20 August 2009

California Edition

Calendar

Consumer Groups Concerned About Remedies

August 29ºSept 2
. The recess ion is driving up costs for off icia ls s ay it is tied to t he st a te ’s h ig her/
Cal ifornia’s he alt h p la ns o n o ut pa t ient c a re, t ha n/ ave ra ge unemployme nt ra te .
‘
’  “ ”•  –’ ’ a ccording to pla n off icials a nd e a rnings “A s e mployers have res ponded to
—•’ “ ˜’
™  
š
 ’  › reports re le a sed by t he publ ic ly/t ra ded economic conditions, we're f inding t ha t
ins urers e a r lier t his mont h. The t rend ha s lowe r ut il izing employees a re
œ
•



•
 ’
’ co ns umer a ctivists co ncerned t he res ponse dis propo rt iona te ly los ing or d ro pping
” • 
 ž’ —”Ÿ   › wi ll be hig he r premiums a nd more c la im covera ge, le aving a hig he r percenta ge of
¡¢  £  ¤“
denials . ot her e mployees enro lled in o ur
š
’   O verall med ic al cost ra t ios a mong t he products,” s ays Peggy Hinz, a n A nt hem
’’” ¥¥¦¦¦¦
’  ¥§’¢
September 13º15
st a te ’s le a d ing he alt h pla ns have t rended spo kes person for t he Cal ifornia ma r ket .
upwa rd a percent a ge po int or more over A nt hem wou ld not re le a se its
t he pa st ye a r (see s pecif ic medic al
c ha rt) . Those cost da t a fo r
numbers were Medical Cost Ratios une 30 009 vs une 30 008 Cal ifornia. Kai ser
Fo unda t ion Heal th
, J , 2 . J , 2
na tionwide, but t he 2009 2008

¨  ©’•  £• ˜¢’ bulk of enro ll ment 86.8

Pla n, t he st a te ’s
“

•’ “ ˜’ ©’’

87 %

š• ˜’  for t hese p la ns is in 86.1 biggest ins urer, did
Cal ifornia. 86 % not re le a se cost ra t io
‘ 
•

•”’ ¢ Ÿ’
 ”•¢ “We ha d 112 ,000 da ta to Payers &
•
¨ £ª
 £  «¬­® «¯­ ¨ new members (in 84.7
Provid ers .
°¢¢

85 %

Cal ifornia ) a nd if t hey 84.2 84.2 Pla n off icia ls

a re…a ccess ing Med i/ a ttribute t he ris ing costs
š
’ ª  Cal covera ge, t here is
84 %
83.3 to a va riety of f a ctors,
’’”  ¦¦¦¨¢°•¨•¨ ¥
¥¥
often a lot of pent/ up 83 % inc l ud ing t re a t ing
dema nd fo r services,” Blue Shield Health Net Molina
pa tients w it h t he H1N1
September 24 s ays Richard Bock, swine f l u virus .
M.D., Mo lina’s med ic al director for However, t he consens us is t ha t p la n
Cal ifornia. enro llees a re see k ing o ut c a re mo re
Ó —’Ÿ
˜’ — ’ Th is wa s ec hoed by comme rcial frequent ly a s a prec a ut io na ry me a s ure
Ô’¦ 
“
 ins urers s uc h a s Anthem/ Blue Cr oss, w hose s hou ld t hey lose t heir jobs – a nd
“ ¨ ¢ ¨ ¨  ’•  cost ra t ios were dow n co mpa nywide fo r t he ins ura nce – in t he ne a r term .

¨ ’Ÿ
¨¨ ’ 
•

 ”°¨ ° second q ua rter of 2009, yet saw a Additionally, Hinz notes t ha t COBRA
” –  ¢•   ’
  •’  ’ s ignif ic a nt s pi ke in Ca lifo rnia . Co mpa ny
’ ’ ©’•  “

•’
£ ¤“ Cont n
i ued on Nex t Page

–¨ 
’’” ¥¥¦¦¦ ¥
Ó—˜’¢

EÖMail
payersandproviders@gmail.com
with the details of your event, or www
kesidec it
ommun yh
e t c
h
e c
om

call (877) 248Ö2360, ext. 3. It will

.la al ar .

be published in the Calendar

section, space permitting.

  
   

 
 P
aye rs &
P
rov i
d
e rs
NEWS P
age 2

Health Plans (Conti nued from Page One)

T t...
op Placemen

B tt t ti
o om less Po en al
e n ro l lme nt is up a bo ut 2 8
% c d
o m pa nyw i e i nc rease i n me d ic a l c os t t re nd s t his yea r, ”

c d t d d d c
o mpa re o t he e n of 2 00 8 . T ha t ’s a lso an wo ul wo r k fo r low “ os t a lt e r na t ives,
Ad ti
ve r se d d ic d d
c c c c i ic .
r iv i ng u p me al os t s, s i n e ma ny but o ul no t prov i e s pe f s

c
e n ro l lee s of t e n o bt a i n se rv i es bef o re t he i r T he o bl iq ue ness has hea lt hc a re
(877) 248 2360 t. 2
ex
Þ , c c c d.
ove rage r uns o ut . o ns ume r a t iv is t s wo r r ie

To c o mba t t h is t re nd , M o l i na d “U c c d
ro lle nf o rt u na t e ly, t he i r t ra k re o r has

d d d
o ut a bo ut a yea r ago a prog ra m t ha t be e n t o sq uee ze t he pa t ie nt ry a n e ny

I i ef c c
n Br pro f i les a l l e n ro llees . T ho se pa t ie nt s w it h a re w he reve r t he y a n, ” says A n th ony

ch c c d it i c di c
ro n i on o ns, t a ke mult i p le W righ t, exe ut ive re t o r of He alt h

d ic t i c d c
o ns o r ove r ut i l ize ho s p it a l A ccess, a Sa ra me nt o o ns ume r
me a “ “ base
c c d c W r ig ht dd c
e me rg e n y roo ms a re mo re lose ly a vo a t e g ro up . a s t ha t a re e nt

Prospect Proj ects mo n it o re

d t
o e ns ure t hey re
c
e ive
c
os t
“
c d d
upt i k i n req ues t s fo r i n e pe n e nt me
d ic
al

Profit ability for Brot man c d

a p pro p r ia t e a re . rev iews f i le w it h t he Depart men t of

O c c c Ma
f f i ia ls w it h t he o mme r ia l pla ns nage d Heal th C are bea rs o ut t his no t io n .

Buoyed by a major financial have a lso sa id t hey wo u ld be proa

ct i
ve Judy Du gan,
c
re se a r h
di c
re t o r f o r

restruct uring, Los Angeles(based a bo ut a

dd
re ss i ng
c
o s t s,
c
pa rt i ula r ly a s C on su mer Wa tchd og, a n a
d
vo
c
a
c
y g ro up i n

Prospect Medical Holdings sharply mo s t a lso re po rt e

d
sa gg i ng ea r n i ng s . B ut
c
Sa nt a M o n i a t ha t has s ue d he a lt h pla ns

narrowed its losses for the third

q uarter ending J une 30.
t hey we re c
le ss fo rt h o m i ng t ha n M o l i na ove r
c
ove ra ge iss ue s, is wo r r ie d t ha t c os t
“

Prospect, which operates five w it h s pe

c i ic .
f s s hif t i ng w i l l o
cc
ur,
c
pa rt i u la r ly a mo ng t he

hospitals in So uthern California – “W

e
c
o nt i n ue t o f o
c
us
c
reso ur es o n i nd iv id ua l a nd s ma l l g ro u p ma r ke t s .

incl uding the Brotman Medical o ut pa t ie nt

c
o sts a n
d
be l ieve we
c “T h
e y ’ l l ra ise t he i r ra t es, a n
d t
ry ve ry

Center in C ulver City – reported a

an

d ha rd t o

loss of $238,000 on revenues of

ct i ma ke t he m g o away a lt og e t he r, ”
ef fe ve ly ma nage t his t re n i n t he

$114 .3 million. That’s compared to

c d D dd i
se on ha lf of t he ye a r, ” Hea lt h Ne t C hief ug a n says, a ng t ha t mos t p la ns w i l l

a loss of $3.5 million on revenues O

pe ra t i ng
O c
f f i e r Ji m Woys t o l
d
a na ly s t s t o le ra t e hig he r me d ic a l c o s t s fo r la rg e

of $80.9 million for the third ea r l ie r t his mo nt h. Howe ve r, a Hea lt h Ne t g ro u ps be

c
a use t ha t b us i ness se g me nt

q uarter of 2008. Company officials d c

l i ne
d t
o e la bo ra t e o n re ma i ns
c
lu ra t ive . S he a lso no t es t ha t

say much of the revenue bump was

s po kes pe rso n e

attributable to folding in Brotman’s

Woys ’ c o mme nt . d d i n c la i ms
s s prov i e rs may se e e lays

operations. It also says that

d d
H i nz no t es t ha t A nt he m wo u l pay me nt , o r e x t ra s t e ps t o f i le a n a p prove

Brotman is projected to ret urn to “c

o nt i n ue t o
c
p r i e o ur b us i ness fo r a s l ig ht
c
la i ms .

profitability after losing as much as

$1 million per month. Prospect had
held a minority stake in Brotman
since 2005, and acq uired majority
ownership last spring, j ust as the
hospital emerged from chapter 11 J i l
o n t E ffor t He ps
i
Pat en ts
i
N av g ate Sys tem

bankruptcy protection.
Prospect also anno unced a J uly
29th closing of a $160 million Ca lifo rnia ns vexed by t he see ming fi c c
pur hase ins ura n e . I t a lso has links to a

senior sec ured notes offering,

na lity of

which c ut the interest rate on its

t he ir hos pita l bills have a new I nte rnet
“ base
d va riety of
c
o ns ume r o rga nizat io ns .

borrowing by 6% per year, and will d T he s ite, w hic h is o pe rated by

nav igat io na l too l s po nso re by a va riety of

increase after(tax cash flow by d c c

vo a y g ro ups .
c
Sa ra me nto“ base
d c d c c
o ns ume r a vo a y g ro up

$ 5
a

abo ut $12 million per year. T he we bs ite, www .hos pita lbillhe lp.o rg,
d d
Health Access, was f un e by 2 0,000 in

The company’s stock fell by g ra nts f ro m Community Catalyst a n

d th

abo ut 5%, to $4 a share, in after(

c d c d e
o nta ins a v i e rega r ing pat ie nts w ho q ua lify

B 774 F
ho urs trading on the American
d c d California HealthCare oundation .
fo r bill re u t io ns un e r A , t he Hospital

Stock Exchange late Wednesday. F air P ricing Act . The s ite

c
o nta ins a va riety of
“W
e wo rke
d
o n t his law fo r fi ve yea rs to

d d he lp peo ple o ut w ho do n’t have ins ura nce

info rmat io n fo r pat ie nts w ho a re unins ure an
d d t hi
d d d an a hig h hos pita l bill, a n s is a way to
un e rins ure may q ua lify fo r billing
L.A. Supes Vote to
an

di c c d d t
s o unts . T hey in lu e sa mple lette rs to se n o

Reopen MLK Hospital hos pita ls, as we ll as a rt ic les adv is ing how to Conti nued on Next Page
The L os Angeles County Board of
Supervisors voted unanimo usly on
Tuesday to try and reopen the
perennially tro ubled Martin Luther Expert Healthcare Communicat ions
King Jr./UCLA Medical Center
while shifting responsibility for its
day(to(day operation to the
University of California. ÅWhite Papers ÅMedia Campaigns ÅNewsletters
Continued on Page 3 (818) 848Þ8510 www.rfsconsult .com

`
V WXVYZ[ \ WZ]^_ YZ[ Wa _[c_def ggh
Q RSST U Ub
Payers & Providers NEW S Page 3

Website (Conti nued from Page Two)

Longer A LOS !*

Adve rt ise
co mmunicate that t hey have o pt io ns,” says Western Center on Law and Poverty in Los
t he
Hea l Access Exec u ive Direc o r Anthony A nge les co nc luded a ma ny os pi a ls ave
th t t th t h t h
(877) 248 2360, ext. 2
 
i
Wr ght . yet to co mply w it h t he post ing req uire me nts of
A B 774 was s ig ned in o law in 200 6 by A B 774 a nd ma ny o e rs wo uld no f urnis
t , th t h
*For our ads ot your hospital Gov. Arnold Schwarzenegger a nd req uires
t he ir isco unt po lic ies o n req uest
d . Wes e rn
,n , t
d d
hos pita ls to prov i e isco unts to unins ure
d F
Ce nte r Staff Atto rney Jen lorey says he r g ro up
d d
o r un e rins ure pat ie nts w hose inco me is at is wo rking w it h t he C HA o n te mplates fo r
In Brief
o r be low 3 50% of the fede ra l mult i4 ling ua l s ig nage t hat ca n be
pove rty leve l. Hos pita ls a re a lso Survey of 66 Hospitals on a ppro priate ly posted o n hos pita l
req uired to post t he ava ila bility AB 774 Compliance pre mises . Flo rey ’s o rga nizat io n
d
of isco unts in co ns pic uo us le nt so me tec hnica l ass ista nce
Unde r t he pro posa l e nd o rs ed by
t he boa rd, Los A ng e le s Co u nt y places . in deve lo ping t he we bs ite .
wo uld c o nt rib ute mo re t ha n $350
T e os pi a l ind us ry was O ne o e r iss ue posed by
h h t t th
mi ll io n – inc lud ing $2 78 mi ll io n ne ut ra l towa rd t he bill in its th e Wes e rn Ce n e r s udy was
t t t
f o r s e is mic u pg ra de s – t o re o pe n d
t he hos pit a l w it h 120 bed s by la te fi na l fo rm, a n has no t he fact t hat ma ny pat ie nts
o bject io ns towa rd t he we bs ite . w ho co uld ava il the mse lves of
20 12 . T he UC sys te m wo uld Only
“We ’re ve ry s uppo r ive of d
o pe ra te it o n a d a i ly bas is as a t Notice Policy not available t he isco unts may lack t he
AB I
te a c hing hos pit a l w it h 250 med ic a l
h os pi t a ls imple me nt ing not available in savvy to use t he nte rnet,
re s ide nt s lo t s . It wo uld be 774 says C HA V ice Pres ide n properly on E nglish mea ning t hey may not be
,” t request
gove rned by a no téf o ré pro f it of Exte rna l Co mmunicat io ns posted a ble to use its se rv ices .
ve nt u re j o int ly r u n by t he c o u nt y
Jan Emerson, a lt ho ug h s he W rig says seve ra l o usa nd
a nd UC .
adds hos pita ls may be
Source: Western Center on Law and Poverty do llaht th
rs of t he g ra nt mo ney
A lt ho ug h t he UC B oard of
Rege ts may vo te o n t he pro posa l e nco unte ring iss ues d d
n has bee n ea rma rke towa r
a t it s next p u b l ic meet ing S e pt . 15 , rega rd ing f ull co mplia nce . ma rket ing t he s ite a nd ma king it mo re
Los A ng e le s Co u nt y S u pe rv iso rs
A s udy pe rfo rmed ea rlie r is yea r by access ible .
G lor i a Mol i a a nd M ike t th
n
A to ov ich a c know led g ed t ha t t he
n n
de a l c o uld s t i ll u nrave l .
Co u nt y o ff ic ia ls c los ed t he
hos pit a l ba c k in A ug us t 200 7, a fte r
t he C e nte rs f o r Med ic a re a nd
Med ic a id S e rv ice s w it hd re w
f u nd ing f o r re pe a ted la ps e s in Despite Gran t ospitals Face Po ten ti al $680M T ab
pa t ie nt c a re . It has o pe ra ted as a n , H
o ut pa t ie nt c l inic s ince t he n.
Co u nt y o ff ic ia ls have t a l ked w it h
s e ve ra l po te nt ia l pa rt ne rs –
inc lud ing t he U ive rs i ty of
Fi Fi i
rst ve Cal forn a i
, t he prog ra m t hat g ives a n g reat need of co mplex ca re . Acco rd ing to J m i
n
S outh e r C al i for i a a nd Pa ci f ic eco no mic a nd hea lthca re boost to t he state ’s Lott exec u ive v ice pres ide n of e Hosp tal
, t t th
i
n n
H osp i tal of Lo g Be a ch – t o t ry
n presc hoo le rs, has injected $81.4 millio n into i i i
Assoc at on of Southern Cal forn a i ’s i , t
a nd re o pe n t he f a c i l it y . F ii
the Healthy am l es prog ra m to protect it est imated t hat ro ug hly 30% of Hea lt hy Fa mily
aga inst loo ming bruta l budget c uts . Howeve r, e nro llees w ill be hos pita lized ove r t he next
$9 000 pe r
J ohn Muir Receiv es the mo ney fa lls fa r s ho rt of prese rv ing t he two yea rs, at a cost of ro ug hly ,
be leag ue red prog ra m. pat ie nt . Eve n exc lud ing t hose cove red by t he
$10 Million Grant T e mo ney Firs Five as pu in o Hea l y
h t h t t th First 5 f und ing, t he cost to Ca lifo rnia ’s
Fa milies w ill kee p so me 200,000 presc hoo le rs d $680 millio n.
T he K. H . H of m a F i h hos pita ls wo ul be a bo ut
nn ou n dat o n as o n its ro lls . Hea lt hy Fa milies is Ca lifo rnia ’s S4 “We ’ve go o ea
ma de a $10 mi ll io n g ra nt t o t he tt t th t cost,” says Lott,
a
John Mu ir Fou n dat i on t o he l p Joh n C HIP pla n. w ho s its o n t he Payers & Pro viders Ed ito ria l
Mu i r He alth w it h a n $800 mi ll io n First 5 has put a lmost $100 millio n into Boa rd .
ex pa ns io n o f it s Wa l n ut C ree k a nd Hea l y Fa milies so fa r is yea r. I co n ribu ed
th th t t t Lott adds t hat hos pita ls a re a lready be ing
Co nc o rd c a mp us e s . As a re s ult, t he $16.7 millio n las Fe brua ry o s a bilize e
p la nned ne w pa t ie nt t ow e r o n t he t t t th ove rburde ned by inc reases in e me rge ncy
Co nc o rd c a mp us w i ll be na med prog ra m f ro m budget c uts e nacted in t his roo m v is its by unins ured pat ie nts, w it h so me
a fte r be nef a ct o rs J e a n a n d Ke n c urre nt fisca l yea r. public inst it ut io ns see ing a 20% inc rease ove r
H off m a . Fo r 200 9420 10, Hea lt hy Fa milies faces a .
n
T he Co nc o rdé bas ed f o u nd a t io n the past yea r
$194 millio n s o r fa ll a nd may w ind up c u ing In e mea n ime Firs
has ma de s e ve ra l o t he r g ra nt s t o h t tt th t , t 5 is see king ot he r
Jo hn M uir Hea lt h in t he past to buy as ma ny as 669,000 c hild re n off t he ro lls co nt ribut io ns to kee p Hea lt hy Fa milies
med ic a l e q u ipme nt a nd t o he l p betwee n now a nd J une 20 10 – 73% of t he funct io ning .
f o u nd t he J oh Mu i r C a ce r prog ra m’s tota l. “We e nco urage like4 minded pa r ne rs o
n n t t
Ce t e r .
n S ince ma ny c hild re n in Hea lt hy Fa milies co me fo rwa rd w it h ass ista nce to e ns ure t he

h ave c hro nic hea lth co nd it io ns, t hey a re in prog ra m's s urv iva l,” says First 5 Exec ut ive
i
Direc o r Kr s Perry .
t

õ ý
æ çèèé êë ìíëîïð ñ ìïòóô îïð ìöê÷ôðøôùúû üü
Payers & Providers OPINION Page 4

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Despite Fina ncial Enviro nme nt Hospitals Must S oldier O n
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pqrrs qu t he co mmunit y ” in way s t ha t co mmunit y ho s p ita ls a re
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~7?D?GH 7@@:9;; d oe s no t c urre nt ly ex is t a ny p rof it ho s p ita ls mus t d o mo re
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†‰ ‡“ ‡• —ˆ €‰ ‰ pe rce ntage of reve nue s w h ic h t he ir t ee t h in d ee p f rus t ra t io n.
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mu be re inve e back in o s t d t T hey mus t o pe ra t e w it h pea k
t he co mmunit y in exc ha nge eff ic ie ncy a nd , mo re t ha n eve r,
Š9C;?O9
fo r a ho s p ita l’s no t ¾fo r¾ p rof it loo k t o t he ge ne ro s it y of
ƒƒƒ{z‡…ˆ‰Š‡“z‰ŒŽˆ‰Š{|Œ} s ta t us t he American Hospital d o no rs to he l p s u pp le me nt lo s t
[7N9C==U ,
Association ha s ca lle d u po n inco me . Tro uble is, d o no rs a re
ƒƒƒ{ ‡|ˆ ŒŒ‡{|Œ}Œz‡…ˆ‰Šz‰ŒŽˆ‰Š
‹ ho s p it a ls t o “vo lunt a rily p ublic ly B fee ling ha rs h eco no mic rea lit ie s
„ F\?OO9: , y
a nd p roac t ive ly re po rt t o t he ir Jane t he ms e lve s , a nd t he nee d le fo r
ƒƒƒ{xƒŽxxˆ‰{|Œ}Œz‡…ˆ‰Šz‰ŒŽˆ‰Š co mmunit ie s t he f ull va lue of Haderlein c ha rit a ble g iv ing is mov ing in t he
J?GU9@ G t s
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ca re , ge ria t ric yc ia t ric e rv ice a n a s s d t o ed it or@ payers andprov iders com or
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leve l t h ree neo¾ na t a l int e ns ive ca re unit . call (877) 248¹2360, ext . 3.

… †‡…ˆ‰Š ‹ †‰ŒŽˆ‰Š † ŽŠ’Ž“”• ––—

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Payers & Providers EMPLOYMENT/MARKETPLACE Page 5

Compliance Adv isor s Coordinates and driv es the

dev elopment and implementation of L A Care’s
. .
policy approv al process and leads the Policy &
Procedure Rev iew Committee (PPRC); activ ely
manages the AntisFraud, Was te & Abus e Program,
including inv es tigation of fraud allegations and
annual reporting to the Department of Managed
Health Care (DMHC) as w ell as is the Team Leader
,
for the S pecial Inv es tigation Unit (SIU); ass is ts w ith the
implementation of new legis lation; and champions
L A Care's Code of Conduct This pos ition is also
. . .
respons ible for ens uring that fraud, w as te, and
abus e compliance education programs are
dev eloped maintained and facilitated for s taff and
, ,
prov iders . Additionally manages the Fraud Hotline
complaints and related followsup
.
For complete j ob des cription ualifications/
,q
requirements , v is it our w ebs ite: www .lacare.org

T o apply email res ume w ith s alary his tory/

,
requirement to: recruiter@lacare.org, referencing
“Pay ers & Prov iders Ad”

It costs up t o $27 000 t o f ill a healt hcare j ob *

, .

W e’ll do it for a lot less

.

Employment list ings st art ing @ $ 1 65 a w ord

.

Advert is e: (8 77) 248 2360 ext 2

, .

Or: www payers andproviders com

. .

We Accept All Major Credit Cards

*New England Journal of M edici ne M ayFJ une 2001

,

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