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Health Care Quarterly

DIGITAL EYESTRAIN A GROWING CONCERN Living in the Digital Age, more than one-third of Americans strain their eyes viewing electronic screens for hours on end – from working in front of a computer, watching television or using a smartphone. (Photograph by the Business Journal’s Thomas McConville)


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HEALTH CARE QUARTERLY March 4-17, 2014

‘DigitEYEzed’: Frequent Computer Use Causes Eyestrain ■ By TIFFANY L. RIDER Editor mong the hundreds of millions of people who use personal computers, tablets and smartphones for multiple hours of work per day, the most frequently reported health problems are associated with vision. A report called “DigitEYEzed,” published by The Vision Council in January, details the impact of viewing digital screens on eye health, noting that nearly 70 percent of American adults have strained their eyes from using electronic devices for hours on end. Data collected from this report is from two consumer surveys conducted in 2012 and 2013. Just last year, more than two billion digital devices – most of which have electronic screens – were shipped around the globe, according to global technology research and advisory firm Gartner, Inc. The reliance on electronics drives anytime-anywhere computing, and eye care physicians have seen a spike in the number of patients with dry eyes, blurred vision, headache and pain caused by what is becoming known as digital eyestrain. Causes of digital eyestrain are continuous demands for eye movement and alignment, as well as saccadic (rapid) eye movements, both of which are required for viewing text, images and video on a screen backlit by fluorescent light. For those with prescription glasses,

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INSIDE 3 ‘DigitEYEzed’: Frequent Computer Use Causes Eyestrain 4 Under ACA, Physician Groups Continue Educating Doctors For Influex Of Patients 4 Assembly Bill 241 Creates Concerns Among Home Care Employers 6 How Eating Right (Or Wrong) Impacts Daily Life, Overall Health 8 Health Care Reform Law Will Likely Reduce Labor Supply, Not The Number Of Jobs 8 Covered California Suspends Online Enrollment Portal For Small Businesses 8 Heath Care News In Brief 10 Perspectives

Long Beach Business Journal 3-B wearing standard progressive lenses may also contribute to digital eyestrain. Dr. Michael P. DeCarlo, a practicing optometrist in Long Beach, told the Business Journal he has seen an increase in patients with digital eyestrain. “In recent years, we’ve seen a lot more need for computer lenses,” he said, which are designed differently from progressive lenses. Progressive lenses use nearly the entire top third of the lens for farsighted correction (distance), a small portion of the center of the lens for intermediate correction and the bottom area for nearsighted correction (reading). “You can lean in toward the computer to see what’s on it, but hours of that not only causes near point stress to the eye but also neck pain and shoulder pain from poor ergonomics,” DeCarlo said. “We are not designed to sit for eight hours at a time and focus on something 20 inches in front of us.” In computer progressive lenses, the main part of the lens is dedicated to intermediate correction in order to accommodate viewing a monitor 15 to 20 inches from the eye for hours on end. Dr. David Ardaya, doctor of optometry and member of the California Optometric Association, told the Business Journal in an e-mail, “I find that every year more patients come to me with complaints about eyestrain, blurred vision, headaches and even neck and back pain after using electronic devices.” Ardaya said he’s also been prescribing computer glasses more often to clients at his offices in Whitter and West Covina. “Our patients have been thrilled with the results,” he said. An option for computer glasses is a tinted coating to block fluorescent light, according to DeCarlo. “We’re just starting to get feedback from people who have glasses with the coating,” DeCarlo said. “We like glare coating. We’ve been using it for years. It’s an added expense, so if they’re concerned, patients will decide to add it.” Colored lenses may have a dramatic effect in reducing the symptoms of digital eyestrain. The Irlen Institute in Long Beach has offered colored lenses, colored screen overlays and other products for more than 30 years. “Your eye is a camera that directs the information to your brain,” Helen Irlen, founder of The Irlen Institute, told the Business Journal. “It’s your visual cortex that processes that information. When you look at scans of people who are working on the computer, that visual cortex is working way too hard.” Irlen expressed concern about the growing trend of reading on electronic screens versus on paper, particularly in the educational system. “We’re switching learning in school from books to computers when we don’t fully know the longterm effects of this,” she said. “It’s almost as bad as staring into fluorescent light. It’s just going to get worse, not better.” ■

Dr. Michael DeCarlo, a Long Beach optometrist, uses this informational card to explain to patients the difference between a typical progressive lens and a computer lens. Computer lenses are designed to support the eye’s effort to focus on a digital screen approximately 20 inches from the face. DeCarlo’s practice is located at 5273 E. 7th St. (Photograph by the Business Journal’s Thomas McConville)

Notice slight strain; break for lunch

Eyes are rejunvenated; turn computer on at work

Eyes feel fatigued from screen time; still (at least) two hours left in the work day!

At the end of the day, vision is blurred, eyes are irritated; time to turn in

Shoulders strained from checking last-minute e-mails on your phone; it’s dinnertime

Various factors can cause digital eyestrain. The Vision Council recommends reviewing digital device habits and any fatigue or eyestrain experienced with a eye care provider, who can tailor a plan for improving eye health. (Image from The Vision Council’s report “DigitEYEzed”)

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HEALTH CARE QUARTERLY 4-B Long Beach Business Journal

March 4-17, 2014

Under ACA, Physician Groups Continue Educating Doctors For Influx Of Patients ■ By TIFFANY L. RIDER Editor hile the floodgates have already opened, medical groups and independent practice associations (IPAs) continue to educate physicians in preparation for large numbers of new patients as a result of the Affordable Care Act (ACA) taking effect. MemorialCare Medical Group worked for months before the ACA kicked in January 1 to equip physicians with insurance materials and the knowledge needed to navigate more patients. “Many health plans changed benefit packages, deductibles and co-pays for current patients in 2014 and we are partnering with them to ensure their members better understand the new and/or changed benefits,” Dr. David Kim, director of MemorialCare Medical Group’s medical facility at the Los Altos MarketPlace in Long Beach, told the Business Journal in an e-mail. “MemorialCare Medical Group is also partnering with our physicians, nurses and other clinical staff to help patients who may have delayed

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needed care because of a lack of insurance and access to primary care services. Many of those need immediate medical attention to diagnose health issues, stabilize chronic health conditions, and improve their overall health.” The urgent care facility, which opened in early 2013, has grown from six physicians to 16 physicians on staff in anticipation of the rising demand for primary care. More than 30 such MemorialCare Medical Group centers are operational at this time, serving communities in need. “Many newly insured are used to accessing health care through the ER, when an urgent care and/or a family physician would be a more value added way to treat most minor illnesses and injuries,” Kim explained. MemorialCare Medical Group also increased its customer service staff in 2013 to prepare for “the barrage of calls from current or potential patients inquiring about which health plans MemorialCare Medical Group is part of in the California health insurance exchange,” Kim said. As government activity in health care continues to ramp up, HealthCare

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Partners’ Vice President of Government Programs Jeff Flick said he and others are attending IPA meetings and sending out communications directly to physicians to keep them up to date and educated. “We have a pilot program about to take place for dual eligible beneficiaries,” Flick told the Business Journal. “Covered California is brand new. There’s a MediCal expansion taking place. There are many relatively new programs happening at the same time.” HealthCare Partners has about 2,000 primary care physicians in Los Angeles and Orange counties, some of whom are contracted to the organization’s IPA and some are employed physicians. Flick, who is a former employee of the U.S. Centers for Medicaid and Medicare Services, said his experience helping the federal government implement prescription drug benefit reforms is applicable to the rollout of the ACA. “I remember consumers at the time didn’t know what a generic drug was, let alone what the donut hole was,” Flick said. (For those who don’t remember, the donut hole is the term used to refer to the Medicare prescription drug coverage gap.) “But people are smart, and in a year or two they did a much better job figuring it out,” Flick said, predicting the same will happen with the latest health care reforms. “It’s a lot for a consumer to take in, but there is good help available.”

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Dr. George Jayatilaka, founder of Accountable Health Care IPA in Signal Hill, said his organization has seen an increase in patients through its plan partners. Those plan partners include Molina Healthcare, Health Net and Blue Cross. “We have informed our providers to expect more patients,” Jayatilaka told the Business Journal. “We have also sent out amendments to our doctors because different health plans are not paying the same way. Overall, doctors have told us they are seeing more patients . . . because they just expanded Medi-Cal and [launched] Covered California.” Accountable Health Care has been educating approximately 550 primary care doctors in Los Angeles County who have an impact on some 35,000 lives, Jayatilaka said. As of the end of January, the IPA had added about 1,100 patients to its membership, mostly through Covered California and expanded Medi-Cal programs. “We are all learning,” he said. “We try our best and we try to educate our doctors as we go along. I think it’s a collaborative effort. Bottom line, we need to take care of these patients.” ■

Assembly Bill 241 Creates Concerns Among Home Care Employers ■ By SAMANTHA MEHLINGER Staff Writer ubbed the “Domestic Worker Bill of Rights,” California State Assembly Bill (AB) 241 ensures that domestic workers, including professional childcare providers and home health care workers, receive overtime pay for more than nine hours worked per day. Professionals in the home care industry are reporting that the bill is detrimental for clients who must cut back on care to save money and for employees whose hours are subsequently reduced. The home care industry provides professional in-home caregivers for senior, disabled and ill individuals. Their clients often require 12- or 24-hour care, according to home care industry employers. Because AB 241 mandates overtime pay for home care and domestic workers who work more than nine hours, that means a cost increase for many home care clients, particularly those who employ live-in workers. The bill, which was authored by State Assemblymember Tom Ammiano, went into effect on January 1. “Essentially the combination of AB 241 and AB 10, which is the California minimum wage increase from $8 to $10 an hour, is going to result in a 36 percent

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HEALTH CARE QUARTERLY March 4-17, 2014 increase of labor costs over a two year period of time for us in home care,” Machelle Thompson, co-owner of locallybased Keen Home Care, told the Business Journal. AB 10 takes effect in July. “Roughly translated, our disabled and senior clients requiring 24-hour live-in care may expect an annual increase in their care costs associated with that,” Thompson explained. “Right now, for example, one of my 24-hour clients was paying $93,000 a year up until January 1, and the increase in the labor costs has now resulted in $130,000 annual cost for the same client,” she added. Clients who cannot afford to pay overtime costs have to decide whether to cut back on care or divvy it up between multiple workers to avoid overtime fees, Thompson said. Other home care businesses, such as LivHOME and Cambrian Homecare, reported the same. “We certainly had some difficult conversations leading up to the New Year with our existing clients to make sure that we had their care needs fully handled in a way that would not be too costly to them,” Kirsten Goulde, vice president of human resources for LivHOME, told the Business Journal. Dividing home care among multiple workers when a client is used to one or two caregivers disrupts what Goulde and Thomspon called “continuity of care.” This is particularly important for patients with memory difficulties, Thompson pointed out. “For clients with dementia who are having more caregivers come in, that jeopardizes their stability,” Thompson explained. Goulde agreed. “[For] somebody with dementia or Alzheimer’s disease for whom stability is a significant need, having people that they don’t know rotating in and coming at different hours of the day and night certainly could impact that person’s quality of care,” she said. Because non-medical home care is not typically covered by Medicare or other health care plans, many clients have to pay for home care out of their own pockets, Debbie Teofilo, owner of Home Instead Senior Care’s Long Beach franchise, told the Business Journal. Insurance companies that do cover home care aren’t adjusting their policies to account for rising costs, according to Rhiannon Acree, president of Cambrian Homecare. “They are not even interested in talking about paying for overtime,” she said. Increased out-of-pocket costs negatively impact clients in several ways, Teofilo explained. “This is forcing them to cut back on service hours, at times jeopardizing their safety, or to make the heartbreaking decision to leave their homes and move to facility care where their costs are lower than the one-on-one care they receive at home,” she said. “In California’s feverish home care regulatory environment, the affordability of care is on the losing end and so are our seniors,” she added. Home care industry professionals reached by the Business Journal acknowl-

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Long Beach Business Journal 5-B California State Assemblymember Tom Ammiano (D-San Francisco) authored Assembly Bill 241, which requires that home care workers be paid time-and-a-half for working more than nine hours per day. (Photograph provided by Ammiano’s office)

edged that the bill was likely meant to improve the lives of home care workers. “By mandating payment of higher overtime wages, AB 241 helps to ensure that caregivers are not taken advantage of during live-in assignments and long-hour shifts, which is a positive outcome of this legislation,” Teofilo said. But she, Goulde, Thompson and Acree agree that ultimately the increased cost to clients is going to result in shorter shifts for some employees, which means less money in the bank for them. “I think the intent of the bill was to help caregivers, when in fact it’s the opposite,” Acree observed. In response to concerns that AB 241 makes the cost of home care prohibitive for clients and ultimately reduces hours for workers, Assemblymember Ammiano told the Business Journal via e-mail: “Anyone who looks at labor history knows this is the employers’ standard argument. We would all still be working 10-, 12- or 14-hour days if our predecessors bought the idea that paying people fairly puts workers at an eco-

nomic disadvantage. Literally hundreds of workers came to Sacramento to support this bill. Companies that profit on domestic workers’ labor don’t want to hire three people when they used to hire one. And they don’t want to have to pay overtime. They’d rather keep things like they were.” Ammiano continued, “Why shouldn’t the home care workers covered by AB 241 have the same protections as a coffee shop barista? People who are ill or disabled, of advanced age or too young to care for themselves – do we really want those people taken care of by people who work 18-hour shifts or longer? That isn’t quality care.” When asked by the Business Journal how he hoped the bill would impact home care workers’ lives, Ammiano responded: “We know from studies that large numbers of domestic workers have not been paid adequate wages for their work, including not getting overtime pay. The result is that many of them have had to spend long days away from their own families and many of them find that even those wages do not suffice to provide food every day for their families. My hope is that AB 241 will help change those circumstances for these underappreciated workers.” AB 241 is in effect for a three-year trial period that ends in January 2017. At that time, a committee studying the impacts of the legislation will report its findings to the governor. ■

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HEALTH CARE QUARTERLY 6-B Long Beach Business Journal

March 4-17, 2014

How Eating Right (Or Wrong) Impacts Daily Life, Overall Health ■ By SAMANTHA MEHLINGER Staff Writer ccording to local nutrition experts, an abundance of studies shows that nutrition impacts our health, happiness and ability to perform daily tasks, yet eating right is still a behavior many Americans struggle with. According to the Centers For Disease Control and Prevention, more than one third of adults in the United States are obese. A slew of campaigns and measures have been implemented in the past few years to combat this problem, from First Lady Michelle Obama’s Let’s Move campaign, to ChooseMyPlate.gov’s food portion chart, to calories being listed on menus. Just last week, the Food and Drug Administration proposed changes to nutrition labels on food packing that would make the calorie content more legible and easier to calculate in relation to portion size.

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Jamie Mok, right, clinical dietitian for Long Beach Memorial Medical Center, confers with her dietetic intern, Alison Tedrow, about ChooseMyPlate.gov’s guidelines for a healthy diet at the hospital’s cafeteria. (Photograph by the Business Journal’s Thomas McConville)

A study published in the Journal of the American Medical Association last month indicated that these types of efforts might be paying off for young children – the American obesity rate among children aged two to five years decreased from 13.9 percent to 8.4 percent between 2003 and 2012. However, there was no significant change in the obesity rate of other age

groups and there was about a six percent increase among women 60 and older. Poor eating choices are often a result of convenience and affordability, according to Koby Moridzadeh, a registered dietitian nutritionist and clinical nutrition manager at Lakewood Regional Medical Center. “Healthy foods like lean cuts of meat and good fruits and vegetables are expensive.

Not everybody can afford that,” Moridzadeh said. “If I have only a couple dollars in my pocket, I can [more easily] afford to go buy three tacos for 99 cents than buy a banana for $1,” she explained. Convenience is also a factor for busy individuals: it’s easier to visit a drive-through window than it is to cook and prepare a meal, Moridzadeh said. Unbalanced diets and inadequate exer-


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HEALTH CARE QUARTERLY March 4-17, 2014

Long Beach Business Journal 7-B

Koby Moridzadeh, registered dietitian nutritionist and clinical nutrition manager at Lakewood Regional Medical Center, told the Business Journal that “healthy eating pays back” by positively impacting overall health and daily functions and decreasing risks for certain diseases. (Photograph by the Business Journal’s Thomas McConville)

cise habits mean that the body may not be getting the energy it needs to function, according to local nutritionists. “If you’re not eating right you don’t have enough energy,” Moridzadeh said. Jamie Mok, a clinical dietitian at Long Beach Memorial Medical Center, said that eating breakfast and healthy snacks helps to ensure that the body has enough energy

to get through the day. “It doesn’t have to be a sit down full meal of eggs and bacon and pancakes or anything like that – it’s as simple as a bowl of cereal,” she said of starting the day off with a meal. In addition to low energy, poor nutrition also leads to various conditions and diseases such as diabetes, high cholesterol and heart disease, Moridzadeh said. To get a simple understanding of what a balanced diet should consist of and how to manage portions, Mok and Moridzadeh suggest using ChooseMyPlate.gov as a reference. The website uses a model that visually shows what portion sizes of protein, vegetables, fruit, carbohydrates and dairy products to include in each meal. “We recommend that people eat from these five groups everyday so you get all the nutrients your body needs for your optimal health,” Moridzadeh said, adding that doing so promotes happiness, physical health and even better performance at school or work. Mok often sees patients who have had unhealthy eating habits for many years and acknowledged that changing long-time habits isn’t easy. “The way we eat started from the way our parents fed us to the way we have grown up, so to change that is very difficult,” she said. She recommended starting out with little things. For instance, if you typically drink three cans of soda per day, try cutting down to one per day, she said. “Cutting things like that out that are such big habits can make a huge difference.” ■

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HEALTH CARE QUARTERLY 8-B Long Beach Business Journal

March 4-17, 2014

Covered Health Care Reform Law California Will Likely Reduce Labor Supply, Suspends Online Not The Number Of Jobs Enrollment Portal ■ By T L. R , Editor For Small ome 2.5 million people over the next decade won’t feel obligated to stick with Businesses a full-time job simply for health benefits due to the federal health care subsidies ANALYSIS

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and expansion of Medicare under the Affordable Care Act (ACA). That’s the estimation from the Congressional Budget Office (CBO), which revised its numbers in a report released last month. The office originally estimated that approximately 800,000 people, many of whom are lower income, part-time workers, would choose to work less in order to qualify for federal assistance. And though there has been discussion about businesses cutting workers or reducing hours because of the ACA, individuals expected to cut back their work hours does not translate to a reduction in jobs. Michael Lanterman, president of Lanterman Insurance Agency, told the Business Journal that many of his clients looked at putting employees at part-time to get under 50 full-time equivalents, thus qualifying as a small business under the ACA and effectively avoiding the health care mandate. None of his clients have done that. “I still think that because of the federal subsidies, it’s going to increase demand for goods and services, and that’s going to increase demand [overall],” he said. So far, discussion of employees reducing their work hours isn’t as much of a topic with the white-collar industry – particularly those in the service field – as it is with the blue-collar industry. “I think it represents lower paid people in the service industries and front-line entry level,” Lanterman said. “I’ve seen it a couple times with some receptionists and a couple of working moms who ask to go part-time to qualify for the subsidy. . . . Most people can’t afford to work less.” Individuals working part-time or those with relatively low incomes to begin with, and are working another job to get health benefits, now have the opportunity to consider buying individual insurance through a health care insurance exchange and to take advantage of a subsidy. Individuals with income between 138 percent and 400 percent of the federal poverty level (between $16,104 to $46,680 in 2014) may qualify. Approximately 2.6 million people are eligible for federal health care subsidies in California and another 1.4 million Californians are now eligible for Medicaid (MediCal). “Subsidy funding under the ACA depends on the number of people who qualify for each, a number that, presumably, can go up or down,” Larry Hicks, spokesperson for Covered California, told the Business Journal in an e-mail. Eduardo Martinez, senior economist with Moody’s/Economy.com, explained to the Business Journal that there are many individuals close to retirement age who continue to work to avoid giving up employer-based benefits. “They can retire and start getting Medicare, or if they have a partner or spouse who is still working, they can get their health benefits,” Martinez said. “Or they can go to the exchange and get a subsidy there.” From an economist’s point of view, Martinez said the money employers pay to provide health insurance coverage to workers comes from what would otherwise be employee wages. “It’s essentially a tax on employees, who are exchanging less takehome pay for the benefit of employer-based health care. . . . If you had a health care system with a single-buyer or single-payer, and you had cost control with health care benefits, they would get more of their take-home pay,” he said. Grocery chain Trader Joe’s decided to no longer provide health insurance to employees who work fewer than 30 hours per week (the threshold for full-time employment under the ACA). Those employees are, more often than not, a combination of college students, individuals near retirement age or spouses of individuals who earn higher incomes and receive employer-based health coverage. “The vast number of those employees are better off going to the health insurance exchanges to qualify for subsidies and keep more take-home pay,” Martinez said. There is an argument that more jobs are being created as a result of the ACA. “The Affordable Care Act relies upon health plans to deliver health care coverage and access to Americans and the plans participating in exchanges have staffed up and expanded hours to serve the influx of new enrollees,” Nicole Kasbian Evans, vice president of communications for the California Association of Health Plans, told the Business Journal in an e-mail. Lanterman echoed Evans, citing a local example. “Let’s take Long Beach for example,” he said. “Molina Healthcare will effectively double their membership. They are generating jobs in this economy because they’re hiring, doing new construction, entering new contracts and opening new clinics. That’s an expansion of jobs.” Martinez reiterated that a decrease in the labor supply isn’t necessarily causing a drag on the economy. “Workers are going to start making decisions in their best interests,” he said. ■

■ By TIFFANY L. RIDER Editor alifornia’s health insurance exchange for small businesses has suspended its online enrollment portal for retooling and enhancements. Paper applications, which remain the most popular enrollment method, are still being accepted. The online component of Covered California’s Small Business Health Options Program (SHOP) was shut down February 12. It is expected to be up and running again by fall. In the meantime, SHOP Service Center representatives are available to answer questions over the phone and paper applications will continue to be accepted. “The SHOP portal was not meeting the needs of agents or small employers and needed improvements,” Covered California Executive Director Peter V. Lee said in a statement. According to Micah Weinberg, senior policy advisor for the business advocacy think tank Bay Area Council, “Covered California has been taking proactive steps to develop efficient and secure electronic systems and will keep working to ensure the site meets the needs of brokers and their clients.” The majority of Covered California’s SHOP enrollment forms have been submitted as paper applications – the conventional practice of most insurance agents. More than 570 groups have enrolled in SHOP so far, representing about 4,500 individuals. Hundreds of applications are still being processed. “Taking the portal offline will not affect the paper application process, which has been the preferred enrollment method traditionally used by insurance agents in the small-group market,” Lee said. “We are committed to ensuring the smoothest possible enrollment experience, and we believe the new version of the online portal will significantly enhance the enrollment process.” Scott Hauge, president of Small Business California, issued a statement thanking Covered California for responding to feedback from the insurance broker community about improving the online portal’s functionality. “SHOP is still very much a viable option for small business owners wanting to explore health insurance coverage options for their employees,” Hauge said. “As the majority of applicants have already done, business owners can still work with the SHOP Service Center or a Certified Insurance Agent to get coverage for themselves, their employees and their families.” ■

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Health Care News In Brief American College Of Private Physicians Announces Formal Launch – American College of Private Physicians (ACPP), a newly formed national organization for concierge medicine practitioners, is set to offer support and educational opportunities. The organization announced its launch on February 18, according to Thomas W. LaGrelius, MD, chair of the nine-member steering committee for ACCP. LaGrelius, who practices in Torrance, told the Business Journal that the purpose of this private society is to support doctors in direct or private practice through legislative, lobbying, educational opportunities, marketing and more. Thomas W. LaGrelius, MD One of the goals of the organization is to develop an online doctor directory with vetted and board certified physicians “so people can reliably go to that site if they’re looking for a direct practice physician and feel confident that they’re picking a qualified physician,” LaGrelius said. He noted the organization would eventually conduct research on outcomes through concierge, or private practice, medicine. “There’s only one published study on the outcomes on concierge medicine,” he said. “It demonstrated massive savings in money and hospitalization rates for patients taken care of in our kind of practices.” For more information about ACPP, including a membership application, visit www.acpp.md or call 855/332-5120. Newly Proposed Cuts To Medicare Advantage Could Mean Premium Hikes – Cuts to Medicare Advantage (MA) plans recently proposed by the U.S. Centers for Medicare and Medicaid Services (CMS) would impact seniors and people with disabilities in the form of benefit reductions and premium increases. The proposal, released February 21, would cut MA payments by just under 6 percent starting in 2015. In an analysis by global management consulting firm Oliver Wyman, MA plan holders would be negatively impacted to the tune of $420 to $900 per year. A previous analysis from the firm showed a 4 to 6 percent cut in MA payments last year, which translated to from $35 to $75 per month in benefits cuts and cost increases. Back-to-back cuts adding up to a double-digit reduction could cause a “high degree of disruption in the MA market,” according to the report. Karen Ignagni, president and CEO of trade association America’s Health Insurance Plans, responded to the CMS proposal in a statement. “CMS should keep Medicare Advantage payment rates flat next year to protect seniors from another round of harmful cuts that would put at risk the high-quality coverage they like and rely on today,” Shje noted that MA has bipartisan support to maintain current payment levels. The Oliver Wyman report indicates the proposed changes to the MA program


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HEALTH CARE QUARTERLY March 4-17, 2014 “would disproportionally affect beneficiaries with low incomes, including the 41 percent of MA enrollees with annual incomes below $20,000 for whom the potential increase in out-of-pocket costs would constitute a significant burden.” CMS will announce final MA payment rates on April 7. If the current proposal is finalized, plan holders would begin seeing the impact of the cuts during the October open enrollment period. UCLA Research Staff To Evaluate Incentives For Reforming Care Delivery System – California’s new health care delivery system incentive program is being evaluated by staff at UCLA’s Center for Health Policy Research to ensure the fundamental changes brought by this program positively impact patient outcomes. The incentive program will base government compensation to hospitals not only on the number of patients cared for, but also on the quality of that care – more specifically, whether the health of a patient improves over time. Considered a “pay-for-performance” model, the program is being evaluated nationwide. California is among the first states to implement the federally funded program as part of a five-year, $3.4 billion demonstration project across its 21 hospitals. “This is one of the most ambitious efforts ever pioneered in California to fundamentally change hearts and minds about how care is provided,” Nadereh Pourat, director of research for UCLA’s Center for Health Policy Research, said in a statement. She has been tasked with leading the evaluation team. “All

Long Beach Business Journal 9-B eyes will be on California to see whether our hospitals can foster the kind of innovative and cost-effective care that is essential to the success of health care reform.” The evaluation team will document lessons learned with the support of the California Department of Health Care Services and grant funding from the Blue Shield of California Foundation. Physicians At Long Beach Memorial, Miller Children’s Hospital Long Beach Recognized As ‘Super Doctors’ – The 2014 Southern California Super Doctors report, issued last month, recognized 77 physicians from Long Beach Memorial and Miller Children’s Hospital of Long Beach as being among the best in their fields. These physicians are among the top 5 percent of doctors practicing in Los Angeles and Orange counties, and are selected based on 10 indicators of professional achievement and peer recognition. “Our physicians are not motivated by public recognition but acknowledge the honor in being recognized by their peers,” Dr. Susan Melvin, chief medical officer for Long Beach Memorial Medical Center, said in a statement. “The physicians listed as ‘Super Doctors’ are driven by their dedication to our patients, their families and the community they serve. Their passion to find advancements in clinical care has proven to greatly improve the lives of the many adults and children who have walked through our doors. I commend the doctors recognized and am proud to call them my colleagues.” ■


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PERSPECTIVE 10-B Long Beach Business Journal

March 4-17, 2014

Desire Is The Fire Within Measuring Your Desire Meter

■ EFFECTIVE LEADERSHIP By Mick Ukleja f I want to get an idea of a person’s desire to grow and develop I ask a simple question: “Are you satisfied with your life right now?” If the answer is, “I’m very satisfied, very content with where I am,” I come to the conclusion that there is very little potential for future growth. Being content is only part of life’s equation for happiness. When contentment is used as a tool to “cap off ” growth it becomes detrimental. Desire is the first key to personal growth. Whenever you learn, feel or know something, desire was already there waiting. It’s the vehicle that carries you where you need to go. I would love to light a fire under some people, but I soon discover that I’ve run out of matches! They aren’t going anywhere and that’s okay. It’s their choice and not my responsibility. It’s okay and I will love them where they are. For me, personally, I still have passion and desires. I’m not all that I want to be nor have I accomplished all that I want to accomplish. I had the privilege of interviewing Coach John Wooden on his 96th birthday. I asked this question: “Coach. You are 96 today. How do you stay so enthusiastic and passionate about life?” His answer: “Mick, the day your past becomes more exciting than your future is the day you start to die.”

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That thought has stuck like a piece of shrapnel in my brain. I am not yet all that I want to be, nor have I accomplished all that I want to accomplish. That fire within you and me is called desire. The philosophers call it existential angst, the desire to make our lives count by making a difference. So keep the engines stoked. Let’s call it a healthy dissatisfaction¹. Enjoy the present and live each day to the fullest. Your desire will get you out of the comfort zone where no growth takes place. Your greatness lies outside your comfort zone. Contentment and satisfaction were never intended to be synonyms for petrified, fossilized or calcified. At times our desire-lights on the dashboard grow dim. Those are the times when you keep the engine running. Eventually you will see your desire meter rev up and you are on your way! Napoleon Hill said, “The starting point of all achievement is desire.” Weak desires bring weak results. Just as weak fires leave us a little cold. They’re not much to look at either! One other tip: Avoid the Flame Busters. This is the crowd that doesn’t have a desire to get out of their “comfort zone” and wonder why you’re pushing yourself forward. If your desire is low, check the company you’re keeping. Dissatisfaction can be divine and becomes the fuel that feeds desire. As children we had lots of ideas about what we wanted to do when we grew up. A child’s imagination isn’t restricted by the boundaries of age, inexperience, education and parental control. They just imagine the

future they want, and it’s fueled by desire. Yet it’s easy to let the restrictions of adulthood get in the way of doing what we desire. So we douse the dream. Many of our boundaries are self-imposed. My grandmother always told us, “While you’re thinking, think BIG! You can always act small later.” The real danger starts by putting limitations on your thinking. • What are the things you would like to do well? • What are the experiences you would like to have? • What do you want to start doing right now? • What are five nonnegotiable values in your life? • What things, events or activities make you feel fully alive? • What have you let slide? Why? What can you do now to reverse that? In our attempt to be practical we often play it safe. Use the preceding questions to help break the imagination gridlock. A ship in the harbor is safe, but that’s not what ships are built for – William Shedd ¹Healthy Dissatisfaction = starting each day with thanksgiving for what you are and have, knowing your life is better than you deserve, yet realizing your life is not all you want it to be. It’s a combination of contentment and desire. Here’s the formula: Healthy Dissatisfaction = Contentment + Desire. (Mick Ukleja is the author of several books including co-author of Managing the Millennials: Discover the Core Competencies for Managing Today’s Workforce, coach, keynote speaker and president of LeadershipTraq, a leadership consulting firm. Check his weekly blog at www.leadershiptraq.com. Mick has been featured on Fox News, CNN, Fox Business Network, NBC and in numerous publications.)

LGB And Destination Long Beach

■ A BETTER WAY TO FLY By Marilo Rodriguez s winter comes to a close and spring is in bloom, it’s time to start planning for summer travelers. Bringing an influx of tourists to the region during this time is an integral part of the area’s economic impact. That’s why Long Beach Airport (LGB) is working with some of the city’s most valuable assets to form a united front as champions of the tourism industry. Locals are familiar with Long Beach’s gems such as: sunshine, the Pacific Ocean, views of the mountains, a lively calendar of events, hotels, restaurants and, of course, your world-class airport. We must find a way to share Long Beach’s gems with the rest of the country. Thousands of people discover Long Beach every year through the Aquarium of the Pacific, The Queen Mary and at major events like the Long Beach Pride Parade and the Toyota Grand Prix of Long Beach. The downtown area is home to some of the city’s finest restaurants, nightclubs and shops. There are also Long Beach’s award-winning parks serving the

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entire city. Combined, the city’s assets have a long list of fun events to entertain every family over the summer. It’s always a happy surprise to discover Long Beach. The Long Beach Convention & Visitors Bureau tells us that travel and entertainment ranks second among the top industries and should be considered one of our priorities for positive economic impact to the city. In fact, tourism pumps about $300 million into the Long Beach economy every year. The Long Beach hospitality industry alone provides nearly 7000 jobs and every dollar invested generates $5.50 in the city. The hospitality industry is an immensely important and integral

Since LGB’s modernization, partners, travelers, and citizens all feel an undeniable parity between Long Beach Airport and the rest of the city, especially in convenience, personality and tone. LGB’s warmth and vibrancy is repeated and echoed throughout the city and vice versa. The upcoming summer season provides an extraordinary chance for all of the city’s assets to showcase the development that has truly transformed and improved the city in recent years. The goal, as a group, is to continue to invest in making Long Beach the best destination in Southern California. There are many ways to lure destination travelers to our home because Long Beach is easy to highlight. From brew hopping to birdwatching, bike riding to train riding, jogging or paddle boarding, it’s all here and Long Beach Airport is the gateway to all of these fine activities. You can help spread the word by connecting with your friends and creating Long Beach fans. Let your posts and pictures on social media tell the story. Long Beach and your Airport as the gateway is worth sharing. (Mario Rodriguez is director of Long Beach Airport. He has 25 years of experience in the aviation industry and has overseen airports from Kuwait to New Orleans. Questions about this column may be directed to public affairs at the Long Beach Airport 562/570-2678.)

A Better Way to Fly Long Beach Airport

part of our local economy and we are committed to growing and developing it. As more destination travelers fly in to Long Beach, this gives us a great opportunity to showcase our diverse and eclectic city and it’s economic boon. Every percent increase in destination traffic, (inbound flight tourists to the area), translates to $17 million more in economic impact to the city from tourism dollars spent on hotel stays, restaurant visits, tourist attractions and more.

Developing Early Healthy Eating Habits Is Best Defense Against Pediatric Obesity arch is National Nutrition Month and the perfect time to discuss a health crisis affecting 17 percent of children and teens in the U.S. – obesity. According to the Center for Disease Control and Prevention, childhood obesity has more than doubled in children and tripled in adolescents in the past 30 years. Getting your child to eat healthy starts at home with parents, grandparents and caregivers as the role models. A well-balanced ■ HEALTHWISE diet, along with plenty of rest and exercise, By Emily Burritt, nourishes your child’s body and reduces the MS, RD, CSNC risk of obesity and its associated diseases. Obesity in children is associated with high cholesterol, high blood pressure and diabetes, and often affects a child’s social and psychological well-being. In addition, children who are obese are more likely to remain obese as adults causing long-term health problems. Serving well-balanced meals and making family meal time a priority promotes a life-long habit of healthy eating. Include as many items from the five major food groups in your child’s meals as possible. At each meal, fill half of your child’s plate with fruits and vegetables, one-quarter with lean proteins and one-quarter with whole grains. • Vegetables – Including a variety of color in your child’s diet will give them a plethora of nutrients. Vegetables can be eaten fresh, frozen, canned or dried. Fresh vegetables should always be washed and eaten shortly after purchase. If they sit too long, they lose some of their nutrients. Frozen vegetables are convenient, easy to manage and many of their nutrients are preserved when frozen. Canned vegetables are just as good as fresh or frozen, but be aware of the salt content – rinse with water before serving. • Fruits – Just like vegetables, fruits can be eaten fresh, frozen, canned or dried. Canned fruit is better in its own juice, not in syrup. If buying fruit juice, look for 100 percent fruit juice and limit it to ½ cup (4 ounces) per day. • Grains – At least half of the grains your child consumes should be whole grains (whole-wheat bread, whole-grain cereal and crackers, oatmeal and brown rice). When looking at the label the first ingredient should say whole wheat. Whole wheat is better, not just because of the fiber it offers, but whole wheat contains more nutrients. • Dairy – Most of the dairy your child consumes should be fatfree or low-fat milk products, because the nutrients in skim milk, 1%, 2%, non-fat and whole milk are exactly the same. Eat highfat foods like butter, sour cream and cream cheese in moderation. • Protein – Your child can get protein from lean meats, poultry, seafood, beans, peas, eggs, natural peanut butter and unsalted nuts. Protein can help your child feel more satisfied at meal time and stay full longer. Fruits and vegetables are packed with vitamins and minerals. If your child doesn’t like to eat a lot of vegetables, allow them to eat more fruits. Continue to offer vegetables at meal times full of color and variety. Watch out for sodas and sugary beverages as they provide little nutrition and extra calories from sugar. Every additional serving of soda increases a child’s risk for obesity by 60 percent. Offer water, sparkling water or low-fat milk as a healthy alternative. Limit the time your child watches TV to two hours per day. The more TV your child watches, the more likely they are to become overweight or obese. Keep TV out of your child’s bedroom. Kids with a TV in their bedroom are more likely to gain excess weight. Feeling overwhelmed? Don’t stress, start with one or two simple goals to work on as a family. For example: • Eat dinner together, as a family, three nights per week • Stop buying soda and sugary beverages for the home • Take a family trip to the farmer’s market • Eat at least one fruit and one vegetable every day • Limit TV watching time to two hours per day Eighty percent of the time you should feed your child food that contains the most nutrients, but on special occasions know that it’s ok to let your child have a treat. Most importantly remember to keep everything in moderation. (Emily Burritt, MS, RD, CSNC, is the director of clinical nutrition at Miller Children’s Hospital Long Beach.)

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PERSPECTIVE March 4-17, 2014

Long Beach Business Journal 11-B

Affordable Housing Being Squeezed

■ REALTY VIEWS By Terry Ross espite what we have seen over the past six-plus years with housing prices dropping and demand (or more precisely the ability to purchase) dwindling down to record levels, the nation and California do not seem any closer to solving the affordability issue in residential real estate. Renters and other non-owners have suffered from being on the short end of the stick for decades because of the high cost of land and housing in California. But the recession succeeded in dashing a large portion of – and in some cases all of – the equity that many home owners had built, putting them in the same position as those who had not even ventured into the real estate waters – or worse. With 30 or 40 percent declines in prices, many owners lost their equity and many lost their homes if they could not afford to continue making the payments. The equity that had served many as a stopgap or emergency financial cushion was gone. A recent report released by the

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California Housing Partnership Corp. (CHPC) details a picture that is even much worse than this. It reveals that in addition to falling real estate prices during the recession, incomes and government help for promoting housing affordability have also gone south. The report notes that California’s median rent rose 20 percent from 2000 to 2012, while medium incomes fell by 8 percent. Meanwhile, a combination of state and federal budget cuts have reduced the funds for affordable housing by 79 percent between the last fiscal year and the 2007-2008 fiscal year (which was the first full fiscal year during the recession). It also noted that nearly one million extremely low-income California households lack affordable, habitable homes, with the Southern portion of the state getting the worst of it. More than 50 percent of these extremely low-income households are elderly or disabled and living on a fixed income. The report goes on to paint a picture of a looming crisis – one that recent government actions is not helping because of lower funding, such as the elimination of redevelopment districts that had been contributing $1 billion annually for the development of low-income housing in California. These have been eliminated to help bolster the state’s critical budget deficit. Also, a larger portion of pay-

checks are going towards rents. In 2011, 53 percent of California’s very low-income households making half the median income spent at least half of their income on rent. That’s up from 30 percent spending half their money on rent in 2000. Half of California’s median income is about $29,000, with occupations from retail cashiers to janitors, security guards and nursing assistants, according to the report. In 2011, only 20 out of 100 California households making 30 percent or less of their metro area’s median income was able to find an affordable home. Those making half their area’s median income did only slightly better, with 29 out of 100 able to find a home. “Even as the crisis in housing affordability grows, investment in affordable homes in California by the state and federal governments has been reduced by over $1.5 billion annually,” read the report by the CHPC. “If the state wants to achieve its economic, social and environmental goals, strong action is required to address the growing imbalance in the housing market and restore the ability of all of California’s households to afford healthy homes that provide access to jobs and services.” And even though Northern California – especially the Bay Area – has enjoyed the largest resurgence in prices in the state because of the growth in the technology sector, it

does not suffer from the shortage of affordable housing units like Southern California. One reason could be the greater number of lower-income residents in the south. There are 19 affordable units for every 100 extremely-low income renters in Los Angeles County and 18 in Orange and San Diego counties, based on Census Bureau estimates, compared with 37 for every 100 in San Francisco. Legislation for low-income housing funding has made it halfway through to the governor’s desk as SB 391 passed the state senate last year and is currently in the assembly. It would create a permanent source for funding low-income housing by adding a tax on the recording of real estate documents. But even this is controversial and has been opposed by the California Association of Realtors as a flawed funding method and calls for another approach. It appears that this problem has two major areas that need to be improved – incomes and more funding from the state to provide the incentive for the development of affordable housing. Neither of these is going to be easy to accomplish, given the economic times that in which we live. (Terry Ross, the broker-owner of TR Properties, will answer any questions about today’s real estate market. E-mail questions to Realty Views at terryross1@cs.com or call 949/457-4922.)

Vol. XXVII No. 4 March 4-17, 2014 PUBLISHER George Economides VICE PRESIDENT SALES & MARKETING Martha Rangel SALES & MARKETING ASSISTANT Heather Dann GRAPHICS/PRE-PRESS Jennifer Ebunilo DISTRIBUTION Conrad Riley EDITORIAL DEPARTMENT EDITOR Tiffany Rider STAFF WRITER Samantha Mehlinger PHOTOJOURNALIST Thomas McConville COPY EDITOR Lindsay Christopher The Long Beach Business Journal is a publication

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Long Beach Needs A New Civic Center

permission is strictly prohibited

Employee Safety, Fiscal Responsibility Are Top Concerns For City Management

expressed by perspective writers

■ EDITOR’S PERSPECTIVE By Tiffany L. Rider utting aside concerns about the process, there is no better option for the City of Long Beach than to build a new civic center. We see the retrofit as a waste of taxpayer dollars. While it may bring structural integrity to the current city hall, a retrofitted building would not stand up to the major quake we are due, and thus would result in the need for a new civic center anyway. The economic impact of a new civic center, if developed as a publicprivate partnership (P3), would benefit the city as a whole. Moreover, the deal would have a project-labor agreement with a request to hire locally. The P3 proposal calls for a combination of government facilities and private development in the form of essentially anything – condos, apartments, hotel rooms, retail, office space, etc. Whether or not the port is involved is yet to be determined. A request for proposals was issued February 28 to three shortlisted bidding teams. Each team has

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until June 2 to determine if a new civic center deal can be made within the funding available. City management and stakeholders will review the options and, if appropriate, a proposal will come to the city council on or before July 1. If that occurs, that entity is responsible for conducting public outreach during a one-year entitlement period. City officials will also get involved in public outreach with regard to the new city hall and library portions of the civic center. In other words, plenty of time will be set aside for public input. That aside, what matters in this process is to act quickly for the safety of city employees and balance that with what’s fiscally responsible. It’s a task not envied by many, but it is exactly what city staff is doing. The task is to manage the serious, albeit calculated, risks associated with keeping city employees in a building that was reconfirmed late last year as having seismic issues. According to a city memo issued last month, the event of a 7.0 magnitude quake would likely result in “significant loss of life.” To quell concerns we’ve heard from city employees about the seismic problems – described by some as a looming, heavy cloud waiting to break – city management assured the Business Journal that they are in fact looking at options for moving city employees to

office space elsewhere. That’s happening concurrently with the P3 effort. In order to address this issue, city staff, as directed by the city council, has paved a path for a P3. The process, used previously to expedite the development of the Governor George Deukmejian Courthouse, provides the necessary timetable that could get a new civic center up and running in as quickly as five years. There’s a chance the P3 won’t work. It’s still unclear if the market value of this type of deal will be amenable to a developer. The consultant hired to prepare the P3 request for proposals told city management that the city’s request is “tough.” If the deal doesn’t

pan out, the choice is to either put a bond measure to a vote of the people to pay for a new civic center or lease office space elsewhere while the 16 acres are put on the market. City leadership – including elected officials, management and staff – are all doing their part to consider the economics and ethics while expediting the process toward a new civic center that would, first and foremost, provide a safe space for city employees to work. Let’s actively allow this process to happen. (Tiffany L. Rider is editor of the Long Beach Business Journal. She is a graduate of the California State University, Long Beach.)

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March 4-17, 2014 Section B