CATEGORY: Issues

The future of UC Health

UC medical centers need to work together to leverage their scale.

John Stobo

By Alec Rosenberg

The University of California’s five academic medical centers need to pick up the pace in their working together as a system to improve quality and reduce costs.

That’s the message UC Health Senior Vice President John Stobo delivered to UC Regents at their May 15 meeting in Sacramento.

With reimbursement for clinical services under enormous downward pressure, decreasing the costs associated with providing those services is critical, Stobo said. Without action, UC medical center expenses are projected to exceed revenues in 2017. That would have a significant effect on UC Health: The financial success of UC medical centers helps sustain UC Health’s three-part mission of clinical care, research and education, including pivotal support to UC’s medical schools.

“While each medical center needs to do what it can individually to contain costs, only by working together and leveraging the scale we have as a system can we collectively contain costs to adjust to the decreases in revenue,” Stobo said. “It’s time for us to look at a new model.”

A new model

Hospitals traditionally have relied on volume-based growth for profitability – that is, they were paid more for doing more, Stobo said. With health care reform, the focus is shifting to value. The hospitals that do best on quality, prevention and collaboration are the ones that will succeed in the future. UC has done well under that first model, but it needs to move quickly to position itself for this new reality.

“I’m convinced that we need to move from a volume-based to a value-based model in which we’re not the sum of five individual medical campuses but we act as an integrated health system,” Stobo said.

UC’s five academic medical centers – Davis, Irvine, UCLA, San Diego and San Francisco – already have started on that path through joint contracting, group purchasing and quality improvement projects.

In March, UC announced a “Leveraging Scale for Value” project to reduce costs at UC hospitals. In 2010, UC created a Center for Health Quality and Innovation to support innovations at UC medical center campuses and hospitals that seek to achieve the “triple aim” of better patient care and better population health while better controlling costs of care. The center, which held its third colloquium May 2, has funded about 50 grant and fellow projects from throughout UC Health and convened systemwide collaborations from fetal treatment to heart surgery.

Staying ahead

Regents praised UC’s efforts to be proactive and deal with the issue before it becomes a crisis.

“It’s gratifying to see that you are ahead of the curve,” Regent Sherry Lansing said. “The culture has changed, and we will maintain the quality and profitability.”

UC’s five academic medical centers had combined revenue of $7.5 billion in 2013. Add in the impact of UC’s 17 health professional schools, and UC Health accounts for nearly half of UC’s overall budget.

UC medical center revenue has increased steadily in the past five years, rising from $5 billion in 2008, but that pace is not expected to continue amid declining reimbursements for clinical services. Meanwhile, costs are rising at an unsustainable rate, putting more pressure on UC Health to act so it can continue to meet its three-part mission, Stobo said.

Much is at stake. UC’s academic medical centers play a critical role in the community, providing $444 million of charity care, 50 percent of California’s transplant surgeries and 25 percent of the state’s extensive burn care. UC’s medical centers also are vital to UC’s research efforts and provide significant support to other UC entities such as its medical schools – more than $900 million in 2013.

“It’s a big challenge,” Stobo said.

Leveraging scale

The Leveraging Scale for Value project will be overseen by a UC Health Shared Services Management Council made up of the five UC medical center CEOs, three medical school deans, two chancellors, one regent, three external expert advisers and Stobo.

The project initially aims to save in the range of $100 million to $150 million a year by collaborating on supply chain, revenue cycle and clinical laboratories. Along with maximizing efficiencies in those three initiatives, UC Health will need to address additional areas such an information technology and human resources to take $900 million out of its costs by 2020, Stobo said.

Gov. Jerry Brown said he viewed those cost strategies “with trepidation,” pointing to the challenges the state is facing with increased Medi-Cal enrollment.

Stobo noted that other large health systems have had success in leveraging their scale to reduce costs, and so too must UC Health.

“We’re serious about this issue of making sure our expenses don’t outstrip our revenues,” Stobo said. “The incentive is, if you don’t change, you go away.”

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Moving toward one UC Health

UC’s medical centers are at an inflection point, UCSF’s Sam Hawgood says.

Dr. Sam Hawgood, UC San Francisco's interim chancellor, urges UC's five academic medical centers to work as a unified force to transform health care.

>>Related: Innovation propels UC Health

By Alec Rosenberg

The University of California’s five academic medical centers are at an inflection point, according to Dr. Sam Hawgood, UC San Francisco interim chancellor and medical school dean.

If they act separately, they can survive but will be marginalized in isolation, Hawgood said. If they work together, they can transform and grow.

Hawgood outlined his case for the latter option during his talk, “UC Health and the Future of Health Care,” at the UC Center for Health Quality and Innovation’s third annual colloquium May 2 in Oakland.

“If we truly acted as a system, we would be quite a force,” Hawgood said.

Change necessitates action

Health care is changing rapidly in the United States, Hawgood said. While people are living longer, health spending is rising, with increasing pressure to meet the “triple aim” of better patient care, better population health and lower costs.

Health providers need to remain connected to the past but prepared to swing in new directions at this “hinge of history,” Hawgood said, borrowing a half-century-old phrase from former UC President Clark Kerr.

In other words, business as usual can’t continue. Academic medical centers can expect significant consolidation in the next decade as they struggle to meet their “triple threat” of clinical care, research and education, Hawgood said, citing futurist Ian Morrison.

What does this mean for UC Health and its five academic medical centers and 17 professional schools?

UC’s academic medical centers — Davis, Irvine, UCLA, San Diego and San Francisco — have been known for providing the most complex care, such as burn care and transplants, as well as conducting research and educating health professionals. That traditional model worked well in what Morrison characterizes as the volume-based first curve, where academic medical centers could be autonomous and focused on the short term. But the value-based second curve is coming, where the future will be focused on new technologies, new consumers and new markets.

As academic medical centers shift from the first curve to the second curve, they must transform their business and health care delivery models to balance quality, cost and patient preferences to achieve real value and outcomes while staying true to their three-part mission, Hawgood said.

A singular system

For UC, that means moving beyond efforts to coordinate regionally, said Hawgood, who praised broader efforts such as the innovation center and “Leveraging Scale for Value” project to reduce costs at UC hospitals.

To thrive in the future, UC must do even more to act as a health system and move toward one UC Health, he said.

“We have tremendous opportunities,” said Hawgood, such as building a statewide strategy, making clinical and educational innovations, collaborating on translational research, branding and marketing, training the workforce, and impacting policy.

Dr. John Stobo, UC Health senior vice president, agrees with Hawgood.

“The ‘second curve’ for UC is to take advantage of its leverage and power when acting as a system,” Stobo said. “In this new paradigm, UC Health and the UC system can truly be a national leader in clinical care, education and research to improve the health of society.”

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UC statement on contract ratification by AFSCME

Patient care technical employees vote to ratify contract with UC.

The University of California was informed today (March 28) that members of the American Federation of State, County and Municipal Employees (AFSCME) voted to ratify a contract agreement with UC. In response to the ratification, Dwaine Duckett, UC’s vice president for human resources, released the following statement:

We are pleased that our dedicated patient care technical employees voted to ratify a contract agreement with the University of California. This follows two years of difficult negotiations focused on the complex issue of pension reform. The negotiations concluded with both sides responding to the other’s key concerns and ultimately compromising.

We are disappointed that this process took as long as it did and became so contentious. The university’s agreement with AFSCME 3299 is very similar to ones UC reached months ago with CNA, a union representing nurses, and UPTE, which represents other hospital workers. These contracts were achieved in less time and with significantly less stress and uncertainty for workers at our hospitals.

From the beginning, the primary issue in our negotiations with AFSCME was pension reform, with the union asserting that no change was needed and choosing to strike over the issue. We’ve successfully bargained through this key issue for the university, and have put the pension plan on a fiscally sound path by addressing this head-on.

Regarding annual wage increases, the union’s initial demands were eventually adjusted from more than 10 percent a year over 3 years to approximately 6 percent a year over 4 years, which includes across-the-board raises and experience-based step increases that we believe are fair and appropriate for these skilled health-care jobs.

Fortunately, settling this agreement spared AFSCME patient care technical workers who wanted to come to work from having to cross a picket line. It also ensured that patients who have come to rely on our top-rated medical facilities for care could continue to receive that care without disruption. We value the work of our respiratory therapists, surgical perfusionists and radiation technicians (who provide cancer treatment), along with many other critical AFSCME patient care employees, and are pleased they are staying on the job. The prospect of yet another strike — even though it was averted at the 11th hour — was a disservice to our patients, employees and the public at large.

With this agreement settled, the university can move forward with our employees and continue to meet UC’s mission of teaching, research and public service at our campuses, medical centers and national labs.

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UC statement on tentative agreement with AFSCME

Deal averts strike March 24-29 at UC medical centers.

Dwaine Duckett, UC vice president for human resources, issued the following statement today (March 23) regarding contract negotiations with the American Federation of State, County and Municipal Employees (AFSCME):

The University of California reached a tentative agreement this morning with AFSCME on a four-year contract for nearly 13,000 patient care technical employees who work at UC medical and student health centers.

As a result, there will be no strike at our medical centers March 24-29 and AFSCME will present the tentative agreement to its membership for a vote.

There was true compromise by both sides to reach this agreement. This ends nearly two years of very challenging negotiations and serves as a foundation for UC and AFSCME to build on going forward. The agreement also allows our medical centers and student health centers to continue to deliver the quality care our patients and students depend on without any interruptions.

Highlights of the four-year tentative agreement, which is subject to ratification by AFSCME members, include:

  • Wages: across-the-board and step increases totaling 24.5 percent, similar to what UC nurses agreed to, along with a ratification bonus
  • Health benefits: rate freezes for lower-salaried employees
  • Retirement benefits: The same pension formula as AFSCME service works and UC nurses
  • Job security: Revised language on layoffs and contracting out to protect employee jobs.

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UC medical centers team up to reduce costs

Systemwide effort expected to save in range of $100M to $150M a year.

The University of California announced today (March 20) that its five medical centers will collaborate as a system to save in the range of $100 million to $150 million a year.

The “Leveraging Scale for Value” project, presented to UC Regents during their meeting at UCSF Mission Bay Conference Center, initially will focus on three areas: supply chain, revenue cycle and clinical laboratories. The effort, developed in consultation with UC leadership, is aligned with UC President Janet Napolitano’s push to identify cost savings and operational efficiencies.

“We are leveraging the UC system’s collective strength to become more efficient,” said Dr. John Stobo, UC senior vice president for health sciences and services. “By collaborating more, we can ensure the financial well-being of our clinical enterprise, allowing us to continue improving the health of Californians.”

UC’s $7.5 billion clinical enterprise, with essentially no support from state general funds, provides approximately $500 million in support of UC’s medical and other health professional schools. But to continue such educational support, fulfill its public service mission and maintain quality in a competitive health care market, UC’s clinical enterprise must lower its costs.

Without changes, UC medical center expenses are projected to exceed revenues in 2017. Challenges include declining reimbursements for clinical services from commercial insurers and government sources such as Medicare and Medi-Cal. By coordinating more as a system, UC Health can take advantage of its medical centers’ size to operate more efficiently and reduce expenses, as other successful health systems have done.

UC has developed the Leveraging Scale for Value project over the past year, considering 10 areas for achieving operating efficiencies and quality improvement, and selecting three to focus on first.

The decision to embark on the project came after a series of meetings that included selected regents, President Napolitano, chancellors, CEOs of the five UC medical centers, deans of the UC schools of medicine, medical center CFOs and COOs, clinical laboratory directors, and CEOs of health systems at the University of Michigan, Vanderbilt University and BJC HealthCare in St. Louis.

The university also engaged with other successful health systems such as the University of Pittsburgh, Johns Hopkins and University HealthSystem Consortium. These discussions confirmed the financial challenges facing UC Health’s clinical enterprise, as well as UC Health’s need to leverage its impact as a large system to achieve significant cost reductions.

The medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco already work together on systemwide contracts with commercial insurers and on some group purchasing. The Leveraging Scale for Value project will increase supply-chain coordination, identifying five areas for systemwide procurement.

By improving revenue cycle management, such as billing and collection processes, UC medical centers are expected to create operational savings and potentially improve revenue. And by sending more lab tests to UC medical centers instead of external labs, the university is expected to save additional money.

A shared services management council made up of the medical center CEOs, medical school deans, two chancellors, three external expert advisers and Stobo is looking at how to manage the project in an effective, efficient and accountable manner.

“The ‘scale’ project does not replace what each medical center must do on its own to contain costs,” Stobo said. “The systemwide efforts focus on what individual medical centers are unable to do on their own. Both local and systemwide efforts are needed to get us where we need to be.”

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Bill proposes new pathway for more physicians

UC co-sponsors bill introduced by Bonilla.

Assemblywoman Susan A. Bonilla’s office issued the following press release today (March 11):

Assemblywoman Susan A. Bonilla, in partnership with the University of California and the Medical Board of California, has introduced legislation to allow graduates of accelerated and fully accredited medical education programs to become licensed physicians in California. By creating this pathway, students will have the opportunity to incur less student debt while becoming dedicated, well-trained physicians.

“We have a growing shortage of trained medical residents and physicians to meet the demands of our communities,” said Assemblywoman Bonilla. “In addition, the accumulation of student debt is overwhelming to many students seeking to become physicians. By creating this new pathway, we can begin to reduce the growing shortage and provide the opportunity for students to graduate with less student debt.”

Medical schools in New York and Texas have developed accelerated programs that produce graduates in three years by focusing more on the medical students’ skills and academic achievement, rather than on the time spent in medical school itself. According to the Journal of the American Medical Association, there is no evidence that four years of medical school enhances clinical skills or the quality of patient care. In addition, for many students, the fourth year of medical school is focused almost entirely on electives and applying for residency. Furthermore, the Washington Post cites that students that have graduated from shortened medical programs perform just as highly on board examinations and placements in residency programs.

“The Medical Board of California is pleased to co-sponsor AB 1838 with the University of California Office of the President. The Medical Board’s mission includes the promotion of access to quality medical care through the Medical Board’s licensing and regulatory functions,” said Medical Board of California’s executive director, Kimberly Kirchmeyer. “We believe that this legislation will meet the needs of the applicants who are enrolling in these programs and will still fulfill the Medical Board’s mission of consumer protection and access to care.”

The University of California operates six of California’s nine M.D.-granting medical schools and provides specialty training for nearly half of the state’s medical residents. “As a major provider of medical education in the state, the University of California believes this change in law is straightforward and will benefit the state by reducing unnecessary and out-dated barriers to practice in the state,” said Dr. Cathryn Nation, UC associate vice president for health sciences. “AB 1838 will benefit not only the future graduates of UC Davis’ new, accelerated M.D. degree program (which plans to enroll its first class of four students in summer 2014), but, also all graduates of any accelerated program offered by an LCME-accredited medical school.”

Assemblywoman Bonilla’s legislation, AB 1838, will allow graduates of accelerated medical education programs accredited by the Liaison Committee on Medical Education or the Committee on Accreditation of Canadian Medical Schools to have a path to licensure in California. The bill is co-sponsored by the Medical Board of California and the University of California.

Media contact:
Ryan Morimune
Assemblywoman Susan A. Bonilla
(916) 319-2014

View original release

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Pharmacy education growing rapidly, easing workforce shortages

Growth seen in California and across the nation.

Enrollment in pharmacy education programs has increased significantly, according to a new report from the University of California. (iStock photo)

>>View pharmacy education report

The landscape for pharmacy education has changed dramatically in recent years, as rapid growth in new schools and student enrollment has eased state and regional workforce shortages, according to a new report from the University of California.

An Era of Growth and Change: A Closer Look at Pharmacy Education and Practice” follows a report UC issued last May examining growth and recent trends in health professions education.

Enrollment in pharmacy education programs has increased significantly, following a nationwide pharmacist shortage that developed in the late 1990s. National trends now suggest that the supply of pharmacists is growing much faster than previously projected. Since 2005, the number of accredited U.S. pharmacy schools has increased by 48 percent, from 87 to 129, with most of the growth occurring at private institutions.

“Enrollment in pharmacy education programs has grown substantially in the past decade – faster than the previous 25 to 30 years,” said Cathryn Nation, M.D., UC associate vice president for health sciences. “This report will be an important tool for policymakers and higher education leaders, highlighting trends that will inform efforts to address the challenges posed by health care reform, an aging population and the ongoing demand for pharmacy services.”

In particular, California has been home to significant growth in pharmacy education. Since 2002, four new pharmacy schools have opened in the state, doubling the number of programs in California from four to eight over the past decade. Other institutions appear interested in opening new pharmacy schools in California within the next few years.

Highlights of the report include:

  • Demand for pharmacists in California is beginning to fall in balance with the state’s growing   supply of pharmacists.
  • Significant growth in pharmacy educational opportunities has occurred throughout California, with the majority of enrollment increases happening at private institutions.
  • California faces a shortage of well-qualified faculty to train future pharmacists.
  • Disparities in health status, changing demographics and the evolving roles of pharmacists in health care delivery will require increased diversity and cultural competence of the workforce.
  • There is a substantial mismatch between the number of residency training positions available and increasing student interest (pharmacy residency positions are post-graduate, advanced training positions that are available following completion of a Pharm.D. degree).

The report includes findings about California’s educational programs and recommendations relevant to the UC system, which operates two pharmacy schools: UC San Francisco, ranked as the nation’s top pharmacy school by U.S. News & World Report, and UC San Diego, whose pharmacy school opened in 2002.

“As we look to the future, pharmacy education must remain relevant and aligned with the needs of patients,” said B. Joseph Guglielmo, Pharm.D., dean of the UCSF School of Pharmacy. “This report provides an overview of the pharmacy landscape and a valuable resource for the UC system and our colleagues throughout the state.”

The UC system operates the nation’s largest health sciences instructional program, with 17 professional schools in seven major health professions, including pharmacy education. UC’s two pharmacy schools accounted for 182 (approximately 21 percent) of California’s 849 graduating pharmacy students in 2011.

California pharmacy schools:

Public schools/institutions
UC San Francisco
UC San Diego (first class admitted in 2002)

Private schools/institutions
University of the Pacific
University of Southern California
Western University of Health Sciences
Loma Linda University (first class admitted in 2002)
Touro University (first class admitted in 2005)
California Northstate University (first class admitted in 2008)

Media contacts:
University of California Office of the President
(510) 987-9200

UC San Francisco
Kristen Bole
(415) 502-6397 (NEWS)
kristen.bole@ucsf.edu

UC San Diego
Jacqueline Carr
(619) 543-6427
jcarr@ucsd.edu

About UC Health
University of California Health includes five academic health centers with 10 hospitals and 17 health professional schools in seven fields on seven UC campuses – UC Berkeley, UC Davis, UC Irvine, UCLA, UC Riverside, UC San Diego and UC San Francisco. For more information, visit http://health.universityofcalifornia.edu.

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UC reaches tentative deal with AFSCME to avert strike

Union calls off strike scheduled for March 3-7.

The University of California announced today (Feb. 27) that it has reached a tentative agreement with the American Federation of State, County and Municipal Employees for a four-year contract covering more than 8,300 service workers.

AFSCME agreed to call off its five-day strike scheduled for March 3-7 at UC campuses and medical centers.

“It is good to have this bargaining wrapped up with a deal on its way to our valued service employees,” said Dwaine B. Duckett, UC’s vice president of human resources. “We worked hard to bridge gaps on the issues. Ultimately both sides chose compromise over conflict.”

AFSCME-represented service staff are expected to vote on the tentative contract soon.

Highlights of the agreement include:

  • Wages: 19.5 percent wage increase over four years
    • 4.5 percent increase as a signing bonus, distributed 60 days after the contract is ratified
    • 3 percent across the board and 2 percent step increase in 2014, 2015 and 2016.
  • Health benefits: No rate increases in Kaiser and Health Net pay bands 1 and 2, to protect take-home pay for lower-salaried employees.
  • Pension benefits: Per AFSCME’s request, the same pension and retiree health care programs as CNA and UPTE, in which employees contribute 9 percent of pay. UC previously offered alternatives in which workers would contribute as little as 5 percent, which AFSCME rejected.
  • Job security: Improved job protections from layoffs and use of outside contractors.

The university and AFSCME have been in contract negotiations for more than a year. UC has shown flexibility on key issues in order to reach today’s tentative agreement. No other union has been offered the freeze on health care costs, which means that an AFSCME worker will continue to pay $11.78 a month for Kaiser or $35.21 for an entire family. That same AFSCME worker at the California State University system would pay $149 a month as an individual and $392 for a family.

AFSCME service members at UC — employees such as janitors, maintenance workers, gardeners and food service workers — currently earn an average annual salary of more than $37,000, in addition to benefits.

UC and AFSCME negotiators are scheduled to return to bargaining today and Friday in an effort to reach an agreement for the union’s nearly 13,000 patient care technical employees.

AFSCME’s last two strikes in May and November cost the UC system more than $30 million to maintain critical services for patients.

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Statement on announced AFSCME strike in March

Response to union’s request that patient care, service workers participate in five-day strike.

Dwaine Duckett, vice president of UC Human Resources, issued the following statement today (Feb. 20, 2014) regarding AFSCME’s announcement that it will ask patient care technical and service employees to participate in a five-day strike March 3-7, 2014:

We are deeply disappointed that even as contract negotiations continue, AFSCME leadership has chosen to take this path, which hurts our students, patients and the UC community in a number of ways. This is patently unfair to the people we serve.

At a cost to UC of about $10 million a day to ensure that critical services for students and patients continue safely, these strikes waste precious university resources and only serve to interfere with reaching a fair contract and getting our employees the raises they deserve and have been waiting too long for.

We have offered AFSCME very good contract proposals: Patient care workers would receive a wage increase of 20 percent over four years and service workers 16 percent over the same period. In addition, the university has offered to freeze employee health care costs — a benefit not offered to any other union — and the same retirement benefits that other unions have. AFSCME rejected our proposals and continues to demand more.

We have asked AFSCME leadership to bargain in good faith. Yet in announcing another strike even as the university prepares for our bargaining session next week, the union has again chosen conflict over compromise.

I urge AFSCME leaders to come to the table ready to reach a fair contract, as we are.

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State audit praises patient care at UC medical centers

Probe finds patient care, satisfaction among best nationwide.

The California State Auditor today (Jan. 30) released the results of its probe into the finances, staffing and quality of patient care at the UCLA and UC San Francisco medical centers, noting that the level of patient care and satisfaction were among the highest in the nation.

State legislators requested the audit in June 2013 at the urging of the American Federation of State, County and Municipal Employees Local 3299. The report made only one recommendation: that the University of California more clearly detail the extent and purposes of revenue transfers from its medical centers to its schools of medicine.

“These latest audit results demonstrate that the university is not only in compliance with all relevant regulations governing our medical centers’ finances, staffing and quality of care, but often far exceeds them,” said Dr. John Stobo, senior vice president for health sciences and services at UC’s Office of the President.

Said Dwaine Duckett, vice president for human resources, “AFSCME called for this audit as a bargaining chip in labor negotiations and has cost California taxpayers hundreds of thousands of dollars. The results prove that the union’s most serious allegations about unsafe staffing levels and patient safety at our medical centers are completely without merit.”

UC has been in contract negotiations with AFSCME for more than a year. The union recently called for a strike authorization vote despite the university’s comprehensive offer that is equal to or better than agreements other unions have signed with UC since October. Should AFSCME call for a strike, it would be the third time in nine months that its workers have walked off their jobs. The May and November 2013 strikes at UC medical centers have cost the university more than $30 million — money that would have advanced physician education and world-class research.

Because of the complexity of the UC system — 10 major campuses, world-class research facilities, five medical centers and a division of agriculture and natural resources — the university opens its books routinely for a myriad of federal, state and local regulatory agencies, as many as 80 times a year, including more than 40 audits. Financial and programmatic data are made available and accessible, not only for these reviewers but also for the public through regular Web postings at http://reportingtransparency.universityofcalifornia.edu.

The latest state audit analyzed major categories of revenues and expenditures, annual profit and caseload volume, compensation, charity care and staffing levels from fiscal 2009 to fiscal 2013 at UCLA and UCSF medical centers.

The report concluded that key measures concerning quality of patient care at the two medical centers have remained stable, while patient satisfaction improved at both. It noted that the latest U.S. News & World Report hospital rankings rate Ronald Reagan UCLA Medical Center as the nation’s fifth-best hospital and UCSF Medical Center as seventh best.

“The percentage of UCSF Medical Center patients indicating they would definitely recommend the hospital to friends and family increased from 77 percent to 84 percent for the period we reviewed,” the audit said. “This statistic also increased at Ronald Reagan UCLA Medical Center and Santa Monica UCLA Medical Center and Orthopaedic Hospital.”

On staffing, the report concluded that levels increased at UCSF Medical Center and remained relatively flat at UCLA Medical Center, with both using more staff per patient, on average, than other hospitals do.

“The changes in staffing levels appear not to have altered key measures of the quality of patient care and of patient satisfaction, with the indicators we reviewed either improving or remaining stable,” the audit said.

With regard to the specific group of employees represented by AFSCME at UCSF Medical Center, the report said that staffing levels of aides and orderlies — non-technical personnel who provide direct nursing care to patients — increased by 18 percent.

On salaries, the report concluded that both medical centers complied with policies for establishing compensation rates and approving compensation increases, which “helped ensure their employees were appropriately compensated.” The report noted that CEO compensation at UCLA and UCSF medical centers, while higher than those of CEOs at UC Davis, UC Irvine and UC San Diego medical centers, is well below that of CEOs at other highly ranked medical centers such as the Cleveland Clinic and Cedars-Sinai Medical Center.

The report also pointed out that UCLA and UCSF medical centers followed state requirements for reporting their activities concerning the provision of charity care, which is free or discounted health care to certain patients. UCLA and UCSF faculty physicians not only provide charity care at their own facilities, but also at county medical centers.

The report noted that the size of fund transfers from UC medical centers to UC medical schools has increased substantially. UC’s medical schools — which receive the bulk of their funding from patient care revenue generated by the medical centers — train nearly half of California’s medical students and residents. At UCLA, the annual amounts of health system support nearly tripled from fiscal 2009 through fiscal 2013 to $103 million, and they nearly doubled at UCSF during that period to $58 million. The report found that these transfers are in line with other academic medical centers, and reflect a growing gap between the revenue the schools generate from physicians’ services and the costs of operating clinical practices.

The report’s one recommendation was that UC should take steps to increase the transparency of its campuses’ health system support transfers, such as by annually issuing a report that describes the financial and programmatic impact of each campus’ health system support transfers. UC agreed that this recommendation was reasonable and has committed to issuing the first such report no later than the end of 2014.

The full state report is available online at www.auditor.ca.gov.

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Why UC is participating in Covered California

UC is helping to increase access to affordable health care.

By Alec Rosenberg

University of California medical centers and physicians are playing an important part in helping increase access to health care through the federal Affordable Care Act.

The law is expected to expand health insurance coverage to millions of Americans by extending Medicaid coverage and creating health exchanges that will offer affordable health insurance options. California’s exchange, called Covered California, is aimed at those who don’t have insurance through their employer or another government program.

Californians who purchase a health benefit plan through Covered California and are looking to access UC’s five medical centers and 5,000 physicians for in-network health care can do so by selecting Anthem Blue Cross as their health care provider. UC Health has a systemwide agreement with Anthem to participate as a Tier 1 provider in the exchange that includes medical centers at UC Davis, UC Irvine, UCLA, UC San Diego and UC San Francisco.

Other insurers on the Covered California exchange also offer access to UC medical centers and physicians, such as Western Health Advantage with UC Davis and Health Net with UCLA and UC San Diego. Through Covered California, individuals may be eligible to receive financial assistance to make health care more affordable. However, if an enrollee already has access to affordable health insurance through another source, such as an employer or government program, the enrollee may not qualify for financial assistance through Covered California. So far, more than 400,000 people have enrolled in health insurance plans through Covered California.

As a public trust, UC has a responsibility to help Covered California be successful and to provide Californians access to affordable health care, said Dr. John Stobo, UC senior vice president for health sciences and services.

At a November summit attended by UC regents, chancellors, medical center CEOs and medical school deans, Stobo explained that UC is participating in Covered California because of its public trust role, even though its medical centers will receive lower reimbursements.

UC Health is a vital part of California’s safety net, providing half of the transplants and one quarter of extensive burn care in the state, as well as providing $444 million in charity care in the past year.

“We understand that we have a responsibility to address issues that affect society,” Stobo said.

As part of those efforts, UC not only is a participant in Covered California but also is doing outreach to inform the public about the exchange and health care reform.

For example, UC Davis has promoted its Covered California involvement at community venues, special events and its own facilities, staffing and passing out fliers at more than 70 events such as farmers markets and community health and safety fairs.

UC San Diego is hosting educational events for the public to learn about the Affordable Care Act and has distributed more than 3,000 fliers about its participation to patient areas, libraries, community centers and at events including the Chargers Blood Drive.

UC San Francisco hosted a town hall about Covered California that included state elected officials and Rep. Nancy Pelosi, House Democratic leader.

UC Irvine hosted its annual Super Saturday Health Fair, where participants could get health insurance and Affordable Care Act questions answered by Covered California as well as receive a free flu shot, a diabetes screening and a blood pressure checkup.

As part of a team of more than 200 health professionals, UCLA staffed the Care Harbor free health care clinic with trained navigators who helped patients sign up for health coverage.

Additional outreach and education is being done through grants awarded by Covered California, with UC receiving two of these grants, each for $1 million. One is for the UC Berkeley School of Public Health and its Health Initiative of the Americas, which works with 13 subcontractors to reach out to Latinos in both rural and urban areas, particularly part-time, seasonal and contract employees as well as post-secondary students and young invincibles. The other is for the UC Davis Center for Reducing Health Disparities, which is partnering with El Concilio, the Council for the Spanish Speaking, to educate nearly 133,000 primarily Spanish-speaking Central Valley residents about Covered California.

The UC Student Health Insurance Plan launched a health care reform education campaign to inform students that they have new choices in their insurance coverage and to promote understanding of the value of UC-sponsored student health plans.

Californians began enrolling in health plans through Covered California on Oct. 1 and can continue to enroll through March 31, 2014.

For more information, visit:

For more information about Covered California, visit www.coveredca.com or call (800) 300-1506.

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Statement following AFSCME Nov. 20 strike

UC leadership urges return to bargaining table.

Dwaine B. Duckett, vice president of systemwide human resources at the University of California, issued the following statement today (Nov. 21) regarding AFSCME’s Nov. 20 strike at UC medical centers and campuses:

First, I want to say how grateful we are to the majority of our patient care technical and service employees, who put the needs of patients and students first and came to work during AFSCME’s strike. Initial reports from our medical centers and campuses indicate that on average more than half of AFSCME-represented employees came in and did their jobs. We appreciate and respect the professionalism and dedication these colleagues displayed. It is outstanding.

We hope AFSCME leadership now will channel its energy into resolving our differences.

It is well past time to get this contract settled. AFSCME’s two-day strike in May and its follow-up strike on Wednesday were counterproductive and costly. It also did nothing to bring us closer together. Our patients and students deserve better.

While AFSCME prepared for its strike, the university worked diligently with its other unions to find common ground. Last weekend, UC reached a comprehensive four-year agreement with the California Nurses Association, which represents more than 11,700 UC nurses. The university also recently finalized contracts with our librarians’, lecturers’ and police officers’ unions. We also have bargaining sessions on the books with the University Professionals and Technical Employees (UPTE) in early December.

We are committed to doing the same with AFSCME, but union leaders have to meet us halfway. If AFSCME will focus on getting back to the table and demonstrate at least some flexibility — the kind of flexibility that we have shown — we hope to reach a fair agreement soon.

As we did the week of Nov. 4, we have invited AFSCME back to the bargaining table and scheduled meetings for Dec. 11–12 and Dec. 17–18. We hope the union’s energies will be directed toward reaching an agreement this time, as opposed to positioning for another strike. We are coming into these meetings ready to reach a settlement. We urge AFSCME to do the same.

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Read more about UC’s negotiations with AFSCME at http://ucal.us/PatientCareTechs

CATEGORY: Issues, NewsComments Off