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12 November 2009

California Edition

Calendar OSHPD To Overhaul Review Process
Web-Based System Will Cut Construction Timelines
November 16-18 Often criticized for delays in approving Much of the boom in hospital
hospital construction projects, California’s construction stems from mandates to
8(2/9-*4/(!>++-?/(;/-4!-9!>*)( Office of Statewide Health Planning and seismically upgrade facilities, an
>5)4?/)+!-4!>5/45!>441(2!8-49)*)4?)6! Development has begun an extensive undertaking hospital officials estimate
W-L4;-L4!7-+!>45)2)+!S(**/-;;B!8-+;! overhaul of its aging computer database. could eventually cost $40 billion.
@>!BX)&4-;)!+J)(Y)*!/+!8(2HJ;/A(!8ZH! OSHPD earlier this week selected San Managing such projects has been
</?3(*0!83(A%)*+B Ramon-based Accela Inc. to create a Web- particularly challenging for hospital
based system that is expected to greatly executives. Construction costs increased
3;;JIKKLLLB?[(B/49-K"##\Z.)4;+='B3;A2 streamline the process to obtain approvals 66% between 2003 and 2006, according
for hospital construction. The system, to the California Hospital Association.
which will cost about $1.9 million to Hospital officials also say that OSHPD –
November 17-20 install, is expected to be online by the which conducts inspections and
second half of 2010. approvals through virtually every phase
8(29-*4/(!:;(;)!<1*(2!=)(2;3!>++-?/(;/-4! An OSHPD official says the current of a construction project – can drive up
@/4;3!>441(2!8-49)*)4?)6!:(?*(A)4;-! system, a “hodgepodge” of computerized the costs via delays of plan checks and
8-4.)4;/-4!8)4;)*B!!C"D#ECFG#B and paper communications, could no approvals. Coleman acknowledges that
longer handle the volume of submissions plans and paperwork gets lost in the
<)5/+;)*!H42/4)I for construction projects. mail, and changes are not always
3;;JIKKLLLB?+*3(B-*5K?-49)*)4?)K"##$K “We were running $2 billion to $3 correctly entered into its database,
/40)MB3;A2 billion a year in terms of project workload. creating contradictory data that
Now we’re at $23 billion, and it’s no longer compounds delay.
robust enough to handle that volume,” says Partly as a result, OSHPD’s average
Paul A. Coleman, OSHPD’s deputy director approval time before construction can
November 19 for the facilities development division and begin is about 16 months, according to
a licensed architect. Coleman. Some projects require an
Moreover, OSHPD’s retrieval-based approval process of two years or more
N3)!O-.)*4(4?)!P4+;/;1;) computer system for managing construction before work can begin.
N3)!<-2)!-9!N3)!Q-(*0!P4!>++1*/45! projects – which dates back to the early Accela, which specializes in creating
P4+;/;1;/-4(2!P4;)5*/;&B 1990s – had become fundamentally interactive computer databases for
R)%/4(*B unstable, according to Coleman. “When government agencies, will create a
S)A%)*+6!T*))U!@-4EA)A%)*+6!C"$V you run identical queries, you get two paperless system that will allow OSHPD
<)5/+;)*!-42/4)I different answers, which makes it very officials and project managers to
suspect,” he says.
Continued on Next Page

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

Payers & Providers NEWS Page 2

OSHPD (Continued from Page One)
Top Placement...
Bottomless Potential communicate via Internet portals and director of business development for
continuously update project data. Accela’s land management division.
Advertise Hospital managers and building Coleman predicts that the Accela
contractors will also have access to a system will eventually reduce the average
(877) 248-2360, ext. 2 “dashboard” that will provide a real-time time for building a hospital in California
status of their projects’ progress with from seven years to five.
OSHPD. And OSHPD inspectors will also According to Sasson, that time
In Brief be able to wirelessly submit data from
construction sites, rather than have to
reduction will also lead to cost reductions
for hospitals.
input handwritten notes at a later date. “They will spending less time paying for
“The future holds some great things construction crews to be on-site,” he says,
for OSHPD in terms of streamlining adding that this could shave millions of
Cedars-Sinai Reports
processes and automating plan reviews dollars off the costs of larger projects.
More Radiation and plan checks,” says John Sasson,
Overexposure Victims

Hospital Margins On The Upswing
Cedars-Sinai Medical Center
disclosed earlier this week that 54
more victims had been discovered

Fueled By Cuts, The Trend May Only be Temporary
to have been dosed with high levels
of radiation due to an improperly
calibrated CT brain perfusion
The Los Angeles hospital
reported that at least 260 patients A national study of hospital margins show they month by the Ofce of Statewide Health
have been dosed with radiation have rebounded dramatically since they were Planning and Development echo the national
levels up to eight times higher than
clobbered by the onset of a steep recession data, with total hospital margins averaging
required to perform the scan, which
is used to determine the extent of last year. Those numbers were echoed in 8.1% in the second quarter, up from -4.9% in
internal bleeding after a stroke. The California, but industry observers believe the fourth quarter of last year.
hospital had previously disclosed nancial pressures unique to providers in the “Hospitals trimmed contract labor,
206 victims. The radiation Golden State will make such gains only increased overtime and focused on boosting
overdoses were linked to the
hospital’s scanner being improperly temporary. productivity,” Pickens says. Investment income
calibrated in early 2008. The error The study of more than 400 hospitals has also rebounded considerably.
was not discovered until August of nationwide by Thomson Reuters concludes According to Jan Emerson, vice president
this year. The Food and Drug that overall margins have rebounded from a for external communications for the California
Administration issued an advisory
low of .37% in the third quarter of 2008 to Hospital Association, notes that total
regarding CT brain perfusion
scanners after Cedars-Sinai reported 8.4% in the second quarter of this year. This operating expenses for hospitals have only
the errors. was achieved primarily by slashing labor costs risen 3.7% over the past year, compared to a
Hospital spokeswoman Simi and other expenses. Cash on hand also rose typical increase of 7% to 8%.
Singer declined to say whether the from 90 days in the rst quarter of this year to “There have been a lot of layoffs, a lot of
victim count might increase in the
future. 146 days in the second quarter – an increase service line closures and reductions in non-
The hospital also reported that of more than 60%. essential travel,” Emerson says, adding that
about 20% of the victims suffered “The majority of hospitals are poised for a collections were also ratcheted up.
radiation exposure in the lenses of strong recovery,” says Gary Pickens, Thomson One area where there is a serious
their eyes, which may put them at
Reuters’ chief research ofcer for healthcare. deviation from the Thomson Reuters data is
risk of developing cataracts at a
higher than average rate. According to Pickens, Thomson Reuters the number of hospitals operating in the red.
Cedars-Sinai has sent letters of has date from 48 hospitals in California, with Only 20% of the hospitals nationwide lost
apology to the afflicted patients, their numbers skewed toward larger teaching
and has offered to pay to treat any institutions. Financial data released late last
medical problems associated with Continued on Next Page
the overdoses.
“We have a responsibility to
do right by our patients, so we are
committed to addressing their
needs by providing information
and resources as we continue to Expert Healthcare Communications
investigate the scanning equipment
issues,” says Mark Gavens, Cedars-
Sinai’s chief operating officer. !White Papers !Media Campaigns !Newsletters
Continued on Page 3
(818) 848-8510

Payers & Providers NEWS Page 3

Longer ALOS!* Margins (Continued from Page Two)
Advertise money during the second quarter. In Passarelli notes that health plan
California, the gure for 2008 was 35%, with enrollment is down signicantly and is not
(877) 248-2360, ext. 2 41% reporting negative operating margins. expected to rebound immediately, meaning
That deviation is more likely to mean that hospitals will have to cope with more
*For our ads, not your hospital California’s hospitals will not share in the uninsured patients. Access to capital markets is
nancial largesse predicted by the Thomson still challenging, meaning costs for borrowing
Reuters study, according to industry are higher than in the past. And an economic
In Brief observers.
“If you look at the big picture, the
recovery will also pressure hospitals to begin
hiring again.
rebound is temporary,” says Shane Passarelli, “Many hospitals have put a freeze on
a senior vice president for Healthcare hiring and capital (expenditures), but you can
Finance Group, which provides nancing to only do that for so long,” he says. “If you do it
Providence, Crescent hospitals throughout California. for too long, you’re out of business.”
Enter Infusion Pact
Anaheim-based Crescent Healthcare

Kaiser Reports Improved Earnings
has entered into a pact with
Providence Health & Services
California Region to provide infusion
therapy to patients at its three
hospitals in the San Fernando Valley Quarterly Numbers up, But Enrollment is Down
region of Los Angeles.
Crescent will service Providence
patients being discharged from
Providence Saint Joseph Medical Kaiser Foundation Health Plan and Kaiser three quarters of the year, and stands at just
Center in Burbank and Providence Hospitals reported improved nancials for the
Holy Cross Medical Center and under 8.6 million.
third quarter ending September 30, but overall Kaiser didn’t break out state-by-state
Providence Tarzana Medical Center,
both in Los Angeles. It will have onsite enrollment in its health plans were down. enrollment numbers, but data from the
clinicians, primarily registered nurses, Kaiser’s nancials reect what has Department of Managed Health Care
to identify patients who would benet aficted many other major health insurers suggests most of the losses are in California.
from early discharge and infusion during the recession: better control of
therapy. Kaiser enrollment statewide stood at 6.75
Crescent has opened outpatient expenses, but lingering doubts about how to million as of June 30, the most recent date for
treatment centers in Burbank and grow membership once a nancial recovery which gures were available. That compares
several other locations to takes hold. to California enrollment of 6.81 million as of
accommodate the patient ow. The Oakland-based Kaiser, a not-for-prot
Crescent ofcials say the can save June 30, 2008 – an overall loss of 58,850, or
that operates in California and eight other 85% of its systemwide decline.
acute care providers money by
facilitating earlier patient discharges states, reported third-quarter net income of However, the enrollment losses in
and closely managing their outpatient $569 million, compared to a loss of $399 California were not nearly as steep as some of
care. million in the third quarter of 2008. Net its competitors. Anthem Blue Cross lost
“We look forward to applying our income for the three quarters totaled $1.6
methodologies to Providence's nearly 337,000 enrollees during the same
specic challenges to reduce costs at billion, compared to $201 million through the period, according to DMHC data – a drop of
their Valley hospitals while providing rst three quarters of 2008. Revenue for the about 8.5%.
smooth transitions into ambulatory rst three quarters of the year was $31.6 Kaiser ofcials made no forecasts about
care for their patients,” says Crescent billion, up from $30.3 billion through the third
Chief Executive Ofcer Robert Funari. the upcoming year. “While we are seeing
quarter of 2008. some positive nancial activity in the
Capital expenditures were cut slightly, to nancial markets, uncertainty in the economy
Blue Shield Makes $1.7 billion from $1.8 billion through the rst and healthcare industry continues,” says
Exec Appointments three quarters of the year. Kathy Lancaster, Kaiser’s chief nancial
Where Kaiser slipped was in enrollment: ofcer.
Blue Shield of California has it has declined by 68,000 through the rst
named John Hedberg as chief
financial officer for its individual,
small group and government
business unit. It also named Mike
Sears as vice president of customer
Hedberg was previously a
business finance officer for Cigna.
Sears was senior vice president of
customer care at Vonage.

Payers & Providers OPINION Page 4

9-2:!;6!<++1)!;" Providers’ Post-H1N1 Threat: MRSA
Migration of The Hospital-Acquired Strain Ups Risks
'(&)*+!,!'*-./0)*+!'1%2/+3/456! Hospital emergency rooms are filling up There may be a variety of reasons, including
778:!?4!(441(2!/40/./01(2! with flu victims much more quickly than the inappropriate disposal of medical or other
+1%+@*/=A/-4!/+!B$$!(!&)(*! normal this fall, driven by the H1N1 swine waste into the oceans or other bodies of
CB;D$!/4!%12EF:!<A!/+!0)2/.)*)0! flu pandemic. Hospital employees are water. MRSA is a hearty bug, and it is not out
%&!)GH(/2!(+!(!'IJ! treating the patients and gritting their teeth of the realm of possibility that lax
(AA(@3H)4A6!-*!(+!(4!)2)@A*-4/@! to try and get through the flu season. environmental regulations in one country is
4)K+2)AA)*: But as the weather warms and flu cases affecting many others.
subside, the spring and summer But if there is a burgeoning of
may hold another new peril, MRSA on the nation’s beaches,
?22!!(0.)*A/+/456!+1%+@*/%)*!(40! one just as pernicious and it is also possible that we could
)0/A-*/(2!/4L1/*/)+M dangerous as H1N1: be confronted by spring and
CNOOF!"DNG"PQ# methicillin-resistant summertime epidemics of the
/4R-S=(&)*+(40=*-./0)*+2:@-H Staphylococcus Aureus, or bug that mirror the fall and
MRSA. The bacteria has been a winter blossoming of H1N1.
T(/2/45!(00*)++M growing plague over the past Were that to occur, hospital
N;N!U:!V-22&K--0!W(&6!X1/A)!Y several decades, killing nearly staff and management would
Y1*%(4E6!8?!$;Z#Z 20,000 people a year – more have to be extraordinarily
than those who succumb to vigilant. The use of N-95
AIDS. Although the antibiotic respirator masks may have to
W)%+/A) vancomycin is effective against become standard. Visitor
KKK:=(&)*+(40=*-./0)*+:@-H MRSA in large doses, a restrictions may have to be
J(@)%--E recently reported strain is imposed. Hand-washing would
KKK:R(@)%--E:@-H[=(&)*+=*-./0)*+ resistant to the drug and has a become a constant. And the
>K/AA)* 50% mortality rate. housekeeping staff would have
KKK:AK/AA)*:@-H[=(&)*+=*-./0)*+ MRSA is also playing an By to be indoctrinated into the practices
7/4E)0<4 insidious supporting role to the Jim Lott of disinfecting every single square
KKK:2/4E)0/4:@-H[/4[ H1N1 pandemic: according to data inch of a hospital room after a patient
=(&)*+(40=*-./0)*+ in the Morbidity and Mortality Weekly leaves, including the window curtains.
Report published by the Centers for I am not saying that hospitals must adopt
Disease Control, MRSA was present in 8% a bunker mentality. The pharmaceutical
\0/A-*/(2!Y-(*0 of the children who died of H1N1 in industry, so long focused on developing
August. “blockbuster” products that focus on non life-
Why do I bring MRSA up? It used to be threatening quality-of-life disorders, may have
a mostly hospital-acquired bug among the to devote more resources to expanding the
^-++!]-20%)*56!83(/*H(4!-R!A3)! severely ill, but that has changed. arsenal of available antibiotics.
Y-(*06!7-+!^-%2)+!V-+=/A(2!,! Completely healthy people have been Moreover, the public awareness
T)0/@(2!8)4A)* getting infected outside of the hospital campaigns about MRSA have been extremely
setting for the past decade or so. A recent limited. Most health experts agree that
_/H!7-AA6!\`)@1A/.)!9/@)!'*)+/0)4A6! study by researchers at the University of transmission outside of the hospital setting
V-+=/A(2!?++-@/(A/-4!-R!X-1A3)*4! Washington turned up MRSA in the water occurs through unprotected cuts and scrapes.
8(2/R-*4/( and sand on seven beaches in and around Sign postings at public beaches asking
Puget Sound. Most of those strains were patrons to bandage any nicks and cuts they
the most dangerous type typically acquired have before they hit the sand and surf could
'2(4! in hospitals. make a huge difference.
The discovery of MRSA may not be
b)/A3!^/@3H(46!T:I:6!\`)@1A/.)! isolated to Washington State beaches. Jim Lott is the Executive Vice President of the
9/@)!'*)+/0)4A6!7(E)+/0)! Researchers tested at least two beaches in Hospital Association of Southern California. He is a
8-HH14/A&!V)(2A3@(*) California. Although those results were member of the Payers & Providers editorial board.
negative, testing was also delayed,
'1%2/+3)* potentially degrading the quality of the
^-4!X3/4EH(4 samples. The death of a Los Angeles Op-ed submissions of up to 575 words are
elementary school principal last year from welcomed. Please e-mail proposals to
)0/A-*S=(&)*+(40=*-./0)*+:@-H MRSA may have been linked to a vacation, or call
he took on the beaches of Cancun. (877) 248-2360, ext. 3.
Why is MRSA showing up on beaches?

Payers & Providers EMPLOYMENT/MARKETPLACE Page 5

HEALTH! EDUCATOR - Under the general supervision of
the Health Education Manager, this position is
responsible for the completion of health education
aspects of L.A. Care's disease management
program(s). !Primary functions include the design,
implementation and evaluation of member and
provider focused interventions on various chronic
disease management topics, including diabetes and
asthma. !Related responsibilities include the
assessment and delivery of patient education and self
care principles, identification and development of
culturally sensitive and linguistically appropriate health
education materials and resources, and participation
in disease management team meetings.!
For complete job description, qualifications/
requirements, and additional opportunities, visit our
For consideration, email resume with salary history/
requirement to, referencing
“Payers & Providers Ad”

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
Call Ron Shinkman at (877) 248-2360, ext. 2,
e-mail him at:
Or visit: