California Healthcare News Jul 6, 2015

California Healthcare News

  • ACA's Premium Subsidies Upheld By Supreme Court

    6-3 Decision, Written by Conservative Chief Justice Roberts, Follows Legislative Intent

    Jun 25, 2015 By Ron Shinkman


    The United States Supreme Court on Thursday upheld tax-based premium subsidies for individuals purchasing coverage through the federal insurance exchange.

    The 6-3 decision likely closes the books on the last major legal challenge to the Affordable Care Act, which was signed into law in 2010 and has been the subject of intense debate in the intervening years, even as it has cut the number of uninsured Americans dramatically.

  • Paid news articleNation’s Uninsured Rate Drops Significantly; Fitbit Raises $841.2 Million In IPO

    Jun 24, 2015 By Payers & Providers Staff


  • Paid news articleObesity Surgery As Incontinence Cure?

    Many Patients Had Full Remission After Bariatric Surgery

    Jun 24, 2015 By Payers & Providers Staff


    A new study by researchers at UC San Francisco has concluded that morbidly obese individuals who undergo bariatric surgery can greatly curb urinary incontinence as a result.

  • Paid news articleDMHC Fines Kaiser, Anthem $350,000

    Linked to HIPAA Violation, Improper Disenrollments

    Jun 24, 2015 By Ron Shinkman


    The Department of Managed Health Care has levied fines this month totaling $350,000 against Kaiser Foundation Health Plan and Anthem Blue Cross of California.

    The agency fined Kaiser $250,000 to settle alleged mishandling of a business associate contract with Sure File, an Indio-based firm that stored some 336,000 of the health plan’s patient records under contract, according to a DMHC spokesperson.

  • Medi-Cal Card, But No Provider Access

    Patients Often Have To Travel Long Distances For Care

    Jun 24, 2015 By Anna Gorman


    Terri Anderson signed up for Medi-Cal earlier this year, hoping she’d finally get treatment for her high blood pressure. But the insurer operating her Medicaid plan assigned the 57-year-old to a doctor across town from her Riverside home and she couldn’t get there.

    “It was just too far away,” said Anderson, adding that she cares for her 90-year-old ill father and can’t leave him alone to make an hour round-trip drive to the doctor. Now she’s crossing her fingers that a health clinic near her house will accept her new insurance.

  • Paid news articleIn Brief: CDPH Reports Another Big Drop In Teen Births; Nurse Practitioner Pay On The Rise

    Jun 18, 2015 By Payers & Providers Staff


  • Paid news articleLong-Term Care Demand Will Skyrocket

    UCSF Says 2.5 Million More Workers Needed By 2030

    Jun 18, 2015 By Payers & Providers Staff


    The United States will need at least 2.5 million new workers to provide long-term care services by 2030.

    That’s the assessment of researchers at the University of California at San Francisco, which published its conclusion in the most recent issue of the journal Health Affairs.

  • Paid news articleKaiser’s New Colonoscopy Protocol

    Focus on Particular Polyps Could Cut Cancer Death Rate

    Jun 18, 2015 By Payers & Providers Staff


    A new study undertaken by researchers at Kaiser Permanente has concluded that focusing on a particular type of polyp during colonoscopies could potentially reduce the rate of colon cancers dramatically.

  • Paid news articleAuditor Slams Medi-Cal Provider Access

    Says DHCS Has Fallen Short on Verifying Data From Plans

    Jun 18, 2015 By Ron Shinkman


    The California Auditor has released a scathing report on access to the Medi-Cal system, raising concerns that those enrolled through commercial health plans may not be able to adequately access providers.

    According to the 60-page report, both the Department of Health Care Services (DHCS), which administers the Medi-Cal program, and the Department of Managed Health Care (DMHC), which ensures the integrity of the provider networks of health plans, both stumbled on the job.

  • Paid news articleIn Brief: Stanford Links Reflux Medicine To Heart Attack Risk; COPE Launches Care Coordination Effort

    Jun 11, 2015 By Payers & Providers Staff


  • Paid news articleMost High-Priced Hospitals For-Profits

    Former Prime Healthcare CEO Plays Role in California

    Jun 11, 2015 By Ron Shinkman


    A new study in the journal Health Affairs discovered that the vast majority of hospitals in the United States with the highest markups in comparison to allowable Medicare charges are for-profit facilities.

  • Paid news articleDMHC Fines Delta Dental $250,000

    Insurer Didn’t Handle Late Claims, Disputes Properly

    Jun 11, 2015 By Payers & Providers Staff


    The California Department of Managed Health Care has fined Delta Dental $250,000 for failing to resolve claims in an appropriate manner.

  • Paid news articleChain Boosts SF Kidney Transplants

    CPMC, UCSF Collaboration Leads to 9 in Just 36 Hours

    Jun 11, 2015 By Ron Shinkman


    Two San Francisco hospitals collaborated to create an elaborate “chain” of organ donors last week, resulting in nine separate kidney transplants being performed between the facilities in a 36-hour period.

    The surgeries were performed at UC San Francisco Medical Center and California Pacific Medical Center on June 4 and 5, officials for the two hospitals said earlier this week, with 18 surgeries being performed to accommodate the nine donors and recipients.

  • Paid news articleIn Brief: Study Urges More In-Person Enrollment Options For Poor Californians; HealthCare Partners Saved $1.8M Through Anthem ACO Collaboration

    Jun 4, 2015 By Payers & Providers Staff


  • Paid news articleOSHPD Adopts Emergency Water Curbs

    Hospitals, Nursing Homes Have to Cut Exterior Irrigation

    Jun 3, 2015 By Payers & Providers Staff


    The Office of Statewide Health Planning and Development (OSHPD) has issued new regulations to hospitals intended to conserve water.

  • Paid news articleBreast Cancer Test Guidance Lacking

    Latinas, African-Americans Often Receive No Advice

    Jun 4, 2015 By Ron Shinkman


    A significant proportion of California women – particularly African-Americans and Latinas – receive hazy or no actionable advice on how to proceed when they are diagnosed with early stage breast cancer, according to a new study led by UCLA researchers.

    The sticking point is primarily over a molecular laboratory test to determine if their form of breast cancer is likely to return in the future, which can help tailor treatments such as chemotherapy regimens for the best outcomes.

  • Paid news articleDMHC Fines Anthem Blue Cross $1.5 Million

    Insurer Failed to Cover Prenatal Tests For 27,000 Enrollees

    Jun 4, 2015 By Ron Shinkman


    The Department of Managed Health Care has levied a $1.5 million fine against Anthem Blue Cross of California for failing to pay for prenatal tests a state agency performed for tens of thousands of its enrollees, records show.

  • Paid news articleIn Brief: State’s Minorities Less Likely To Receive Colon Cancer Screening Advice; Covered California Imposes Specialty Drug Cost Caps

    May 28, 2015 By Payers & Providers Staff


  • Paid news articleCDPH Fines 12 Hospitals $750,000

    Incidents Led to Deaths of Six Patients, Unborn Child

    May 28, 2015 By Payers & Providers Staff


    The California Department of Public Health has levied administrative penalties and $750,000 in fines against 12 hospitals for lapses in care that either endangered, injured or killed patients.

  • Paid news articleBlue Wolf Leading Pack For Daughters

    Improved Bid Suggests Equity Firm Likeliest to Close Deal Soon

    May 28, 2015 By Ron Shinkman


    As the Daughters of Charity Health System tries to forge a path forward after a months-long saga to sell itself off to a for-profit operator fell through, a New York-based private equity firm appears to be its likeliest savior.

    Multiple sources have told Payers & Providers that Blue Wolf Capital Partners LLC is the leading candidate to acquire the Los Altos-based Daughters of Charity. The hospital system, which operates six acute care facilities in and around Los Angeles and San Jose, would likely remain a not-for-profit entity if it accepted Blue Wolf’s offer, though few specific details of its proposal were available.

  • Paid news articleIn Brief: Sharp, Scripps Join HIE; UCSF Links Depression To Stroke Risk

    May 14, 2015 By Payers & Providers Staff


  • Hoag Reduces C-Sections Dramatically

    Widespread Planning Leads to Systematic Changes

    May 14, 2015 By Anna Gorman


    Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.

    A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many cesarean sections.

  • Paid news articleCovered California Unveils 2016 Budget

    Significant Cuts Reflect Lower-Than-Projected Enrollments

    May 14, 2015 By Ron Shinkman


    California’s state health insurance exchange proposed a modest 2016 budget that includes reductions in both spending and enrollment projections.

    The Covered California budget included a spending plan for $332.9 million in fiscal 2015-16, down from $390.6 million. Spending forecasts are expected to be pared down further in 2016-17, until they reach a steady state of $300 million a year in fiscal 2018.

  • Paid news articleUCSF Promotes Trauma-Based Primary Care Model; California Receives Significant Grants To Build Community Health Centers

    May 7, 2015


  • Paid news articleDMHC Fines Western Dental $110,000

    Includes Penalty For Underreporting Enrollees to Agency

    May 7, 2015 By Ron Shinkman


    The Department of Managed Health Care has fined the Orange-based Western Dental Services dental insurance plan $110,000 for failing to pay its providers in a timely manner and for neglecting to pay the regulator a special assessment, records show.

    The DMHC dinged Western Dental $80,000 because it failed in the first quarter of 2013 to report enrollees who received services from its provider network.

  • Paid news articleJapanese-Americans: Aging Template?

    Their Demographics in California Are Tempting to Study

    May 7, 2015 By Payers & Providers Staff


    The proportion of older Japanese-Americans is far larger than any other ethnic group in the United States, making them a good study cohort to determin how the rest of the country will handle aging in the future, according to UCLA researchers.

    A recently released study by the UCLA Center for Health Policy Research concluded that nearly a quarter of Japanese-Americans are over the age of 65, twice the populace at large. However, over the next 35 years, the proportion of the U.S. population over 65 will match the current numbers of Japanese-Americans – meaning the former group could provide a glimpse of what is in store for older Americans down the line.

  • Paid news article2015 Fines For Data Breaches Top $1M

    Many Involve Employees Surreptitiously Looking up Data

    May 7, 2015 By Ron Shinkman


    The California Department of Public Health has fined six hospitals and two other healthcare providers more than $1.1 million so far this year for breaches of confidential patient information.

    Records show the breaches are typically the result of patient data that was not properly secured either being lost or stolen, or employees inappropriately accessing patient records, often of family members or acquaintances. Health privacy experts say such types of breaches are common.

  • Paid news articleIn Brief: 5,000 Nurses Set To Strike Statewide; PAMF, UnitedHealthcare Create ACO; Sutter Donates $500K For Nepal Recovery Effort

    Apr 30, 2015 By Payers & Providers Staff


  • Paid news articleMedi-Cal Expansion, ER Usage Linked

    OSHPD Data Helps Put ACA Reforms in Stark Relief

    Apr 29, 2015 By Ron Shinkman


    When a patient shows up at a California emergency room, the likelihood that they are enrolled in the Medi-Cal program has skyrocketed, new state data shows.

    According to the information from the Office of Statewide Health Planning and Development, ER visitors who identified as Medi-Cal patients rose some 50% from 2013 to last year, from just under 800,000 in the first quarter of 2013 to 1.16 million during the fourth quarter of 2014.

  • Paid news articleLGBT-Sensitive Physicians Still A Rarity

    Few Academic Medical Practices Provide Referrals,Training

    Apr 29, 2015 By Ron Shinkman


    When Allison L. Diamant, M.D., an adjunct professor at the UCLA Geffen School of Medicine, began practicing medicine in the 1990s, there was still a lot of apprehension among lesbians, gays and transgender patients about disclosing their sexual or gender orientations to physicians.

    Some 20 years later, with same sex marriage legal in a majority of states and transgender characters in two popular television shows, a lot of attitudes have changed. But according to Diamant, members of the LGBT community still have issues accessing providers sensitive to their needs.

  • Paid news articleSeton Medical Center Fined $100,000

    Cited For Death of Patient at Its Skilled Nursing Facility

    Apr 30, 2015 By Payers & Providers Staff


    The skilled nursing facility at Seton Medical Center in Daly City has been fined $100,000 by the California Department of Public Health for a November 2014 incident that led to the suffocation of a patient.

    The patient, a female with a history of pneumonia and profound swallowing problems, had had a permanent tracheostomy not long after she was admitted in January 2014.

  • Paid news articleIn Brief: L.A. Care Accepting Cash Payments For Premiums; State's Residents Say They Face Treatment Barriers Over Psychological Care

    Apr 23, 2015 By Payers & Providers Staff


  • Paid news articleCDPH Says Measles Outbreak Is Over

    But Agency Cautions it Could Return in The Future

    Apr 23, 2015 By Payers & Providers Staff


    The California Department of Public Health has announced that the outbreak of measles that began late last fall has concluded, but warned that cases could flare anew.

  • Paid news articleDMHC Fines Anthem Blue Cross $57,500

    Agency Cites Plan Over Seven Separate Incidents

    Apr 23, 2015 By Payers & Providers Staff


    The Department of Managed Health Care has fined Anthem Blue Cross of California $57,500 in connection with what the agency says were seven incidents where it violated state regulations, primarily involving how it handles enrollee grievances.

  • Paid news articleDaughters Of Charity Slashes Jobs

    Cost-Cutting in Response to Prime Deal Falling Through

    Apr 23, 2015 By Ron Shinkman


    Just weeks after a proposed acquisition of its hospitals by Prime Healthcare Services fell through, the Daughters of Charity Health System cut hundreds of jobs throughout the organization as a cost-cutting measure, it acknowledged on Wednesday.

    Altogether, 4% of Daughters of Charity’s workforce was laid off, the Los Altos Hills-based not-for-profit announced in a statement. That represents some 280 employees, with cuts coming throughout the organization.

  • Paid news articleJones Slams Anthem Over Latest Hike

    Says 8.7% Average Increase For 170,000 Enrollees Unjustified

    Apr 23, 2015 By Ron Shinkman


    California Insurance Commissioner Dave Jones on Wednesday denounced a proposed rate increase on individual policyholders by Anthem Blue Cross of California, calling it unreasonable and unjustified.

    The rate increase was for some 170,000 enrollees with PPO plans that were “grandfathered” in under the Affordable Care Act. The increase, which Jones said Anthem enacted on April 1, averaged 8.7%, with some older policyholders seeing increases as high as 24.9%.

  • Paid news articleIn Brief: Kaiser Says Patient Data Breaches On The Rise; SGR Repeal Moves Closer To Reality

    Apr 16, 2015 By Payers & Providers Staff


  • Paid news articleCalifornians Want More Time With Docs

    New Foundation Survey Says Some Have Access Issues

    Apr 16, 2015 By Payers & Providers Staff


    Enrollees in the Medi-Cal program said they were more likely to have issues finding a physician to provide care than Californians with other forms of insurance.

  • Paid news articleKaiser Finds Autism-Diabetes Link

    Study Pins Blame on Gestational Form of Disease

    Apr 16, 2015 By Payers & Providers Staff


    The causes of autism in children has been speculated on as incidences of the disorder continue to rise, but Kaiser Permanente has apparently linked to to gestational diabetes in expectant mothers.

    Gestational diabetes is a fairly common condition in expectant mothers, occurring about 9% of the time, based on data from the Centers for Disease Control and Prevention.

  • Paid news articleJones Critical Of Proposed Drug Costs

    Says Covered California Is Setting Patient Caps Too High

    Apr 16, 2015 By Ron Shinkman


    Insurance Commissioner Dave Jones has been highly critical of a plan issued by the Covered California insurance exchange to cap the patient co-payments for pricey specialty drugs.

    The proposal issued by Covered California would place caps on co-payments ranging from $200 to $500, depending on what level plan they are enrolled in. However, those enrollees in the lowest-cost Bronze plan would pay a co-payment capped at $500 per month per specialty drug. Jones said on Wednesday that was unreasonable.

  • Paid news articleHospital May Sue Over Trauma Funding

    Antelope Valley Facility Chafes Over Measure B Allocation

    Apr 16, 2015 By Ron Shinkman


    Antelope Valley Hospital received a designation as a level two trauma center in 2010. The number of trauma patients it treats today is about 30% higher than five years ago.

    But the 420-bed hospital, located 60 miles northeast of Los Angeles in Lancaster, has received the same supplementary trauma funding from Los Angeles County every year: about $1.3 million.

  • Paid news articleIn Brief: Covered California Signs Up 18,000 During Special Enrollment;

    Apr 9, 2015 By Payers & Providers Staff


  • Paid news articleBlue Shield Fined $45,000 By DMHC

    Sums Tied to Five Different Citations From Agency

    Apr 9, 2015 By Payers & Providers Staff


    Blue Shield of California was fined $45,000 by the Department of Managed Health Care last month for five separate violations of the Knox-Keene Act, records show.

  • Paid news articlePBGH Turns Focus To Spinal Surgeries

    Wants to Cut Costs For Often Controversial Procedure

    Apr 8, 2015 By Ron Shinkman


    The Pacific Business Group on Health (PBGH), one of the state's biggest group purchasers, has expanded a value-based purchasing program to include spinal surgeries.

    The procedure – which has drawn controversy because of its costs and criticisms in some quarters because it is thought to be overutilized – is being added to PBGH's Employers Centers of Excellence Network.

  • Paid news articleMany State Mortality Indicators Improve

    But Alzheimer’s And Other Categories Lagging Behind

    Apr 9, 2015 By Payers & Providers Staff


  • Paid news articleA Big Gap In Breast Cancer Testing

    Access to Specialized Assay Dictated by Income, Race

    Apr 9, 2015 By Ron Shinkman


    A new study by UCLA researchers concludes that income plays a significant role for women seeking front-line diagnostic screenings to help treat their breast cancers.

    The study, which focused on more than 1,800 breast cancer patients in 31 states, showed a distinct division by income and race among women who have access to the latest testing, known as gene expression profiling.

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