12 May 2011
California Edition
Calendar
May 21-22
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June 12-15
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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.
Health Coverage’s $20,000 Tab
Household Costs in L.A. Inch Toward New High
It costs nearly $20,000 a year for a household
in Los Angeles to obtain healthcare through
job-based insurance coverage – an amount
that has nearly doubled in less than a decade,
according to a new report by Milliman, Inc.
Milliman’s annual Medical Index was
published just as UCLA researchers concluded
that the state’s uninsured population could
signifcantly benet from subsidized coverage
expected to be offered on the state’s health
insurance exchanges beginning in 2014, as
well as an expansion of the Medi-Cal
program.
The annual healthcare cost for a family
of four in Los Angeles this year was $19,391,
just below the nationwide average of $19,393.
That is an increase of 6.7% from a year ago,
when the cost was $18,098, $24 above the
nationwide average.
The cost increase is one of the lowest in
years, but households in Los Angeles and
elsewhere remain under tremendous cost
pressures, according to Milliman ofcials.
"As costs continue to grow—and even as
the cost trend decelerates—the total cost of
care for American families constitutes a larger
and larger portion of the household budget,"
said Lorraine Mayne, a Milliman principal and
consulting actuary.
Costs in Los Angeles were $13,537 in
2006, meaning they have increased more than
43% in ve years. Milliman noted in a
statement that nationwide costs stood at
www.lakesidecommunityhealthcare.com
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$9,235 nationwide in 2002, meaning they
have more than doubled in less than a decade.
As for California, Milliman Principal Chris
Girod conceded that costs are almost certainly
higher in Northern California, where hospitals
tend to be consolidated into chains and often
charge signicantly more for procedures.
“It’s a well-known fact that hospital costs
in the north tend to be more expensive,” Girod
said, “but even in the Los Angeles market you
can see tremendous variations of cost.”
Girod was unable to say whether the
more than 2 million Californians who have
lost their healthcare insurance during the
recession have impacted hospital pricing
further. “We look at negotiated prices
(between hospital and insurers), which tend to
be tightly controlled due to limitations in
contracts,” he said.
Physician costs are the largest
component of the nationwide index,
representing $6,329, followed closely by
hospital inpatient care at $6,068. Outpatient
care and pharmacy are far smaller
components, representing $3,404 and $745,
respectively.
Employees will shell out $8,008 for
their care, or 41%, of which $4,728 will be
their contribution toward healthcare coverage,
while $3,280 will be spent on out-of-pocket
costs such as deductibles and co-payments.
Continued on Next Page
 Payers & Providers
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In Brief
Quest Diagnostics
Pays $241M To Settle
Medi-Cal Billing Suit
Laboratory operator Quest
Diagnostics has reached a $241
million settlement with the Medi-
Cal program regarding a lawsuit
accusing it of overbilling.
Quest had been sued in
California by rival Hunter
Laboratories. The State of
California later joined the
litigation.
As part of the settlement,
Quest will provide a discount to
Medi-Cal for lab services until July
2012. It is taking a pre-tax charge
of $236 million in the first quarter
of 2011, the company said in a
statement.
Long-Term Care More
Expensive In California
Than Elsewhere
Long-term care costs are
significantly higher in California
than the rest of the nation,
according to a new survey by
Genworth Financial.
Genworth’s annual cost of
care survey concludes that the cost
of a home health aide to provide
long-term care – the most popular
option – is $21, versus $19 an
hour nationally. However, the cost
of such care has increased 0.8%
over the past six years, versus
1.4% per year in other parts of the
country.
A room in a private nursing
home has an annual median rate in
California of $91,250 per year,
14.8% higher than the national
median of $77,745.
Continued on Page 3
NEWS
Costs (Continued from Page One)
Employers will shoulder the remaining
$11,385.
Meanwhile, new research by the
UCLA Center for Health Policy Studies
concluded that the statewide insurance
exchange being created as a result of last
year’s landmark federal healthcare reform law
and a planned expansion of Medi-Cal could
cover an additional 4.6 million Californians.
Of those, 2.13 million would be
eligible for expanded Medi-Cal coverage,
while another 2.5 million might obtain
coverage through the exchange, including
more than 737,000 who already have
CDPH Disputes Prime’s Sepsis Claims
Hospital Operator Billed Often For Treatment
An investigation by the California Department
of Public Health concluded that hospital
operator Prime Healthcare often billed
Medicare to treat patients for septicemia when
the condition likely did not exist.
The ndings were reported by the
investigative website California Watch earlier
this week and conrmed by Payers &
Providers through a CDPH spokesman.
Also known as sepsis, septicemia is a
massive blood infection that can lead to organ
shutdown and even death. The condition is
often acquired via hospital-inserted catheters
or intravenous central lines, although it can
also be acquired outside of a hospital.
The CDPH's probe of four Prime hospitals
– San Dimas Community Hospital, Desert
Valley Hospital, Chino Valley Hospital and
West Anaheim Medical Center – found that
22 of 120 patients diagnosed with septicemia
showed few symptoms of the condition. At
Chino Valley, a patient was diagnosed with the
condition, even though there was no sign of
infection, according to a CDPH inspection of
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Page 2
individual coverage but mind nd a better
deal.
Nadereh Pourat, a UCLA health
services professor who was lead author for the
research, believes that many younger and
single Californians who have gone without
coverage are likely to obtain it. Many have
either been unable to afford the coverage, or
believed their relative good health made it a
superuous expense, she added.
"Costs will go up but may also be
mitigated by the relative youth and health of
the eligible population," Pourat said.
hospital records. Seven other patients
diagnosed with the condition at San Dimas
also had no signs of the condition, the CDPH
concluded.
Medicare pays a premium of about
$6,000 to treat septicemia compared to more
typical urinary tract infections, suggesting to
investigators that hospitals could use such a
diagnosis to pump up billings. An
investigation of Prime by the Service
Employees International Union concluded
that Prime billed Medicare for septicemia at
three times the national rate.
CDPH said it began an investigation of
the for-prot chain’s billing practices for
septicemia late last year at the urging of
several state lawmakers. The U.S. Department
of Health and Human Services is also probing
Prime regarding its septicemia billings.
CDPH conducted the investigations in
February and asked for corrective actions
Continued on Next Page
Payers & Providers
Longer ALOS!*
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*For our ads, not your hospital
In Brief
L.A. Care Gets Rare
Fine From DMHC
L.A. Care Health Plan, the Medi-
Cal managed care payer for Los
Angeles County, has received a
rare fine from the Department of
Managed Health Care.
The DMHC levied a $2,500
fine against L.A. Care for not
communicating with an enrollee
in Spanish. The plan had denied
coverage in 2009 for a
tonsillectomy due to a nasal
obstruction, claiming that the
enrollee had not suffered
significant infections to merit such
a procedure. However, its
communications were in English,
even though the enrollee
primarily spoke Spanish, violating
regulatory requirements that it
provide translations. L.A. Care
later reversed its decision when
the enrollee requested an
independent medical review with
the DMHC.
Although it has more than
750,000 enrollees, L.A. Care has
received only four fines in seven
years from the DMHC. Its last fine
was in June 2009. That compares
to dozens of fines levied against
the agency against similarly-sized
commercial health plans.
HHS: Few Uninsured
Can Pay Hospital Bills
A new report by the U.S.
Department of Health and
Human Services concludes that
just 12% of those who lack health
insurance are able to pay their
hospital bills.
“One of the most enduring
myths is that people without
health insurance can get care with
little or no problem,” said HHS
Secretary Kathleen Sebelius, who
reiterated her support for the
Patient Protection and Affordable
Care Act.
NEWS
Prime (Continued from Page One)
regarding infection control protocols at some
of the facilities, but did not issue any nes.
In addition to its billings for septicemia,
Prime was also found by California Watch to
have extensive Medicare billings for a
malnutrition condition called kwashiorkor,
which is typically seen among children in
developing countries.
Although California Watch has
examined both the septicemia and
malnutrition issues in depth, both were
originally disclosed by the Service
Employees International Union, which
analyzed Prime’s billing records.
Kaiser Reports First Quarter Earnings
Attributes Growth In Part To Market Recovery
Citing recovery in the nancial markets,
Oakland-based Kaiser Permanente reported
robust results for the rst quarter of 2011.
Kaiser reported revenue of $12 billion for
the rst quarter ending March 31, compared
to $11 billion for the rst quarter of 2010, an
increase of 8.4%.
Net income for the quarter was $921
million, compared to $706 million for the
year-ago quarter, an increase of 23.4%.
Kaiser ofcials attributed the growth
partly to an increase in membership of
208,000, to slightly more than 8.8 million,
along with an improved capital market for its
investments.
Its net non-operating income was $291
million for the quarter, compared to $225
million during the rst quarter of 2010, a
22.7% increase.
Operating income for the quarter was
$630 million, up 23.7% from the $481 million
reported in the rst quarter of 2010.
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Page 3
Prime has contended its billings are
accurate, and that the SEIU is using its probes
as leverage in contract negotiations. It
contends that the ndings by CDPH will
eventually be reversed.
“Contrary to the well-established practice
of medicine and national coding guidelines,
CDPH's surveyors falsely assumed that blood
cultures have to be positive in order to
diagnose septicemia...and CDPH's surveyors
were not knowledgeable about the diagnosis
and coding principals related to septicemia,”
the company said in a prepared statement.
“Our strong membership growth and
consistent performance, coupled with
improvement in the nancial markets,
contributed to our overall net income,” said
Kathy Lancaster, Kaiser’s executive vice
president and chief nancial ofcer. “We are
pleased that our nancial performance allows
us to continue to invest in technology and
facilities, and support high-quality, affordable
healthcare.”
Capital spending for the quarter was $623
million, up 26.5% from the $458 million
earmarked for capital spending during the
year-ago quarter.
“We continue to reinvest in our people
and technology to deliver the right care at the
right time,” said Kaiser Chief Executive Ofcer
George Halvorson. “Our integrated model
allows us to meet the evolving needs of our
members and the communities we serve in a
changing health care environment,
consistently delivering patient and family-
centered care.”
]
Payers & Providers
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OPINION
A Gold Watch’s Ceaseless Ticking
Payout May Stress Salinas Valley For Years to Come
Former Salinas Valley Hospital Chief Executive
Ofcer Samuel Downing began his retirement
last month under a cloud.
The Los Angeles Times reported on $4
million in lump-sum retirement payouts
Downing took from the hospital, which is part
of a public healthcare district. That's on top of
his $150,000 annual pension.
Should he live into his 80s, Downing
could receive about $7 million from a
taxpayer-subsidized hospital in his
retirement – likely as much as he
received for 39 years of work for
the district.
Downing's payouts came
from multiple hospital accounts
as an end-run around IRS
regulations regarding inurement--
excessive payments to executives
of not-for-prot organizations.
On top of that, Downing was
also paid more than $668,000 in
2009, nearly triple the statewide
average for a hospital district CEO By Ron
in California.
"I think I've earned it,"
Shinkman
Downing told the Los Angeles
Times about his pay and payouts. "I worked for
this institution and gave them my heart and
soul."
At least Salinas Valley was spreading the
wealth: The hospital spent more than $1,678
per adjusted patient day on staff salaries in
2008--about 60% higher than the average
California hospital, according to data from the
Ofce of Statewide Health Planning and
Development.
Meanwhile, nearly a quarter of Salinas’
residents live in poverty – also about 60%
higher than the statewide average.
This is borne out by some of Salinas
Valley's other bottom-line stats. It spent more
than $14 million on charity and
uncompensated care in 2008, about ve times
the average California hospital. And while it
reported a surplus in that year, it lost about $64
million treating Medicare patients.
Given the combination of California's
woeful economy and aging population, those
stats have virtually no chance of improvement
for the foreseeable future. In fact, Salinas Valley
had to eliminate about 600 staff positions over
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Page 4
the past year. Downing's payout could have
been used to save scores of those jobs.
I’m not a hospital CFO, nor do I pretend to
be one. But Salinas Valley’s payroll appears out
of whack with its demographics. The hospital
has two vice presidents of nance, who are paid
more than $630,000 a year combined. I’d like to
think they are aware of this fact.
I'd also like to say that hospitals like Salinas
Valley--where the compensation practices are as
iffy as the patient demographics--
are a rare exception, but they're
not.
Payers & Providers’ sister
edition in the Midwest will be
reporting this summer on hospital
CEO compensation in the region
– a followup to the work this
publication published in 2010.
Payers & Providers and
researchers at MCOL examined
the pay of nearly 2,000 CEOs,
CFOs and COOs of not-for-prot
hospitals in the Midwest over the
past year, and there are dozens
that have received seven-gure
retirement payouts. Some even
received millions more than Downing.
Virtually all of those hospitals are facing the
same demographic and funding time bombs as
Salinas Valley, but they have all convinced
themselves that they must earmark signicant
amounts of their revenue to attract what is
deemed the best talent possible. This may get
them veteran hospital executives, but it also
serves to drive up their pay demands – creating
potential future shortfalls and PR fallout.
Downing is entitled to a solid pension, but
the extra money purposely set aside for his exit
will be sorely missed by his former employer. If
his successor believes it has set a precedent,
even more millions will be taken out of that
system.
That inevitably will make it hard for Salinas
Valley to live up to its motto: "Neighbors Who
Care."
Ron Shinkman is the publisher of Payers &
Providers.
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com,
 Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

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Maintains effective administration of UM and CM functions. Coordinates staff schedule to assure effective coverage of UM and
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

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