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18 February 2010

California Edition

Calendar Inland Empire Inches Toward A RHIO

10 Bidders Interested, But Funding Remains Big Issue
February 25-26
Providers in the Inland Empire are moving Green says that an IT contractor
toward the formation of a regional health typically charges implementation fees of
98:!;)(2<3=(*)!>-*)=(+<!8-4?)*)4=)6! $200,000 to $500,000, plus an ongoing
@)=AB(4!8)4<)*6!:*./4)C information organization (RHIO) to better
provide coordinated patient care to the far- operational fee that is usually several
>-=1+!D/22!%)!-4!3)(2<3=(*)!E-2/=/)+!/4!(4! flung area, but raising money for the effort dollars each month for each patient
)2)=</-4!&)(*6!(40!3-D!<3)!3)(2<3=(*)! could prove a formidable obstacle. being cared for by the providers
)4./*-4B)4<!B/53<!=3(45)!/4!<3)!D(A)!-?! The Inland Empire involved.
Health Information “It’s millions of dollars,”
L)5/+<)*!M42/4)N Technology Coalition has Inland Empire RHIO Bidders says Christina Bivona-
solicited ten potential Axolotol Corp.
Tellez, regional vice
3<<ENOOB)*(5)C1=/C)01O).)4<+/<)+O bidders from a recently- Medicity president for the Hospital
issued request for Carefix Association of Southern
proposals, attracting Excita California, which has been
March 3-5 attention from some
Long Beach Health Network
convening meetings of all
Health Access Solutions
powerhouse IT firms such IntelliChart the coalition members.
R441(2!L1*(2!;)(2<3=(*)!S&BE-+/1B6! as Microsoft. Information Corp. of America The potential payoff is
;&(<<!L)5)4=&6!S(=*(B)4<-C UAI immense, however. An
However, the
Microsoft Corp. integrated data exchange
T/+=1++/-4!-?!=3(45)+!/4!E-2/=&!(??)=</45! coalition, which was
*1*(2!3)(2<3=(*)!E*-./0)*+!/4!8(2/?-*4/(C! formed about a year ago network between providers
FG"HIFHH# and includes 22 hospitals in the nation’s two largest
L)5/+<)*!M42/4)N! and 27 medical groups in Riverside and counties – where some hospitals are
San Bernardino Counties, may take a step nearly 200 miles apart – could reduce
back first and hire a consultant to ponder costs significantly. Bivona-Tellez says
its options for raising capital. that most providers are investing in
“What we hope to do is to be able to electronic health records, but have no
March 9-10 hire a consultant that has successfully way of sharing them with other hospitals
implemented a health information or physician groups.
;)(2<3&!')-E2)!8-4?)*)4=)C!P-45!Q)*2))! exchange in other communities,” says “It’s a very valuable tool in terms of
8-4?)*)4=)!8)4<)*6!7-B(!7/40(!94/.)*+/<&C! Dolores Green, executive director of the primary care,” says Green, noting that
R!0/+=1++/-4!-?!3-D!=-BB14/</)+!=(4! Riverside County Medical Association. “We being able to exchange patient records
/BE*-.)!<3)/*!3)(2<3!<3*-153!%)<<)*!0/)<+! need to be able to get to a model that is
self-sustaining.” Continued on Next Page


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Payers & Providers NEWS Page 2

Inland Empire (Continued from Page One)

Top Placement...
Bottomless Potential would eliminate services that are often operational in the long-term. The California
duplicated when an Inland Empire RHIO all but disbanded last year after being
Advertise resident has to travel between providers. in operation since 2005. Although it was
Bivona-Tellez says startup funds for named as a co-finalist to act as a conduit
(877) 248-2360, ext. 2 the project could be raised by imposing a for federal funds, it could not reach an
fee on all the RHIO participants, or by agreement with CAEHC, the other co-
soliciting grant funds. One potential area finalist, on how such an arrangement would
In Brief of capital might be stimulus funds from
the Obama Administration, which has
According to the CAEHC website, only
been encouraging the use of electronic five of 14 planned RHIOs in California are
medical records and electronic currently operating. Two others, in Santa
exchanges. The California e-Health Barbara and San Jose, have ceased
Anthem Blue Cross
Collaborative (CAEHC) is the likeliest operations.
Delays Rate Increases conduit for such funds, she adds. “The price tag is so big to get started up
RHIOs, also known as health that we don’t want to make a mistake,”
Anthem Blue Cross of California Green says.
information exchanges, have been
has agreed to delay a rate increase
of as much as 39% for its individual struggling in California to remain
health plan enrollees.

Physical Therapists Criticize Anthem

The increase, which was to
have gone into effect on March 1,
will be stayed 60 days in order to

Claim Payment Changes Will Hurt Practices, Care

be reviewed by the California
Department of Insurance, Anthem
said late last week.
Anthem has come under fire
for the rate increases. Both state
and federal officials have asked for Under re in recent weeks for attempts to payment (from Anthem) will be regardless of
reviews. increase individual policyholder premiums as care,” he says.
“Our decision to agree to much as 39%, Anthem Blue Cross of Physical therapy provided via medical
postpone the rate adjustment does California is now drawing criticism from groups or in hospitals will be excluded from
not change the underlying issue. All
physical therapists for potentially cutting their the payment change, according to Katz, who
health plans are in the same
situation in trying to deal with the payments by as much as half. sits on the CPTA board.
steadily increasing medical costs in According to the California Physical Katz also claims that Anthem dropped a
the delivery system, which are not Therapy Association and other sources, longtime provider of networked physical
sustainable,” said Brian Sassi, Anthem will move on March 1 from a therapsists, Calabasas-based PTPN, and will
President of Anthem’s consumer
business unit, in a prepared discounted fee-for-service model for physical network with individual practices directly.
statement. “We are also therapists participating in its PPO network to PTPN ofcials were not immediately available
experiencing a higher proportion of $75 per visit. As a result, therapists expect for comment.
healthy individuals choosing not to average payments for their work to drop Anthem conrmed the changes in
enroll, leaving an insured pool that
signicantly. reimbursement through a written statement,
utilizes significantly more services.”
Richard Katz, who operates physical but would not comment further. “Under the
therapy practices in both Los Angeles and the new structure if the amount paid to the
Bay Areas, estimates that the average therapist is reduced then the member will
OSHPD Grants $1.7M reimbursement has been close to $100 per experience a corresponding decrease in their
For Nurse, PA Training visit. “If you get into specialty care, such as out of pocket expense,” read a portion of the
hand therapy, it goes much higher. This statement.
The Office of Statewide Health
Planning and Development has Continued on Next Page
awarded $1.7 million in grants to
15 universities statewide to fund
training programs for nurse
practitioners and physician
The grants, which were given
to both public and private
universities, ranged from $25,530
to $170,000. Recipients of the
largest grants were Cal State Long

Continued on Page 3

Payers & Providers NEWS Page 3

Longer ALOS!* Physical Therapists (Continued from Page Two)

Advertise Physical therapists provide rehabilitative that many therapists dropped PaciCare and
care to patients with constricted motion, United due to reimbursement issues, but given
(877) 248-2360, ext. 2 particularly after spinal and limb surgeries, or that Anthem Blue Cross covers some 6 million
strokes. Californians, it is a much more difcult
*For our ads, not your hospital Although Katz says he has a minimal decision.
number of patients insured by Anthem Blue “Anthem has a lot more clout than many
Cross, he notes many practices rely on the of the other plans,” she says, adding that her
In Brief insurer for as much as 60% of their income.
He estimates that Anthem has contracts with
practice would operate at a loss if it accepted
the per diem rate.
a network of about 1,000 physical therapists In addition to the nancial burden on
statewide. therapists, the CPTA suggests that it may also
Beach, UC Davis, Cal State Fresno
and Sonoma State University. “This is going to have a huge impact on affect patient care.
“Each of these programs have literally hundreds of practitioners,” Katz says. “Physical therapists are concerned that
shown ongoing commitments in He adds that only PaciCare and United Anthem's dramatic and unilateral reduction in
training and preparing healthcare HealthGroup have a per diem payment, but payment will have a substantial effect on the
professionals with the knowledge
those insurers often negotiate rates with quality of care being provided, as well as the
and skills necessary to provide
culturally competent healthcare individual therapists. The CPTA, which ability of therapists to continue to participate
that meets the needs of California’s represents about 5,000 therapists statewide, in Anthem's network,” says CPTA President
underserved populations,” says claims Anthem has refused to negotiate. Cheryl Resnick, a professor of biokinesiology
OSHPD Director David Carlisle. Christina Kauk, who is chief nancial at the University of Southern California.
Three colleges – including
USC’s Keck School of Medicine – ofcer of a practice in Sonoma County, notes
also received grants of nearly
$100,000 apiece to provide
students with specific training in
mental health services. Kaiser Reports Strong Rebound
Investment Bounce Puts it Back in the Black
SDSU Partners in $5M
Biotech Training Grant
Citing a bounceback of the nancial markets, that more appropriately supports our
San Diego State University and Kaiser Permanente’s health plan and hospital investments in our care delivery
three other partners have received system were able to return to the black during infrastructure,” says Kathy Lancaster, Kaiser’s
a $5 million grant from the U.S.
2009. executive vice president and chief nancial
Department of Labor for a new
initiative to help grow the region’s The Oakland-based Kaiser posted fourth ofcer. “Given the volatility in the nancial
life sciences industry. quarter net income of $490 million on markets and ongoing governmental actions
The Biotechnology Readiness, revenues of $10.6 billion. That compares to a related to Medicare Advantage payment rates,
Immersion, Certification and loss of $996 million on revenues of $10 we are continuing to take prudent measures
Degrees for Gainful Employment
(BRIDGE) project will provide billion for the fourth quarter of 2008. to manage our operations and investments in
education, training, and Aiding Kaiser’s bottom line was net non- a responsible way.”
placement services to more than operating income of $276 million for the For calendar 2009, net income was $2.1
1,000 veterans and unemployed quarter, compared to a net non-operating loss billion, compared to a $794 loss for calendar
workers in the San Diego area. The
of $1.1 billion in the fourth quarter of 2008. 2008. Of that, $524 million came from gains
program will work on enhancing
the number of clinical laboratory Kaiser ofcials attribute that to a rebound of in investments. That compares to an
scientists, medical laboratory the nancial markets. investment loss of $2.3 billion in 2008.
technicians, medical physicists, “We are…pleased that our non-operating Kaiser’s capital spending totaled $2.6
and income beneted from the partial recovery of billion in 2009, compared to $2.9 billion in
professional scientists.
Along with SDSU, grantees the nancial markets, and returned to a level 2008.
include the San Diego Workforce
Partnership, the Southern
California Biotechnology Center at
Miramar College and the trade
group Biocom.
The money is part of the
federal government’s nearly $800-
Expert Healthcare Communications
billion effort to stimulate the
economy. !White Papers !Media Campaigns !Newsletters

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Payers & Providers OPINION Page 4

9-21:)!"6!;++1)!< A New Life For The Process Of Dying

To Address Subject, we Must Overcome Our Fears
'(&)*+!,!'*-./0)*+!'1%2/+3/456! Google “end-of-life care” and you will find what options are available to each patient at
778?!@4!(441(2!/40/./01(2! 193 million entries. So surrounded by all this time in their life.
+1%+A*/=B/-4!/+!CDD!(!&)(*! this information, why is the subject still A good place to start would be educating
EC$FD!/4!%12GH?!;B!/+!0)2/.)*)0! taboo for otherwise educated people to more healthcare professionals on palliative
%&!)I:(/2!(+!(!'JK! discuss? care so as to make the subject less queasy to
(BB(A3:)4B6!-*!(+!(4!)2)AB*-4/A! Increasingly the public is demanding confront.! In 2005 70 percent of large
4)L+2)BB)*? candor when it comes to their hospitals in the United States
healthcare so they can make reported having some palliative
informed decisions about care program in place, but most
@22!!(0.)*B/+/456!+1%+A*/%)*!(40! everything from whether to get a of these programs are very small
)0/B-*/(2!/4M1/*/)+N flu shot to various cancer and require primary care
EO<<H!"FOI"PQ# treatment options. But when it physicians to make the referral,
/4R-S=(&)*+(40=*-./0)*+2?A-: comes to arguably the most which not enough are willing to
important decision they will ever do.
T(/2/45!(00*)++N make -- how to live out their Health plans can play an
O$O!U?!V-22&L--0!W(&6!X1/B)!Y final days -- there is a deafening important role by encouraging
Y1*%(4G6!8@!D$Z#Z hush in the discussion. ! It members to have advance
doesn’t need to be this way and it’s By directives, designate a durable power
time for all of us in the healthcare of attorney and have frank discussions
W)%+/B) arena to do something about it. Dave with their doctors.! At SCAN Health
LLL?=(&)*+(40=*-./0)*+?A-: Let’s begin by openly Schmidt Plan, we also make available the “Five
K(A)%--G acknowledging that death is a part of Wishes” which has become America’s
LLL?R(A)%--G?A-:[=(&)*+=*-./0)*+ the natural life-cycle. Our patients and most popular living will and which is a
>L/BB)* members are best served by making sure positive step in changing the way Americans
LLL?BL/BB)*?A-:[=(&)*+=*-./0)*+ that they are prepared both logically and plans for care at the end of life.
emotionally and have the information !!!!!!In addition, we’ve embraced POLST
\0/B-*/(2!Y-(*0 needed to make informed decisions on this (Physician Orders for Life Sustaining
important topic. Treatment), a tool for patients with advanced
XB).)4!>?!9(2)4B/4)6!'*)+/0)4B6! It is an indisputable fact that education illness which captures one’s values and
>3)!8(:0)4!]*-1= trumps ignorance. A study published preferences for treatment and facilitates
January 10 in the Journal of Clinical discussion between patients and doctors.! We
^-++!]-20%)*56!83(/*:(4!-R!B3)! Oncology found that cancer patients who are working to train our case managers to
Y-(*06!7-+!^-%2)+!V-+=/B(2!,! watched a six-minute video explaining present POLST to appropriate members and
lifesaving procedures, hospice care and are also utilizing our website, our annual
_/:!7-BB6!\`)A1B/.)!9/A)!'*)+/0)4B6! palliative care made far different choices Geriatric Symposium and other means to
V-+=/B(2!@++-A/(B/-4!-R!X-1B3)*4! than those who didn’t watch. engage physicians in this process.
8(2/R-*4/( By not addressing this issue openly we There is mounting evidence that end of
are failing in our duties to truly provide life discussions lead to more contented
\2(/4)!Y(BA32-*6!T?J?6!83/)R! patient-centered care. For too long, there patients as such conversations help
T)0/A(2!aRR/A)*6!7?@?!8(*)!V)(2B3! has been a paralysis in discussing end of individuals feel a sense of empowerment
'2(4! life issues for reasons ranging from not rather than hopelessness.! Such a feeling
wanting to dash patients’ hopes (a false allows people to spend their last days with
b)/B3!^/A3:(46!T?J?6!\`)A1B/.)! belief) to the outdated incentives in the dignity and compassion that a lifetime of
continuing to provide care to sincerely living deserves.
believing that patients simply don’t want
V)4*&!7-1%)B6!X)4/-*!9/A)! to hear about these things.! But patients Dave Schmidt is President and CEO of SCAN
'*)+/0)4B6!b))4(4 want to understand their illness and how it Health Plan, the fourth-largest not-for-profit
is likely to progress because only then can Medicare Advantage Plan in the United States.
'1%2/+3)*[\0/B-*I/4I83/)R they make knowledgeable choices. I
believe everyone who is part of the health
^-4!X3/4G:(4 care system has a moral obligation to Op-ed submissions of up to 575 words are
)0/B-*S=(&)*+(40=*-./0)*+?A-: speak with patients and families about welcomed. Please e-mail proposals to
their goals of care, what modern medicine, or call
realistically can and can’t achieve and (877) 248-2360, ext. 3.

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*New England Journal of Medicine, 2004.

Payers & Providers MARKETPLACE/EMPLOYMENT Page 7


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