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Payers & Providers California Edition – Issue of October 18, 2012

Payers & Providers California Edition – Issue of October 18, 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 Oct 18, 2012
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Calendar 
18 October 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
In what could be a harbinger for California’srural hospitals, the
Mendocino Coast HealthCare District
voted late last month to
le forbankruptcy protection after the hospital itoperates in Fort Bragg all but ran out of cash.The 49-bed
Mendocino Coast DistrictHospital
had actually enjoyed some of its bestyears after converting to a critical accessfacility in 2006, which boosted its Medicarerevenues signi
cantly, according to
RaymondHino
, its chief executive of 
cer.However, a combination of the GreatRecession, surgical equipment malfunctionsand a loss of market share to larger hospitaloperators badly damaged its operatingposition over the past year, Hino observed.On Sept. 27, the district board voted 3-0to enter into a chapter 9 bankruptcy
ling,which is reserved exclusively formunicipalities such as cities and specialdistricts. Two board members – localphysicians who contract with the hospital –abstained.Although Nov. 15 was targeted by theboard as the
ling date, Hino indicated itwould likely occur before the end of thismonth.“This kind of 
ling is speci
cally aboutrestructuring debts,” he said.The most memorable chapter 9
ling inCalifornia occurred in Orange County duringthe mid-1990s, although cities such as Vallejoand Stockton have entered into high-pro
lebankruptcies more recently.The most recent hospital districtbankruptcy occurred in 2010, when the
KingsSierra Health Care District
in the FresnoCounty town of Reedley
led chapter 9. Itemerged from bankruptcy last February.In Mendocino Coast’s case, the movetoward insolvency was entirely operational.Two particular calamities have befallen thehospital in the past year: What Hino termed a“disastrous” winter last year, when mildweather translated into far fewer admissionsfor pneumonia. And, a surgical instrumentsterilizer was of 
ine for months, forcingMendocino to send its instruments to otherhospitals for sterilization. That mishap cutsurgical volumes by half – including lucrativeprocedures such as hip replacements, Hinosaid.However, some observers say ruralhospitals such as Mendocino Coast are in aparticularly dif 
cult position to begin with.“They’re out in the middle of nowhere,and they have trouble getting physiciansupport. And because of that, they havedif 
culty offering the full breadth of services,”said
Steven T. Valentine
, president of 
TheCamden Group
, an El Segundo-basedconsulting
rm which has ties to the region.Valentine sits on the
Payers & Providers
 editorial board.
November 1-2
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Mendocino Coast Filing Bankruptcy
Hospital District Plans to Enter Chapter 9 This Month
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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.
a HealthcareWebSummit Event
co-sponsored by
PAYERS & PROVIDERS
 
Continued on Next Page
 
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Payers & Providers
Page 2
Top Placement...Bottomless Potential
Advertise Here
(877) 248-2360, ext. 2
In Brief 
Sacramento CountyLaunches LIHP
Sacramento County will belaunching its low-income healthplan next month as part of California’s “Bridge to Reform”initiative.The Bridge to Reform isintended to expand Medi-Calcoverage prior to the plannedexpansion under the AffordableCare Act in 2014. It relaxes Medi-Cal eligibility to include childlessadults. As many as 400,000Californians are expected to beenrolled under the initiative.Sacramento County expectsbetween 10,000 to 14,000 liveswill be added to the Medicaid viathe low income health plan in thecoming months. Long Beach-basedMedi-Cal managed care payer
Molina Healthcare
will beadministering benefits.“Tremendous work has goneinto getting us to thispoint, and LIHP is a true testamentto the commitment these providersin our region have to serving thosein need,” said Rep.
Doris Matsui,
aSacramento-area Congresswomanand Democrat.
El Camino LaunchesBreast CancerProgram That FocusesOn Pre-Diagnosis,Prevention
El Camino Hospital
in MountainView is launching a breast cancerprogram that will focus on womenwho are genetically at high risk forcontracting the disease.The program will screen womenwho are at higher-than-average riskfor contracting breast cancer, and
Continued on Page 3
NEWS
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
Claire Thayer
at (877) 248-2360, ext. 3 or e-mail her atclairet@mcol.com.
As a result, Valentine observed that therehas been a lot of patient out-migration toSanta Rosa, 110 miles to the south and thenearest city of any size, where regionalpowerhouse
Sutter Health
operates a hospital.
Adventist Health
also operates several smallerhospitals closer to Fort Bragg.Physician shortages have bedeviled manyhospitals in rural areas, according to
TomPetersen
, executive director of the
Associationof California Healthcare Districts. 
“If you don’t have surgical specialists, thesecondary effect is that the patients also windup using primary care physicians out of thearea,” he said.Petersen added that nearly 60% of California’s physicians practice in just
ve of the state’s 58 counties – those that are themost heavily urban. And California’s overallshortage of physicians is already severe tobegin with, he noted.Hino con
rmed that his hospital hasstruggled with out-migration to other facilitiesfor years. And while Mendocino Coastrecently recruited a second orthopedicsurgeon, it did not stem the
ow of patientsout of the area.“People got used to leaving town andthen referring their friends as well,” Hino said.He added that his hospital’s size makes itdif 
cult to compete with Sutter and Adventiston price.The district’s fate was sealed over thesummer when negotiations with its majorcreditors failed. They included the
UnitedFood and Commercial Workers
union, whichrepresents 80% of Mendocino Coast’s 320employees, and
Cal-Mortgage
, which holdsabout $30 million in district bonds.By the time the board decided to vote forbankruptcy, it was projected the hospital couldlose as much as $2.5 million this year, anegative operating margin of nearly 6%. Cashon hand had dwindled to where it couldsustain ongoing operations for less than threedays.
Mendocino
(Continued from Page One)
Brown & Toland, Cigna Launch ACO
Covers Health Plan Enrollees In San Francisco
San Francisco-based
Brown & TolandPhysicians
is forming an accountable careorganization intended to enhance the care of enrollees in a PPO plan operated by insurancegiant
Cigna
.The Connecticut-based Cigna has beenparticularly active in forming ACOs: Theinitiative with Brown & Toland is its 42nd in18 states.Of 
cials with both organizations say it’sthe
rst ACO operating within the city of SanFrancisco involving a commercial health planand an independent practice association.“Our physicians are best suited to usetimely health information at the point of careto improve quality and reduce costs. Thisaccess to information bene
ts both physiciansand patients,” said Brown & Toland Chief Executive Of 
cer
Richard Fish
.Altogether, the ACO will cover 6,000Cigna enrollees, according to a Brown &Toland spokesperson. The medical group willuse a team of “care coordinators” to closelymonitor recently hospitalized patients toreduce the risk of readmission, keep tabs onthose with chronic health conditions, and
Continued on Next Page
 
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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 
help them make decisions movingforward."Approximately 3-6% of themammography population – whohave no history of cancer – fall intothe high risk category," said
MicheleVan Zuiden
, the executive director of El Camino’s Women's Hospital. “Thiscomprehensive offering will allow usto help our patients assess andunderstand their lifetime risk and thenmake informed choices about furthertesting, diagnosis, risk reductionstrategies and treatment options.”El Camino is also offeringspecial 3-D screening equipment forwomen who have dense breast tissue.About 40% of women with densebreast tissue cannot have potentialcancers diagnosed using traditionalmammograms. And the 3-Dequipment tends to diagnose about30% more tumors than mammogramsdo.Additionally, El Camino is the
rst hospital in Northern California tooffer such screening for women withdense breast tissue.
UCI Receives $1 MillionElder Abuse PreventionGrant
The
UC Irvine
geriatrics program hasreceived a three-year, $1 million grantfrom the U.S. Administration on Agingto
ght elder abuse.The grant is part of an initiativeby the
U.S. Department of Health andHuman Services
to study new ways tocombat elder abuse. Five recipientsnationwide received grants.UCI of 
cials said they would usethe money to focus on stopping abuseof the elderly who suffer fromdementia.“Adults with dementia areparticularly vulnerable to abuse. Thesad fact is that about one of every twopeople with dementia is abused orneglected,” said
Laura Mosqueda
,M.D., chair of UCI’s department of family medicine.
NEWS
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 atwww.contexomedia.com
19144
Kaiser’s Exercise Data Discouraging
Only Fraction of Patients Engage in Regular Activity
Kaiser Permanente’s
weaving of the exercisehabits of its patients into their electronicmedical records has given the Oakland-basedprovider a better idea of the health of those itis treating, and the results are unsettling.According to a study of nearly 1.8 millionmedical records of Kaiser Permanente patientsin Southern California between April 2010and March 2011, 86% had had what theorganization refers to as an “exercise vitalsign” inserted into their EMRs.However, only one-third of those patientswere meeting national guidelines for physicalactivity. Among those two-thirds of patientswho were not meeting the guidelines, half were not exercising at all.Those who were inactive also tended tofollow national demographics: Enrollees whoare female, older, obese, belonging to anethnic minority or suffering from chronicconditions were less likely to exercise.Kaiser launched the exercise vital signinitiative in 2009, and has since beendeployed to several of its operating regions.Patients are queried about their exercise habitsduring outpatient visits, and the data is storedin their EMR.“Embedding questions about physicalactivity in the electronic medical recordprovides an opportunity to counsel millions of patients during routine medical care regardingthe importance of physical activity for health,”said
Karen J. Coleman
of Kaiser’s research andevaluation division. She added that such datacan also be used to link the relationshipbetween exercise, chronic diseases and theutilization of healthcare services in uniqueways.According to recommendations from the
U.S. Department of Health and HumanServices
, the typical American should engagein 150 minutes of moderate physical activity,such as a brisk walk.A variety of studies have shown thatregular exercise staves off or mitigates manychronic conditions, including diabetes andheart disease. Kaiser CEO
George Halvorson
 has regularly advocated for exercise duringspeeches, and the company’s branding haspromoted exercise.“Given that healthcare providers havecontact with the majority of Americans, theyhave a unique opportunity to encouragephysical activity among their patients throughan assessment and brief counseling,” Colemansaid. “Future studies will examine if adding aphysical activity assessment during clinic visitsactually leads to higher rates of physiciancounseling and eventually increases the ratesof physical activity.”
ACO
(Continued from Page One)
increase adherence to prescriptionmedications.“Cigna's collaborative accountable careprogram is based on our belief that a systemthat's focused on the value of care rather thanvolume of care offers the best path toimproved health and lower medical costs,”said
Peter B. Welch
, president of Cigna’sNorthern California division. “We lookforward to collaborating…to advance apatient-centered healthcare system thatemphasizes prevention and primary care, andrewards physicians for outcomes.”Cigna typically pays its ACO providers ona fee-for-service model, with a “carecoordination fee” added on a per-member per-month basis.The additional payment is in lieu of providing speci
c patient data and meetingbenchmarks for improving care. If theoutcomes improve, the fee is increased insubsequent years.

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