NEVADA MEDICAL GROUP MANAGEMENT ASSOCIATION

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  • 01 Jun 2017 5:44 AM | Deleted user

    05/31/2017

    NV MGMA Membership - Legislative update

    Call to action

    This session has included a myriad of healthcare issues, but as the final days come into focus, there are several issues around the payment for emergency services to providers and hospitals that remain unresolved and threaten the viability of those services within the state.

    Two bills were introduced to address Out-of-Network payments for providers who care for emergent patients.  The Senate Bill promulgated by NSMA and MGMA, sponsored by Senator (and Doctor) Joe Hardy has died in Committee.  That bill would have used market-rate charges to identify the payments required by insurance companies.

    AB382 is still alive and gets worse for physicians on every amendment.  In its current form, physicians would be required to accept as payment the 1) “average amount negotiated by the third party for in-network care” (no word on how this would be determined or verified), 2) 125% of Medicare or 3) arbitration.  We had worked hard to make arbitration something we could live with but in this version, the expense is split between both parties which is untenable for the vast majority of ER bills, which average a charge of $770 for an ER provider bill, the timeframes and steps are onerous and the guiding principles for the arbitrator to consider don’t include protective guidance about what should be considered.

    Additionally, in late May, Maggie Carlson introduced AJR14 (first hearing was yesterday) which would rate-set the hospitals to 115% of Medicare for their emergency care. 

    • Providers aren’t included, but we de facto are because this influences the hospitals ability to pay for ER Call and the like.
    • Joint Resolutions (this is an Assembly JR) do not cross the Governor’s desk, so there is no opportunity for a veto.  They must pass two sessions in a row then go to a vote then become a constitutional amendment.  We would have rate-setting for emergency care in the Nevada Constitution. 

    What are we doing?

    Highly disturbing?  Correct!  The Nevada Medical Association (Catherine O’Mara) and their lobbyists have taken the lead on this fight.  NV MGMA has engaged through their association and has been present for negotiations, document reviews, drafting of compromises and the like.  Jeff Snyder, Donna Juell and I have offered suggestions, crafted responses, given testimony (I have testified 3 times on these issues), met with the Governor’s office (multiple times including yesterday).  We were met by an absolute unwillingness to negotiate on our bill.  Although they engaged us on AB382, it appears that none of that was taken to heart since the most recent amendment is worse than the original bill.  One can only assume it was a tactic to run out the clock.

    What can you do?

    Until the last amendment broke late Friday afternoon, we had been hopeful to have a reasonable compromise.  Sadly, the language put out was worse.  It is probably by design to allow us no time to rally the troops.  What you can do includes

    • Call your legislators, particularly those in the Senate and let them know you OPPOSE AB382 and AJR 14.  Click here to find your State Senator and State Assemblyman.
    • Review and distribute the attached flier (Click here for flyer)
    • Watch your email and plan to attend, sign-in in opposition at the next hearing for either/or both bills. 

     

    Karen Massey, MHA, FACMPE, CPMSM

     

  • 22 May 2017 10:56 AM | Deleted user

    Practitioners in Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island are required to report on claims data on post-operative visits furnished during the global period of specified procedures using CPT code 99024, beginning July 1, 2017. 

    The specified procedures are those that are furnished by more than 100 practitioners and either are nationally furnished more than 10,000 times annually or have more than $10 million in annual allowed charges. Practitioners who only practice in practices with fewer than 10 practitioners are exempted from required reporting, but are encouraged to report if feasible. 

    Although reporting is required for global procedures furnished on or after July 1, 2017, we encourage all practitioners to begin reporting as soon as possible.

  • 27 Dec 2016 7:47 AM | Deleted user

    There have been changes to the ACMPE certification eligibility criteria, plus the 2017 AMPE Exam dates have been published — with a link to the ACMPE page so that everyone can access it easily.

    Please visit our ACMPE Certification page for full details.

    We would love to see more of our Nevada Members obtain Certification and we are here to help!

    If you have any questions, contact me.

    Jackie Shoupe, FACMPE
    j.shoupe@sbcglobal.net
    (775) 329-8423
    ACMPE Forum Representative for Nevada MGMA

  • 22 Feb 2016 11:28 AM | Deleted user

    CMS formally reaffirms 2015 MU hardship exception does not nullify incentive opportunity

    In direct response to MGMA, the Centers for Medicare & Medicaid Services published a formal FAQ stating that an eligible professional (EP) may submit a hardship exception application, while still remaining eligible for an incentive payment if they successfully attest for 2015 Meaningful Use (MU). MGMA continues to encourage all EPs to take advantage of this opportunity for the 2015 reporting year and apply for the hardship exception, even if they plan to attest. This simple process will provide an extra layer of protection against potential penalties. Review MGMA's member-benefit 2015 MU hardship exception resource.

    Key dates:

    • March 11, 2016 – 2015 MU attestation deadline
    • March 15, 2016 – 2015 MU hardship exception application deadline


  • 09 Feb 2016 7:30 AM | Deleted user

    This tip sheet was developed by Karen Massey (last updated on 2/9/2016) based on materials from the Nevada Office of Vital Records and is intended only as assistance. For specific rules and requirements, please contact the Nevada Office of Vital Records.

    The NV State Medical Association is working on the Death Certificate issue and has obtained some useful results such as help desk hours on the weekend. 

    Please CLICK HERE to view the Tip Sheet that I developed for our group's internal use, and I am happy to share it with my colleagues in MGMA.  There are only 4 tabs that require completion for providers, and that is not readily obvious within the system.  I hope you find it helpful and we will provide updates as we are able to make more advances on this issue.

    Karen Massey, MHA, FACMPE, CPMSM
    NV MGMA Legislative Liaison
    Executive Director, Northern Nevada Emergency Physicians

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Managing chronic care populations: Improve health & contain costs

April 29, 2019


Healthcare in the U.S. continues to move from volume-based care to value-based care. In the process, managing chronic disease has become both a universal imperative and a foundational element of a patient-focused population health program.

Leaders of many physician groups—including those partnered with multi-hospital systems—look for a solid, practical approach to chronic care management. Though difficult, practices are changing up their organizational structure to support alternative payment models that reward maintaining a healthy population.

This paper, a joint effort between Virence Health and Physicians Medical Center, PC, used a real-world example of how PMC introduced a successful population health program into its culture and, by doing so, made the shift to proactive, team-based care, allowing them to leverage their data and improve the lives of their patients.


Click Here to Read More

Three Environmental Factors Impacting the PPM Industry and Getting Deals Done

April 23, 2019


The PPM industry is by no means immune to the ebbs and flows of a traditional marketplace. Since the consolidation bubble burst in the 1990s, PPMs have gone from practically extinct to a once-again substantial component of the health care delivery system. But with greater influence comes more pressure to respond, and adapting to today’s complex operating environment requires those in the PPM industry to ensure they are building the foundational structure needed to help practices adapt to external factors and achieve long-term success.and achieve long-term success.

Click Here to Read More


Social determinants of health in an ACO for better population health

April 16, 2019


Valerie was a 31-year-old woman with uncontrolled diabetes, asthma, hypertension and was morbidly obese; she also had a history of trauma and depression. She increasingly was a no-show for appointments and would go to the emergency room instead of her primary care visits at Massachusetts General Hospital in Boston.

It wasn’t until Mass General implemented a social determinants of health (SDoH) survey that the providers learned that Valerie faced homelessness — until then, a P.O. box and a telephone number gave no indication of the larger issue in her life. They also learned that, despite being born and raised in Boston, Valerie could not read and write in English, her primary language.

Through SDoH work, Mass General staff were able to direct Valerie to emergency housing and ask what her goals were beyond health: Learning English, getting a job, securing an apartment and reuniting with her 3-year-old daughter, who was taken at birth due to Valerie being homeless.

As with most of us, social factors such as housing, education and a safe environment largely lead to better health outcomes.1 In Valerie’s case, her factors meant insufficient healthy food, lack of refrigeration for medication and issues with blood pressure heightened by living in a van and a lower sense of personal safety — all directly affecting the care providers working with Valerie.

Click Here to Read More


Nevada MGMA
staff@mgmanv.com
PO Box 3403, Hamilton, NJ 08619
866-492-3590