23 February 2012

California Edition
Calendar
February 23-24
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Prime CEO Departs From Company

Lex Reddy Resigns From Troubled Hospital Chain
The chief executive ofcer of Prime Healthcare Services, the once swiftly growing but now troubled hospital chain, has resigned from the company. Multiple sources conrmed that Lex Reddy submitted his resignation on Wednesday. Reddy also reportedly resigned from the board of directors of the California Hospital Association, although a CHA spokesperson could not immediately conrm that. A spokesperson for the Ontario-based Prime declined to comment late Wednesday, but did not deny Reddy was departing. The 52-year-old Reddys exit comes as Prime, which operates 14 hospitals in California, comes under increasing scrutiny by both state and federal regulators for allegedly treating patients and billing Medicare for septicemia and a rare form of malnourishment at rates far higher than other hospitals statewide or nationally. The FBI is also looking into reports that executives with the Prime-owned Shasta Regional Medical Center violated federal privacy laws when they shared the records of a patient with a local newspaper to refute her claims she had been billed for malnutrition treatments during an inpatient stay that she had never received. As the allegations against Prime have mounted, it recently pulled out of a deal to acquire a hospital in New Jersey after pressure from local regulators. It lost another bid to acquire what would have been its second hospital in Victorville when California Attorney General Kamala Harris ruled it would not be in the communitys best interest, even though Prime executives generously contributed to her 2010 election. The California State Senate and Assembly Health Committees have scheduled a rare joint hearing in Los Angeles Friday to further probe Primes business practices. California Watch, the investigative website that regularly broke stories on Primes billing issues, won the prestigious George Polk Award earlier this week for its work. Although Primes troubled public image is a liability that could undo many CEOs, sources indicate Reddys departure had more to do with ongoing personality clashes with his brother-in-law, 62-year-old Prime Chairman and co-founder Prem Reddy, M.D. A cardiologist by training who emigrated from India in the 1970s, a 2007 report by the Los Angeles Times said that Prem Reddy had reportedly clashed with various employees and was once ordered by a San Bernardino County Superior Court judge to stay away from two business associates. Lex Reddy will reportedly form a new hospital management company on his own, sources say.

February 28-March 1
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February 29
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NEWS

Page 2

Self-Dealing Alleged At CalOptima

Nguyen Criticizes Chairmans Business Relationships
A philanthropy headed by the chairman of the CalOptima health plan and another organization he helps oversee are vying for more than $20 million to provide care for its enrollees, prompting conict of interest charges by Orange County Supervisor Janet Nguyen. Nguyen, who also serves on the CalOptima board, said she had not been informed the Irvine Health Foundation submitted an application last month for a $9.3 million grant from the Center for Medicare and Medicaid Innovation !a process sources say received extensive assistance from CalOptima staff. The CMMI is a division of the Centers for Medicare and Medicaid Services. The Irvine Health Foundation's president, Edward B. Kacic, 57, has served on the CalOptima board since 2009. He was appointed its chairman last August. In addition to trying to secure the grant, the Irvine Health Foundation has helped fund another potential recipient of millions of dollars directly from CalOptima, and pays another CalOptima trustee to sit on its board. "That is very problematic for me...it is a direct conict of interest," said Nguyen last week. She added that she would confer with the Board of Supervisors and County Counsel about what actions should be taken. "We have a chairman on the (CalOptima) board who is applying for these grants and doing all those other things none of use were aware of," Nguyen said. "If you're not on the board, have fun. But as a public ofcial or as an appointee to a government agency board, you're held to a different standard." Documentation submitted for the federal grant said the funds would be used to create the Healthcare Innovation Center for Orange County. It would create medical homes and other potentially money-saving initiatives for CalOptima and other Medi-Cal enrollees. It proposed a staff of 12 employees, managed by the Irvine Health Foundation. "Innovations will be tested primarily using CalOptima's highest risk membership of about 100,000 members, providing a pre-dened laboratory' that is readily measured and compared," read an abstract of the proposal. Kacic, along with CalOptima Chief Executive Ofcer Richard Chambers and Orange County Health Care Agency Director David Riley, simultaneously hold seats on the CalOptima board along with seats on the steering committee of the Managed System of Care. That body is in line to receive as much as $12.7 million in funding from CalOptima. The Managed System of Care is described by various observers as an ad hoc group of 22 Orange County healthcare leaders and professionals intent on bringing more efciencies into the region's safety net system. It includes top executives from Hoag Memorial Hospital Presbyterian, Monarch Healthcare, Kaiser Permanente!and the Memorial Care hospital system. Its member organizations have contributed more than $1.4 million toward its operations since its formation in 2009. The Managed System of Care is an initiative created by the Health Funders Partnership of Orange County. That organization received a $400,000 grant in 2010 from the Irvine Health Foundation for what is described in the foundations tax return as consulting fees, technology/IT. The grant was by far the largest made that year by the foundation, comprising nearly 90% of the dollar amount in grants it made that year, according to its tax return. CalOptima board member Margarita Pereyeda, M.D., who operates a clinic for low income residents in the county, also sits on the Irvine Health Foundation board. She was paid a stipend of $12,500 in 2010 by the foundation for her service. Nguyen noted that she had already raised concerns regarding the roles of Kacic, Chambers and Riley with the Managed System of Care, particularly regarding the plan for CalOptima to give it the funds, which would be comprised of intergovernmental transfers from the Department of Health Care Services and matching funds from CMS. Documents obtained by Payers & Providers say the money would be used ostensibly to perform the same tasks as the federal grant sought by the Irvine Health Foundation. Nguyen said she had also raised objections to a request by Robert Gates, a Managed System of Care project manager and
Continued on Next Page

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In Brief
Fielding Gives UCLA School of Public Health $50 Million Gift
The longtime leader of the Los Angeles County Department of Public Health has made a gift of his holdings in an equity rm to the UCLA School of Public Health. Valued at up to $50 million, the gift from Jonathan Fielding, M.D. and his wife Karin Fielding is the largest since the school was founded in the early 1960s. Fielding was the rst director of the Department of Public Health when it split off from the Los Angeles County Department of Health Services six years ago, and has held the post since 1997. He has been a member of the UCLA faculty since 1979, serving as a professor of health services and pediatrics. Karin Fielding, serves as an ofcer for The Everychild Foundation, which focuses on alleviating the suffering of Los Angeles-area children.! "I am humbled by the exceptional generosity of Jonathan and Karin Fielding," said UCLA Chancellor Gene Block. "This investment from longtime champions of public health reects our shared condence in the UCLA School of Public Health as a resource not only for greater Los Angeles but the entire world." The school will be renamed the UCLA Jonathan and Karin Fielding School of Public Health. The Fieldings gift comes from their holdings in Dimensional Fund Advisors, a Texas-based investment rm. The income stream from these assets, and proceeds from any eventual sale will endow a chair in population health and support the schools activities. Media reports suggested that Fieldings colleagues

Continued on Page 3

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NEWS
CalOptima (Continued from Page Two)
onetime director of the Orange County and Los Angeles County health departments, to put the IGT payment issue on the board agenda last month as an action item. "I wanted to see a budget, some performance measures, and how consultants were going to be managed," Nguyen said, before she would agree to provide any funds to the Managed System of Care. The action item was changed to a report item for both the January and February meetings. According to minutes from the Jan. 5 CalOptima board meeting, Kacic, Chambers and Riley recused themselves from the discussions. "I can't get an answer as to who's paying for who, who is on rst and who is on second, and that is the problem," Nguyen said. During a telephone interview, Kacic disclosed that the Managed System of Care played a role in the Irvine Health Foundation being selected to apply for the grant. "I agreed to do so on one condition - that the IHF not accept any money (for its services)," said Kacic, who denied assertions by sources that he had engineered much of the process himself. Kacic could not say why philanthropic organizations afliated with Memorial Care, Hoag or Kaiser did not apply for the grant instead. Gates said the intent was to have the Irvine Health Foundation act as a temporary conduit. The application needed to be submitted by a 501(c)(3) non-prot organization, which the Managed System of Care is not, and had to be completed by late last month. "We didn't have a lot of time to spend submitting the application, and this was mostly as an accommodation for the Managed System of Care...and they were essentially a placeholder," said Gates. He added it was likely the Managed System of Care may soon convert to a 501(c)(3) and eventually receive most or all of the grant money.

Page 3

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In Brief
had no idea he held assets of such value. KATHY MILLER KELLEY

CDPH Fines Four Nursing Homes For Patient Deaths

The California Department of Health has levied nes and issued citations to three Los Angeles-area nursing homes totaling $235,000 for negligence that led to patient deaths. The Downey Care Center in Downey was ned $80,000 for failing to measure the blood glucose of a diabetic patient who had been admitted several times from hospitals during 2009 and 2010. The patient lost consciousness and died partly as the result of the lack of monitoring. The nursing staff said the admitting physician had never ordered blood glucose monitoring for the patient. The Motion Picture Television Hospital in Woodland Hills was ned $80,000 after a patient with Alzheimers disease and a history of leaving supervision and experiencing falls fell out of her wheelchair on the facilitys stairwell. She suffered a severe spinal fracture and a lumbar fracture as a result and died a week later. An investigation had determined that the patient had recently been transferred from a one-story building to a two-story building where she had previously fallen. The Fountain View Subacute and Nursing Center in Los Angeles was ned $75,000 after a patient who had been evaluated for a high risk of falling had been placed in a regular bed rather than one modied to be closer to the oor. The patient suffered a subdural hematoma to the brain after falling out of bed and later died in a hospital. All three of the facilities received AA citations, the most severe issued by the CDPH.

Although the documents suggest the Irvine Health Foundation would eventually cede authority to manage the funds to another unnamed entity, no timeline for such a transfer was included in the documentation. And while Kacic said CMS ofcials had been notied of his relationship with CalOptima, no mention of it was made in the grant application, which also included letters of support from local political leaders such as Rep. Loretta Sanchez and state Sen. Lou Correa. Aside from Nguyen, the various arrangements involving Kacic have also raised the ire of at least one CalOptima employee, who described the grant application process as "self-dealing" in a letter of complaint sent to the CalOptima board last week. "Many of us working at CalOptima are just sick about what is happening to our company, and we are tired of these kind of dealings by our board," a portion of the letter read. The revelations regarding the funding plans surfaced the same week that longtime CalOptima CEO Chambers announced he would step down in April to take a position with Molina Healthcare. News of Chambers' departure came soon after an internal audit in late November was critical of his leadership and suggested CalOptima had been mismanaged. The Board of Supervisors also recently approved a plan to expand the CalOptima board and extend Nguyen's term by another year. The new allegations brought out a mixture of weariness and wariness from those involved with health plan, which insures 400,000 Orange County Medi-Cal enrollees. I'm getting tired of all this anonymous mudslinging that is going on," said CalOptima spokesman Laer Pearce. "I'm not thrilled of accusations of impropriety," Gates said. "We're just trying to provide for the county's safety net."

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Payers & Providers

OPINION

Page 4

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Healthcare The Orange County Way

CalOptimas Governance Reflects Political Culture
Orange County is geographically part of arising from not doing so has caused some of Southern California, but it is home to a Orange Countys elected ofcials and a few decidedly unique political climate that often CalOptima stakeholders to question whether touches on healthcare delivery. this Medi-Cal managed care agency should The Orange County Board of Supervisors continue to exist. passed an ordinance last year forbidding These critics have yet to suggest what Medi-Cal insurer CalOptima from should take CalOptimas place, so participating in the California the health plan should indeed Health Benets Exchange. It is the continue its vital mission of only public health plan in the managing the medical care needs state explicitly barred from and services provided to the offering services to the millions of countys poor and medically Californians who will obtain new vulnerable population. No healthcare coverage under the evidence exists to suggest that the Affordable Care Act, which is not agency cannot produce the results terribly popular in the region. and value-added benets of Now a new controversy has administering Medi-Cal and other arisen. As reported by Payers & low-income health insurance Providers, the non-prot Irvine programs at the local level. Health Foundation headed by It is true that doctors and CalOptima Chairman Edward B. hospitals have not always agreed Kacic is vying for more than $9 with the policies and practices of million in funding from the CalOptima. Many, including Centers for Medicare and Medicaid HASC, supported the successful recent By Services to provide some facets of care Jim Lott efforts to expand and restructure its to CalOptima enrollees. Kacic also cogoverning board. This was the result of chairs the Managed System of Care, growing tensions over CalOptimas lack which could receive more than $12 million in of transparency with regard to its policies and intergovernmental transfers from CalOptima. the agencys inadequate effort to collaborate As a result, Kacic has been accused of with stakeholders. self-dealing, a possible violation of state law To be sure, a certain amount of tension and rules issued by the Fair Political Practices between providers and health plans should be Commission, promising this turmoil will expected: It is a dynamic that produces a continue for some time. healthy balance between payers and providers I wont comment on the merits of the in the market place. Arguably, the tension accusations except to say that the Hospital between CalOptima and some medical Association of Southern California and the providers grew to be unhealthy and therefore hospitals serving the communities of Orange problematic. But that is surmountable and County fully support the efforts of CalOptima efforts to return to a much needed equilibrium that are cited in this controversyspecically, are underway. to improve Orange Countys healthcare My only concern is that neither the delivery system for its poorest residents. medical services provided to the vulnerable This situation does make me better patients who rely on CalOptima nor the appreciate the ethics primer produced by the payments to doctors and hospitals serving FPPC for those serving on public boards and them be disrupted by any dysfunction caused commissions. I became tediously familiar with by the continuing turmoil. That is one climate that primer when I served on the board of the differential the county cannot tolerate. L.A. Care Health Plan CalOptimas Los Angeles County equivalent. A key takeaway Jim Lott is the executive vice president of the if not the governance rst commandment itself Hospital Association of Southern California. is to avoid even the appearance of impropriety or conict of interest. Op-ed submissions of up to 600 words are CalOptimas board should take that rst welcomed. Please e-mail proposals to commandment closer to heart. The turmoil
editor@payersandproviders.com

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MARKETPLACE/EMPLOYMENT

Page 5

SNF NURSE PRACTITIONER/PHYSICIAN ASSISTANT (Long Beach, CA)

The Nurse Practitioner/Physician Assistant is responsible for evaluating and treating physical and psychosocial health needs of the adult and geriatric patient in the Skilled Nursing Facilities. The SNF NP/ PA is responsible for seeing all patients at least once per week and within 72 hours of admit. Education and/or Experience: Nurse Practitioner: Completion of Family or Geriatric Nurse Practitioner program from an accredited school, Board of Consumer Affairs, Masters Degree in Nursing, Registered Nursing License, Furnishing License & BLS. Physician Assistant: Has a current California license issued by the Physician Assistant Committee (PAC). 2 years of experience preferred. Willing to train new graduate who meets the skills and job requirement.

HOSPITALIST (Los Angeles, CA / High Desert, CA / Modesto, CA / Phoenix, AZ / Las Vegas, NV)
The Hospitalist provides Internal Medicine Services to patients. Responsibilities include: Round in the hospital in the mornings and sees an average of 6 to 10 patients. Conference calls with Case Managers to review patients, and discuss the discharge needs and plans. Admit the patients from the ER in the afternoon (usually 2 to 4 patients), if they are assigned float position for the given day. Work with Case Managers in transferring the patients from out of area hospitals into network hospitals. See patients in the CareMore Care Center (CCC). All patients discharged from the hospital are seen by the Hospitalists in the clinic until they are stabilized. Patients with falls are assessed. Pre operative clearance is done on patients undergoing surgeries requiring general and spinal anesthesia. Assist Nurse Practitioners by reviewing the cases with them. See the skilled patients in the SNFs. These patients are seen once a week until they remain skilled, which is normally from 1 to 2 weeks. Attend the SNF meetings once a week to review the cases. Education and/ or Experience: Internal Medicine Residency, Medical Doctorate, and minimum of 2-3 years of Hospitalist experience preferred. Bilingual Spanish preferred. Certificates, Licenses, Registrations: Medical License in the state in which you are applying, DEA license. Must be board-certified or board eligible in specialty.

TOUCH NURSE PRACTITIONER (Tucson, AZ / Las Vegas, NV)

The Nurse Practitioner for our Touch program (institutional special needs plan), ensures effective and efficient treatment of our Touch members. This individual will be responsible for managing patient care at multiple facilities through the implementation of cohesive and efficient processes, with emphasis to include patient and family satisfaction and physician and facility support. This individual provides general medical care and treatment to members in institutionalized settings such as nursing homes, assisted livings, or board & care facilities, under the direction of the Physician. Education and/or Experience: Masters degree in Nursing with emphasis in Family, Adult, or Gerontological practice. Certificates, Licenses, Registrations: Current registered nursing license and Nurse Practitioner license in good standing with the state in which you are applying.

PRIMARY CARE PHYSICIAN (Anaheim, CA)

The Primary Care Physician provides Internal Medicine/ Family Practice Services to patients. Responsibilities include: Provides medical patient care by interviewing, examining and treating of clinical patients in order to meet their medical needs. Educates patients on wellness, prevention and early detection by providing materials and resources to the patients and families. Determines which referrals are required based on examination and patient needs. Participates in quality improvement, management, continuing education, and other patient care programs established by the medical group. Assists in the resolution of complaints, requests and inquiries from patients. Maintains confidentiality of all patient information according to federal guidelines and regulations. Completes medical records (EMR) documentation daily. Night calls. Certificates, Licenses, Registrations: Medical License in California, DEA, Internal Med or FP, Board Eligible or Certified.

EMPLOYEE RELATIONS MANAGER (Cerritos, CA)

The Employee Relations Manager partners with Senior Management and the Human Resources Management team regarding policies, programs and practices. Provides guidance, advice, counsel, and leadership on various aspects of the employment relationship to all levels of employees. Utilizes the disciplines of Human Resource management, employment law, internal procedures, policies, practices, and programs to support the achievement of the organizations strategic objectives and shape a culture that meets the company Values, Vision, Mission, and Business Strategy. Education and/or Experience: Bachelors degree in Business, Human Resources, or equivalent combination of education and experience required. Minimum of 5-7 years of experience in employee relations and 2-5 years of experience in management. Background in employment law and other government compliance regulations is preferred. Certificates, Licenses, Registrations: Certification in Human Resources preferred, but not required.

To submit your CV/Resume for consideration, visit http://www.caremore.com/en/About/Careers.aspx to apply online.

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MARKETPLACE/EMPLOYMENT

Page 6

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
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Alameda Alliance for Health is a public, not-for-profit managed care health plan for lower income people in Alameda County. The Alliance provides healthcare coverage to over 130,000 children and adults through four programs: Medi-Cal, Healthy Families, Alliance Group Care, and Alliance CompleteCare.
This position assists in the day-to-day supervision of Claims staff and claims work flow ensuring that all claims are adjudicated within appropriate time frames. This position will train Claims staff and advise management on opportunities to improve claims processing procedures. Medicare claims processing experience is required. Must have detailed knowledge of claims coding and forms and the ability to correctly interpret and communicate claims processing rules, regulations, and procedures to staff and external customers. 3 years of experience in a medical managed care claims processing environment and 1 year of supervisory experience is required. A High School Diploma and relevant experience is required with a B.S. degree preferred. Excellent salary & benefits.

SUPERVISOR, CLAIMS RESOLUTION

This position will oversee the application portfolio and be responsible for the overall functionality and configuration of systems that support the organization. The position will also manage the performance and functions of analysts who are responsible for configuration including planning, reviewing and controlling activities of project team members. Will also identify solutions that result in high quality, cost effective support to all levels of users including support for both the technology and business processes. Must have a minimum of 7 years managerial and professional experience in the applications or information systems field and technical work experience in positions such as configuration/ development analyst, business analyst, systems analyst, etc., in a managed care organization. Excellent salary & benefits.

DIRECTOR, APPLICATIONS & CONFIGURATION

Please visit our website at www.alamedaalliance.org and click on the Careers button for more specific job information and to apply for these positions. EEO.

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MARKETPLACE/EMPLOYMENT

Page 7

MDS Consulting is a national healthcare consulting firm with substantial healthcare management experience working in and with hospitals, medical groups, health systems, and other healthcare organizations. Qualified candidates should email their rsums and expectations to blambon@mdsconsulting.com VICE PRESIDENT OF PHYSICIAN SERVICES MDS Consulting is seeking a consulting leader that is highly experienced in medical group, medical foundation, and physician practice development and operations. The successful candidate will have depth of knowledge regarding compensation plans, information technology, organizational structure and finance related to medical groups, IPAs, and ACOs. Development skills in client relations, team management, communications, and report writing a necessity. Position located in Southern California and requires a Masters degree in related field and at least 10 years of related experience. SENIOR MANAGER OF PHYSICIAN SERVICES The Senior Manager of Physician Services manages client engagements related to medical group operations, physician/hospital alignment models, physician contracts, compensation and fair market value studies, etc. Candidate will have excellent analytic and communication skills and a strong financial background. Masters degree with at least 5 years of related experience required. The position is based in Los Angeles.

DIRECTOR OF PROVIDER NETWORK DEVELOPMENT & SERVICES (Managed Care)

The Health Plan of San Mateo (HPSM), an innovative Medicaid and Medicare health plan, seeks a strategic thinker and doer to guide development of its network strategies as it embarks on significant new program ventures and prepares for health reform. Reporting to the Chief Executive Officer and as a senior manager of the organization, the Director will maintain responsibility for the strategic development and management of HPSMs provider network, including contracting, compliance, quality, provider relations, and associated activities and data analysis; and provide direction to department staff. Requires a Bachelors degree in Business Administration, Healthcare Administration or a related field; a Masters degree is preferred. 5 years contracting and network development/management experience in a managed care setting (HMO, IPA/Medical Group or equivalent) at a senior management level. Please visit www.hpsm.org for more information about the position and the excellent benefits offered. For immediate consideration, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 701 Gateway Blvd., Suite 400, South San Francisco, CA 94080. Email: careers@hpsm.org. Fax: (650) 616-8039. Phone: (650) 616-0050. EOE

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