4 February 2010
California Edition
Calendar
February 10
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March 9-10
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E-Mail
info@payersandproviders.com with
the details of your event, or call
(877) 248-2360, ext. 3. It will be
published in the Calendar section,
space permitting.
Central Line Infections All Over Map
Group Says Hospital Reporting May be Delayed
infection reports to the CDPH on paper,
Intensive care patients at hospitals in Los which must then be inputted manually.
Jim Lott, executive vice president of
Angeles County and the Bay Area suffer
infections of their central lines at greatly the Hospital Association of Southern
varying rates, according to new data California, confirms that the data has
released this week by been submitted by hospitals on paper,
Consumers Union. but dismisses the
The New York- allegations as
based advocacy Central Line Infection Rates, 2008 insignificant.
group, which Foothill Presbyterian Hospital – No Infections “We’re not
publishes Consumer Stanford Hospital & Clinics – 64% above average talking about a
Alvarado Hospital – 24% above average
Reports magazine, huge data
Miller Children’s Hospital – 27% below average
linked improved submission,” says
infection rates to
USCF Medical Center – 80% below average
St. Francis Medical Center – 177% below average Lott, who sits on
more consistent the Payers &
public reporting of Providers Editorial
Board. “If there
such infections by Source: Consumers Union
hospitals. However, it suggests were thousands or millions of
the California Department of datapoint entries, that would
Public Health may not be able to release be one thing, but it’s not.”
hospital infection rates by early 2011, Officials with the California Hospital
despite state laws mandating it do so. Association also dismissed the
“We have not seen in California the allegations. The CDPH was unable to
kind of ‘can-do’ attitude about reporting immediately respond.
infection rates that we have seen in other Despite the criticism from
states,” says Lisa McGiffert, director of Consumers Union, 47 of the 70 hospitals
Consumers Union’s Safe Patient project, it surveyed reported either no central line
which used 2008 data the hospitals infections at all, or infection rates below
voluntarily submitted to the Leapfrog the national average, which it calculated
Group for its survey. McGiffert insinuates at just above two infections per every
foot dragging on the part of hospitals,
which she says have been submitting Continued on Next Page
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In Brief
United HealthGroup
Pledges $14.3M to L.A.
Non-Profit
An initiative of Minneapolis-based
UnitedHealth Group has earmarked
$14.3 million to help finance the
construction of a new center for Los
Angeles-based Children’s Institute,
Inc.
The money was provided
through UnitedHealth’s purchase of
tax-exempt bonds through its
California Health Care Investment
Program. That initiative is spending
$200 million over a decade to
healthcare organizations in the
state that provide services to
underserved populations.
Children’s Institute will use the
funds to build a new campus and
headquarters near downtown Los
Angeles. It will provide health and
social services to 5,000 families per
year.
“We are pleased to be able to
help Children’s Institute meet its
community’s healthcare and social
services needs, and we believe it is
essential that underserved residents
in Los Angeles have such an
important health care and social
services resource in their
community,” says Steve Nelson,
CEO, UnitedHealthcare west
region.
John Muir Health
Opens Center to Treat
Incontinence Issues
Walnut Creek-based John Muir
Health is opening a new Center for
Women’s Continence & Pelvic
Health later this year.
The center, which is located at
the hospital system’s women’s
health center in Walnut Creek, will
focus on educating and women
who are confronted by
Continued on Page 3
NEWS
Infections (Continued from Page One)
1,000 hours a patient is attached to a
central line. Each infection costs on
average $42,000 to treat, according to
Consumers Union.
Twenty-three hospitals had rates
higher or significantly higher than the
national average. Eighteen of those were
in the Los Angeles area.
Lott says the disparity between the
Bay Area and Los Angeles was simply an
expression of the law of averages. “There
are a lot more hospitals here,” he says.
Alhambra Hospital Medical Center
had the worst rate, 440% above the
national average. Iris Lai, the hospital’s
chief executive officer, did not respond to
a request for comment.
Despite having a “checklist” in place
for appropriately inserting and maintaing
central lines, Kaiser Permanente
demonstrated disparities among many of
its hospitals. For example, five of its
hospitals reported no infections at all.
Nine reported rates that were better than
the national average. But its facilities in
San Jose, Oakland, West Los Angeles and
Woodland Hills reported rates worse than
the average. The Woodland Hills facility’s
rate was 330% worse than the national
average.
Kaiser spokesman Jim Anderson says
the Woodland Hills hospital has since
Mixed News on Health Net Earnings
2010 Forecast is Strong, But Enrollment Still Down
Woodland Hills-based insurer Health Net
says its transition to a leaner and more
focused company has placed it in a position
to have a competitive 2010, but it does not
expect a drop in its enrollment to be reversed
anytime soon.
Health Net reported a loss of $45.2
million for the quarter ending Dec. 31, on
revenues of $3.8 billion. Much of the loss is
!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 2
revised the way it maintains its central
lines, and has not had a reported infection
since 2008.
A similar disparity occurred within the
UCLA hospital system. UCLA Ronald
Reagan Medical Center was above the
national average, while its Santa Monica
campus was below. Improvements have
since been made at the Santa Monica
hospital, according to UCLA officials, and
both campuses are now comparable in
performance.
McGiffert notes that central line
infection rates can vary between hospitals
even under the same management,
particularly if protocols are not rigidly
followed. “It’s not a matter of just following
a checklist, but of changing the culture,
allowing nurses to step in if doctors or
someone else do something that poses a
threat (of infection),” she says.
Ultimately though, McGiffert says
following protocols “are not a proxy for
reporting infection rates.”
Lott says that a recently announced
patient care collaborative between
California’s three hospital associations, Blue
Cross of California and the National Health
Foundation will address the rates of central
line infections directly and bring them
down significantly.
attributable in $106 million in writedowns it
took associated with the sale of its
northeastern operations to UnitedHealthcare
for $350 million. For the fourth quarter of
2008, it earned $35.6 million on revenues of
$3.9 billion.
For the year, Health Net reported a loss of
$49 million on revenues of $15.7 billion. It
Continued on Next Page
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In Brief
incontinence issues. It the only
center of its type in the East Bay.
“When something affects your
daily life, it is not normal and you
need to find trusted resources to
address your health issues,” says
Rachel Cabriera, a nurse
practitioner who will work at the
cenrer. “We listen to your problems
and provide a variety of treatment
options to best match your needs:
nutrition counseling, medication,
biofeedback, physical therapy,
behavior change, and surgical
options including minimally
invasive procedures for quicker
recovery.” Patients will be guided
through services via a concierge
center, Cabriera says.
Biomed Jobs Hold
Steady During
Recession
While much of California has
suffered huge jobs losses during
the Great Recession, the state’s
biomedical industry has fared
relatively well.
According to a report by the
California Healthcare Institute and
Pricewaterhouse Coopers LLC,
64% of the state’s biomedical firms
either maintained or grew their
number of employees. Eighty-one
percent of the firms expect to
maintain or grow their workforce
over the next two years.
However, two-thirds of the
companies surveyed expect to
expand their manufacturing
capabilities outside of California
over the next two years. And more
than half expect to expand their
research and development staffs
out of state.
And job growth has slowed to
a crawl – the state added only
3,000 biomedical jobs in 2008, up
just 1% from 2007.
The Bay Area has the largest
number of biotech jobs – nearly
52,000. Los Angeles has slightly
more than 45,000 jobs.
NEWS
Health Net (Continued from Page Two)
earned $95 million on revenues of $15.4
billion in 2008.
Chief Executive Ofcer Jay Gellert says
that the company will now focus exclusively
on west coast operations, and emphasize
low-cost products such as its health plans
connected to smaller, easier-to-manage
medical networks.
“Our structure is now simpler and
clearer,” Gellert says. With the sale to
UnitedHealthcare, the company had $450
million cash on hand at the end of 2009. It is
using some of the money to reinitiate a stock
buyback program it had suspended for
several years. It has also been trimming
expenses and jobs, about 1,300 in the past
year, according to Gellert.
As a result, the company projects 2010
Staffing Firm Finds Nursing Burnout
Suggests Many Will Seek Change in Careers
Despite a relatively tough job market for
nurses, a new survey by San Diego-based
stafng rm AMN Healthcare suggests that
many may soon exiting the profession for
other jobs.
According to AMN’s survey of nearly
1,400 nurses that occurred in December, 29%
say they plan to take steps to reduce their roles
as nurses, or take them out of nursing
altogether. Another 15% say they play to
switch from their current roles and become
traveling nurses or nurse practitioners.
Job dissatisfaction appears to be playing
some role. Twenty-nine percent of nurses
surveyed say they often feel like resigning their
position. Forty-six percent say they worry their
work is affecting their health.
“Our survey clearly indicates signicant
job dissatisfaction and that is concerning in
terms of quality healthcare delivery,” says
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Page 3
earnings to be in the range of $1.92 to $2.02 a
share, or about $200 million, on revenues of
about $13 billion. That includes a projected
$69 million in writedowns.
However, Health Net projects its 2010
enrollment to be at. Its Caliornia enrollment
dropped 1.3% from the end of 2008 to the end
of 2009, although its small group and
individual enrollment dropped nearly 14%,
and its large group dropped 9.2%. This was
offset in part by gains made in Medi-Cal and
Medicare enrollees.
“We’ve been careful to price
responsibly, and are seeing some initial signs
of enrollment improvement this year,” Gellert
says.
Ralph Henderson, president of AMN’s nursing
and allied division. “Nurses are at the core of
quality care in our nation's delivery system
and if we see large numbers of nurses leaving
the profession it could negatively impact
patient care outcomes.”
Although the nursing profession has been
impacted by the recession and recent studies
suggest as many as 40% of new nursing
graduates cannot nd jobs, most experts
believes that the long-term nursing shortage
will be exacerbated when the economy
improves. Peter Buerhaus, a professor of
nursing at Vanderbilt University, projects a
shortage of some 260,000 nurses nationwide
before the end of the decade.
Nonetheless, the AMN survey did nd
some bright spots: 66% of respondents say
they are satised with their current job.
Another 65% say they would recommend the
profession to others.
!Newsletters
www.rfsconsult.com
Payers & Providers
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OPINION
The Big Storm Coming This Way
Single-Payer Bill Has Distracted From Looming Cuts
We have been distracted by the stalled
national healthcare reform effort and a
soon-to-be-doomed local effort from a new
tornado about to descend on California.
What attention is being paid to the
state’s healthcare affairs has been on the
single-payer bill sponsored by State Sen.
Mark Leno, D-San Francisco. Leno got his
bill through the Senate, but it is
preordained to fail: Gov.
Arnold Schwarzenegger will
veto it as surely as he lights
up his afternoon cigars.
Ironically, Leno’s stillborn
legislation is at the moment
the only thing that might
cushion the impending
collision between
California’s providers and yet
another round of profound
budget cuts the Legislature
will undertake later this year.
If you thought the reductions
were bad for 2009 and 2010,
what could be in store for
2011 may make them seem like fender-
benders.
The Schwarzenegger Administration
is looking to close a projected $19.9
billion budget gap, which comes on top of
the $21 billion gap that had to be closed
last year. It was done so by eliminating
some healthcare entitlements completely,
such as the Denti-Cal program for adults.
The only alternative is to revisit healthcare
expenditures and reduce them further.
What’s potentially on the chopping
block? Here’s a list:
•Healthy Families This source of insurance
for nearly 1 million of California’s
children could be eliminated entirely. It
escaped this fate in the last budget year
with a last-minute injection of funds from
the Obama Administration and First 5
California, but the chances of getting
outsiders to pony up again is in doubt.
This is in contraindication of many states,
which have moved to expand their S-
CHIP programs in recent years.
•Medi-Cal Inpatient Payments Despite the
fact that the Medi-Cal program is in some
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Page 4
ways untouchable, there are still ways the
Legislature could enact “backdoor” cuts in
payments to hospitals. For instance, the
Department of Health Care Services could
decide to only pay for six days of inpatient
care. Such a cut was first attempted in the
mid-1990s, but the California Hospital
Association sued and won. However, that
victory pivoted on a legal technicality. If
the state can find a loophole
to exploit that will hold up in
court, it will. Resolving such a
matter could take years. Keep
in mind that litigation from
the 10% cuts in
reimbursement enacted in
trailer bill ABX 5 two years
ago is still ongoing.
•The Aged, Blind and
Disabled Deep cuts are likely
to occur in this segment.
Particularly vulnerable are
people with developmental
disabilities who receive
By community-based services. Adult Day
Jim Lott Health Care – which gets many elderly
Californians out of their homes – is
likely to be eliminated entirely.
The days of steep recession and colossal
budget deficits will not last forever. However,
the long-term health of millions of
Californians could be profoundly impacted by
deep cuts in these programs. Providers will
also be impacted in the form of more
uncompensated care, a more acute inpatient
population and other costly consequences.
It is therefore imperative that we not
distract ourselves with single-payer healthcare
bills that have no chance of being enacted for
now, and focus on the dire cuts that are
almost certain to be inflicted in the
immediate future.
Jim Lott is the Executive Vice President of the
Hospital Association of Southern California. He is a
member of the Payers & Providers Editorial Board.
Op-ed submissions of up to 575 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com, or call
(877) 248-2360, ext. 3.
Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

Senior Clinical Data Analyst - manages the HEDIS project and oversees activities related to data
collection and analysis, vendor selection and oversight, quality control, directing the activities required for
the annual external HEDIS audit, and reporting the nal results to NCQA. Responsibilities include
coordination of information collection from key departments and Plan Partner contacts. The individual
works closely with the lead medical record abstractor and schedulers, to assure accurate and timely
project completion. The position is supported by the clinical data analysts and secretary in the Healthcare
Outcomes and Analysis Department. The Senior Clinical Data Analyst deals directly with the external
HEDIS auditor and contract vendors, conducting data quality checks to assure electronic data sources
are correct and complete throughout the project. The individual also conducts an annual debrief with the
Plan Partners, consisting of an executive summary and detailed descriptive analysis of the ndings by
Plan Partner and product line, including trends, statistical tests for differences between years, and
comparison with other plans and benchmarks. The individual participates in key discussions with the
State Department of Health Services (DHCS) and key quality intervention meetings within the
organization, and supports the director of Healthcare Outcomes and Analysis in contract negotiations with
vendors and the annual budget. !
!
For complete job description, requirements/qualications, and additional opportunities, visit our website:
www.lacare.org!

To apply, email resume with salary history/requirement to: recruiter@lacare.org, referencing

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