Payers & Providers California Edition – Issue of May 17, 2012

7/31/2019 Payers & Providers California Edition Issue of May 17, 2012

1/6

!"#!$%&!'($'!)!'($'!*#!+"#,-.!/!+-0123,-.!+4*52.6278&!99:

Calendar

17 May 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 sudden decit that breached Californiasbudget and requires nearly $7 billion inimmediate cuts will hit hospitals and otherhealthcare providers hard, say state policy

leaders and healthcare ofcials.As a result, hospitals will have their Medi-

Cal payments slashed once again promptingthat sectors primary lobby to suggest stateofcials reneged on a delicate deal to leveragenew federal funds.

Lower tax revenues, coupled withfederal government obstructions that blockedbillions in necessary cuts, have created adeeper budget hole, said Gov. Jerry Brownwhen he announced the cuts last week. Morepainful reductions will be necessary as aresult, but education and public safety mustbe protected.

As a result, In-Home Supportive Serviceswill experience a 7% across-the-board cut.Some Healthy Families enrollees will moveover to the Medi-Cal program, wherepayments to their providers are smaller.Nursing homes will have a recently enacted2.4% increase in payments eliminated.

Altogether, the cuts to healthcare areabout $2.5 billion, including more than $400million in cuts to Medi-Cal provider payments.Thats about 40% of the total cuts proposedlast week by Brown, who is also pushing for a

temporary tax increase to close the gap evenmore. The tax increase proposal, in the form oa voter initiative, is slated for the Novemberballot.

The problem we have is that healthcareis where most of the (discretionary) spendingis, said Diana Dooley, Secretary of the statesHealth and Human Services agency, during aMonday press conference.

Patient advocacy groups came out againsthe cuts, particularly those to IHSS, whichprovides care primarily to housebound elderlyand blind Medi-Cal enrollees.

This proposal cuts hundreds of millionsof dollars more to hospitals and nursinghomes that millions of Californians dependon," said Anthony Wright, executive directorofHealth Access California and a member of

the Payers & Providers editorial board. Theseare the wrong cuts at the wrong time, duringan economic downturn when Californiansneed this help the most, and when we need toget ready for health reform to maximize thebenet for our families and our state.

Ofcials with the California HospitalAssociation were particularly upset about the

May 23-25

:"52;0-72"!


2/6

!"#!$%&!'($'!)!'($'!*#!+"#,-.!/!+-0123,-.!+4*52.6278&!99:

Payers & Providers Page 2

Top Placement...Bottomless Potential

Advertise Here

(877) 248-2360, ext. 2

In Brief

Cuts Loom ForCalfornia SkilledNursing Facilities

Medicare payment cuts to nursinghomes will total $75.9 million in

early 2013 if Congress does notovercome a budget stalemate.

The total cut nationwide is$782.3 million, but California wouldby far have the biggest payment cut,according to the Washington-basedAlliance for Quality Nursing HomeCare, which underwrote the study.

The cuts come on top of aproposal by the state of California totake back a recently enacted hike inpayments in order to close a $16billion budget gap.

This latest, looming threat toCalifornia seniors' nursing home carecomes at a time when facilitiesthroughout the state are caring for

rising numbers of patients requiringhigher and higher levels of care, saidAlliance President Alan G.Rosenbloom. We need a morerational, cost-effective Medicare post-acute payment system not moreirrational Medicare cuts that

jeopardize California seniors'ongoing access to quality care. Thereare better, smarter ways to nanceour seniors' nursing home care, and athorough discussion about how to doso is a paramount health policypriority both in Washington andSacramento.

Kaiser Makes $6.5Million In Community

Grants

Oakland-based Kaiser Permanentehas issued $6.5 million in grants to avariety of community organizations.

The recipients included sevenpark districts and cities in Southern

Continued on Page 3

NEWS

proposed cuts, which include a $400 millionreduction in Medi-Cal payments much

which will go back into the general fund,according to Dooley.The CHA had spent months negotiating

with both state and federal ofcials last yearon a self-imposed fee used to leveragehundreds of millions of dollars in Medi-Calmatching funds from the Centers forMedicare and Medicaid Services. CHAPresident C. Duane Dauner called the move arake-off and suggested that the state hadbacked out of the deal.

This proposal goes against a 2011agreement between hospitals and stategovernment that generates more than $900

million in new money to the state GeneralFund between July 1, 2011 and December 31,2013 through the Medi-Cal hospital feeprogram, Dauner said in a statement.

Dooley said the movement of theleveraged federal funds into the general fund

was legal.Although Dauner supported the propose

tax increase, he said it should beaccompanied by cuts in hospital expenses.Revenues, combined with budget cuts,

are a reasonable compromise, he said. Thesame principle should apply to hospitals. Ifmore Medi-Cal cuts are imposed on hospitalsthe state should make needed regulatorychanges that reduce hospital costs.Otherwise, Medi-Cal losses in hospitals willget worse and private patients will get stuckwith higher bills.

Wright noted that passage of the ballotinitiative was crucial. The result of that ballomeasure failing is unimaginable, he said.

One program that went untouched wasthe Bridge to Reform program that isexpanding Medi-Cal enrollment by about400,000. However, its relatively lowenrollment has resulted in a surplus hat willalso go back into the general fund.

Budget (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 yourmarketing 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].

FPL Leads To Poverty UndercountingUCLA Study Urges Use of More Methodologies

The current federal poverty guidelines are abad t for California, with many residentsundercounted for potential safety net programeligibility, according to a new study by theUCLA Center for Health Policy Research.

The study stated that the current FederalPoverty Level $15,130 for a couple shouldbe closer to triple that in some portions ofCalifornia. It concluded that 40% of adultsover the age of 65 are not counted as poor,while up to 25% of non-seniors are alsoundercounted.

The studys authors noted that the FPL is aproduct of the 1960s and is based on 1950s

spending patterns, and its methodology hashad few updates in the intervening decades. Asurvey it undertook of California lawmakers

noted that the FPL is the measure it mostcommonly relies on in addressing low-incomconstituents.

The Legislature relies on the FPL tocomply with federal requirements for a varietof social programs, said Imelda Padilla-Frausto, the studys lead author. However,having additional data could be useful tocapture the complexity of the current socialand economic reality in California and couldhelp protect Californias most vulnerablepopulations.

The studys authors praised the signing ofAB 138 into law last year, which requires the

California Department of Aging to use moregenerous economic indices for craftingregional plans.
https://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htmhttps://www.managedcarestore.com/pandp/p&pwhitepapers.htm


3/6

!"#!$%&!'($'!)!'($'!*#!+"#,-.!/!+-0123,-.!+4*52.6278&!99:

Page 3Payers & Providers

Longer ALOS!*

Advertise Here

(877) 248-2360, ext. 2

*For our ads, not your hospital

In Brief

California, which received more than$500,000 for the Operation Splashprogram which promotes both poolsafety and physical activity. Parks inNorthern California received $65,000to promote health and tnessactivitites.

There is a denite link between

our health and our communities.Obesity and the high rates of chronicconditions are often times the resultof how we live. Kaiser Permanente isnot only actively involved in drawingattention to these public healthchallenges, but also supportingsolutions that make healthy choicesavailable and accessible, saidRaymond J. Baxter, Kaisers seniorvice president in charge ofcommunity benets.

City Of HopeResearchers Working On

Type 1 Diabetes Cure

Researchers at City of Hope may havefound a cure for late-stage Type 1diabetes.

Type 1 diabetes is the result of anautoimmune disorder and is unrelatedto Type 2 diabetes, which is usuallyrelated to obesity or other lifestylefactors.

The work by the medical centerin Duarte is focused on reducing theautoimmune issues in the patientwhile also replacing islet sells, whichare used to produce insulin. Islet celltransplants have been effective in theearly stage of the disease, but only hasa temporary effect for those in the latestages of type 1 diabetes. Growthhormones are also used to stimulatethe process.

The process was able to reversediabetes in 60% of laboratory mice,compared to zero for a control group.

The studys ndings waspublished in the most recent edition ofScience Translational Medicine.Researchers hope to soon use theprocess in clinical trials with humans.

NEWS

Kaiser, Unions Reach AgreementThree-Year Pact Would Cover 76,000 in California

Oakland-based Kaiser Permanente hascome to terms with its major employeelabor unions on a multi-year pact thatincreases wages and preserves healthbenets.

The deal is with what is known as thecoalition of Kaiser Permanente Unions, acollection of 28 different bargaining unitsthat represents about 100,000 Kaiseremployees at hospitals and other facilities innine states, although 76,000 are inCalifornia.

Under the three-year deal, employees inCalifornia will receive a 3% annual pay

raise, and 2% outside of California. All otherbenets under the former plan will bepreserved. Kaiser also agreed to set aside$57 million for employee education.

This contract takes labor relations to a

newlevel by going beyond the normal bread andbutter issues typically covered in a laboragreement, said Dave Regan, president ofService Employees International Union Healthcare Workers West. It represents45,000 members, by far the largest union inthe pact.

Regan noted one of the provisions in thenew contract is an initiative called TotalHealth. The program will focus on creatinghealthier food choices, provide healthyactivities at the worksite and wellnesseducation for employees and families.

The agreement maintains benets andprovides good raises, and we are proud ofthat, but we are also proud about provisionsthat will make employees healthier, Regansaid.

]

CALIFORNIAS MOST LITIGIOUS PHYSICIANWhite Paper Release Date: May 31

NOW FREE IF YOU BUY AN ANNUAL SUBSCRIPTIO

Call (877) 248-2360, ext. 2 to orderOR CLICK HERE

Health Net Reports A Tough QuarterMedical Claims Up; 2012 Earnings Forecast Down

Health Net reported lower-than-projected

numbers for the rst quarter and cut earningsprojections for the remainder of the year.

The Woodland Hills-based insurerreported a loss for the quarter of $26.6million, of which $18.8 million was due towritedowns related to discontinuedoperations. It reported a loss of $108.2 millionfor the year-ago quarter. Revenue was $2.8billion, compared to $3.4 billion for the rstquarter of 2011.

It blamed the down numbers to anadditional $67 million in medical claims thatwere paid in the fourth quarter of 2011 but

had not been booked due to processing erro

on behalf of outside vendors.Health Net also cut its 2012 prot

forecast from $3.30 to $3.40 a share down to$2.35 to $2.50 a share.

Chief Executive Ofcer Jay Gellert saidthe companys book of business, particularlyMedicare, was stable. He vowed to work onimproving performance for the remainder ofthe year.

Health Nets stock has taken a beating aa result of the earnings report. It had beentrading at more than $35 a share prior to thereport, but has since dropped 30% in value.
https://www.managedcarestore.com/pandp/p&pcaedition89.htmhttps://www.managedcarestore.com/pandp/p&pcaedition89.htm


4/6

!"#!$%&!'($'!)!'($'!*#!+"#,-.!/!+-0123,-.!+4*52.6278&!99:

Payers & Providers PageOPINION

The ACAs One Size Fits All ProblemThe Component Expanding Medicaid is Too Genero

Chris Rangel, M.D. is an internist in private

practice in Texas. This is adoped from his

RangelMD blog.

;054..4,!$?+"#,-.!/!+-0123,-.!2.!

@4*52.6,3!,1,-#!A64-.3"#!*#!+"#,-.!/!+-0123,-.!+4*52.6278&!99:B!C7!"774"5!27321234"5!.4*.D-2@E207!2.!F??!"!#,"-!GF$=?!27!*45H!4@!E0!$(!

.4*.D-2*,-.IB!>E!2.!3,521,-,3!*#!,J


5/6


6/6

Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

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 May 17, 2012