9 September 2010
California Edition
Calendar
September 19-21
9:;<!8(2/=-*4/(!:(22!8-4=)*)4>)?!7-45!
@)(>3!9&(AA?!BC0(A)+!-4!D;986!
3)(2A3>(*)!+A/E121+?!FGHIJFKHI?
L)5/+A)*!M42/4)N
3AACNOOPPP?3=E(J>(=(22>-4=?-*5O
*)5/+A)*?2(++-
September 20-22
U3)!8-*C-*(A)!S)224)++!8-4=)*)4>)?!9&(AA!
L)5)4>&!8)4A1*&!'2(V(!9-A)26!7-+!
<45)2)+?!!Q)++/-4+!P/22!)W(E/4)!3-P!
3)(2A3>(*)!*)=-*E!P/22!/EC(>A!>-*C-*(A)!
P)224)++!C*-5*(E+?!FXHH?
L)5/+A)*!M42/4)N
3AACNOO
PPP?>-*C-*(A)P)224)++>-4=)*)4>)?>-EO
September 22-24
;)0/>(2!D).)2-CE)4A!QC)>/(2/+A+!<441(2!
9)(2A3>(*)!8-4=)*)4>)?!R4>-*)!(A!S&44!
9-A)26!7(+!T)5(+?!D/+>1++/-4!-=!3-P!
*)=-*E!P/22!(==)>A!A3)!).-21A/-4!-=!A3)!
3-+C/A(2!(40!C3&+/>/(4!%1+/4)++!E-0)2+?!
FGHIJF$6$HI?!
L)5/+A)*!M42/4)N
3AACNOOE0+>-4+12A/45?>-E
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.
Healthcare Cash Is Flowing To Brown
His Fundraising Totals More Than Double Whitman’s
Attorney General Jerry Brown has a big
fundraising lead among healthcare industry
donors versus his gubernatorial opponent
Meg Whitman, according to campaign
finance data submitted to the California
Secretary of State’s office.
The 72-year-old Brown, who is trying to
recapture the governor’s seat after serving
two terms in the 1970s and 1980s, has
raised $744,100 among healthcare industry
donors who have contributed $5,000 or
more.
Brown’s donors include Molina
Healthcare; the California Nurses
Association; the California Medical
Association; the California Hospital
Association’s political action committee;
and executives with the for-profit hospital
chain Prime Healthcare.
Brown has also proven popular among
the nursing home industry, with multiple
donations from national nursing home
chains and the California Association of
Health Facilities, the statewide trade group
representing nursing homes.
By contrast, former eBay Chief
Executive Officer Whitman has raised just
$320,400 from the industry – less than half
of Brown’s total – according to campaign
filings.
HEALTHCARE’S BEST ADVERTISING VALUE
]
PAYERS & PROVIDERS reaches 5,000 hospital, health plan and non-
prot executives statewide. There is no better venue for marketing
your organization or conference, or recruiting new staff.
LEARN MORE HERE
OR CALL (877) 248-2360, ext. 2
!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Whitman has been making some
inroads since winning the primary. She
has raised $173,600 from healthcare
interests since June 30. But Brown has
raised $268,300.
Brown and Whitman’s last reported
contributions were filed on Tuesday.
Officials from neither campaign returned
phone calls seeking comment.
The imbalance between the
candidates is unusual, say some industry
observers, who note that the healthcare
industry tends to favor Republican
gubernatorial candidates in California in
order to balance out traditional
Democratic majorities in the Legislature.
“It is possible that some people did
not think Whitman needed the money,”
mused one industry insider who requested
anonymity.
The 54-year-old Whitman, whose net
worth is believed to exceed $1 billion,
has contributed more than $100 million to
her own campaign since the start of the
year.
Despite vastly outspending Brown,
Whitman has been unable to carve a lead
outside of the pollsters’ margins of error,
Continued on Next Page
 Payers & Providers
Top Placement...
Bottomless Potential
Advertise Here
(877) 248-2360, ext. 2
In Brief
PacifiCare Faces
Potential Fine In Billions
Cypress-based PacifiCare Health
Systems is facing potential fines
that could approach $10 billion
based on alleged mass violations of
state laws and regulations following
its 2003 acquisition by
Minneapolis-based UnitedHealth
Group, according to published
reports.
State regulators claim
PacifiCare may have committed as
many as 992,936 violations
regarding lost patient records,
bungled claims and failures to pay
what was owed their physician
network, among other allegations.
PacifiCare could be liable for up to
$10,000 for each violation.
“This is about intentional
disregard for the interests of
doctors, hospitals and patients in
California, and the pursuit of
cutting costs at any means
possible,” Adam Cole, general
counsel for the California
Department of Insurance, told the
Los Angeles Times. “It's a story of
intense corporate greed.”
PacifiCare officials deny the
allegations, claiming that if any
violations occurred, they were
unintentional and harmless.
The insurer is in the middle of
an administrative law hearing that
began in Oakland in late 2009 to
determine its level of culpability.
If the hearing judge finds
PacifiCare liable, the final decision
on the amount of fines PacifiCare
could pay would be determined by
Insurance Commissioner Steve
Poizner.
Health Net Gets OK On
Rate Hike
Woodland Hills-based insurer Health
Continued on Page 3
NEWS
Funding (Continued from Page One)
and most still say the race remains a
tossup.
Molina, some nursing home operators
and pharmaceutical companies have
crossed over to Whitman, but many have
made significantly smaller campaign
donations than they have to Brown’s
campaign.
For example, Long Beach-based
Medi-Cal managed care insurer Molina
has contributed $25,900 to Brown’s
campaign, but only $5,000 to Whitman’s.
Molina officials did not immediately
respond to a phone call seeking
comment. CAHF has contributed $10,000
to Brown, but half as much to Whitman.
Prime Healthcare and its executives
contributed $51,800 to Whitman’s
campaign in July, but has contributed
$75,000 to Brown to date, including
$50,000 earlier this week from two senior
executives.
Among the largest of Whitman’s
individual healthcare donors is Kali P.
Chaudhuri, M.D., the founder of medical
group network KPC Medical
Nursing Chain To Settle Suit For $50M
Agreement Reached Soon After Staggering Verdict
An Orange County nursing home chain has
agreed to pay $50 million to settle a class
action lawsuit, far below the $677 million a
Humboldt County jury ordered it to pay earlier
this year.
Foothill Ranch-based Skilled Healthcare
Group will pay the sum to settle a suit
claiming it had understaffed 22 nursing
facilities statewide that it either owned or
managed.
NON-PROFIT HOSPITAL CEO SALARIES
A PAYERS & PROVIDERS EXCLUSIVE WHITE PAPER
Analyzes Compensation Of Nearly 120 of California’s CEOs
$149 (Executive Summary) $275 (Summary and Salary Data)
Call (877) 248-2360, ext. 2 to order, or CLICK HERE
!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 2
Management, which collapsed a decade
ago. He has ponied up $25,000. Angela
Braly, the chief executive officer of
WellPoint, the parent company of Anthem
Blue Cross of California, has contributed
$1,000.
Brown has strong union support,
particularly from various chapters of the
Service Employees International Union.
Its healthcare-specific chapters have
contributed $38,400 since early June.
Moreover, the CNA, in addition to
making regular contributions to Brown,
has expended nearly $287,000 to date to
campaign against Whitman. CNA officials
did not return phone calls seeking
comment.
Health plans and their affiliated PACs
have mostly avoided the gubernatorial
campaign. To date, only Anthem Blue
Cross has stepped in, contributing $25,000
to Whitman’s campaign. However, the
health plans have been heavily active in
the Assembly and state Senate races.
The lawsuit, which was originally led in
2006, alleged Skilled had provided far below
the 3.2 nursing hours per patient per day
required under California law between 2003
and 2009, endangering patients. The
Humboldt County District Attorney’s Ofce
joined in the suit, claiming Skilled had
engaged in unfair business practices.
Continued On Next Page
Payers & Providers
Longer ALOS!*
Advertise Here
(877) 248-2360, ext. 2
*For our ads, not your hospital
In Brief
Net has received approval from the
California Department of Insurance
to hike rates for its individual
policyholders an average of 16% after
an outside actuarial rm determined
its justications for seeking the hikes
were sound.
Health Net will increase the
premiums between 8% and 24% for
its 38,000 individual policyholders.
The rate increase will be effective on
Oct. 1.
The insurer had been holding off
on imposing the rates for three months
pending regulatory review. An outside
actuary, Winchester-based Axene
Health Partners, LLC, determined
earlier this week that Health Net’s rate
increase still permitted it to spend a
minimum of 70% of all premium
dollars on patient care as required
under Insurance Department
regulations.
The increase was announced
shortly after the Insurance Department
approved double-digit average
increase for individual policyholders
of Anthem Blue Cross of California
and Blue Shield of California.
Providence Enters Deal
With Laboratory
Operator
Providence Health & Services has
entered into an agreement with
Pathology Associates Medical
Laboratories to create a new lab
company to initially provide
services in the San Fernando Valley
area of Los Angeles.
The new business, called
California Laboratory Associates,
will begin operations in 2011, and
is expected to expand throughout
Southern California. It will use
facilities at Providence Saint
Joseph Medical Center in Burbank
and Pathology Associates’ lab in
Washington State.
NEWS
Suit (Continued from Page Two)
In July, the jury slapped Skilled with
$619 million in general damages and another
$58 million in punitive damages, the largest
jury verdict in the United States this year.
Trial judge W. Bruce Watson refused to
dismiss the verdict late last month, putting
pressure on Skilled to settle. The company’s
stock price lost about 85% of its value after
the verdict was reached.
The $50 million will go toward payments
to the 32,000 class-action plaintiffs and legal
fees. The facilities also named in the suit
agreed to be monitored for stafng levels
over the next two months. A statement issued
by the plaintiff’s attorneys estimated that the
two-year monitoring period is worth an
Heart Bypass Is Ranked For Patients
19 Calif. Groups Measured by Consumer Reports
Consumer Reports has aimed its sights at the
hundreds of medical groups in the United
States whose physicians perform heart bypass
surgeries, including 19 groups in California.
The Yonkers-based consumer advocacy
publisher worked with the Society of
Thoracic Surgeons to compile its rates.
According to Consumer Reports, the
organization has medical records on more
than 4 million heart bypass patients.
However, less than a quarter of the nation’s
medical groups agreed to participate in the
survey.
The medical groups were measured on
four criteria: whether 30-day patient survival
rates were 98% or higher; whether patients
escaped major complications at least 87% of
the time; whether patients receive
appropriate medications at least 90% of the
time; and whether patients have a 98%
chance of receiving at least one optimal
surgical graft.
Consumer Reports used a three-star
Expert Healthcare Communications
!White Papers !Media Campaigns
(818) 848-8510
!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 3
additional $12.8 million in care provided to
its clients.
The Janssen Law Firm, which co-
represented the plaintiffs, stated “although the
monetary amount of the settlement is less than
the verdict, we are satised that it reects the
best possible recovery for our clients taking
into consideration the uncertainty, risks and
delays associated with proceeding to
judgment.” Lead attorney W. Timothy
Needham declined further comment.
A statement issued by Skilled said the
settlement would be funded out of its
revolving credit facility. The company’s stock
price jumped about 25% after the settlement
was announced.
rating system for the survey, which ranged
from one star (below average) to three stars
(above average). Altogether, it ranked 221
medical groups in 42 states and the District of
Columbia.
Of those groups, 50 received above
average ratings, 166 received average ratings,
and ve received below average ratings.
Among the groups rated in California,
three were ranked as “above average” – Easy
Bay Cardiac Surgery Medical Group in
Oakland; Orange County Thoracic and
Cardiovascular Surgeons in Orange and
Pomona Valley Cardiac Surgery Medical
Group in Pomona.
The remaining 16 groups all received
average ratings. The other groups included
Stanford Cardiothoracic Surgeons, and
medical groups afliated with Glendale
Adventist Medical Center; Long Beach
Memorial Medical Center; and Sharp Chula
Vista Medical Center.
The full nds will be published in the
October issue of Consumer Reports magazine.
!Newsletters
www.rfsconsult.com
Payers & Providers
9-21:)!"6!;++1)!<=
'(&)*+!,!'*-./0)*+!/+!
>1%2/+3)0!).)*&!?31*+0(&!%&!
'(&)*+!,!'*-./0)*+!'1%2/+3/456!
778@!A4!(441(2!/40/./01(2!
+1%+B*/>C/-4!/+!DEE!(!&)(*!
FD$GE!/4!%12HI@!;C!/+!0)2/.)*)0!
%&!)J:(/2!(+!(!'KL!
(CC(B3:)4C6!-*!(+!(4!)2)BC*-4/B!
4)M+2)CC)*@
A22!(0.)*C/+/456!+1%+B*/%)*!(40!
)0/C-*/(2!/4N1/*/)+O
FPQQI!"GPJ"<=#
/4R-S>(&)*+(40>*-./0)*+@B-:
T(/2/45!(00*)++O
P$P!U@!V-22&M--0!W(&6!X1/C)!Y
Y1*%(4H6!8A!E$Z#Z
W)%+/C)
MMM@>(&)*+(40>*-./0)*+@B-:
L(B)%--H
MMM@R(B)%--H@B-:[>(&)*+>*-./0)*+
?M/CC)*
MMM@CM/CC)*@B-:[>(&)*+>*-./0)*+
\0/C-*/(2!Y-(*0
XC).)4!?@!9(2)4C/4)6!'*)+/0)4C6!
?3)!8(:0)4!]*-1>
^-++!]-20%)*56!83(/*:(4!-R!C3)!
Y-(*06!7-+!^-%2)+!V-+>/C(2!,!
T)0/B(2!8)4C)*
\2(/4)!Y(CB32-*6!T@K@6!83/)R!
T)0/B(2!_RR/B)*6!7@A@!8(*)!V)(2C3!
'2(4!
V)4*&!7-1%)C6!83/)R!XC*(C)5&!
_RR/B)*6!`))4(4
'1%2/+3)*[\0/C-*J/4J83/)R
^-4!X3/4H:(4
)0/C-*S>(&)*+(40>*-./0)*+@B-:
OPINION
Why A Public Option May Yet Return
Legislation May Allow Medi-Cal Plans Into Exchanges
When Sen. Joseph Lieberman, I-Conn.,
caved to pressure from the powerful
insurance entities headquartered in his
state, the so-called “public option” health
plan as part of Patient Protection and
Affordable Care Act died.
Untimely deaths often lead to musings
of reincarnation. Although a recent Pew
survey suggests that 25%
of Americans believe in
this phenomenon, its
existence remains unlikely
(just imagine how it would
impact underwriting).
However, reincarnation
is possible with a non-
human entity such as the
public option. And as
California is home to more
yoga studios and self-
realization cults than any
other part of the country, it
seems the most likely
place where the public
option could rise again.
The public option’s
By Jim
compromise replacement – Lott
voluntary insurance exchanges –
is the place where it may
reappear, prodded along by some timely
legislation.
That legislation was AB 1602, passed
to Gov. Arnold Schwarzenegger’s desk last
week. It is one of two bills that will
govern how the California Health Benefit
Exchange will operate.
AB 1602 offers something
breathtakingly straightforward: any plan
with a Knox-Keene license is eligible to
participate in the exchange and offer
coverage, subject to the approval of the
exchange board.
That would allow the county-operated
managed care plans, such as L.A. Care
Health Plan and San Francisco Health
Plan, to offer coverage to all comers.
Individuals and small groups could begin
enrolling in 2014. Coverage to all would
be opened by 2017.
This could prove a boon for the county-
operated health plans, which are currently
limited to providing coverage to Medi-Cal,
Healthy Families, Healthy Kids and dual-
eligible Medi-Cal and Medicare enrollees.
!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 4
These plans are all quasi-governmental,
not-for-profit entities with extensive provider
networks, thin margins and no doubt a desire
to mitigate their tendency toward adverse
selection (many Medi-Cal enrollees have
chronic health conditions). Most also offer
extensive preventative health programs. They
potentially could offer highly competitive
premiums to the public.
That was the original intent of the
public option: keeping premiums
down by offering a government-run
plan with less overhead than
commercial plans. Of course, the
commercial plans objected to
actually having to be competitive
in this manner.
Indeed, some of the larger
commercial plans, such as Anthem
Blue Cross, have carped about
entering the exchange. However, if
plans do not participate, AB 1602
will require most of them to offer
plans with levels of coverage
identical to what will be required in
the exchange. So even if they’re out,
they’re in.
The potential commingling of
commercial and public enrollees would
be just a first step toward the public option’s
resurrection. The Affordable Care Act eases
income eligibility for participation in Medi-
Cal, and is expected to boost enrollment by 2
million in the coming years.
That means upward of 14 million
Californians – 40% of the state’s population –
would be enrolled in government healthcare
programs by the end of the decade. That
doesn’t even include those commercial
enrollees who may opt for the Medi-Cal
managed care plans.
On paper, the public option appears to be
dead. But there is a distinct possibility the
winds of reform will take hold that particular
piece of paper and give it flight once more.
Jim Lott is the Executive Vice President of the
Hospital Association of Southern California.
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com, or call (877)
248-2360, ext. 3.
Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

!"#$%$"&'#"()*%

!"#$%&'#()*+,*-.*/%&"%*012*'(34%"(*5#(6*%78%7(#7*'9#88:'%(*'%%9'*.*,388:(#;%*&+8%*5#(6*
.*<.)%&*+&*<&+$#4%&*+&=."#>.(#+"*(6.(*#'*=3#4%4*?)*(&."',+&;.(#+".8*%@%73(#$%*
8%.4%&'6#<A!

1%.8(6*7.&%*<+8#7)*."4*BB2C2*&%8.(%4*&+8%'*D.34#(E*(&."'<.&%"7)*&%<+&(#"=E*;%4#7.8*
8+''*&.(#+*7+;<8#."7%E*;%."#"=,38*3'%*7+;<8#."7%E*F3.8#()*#;<&+$%;%"(E*
&%.4;#''#+"'*;.".=%;%"(E*%,!7#%"7)*+,*7.&%G*.&%*+,*<.&(#738.&*#"(%&%'(*(+*(6%*H+?*
'%%9%&A!*1)?&#4E*"+":(&.4#(#+".8E*4)".;#7E*."4*3"'(&37(3&%4*+<<+&(3"#(#%'*.&%*
%'<%7#.88)*5%88:'3#(%4*(+*(6%*H+?*'%%9%&A!*I@7%<(#+".8*.7.4%;#7*."4*<&+,%''#+".8*
&%,%&%"7%'*.&%*.$.#8.?8%A!

$+,-.'"!!"/%(&$%01!*J+8%'*(6.(*5#88*%"6."7%*+"%K'*7.<.7#()*(+*.44*$.83%*(+*)+3&*
#""+$.(#$%*+&=."#>.(#+"A!*L6%*#4%.8*+&=."#>.(#+"*5#88*?%*.*76.88%"=#"=E*;%(."+#7*
%"$#&+";%"(*#"*56#76*(6%&%*.&%*,%5*4388*;+;%"('E*;+&%*5+&9*(+*?%*4+"%*(6."*(#;%*
#"*56#76*(+*4+*#(E*."4*56%&%*#"(%88%7(*."4*.<(#(34%*.&%*$.83%4A!

*"(/#1!*M8%@#?8%E*"+":'(."4.&4*'76%438%E*#"7834#"=*5%%9%"4'E*#'*.77%<(.?8%A!

),")/-!*$2'/,3($/,4,&%1!*L&.#"*+&*.3(+;+?#8%*7+;;3(%*,&+;*B.'.4%".E*C2A!

2"4!,&#-%$"&',5!,2%-%$"&1!*2"*%@(&.+&4#".&)*+<<+&(3"#()*(+*;.9%*.*
;%."#"=,38*7+"(&#?3(#+"*#'*+,*<&#;.&)*#;<+&(."7%A!*

2"&%-2%1'

6$2%"/$-'!,-/#"&E*-IIN*2BE*012*D."(#7#<.(%4*0.)E*OPQQG

/#7(+&#.BR%.&(68#"9A"%(
SOSAOTUAQOVO

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

SENIOR MEDICARE COMPLIANCE ADVISOR - Along with the Compliance Officer

and Privacy & Information Security Officer, serves as the focal point for all Medicare
Advantage compliance activities. Coordinates and communicates all assigned
Medicare Advantage compliance activities internally and with L.A. Care's contracted
provider network. Along with the Compliance Officer, is L.A. Care's liaison with
Centers for Medicare & Medicaid Services (CMS) and other federal agencies
concerning L.A. Care's Medicare Advantage product(s). Ensures that L.A. Care and
its subcontracted provider network is compliant with all CMS federal regulatory
requirements. This is achieved by working with internal and external staff to correct
performance deficiencies, ensuring staff are aware of CMS reporting requirements
and reports are submitted to CMS identifying internal areas for improvement.
Responsible for performing internal audits, monitors implementation of corrective
measures, and interpretation of CMS requirements. Working knowledge of federal
and state requirements is required, as well as highly developed analytical skills and
excellent written and verbal communication skills.

For complete job description, qualifications/requirements, visit our website:

www.lacare.org

To apply, email resume with salary history and requirement to: recruiter@lacare.org
referencing “Payers & Providers Ad”

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers MARKETPLACE/EMPLOYMENT Page 7

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 word

Call (877) 248-2360, ext. 2

Or e-mail: advertise@payersandproviders.com

Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.

LOOKING FOR A NEW POSITION?

can help.
We publish advertisements for those seeking
new career
opportunities for just $1.25 a word.

If you prefer discretion, we’ll handle all

responses to your ad.
Call (877) 248-2360, ext. 2, or e-mail
advertise@payersandproviders.com.

!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778