Payers & Providers California Edition – Issue of June 21, 2012

7/31/2019 Payers & Providers California Edition Issue of June 21, 2012

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Calendar

21 June 2012

[email protected]

the details of your event, or call(877) 248-2360, ext. 3. It will be

published in the Calendar section,space permitting.

California Edition

The saga ofMarin General Hospital and itscontentious relationship with Sutter Healthhas come to a close, with both sides fallingwell short of complete victory while claiming

it nonetheless.An arbitration judge earlier this weekawarded $21.6 million in damages to thehospital and its owner, the Marin HealthcareDistrict.

Judge Rebecca Westereld ruled thatwhile the Greenbrae-based Marin General attimes had been mismanaged by Sacramento-based Sutter, it did not rise to the level ofsystematic duciary malfeasance alleged by itsowner, the Marin Healthcare District.

Sutter managed the hospital between1995 when it merged with CaliforniaHealthcare Systems and inherited its lease

and 2010, when it agreed to terminate theagreement nearly ve years early after beingsued by the district over which party would beresponsible for seismic upgrades. The districthad leased the hospital to CHS in 1985 for 30years.

The Marin Healthcare District claimedthat Sutter had siphoned more than $120million out of the hospitals coffers between2006 and 2010, a transition period betweenSutter agreeing to end the lease and return thehospital to district control. It also claimedSutter neglected to ensure the facility had an

adequate reserve for capital projects andobligations to retired employees, and that itfailed to keep medical staff dedicated toaligning themselves to the hospital in the long

term. It sought about $300 million indamages.Oral arguments in the case stretched

more than two weeks. It included thetestimony of more than 50 witnesses eitherthrough appearances and depositions, alongwith hundreds of exhibits.

In her 64-page decision, Westereldconcluded that Sutter owed little more thanensuring that the hospital was transferred backto the district debt-free and with workingcapital of $5 million on hand, $5 million in itscharitable foundation and a guaranteed $20million in accounts receivable.

Westereld noted that Sutter had the righto transfer funds out of the district as part of

agreements it had in place that the operationof the hospital would benet its entire networof hospitals. Westereld also noted that Suttersurrendered an estimated $135 million inincome from hospital operations byterminating the lease early, and it made noguarantees that the ongoing operations of thehospital would be successful.

July 19-21

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In Marin v. Sutter, Pyrrhic VictoriesBoth Sides Claim Wins In Final Arbitration Decision

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Continued on Next Page

WEBINAR Wednesday, June 27, 2012 1 P.M., PDT

HOSPITAL VALUE-BASED PURCHASING: A ROADMAPPlease 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 PAYERS & PROVIDERS
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Payers & Providers Page 2

Top Placement...Bottomless Potential

Advertise Here

(877) 248-2360, ext. 2

In Brief

California CommunityFoundation Makes

$3.95 Million InHealthcare Grants

The California CommunityFoundation has announced morethan $5.1 million grants for recipientsthroughout Los Angeles County, withthe large bulk of that moneyearmarked for healthcare projects.

A total of $3.95 million hasbeen granted to healthcare recipients.$2.62 million has been granted to theCentinela Valley and CommunityFunds to expand healthcare access,care coordination and patientnavigation, according to a statementissued by the foundation. Another$863,500 has been earmarked tomore than a dozen clinics throughoutL.A. County to help disadvantaged

communities increase access to care.Thanks to the generosity ofdonors past and present, CCFcontinues to make grants at arelatively high and consistent level,"said foundation Chief ExecutiveOfcer Antonia Hernandez. Westrongly encourage morefoundations, corporations andhouseholds to invest in the LosAngeles of today and tomorrow withus by helping stabilize and sustaincommunity-basedorganizations.

HHS Says Reform Has

Helped Millions OfYounger AmericansRetain Healthcare

Coverage

New data released by the U.S.Department of Health and HumanServices concluded that 3.1 million

Continued on Page 3

NEWS

Westereld did rule that Sutter was wrongto charge back the hospital its cost ofobtaining capital; required excessive

contributions from hospital operations to theretirement funds of its own employees; anddid not provide enough support to transitionthe hospitals IT systems out of its ownpurview. However, the total award was lessthen one-tenth of what the district had sought.

Marin ofcials claimed victory in thedecision.

This ruling validates our longstandingcontention that in the years leadingup to the transition, Sutter did not operateMarin General in a manner consistent with thebest interests of our community, said MarinGeneral Chief Executive Ofcer Lee

Decision (Continued from Page One)

MEET OUR READERS

Need to promote a conference? Your brand? Payers &Provider!se-mail list for all editions is available for youmarketing needs. Reach out to more than 12,000healthcare professionals who read our publications. Caour advertising director Claire Thayer at (503) 226-985or e-mail her at [email protected].

Domanico. Instead they diverted funds forthe benet of Sutter and the detriment of thpeople of Marin.

Sutter also claimed it had prevailed."We were always condent that we meour duciary obligations to Marin GeneralHospital, invested an appropriate amount ocapital and left the hospital in a strongnancial position," said Sutter Health CEOPatrick Fry. "Sutter is extremely pleased witthe arbitrator's decision to deny the vastmajority of the damages the districtsought and her nding that Sutter and itsdirectors acted prudently and in accordancwith duciary duties.

Westerelds ruling is binding.In Marin County, Sutter currently opera

Novato Community Hospital.

Californians To Benefit From ACAMillions Would Obtain Coverage If Law is Upheld

As doubts about how the U.S. Supreme Courtwill rule regarding the constitutionality of theAffordable Care Act continue to preoccupy thehealthcare sector, a new study by UC Berkeleyand UCLA conclude that as many as 2.7

million Californians would benet fromkeeping healthcare reform intact.

Altogether, researchers estimate that asmany as 1.6 million Californians will enroll inan expanded Medi-Cal program. Under thechanges, families with income of up to 138%of poverty level, $31,809 for a family of four,would be eligible for coverage. Childlessadults would also be eligible; asset tests wouldbe eliminated and enrollment rules would bestreamlined.

Another 2.1 million residents couldpurchase healthcare insurance through thestate-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 bythe Supreme Court and fully implemented, will signicantly expand access to affordab

health coverage, said Ken Jacobs, chair of UC Berkeley Center for Labor Research anEducation and the study's lead author. "Bason our simulation, millions of Californiansstand to gain, either through insurance theywouldn't otherwise have or from moreaffordable premiums and increased benetstandards."

As many as 92% of Californians under age of 65 would have healthcare coverage the time the ACA is fully implemented in 20versus 84% of Californians being insuredshould the ACA not survive.

Continued on Next Page


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Page 3Payers & Providers

Longer ALOS!*

Advertise Here

(877) 248-2360, ext. 2

*For our ads, not your hospital

In Brief

young adults have been able to gainand sustain healthcare coverage as aresult of the passage of the AffordableCare Act.

One of the tenets of the reformlaw is permitting children to stay ontheir parents insurance policy untilthey reach the age of 26.

This policy doesnt just giveyoung adults and their families peaceof mind, it also gives them freedom,said HHS Secretary KathleenSebelius. It means that as they begintheir careers, they will be free tomake choices based on what theywant to do, not on where they can gethealth insurance.

Altogether, about 75% of youngadults have healthcare insurance, aproportion that has risen since thepassage of ACA in 2010. As of late2011, 2.5 million young adults wereable to retain their coverage, anumber that has continued to rise.

Cedars-Sinai NamesWomens Heart Center

After Streisand

Cedars-Sinai Medical Center in LosAngeles has named its new womensheart center after entertainer BarbraStreisand.

The Barbra Streisand WomensHeart Center is part of Cedars-SinaisHeart Institute. It will focus onresearch specic to female cardiachealth issues.

Cardiac disease and heart attacksare the number one killer of women inthe United States, and symptoms of animpending cardiac incidents are oftendifferent compared to their onset inmales. Streisand has donated asignicant amount of money andfundraising prowess to Cedars toaddress female cardiac issues, whichshe believes is comparativelyunderfunded compared to researchperformed on behalf of males.

Barbra Streisand's leadershipallows us to dedicate signicantresources to women's hearthealthcare, education, and research,"said Eduardo Marban, M.D., directorof the Cedars-Sinai Heart Institute.

STORIES OF ONE HIGHLY LITIGIOUS PHYSICIAN

$149

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ACA (Continued from Page Two)

However, Supreme Court justicesaggressively questioned U.S. SolicitorGeneral Donald Verrilli during oralarguments earlier this year. The tone from the

Courts conservative jurists raised doubtswhether the individual mandate or even theentire 2,700-page law could be thrown out asunconstitutional.

There are also a wide range of variablesin the study. The number of overall Medi-Caland commercial enrollees could be as muchas 700,000 lower than the most optimisticgures, depending on variables such asprociency of English in a household, healthstatus of its individuals, and any shifts in costto obtain coverage.

Outreach is the key to coverage, said

Gerald Kominski, director of the UCLA Centefor Health Policy Research and one of thestudys co-authors. Helping California'sdiverse population understand the different

types of coverage available and the enrollmenprocess should signicantly boost enrollmentrates and broaden the risk pool, which isessential to keeping down costs.

Despite the encouraging number ofenrollees by the end of this decade if the ACAremains in effect, as many as 4 millionCalifornians would still lack coverage.However, about a quarter of this numberwould lack coverage as a result of theirimmigration status.

The Supreme Court is expected toannounce its ruling on the ACA no later thanJune 28.

Employer Health Plans May FadeJ.D. Power Study Says Many May Be Dropped

Many companies are likely to eschewproviding direct healthcare coverage to theiremployees in the coming years, according toa new survey by J.D. Power & Associates.

Powers third annual employer healthplan study has concluded that 47% ofrmssurveyed say they either will denitely orprobably switch their workers to a privateinsurance exchange within a denedcontribution model in the coming years.

A statement issued by the WestlakeVillage-based Power observed as otheroptions become available, some employersmay consider eliminating coveragealtogether. However, the rm was quick toadd that only 13% of fully insured employersand 14% of their self-funded brethren say it islikely they would drop coverage for theirworkers altogether.

As the landscape of healthcare changes,

employers face many choices in how to bestserve their employees with competitivecoverage at affordable costs, said RickMillard, a Power senior director. While somreports have predicted that a large number ofemployers might stop offering coverage, studyndings indicate that a large majority won'twalk away from offering coverage to theiremployees.

The survey concluded that costs are thebiggest driver for making health plan choices,although the source of those costs divergebased on point of view. Employers considerhigh hospital and physician fees as theprimary driver, while employees believe it isadministrative costs tacked on by insurers.

Among individual health plans servingfully-insured employers, Oakland-basedKaiser Permanente received the highestsatisfaction score.
https://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htm


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Payers & Providers PageOPINION

The Pressure On Payers Is RelentlessCosts Must be Kept Down While Efficiencies Rise

Michael Frank is the chief executive officer

Blue Cross Blue Shield Montana.

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

EDI Software Engineer III - Ashland, OREDI 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 skillsMENTAL 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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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

MEDICAL DIRECTOR

Coast Healthcare Management has been providing man-agement services to Medical Groups and IPAs since 1986.Coast has an excellent opportunity for an experiencedMEDICAL DIRECTOR with a strong UM and managedcare background who can lead all aspects of clinical opera-ions. The ideal candidate will have demonstrated success-

ful implementation of process improvement; the ability tooversee patient care through Hospitalist and case man-agement programs; the ability to manage ER utilization;and the knowledge and ability to manage global risk. Werequire superior interpersonal and conflict resolution skillswith the ability to articulate the goals and objectives of the

organization throughout the provider network; an under-standing of financial systems, business strategies, and thedevelopment of an integrated healthcare delivery networkfounded in quality with a commitment towards service andexcellence. Candidate should be a board certified physicianwith at least 5 years clinical practice experience along with5 years experience in a managed care clinical position anddocumented leadership capabilities. This position offers acompetitive salary and incentive package.

DIRECTOR OF FINANCIAL OPERATIONS

The DIRECTOR OF FINANCIAL OPERATIONS will reporto the CEO and be involved in all aspects of financial man-

agement and operations. Candidate must be a proveneader with an exceptional understanding of managed

care finance, delegated activities, health plan contracting,DOFRs, claims, reimbursement methodologies, risk poolreview and reconciliation and financial review and analysis.n addition the candidate must possess excellent oral and

written communication skills; ability to utilize an analyticaland systems approach to work and be a team builder. Thedeal candidate will be a strategic and innovative managerwith a Masters degree in business, or CPA with at least 5-7years experience in IPA/Group management.

IPA MANAGER

The IPA MANAGER will provide services and support ofPA operations with regard to providers and contract-ng with the ability to assist in contract financial analysis.This position requires extensive knowledge and experiencewith a variety of compensation methodologies. Candidateshould have a Bachelors degree in health care, business orrelevant domain and a minimum of 3-5 years experience inmanaged care, HMO contracting and/or operations.

nterested candidates should send their resumes in confi-dence to: [email protected]

Please send resume to AllCare,

3320 Tully Rd., Ste. 1 Modesto, CA 95350,

or fax to 209-338-5657.

Attn: Human Resources/Information Technolog

AllCare IPA

MANAGER OF INFORMATION TECHNOLOGY

AllCare IPA is currently accepting resumes for an

experienced Information Technology professional.Qualified candidates should have experi-

ence 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, Equa llogic iSC SI SA Ns,

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 multi-

function printing/scanning and HP stand alone

printers, digital fax servers, and electronic sub-

mission of claims/authorizations. Strong skills inAccess and SQL are desired. Previous experi-

ence 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 thou-

sands of local residents for the majority of major

health plans.

Al lC are of fe rs a compet it iv e salar y pac ka ge

including fully paid employee health, vision, den-

tal, LTC, and employer matched 401K with imme-

diate vesting.


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Page 7Payers & Providers MARKETPLACE/EMPLOYMENT

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. 2Or e-mail: [email protected]

Or visit: www.payersandproviders.com

*New England Journal of Medicine, 2004.

SEEKING A NEW POSITION?

CAN HELP.

We publish advertisements for those seekingnew career

opportunities for just $1.25 a word.

If you prefer discretion, well handle allresponses to your ad.

Call (877) 248-2360, ext. 2, or [email protected].

Documents

Payers & Providers California Edition – Issue of June 21, 2012