The Best States rankings from U.S. News & World Report show how each of the 50 U.S. states ranks in 71 metrics across eight categories. The data behind the rankings aims to show how well states serve their residents in a variety of ways. In calculating the rankings, each of the eight categories was assigned weights based on the average of three years of data from recent national surveys that asked nearly 70,000 people total to prioritize each subject in their state. In the Health Care category, California ranked #6 in the nation this year. The top ten were 1. Hawaii, 2. Massachusetts, 3. Connecticut, 4. New Jersey, 5. Rhode Island, 6. California, 7. Maryland, 8. New York, 9. Delaware and 10. Washington. Out of the eight categories, the Health Care Category follows the following three metric areas: Health Care Access - - Population Without Health Insurance: The percentage of adults ages 19 to 64 who reported having no health insurance coverage. (U.S. Census Bureau American Community Survey 1-year estimates; 2022) - - Child Dental Visits: The percentage of children and young adults enrolled in Medicaid who received past-year preventive dental services among those eligible for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for 90 continuous days. (Centers for Medicare & Medicaid Services; fiscal 2021) - - Child Wellness Visits: The percentage of children and young adults enrolled in Medicaid and eligible for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit who received screening services among those who should have received such services. (Centers for Medicare & Medicaid Services; fiscal 2021) - - Adults Without Dental Visit: The age-adjusted percentage of adults who reported not visiting a dentist or dental clinic within the past year. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Adults Without Wellness Visit: The age-adjusted percentage of adults who reported they had not visited a doctor for a routine checkup within the past year. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Adults Deterred From Care Due to Costs: The age-adjusted percentage of adults who reported there was a time in the past 12 months when they needed to see a doctor but could not because they could not afford it. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) Health Care Quality - - Preventable Hospital Admissions: The number of preventable hospital admissions per 100,000 Medicare beneficiaries. (Centers for Medicare & Medicaid Services; 2022) - - Medicare Enrollees With Top-Quality Coverage: The percentage of Medicare Advantage enrollees with a health plan rated 4 stars or better, among plans with a published star rating and number of enrollees. (Centers for Medicare & Medicaid Services; enrollment data as of February 2024, performance data reflective of March-June 2023) - - Nursing Home Quality Rating: An average index score per state reflecting a proportional scale between nursing homes rated by U.S. News as "high-performing" and those rated as "below average." (U.S. News Best Nursing Homes; 2023-2024) - - Hospital Quality Rating: An average index score per state reflecting a proportional scale between hospitals rated by U.S. News as "high-performing" and those rated as "below average,” among hospitals that perform or treat specific procedures or conditions. (U.S. News Best Hospitals; 2023-2024) Public Health - - Infant Mortality Rate: The number of infants who died before turning 1 year old, per 1,000 live births. (Centers for Disease Control and Prevention; 2021) - - Mortality Rate: The number of age-adjusted deaths per 100,000 population. (Centers for Disease Control and Prevention; 2022 provisional data) - - Obesity Rate: The age-adjusted percentage of obese adults, based on self-reported height and weight. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Smoking Rate: The age-adjusted percentage of adults who are current smokers, based on self-reported tobacco usage. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Poor Mental Health: The age-adjusted percentage of adults who reported their mental health was not good for 14 days or more in the past 30 days. (Centers for Disease Control and Prevention, Behavioral Risk Factor Surveillance System; 2022) - - Suicide Rate: The age-adjusted rate of suicides per 100,000 population. (Centers for Disease Control and Prevention; 2022 provisional data) Sadly, despite California's high ranking in health care, it ranked #37 in terms of "Best States Overall." This global category is based on ranking of the 8 sub-categories which includes health care. The California rankings in each of the 8 sub-categories was #34 Crime & Corrections, #34 Economy, #23 Education, #42 Fiscal Stability, #6 Health Care, #32 Infrastructure, #33 Natural Environment, and #50 Opportunity. And out of the 30 Worst Places to Live, San Francisco was 3rd worst. The City by the Bay is one of the most expensive places to live in the U.S. The median income is higher here, but so are the costs for gasoline and utilities, which fall well above the national average. Job growth hovers just above 1%. Renters pay an average of $4,030 per month for a place to live. About 10% of the population lives below the poverty level. As for crime, the city experienced more than 50 murders and nearly 4,000 assaults in 2021 ...

According to a report by The American Prospect, the big three Group Purchasing Organizations (GPOs) - Premier, Vizent and HealthTrust use sole-source contracts to require hospitals to purchase virtually the same amount from suppliers every year. If a supplier cannot snag one of these contracts, they cannot sell to nearly all hospitals, and they cannot go forward as a business. This dramatically shrinks the manufacturers available for particular sterile injectable drugs, any of which can be thrown offline by the slightest imperfection. The GPO structure therefore limits competition for these drugs, and exacerbates resiliency challenges. It also can increase prices, because the determining factor of getting a contract is often the highest fee a manufacturer can provide. These fees cut into supplier margins and induce them to take shortcuts to ramp up production, making the system even more vulnerable to supply shocks. Hospitals have favored the scheme because they get paid too, through "share-backs" from the GPOs. This secures their participation and keeps the system stuck with supply challenges. Ending the anti-kickback safe harbor would shift the GPO compensation model. They would be paid by hospitals as co-op purchasers, for finding the cheapest prices for medical supplies, rather than being paid by suppliers as for-profit operators, hunting the biggest fees for access. A market with suppliers competing for business rather than paying GPOs to get into hospitals would reduce what hospitals pay, studies have shown. The Senate Finance Committee is releasing a bipartisan discussion draft this month that aims to tackle the epidemic of drug shortages, mostly in low-margin generic injectables used in hospitals. It attempts to reckon with the broken market structure that has created the most drug shortages in America on record. The discussion draft uses Medicare and Medicaid payments to incentivize reform of contracting practices that put generic injectables and other drugs at heightened risk for shortages. In particular, Senate Finance Committee chair Ron Wyden (D-OR) has taken aim at group purchasing organizations (GPOs), three of which handle bulk purchasing for 90 percent of all hospitals. Sole-source contracts and profit-skimming by GPOs (and large wholesalers, which also have extreme concentration, with three controlling 90 percent of purchases) have been blamed for creating the conditions where low-margin drugs are no longer profitable to most manufacturers, thinning out the supply chain and opening it up to regular disruptions. Yet the bill does not take what some have identified as the easiest path to breaking the power of GPOs: removing the safe harbor from anti-kickback laws that allows the companies to maintain their dominance by taking fees from hospital suppliers in exchange for inclusion in their guaranteed sale contracts. Instead, it creates a new framework starting in 2027 called the Medicare Drug Shortage Prevention and Mitigation Program. Hospitals and other providers would be eligible for incentive payments under the program, but only if they commit to a variety of contracting reforms to ensure that certain generic drugs are no longer chronically in shortage. This includes injectables like saline, and chemotherapy drugs that have recently gone into short supply. Some critics see that as a missed opportunity. "This draft is a convoluted, unworkable, nonsensical, overly complex mess," said Phillip Zweig, co-founder and executive director of Physicians Against Drug Shortages, which has highlighted anti-competitive contracting practices and kickbacks as the source of the problem. That there’s a draft at all reflects renewed attention to the problematic function of middlemen in the health care system, both on prices and the timely dispensation of treatment. Pharmacy benefit managers (PBMs), which play a similar role for prescription drugs purchased at pharmacies, have also come under scrutiny in Washington. Federal regulators are currently examining both GPOs and PBMs. But solutions have been elusive, and while the committee is optimistic that they could really get something done, critics argue that there are much simpler alternatives available: in this case, making pay-to-play GPO schemes illegal again ...

The Malibu Times as well as a story in the Conejo Valley Acorn, reports that Malibu/Lost Hills Sheriff’s Capt. Jennifer Seetoo has won her lawsuit against Los Angeles County implicating former Sheriff Alex Villanueva. Villanueva was accused of discrediting Seetoo by spreading false rumors about her and denying her the opportunity to interview for a promotion. In just under two hours of deliberations, a jury awarded Seetoo just over $971,000 in damages. The trial unfolded over nine days of testimony from April 8 to 19 at the Stanley Mosk Courthouse in downtown L.A. Among the witnesses were Seetoo herself and former L.A. County Sheriff Alex Villanueva, under whose administration the alleged mistreatment occurred. Villanueva himself was not named as a defendant in the lawsuit. Seetoo started with LASD as a custody assistant in 1997 at age 20. She was first in her class at the academy and rose through the ranks, arriving at Malibu/Lost Hills sheriff station as operations lieutenant, or second-in-command, in November 2018. On her first day the captain, Josh Thai, suffered a medical emergency, making her acting captain. That same week saw the Borderline mass shooting and the Woolsey fire, with Seetoo leading the station’s response to that historic disaster. In early December Villanueva was sworn in as sheriff, having campaigned on a promise to let local communities choose their captains. According to Seetoo’s original complaint, filed in January 2020, she soon began to face accusations from higher-ups that she was jockeying for the absent captain’s job. These included false comments about an "inappropriate relationship" with the city manager in one of the municipalities in her jurisdiction, insinuations which Seetoo believed came from the office of the sheriff himself. Seetoo was removed as acting captain and told she owed additional time as watch commander to be eligible for promotion. But this policy of Villanueva’s was not consistently applied to male officers, her suit alleged. She was also prevented from transferring to the detective bureau for a similar reason. When the captain position at Lost Hills opened in June 2019, Seetoo applied but did not get an interview. The 10 candidates selected to interview were all male. City officials told Seetoo they had sent a letter to LASD demanding that she be considered, which made her concerned about the potential repercussions. After Agoura Hills honored her Woolsey fire work by asking her to ride in the Reyes Adobe Parade, new Lost Hills Capt. Matt Vander Horck was allegedly directed to remove Seetoo from the operations lieutenant position he had asked her to fill, as well as her role as Malibu liaison. At that point, in October, Seetoo complained about the unfounded rumors and retaliation in an email to a commander. Shortly thereafter Vander Horck told her the decision had been made to transfer her to West Hollywood. Sending employees to work at stations far from their homes as punishment is a familiar tactic in the sheriff’s department, known as "freeway therapy." Vander Horck himself was abruptly removed as captain and transferred in Feb. 2020. Although Villanueva was not named as a party in the lawsuit, he was accused of spreading an unfounded rumor that the married Seetoo, then the Malibu Sheriff’s liaison, was having an affair with a city manager in Agoura Hills, a city in her jurisdiction. Villanueva did testify at the trial, but so did a Villanueva colleague, an assistant sheriff who contradicted Villanueva’s testimony. That witness testified that he heard the rumor directly from Villanueva, who stated it as if it was a fact. The former Agoura Hills city official, who now works for another nearby municipality, testified in support of Seetoo, a mother of two, that the rumor was completely baseless and unsubstantiated. Seetoo did not allege discrimination by her direct superiors, but rather from the very top of the department. Her complaint mentioned "spies" planted by the sheriff to watch her work. It also spoke of a larger pattern of discrimination against female sworn officers in the LASD under Villanueva. In May 2022 Seetoo finally became the first female captain at Lost Hills. Jurors found in Seetoo’s favor after deliberating for just over one and a half hours. The bulk of the jury award - $750,000 - was for non-economic losses including harm to her reputation and emotional distress. An additional $221,369 was awarded for lost earnings and benefits, bringing the total to $971,369. Seetoo also won legal fees. Seetoo’s attorney, Kathleen Erskine, said, "It has been a highlight of my career to represent Jennifer Seetoo. She led the Malibu/Lost Hills Station with bravery and skill during the Woolsey Fire, one of the most devastating events in its history. Rather than allowing her to compete for the promotion she deserved, former Sheriff Alex Villanueva and his high-ranking executives discriminated and retaliated against her." The ongoing case is Jennifer Seetoo v County of Los Angeles et. al assigned to Hon. Rupert A. Byrdsong in Department 28 Stanley Mosk Courthouse ...

On March 13, 2020, President Trump declared a national state of for COVID- 19, initiating the expansion of Medicare’s telehealth benefits under the section 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act.4 The Centers for Medicare & Medicaid Services (CMS) worked with Congress to waive Medicare’s restrictions on telehealth utilization, such as geographic restrictions and provider reimbursement. Prior to the public health emergency (PHE), an average of 13,000 fee-for- service (FFS) Medicare beneficiaries received telehealth services per week. At the end of April 2020, the number of FFS beneficiaries receiving telehealth services per week reached 1.7 million. The flexibilities that Congress expanded in order to increase patient access to telehealth services during the COVID-19 Public Health Emergency were extended through the end of 2024 in the Consolidated Appropriations Act of 2023. Additionally, CMS has also continued certain telehealth regulatory flexibilities to align with the statutory extensions. Notable flexibilities that are set to expire at the end of 2024 include: - - The ability for Medicare patients to receive telehealth services in their home; - - Removal of geographic restrictions for originating site for non-behavioral/mental telehealth services; - - Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are permitted to serve as a distant site provider for non-behavioral/mental telehealth services; - - The ability to deliver certain non-behavioral/mental telehealth services using audio-only communication platforms; - - Removing the requirement for an in-person visit within six months of an initial behavioral/mental telehealth service, and annually thereafter; and - - Allowing telehealth services to be provided by all eligible Medicare providers. During an hours-long House Energy and Commerce subcommittee hearing this week, lawmakers considered 15 different legislative proposals surrounding telehelath access, noting changes in Medicare will impact decisions of private insurers. "There’s an urgent need to extend these flexibilities because it’s going to run out," said Rep. Anna Eshoo, D-Calif. "We need to take action on this." Lawmakers lauded the benefits of telehealth during a hearing Wednesday, but House members also raised questions about cost, quality and access that still need to be answered as a year-end deadline looms. As a December deadline draws closer, legislators are working to hash out details about extending or making pandemic-era telehealth flexibilities in Medicare permanent. Telehealth offers promising support to providers struggling to keep pace with current workforce shortages. The Health Resources and Services Administration (HRSA) projects a shortage of 139,940 physicians by 2036. Currently, there are 39.8 primary care physicians per 100,000 people in rural areas, compared to 53.3 primary care physicians per 100,000 people in urban areas Telehealth and remote patient monitoring can help alleviate some of these workforce challenges. According to a 2022 survey, 8 in 10 practitioners reported that retaining telehealth for health care practitioners would make them more likely to continue working in a role that maintains flexibility. According to the testimony at Wednesday's hearing of Eve Cunningham, M.D., group vice president and chief of virtual care and digital health at Renton, Washington-based Providence health system said: "Telehealth has become an integrated part of Providence's care delivery system making up about 20% of ambulatory care visits. Telehealth services are deployed across 93 acute care hospitals, including 42 hospitals from other health systems, and two high schools, with more than 1.2 million telehealth visits annually," "Telehealth is no longer a nice to have, but a core function of our healthcare delivery," Cunningham said. She added, "Telehealth expands access to high-quality, coordinated care to more people in more places. Telehealth enables us to offer specialty services in remote and rural areas like Kodiak, Alaska, while also allowing us to care for underserved communities in urban areas like Los Angeles," she said ...

Palm Care Pharmacy, a San Diego County pharmacy chain with a storefront in El Cajon, has paid $350,000 to resolve allegations that it diverted controlled substances, failed to keep necessary accounting records for controlled substances, and improperly sold pseudoephedrine chemical products. The settlement arises from a U.S. Drug Enforcement Administration investigation into suspected illegal activity at Talimi International, Inc. d/b/a Palm Care Pharmacy. Based on an inventory audit conducted by the DEA and other investigative activities, the government concluded that Palm Care Pharmacy’s El Cajon location committed multiple violations of the Controlled Substances Act and the Combat Methamphetamine Epidemic Act from 2018 through 2022. The government alleged that Palm Care Pharmacy failed to control its inventory of controlled substances, failed to maintain a complete record of controlled substances and the transactions, and sold listed chemical products (e.g., pseudoephedrine) without the necessary training and certification. Palm Care Pharmacy’s failure to control inventory resulted in unaccounted-for pills, including: opioids (oxycodone, hydrocodone, and tramadol), benzodiazepines (Xanax), and muscle relaxants (Soma). In addition to paying $350,000 to resolve the government’s claims, Palm Care Pharmacy entered into a Memorandum of Agreement with the DEA requiring Palm Care Pharmacy to undertake additional measures to handle controlled substances properly and safely. "Accurate record keeping prevents controlled substances from ending up in the wrong hands," said DEA Diversion Program Manager Rostant Farfan. "DEA will continue to hold registrants accountable to ensure they are operating within the closed system of distribution." This settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the Southern District of California and the Drug Enforcement Administration. This case was prosecuted by Assistant U.S. Attorney Dylan M. Aste. The claims resolved by the settlement are allegations only, and there has been no determination of liability ...

According to recent studies published by the National Council on Workers' Compensation (NCCI) workers’ compensation has experienced a long-term decline in overall claim frequency, thanks to automation, robotics and continued advances in workplace safety. However, for WC Motor Vehicle Accident (MVA) claims, the story is quite different, with frequency declining for many years and then suddenly turning upward. These accidents can be very severe and are responsible for a significant portion of fatal WC claims. MVA lost-time claims continue to cost over 80% more than the average lost-time claim, because MVA claims tend to involve severe injuries (e.g., head, neck, and spine). In its 2020 update, NCCI noted that according to the National Highway Traffic Safety Administration (NHTSA) "the installation of automatic emergency braking (AEB) was part of a voluntary commitment by 20 automakers to equip virtually all new passenger vehicles with low-speed AEB that includes forward collision warning by September 1, 2022. The NHTSA further noted that "manufacturers have made great strides in providing advanced safety to consumers compared to 2018, when only 30% of their new vehicles were equipped with AEB." The the Insurance Institute for Highway Safety maintains that autobraking is making driving safer, estimating that the technology could cut rear-end collisions in half. This month the voluntary efforts of these 20 automakers have become a mandatory requirement for all of them. The National Highway Traffic Safety Administration (NHTSA) finalized Monday a new Federal Motor Vehicle Safety Standard which makes automatic emergency braking (AEB), including pedestrian AEB, standard on all passenger cars and light trucks by September 2029. According to the agency, this safety standard is expected to significantly reduce rear-end and pedestrian crashes, saving at least 360 lives a year and preventing at least 24,000 injuries annually. AEB systems use sensors to detect when a vehicle is close to crashing into a vehicle or pedestrian in front and automatically applies the brakes if the driver has not. The new standard requires all cars be able to stop and avoid contact with a vehicle in front of them up to 62 miles per hour and that the systems must detect pedestrians in both daylight and darkness. In addition, the standard requires that the system apply the brakes automatically up to 90 mph when a collision with a lead vehicle is imminent and up to 45 mph when a pedestrian is detected. In June 2023, the National Safety Council (NSC) supported NHTSA’s notice of proposed rulemaking to require AEB and pedestrian AEB on new passenger cars and light trucks. The standard fulfills a provision in the Infrastructure Investment and Jobs Act to establish minimum performance standards requiring that all passenger vehicles be equipped with AEB and also aligns with the Department of Transportation’s National Roadway Safety Strategy, further embracing the Safe System Approach by directly taking a step toward making safer vehicles, a pillar of the holistic approach to roadway safety. NSC believes the development, design, and accessibility of vehicle technology are key components to addressing the tragic trend of roadway fatalities. Improvements in vehicle safety must take into account risks to both vehicle occupants and non-occupants, and ways to mitigate these risks must be clearly communicated to the public ...

Sedgwick, announced several new updates to its artificial intelligence-powered (AI) technology program, ahead of the upcoming RISKWORLD 2024, the annual conference of RIMS, Sedgwick also said it "remains at the vanguard of technological innovation in the industry with its pioneering generative AI technologies and claims management applications." The latest enhancements are significant milestones on Sedgwick’s journey of technology evolution and have been supported by dedicated research and development in predictive modeling, machine learning and now, generative AI. This work has been propelled by the company’s vast global dataset and expert in-house data science and technology teams. Their goal is to expedite the claims process by predicting, addressing, and automating steps in the claim lifecycle, thereby enhancing consumer experiences, and streamlining claim resolutions. Claim resolution times are expected to decrease, early adopters will swiftly benefit from the technological advancements, and the overall experience for Sedgwick’s consumers and clients will be significantly elevated. Sedgwick’s technology stack is built around several AI-enhanced tools that comprise a scalable, rapidly deployable platform. Recent enhancements to Sedgwick technologies include: 1- Sidekick+: In April, Sedgwick achieved integration of generative AI tools into its proprietary technology program with a best-in-class claims workflow. New updates to Sidekick+, an industry-first application that integrates Microsoft/OpenAI’s ChatGPT technology with Sedgwick’s established claims management tools, leverage API integration so that claim professionals automatically receive medical document summarizations directly into their claim files. Sidekick+ has processed 50,000 documents in the initial pilot with greater than 98% accuracy in its summarizations. Sidekick is bundled with Sedgwick’s digital intelligence suite, including predictive models and decision engines, so that AI can prescribe optimal workflows, leading to genuine process transformation. Sedgwick was named by Foundry’s CIO as a 2024 CIO 100 Award winner for Sidekick+, which is a first-of-its-kind application developed by the company’s technology team. Foundry’s CIO 100 award recognizes enterprise excellence and innovation in IT. 2- AI care guidance: Sedgwick has expanded its offerings with the launch of an AI-powered care guidance application to identify claims on workers’ compensation programs with integrated managed care whose progression could benefit from early clinical intervention. The proprietary model uses modern AI, machine learning and natural language processing to rapidly review unstructured data - such as claim notes, correspondence, medical bills, and clinical documentation - and collect meaningful, actionable information for review. By identifying subtle patterns that might otherwise be overlooked, AI care guidance detects the warning signs of claim severity early in the process and facilitates prompt referrals to appropriate clinical resources. 3- mySedgwick: With an eye toward continued innovation addressing communication gaps in the claims process, mySedgwick - Sedgwick’s customer-centric self-service tool and virtual guide through the claims journey - has been refreshed with a simplified, mobile- first user experience for U.S. casualty and workforce absence clients and their employees/customers. Today, nearly 70% of claimants use mobile devices to check on their claims and ask questions - up from 30% just three years ago. AI-backed chat capabilities can address many claims questions in real time or direct claimants to their assigned examiners for more complex queries. This update simplifies the claims experience and meets claimants where they are in the digital realm ...

The Leapfrog Group is a non-profit organization in the United States that focuses on patient safety, quality, and transparency in healthcare. It was founded in 2000 by large employers and healthcare experts to work to improve the healthcare system through public reporting initiatives. For more than 20 years, The Leapfrog Group has collected, analyzed, and published hospital data on safety and quality in order to push the health care industry forward. Leapfrog’s bold transparency has promoted high-value care and informed health care decisions - and helped trigger giant leaps forward in the safety, quality, and affordability of U.S. health care. Leapfrog just released its spring 2024 Hospital Safety Grades, assigning an "A," "B," "C," "D" or "F" to nearly 3,000 general hospitals on how well they prevent medical errors, accidents and infections. Nationally, patient experience - a set of measures using patient-reported perspectives on hospital care - indicates significant signs of improvement since the fall 2023 Safety Grades, and preventable health care-associated infections show a sustained drop after unprecedented rates during the height of the pandemic. In addition to assigning letter grades to individual hospitals, The Leapfrog Group also reports best patient safety performance by state and, for the first time, by metro area based on highest percentage of "A" hospitals. In spring 2024, Utah ranks number one among states for the second cycle in a row. The top three metro areas are Allentown (Pennsylvania), Winston-Salem (North Carolina), and New Orleans (Louisiana). Three California hospitals made the Leapfrog list of the 10 nationwide to receive an "F" grade in The Leapfrog Group's spring safety rankings, released May 1. - - Mission Community Hospital (Panorama City) - - Pacifica Hospital of the Valley (Sun Valley) - - Providence St. Mary Medical Center (Apple Valley) There are 15 hospitals Leapfrog has rated with 25 consecutive "A" grades. Two of them are in California. - - French Hospital Medical Center (San Luis Obispo) - - Kaiser Permanente Orange County-Anaheim Medical Center Twice a year, the nonprofit healthcare watchdog organization publishes a letter grade for 3,000 hospitals on how well they prevent medical errors, accidents and infections. Among the 3,000 hospitals evaluated nationwide, fewer than 1 percent received an "F." ...

May 1st, 2024, marked a turning point for Walmart's healthcare ambitions. All 51 Walmart Health clinics in six states will be closed, and the giant retailer will end virtual health care services, the company said Tuesday. The company had opened these clinics next to its superstores, and offered primary and urgent care, labs, X-rays, behavioral health and dental work. It had expected that it could use its massive financial scale and store base to offer convenient, low-cost services to patients in rural and underserved areas that lacked primary care options. The decision, came as a shock to many. Just five years ago, Walmart had entered the healthcare scene with a bold promise: to disrupt the system and provide high-quality, low-cost care as an alternative to traditional doctor's offices. Their clinics offered primary care, urgent care, x-rays, and even dental work, all conveniently located next door to the familiar blue vestibules. "Health care looks like a big opportunity," Walmart CEO Doug McMillion said in 2020, shortly after the first clinics opened. However, the dream of revolutionizing healthcare proved elusive. Walmart cited "challenging reimbursement environments and escalating operating costs" as reasons for the closure. In simpler terms, the clinics just weren't profitable enough. This echoed a wider trend - Walgreens had recently shuttered a significant number of their own in-store clinics, suggesting that the retail healthcare model might not be sustainable in the current climate. Ateev Mehrotra, a professor of health care policy and medicine at Harvard Medical School who researches retail health clinics said Walmart’s closures reflect the challenges for primary care providers in the United States. The closure leaves many patients scrambling for alternatives. Walmart has assured them that existing appointments will still be honored, and they're working to connect patients with other providers within their insurance networks. However, finding a new doctor, especially in underserved areas, can be a daunting task. The impact goes beyond patients. Hundreds of healthcare workers, from doctors and nurses to administrative staff, now face an uncertain future. Walmart has offered them the opportunity to transfer to other positions within the company, but for many, this may not be a viable option. The story of Walmart's healthcare experiment serves as a cautionary tale. While the goal of affordable, accessible care was noble, the execution proved difficult. The complex landscape of healthcare reimbursement and the high cost of operation ultimately proved insurmountable. However, Walmart's exit doesn't necessarily negate the potential of retail healthcare entirely. It simply underscores the need for a more sustainable model. The future of affordable healthcare access remains an open question, and Walmart's story serves as a reminder of the ongoing struggle to find a solution that works for everyone ...

The owner and operator of addiction treatment facilities in Orange County has been charged by a federal grand jury indictment alleging he paid nearly $175,000 in illegal kickbacks to so-called "body brokers" in exchange for finding him new patients. He pleaded not guilty on April 29, and trial has been set for June 25th. 57 year old Scott Raffa who lives in Newport Beach, was arrested Saturday at Los Angeles International Airport. Raffa is charged with 12 counts of illegal remunerations for referrals to clinical treatment facilities. According to the indictment that a grand jury returned on April 10, Raffa operated Orange County-based sober living homes, including Sober Partners Waterfront Recovery Center, Sober Partners Reef House, and Sober Partners Beach House. These facilities treated patient populations that received health care benefits through health insurers. Raffa allegedly paid thousands of dollars per patient in illegal kickbacks to individuals who referred patients to his facilities, a practice known as "body brokering." The body brokers in this case each controlled their own business entities and Raffa allegedly paid them kickbacks by depositing checks or wiring money to bank accounts that the brokers controlled. The kickbacks were intended as compensation for the brokers referring patients and to induce the brokers to continue to refer patients to Raffa’s facilities, the indictment alleges. Raffa allegedly entered into sham contracts with certain body brokers that were designed to conceal the nature of the illicit payments, including by purportedly prohibiting payments from Raffa’s sober living homes based on "volume or value" of the body brokers’ patient referrals. The brokers and Raffa allegedly met or would communicate via encrypted messaging services to calculate and negotiate the kickback amounts he owed the brokers for patient referrals. The kickback amounts allegedly were based on the insurance revenues that Raffa expected to receive for the respective patients, factoring in each patient’s insurance provider and the duration of the patient’s treatment at one of his sober living homes. Raffa refused to pay the kickbacks unless patients received at least 21 days’ treatment at one of his facilities, according to the indictment. From April 2020 to October 2021, Raffa paid a total of $174,600 in illegal kickbacks to body brokers, the indictment alleges. A report by the Orange County Register said that the DOJ’s Sober Home Initiative began in 2021, after O.C. overtook South Florida as the national epicenter for addiction industry fraud. Historically, the Miami area had that dubious distinction, but crackdowns in Florida pushed the problems westward, Assistant U.S. Attorney Benjamin Barron, chief of the Santa Ana Branch Office, said at the time. Myriad arrests and guilty pleas have resulted from the Sober Home Initiative. Most recently, Kevin M. Dickau, 35, of Tustin, pleaded guilty to conspiracy to commit health care fraud on April 23 and was sentenced to 15 months in prison and three years of supervised release. It doesn’t appear that the DOJ is done just yet. Raffa’s indictment mentions mysterious unnamed body brokers, and when we asked if there’d be more indictments coming, spokesperson Ciaran McEvoy said, "We have no comment." The vast majority of addiction treatment facilities in the state are here in Southern California ...

On July 10, 2016, a Pro-Care Building Maintenance employee was injured while on the job and a workers’ comp claim was filed with one of the company’s insurance carriers. During a review of the claim, it was reportedly found that Pro-Care underreported payroll and failed to report the end of policy payroll to the insurance company as the policy required. The California Department of Insurance investigation further discovered that the company owner,Jorge Maldonado, failed to report payroll and employees of Pro-Care to three insurance carriers from 2017 through 2019. The alleged unreported payroll was over $5 million. Maldonado was charged with three felony counts of insurance fraud after allegedly underreporting payroll and employees to illegally save on workers’ compensation insurance premiums, resulting in a $687,560 loss to three insurance carriers. The Sacramento County District Attorney's office announcedthat on April 18, 2023, Maldonado was convicted of felony workers’ compensation insurance fraud. At a restitution hearing in April 2024, the Honorable Tami Bogert ordered Maldonado to pay $687,560.96 in restitution to the victims. Insurance fraud of this nature puts employees of the company at risk if they are injured on the job. It also illegally reduces costs for the fraudster, allowing them to undercut honest employers on job bids. This results in unfair competition and hurts not only other companies within the industry, but also consumers who have fewer choices and less reputable companies to choose from ...

Applicant Abate Villalpando alleged injury to his head, neck, back, psyche, headaches, internal [system], and in the form of sleep disorder, while employed during the period February 1, 2016 to October 15, 2017 by G Burger, insured by Employers Preferred Insurance Company and State Farm Insurance Company administered by Sedgwick CMS; Golden Road Food Services DBA Fresh Brothers Pizza by Liberty Mutual; and Garden Fresh Restaurants DBA Souplantation by Travelers Insurance Company. Defendants denied all liability for applicant’s claim. On June 13, 2023, the parties prepared a Pre-trial Conference Statement, indicating the need for adjudication of multiple issues, including injury AOE/COE. On August 8, 2023, applicant filed a Notice of Election as against G. Burger and State Farm. On the same day, parties appeared at Mandatory Settlement Conference, and the matter was set for trial on September 13, 2023. On September 13, 2023, the parties appeared at trial. However, applicant was unavailable, and the WCJ continued the matter to another trial date. The WCJ further issued a minute order, as follows: "AA’s Election against G Burger under the coverage of State Farm is presently DENIED due to objection to election by State Farm and also because this case involves multiple employers and carriers for a CT claim that may extend past the alleged period and also because the terminal employer/carrier is not G Burger and State Farm." On September 27, 2023, applicant filed a Petition for Removal from the WCJ’s September 13, 2023 order denying election. On October 11, 2023, the WCJ issued an Order Vacating Denial of Election pursuant to WCAB Rule 10955(d) (Cal. Code Regs., tit. 8, § 10955(d)), in which the WCJ vacated the minute order denying applicant’s election, and substituted the following: "AA’s Election against G Burger under the coverage of State Farm is DEFERRED pending adjudication at trial of this threshold issue due to objection to election by State Farm and the need to determine whether the applicant’s alleged CT injury is AOE/COE." On October 19, 2023, applicant filed the instant Petition for Removal in response to the WCJ’s amendment of the minute order. Applicant avers his election "falls squarely within the language and legislative purpose of Labor Code § 5500.5," and that he "should be permitted to proceed against one defendant only, G Burger, as elected, whereas the remaining defendants lose no rights whatsoever except that they must await issuance of applicant’s award prior to contribution issues." The WCAB granted the Petition for Removal and affirmed the Order, except that it amend it to reflect that the issue of applicant’s election is deferred pending the creation of an evidentiary record. The WCAB then returned this matter to the WCJ for further proceedings and decision in the panel decision of Villalpando v G Burger -ADJ10620763 (April 2024) State Farm has filed an Answer, averring that "applicant’s right to elect one defendant is not unfettered; in fact, the Workers’ Compensation Appeals Judge can decline even to allow an election in his or her discretion" citing Schrimpf v. Consolidated Film Industries, Inc. (1977) 42 Cal.Comp.Cases 602 (appeals board en banc)). State Farm contends that the fact that it has five more days of coverage than codefendant Employers Preferred Insurance Company "is not a compelling basis under which to elect against a carrier when considering that for the duration of the case, applicant had engaged in direct litigation and discovery with Employers." The WCAB panel noted that "It is the responsibility of the parties and the WCJ to ensure that the record is complete when a case is submitted for decision on the record. At a minimum, the record must contain, in properly organized form, the issues submitted for decision, the admissions and stipulations of the parties, and admitted evidence." (Hamilton v. Lockheed Corp. (2001) 66 Cal.Comp.Cases 473, 476 [2001 Cal. Wrk. Comp. LEXIS 4947] (Appeals Board en banc) "Here, the record does not adequately set forth the arguments advanced by the parties, or the evidence relied upon by the WCJ in determining initially to deny applicant’s election pursuant to section 5500.5, and later to defer the election." ...

The United States and the State of California have reached a $7,084,000 civil settlement with Monrovia-based ReNew Health Group LLC, ReNew Health Consulting Services LLC, and two corporate executives for knowingly submitting false Medicare Part A claims for nursing home residents. During the COVID-19 pandemic, to conserve hospital beds, the Centers for Medicare and Medicaid Services waived the requirement that a person must have had a hospital stay of at least three days (signaling an acute illness or injury) before reimbursing for skilled care in a nursing home. The United States and the State of California alleged that the defendants knowingly misused this waiver by routinely submitting claims for nursing home residents when they did not have COVID-19 or any other acute illness or injury, but merely had been near other people who had COVID-19. Under the settlement, the defendants will pay $6,841,727 to the United States and $242,273 to the State of California, plus interest. "False claims are anathema to the Medicare system, especially during a public health crisis," said United States Attorney Martin Estrada of the Central District of California. "This settlement agreement highlights my office’s determination to ensure our nation’s health care programs help those who actually need them." "The Department of Justice is committed to protecting the integrity of taxpayer-funded programs," said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Department of Justice’s Civil Division. "We will hold accountable those who sought to defraud such programs during the COVID-19 pandemic, including those who knowingly misused emergency waivers for personal gain." This investigation was prompted by a lawsuit filed under the whistleblower provisions of the False Claims Act, which permit private parties to sue on behalf of the government to redress false claims for government funds and to receive a share of any recovery. The settlement agreement in this case provides for the whistleblower, Bay Area Whistleblower Partners, to receive $1,204,280, plus interest, as its share of the settlement. The case is captioned United States and State of California ex rel. Bay Area Whistleblower Partners v. ReNew Health Group LLC et al., No. 2:20-cv-09472 (C.D. Cal.). Assistant United States Attorney Karen Y. Paik of the Civil Division’s Civil Fraud Section and Senior Trial Counsel Albert P. Mayer of the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section are handling this matter with assistance from the Department of Health and Human Services’ Office of Inspector General and the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse. The claims settled by the United States and the State of California are allegations only, and there was no determination of liability ...

A Tustin California man was sentenced to 15 months in prison for his role in a conspiracy to broker patients as part of a multistate patient scheme in which he directed recruiters to bribe drug-addicted individuals to enroll in drug rehabilitation and received referral fees from the rehabilitation centers. 35 year old Kevin M. Dickau pleaded guilty by videoconference before U.S. District Judge Peter G. Sheridan to an information charging him with one count of conspiracy to commit health care fraud. Judge Sheridan imposed the sentence on April 23, 2024. Six other individuals have previously pleaded guilty for their roles in the scheme: Peter Costas; Seth Logan Welsh; John C. Devlin; Akikur Mohammad; Lauren Philhower; and Anastasia Passas. According to documents filed in the case and statements made in court:, Dickau, Welsh, Devlin, and their conspirators owned and operated a marketing company in California. Dickau, Welsh, and Devlin used the marketing company to help orchestrate a scheme in New Jersey, Maryland, California, and other states that involved bribing individuals addicted to heroin and other drugs to enter into drug rehabilitation centers so Dickau, Welsh, Devlin, and their conspirators could generate referral fees from those facilities. Two facilities in California that paid such referral fees were owned or operated by Mohammad, Philhower, and Passas. One located in Los Angeles, the other in Santa Ana. California Insurance code section 750 criminalizes receiving or paying remuneration for referrals to any person or entity that bills claims under insurance policies, which includes recovery homes, clinical treatment facilities, and laboratories. The marketing company run by Dickau, Welsh, and Devlin maintained contractual relationships with drug treatment facilities around the country, including the ones run by Mohammad, Philhower, and Passas. The marketing company also engaged a nationwide network of recruiters - including Costas in New Jersey - to identify and recruit potential patients, from New Jersey and other states, who were addicted to heroin or other drugs and who had robust private health insurance. To convince drug-addicted individuals to travel to and enroll in rehabilitation when they otherwise would not have, Costas and other recruiters offered to bribe them - often as much as several thousand dollars - with the approval of Dickau, Welsh, and Devlin. Once the patients agreed to enroll in drug rehabilitation in exchange for the offered bribe, Dickau, Welsh, Devlin, and Costas would arrange and pay for cross-country travel to the drug treatment centers in California and other states, in concert with the owners of the facilities themselves, including Mohammad, Philhower, and Passas. Costas would stay in touch with the New Jersey patients at the facilities and specifically instruct them to stay at the facilities long enough to generate referral payments, and he would pass along information to Dickau, Welsh, and Devlin about the patients’ status at the facilities. Dickau, Welsh, and Devlin would monitor the other patients they brokered by speaking to other recruiters or to the owners and employees of the drug treatment facilities themselves. The drug treatment facilities run by Mohammad, Philhower, and Passas had contracts with the marketing company. Those facilities typically paid the marketing company a fee of $5,000 to $10,000 per patient referral. Dickau, Welsh, Devlin, and their conspirators shared that money among themselves. Costas and other recruiters received approximately half that amount for each patient they brokered. Dickau, Welsh, Devlin, and their conspirators brokered scores of patients to drug treatment facilities around the country, including the ones run by Mohammad, Philhower, and Passas, and the conspiracy caused millions of dollars of losses for health insurers. In addition to the prison term, Judge Sheridan sentenced Dickau to three years of supervised release ...

Founded in 2006, the UFW Foundation is a nonprofit organization that advocates for workers’ rights and protections for farm workers across the United States and provides educational outreach and critical services such as immigration legal services to low-income rural communities. KVPR announced a new documentary series released this week by the United Farm Worker Foundation highlights how farm laborers face a wide range of risks and dangers while harvesting the nation’s crops, from sweltering temperatures to more frequent natural disasters The five-part mini-series, called Farm Worker Voices, aims to show how climate change affects the everyday lives of agricultural laborers, and spotlights the stories of farmworkers across the country who are directly affected. The UFW Foundation is releasing a video every week until May 20. "They’re extremely vulnerable to heat, illness and death. They’re vastly affected by climate change," says Daniel Larios, a spokesperson for the foundation. Two farmworkers from the San Joaquin Valley are featured in the series. Elizabeth Ramirez, 44, from Bakersfield, talks in one video about the impacts brought on by last year’s record-breaking floods. Heavy rainfall from a series of record atmospheric rivers drenched the state and flooded farms. "Before the floods, I’d never seen such a widespread loss of work," Ramirez says in Spanish. "We couldn’t pay our bills or provide for our kids." Adela Leon, a 43-year-old farmworker from Fowler, speaks about another challenge for farmworkers - pesticides - and how a lack of protections from pesticide drift affected her while she was pregnant. "Sometimes [our bosses] don’t tell us what kind of chemical is being sprayed," Leon says in Spanish. "I started having heart problems. My son was born with asthma and other health issues." Last year Regulators with the California Department of Pesticide Regulation filed suit in Kern County Superior Court against a company, known as Agra Fly, which drops pesticides onto agricultural fields using planes and helicopters. A judge temporarily ordered the company to stop aerially applying pesticides. Regulators say its operations resulted in at least six incidents of illegal drift, which is when a pesticide travels from its target area onto an unintended one. "Defendants’ activities are a public nuisance that endanger the life, wellbeing, and property of the community. Each day that [Agra Fly] conduct aerial pesticide applications, the significant threat to the community exists," reads the complaint. In the last year, DPR took disciplinary action and then entered into a legal settlement with another company, Hollister-based TriCal Inc., following nine incidents and 61 violations in multiple Central California counties. The documentary also calls attention to workers who have labored under scorching temperatures - an issue the Valley is familiar with. A farmworker reportedly died last August of heat exhaustion. The UFW Foundation, through the series, is calling on state and federal agencies to implement stronger regulations to protect workers such as a national heat standard, pesticide bans, and more widely available relief programs. While there are some protections for outdoor workers in California, there is no federal heat standard. "Climate change is real," Larios of the foundation says. "We need to do more to support our farmworkers." ...

3 Stonedeggs, Inc. - (DBA California Sandwich Company) business was to provide food service to firefighters and forestry workers at various locations. The employer won a contract to provide food service at a remote location near Happy Camp, California, and it was expected that the job would last 3 to 6 months. The employer asked employees assigned to its Brownsville camp to volunteer to work at Happy Camp, a remote location without cellular telephone services where it was to serve meals for the three-to-six month period. Braden Nanez and two other employees from the Brownsville camp agreed to travel to work providing food service at Happy Camp, and the employer authorized Nanez to drive his own car from Brownsville to his residence and then to Happy Camp. On October 5, 2020, the day of the vehicular accident at State Highway 263/Shasta River Bridge, Nanez worked the breakfast shift and, afterwards, at about 9:00 a.m., commenced a seventy-mile drive to Yreka in his own car. He texted manager Brossard later that he would return for his next shift at about 4:00 p.m., a timeframe permitting daytime travel in his off hours. The employer was not informed of his reasons for traveling to Yreka, but manager Todd surmised that it was to use his cellular telephone. On April 26, 2022, the matter proceeded to trial as to the following issues: "Injury arising out of and in the course of employment per Labor Code section 3600(a), (the going and coming rule); and intoxication." The WCJ found that applicant (1) did not sustain injury arising out of and in the course of employment (AOE/COE); (2) violated company policy when he left the worksite without permission on the date of his injury; and (3) was engaged in a material deviation and complete departure from his employment at the time of injury. The WCJ ordered that Nanez take nothing on his workers’ compensation claim. On reconsideration, Nanez contended that the evidence established that he was engaged in an activity reasonably expected to be incident to his employment at the time of his injury, and, therefore, that the commercial traveler rule applies to his accident. The WCAB agreed, and rescinded the F&O, and substituted findings that the commercial traveler rule applies to his accident, that his claim is not barred by the going and coming rule and intoxication, and that he sustained injury AOE/COE in the form of a fracture to the right femur, and deferred his claim of injury to other body parts in the panel decision of Nanez v 3 Stonedeggs, Inc. -ADJ14015513 (February 2023) The employer filed a timely Petition for Writ of Review, and the Court of Appeal reviewed the case, and affirmed the WCAB in the unpublished case of 3 Stonedeggs v. Workers' Compensation Appeals Board et al -C098711 (April 2024). On appeal, the employer contends in part that any activity that involved leaving the camp without approval and for comfort and safety when the employer provided all items the employees would need was not a personal activity reasonably contemplated by the employer under the circumstances of this case. The Court of Appeal reviewed the great body of decisions, including WCAB panel decision on the application of the commercial traveler rule and concluded as follows: "Synthesizing these decisions and looking at the nature of Nanez’s activity and his employment, we conclude substantial evidence supports the Board’s decision. We disagree with the employer’s argument that any departure from the camp without authorization was outside the course of employment. Substantial evidence establishes that the employer could reasonably expect that Nanez, incident to the employer’s requirement that he spend time away from home, would leave camp in his personal automobile and drive 'to town' during his off hours. The employer made clear to employees its 'expectation' that employees not leave camp. It told employees it did not want them leaving camp 'if they don’t have to' due to safety reasons, and it 'really encouraged' the employees not to drive on the roads. But in none of these explanations did the employer actually prohibit the employees from leaving camp." "Substantial evidence thus supports the Board’s determination that Nanez’s departure from camp was a leisure activity that the employer may reasonably have expected to be incident to its requirement that Nanez spend time away from home." ...

Renee Vines sued his former employer, O’Reilly Auto Enterprises, LLC, for violations of the Fair Employment and Housing Act (FEHA) (Gov. Code, § 12900 et seq.), alleging causes of action for race- and age- based discrimination, harassment, and retaliation. A jury found in his favor on his causes of action for retaliation and failure to prevent retaliation, but against him on his other causes of action. Although Vines asked for $253,417 in economic damages and 3 $1.3 million to $2.3 million in non-economic damages, the jury awarded him only $70,200. Vines moved for $809,681.25 in statutory attorneys’ fees. On September 9, 2019 the trial court granted the motion, but awarded only $129,540.44 in fees, based in part on the court’s determination Vines’s unsuccessful discrimination and harassment causes of action were not closely related to or factually intertwined with his successful retaliation causes of action. Vines appealed, and the Court of Appeal reversed. It held the trial court erred in finding that, because the facts related to Vines’s (successful) retaliation causes of action arose after he complained about the discriminatory and harassing conduct, the (unsuccessful) discrimination and harassment causes of action were not related to the (successful) retaliation causes of action. Therefore, it concluded, the trial court erred in ruling Vines was not entitled to recover any fees he incurred pursuing his discrimination and harassment causes of action. (Vines v. O’Reilly Auto Enterprises, LLC (2022) 74 Cal.App.5th 174, 185 (Vines I).) On remand the trial court on June 29, 2022 awarded Vines $518,161.77 in fees. O’Reilly paid the fee award, including post judgment interest from June 29, 2022. Vines’s attorneys, however, wanted more; specifically, they wanted interest on the attorneys’ fees award from September 9, 2019, not June 29, 2022, which amounted to an additional $138,454.44 in interest. Rather than asking the court to enter an amended judgment that included the award of attorneys’ fees plus additional interest or seeking an order for additional interest, Vines applied for and obtained a renewal of the judgment in the amount of $138,454.44 (i.e., the additional interest). O’Reilly filed a motion to vacate the renewal of judgment, which the trial court denied. O’Reilly appeals from the order denying its motion to vacate the renewal of judgment, challenging only the amount of interest on the award of attorneys’ fees. O’Reilly argues that, because our decision in Vines I was a reversal, not a modification, of the trial court’s September 9, 2019 order, interest on the amount of attorneys’ fees awarded should run from June 29, 2022, not September 9, 2019. The Court of Appeal agreed with O’Reilly, reversed the order denying O’Reilly’s motion to vacate the renewed judgment, and direct the trial court to grant the motion in the published case of Vines v. O'Reilly Auto Enterprises (Vines II) - B327821 (April 2024). "The line between modification and reversal, however, like that (for example) between a mandatory and prohibitory injunction, can be a little blurry. Here, however, we can safely draw that line. Our directions in the prior appeal required the trial court to do more than perform a pure mathematical computation or add or delete a category of fees; the trial court had to exercise its discretion to determine an appropriate award of attorneys’ fees. Therefore, our prior opinion was a reversal, not a modification, which means interest runs from the second attorneys’ fees award." ...

According to the California Hospital association Anthem Blue Cross, one of California’s largest health insurance companies, consistently leaves thousands of its patients stranded in hospital beds long after they have been medically cleared for discharge, a violation of California law. These victims of discharge delays are forced to stay in hospitals longer, are deprived of timely post-hospital health care services, and cause backlogs for other patients who have to wait longer for hospital beds. These failures, along with Anthem’s disregard of state requirements to maintain an adequate network of care providers and not paying for the additional hospital care it forces to be provided to patients, are the basis of a new lawsuit filed in Los Angeles County Superior Court against the insurance giant by the California Hospital Association (CHA) on behalf of the state’s more than 400 hospitals and health systems and the patients they serve. "California has some of the strongest laws in the nation governing insurance company practices," said CHA President & CEO Carmela Coyle. "Regrettably, far too many insurance companies that put their bottom lines over patient care are violating these essential patient protection laws every day, hurting patients, hospitals, and the public good. By filing this lawsuit, we are asking the court to put a stop to these illegal practices and force insurers to do what is best for patients." According to a statewide survey of hospitals conducted last year by CHA, an estimated 4,500 Californians are stuck every day in hospital beds and emergency departments waiting for their insurers to approve and arrange for their discharge to care settings such as skilled-nursing facilities, home health services, rehabilitation facilities, or behavioral health services. According to the survey, patients whose discharge is delayed by at least three days (~300,000 patients annually) spend, on average, an additional 14 days in the hospital after being medically cleared for post-acute care. Other findings from the survey include: - - California hospitals provide an estimated 1 million days of unnecessary inpatient care and 7.5 million hours of wasted emergency department care annually due to discharge delays. - - In some extreme cases, patients - especially those experiencing behavioral health issues - have languished in hospital beds for as long as a year. - - These delays result in at least $3.25 billion in avoidable hospital costs every year. - - Patients enrolled in managed care plans - especially those covered by Medi-Cal - are more likely to experience delays than those who have fee-for-service coverage. The lawsuit alleges that Anthem fails to meet its legal obligations to arrange for timely access to care for its members as required under California law. Anthem is also accused of not responding in a timely manner - or at all - "to requests for authorization" for post-acute care for its members. Additionally, the complaint charges Anthem with "unilaterally discontinuing authorization" for hospitals to continue caring for patients while they need to remain in hospital beds longer as a result of the insurance company’s failure to arrange for timely post-acute discharge. In the lawsuit, CHA is seeking an injunction against Anthem that would bar the insurer from engaging in these illegal and harmful business practices. "It is time for the courts to hold insurers accountable by enforcing the law. Care that is delayed is care that is denied," Coyle said. Coyle also said the association has raised the issue with the Department of Managed Health Care, which oversees most health insurers. In a statement, department spokesperson Kevin Durwara said the agency has been meeting with the hospital association to address hospitals’ "concerns and challenges" with insurance delays since 2021. The meetings resulted in a letter issued to insurers in Fresno County, where hospital capacity was particularly limited, instructing them to make it easier for hospitals to discharge patients. According to CalMatters a spokesperson for Anthem said the company did not have an immediate response and would be investigating the allegations ...

The National Committee for Quality Assurance (NCQA) has just announced the launch of its Virtual Care Accreditation Pilot program, a key step in NCQA’s development of a quality improvement framework for organizations that provide care via telehealth or other digital platforms. NCQA selected as pilot organizations a diverse set of 18 organized and engaged entities from the more than 100 that applied. Based in 12 states and Puerto Rico, pilot organizations include health plans, health systems, Federally Qualified Health Centers, patient-centered medical homes and virtual first/virtual only organizations. The pilot organizations will provide valuable input to the development of NCQA’s Virtual Care Accreditation, a first-of-its-kind program highlighting the quality of care patients receive through virtual or hybrid modalities from many kinds of health care organizations. Virtual Care Accreditation will highlight and distinguish organizations using virtual modalities to identify gaps in care, provide high-quality care and report and track outcomes. Early versions of the program will focus on primary care and urgent care. Later versions will provide opportunities for organizations to distinguish themselves for other kinds of care they deliver virtually. Likely options include behavioral healthcare and acute, post-acute or specialty care. "Care delivery has evolved, and virtual care is a new normal in desperate need of standardization and reliable quality assessment," said NCQA President Margaret E. O’Kane. "Virtual Care Accreditation will be a roadmap and the foundation of the safe, effective and equitable virtual care people need." Four phases compose the roughly 10-month pilot program: learning, testing, preparation and evaluation. An early adopter program and launch of Virtual Care Accreditation will follow the pilot program in mid- to late-2024. The Joint Commission also just announced it is launching a new Telehealth Accreditation Program for eligible hospitals, ambulatory and behavioral healthcare organizations, effective July 1, 2024. This accreditation program provides updated, streamlined standards to provide organizations offering telehealth services with the structures and processes necessary to help deliver safe, high-quality care using a telehealth platform. The Telehealth Accreditation Program was developed for healthcare organizations that exclusively provide care, treatment and services via telehealth. Hospitals and other healthcare organizations that have written agreements in place to provide care, treatment and services via telehealth to another organization’s patients have the option to apply for the new accreditation. The Telehealth Accreditation Program’s requirements contain many of the standards similar to other Joint Commission accreditation programs, such as requirements for information management, leadership, medication management, patient identification, documentation, and credentialing and privileging. Requirements specific to the new accreditation program include: - - Streamlined emergency management requirements to address providing care and clinical support remotely rather than in a physical building. - - New standards for telehealth provider education and patient education about the use of telehealth platforms and devices. - - New standards chapter focused on telehealth equipment, devices and connectivity ...

When the nation first observed Workers Memorial Day on April 28, 1970, an estimated 38 U.S. workers suffered fatal on-the-job injuries each day and many more endured debilitating respiratory diseases and other life-altering illnesses related to workplace exposures. Today, work-related injuries in the U.S. claim about 15 people’s lives a day. In 2022, a reported 5,486 workers suffered fatal injuries, an increase of 296 worker deaths from 2021. This year, the Department of Labor’s Occupational Safety and Health Administration and Mine Safety and Health Administration will remind the nation of the importance of protecting workers as families, friends, co-workers and the community at-large gather across the country for Workers Memorial Day events on Sunday, April 28 to honor people who didn’t come home at the end of their shift. "As we honor our fallen workers on Workers Memorial Day, we must remember that behind each workplace fatality there are loved ones enduring unimaginable grief," said Assistant Secretary for Occupational Safety and Health Doug Parker. "It is for the lost workers and those left behind that we continue to fight for every worker’s right to a safe working environment. Our mission at OSHA is to ensure that when someone leaves for work, they know they’ll come home safe at the end of the day to the arms of their families and loved ones." To commemorate Workers Memorial Day, the department will host a week-long series of events from April 22-25 to educate employers on the importance of safe and healthy workplaces. The series will culminate at an in-person and nationally livestreamed event at 1 p.m. EDT at its Washington headquarters where OSHA and MSHA leaders will join AFL-CIO President Liz Shuler and United Support & Memorial for Workplace Fatalities Board Member Stacy Sebald, whose 19-year-old son Mitchell McDaniel suffered fatally injuries in an agriculture incident in 2019. "We come together on Workers Memorial Day to remember those we have lost in workplace accidents and to prevent work-related illnesses," said Assistant Secretary for Mine Safety and Health Chris Williamson. "At MSHA, we know a safe workplace isn’t a privilege - it’s every miner’s right. It is in the memory of fallen workers that we continue to advocate for each miner’s safety, health and dignity." Join OSHA and MSHA representatives, families, workers, labor unions, advocates and others to remember the lives lost and raise awareness of workplace safety to help prevent future tragedies. Find a local Workers Memorial Day event. Learn more about Workers Memorial Day events nationwide and view the April 25 livestream ...