28 June 2012

California Edition
Calendar
July 12
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Much Of ACA Survives A Squeaker

Healthcare Leaders Praise Supreme Courts Ruling
In a decision that brought a mixture of cheer and relief from Californias healthcare leaders, the U.S. Supreme Court narrowly upheld the linchpin of the Patient Protection and Affordable Care Act, requiring Americans purchase health insurance or pay a tax penalty. Much of the law was left intact as a result. The justices did strike down another mandate requiring states expand their Medicaid programs for millions more lowincome Americans or lose program funding. It is widely believed California will move to expand the Medi-Cal program anyway. Chief Justice John G. Roberts, Jr. surprisingly joined the liberal wing of the court in the 5-4 ruling to uphold the individual mandate, siding with Associate Justices Stephen Breyer, Sonia Sotomayor, Elena Kagan and Ruth Bader Ginsburg. Associate Justice Anthony Kennedy, a conservative who is often the swing vote in such matters, dissented along with Justices Antonin Scalia, Clarence Thomas and Samuel Alito and declared that the entire healthcare law is unconstitutional. In writing for the majority, Roberts said the individual mandate could not be enforced under the commerce clause of the U.S. Constitution, but was legal as part of the overall authority of Congress to levy taxes. The requirement that certain individuals pay a nancial penalty for not obtaining health insurance may reasonably be characterized as a tax, Roberts declared. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness. The Courts ruling was in contrast to what transpired during oral arguments in March, when many justices skeptically questioned the individual mandate, leaving Solicitor General Donald B. Verrilli halting and off-balance in making his case for the Obama Administration. The ruling is expected to greatly reduce the number of uninsured in California. The state currently has nearly 7 million residents without coverage, about one in ve Californians. This is a great day in our opinion, because it sets the stage without a cloud toward where were going, said C. Duane Dauner, president of the California Hospital Association. Dauner noted that the high courts ruling continued the organizations 20year plan to improve the health of Californians. Dauner also believed California would move to expand the Medi-Cal program by as many as 2 million enrollees, receiving 95% of the funding to do so from the federal government in the early years of implementation. While the state has one of the lowest rates of inpatient Medicaid payments in the nation, Dauner said his constituents would rather have little money than none at all.

July 19-20
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July 19-21
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Continued on Next Page

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NEWS
Decision (Continued from Page One)
Dauners view was echoed by the MediCal payer sector. I feel condent that Gov. Brown and legislative leaders will work with the Obama Administration to expand the Medi-Cal program in California, said Howard Kahn, chief executive of L.A. Care Health Plan, which provides coverage to nearly 1 million Medi-Cal and Healthy Family enrollees in Los Angeles County. Kahn said the ruling would not cover everybody in California, particularly since Medi-Cal reimbursement rates are so low, but he and others agreed it was a game changer. In the Los Angeles area, depending on the region, one in four or one in ve people are uninsured. If that is cut in half, its huge for hospitals, said Jim Lott, executive vice president of the Hospital Association of Southern California. Although hospitals are expected to benet more widely from the decision than commercial insurers which will have to guarantee coverage to all applicants that sector was also pleased by todays ruling. The Supreme Courts decision means that California will continue to pursue the shared goal of helping as many citizens as possible get healthcare coverage, said Patrick

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In Brief
Kaiser Study Delves Into Healthy Eating At Schools
Healthy eating programs can dramatically cut the amount of poor foods on school campuses so long as proper steps are taken, according to a new study by Kaiser Permanente. The study, which was funded by the U.S. Department of Agriculture, concluded that using a participatory program that solicits input from from teachers, parent and staff can cut the presence of unhealthy foods and beverages on school campuses by 30%. That compared to an ongoing increase in unhealthy foods at campuses without such a program in place. "Schools are an ideal place for establishing lifelong healthy eating habits, but until now that's been easier said than done," said Kaiser researcher Karen J. Coleman. The study helped us understand how communities and schools could work together to get kids to eat healthier at school and help address childhood obesity. The results of the study are published in the most recent issue of International Journal of Behavioral Nutrition and Physical Activity.

Johnston, president of the California Association of Health Plans. Health plans continue their commitment to effectively implement the Affordable Care Act and constrain the cost of care for all Californians. Johnston added that the entire sector must also focus on containing the costs of healthcare delivery. California Insurance Commissioner Dave Jones also praised the decision, stating it was a win-win-win for the states families and economy, and that it was a validation of the leadership of President Barack Obama. Millions of Californians who have health insurance will continue to enjoy benets such as keeping their kids on their insurance to age 26, prohibitions on rescinding your insurance, elimination of lifetime and annual caps on your benets, no co-payments for preventive care, cheaper medications for seniors on Medicarethe list of immediate benets goes on and on, Jones said. However, Jones cautioned that the state will need to enact legislation control the escalation of health insurance premiums. A ballot initiative on the issue is expected to be placed before voters in November as they also make their decision whether to re-elect President Obama.

Other Reactions To ACA Ruling

We can look toward 2014 with renewed energy. The results of the first two years speak for themselves: 10,000 Californians denied coverage due to pre-existing conditions now have coverage; 350,000 seniors got help in paying for their prescription drugs; and 435,000 young adults are insured through their parents coverage. With our Latino population growing rapidly, we must continue to educate our communities about the availability of these and other coverage options, and todays ruling enables us to do so." Monica Blanco-Etheridge, Executive Director of the Latino Coalition for a Healthy California. The Supreme Court has ruled to uphold the Presidents Obamacare.!Despite being viewed as constitutional by a narrow majority, this law will do great harm to our country by imposing new taxes, burying job creators in new red tape and saddling future generations with debt they cant afford. Rep. Darrell Issa, R-CA "This is a victory for consumers and especially for California. No state in the nation had more at stake. This removes the cloud. There will be no more political speeches in the Legislature saying we should hold off on bills until the Supreme Court rules." Anthony Wright, executive director, Health Access California CMA vigorously supported the individual mandate to ensure universal insurance coverage for the millions of uninsured Californians and the reforms on the for-profit insurance industry, and we are pleased that those reforms were upheld...it does not guarantee that these newly insured patients will have access to doctors because the Medicare and Medicaid programs were left grossly underfunded. CMA was also strongly opposed to the ACAs creation of an unaccountable Independent Medicare Payment Advisory Board, which will mandate arbitrary spending cuts, force more physicians out of the program, and limit seniors treatment options. James T. Hay, M.D., President, California Medical Association

OC Surgeons Start New Medical Group

A group of Orange County physicians has banded together to create a specialty surgical medical group. The organization, called Newport Irvine Surgical Specialists, is based in Newport Beach. Its comprised of specialty surgeons in

Continued on Page 3

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Scripps Healthcare Slashes Costs

2010 Initiative Has Helped to Remake System
A major restructuring of care delivery at Scripps Healthcare undertaken in late 2010 has led to a dramatic improvement in its nances. The San Diego-based Scripps, which operates four hospitals and a variety of clinics and medical groups in the region, reported the overhaul which favored an integration of its hospitals and clinics versus the prior siloed approach saved the organization $77 million in its last scal year. Among the changes: ER patients are immediately assessed by a nurse, with followup by a physician. This has reduced the average waiting times at Scripps hospitals to 30 minutes or less. ER capacity has expanded as a result to accommodate another 21,000 patients and generated an additional $19 million in revenue. Scripps renegotiated its contracts and centralized the purchasing process for its pharmacy operations, saving $14 million to date. It expects to save another $5 million in the coming years via technological updates. Laboratory services were centralized at a single location in San Diego, cutting costs by $6 million a year Cardiac surgery outcomes were improved, saving $3.3 million a year a year. Single-used medical devices are being resterilized. Its saving about $350,000 a year in a single cardiac lab, and is being slowly rolled out systemwide. Scripps has also implemented genomic screening for patients prescribed Plavix, which is used to treat heart conditions, and interferon, which is used to treat leukemia, hepatitis c and other conditions. Such drugs can be ineffective in patients with certain genetic makeups. Such screenings may be extended for other medications in the future. Despite the dramatic changes, a Scripps spokesperson said no jobs have been cut. We're knitting together what has been a fragmented delivery system through a focus on streamlined management in the hospital and ambulatory setting, said Scripps Chief Executive Ofcer Chris Van Gorder. Many hospitals and healthcare systems have been launching such efciency campaigns in order to make it easier to issue bonds and attract other forms of capital, according to James LeBuhn, senior director of the healthcare division for ratings rm Fitch, Inc. Organizations have been really focused on cost control and ongoing efciency initiatives, LeBuhn said. However, the savings Scripps has achieved have been fairly dramatic, adding about 3% to its overall operating margins in its 2011 scal year. Van Gorder noted that such sweeping changes will be mandatory for the U.S. healthcare system if it wishes to endure. Healthcare in this country is already changing and must keep evolving, because it's broken, he said.

In Brief
the area. They have long had ties to Hoag Memorial Hospital Presbyterians two campuses and Orange Care Memorial Hospital. It will be based on Hoag property in Newport Beach. The group already oversees Hoags wound care center. Healthcare is rapidly changing, said Lincoln Snyder, M.D., the groups president and an oncology specialist. Regardless of what happens with the federal healthcare law, the practice of medicine and the way care is delivered is being transformed. The new landscape needs signicant physician leadership to be shaped positively. Our group plans to have a substantial role in the communities we serve in determining how these changes play out. Newport Beach-based Sovereign Healthcare will provide management services to the group practice.

Workers Compensation Insurers Report Big Losses For 2011

A new study by the California Workers Compensation Bureau estimated the states insurers lost $2.3 billion in its operations during 2011. Altogether, insurers paid out $7.7 billion in claims and had another $5 billion in overhead, including $4.4 billion paid out in medical care about 48% of the $10.4 billion in premiums collected, up from 43% of premiums in 2010. Insurers in the state have had a difcult time keeping a lid on expenses since 2008, when they began exceeding premiums. However, the red ink is still far below what was reported in the late 1990s. Insurers have claimed a number of reforms ushered in by former Gov. Arnold Schwarzenegger have led to the losses, although there is no legislative initiative underway to reform the current system.

Contracts were renegotiated with a variety of ancillary vendors, including ones for medical transcription, servicing elevators, operating the systems blood bank and conducting tests to assess vitamin levels in patient. The initiatives have saved $6 million

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OPINION

Page 4

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Sound ACO Deployment Questions

Theyre The Wave of The Future, But Tough to Get Right
Few healthcare changes in recent years have ACO? Do they have experience with stirred as much industry discussion as has the managed care or population health notion of accountable care organizations. This management? type of payment and delivery reform model Do you have the right leaders and leadership seeks to tie provider reimbursements to quality structure to guide the process and make this metrics and risk sharing in a manner that successful? Included in this must be a boardreduces the total cost of care for an assigned certied physician serving as the ACO population of patients. Presently, a range of medical director, a principal CMS liaison, and ACO pilots are underway, and the Center for a governing body that is at least 75 percent Medicare & Medicaid Services estimates that controlled by ACO participants. ACO implementation could lead to an Do you have or can you build the essential estimated median savings of infrastructure support in such areas as $470 million from 2012 2015. information technology and human As optimistic as these resources? projections might be for the Is there sufcient capital to launch government, the path to and successfully operate an ACO, successful development of an including an adequate reserve to carry ACO is laden with many the ACO during its formation period? challenges. These include the Is the competitive landscape lack of specicity regarding how favorable? Who else in your market ACOs should be implemented, may be considering forming an ACO, the potentially high startup costs and how are they positioned with the and large annual expenses to local medical community? maintain the system, and the risk What is the opportunity for shared of an ACO being accused of savings? The ACO application must violating antitrust laws if they are include a description of the criteria that By perceived to reduce healthcare the ACO plans to employ for distributing Phil Dalton competition. shared savings among ACO participants. Perhaps the greatest challenge of all is Are you prepared to document, to the meeting the requirements necessary to be satisfaction of CMS, the ACOs procedures for successful with the formal application process. evaluating the health needs of its Medicare CMS requires an ACO applicant to submit population, including consideration of (among other things) materials that describe the diversity and a plan to address the needs of ACOs leadership and management structure; those persons? documents that describe the scope and scale of Do you have experience with submitting an the quality assurance and clinical integration application to Medicare? If you dont it would program; credentials that describe the be wise to nd a partner that has helped applicants plans to promote evidence-based guide other hospitals, medical groups, health medicine and patient engagement; and much, systems and other healthcare organizations much more. through a process like this so they achieve With this in mind, those considering ling their goals for growth and protability. an ACO application should ask themselves these key questions: ACOs have the potential to improve quality of care while reducing healthcare spending. Dont be left out of this exciting new chapter in our Do you have the necessary physician support and is the right physician structure in place, nations healthcare future. such as an employed physician base, IPA, medical group, medical foundation or hospitalist group that can serve as an anchor? Phil Dalton is the chief executive officer of If not, can you create one or more? MDS Consulting. Are their enough Medicare lives in your community to support an ACO, and do your physician partners collectively have enough Op-ed submissions of up to 600 words are Medicare patients to qualify as a Medicare welcomed. Please e-mail proposals to
editor@payersandproviders.com

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MARKETPLACE/EMPLOYMENT

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MANAGER ENCOUNTER DATA JOB SUMMARY: Manages and coordinates encounter data acquisition, validation, submission, and remediation. Provides expertise in encounter processing to support business and analytical projects. Responsibilities include interaction with the provider partners, vendor management, inter-departmental collaboration, and supervision of staff. ESSENTIAL JOB RESULTS: Manages operations of encounter data processing by coordinating and overseeing staff, prioritizing tasks and resolving issues. Manages encounter data vendor relationships by monitoring their performance and guiding them through issues and priorities. Maintain Encounter Data Processing System and Encounter Data Portal by guiding technical staff, including timeframes, requirements, and testing. Provide expertise and guidance for all encounter data analytics and reports by ensuring all data is accurate, reports are delivered timely and consistently. Collaborates with inter- and intra-departmental teams and groups though meetings, emails, and various workgroups. Maintains staff by recruiting, selecting, orienting, developing, and training employees. Maintains staff results by communicating job expectations; planning, monitoring, and appraising job results, counseling and coaching employees; initiating, coordinating, and enforcing systems, policies, and procedures. Maintains a professional business and technical knowledge of encounter data processing requirements and regulation by attending regulatory conferences, participating in industry workgroups, and monitoring announcements from regulatory agencies. Contributes to team effort by accomplishing related results as needed. QUALIFICATIONS: Bachelors Degree in business or healthcare field, or equivalent experience. 3 - 5 years of healthcare data processing experience. Supervisory or management experience required. Knowledge of CMS Encounter Data Processing and risk adjustments preferred. Strong technical, verbal, and written communication skills. Ability to exercise independent and professional judgment and decision making skills. Ability to handle multiple tasks simultaneously; excellent organizational skills and strong commitment to details. Excellent windows based computer and MS office skills are required, and experience in MS SQL is preferred. FT position, M-F 8 AM to 5 PM, with extended work hours and occasional travel, as needed. Please apply to www.scanhealthplan.com | Job opportunities | Req. # 12-728

COMPLIANCE SPECIALIST JOB SUMMARY: Ensures compliance and adherence to regulatory requirements by monitoring internal policies and procedures and state and federal regulations and advising management on needed actions. ESSENTIAL JOB RESULTS: Ensures compliance with established internal control procedures by examining records, reports, operating practices, and documentation and providing information to the Director for approval. Ensures compliance with state and federal agencies by studying existing and new legislation; auditing for adherence to requirements and participating in cross-functional teams to advise management on needed actions. Ensures compliance by performing standardized audits and recommending new policies and procedures. Provides guidance and information by interpreting policies and procedures: answering questions and requests, and upon Directors approval forwarding to functional key contacts. Maintains customer confidence and protects operations by keeping information confidential. Prepares reports by collecting, analyzing, and summarizing information and trends. Satisfies training needs by providing end-user training. Maintains compliance database by entering and backing up data. Maintains company reputation by complying with regulatory requirements in collaboration with the Compliance Department. Provides support to the Senior Compliance Specialists for completion of specific projects. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Contributes to team effort by accomplishing related results as needed. QUALIFICATIONS: Bachelors Degree, or equivalent experience required. 2 years of experience in managed care. Demonstrated understanding of HIPAA Privacy. Ability to work effectively and participate in a team environment. Ability to handle and prioritize multiple tasks simultaneously. Proficient in MS Word. FT position, M-F 8 AM to 5 PM, with extended work hours and occasional travel as needed. Please apply to www.scanhealthplan.com | Job Opportunities | Req. # 12-705

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MARKETPLACE/EMPLOYMENT

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CONTROLLER/ DIRECTOR OF FINANCE

Casa Colina Centers for Rehabilitation, a nationally recognized leader in the field of medical rehabilitation located in Pomona, is seeking to fill the vital role of Controller to oversee the Finance and Accounting functions for the entire rehabilitation continuum with a total bed complement of 178 beds, and consisting of a hospital, brain injury program, 3 long term care facilities, an Adult Day Health Center and outpatient childrens program. The selected candidate will be responsible for all financial, payroll and A/P activities. Oversees internal controls to ensure revenue cycle effectiveness, expenditure management and safeguarding of assets. Prepares financial statements in a timely, accurate and efficient manner. Supervises all accounting and payroll staff. Responsible for tax returns and regulatory filings. Requirements include a Bachelors degree in Accounting or Business related field, two (2) years of supervisory experience, prior hospital/ healthcare accounting experience, and a working knowledge of accounting software programs. CPA background is strongly preferred. Excellent work ethic and motivation required. Competitive compensation and excellent benefit options available. To apply, visit us at www.casacolina.org/jobs. Principals only at this time.

HEALTH PLAN/HOSPITAL CONTRACTING CONSULTANT (flexible hours) A dynamic and growing medical group in the Los Angeles County area is currently seeking a highly experienced contracting consultant for the purpose of leading and successfully negotiating and renegotiating health plan and hospital contracts. The ideal candidate will have an understanding of all product lines within the managed care industry, be well-versed in contractual language, excel at maintaining positive working relationships internally and externally, and demonstrate an understanding of legal, financial and operational processes that meet company objectives. Flexible hours and telecommuting are available. If interested, please email your cover letter and resume to: ssabanal@ahcipa.com

It costs up to $27,000 to fill a healthcare job*

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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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MARKETPLACE/EMPLOYMENT SEEKING A NEW POSITION?

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CAN HELP.
We publish advertisements for those seeking new career opportunities for just $1.25 a word. If you prefer discretion, well handle all responses to your ad. Call (877) 248-2360, ext. 2, or e-mail advertise@payersandproviders.com.

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