Payers & Providers California Edition – Issue of August 23, 2012

7/31/2019 Payers & Providers California Edition Issue of August 23, 2012

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Calendar

23 August 2012

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

published in the Calendar section,space permitting.

California Edition

In the ve years since the CaliforniaDepartment of Public Health beganpenalizing hospitals for safety lapses thatendangered patients lives, nearly 30 hospitals

have appealed the discipline meted out by theagency.A tiny facility in the northwestern corner

of the state is the only one to have completedthe process so far.

The 78-bed Mad River CommunityHospital in Arcata prevailed after a two-dayhearing in front of a Sacramentoadministrative law judge in May 2010,according to documents obtained by Payers &Providers as part of a public records request.The CDPH dropped the penalty and $25,000ne against the hospital during the second dayof the hearing, which lasted exactly two

minutes.What transpired during the rst day of thehearing remains mostly a mystery. Accordingto CDPH spokesman Ralph Montano, theagency called two witnesses: Mad Rivershealth facilities evaluator nurse and thatemployees supervisor. They testied and werecross-examined by the two attorneysrepresenting the hospital: Michael SpikeMorrison and Amelia Burroughs. Bothpractice at a small rm in Eureka, according torecords of the hearing.

However, the CDPH did not release toPayers & Providers a transcript of the rst day

of the testimony. Montano said the agency didnot have one on hand. Morrison, Burroughsand Mad River ofcials did not respond torepeated requests for comment.

According to CDPH records, Mad Riverhad received the penalty and ne for a Januar2008 incident when a patient undergoingspinal x-rays may have been overexposed toradiation when more than 150 images weretaken by accident.

By comparison to the nearly 200penalties levied by the agency, thetransgression was mild; many penaltiesinvolved the unintentional deaths of patients,or their undergoing second surgeries toremove an object left in their bodies duringthe initial procedure.

Mad River was penalized again in June

and received a $50,000ne for leaving asurgical towel in the abdominal cavity of a

patient who underwent surgery. The CDPHwebsite noted it was the rst penalty leviedagainst the hospital.

Records of several other penalties havebeen removed from the CDPH website as theresult of negotiations to have the penaltiesdropped, ofcials said.

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The Long, Mysterious Appeals RoadMad River Wins Against CDPH, But Data is Scarce

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An afliate company of Woodland Hills-basedinsurer Health Net has won a large contract toproviding counseling services to militarypersonnel and their dependents in the UnitedStates and overseas.

The pact between the Rancho Cordova-based MHN Government Services and theU.S. Department of Defense begins on Nov.15. It is expected to be worth about $100million during its rst year. The DefenseDepartment hold an option to renew thecontract annually over the next four years.

Under the pact, MHN providespsychological counseling to members of the

military and their dependents on U.S. militaryinstallations, overseas and even in combattheaters. It is part of the Military & Family LifeCounseling program.

Payers & Providers Page 2

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In Brief

HCCA Says Not-For-Profits Much More

Likely To Be Audited

Not-for-profit healthcare

institutions experience audits fromoutside entities at a rate more than50% higher for-profits, accordingto a new study by the Minneapolis-based Health Care ComplianceAssociation.

Not-for-profits experienced anaverage of six audits per calendaryear, compared to fewer than fouraudits per calendar year amongfor-profits.

The survey also found 42% ofnot-for-profits had undergoneaudits from either the U.S.Department of Health & HumanServices' Office of Civil Rights,Office of Inspector General, RACs

or other outside agencies. Only25% of for-profits experiencedsuch audits.

The amount of governmentand healthcare resources devotedto these audits is staggering. And ifthat was not enough, I would notbe surprised if these numbersincreased significantly in the nextfew years, said HCCA ChiefExecutive Officer Roy Snell.

CINHC Names NewExecutive Director

The California Institute for Nursingand Health Care has named Judith G.Berg as its new executive director.

Berg, an executive withNursing.com and a former chiefnurse executive with Kaweah DeltaMedical Center and Santa BarbaraCottage Hospital, will assume thenew position on Sept. 24. Shereplaces Deloras Jones.

Continued on Page 3

NEWS

MEET YOUR FELLOW READERS

Need to promote a conference? Your brand? Payers &Provider!se-mail list for all editions is available for yourmarketing needs. Reach out to more than 12,000healthcare professionals who read our publications. CalClaire Thayer at (877) 248-2360, ext. 3 or e-mail her [email protected].

Various members of the legal communityhave observed that appealing a penalty fromCDPH can take years. In some instances,penalties levied in 2007 are still beingcontested.

The state has no budget to handleappeals, Mark A. Kadzielski, a partner in theLos Angeles ofcce ofFulbright & Jaworski,told Payers & Providers back in June.

Public records appear to conrm theassertions of Kadzielski, who defendshospitals that have been penalized by theagency.

According to the CDPH, 28administrative penalties are currently underappeal. Of those, only six hospitals have lednotices of the defenses they would takeduring a hearing. And only two hearings both involving administrative penalties againstKaiser Permanentes Fontana hospital arecurrently scheduled. They will take place

during the second week of October,according to CDPH.

The CDPH announced the penaltiesagainst Kaiser Fontana in 2010. In a 2009incident, a patient received third-degreeburns on their leg from an instrument thathad been ash sterilized for surgery but nocooled before being used. In 2008, a surgicsponge was left in the body of a patient,requiring a second procedure to remove it.The nes totaled $75,000 for the twoincidents.

According to Kaisers notices of defenseit claimed the CDPH was vague in itsaccusations that led to the penalties andnes, and that the statute of limitations forenforcing such penalties had passed. Mary Powers Antoine and RobertSullivan, the Sacramento attorneysrepresenting Kaiser, declined to comment othe case.

Appeals (Continued from Page One)

Health Net Affiliate Wins $100M PactMHN Will Provide Counseling to Military, Families

The services, which are provided byclinical professionals who either work for orcontract with MHN, include a focus onshoring up relationships, providing crisisintervention, stress and grief management,among other services.

A variety of studies have shown thatmilitary families undergo enormous stresswhen members are deployed and return fromdeployments. Many military personnel are amuch higher risk for divorce and suicide as aresult of the stresses.

The program began as a pilot in 2004,with MHN as the single contractor. In its

permanent rollout, the Defense Departmentawarded contracts to MHN and two otherrms, including Maryland-based MagellanBehaviorial Health.


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Page 3Payers & Providers

Longer ALOS!*

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*For our ads, not your hospital

In Brief

In a statement, Berg said one ofher objectives was to increasepartnerships with outsideorganizations to further CINHCsgoals of expanding nurse education.

I am eager to take on this newchallenge and look forward toworking with the CINHC Board, staff,

advisory committee and currentpartners to advance CINHC's work indeveloping sustainable solutions toCalifornia's nursing workforce issues,Berg said.

L.A. Times Reports OnMartello

After several stories covering thelitigious South Pasadena plasticand reconstructive surgeonJeannette Y. Martello, M.D., werepublished in Payers & Providers,

the story was picked up by thelargest daily newspaper in thewestern U.S.

The Los Angeles Timespublished a front-page story onAug. 18, focusing on the lawsuitthe Department of ManagedHealth Care filed against Martelloafter she sued scores of herpatients after treating them inhospital emergency rooms inSouthern California.

According to a Payers &Providers investigation, Martellosued as many as 70 of her patientsin Los Angeles County courtsbetween 2007 and 2011, and

sometimes obtained liens againsttheir property.The DMHC sued Martello last

year after she ignored its 2010order to cease and desist balancebilling her insured patients. It isthe only cease and desist order andlawsuit the agency has ever filedagainst an individual physician.

The California Medical Boardhas also taken action againstMartello and is trying to revoke herlicense to practice medicine.

The Times article cited Payers& Providers and editor RonShinkman in its coverage.

NEWS

Other ndings of note include that thenumber of visits for acute medical problemsdropped from 78 to 51 percent in 2009. Alsomore than 60 percent of patients visiting the

clinics said they did not have a regularprimary care provider.

The study, published online in the journHealth Affairs, also found that almost half oall clinic visits fell on the weekend or whenphysician ofces are closed.

The rapid growth of retail clinics makeit clear that they are meeting a patient need,said the studys authors. Convenience andafter-hours accessibility are possible drivers this growth. TAMMY WORTH

A recent study by the Santa Monica-basedRand Corp. has found that retail-based healthclinics are providing more preventive care andbeing used more frequently by older patients.

The visits to retail medical clinics rosefour-fold between 2007 and 2009, from 1.48million to approximately 5.97 million visits.Between 2000 and 2006, only about 7.5percent of patients visiting the clinics were 65or older. From 2007 to 2009, that number roseto 14.7 percent.

Prevention, specically providing uvaccines, increased from 21% of careprovided to almost 48% of care over the sametwo time periods. The number of vaccinesgiven reached more than 1.9 million in 2009.

Retail Clinic Use Continues To GrowRand Study Chronicles Huge Increase in Demand

Blue Shield of California is continuing its briskpace of creating accountable careorganizations, forming an ACO in Santa CruzCounty to help lower the costs of caring for itsenrollees in the region.

Formed in conjunction with 235-bedDominican Hospital and 300-doctorPhysicians Medical Group, both in SantaCruz, the ACO will provide care for about8,000 Blue Shield HMO enrollees, of which5,200 are members of the California PublicEmployees Retirement System.

The ACO is San Francisco-based BlueShields sixth since 2010, the most of any

health plan in the state. In late 2011, BlueShield pledged $20 million to 18 healthsystems, hospitals, physician groups andclinics to help them better participate in anACO structure.

Its oldest ACO, which operates in theSacramento area in conjunction with HillPhysicians Group and Dignity Health, coversabout 40,000 CalPERS enrollees. It cutinpatient days and readmissions by 15% andsaved $15.5 million in 2010.

However, there are multiple challenges tooperating within an ACO structure. BlueShields ACOs operate on a shared-risk system,

wherein providers have to operate within aglobal budget intended to keep costs from

growing no more than a percentage point ortwo annually. In the new Santa Cruz ACO,there will be no cost increases in the rst yeand only low single-digit increases insubsequent years.

We guarantee little or no cost ofhealthcare increase to the covered lives andthe ACO partners must nd the efcienciesand/or healthcare delivery improvements tomeet or beat that goal, said Blue Shield vicepresident of communications Steve Shivinsk

According to Shivinsky, Dominican andPMG will focus on reducing costs by cuttingdown on inpatient admissions and hospitals

stays longer than 20 days. In the SacramentoACO, such long-term stays have been cut inhalf, according to Blue Shield data.

Among the initiatives that will belaunched in the Santa Cruz ACO includemedication reconciliations upon a patientsdischarge and ensuring they see their primarcare physician shortly after they leave thehospital. Both are meant to increasemedication adherence and avoid readmissio

We are proud to participate in thiscollaboration as we believe it is an importanstep in modernizing the healthcare system sothat we can deliver better care at an affordab

price, said Dominican Hospital PresidentNan Mickiewicz, M.D.

Blue Shield Forms Another ACOArrangement With Hospital, IPA in Santa Cruz


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Payers & Providers PageOPINION

Medicares Chronic FFS ConditionTaxpayer Funds Wasted In Current Treatment Mode

Alain Enthoven is the emeritus Marriner S.

Eccles Professor of Public and Private

Management at Stanford University. Alan

Glaseroff, M.D., is a clinical professor of

medicine at Stanford.

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Payers & Providers California Edition – Issue of August 23, 2012

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