April 2011
National Edition
Calendar
May 2-5
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May 10-13
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E-Mail
info@payersandproviders.com
with the details of your event,
or call (877) 248-2360, ext. 3.
It will be published in the
Calendar section, space
permitting.
A Discussion On Green Healthcare
Industry Leaders Talk About Returns on Investment
Moderator: There is emerging evidence that Gil Friend:
green healthcare can add to an organization’s Well, there's a lot of context behind that
bottom line. But typically such initiatives question, but also some assumptions. Yes,
require a substantial upfront investment, and it people often assume that "typically such
can take years to reap a return. How do you initiatives require a substantial upfront
investment" but that's not always the case.
convince decisionmakers to take that leap?
What works in terms of an argument? Sometimes it's a small investment, sometimes
Gary Cohen: none. For example, a recent Kaizen event at
There are our client
immediate SunPower found
Participants
savings in ways to reduce
energy electricity
reduction and 1. Gary Cohen, co-executive director, Health consumption
waste reduction Care Without Harm, Boston. 20% at no
without any up 2. Kathy Gerwig, Vice President, capital cost. We
front environmental stewardship, Kaiser nd that it's
investment. Just Permanente, Oakland, Calif. often more
reprocessing 3. Gil Friend, CEO, founder, Natural Logic, useful to talk in
medical devices Berkeley, Calif. terms of % ROI
is savings rather than years
hospitals to payback.
Date of Roundtable: April 12, 2011 Three years can
millions of
dollars per year. sound like a
Moderator: Ron Shinkman, Publisher, Payers &
In terms of long time, but
Providers
green building, it's better than
hospitals are Technical Oversight: David Bronstein, MCOL 33% per year
building high ROI --
performance handsome
buildings with less than 2% rst cost, and returns in any economy.
signicant cost savings during the life of the Gary Cohen:
building. Practice Greenhealth, our membership
Kathy Gerwig: organization, just signed an agreement with
We actually don't typically make large upfront Citi to offer similar no upfront nancing for
investments on sustainability initiatives. Our renewable energy based on the KP
solar and fuel cell arrangements have a third experience. This model especially works in
party that owns the installations and energy, states with tax breaks for renewables.
and we commit to buying the energy at rates Kathy Gerwig:
that are favorable to what we'd be paying Kaiser Permanente has two ways we embed
through traditional channels. That way our costs sustainability into our supply chain. First,
are either neutral or we realize a savings. through an environmentally preferable
purchasing program that has been in place for
Additionally, for new facilities or major
renovations, if sustainability measures are years. That communicates our intent to the
planned into the design, we realize cost savings marketplace.
while building environmentally sound facilities.
I Continued on Page 2
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 Payers & Providers
In Brief
Trinity Health Will Pay
$100 Million For Loyola
Hospital Purchase
Loyola University Chicago stands to
gain $100 million from the sale of its
medical complex in the western
suburbs, announced in March. (Payers
& Providers, 8 March 2011, p. 2)
The purchaser of the university’s
health complex, Trinity Health
Corp., of Novi, Mich., will
dramatically reduce payments to
the university. Between 2003 and
2008, the medical complex paid an
average of $31.9 million a year to
the university, as a subsidy to the
medical school. Going forward,
Trinity will pay $22.5 million a
year.
The Loyola University Health
System has been a money drain to the
university since 2004. In 2009 it lost
$37 million on operations and in
2010, $7 million, according to Crain’s
Chicago Business.
With the transaction, some $350
million in debt will go off the
university’s books but will stay with
the hospital system. The university has
had to make occasional advance
payments to the hospital to avoid a
nancial squeeze.
Trinity and Loyola have agreed to
put in $75 million each to construct a
new research facility at the medical
center in Maywood, Ill.
Aetna’s Williams
Receives $72 Million
Exit Package
Ronald A. Williams, who recently
retired as CEO of Aetna Inc., received
$72 million in compensation in 2010,
according to a report in the Hartford
Courant.
The main form of payment was
$50.4 million for the exercise of stock
options that were granted in 2001. He
received $1.1 million in salary, $2.75
million in incentive pay, plus $2.3
million in pension value.
Williams, 61, stepped aside as CEO
at the end of November. He remained
chairman of the board until last week.
Information about his compensation
was included in documents led with
the Securities and Exchange
Commission last week.
Continued on Page 3
NEWS
Roundtable (Continued from Page One)
Gil Friend:
Third, I'd suggest that organizations not
subject environmental/sustainabilty
investments to a higher hurdle rate than other
investments. SAP for exapmle has gone the
other way, committing to fund any
sustainability inevstments with shorter than
ve year payback.
Kathy Gerwig:
Second, we introduced a “sustainability
scorecard” that requires suppliers of medical
products to disclose, at the point of bid and at
the product level, various harmful chemicals
in their products and safer alternatives.
Moderator:
Is the patient community aware of the
environmental footprint of their providers? If
not, what can you do to educate them? Are
there some parts of the country that are more
amenable or resistant to green healthcare
initiatives?
Gary Cohen:
HCWH was able to educate the general public
years ago that healthcare was the largest
source of dioxin emissions adn also
responsible for 10% of all mercury air
emissions. Hospitals responded by phasing out
both. The public does not realize yet how
signicant the carbon and toxics footprint of
healthcare is.
Kathy Gerwig:
Rather than talking about the environmental
footprint, we talk about ”total health.” That
means high quality healthcare, and also how
we can support healthier communities. We
also inform members about environmental
contributors to disease.
Moderator:
A followup on that, Gary, you noted that the
burning of medical waste has been reduced
drastically in just the past 15 years. Is most of
that waste being recycled now? Or is it being
disposed of in another manner?
Gary Cohen:
A lot of waste is being reduced in volume
through reuse and recycling. And better
segregation. More waste is being treated
through sterilization techniques, rather than
burning. The biggest winner on waste in
healthcare is reprocessing medical devices,
which allows what were called single use
devices to be sterilized and resold back to
hospitals at 50% of the cost. Medical
manufacturers actively resist and undermine
this practice, but it is becoming widespread
thoughout healthcare.
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Page 2
Kathy Gerwig:
At KP, we have long relied on autoclaving
(steam sterilizing) bio-hazardous waste except
that which must by law be incinerated.
Additionally we divert about 31% of our total
waste volume from the landll through
recycling. To illustrate Gary's point, at KP last
year we reprocessed 376,000 devices,
reduced waste by 274,000 pounds and saved
$7.7 million in purchasing costs.
Moderator:
Gil, your company works both in and out of
the healthcare industry. Can you delineate
some of the specic environmental needs and
goals of the healthcare industry versus
ventures outside of healthcare? How does the
supply chain network in healthcare differ
versus, say, the food industry?
Gil Friend:
(The most interesting question with regard to
"waste" isn't "what's the best way to dispose of
it" but rather "how can we prevent it from
being generated in the rst place" -- which
points to both the sort of purchasing practices
that Kathy was discussing (since purchases
largely determine potential waste) as well as
operational procedures at facilities.
At one level, we see sectors as more similar
than different. Even though everyone feels
unique, every client buys energy and
materials, and produces intended results
(products & services) and unintended results
("waste" of all kinds -- not just physical waste!)
So we always start with a "metabolic"
approach that helps an organization
understand how it does and doesn't add value
to its resource ows.
Moderator:
Gary, you have noted that the OR is one of
the biggest cost centers that a green initiative
can concentrate on. Is it fairly easy to get buy-
in from physicians, or is that a challenge? If
so, what can you do to win hearts and minds?
Gary Cohen:
Practice Greenhealth also has a program
called Greening the OR which is aiming to
change purchasing and waste and energy
practices, which is where the greatest waste in
a hospital occurs. We need to show safety
rst, equivalent performance, then
environmental savings, in that order. Having
physicians involved in purchasing and
validation efforts is important. Nurses are
even better since they are more active change
agents in their hospitals.
Continued on Next Page
 Payers & Providers
In Brief
Aetna has 18.9 million people
enrolled in its health plans and had
revenues of almost $38 billion in
2009.
Insurance
Commissioner Joins
Sutter Health
Whistleblower Suit
California Insurance Commissioner
Dave Jones has joined a civil
whistleblower lawsuit against
Sacramento-based hospital
operator Sutter Health.
The suit, which dates to 2009
and was filed in Sacramento
County Superior Court, was
originally filed against Sutter and
billing intermediary Interplan by
Rockville Recovery Associates
Limited, which inspects billings for
potential fraud.
The suit claimed that Sutter’s
hospitals routinely overbilled
insurers for anesthesia services.
Typically, hospitals charge nominal
fees for such services to cover the
cost of its anesthesia technician,
while the anesthestiologist submits
a separate bill.
However, Sutter billed as
much as $5,000 per procedure.
and in some instances allegedly
billed for anesthia services when
no anesthesia was used.
"We believe the amount of the
fraudulent charges is in the
hundreds of millions of dollars, if
not more," said Jones, who used his
authority under the California
Insurance Frauds Prevention Act to
intervene.
SCAN Health Plan
Names New Medical
Director
California-based Medicare
Advantage insurer SCAN Health
Plan has named Raymond L. Chan,
M.D. as its medical director.
Chan previously served as
director of clinical services and
quality for Hil Physicians Medical
Group in San Ramon, and was a
medical director for Health Net
and Private Healthcare Systems.
NEWS
Roundtable (Continued from Page Two)
Gil Friend:
We need to show safety rst, equivalent
performance, then environmental savings, in
that order. Absolutely. And sometimes BETTER
performance. People often assume than
environmental benet has to come at the
expense of performance; demonstrably not so.
Moderator:
I also want to talk about food. Some hospitals
have been focusing on healthier selections from
locally-sourced businesses. However, a lot of
hospitals are reliant on the Sodexhos and other
large institutional providers to run their patient
food service, cafeterias, etc. Have those larger
vendors been able to adapt and make greener
food selections and waste disposal?
Kathy Gerwig:
The institutional food suppliers have been
engaged by the large systems including KP to
shift to healthier and sustainable food. Last year
we purchased 100 tons of sustainable food for
patients, and we host 39 on-site farmers
markets. Our goal this year is for 15% of our
annual food (expenditures) to be on sustainable
food. We are already achieving that goal YTD.
Gary Cohen:
On the food issue, the national suppliers have a
model that is not built on local and regional
suppliers. They are being pressured to change
their model due to concerns about food miles
and support for local agriculture. Hospitals are
also realizing that they can support sustainable
agriculture as a disease prevention strategy and
community benet.
Moderator:
Kathy, I noticed that you promote the use of e-
mail with providers to cut down on ofce visits
and car trips. However, outside of Kaiser, there
is still some resistance by doctors to
communicate by e-mail, particularly in some
smaller and medium-sized practices. Is Kaiser
promoting this change with providers outside of
its system? Do you have any tips on how to
encourage providers to be more e-mail friendly?
Kathy Gerwig:
We've found that our members and patients are
very excited about using technology to
communicate with their doctors, to get Rx
rells, to receive lab results, etc. I suggest to
those providers who are resistant to e-mail to
think about how better communication with
their patients can support better compliance
with physician instructions and better outcomes.
Moderator:
Thanks! Can all of you talk about some of the
retro-commissioning that can be performed to
improve a hospital or clinic’s bottom-line
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Page 3
operations?
Kathy Gerwig:
Getting all of a building's systems to work
optimally is foundational to energy efciency.
And every kilowatt saved is money in the
bank.
Gary Cohen:
Many of the hospitals we work with use retro-
commissioning as the low hanging fruit on
energy reduction strategies, then go on to
other strategies. That includes energy audits,
upgrading boilers and chillers; changing out
lights; tightening up air and water ow
systems. Advocate Healthcare is Chicago has a
check list of 200 interventions that every
hospital needs to work on.
Kathy Gerwig:
Commissioning is more than an energy audit.
Imagine complex building systems where a
pump here is set in a way that conicts with
other equipment over there, and both are
using more power than needed.
Understanding all of a building's systems, how
they interrelate, and how to optimize
them...and maintain that optimal
performance...is what commissioning is about.
Moderator:
Last question for everyone: can you all
provide some tips for healthcare planners/
managers when dealing with and choosing a
green contractor or consultant to perform
work?
Gil Friend:
You need someone who plays well with
others. A contractor who is comfortable and
capable working in integrative process, with
architects, builders, electrical, mechanical and
other contractors working together, rather than
just lobbing designs & documents from one to
the other. It takes a certain skill to coordinate
this process -- and sometimes a bit more
upfront work -- but pays big dividends in
project time, performance and economics.
Gary Cohen:
See if they have an integrated vision,
especially around sustainable design. See if
they have a strong track record; see if others in
the healthcare eld can validate their
performance.
Kathy Gerwig:
We look for evidence that they've contributed
to sustainability in real ways. Most businesses
today have statements about being green, but
it is important to see actual results and proof
that they're engaged in projects that reap real
results.
Payers & Providers VITALS Page 4

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We Must Keep The Medicare Program
The Republican Proposal is Unfair and Benefits Nobody
On April 15, the Republican-controlled U.S.
House of Representatives voted to end
Medicare for Americans who are currently
under the age of 55. No Democrat voted in
favor of the plan.
For those tens of millions affected, and for
all future generations, the Republican plan ends seniors with affordable and quality health care.
Medicare and "privatizes" health care for
American seniors. The plan, if acted upon,
would create a voucher system in place of
Medicare. The U.S. government
would assign approximately
$8,000 to purchase private health
insurance for each senior once he
or she turned 67 years of age.
Under the Republican plan,
the average senior would see their
out-of-pocket health care costs
double to $12,150 per year — not
including co-pays.
There would be no more
government lifetime coverage. If
you could not afford a private healthcare
premium because you had a preexisting
condition (for example, high blood
pressure, diabetes, breast cancer) you’d
have to nd the money to pay whatever Rothman families; reducing or eliminating subsidies
premium the private marketplace would
charge. The government, under the Republican
plan, would not even limit the amount the
private market could charge. If you could not
afford to purchase a private health insurance
plan at the age of 67 or older you’d be
uninsured.
Imagine the suffering, pain and terror for those
tens of millions of seniors under those
circumstances. Where would they turn?
Yes, the United States has a $1.4 trillion
annual decit and a $14 trillion national debt.
But what are the best and fairest ways to deal
with those extremely serious problems?
The Republican plan is at best a misguided
approach to solving our nation’s common
problems. At worst, the Republican plan reects end Medicare.
their undiminished zeal to "shrink" government
by eliminating programs most Americans rely
on, including Medicare. As a result, however,
this would hurt the middle class and most
Americans, leaving only the rich and super-rich
to be assured of a good education for their
children and affordable healthcare for them and
their children.
Remember that the median income for
seniors in America in 2009 was $19,167; with
most seniors having at least one chronic
condition and many having multiple chronic
conditions. Can you imagine the premiums
they’d have to pay?
Medicare was created in 1965 precisely
because the private market failed to provide
Before Medicare, nearly half of American seniors
had no health insurance, and nearly 35 percent
lived in poverty. We must not end Medicare. Too
many American seniors would suffer
or die prematurely if we did.
As for our extremely important
decit and debt problems, I believe
that all options should be on the
table, with sacrices shared by all,
according to assets owned and
annual income. That means that the
following items must be considered:
making additional cuts in spending,
including defense; reducing income
and capital gains tax deductions for
By earnings over $350,000 per year; reforming
our tax code to prevent individuals and
Rep. companies from avoiding all tax liabilities;
Steve eliminating subsidies to America’s richest
to agribusiness, big oil and gas; ending or
proportionately scaling back the Bush tax cuts
for the wealthiest Americans; and, additional
cost control measures to the healthcare reform
law, including a public option.
Forcing seniors and the middle class to
bear a disproportionate burden in solving our
nation’s scal crisis is, in my opinion, unfair and
unnecessary. The better, more typically American
way to address our common problems is with
shared sacrice and fairness. Medicare is an
essential and successful American program that
has worked extremely well for the past 46 years.
It makes possible a longer and healthier life for
millions of our seniors. It is, also, often the
difference between life and death. We must not
Rep. Steve Rothman is a Democract serving New
Jersey’s ninth district in the House of
Representatives.
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com, or call (877)
248-2360, ext. 3.

!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Payers & Providers MARKETPLACE/EMPLOYMENT Page 7

HEALTHCARE CONSULTING OPPORTUNITY

Project Manager / Senior Consultant

For Consulting Practice
Health Dimensions Group is one of the nation’s leading rms advising hospitals, post acute providers and managed long
term care providers in all aspects of post acute operations. We are leading the development of innovative care models that
will thrive under a reformed health care system.

The Project Manager will have a high degree of direct client interaction, be responsible for managing multiple projects,
and participate in the business development and sale of consulting projects.

Responsibilities include preparing and managing projects to include: strategic plans and feasibility studies for a range of
post acute providers, such as long term acute care hospitals, rehabilitation hospitals, skilled nursing facilities, and assisted
living communities. In addition the Project Manager will be involved with PACE (Program for All-Inclusive Care for the
Elderly), as well as health care reform planning projects and operational reviews.

The position requires a Masters degree in business or related eld and a minimum of 5 years of consulting and/ or
hospital, post acute or managed care planning or operational experience. Prior consulting experience in long-term/acute
care preferred. Health Dimensions Group is based in Minneapolis, MN, but this position may be home based and work
from any location as the job will require substantial travel to work with clients throughout the nation.

Health Dimensions Group is a values driven organization and offers a competitive wage and benet package. Please send
resume to: hrinbox@hdgi1.com.

Human Resources
Health Dimensions Group, Inc.
4400 Baker Road, Suite 100
Minneapolis, MN 55343
Phone: 763-537-5700

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 8

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*New England Journal of Medicine, 2004.

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