10 June 2010
California Edition
Calendar
June 13-16
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Kaiser First To Equalize Patient Rights
New Policy Lauded By LGBT Group; Others Lag
Just weeks after President Barack Obama
issued an executive order to start the
process of abolishing discrimination against
same-sex couples in acute care and
outpatient settings, Oakland-based Kaiser
Permanente became the first inpatient
provider in the country to adopt a
comprehensive policy addressing the issue.
Meanwhile, a survey of other hospitals in
California show policies that have yet to be
updated, or are unavailable.
Kaiser updated its 19-point Patient Bill of
Rights on June 7 to allow patients to choose
whomever may visit them in its hospitals,
and to enjoy all the rights without regard to
sexual orientation.
As a result, Kaiser was recognized earlier
this week as the only hospital operator in
the country to achieve a perfect score on
the Healthcare Equality Index (HEI), an
annual survey of patient rights policies at
hospitals. The survey is administered by the
Washington-based Human Rights
Campaign Foundation (HRC) and the Gay
and Lesbian Medical Association.
“Kaiser Permanente is deeply committed
to providing equitable, compassionate and
high-quality care to our lesbian, gay,
bisexual and transgender patients and their
families, a level of care that is standard
across our diverse patient population,” said
George Halvorson, M.D., Kaiser’s chief
executive officer and chairman.
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According to Human Rights Campaign
officials, Kaiser has been working closely
with the compilers of HEI over the past
several years to improve its score.
“We’ve identified model language (for
providers) and Kaiser has continued to
meet the bar as we have raised it, going
all the way to the top in terms of non-
discriminatory patient policies,” said Tom
Sullivan, deputy director of the HRC’s
family project. He added that he hoped
Kaiser’s move would prod other hospitals
to do the same.
Sullivan noted that ambiguous
language in individual patient’s bill of
rights can often leave enforcement of
policies to individual hospital
employees, who may move to ban a
member of a gay or lesbian couple from
visiting their partner while they are being
treated.
Data for the HEI is either provided
voluntarily by the hospitals, or is
gathered by researchers. According to
Sullivan, just 30 of the nation’s 200
largest hospitals voluntarily provided
data for the latest survey. Little more than
half of the hospitals surveyed used
language in their bill of rights that
Continued on Next Page
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In Brief
Court Prohibits One-
Day Nurses Strike
The University of California was
successful in obtaining a temporary
restraining order against 11,000 nurses
from striking at ve UC hospital
campuses today.
San Francisco County Superior
Court Judge Peter J. Busch sided with
attorneys representing the UC system
who had argued that the strike would
endanger public safety. Busch’s
temporary restraining order remains in
effect until June 18, at which point he
will hear arguments about whether or
not to grant a permanent injunction.
Represented by the California
Nurses Association, the nurses had
planned to strike with 12,000 other
nurses in Minnesota, making it the
largest walkout of nurses in U.S.
history. The temporary restraining order
does not affect planned walkouts at
three non-UC hospitals in the Los
Angeles area.
The nurses claim that the hospitals
have kept their stafng at levels that
are too low to guarantee patient safety.
CNA ofcials say they will stage non-
strike rallies at the hospitals instead.
“All the resources the University has
wasted trying to silence the nurses will
do nothing to solve the stafng crisis at
UC hospitals, and nurses will not rest
until their concerns are addressed,”
said CNA negotiator Beth Kean.
Kaiser: Norcal Heart
Attacks in Decline
The number of heart attacks among
Kaiser Permanente’s membership in
Northern California have declined by
24% since 2000, according to a study
undertaken by the organization and
published in the New England Journal
of Medicine.
Continued on Page 3
NEWS
Kaiser (Continued from Page One)
addressed discrimination against gay and
lesbian patients.
On April 15, President Obama issued an
executive order meant to ban such
discrimination altogether, but also asked
the U.S. Department of Health and
Human Services to draft regulations, a
process that could take years to complete.
Sullivan suggested that many institutions
may be waiting for the regulations to be
finalized before officially changing their
policies.
Although exclusions of same sex
couples are relatively rare nowadays, it
was commonplace well into the 1980s,
often aided by blood relatives who
resented having gay or lesbian family
members, and sometimes leading to a
separation even as a loved one died.
Isolated incidents of exclusion do still
occur.
Community Medical Center in Fresno
agreed to change its policies and undergo
staff training after emergency room
personnel excluded Teresa Rowe from
visiting her partner, Kristin Orbin, while
undergoing treatment for an epileptic
seizure in May 2009. Orbin claimed she
HMO Complaints Up More Than 7%
Kaiser Experiences 16% Increase; IMRs Go Down
Consumer complaints led against health
maintenance organizations with the
Department of Managed Health Care
increased 7.4% in 2009, a rise the agency
attributed to greater nancial stress
experienced by policyholders.
A total of 4,397 complaints were resolved
by DMHC last year, up from 4,076 in 2008.
Virtually all of the complaints – 4,274 – were
led against large health plans, those with
enrollments of more than 400,000 lives.
The largest year-to-year increase in
complaints was against Oakland-based Kaiser
Foundation Health Plan. A total of 1,809
complaints were lodged against the insurer,
up 16.2% from 2008, even though its overall
enrollment was down 5.2%. San Francisco-
based Blue Shield of California received 799
complaints, up 15.6% from the 675 it
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Page 2
was overmedicated as a result of the
separation.
The HEI surveyed 47 hospitals in
California (28 of which were Kaiser
facilities). It listed Community Medical
Center as “unknown” when it came to its
policies regarding same sex couples. A
hospital spokesman did not return a call
seeking comment.
Los Angeles County-USC Medical
Center, St. Mary Medical Center in Long
Beach, and UC San Diego Medical
Center were listed as not having specific
policies that permitted visitation for
same-sex couples.
Scoring an “unknown” regarding their
visitation policies were UCLA Medical
Center, San Pedro Peninsula Hospital,
San Francisco General Hospital, the V.A.
Medical Centers in Los Angeles and Palo
Alto, Cedars-Sinai Medical Center, Loma
Linda University Medical Center,
Huntington Memorial Hospital in
Pasadena, California Pacific Medical
Center, UC Davis Medical Center and
Scripps Mercy Hospital and Sharp
Memorial Hospital, both in San Diego.
received the year before, even though its
enrollment was down 4.7%.
Although Anthem Blue Cross of California
is by far the most penalized insurer by the
DMHC (Payers & Providers, May 27, 2010), its
complaints declined 10.7%.
DMHC spokeswoman Lynne Randolph
attributed the increase in part to the
increasingly complexity of the health plans,
and escalating cost-shifting.
“There are more higher-deductible plans,
more tiered co-payments for prescriptions, and
consumers may have difculty understanding
that,” Randolph said, but added that changes
in physician networks may also be to blame.
Complaints about benets and claims rose
modestly, but grievances regarding
coordination of care issues were up 22.7%.
Continued on Next Page
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In Brief
In addition to the decline in overall
heart attacks, the number that inicted
permanent damage to the heart
declined by 62%, according to data
from the Kaiser Permanente Division
of Research.
Researchers attributed the decline
to more accurate electrocardiograms
that are able to assess the risk of
patients having heart attacks, as well
as the detection of elevated levels in
the body of troponin, a substance that
can signal a coming heart attack and
its severity.
“This research provides new
insights into the changing landscape
of heart attack incidence and
associated outcomes in the
community,” said Alan S. Go, M.D.,
director of the Comprehensive
Clinical Research Unit at the Kaiser
Permanente Division of Research in
Oakland. Go was the study’s lead
investigator.
Kaiser examined the medical
records of more than 46,000 members
who were hospitalized for heart
attacks between 1999 and 2008.
Four California
Hospitals Win Premier
Quality Award
Four California hospitals were
named winners of the Premier
Healthcare Alliance’s Award for
Quality.
The facilities are St. Joseph’s
Medical Center in Stockton,
Providence Little Company of
Mary Medical Center in Torrance,
Mercy General Hospital in
Stockton, and Palomar Medical
Center in Escondido.
The hospitals were cited for
their high scores in quality and
efficiency, with a focus on
morbidity, mortality and
complications. Twenty-one
hospitals and systems nationwide
received the award..
NEWS Page 3
DMHC (Continued from Page Two)
However, the number of independent media coverage of insurance-related issues,
medical reviews conducted were down particularly in the wake of national healthcare
9.3%, a drop Randolph attributed to a spate reform.
of ER and urgent care coverage complaints “Those complaints are part of the reason
the agency handled in 2008. we had reform, and the statistics suggest we
Kaiser spokesman Jim Anderson said need to continue to have a feedback loop,” he
the percentage of complaints per Kaiser said. Wright added that the DMHC’s telephone
enrollees – 3.2 per 10,000 – was too small
to attribute to a trend.
hotline is particularly easy for consumers to
use.
“We take every complaint seriously, but Randolph is not making any predictions,
we also need to put them into perspective,” but she does believe consumers will have
he said. questions regarding their coverage as reforms
Anthony Wright, executive director of are enacted in the coming years.
Health Access, a Sacramento-based “We do want to present ourselves as a
consumer advocacy group, believes the resource,” she said.
complaints may have rose because of more
UCLA, LAC To Study Health Impacts
Will Use $300K Grant On Transportation, Water Issues
The UCLA School of Public Health and the Line subway or similar projects down Wilshire
Los Angeles County Department of Public Boulevard may affect residents and workers in
Health have jointly received a $300,000 the area, and how water conservation efforts
grant from the Pew Charitable Trusts and among municipalities in the Los Angeles
Robert Wood Johnson Foundation to study region may affect public health. The
the health-related impacts of two major transportation study is scheduled to be
issues confronting Angelenos – public released in mid-2011; the water report in
transportation and water conservation. mid-2012.
The grant – among six announced to Although costly and extensive
recipients nationwide earlier this week – was environmental impact reports are required by
provided by the Health Impact Project (HIP), various agencies as part of any subway
a collaboration between Pew and RWJF to construction project, UCLA Health Assessment
discover how public policy may impact Project manager Brian Cole said the report
community health. A statement issued by HIP being undertaken here would study “softer”
said the projects “are at the forefront of a health aspects. Among them: how people who
burgeoning movement in the United States to walk through the Wilshire corridor for exercise
ensure health is considered in sectors that do or errands would have their health affected if
not traditionally factor it into their decision construction barred them from doing so. The
making.” water study would examine “the pluses and
UCLA and L.A. County researchers will minuses of different alternatives to reducing
study how a proposed extension of the Metro water consumption,” he said.
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Payers & Providers
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OPINION
Keeping An Eye Out For Sea-Change
New Demonstration Projects Signal Shift in CMS Policy
The passage of national healthcare reform
has given clear indication of a policy shift
in how the Centers for Medicare and
Medicaid Services (“CMS”) will relate to
healthcare providers and markets.
Through the development of accountable
care organizations (“ACOs”) and on a
smaller scale, “bundling” arrangements
(i.e., where both the hospital and
professional components are paid to the
hospital in a single payment from CMS),
CMS is signaling a shift away from an “all
provider/all services available” model to a
model more regional and more selective
in certain areas of clinical care. !
While the ultimate future model for
acute care providers and large medical
groups may be to achieve ACO status,
which is to provide all the healthcare
needs to a defined population, a less risky
first step is to increase an organization’s
abilities and competencies by first
expanding its current service line
approach to integrate the medical
professional components into the
pricing and cost structure of the
organization.!
The recent demonstration projects
approved by CMS give those in the acute
care space an opportunity to develop
these models. Last year, CMS approved
five Acute Care Episode (“ACE”)
demonstration projects for two service
lines – cardiac and orthopedics (28
cardiovascular and 9 orthopedic DRGs) –
and promises to expand them for other
clinical services very soon.!
Those early adopters successful in
winning these designations may be
positioned as a preferred provider with
Medicare that could shift substantial
market share for both Medicare as well as
commercial insurance populations.! This
in turn may positively influence an
organization’s profitability through the use
of excess capacity.! For the first time, high
quality and low cost will result in a shift
of market share at a large scale.!
As organizations begin to consider
undertaking a bundling strategy, forward-
thinking CEOs should bear in mind the
following key issues:! !
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Page 4
• A broader strategic end-game.! Bundled
payment is one of several models of care
designed to achieve enhanced quality and
reduced costs, like those associated with
readmissions and unnecessary use of
resources. It can be an early stepping stone
to more comprehensive models such as an
accountable care organization. It is helpful
to assure those in the organization of a
broader vision of the future and the role of
bundled payments in driving the value
proposition.
• !Management, board, and physician
education and buy-in. The CEO must
educate the organization, board, and
medical staff leaders to create consensus
before moving ahead.! Shifting to bundled
payments is a drastic change, and buy-in
from all is critical to success.
By •Quality-focused medical staff
leadership. The organization must find
Robert medical staff leaders who are
Minkin passionate about quality and are
willing to change their practices’
relationship to the market (i.e., give up
their “independence”) in order to provide
improved care and a superior patient
experience.
• Flexibility in engaging physicians. CEOs
considering bundled payments should be
prepared to “let go” by exploring new ways
of engaging physicians, such as through co-
management arrangements with the service
line medical staff leadership.
• Perseverance.! Change of this magnitude
is daunting and requires tenacity from the
CEO.! The CEO must believe firmly that
moving to bundled payments is the right
decision for the organization, medical staff,
and community.!!!!!
Robert Minkin is a senior adviser with The
Camden Group, a hospital and medical
group consulting firm in El Segundo.
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.
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Payers & Providers MARKETPLACE/EMPLOYMENT Page 7

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