MAY 8, 2012

 Printable Version

Lora McPhail, Cigna Healthcare
Lora is Regional Assistant VP of Healthplan Operations at Cigna, one of the nation's largest health insurers, covering over nine million people with its various medical plans, including PPO, HMO, point-of-service, indemnity, and consumer-directed products. Lora has held her current position since January 2012, and was previously Cigna's Manager of Healthplan Operations for three years. Referred to ABL by Chris De Rosa of Cigna, Lora has joined the Leadership Round Table.

NCHS Awarded $5 Million; AltaMed Wins Too
A $5 million grant has been awarded to North County Health Services, part of a $728 million nationwide program contained in the 2009 Affordable Care Act to help community health programs expand their capacity by new construction and renovating existing centers.  Also, AltaMed Health Services was awarded $500,000. (Irma Cota, San Diego; Castulo de la Rocha, Los Angeles)

OneLegacy Sees Spike in Organ Donation Registration
California's organ donation database had a significant increase in registrations last week after Facebook introduced an optional "organ donor" status designation. Tom Mone, CEO of OneLegacy, the federally designated organization that does organ recovery in Southern California, didn’t know about the Facebook plan until last Tuesday, and was thrilled with the news. By late Tuesday, the Donate Life California website reported an increase of over 1,300% in online registrations from Monday. Tom also shared that he worked with Steve Jobs on a piece of legislation in California that will take effect this autumn, which will set up a registry for people who want to donate organs while they are still alive. Tom also said he’s supporting legislation that would incorporate organ donation into school health classes. (Tom Mone, Los Angeles)

Paul Hastings Advises Ardea Biosciences in Acquisition
Ardea Biosciences, a San Diego, CA-based biotechnology company, is being represented by Paul Hastings LLP in its $1.26 billion all-cash acquisition by AstraZeneca. Ardea is focused on the development of small-molecule therapeutics for the treatment of serious diseases. Global M&A chair and partner Carl Sanchez led the Paul Hastings team. (Carl Sanchez, San Diego; Jim Owens, Los Angeles; Mike McKinnon, Orange County)

PerfectServe Deemed a "Cool Vendor"
Gartner, Inc. has named PerfectServe to its "Cool Vendors in Healthcare, 2012" report. Cool Vendors are selected for being innovative, impactful and intriguing, according to Gartner, and are true innovators that have found nuanced ways to apply technology to practical administrative, clinical and social problems of delivering healthcare. (Gene Barduson, San Diego)

QSI Acquires Matrix Management Solutions
To support the growth of its NextGen Practice Solution offering, Quality Systems, Inc. has acquired Matrix Management Solutions, an Ohio-based value-added reseller. This enables NextGen to expand its footprint among private and hospital-based physicians and groups by leveraging Matrix's revenue cycle management expertise. (Steve Plochocki, Orange County)

Robert Bosch Healthcare Teams with Waldo Health
Waldo Networks, Inc. (aka Waldo Health) and Robert Bosch Healthcare Systems have entered into a licensing agreement that gives Waldo the right to sell products and services incorporating technologies from Bosch’s extensive telehealth portfolio, which consists of 145+ issued U.S. patents and 60+ U.S. patent applications and foreign equivalents. (Jasper zu Putlitz, San Francisco)

State Launches "Health Happens in the Workplace"
A pilot state government workplace wellness program has been announced by The California Endowment, Kaiser Permanente, HealthCorps, California State Controller John Chiang, State Treasurer Bill Lockyer, the Department of Personnel Administration, CalPERS, and the SEIU Local 1000. The two-year pilot will be based on proven interventions with a focus on increasing physical activity, eating better, and reducing stress. Benchmarks will be established so that both changes in the health status of the participating employees and savings to the State can be measured.
     Also, Kaiser Permanente has joined with HBO, the National Institutes of Health, the Institute of Medicine, the Michael & Susan Dell Foundation, and Centers for Disease Control and Prevention to launch The Weight of the Nation - a four-part documentary series that will be available to all cable subscribers (not just HBO) on May 14 and 15. These organizations have launched a public-health campaign during May aimed at obesity, excess weight, and their effects on the nation’s health. (Kathlyn Mead, Los Angeles; Dan Edmonds-Waters, San Francisco; Chris Boyd, Silicon Valley)

Anthem Blue Cross Intro's Availity Info Network
Availity, a new information network, is now available to Anthem Blue Cross network physicians and hospitals. Providers can use the secure, Web-based exchange to quickly and easily obtain current insurance coverage information on patients (including eligibility and benefits); submit claims online and monitor their status; access patient clinical history and care alert messages; and access CareProfile, Availity's claims-based EMR. (Pam Kehaly, Los Angeles)

AT&T Announces Remote Patient Monitoring Service
Valued Relationships Inc. (VRI) and AT&T will deliver a remote patient monitoring service to more effectively manage chronic diseases and help reduce hospital readmissions. The end-to-end managed solution will allow a VRI nurse-staffed telemonitoring center to monitor patients around the clock for everything ranging from basic vital signs to chronic diseases, following standard of care guidelines established by physicians and healthcare providers. The intelligent service can alert caregivers when intervention is needed. (Judi Manis, Orange County; Marina Younani, San Francisco)

Fundraisers: Catasys & Independa
Catasys, Inc. has closed a private placement to raise approximately $3.4 million with institutional and other accredited investors.  And, Independa has closed its convertible note funding at $2.35 million, with investment that surpassed the target of $2.2 million. (Rick Anderson, Los Angeles; Kian Saneii, San Diego)

CEI's Peter Szutu Recognized as Outstanding
Peter Szutu, CEO of Center for Elders Independence, the East Bay Area’s PACE program, is being honored as “Outstanding Mentor of the Year” by Aging Services of California, at their Annual Conference and Exposition, May 7 - 9. Since joining CEI in 1994, Peter has nurtured its growth from 80 participants to over 500, from one site to four. He has also actively mentored his staff and others who are dedicated to helping seniors, particularly the poor, frail elderly, age well into the future. (Peter Szutu, San Francisco)

CMS: Over $3.4 Billion Saved on Rx
Seniors and people with disabilities with Medicare have saved a total of $3.4 billion on prescription drugs since the enactment of the Affordable Care Act through March of 2012, according to the Centers for Medicare & Medicaid Services. In the first three months of 2012, 220,000+ people saved an average of $837 on the prescription drugs they purchased after they hit the prescription drug donut hole, for a total of $184.5 million in savings. This builds on the $3.2B saved in 2010 and 2011 on prescription drugs by over 5.1 million people with Medicare. In addition, from January through March, 8.9 million people in traditional Medicare received at least one preventive service at no cost to them, including over 560,000 who utilized the new Annual Wellness Visit. In 2011, over 32.5 million people in traditional Medicare received one or more preventive benefit free of charge. (Dave Sayen, San Francisco)

Cigna Wins Montana Contract + Honored in Arizona
The state of Montana has awarded Cigna a three-year contract to provide health services to over 30,000 state employees and family members, beginning in 2013.  Meanwhile, Cigna Medical Group was honored by The Arizona Partnership for Immunization with the “Dr. Daniel T. Cloud Outstanding Practice Award” in recognition of its leadership and excellence in immunizing Arizona children – reaching 90% coverage levels. (Chris De Rosa, Orange County; Lora McPhail, Leadership Round Table)

Doximity Achieves New Milestone
In the year since its launch, Doximity has grown to over 50,000 active physicians and is now used by 9% of all doctors in the U.S. In that time, Doximity has facilitated more than one million connections between doctors, affecting the care of tens of millions of patients. In the past year, Doximity has also secured partnerships with leading research, medicolegal, and second opinion firms to build ExpertFinder, which matches Doximity physician CVs with paid consulting and interview opportunities. In total, Doximity's clients paid over $100 million in honoraria to physicians last year. (Jeff Tangney, San Francisco)

GSK Collaborates with Yale on Drug Discovery
Yale University and GlaxoSmithKline have established a drug discovery research collaboration to design a potential new class of medicines that degrade disease-causing proteins. It combines GSK’s expertise in medicinal chemistry with Yale’s pioneering work on proteolysis targeting chimeric molecules (PROTACs). PROTAC technology guides disease-causing proteins to a cell’s “garbage disposal” where they can be destroyed. Mutant or higher-than normal amounts of these proteins typically drive disease progression in areas such as oncology, inflammation and infections. (Arlene Kirsch, San Francisco)

HeartMath Teams with Huffington Post on New App
The Huffington Post and HeartMath LLC have partnered to release a new app in June called GPS for the Soul that will proactively address the persistence of the world’s stress epidemic. The goal is to provide millions of people with tools, techniques, and technology to take charge of stress and find more joy, peace, and quality in life.  Meanwhile, registration is open for Bruce Cryer's workshop, "The Regenerative Power of Heart Intelligence: Restoring Balance, Harmony and Resilience with the HeartMath System" in Montefalco, Italy, Sept. 13-18, 2012. (Bruce Cryer, Silicon Valley)

Keenan Reviews Proposed Workers' Comp Legislation
A new Briefing is available from Keenan: 2012 Workers' Compensation Legislation Introduced, which discusses some of the proposed legislation introduced in the California Assembly and Senate by the bill introduction deadline of February 24, 2012. (Steve Richter, Los Angeles)

Linden Makes Acquisitions
Linden Capital Partners has completed the acquisition of SeraCare Life Sciences, Inc., of Massachusetts, which provides products and services to facilitate the discovery, development, and production of human diagnostics and therapeutics.  Also, Linden-owned CORPAK MedSystems, Inc., a developer, manufacturer, and marketer of medical devices for the enteral feeding and bedside-location markets, announced a definitive agreement to acquire the intellectual property of Micronix, Pty Ltd. (Tony Kesman)

UPCOMING ROUND TABLES & EVENTS

5/8 - Silicon Valley Round Table
5/9 - San Francisco Round Table
5/15 - San Diego Round Table
5/18 - Los Angeles Round Table
5/23 - Approaches That Work to Create a More Productive Culture - Newport Beach, Membership-Wide Conference
6/6 - Orange County Round Table
6/15 - Bay Area Social - San Rafael Hills

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MEMBERS ARE READING . . .

ABL Members, please let us know what books, industry journals, etc. you're finding especially worthwhile these days and we'll share them with your fellow Members - here and on the Members Only portion of ABL.org.

At a recent Round Table, these books were recommended:

Join the Club: How Peer Pressure Can Transform the World by Tina Rosenberg

Delivering Happiness: A Path to Profits, Passion, and Purpose by Tony Hsieh (CEO of Zappos.com)

Only the Paranoid Survive: How to Exploit the Crisis Points that Challenge Every Company by Andrew S. Grove

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CMS Proposes Small Pay Hike for Acute-Care Hospitals
In a proposed rule, the CMS said it expects operating payments to acute-care hospitals will increase by about 0.9% in 2013. That figure includes a 2.3% net payment update - which accounts for inflation, productivity improvements, coding changes, and other adjustments - and other policies included in the rule. Overall, CMS said it expects total Medicare spending on inpatient hospital services will increase by about $175 million in fiscal 2013. Also under the proposed rule, payments to long-term acute-care hospitals are expected to increase by about 1.9%, or about $100 million, next year. That projection is based on a 2.1% payment increase to those facilities that is then reduced by 1.3% to account for one-time budget-neutrality adjustment, which brings the actual payment-rate increase for long-term-care hospitals to 0.8% for next year. The regulation also suggests changes to the hospital inpatient quality reporting program; outlines new measures for the hospital value-based purchasing program; and proposes requirements for the ambulatory surgical center quality data reporting program that is effective as of 2014. (modernhealthcare.com, 4/24/12)

HHS Incentivizes Community Services
Health and Human Services has finalized the Community First Choice rule - a new state plan option under Medicaid - so that it provides states choosing to participate with a six percentage point increase in federal Medicaid matching funds for providing community-based attendant services and supports to beneficiaries who would otherwise be confined to a nursing home or other institution. (CMS release, 4/26/12)

Brown Orders Task Force on Californians’ Healthcare
California Governor Jerry Brown ordered HHS Secretary Diana Dooley last week to form a task force to write a 10-year plan for improving Californians’ health and controlling healthcare costs. Brown called for a “Let’s Get Healthy California Task Force” to include representatives of patients, providers, and labor unions, among others. The group is to report by Dec. 15, 2012, on targets for reducing diabetes, asthma, childhood obesity, and other chronic conditions, as well as reducing hospital re-admissions and increasing the number of children who receive vaccines. (Sacramento Bee, 5/4/12)

Tips on Managing the "Confusion" of Hospital Pricing
A recent article in the New York Times - The Confusion of Hospital Pricing - discussed a new study which found hospital charges for various procedures to be “all over the map” - even among patients treated for the same condition at the same hospital. “We expected to see variations of two or three times the amount, but this is ridiculous,” said Dr. Renee Y. Hsia, the study’s lead author and an assistant professor of emergency medicine at UC San Francisco. “There’s no other industry where you get charged 100 times the same amount, or 121 times, for the same product,” she said. The article concludes with “some advice from experts”:
*Hospitals in Network: When you purchase or renew a health insurance policy, learn which local hospitals are in your network and when pre-approval is required. Inquire about out-of-network coverage in advance of travel. If possible, avoid plans that base out-of-network reimbursement on Medicare rates, which are comparatively low.
*Insurance Coverage: If you need an elective procedure and are insured, ask your insurer for an E.O.B. - an explanation of benefits - before the treatment. If you have insurance and the procedure is pre-approved, get it in writing.
*Pricing Information: If you’re uninsured or have a high-deductible policy, and if your state has hospital pricing transparency laws, contact the appropriate person at each hospital for pricing information. State hospital associations may help. Consult the Healthcare Blue Book to get an idea of fair prices, but remember that’s no guarantee. Under the Affordable Care Act, all hospitals are supposed to publish their prices for common services by 2014. If you manage to get an estimate of charges from a hospital, make sure you know exactly what services are included. Physician fees are billed separately, for instance - an anesthesiologist’s charges are separate from a surgeon’s. Having medical billing codes is helpful.
*Physicians’ Fees: Broach the subject of charges with your doctor, even if it’s uncomfortable. FairHealth, an independent nonprofit corporation, provides medical pricing information. Healthcare Blue Book suggests asking your doctor to sign a binding price estimate in advance and suggests language in this example. (well.blogs.nytimes.com, 4/23/12)

Few Doctors Consider Themselves Rich - Survey
In 2011, compensation self-reported by surveyed physicians ranged from an average of $156,000 for pediatricians to $315,000 for radiologists and orthopedic surgeons, according to survey results released by Medscape. Also found, 51% of all physicians, and 46% of primary care physicians, think they’re compensated fairly. Only about 11% of doctors consider themselves rich, mostly because of their debts and expenses, according to Medscape. More than half said they expect their incomes to decline because of ACOs (although very few were participating in such a system), and 25% said quality measures and treatment guidelines will improve patient care. Overall, 54% of physicians said they would choose medicine as a career again; 41% said they would choose the same specialty and 23% would choose the same practice setting. (Kaiser Health News, 4/25/12)

Guidelines Given on Social Media Use by Docs
The Federation of State Medical Boards (FSMB) House of Delegates recently adopted new policy guidelines on the appropriate use of social media and social networking sites by physicians – developed to encourage physicians who use social media to protect themselves from unintended consequences. Recommendations include: *Physicians should only have online interaction with patients when discussing the patient’s medical treatment within the physician-patient relationship – and these interactions should never occur on personal social networking or social media websites. *Patient privacy and confidentiality must be protected at all times, especially on social media and social networking websites. Although physicians may discuss their experiences in non-clinical settings, they should never provide any information that could be used to identify patients. *Physicians should be aware that any information they post on a social networking site may be disseminated to a larger audience, and that what they say may be taken out of context or remain publicly available online in perpetuity. (FSMB release, 5/2/12)