12 January 2012

California Edition
Calendar
January 12-14
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Hospital-Acquired Infections Detailed

Long-Term Care Facilities Report Some Higher Rates
Long-term acute care hospitals in California reported signicantly higher rates of some infections acquired during patient stays than their general acute care counterparts, according to data they reported to the Department of Public Health. The data covered surgical site infections, central line bloodstream infections, Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE ) infections and incidents of Clostridium difcile, a form of diarrhea transmitted by bacterial exchanges in the hospital setting. Hospitals have been reporting the data for the past two years, following passage of a law in 2008 making such reporting mandatory. These reports provide the most detailed picture yet of healthcare-associated infections in California's hospitals, said CDPH Directtor Ron Chapman, M.D. The information in these reports is intended to increase awareness and lead to appropriate changes that will decrease the number of these infections. Among long-term facilities, the MRSA/ VRE infection rate was 1.1 cases per 10,000 patient days, compared to a statewide average of 0.6. The rate among major teaching hospitals was 1.0, and 0.5 for community facilities. For C. difcile, the rate was 18.8 cases per 10,000 patient days, compared to 9.4 per 10,000 patient days among general acute care hospitals. For both sets of infections, data was studied for the period of April 1, 2010 to March 31, 2011. Altogether, 49% of hospitals did not have a single MRSA infection during the reporting period, and 50% did not report a single VRE infection. The executive summary on C. difcile transmission suggested why the infection rates may be higher at the long-term facilities: patient stays at those hospitals are at least 25 days about ve times longer than the average stay at an acute care facility. As a result, there is far more opportunity for a patient to be exposed to infection-causing bacteria. The surgical site infection data studied incidents of infection for colon surgery, coronary artery bypass graft, hip replacement and knee replacement procedures. Data was studied for surgeries performed between April 1 and June 30 of last year. The CDPH did not include specic rates because surgeries were not performed at all facilities. No hospital reported more than four surgical site infections per procedure, although in those instances, the rate was far higher than the predicted average.

January 19
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January 23-24
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A NEW WEBINAR! Friday, January 20, 2012 10 A.M. PST

Hospital C-Suite Compensation: How Much Is Too Much?

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.

Please join Mike Rosenbaum, Partner, Drinker Biddle Reath, Claudia Wyatt-Johnson, Co-Founder, Partners in Performance, and Ron Shinkman, Publisher of Payers & Providers, to discuss trends in compensation in California and elsewhere.

http://www.healthwebsummit.com/pp012012.htm
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NEWS
Ruling (Continued from Page One)
Meanwhile, more than 93% of Californias hospitals reported that they had protocols in their intensive care units in place to insert central lines in a manner designed to reduce related infections. A protocol designed by Johns Hopkins University researchers virtually eliminates central line infections if followed precisely.

Page 2

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In Brief
Health Net Sells Medicare Pharma Subsidiary
Woodland Hills-based insurer Health Net has agreed to sell its standalone Medicare prescription drug plan subsidiary to an afliate of CVS Caremark for $160 million. Health Net has 400,000 Medicare enrollees in 40 states and the District of Columbia in the plan, which has $490 million in annual revenue. The plan has worked closely with CVS for the past ve years. Health Net will continue to offer prescription drug coverage through its Medicare Advantage plan. We believe this proposed transaction is in the best interests of our Medicare PDP members and our stockholders, said Health Net Chief Executive Ofcer Jay Gellert. Our Medicare PDP members...will now be afliated with one of the nations largest Medicare PDP sponsors. Health Net expects to net $140 million from the sale after taxes and costs. Gellert said the money would be used to benet Health Net stockholders, but did not provide specics. The deal is subject to regulatory scrutiny, including approval from the Centers for Medicare and Medicaid Services, but is expected to close in the second half of this year.

The rates of adherence were slightly lower at pediatric and neonatal ICUs. Such infections kill about 28,000 hospital patients each year and cost more than $2 billion annually to treat. CDPH ofcials indicated that more reports regarding hospital-acquired infection data would be released in July.

Reform Will Shift Hospital Staffing

Report Says Management Skills Must Change
A new report by the consulting rm Towers Watson predicts that the labor demand at hospitals in California and elsewhere will change dramatically in the coming years due to the implementation of the Affordable Care Act. More than three-quarters of the 100 hospital and hospital systems surveyed agree that they will have to recruit executives with a far more diverse range of experience. Physician management skills will be particularly coveted. Organizations that arent already preparing for this change by dening the necessary leadership competencies and refreshing their succession-planning processes could nd themselves with a limited pipeline of talent with the right combination of skills to drive transformation, the report said. While most of those surveyed say there is no shortage of executive talent, the report concludes that respondents may not be concerned enough about recruiting to an expanded skillset. The study also suggested that hospitals and health systems are not fully prepared to expand primary care and outpatient services considered big keys to a functional accountable care organization. Projected nances are not expected to leave much margin to implement such dramatic changes: 93% of respondents say they expect reimbursements will be cut in the coming years. At the same time, 70% of the respondents forecast labor shortages in specic professions over the next several years, particularly physicians and nurses. Towers Watsons own research suggests that many providers are being lulled into a false sense of security due to the recent glut of nursing school graduates. A perfect storm of forces is hitting the hospital industry all at once...hospital have to rethink and rene core business and operating processes while continuing to deliver quality care to the communities they serve, said Heidi Toppel, a Towers Watson senior consultant. Many executives recognize the transformation required to meet the vision of multidisciplinary accountable care will ultimately help improve health outcomes and reduce costs. However, the path from the current to the enhanced state wont be a smooth one in the short term.

IEHP Expands Health Navigator Service

Inland Empire Health Plan will expand its Health Navigator program to the High Desert region of San Bernardino County later this month. The service helps IEHPs Medicaid managed care enrollees to better use their coverage, avoiding unnecessary emergency room visits and hospitalizations. Enrollees get a home visit from staff to educate them

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Continued on Page 3

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UCLA Expands Teen Health Initiative

Health Net Partnership Focuses on Social Media
Health Net and the UCLA School of Public Health are expanding a social media program to help adolescents better understand their healthcare options. The initiative, known as teen2extreme or T2X, was created to test whether the use of social networking could increase teen understanding of healthcare delivery and better engaged them in making healthcare decisions. The National Institutes for Health provided a $1.1 million grant to launch the initiative. Although the results of the test phase have yet to be fully evaluated, access to the website was recently expanded to all U.S. teenagers with a computer and an Internet connection. The website, www.t2x.me, includes services such online chats with healthcare experts, a nurse advice line to teens who have coverage through Health Net, and a service to receive healthcare-related texts through a users cell phone. T2X was recently cited by the National Committee for Quality Assurance as a best practice in patient engagement. If this intervention is indeed successful in allowing teens to become more engaged in their healthcare and health decisions, we could validate the use of social networking sites for the rest of our population, said Nancy Wongvipat Kalev, Health Nets director of health education and cultural and linguistic services.

In Brief
about the differences between ERs and urgent care, provide information about dental providers, and help schedule primary care visits and immunizations. Since its rollout last year in San Bernardino and Riverside, the program helped cut avoidable ER visits by about 40%. The program serves as a link between members, providers and the health plan, which ultimately leads to better coordination and care, said IEHP Chief Executive Ofcer Bradley Gilbert, M.D. It is funded through a grant from First 5 San Bernardino. The rollout will begin in Victorville, then move to Hesperia and other communities in the region.

Sutter Health Bolsters Pension Plan

$400 Million Contribution Helps Maintain Full Funding
Sutter Health has placed $400 million into its pension plan to keep it fully funded part of a $1 billion effort by the Sacramento-based hospital operator in recent years to preserve the benet for its retired employees. "At a time when companies are downsizing or eliminating employee pensions, Sutter Health has made funding our pension a top priority," said Sutter Chief Executive Ofcer Patrick Fry. "Employees deserve to know that when they retire, the money they worked so hard for will be there for them." The cash infusion comes on top of a $120 million injection by Sutter in 2010 and $500 million in 2008. The move comes at a time when many other non-prot healthcare entities are scrambling to keep their pension plans fully funded. According to Standard & Poors, the typical non-prot healthcare pension plan had only 68% of required funds on hand to pay its pension liabilities, down from 90% in 2007. Ofcials said that pension assets fell primarily due to the 2008 nancial crisis that battered the stock market. Although prices have since rebounded, the discount rate pension accounting pegged to returns on highgrade, xed income debt have fallen. Even a small decline in such rates can dramatically worsen forecasts for covering pension liabilities. The funded status hasnt improved, said Standard & Poors Director Elizabeth Sweeney. Even as assets have bounced back, liabilities have (gone up). She added though that pension-to-asset liabilities are beginning to stabilize.

El Camino Hospital To Expand Its Board

The board of directors at El Camino Hospital in Mountain View has undertaken a rare feat in healthcare governance an expansion of its size. The 399-bed hospital about 20 miles southeast of San Francisco will expand its board from six to nine directors by June. It is seeking candidates with expertise in nance, quality measures and healthcare policy. El Camino is also seeking up to 15 more individuals for appointments to six committees that advise the hospitals board. As the complexity of the healthcare environment continues to evolve, it is important that we prepare our organization," said El Camino Chairman John Zoglin. The hospital and the community stand to gain from the additional expertise placed on our board and committees. In recent years, many hospitals have sought to shrink their board size, trying to move from bodies with up to 50 trustees with a philanthropic focus to a leaner governance more focused on business and healthcare policy. Typically, a 15-member board is now considered ideal by most healthcare governance experts.

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OPINION

Page 4

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Brokers, Exchange Need Each Other

Good Execution Means Both Will Prosper Post-Reform
California is implementing provisions of the Affordable Care Act that could signicantly help small businesses, but none more so than the California Health Benet Exchange. If implemented correctly, the exchange could be instrumental in lowering insurance costs while increasing choice for small employers and their employees. Californias exchange board, the rst in the country, is focused on creating the Small Business Health Options exchange, otherwise known as the SHOP exchange. This will be an online marketplace where small employers can pool their buying power to drive down health insurance costs. When the SHOP opens in 2014, the healthcare marketplace will look different and brokers are uncertain as to what their exact role in the exchange will be. Some are even concerned it may put them out of business. As a long-time broker in the state, I know that if our broker community works with the exchange and vice versa the exchange and small businesses can all benet. The new law leaves it up to the exchange to determine the roles brokers play. At a Nov. 16 panel discussion hosted by Small Business Majority, we discussed Jason molding a productive relationship between brokers and the exchange. New Yorks HealthPass and Connecticuts Health Connections are examples of this type of partnership working extremely well. Both have formal roles for brokers, and both partnerships have led to successful exchanges. In January, an Insure the Uninsured Project workgroup offered recommendations for implementing the exchange and used the successes of other exchange models to conrm that come 2014, brokers will be in a unique position to educate others, particularly small businesses, on the Exchanges benets and operations. Past marketplaces like the Health Insurance Plan of California (HIPC), which later became PacAdvantage and shut its doors in 2006 minimized the role of brokers. HIPC's policies discouraged broker participation, and while the state later reversed this and had more broker friendly policies, it was too little, too late. Whats more, it would have been less expensive to pay broker commissions than to sell directly to employers. Why? Because small-business owners trust their brokers and turn to them when making decisions about health insurance. A report released last month by Pacic Community Ventures showed 75% of smallbusiness owners with fewer than 20 employees use brokers when making coverage choices. And 88% of those employers say their brokers opinion carries signicant weight when they make important decisions. Entrepreneurs are busy people focused on growing their businesses. Theres just not enough time in the day for them to become experts on health insurance. If the examples of past exchanges are any indication, small businesses participating in the SHOP will continue to rely on their brokers for their invaluable expertise and assistance. Peter Lee, the executive director of the exchange, recently made encouraging comments in an IBA West newsletter about forming a partnership with brokers: We recognize the important role brokers can play and look forward to By working with the broker Andrew community. This is good news, and my hope is that we will continue to see ongoing engagement with the brokerage community and others to make the exchange successful. The Affordable Care Act is changing the way our country approaches healthcare, and the need for brokers has never been greater. Innovative brokers who adapt to the new market will nd new business opportunities in helping ensure that employers understand the SHOP exchange once it is up and running. More importantly, we will help ensure business owners use it.
Jason Andrew is the owner/operator of Stone Meadow Benefits and Insurance Associates in Redwood City. Email: jason@smbinsure.com.
Op-ed submissions of up to 600 words are welcomed. Please e-mail proposals to editor@payersandproviders.com

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MARKETPLACE/EMPLOYMENT

Page 5

CLAIMS ENCOUNTERS ANALYST Large MSO in the SFV has an immediate opening for a Claims Encounters Analyst. This is a challenging and results oriented position with oversight of all Claim encounters submissions to the contracted health plans. Processes will include meeting turnaround times, meeting adequacy requirements by the plans, ensuring claims data accuracy, provider training on encounter submissions and feedback reporting.
This person will be the primary liaison with the health plans and clearinghouses. This person must also be knowledgeable of EDI 5010 transaction requirements. Must have a minimum of 2 years experience in claims processing and management and/ or EDI analysis, understanding of claims payment arrangements, procedures, coding, and regulatory and health plan requirements with emphasis on Medi-Cal. Strong working knowledge of MS Office 2007, EZ-CAP, Crystal Reports XI and/or SQL Server Reports preferred. Strong communication skills are a must. Competitive Salary and Benefits. For immediate consideration, please e-mail resume to personnel@medpointmanagement.com, or fax to 818-702-9128.

MANAGER, PROVIDER CONTRACTS

Molina Healthcare is a publicly traded Fortune 1000 company with over 5,000 employees and revenues of $3.6 billion. RESPONSIBILITIES: Manage, train and assist the Contract Managers and Contract Specialist(s). Oversee development of provider contracting strategies and establishing a sufficient network of Participating Providers to serve the health care needs of Molina membership. Advise in preparation and negotiations of provider contracts and oversee negotiation of contracts. Oversee the maintenance of all Provider Contract Templates. Adheres to the company and/ or departmental confidentiality standards, HIPAA compliance programs, fraud and abuse prevention/detection policies and programs. QUALIFICATIONS: BA or equivalent education and experience required.Masters preferred. Minimum 5 years in managed care with contract negotiations experience (all provider types - physician, hospital and ancillary providers). Minimum 3 years of supervisory experience (hospital and ancillary provider contracting). Demonstrated knowledge of reimbursement methodologies and managed care processes; specific knowledge of managed care lines of business, including Medicaid, Managed Medicaid, Medicare and Commercial HMO products. Contract management system/software experience. Please forward resumes to: austin.dragon@molinahealthcare.com

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

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Employment listings begin at just $1.65 a word Call (877) 248-2360, ext. 2 Or e-mail: advertise@payersandproviders.com Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.

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MARKETPLACE/EMPLOYMENT

Page 6

SEEKING A NEW POSITION?

CAN HELP.
We publish advertisements for those seeking new career opportunities for just $1.25 a word. If you prefer discretion, well handle all responses to your ad. Call (877) 248-2360, ext. 2, or e-mail advertise@payersandproviders.com.

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