
compared against CHIS interviews of Latino
individuals. The evidence suggested that U.S.-
born Latinos were far more likely to be
overweight, engage in binge drinking and
intravenous drug use than their counterparts
born outside of the U.S. Such behaviors can
damage the liver or encourage hepatitis.
Although Chang acknowledged it would
be difcult to make drastic lifestyle changes to
cut down on incidences of liver cancer, she
urged that Latinos engage more in liver cancer
screenings, which make treatment of the
disease more successful. That normally
includes blood tests and ultrasound
examinations of the liver.
Bundled payments are being tested in
other forms as precursors for accountable care
organizations.
“Knee and hip replacements are growing
cost concerns for providers,” said Weslie Kary,
an IHA program director in medical
technology.
IHA will not have a say in how the
bundled payments are apportioned. The
money will be used by IHA for ongoing
evaluation of the project.
Payers & Providers
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In Brief
encourages participants to eat
healthier foods, become more
physically active and engage in
healthier relationships.
"The short- and long-term
dangers associated with childhood
obesity bring special importance to
our work with Boys & Girls Club of
America,” said Kurt Tamaru, M.D.,
Anthem’s medical director. “We are
excited to partner with our local
clubs to help them to head off one
of the country's most pressing
health challenges."
Club officials estimate the
grant will help shepherd 3,500
children in California through the
program.
Anthem health plans are pledging
$5 million to help implement Triple
Play nationwide.
Apollo Acquires
Aligned In Stock Deal
Glendale-based hospitalist firm
Apollo Medical Holdings has
acquired Aligned Healthcare
Group, a provider of physician call
centers and management services
to health plans for stock.
The deal is worth about $1.1
million based on the current price
of Apollo stock, which trades on
the NASDAQ bulletin board.
Aligned shareholders will receive
about $210,000 worth of stock up
front, with another $900,000 worth
to be paid out over the next three
years based on cash flow of the
operation.
"By combining our two
organizations, we will broaden our
service offering to improve the
quality of patient care in hospitals,
post-acute care facilities and at
home,” said Adrian Vazquez, M.D.,
Apollo’s chairman and president.
“It also enables us to achieve a
balance between optimal length of
stay and avoidance of
readmissions."
In addition to the transaction,
Raouf Khalil, Aligned’s chief
executive officer, was given a seat
on Apollo’s board of directors.
NEWS/OPINION
LETTER TO THE EDITOR
The February 3, 2011 edition of Payers &
Providers repeats the Services Employees
International’s allegation that Prime
Healthcare hospitals use a diagnosis of
malnutrition to increase reimbursement.! This
allegation is baseless and nothing more than
another example of the SEIU distorting the
facts in order to mislead the public and extort
concessions from Prime Healthcare.!
!!!!!!First, Prime Healthcare hospitals do not
use a diagnosis of malnutrition to increase
reimbursement.! Indeed, the relevant (i.e.,
where the diagnosis affected reimbursement)
malnutrition rate at all Prime Healthcare
hospitals was 3.6%, which is much less than
the rates thrown around by SEIU.! For
example, the relevant malnutrition rate at
Huntington Beach Hospital was 5.3% rather
than the 36% claimed by SEIU and was 1.9%
rather than the 34% claimed by SEIU at
Montclair Hospital Medical Center.
!!!!!!In addition, the higher than average
malnutrition rates at Prime Healthcare
hospitals are the result of Prime Healthcare’s
commitment to providing high quality
healthcare for all of its patients for which
Prime Healthcare should be applauded rather
than criticized.! Published studies estimate
that up to 15% of ambulatory elderly patients,
up to 44% of homebound elderly patients, up
to 65% of hospitalized elderly patients, and
up to 85% of nursing home patients are
malnourished.! Given these statistics and the
morbidity and mortality rates associated with
undetected and untreated malnutrition, Prime
Healthcare hospitals have implemented a
nutritional screening program in order to
improve patient care outcomes and decrease
mortality and morbidity.! This program
HEALTHCARE’S BEST ADVERTISING VALUE
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Page 3
includes policies and procedures designed to
ensure that each elderly patient admitted to
the hospital receives a nutritional screening.!
Physicians also routinely order serum albumin
tests and promptly assess patients based on
the serum albumin levels and other
malnutrition indicators.! While this initiative
has undoubtedly improved patient care
outcomes and decreased mortality and
morbidity, it has also resulted in more
Medicare patients being properly diagnosed
with malnutrition and the average malnutrition
rates being higher at Prime Healthcare
hospitals than other hospitals.! However, the
increase in malnutrition diagnoses has not
lead to a similar increase in reimbursement as
a substantial majority of the malnutrition
diagnoses did not lead to enhanced
reimbursement.! Rather, these quality
measures and Prime Healthcare’s commitment
to providing the highest quality of patient care
lead to Prime Healthcare being ranked as one
of the Top 10 Health Systems in the Nation by
Thomson Reuters, the only for-prot hospital
system to be so recognized.!
!!!!!!Like SEIU’s earlier allegations concerning
septicemia rates, its most recent allegations
concerning malnutrition rates are part of
SEIU’s concerted corporate campaign of
extortion against Prime Healthcare.! Prime
Healthcare has and will continue to stand up
to SEIU’s extortion tactics so as to protect the
interests of its 9,000 employees and the
hundreds of thousands of patients it serves.
Michael J. Sarrao
Vice President and General Counsel
Prime Healthcare Services
]
Payers & Providers
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OPINION Page 4
Getting Over The Initial EHR Jitters
Most Fears Are Dispelled Once a System is in Place
Providers and healthcare consumers both more easily on a more global level.
feel that the electronic health records will Through EHRs, practices can also identify
produce better healthcare outcomes. where and when they are increasing revenue,
However, there is still some disagreement all the way through scheduling, wait time,
on how each party feels about the security office visit length and more. The real story of
of such tools. the changing healthcare landscape is, and
Our physician clients tell us daily that will continue to be, all about reporting and
EHR tools assist them in providing better connecting. Also, the quality of care will
care. However, the patients increase and patients will take health
of those physicians worry more personally and seriously
about security of EHRs. That because they have more ownership
fear is easily countered once over their healthcare regime.
they see the technology From this point onward, healthcare
being used. will be about electronic records and
EHRs far outpace paper connection: connection to a system,
records in terms of security and electronic health and
and accessibility. If of all the information exchanges between
times a paper record made physicians and their patients.
its way out of the office in a Connected services are essential, as
physician’ briefcase and was are accuracy, security and increased
lost, stolen or damaged, efficiency.
think of the time, money and Connection and EHRs will continue
resources that could have to be the foundation for increased
been saved had the records been By Tony efficiency in the medical office, and
electronic instead. Paper records Ryzinski leading to patients’ better understanding
are also nearly impossible to of health and to taking ownership of their
replace, which is not the case with an care. The new healthcare economy -- as it
electronic record. relates to interconnected services and
Stockton MRI recovered from a interoperability, is changing the way vendors
disastrous fire to the practice last year with must communicate to physicians and
all patient records intact because of the healthcare -- is being driven by the healthcare
clinic’s electronic system. A few months consumer. It is therefore our job as members
after the fire, Stockton MRI was practicing of the healthcare technology industry to be
out of a temporary mobile MRI unit at full “physician-focused, patient-centric” and to
capacity while rebuilding. Such a quick continue producing the products that serve
recovery would not have been possible consumers as they seek greater ownership of
with paper records. their health information and desire to have an
And it goes without saying that EHRs “always on” connection with their care
make records more accessible. A patient’s providers. As such, we must support
information can be viewed from any place physicians so that they are able to continually
in the world that has a connection without meet their patients’ expectations.
the record ever having to leave the office. Regarding safety, physicians using an EHR
In the case of a disaster such as a fire, the are much less concerned about security than
electronic record is backed up and saved patients or physicians in the market for an
multiple times over. EHR. Once they begin using an EHR, much of
Healthcare and the healthcare their fear and apprehension is alleviated.
environment are evolving according to the
changing market, and will continue to do Tony Ryzinski is a senior vice president with
so. With the trend progressing toward Sage Healthcare.
patients having more complete access to
data, the consumption of healthcare
Op-ed submissions of up to 600 words are
information is growing and the medical welcomed. Please e-mail proposals to
community can see across populations and editor@payersandproviders.com,
manage care – chronic care, for example –
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

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Governors meetings, internal and external committee meetings, L.A. Care leadership, external business associates, and other
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stand-in for the CMO at committee meetings. ! Key to this role is project management experience, including strong qualitative
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

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