payers & providers -- issue for february 4, 2010

8/14/2019 Payers & Providers -- Issue for February 4, 2010

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Intensive care patients at hospitals in LosAngeles County and the Bay Area sufferinfections of their central lines at greatly

varying rates, according to new datareleased this week byConsumers Union.

The New York-based advocacygroup, whichpublishes ConsumerReports magazine,linked improvedinfection rates tomore consistentpublic reporting ofsuch infections byhospitals. However, it suggests

the California Department ofPublic Health may not be able to releasehospital infection rates by early 2011,despite state laws mandating it do so.

We have not seen in California thekind of can-do attitude about reportinginfection rates that we have seen in otherstates, says Lisa McGiffert, director ofConsumers Unions Safe Patient project,which used 2008 data the hospitalsvoluntarily submitted to the LeapfrogGroup for its survey. McGiffert insinuatesfoot dragging on the part of hospitals,which she says have been submitting

infection reports to the CDPH on paper,which must then be inputted manually.

Jim Lott, executive vice president ofthe Hospital Association of Southern

California, confirms that the data hasbeen submitted by hospitals on paper,

but dismisses theallegations asinsignificant.

Were nottalking about ahuge datasubmission, saysLott, who sits onthe Payers &Providers EditorialBoard. If there

were thousands or millions of

datapoint entries, that wouldbe one thing, but its not.

Officials with the California HospitalAssociation also dismissed theallegations. The CDPH was unable toimmediately respond.

Despite the criticism fromConsumers Union, 47 of the 70 hospitalsit surveyed reported either no central lineinfections at all, or infection rates belowthe national average, which it calculatedat just above two infections per every

Central Line Infections All Over MapGroup Says Hospital Reporting May be Delayed

California Edition

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March 9-10

February 10

Calendar

4 February 2010

February 10

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[email protected]

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

Continued on Next Page

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Central Line Infection Rates, 2008

Foothill Presbyterian Hospital No Infections

Stanford Hospital & Clinics 64% above average

Alvarado Hospital 24% above average

Miller Childrens Hospital 27% below average

USCF Medical Center 80% below average

St. Francis Medical Center 177% below average

Source: Consumers Union
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Payers & Providers

1,000 hours a patient is attached to acentral line. Each infection costs onaverage $42,000 to treat, according toConsumers Union.

Twenty-three hospitals had rateshigher or significantly higher than thenational average. Eighteen of those werein the Los Angeles area.

Lott says the disparity between theBay Area and Los Angeles was simply anexpression of the law of averages. Thereare a lot more hospitals here, he says.

Alhambra Hospital Medical Centerhad the worst rate, 440% above thenational average. Iris Lai, the hospitalschief executive officer, did not respond toa request for comment.

Despite having a checklist in placefor appropriately inserting and maintaingcentral lines, Kaiser Permanentedemonstrated disparities among many ofits hospitals. For example, five of itshospitals reported no infections at all.Nine reported rates that were better thanthe national average. But its facilities inSan Jose, Oakland, West Los Angeles andWoodland Hills reported rates worse thanthe average. The Woodland Hills facilitysrate was 330% worse than the nationalaverage.

Kaiser spokesman Jim Anderson says

the Woodland Hills hospital has since

Page 2

revised the way it maintains its centrallines, and has not had a reported infectionsince 2008.

A similar disparity occurred within theUCLA hospital system. UCLA RonaldReagan Medical Center was above thenational average, while its Santa Monicacampus was below. Improvements havesince been made at the Santa Monicahospital, according to UCLA officials, andboth campuses are now comparable inperformance.

McGiffert notes that central lineinfection rates can vary between hospitalseven under the same management,particularly if protocols are not rigidlyfollowed. Its not a matter of just following

a checklist, but of changing the culture,allowing nurses to step in if doctors orsomeone else do something that poses athreat (of infection), she says.

Ultimately though, McGiffert saysfollowing protocols are not a proxy forreporting infection rates.

Lott says that a recently announcedpatient care collaborative betweenCalifornias three hospital associations, BluCross of California and the National HealthFoundation will address the rates of centralline infections directly and bring themdown significant ly.

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Mixed News on Health Net Earnings2010 Forecast is Strong, But Enrollment Still Down

In Brief

United HealthGroupPledges $14.3M to L.A.

Non-Profit

An initiative of Minneapolis-basedUnitedHealth Group has earmarked

$14.3 million to help finance theconstruction of a new center for LosAngeles-based Childrens Institute,Inc.

The money was providedthrough UnitedHealths purchase oftax-exempt bonds through itsCalifornia Health Care InvestmentProgram. That initiative is spending$200 million over a decade tohealthcare organizations in thestate that provide services tounderserved populations.

Childrens Institute will use thefunds to build a new campus andheadquarters near downtown LosAngeles. It will provide health and

social services to 5,000 families peryear.

We are pleased to be able tohelp Childrens Institute meet itscommunitys healthcare and socialservices needs, and we believe it isessential that underserved residentsin Los Angeles have such animportant health care and socialservices resource in theircommunity, says Steve Nelson,CEO, UnitedHealthcare westregion.

John Muir HealthOpens Center to Treat

Incontinence Issues

Walnut Creek-based John MuirHealth is opening a new Center forWomens Continence & PelvicHealth later this year.

The center, which is located atthe hospital systems womenshealth center in Walnut Creek, willfocus on educating and womenwho are confronted by

Infections (Continued from Page One)

Woodland Hills-based insurer Health Netsays its transition to a leaner and morefocused company has placed it in a positionto have a competitive 2010, but it does notexpect a drop in its enrollment to be reversedanytime soon.

Health Net reported a loss of $45.2

million for the quarter ending Dec. 31, onrevenues of $3.8 billion. Much of the loss is

attributable in $106 million in writedowns ittook associated with the sale of itsnortheastern operations to UnitedHealthcarefor $350 million. For the fourth quarter of2008, it earned $35.6 million on revenues of$3.9 billion.

For the year, Health Net reported a loss o

$49 million on revenues of $15.7 billion. It

Continued on Page 3

NEWS

Continued on Next Page
http://www.lakesidecommunityhealthcare.com/


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Despite a relatively tough job market fornurses, a new survey by San Diego-basedstafng rm AMN Healthcare suggests thatmany may soon exiting the profession forother jobs.

According to AMNs survey of nearly1,400 nurses that occurred in December, 29%say they plan to take steps to reduce their rolesas nurses, or take them out of nursingaltogether. Another 15% say they play toswitch from their current roles and becometraveling nurses or nurse practitioners.

Job dissatisfaction appears to be playingsome role. Twenty-nine percent of nursessurveyed say they often feel like resigning theirposition. Forty-six percent say they worry theirwork is affecting their health.

Our survey clearly indicates signicantjob dissatisfaction and that is concerning in

terms of quality healthcare delivery, says

Ralph Henderson, president of AMNs nursinand allied division. Nurses are at the core ofquality care in our nation's delivery systemand if we see large numbers of nurses leavingthe profession it could negatively impact

patient care outcomes.Although the nursing profession has beenimpacted by the recession and recent studiessuggest as many as 40% of new nursinggraduates cannot nd jobs, most expertsbelieves that the long-term nursing shortagewill be exacerbated when the economyimproves. Peter Buerhaus, a professor ofnursing at Vanderbilt University, projects ashortage of some 260,000 nurses nationwidebefore the end of the decade.

Nonetheless, the AMN survey did ndsome bright spots: 66% of respondents saythey are satised with their current job.

Another 65% say they would recommend theprofession to others.

Page 3

Staffing Firm Finds Nursing BurnoutSuggests Many Will Seek Change in Careers

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NEWS

In Brief

incontinence issues. It the onlycenter of its type in the East Bay.

When something affects yourdaily life, it is not normal and youneed to find trusted resources toaddress your health issues, saysRachel Cabriera, a nursepractitioner who will work at thecenrer. We listen to your problemsand provide a variety of treatmentoptions to best match your needs:nutrition counseling, medication,biofeedback, physical therapy,behavior change, and surgicaloptions including minimallyinvasive procedures for quickerrecovery. Patients will be guidedthrough services via a conciergecenter, Cabriera says.

Biomed Jobs HoldSteady During

Recession

While much of California hassuffered huge jobs losses duringthe Great Recession, the statesbiomedical industry has faredrelatively well.

According to a report by theCalifornia Healthcare Institute andPricewaterhouse Coopers LLC,64% of the states biomedical firmseither maintained or grew theirnumber of employees. Eighty-onepercent of the firms expect tomaintain or grow their workforceover the next two years.

However, two-thirds of thecompanies surveyed expect to

expand their manufacturingcapabilities outside of Californiaover the next two years. And morethan half expect to expand theirresearch and development staffsout of state.

And job growth has slowed toa crawl the state added only3,000 biomedical jobs in 2008, up

just 1% from 2007.The Bay Area has the largest

number of biotech jobs nearly52,000. Los Angeles has slightlymore than 45,000 jobs.

earned $95 million on revenues of $15.4billion in 2008.

Chief Executive Ofcer Jay Gellert saysthat the company will now focus exclusivelyon west coast operations, and emphasizelow-cost products such as its health plansconnected to smaller, easier-to-managemedical networks.

Our structure is now simpler andclearer, Gellert says. With the sale toUnitedHealthcare, the company had $450million cash on hand at the end of 2009. It isusing some of the money to reinitiate a stockbuyback program it had suspended forseveral years. It has also been trimmingexpenses and jobs, about 1,300 in the pastyear, according to Gellert.

As a result, the company projects 2010

earnings to be in the range of $1.92 to $2.02 share, or about $200 million, on revenues ofabout $13 billion. That includes a projected$69 million in writedowns.

However, Health Net projects its 2010enrollment to be at. Its Caliornia enrollmentdropped 1.3% from the end of 2008 to the enof 2009, although its small group andindividual enrollment dropped nearly 14%,and its large group dropped 9.2%. This wasoffset in part by gains made in Medi-Cal andMedicare enrollees.

Weve been careful to priceresponsibly, and are seeing some initial signsof enrollment improvement this year, Gellertsays.

Health Net (Continued from Page Two)

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Payers & Providers Page

We have been distracted by the stallednational healthcare reform effort and asoon-to-be-doomed local effort from a newtornado about to descend on California.

What attention is being paid to thestates healthcare affairs has been on thesingle-payer bill sponsored by State Sen.Mark Leno, D-San Francisco. Leno got hisbill through the Senate, but it ispreordained to fail: Gov.Arnold Schwarzenegger willveto it as surely as he lightsup his afternoon cigars.

Ironically, Lenos stillborn

legislation is at the momentthe only thing that mightcushion the impendingcollision betweenCalifornias providers and yetanother round of profoundbudget cuts the Legislaturewill undertake later this year.If you thought the reductionswere bad for 2009 and 2010,what could be in store for2011 may make them seem like fender-benders.

The Schwarzenegger Administration

is looking to close a projected $19.9billion budget gap, which comes on top ofthe $21 billion gap that had to be closedlast year. It was done so by eliminatingsome healthcare entitlements completely,such as the Denti-Cal program for adults.The only alternative is to revisit healthcareexpenditures and reduce them further.

Whats potentially on the choppingblock? Heres a list:

Healthy Families This source of insurancefor nearly 1 million of Californias

children could be eliminated entirely. Itescaped this fate in the last budget yearwith a last-minute injection of funds fromthe Obama Administration and First 5California, but the chances of gettingoutsiders to pony up again is in doubt.This is in contraindication of many states,which have moved to expand their S-CHIP programs in recent years.

Medi-Cal Inpatient Payments Despite thefact that the Medi-Cal program is in some

ways untouchable, there are still ways tLegislature could enact backdoor cutpayments to hospitals. For instance, theDepartment of Health Care Services codecide to only pay for six days of inpatcare. Such a cut was first attempted in tmid-1990s, but the California HospitalAssociation sued and won. However, thvictory pivoted on a legal technicality.

the state can find a loophoto exploit that will hold ucourt, it will. Resolving sumatter could take years. Kin mind that litigation from

the 10% cuts inreimbursement enacted intrailer bill ABX 5 two yearago is still ongoing.

The Aged, Blind andDisabled Deep cuts are lito occur in this segment.Particularly vulnerable arepeople with developmentdisabilities who receive

community-based services. Adult DaHealth Care which gets many eldeCalifornians out of their homes is

likely to be eliminated entirely.

The days of steep recession and colosbudget deficits will not last forever. Howethe long-term health of millions ofCalifornians could be profoundly impactedeep cuts in these programs. Providers walso be impacted in the form of moreuncompensated care, a more acute inpatipopulation and other costly consequence

It is therefore imperative that we notdistract ourselves with single-payer healthbills that have no chance of being enactenow, and focus on the dire cuts that are

almost certain to be inflicted in theimmediate future.

OPINION

The Big Storm Coming This WaySingle-Payer Bill Has Distracted From Looming Cu

By

Jim Lott

Jim Lott is the Executive Vice President of the

Hospital Association of Southern California. He

member of the Payers & Providers Editorial Boa

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Op-ed submissions of up to 575 words a

welcomed. Please e-mail proposals to

[email protected], or ca

(877) 248-2360, ext. 3.


5/7
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

Senior Clinical Data Analyst - manages the HEDIS project and oversees activities related to datacollection and analysis, vendor selection and oversight, quality control, directing the activities required for

the annual external HEDIS audit, and reporting the nal results to NCQA. Responsibilities includecoordination of information collection from key departments and Plan Partner contacts. The individual

works closely with the lead medical record abstractor and schedulers, to assure accurate and timelyproject completion. The position is supported by the clinical data analysts and secretary in the HealthcareOutcomes and Analysis Department. The Senior Clinical Data Analyst deals directly with the external

HEDIS auditor and contract vendors, conducting data quality checks to assure electronic data sourcesare correct and complete throughout the project. The individual also conducts an annual debrief with the

Plan Partners, consisting of an executive summary and detailed descriptive analysis of the ndings byPlan Partner and product line, including trends, statistical tests for differences between years, and

comparison with other plans and benchmarks. The individual participates in key discussions with theState Department of Health Services (DHCS) and key quality intervention meetings within theorganization, and supports the director of Healthcare Outcomes and Analysis in contract negotiations with

vendors and the annual budget. !!For complete job description, requirements/qualications, and additional opportunities, visit our website:www.lacare.org!To apply, email resume with salary history/requirement to: [email protected], referencingPayers & Providers Ad
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7/7

Page 7MARKETPLACE/EMPLOYMENTPayers & Providers

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payers & providers -- issue for february 4, 2010

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