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Payers & Providers California Edition – Issue of September 20, 2012

Payers & Providers California Edition – Issue of September 20, 2012

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Published by PayersandProviders
Payers & Providers is California's premier healthcare business journal.
Payers & Providers is California's premier healthcare business journal.

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Published by: PayersandProviders on Sep 20, 2012
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Calendar 
20 September 2012
E-Mailinfo@payersandproviders.comwiththe details of your event, or call(877) 248-2360, ext. 3. It will bepublished in the Calendar section,space permitting.
California Edition
California’s hospitals and their advocacygroups have reported a number of improvements this week in a number of patient safety measures, particularly in areassuch as retained surgical instruments andinfections acquired during care.Although the improvements reported bythe
California Hospital Association
weremostly anecdotal, an initiative between thestate’s hospitals,
Anthem Blue Cross
and thenon-pro
t
National Health Foundation
has ledto a dramatic plunge in elective births prior to39 weeks of gestation.In that program, known as Patient SafetyFirst, 180 hospitals throughout California cutthe percentage of elective births prior to 39weeks gestation from 10.4% in 2010 to 3.6%last year. That’s a drop of 65%.“The reduction of early term electivedeliveries by nearly two thirds is an amazingresult and a testimony to the potential of thePatient Safety First collaborative,” said
PamKehaly
, president of Anthem Blue Cross of California. Kehaly added that it was hoped theinitiative can be spread to every hospitals inthe state.Elective births prior to 39 weeks hadbecome fairly commonplace as a way toaccommodate the often hectic schedules of both obstetricians and expectant parents.However, several studies showed that childrenborn prior to 39 weeks gestation hadencountered issues with brain developmentand suffered higher mortality rates.Some hospitals participating in theinitiative were engaged in pre-39 weekdeliveries as a matter of routine.
San AntonioCommunity Hospital
in the San BernardinoCounty town of Upland was delivering 31% of its newborns prior to 39 weeks in 2009. Nowit is around 4%.According to San Antonio’s maternalservices nursing director
Rhonda Mulvehill,
 the hospital’s obstetrics staff were presentedwith data regarding earlier elective deliveriesto help change their practices. Educationalposters about how such births affecting thebrain development of newborns were postedin the hospital and in the areas wherechildbirth classes were held.“It took a while, but now it’s the standardof care,” said Mulvehill, who added that casesof jaundiced infants and readmissions havedropped, and that the hospital’s newborns arenow breastfeeding more quickly.As a result of these later births, of 
cialsinvolved with the initiative say participatinghospitals have saved about $3.7 million todate.The CHA also reported that initiativesfocused on reducing the incidents of surgicalerrors, medication errors and the hospital-acquired infection
C. dif 
 
cile.
Such infectionskill about 1,400 Californians a year in
September 20
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State’s Hospitals Make Quality Gains
Initiatives Slash Pre-Term Births, Cut Infection Rates
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Continued on Next Page
 
WEBINAR Thursday, October 25, 2012 10 A.M., PDT
MEDI-CAL EXPANSION: 2014 AND BEYOND
Please join
Lucien Wulsin
, Executive Director of the Insure the Uninsured Project, and ElizabethBenson Forer,
CEO of the Venice Family Clinic
, to discuss the challenges of Medi-Cal expansionunder the ACA.
http://www.healthwebsummit.com/pp102512.htm
a HealthcareWebSummit Event
co-sponsored by
PAYERS & PROVIDERS
 
 
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Payers & Providers
Page 2
Top Placement...Bottomless Potential
Advertise Here
(877) 248-2360, ext. 2
In Brief 
Delano Pays $975K ToSettle DiscriminationSuit
Delano Regional Medical Cente
rin Central California has paid$975,000 to settle a lawsuitclaiming Filipino-born members of its nursing staff were discriminatedagainst.According to the lawsuit, filedwith the support of the
U.S. EqualEmployment OpportunityCommission
, the nurses were toldonly to speak English on thehospital premises. Co-workerswere also allegedly ordered toeavesdrop on them to make surethey complied with the order.The case was initiated bycomplaints from 69 current andformer nurses at Delano, whoclaimed that the insistence theyspeak only English on hospitalpremises created a hostileenvironment. The hostility, theysay, did not abate even after 100members of the nursing staff sent asigned petition to management.Hospital officials said theydecided to settle the case becauseit avoided the expense of a trial,and said the nurses had “attacked”the facility, which is located about35 miles north of Bakersfield, withthe lawsuit.Although it admitted nowrongdoing, it agreed as part of the settlement to provide anti-discrimination training and retaina monitor to track how itsemployees and managementbehaved in the workplace.According to the
Asian PacificAmerican Legal Center
, thesettlement is the largest everinvolving language discriminationin healthcare.
Continued on Page 3
NEWS
hospitals, nursing homes and outpatientfacilities.According to the CHA, the not-for-pro
thospital chain
Dignity Health
, formerlyknown as
Catholic Healthcare West
, initiateda program intent on making sure no patientssuffered from retained surgical sponges whilegiving birth. Between July 2010 and 2011, itsmaternal wings handled more than 650,000sponges without leaving a single one in apatient.On the medication front,
UCSF MedicalCenter
has not encountered a singlemedication error since installing anautomated hospital pharmacy in 2010. And
Kaiser Permanente’s
Northern Californiaregion has used electronic medical records toreduce errors involving high-risk medicationsby more than 90%.Regarding
C. diff 
infections,
Paci
cHospital of Long Beach
was able to eliminatesuch incidents completely between 2009 and2010, primarily by improving the hygiene of both patients and hospital workers andcleaning its facilities more thoroughly.
ElCamino Hospital
in Mountain View cut itsinfection rate by 50% using similar measures.“It is a shared responsibility involvingeveryone who comes to the hospital.Everyone – doctors, nurses, hospitalemployees, patients and visitors – plays a rolein ensuring the delivery of safe, high-qualitypatient care,” said CHA Senior Vice Presidentand Chief Medical Of 
cer
David Perrott
,M.D.The CHA has posted the results of suchinitiatives on a website it has dedicated topatient safety initiatives,www.caringisourcalling.org.
Hospitals
(Continued from Page One)
CalOptima Seeking Reimbursement
Wants $90K Over Alleged Misuse of Employees
CalOptima
is seeking more than $90,000from two of its former board chairs and acoalition of healthcare executives tocompensate for alleged unauthorized use of its employees.According to letters issued last week byCalOptima’s compliance director, the agencywants $82,045 from former chairman
Michael Stephens
, and $8,346 from formerchairman
Edward B. Kacic
and the
IrvineHealth Foundation
, where Kacic serves as itschief executive of 
cer.The agency is also seeking payment of those combined sums from the
ManagedSystem of Care
through
OneOC
, a non-pro
tgroup that acts as the MSC’s
scalintermediary.The reimbursement requests followmonths of management and governancetumult at CalOptima, which provides Medi-Cal managed care coverage for about 450,000Orange County residents. It also shines a lighton the amalgam of formal and ad hocorganizations that forge healthcare policy inone of the state’s most populous regions.CalOptima alleges that Stephens, whoserved as the health plan’s board chairbetween 2007 and 2011, had used one of itsemployees full-time to support his work afterhe was appointed as executive director of theMSC in 2010. Stephens, who retired as thelongtime chief executive of 
cer of 
Hoag
Continued on Next Page
 
MEET YOUR FELLOW READERS
Need to promote a conference? Your brand?
Payers &Provider 
!   
e-mail list for all editions is available for yourmarketing needs. Reach out to more than 12,000healthcare professionals who read our publications. Call
at (877) 248-2360, ext. 3 or e-mail her atclairet@mcol.com.
 
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Page 3
Payers & Providers
Longer ALOS!*
Advertise Here
(877)248-2360, ext. 2
*For our ads, not your hospital
In Brief 
Keck Opens KidneyCenter
The
Keck School of Medicine
at the
University of Southern California
hasestablished a kidney research center.The center was funded with a $3.5million grant from the
United KidneyResearch Organization
, a not-for-pro
t that sponsors kidney research.The program will be managedunder the auspices of Keck’snephrology department. It will bechaired by Vito Campanese, a USCprofessor who also chair’s UKRO’sscienti
c advisory board.“Millions of people in Americasuffer from chronic kidney disease,but with the establishment of thiscenter, those patients now have anextra champion in the
ght," saidKeck dean
Carmen A. Pulia
to,
M.D.
Greater NewportPhysicians PresidentDies Suddenly
Catherine Campion-Ritz
, M.D, chief executive of 
cer of 
Greater NewportPhysicians
in Orange County, died ina bicycle accident last week. She was57 years old.A family physician by training,Campion-Ritz had been president of Greater Newport Physicians since1994. It has more than 500physicians, making it one of thelargest IPAs in California. She playedan integral role in af 
liating it with theMemorialCare hospital system in LongBeach.“Dr. Campion cared forthousands of patients over the lastthree decades and played animportant role in the health of somany Orange County families.Everyone at Greater NewportPhysicians is deeply saddened by thisgreat loss,” said
Diane Laird
, GreaterNewport’s chief executive of 
cer.
NEWS
CalOptima
(Continued from Page Two)
Memorial Hospital Presbyterian
in 2005,was paid by OneOC on an hourly basis tooversee the MSC, which is comprised of about 20 Orange County healthcare leaderswhose goal is making the region's safety netsystem more ef 
cient.The MSC was created by the
HealthFunders Partnership of Orange County
,another loose coalition of executives whose
scal affairs are handled by OneOC.However, it has mostly ceased operations inrecent months, and its phone number wasdisconnected as of this week.According to the letter, Stephens hadused the services of a CalOptima seniorproject manager full-time between April andAugust 2010, and then for eight hours aweek through the remainder of that yearwithout approval of the CalOptima board.Stephens was also given of 
ce space atCalOptima’s headquarters in Santa Ana.The letter suggested Stephens may havealso billed OneOC for the CalOptimaemployee’s time, even though she drew herpaycheck from the insurer the entire timeshe performed tasks for the MSC.“Mr. Stephens declined to providecopies of his billing statements/time sheets,or to authorize OneOC to release them, sowe have been unable to verify whether hemay have billed for time worked by thisCalOptima employee,” the letter said.Stephens did not return phone calls tohis Newport Beach home seeking comment.OneOC Executive Director
Daniel J.McQuaid
did not respond to calls and e-mails seeking comment.Kacic succeeded Stephens asCalOptima chair last year. CalOptimaalleges that he used its director of strategicoperations for 70% of her time to work last January in an unsuccessful attempt to securea $9.3 million federal grant. That moneywould have gone to the Irvine HealthFoundation to create medical homes andprovide other services to CalOptima andMedi-Cal enrollees.“We are still determining what ourresponse may be,” Kacic said in an e-mail,speaking on behalf of both himself and theIrvine Health Foundation.Kacic took issue with the letter fromCalOptima, which he said “contains manyfactual inaccuracies and revisionist history.”He noted that
Richard Chambers
, theformer CalOptima executive director whohas since taken a high-level position with
Molina Healthcare
, had approved the useof CalOptima personnel to work on thegrant, and that he believed he had theauthority to do so. Under Chambers’direction, the use of the employees wasconsidered a non-cash contribution to theMSC, according to published reports.Kacic has also maintained the IrvineHealth Foundation was merely acting as anintermediary for the MSC because it wasnot properly incorporated to receive federalgrant money. However, the lengthy grantapplication included provisions for hisfoundation to hire as many as 12employees to manage the project.CalOptima’s letter to Kacic also tooknote of the fact the grant application didnot have the full support of the insurer,even though its board asked for additionalinformation before taking an of 
cialposition.Kacic said that had to do with anotherissue: The MSC’s attempts to secure $12.7million in intergovernmental transfers foranother care initiative. Kacic co-chaired theMSC while that process was underway.Those arrangements,
rst reported by
Payers & Providers
last February, wereextensively criticized as a con
ict of interest by Orange County Supervisor
JanetNguyen
, another CalOptima boardmember. That led in part to Kacic beingremoved as CalOptima board chair in May,not long after a routine reappointmentearlier this year was tabled by the Board of Supervisors. Kacic later resigned from theboard altogether.
Contexo Media is an independent provider of revenue-enhancing solutions for medical practices to maximize their coding, reimbursement and compliance efforts. Thousands of health careprofessionals rely on Contexo Media’s coding books, software, eLearning and educational workshops to stay on top of critical updates across the fast-changing medical landscape.
 To learn more about our products and services, visit our website at www.contexomedia.com
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