21 June 2012

California Edition
Calendar
June 26-29
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In Marin v. Sutter, Pyrrhic Victories

Both Sides Claim Wins In Final Arbitration Decision
The saga of Marin General Hospital and its contentious relationship with Sutter Health has come to a close, with both sides falling well short of complete victory while claiming it nonetheless. An arbitration judge earlier this week awarded $21.6 million in damages to the hospital and its owner, the Marin Healthcare District. Judge Rebecca Westereld ruled that while the Greenbrae-based Marin General at times had been mismanaged by Sacramentobased Sutter, it did not rise to the level of systematic duciary malfeasance alleged by its owner, the Marin Healthcare District. Sutter managed the hospital between 1995 when it merged with California Healthcare Systems and inherited its lease and 2010, when it agreed to terminate the agreement nearly ve years early after being sued by the district over which party would be responsible for seismic upgrades. The district had leased the hospital to CHS in 1985 for 30 years. The Marin Healthcare District claimed that Sutter had siphoned more than $120 million out of the hospitals coffers between 2006 and 2010, a transition period between Sutter agreeing to end the lease and return the hospital to district control. It also claimed Sutter neglected to ensure the facility had an adequate reserve for capital projects and obligations to retired employees, and that it failed to keep medical staff dedicated to aligning themselves to the hospital in the longterm. It sought about $300 million in damages. Oral arguments in the case stretched more than two weeks. It included the testimony of more than 50 witnesses either through appearances and depositions, along with hundreds of exhibits. In her 64-page decision, Westereld concluded that Sutter owed little more than ensuring that the hospital was transferred back to the district debt-free and with working capital of $5 million on hand, $5 million in its charitable foundation and a guaranteed $20 million in accounts receivable. Westereld noted that Sutter had the right to transfer funds out of the district as part of agreements it had in place that the operation of the hospital would benet its entire network of hospitals. Westereld also noted that Sutter surrendered an estimated $135 million in income from hospital operations by terminating the lease early, and it made no guarantees that the ongoing operations of the hospital would be successful.

June 25-29
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July 19-21
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WEBINAR

Wednesday, June 27, 2012

1 P.M., PDT

HOSPITAL VALUE-BASED PURCHASING: A ROADMAP

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.

Please join Robert A. Minkin, senior vice president, The Camden Group and Guy D!Andrea, president, Discern Consulting, to discuss the critical components of Medicare!s upcoming valuebased purchasing program for hospitals.

http://www.healthwebsummit.com/pp062712.htm
a HealthcareWebSummit Event
co-sponsored by

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Top Placement... Bottomless Potential

NEWS
Decision (Continued from Page One)
Westereld did rule that Sutter was wrong to charge back the hospital its cost of obtaining capital; required excessive contributions from hospital operations to the retirement funds of its own employees; and did not provide enough support to transition the hospitals IT systems out of its own purview. However, the total award was less then one-tenth of what the district had sought. Marin ofcials claimed victory in the decision. This ruling validates our longstanding contention that in the years leading up to the transition, Sutter did not operate Marin General in a manner consistent with the best interests of our community, said Marin General Chief Executive Ofcer Lee

Page 2

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In Brief
California Community Foundation Makes $3.95 Million In Healthcare Grants
The California Community Foundation has announced more than $5.1 million grants for recipients throughout Los Angeles County, with the large bulk of that money earmarked for healthcare projects. A total of $3.95 million has been granted to healthcare recipients. $2.62 million has been granted to the Centinela Valley and Community Funds to expand healthcare access, care coordination and patient navigation, according to a statement issued by the foundation. Another $863,500 has been earmarked to more than a dozen clinics throughout L.A. County to help disadvantaged communities increase access to care. Thanks to the generosity of donors past and present, CCF continues to make grants at a relatively high and consistent level," said foundation Chief Executive Ofcer Antonia Hernandez. We strongly encourage more foundations, corporations and households to invest in the Los Angeles of today and tomorrow with us by helping stabilize and sustain community-based organizations.

Domanico. Instead they diverted funds for the benet of Sutter and the detriment of the people of Marin. Sutter also claimed it had prevailed. "We were always condent that we met our duciary obligations to Marin General Hospital, invested an appropriate amount of capital and left the hospital in a strong nancial position," said Sutter Health CEO Patrick Fry. "Sutter is extremely pleased with the arbitrator's decision to deny the vast majority of the damages the district sought and her nding that Sutter and its directors acted prudently and in accordance with duciary duties. Westerelds ruling is binding. In Marin County, Sutter currently operates Novato Community Hospital.

Californians To Benefit From ACA

Millions Would Obtain Coverage If Law is Upheld
As doubts about how the U.S. Supreme Court will rule regarding the constitutionality of the Affordable Care Act continue to preoccupy the healthcare sector, a new study by UC Berkeley and UCLA conclude that as many as 2.7 million Californians would benet from keeping healthcare reform intact. Altogether, researchers estimate that as many as 1.6 million Californians will enroll in an expanded Medi-Cal program. Under the changes, families with income of up to 138% of poverty level, $31,809 for a family of four, would be eligible for coverage. Childless adults would also be eligible; asset tests would be eliminated and enrollment rules would be streamlined. Another 2.1 million residents could purchase healthcare insurance through the state-run health plan exchange, subsidized with income tax credits for incomes up to 400% of the federal poverty level, or about $90,000 for a family of four. If the Affordable Care Act is upheld by the Supreme Court and fully implemented, it will signicantly expand access to affordable health coverage, said Ken Jacobs, chair of the UC Berkeley Center for Labor Research and Education and the study's lead author. "Based on our simulation, millions of Californians stand to gain, either through insurance they wouldn't otherwise have or from more affordable premiums and increased benet standards." As many as 92% of Californians under the age of 65 would have healthcare coverage by the time the ACA is fully implemented in 2019, versus 84% of Californians being insured should the ACA not survive.

HHS Says Reform Has Helped Millions Of Younger Americans Retain Healthcare Coverage
New data released by the U.S. Department of Health and Human Services concluded that 3.1 million

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Continued on Page 3

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Longer ALOS!*

Page 3
ACA (Continued from Page Two)
However, Supreme Court justices aggressively questioned U.S. Solicitor General Donald Verrilli during oral arguments earlier this year. The tone from the Courts conservative jurists raised doubts whether the individual mandate or even the entire 2,700-page law could be thrown out as unconstitutional. There are also a wide range of variables in the study. The number of overall Medi-Cal and commercial enrollees could be as much as 700,000 lower than the most optimistic gures, depending on variables such as prociency of English in a household, health status of its individuals, and any shifts in cost to obtain coverage. Outreach is the key to coverage, said Gerald Kominski, director of the UCLA Center for Health Policy Research and one of the studys co-authors. Helping California's diverse population understand the different types of coverage available and the enrollment process should signicantly boost enrollment rates and broaden the risk pool, which is essential to keeping down costs. Despite the encouraging number of enrollees by the end of this decade if the ACA remains in effect, as many as 4 million Californians would still lack coverage. However, about a quarter of this number would lack coverage as a result of their immigration status. The Supreme Court is expected to announce its ruling on the ACA no later than June 28.

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In Brief
young adults have been able to gain and sustain healthcare coverage as a result of the passage of the Affordable Care Act. One of the tenets of the reform law is permitting children to stay on their parents insurance policy until they reach the age of 26. This policy doesnt just give young adults and their families peace of mind, it also gives them freedom, said HHS Secretary Kathleen Sebelius. It means that as they begin their careers, they will be free to make choices based on what they want to do, not on where they can get health insurance. Altogether, about 75% of young adults have healthcare insurance, a proportion that has risen since the passage of ACA in 2010. As of late 2011, 2.5 million young adults were able to retain their coverage, a number that has continued to rise.

Employer Health Plans May Fade

J.D. Power Study Says Many May Be Dropped
Many companies are likely to eschew providing direct healthcare coverage to their employees in the coming years, according to a new survey by J.D. Power & Associates. Powers third annual employer health plan study has concluded that 47% of rms surveyed say they either will denitely or probably switch their workers to a private insurance exchange within a dened contribution model in the coming years. A statement issued by the Westlake Village-based Power observed as other options become available, some employers may consider eliminating coverage altogether. However, the rm was quick to add that only 13% of fully insured employers and 14% of their self-funded brethren say it is likely they would drop coverage for their workers altogether. As the landscape of healthcare changes, employers face many choices in how to best serve their employees with competitive coverage at affordable costs, said Rick Millard, a Power senior director. While some reports have predicted that a large number of employers might stop offering coverage, study ndings indicate that a large majority won't walk away from offering coverage to their employees. The survey concluded that costs are the biggest driver for making health plan choices, although the source of those costs diverge based on point of view. Employers consider high hospital and physician fees as the primary driver, while employees believe it is administrative costs tacked on by insurers. Among individual health plans serving fully-insured employers, Oakland-based Kaiser Permanente received the highest satisfaction score.

Cedars-Sinai Names Womens Heart Center After Streisand

Cedars-Sinai Medical Center in Los Angeles has named its new womens heart center after entertainer Barbra Streisand. The Barbra Streisand Womens Heart Center is part of Cedars-Sinais Heart Institute. It will focus on research specic to female cardiac health issues. Cardiac disease and heart attacks are the number one killer of women in the United States, and symptoms of an impending cardiac incidents are often different compared to their onset in males. Streisand has donated a signicant amount of money and fundraising prowess to Cedars to address female cardiac issues, which she believes is comparatively underfunded compared to research performed on behalf of males. Barbra Streisand's leadership allows us to dedicate signicant resources to women's heart healthcare, education, and research," said Eduardo Marban, M.D., director of the Cedars-Sinai Heart Institute.

STORIES OF ONE HIGHLY LITIGIOUS PHYSICIAN

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Payers & Providers

OPINION

Page 4

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The Pressure On Payers Is Relentless

Costs Must be Kept Down While Efficiencies Rise
No matter the outcome of the Affordable Care our company by interviewing approximately a Act, the long-term picture for payers remains third of our employees to identify areas that uncertain. Even if all the ACA provisions are would most benet from process improvement. enforced by the Supreme Court, there are still They then set up a number of kaizens many issues to sort out. If some of the (highly focused process improvement work provisions are struck down, then other issues sessions that included a cross section of will be encountered. employees) to focus on solving the There is one thing for most obvious roadblocks and sure, however, amidst all this waste points quickly. uncertainty: though we cant One of the rst projects was know exactly what changes improving the claims processing we will face, none of them workow in our medical are going to ease the pressure management area. We physically on cost reduction and moved all the departments to a improved performance. single location to create real time, In an unpredictable face-to-face collaboration. business environment, Blue Previously, the teams were divided Cross Blue Shield Montana into separate areas, which decided to give itself a hampered their ability to make physical and make process decisions on treatment and improvements to control reimbursement. We also trained what we could control. Over employees on multiple system the past two years, we have software and programs so that they reduced costs in a number of could recognize efciency critical operational areas at improvements between the By the same time that we made it different divisions. Taking a more easier and faster for customers to do Michael Frank collaborative approach and applying data business with us. methods has: One of the biggest challenges at BCBSMT was the increasing complexity of customer Reduced the claims processing backlog service. Our internal process improvement team collaborated with our customer service Reduced the appeals backlog area implementing six sigma principles. As a result of these efforts, BCBSMT reached each Resulted in double digit improvement in customer service process improvement goal productivity and responsiveness. that we set: The average speed of answering the phone Other departments followed suit and realized is now 10 seconds or less. similar improvements. Abandon call rates are down to less than 1%. These are exactly the kinds of gains that all A 50% improvement in the number of calls healthcare insurers must achieve given handled by a customer service representative regulatory demands and the likely increase in each day. insurance choices for consumers. Continuing While we had success performing process market changes provides a clarion call to act improvement with our own team, we pre-emptively to improve cost, quality, and recognized that we needed to establish more responsiveness as well as mobilize employees to rigor around our improvement efforts and raise their improvement consciousness and increase our scope to include more areas in our customer centricity. company. We partnered with Guidon Performance Solutions, which deployed Michael Frank is the chief executive officer of experienced process improvement Black Belts Blue Cross Blue Shield Montana. or coaches who helped us involve all employees in embracing and applying lean six sigma improvements. Op-ed submissions of up to 600 words are Guidon conducted an initial assessment of welcomed. Please e-mail proposals to
editor@payersandproviders.com

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MARKETPLACE/EMPLOYMENT

Page 5

EDI Software Engineer III - Ashland, OR

EDI Software Engineer Level III at Plexis Healthcare Systems in Ashland, OR Plexis Healthcare Systems is seeking an experienced EDI Software Engineer for production development, Integration, and Sales Support. POSITION PURPOSE: This position is responsible for the coordination, development and delivery of software products created by Plexis to maintain and improve on existing functionality, and incorporates new processes into the code base. This includes handling a wide variety of situations and conicts involving the functional and implementation specs as well as coding the functionality outlined in the functional specications. Takes direction from lead Software Engineers; as well as contributing to the team in a constructive manner. ESSENTIAL FUNCTIONS AND BASIC DUTIES: Develop enterprise level applications in Microsoft.NET, Windows, NHibernate, C# and MS SQL Server. Leverage his/her knowledge of object-oriented, Windows based development and advanced modeling techniques to implement scalable, multi-tiered applications. Present demonstrable experience in systems development tools and methodologies including Agile, SCRUM, Extreme Programming (XP) & UML modeling. Write SQL code (stored procedures, triggers, views, etc.) as part of a project team to implement functional requirements ensuring correctness and optimized performance. Conduct Code Reviews and assist Management in establishing Standards and Best Practices. Analyze and mature existing solutions. Analyze troubleshoot program code to isolate and correct errors. Collaborates with cross functional teams to analyze customer requirements and create technical specications and/or design documents for new applications. Create technical documentation for internal and external clients that accurately describe the conguration of technology utilized to implement a development solution. Create estimates of development tasks to be used for project scheduling. Analyze and troubleshoot existing program code to isolate and correct errors. Solves complex, analytical problems Understands the use of industry tools and technology and how their implementation affects project goals. QUALIFICATIONS: 5+ years of experience in the development and implementation of Client Server & Windows based applications High-level experience in the following: X12 Implementation Specication terminology and usage, C#, XML, Visual Studio, Visual Studio UnitTest functionality, MS SQL, Windows Workow, NHibernate and Service Oriented Technology Methodologies. Advanced knowledge with large scale development of enterprise systems. Experience with Object Oriented Analysis and Design as well as Object Oriented Design Patterns. Advanced knowledge in using best practices to perform software design, leveraging the methodologies of software systems analysis, design, testing. Experience creating technical documentation. Experience creating UML and implementing Object-oriented design patterns. Experience with reverse engineering and refactoring of systems. Advanced knowledge of SQL Server tools (Management Studio, Conguration Manager, SQL Server Integration Services) Advanced knowledge of database design, writing queries, triggers and stored procedures on SQL Server Deadline driven accountability Excellent communication and management skills MENTAL ACTIVITIES AND REQUIREMENTS OF THIS POSITION: EDI Software engineering functions are efcient, effective, and conducted in accordance with department policies and procedures, and with applicable laws Engineering policies and procedures are regularly reviewed and followed. Management is appropriately informed of any signicant problems Suggestions for improved efciency and effectiveness are provided Required reports and records (including time entry) are accurate and timely Good communication and effective working relations exist with related departments The company's professional reputation is projected in all documentation Successfully prioritizing tasks and meeting project deadlines Working independently when required Working successfully in a team environment This is an immediate opening. Only fully qualied individuals will be considered. For more information about our company, please visit www.plexisweb.com.

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MARKETPLACE/EMPLOYMENT

Page 6

AllCare IPA
MEDICAL DIRECTOR Coast Healthcare Management has been providing management services to Medical Groups and IPAs since 1986. Coast has an excellent opportunity for an experienced MEDICAL DIRECTOR with a strong UM and managed care background who can lead all aspects of clinical operations. The ideal candidate will have demonstrated successful implementation of process improvement; the ability to oversee patient care through Hospitalist and case management programs; the ability to manage ER utilization; and the knowledge and ability to manage global risk. We require superior interpersonal and conflict resolution skills with the ability to articulate the goals and objectives of the organization throughout the provider network; an understanding of financial systems, business strategies, and the development of an integrated healthcare delivery network founded in quality with a commitment towards service and excellence. Candidate should be a board certified physician with at least 5 years clinical practice experience along with 5 years experience in a managed care clinical position and documented leadership capabilities. This position offers a competitive salary and incentive package. DIRECTOR OF FINANCIAL OPERATIONS The DIRECTOR OF FINANCIAL OPERATIONS will report to the CEO and be involved in all aspects of financial management and operations. Candidate must be a proven leader with an exceptional understanding of managed care finance, delegated activities, health plan contracting, DOFRs, claims, reimbursement methodologies, risk pool review and reconciliation and financial review and analysis. In addition the candidate must possess excellent oral and written communication skills; ability to utilize an analytical and systems approach to work and be a team builder. The ideal candidate will be a strategic and innovative manager with a Masters degree in business, or CPA with at least 5-7 years experience in IPA/Group management. IPA MANAGER The IPA MANAGER will provide services and support of IPA operations with regard to providers and contracting with the ability to assist in contract financial analysis. This position requires extensive knowledge and experience with a variety of compensation methodologies. Candidate should have a Bachelors degree in health care, business or relevant domain and a minimum of 3-5 years experience in managed care, HMO contracting and/or operations. Interested candidates should send their resumes in confidence to: kathryn.hogan@coasthealthcare.net

MANAGER OF INFORMATION TECHNOLOGY

AllCare IPA is currently accepting resumes for an experienced Information Technology professional. Qualified candidates should have experience in the healthcare industry, have a thorough understanding of HIPAA/HITECH regulatory requirements, and the following: MS Windows 2008, Active Directory, DNS, WSUS, WDS, MS Exchange 2010, MS SQL 2005/2008, MS Windows 7, MS Office 2010, VMware vSphere 5, Equallogic iSCSI SANs, Crystal Reports XI, Trend Antivirus, firewalls, cisco switching & routing, Telecommunications (T1, Broadband, Nortel Phone System), VPN and colocation, backup-to-disk and disaster recovery, document management solutions, Xerox multifunction printing/scanning and HP stand alone printers, digital fax servers, and electronic submission of claims/authorizations. Strong skills in Access and SQL are desired. Previous experience with EZ-CAP is a plus. AllCare IPA, established in 1989, is a dynamic managed care company with in excess of 500 physicians coordinating the care for tens of thousands of local residents for the majority of major health plans. AllCare offers a competitive salary package including fully paid employee health, vision, dental, LTC, and employer matched 401K with immediate vesting.

Please send resume to AllCare, 3320 Tully Rd., Ste. 1 Modesto, CA 95350, or fax to 209-338-5657. Attn: Human Resources/Information Technology.

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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.

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