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October 19
October 17-19
Calendar
6 October 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
Providence Moves Toward An ACO
New Physician Venture May be an Initial Step
Continued On Next Page
Providence Health & Services has formed a
new entity intended to more closely align its
hospitals and afliated physicians in a rst
step toward an accountable care organization.
Called Providence Partners for Health,
LLC, the entity is a joint venture that will be
jointly owned by Providence Health and the
participating physicians.
It will focus on a collaboration between
the physicians and the ve hospitals
Providence operates in the Los Angeles area
and will attempt to smooth out practice
variations. The alliance will share data on
quality and focus on standardizing best
practices. Physicians who join will have
access to Providences electronic medical
records and other information technology.
The new Providence Partners for Health
is not currently an ACO, but could evolve that
way, said Kerry Carmody, who is
Providences chief operating ofcer in
Southern California. Our current focus is
creating a clinically integrated organization to
improve both quality and affordability for all
payers...we want to participate in various
facets of healthcare reform initiatives
including pay for performance, bundled
payments, narrow networks and eventually
ACOs.
The move by Providence marks another
step toward ACO formation in California. Most
of the most visible projects so far have been a
three-way collaboration between physicians,
hospitals and payers. They have included
efforts involving Blue Shield of California, Hill
Physicians Group and Catholic Healthcare
West in the Bay Area and Anthem Blue Cross
of California with a variety of medical groups
and hospitals in Orange and San Diego
Counties.
Steve Valentine, president of The Camden
Group, an El Segundo-based healthcare
consulting rm, said the entity was part and
parcel to an ACO. He added that it would
help improve patient outcomes and cut
unnecessary costs, such as redundant lab tests.
What they are trying to do is get a system
alignment with physicians...under this one big
network that would allow them to approach
clinical integration, focus on waste,
unnecessary admissions, readmissions, and so
on, he said.
Providence Partners for Health will be
governed by a 15-member board with nine
physicians and six Providence ofcials. It is
being chaired by John Armato, M.D., a
Redondo Beach internal medicine physicians.
"(This) provides a tool for us...to share
best practices and clinical data and to foster
and sustain a system driven by both quality
and value, Armato said. "The healthcare
industry is changing rapidly with an increased
!"#$%&'!()!*+,,!-!*+,,!%.!/0.&'1!2!/'$345&'1!/6%741849:)!;;<
Payers & Providers Page 2
Top Placement...
Bottomless Potential
Advertise Here
(877) 248-2360, ext. 2
In Brief
Underage Tobacco
Sales Reach All-Time
Low
Tobacco sales to Californians under
the age of 18 have reached their
lowest level since state health ofcials
began monitoring such transactions
more than a decade ago.
The 2011 Youth Tobacco
Purchase Survey concluded that
tobacco sales to minors at retailers
occurred only 5.6% of the time. Thats
down from a 12.6% rate in 2009.
When the rst survey was conducted
in 1995, the rate was 37%.
Teenagers work with the
California Department of Public
Health, acting as secret buyers of
tobacco.
It is important to protect our
youth from using tobacco which is
deadly and addictive, said CDPH
Director Ron Chapman, M.D. We
are proud that fewer retailers are
selling cigarettes to minors, but we
have more work to do to guarantee
that all kids in California grow up
tobacco-free.
CDPH ofcials noted that
tobacco sales to minors at non-
traditional retail outlets tend to be
much higher than traditional outlets
such as convenience stores and
supermarkets, which engage in illegal
sales at rates below the statewide
average. By comparison, businesses
such as meat markets and delis
illegally sell cigarettes at a nearly
12% clip, while discount and gift
stores sell at a rate exceeding 8%.
Statewide, the percentage of
adult Californians who smoke is 11%,
the second-lowest rate in the nation.
Nurses Union Files
Charges Against Sutter
The Oakland-based California Nurses
Association/National Nurses United
Continued on Page 3
NEWS
Providence (Continued from Page One)
Continued On Next Page
focus on accountability, controlled costs and
most importantly, quality.
Physicians who practice at the Providence
hospitals Holy Cross Medical Center in
Mission Hills, Little Company of Mary
Medical Centers in Torrance and San Pedro,
Saint Joseph Medical Center in Burbank and
Tarzana Medical Center or belong to their
afliated medical groups are qualied to join
the entity, which will be jointly nanced by
Providence and the physicians.
Some form of nancial investment is
required by participating physicians, although
Providence ofcials declined to disclose
specics.
However, some sources say the doctors
are being asked to pony up a nominal sum
intended to encourage participation.
CDPH Completes Probe Of Prime
Does Not Rule on Malnutrition, Septicemia Billing
Ontario-based hospital operator Prime
Healthcare Services claimed a victory in the
recent inspections that occurred at its seven of
its hospitals by the California Department of
Public Health, although a high ranking ofcial
with the agency said Primes billing practices
will be referred to several state and federal
agencies for further probes.
CDPH Chief Deputy Director Kathleen
Billingsley said her agency would refer Primes
billing and coding issues to the U.S.
Department of Health and Human Services
Ofce of the Inspector General, the Centers
for Medicare and Medicaid Services, the
California Department of Health Care
Services, the Joint Commission and the
Healthcare Facilities Accreditation Program,
which is also overseen by CMS.
Billingsley noted that her agency focuses
on healthcare delivery issues only and is not
authorized to make judgments on how
hospitals bill or code for care.
The inspections by CDPH of West
Anaheim Medical Center, Chino Valley
Medical Center, Desert Valley Hospital in
Victorville San Dimas Community Hospital,
Shasta Regional Medical Center in Redding
and Sherman Oaks Hospital did not result in
any citations issued by the department for
decient care or record keeping. However,
shortcomings in the monitoring of the
nutritional intake of several undernourished
patients were detected at Shasta Regional and
at Sherman Oaks. A single patient was
discovered to have not had the insertion of a
central line catheter properly documented at
Desert Valley.
The rule is...to look at patient safety. And
with respect to infection control standards and
malnutrition, we did not see any deciencies,
said Billingsley said.
Prime has taken corrective actions,
according to a statement issued by the
company and CDPH ofcials.
Several modications to the inspection
reports were made by CDPH after Prime
appealed the initial ndings that it had failed
to maintain proper infection control practices
and in one instance did not properly maintain
medical records. Billingsley said an appeal
was unusual although not unprecedented.
Primes appeal claimed that CDPH made
several judgments of deciencies based on
improper coding and the evaluation of the
clinical judgment of medical staff, neither of
FOLLOW THE MONEY
Healthcare and Political Finance in California
White Paper $149
White Paper & Data $329
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!"#$%&'!()!*+,,!-!*+,,!%.!/0.&'1!2!/'$345&'1!/6%741849:)!;;<
Page 3
Payers & Providers
Longer ALOS!*
Advertise Here
(877) 248-2360, ext. 2
*For our ads, not your hospital
NEWS
In Brief
has led a complaint with the
National Labor Relations Board,
claiming that Sutter Health conducted
an illegal lockout.
The union, which represents
about 35,000 registered nurses
statewide, claimed in its complaint
with the NLRB that the Sacramento-
based Sutter locked out its members
after a one-day work stoppage
conducted late last month. That action
constituted an illegal retaliation, the
union claims.
Sutters lockout was not only
unwarranted, unnecessary, and
unconscionable, it was also unlawful,
said RoseAnn DeMoro, the unions
executive director.
The CNA and hospital operators
have engaged in a particularly bitter
dialogue after a patient at Alta Bates
Summit Medical Center in Oakland
died during the alleged lockout as the
result of a medication error committed
by a traveling nurse.
Along with the NLRB complaint,
CNA and afliated nurses joined
demonstrations in New York, Boston
and San Francisco this week to protest
the nations nancial inequities.
Brown & Toland
Appoints Senior VP
The former chief executive ofcer of
Sutter Healths self-funded employee
medical plan has been appointed
senior vice president of San Francisco-
based Brown & Toland Physicians
medical group.
Jackie Bright will oversee Brown
& Tolands health plan and network
strategies.
"We have many exciting
initiatives here at Brown & Toland,
including our recent afliation with
Alta Bates Medical Group in the East
Bay and the deployment of our
electronic health record to more of
our network physicians, said Chief
Executive Ofcer Richard Fish. We
are looking forward to her
contributions."
Prime (Continued from Page Two)
which the agency has jurisdiction over, and
that it improperly identied some
documentation.
Primes claims for appeal were upheld by
Howard Backer, M.D., a CDPH physician
who is not involved in hospital licensing
issues. Backer had served as an interim
director of CDPH earlier this year.
However, Backers memorandum
concluded that coding and billing
irregularities may be the reason behind the
elevated levels of sepsis reported by Prime.
He suggested that other agencies review
them.
CDPHs inspections were at the behest of
several lawmakers after the investigative
journalism organization California Watch and
the Services Employees International Union
reported that Prime was billing Medicare for
rates of malnutrition and septicemia far higher
than the nationwide average. In its statement,
Prime termed the allegations by the union and
lawmakers as baseless.
The for-prot Prime operates 14 hospitals
in New Jersey and is trying to acquire another
facility in New Jersey.
OSHPD Grants $2.6M For Education
Money is Earmarked For Family Practice Residents
HEALTHCARES BEST ADVERTISING VALUE
]
PAYERS & PROVIDERS reaches 5,000 hospital, health plan and non-
prot executives statewide. There is no better venue for marketing
your organization or conference, or recruiting new staff.
CALL (877) 248-2360, ext. 2
The Ofce of Statewide Health Planning and
Development has awarded $2.6 million in
grants to more
than two dozen
residency
programs
statewide to train
family practice
physicians.
The grants
range in size
from slightly
more than
$50,000 to more
than $200,000.
They were given
to 26 hospitals
throughout
California.
The grants are administered through
OSHPDs Song-Brown workforce training
program. Twenty-eight family practice
residency programs and 14 programs to train
physician assistants and nurse practitioners
periodically receive grants.
Investing in these programs is one of the
many ways
California is
working to address
the inequity of
primary care
physicians
statewide, said
OSHPD Acting
Director Stephanie
Clendenin.
In 2011 to
date, OSHPD has
made $5.3 million
in educational
grants, including
$2.7 million
awarded to nursing
education programs in April. It typically grants
about $7.5 million annually for workforce
education.
More grants will be announced later this
year, according to an OSHPD spokesperson.
Grant Recipient Sampling
White Memorial Medical Center $206,460
Santa Rosa Family Medicine $154,845
UCSF San Francisco General $154,845
Contra Costa County Health $103,230
Harbor-UCLA Medical Center $103,230
Loma Linda University $51,615
UCI Medical Center $51,615

Source: OSHPD
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Payers & Providers Page 4
OPINION
Doctors Need Closure With Patients
A Final After-Procedure Visit Provides Vital Education
Westby Fisher, M.D., is an internist,
cardiologist, and cardiac electrophysiologist
who practices at NorthShore University Health
System in Evanston, Ill.
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Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com
The chief complaint, the history and physical,
the differential diagnosis, the proper testing,
the treatment -- from Day 1, these are the
pieces of medicine that are hammered in to
young doctors' heads: the best way to treat
this or that, the best drug, widget or gizmo,
the latest advance. We learn which approach
is better than the other, which treatment to
apply when more conventional approaches
can't be taken. Each of these steps are drilled
over and over again in the hopes of crafting a
strategy for each clinical scenario a doctor is
likely to encounter. Yet while each
of these steps are important in their
own right, they by themselves wont
entirely sustain a doctors
satisfaction in the profession.
Because after the treatment
strategy or therapy is applied,
there's another vital part of medical
care that is often under-appreciated:
the closure.
Closure is the time in
medicine where we either revel in
our success or squirm in our failure.
It's where we must face the music --
good or bad -- with our patients.
More often than not, it's the
moment that brings meaning to our
efforts and the hours we work.
Closure can occur at different times for
different doctors. For specialists, closure
usually occurs in the post-operative or post-
procedure period. For primary-care doctors,
closure occurs during the follow-up visit
after a prolonged hospitalization or difcult
illness. For both types of doctors, its the
chance to see the good they did or bad they
did rst-hand. Its a time to validate their
understanding of the patient's ailment and the
caliber of their treatment plan. Importantly, its
not the end of the patients ongoing care but
the conclusion to a particular chapter of their
care. For doctors, its the moment when we
grow as professionals.
Yet sadly, these moments of closure are
becoming rarer for both the patient and the
doctor.
With doctors racing to perform more cases
in less time and in more locations to offset
declining payment rates, it's become harder
both logistically and nancially to justify
excessive post-operative time with patients
after their procedures. The money required to
feed our administrators, collectors, and
quality-score counters demands an ever-
growing source of funds.
To that end, specialist physicians have seen
post-operative care clumped together with the
pre-procedure and intra-operative care into
one big encounter that pays health systems
only once. Increasingly, policy makers are
shifting the risk of caring for patients to
providers. Insurers and policy makers like to
call this a shift from procedural-based
payments to outcome-based payments. In
theory this sounds nice, but its
robbing the doctors of the
closure time they need in their
profession.
For primary-care doctors who
now only see patients in their
ofces, the opportunity to see the
product of a continuous-care
strategy has been surrendered to
the hospitalist, robbing them of
closure time. And even for the
hospitalists who diagnose and
say adios from the connes of
the hospital, the opportunity see
the late consequences of their
care in a non-critical
environment has been lost to
production quotas. No fractious group
medical home care in the world can replace
this loss of closure inicted upon primary-care
and shift-working hospitalist physicians or the
patients for whom they care.
Our health policy analysts have assured us
these closure visits can be accomplished by
ancillary care providers. Technically, they are
correct. But there is no question that the loss
of these post-procedure visits by the treating
physician or operating surgeon robs them of
an opportunity to improve. Further, doctors
lose a chance to educate and re-connect with
the patient. Doctors need this time with their
patients just like patients like this time with
their doctors -- maybe even more.
By Westby Fisher,
M.D.
!"#$%&'!()!*+,,!-!*+,,!%.!/0.&'1!2!/'$345&'1!/6%741849:)!;;<
MARKETPLACE/EMPLOYMENT
Payers & Providers Page 5
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Employment listings begin at just $1.65 a word
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Or e-mail: advertise@payersandproviders.com
Or visit: www.payersandproviders.com
*New England Journal of Medicine, 2004.
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Payers & Providers
MARKETPLACE/EMPLOYMENT
Page 6


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promnuros und mmodutoy knov vhut's on thor mnd.
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docudos ol oxporonco n ournusm und tho houthcuro ndustry v promso concso und rovoung ntorvovs.
1opcs lor upcomng koundtubo lntoructvos ncudo:
!! lntogrutod Systoms vs. lrvuto lructco: 1o vhut dogroo v physcuns not uroudy n urgor modcu groups or ntogrutod
houth systoms romun n prvuto pructco durng ths docudo, und vhy. \hut uro tho udvuntugos, dsudvuntugos und
mpcutons n toduy's onvronmont:
!! Modcud luns und Dovory Systoms: Hov much s thor cout grovng us Modcud onromont s prooctod to sour us
purt ol rolorm: \ Modcud ncrousngy bo usod us u vohco lor sottng houthcuro pocy: 1o vhut dogroo v muor
houth puns und systoms try to ncrouso shuro und concontruton n ths murkot:
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vhut systoms shoud bo sttng on tho sdonos lor nov: Hov tod s tho ACC movomont to tho succoss or luuro ol
Modcuro ACC pots: Doos tho dolnton ol ACCs nood moro spoclcty, or s t prolorubo to huvo u bg tont ol
ncuson:
Do you vunt to proposo or purtcputo n u luturo koundtubo lntoructvo: lurtcputon s ontroy onno, vth u commtmont ol
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