20 September 2012

California Edition
September 20
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State’s Hospitals Make Quality Gains
Initiatives Slash Pre-Term Births, Cut Infection Rates
California’s hospitals and their advocacy groups have reported a number of improvements this week in a number of patient safety measures, particularly in areas such as retained surgical instruments and infections acquired during care. Although the improvements reported by the California Hospital Association were mostly anecdotal, an initiative between the state’s hospitals, Anthem Blue Cross and the non-prot National Health Foundation has led to a dramatic plunge in elective births prior to 39 weeks of gestation. In that program, known as Patient Safety First, 180 hospitals throughout California cut the percentage of elective births prior to 39 weeks gestation from 10.4% in 2010 to 3.6% last year. That’s a drop of 65%. “The reduction of early term elective deliveries by nearly two thirds is an amazing result and a testimony to the potential of the Patient Safety First collaborative,” said Pam Kehaly, president of Anthem Blue Cross of California. Kehaly added that it was hoped the initiative can be spread to every hospitals in the state. Elective births prior to 39 weeks had become fairly commonplace as a way to accommodate the often hectic schedules of both obstetricians and expectant parents. However, several studies showed that children born prior to 39 weeks gestation had encountered issues with brain development and suffered higher mortality rates. Some hospitals participating in the initiative were engaged in pre-39 week deliveries as a matter of routine. San Antonio Community Hospital in the San Bernardino County town of Upland was delivering 31% of its newborns prior to 39 weeks in 2009. Now it is around 4%. According to San Antonio’s maternal services nursing director Rhonda Mulvehill, the hospital’s obstetrics staff were presented with data regarding earlier elective deliveries to help change their practices. Educational posters about how such births affecting the brain development of newborns were posted in the hospital and in the areas where childbirth classes were held. “It took a while, but now it’s the standard of care,” said Mulvehill, who added that cases of jaundiced infants and readmissions have dropped, and that the hospital’s newborns are now breastfeeding more quickly. As a result of these later births, ofcials involved with the initiative say participating hospitals have saved about $3.7 million to date. The CHA also reported that initiatives focused on reducing the incidents of surgical errors, medication errors and the hospitalacquired infection C. difcile. Such infections kill about 1,400 Californians a year in
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September 28-30
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October 11-12
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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

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


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Hospitals (Continued from Page One)
hospitals, nursing homes and outpatient facilities. According to the CHA, the not-for-prot hospital chain Dignity Health, formerly known as Catholic Healthcare West, initiated a program intent on making sure no patients suffered from retained surgical sponges while giving birth. Between July 2010 and 2011, its maternal wings handled more than 650,000 sponges without leaving a single one in a patient. On the medication front, UCSF Medical Center has not encountered a single medication error since installing an automated hospital pharmacy in 2010. And Kaiser Permanente’s Northern California region has used electronic medical records to reduce errors involving high-risk medications by more than 90%.

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In Brief
Delano Pays $975K To Settle Discrimination Suit
Delano Regional Medical Center in Central California has paid $975,000 to settle a lawsuit claiming Filipino-born members of its nursing staff were discriminated against. According to the lawsuit, filed with the support of the U.S. Equal Employment Opportunity Commission, the nurses were told only to speak English on the hospital premises. Co-workers were also allegedly ordered to eavesdrop on them to make sure they complied with the order. The case was initiated by complaints from 69 current and former nurses at Delano, who claimed that the insistence they speak only English on hospital premises created a hostile environment. The hostility, they say, did not abate even after 100 members of the nursing staff sent a signed petition to management. Hospital officials said they decided to settle the case because it avoided the expense of a trial, and said the nurses had “attacked” the facility, which is located about 35 miles north of Bakersfield, with the lawsuit. Although it admitted no wrongdoing, it agreed as part of the settlement to provide antidiscrimination training and retain a monitor to track how its employees and management behaved in the workplace. According to the Asian Pacific American Legal Center, the settlement is the largest ever involving language discrimination in healthcare.

Regarding C. diff infections, Pacic Hospital of Long Beach was able to eliminate such incidents completely between 2009 and 2010, primarily by improving the hygiene of both patients and hospital workers and cleaning its facilities more thoroughly. El Camino Hospital in Mountain View cut its infection rate by 50% using similar measures. “It is a shared responsibility involving everyone who comes to the hospital. Everyone – doctors, nurses, hospital employees, patients and visitors – plays a role in ensuring the delivery of safe, high-quality patient care,” said CHA Senior Vice President and Chief Medical Ofcer David Perrott, M.D. The CHA has posted the results of such initiatives on a website it has dedicated to patient safety initiatives, www.caringisourcalling.org.

CalOptima Seeking Reimbursement
Wants $90K Over Alleged Misuse of Employees
CalOptima is seeking more than $90,000 from two of its former board chairs and a coalition of healthcare executives to compensate for alleged unauthorized use of its employees. According to letters issued last week by CalOptima’s compliance director, the agency wants $82,045 from former chairman Michael Stephens, and $8,346 from former chairman Edward B. Kacic and the Irvine Health Foundation, where Kacic serves as its chief executive ofcer. The agency is also seeking payment of those combined sums from the Managed System of Care through OneOC, a non-prot group that acts as the MSC’s scal intermediary. The reimbursement requests follow months of management and governance tumult at CalOptima, which provides MediCal managed care coverage for about 450,000 Orange County residents. It also shines a light on the amalgam of formal and ad hoc organizations that forge healthcare policy in one of the state’s most populous regions. CalOptima alleges that Stephens, who served as the health plan’s board chair between 2007 and 2011, had used one of its employees full-time to support his work after he was appointed as executive director of the MSC in 2010. Stephens, who retired as the longtime chief executive ofcer of Hoag
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CalOptima (Continued from Page Two)
Memorial Hospital Presbyterian in 2005, was paid by OneOC on an hourly basis to oversee the MSC, which is comprised of about 20 Orange County healthcare leaders whose goal is making the region's safety net system more efcient. The MSC was created by the Health Funders Partnership of Orange County, another loose coalition of executives whose scal affairs are handled by OneOC. However, it has mostly ceased operations in recent months, and its phone number was disconnected as of this week. According to the letter, Stephens had used the services of a CalOptima senior project manager full-time between April and August 2010, and then for eight hours a week through the remainder of that year without approval of the CalOptima board. Stephens was also given ofce space at CalOptima’s headquarters in Santa Ana. The letter suggested Stephens may have also billed OneOC for the CalOptima employee’s time, even though she drew her paycheck from the insurer the entire time she performed tasks for the MSC. “Mr. Stephens declined to provide copies of his billing statements/time sheets, or to authorize OneOC to release them, so we have been unable to verify whether he may have billed for time worked by this CalOptima employee,” the letter said. Stephens did not return phone calls to his Newport Beach home seeking comment. OneOC Executive Director Daniel J. McQuaid did not respond to calls and emails seeking comment. Kacic succeeded Stephens as CalOptima chair last year. CalOptima alleges that he used its director of strategic operations for 70% of her time to work last January in an unsuccessful attempt to secure a $9.3 million federal grant. That money would have gone to the Irvine Health Foundation to create medical homes and provide other services to CalOptima and Medi-Cal enrollees.

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In Brief
Keck Opens Kidney Center
The Keck School of Medicine at the University of Southern California has established a kidney research center. The center was funded with a $3.5 million grant from the United Kidney Research Organization, a not-forprot that sponsors kidney research. The program will be managed under the auspices of Keck’s nephrology department. It will be chaired by Vito Campanese, a USC professor who also chair’s UKRO’s scientic advisory board. “Millions of people in America suffer from chronic kidney disease, but with the establishment of this center, those patients now have an extra champion in the ght," said Keck dean Carmen A. Puliato, M.D.

Greater Newport Physicians President Dies Suddenly
Catherine Campion-Ritz, M.D, chief executive ofcer of Greater Newport Physicians in Orange County, died in a bicycle accident last week. She was 57 years old. A family physician by training, Campion-Ritz had been president of Greater Newport Physicians since 1994. It has more than 500 physicians, making it one of the largest IPAs in California. She played an integral role in afliating it with the MemorialCare hospital system in Long Beach. “Dr. Campion cared for thousands of patients over the last three decades and played an important role in the health of so many Orange County families. Everyone at Greater Newport Physicians is deeply saddened by this great loss,” said Diane Laird, Greater Newport’s chief executive ofcer.

“We are still determining what our response may be,” Kacic said in an e-mail, speaking on behalf of both himself and the Irvine Health Foundation. Kacic took issue with the letter from CalOptima, which he said “contains many factual inaccuracies and revisionist history.” He noted that Richard Chambers, the former CalOptima executive director who has since taken a high-level position with Molina Healthcare, had approved the use of CalOptima personnel to work on the grant, and that he believed he had the authority to do so. Under Chambers’ direction, the use of the employees was considered a non-cash contribution to the MSC, according to published reports. Kacic has also maintained the Irvine Health Foundation was merely acting as an intermediary for the MSC because it was not properly incorporated to receive federal grant money. However, the lengthy grant application included provisions for his foundation to hire as many as 12 employees to manage the project. CalOptima’s letter to Kacic also took note of the fact the grant application did not have the full support of the insurer, even though its board asked for additional information before taking an ofcial position. Kacic said that had to do with another issue: The MSC’s attempts to secure $12.7 million in intergovernmental transfers for another care initiative. Kacic co-chaired the MSC while that process was underway. Those arrangements, rst reported by Payers & Providers last February, were extensively criticized as a conict of interest by Orange County Supervisor Janet Nguyen, another CalOptima board member. That led in part to Kacic being removed as CalOptima board chair in May, not long after a routine reappointment earlier this year was tabled by the Board of Supervisors. Kacic later resigned from the board altogether.

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The End Of My Practice As I Know It
Burnout Fueled Doc’s Decision to Limit Seeing Patients
Probably the hardest part of making the this what being a doctor is about? Aren’t they change from a traditional to a direct-care paying for my attention, for explanations, for practice is the effect it has on relationships. I listening? Isn’t it dangerous as a doctor to not am only taking a maximum of 1,000 patients listen? (less at the start) and will be no longer If those doctors don’t talk, what are they accepting insurance. These changes make it doing? Singing? Doing sign language? Using impossible for me to continue in a doctortheir psychic powers to probe the patients’ patient relationship with most of my patients. minds? Whatever the case, I see from these For some, this transition will be more statements that I either care more than many hassle than anything. Some people do doctors, or I just love to talk. The last one is everything they can to avoid my ofce, and denitely true, but the burnout has occurred so are not going to be greatly affected by my because of my inability to not care. absence. They will simply choose another The most gratifying thing that has provider in our ofce and continue avoidance happened since my announcement is that as always. patients have almost universally expressed There are others who see me as their their happiness for me in making this change. doctor, but they haven’t built a strong bond They aren’t surprised that I burned out, and with me (despite my charm), so the change they are pretty fed up with the system, so they may even be a welcome relief, or a chance to don’t question why that would happen. But the avoid initiating the change to another doctor. genuine happiness for me as a person has But there are many people, some of really touched me. which have already expressed this, for whom For those I’ve taken care of for many years my departure will be traumatic. “Nobody else (some of them nearly 18 years), there is a bond knows me or understands me like that is hard to explain. I’ve walked By you do,” one person told me this through life with them, and for week. “I’ve seen you for so many Rob Lamberts, many, that life has been very hard. years, you just know so much more My decision to leave my current M.D. about me than any other doctor,” practice didn’t involve money. I am said another. paid just ne for what I do and haven’t seen a I’ve seen tears, have gotten hugs, and get drop in salary, despite the mess our system is frequent demands for a clearer explanation as in. to what I am doing and why. It’s been a rough My decision was largely driven by week for me, as I don’t feel I can cut off these relationship. I’ve watched as my ability to relationships without some sort of closure. draw close to my patients has been slowly For someone who sometimes goes overboard taken away. Some have suggested that I have in the importance of others not being mad, been selsh in this decision, bolting from the it’s been hell. sinking ship instead of trying to x it. But I In truth, the depth of the response I’ve have been obsessed with xing the system – seen underlines the main reason I am going rst through use of computers to improve the to this new kind of practice: I care too much. process, and then through my voice on the I have always run behind because I talk to Internet through writing. I have done all I can people, joke with them, tickle the kids, and to change the system from within; now it’s ask open-ended questions. When I am time to be real disruptive, and change it by running behind, I don’t let that stop me from stepping out. giving my full attention to the next person in the exam room. Despite my chronic Rob Lamberts, MD, is a primary care lateness, people don’t complain much. They physician practicing in the Southeastern know that I will give them the time they need United States. He blogs regularly at More when I am in with them; I can’t cheat them of Musings (of a Distractible Kind) where this post the time they need. first appeared. I’ve always been puzzled when people say things like, “You are the rst doctor who’s Op-ed submissions of up to 600 words are really listened to me,” or “You always give me welcomed. Please e-mail proposals to your time and attention when I come in.” Isn’t

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Payers & Providers


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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.

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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