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10 December 2009

California Edition

Calendar OC Bets Big On Pediatric Specialists

County Agency Offers Six-Figure Loan Forgiveness
December 10
In what officials say is the first-of-its-kind care physicians. Waiting times for some
N8U7!9)(2;3=(*)!V)%!?1AA/;6!V)%/4(*B use of Proposition 10 tobacco tax funds, specialty care can be as long as five
the Children & Families Commission of months, according to Children & Families
<!0/+=1++/-4!->!->!3-I!3)(2;3=(*)!*)>-*A! Orange County has pledged nearly $1 Commission officials.
I/22!/A:(=;!N)0/=(*)!(40!3)(2;3!:2(4+B! million to attract badly needed pediatric Advocates for children’s medical care
specialists to the area. say the approach being taken by the
F)5/+;)*!-42/4)G The agency, Orange County’s affiliate of Childrens & Families Commission is
First 5 California, tries to expand access to unique. “We’re always looking for
3;;:GHHIIIB3)(2;3I)%+1AA/;B=-AH care to children from birth to the age of 5. innovative ways in an era of strained
It is offering $125,000 of medical resources to try and attract and retain
education debt forgiveness to each physicians. They’ve been kind of self-
January 28 pediatric specialist who chooses to move to starters on that,” says Tim Shannon, the
Orange County to practice – more than six legislative representative for the
9-+:/;(2!<++-=/(;/-4!->!?-1;3)*4! times the amount offered by state-run Children’s Specialty Care Coalition, a
8(2/>-*4/(6!"40!<441(2 programs. The initiative is slated to begin trade group for more than 2,000
'(;/)4;!?(>);& next month. pediatric specialists statewide.
8-22(%-*(;/.)!8-22-@1/1AB!9/2;-4!9-;)26! “Our goal is to bring at least half a The program was approved by the
'(+(0)4(B!C(*/-1+!%*)(D-1;!+)++/-4+!-4! dozen new pediatric specialists to Orange Childrens & Families Commission after a
E$$B County within the next three years,” says lengthy internal debate, including how to
Michael Ruane, the Children & Families determine the amount of loan
F)5/+;)*!-42/4)G Commission’s executive director. The forgiveness. “We felt we had to offer at
commission will focus specifically on least $100,000 to generate interest,” says
;(+DK0)+=*/:;/-4,A-012)KL,;)A:2(;)KL$, attracting pediatricians with expertise in Kathi Crowley, a consultant to the
orthopedics, neurology and endocrinology. commission.
California is struggling to recruit Sherry Novick, executive director of
January 24-27 pediatric specialists, say observers familiar the First 5 Association of California, the
with the situation, but the shortage is lobbying group for the county-level
9MN<!F)5/-4(2!8-4>)*)4=)B! particularly acute in Orange County. commissions, notes that Orange County
8()+(*’+!'(2(=)6!7(+ According to a recent survey by has been trying to build physician
C)5(+B!!O(./0!P*(/2)*6!NBOB6!/+!;3)! CalOptima, the county’s Medi-Cal managed capacity internally, as opposed to trying
D)&4-;)!+:)(D)*B care health plan, just 92% of pediatric to get specialist physicians to visit from
patients are referred to a specialist within
EQ$QRESTQ 30 days. That compares to nearly 100%
F)5/+;)*!U42/4)G access rates to primary care and urgent 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

Pediatricians (Continued from Page One)

Top Placement...
Bottomless Potential other counties, or transporting children would be remitted directly to the
for visits. physician’s education creditors over a three-
Advertise “Although loan repayment is not year period.
unique, it is to this program,” Novick Shannon believes the amount being
(877) 248-2360, ext. 2 says, adding that it will be studied closely offered is generous enough to attract
by other First 5 commissions. interest, particularly among younger
Novick believes that Orange County physicians who are likely facing
In Brief has an advantage many other of
California’s 58 counties do not: a
considerable debt. According to data
released in October by the Association of
teaching institution such as UCI Medical American Medical Colleges, the average
Center, which not only produces many medical school debt carried by a newly
new physicians but also employs them minted physician has ballooned to
CMS to Cover HIV Tests
directly. $156,000 today, compared to $139,517 just
Physicians who accept two years ago – an increase of 11%.
The Centers for Medicare and
Medicaid Services announced this reimbursement must be in solo practice, The Health Professions Education
week its intent to cover testing of or employed by a clinic or teaching Foundation, an affiliate of the Office of
any enrollees for the human hospital in Orange County, and have at Statewide Health Planning and
immunodeficiency virus (HIV), least 51% of their patient base enrolled in Development, will administer the program
which causes AIDS.
“The decision marks an Medi-Cal or Healthy Families. Funds for the commission and assist in recruitment
important milestone in the history efforts.
of the Medicare program,” Health
and Human Services Secretary
Kathleen Sebelius said in a
statement. “Beginning with Radiation Errors Continue To Surface
expanding coverage for HIV
screening, we can now work Cases in California Now Linked To Three Hospitals
proactively as a program to help
keep Medicare beneficiaries
healthy and take a more active role As ofcials with the U.S. Food and Drug manufactured by Toshiba American Medical
in evaluating the evidence for
Administration suggest the overdosing of Systems, which is based in Tustin.
preventive services.”
The expansion of coverage was patients with radiation while undergoing CT According to Fielding, the issues that led
included as part of the Medicare brain perfusion scans may take on a national to the radiation overexposures were similar to
Improvement for Patients and dimension, errors involving the devices in those in the Cedars and Glendale Adventist
Providers Act that was enacted into California have so far been linked to three cases: the devices functioned properly, but
law last year.
Among those eligible for HIV- hospitals in Los Angeles County. hospital staff or outside technicians changed
testing are pregnant women Jonathan Fielding, M.D., director of the dosage defaults for brain perfusion scans to
enrolled in the Medicaid program, Los Angeles County Department of Public much higher levels and the error was not
and all Medicare enrollees. Health, conrmed that an investigation by his caught. “It appears to be related to software
According to the Centers for
agency’s radiation safety branch discovered and protocols,” he says.
Disease Control and Prevention,
nearly a quarter of those living with 34 patients at Providence Saint Joseph Providence Saint Joseph issued a brief
HIV or the AIDS virus were over the Medical Center in Burbank were exposed to statement that did not specically discuss
age of 50 in 2005, up from 17% in excess radiation while undergoing CT brain incidents at its facility. “To date, we have had
2001. Nearly 20% of all new AIDS perfusion scans during a 20-month period no adverse reactions reported due to
diagnoses come from this group.
“Every adult should know their that ended in October. Cedars-Sinai Medical unnecessary exposure,” it read in part, adding
HIV status,” says assistant health Center in Los Angeles disclosed 206 patients that it was still evaluating whether any patients
secretary Howard K. Koh, M.D. had been exposed to excess radiation in had received overdoses.
“This decision by Medicare should 2008 and 2009, a number FDA ofcials Fielding does not believe any more
help promote screening and save
boosted to 256 this week. Glendale Adventist facilities in Los Angeles County will be linked
Medical Center disclosed last month that 10 to radiation overexposures. “We’ve called all
patients were exposed to excess radiation. 78 hospitals and 38 imaging centers. Only 11
Miller Childrens Opens FDA ofcials linked 14 cases to Glendale were using the brain perfusion test, and all
New Hospital Pavilion Adventist, but a hospital spokesperson says have been investigated,” he says.
the number of known cases remains An ofcial with the California
Miller Children’s Hospital in Long unchanged at 10. Department of Public Health conrmed that
Beach has completed a new 124,000- Unlike the Cedars-Sinai and Glendale no other facilities statewide are being
square-foot patient pavilion after six
Adventist cases, which involved a CT scanner investigated. Late last month, the CDPH issued
years of planning and construction.
manufactured by GE Healthcare, the an advisory to more than 800 hospitals and
Providence Saint Joseph device was
Continued on Page 3 Continued on Next Page

Payers & Providers NEWS Page 3

Longer ALOS!* Radiation Overdoses (Continued from Page Two)

Advertise outpatient facilities statewide to examine Alabama case will not be isolated. “The FDA
their CT brain perfusion protocols. has also received reports of possible excess
(877) 248-2360, ext. 2 “That is one of the ways the state is exposure from other states,” he says, but adds
trying to nd out whether the problem is that there should not be a concern regarding
*For our ads, not your hospital larger,” says CDPH spokesman Ralph the overall safety of the devices as long as they
Montano. are operated properly.
Meanwhile, the FDA reported earlier this To that end, the FDA issued ve interim
In Brief week that at least one case of overexposure
was reported in Alabama. The FDA did not
guidelines on how to operate CT scanners for
all perfusion scans. They include ensuring all
disclose the name of the facility, although the facilities scrutinize their current dosing
Los Angeles Times reported the incident protocols; examine the CT scanner’s display
The pavilion includes 24 new
neonatal intensive care beds and occurred at Huntsville Hospital. panel for radiation dosage levels prior to
seven new surgical suites, as well as Jeffrey Shuren, M.D., acting director of performing the scans; and adjusting the
room for additional acute care beds. the FDA’s Center for Devices and radiation dosages as appropriate for each scan
The addition brings the hospital’s total Radiological Health, suggests that the if a patient undergoes multiple scans.
bed count to 308.
“We are deeply committed to
continuing to serve the Long Beach

California Hospitals Top Leapfrog List

community by offering an
environmentally-friendly and modern
care facility that exists to improve the
lives of children for generations to
come,” says Diana Hendel, chief Six of Kaiser’s 30 Hospitals in State Included
executive ofcer of Miller Childrens
and Long Beach Memorial Hospital.
The expansion project cost $196 Thirteen of the 45 hospitals named by the data reporting. Among the reasons are
million, of which $172 million came
Leapfrog Group this week as delivering the existing state-level quality reporting initiatives
from Proposition 3 and Proposition
61 funds. The additional $24 million highest efciency and quality were in such as the one managed by the Integrated
came from the hospital’s capital California, including six operated by Kaiser Healthcare Association, according to Binder.
campaign. Permanente. As for Kaiser predominating among
The hospitals were judged by the California hospitals, Binder says it has strong
Washington, D.C.-based Leapfrog on four internal incentives for controlling its acute
Health Net Resumes criteria: meet standards for implementing care resources.
Stock Repurchases computerized physician order entry systems; Jim Anderson, spokesperson for Kaiser’s
meet standards for complex procedures such Southern California Region, says the hospital
Woodland Hills-based insurer as heart bypass surgery; and meet specic system has made strong use of its electronic
Health Net, Inc. has resumed its standards for intensive care unit stafng. medical records and CPOE systems.
stock repurchase program after a
13-month suspension. The The hospitals were also judged on a new “Healthcare quality and efciency can go
program, originally launched in efciency score, which is a combination of together,” he says.
2002, was authorized to purchase quality outcomes, length of stay, readmission Along with the Kaiser hospitals,
back $700 million worth of shares. rates and rates of hospital-acquired infections California Pacic Medical Center’s three
Health Net’s board of
and other complications. The quality portion campuses were also named, as were
directors suspended the program in
November 2008, partly due to accounts for two-thirds of the score. Childrens Hospital Los Angeles and
concerns related to the ongoing “California has certainly emerged on our Children’s Hospital of Orange County.
financial crisis. At the time, Health list as the clear winner in efciency Binder says the quality ratings of the
Net’s stock had plummeted to just nationally,” says Leapfrog Chief Executive more than 200 hospitals that participated in
over $8 a share, down from more
than $52 a share in January 2008. Ofcer Leah Binder. She adds that California’s the survey will be released in the spring.
The stock’s price has since hospitals are relatively transparent in terms of
rebounded to $23 a share.
“The board’s action
underscores our confidence about
the future,” says Health Net Chief
Executive Officer Jay Gellert.
About $103 million in
purchasing capacity remains in the Expert Healthcare Communications
program, according to Health Net
officials. Health Net may
repurchase shares on the open !White Papers !Media Campaigns !Newsletters
market, private transactions or
accelerated share repurchase
programs. (818) 848-8510

Payers & Providers OPINION Page 4

9-2:!;6!<++1)!;= How To Position The Public Option

Should Plan Come To Pass, it Must Operate Properly
'(&)*+!,!'*-./0)*+!'1%2/+3/456! Why is a public plan option important to quality of care.
778:!@4!(441(2!/40/./01(2! healthcare reform? In the words of • Focus the public plan option on
+1%+A*/>B/-4!/+!C$$!(!&)(*! President Obama, it’s to “keep insurance improving health Because the public plan
DC;E$!/4!%12FG:!<B!/+!0)2/.)*)0! companies honest.” In a more positive is not profit driven, it will be able to
%&!)HI(/2!(+!(!'JK! light, a public plan option could raise the reinvest surpluses realized by efficiencies
(BB(A3I)4B6!-*!(+!(4!)2)AB*-4/A! bar in terms of health plan performance. directly into the community. Regional
4)L+2)BB)*: How can it be structured so this is public plans could develop and test new
accomplished? care models, reinvest in the safety net,
Recognize that healthcare markets are provide grant programs, or return monies
@22!!(0.)*B/+/456!+1%+A*/%)*!(40! local. Health care markets vary in terms directly to purchasers and consumers, with
)0/B-*/(2!/4M1/*/)+N of population demographics, provider the goal of improving the health of the
DOPPG!"EOH"QR# density, hospital accessibility, and many community. At L.A. Care, we have been
/4S-T>(&)*+(40>*-./0)*+2:A-I other factors. The two key health care able to invest over $80 million locally to
providers that account for the majority of support community clinics and provide
U(/2/45!(00*)++N spending, doctors and hospitals, are local. coverage for tens of thousands of kids who
O;O!V:!W-22&L--0!X(&6!Y1/B)!Z A local or regional plan is nimble would otherwise be uninsured. This
Z1*%(4F6!8@!$;=#= enough to adjust to ever- is another example of “raising of
changing local market the bar” for all health plans.
conditions. Let’s offer states
X)%+/B) incentives to create regional •Protect the safety net Safety net
LLL:>(&)*+(40>*-./0)*+:A-I health plans that can be public, providers will continue to be the
K(A)%--F not-for-profit, or cooperatives, main source of care for those who
LLL:S(A)%--F:A-I[>(&)*+>*-./0)*+ and are designed to serve local remain uninsured or are socially
?L/BB)* markets. For over a decade in or behaviorally difficult to
LLL:BL/BB)*:A-I[>(&)*+>*-./0)*+ California, nine counties have effectively treat in private settings.
7/4F)0<4 had public health plans that These providers will continue to
compete with private health plans in By provide care to many insured through
>(&)*+(40>*-./0)*+ the Medi-Cal program. All of these Elaine government-sponsored programs.
regional health plans have been Batchlor, Regional public plans should be
highly successful in taking advantage M.D. required to include in their networks
\0/B-*/(2!Z-(*0 of local market conditions to qualified safety-net providers that
improve not only efficiency in the agree to provide services with the
delivery of care, but also the quality of the same terms and conditions required of any
care delivered. other providers. This provision would help
^-++!]-20%)*56!83(/*I(4!-S!B3)! safety net providers stay in business, once
Z-(*06!7-+!^-%2)+!W-+>/B(2!,! • Engage local stakeholders Local most of the uninsured have coverage.
U)0/A(2!8)4B)* stakeholders are crucial in helping to
design a plan that will reflect the needs The public plan option should be just that
_/I!7-BB6!\`)A1B/.)!9/A)!'*)+/0)4B6! and priorities of the communities it – another choice that helps keep local
W-+>/B(2!@++-A/(B/-4!-S!Y-1B3)*4! serves. Public option plans should markets functioning with transparency and
8(2/S-*4/( include a board with representation from accountability, and serves the public interest.
membership, doctors, hospitals and California public plans, with their long track
clinics. Such a design is vital to “keep records, can lead the way and show the
'2(4! health insurance companies honest.”! It nation how it’s done.
provides the transparency and the
b)/B3!^/A3I(46!U:J:6!\`)A1B/.)! accountability so critical for true Dr. Elaine Batchlor is the chief medical officer of L.A.
9/A)!'*)+/0)4B6!7(F)+/0)! healthcare reform.! Care Health Plan, the nation’s largest public insurer.
8-II14/B&!W)(2B3A(*) She is a member of the Payers & Providers editorial
• Create a level playing field All plans, board.
'1%2/+3)* whether public or private, should have
^-4!Y3/4FI(4 the same licensing, oversight, regulatory, Op-ed submissions of up to 575 words are
actuarial rate setting methodology, and welcomed. Please e-mail proposals to
)0/B-*T>(&)*+(40>*-./0)*+:A-I financial reserve requirements. In, or call
addition, the public plan should be held (877) 248-2360, ext. 3.
to the same requirements for access and

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*New England Journal of Medicine, 2004.


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