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Despite years of concern about crowdedemergency rooms, many Californiahospitals have embarked on aggressivelycourting patients to their ERs – a nascent

campaign that has raised concerns amonghealthcare advocates and providers.At least 10 for-

profit and not-for-profit facilities havein recent monthsbegun marketingtheir ERs as aselling point forswifter healthcaredelivery. This isdespite the fact anew Press Ganeyreport concludes ER

waiting timescontinue to increasestatewide (see InBrief, page 2).

The marketingcampaigns include:

• Hospital Corp. of America’s fivehospitals in California are using a textingservice for patients to determine ERwaiting times. The waiting time of theclosest hospital is sent to the would-bepatient’s phone, or they are urged to calla toll-free hotline for more information.

• Loma Linda University MedicalCenter offers a service for patients tomake ER appointments online for a $25fee.

• Two Tenet Healthcare Corp.hospitals – SierraVista RegionalMedical Center inSan Luis Obispoand Placentia-LindaHospital inPlacentia – havebegun postingwaiting times on itswebsites.

Other hospitals

are alsomarketing theirERs throughmailers toprospective

patients. Their content suggests thehospitals are trying to displace primarycare physicians or community clinics asproviders of non-emergency care.

One consumer mailer, sent out byPetaluma Valley Hospi tal in Sonoma thismonth, boasted that “our average waittime is anything but average.” It alsotouted free parking and provided a map.

The Hospital ER As Main Selling PointFacilities Market Wait Times – And Prompt Concerns

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Calendar 

29 July 2010

September 22-24

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E-Mailinfo@payersandproviders.comwith

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

California Edition

HCA’s five California hospitals have been

marketing ER wait times via cell phone sinceMarch. This consumer-oriented mailer is for the

service at Riverside Community Hospital.

NON-PROFIT HOSPITAL CEO SALARIES

A PAYERS & PROVIDERS EXCLUSIVE WHITE PAPE

Analyzes Compensation Of Nearly 120 of California’s CEO

$149 (Executive Summary) $275 (Summary and Salary Data)

Call (877) 248-2360, ext. 2 to order, or CLICK HERE

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Payers & Providers

“We wanted to seek to appeal to abase of consumers beyond the PetalumaCommunity,” said hospital spokesperson

Katy Hillenmayer. She added the hospitalrecently reconfigured its ER operations toreduce waiting times.

“There is a faster turnaround time forER services here, and if a patient isequidistant between our hospital andanother facility, they should consider ourhospital,” Hillenmayer said.

Hillenmayer disputed that the mailerwas encouraging patients who do not havea medical emergency from using PetalumaCommunity’s ER. That’s despite the fact themailer contains a warning that those with“life threatening emergencies” should call

911 – an option that tends to eliminatehospital choice.

Nonetheless, such marketing appearsto be the wave of the future for the state’shospitals. According to the CaliforniaHospital Association, 80% of hospitaladmissions come through the ER,compared to about 50% a couple of decades ago. That means the ER can be asignificant source of revenue if manageddeftly.

“Despite all the protestations abouthospitals losing money on their ERs, itserves as a loss leader for them in terms of 

bringing in new business” said AnthonyWright, executive director of HealthAccess, a patient advocacy group.

Wright considers the marketing of ERwait times as good for consumers,particularly in congested urban areas suchas Los Angeles. But he and otheradvocates raised a concern that suchmarketing may encourage theinappropriate use of ERs and cherry-picking of paying patients.

“It’s a good business decision if they’retargeting insured patients,” said JudyDugan, director of research for Consumer

Page 2

Watchdog, a Santa Monica-basedadvocacy group. “But it’s the opposite of what the healthcare system needs.”

Dugan noted that many patients arecharged co-payments and other fees theywould not incur if they visited theirprimary care physician or an urgent careclinic.

“We’re not allowed to give discountsfor ER care,” said Ron Yukelson, directorof business development for Sierra Vista.

The cost concern was echoed by theCalifornia Association of PhysicianGroups, which represents many primarycare doctors statewide.

“It’s good customer service, it’stransparency, it’s consumerism, and I

think you have to applaud that,” saidWilliam Barcellona, the CAPG’s vicepresident of government relations. “Iwould just hate to think that patients whoget access to medical groups for freewould get into a queue at the ER.”

Barcellona noted that on January 1,most of the state’s medical groups mustcomply with timely access regulationsthat would prompt them to provide same-day care. He added that many medicalgroups have been marketing their quickappointment times. However, they mustcompete with hospitals that are open

around the clock, and it appears they aregoing to tout that advantage.

Meanwhile, hospitals such a SierraVista are taking a close look at theprogram launched by Loma Linda. It usessoftware created by InQuickER, aGeorgia-based firm that helps schedule Eappointments online for seven hospitals,mostly in the Southeastern U.S.

“We’re a small community hospital ina rural area, and we have to keep thelights on,” Yukelson said. “Our goal i s tohave or drive a paying patient here.”

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In Brief 

Survey: ER Wait TimesContinue To Climb

A new report by the South Bend,Ind.-based research firm PressGaney concludes that hospital ERwaiting times in California and therest of the nation climbed in 2009after retreating in 2008.

The overall ER wait timeclimbed four minutes in 2009, tofour hours and seven minutes. InCalifornia, the average timeclimbed two minutes, to four hoursand 34 minutes. The state iscurrently ranked 40th for ER waittimes, unchanged from the lastsurvey.

The shortest wait time belongsto Iowa hospitals, which averaged

two hours and 55 minutes, a dropof seven minutes from 2008.Nevada had the biggestimprovement, cutting ER wait timesby 66 minutes, to four hours and 22minutes. It was among 32 statesthat have cut their waiting times.

“Some states have done reallywell in keeping emergencydepartment times in check, despitegrowing challenges of higherpatient volumes and understaffing.But there’s still a long way to go tomake visits to the emergencydepartment much more efficient forpatients,” said Deirdre Mylod, PressGaney’s vice president of hospital

services.The worst waiting timesbelonged to Utah, with an averagewait of six hours and 17 minutes,up 89 minutes from 2008. Thereport suggested that the state’shigh level of uninsured, and lowlevel of beds and licensed medicalstaff have contributed to the logjamat its ERs.

. 

ER Marketing (Continued from Page One)

Continued on Page 3

NEWS

Expert Healthcare Communications

!White Papers !Media Campaigns !Newsletters

(818) 848-8510 www.rfsconsult.com

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Page 3Payers & Providers

Longer ALOS!*

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(877) 248-2360, ext. 2

*For our ads, not your hospital

NEWS

In Brief 

Kehaly To Take ReinsOf Anthem Blue Cross

Anthem Blue Cross of California has

named Pam Kehaly as its newpresident and general manager, aweek after the departure of LeslieMargolin.

Kehaly will begin work on Aug. 30.She was previously at Aetna, servingas president of national accounts.

“Her extensive experiencein...management, strategic planning,and operations management will bean asset to our California team andour commitment to deliveringoutstanding service to our customersand members throughout the state,”said Ken Goulet, president of commercial business for Blue Cross’Indianapolis-based parent company.

Margolin announced her departurelast week. Anthem Blue Cross hadcome under re in recent months fortrying to impose premium increasesas high as 39% for its individualmembers earlier this year. Blue Crossretreated from the rate increase, butAnthem of cials say it was not relatedto Margolin’s departure.

Kaiser Data GuidesJoint Replacements

A study of Oakland-based KaiserPermanente’s registry of joint

replacement patients shows anelevated risk for the procedureamong younger patients, thosewith diabetes and those who aresuffering from a disease other thanosteoarthritis.

The data was drawn fromKaiser’s Total Joint ReplacementRegistry, which includes more than100,000 patients nationwide. Thestudy was recently published in the

 journal Clinical Orthopaedics and Related Research.

AHF Extends Ban To Bristol-MyersChiang Joins Battle to Lower Price of AIDS Drug

The California Health Care Foundation hasprovided $280,000 in funding to help 20hospitals participate in Project BOOST (BetterOutcomes for Older Adults through SafeTransitions), a program operated by theSociety of Hospital Medicine.

Project BOOST is a training programfocused on hospitalists and allied healthcarestaff to minimize the number of inpatients whoare readmitted to hospitals within 30 days of discharge. Such readmissons cost theMedicare program alone more than $17billion a year.

According to Janet Nagamine, M.D., ahospitalist with Kaiser Permanente SantaClara Medical Center and chair of ProjectBOOST’s California Leadership Council,

participants will be trained in more closelymonitoring patients at high risk forreadmission, such as those taking ve or mormedications.

Under BOOST, such patients would beclosely monitored by both hosptialists and

primary care physicians after discharge.BOOST has proven a success elsewhere.

At the Piedmont Health Care hospital inAtlanta, readmission rates among patientsyounger than 70 dropped to 8.5% from 25%.Rates among patients over 70 dropped to22.1% from 26.1%.

The 20 hospitals that will participate willpay a $14,500 fee for the two-year program,supplemented by the CHCF grant. Participantwill be announced by the end of the year. 

The AIDS Healthcare Foundation has bannedsales representatives from Bristol-MyersSquibb from its clinics for refusing to lower theprice of its antiretroviral medication – part of abattle against escalating drug prices the LosAngeles-based organization claims it’swinning.

California State Controller John Chianghas joined the AHF in applying pressure onBristol-Myers. In a letter Chiang sent to Bristol-Myers Chief Executive Of cer LambertoAndreotti on July 9, he chastised the New YorkCity-based rm for raising the wholesale priceof its antiretroviral drug Reyataz more than25% since it was introduced to the market in2003. A year’s regimen of the drug costs morethan $13,000 a year, and must be combinedwith other antiretroviral medications to beeffective.

“California has no interest in deprivingpeople withHIV/AIDS of drugs that keep themalive, so the only available recourse is to reinin the growing drug costs,” Chiang wrote,adding that the current budget crisis hasstretched the state’s drug assistance programthin.

Nationwide, more than 2,000 patients areon waiting lists to receive nancial assistance

in order to receive drugs to treat HIV or AIDS,

according to AHF data.It’s the second time this year that AHF

has banned pharmaceutical salesrepresentatives from its clinics after it claimethe companies engaged in price gouging ontreatments for AIDS patients. In January, itbanned pharmaceutical manufacturer Merck& Co. after it refused to reduce the price of iantiretroviral drug Isentress.

However, Merck has since relented anddoubled the rebates offered on Isentress,saving global customers about $35 million ayear, according to AHF President MichaelWeinstein, who said the ban on Merck woube lifted shortly.

Merck is among several drugmanufacturers that have agreed to reduceprices after AHF applied pressure – leading twhat Weinstein estimates will be a savings oabout $135 million a year for patients anddrug assistance programs.

AHF of cials claim that mostantiretrovirals can be sold for less than$9,000 per patient per year at the wholesalelevel.

“To the extent that we’ve been successfuso far, I expect we will eventually besuccessful with (Bristol-Myers),” Weinstein

said.

CHCF Funds BOOST Hospital ProgramProject Will Focus On Cutting Costly Readmissions

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Payers & Providers Page

Healthcare is a business of relationships.Patient to doctor. Doctor to hospital.Hospital to community. Like otherrelationships that endure over time, thosein healthcare are built on a foundation of trust, respect and mutual benefit.!

More and more, hospitals nationwideare discovering the awesome power of relationships. Nowhere is this moreevident than right here in California,where hospitals and systemssuch as Huntington MemorialHospital in Pasadena, Mission

Hospital in Orange County, Loma Linda University MedicalCenter and Sutter Health inSacramento are reaching out tolocal employers as neverbefore. By cultivating andnurturing relationships withthis critically importantaudience, these hospitals havefound a way to attract new anddesirable customers, buildprofitable market share, anddistinguish themselves as thehealthcare destination of choice in

their communities.!

Historically, hospitals have reliedon traditional marketing and advertisingtactics to raise community awareness andgain market share. Yet this approachblankets the entire population eventhough not all payer profiles are createdequally. To offset other declining payersources, hospitals must attract patientswho bring with them a desirablereimbursement profile. That means notonly insured consumers but those whoseinsurance translates into the right payermix for the institution. !

Since a large percentage of America’shealth benefits originate at the worksite,local employers represent a logical placefor a hospital to direct its businessdevelopment strategy. Whether interestedin reaching commercially insuredconsumers in the workplace, influencinggroup health benefits and open enrollmentdecisions, or gaining access to valuableoccupational health, intelligently targetinglocal employers offers the best approachto smartly increase market share andenhance revenue.

On a daily basis, local business owneare making purchasing decisions that impthe revenue of the hospital and its medicastaff. They are asking themselves:!

• Which health plans should I makeavailable to our employees?

• Which providers should be includethese plans?

• How can I better address employeehealth risks as a means toreduce claims and lower mycost of health benefits?

•How can I better promote health of our employees?

•Who is best equipped to mour occupational health neeWho can I trust to guide methrough these important issu

All of these questions represopportunities for those locahospitals ready to take aleadership role in influencin

businesses as they make thesedecisions. !Building relationships with local

employers is a successful strategy fhospitals because it is one whereeveryone wins. Hospitals win by drivingdesirable patient volume into their facilit(and medical staffs) and establishingthemselves as the provider of choice in thcommunity. Employers win because byworking with the local hospital they are ato identify employee health risks andimplement employee-specific earlydetection, prevention and educationalinitiatives. This creates a healthier workfowhich saves them dollars in insurancepremiums, absenteeism and worker’s

compensation claims. And employees winlearning more about their health risks anddeveloping the knowledge and tools theyneed to lead a healthier lifestyle. !

OPINION

Building Relationships To Heal LivesWhy Hospitals Should Market Directly to Businesses

By

Henry

Ross

Henry Ross is chief executive officer of Aeg

Health Group, one of the nation’s leading

healthcare business development firms.

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^-4!X3/4F:(4)0/B-*S=(&)*+(40=*-./0)*+?A-: Op-ed submissions of up to 600 words are

welcomed. Please e-mail proposals to

editor@payersandproviders.com, or call (87

248-2360, ext. 3.

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*New England Journal of Medicine, 2004.

Page 6

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