27 October 2011

California Edition
Calendar
November 1-3
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Hospitals Confront Blood Infections

Industry Questions CMSs Hospital Compare Data
New data posted by the Centers for Medicare effort to improve the quality of care among its and Medicaid Services show that many of membership. Californias major hospitals have blood The category in question is referred to on infection rates multiples higher than the the HHS site as blood infection from a national average, but industry ofcials are catheter in a large vein.That includes adult questioning its validity. Medicare patients treated in and out of the The data, posted earlier this month on the ICU, and with or without central lines, Department of Health and Human Servicess according to Patrick Romano, M.D., a UC Hospital Davis professor who Compare website assisted in validating Blood Infections From Catheters In A for consumers, the CMS data and its Large Vein comes as more risk-adjustment than 160 acute Nationwide Rate: 0.367 per 1,000 discharges processes. Romano care facilities suggested that the L.A. County-USC Medical Center: 1.785 statewide are added vigilance engaged in an regarding central lines Ronald Reagan UCLA Medical Center: 1.723 initiative to should reduce the combat infections Alta Bates Summit Medical Center: 0.928 overall rates. The CMS stemming from is not yet releasing UCSF Medical Center: 0.824 central line central line infection catheters inserted California Pacific Medical Center Pacific Campus: 0.747 rates. into intensive Several of the Source: CMS care unit patients. Sutter General Hospital: 0.533 states leading Such infections hospitals reported are fatal about rates signicantly half the time and cost the industry tens of higher than the national average. Los Angeles millions of dollars a year. County-USC Medical Center and Ronald However, the data, culled by CMS from Reagan UCLA Medical Center reported rates patient discharge records and used for a new around ve times the national average. rating category for patient safety, has been called into question by the California Hospital Association, which has been spearheading an Continued On Next Page

November 15-17
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November 29
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NEWS
Hospital Compare (Continued from Page One)
Ofcials at both hospitals did not immediately respond to a request for comment. Debby Rogers, vice president of quality and emergency services for the CHA, noted that the statistics being compiled for the Hospital Compare website is based on hospital discharge data which is complied by coders, rather than clinical data compiled by physicians. Using coding data for a quality measure is a relatively new science, while using (patient) chart abstracted data is older, and were better at it, Rogers said, adding that its a bit of an apples to oranges comparison.

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In Brief
DMHC FInes Part D Plan $65,000
The rst standalone Medicare Part D plan to be licensed in the state of California was ned $65,000 by the Department of Managed Health Care for misrepresenting its corporate structure during the application process. Ohio-based Envision Insurance Co. admitted on Oct. 7 that when it applied for a Knox-Keene license in March 2007, it had declared in four documents it had submitted to the agency that its parent company was a rm known as RX Options, Inc. However, its ownership changed in July 2007 to Envision Pharmaceutical Holdings, Inc. The DMHC was not notied of the change, violating the state Health and Safety Code and the Code of Regulations. Envision received its Knox-Keene license in late 2007. A press release Envision issued four days after it received the license correctly stated its corporate parent. Its the rst ne issued by the DMHC against a plan for failing to operate in accordance with the documents it led with the department.

Rogers also noted that the data does not include condence intervals a sample sizerelated margin of error. Without that level of detail, theres no way of telling how accurate they are. The data sets have also been questioned by the Institute for Healthcare Improvement and the American Hospital Association. We believe the data is fairly seriously awed in the way it's calculated," American Hospital Association Vice President Nancy Foster told Kaiser Health News. "When inaccurate data is out there...it misleads the public."

Bariatric Surgery Continues Gains

Mortality Rate Is Low, But Complications Are High
A new study of bariatric surgery by the Ofce of Statewide Health Planning and Development indicates a low mortality rate for the popular procedure, but it is beset by a high complication rate. According to data submitted by the states hospitals, the number of Californians undergoing the procedure which restricts the size of the stomach and in some cases bypasses portions of the intestinal tract increased 7% between 2005 and 2009. Most who underwent the procedure did so to control their weight and co-morbidities such as hypertension and diabetes. Forty patients who underwent a bariatric procedure in California between 2005 and 2009 died as a result, for a mortality rate of 0.6 per 1,000 surgeries. The overall mortality rate declined from 0.7 per 1,000 procedures in 2005 to 0.5 in 2009. However, the death rate doubled when mortalities within 30 days of hospital discharge were added in. That death rate increased from 1.3 per 1,000 procedures in 2005 to 1.5 per 1,000 in 2008. The mortality rate doubled when the timeframe was extended to 180 days after discharge. Hospital readmissions within 30 days of a bariatric procedure was 6.4%, compared to an overall 2.6% readmission rate in California for all inpatient admissions excluding those for maternity and cancer care. While the mortality rate is really quite low...the complication rate for these surgeries is less than ideal and could probably be lower, said Joseph Parker, manager of OSHPDs Healthcare Outcomes Center. Thirteen percent of bariatric procedures resulted in some forms of post-surgical complication. Of the four widely-used procedures, the most radical form had the highest rate of complications: 26.7% for the biliopancreatic diversion, which includes a partial removal of the stomach and is normally
Continued On Next Page

States Latino Population Suffers From High Asthma Risk

A new report by the American Lung Association concludes that Latinos suffer asthma at disproportionate rates compared to rest of the U.S. population, and those in California may be at particular risk for contracting the disease and having issues controlling symptoms when it strikes. According to the association, 90% of Californias Latino population live in counties that have unhealthful

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Longer ALOS!*

NEWS
Bariatric (Continued from Page Two)
used in only the severest cases of obesity. The complication rate for that procedure is on the rise, growing from 26% in 2005 to nearly 39% in 2009. The open Roux-en-Y gastric bypass procedure, which includes stomach stapling, saw a complication rate of 22.4%. In many cases, the patient had to be operated on again, or suffered from hemorrhaging. By contrast, the complication rates were much lower for the less invasive forms of the procedure, which includes placing an adjustable band around the stomach to control its size. The so-called LAP band procedure saw a complication rate of only 6.6% in 2009, down from 13.7% in 2005, although another form of the LAP procedure saw complication rates rise during the same period, reaching 13.2% during the last year of the study.

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In Brief
air quality at least some part of the year. And in Los Angeles County, home to the states largest Latino population, more than a third live below the Federal Poverty Level, which is linked to more difculty controlling episodes of asthma. Uncontrolled asthma is one of the leading causes for hospital emergency room visits. "Some Hispanics face social and economic disadvantages that make them less able to manage their asthma," said Jane Warner, chief executive ofcer of the American Lung Association in California. "Hispanics make up 37% percent of the population in California and it is critical that we address the burden of asthma as it grows with the population." The report, Luchando por el Aire: The Burden of Asthma on Hispanics, is available on the associations website, lungusa.org.

The OSHPD data did not include outpatient bariatric procedures, which have grown increasingly popular for LAP band insertions. At least ve post-surgical deaths have been linked to an outpatient center in the West Hills neighborhood of Los Angeles between 2009 and last month, according to a recent report by the L.A. Times. The center has changed its business name several times. "Californians should discuss all options for weight loss with their physicians to determine the most appropriate course of care," said OSHPD acting director Stephanie Clendenin. "If the decision is made to have bariatric surgery, the patient can consult this report for information on the number of procedures performed at particular hospitals and the statewide outcomes associated with each particular surgery before making a nal decision."

Molina Reports Stronger Earnings

Gains Made Despite California Premium Loss
Long Beach-based Medicaid managed care plan Molina Health Care posted stronger third-quarter earnings despite having premium revenue for its California plan reduced by $7.5 million. Net income for the quarter ending Sept. 30 was $19 million, on revenues of $1.18 billion, an increase of 15.2% from the third quarter of 2010, when net income was $16.2 million. Revenue for the year-ago quarter was $1.04 billion. Our diversication strategy and our focus on our less mature health plans were the keys to success in the third quarter, said Molina Healthcare Chief Executive Ofcer J. Mario Molina, M.D. He added that strong performances from Molinas Medicaid managed care plans in Texas and Florida offset the California losses. Enrollment in the Texas plan grew by 52,000 between the third quarter of 2010 and 2011 to 148,000, an increase of 54%, while premium revenue more than doubled. Floridas enrollment grew by just under 20%, to 67,000 from 57,000, while revenue grew by more than 20%. Molinas overall enrollment grew from 1.6 million to 1.7 million. For the nine months ending Sept. 30, net income was $53.8 million on revenues of $3.5 billion. Molinas year-ago net income was $37.3 million on revenues of just under $3 billion.

Lucile Packard Enters Into New Pact With Blue Shield

Lucile Packard Childrens Hospital in Palo Alto has entered into a network contract with Blue Shield of California after going nearly two months without a contract. The new pact began on Oct. 20. "Were happy to have this new agreement in place," said Gary May, vice president of payer relations and pricing for the hospital. "Both Blue Shield and Packard Childrens have worked diligently on this matter, and everyone is pleased that Blue Shield families will continue to have full access to our world-class care." During the non-contract period, between Aug. 31 and Oct. 19, Blue Shield members were charged rates under the previous contract. Negotiations between Lucile Packard and Anthem Blue Cross of California for a new provider pact continue, hospital ofcials said.

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OPINION

Page 4

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My Visit To Occupy Wall Street

Individual Concerns About Healthcare Are Strong
Earlier this week I visited Los Angeles City combination of simultaneously overspending Hall. Its front lawn is playing host to the L.A. she noted that providers are relentlessly edition of the Occupy Wall Street marketed more than 6,000 new medical movement. I wanted to know what these devices and drugs every year while denying people have to say about healthcare and care. whether its relevant to anyone. The insurance industry has to disappear. Occupy L.A. is a motley collection of If you put a company in the middle that makes tents and signs, many of which sport Socialist money denying services and care, and slogans and graphics. The piney scent of because they have shareholders they have to marijuana smoke occasionally drifted into my post a bigger prot every year. That leads to nostrils. I generously presumed it was for more denial of services, she said. medicinal purposes. Cruise added that people tend to conate their But then I spoke to the people. For the healthcare with their insurer. Healthcare is most part, their concerns about healthcare are supposed to take care of your well-being, she those of many other Californians: access and observed. cost. Weirdly enough, Cruise is enrolled in everyone I interviewed had Kaiser, a political as much insurance coverage. as a lifestyle choice. Its the I feel bad for people, closest to what you would many of whom cant get get in Europe, she said. care, while there is an When the care is under the ongoing debate as to control of the payer as well, whether quality or access is they want you to be well. most important, said Kevin Which brings me to the Nally, a 21-year-old who is 68-year-old Tony King. studying foreign relations at Retired and enrolled in Cal State Long Beach. Medicare, volunteers for an Ironically, Nally has organization that assists the about the best health homeless. He is keenly insurance you can get in this aware that the vicissitudes country. Hes enrolled in the of old age could make him TriCare program due to his one of the people he father being a Marine Corps currently helps. When you By ofcer. It hasnt raised its premiums get older and unwanted, and you raised since the mid-1990s. dont have family or ties to Ron Shinkman Nevertheless, Nally thinks neighborhood service programs, some changes are in order.We youre put in the trash, he said. could look to the European model. But we And of course, the frequent iers who have a pride issue that our system is the best plague many an urban emergency room are in the world, and that keeps us from looking at usually without a permanent address other examples for care, he said. Maybe if something many hospital executives are only those who wanted to limit access were willing now beginning to address. to invest more, it would pay off for There werent many practical or even them. original solutions being offered by the people I Maureen Cruise doesnt really represent interviewed. But strip away the tents and the the plight of the 99%. Shes a 61-year-old slogans and their concerns essentially trouble retired nurse who use to work for the Los us all. Angeles County Department of Health Services. Her husbands a retired attorney and Ron Shinkman is the publisher of Payers & they live in Pacic Palisades, whose beach Providers. views dont exactly bring to mind squeezed families. But she believes the healthcare Op-ed submissions of up to 600 words are industry has come under the force of what she welcomed. Please e-mail proposals to called nancialization. That is a
editor@payersandproviders.com

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