David E. Hald, MD
NSMA President 2013-2014

Every Nevadan is affected in some way by the members of the NSMA. They are not only your physicians, but your neighbors, friends and advocates in the health care delivery system.

Nevada physicians organized into a state medical society in 1875. As the state's oldest and largest physician advocacy group, today's NSMA mission remains consistent with those pioneer doctors: to serve the practice and professional needs of Nevada physicians so they can serve the needs of their patients. Our diverse membership includes practicing physicians and surgeons, medical researchers, educational faculty and institutional administrators.

Though this site has information restricted to our membership, there is also much information available for the public and the health care community. Development of this site and available resources will continue to expand, so bookmark the NSMA and come back often!

We are proud to represent organized medicine in Nevada, and proud to be your physicians of the Nevada State Medical Association. Is your physician a member?

Meaningful Use Exemptions

The Centers for Medicare & Medicaid Services (CMS) has expanded the means of qualifying for  meaningful use exemptions as listed below:

•  The physician’s software vendor is unable to achieve 2014 Edition certification, the most recently added hardship exemption

•  The physician can’t get sufficient Internet access or faces other infrastructure barriers

•  The physician is newly practicing and has not had enough time to establish meaningful use, in which case the physician can apply for a two-year exception

•  The physician is practicing at multiple locations and has no control over the availability of certified EHR technology for more than one-half of patient encounters

•  A natural disaster or other unforeseeable circumstance occurs

•  A physician hasn’t had enough patient interactions to meet the threshold requirements

More information can be found on the AMA’s website: Meaningful Use Exemptions.

Source: AMA

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Free HIPAA risk assessment tool can help ensure compliance

Physicians in small to mid-sized practices can conduct their own risk assessments using a free tool newly available from the U.S. Department of Health and Human Services.

The security risk assessment (SRA) tool is designed to help practices conduct and document a risk assessment to evaluate potential security risks in their organizations under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. Conducting an SRA also is a core requirement for physicians seeking payment through the federal meaningful use program for electronic health records.

Physicians can watch a tutorial and other videos about risk analysis and contingency planning to provide further context. The assessment tool is available through the Apple App Store (search for “HHS SRA tool”) for use on iPads, and can be downloaded onto computers running Windows operating systems.

HIPAA regulations were updated last year in what were called the “most sweeping changes” since the law was implemented. The AMA offers free resources to help physicians ensure their practices are HIPAA-compliant, including a new HIPAA toolkit and an associated continuing medical education activity.

Source: American Medical Association

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Study on Danger of Home Births

A recently released American Journal of Obstetrics and Gynecology study examined neonatal mortality rates for births by birth setting and birth attendant (hospital physician, hospital midwife, freestanding birth center midwife, and home midwife). Among the study’s findings:

·         Midwife home births had a significantly higher nearly 4-fold total neonatal mortality risk when compared to those delivered by hospital midwives as well as a significantly higher nearly 7-fold early neonatal mortality risk when compared to those delivered by hospital midwives.

·         Midwife home births of women with a first birth had a significantly higher nearly 7-fold risk of total neonatal mortality than those by hospital midwives and a neonatal mortality over twice that of those with a subsequent birth.

·         Midwife home births ≥41 weeks had a significantly higher nearly 7-fold risk of total neonatal mortality than those delivered by hospital midwives.

·         Midwife home births of women with a first birth had a significantly higher 13- to 14-fold risk of early neonatal mortality than those by hospital midwives and an early neonatal mortality nearly 3 times that of those with a subsequent birth.

·         Midwife home births ≥41 weeks had a significantly higher nearly 10-fold risk of early neonatal mortality than those delivered by hospital midwives

The study also found a higher neonatal mortality rate for hospital physicians when compared to hospital midwives, which the study attributed to the fact that hospital physicians deliver a higher risk population than hospital midwives and deliver patients with complications transferred from the hospital midwifery service to the hospital physician service.

A New York Times article covering the study can be found here: Link.

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Searchable, Physician Specific Medicaid Claims Data

The Centers for Medicare and Medicaid Services (CMS) posted searchable, physician-specific Medicare claims data on its web site.  The spreadsheet files show for each physician their NPI, name and address, average charge and Medicare payment amounts, unique beneficiary counts, and other information for the various Medicare services they provide.  This decision was likely made to deal with a tidal wave of Freedom of Information Act (FOIA) requests for the data that the agency felt could not be handled on a case-by-case basis.

Link to CMS data release web page:


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POLST Coalition

The Nevada POLST Coalition, a group representing an array of healthcare providers and patient advocates, after many years of dedicated effort and successful legislation announces the Nevada POLST Program with the introduction of its website: Nevada POLST  (www.nevadapolst.org). The POLST Program is a process  to assure treatment wishes of those with life-limiting, serious illness and frailty are honored. Key to the process is the POLST form. Health care providers discuss the goals of treatment with their patients then complete the POLST form, translating patient treatment goals and wishes into specific medical orders.

POLST, originally introduced in Oregon in 1991, differs from Advanced Directives and is intended for use by the severely ill or frail.  POLST forms may be by ordered by  health care professionals here.

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Annual Meeting

2014 NSMA Annual Meeting

Mark your calendars now for the 110th NSMA Annual Meeting, April 25-27, 2014, at Lake Las Vegas. Room reservations must be made by March 25, 2014.

Please call the local hotel number, 702.567.4700, and specify you are attending the Nevada State Medical Association meeting to reserve your room.  Please do not use online providers or 800 numbers, as those will not count toward the NSMA room block.

Download the program and registration information here.

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Medicare Patch

Last night, the Senate passed H.R. 4302, the “Protecting Access to Medicare Act of 2014,” which postpones the 24 percent Medicare physician payment cut for 12 months, until April 1, 2015.  Although many Senators spoke against passing this 17th Medicare payment patch, the Senate vote was 64 to 35.  (Sixty votes were needed for passage.)  The House passed an identical version of the bill by voice vote on March 27, and President Obama is expected to sign the legislation into law.

Over the past year, bipartisan, bicameral policy was developed to eliminate SGR and reform the Medicare physician payment system, which is strongly supported by the AMA and over 600 medical organizations.  The AMA will continue to urge Congress to return to the bipartisan process that produced the unprecedented agreement on Medicare physician payment and delivery system reform.

A summary of H.R. 4302 can be found here.

Source: AMA

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Open Enrollment

Open enrollment officially ends today but exchange officials hope an extended enrollment period will help boost enrollment numbers. Xerox officials will target almost 80,000 individuals who did not finish the enrollment process. The extended enrollment period ends May 30.

Source: RJ

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CME Webcasts

Free webcasts are now available through the American Medical Association Organized Medical Staff Section (OMSS). Access webcasts 24 hours a day, seven days a week, and earn valuable AMA PRA Category 1 Credit™.

These activities are designed for medical staff leaders (e.g., chiefs of staffs, medical staff presidents, medical directors and medical staff members), physicians interested in leadership issues, medical staff service professionals and medical staff legal counsel.

webcast #1

ICD-10: Actions physicians need to be taking now to prepare for the regulatory mandate

Source: AMA

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Additional Meaningful Use hardship exception available to physicians

Due to AMA advocacy, CMS announced there will be an additional hardship exception available to physicians to avoid a financial penalty under the electronic health records (EHR) Meaningful Use (MU) incentive program. The exception applies to those who have not received or were unable to implement updated, Version 2014 certified software. Some physicians such as those new to Medicare or those in certain specialties, are exempt from the penalty and do not need to apply for a hardship in 2014. Below is a list of the hardship exemptions now available.

Infrastructure: Eligible professionals must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband).

New eligible professionals: Newly practicing eligible professionals who would not have had time to become meaningful users can apply for a 2-year limited exception to payment adjustments. Thus eligible professionals who begin practice in calendar year 2015 would receive an exception to the penalties in 2015 and 2016, but would have to begin demonstrating meaningful use in calendar year 2016 to avoid payment adjustments in 2017.

Unforeseen circumstances: Examples may include a natural disaster or other unforeseeable barrier.

Patient interaction:

  • Lack of face-to-face or telemedicine interaction with patient
  • Lack of follow-up need with patients

Practice at multiple locations: Lack of control over availability of CEHRT for more than 50 percent of patient encounters.

2014 EHR vendor issues: The eligible professional’s EHR vendor was unable to obtain 2014 certification or the eligible professional was unable to implement meaningful use due to 2014 EHR certification delays.
The application and information on the exceptions can be found below.

Hardship Application

Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals

2014 CEHRT Hardship Exception Guidance for Eligible Professionals


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