22 May 2012

Midwest Edition
Calendar
June 6-7
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Doc FInancial Reporting Is Stalled

ACA-Mandated Payment Disclosures Off Until 2013
The Center for Medicare and Medicaid Services has delayed requiring pharmaceutical companies and medical device manufacturers to begin collecting and disclosing information on payments they make to providers until January 1, 2013. This postponement is one year beyond the date scheduled initially in the Affordable Care Act. In a public statement, CMS said it received more than 300 statements from various stakeholders during the 60-day comment period about the law, designated the Physician Payments Sunshine Act, co-authored by Sens. Chuck Grassley, R-Iowa and Herb Kohl, D-Wis. In order to provide time for organizations to prepare for data submission and to sufciently address the important input we received during the rulemaking process, CMS will not require data collection by applicable manufacturers and applicable group purchasing organizations before January 1, 2013, the statement said. Grassley was unhappy with the delay. The process has dragged on long past the statutory deadline for implementation, he said in a statement. Consumers need to know more about the nancial relationships between their doctors and drug companies sooner rather than later Given all of the extra time, CMS will have no further excuses for not accomplishing these goals. CMS has likely delayed the process because this wasnt one of the main pieces of legislation created by the ACA, said Douglas Wood, director of strategy and policy for the Mayo Center for Innovation at the Mayo Clinic and chair of the medical nance access and delivery committee for the Minnesota Medical Association. They still have a lot of guidance to come for the exchanges and essential benets and other things, he said. I would presume its simply because they have a lot of things to do and this isnt a top priority and it isnt a problem. A handful of states already have some sort of nancial disclosure or limit. These include Vermont, Massachusetts and Minnesota. For those already reporting, the federal legislation may not have much of an affect. The Minnesota Medical Association adopted its provision about a year ago. It was a result of bills that were introduced in the state House that were aimed at detailing what pharmaceutical companies gifts to physicians and direct-to-consumer advertising. The policy, adopted unanimously by the MMA board, said that physicians shouldnt
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June 11-13

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June 26-27

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E-Mail info@payersandproviders.com with the details of your event, or call (877) 248-2360, ext. 3. It will be published in the Calendar section, space permitting.

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NEWS
Sunshine (Continued from Page One)
accept gifts of any value from pharmaceutical or medical supply companies. Physicians should be very transparent and avoid the appearance of a conict of interest by avoiding accepting gifts of any value by pharmaceutical and device companies whether food in the ofce or pens or anything, Wood said. The policy applies only to MMA members. There is no method of surveying physicians, so Wood said it is, to some degree, voluntary. He added, though, that device companies have been reporting the information for a number of years, and it is readily available on their Websites. There were physicians in the organization who expressed opposition to the policy, Wood said. They were concerned it would create a chilling effect on their ability to collaborate with outside business. But Wood and the MMA disagreed. Im not sure of where there is any example of a policy of this sort that has limited education or research efforts between companies and physicians, he said. And the federal law shouldnt be an impediment either. The law would benet other physicians who would know that literature or a lecture

Page 2

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In Brief
Minnesota Blues Names New CFO
Jamie Rice, a veteran finance executive with a number of Minneapolis-area firms, has been named as chief financial officer and senior vice president of Eagan, Minn.-based Blue Cross Blue Shield of Minnesota. Rice has spent the past four years at Yukon Partners, a capital investment firm based in Minneapolis, where he also served as CFO. Prior to that, he spent seven years with UnitedHealth Group, serving as CFO of its commercial business and director of corporate development. Prior to UnitedHealth, Rice served as an auditor for the Arthur Andersen accounting firm. "Jamie's considerable industry experience and financial acumen will be a great asset in managing the financial strength of Minnesota's largest health plan," said Minnesota Blues Chief Executive Officer Ken Burdick. Rice, who also serves as treasurer for the Second Harvest Heartland charity, will start at the health plan on June 18.

they are hearing may be biased because of nancial conicts, he said. It will benet policy makers who hear physicians arguing for payment or reimbursement reform and may have conicts. And ultimately, if information could be provided in a way thats more helpful for consumers to understand, it might inuence some of their decisions, too, he said. A lot of providers, including the Mayo Clinic, receive money for research and development. According to the Pew Health Group, direct marketing by pharmaceutical companies to healthcare professionals is estimated to be anywhere from $20 billion to $57 billion annually. For most providers, it likely doesnt inuence what they do. But Wood argues that the information should be disclosed so patients and others at least have the knowledge to make informed decisions. It is important we be able to collaborate with industry to develop and study how devices perform, Wood said. There needs to be some relationship and industry makes payments to physicians for development, but I think its important for those to be open and people understand where those conicts exist. TAMMY WORTH

Hospitals Want Healthier Employees

More Bars on Weight, Smoking Are Implemented
A for-prot cardiac hospital in rural Texas has a new policy prohibiting the hiring of overweight employees. Citizens Medical Center in Victoria no longer hires employees who score higher than 35 on the body mass index (about 210 pounds for someone about ve feet, ve inches tall). According to an article in the Texas Tribune, the hospital adopted the policy
Continiued on Next Page

OSU Completes Hospital Expansion

Ohio State University has completed a $1.1 billion expansion of its medical campus, which includes one of the tallest healthcare-related buildings in the U.S. The Wexner Medical Centers expansion includes the construction of a 21-story building housing the James Cancer Center and the

WEBINAR

Thursday, May 24, 2012

Noon CST

HOSPITAL DISTRICTS: MAPPING THE FUTURE

Please join Michael A. Dowell, partner, Hinshaw & Culbertson, Walter Kopp, president, Medical Management Services, Inc. and Cleo E. Burtley, manager, The Camden Group, to discuss the future of hospital district management. More Info @:

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Continued on Page 3

PAYERS & PROVIDERS

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Longer ALOS!*

NEWS
Smoking (Continued from Page Two)
because it wants its employees to have a representational image or specic mental projection of the job of a healthcare professional. The hospitals CEO, David Brown, also said in the article that it is due to the healthcare costs the organization incurs associated with overweight employees. This is an extreme example of how hospitals are trying to create a healthier workforce. It may not be modeled elsewhere, but a growing number of healthcare providers are taking up the same charge with a different target: tobacco users. According to the Bureau of Labor Statistics, 19 states allow job screening for tobacco use. Geisinger Health System based in Danville, Penn. quit hiring smokers at the beginning of the year as did Summa Health System in Akron, Ohio. Other Midwestern entities that no longer hire smokers include Truman Medical Centers in Kansas City, and St. Francis Medical Center in Cape Girardeau Mo.; Crittenton Hospital Medical Center in Rochester, Mich; and ProMedica, a system with hospitals in Michigan and Ohio. Cleveland Clinic was one of the rst to stop hiring smokers when it instituted a policy in 2007. Paul Terpeluk, the osteopathicallytrained medical director of employee health at the organization, said the move was part of a continuous wellness initiative at the clinic. Potential hires are tested and if they are positive, their employment offer is rescinded for 90 days. During that time, they are able to undergo a smoking cessation program. If they test negative, they are eligible for employment. Terpeluk said it has reduced the number of smokers, but only affects a small number of applicants. The provider has performed about 25,000 tests since 2007 and about 250 were positive. What we want is a healthier workforce,

Page 3

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In Brief
Solove Research Institute and Critical Care Center. It is the largest construction project in the Ohio State University systems history. Ohio State officials say the expansion project generated 5,000 full-time construction jobs, and will generate 6,000 full-time research and healthcare-related jobs.

Michigan Blues Announces Clinic Grants

Blue Cross Blue Shield of Michigan is accepting grant applications from the states safety net clinics who treat the uninsured. The clinics may receive noncompetitive grants of up to $15,000, and competitive grants of up to $50,000. The Michigan Blues made grants to more than 50 safety net clinics in 2011. About 1 million Michiganders lack health insurance approximately 10% of its population. The Michigan Blues have provided $7 million in grants to safety net clinics since 2005. Blue Cross is proactively working with safety net providers around the state to help free clinics continue their important mission of providing uninsured Michigan residents with access to quality health care, said Lynda Rossi, the Michigan Blues senior vice president of public affairs. Access to quality healthcare helps people stay healthier, keeps them out of the emergency room, and saves the healthcare system money. The grants may be used for a variety of purposes, including the streamlining of ofce operations via the installation of new technology, or collaborations with local hospitals or other providers to increase the number of patients receiving care. Notice of intent to apply for a grant is due by June 21. Full grant applications are due by July 9.

he said. But it also gave us a national platform we have gotten good publicity about it and it is good for people to have the debate about whether or not they should hire smokers. ProMedica instituted its policy in January 2011. Laura Ritzler, director of wellness, likens the move to screening for drug use during the interview process. Theres no use of tobacco that is healthy for you, she said. It is about making personal choices that are bad for you. The main motivation behind the move was to be a role model in the community, but it has had peripheral benets as well. Wendy Papenfuss, the organizations director of human resources, said it is a very costly habit for an employer to take on. Studies have shown that smokers miss an average of six sick days of work per year (as opposed to nonsmokers, who miss three). The U.S. Centers for Disease Control and Prevention estimates that smokers cost an employer almost $3,400 annually in lost productivity and increased medical spending. Ritzler said they hired about 2,000 people last year, of which about 400 would have been tobacco users (if they had a smoking rate similar to that of the overall community). This equates to more than $1 million in savings a year in related healthcare costs. The organization is also one of the largest healthcare employers in its area and acts as a clinical site for a number of local medical schools. The schools have put the word out that if students want to be hired at ProMedica, they cant smoke. We are living our mission, Ritzler said. And the impact on the schools is that, when students are nishing up clinicals, the school is telling them this is probably a trend in healthcare so dont use tobacco. TAMMY WORTH

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Payers & Providers

OPINION

Page 4

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Illinois Is Facing Medicaid Black Hole

Proposed Cuts Are Too Steep to Maintain Safety Net
We agree Illinois Gov. Pat Quinn and the states thoughtful and realistic strategy that makes the General Assembly must address the Medicaid Medicaid program more cost effective, through programs challenges, and hospitals are greater efciencies and cost savings, providing committed to partnering with the state on this up to $1.4 billion in possible savings. IHAs critical issue. alternatives include: But a proposed cut of more than $2 billion Enforcing current Medicaid eligibility in Medicaid, including an 8% rate cut (more requirements while maintaining the health care than $350 million) to hospitals, would cause safety net for those who truly are eligible, irreparable harm to our already fragile health providing savings in the hundreds of millions of care system and undermine hospitals in their dollars; vital roles as health care providers and as major Identifying third-party liability and assuring job creators and employers. proper billing of such payers; There is a better way. The Reimbursing hospital outpatient Illinois Hospital Association drugs separately, enabling the has proposed a 12-point plan state to collect drug that will help x the Medicaid manufacturers' rebates; and program and not cause Improving care to reduce costs devastating side effects. through greater care Medicaid is a healthcare coordination, including the lifeline to 2.7 million current Primary Care Case Illlinoisans, including the Management Program, which has elderly, the disabled, children saved the Illinois Medicaid and people who recently lost a program more than $530 million job and their insurance from 2007 to 2010. coverage. In fact, more than Hospitals have been one of the half of the births in Illinois each only provider groups to offer By year are covered by Medicaid. cost-saving alternatives. Maryjane A. signicantthe Medicaid program's These patients are served by However, Wurth hospitals that are reimbursed by challenges cannot be addressed just Medicaid far less than their actual costs. Illinois through reductions and savings. The state also already has one of the lowest costs per needs additional sources of revenue. Medicaid patient, ranking 44th in the nation, Thats why hospitals support increasing the and this would be one of the largest Medicaid state's cigarette tax by $1 per pack. This will save cuts in the country. Every dollar in rate cuts lives and improve the health of Illinoisans, means half is returned to the federal substantially reduce costs for the Medicaid government. Now is not the time to give back program (by $50 million in the rst year), and federal revenues. generate $377 million in new revenue for the Nearly one in three Illinois hospitals is state, which would be matched dollar-for-dollar operating in the red. Another 12% of Illinois by the federal government when used for hospitals have margins of less than 2%. Severe Medicaid, for a total of $754 million. Medicaid cuts would force many hospitals to Nobody expects a miracle cure to the states reduce or eliminate key services or lay off staff budget problems. But by pursuing steady or both. Some hospitals may even close, progress through thoughtful solutions, we can creating health care deserts around the state, nurse the Medicaid program and states nances where critically needed health services will no back to health without atlining hospitals and longer be available for everyone, not just health care system and the patients and Medicaid patients. communities that depend on them. At the same time, health care costs for businesses and employers will rise. The Maryjane A. Wurth is President of the Illinois proposed rate cut also would result in the loss Hospital Association. of nearly 3,700 jobs and $470 million in business activity, neither of which the state can Op-ed submissions of up to 600 words are afford. welcomed. Please e-mail proposals to In contrast, IHAs Medicaid plan is a editor@payersandproviders.com

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MARKETPLACE/EMPLOYMENT

Page 5

AVP - Accountable Care Organization

Patients and families from across the region and around the world come to Cincinnati Children s Hospital Medical Center because we are dedicated to improving child health. We serve the medical needs of infants, children and adolescents with family-centered care, innovative research and outstanding teaching programs. Cincinnati Children's Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S.News and World Report's 2011- 2012 Best Children's Hospitals ranking. It is ranked #1 for gastroenterology and in the top 10 for all pediatric specialties - a distinction shared by only two other pediatric hospitals in the United States. Cincinnati Children's is one of the top two recipients of pediatric research grants from the National Institutes of Health. It is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Working for the largest national pediatric healthcare system, the Assistant Vice President will lead and manage its newly created Accountable Care Organization (ACO) with anticipated annual revenues up to $500 million. Major responsibilities include Network Delivery, Network Management, Credentialing, Data Analysis and Reporting, People Management and Payor Contracting and Relations. Specifically responsible for provider enrollment with payors, network provider contracting and provider relations issues, ACO credentialing program, processes related to administering payor contracts, medical management functions including care management, care coordination, utilization and disease management programs, quality improvement programs across ACO provider network, data analysis and reporting. Assist in payor contract negotiations. To be successful, our ideal candidate will possess a Bachelor s degree along with ten years experience managing network management, care management, medical management, and/or care coordination activities in hospital-owned or physician-owned health plan, PHO, or payor environment. Master s degree in business or health administration preferred. The incumbent must possess resiliency and perseverance in both starting up new business enterprises and in scaling up business enterprises after start-up phase. Demonstrated leadership and management skills required along with experience in formulating credible, effective, long-range strategies to attain overarching organizational objectives; anticipating future trends, as well as potential threats or opportunities; and accurately predicting how strategies will play out. Network management experience in Medicaid managed care plan desirable. Experience starting up new business enterprises preferred. Cincinnati Children's Hospital Medical Center offers a comprehensive employee benefits program that is equal to or better than the majority of the other health care institutions in the city. The benefits program is constantly reviewed to identify better ways to deliver world-class benefits. Visit our career site at www.cincinnatichildrens.org to submit your resume and application. Job ID# 58097. Cincinnati Children s is an Affirmative Action/Equal Opportunity Employer.

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Page 6

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