18 October 2012

California Edition
Calendar
Oct. 30-Nov. 1
=0#4$907!><!!<$9:'&11?!@&3&'7.!A4771! A47#$9?!B0'4$61!4116&1!095!C$74"4&1!0%$6#! ><!!D$'E0#4$9!095!$C&'0#4$9!0'&! 541"611&5!#8'$6:8!5$F&91!$D!1C&0G&'1?! H(*IJK? ! <74"G!A&'&!D$'!L$'&!M9D$'E0#4$9

Mendocino Coast Filing Bankruptcy

Hospital District Plans to Enter Chapter 9 This Month
In what could be a harbinger for Californias rural hospitals, the Mendocino Coast Health Care District voted late last month to le for bankruptcy protection after the hospital it operates in Fort Bragg all but ran out of cash. The 49-bed Mendocino Coast District Hospital had actually enjoyed some of its best years after converting to a critical access facility in 2006, which boosted its Medicare revenues signicantly, according to Raymond Hino, its chief executive ofcer. However, a combination of the Great Recession, surgical equipment malfunctions and a loss of market share to larger hospital operators badly damaged its operating position over the past year, Hino observed. On Sept. 27, the district board voted 3-0 to enter into a chapter 9 bankruptcy ling, which is reserved exclusively for municipalities such as cities and special districts. Two board members local physicians who contract with the hospital abstained. Although Nov. 15 was targeted by the board as the ling date, Hino indicated it would likely occur before the end of this month. This kind of ling is specically about restructuring debts, he said. The most memorable chapter 9 ling in California occurred in Orange County during the mid-1990s, although cities such as Vallejo and Stockton have entered into high-prole bankruptcies more recently. The most recent hospital district bankruptcy occurred in 2010, when the Kings Sierra Health Care District in the Fresno County town of Reedley led chapter 9. It emerged from bankruptcy last February. In Mendocino Coasts case, the move toward insolvency was entirely operational. Two particular calamities have befallen the hospital in the past year: What Hino termed a disastrous winter last year, when mild weather translated into far fewer admissions for pneumonia. And, a surgical instrument sterilizer was ofine for months, forcing Mendocino to send its instruments to other hospitals for sterilization. That mishap cut surgical volumes by half including lucrative procedures such as hip replacements, Hino said. However, some observers say rural hospitals such as Mendocino Coast are in a particularly difcult position to begin with. Theyre out in the middle of nowhere, and they have trouble getting physician support. And because of that, they have difculty offering the full breadth of services, said Steven T. Valentine, president of The Camden Group, an El Segundo-based consulting rm which has ties to the region. Valentine sits on the Payers & Providers editorial board.

November 1-2
M91#4#6#&!D$'!L&54"07!R6074#.!>99607! /'&<>;S!<$9D&'&9"&?!NE%011.!S64#&1!S09! T'09"41"$!>4'C$'#QU0#&'D'$9#?!N56"0#4$9!$9! E&&#49:!V6074#.!16'3&.!1#0950'51*! #&7&E&54"49&*!"$EE4##&&!4116&1!095!E$'&?! HKJKQHW+K? <74"G!A&'&!D$'!L$'&!M9D$'E0#4$9

December 3-4

M9561#'.!<$770%$'0#4$9!NDD$'#!>99607! <$9D&'&9"&?!>!541"6114$9!$D!O0.1!#$! $%#049!$C&'0#4$907!&DD4"4&9"4&1!D$'! C'$345&'1?!HP,,QHKK,? <74"G!A&'&!D$'!L$'&!M9D$'E0#4$9

Continued on Next Page

WEBINAR
E-Mail info@payersandproviders.com with the details of your event, or call (877) 248-2360, ext. 3. It will be published in the Calendar section, space permitting.

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 Elizabeth Benson Forer, CEO of the Venice Family Clinic, to discuss the challenges of Medi-Cal expansion under the ACA.

http://www.healthwebsummit.com/pp102512.htm a HealthcareWebSummit Event co-sponsored by PAYERS & PROVIDERS

!"#$%&'!()*!+,(+!-!+,(+!%.!/0.&'1!2!/'$345&'1!/6%741849:*!;;<

Payers & Providers

Top Placement... Bottomless Potential

NEWS
Mendocino (Continued from Page One)
As a result, Valentine observed that there has been a lot of patient out-migration to Santa Rosa, 110 miles to the south and the nearest city of any size, where regional powerhouse Sutter Health operates a hospital. Adventist Health also operates several smaller hospitals closer to Fort Bragg. Physician shortages have bedeviled many hospitals in rural areas, according to Tom Petersen, executive director of the Association of California Healthcare Districts. If you dont have surgical specialists, the secondary effect is that the patients also wind up using primary care physicians out of the area, he said. Petersen added that nearly 60% of Californias physicians practice in just ve of the states 58 counties those that are the most heavily urban. And Californias overall shortage of physicians is already severe to begin with, he noted. Hino conrmed that his hospital has struggled with out-migration to other facilities

Page 2

Advertise Here
(877) 248-2360, ext. 2

In Brief
Sacramento County Launches LIHP
Sacramento County will be launching its low-income health plan next month as part of Californias Bridge to Reform initiative. The Bridge to Reform is intended to expand Medi-Cal coverage prior to the planned expansion under the Affordable Care Act in 2014. It relaxes MediCal eligibility to include childless adults. As many as 400,000 Californians are expected to be enrolled under the initiative. Sacramento County expects between 10,000 to 14,000 lives will be added to the Medicaid via the low income health plan in the coming months. Long Beach-based Medi-Cal managed care payer Molina Healthcare will be administering benefits. Tremendous work has gone into getting us to this point, and LIHP is a true testament to the commitment these providers in our region have to serving those in need, said Rep. Doris Matsui, a Sacramento-area Congresswoman and Democrat.

for years. And while Mendocino Coast recently recruited a second orthopedic surgeon, it did not stem the ow of patients out of the area. People got used to leaving town and then referring their friends as well, Hino said. He added that his hospitals size makes it difcult to compete with Sutter and Adventist on price. The districts fate was sealed over the summer when negotiations with its major creditors failed. They included the United Food and Commercial Workers union, which represents 80% of Mendocino Coasts 320 employees, and Cal-Mortgage, which holds about $30 million in district bonds. By the time the board decided to vote for bankruptcy, it was projected the hospital could lose as much as $2.5 million this year, a negative operating margin of nearly 6%. Cash on hand had dwindled to where it could sustain ongoing operations for less than three days.

Brown & Toland, Cigna Launch ACO

Covers Health Plan Enrollees In San Francisco
San Francisco-based Brown & Toland Physicians is forming an accountable care organization intended to enhance the care of enrollees in a PPO plan operated by insurance giant Cigna. The Connecticut-based Cigna has been particularly active in forming ACOs: The initiative with Brown & Toland is its 42nd in 18 states. Ofcials with both organizations say its the rst ACO operating within the city of San Francisco involving a commercial health plan and an independent practice association. Our physicians are best suited to use timely health information at the point of care to improve quality and reduce costs. This access to information benets both physicians and patients, said Brown & Toland Chief Executive Ofcer Richard Fish. Altogether, the ACO will cover 6,000 Cigna enrollees, according to a Brown & Toland spokesperson. The medical group will use a team of care coordinators to closely monitor recently hospitalized patients to reduce the risk of readmission, keep tabs on those with chronic health conditions, and

El Camino Launches Breast Cancer Program That Focuses On Pre-Diagnosis, Prevention

El Camino Hospital in Mountain View is launching a breast cancer program that will focus on women who are genetically at high risk for contracting the disease. The program will screen women who are at higher-than-average risk for contracting breast cancer, and

Continued on Next Page

MEET YOUR FELLOW READERS

Need to promote a conference? Your brand? Payers & Provider!s e-mail list for all editions is available for your marketing needs. Reach out to more than 12,000 healthcare professionals who read our publications. Call Claire Thayer at (877) 248-2360, ext. 3 or e-mail her at clairet@mcol.com.

Continued on Page 3

!"#$%&'!()*!+,(+!-!+,(+!%.!/0.&'1!2!/'$345&'1!/6%741849:*!;;<

Payers & Providers

Longer ALOS!*

NEWS
ACO (Continued from Page One)
increase adherence to prescription medications. Cigna's collaborative accountable care program is based on our belief that a system that's focused on the value of care rather than volume of care offers the best path to improved health and lower medical costs, said Peter B. Welch, president of Cignas Northern California division. We look forward to collaboratingto advance a patient-centered healthcare system that

Page 3

Advertise Here
(877) 248-2360, ext. 2
*For our ads, not your hospital

In Brief
help them make decisions moving forward. "Approximately 3-6% of the mammography population who have no history of cancer fall into the high risk category," said Michele Van Zuiden, the executive director of El Caminos Women's Hospital. This comprehensive offering will allow us to help our patients assess and understand their lifetime risk and then make informed choices about further testing, diagnosis, risk reduction strategies and treatment options. El Camino is also offering special 3-D screening equipment for women who have dense breast tissue. About 40% of women with dense breast tissue cannot have potential cancers diagnosed using traditional mammograms. And the 3-D equipment tends to diagnose about 30% more tumors than mammograms do. Additionally, El Camino is the rst hospital in Northern California to offer such screening for women with dense breast tissue.

emphasizes prevention and primary care, and rewards physicians for outcomes. Cigna typically pays its ACO providers on a fee-for-service model, with a care coordination fee added on a per-member permonth basis. The additional payment is in lieu of providing specic patient data and meeting benchmarks for improving care. If the outcomes improve, the fee is increased in subsequent years.

Kaisers Exercise Data Discouraging

Only Fraction of Patients Engage in Regular Activity
Kaiser Permanentes weaving of the exercise habits of its patients into their electronic medical records has given the Oakland-based provider a better idea of the health of those it is treating, and the results are unsettling. According to a study of nearly 1.8 million medical records of Kaiser Permanente patients in Southern California between April 2010 and March 2011, 86% had had what the organization refers to as an exercise vital sign inserted into their EMRs. However, only one-third of those patients were meeting national guidelines for physical activity. Among those two-thirds of patients who were not meeting the guidelines, half were not exercising at all. Those who were inactive also tended to follow national demographics: Enrollees who are female, older, obese, belonging to an ethnic minority or suffering from chronic conditions were less likely to exercise. Kaiser launched the exercise vital sign initiative in 2009, and has since been deployed to several of its operating regions. Patients are queried about their exercise habits during outpatient visits, and the data is stored in their EMR. Embedding questions about physical activity in the electronic medical record provides an opportunity to counsel millions of patients during routine medical care regarding the importance of physical activity for health, said Karen J. Coleman of Kaisers research and evaluation division. She added that such data can also be used to link the relationship between exercise, chronic diseases and the utilization of healthcare services in unique ways. According to recommendations from the U.S. Department of Health and Human Services, the typical American should engage in 150 minutes of moderate physical activity, such as a brisk walk. A variety of studies have shown that regular exercise staves off or mitigates many chronic conditions, including diabetes and heart disease. Kaiser CEO George Halvorson has regularly advocated for exercise during speeches, and the companys branding has promoted exercise. Given that healthcare providers have contact with the majority of Americans, they have a unique opportunity to encourage physical activity among their patients through an assessment and brief counseling, Coleman said. Future studies will examine if adding a physical activity assessment during clinic visits actually leads to higher rates of physician counseling and eventually increases the rates of physical activity.
To learn more about our products and services, visit our website at www.contexomedia.com

UCI Receives $1 Million Elder Abuse Prevention Grant

The UC Irvine geriatrics program has received a three-year, $1 million grant from the U.S. Administration on Aging to ght elder abuse. The grant is part of an initiative by the U.S. Department of Health and Human Services to study new ways to combat elder abuse. Five recipients nationwide received grants. UCI ofcials said they would use the money to focus on stopping abuse of the elderly who suffer from dementia. Adults with dementia are particularly vulnerable to abuse. The sad fact is that about one of every two people with dementia is abused or neglected, said Laura Mosqueda, M.D., chair of UCIs department of family medicine.

Contexo Media is an independent provider of revenue-enhancing solutions for medical practices to maximize their coding, reimbursement and compliance efforts. Thousands of health care professionals rely on Contexo Medias coding books, software, eLearning and educational workshops to stay on top of critical updates across the fast-changing medical landscape.
19144

!"#$%&'!()*!+,(+!-!+,(+!%.!/0.&'1!2!/'$345&'1!/6%741849:*!;;<

Payers & Providers

OPINION

Page 4

=$76>&!?*!@116&!?,
/0.&'1!2!/'$345&'1!41! A6%7418&5!&3&'.!B86'150.!%.! /0.&'1!2!/'$345&'1!/6%741849:*! ;;<C!D9!099607!4954345607! 16%1"'4A#4$9!41!EFF!0!.&0'! GE(?F!49!%67H!6A!#$!(,! 16%1"'4%&'1IC!@#!41!5&743&'&5!%.! &J>047!01!0!/KL!0##0"8>&9#*! $'!01!09!&7&"#'$94"!9&M17&##&'C
D77!053&'#4149:*!16%1"'4%&'!095! &54#$'407!49N64'4&1O
G)PPI!+?)J+QR, 49S$TA0.&'1095A'$345&'1C"$>

The GOP Wants The AHRQ To Fly Away

Party Puts Safety Agency In Same Category As Big Bird
The ap greeting Mitt Romneys cheerful likely to spend political capital on a admission that as president hed defund Big compromise that saves higher-prole funding Birds nesting place on public television victims. could turn out to be good news for a federal Naturally, if the Republicans add control agency promoting safe medical care that of the Senate or the presidency, the AHRQ faces a similar extinction threat. But we wont outlook worsens. know till after the election whether the littleRomney made it crystal clear on national known agency beneted from Big Birds television that the reasoning used in the House protective presence. subcommittee vote is an approach he The stage was set for Romneys Big Bird embraces, not just a political gesture: I love boast by a bill Republicans pushed through a Big Bird, Romney told presidential debate House Appropriations subcommittee in July moderator Jim Lehrer, but then quickly noted that slashed or eliminated budgets for a host he was not willing to borrow from China to of programs, including public televisions subsidize public TV. parent, the Corporation for Public Romneys spending test is a legitimate Broadcasting. That same bill completely effort to focus attention on what we, the abolished the Agency for Health American public, want our Care Research and Quality (AHRQ). government to pay for as we seek to By Health policy wonks lamented balance the federal budget. Michael that terminating the agency would But that effort should be driven by Millenson thoughtful consideration, not political badly undermine important research on health care quality, disparities in calculation. If the National Institutes care and patient safety, as a member of of Healths $30.6 billion scal 2013 budget AHRQs national advisory council put it. But request is such an important investment that it hardly anyone else noticed. goes untouched in the House subcommittee The end of AHRQ didnt even rate a budget, is there a rationale other than political separate mention in the committees lengthy pique over Obamacare for eliminating press release. It was just a budget-balancing AHRQs $0.4 billion budget entirely? (The action and not a reection on anything. actual request was $408.8 million, for those Thats where Big Bird waddles into the counting pennies.) picture. Now that Romneys Big Bird budget has The health policy community has tried to become a social media sensation, perhaps tell itself that the AHRQ elimination vote was thats a conversation we can nally have. meaningless political theater, since there was Because the Americans harmed by unsafe care no realistic chance the bill would be or overtreatment or undertreatment include approved in anything close to its original Republicans, Democrats and those utterly form before the election. In the event, indifferent to politics. So how do you get to Congress nally did settle for a measure Sesame Street? Clearly, AHRQ needs a more extending existing government funding for kid-friendly approach to t in with its new another six months. But that whistling past neighbors. I suggest ABCD Adventures in the graveyard ignores the bright ashing Better Care Delivery. warning signal that Romney has reafrmed. And those nasty House Republicans? Put bluntly, the GOP is expected to Well, when it comes to Big Bird, Oscar the retain control of the House of Grouch is no match. Representatives. If the party is willing to kill Big Bird, despite the public image problem Michael Millenson is president of Health that presents, why would there be the Quality Advisors LLC in Highland Park, Ill. and slightest concern about axing AHRQ, an a member of the Payers & Providers Midwest agency that even supporters acknowledge is a editorial board. A version of this op-ed rounding error in the Department of Health originally appeared on the Forbes.com. and Human Services budget? In fact, cuts to programs like public TV and the Jobs Corps Op-ed submissions of up to 600 words are may even hurt AHRQ, since a Democratic welcomed. Please e-mail proposals to Senate (if it remains that way) would be more
editor@payersandproviders.com

U04749:!055'&11O
)()!VC!W$77.M$$5!X0.*!Y64#&!Z Z6'%09H*!<D!F([,[

X&%14#&
MMMCA0.&'1095A'$345&'1C"$>

L0"&%$$H
MMMCS0"&%$$HC"$>\A0.&'1A'$345&'1

BM4##&'
MMMC#M4##&'C"$>\A0.&'1A'$345&'1

]54#$'407!Z$0'5
Y#&3&9!BC!=07&9#49&*!/'&145&9#*! B8&!<0>5&9!^'$6A _$11!^$75%&':*!@>>&540#&!/01#! /'&145&9#*!;$1!_$%7&1!W$1A4#07! 095!U&54"07!<&9#&' U0'H!L496"09&*!U090:49:! K4'&"#$'*!D730'&`!2!U0'107 W&9'.!;$6%&#*!<84&S!Y#'0#&:.! !SS4"&'*!a&&909 D9#8$9.!X'4:8#*!]b&"6#43&! K4'&"#$'*!W&07#8!D""&11!<074S$'940

/6%7418&'\]54#$'
_$9!Y849H>09
A6%7418&'TA0.&'1095A'$345&'1C"$>

<$9#'4%6#49:!]54#$'
a0#8.!U477&'!a&77&.
@S!.$6!5$!9$#!'&"&43&!.$6'!4116&!$S! /0.&'1!2!/'$345&'1!%.!(!/CUC!$9! B86'150.*!A7&01&!"077!G)PPI+?)J+QR,C

!"#$%&'!()*!+,(+!-!+,(+!%.!/0.&'1!2!/'$345&'1!/6%741849:*!;;<

Payers & Providers

MARKETPLACE/EMPLOYMENT

Page 5

It costs up to $27,000 to fill a healthcare job*

will do it for a lot less.

Employment listings begin at just $1.65 a word Call (877) 248-2360, ext. 2 Or e-mail: advertise@payersandproviders.com Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.

SEEKING A NEW POSITION?

CAN HELP.
We publish advertisements for those seeking new career opportunities for just $1.25 a word. If you prefer discretion, well handle all responses to your ad. Call (877) 248-2360, ext. 2, or e-mail advertise@payersandproviders.com.

!"#$%&'!()*!+,(+!-!+,(+!%.!/0.&'1!2!/'$345&'1!/6%741849:*!;;<