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October 19
October 17-19
Calendar
29 September 2011
November 1-3
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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.
California Edition
Why Caregiving Can Be Dangerous
Looking After Loved Ones Linked To Health Risks
Continued On Next Page
The more than 6 million Californians who
provide care to loved ones with disabilities or
serious illnesses are at greater risk than the rest
of the population of developing signicant
health problems of their own, according to a
new study by UCLA researchers.
The typical caregiver tends to be well off:
they are usually a middle-aged white female
who is employed, lives in
an urban or suburban area
and has a household
income of at least
300% of the Federal
Poverty Level, which
would be more than
$66,000 a year for a
family of four.
However, these
caregivers are
performing an
enormously time-
consuming task. The
amount of time per
week devoted to providing
care ranges from 19.1 hours among
caregivers between the ages of 18 and 44,
rising to more than 32 hours per week for
those 65 and older, presumably because the
parents and spouses they are caring for are
older and require more complex care. Nearly
20% are also spending $250 a month or more
on providing care.
As a result, all caregivers reported that the
stress of accomplishing this task interfered
with their social lives and performing
household chores. Nearly 30% of caregivers
said their ability to perform household tasks
due to emotional pressures was severe,
compared to 23.4% of the general population.
A third of caregivers also said that
emotional distress severely
impaired their social lives,
compared to 26.4% of the
population in general.
Caregivers need help,
especially as baby
boomers age and place
even greater strains on
their and their families'
abilities to cope," said
Geoffrey Hoffman, a
doctoral candidate at the
UCLA School of Public
Health who was the lead
author for the study,
which was published by the
universitys Center for Health Policy
Research.
Subjects of the study which were part of
the 2009 California Health Interview Survey
were also far more likely to engage in
behaviors that could severely undermine their
Obese Smokers
Caregiver
Non-Caregiver
Percentage Rates of Morbidities
Source: UCLA
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Payers & Providers Page 2
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Bottomless Potential
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In Brief
Zettel To Oversee
States Organ Donation
Database
Former state lawmaker and University
of California Regent Charlene Zettel
has been named to oversee
Californias online organ and tissue
donor registry.
Zettel, 64, served in the
Assembly between 1999 and 2003,
representing the 75th District in San
Diego as a Republican. Shes the rst
chief executive ofcer of Donate Life
California, which was founded in
2004 and certied by state ofcials in
the hopes of encouraging donations
through online registrations. Although
Californians can register as organ
donors through the Department of
Motor Vehicles, fewer than a third of
licenses drives have done so.
Meanwhile, 20% of those on the
national transplant waiting lists live in
California.
As we enter the next phase in
our organizations evolution, it is
critical that we effect the kind of
strategic outreach that is achievable
with the help of a distinguished
professional like Charlene, said
Donate Life President Lisa Stocks.
UCSF Develops
Consumer Diabetes
Management App
UC San Francisco has co-developed
an application intended to better
managed the care of the 4 million
Californians who have diabetes.
UCSFs Diabetes Teaching Center
developed the app, DiabetesIQ, in
conjunction with QuantiaMD, a
Massachusetts software company. Its
available on the iPhone, iPad and
Android platforms.
Users of the app can engage in a
real-time quiz show format game
Continued on Page 3
NEWS
Caregivers (Continued from Page One)
www.healthexecstore.com
Continued On Next Page
health, such as smoking and binge drinking
and overeating. The more stressed out
caregivers were, the more likely they were to
smoke: nearly 37% of caregivers who said
they experienced severe levels of distress
smoked. Thats about double the statewide
average and a rate 75% higher than
Californians under severe stress who do not
care for a loved one.
Meanwhile the report noted that only
about 13% of those caregivers surveyed use
respite services such as adult day health
care or in-home services.
Given recent state budget cuts to the In-
Home Supportive Services and Adult Day
Health Care programs, the utilization rates are
not likely to increase. However, those cuts
could be partially restored due to new funding
from the Affordable Care Act.
"Programs that support family caregivers
can help them create and sustain vulnerable
elders in community settings, which promotes
the values of dignity, choice and
independence as loved ones grow older," said
Bruce Chernof, President of the SCAN
Foundation, which provided funding for the
study.
Expanding paid family leave policies to
include all types of familial relationships can
also protect caregivers jobs and keep
caregivers in the workforce rather than having
them rely on the dwindling public safety net
after losing or leaving their jobs because of
caregiving, the report concluded.
Hospitals, Union Trade Charges
Tensions Up After Patient Dies During Work Dispute
In one of the most visible and bitter disputes
between healthcare providers and labor
unions in recent memory, the powerful heads
of Californias leading nurses union and
hospital lobby traded charges of negligence
and exploitation surrounding the death of a
patient in a Bay Area hospital last week.
The death of 66-year-old Judith Ming on
Sept. 23 at Alta Bates Summit Medical Center
in Oakland occurred during a lockout
involving the California Nurses Association/
National Nurses United and its longtime
nemesis Sutter Health, which operates the
facility.
The CNA had staged a one-day strike the
day prior to Mings death, but claimed to have
been locked out at Alta Bates the following
morning.
Ming, who had been suffering from
ovarian cancer, died after a an error involving
a medication she was not suppose to receive,
according to Oakland police.
According to the CNA, the medication was
administered by a replacement nurse Sutter
hired from outside California. An experienced
oncology nurse scheduled to work in Mings
ward that Friday had been part of the lockout,
the union claimed.
"An incident like this is chilling and
strikes right to our nurses' concern about their
ability to advocate for their patients," said
CNA/NNU Executive Director RoseAnn
DeMoro. "It was irresponsible to lock out
those nurses." The CNA also claimed that Alta
Bates touched base with the union after the
mishap to obtain a more experienced
oncology nurse.
A statement issued by Sutter conceded an
error had occurred and that Alta Bates was
undertaking an investigation. However, it
!"#$"%&"'!()*!(+,,!-!(+,,!&.!/0."'1!2!/'3456"'1!/7&85195:;*!<<=
Page 3
Payers & Providers
Longer ALOS!*
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*For our ads, not your hospital
NEWS
In Brief
where theyre peppered with
questions about how to best manage
the chronic disease. Their answers are
compared to other users in real time.
The intent of the game is to educate
users on how to exercise while
controlling their blood sugar, among
other purposes.
Education is a fundamental part
of therapy, said Martha Nolte
Kennedy, M.D., medical director of
the Diabetes Teaching Center. Almost
anything you do can change your
blood sugar and your response to
insulin.
California Gets $22
Million In HHS Grants to
Fight Chronic Disease
In Rural Counties
The U.S. Department of Health and
Human Services has granted $103
million to communities throughout the
United States to ght chronic
conditions and improve healthcare
outcomes. California received more
than $22 million.
Part of the Community
Transformation Grants program, the
money is part of the Affordable Care
Acts Prevention and Public Health
Fund. The money is focused on
promoting exercise, reducing blood
pressure and cholesterol levels and
reducing the use of tobacco. Chronic
conditions often connected to poor
diet and exercise are responsible for
75% of the nations healthcare costs.
The Affordable Care Act is
empowering Americans across the
country to truly transform their
communities by investing in programs
that make us all healthier, said HHS
Secretary Kathleen Sebelius. These
grants will offer communities the
opportunity to both improve
Americans health and control
healthcare
spending by avoiding costly, chronic
diseases in the rst place.
Among the recipients in
California was the Oakland-based
Public Health Institute, which
received a grant to improve outcomes
in the states 42 counties with
populations of 500,000 or less.
Patient Death (Continued from Page Two)
defended the use of contract nurses, whether
during labor actions or for other purposes.
Contract nurses are part of the daily
complement of staff at most hospitals. These
nurses are registered, highly trained and
qualied, and they undergo screening and
orientation before they come to work with
us, Sutter said.
The CHA, which represents more than
200 hospitals statewide, including all of
Sutters inpatient facilities, shot back that the
CNA was trying to use Mings death to its
advantage.
It is inappropriate and irresponsible for
the California Nurses Association labor union
to exploit this tragedy to further their union
agenda, said CHA President C. Duane
Dauner in a statement. This is the same
union that has taken nurses away from patient
bedsides more than 100 times during the past
three years. It also is unfortunate that the
nurses union is questioning the qualications
of other nurses providing patient care.
Medication errors are the leading cause of
administrative penalties levied against
hospitals by the California Department of
Public Health. The CNA has asked that the
CDPH begin an investigation into Mings
death. Although the CDPH often undertakes
investigations after a hospital self-reports a
mishap, it often take 18 months or more
before its ndings are made public.
Premiums Skyrocketing During 2011
9% Rise Is Far Higher Than Trend For Recent Years
HEALTHCARES BEST ADVERTISING VALUE
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After years of relatively modest increases in
the costs for healthcare insurance, new data
by the Kaiser Family Foundation and the
Health Research and Educational Trust
concludes that premiums are leaping upward
in 2011.
According to the Menlo Park-based
research organization, the average annual
premium for employer-sponsored health
insurance coverage increased 9% during
2011, to $15,073. Employers pay just under
$11,000 of those costs, while employees are
on the hook for $4,129.
The study does not focus on individual
states, but premiums in the western U.S. are
slightly above the nationwide average,
reaching $15,103.
The sharp increase was a bit of stunner in
what has been a moribund economy with
relatively little ination. Employee wages rose
just over 2%, while general ination was at
3.2%.
"This year's nine percent increase in
premiums is especially painful for workers and
employers struggling through a weak
recovery," said KFF Chief Executive Ofcer
Drew Altman.
The KFF did not speculate as to why costs
surged this year, although some industry
observers say insurers are locking in rate
increases before the brunt of the Affordable
Care Act goes into effect in 2014.
Overall, premiums for family coverage
have soared 113% over the past decade, while
wages have gone up only 34%. Ination
inched up just 27%.
Premiums to cover individual workers
increased 8%, to $5,429 a year, with those
employees contributing $921.
California Insurance Commissioner Dave
Jones who has been critical of recent
premium hikes by health insurers said the
study was evidence that his ofce should have
the power to regulate premiums.
!"#$"%&"'!()*!(+,,!-!(+,,!&.!/0."'1!2!/'3456"'1!/7&85195:;*!<<=
Payers & Providers Page 4
OPINION
Medicare Incentives Need To Change
Is It Time to Ask Patients to Think About Their Costs?
Gail Wilensky is a senior fellow at Project
HOPE. She was director of the Health Care
Financing Administration under President
George H.W. Bush.
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Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com
As the country has struggled to raise the debt
ceiling, there have been periodic expectations
that the current scal distress would produce
the right environment to nally reform
entitlements -- particularly Medicare. This has
seemed quite astounding to me, 15 months
before a presidential election year, with a
divided Congress and our highly charged
political environment.
And, while the weight of this expectation
now falls to a congressional panel, the need to
reform Medicare is no less important, both as
a strategy to reduce the debt as
well as to strengthen the program
for future generations.
Even in this context, though,
getting politicians and the public
to engage seriously in discussing
Medicare reform won't be easy.
As important as entitlements
may be to resolving the debt and
decit challenges, it's critical to
remember that the need to put
Medicare on a scally sustainable
path predates the current
environment. The biggest
problem in Medicare is the same
as it is for all of healthcare -- spending that has
been growing two to two-and-a-half
percentage points faster than the economy.
The retirement of the baby boomers, which
ofcially started last January, will increase the
number of people on Medicare from the
current 44 million to around 78 million and
will produce added stress.
To be sure, guring out a way to slow
spending on Medicare has been a part of the
Medicare program almost from its beginning.
The strategy has been to place all of the
pressure on providers, primarily by controlling
their payments. But through the program's
history, this emphasis has not provided a
sustained ability to control costs.
Nonetheless, it appears that, as part of the
debt deal, payments to providers will again be
among the principal sources of savings.
To a lesser extent, Medicare has also tried
to slow spending by changing the incentives
embedded in its reimbursement structure.
The Affordable Care Act, for instance, seemed
to follow this model. The health law makes
some limited attempts to change provider
incentives such as the provisions for value-
based purchasing, accountable care
organizations and other yet-to-be developed
projects that will be funded by the Center for
Medicare and Medicaid Innovation.
But the measure also introduced a "fail-
safe" mechanism to enforce spending
reductions -- the Independent Payment
Advisory Board. This panel will be responsible
for making recommendations to the Congress
for reductions needed to produce the
spending rates established for Medicare. In
keeping with the past exclusive focus on
providers, the IPAB's recommendations are
limited to changes in provider reim-
bursement and cannot consider
changes in benets or eligibility.
The question of whether to involve
Medicare beneciaries more directly
in strategies that slow spending is
being discussed more explicitly than
in the past. This is the rationale
underlying the premium support
proposal included in the Dominici-
Rivlin Debt Reduction Task Force
recommendations, where a variety of
private plans would be offered to
seniors along with traditional
Medicare, with a xed subsidy from
the government to purchase a plan. It is also
the motivation that underlies proposals to limit
or ban rst-dollar wrap-around insurance to
traditional Medicare.
Congress has previously shied away from
encouraging seniors to be concerned about
the cost of Medicare-covered services --
especially the vast majority with
supplementary insurance.
Slowing spending is not the only issue that
will need to be considered to ensure Medicare
solvency. Increasing the eligibility age,
reducing benets for higher income bene-
ciaries, or modifying Medicare's funding
sources are all likely to be up for discussion.
All of these decisions will be challenging for
the country and the Congress.
By Gail Wilensky
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*New England Journal of Medicine, 2004.
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