Payers & Providers California Edition – Issue of August 25, 2011

8/4/2019 Payers & Providers California Edition Issue of August 25, 2011

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Eisenhower Medical Centers mostly fabledexistence has hit a rough patch.

The 289-bed acute care facility in RanchoMirage was built on land donated by Bob

Hope. It has treated former presidents andother world-famous patients, enjoys generouspatronage of the areas mega-rich denizensand has spent hundreds of millions in recentyears on revamping and expanding itsfacilities.

But Eisenhower is facing a rare period ofred ink, has been forced to cut jobs, andcould soon see its second debt downgrade inless than a year.

According to Moodys Investors Service,Eisenhower posted an operating loss of $30.8million for scal 2011, according to unauditednancials. That compares to an operating

prot of $22.8 million for scal 2010.Although the hospital continues to report

positive cash ow, its net margins have beenshrinking in recent years.

As a result of the deteriorating nancials,Moodys placed Eisenhower under a ratingswatch for a potential downgrade, and willfocus on the factors being the deterioration ofthe organizations credit position and whatsteps management has taken in response. Itwill announce further actions within 90 days.

The agency downgraded Eisenhowersdebt from A3 to Baa1 in July 2010, citing arecent doubling of its debt load and a need to

support strong numbers to continuesupporting its service. The overall outlook forthe debt remained stable, which had beendowngraded from a positive outlook in 2007.

However, Baa1 is Moodys lowest rating forinvestment grade bonds; another downgradewould push Eisenhowers debt into aspeculative grade.

Interviews and published reports suggestthat Eisenhower is suffering from the doublewhammy of a steep recession that began inlate 2007 and coincided with a signicantexpansion.

The hospital recently spent $385 millionto revamp its acute care facilities to complywith seismic regulations, and also built newoutpatient facilities in Palm Springs and LaQuinta.

Eisenhower CEO G. Aubrey Sering toldthe Desert Sun newspaper that the expansionand higher debt load was projected to putsome strain on the hospitals nances. Thepart that was not foreseeable was the darnrecession, Sering said.

The demand for both inpatient andoutpatient services is down dramatically invirtually all parts of California, according toSteve Valentine, president ofThe Camden

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Payers & Providers Page 2

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In Brief

Kindred Purchases EastBay Home Healthcare

Firm

Walnut Creek based ProfessionalHealthCare has been purchased by

Louisville, Ky.-based hospital operatorKindred Healthcare for $51 million incash.

The deal will provide Kindredwith 27 new home healthcarelocations in Northern California,Arizona, Nevada and Utah--morethan doubling its current 20 locations.

"The Professional transactionadds to the size and scale of ourgrowing home health and hospicebusiness," Paul Diaz, Kindred's chiefexecutive ofcer, said in anannouncement. "There is substantialoverlap with Kindred's businesses inmany of Professional's markets, whichwill allow us to expand our

continuum of post-acute services inthese cluster markets."Kindred has made several home

healthcare acquisitions since the fallof 2010.

Women Throws BabyFrom Hospital Parking

Structure

A La Habra woman has been chargedwith murder for throwing her seven-month-old son from the second storyof a parking structure at ChildrensHospital Orange County in Orange.

The boys mother, SoniaHermosillo, 31, allegedly threw thechild, Noe Medina, Jr. to the groundon Monday evening. He died at UCIMedical Center on Wednesday.

Although hospitals are often thesites of violence, it is rare for suchincidents not to involve patients ortheir family members. According tothe Los Angeles Times, Noe had beentreated at CHOC for a birth defect,but was not undergoing treatment at

Continued on Page 3

NEWS

Group and a member of the Payers &Providers editorial board.

We have seen a rather signicant

dropoff in the utilization of hospitals from2009 to 2010. It was down 8% to 12% in2009, and another 8 to 10% in 2010,Valentine said, noting that many Californianshave lost their insurance coverage or haveswitched to high-deductible plans, promptingmany to put off care. So many of thehospitals are in general are kind of running alittle thin.

Eisenhower also has other issues uniqueto its geography, industry observers say. Theregions population is often seasonal, creatingmuch higher demand in the winter monthsand forcing the institution to pay for pricey

traveling nurses. The aging community alsomakes it heavily reliant on Medicare, whichcomprises nearly 68% of its patient revenues,according to Moodys raising concerns thatcuts slated to the program in the coming yearscould further erode its bottom line.

But Riverside County has also beenamong the hardest-hit regions of Californiaduring the recession. Charitable contributio

to Eisenhower were down by about a thirdbetween 2008 and 2009, according to thehospitals tax returns.

Meanwhile, the hospital whichtraditionally has spent relatively little oncharity services has seen the number ofuninsured patients soar as much as tenfold,according to hospital spokeswoman ElizabeWholihan.

As a result, the hospital has eliminatedabout 100 positions or 5% of its totalworkforce through a combination of attritand layoffs, Wholihan said.

Whether the cuts will stem the tide

anytime soon remains to be seen.Valentine does not expect the economi

climate for California to change in the near-term.

I think 2012 is going to look a lot like2011, which looks like 2010, he said.

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Eisenhower (Continued from Page One)

Hospital Collaborative Bearing FruiCuts in Infections And Millions in Savings Reported

A widespread collaboration involving more

than a third of Californias acute carehospitals has reported some early success inreducing infections that claim the lives ofthousands of inpatients statewide every year.

Data released this week by the LosAngeles-based National Health Foundationindicated that the Patient Safety Firstcollaborative has cut ventilator-associatedpneumonia (VAP) by 41%, central line bloodstream infections (CLBSI) by 25%, andcatheter-associated urinary tract infections

(CAUTI) by 24%.

Deaths from septicemia an infectionthat shuts down most of a patients vital orgaand almost always fatal if not treated quicklwere also trimmed by 12%. That reductionsaved an estimated 800 lives.

Theres been a statistically signicandecrease in hospital-acquired infections, saNHF President Eugene Grigsby.

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Page 3Payers & Providers

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NEWS

In Brief

the time of the incident. It is believedhis mother picked the site randomly.

"As an organization dedicated toits mission to nurture, advance andprotect the health and well-being ofchildren, CHOC is deeply saddened,"CHOC said in a statement.

WellPoint CompletesCareMore Deal

The acquisition of Cerritos-basedMedicare Advantage Plan CareMoreby WellPoint, Inc. has been completedahead of schedule, according to astatement issued by the companies.

The $800 million deal wasoriginally announced in June, pendingregulatory approvals. CareMore hasabout 54,000 enrollees in California,Nevada and Arizona.

CareMore CEO Alan Hoops willremain in his position, and the planwill continue to operate as a wholly-owned division of WellPoint.WellPoint reports that the acquisitionwill be nancially neutral in its rstyear, and accretive in the yearsmoving forward.

California AboveAverage In Overall

Well-Being

California scored slightly aboveaverage for the overall well-bring of itsresidents, according to a new surveyby Gallup-Healthways.

The state scored 67.6 on a scaleof 100. The national survey of morethan 176,000 residents tracks suchissues as levels of diabetes, frequencyof exercise, produce consumption andlevels of uninsured, among othercategories. San Jose and Santa Rosascored among the top 15 metropolitanareas in the United States.

Hawaii had the highest overallscore among states, with 71.1. WestVirginia was the lowest, with a scoreof 62.4.

Kaiser Further Ramps Up Greening

Sets New Systemwide Recycling Targets

The collaborative has also been able toreduce the number of elective deliveries ofnewborns before 39 weeks of gestation by

14%. Such births which are oftenpurposely scheduled by either theobstetrician or the mother lead tosignicantly higher numbers ofhospitalizations in the neonatal intensive careunit and can cause development issues in thefuture, according to Grigsby.

Using face-to-face meetings, webinarsand other forms of communication, theparticipating hospitals work to adopt bestpractices to avoid infecting patients duringtheir stay.

With infection prevention, that means

adopting and rigorously following a carefullycrafted checklist of steps physicians, nursesand other medical personnel must followduring medical procedures. In the case ofinserting a central line in a patient, it meansusing specic sterile coverings for the patient,medical staff and central line both during andafter the insertion.

The NHF, an afliate of the HospitalAssociation of California, analyzed datasubmitted by the more than 160 hospitalsinvolved in the three-year collaborative. Itsfunded through a $6 million grant fromAnthem Blue Cross of California and

overseen by HASC and Californias two otherhospital associations.

Blue Cross investment appears to havepaid off: the participating hospitals reportsavings of $11 million during the rst year.The impact of Patient Safety First will be feltby even more Californians as the programexpands to additional hospitals," said AnthemBlue Cross of California President Pam

Kehaly.The collaborative has lofty goals:

eliminate VAPS, CLBSIs and CAUTIs entirely

within three years, and cut septicemia-relateddeaths by 30%.However, Grigsby noted that some

hospitals have eliminated some categories ofinfections entirely, although he did not releaseany specics. Several hospitals contacted byPayers & Providers did not respond to requestfor comment.

Despite the early successes, thecollaborative continues to face challenges.Participation among hospitals in Northern andCentral California reached only 54% of thoseinstitutions that originally said they wouldparticipate, (by contrast, hospitals in Southern

California over-subsrcibed). Grigsby said thatwas related to many of the Northern Californiahospitals being isolated in rural areas.

In response, a nurse has been travelingto the farther ung facilities in what Grigsbycalled a simbus, and performingdemonstrations with a technologicallysophisticated mannequin.

It has also been challenging to getobstetricians and mothers to change theirways regarding how infants are delivered.

The collaborative will work on acampaign with the March of Dimes whichhas developed a toolkit on when to induce

birth to inform and educate the public aboubirthing children after 39 weeks.The physicians often need some hardempirical evidence before theyre willing tochange, and there are still mothers who wantto have their deliveries t their schedule,Grigsby said. Its sort of like texting whiledriving. People know they shouldnt do it, butit takes a while to make that change.

Collaborative (Continued from Page Two)

Further pushing its green initiatives, Oakland-based Kaiser Permanente said it would boostthe amount of materials its hospitals andmedical ofces recycle to at least 40% by2015.

Kaiser currently recycles slightly morethan 30% of its medical materials, making itone of healthcares greener organizations. ItsLos Angeles and Riverside hospitals have eventrained janitorial staff to practice conservation.

Waste reduction creates healthiercommunities by preserving natural resourcesand reducing greenhouse gas emissionsthroughout the lifecycles of the products weuse, said Joe Bialowitz, Kaisers seniorenvironmental stewardship consultant.

Hospitals in the U.S. currently produce5.9 million tons of waste in the U.S. annuallyaccording to the environmental organizationPractice Greenhealth.


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Payers & Providers Page

California comprises more than 10% of whatthe U.S. spends on healthcare annually.Therefore, it is not surprising that statelegislation has designated certain opportunitiesfor its hospitals to benet from special programsdesigned to fortify their nancial stability in theshort term. Here are some of them:

1. Medi-Cal Disproportionate Share Program

In just under 31,000 words, Californias Welfareand Institutions Code codies the Medi-Caldisproportionate share program (DSH). Itensures that hospitals serving a large number ofMedi-Cal patients, as well as low-income

patients, receive additional support as a meansto balance out Medi-Cals low reimbursementrates. In 2009 alone, this gure weighed in atmore than $2.2 billion. With its origins in theOmnibus Budget Reconciliation Act of 1981(P.L. 97-35), DSH funds have over the yearsprovided a lifeline for struggling hospitals thatmay have otherwise shut their doors long ago.

2. California Medical Assistance Commission

The California Medical AssistanceCommission (CMAC) oversees theprivate hospital supplemental fundfor hospitals meeting certain criteria relating toemergency services, teaching hospitals,childrens hospital medical education, andsmall and rural hospital programs. For scalyear 2010, hospitals received close to $242million from this fund.

CMAC is also responsible for administeringa state program to compensate a handful ofhospitals with distressed hospital funds basedupon criteria relating to their commitment tothe Medi-Cal population in the state (althoughnot tied to DSH payments) and the degree towhich each hospital has experienced nancialhardship. CMAC continues to work with theCalifornia Department of Health Care Servicesto coordinate the Construction and RenovationReimbursement Program, having paid anestimated $90 million during scal year2010-2011 for contracting hospitals that meetcertain new construction criteria for planssubmitted to Californias Ofce of StatewideHealth Planning and Development between1988 and 1994.

3. The Hospital Fee Program

Signed into law last year, Californias hospital

fee program has already brought an infusion o$2.6 billion in quality assurance fees to the stamedical facilities, as well as providingstabilization act supplemental payments toeligible hospitals. With the help of matchingfederal funds, the program was initially designto help offset the estimated $4.6 billion in MeCal losses suffered by these same hospitals theprevious year. Considered a boon by many, tprogram has been extended through 2012, wits second round already nearing completion.Successful in large part due to the Herculeanefforts of the California Hospital Association,

program has accomplished the unimaginablehas forced hospitals to work together for a gregood.

4. Californias Medicaid Waiver

Late last year, the federal government approveCalifornias $10 billion Medicaid waiver. Thisallowed the state Medicaid program to customcoverage under Medi-Cal and deviate fromcertain federal requirements. The inherentexibility in this waiver was designed to impr

the Medi-Cal program and reduexpenses between now and 201when the state health insurance

exchanges under the Patient Protection and

Affordable Care Act are scheduled to begin.While by no means an exhaustive list, the

programs referred to above provide an importglimpse into the complex nature of healthcarefunding in California. Without these programsis hard to imagine what the states healthcaresystem would resemble today. Even with theAffordable Care Act in place, immediateimprovements in our nations healthcare systedo not appear to be forthcoming, and morespecically, ordinary reimbursements areexpected to decline. Californias efforts to keehealthcare system vibrant are both admirable necessary in the short term.

OPINION

Californias Unique Funding PictureThe States Bold Programs Help Fill Many Gaps

Craig Garner is an attorney and healthcare

consultant, and teaches at Pepperdine

University School of Law. Between 2002 and

2011, he served as chief executive officer o

Los Angeles-area community hospital.

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

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We currently have two exciting career opportunities in our Torrance, CA headquarters, supporting our Healthcare TPA:

NURSE CASE MANAGER

Will identify, implement, and provide oversight of employer group populations in order to optimize Blue Cross Medical Management programs and/or strategiwill include case management oversight of the Utilization Management, Care Coordination, Disease Management, Case Management, and Transition of Carprograms.Essential responsibilities include: Implement and utilize protocols, criteria, guidelines, references, and resources to determine if current medical delivery of services is effective and optimal. Evaluate current reporting capabilities and data feeds provided by carrier in order to triage and isolate employee populations that may not be optimizing thecurrent Medical Management Services. Develop Case Management Plan. Gather information and coordinate multiple medical services . Validate current plan of care or changes through ongoing monitoring and gathering of information. Perform oversight of the medical care delivery systems. Monitor expediency of services. Benchmark appropriate patient recovery against community standards and evaluation tools which are utilized by the carrier Medical Management Teams/Product Unit Managers. Assess patients recovery and progress by frequent monitoring and interface with the Blue Cross Management Staff. This will involve review and evaluationcoordination of Home Care Services, Durable Medical Equipment, Pharmaceutical Services, and other auxiliary rehab/medical services. Communicate collaboratively. Nurture healthy and effective communications. Oversee appropriate correspondence in relation to the case management and utilization review process. Assess the individuals psychosocial status via frequent contact and relationship building. Divert barriers to recovery and progression via frequent conferencand collaboration with the patient as well as the patients support system. Document decisions, rationale, and resources regarding cases by maintaining on-line Nurse Case Management Software Systems and other applications.Minimum Suggested Qualifications: Requires clinical expertise, especially in assessing chronic care needs and service coordination. Registered Nurse with acurrent, active, and unrestricted California license. Prefer graduates of an accredited school of Nursing (Associates Degree at minimum: BSN is preferred) anCCM. Advanced degree in Business Administration, Healthcare Administration, or IT highly desirable.. Must possess theoretical knowledge base of nursingprocess, clinical pathways, continuum of care, and case management methods & standards. Must be versed in Nursing Theories and Models of Recovery(Orem, Watson, Roy) Must be comfortable with IT applications and should be able to interpret and identify claims trending data.

MANAGER, CLAIMS AND CUSTOMER SERVICE

Will be responsible for the Healthcare TPA departmental budgeting, procedures, production goals, quality standards, service metrics and personnel managemof the Claims, Customer Service, Provider Relations, Clerical Support and Adjustment teams.Essential responsibilities include: Provide benefit claims team with technical direction and resources to achieve efficient benefit claims handling at efficient cost level while maintaining a highevel of customer service. Responsible for the development and implementation of the best claims practices which will result in operational excellence. Specifically, the claims team wachieve quantitative and qualitative performance expectations, meet customer expectations as outlined in client service plans, and achieve high ratings in

customer feedback surveys. Continuously review all performance standards and measurements to ensure appropriateness and provide tracking and reporting of results against allmeasurements to facilitate improvement in customer service and productivity. Accountable for developing and mentoring team members. Manage coaching and skill building to strengthen the technical and professional level of the team Responsible for quality assurance and audits of customer service representatives through either silent call monitoring or implementation of a call recordingprogram. Responsible for meeting claim adjudication quality and processing turnaround in conformance with industry standards. Conduct customer satisfaction interface/surveys and disseminate findings to management. Develop plan to address areas of improvement.Minimum Suggested Qualifications: Bachelors Degree or equivalent experience. Management, benefits administration and claims adjudication experiencenecessary. Must have strong understanding of all aspects of self-funded healthcare claims. Five plus years as a manager in a similar industry, environment..Experienced at monitoring and maintaining production goals. Must be proficient in Microsoft Word. Excel knowledge preferred, but not mandatory. Adept ataccessing data from the Internet when required.Keenan provides a competitive compensation and benefits package. We encourage teamwork and employee initiative - people working together is what makKeenan a success. We invite you to share in the commitment of preserving our warm tradition, reputation and dedication to our clients. After allWhat you dmakes a difference!

Please submit your resume and salary history to Beth Cross at [email protected]. For more information, visit our website atwww.keenan.com. Keenan is an equal opportunity/affirmative action employer and supports workplace diversity.


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Payers & Providers California Edition – Issue of August 25, 2011

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