10 December 2009

10 December 2009

California Edition

Calendar

OC Bets Big On Pediatric Specialists County Agency Offers Six-Figure Loan Forgiveness

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In what officials say is the first-of-its-kind use of Proposition 10 tobacco tax funds, the Children & Families Commission of Orange County has pledged nearly $1 million to attract badly needed pediatric specialists to the area. The agency, Orange County’s affiliate of First 5 California, tries to expand access to care to children from birth to the age of 5. It is offering $125,000 of medical education debt forgiveness to each pediatric specialist who chooses to move to Orange County to practice – more than six times the amount offered by state-run programs. The initiative is slated to begin next month. “Our goal is to bring at least half a dozen new pediatric specialists to Orange County within the next three years,” says Michael Ruane, the Children & Families Commission’s executive director. The commission will focus specifically on attracting pediatricians with expertise in orthopedics, neurology and endocrinology. California is struggling to recruit pediatric specialists, say observers familiar with the situation, but the shortage is particularly acute in Orange County. According to a recent survey by CalOptima, the county’s Medi-Cal managed care health plan, just 92% of pediatric patients are referred to a specialist within 30 days. That compares to nearly 100% access rates to primary care and urgent

care physicians. Waiting times for some specialty care can be as long as five months, according to Children & Families Commission officials. Advocates for children’s medical care say the approach being taken by the Childrens & Families Commission is unique. “We’re always looking for innovative ways in an era of strained resources to try and attract and retain physicians. They’ve been kind of selfstarters on that,” says Tim Shannon, the legislative representative for the Children’s Specialty Care Coalition, a trade group for more than 2,000 pediatric specialists statewide. The program was approved by the Childrens & Families Commission after a lengthy internal debate, including how to determine the amount of loan forgiveness. “We felt we had to offer at least $100,000 to generate interest,” says Kathi Crowley, a consultant to the commission. Sherry Novick, executive director of the First 5 Association of California, the lobbying group for the county-level commissions, notes that Orange County has been trying to build physician capacity internally, as opposed to trying to get specialist physicians to visit from

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In Brief CMS to Cover HIV Tests The Centers for Medicare and Medicaid Services announced this week its intent to cover testing of any enrollees for the human immunodeficiency virus (HIV), which causes AIDS. “The decision marks an important milestone in the history of the Medicare program,” Health and Human Services Secretary Kathleen Sebelius said in a statement. “Beginning with expanding coverage for HIV screening, we can now work proactively as a program to help keep Medicare beneficiaries healthy and take a more active role in evaluating the evidence for preventive services.” The expansion of coverage was included as part of the Medicare Improvement for Patients and Providers Act that was enacted into law last year. Among those eligible for HIVtesting are pregnant women enrolled in the Medicaid program, and all Medicare enrollees. According to the Centers for Disease Control and Prevention, nearly a quarter of those living with HIV or the AIDS virus were over the age of 50 in 2005, up from 17% in 2001. Nearly 20% of all new AIDS diagnoses come from this group. “Every adult should know their HIV status,” says assistant health secretary Howard K. Koh, M.D. “This decision by Medicare should help promote screening and save lives.”

Miller Childrens Opens New Hospital Pavilion Miller Children’s Hospital in Long Beach has completed a new 124,000square-foot patient pavilion after six years of planning and construction.

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NEWS

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Pediatricians (Continued from Page One) other counties, or transporting children for visits. “Although loan repayment is not unique, it is to this program,” Novick says, adding that it will be studied closely by other First 5 commissions. Novick believes that Orange County has an advantage many other of California’s 58 counties do not: a teaching institution such as UCI Medical Center, which not only produces many new physicians but also employs them directly. Physicians who accept reimbursement must be in solo practice, or employed by a clinic or teaching hospital in Orange County, and have at least 51% of their patient base enrolled in Medi-Cal or Healthy Families. Funds

would be remitted directly to the physician’s education creditors over a threeyear period. Shannon believes the amount being offered is generous enough to attract interest, particularly among younger physicians who are likely facing considerable debt. According to data released in October by the Association of American Medical Colleges, the average medical school debt carried by a newly minted physician has ballooned to $156,000 today, compared to $139,517 just two years ago – an increase of 11%. The Health Professions Education Foundation, an affiliate of the Office of Statewide Health Planning and Development, will administer the program for the commission and assist in recruitment efforts.

Radiation Errors Continue To Surface Cases in California Now Linked To Three Hospitals As ofcials with the U.S. Food and Drug Administration suggest the overdosing of patients with radiation while undergoing CT brain perfusion scans may take on a national dimension, errors involving the devices in California have so far been linked to three hospitals in Los Angeles County. Jonathan Fielding, M.D., director of the Los Angeles County Department of Public Health, conrmed that an investigation by his agency’s radiation safety branch discovered 34 patients at Providence Saint Joseph Medical Center in Burbank were exposed to excess radiation while undergoing CT brain perfusion scans during a 20-month period that ended in October. Cedars-Sinai Medical Center in Los Angeles disclosed 206 patients had been exposed to excess radiation in 2008 and 2009, a number FDA ofcials boosted to 256 this week. Glendale Adventist Medical Center disclosed last month that 10 patients were exposed to excess radiation. FDA ofcials linked 14 cases to Glendale Adventist, but a hospital spokesperson says the number of known cases remains unchanged at 10. Unlike the Cedars-Sinai and Glendale Adventist cases, which involved a CT scanner manufactured by GE Healthcare, the Providence Saint Joseph device was

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manufactured by Toshiba American Medical Systems, which is based in Tustin. According to Fielding, the issues that led to the radiation overexposures were similar to those in the Cedars and Glendale Adventist cases: the devices functioned properly, but hospital staff or outside technicians changed dosage defaults for brain perfusion scans to much higher levels and the error was not caught. “It appears to be related to software and protocols,” he says. Providence Saint Joseph issued a brief statement that did not specically discuss incidents at its facility. “To date, we have had no adverse reactions reported due to unnecessary exposure,” it read in part, adding that it was still evaluating whether any patients had received overdoses. Fielding does not believe any more facilities in Los Angeles County will be linked to radiation overexposures. “We’ve called all 78 hospitals and 38 imaging centers. Only 11 were using the brain perfusion test, and all have been investigated,” he says. An ofcial with the California Department of Public Health conrmed that no other facilities statewide are being investigated. Late last month, the CDPH issued an advisory to more than 800 hospitals and Continued on Next Page

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In Brief The pavilion includes 24 new neonatal intensive care beds and seven new surgical suites, as well as room for additional acute care beds. The addition brings the hospital’s total bed count to 308. “We are deeply committed to continuing to serve the Long Beach community by offering an environmentally-friendly and modern care facility that exists to improve the lives of children for generations to come,” says Diana Hendel, chief executive ofcer of Miller Childrens and Long Beach Memorial Hospital. The expansion project cost $196 million, of which $172 million came from Proposition 3 and Proposition 61 funds. The additional $24 million came from the hospital’s capital campaign.

Health Net Resumes Stock Repurchases Woodland Hills-based insurer Health Net, Inc. has resumed its stock repurchase program after a 13-month suspension. The program, originally launched in 2002, was authorized to purchase back $700 million worth of shares. Health Net’s board of directors suspended the program in November 2008, partly due to concerns related to the ongoing financial crisis. At the time, Health Net’s stock had plummeted to just over $8 a share, down from more than $52 a share in January 2008. The stock’s price has since rebounded to $23 a share. “The board’s action underscores our confidence about the future,” says Health Net Chief Executive Officer Jay Gellert. About $103 million in purchasing capacity remains in the program, according to Health Net officials. Health Net may repurchase shares on the open market, private transactions or accelerated share repurchase programs.

NEWS

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Radiation Overdoses (Continued from Page Two) outpatient facilities statewide to examine their CT brain perfusion protocols. “That is one of the ways the state is trying to nd out whether the problem is larger,” says CDPH spokesman Ralph Montano. Meanwhile, the FDA reported earlier this week that at least one case of overexposure was reported in Alabama. The FDA did not disclose the name of the facility, although the Los Angeles Times reported the incident occurred at Huntsville Hospital. Jeffrey Shuren, M.D., acting director of the FDA’s Center for Devices and Radiological Health, suggests that the

Alabama case will not be isolated. “The FDA has also received reports of possible excess exposure from other states,” he says, but adds that there should not be a concern regarding the overall safety of the devices as long as they are operated properly. To that end, the FDA issued ve interim guidelines on how to operate CT scanners for all perfusion scans. They include ensuring all facilities scrutinize their current dosing protocols; examine the CT scanner’s display panel for radiation dosage levels prior to performing the scans; and adjusting the radiation dosages as appropriate for each scan if a patient undergoes multiple scans.

California Hospitals Top Leapfrog List Six of Kaiser’s 30 Hospitals in State Included Thirteen of the 45 hospitals named by the Leapfrog Group this week as delivering the highest efciency and quality were in California, including six operated by Kaiser Permanente. The hospitals were judged by the Washington, D.C.-based Leapfrog on four criteria: meet standards for implementing computerized physician order entry systems; meet standards for complex procedures such as heart bypass surgery; and meet specic standards for intensive care unit stafng. The hospitals were also judged on a new efciency score, which is a combination of quality outcomes, length of stay, readmission rates and rates of hospital-acquired infections and other complications. The quality portion accounts for two-thirds of the score. “California has certainly emerged on our list as the clear winner in efciency nationally,” says Leapfrog Chief Executive Ofcer Leah Binder. She adds that California’s hospitals are relatively transparent in terms of

data reporting. Among the reasons are existing state-level quality reporting initiatives such as the one managed by the Integrated Healthcare Association, according to Binder. As for Kaiser predominating among California hospitals, Binder says it has strong internal incentives for controlling its acute care resources. Jim Anderson, spokesperson for Kaiser’s Southern California Region, says the hospital system has made strong use of its electronic medical records and CPOE systems. “Healthcare quality and efciency can go together,” he says. Along with the Kaiser hospitals, California Pacic Medical Center’s three campuses were also named, as were Childrens Hospital Los Angeles and Children’s Hospital of Orange County. Binder says the quality ratings of the more than 200 hospitals that participated in the survey will be released in the spring.

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OPINION

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How To Position The Public Option Should Plan Come To Pass, it Must Operate Properly Why is a public plan option important to quality of care. healthcare reform? In the words of • Focus the public plan option on President Obama, it’s to “keep insurance improving health Because the public plan companies honest.” In a more positive is not profit driven, it will be able to light, a public plan option could raise the reinvest surpluses realized by efficiencies bar in terms of health plan performance. directly into the community. Regional How can it be structured so this is public plans could develop and test new accomplished? care models, reinvest in the safety net, Recognize that healthcare markets are provide grant programs, or return monies local. Health care markets vary in terms directly to purchasers and consumers, with of population demographics, provider the goal of improving the health of the density, hospital accessibility, and many community. At L.A. Care, we have been other factors. The two key health care able to invest over $80 million locally to providers that account for the majority of support community clinics and provide spending, doctors and hospitals, are local. coverage for tens of thousands of kids who A local or regional plan is nimble would otherwise be uninsured. This enough to adjust to everis another example of “raising of changing local market the bar” for all health plans. conditions. Let’s offer states incentives to create regional •Protect the safety net Safety net providers will continue to be the health plans that can be public, main source of care for those who not-for-profit, or cooperatives, remain uninsured or are socially and are designed to serve local or behaviorally difficult to markets. For over a decade in effectively treat in private settings. California, nine counties have These providers will continue to had public health plans that By provide care to many insured through compete with private health plans in Elaine government-sponsored programs. the Medi-Cal program. All of these Batchlor, Regional public plans should be regional health plans have been required to include in their networks highly successful in taking advantage M.D. qualified safety-net providers that of local market conditions to agree to provide services with the improve not only efficiency in the same terms and conditions required of any delivery of care, but also the quality of the other providers. This provision would help care delivered. safety net providers stay in business, once most of the uninsured have coverage. • Engage local stakeholders Local stakeholders are crucial in helping to The public plan option should be just that design a plan that will reflect the needs – another choice that helps keep local and priorities of the communities it markets functioning with transparency and serves. Public option plans should accountability, and serves the public interest. include a board with representation from membership, doctors, hospitals and California public plans, with their long track clinics. Such a design is vital to “keep records, can lead the way and show the health insurance companies honest.”! It nation how it’s done. provides the transparency and the accountability so critical for true Dr. Elaine Batchlor is the chief medical officer of L.A. healthcare reform.! Care Health Plan, the nation’s largest public insurer. • Create a level playing field All plans, whether public or private, should have the same licensing, oversight, regulatory, actuarial rate setting methodology, and financial reserve requirements. In addition, the public plan should be held to the same requirements for access and

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She is a member of the Payers & Providers editorial board.

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It costs up to $27,000 to fill a healthcare job* will do it for a lot less. Employment listings begin at just $1.65 a word Call Ron Shinkman at (877) 248-2360, ext. 2, e-mail him at: [email protected] Or visit: www.payersandproviders.com *New England Journal of Medicine, 2004.

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