In this Issue...

1. AMA Interim Meeting of the House of Delegates Medicare Reform Discussion
2. Federal Judge Orders Temporary Restraining Order on Idaho’s ‘Abortion Trafficking’ Law
3. Budget Neutrality Discussion Draft is Circulated
4. Medicaid Officials Anticipate Sharp Enrollment Declines and Increases in State Spending on Medicaid as Pandemic-Era Policies Continue to Unwind
5. Medicaid Facts, Budget, and Public Polling
6. It's Time To Renew Your IMA Membership!
7. Chronic Kidney Disease (CKD) Screening and Management Learning Collaborative
8. Behavioral Aspects of Neurological Disease Across the Lifespan Conference 2024
9. Why Partnership is Good for Community Health
10. IMA Education Webinar - CPT Changes 2024
11. Medical Practice Opportunities

Federal Judge Orders Temporary Restraining Order on Idaho’s ‘Abortion Trafficking’ Law By Idaho Capital Sun

A U.S. District Court decided that it would temporarily block enforcement of Idaho’s “abortion trafficking” law, which took effect in May after Idaho legislators voted on its passage during the 2023 legislative session. 

In the latest decision of Matsumoto v. Labrador, U.S. Magistrate Judge Debora K. Grasham granted a temporary restraining order against the “abortion trafficking” statute in House Bill 242, preventing it from being enforced.

According to House Bill 242, “an adult who, with the intent to conceal an abortion from the parents or guardian of a pregnant, unemancipated minor, either procures an abortion… or obtains an abortion-inducing drug for the pregnant minor to use for an abortion by recruiting, harboring or transporting the pregnant minor within this state commits the crime of abortion trafficking.”

If enforced, those convicted of “abortion trafficking” would face a penalty between two to five years in prison. 

In July, Lourdes Matsumoto, the Northwest Abortion Access Fund, and the Indigenous Idaho Alliance — all of whom provide assistance to pregnant patients to access legal abortion in neighboring states — filed the lawsuit against Idaho Attorney General Raúl Labrador alleging the law restricts freedom of speech, the right to travel and the right to freely associate.

Grasham approved and rejected parts of Labrador’s motion to dismiss the case. She dismissed a section of the lawsuit claiming that the law infringes upon the right to intrastate travel. However, she denied the remaining aspects of Labrador’s motion to dismiss. 

In her concluding paragraph of the temporary restraining order decision, Grasham said the lawsuit is not about the right to an abortion, but rather it is about the rights to freedom of speech, expression, due process, and parental rights.

“The state can, and Idaho does criminalize certain conduct occurring in its own borders such as abortion, kidnapping, and human trafficking,” Grasham said. “What the state cannot do is craft a statute muzzling the speech and expressive activities of a particular viewpoint with which the state disagrees under the guise of parental rights, as Idaho Code Section 18-623 does here.”

To read the entire article, click the button below.

Budget Neutrality Discussion Draft is Circulated

The Center for Medicare and Medicaid Services (CMS) actuaries have occasionally overestimated the impact of Relative Value Units (RVUs) changes in the fee schedule, resulting in the permanent removal of billions of dollars from the payment pool. The GOP Doctors Caucus Co-Chairs, Reps. Greg Murphy (R-NC), Brad Wenstrup, and Michael Burgess (R-TX), working closely with Ways and Means Committee Chairman Jason Smith (R-MO), and the AMA, have released a discussion draft of legislation seeking to reform the budget neutrality policies applied to the Medicare Physician Fee Schedule (MPFS). The goal is for this proposal to generate bipartisan support from the key House and Senate committees with jurisdiction over the Medicare program. Please see (below) a summary of the draft legislation and click the button to view the press release from the GOP Doctors Caucus.

This legislative proposal is largely based on the work product that came out of the AMA Medicare Reform Workgroup. The discussion draft’s provisions offer practical policy improvements to provide some needed stability to the physician payment system by assuring that this CMS payment policy is based on reality, not projections. While refining Medicare fee schedule budget neutrality policies is a key component of Medicare physician payment reform, it is important for medicine to continue pressing for the other proponents of comprehensive reform, including: (1) automatic, annual inflation updates based on the Medicare Economic Index (MEI) as proposed by H.R. 2474; (2) reducing administrative burden and improving the clinical relevance of the Merit-based Incentive Payment System (MIPS); and (3) maintaining a viable pathway for physicians to opt into alternative payment models, as provided in H.R. 5013, the Value in Health Care Act.

The Subcommittee will discuss the budget neutrality proposal, posted by the committee as H.R., the Provider Reimbursement Stability Act of 2023, to reform the budget neutrality rules for the Medicare physician payment system.  

Summary of the Budget Neutrality Proposal

Section 2. Updating the Budget Neutrality Threshold

1. Increasing budget neutrality threshold from $20 million to $53 million and increasing every five years by the cumulative increase in Medicare Economic Index (MEI) since the last update to the threshold.

• The $20 million was established in 1992 and has not been updated since. This would allow for greater flexibility in determining pricing adjustments for services without triggering across-the-board cuts.

Section 3. Budget Neutrality Corrections for Overestimates and Underestimates in Utilization

1. Provide a lookback period to reconcile overestimates and underestimates of pricing adjustments for individual services no later than 9/1 of the subsequent year. This would allow for the Medicare conversion factor to be more accurately based on actual utilization data and claims.

• For example, if CMS proposes something for CY2025 that requires a budget neutrality adjustment based on projections of how much a new code or service was going to be utilized, data would then be collected on the accuracy of those projections, and CMS would propose a correction based on actual CY2025 utilization data for the CY2027 Physician Fee Schedule. 

Section 4. Timely Updates to Direct Costs Used to Calculate Practice Expense RVUs

1. Requires the Secretary to, no less than every five years, update prices and rates for direct cost inputs for practice expense (PE) relative value units (RVUs), which includes clinical wage rates, prices of medical supplies, and prices of equipment.

• CMS did not update supply and equipment prices from 2005-2019 and clinical staff wage rates from 2002-2022. The length between updates made price changes more significant rather than if prices were updated more frequently, creating larger swings in payment than if more consistently updated. 

Section 5. Limitation on Year-to-Year Conversion Factor Variance

1. Starting in 2025, the Secretary would be required to limit positive or negative increases in the conversion factor to no greater than 2.5% each year. The policy goal is to provide stability for the PFS by removing relatively large and abrupt changes in conversion factor calculations.

The 23rd annual survey of state Medicaid directors has revealed that there will be a significant decline in national Medicaid enrollment by 8.6% during state fiscal year (FY) 2024. This decline results from state Medicaid agencies' unwinding pandemic-related continuous enrollment protections. Despite reaching a record-high enrollment, these estimates indicate a drastic year-over-year decline in program enrollment from that high.

Driven by anticipated changes in enrollment, total Medicaid spending growth (federal and state spending combined) is expected to slow in FY 2024 to 3.4%; however, the state (non-federal) share of Medicaid spending is expected to increase by 17.2% in FY 2024 primarily due to the phase-out of enhanced federal Medicaid matching funds (set to expire December 31, 2023.) State spending on Medicaid declined in FY 2020 and FY 2021 due to the pandemic-era enhanced FMAP. Most officials indicated that their projections reflect what is assumed in their states’ adopted budgets, though estimates of both enrollment and spending are uncertain, and the effects of unwinding are evolving, with significant variation across states. Enrollment change estimates for FY 2024 reflect new enrollments as well as coverage losses due to unwinding, but they also assume some “churn” – that is, that some individuals losing coverage will re-enroll within the year.  

While the unwinding of the continuous enrollment provision and enhanced federal match rate were dominant policy issues at the end of FY 2023 and headed into FY 2024, states were also focused on an array of other policy responses. A companion survey report highlights key policies that state Medicaid programs implemented in FY 2023 or planned for FY 2024.

Medicaid Facts, Budget, and Public Polling

Medicaid is an important part of the healthcare landscape, particularly for Idaho’s low-income families. Every year, the legislature reviews and approves a Medicaid budget, which impacts reimbursement for services and funding for programs for patients. If you want to know more about the status of Medicaid in Idaho, below are links to two opportunities to listen to a webinar. It is a collaboration between the Idaho Hospital Association, Idaho Voices for Children, and the Idaho Community Health Center Association. It covers an overview of Medicaid funding, the “unwinding” that took place this year, and the public’s attitudes towards Medicaid based on a recent poll.

Webinars



Thursday, November 30

Noon to 1 pm

Click here to register

Monday, December 11

1 pm to 2 pm

Click here to register

Renew Your IMA Membership Today!

Why Join IMA?

When you join the Idaho Medical Association, you hire a powerful staff to protect the viability of your practice. By protecting your practice from legal, legislative, and regulatory intrusions, your IMA membership lets you focus on what’s really important: Your Patients. Become a member today and join the IMA Community of over 4,000 Idaho physicians and medical professionals.

* Don't forget: If you pay your AMA dues through the IMA, the IMA benefits.



Visit www.idmed.org TODAY to easily join or renew for 2024!

Why Partnership is Good for Community Health

November 16 is National Rural Health Day, and to celebrate, Smith & Malek would like to spotlight Federally Qualified Health Centers (FQHCs), the unsung heroes of rural communities. Their commitment to supporting these clinics isn't just a professional endeavor; it's a deeply personal passion.

Smith & Malek's co-founder, Luke Malek, comes from a line of rural physicians; his grandfather practiced in Wyoming during the 1960s, and his mother practiced in Northern Idaho in the 1980s, eventually opening the first free clinic in that region.

When Smith + Malek opened its doors in 2015, one of our first clients was an Idaho-based FQHC. It offers high-quality healthcare to everyone in the community they live, work, and play in, which is why they are intrinsically motivated to help it grow. Today, it is a $45 million organization with nearly 400 employees.

Smith & Malek's role as legal counsel extends beyond courtroom battles; they work with in-house legal teams across the business sector to help clients shape policies, refine processes, and facilitate actionable strategic planning workshops. Their core values are to make tomorrow better than today and to be a force of justice in the world. Helping a values-aligned business expand in order to serve more customers - or patients, as the case may be - brings meaning to Smith & Malek's work.

National Rural Health Day will come and go, but the Smith and Malek healthcare team works with FQHCs in six Western states every day of the year to elevate the impact of accessible, affordable, high-quality healthcare. For them, it's not just about being lawyers; it's about being advocates and architects of a healthier, happier future.

Ardent Health Services (Chief Medical Officer (CMO))

Ardent Health Services invests in quality healthcare.

Ardent Health Services, located in Nashville, Tennessee, has earned a reputation as one of the industry’s strongest – and most innovative hospital operators. We are driven by our purpose of caring for people: our patients, their families, and one another. Our facilities and clinics are consistently recognized among healthcare’s best employers.

To support operations, Ardent invested more than $1.4 billion since 2011 to raise the standard of care in the communities we serve. Additionally, Ardent has invested $220 million in Epic, towards uniting our hospitals and clinics on a single information-sharing platform to improve patient outcomes and increase efficient care delivery. We recognize each hospital is as unique as the community it serves. We strive to maintain strong community ties through advisory boards, contributions, charitable care, education, and outreach.

Ardent includes:

• 30 Hospitals
• 200+ Sites of Care
• 4,453 Beds
• 23,000+ Team Members
• 6,818 Nurses
• 1,438 Aligned Providers
• 3.2 Million Annual Provider Encounters
• $5.1 Billion in Revenues

Ardent Health Services invests in quality healthcare. AHS makes considerable investments in people, technology, facilities, and communities, producing high-quality care and extraordinary results. From newly constructed facilities and expanded services to lifesaving technology and outstanding opportunities for employees, AHS is committed to providing its hospitals and clinics with the tools needed to succeed. 

OUR PURPOSE is caring for people: our patients, their families, and one another.

We believe it is this mix of corporate support and local autonomy that equips our facilities for success.

Portneuf Medical Center:

Portneuf Medical Center (PMC) is a 205-bed regional referral hospital for southern and eastern Idaho and western Wyoming. Our mission is to be the first choice for patients in the region for all their healthcare needs. PMC offers a Level II trauma center, Level III neonatal intensive care unit (NICU), a Quality Oncology Practice Initiative (QOPI®) certified cancer center, high-performing orthopedic services, and a full suite of cardiac care. Portneuf Medical Group is a large multi-specialty physician group employed by Portneuf and has 60 physicians and 40 Advanced Practice Providers. In addition, PMC has one of the largest surgery practices in the state, robotics-trained surgeons, an award-winning vein center, a fully accredited wound care clinic, innovative urological care, high-performing orthopedics, and primary care to support all ages. 

As a teaching hospital, PMC is committed to raising the bar in healthcare while also raising the next generation of providers. And, as a major employer in Pocatello, we have 1,700 well-qualified employees.                                                                                      

In a joint venture partnership with the Portneuf Health Trust, Ardent Health Services operates Portneuf Medical Center located in Pocatello, Idaho. Based in Nashville, Tennessee, Ardent Health Services includes 30 hospitals and more than 200 sites of care.

Job Overview:

We are currently recruiting for a Chief Medical Officer (CMO) to support our Portneuf Medical Center in Pocatello, Idaho.

The Chief Medical Officer (CMO) will interface with Administration, the Medical Staff, and other physician organizations. The primary objective of this position is to lead clinical and quality initiatives that support consistent clinical performance and quality of care through outcomes measurement and performance improvement processes.

The CMO is a leadership position created to build on and strengthen the positive and mutually supportive relationships between hospital administration and the medical staff. As such, the CMO will work closely with the Ardent CMO, administrative staff, members of the medical staff, and its leadership to maintain the high quality of the medical staff and to help lead the medical staff participating in furthering the mission of the organization, with a duty to support the mission and philosophy of Portneuf Medical Center.

The CMO will work closely with and facilitate positive relationships with nursing leadership in order to ensure successful performance improvement initiatives and overall quality of care. The incumbent will forge strong linkages and alignments with physician providers. The CMO will support and advise the Medical Executive Committee and the Departments in responding to complaints regarding physician behavior and performance.

Responsibilities

Administrative

• Serve as a member of the senior management team and assist in strategic development of initiatives and programs. 
• Investigate and study new developments in medical practice techniques and initiate medical staff and administrative discussions of the implementation of new procedures.  
• Promote effective and timely communication with the medical staff and leadership.
• Participate in the annual operating and capital budget process providing input regarding the budgets of medical affairs and integrating medical staff and clinical issues into the region’s planning, budgeting, and marketing processes.
• Collaborate with key medical staff committees. Works to forge stronger bonds with the nursing staff.
• Participate in the development and implementation of patient care programs and collaborate with hospital leaders on medical staff partnerships, co-management, and joint ventures.

Medical Staff

• Work to optimize and share best practices as it relates to privileges, bylaws, quality, and medical staff.
• Assist with efforts to identify and retain continuing sources of physician staff and other key employees. Also, assist in the recruitment and location of physicians and needed specialists for filling hospital staff needs, as needed
• Receive, investigate, and, where possible, resolve conflicts referred by the medical staff leadership. Report complaints against members of the medical staff to the appropriate bodies. 
• Work with other physician leaders to implement identified best practices and evidence-based initiatives.
• Serve as a resource for medical staff leaders on complex complaints, incidents, and credentialing issues.

Clinical Care Management

• Work with hospital leadership on developing standardized approaches to reducing HACs, Improving Core Measures, and reducing problematic safety events.
• Work with Ardent CMO and Case Management leaders on continuum of care, medical necessity, length of stay, denials, and other key physician-driven case management initiatives.
• Evaluate the medical staff quality assurance, disease management, and utilization review activities, and develop standards to improve quality outcomes, both clinically and administratively, to ensure the highest standards in the treatment and care of patients, and to ensure compliance with all relevant licensing and accrediting bodies.
• Assist in development, implementation, and evaluation of all care management plans.
• Serve as point person for EPIC clinical resource.
• Develop and implement strategies that control the risks of patient care, monitor the effectiveness of these actions, and ensure proper documentation.
• Dedicate specific resources to patient safety, particularly as related to medication errors and infection surveillance.
• Provide leadership and vision in the development of clinical guidelines and care pathways.

Education

• Provide direction for continuing medical education programs for the medical staff, support staff, graduate, and post-graduate medical education.
• Work with local leadership to ensure appropriate administrative direction for graduate and post-graduate medical education programs

Resource Allocation

• Support the development of managed care plans and physician services strategic plans supporting the business plan of the organization and develop annual work plans to implement strategies.
• Foster an environment conducive to a managed care market with continuous review of resource utilization, education, and training opportunities that support resource effectiveness.
• Participate in information systems development to allow feedback to physicians regarding practice patterns and performance.
• Support clinical integration and population health initiatives.

Qualifications

Required Experience/Education:

• 5+ years of medical executive leadership roles preferred 
• MD or D.O. Degree required; MBA or other advanced management degree preferred
• Board Certified
• Advanced degree in the area of healthcare administration or related field is desirable

Preferred Experience:

• Demonstrated success in achieving performance goals with Medicare clinical outcomes such as HAIs, PSI90s, and Core Measures.
• Leadership of a hospital or system-wide patient safety initiative—ERAS, High-Reliability interventions, Patient Safety Organization, Peer Review Leadership.
• Experience as a hospital medical director and success on the administrative side in a complex healthcare environment or equivalent is preferred.

To apply follow the link below:

Chief Medical Officer – Portneuf Medical Center in Pocatello, Idaho | Ardent Health Careers

Associates in Family Practice (Physician Assistant or Nurse Practitioner)

Associates in Family Practice is seeking a Certified Physician Assistant or Nurse Practitioner, serving three locations in Gooding, Wendell, and Hagerman, Idaho.

If you would like more information and to apply, email [email protected] or call (208) 539-1959.