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California Healthcare News Archive of Prior Editions

Welcome to the Archive page of the California Healthcare News web site! This is where you will find PDF downloads of each of our prior editions.

New! October 2012 Edition:  Improving Teamwork for Better Patient Care with TeamSTEPPS®

If your Quality Improvement program needs an injection of vitality - a new approach to error prevention and a culture known for high reliability in quality and patient safety - consider a TeamSTEPPS intervention. The program - Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) - teaches professionals how to integrate teamwork principles into daily practice throughout the organization. It was designed to train health care professionals who work in high stress areas - such as surgical suites, critical care, labor and delivery, and the ED - and throughout the hospital to create a culture of situational awareness, mutual support and a shared mental model. These program attributes take communication improvement all the way to culture change.

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September 2012 Edition: Health Care After the Supreme Court Decision: Establishing and Operating State Exchanges

The Supreme Court has ruled on the Affordable Care Act and, although it upheld its constitutionality, it opened the door to giving states more flexibility on the expansion of Medicaid. Consequently, a large number of states appear to be opting out of the expansion program, potentially leaving an estimated three million people uninsured who would have been covered before the ruling, according to the Congressional Budget Office. Participation is no longer a requirement, and states no longer risk losing all their federal funding for Medicaid if they don’t participate. States are now turning their focus to exchanges—health insurance marketplaces in which people who lack affordable coverage through an employer will be able to shop for policies.

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August 2012 Edition: What’s Driving the M&A Frenzy in Health Care IT?

Information technology is at the core of building the new 21st-century health care system. Yet transforming health care won’t be as easy as it’s been for many other industries that have experienced change through technology, such as financial services and manufacturing.

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July 2012 Edition: HHS Proposes Changes to the Medicare Wage Index System

Medicare, like any large organization or business, has long known that labor costs vary across the nation. For example, a small community may lie less than 20 miles from a large metropolitan area, but the two are likely to be worlds apart when it comes to what the average health care worker in each city is paid. Which only makes sense—after all, it typically costs quite a bit more to live in a city of three million people than it does in a community of only 20,000.

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June 2012 Edition: Helping Health Care Payers Improve Claim-Payment Accuracy

The American Medical Association’s fourth annual National Health Insurer Report Card found that commercial health insurers average a 19.3 percent error rate in processing claims, up 2 percent from the previous year. This increase means there were 3.6 million more erroneous payments and $1.5 billion worth of additional, unnecessary administrative costs in the health care system. The AMA estimates that eliminating all errors would save more than $17 billion overall.

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May 2012 Edition: Is Your Practice Making Value-Based Decisions?

Former Health and Human Services secretary Mike Leavitt once said about change, “You can fight it and fail; you can accept it and survive; or you can lead it and prosper.”

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April 2012 Edition: Keeping Costs Down on Self-Funded Health Care Plans

In the era of health care reform, one of the most significant issues everyone is facing is increasing costs. Yet organizations that have 50 or more employees can control expenses while maintaining valuable health care options for employees—through proper design and administration of a self-funded plan.

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March 2012 Edition: Capitation Isn’t a Four-Letter Word

Yes, of course, it’s a 10-letter word. But those of us who have been in the health care industry for a while can remember the days of managed care, when capitation was marred by many negative characteristics including an intense and distracting bottom-line focus, inadequate technology that didn’t always facilitate data capture and care management, and a shortage of clinical oversight and involvement.

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February 2012 Edition: Palmdale Regional’s ‘Rounding for Success’

Palmdale Regional Medical Center (PRMC), a spectacular new hospital in Palmdale, CA, opened on December 11, 2010. Prior to the hospital’s opening, Palmdale was the largest city in California without a hospital. Universal Health Services, the parent company from King of Prussia, Pennsylvania, built PRMC and closed the older facility that the staff had previously operated in a neighboring city.

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January 2012 Edition: California Health Plans Report Solid Profits Through September 30, 2011

California domestic health plans recently reported third quarter 2011 financial results and thirty of the largest thirty-five plans recorded a profit. However, twenty-one of the plans reported lower net income than the same time period in 2010, suggesting premiums may rise more than usual in 2012.

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December 2011 Edition: Sociocultural Considerations in Mass Decontamination

It is an unfortunate reality of our era that health systems will have to deal with the stresses of patient decontamination. Whether the result of terrorism or the byproducts of industrialized society, the potential for radiological, chemical, and biological contamination is all around us. Hospitals must be prepared to deal with the operational and safety issues posed by decontamination, an issue that has been largely addressed through the allocation of government funding towards the development of guidance, training, and equipment purchasing throughout California.

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November 2011 Edition: Palomar Medical Center West Palomar Medical Center West: Hospital of the Future

On the west side of the Escondido city limits, Palomar Pomerado Health is building the “hospital of the future.” The 50+ acre site is about two miles from the existing Palomar Medical Center, neatly placed to be easily accessible by Escondido and San Marcos residents via either the nearby I-15 or Highway 78. The two-towered, 740,000 sf facility will house full diagnostic services, operating rooms, cardiac catheter and interventional radiation, procedure rooms and space for a future inter-operative MRI, plus a large ED and Trauma Medicine area.

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October 2011 Edition: From the 2nd Percentile to the 75th Percentile in Four Years

In the September 2010 edition of the California Healthcare News, Enloe Medical Center’s quality improvement journey was presented (Creating a Quality Movement in Your Hospital). That article focused on creating a sustainable quality culture based on adopting best-practice care, engaging physician leadership and advancing their work with robust Board, administration and staff support. Now in the third year of that process, it continues to drive much of the organizational focus throughout the year.

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September 2011 Edition: ICD-10 Readiness and Adoption

The Department of Health and Human Services has issued a final rule on HIPAA electronic standards that would replace ICD-9 code sets with the greatly expanded ICD-10 code sets for claims, remittance advice, eligibility inquiries, referral authorizations, and other transactions.

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August 2011 Edition: ACOs and Shared Savings: Making a New Health Care Model Work

Health care reform has always been complicated, but the complexity is escalating at an accelerated pace. One of the reasons for this growing intricacy is the Patient Protection and Affordable Care Act (PPACA), enacted in March 2010, which requires the Department of Health and Human Services to establish a Medicare Shared Savings Program by the start of 2012.

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July 2011 Edition: Breaking Language Barriers in Health Care

Imagine finding yourself in a hospital, only to discover that you no longer have a mouth or ears. You cannot explain your symptoms, identify next of kin, or describe your medical history, nor can you understand the doctor’s diagnosis, instructions, or prognosis. For the growing number of patients in Emergency Rooms across the United States who arrive unable to communicate effectively in English, this is no dream, but a frightening reality.

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June 2011 Edition: Plan Readiness - Preparing for an Influx of Seniors and Persons with Disabilities Medicaid Beneficiaries

Caring for some of California’s most vulnerable citizens is nothing new for Molina Healthcare of California. Currently Molina manages over 15,000 Seniors and Persons with Disabilities (SPDs) members (5% of Molina’s total California membership). And company-wide Molina has been managing this population for 30 years and currently serves 150,000 in the states where we operate health plans. However beginning in June, Molina and other Medicaid health plans will begin managing more of these members. Why?

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May 2011 Edition: “One Team, One Journey” Motto Drives UC San Diego Sulpizio Cardiovascular Center Project Success

In April 2011, San Diegans gained their first and only dedicated cardiovascular center with research, programs and patient services all in one location. The culmination of a seven-year project, the Sulpizio Cardiovascular Center was named for Richard and Maria (Gaby) Sulpizio, who bestowed a $10 million dollar leadership gift on the University of California, San Diego.

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April 2011 Edition: Maximizing Value from Purchased Services

No one knows whether the health care reform law will withstand the series of challenges that now confront it in the courts, Congress, and the states. But one thing is certain: Whether it’s through decreasing fraud and abuse or increasing operational efficiency, the drive to cut health care administrative costs will continue, no matter how the health care reform battle turns out in 2011 and 2012.

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March 2011 Edition: Is Your Audit Committee Highly Functional?

Responsibilities of audit committees have increased significantly over the past 20 years. Although some committees have shifted to accommodate new structures and operations, many have been slow to embrace the increase in roles and responsibilities, leaving them vulnerable to shareholder and stakeholder scrutiny.

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February 2011 Edition: 2011 Human Resource Checklist

Human resource professionals are critical to the success of every organization. As the New Year begins, they should ensure their companies have updated policies and employees trained on new and developing issues.

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January 2011 Edition: Federal Healthcare Reform Begins for Health Plans

The passage of federal healthcare reform in 2010 marks a new era for employer-sponsored health plans. Along with the requirements of other recently passed laws, group health plans must comply with several new provisions of the Patient Protection and Affordable Care Act (“PPACA”) summarized in this article.

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December 2010 Edition: HIPAA Version 5010: Staying Ahead of the Curve

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was designed to simplify health care administration and improve efficiency and cost effectiveness. But much to everyone’s surprise, the legislation didn’t have a tremendous impact until 2003, when the Centers for Medicare & Medicaid Services mandated the use of electronic data interchange (EDI) and set standards for information privacy and security.

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November 2010 Edition: RAC Attack: How Can Hospitals Guard Against Medicare Reimbursement Loss?

One of the biggest high-wire acts for hospital administrators and executives today is ensuring that the clinical documentation supports the services coded and billed. Why is this important? Because, to put it simply, Medicare revenue retention is directly tied to hospitals’ clinical documentation quality and coding accuracy.

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October 2010 Edition: Loma Linda University Heart & Surgical Hospital: Delivering a Next-Generation Patient Experience

When a brand new hospital opens its doors, the expectations are always high for delivering a stellar patient experience. That was certainly the case when the Loma Linda University Heart & Surgical Hospital (LLUHSH) opened its doors in January 2009.

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September 2010 Edition: Creating a Quality Movement in Your Hospital

“We can stand still and fall behind, we can move forward and stay even, or we can choose to lead and define the future.”

These words by Dr. Arthur Dugoni served as a wake-up call and challenge to Enloe Medical Center in 2009. In 2006, Enloe’s administration received a no-confidence vote from its medical staff. The following three years were marked by four different acting hospital administrators, several tragic surgical services outcomes and three Immediate Jeopardy determinations. In addition, regulatory agencies were on-site nearly two-thirds of the time for months on end. This drama was played out in the local press and in coffee shops and businesses. The status quo had to change, and it had to change immediately.

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August 2010 Edition: Leadership 101: Are You Paying Retail?

I was recently honored to attend the 58th Annual Meeting of the Association of California Healthcare Districts (ACHD). On the shores of Lake Tahoe, representatives from the member districts listened to industry leaders on topics important to management of these government instrumentalities in the midst of very trying times.

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July 2010 Edition: Owner Controlled Insurance Programs Significantly Reduce Construction Costs

Since 2007, California hospital construction expenditure has increased from $2 billion to $9 billion annually (California Healthcare Foundation). This surge in costs is expected to continue for the next 15 years, as hospitals strive to comply with seismic regulations and modernize physical infrastructure.

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June 2010 Edition: A Solution to the New Nursing Graduate Hiring Dilemma

Newly graduated nurses are having great difficulty finding jobs as registered nurses (RNs) as they compete with experienced nurses who are working more because of the economy. With fewer nurses retiring or working part-time, positions typically available to new nurses have dried up and hospitals and health systems have cut back dramatically on new graduate hires.

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May 2010 Edition: Exit Strategies for Physician Groups

Whether you’re a physician with a small or large group, you’re likely concerned about the future of your practice. You’ve dedicated a great deal of time and energy to building your practice and taking care of patients.

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April 2010 Edition: California Hospital Financial Health Improves

New figures published by the California State Office of Statewide Health Planning and Development (OSHPD) indicate the financial health of California hospitals may be improving.

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March 2010 Edition: Build America Bonds Combine with HUD Mortgage Insurance to Provide Exceptional Borrowing Option

Governmental hospitals seeking capital for renovations, new construction or acquisition may have only until the remainder of the year to take advantage of a temporary Federal option designed to provide lower-interest financing.

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February 2010 Edition: Investment Income: Revenue Enhancement for Pension Plan, Foundation & Endowment Investors

The Demand for More Income

Most liability-driven institutional investors are in a difficult position these days. Pension plans are faced with challenging regulatory and market conditions in the form of increased funding obligations. These reflect actuarial calculations that integrate regulations, assumptions, historical investment returns and expectations and projections for future investment results.

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January 2010 Edition: Money and Medicine: How Better Financial and Retirement Planning Can Benefit Physicians - and Their Practice

Being a physician has always been challenging. But today it's tougher than ever. In addition to focusing on the best medical outcomes for patients, doctors must cope with the wealth-shrinking impact of last year's financial meltdown as well as the potential consequences of healthcare reform, which could force them to significantly alter the way they practice.

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December 2009 Edition: Recapitalization in the Healthcare Industry: We've Only Just Begun

The extraordinary impact of the ongoing national economic crises has profoundly affected most sectors of the healthcare industry. Today one of the major issues confronting mid-size hospitals, and other investor-owned or not-for-profit facilities, is the ability to identify sources of reasonably priced, and structured, debt and equity capital. This financial constraint includes equity and debt for new capital projects or to help strenthen current balance sheets; debt to refinance and extend the maturity of bonds or other outstanding senior debt; and even the level of capital needed to support the continuation of operating lines at their current levels.

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November 2009 Edition: Where to Find the Perfect Finance Director

The Finance Director is one of the most critical positions in any healthcare business. In small and medium size organizations it could be the top finance leader. In large organizations it could be several levels down from the top finance leader. This article summarizes the methods currently used to find Finance Director candidates and evaluates each method's overall effectiveness.

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October 2009 Edition: Keeping ICE Out of the Workplace: An Update in I-9 Compliance

By now, most healthcare employers have heard of E-Verify. But many remain uncertain as to whether E-Verify applies to them. And for good reason - the final rule requiring certain federal contractors and subcontractors to use E-Verify has been embroiled in litigation and its implementation delayed no less than four times.

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