California Healthcare News Jul 24, 2014

California Healthcare News

  • In Brief: CDPH Declares Whooping Cough Epidemic; Good Samaritan Hospital, USC Keck Medical School Form Affiliation

    Jul 24, 2014 By Payers & Providers Staff


  • Paid news articlePast Disarray Costs CalOptima $20K

    Exodus of Trustees, Execs Led in Part to DMHC Fine

    Jul 24, 2014 By Ron Shinkman


    Little more than two years ago, CalOptima was in disarray – board members were trading accusations that of self-dealing, their seats were being regularly rotated, and there appeared to be a revolving door to its c-suite.

    That period of disorganization led in part to the Department of Managed Care's decision to impose a $20,000 fine earlier this month against CalOptima, among the largest penalties ever levied against a county Medi-Cal managed care organization.

  • In Brief: Social Services Posts Data On LTC Facilities; CDPH Warns Of Telephone Scam

    Jul 16, 2014 By Payers & Providers Staff


  • Anthem Sued Over Network Issue

    Consumer Group Said it Bait-And-Switched Enrollees

    Jul 17, 2014 By Julie Appleby


    Anthem Blue Cross of California misled “millions of enrollees” about whether their doctors and hospitals were participating in its new plans, and failed to disclose that many policies wouldn’t cover care outside its approved network, according to a class action lawsuit filed earlier this month.

    As a result, many consumers have been left on the hook for thousands of dollars in medical bills, and have been unable to see their longtime doctors, alleges the suit by Santa Monica-based advocacy group Consumer Watchdog.

  • Paid news articleHealthier Finances For State’s Hospitals

    OSHPD Data Suggests They Have Overcome Recession

    Jul 17, 2014 By Ron Shinkman


  • Online Appointments For ER Visits

    Dignity Health Begins Offering Service For Convenience

    Jul 24, 2014 By Anna Gorman


    Three times within a week, 34-year-old Michael Granillo went to Northridge Hospital Medical Center in the San Fernando Valley area of Los Angeles because of intense back pain. Each time, Granillo, who didn’t have insurance, stayed for less than an hour before leaving without being seen by a doctor.

    “I was in so much pain I wanted to be taken care of now,” said Granillo, who lives in Reseda and runs a hot dog cart business. “I didn’t want to sit and wait.”

  • In Brief: DMHC, Blue Shield Disclose Data Breach; Kaiser Links HIV To Stroke Risk

    Jul 10, 2014 By Payers & Providers Staff


  • Kaiser Opens New Oakland Hospital

    Facility And Offices Cost $1.3 Billion to Construct

    Jul 10, 2014 By Payers & Providers Staff


    Kaiser Permanente has opened up its state-of-the art new hospital and medical offices in Oakland, a project that came with a hefty total pricetag of $1.3 billion.

  • CDPH: STDs On The Rise In California

    Rates of Syphilis And Gonorrhea Tick Upward in 2013

    Jul 10, 2014 By Payers & Providers Staff


    The rates of certain types of sexually transmitted diseases rose substantially in California last year, according to data from the Department of Public Health.

  • Paid news articleHealthCare Partners Gets Falling Grant

    Initiative Will Attempt to Cut Rates of Injuries Among Elderly

    Jul 10, 2014 By Ron Shinkman


    Torrance-based HealthCare Partners is one of 10 providers nationwide participating in an initiative to reduce falls among elderly patients.

    The initiative, organized by the National Institute of Health's aging division and the Patient-Centered Outcomes Research Institute, will spend at least $30 million over the next five years to try and reduce the number of falls among older patients. HealthCare Partners, which was selected in part because it has gathered extensive patient fall data through its electronic medical records system, is the only participant from California.

  • Paid news articleFirst Essential Provider List Released

    Intended For Covered California’s Low-Income Enrollees

    Jul 10, 2014 By Payers & Providers Staff


    Some purchasers of healthcare insurance via Covered California may have had issues with the provider networks of the health plans they selected, but the exchange itself is putting the finishing touches on a list of essential providers available to a large number of enrollees.

    Known as essential community providers, or ECPs, the list was mandated under the Affordable Care Act as a way to address disparities in care based on income, geography and other demographics. It is intended to ensure that people who have become newly insured under the ACA are able to remain with the community providers after they obtain coverage.

  • CDPH Says L.A. County Lax On Nursing Home Inspections

    Led to Incomplete Investigations

    Jun 26, 2014 By Anna Gorman


    Los Angeles County public health staff repeatedly failed to follow state policies on nursing home inspections, leading to improper closure of cases and incomplete and delayed investigations, according to a report issued by the California Department of Public Health.

    After reviewing a sampling of 136 cases received since 2009, the state health department found that L.A. County officials did not properly prioritize or track investigations. The county faces a backlog of hundreds of nursing home safety complaints.

  • In Brief: DMHC Investigating Anthem Blue Cross, Blue Shield

    Jun 26, 2014


  • Paid news articlePatients Receive Little Pricing Data

    California Slightly Better Than Average in National Survey

    Jun 25, 2014 By Ron Shinkman


    A new survey by TransUnion Healthcare concludes that the majority of Americans are confused by the bills they receive from their medical providers, and that few receive any meaningful cost estimates in advance.

  • Paid news articleCan Hospitals Make More With Less?

    Lower Costs Raise Margins Independent of Revenues

    Jun 26, 2014 By Payers & Providers Staff


    Low cost hospitals in California generate less revenue than higher-cost facilities, but they tend to be more profitable.

    That's the conclusion of Cleverley & Associates, an Ohio-based hospital consulting firm that surveyed 74 non-teaching hospitals in California with annual revenue of between $100 million and $300 million per year. Cleverley's firm used 2012 Medicare cost reports from the Centers for Medicare & Medicaid Services and data from the Office of Statewide Health Planning and Development, among other sources.

  • Paid news articlePending Pharmacy Bill Creates Friction

    Mail Order Operations Say Opt-Out Would Hurt Business

    Jun 26, 2014 By Ron Shinkman


    A bill in the state Legislature that would allow health plan enrollees to opt-out of mandatory mail-order prescription drug plans has raised the ire of a lobbying group for that sector, claiming it would lead to Californians forfeiting nearly $2 billion a year in cost savings next year.

    The bill, AB 2418, is in hearings in front of the Senate Health Committee this week after being passed by the Assembly 75-1 late last month. Authored by Susan Bonilla, D-Concord, it would allow any enrollee in a health plan that mandates mail-ordered prescriptions to be able to opt out starting in 2016.

  • In Brief: Covered California Raises Concerns On Ballot Initiative; UCLA Releases Insurance Demographic Data

    Jun 19, 2014 By Payers & Providers Staff


  • Feds Sue IPC For Upcoding Claims

    Joins Lawsuit Filed by Former Employee Back in 2009

    Jun 19, 2014 By Payers & Providers Staff


    The federal government has joined a lawsuit against IPC The Hospitalist Co. that accused the North Hollywood firm of systematically upcoding charges for patient care submitted to the Medicare program.

  • Paid news articleMore Stiff Penalties From The DMHC

    ValueOptions, Citizens Choice Fined Combined $125K

    Jun 19, 2014 By Ron Shinkman


    The Department of Managed Health Care has continued to levy significant fines against insurers for their operational and financial shortcomings, dinging two carriers earlier this month to the tune of $125,000.

  • Paid news articleState Launches Transparency Initiative

    DOI Picks UCSF, Consumers Union to Build Database

    Jun 19, 2014 By Ron Shinkman


    In a move to push greater price transparency in the healthcare setting, the California Department of Insurance has selected UC San Francisco to construct a price and quality database to help patients discover how much their healthcare services cost.

    The DOI obtained a $5.2 million grant from the U.S. Department of Health and Human Services last year to promote price transparency in healthcare. As part of an interagency agreement, much of that money will be furnished to the Philip R. Lee Institute for Health Policy Studies at UCSF to construct a database of what the department termed “common medical procedures and episodes of care.” The average pricing for those procedures would be posted online for consumers to review.

  • Paid news articleIn Brief: Advocacy Groups Sues CDPH Over Prime; ACO Saves $4.7 Million

    Jun 12, 2014 By Payers & Providers Staff


  • Kaiser Develops Newborn Sepsis Tool

    Feverish Infants No Longer Automatically Admitted to NICU

    Jun 12, 2014 By Payers & Providers Staff


    Kaiser Permanente researchers have been able to aggregate large volumes of data to better evaluate the risk of sepsis in newborns.

  • Stanford Develops Epilepsy Implant

    Certain Patients Will Begin Receiving Device This Month

    Jun 12, 2014 By Payers & Providers Staff


    Stanford Hospital & Clinics will begin this month implanting a device that is expected to preempt the seizures of some epilepsy patients.

  • Paid news articleDual-Eligibles Don’t Want Any Surprises

    They Tell UCLA Researchers of Craving Consistency

    Jun 12, 2014 By Ron Shinkman


    Enrollees in both the Medicare and Medi-Cal programs want their coverage to remain consistent as the state of California moves them into managed care health plans.

    That was the conclusion of UCLA researchers, who interviewed 39 seniors who are being migrated into managed care coverage under the Cal MediConnect program. Altogether, about 455,000 dual-eligibles in eight counties statewide began being moved into the program on April 1 in order to better coordinate the care they receive and reduce costs.

  • Paid news articleRuling Widens Mental Health Coverage

    Court Supports Residential Treatment For Eating Disorders

    Jun 12, 2014 By Ron Shinkman


    A California appellate court has issued a ruling that could compel health insurers to spend millions of dollars a year on residential treatments for their enrollees who suffer from eating disorders.

  • In Brief: Health Exchange Plans Much Cheaper Than Other Coverage; State Gets $7.1M Settlement

    Jun 5, 2014 By Payers & Providers Staff


  • Paid news articleState Teen Birth Rate Continues Plunge

    CDPH Credits State-Mandated Sex Education Programs

    Jun 5, 2014 By Ron Shinkman


    The birthrate among California's teenagers continues to plummet among all demographic groups, according to new data from the Department of Public Health.

    The state's birth rate has dropped to 25.7 births per 1,000 females age 15 to 19 in 2012, compared to 28 per 1,000 in 2011, a decline of 8%.

  • UCLA Report Warns Of DSH Shortfall

    Safety Net HospitalsMay Face $1.5B Deficit By 2019

    Jun 4, 2014 By Payers & Providers Staff


    Pending payment cuts to the so-called disproportionate share hospitals (DSH) could deprive them of more than $1.5 billion before the decade is out, according to a new report by the UCLA Center for Health Policy Research.

  • Less Aggressive Breast Cancer Care?

    Kaiser Scrutinized Multiple Therapies For Some Patients

    Jun 5, 2014 By Payers & Providers Staff


    A new study by Kaiser Permanente researchers suggests that a widely-used regimen to treat breast cancer patients may not necessary work for all patients.

  • Paid news articleDMHC Penalizes Care1st, Contra Costa

    Levies $95,000 in Fines For Poor Claims Management

    Jun 5, 2014 By Ron Shinkman


    The Department of Managed Health Care has taken enforcement actions and levied fines totaling $95,000 against Medi-Cal managed care plans operating near Los Angeles and in the Bay Area.

    The DMHC levied a $75,000 fine late last month against Care1st Health Plan, which is based in Monterey Park, just east of Los Angeles. The fine was related to how care was assigned to a special needs prostate cancer patient in 2011.

  • Reference Pricing Saves CalPERS More Than $5 Million; CHLA Gets $1.5 Million From Walgreens

    May 29, 2014 By Payers & Providers Staff


  • Emission Initiative Could Save $8.3B

    Lung Association Studies State’s Cap And Trade Plan

    May 29, 2014 By Payers & Providers Staff


    California's plan to cut its greenhouse gas emissions could cut the state's healthcare costs by $8.3 billion by 2025, according to a new analysis by the American Lung Association and the Environmental Defense Fund.

  • Paid news articleUC Davis, Orbis Enter Telehealth Pact

    Will Provide Remote Training, In-Person Staff Development

    May 29, 2014 By Payers & Providers Staff


    UC Davis Health System has entered into an agreement with a blindness prevention charity to provide telehealth services in support of the ophthalmological care it provides.

    The agreement between UC Davis and the New York-based Orbis International will include remote consultations with providers affilated with Orbis as they treat patients, and the transmission of eye surgeries at UC Davis for training purposes. Both will be performed in real-time.

  • Paid news articleNew Growth, New Costs For Health Net

    ACA Boosts Enrollment And Expenses For First Quarter

    May 29, 2014 By Ron Shinkman


    The Affordable Care Act has helped boost Health Net's enrollment during the first quarter of 2014, but costs associated with a pricey hepatits drug and other issues have caused expenses to balloon, cutting into the Woodland Hills-based health plan's earnings.

  • Paid news articlePrepping Community Clinics For The ACA

    Many in L.A. County Say They’re Not Yet Fully Ready

    May 29, 2014 By Ron Shinkman


    Community clinics are expected to play a key role in the implementation of the Affordable Care Act as they provide key primary care services to millions of newly insured. But a new study by UCLA researchers suggests such facilities in California's most populous county may not be properly prepared to undertake such an effort.

    The study – undertaken by the UCLA Center for Health Policy Research with support from the Weingart Foundation and the California Community Foundation – discovered that 62% of community clinics in Los Angeles County were in some stage of preparation for the ACA, their level of readiness varied greatly.

  • In Brief: Kaiser Pledges $2 Million For New King Hospital; Blue Shield Foundation Grants $200K To L.A. Care Health Plan

    May 22, 2014 By Payers & Providers Staff


  • Paid news articleMedi-Cal For Illegals Cost-Effective

    UC Says Expansion Could Be Done For $353 Million

    May 22, 2014 By Ron Shinkman


    A nominal increase in Medi-Cal spending could potentially make an enormous difference in the ability of California's hundreds of thousands of undocumented residents to access primary and preventative care.

    That’s the conclusion of researchers with UC Berkeley's Center for Labor Research and Education and the UCLA Center for Health Policy Research.

  • Paid news articleHospitals To Bankroll Much Of SEIU Pact

    They Will Put up 80% of Money to Obtain Medi-Cal Bump

    May 22, 2014 By Ron Shinkman


    The California Hospital Association and its member institutions will furnish the vast majority of a $100 million fund to try and increase Medi-Cal provider payments, with the SEIU-UHW labor union's ability to recruit tens of thousands of new members hinging on its success.

  • Some Insured Latino Californians Cross Border For Care

    Care Is Less Expensive And Rushed In Mexico

    May 15, 2014 By Anna Gorman


    Irma Montalvo signed up for a health plan through California's new insurance exchange last month, getting coverage for the first time in eight years.

    But when she needed treatment for a painful skin rash, Montalvo didn't go to a doctor near her home in Chula Vista. Instead she drove to Mexico, about 16 miles south. Her doctor, Cecilia Espinoza, M.D., diagnosed her with shingles and prescribed medication to relieve pain and head off complications.

  • In Brief: Brown Earmarks More Money For Medi-Cal; Kaiser Pharmacists May Strike

    May 15, 2014 By Payers & Providers Staff


  • Kaiser Has Strong Quarterly Earnings

    Plans to Greatly Increase Use of Solar Panels in California

    May 15, 2014 By Payers & Providers Staff


    Kaiser Permanente reported sharply higher revenue and net income for the first quarter of 2014.

    For the quarter ending March 31, Oakland-based Kaiser reported first-quarter net income of $1.1 billion, up 43% from the $765 million reported in the first quarter of last year. A significant portion of the boost to the bottom line came from Kaiser's investment income, which rose $105 million, to $324 million.

  • Paid news articleEight In State Facing Federal Charges

    Indicted For Allegedly Defrauding Medicare, Medi-Cal

    May 15, 2014 By Ron Shinkman


    Eight individuals in Southern California, including two physicians, were among 90 indicted nationwide on federal charges earlier this week for allegedly defrauding the Medicare and Medicaid programs.

    The indictments, which were announced on Tuesday, were part of the ongoing work of a strike force jointly operated by the U.S. Justice Department and the U.S. Department of Health and Human Services.

  • Paid news articleHealth Plans Will Publish Pricing Data

    UnitedHealth, Aetna Will Contribute to Consumer Portal

    May 15, 2014 By Ron Shinkman


    A new portal intended to give consumers specific information about what their care will cost them has obtained the rare cooperation of three of the nation's biggest health insurers.

    Minnesota-based United HealthCare, Connecticut-based Aetna and Kentucky-based Humana have all agreed to share pricing data with the Health Care Cost Containment Institute, a Washington, D.C.-based organization that researches cost issues.

  • California's SHOP Remains Stuck In Starting Blocks

    Small Business Exchange Has Been Beset With Low Enrollment, Glitches

    May 8, 2014 By Anna Gorman


    California’s insurance marketplace for small businesses has attracted just a fraction of eligible companies, with most being deterred by technology glitches, paperwork delays and customer service problems.

    The program, designed to make insurance more affordable and easier to purchase for small businesses, has only attracted about 1,200 companies. There are roughly 700,000 small businesses in the state, and more than half could be eligible for tax credits under the health law, according to the Small Business Majority, a national organization of small businesses.

  • In Brief: CDPH Fines Three Hospitals; Cedars-Sinai, MemorialCare Form New Venture

    May 8, 2014 By Payers & Providers Staff


  • Paid news articleUnion Shelves Hospital Ballot Initiatives

    Pledges to Work With The CHA on Medi-Cal And Costs

    May 8, 2014 By Ron Shinkman


    Two ballot initiatives that would have capped both what not-for-profit hospitals could charge patients and how much they can pay its executives were officially shelved by their sponsor earlier this week in lieu of a closer alliance with the California Hospital Association.

    The Service Employees International Union-Healthcare Workers West had been gathering signatures for the two initiatives, which were due to the Secretary of State's office later this month, to place them on November's ballot.

  • Paid news articleAlameda Alliance For Health Seized

    Concerns About Plan’s Solvency Prompted DMHC Action

    May 8, 2014 By Ron Shinkman


    Citing ongoing financial and operational difficulties, the Department of Managed Health Care has seized control of the Medi-Cal managed care plan serving one of Northern California's most populous regions.

    The DMHC announced on Tuesday that it would go to court this week to obtain a conservatorship appointment for Oakland-based Alameda Alliance For Health. The carrier serves Medi-Cal managed care recipients in Alameda County, including Oakland and virtually the entire East Bay region. It has about 201,000 enrollees in total, of which 186,000 are enrolled in Medi-Cal.

  • California Cities Clean Up Air, But Remain Among Nation's Most Polluted

    May 1, 2014 By Payers & Providers Staff


  • California Hospitals Rated On Safety

    About 40% Get Top Grades; Kaiser Dominates Scores

    May 1, 2014 By Payers & Providers Staff


    California's hospitals ranked ninth in the nation in terms of safety, according to new data issued on Tuesday by the Leapfrog Group. And while just 41% of the 253 facilities graded statewide by Leapfrog received a score of “A,” that is significantly higher than the nationwide rate, which was about 32%.

    The Washington, D.C.-based Leapfrog's annual Hospital Safety Score ranks inpatient facilities on a variety of criteria, including the use of practices intended to avoid medical errors that lead to potentially fatal patient conditions.

  • Paid news articleDMHC Fines CareMore Health $75,000

    Medicare Plan Failed To Reserve Enough Contingency Cash

    May 1, 2014 By Payers & Providers Staff


    CareMore Health Plan, the Cerritos-based Medicare Advantage insurer, was fined $75,000 by the Department of Managed Health Care earlier this month for failing to keep enough cash on hand to cover potential financial shortfalls.

  • Paid news articleLow Mammogram Rate Among Korean-Americans

    Only Half of State’s Population Get Regular Screenings

    May 1, 2014 By Ron Shinkman


    Korean-American women are far less likely to undergo regular mammogram screenings for breast cancer than any other ethnic group in California, according to new data from the UCLA Center for Health Policy Research.

    UCLA researchers concluded that just 51.8% of Korean-American women over the age of 40 in California have undergone a mammogram within the past two years. That compares to the statewide average of 79%.


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