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Washoe County Medical Society

Coldwell Banker Select and Century 21 Offers Real  Estate Services To WCMS Members, Families & Employees

WCMS members, their employees and their families are eligible for a menu of real estate services when they purchase homes using Coldwell Banker Select in Northern Nevada. To be eligible, register at www.sep.cbselectre.com.

The Select Group, which includes Coldwell Banker and Century 21, has created a national buying, selling and refinancing program called the Select Employer Program (SEP). This program allows for cash credits to escrow, which range from $2,000 to $15,000, for Washoe County Medical Society members.

The Select Group also offers services to Renown Healthcare, the University of Nevada School of Medicine among other Northern Nevada businesses.

Your practice manager can obtain brochures, posters and other information by calling Jim Davis at 775-336-6755, or go to wcmsnv.org/benefits/ to download informational materials.

Changing of the Seasons

Anita-savell-medical-student

It is that time of year again — July 1 is here and along with it, the changing of the medical season. It is time for all of us to transition from the roles we grew comfortable with into a new position with new responsibilities and expectations.

Some residents are graduating and embarking on fellowship or new jobs—with at least 11 years of education under their belts.

Interns are steadier on their feet in the hospital. For some, just 2 years until graduation. For others, they are finally moving into the specialty training.

Former fourth year medical students have graduated and taken the Hippocratic oath. They are falling from the top of the medical school food chain to getting lost in the corridors of a new hospital.

Our new fourth year medical students are preparing to apply to residencies and are happy to waive goodbye to the grueling MS3.

Newly minted MS3’s — like myself—are anxiously awaiting board score results and the first days of rotations. We have climbed the mountain that was step 1 only to realize it was just a foothill and the steepest slopes are still to come.

Our incoming MS2’s spent the last several months watching the upperclassmen stress about Step 1 and are enjoying “the last summer of their lives” before they too start the step 1 climb.
And our incoming MS1’s are excited, hopeful, and in preparation for the start of their medical education.

Good luck to everyone in their transitions and congratulations on another year of progress towards your goals—whatever they may be. And if you have already made your full metamorphosis into a provider, look for the students finding their footing and give them a hand during this change of seasons.

Call For Delegates to the NSMA Annual Meeting

sign up for WCMS delegates

The NSMA house of delegates is the forum for us to present and debate the ideas, concerns, and issues that affect our daily work lives and the health of all Nevadans, to set policies and give direction to our lobbyists and our representatives to the AMA to put those ideas and issues into action on the state and federal levels. This is a particularly important meeting for our interests to be forwarded to and heard by our legislators during Nevada Legislative session. If you want to have your say regarding any other issues, you need to PARTICIPATE!

WCMS Bylaws changes now require interested physicians to volunteer to participate as delegates and alternate delegates for the County delegation to he annual NSMA meeting to be held at The Row, Reno NV. For more information on NSMA’s annual meeting please visit www.nvdoctors.org

This year, both delegates and alternate delegates are encouraged to participate in the House of Delegates meeting, to bring forth ideas, comments, opinions, and resolutions regarding resolutions brought to the house of delegates; however, each county society is only allotted a finite number or delegates for votes. Alternate delegates will be “seated as delegates” when necessary to fill our quota for votes, to maximize our voice and allow for as much participation as possible.

Sign-ups by email for our delegation positions start today and will be on a “first come” basis to fill our allowed number of delegates and alternates.

If you have a gripe, a concern, or an idea about how government, hospitals, other doctors, insurers, etc affect your practice, or about how to better serve your patients, now is the time to get involved and be heard at the NSMA house of delegates.

What if Nevada State Medical Association was not at the 2019 Legislative Session?

NV State Medical Assoc

NSMA has a core group of dedicated members who put in incredible effort during the last legislative session focusing on advocacy. Ask any of these folks about the value of NSMA and they will readily jump in with successes from 2019: our efforts to improve the opioid law to make the rules more patient and physician friendly, or to stop very bad legislation to unwind tort reform, or some of our public health successes. Those physicians who may be less “plugged in” to our daily activities often ask me what is the value of my membership in NSMA? What is it all for?

For those physicians and for each of us, it’s worth a pause to consider: What would have happened to Nevada physicians if the NSMA was not at the 2019 Legislative Session?

Without the NSMA in 2019, you as a Nevada physician would face:

  • Less Protection from frivolous lawsuits and weakening of KODIN
  • Continued frustration for patients and physicians dealing with opioid prescriptions
  • More mandated CME and yearly unfunded reporting requirements
  • Mandated E-prescribing of all medications starting in 2020, without exemptions or waivers
  • An outright ban on balance billing with no protection for physicians’ contracts or the market
  • Scope of practice creep including independence for Physicians Assistants
  • A moratorium on necessary surgeries for babies and children to correct hypospadias
  • No improvements for patient protections in insurance coverage
  • No increased transparency in insurance rental markets
  • No Maternal Mortality Review Committee to improve maternal mortality and morbidity

Fortunately, NSMA was there for you and your patients, working tirelessly to improve the practice of medicine in Nevada. In 2019, NSMA:

  • Prevented legislation from being introduced that would impact tort reform protections
  • Improved the process of opioid prescribing. (AB239)
  • Stopped harmful mandates including CMEs and reporting requirements, instead working with agencies to provide physicians who treat veterans with information to treat their patients.
  • Negotiated a mandate on e-prescribing to apply to only prescriptions for controlled substances, to be implement in 2021 in alignment with new federal rules and which allows for several exemptions and waivers to ensure the needs of patient care and physician practices are met. (AB310)
  • Negotiated a hard-fought deal on out of network billing in emergency situations that includes protections for existing contracts, dispute resolution system that considers the low dollar amounts of most out of network bills and establish a reporting requirement that ensures transparency in networks and contracting practices of insurers. (AB469)
    Prevented independence for PAs and began discussions to help PAs be successful in their practices within the practice team. These discussions will be on-going through the interim.
  • Prevented legislation that would ban necessary surgeries and began an important dialogue with proponents of the legislation to better communicate the clinical side to address their concerns of unnecessary surgeries.
  • Improved patient protections by protecting pre-existing conditions and requiring insurance agencies to register case contacts with the office of consumer health advocates to help patients navigate complicated insurance plans and sparse networks.
    Improved transparency by requiring insurers to disclose to physicians, those renting networks and provide physicians with the opportunity to decline to be a part of the rental arrangement.
  • Established Nevada’s Maternal Mortality Review Committee (AB169) to study instances of maternal mortality and morbidity and to make recommendations to improve the lives of Nevada mothers, and
  • Represented Nevada Physicians with dedication and integrity.

As we often say at NSMA about politics and policy making, “you’re either at the table or you’re on the menu.” NSMA was at the table for you in 2019, and with your help, we will continue to be there, protecting you and your patients for years to come.

Geriatric Specialty Care Home-Based Medical Care Practice Receives National Recognition

Geriatric Specialty Care HBMC, established in 2001, serves more than 1,100 Medicare beneficiaries in Gardnerville, Carson City, Reno, Sparks, Fallon, Fernley and Elko. Patients residing in private homes, assisted living and group care settings are seen onsite by clinicians. In addition, patients, families and caregivers have direct access to a comprehensive care coordination team that includes nurses, medical assistants and other support staff. GSC employs face-to-face, cloud-based electronic medical record technology and telehealth for chronic care management, transitional care and community-based programs serving their patients, families and caregivers.

Washoe County Medical Society salutes Reno-based Geriatric Specialty Care (GSC) for being ranked in the top 2% nationally of Home Based Medical Care (HBMC) practices.

The ranking comes from a review of Medicare claims in 2013-14 by the American Academy of Home Care Medicine (AAHCM), the Home Centered Care Institute (HCCI) and Westat, an independent research services organization. The Geriatric Specialty Care team includes Washoe County Medical Society (WCMS) members: Reed Dopf, MD, WCMS president; Carl Heard, MD; Steven Phillips, MD, and Steven Rubin, MD.

“We are proud of being ranked among the top 2% nationwide,” said Steven Phillips, MD, president and CEO, “But more important, by seeing patients where they live, we get a better picture of their situations, which results in a more robust care plan for chronic illness management. In addition, our care model is saving an average of $10,000 a year per patient.”
The Geriatric Specialty Care HBMC practice was among the top 10 of 330 HBMC programs nationwide which made more than 100 house call with patients in 2014. The programs were evaluated for overall patient care and potential savings to the Medicare and Medicaid program (CMS).

The claims review analyzed fee-for-service Medicare claims that included patient demographics, medical conditions, a frailty index that assesses one’s ability to perform daily activities (dressing, grooming, bathing, eating and toileting), risk adjustment scores, along with other benchmarks to characterize patient complexity. In addition, utilization of emergency department, acute inpatient hospital and home health care services, along with claims-based quality measures used for Accountable Care Organizations (ACOs) and the Independence at Home (IAH) demonstration were used to characterize practice performance.

Geriatric specialty care logo

 

Geriatric Specialty Center Doctors

 

Reading with Patient

Calculated PBPM Medicare Allowable Due to Complexity

Total PBPM Cost

Inpatient PBPM

Outpatient PBPM

Emergency Room PBPM

Nursing Facility PBPM

Clinician PBPM

Home Health PBPM

DME PBPM

Hospice PBPM

Geriatric Specialty Care

2,920.00

2,030.00

764.00

159.00

5.00

161.00

340.00

283.00

94.00

225.00

HBMC Average

2,592.00

2,566.00

884.00

179.00

7.00

235.00

476.00

550.00

66.00

170.00

Paving the Way for Young Medical Professionals

Dr Bayo Curry-Winchell

By Erika Hansen, UNR Intern

Dr. Bayo Curry-Winchell, an individual who has made an impact on many throughout her medical journey. That impact is being recognized both within the profession and by the community. She recently was chosen as one of the 20 Under 40 recipients and as one of the 2019 Sierra Nevada Top 20 Powerful Women.

She is a family medicine physician and works in the urgent care at Saint Mary’s Regional Medical Center. Although she is a practicing physician, her journey in the medical field started out as a physician’s assistant. Dr. Curry-Winchell has a master’s in physician assistant studies which took her two years to achieve after completing her undergraduate program. She practiced as a physician assistant for three years in occupational, family, and urgent care specialties. Her PA position gave her a foundation to practicing medicine.

Bayo and husband

Dr. Curry-Winchell explained that she was eager to learn more and wanted to be able to provide as much care as she could to her patients as a physician. So, she made the switch to becoming a physician to increase her knowledge of medicine. Once deciding to make that switch from physician assistant to physician, she had to go back to medical school for four years. After completing her four years of medical school, she then started her three years of residency focusing on family medicine. This is a grand total of eleven years of education to be in her position.

NNBW-Powerful-Women-Nominations-Logo-1240x886

When asking Dr. Curry-Winchell about what the 20 under 40 award means to her she simply explained that she was very grateful and thankful to have received this award. “ The best part was the opportunity to highlight the charity, the Women and Children’s Center of the Sierra,” Dr. Curry-Winchell said, adding that she volunteers with this organization

The selection committee is made up of two board members from Young Professionals Network (YPN), two former 20 under 40 awards recipients, two area executives, and lastly one community member who has been involved significantly with the 20 under 40 award program. In order for a candidate to stand out, individual professional success and community leadership is among the top criteria for nominations.

The 2019 Sierra Nevada Top 20 Powerful Women is sponsored by Northern Nevada Business. This prestigious award is given to a woman who facilitates change and continues to help different organizations throughout the community. Another accolade she has been awarded is resident teaching honor roll at the UNR School of Medicine, as well as multiple outstanding patient care awards. Dr. Curry-Winchell also works at the CARES program as an assistant medical examiner.

Bayo and family

These accolades surely will not be the only ones received by Dr. Curry-Winchell throughout her medical career. She has made such an impact on the community and will continue to do so. Jennifer Williamson, business development and marketing communications manager at Saint Mary’s, who works closely with Dr. Curry-Winchell could not say enough about her.

She explained, “Dr. Curry-Winchell is always willing to help when called upon and does it with a smile on her face. All of the people and patients that Dr. Curry-Winchell interacts with have nothing but pleasant things to say about her.” Those are just a few highlights as to why she was awarded the 20 under 40 award.

Teaching Anatomy Through Tech and Touch

Dr. Thomas Schwenk Dean of the School of Medicine and VP of Health Science

Studying the structure of the human body is one of the most important courses for health care professionals. All physicians remember their first day in the anatomy lab. We enter the laboratory with anxiety, fear, wonder and awe.

We also enter the anatomy lab with a clear understanding of the sacredness of the human body, and a clear appreciation of the sacredness of the covenant we share with our first patient-an anatomical donor whose final act was to donate their body for the training of health care professionals. We remember that first day with extreme gratitude to the generosity of the donor and their ultimate gift to medical education.

Last week we honored these donors-our students’ very first patients-during our annual Anatomical Donation Memorial Service at Walton’s Sierra Chapel. Every summer, UNR Med first-year students express their appreciation to the donors’ families and friends during a memorial service featuring song, speech and poetry.

The memorial service provides a fitting tribute and closure to the yearlong anatomy course and provides medical students with the opportunity to show their appreciation for the great gift their donors have made to anatomical research and education. The School of Medicine and our students invite the family and friends of donors to attend the service to learn more about the anatomical donation program and gain a sense of closure for the loss of their loved one.

Through the anatomical donation program at UNR Med, which began in 1987, donors teach medical students about far more than gross anatomy. Cadavers posthumously teach medical students how to care, detach, work as a team and develop a sense of curiosity and discovery.

Many medical schools solely provide anatomy training through technology. While we believe there is no substitute for true human touch, it is important for us to acknowledge that technology can enhance the ever-evolving study of human anatomy.

As of last fall, the anatomy lab now includes an AnatomageTM life-sized digital dissection table, made possible through a generous gift from the William N. Pennington Foundation. Not meant as a substitute for, but rather a supplement to human cadavers, life-sized cadavers are revolutionizing anatomy in three-dimensional high definition with the click of a button or touch of a screen that resembles and oversized computer tablet mounted on a wheeled stretcher.

The AnatomageTM Table allows medical students to examine a virtual human body layer-by-layer, perform digital dissections and identify anatomical features with ultra-high quality visualization that provides instant access to photorealistic human anatomy.

In the traditional cadaver course of dissection, whether removing a vein, artery or organ, only so much cutting can be done and internal or underside views can be hidden or blocked. By pausing the digital dissection, students are able to interact with the dissection, turn it around and look at in three-dimensions.

Second-year medical student Miguel Gonzales, Class of 2022, said the use of both cadavers and technology provides a beneficial blend of instruction in anatomy education.

“I strongly believe there is no substitute for having actual cadavers, but the Anatomage Table offers supplemental instruction that cannot be achieved with a traditional cadaver,” Gonzalez said. “The ability to view a perfect, digital cadaver allows me to see and learn everything I need to know to build a solid anatomy foundation for working on a more challenging, traditional cadaver.”

But the Anatomage Table is a supplement to, not a replacement for, traditional dissection. It cannot at all replace the emotional power of understanding the life and death of a cadaver donor, or the educational value of memorializing the donor’s gift with poetry, song and eulogies, or the professional value of learning how to thank the family for their loved one’s ultimate gift.

What’s New/Makes Me Proud

Reed-Dopf-president

We launched into summer with a full calendar of activities and projects underway. The premier project is the introduction of the WCMS group health plan. Being able to once again offer group health to our members is an awesome benefit. It is available to groups of two to 50 employees, based on regulatory criteria. While that won’t fit all our members and their practices, it does cover a signification portion.

The program encompasses seven plan options of which groups may choose three that best meet their budgets and their employees’ needs. The eligibility criteria are simple: all physicians in the group must be WCMS members and groups of only two cannot be related. Call your broker or contact Kathy Wells, at Kathy.Wells@uhsinc.com. The plan launched with great enthusiasm garnering four or five requests from groups in the first few days.

Also scheduled for this summer are back-to-back CME’s sponsored in collaboration with and presented by the NorCal Group. On July 31, NorCal will be presenting: Boosting Your Immunity to Burnout and Pain Management & Opioid Prescribing. Dinner and the programs were presented from 6:00-8:00 at The Grove.

Our happy hours at the Shore Bar in the Renaissance are continuing with attendance growing each month. These small networking events are proving to be a great way for new members to get acquainted with our leadership. If haven’t stopped by, please join us any third Thursday from 5:00-7:00.
The Family BBQ at Bartley Ranch is set for Aug. 22. Again, this year we are asking participants to bring kid stuff to support the Women’s and Children’s Center of the Sierra. The center is always in need disposable diapers, formula and children’s gently used clothing. Women’s toiletries also are much appreciated. Because it’s Friday, the party begins at 4:00. This is a very family friendly event so make it an evening out with kids.

After our July break, the board will be back together to work on governing issues such as some bylaws revisions to make certain we stay current, membership recruitment, reviewing and updating our strategic plan and planning for our 2020 board transition.

As always, to keep all programs, education and networking rolling, we need your support on committees and task forces. Contact Mary Ann at maryann@wcmsnv.org and she’ll find the right spot for your talents and interests.

SAVE THE DATE
Monday, August 22
4:00 p.m. – 8:00 p.m.
Bartley Ranch Regional Park

Mark August 22 on your calendars for the third annual WCMS Family BBQ at Bartley Ranch Regional Park. We’ll gather from 4pm to 8pm for an evening of food, entertainment and activities for adults and children. Again, this year, we’re asking our guests to join us in supporting the Women’s & Children’s Center of the Sierra (waccs.org) by bringing clothing, diapers, formula and unopened toiletries to the BBQ.

The Women and Children’s Center of the Sierra (WACCS) provides services to support women as they work to move out of poverty and improve their lives. Their comprehensive approach includes ESL and GED (HiSet) education, job search and preparation, a free diaper bank, crisis intervention, and information and referrals for other community services a woman may need to move forward in her life. WACCS serves women as they work toward their individual goals on their journey out of poverty and away from public safety net programs. They counsel, educate, support, encourage, guide and otherwise empower women as they strive to transform their lives.

If you have questions or wish to be a sponsor, call 775.825.0278, or email Wendy at wendy@wcmsnv.org, or Mary Ann at maryann@wcmsnv.org.

Dr. Swanger & Dr. Killeen
Reed Dopf President

We’re Your Seat at the Table

NSMA and WCMS represent you before, during and after the Legislature meets. We ensure that Nevada’s physicians have a seat at the table when regulatory boards, committees and the legislators meet to discuss the practice of medicine and delivery of health care. Being a member gives you an extra boost in that you can share your opinions as priorities are being set. Our voice could be louder and clout greater if each one would one recruit one member this year.

Our 2019 priorities were established through the NSMA House of Delegates and Catherine O’Mara’s many long hours at meetings representing NMSA and our county societies.

2019 Priorities: We are working to:

Opioid Law Refinement: Revise the law to keep certain patient protections in place, enhance clinical judgment, allow multiple practitioners to more easily provide patient care and reduce workflow burdens.

Medicaid: Ensure access to care under for all patients including Medicaid patients. This includes Medicaid reimbursement and reducing administrative burdens for physicians participating in Medicaid.

Surprise Lapse in Coverage for Emergency Services: Fight for fair payment for physicians who provide services to patients in emergency settings.

Tort Reform: Address challenges to Keep our Doctors in Nevada (KODIN), including the caps for non-economic damages.

Maternal Mortality Review Panel: Establish a Maternal Mortality Review Panel to study causes of maternal mortality that result in identifying best practices.

Insurance Issues: Reduce regulatory burdens such as prior authorization, step therapy and other insurance policies that may negatively impact patients.

Mandatory E-Prescribing: Oppose mandates without appropriate exemptions and flexibility to ensure that physician practices can modernize without penalty.

Highlights of 2017 Successes

2016-2017 Regulatory Successes

  • Defeated a dental board regulation authorizing dentists and dental hygienists to administer botulinum toxin (“Botox”) and dermal filers.
  • Defeated a Board of Health regulation requiring all providers of care to report actual or suspected cancer to the Cancer Registry or face a $25,000 fine.
  • Lobbied to pass a new regulation allowing physician prescribers to delegate the transmission of an electronic prescription to a designated agent such as an RN, MA or scribe.
  • Negotiated a Board of Medical Examiner’s regulation providing common sense guidelines for physician oversight of a medical assistant.

2017 Legislative Successes

  • Secured Governor’s veto of an insurance bill banning balance billing and capping fees for out of network health care services to the insurer’s economic advantage.
  • Negotiated with the Governor’s office to ensure new opioid legislation preserves clinical judgment and avoids draconian prescribing caps found in other states.
    Improved a collaborative pharmacy bill ensuring that physician’s oversight and clinical judgment directs the patient care and clarifying in Nevada law that pharmacists do not diagnose.
  • Secured provision to reduce to three days the time a pharmacist must notify an ordering physician of the substitution of any interchangeable biosimilar.
  • Negotiated a common-sense revision to a proposed partnership bill allowing physicians and psychologists to form partnerships and still protects the tenets of Nevada’s implied prohibition of the corporate practice of medicine.
  • Defeated a measure criminalizing and prohibiting a physician from performing a procedure deemed to reassign the anatomical sex of a patient, including relocating the urethral meatus, unless the child assented to the procedure.
  • Removed physicians from a bill assessing a “provider tax” on all physicians to leverage monies for Medicaid funding.
  • Supported legislation requiring regular review and adequacy of Medicaid payment rates.
  • Secured Governor’s veto of a bill allowing any Nevadan to purchase Medicaid without limitation.
  • Protected patients from unskilled application of botulinum toxin (“Botox”) by limiting licensed professionals who may administer and requiring administration in medical facilities only.
  • Protected Ambulatory Surgical Centers from attempts to force certain procedures into hospitals.
  • Negotiated the reduction of proposed mandatory CME for suicide prevention from 3 CME units every two years to 2 CME units every four years.
  • Worked with Board of Medical Examiners to authorize them to take possession of records due to physician death or another incapacitation.
  • Supported a bill to place burden of supplying medical records on custodian of records instead of every physician who had seen the patient and reduced related penalty.

To support our advocacy, renew your membership, recruit a member and make sure you legislative updates by emailing admin@nvdoctors.org.