California Healthcare News

No Medi-Cal Restoration In May Revise

Money is Earmarked For ACA Implementation Instead

May 16, 2013 By Ron Shinkman

Gov. Jerry Brown released this week his May revise for the California budget, and it is a decidedly mixed bag for healthcare.

Although the revise reduces overall spending on all programs by $1.3 billion, for a total of $96.4 billion for the fiscal year – the result of slower economic growth and the expiration of a federal payroll tax holiday – more money was earmarked for some healthcare programs. That included $1.2 billion to expand Medi-Cal coverage.

Covered California Grants $37 Million

Recipients to Use Money For Enrollment Outreach Efforts

May 16, 2013 By Ron Shinkman

Covered California, the government entity that operates the state health insurance exchange, announced on Wednesday it was granting $37 million to a variety of community organization to encourage outreach and education in order to boost enrollment in health insurance plans.

As many as 5.3 million Californians are eligible to purchase healthcare benefits from the insurance exchange, officials say, with half or more receiving federal income tax subsidies in order to do so.

Kaiser Reports Quarterly Earnings

Strong Revenue Growth Tempered By Net Income Drop

May 16, 2013 By Payers & Providers Staff

Kaiser Permanente posted strong revenue growth for the first quarter of 2013, although earnings were flat.

The Oakland-based Kaiser reported revenue of $13.3 billion for the quarter ending March 31, compared to $12.7 billion for the first quarter of 2012, up 5%

In Brief: Centene Wins Medi-Cal Pact; Saint John's In Bidding War

May 16, 2013 By Payers & Providers Staff

In Brief: Medicare Hospital Charges Vary Widely, KFF Redesigns Website

May 9, 2013 By Payers & Providers Staff

Kaiser Researchers Link MS To Race

Disputes Long-Held Notion Rates Among Blacks Are Lower

May 9, 2013 By Payers & Providers Staff

Researchers have used data from Kaiser Permanente's Southern California health plan enrollees to establish a higher rate of multiple sclerosis among African American women than compared to caucasians.

The data, which was published in the most recent issue of the academic journal Neurology, questions prior assumptions that African Americans were less likely to contract the degenerative nerve disease than caucasians.

DHCS Delays Dual Eligibles Project

Launch Now Planned For January 2014 at The Earliest

May 9, 2013 By Ron Shinkman

Just weeks after it announced a demonstration project to better manage the care for hundreds of thousands of Californians enrolled in both the Medi-Cal and Medicare programs, the Department of Health Care Services has delayed its implementation by at least 90 days.

DHCS Director Toby Douglas announced on Monday that the program, known as Cal MediConnect, will not commence until January 2014 at the earliest.

Adventist Settles Doc Kickback Charges

$14.1 Million to State, Feds Over White Memorial’s Deals

May 9, 2013 By Ron Shinkman

Adventist Health has agreed to pay $14.1 million to state and federal agencies to settle allegations that one of its Southern California hospitals paid kickbacks to two medical groups.

The allegations surfaced as part of a recently unsealed whistleblower lawsuit filed by two osteopathic doctors in 2008 in U.S. District Court in Sacramento. Both the U.S. Department of Justice and the California Department of Health Care Services joined the lawsuit last month, likely pressuring a settlement on Adventist's part.

In Brief: CareFusion Announces $41 Million Settlement With Feds; Nevada Psychiatric Facility Accused of Patient Dumping

May 2, 2013 By Payers & Providers Staff

Jim Lott On Healthcare And California

Reflects On Long Tenure in Lobbying And Policymaking

May 2, 2013 By Ron Shinkman

After nearly two decades with the Hospital Association of Southern California, executive vice president Jim Lott told Payers & Providers this week that he will be stepping down on May 31.

Lott has been quoted in hundreds of newspaper articles and radio and television reports on healthcare issues during his tenure at HASC and the Hospital Association of San Diego & Imperial Counties, where he served as president between 1989 and 1994.

In Brief: Shortage of Pediatric Subspecialists

Apr 25, 2013 By Payers & Providers Staff

Kaiser Studies Prescription Adherence

Differing Reasons For Not Using Statins, Bisphosphonates

Apr 24, 2013 By Ron Shinkman

Two new studies by Kaiser Permanente have delved into the reasons patients do not adhere to medications to control cholesterol and stem the progression of osteoporosis.

The studies included interviews with nearly 100 Kaiser enrollees who were prescribed statins to control their cholesterol but did not fill their prescriptions, and the examination of the electronic medical records of more than 8,400 Kaiser Permanente enrollees over the age of 55 who were prescribed bisphosphonates to address their osteoporosis.

Anthem To Settle Late Claims Dispute

Comes to Terms With DMHC to Pay $3.2M in Interest

Apr 25, 2013 By Ron Shinkman

Anthem Blue Cross of California has reached terms with the Department of Managed Health Care to settle incorrect interest payments on emergency care claims submitted by providers that were mishandled by the insurer.

The settlement was announced as the DMHC has come under pressure by an outside group in recent weeks regarding its policing health plans.

CABG Mortality Inches Up Statewide

But Rates Are Much Lower Compared to a Decade Ago

Apr 25, 2013 By Payers & Providers Staff

The mortality rate for coronary artery bypass graft surgeries in California is up slightly in 2010 versus 2009, but remains far lower than a decade ago, according to data from the Office of Statewide Health Planning and Development.

The average mortality rate from the CABG among the 121 reporting hospitals was 2% in 2010, up slightly from 1.9% in 2009, but down from 2.2% in 2008.

In Brief: Dignity Health Sells Lab Business; CMA Sponsors Bills To Address Physician Shortage

Apr 18, 2013 By Payers & Providers Staff

CHA Merges Hospital Quality Initiatives

Regional Efforts Will Migrate Into A New, Single Institute

Apr 18, 2013 By Payers & Providers Staff

The California Hospital Association and the state's three other regional hospital lobbies have launched a new organization focused on quality initiatives at acute care facilities.

The Hospital Quality Institute will absorb the various quality improvement efforts currently managed by the Hospital Association of Southern California, the Hospital Council of Northern and Central California and the Hospital Association of San Diego and Imperial Counties.

DMHC Freezes Loma Linda Enrollment

Action Comes Due to RBO’s Lack of Financial Filings

Apr 18, 2013 By Payers & Providers Staff

The Department of Managed Health Care has suspended enrollment in Loma University Health Care's risk-bearing organization after it failed to file financial disclosures in a timely manner.

The DMHC stopped enrollment as part of an enforcement action it took on April 3. No monetary penalty was assessed, according to records.

Heritage ACO Focuses On Renal Care

Works With Fresenius to Improve Outcomes, Cut Costs

Apr 18, 2013 By Ron Shinkman

The Heritage California ACO in Los Angeles has teamed with Fresenius Medical Care to provide targeted services to its enrollees with end-stage renal disease.

Under the agreement, Fresenius will create a population health management program for Heritage California's enrollees who have the condition.

UCSF To Buy Stake In Pacific Partners

Deal is Part of Plan to Create Regional Integrated Network

Apr 18, 2013 By Ron Shinkman

UCSF Medical Center has agreed to purchase a stake in the management services organization for the 800-physician Santa Clara County IPA, part of what officials said this week is a plan to create an integrated and risk-bearing healthcare system in the Bay Area.

UCSF signed a letter of intent late last month to acquire a minority stake in the Foster City-based Pacific Partners Management Service. The deal is expected to close by mid June, according to Randall Frakes, Pacific Partners' chief executive officer.

In Brief: Physician Wins Judgment Against Anthem Blue Cross; CDPH Fines Nursing Home

Apr 11, 2013 By Payers & Providers Staff

Caution On Hospital “Alarm Fatigue”

California Facilities Respond to Joint Commission Warning

Apr 10, 2013 By Payers & Providers Staff

The Joint Commission has issued a warning about too many warnings.

The Oakbrook Terrace, Ill.-based organization that surveys and accredits most of the nation's hospitals alerted its membership on Monday about the dangers posed by an excess of alarms that go off in inpatient settings.

CalOptima’s $90,000 Mystery Payment

Who Reimbursed Plan For Use of Staff, Office Space?

Apr 11, 2013 By Ron Shinkman

The chief executive officer of the recently created Covenant Health Network sent CalOptima late last month a check of more than $90,000 to reimburse the Medi-Cal managed care plan for use of its employees and office space by another organization to secure a federal grant.

CalOptima on Wednesday released a March 28 letter Richard Afable, M.D., sent to CalOptima. It was accompanied by a cashier's check for $90,391.

Pacific Health Shutters Four Hospitals

Fines And Years of Huge Losses Sink SoCal Operator

Apr 4, 2013 By Ron Shinkman

After years-long entanglements with state and federal authorities that cost it millions of dollars in fines, Pacific Health Services is suspending operations and closing its remaining four Southern California hospitals.

In a statement issued earlier this week, Pacific Health said it would suspend services at its four remaining facilities: Bellflower Medical Center, the two campuses of Los Angeles Metropolitan Medical Center, and Newport Specialty Hospital.

Jones Blasts Another Premium Increase

Says Another Anthem Blue Cross Hike is Unreasonable

Apr 4, 2013 By Ron Shinkman

California Insurance Commissioner Dave Jones has locked horns with Anthem Blue Cross of California again, blasting the insurer for another premium hike he has declared unreasonable.

At a press conference in Sacramento on Tuesday, Jones called an average rate hike of 5.2% by Anthem Blue Cross levied April 1 on more than 45,000 individual policyholders and 7,000 small business owners as unreasonable and excessive.

Up And Down For Exchange Enrollees

Lower-Income Brackets Will Pay Less, Affluent More

Apr 4, 2013 By Payers & Providers Staff

A new actuarial report has determined that tax subsidies will be the deciding factor in whether consumers enjoy a price break when purchasing coverage through the Covered California health insurance exchange.

The report by Milliman, Inc. projects that premiums will increase an average of 9% between 2013 and 2014, driven primarily by changes linked to the Affordable Care Act, including mandates for increased benefits.

In Brief: UnitedHealthcare Grants $5.2 Million; HealthSouth To Build New Hospital

Apr 4, 2013 By Payers & Providers Staff

OPA Releases Annual Report Card

Revamps Scoring And Website, Introduces Mobile Apps

Mar 28, 2013 By Ron Shinkman

California’s Office of the Patient Advocate rolled out this week a revamped website and report card to provide ratings on health plans and medical groups.

The website, www.opa.ca.gov, was redesigned partly in response to consumer input, but also because hundreds of thousands of more Californians are expected to purchase coverage from the state-operated health insurance exchange, Healthy California, starting in October.

DHMC Fines Care1st For Outsourcing

Sent Claims Processing to China Without Notice or Consent

Mar 28, 2013 By Ron Shinkman

The Department of Managed Health Care has levied a $120,000 fine against Medi-Cal managed care insurer Care1st Health Plan for sending a large portion of its claims for processing overseas without notifying the agency, and providing inaccurate information about the change.

Care1st has about 410,000 enrollees in California, mostly through the Medi-Cal and Healthy Families programs. It also enrolls dual-eligibles who quality for both Medi-Cal and Medicare.

Health Net Wins Big Arizona Contract

Phoenix Medicaid Pact Worth Tens of Millions Annually

Mar 28, 2013 By Payers & Providers Staff

Woodland Hills-based Health Net has won a three-year contract to manage Medicaid benefits in Maricopa County, Ariz. – a pact that sources suggest could be worth as much as $70 million annually.

Health Net will manage Medicaid benefits offered to enrollees in Maricopa County, which includes Phoenix, by far Arizona's largest metropolitan area. It contains about 65% of the state's 1.3 million Medicaid enrollees. The Medicaid program is known as the Arizona Health Care Cost Containment System.

Park Access Affects Physical Activity

Teens Far More Likely To Get Exercise If Living Nearby

Mar 28, 2013 By Payers & Providers Staff

If you're a teenager in California who lives near a park, you're far more likely to exercise on a regular basis, according to a new study by UCLA researchers.

The report, issued by the UCLA Center for Health Policy Research, concluded that more than 44% of California youths who live in what is known as a park service area engage in one hour of exercise at least five days a week. The statewide average is 22%.

In Brief: CMS Approves Dual Eligibles Demonstration Project; UC Regents Settle Whistleblower Suit

Mar 28, 2013 By Payers & Providers Staff

In Brief: O.C. Supervisors Considering Cuts To Latino Health Access

Mar 21, 2013 By Payers & Providers Staff

DHCS, CDSS Settle Lawsuits On In-Home Service Cuts

IHSS Program Funding Could Be Restored in Full by 2015

Mar 21, 2013 By Payers & Providers Staff

The California Department of Social Services and the Department of Health Care Services have come to terms with labor organizations and the recipients of in-home supportive services to settle legal disputes over pending cuts in the program.

Hospital Inspection Reports Released

Database Details Hundreds of Incidents at California Facilities

Mar 21, 2013 By Ron Shinkman

A trove of recently released federal hospital inspection reports paints an uneven picture regarding the quality of care at California's hospitals.

The reports were compiled on hospitals at the behest of the Centers for Medicare and Medicaid Services during 2011 and 2012, and usually conducted by the California Department of Public Health. It is compiled in a new database, hospitalinspections.org, operated by the Association of Health Care Journalists.

Charity Bill Raises Hospitals’ Hackles

They Claim Top-Down Mandate Would Lead to Closures

Mar 13, 2013 By Ron Shinkman

A bill requiring California's acute care facilities to provide certain levels of charity care in order to preserve their not-for-profit status has pitted the hospital sector against the legislation's labor-oriented backers.

Assembly Bill 975, co-authored by Assemblymen Rob Bonta, D-Oakland, and Bob Wiecowski, D-Fremont, would mandate not-for-profit hospitals spend a minimum of 8% of their annual operating margin on charity care starting in 2015. If the hospital operates any outpatient clinics, the clinics would also have to spend 5% of their net annual revenues on charity care.

Individuals Likely To Use Exchanges

J.D. Power Poll Indicates Many Believe it Will Cut Costs

Mar 14, 2013 By Payers & Providers Staff

A new survey by consumer polling firm Westlake Village Village-based J.D. Power & Associates has concluded that individuals have high expectations from the healthcare insurance exchanges slated to enroll millions in California and the rest of the nation next year.

According to the Power survey of enrollees in 136 health plans in 17 regions nationwide including California, 73% of those with individual coverage said they plan to purchase a policy through exchanges. Enrollees earning up to $93,000 a year are eligible to claim federal tax subsidies to reduce their premiums.

Hospitals Struggling With C. Diff Control

Increased Prevention Practices Not Matched by Results

Mar 14, 2013 By Payers & Providers Staff

Hospitals in California and elsewhere are taking more steps to combat potentially deadly infections of Clostridium difficile among its patients, but are being mostly thwarted in their attempts to curb new cases.

The bacterial infection, known in healthcare as C. diff, is typically hospital-acquired and kills about 14,000 patients nationwide every year. In California, there were more than 13,300 such infections reported by hospitals between March 2010 and March 2011, according to data they submitted to the Office of Statewide Health Planning and Development.

In Brief: Blue Shield Rate Hike Will Stand; OAL Approves Emergency Autism Regs

Mar 14, 2013 By Payers & Providers Staff

CLARIFICATION

Mar 7, 2013

Reporting in the Feb. 28 edition of Payers & Providers may have suggested Consuners Union did not wish to make a comment about the Department of Managed Health Care because it had a contract with that agency. A Consumers Union spokesperson declined comment because he was not familiar with the subject matter.

HMOs Confront Language Struggles

Limited English Enrollees Have Tough Time With Doctors

Mar 7, 2013 By Payers & Providers Staff

A new study by UCLA researchers has discovered a link between low levels of English proficiency among health plan enrollees and difficulty in accessing healthcare.

According to the study, which was undertaken by the UCLA Center for Health Policy Research, as many as 1.3 million Californians with limited proficiency in the English language are enrolled in health maintenance organizations. Most are enrolled in plans that are designed to serve low-income enrollees, although nearly 10% are enrolled in commercial plans.

Study Finds Health Media Disconnect

Doctors, Journalists, Politicians Discussing Different Points

Mar 7, 2013 By Payers & Providers Staff

A Kaiser Permanente study of millions of healthcare related tweets, posts by physicians, journalists and members of Congress found stark differences in how the three groups communicate about healthcare.

The study examined the tweets, online posts by more than 3,000 physicians, 458 members of Congress and 154 journalists. It was conducted in late 2012 for Kaiser by WCG, a media relations firm.

IN BRIEF: DHCS Selects Health Plans For Rural Expansion; Hoag Names Braithwaite CEO

Mar 7, 2013 By Payers & Providers Staff

Insurance Regulators Show Some Bite

DMHC Blunts Some Rate Hikes; Jones Files Autism Regs

Mar 7, 2013 By Ron Shinkman

The two major insurance regulators in California have gone to the mat with healthcare carriers about premium hikes and coverage for autism therapies.
The Department of Managed Health Care on Wednesday announced it had come to terms with Anthem Blue Cross of California and Aetna to moderately reduce upcoming or recently implemented premium rate hikes or freeze them altogether.

In Brief: Berkeley Forum Calls For Better Integration Of Care To Cut Costs; El Camino Rating Upgraded

Feb 28, 2013

DMHC Actions, Fines Drop Significantly

Group Blames Former Insurance Lobbyist’s Appointment

Feb 27, 2013 By Ron Shinkman

Between 2009 and 2011, the Department of Managed Health Care issued nearly 1,000 enforcement actions against health plans, fining them nearly $9 million for a variety of misdeeds and demanding they take corrective actions to protect the interests of their enrollees.

But after Aug. 11, 2011, when Gov. Jerry Brown appointed former health plan lawyer and lobbyist Brent A. Barnhart to head the agency, enforcement actions dropped almost immediately. The DMHC issued only 74 such actions during the remainder of the year, compared to 433 in the portion of 2011 prior to his appointment – although an agency official said that number should be condensed.

In Brief: CAHP Says Margins Are Low, CalHIPSO Launches Consulting Service

Feb 21, 2013 By Payers & Providers Staff

Hip Failure More Likely In Women

Kaiser Study Examined Nearly a Decade of Its Records

Feb 21, 2013 By Payers & Providers Staff

Hip replacements in women are far more likely to fail than when a similar procedure is performed on a man, according to data analyzed by Kaiser Permanente's Southern California division.

Kaiser studied 35,000 non-emergency hip replacements performed at its facilities in Southern California between April 2001 and the end of 2010, using its own electronic medical records for analysis.

HealthPocket’s “Rate-Up” Roundup

Insurers Often Increase Prices During an Application

Feb 21, 2013 By Ron Shinkman

A new study by a Sunnyvale firm concludes that 80% of the individual health plans offered to applicants in the United States can be paired with a “rate-up” – an often sharp rise in price from the originally quoted premium prior to the finalization of enrollment.

The study, undertaken by HealthPocket, which offers Web-based health plan shopping tools for consumers, found that 18% of all consumers encounter a rate-up. The price increase is often the product of the underwriting process and the vetting for pre-existing health conditions. They may prompt the insurer to consider an applicant more of a financial risk, therefore justifying the hike in premium.