6 September 2012

California Edition
Calendar
September 9-11
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CDPH Fines 14 Hospitals $825,000
Hedges on Improving Glacial Appeals Process
The California Department of Public Health levied $825,000 worth of penalties against 14 hospitals late last week for serious safety breaches that led to the deaths of ve patients. However, the agency had scant details about plans to speed up a painfully slow appeals process that has delayed the collection of about $1.4 million in nes. The CDPH has issued a total of 221 administrative penalties and levied $8.425 million in nes. It has collected about $6.7 million to date, and granted ne reductions of about $350,000. However, 28 hospitals are appealing penalties, or about one in seven levied, and have yet to pay any nes. The appeals process includes a hearing in front of a state administrative law judge. CDPH ofcials conrmed that just a single hearing has taken place. In that 2010 hearing, the agency withdrew a penalty levied against Mad River Community Hospital after a day of testimony. Only two more appeals are currently scheduled for hearings. Some hospitals are still contesting penalties levied in 2007, when the CDPH rst began issuing them. “We are looking at out internal processes to handle appeals as effectively as possible,” said Debby Rogers, deputy director of CDPH’s Center for Health Care Quality. Rogers declined to provide specic details. The penalties meted out last week include: Patient Death Penalties • California Hospital Medical Center in Los Angeles received a $75,000 ne and its second administrative penalty for a 2010 incident in which administering CPR to a patient who experienced heart failure while being injected with contrast dye prior to a CT scan was delayed. A nurse declined to call a code blue for the patient. • Kaiser Permanente’s hospital in San Francisco received its third penalty and a $100,000 ne for its failure to remove an insulin pump from a patient who had been admitted for high levels of blood sugar. It is believed the pump and other injections of insulin she received led to her death from hypoglycemia. • Kaiser Permanente’s facility in Los Angeles received its rst penalty and a $50,000 ne when staff failed to monitor the vital signs of a patient who had pulled out a femoral catheter, causing her to bleed to death. The incident occurred in 2010. • Stanford Hospital & Clinics received its rst penalty and a $50,000 ne for a patient death caused by a nurse cutting sutures on a tracheostomy tube without prior permission from a physician in order to better clean it. The tube later became disconnected.

September 20
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September 28-30
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Continued on Next Page

MEET YOUR FELLOW READERS
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.

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NEWS
Fines (Continued from Page One)
• St. Mary’s Medical Center in San Francisco received its rst administrative penalty and a $50,000 ne for not properly connecting the tubes of a portable heart-lung machine. The machine disconnected when the paitent was lifted into an ambulance at the facility, leading to his death.

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armpit. The sponge was removed some time later in a physician’s ofce. • UCI Medical Center received its fourth penalty and a $75,000 ne for leaving a sponge inside a patient’s abdomen. A second surgery was required to remove it. • Kaiser’s South San Francisco facility received its third penalty and a $75,000 ne for leaving a surgical sponge in a patient who underwent tumor surgery. The sponge was removed months later after the surgical wound failed to heal properly. • Saint Francis Memorial Hospital in San Francisco received its rst penalty and a $50,000 ne for leaving a surgical sponge in a patient. Two traveling nurses were involved in the surgery, leading to a mix-up in the nal sponge count. • Simi Valley Hospital received its rst penalty and a $25,000 ne for leaving a sponge in a patient who underwent a hysterectomy in 2007. The sponge was not discovered until last year. Other Penalties • Fountain Valley Regional Medical Center received its third penalty and a $25,000 ne for a 2008 incident when a licensed vocational nurse removed a patient’s gastronomy tube without a physician’s permission. The patient required surgery to replace the tube, and had to take blood thinners for months after discharge.

In Brief
Arbitrator Says Marin General Won Case
Marin General Hospital received a fraction of what it was seeking from Sutter Health to settle a years-long dispute over siphoned revenues. Nevertheless, Marin was declared the “prevailing party” earlier this week by the arbitrator who decided the case earlier this year. Arbitrator Rebecca Westerfield, a retired judge, ordered Sutter earlier this summer to pay Marin $21.5 million, far less than the $120 million it sought from the Sacramento-based hospital chain. Marin had claimed Sutter had siphoned revenue from the facility during the 25 years it had operated the hospital under a lease agreement. Westerfield ruled against Marin’s specific claim about siphoning revenue, but did order Sutter to reimburse the hospital for money it appropriated for its own employee pension plan, the underrecruitment of physicians and other peripheral issues. With Westerfield’s declaration that Marin prevailed in the litigation, it allows Marin to seek reimbursement for its legal fees, which officials said amounted to “millions of dollars.”

Surgical Error Penalties • John F. Kennedy Medical Center in Indio received its fth penalty and a $50,000 ne for a surgical error involving a six-year-old patient. The patient’s tongue underwent a cutting procedure rather than the removal of a lesion as planned. Staff did not perform a required “time out” prior to surgery to ensure they were performing the correct procedure. • Menlo Park Surgical Hospital received its rst penalty and a $50,000 ne when the wrong surgical instrument was used during a pelvic examination, leading to a ruptured bladder. Retained Object Penalties • Saint Agnes Medical Center in Fresno received its fourth administrative penalty and a $50,000 ne when a surgical towel was left in a patient’s abdomen, requiring a second surgery to remove it. • St. Jude Medical Center in Orange County received its fourth penalty and a $100,000 ne for leaving a surgical sponge in their

Kids Medi-Cal Program Cuts Costs
Expansion of Palliative/Clinical Care is Urged
A program that concurrently provides curative and palliative care to children enrolled in Medi-Cal has signicantly cut spending per child, according to new data from the UCLA Center for Health Policy Research. Launched in 2009 in 11 of California’s 58 counties, the pilot program provides palliative care to pediatric Medi-Cal enrollees with lifeendangering conditions no matter whether their condition is terminal. Under current Medi-Cal regulations, palliative care is only rendered in the last six months of a child’s life. According to the data from the three-year pilot project, known as Partners For Children, the combination of palliative and curative care cut costs an average of $1,677 per child per month, or more than $20,000 per year. That represents an 11% overall savings on costs for treating pediatric Medi-Cal enrollees with lifethreatening illnesses. Overall, there are about 500,000 children in the United States enrolled in Medicaid who are ghting life-threatening illnesses. A total of 123 children were enrolled in the Parent For Children program in California as of last spring. Nearly 70% of the children are Latino males. Prior to their enrollment in the PFC program, 65% of their healthcare costs were
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Rideout Health Rebrands
Rideout Health is the resulting name after a rebranding effort by the former Fremont-Rideout Health Group, which operates hospitals in the Northern California towns of Marysville and Yuba City. Rideout, the surname of the system’s original founder more than a century ago, was the preferred choice

Continued on Page 3

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NEWS
Kids (Continued from Page One)
associated with inpatient hospital care, and 26% was pegged to outpatient care. Total healthcare costs averaged $15,653 per month. Once enrolled in PFC, children receive more extensive pain and symptom management, along with art and music therapy. Parents received training on how to use any home healthcare equipment they need. They were also given access to an aroundthe-clock urgent care hotline, occasional breaks in caring for the child, and bereavement counseling if the child died.

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In Brief
after the system conducted several stakeholder surveys in 2011. “We were gratied to see how important the Rideout legacy is to the community,” said Rideout Health Chief Executive Ofcer Terri Hamilton. “The name keeps us rooted in our history and mission, while the streamlined brand is more easily paired with both clinical and business partners to expand healthcare resources for our patients.” The rebranding comes as Rideout Memorial Hospital in Marysville is in the midst of a $225 million expansion and renovation.

After enrollment in the program, costs for hospitalization were reduced to 47% of the total, while less costly outpatient care grew to 39% of the total. As a result, total healthcare costs dropped to $13,976 per month. Moreover, families also reported decreased levels of anxiety, greater condence in being able to care for their child, and higher levels of sleep. UCLA researchers recommended that the program be expanded beyond the 11 counties in which it currently operates, pending full analysis of the pilot project data.

SCAN Pays $323.7M To Settle Suit
Overpayments For Dual-Eligible Care Alleged
Long Beach-based Medicare Advantage insurer SCAN Health Plan has agreed to pay $323.7 million to state and federal regulators to settle claims of overpayments for care provided to dual-eligible seniors. The settlement is the largest ever involving overpayments for dual-eligibles, who are simultaneously enrolled in the Medicare and Medi-Cal programs. The overpayments occurred between 2001 and 2008. According to a statement issued by SCAN, the state of California mistakenly calculated payment rates for dual-eligible care during that period. “We played no role in how the state set rates for the population at issue, and we were previously unaware of the mistake the state made,” SCAN Chief Executive Ofcer Chris Wing said in the statement. “Once we learned that the State made errors, we decided to refund all the money mistakenly paid. This is the right thing to do and is in the best interests of the thousands of senior citizens we serve.” However, state and federal regulators claimed SCAN did not provide the appropriate nancial information in order for it to properly set payment rates, and may have inated the risk scores of its dual-eligible enrollees to obtain higher payments. “This settlement is a victory for the MediCal beneciaries we serve,” said Toby Douglas, director of the Department of Health Care Services, which administers the MediCal program. Much of SCAN’s settlement – $320 million – is to settle the Medi-Cal portion of overpayments. It will be split between the state and the federal government. The remainder of the settlement, about $3.8 million, covers overpayments from the Medicare program. The settlements stem from a 2009 federal whistleblower suit led by a former SCAN consultant. He claimed the plan was closely analyzing patient data and systematically upcoding the medical conditions of its enrollees. In settling the claims, SCAN did not admit any wrongdoing. It has about 120,000 Medicare Advantage enrollees in California.

Legislature Passes Insurance Fraud Funding Bill
A bill expected to boost funding to fight healthcare fraud in California has been passed by both the Assembly and Senate and is awaiting the signature of Gov. Jerry Brown. AB 2138, authored by Assemblyman Bob Blumenfeld, a Los Angeles Democrat, would increase the current annial surcharge on health and disability insurers from 10 cents per insured life to 20 cents, which is expected to raise an additional $4 million a year. Seventy percent of the money would be doled among local district attorneys – up from 50% – to better prosecute healthcare and disability fraud. The remaining 30% would go to the fraud division of the California Department of Insurance, down from the 50% the agency currently receives. “I am pleased that the State Legislature passed this bill,” said Insurance Commissioner Dave Jones, whose agency sponsored the legislation. “This type of fraud hurts everyone from policyholders to providers, and, unfortunately, it is becoming more sophisticated.”

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Payers & Providers

OPINION

Page 4

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A Compendium Of Telemedicine Tips
Take These Steps When Implementing a Program
For many organizations, telemedicine offers the ability to improve access to medical services while potentially lowering the costs associated with the delivery of care. This objective aligns well with the national mandate to deliver efcient and effective care in a consistent and reproducible way. The implementation of a telemedicine program requires the active participation of physicians, clinical and management staff, as well as patients. Here are ve essential factors to consider when implementing a telemedicine system: single point of contact to manage the implementation from testing to ongoing utilization. This coordinator should work with the steering committee to develop all the policies and procedures for the clinical and medical staff members to follow when using the telemedicine system. They should also be responsible for executing the project plan, managing deadlines, troubleshooting equipment issues, and accessing technical support as well as responding to any concerns while telemedicine is adopted by the organization. 4. Recruit and train staff who are interested in 1. Create and maintain a steering committee the implementation and utilization of composed of a multi-disciplinary team of telemedicine. Identify or recruit staff members physicians and clinical and management staff. who are eager to embrace a new model of The purpose of this steering committee is to healthcare delivery. Look for staff members who develop the mission and vision of a feel comfortable using the technology, as well as telemedicine program within the organization. working with patients via a computer monitor. All committee members should embody the As part of recruitment and training processes, position of the organization that telemedicine is ask staff to participate on mock sessions. simply a tool that supports quality and cost 5. Provide a feedback loop and a effective care. Initially, this steering committee communication plan for staff and patients. The should develop and update a project plan with organization should create an deadlines and budget variances and By environment where the staff and eventually create the policies and procedures related to the use of the Anna Grellert patients feel comfortable providing feedback to the coordinator and/or telemedicine program. The steering committee. All staff involved or committee should also serve as the impacted by telemedicine should be surveyed communication hub for internal purposes. frequently in the early stages of adoption and, at 2. Establish strong physician leadership to a minimum, on an annual basis. In addition, all advocate and provide telemedicine services. patients should receive a satisfaction survey at The steering committee should include the end of each telemedicine session. The physician leaders known by the medical staff results of the staff and patient surveys should be for their commitment to improving the patient compiled and presented to the steering care experience and to the implementation of committee for discussion. A communication innovative care delivery systems. Committed plan should be developed to share success physician leadership with strong stories and challenges that have been identied communication and conict resolution skills and already addressed. will provide the medical staff personnel needed to introduce, implement, and embrace telemedicine among the organization’s practitioners. These physician leaders will need to identify the medical staff members who have the skills to manage patients via the telemedicine system in a manner that ensures a seamless interaction between the patient and physician. The patient should feel like the interaction was meaningful and addressed their needs. 3. Identify a telemedicine coordinator to implement, assess, manage, and provide managerial oversight to telemedicine. The role of telemedicine coordinator is to provide a By creating and promoting this level of commitment to feedback and action, staff members and patients will participate in the development and possible growth of telemedicine within the organization.
Anna Grellert is a manager with The Camden Group, an El Segundo-based national healthcare consulting firm.
Op-ed submissions of up to 600 words are welcomed. Please e-mail proposals to editor@payersandproviders.com

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MARKETPLACE/EMPLOYMENT

Page 5

eCONSULT PROJECT MANAGER
L.A. Care’s Safety Net eConsult Program is seeking a dynamic PROJECT MANAGER to manage the 18-month eConsult program implementation in Los Angeles County. The Safety Net eConsult Program is a project in which L.A. Care is the lead and in collaboration with MedPoint Management and the L.A. County Department of Health Services to implement eConsult technology in Los Angeles county’s safety net community clinic community. eConsult in this context is a primary care to specialist communication or messaging to increase efficiency and create additional capacity for specialist offices. The eConsult Project Manager will work closely with L.A. County Department of Health Services in this county wide effort as well as other stakeholders during this project. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned: • Creates and executes project work plans and revises as appropriate to meet changing needs and requirements. • Identifies resources needed and assigns individual responsibilities. • Manages day-to-day operational aspects of a project and scope. • Effectively applies project methodology and enforces project standards. • Prepares for engagement reviews and quality assurance procedures. • Minimizes exposure and risk on project. • Ensures project documents are complete, current, and stored appropriately. • Motivates team to work together in the most efficient manner. Keeps track of lessons learned and shares those lessons with team members. • Leads internal teams/task forces. • Suggests areas for improvement in internal processes along with possible solutions. • Performs other duties as assigned.

HEALTH INFORMATION TECHNOLOGY (HIT) PROGRAM MANAGER
As the nation’s largest public health plan, we are dedicated to helping Los Angeles County residents obtain health care for their families from doctors and health care providers. L.A. Care Health Plan is a community-accountable health plan that serves over 1 million Los Angeles County residents through four free or low-cost health insurance programs: Medi-Cal, Healthy Families, L.A. Care’s Healthy Kids. And L.A. Care Health Plan Medicare Advantage HMO. The Health Information Technology (Health IT) Program Manager will have responsibility for strategic planning and project management of technology enabled initiatives to improve clinical quality and operational outcomes for L.A. Care’s members in accordance with the Health IT strategic plan and federally supported project workplans. The Health IT Program Manager will lead in developing and overseeing project plans as well as the technical and analytical infrastructure necessary to miximize the use of health information technology and telehealth and effectively utilize the data to improve patient health outcomes and obtain available marketplace incentives. This position will have a key role in the development, project management and delivery of Health IT adoption and implementation support services to L.A. Care’s members and providers and will serve as liaison with HITECH-LA, working closely with their technology staff on statewide health IT issues and initiatives. The Health Program IT Manager will directly manage the collaboration across the Health Services department and other departments in coordinating Health IT programs. QUALIFICATIONS: Bachelor’s degree in related field required, Master’s preferred. PMP certification preferred. Minimum of 7 years of experience in health care information systems and project management. Primary Health Care services experience, Safety-Net and public health provider knowledge a plus. Knowledge of EHR systems and practice management. Knowledge of current healthcare landscape and awareness of existing and emerging state and national Health IT initiatives. Excellent communication (verbal and written) and presentation skills. Must possess excellent computer skills, particularly with all Microsoft Office applications, including Word, Excel, Access, PowerPoint and Outlook. Excellent client/ customer service orientation. Ability to deal effectively with a variety of people and work in a team environment. Ability to multi-task, priortize and work under deadlines. Must be detail oriented. Public Health and Safety-Net provider knowledge a plus. Qualified candidates please apply to clefebvre@lacare.org

QUALIFICATIONS: Bachelor’s degree in related field with a minimum of ten years experience in health care field and project management required. Project Management Certification preferred. Primary Health Care services experience, Safety-Net provider knowledge a plus. Knowledge of EHR systems and practice management. Knowledge of current healthcare landscape and awareness of existing and emerging state and national HIT initiatives. Excellent communication (verbal and written) and presentation skills. Must possess excellent computer skills, particularly with all Microsoft Office applications, including Word, Excel, Access, PowerPoint and Outlook. Excellent client/customer service orientation. Ability to deal effectively with a variety of people and work in a team environment. Ability to multi–task, prioritize and work under deadlines. Must be detail oriented. Preferred: History of EHR coordinating/training/implementation. Clinical experience in medical practices. Qualified candidates please apply to clefebvre@lacare.org

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MARKETPLACE/EMPLOYMENT

Page 6

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