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Alvarado Hospital filed a countersuit Aug. 31 in San Diego Superior Court against Blue Shield of California regarding overpayments for its members.
The private, 306-bed hospital in San Diego alleges that the insurance company “tried to negotiate rates even lower” than with Tenet Healthcare Corp., according to Chuck LaBella, a San Diego-based attorney for Alvarado Hospital. Dallas-based Tenet, which had a partnership with Blue Shield for more than 20 years, sold the hospital to Pejman and Pedram Salimpour on Jan. 1 for $22.5 million.
The original lawsuit filed July 24 required the hospital to accept a contract negotiated by Tenet, according to a news release from Alvarado Hospital; hospital officials are worried that if Alvarado is forced to “accept below-cost reimbursement,” the existence of the hospital will be threatened.
Blue Shield is a not-for-profit health plan based in San Francisco, according to its Web site, and has more 35,000 members within a 15-mile radius of the hospital.
“The whole issue at stake is whether the contract stands with Alvarado,” said David Seldin, corporate communications director for Blue Shield. “Alvarado, for some reason, acted like the contract was not intact.”
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PPH Site Visit:
Palomar Pomerado Health was one of five hospitals selected for a national site visit as part of a pay-for-performance project that is working to establish whether or not economic incentives improve patient care.
More than 40 health care officials from around the country were scheduled to attend a demonstration by five practice teams at Palomar Medical Center on Sept. 10, according to Opal Reinbold, chief quality officer for the health system at PPH.
“It’s a very nice honor,” she said. “It’s such excellent performance, better care for our patients and wonderful recognition for our staff.”
Premier Inc., a San Diego-based health care alliance owned by not-for-profit hospitals, is working with the Centers for Medicare and Medicaid Services for the Hospital Quality Incentive Demonstration pay-for-performance project.
Top-performing hospitals will be rewarded with increased payment for Medicare patients, according to CMMS.
Since the project’s inception in 2003, 260 hospitals nationwide have participated. Hospital performance is tracked in five areas: acute myocardial infarction, heart failure, community-acquired pneumonia, coronary artery bypass graft and hip and knee replacement.
Palomar Medical Center is a projected second decile performer in four areas (except pneumonia), meaning that it will receive a 1 percent bonus of Medicare DRG payments for each of those four clinical areas. In the second year of participation, Pomerado Hospital and four other hospitals in California were eligible to receive reimbursement.
“This is not just the project,” Reinbold said. “This is day-to-day care.”
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Hybrid Nursing Program OK’d By Board:
The California Board of Registered Nursing approved an accelerated nursing program for local residents with bachelor’s degrees to address the nationwide nursing shortage.
The didactic component will be taught online from the University of Oklahoma Health Sciences Center’s nursing school, while the clinical education will be taught at Sharp Healthcare facilities, according to Jennifer Jacoby, chief nursing officer at Sharp.
The program is sponsored by San Diego State University and Southwestern College.
A degree can be completed in 14 months and include 600 hours of online work and 900 hours of clinical work. Although the program’s first class of 24 students began in August, the program will start the second class in January.
The cost for the program runs about $30,000, according to Jacoby, but other local programs are impacted like SDSU, which limits students to receiving only one bachelor’s degree.
If students can enroll for a bachelor’s degree, the program can take two to three years to complete before graduation. Jacoby said that San Diego has a higher percentage of residents with bachelor’s degrees , about 25 percent as opposed to the average 23 percent.
Entry-level nurses are earning $28 to $30 an hour and an average nursing salary is about $58,000 a year.
Sharp nurses who would like to earn bachelor’s degrees may also enroll in a similar hybrid program. There have already been six graduates and 12 students enrolled.
More than 1 million nursing positions are expected to be unfilled by 2020.
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Scripps Awards Two Construction Management Contracts:
Scripps Health of San Diego awarded two construction management contracts to Jacobs Engineering Group Inc. for a combined value of $17.4 million, according to the Pasadena-based general contractor.
The first contract is the seven-year management of structural upgrades at Scripps Memorial Hospital La Jolla, estimated at $187 million and part of the Seismic Retrofit Program; the second is the new eight-year construction management of the $434 million Scripps Cardiovascular Institute, according to a news release from Jacobs Engineering.
Scripps Health is a nonprofit health system that treats 500,000 patients each year with its 2,600 affiliated physicians and 11,000 employees.
Send health care news to Jaimy Lee at
jlee@sdbj.com
. She may also be reached at (858) 277-6359, ext. 3107.
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