(4/21/08 - updates in progress)
ADVOCACY & MEMBER SUPPORT
LEGISLATIVE
NRHP works with the Nevada State Legislature to help ensure a supportive operating environment for small and rural hospitals in our state. Each legislative session involves a wide range of issues. Examples include Medicaid eligibility and reimbursement, quality of care and patient safety, billing practices, transparency of pricing and quality information, tort reform, employment practices, issues affecting public entities, insurance, and many more.
REGULATORY
In addition to legislative advocacy, NRHP helps ensure a supportive operating environment for members by working with a variety of state agencies and boards, such as the Nevada Department of Health and Human Services, the Nevada Health Division, and multiple professional licensing boards. Examples of issues at this level include compliance with the state's quality of care reporting requirements, physician licensure processes, facility licensure issues, and mental health service delivery in rural areas. NRHP also monitors change at the federal level, provides input on behalf of the members, and supports members' adjustment to changes in federal law and regulation.
GRANT WRITING AND RESOURCE DEVELOPMENT
NRHP writes and manages grants that support various goals involving shared services. NRHP has brought approximately 6.8 million dollars in resources to the membership. Funding has supported information technology programs, establishment of a revolving loan pool for rural providers as a tool to improve recruitment and retention of professionals, coordination and support for Nevada's Critical Access Hospitals, and the development of a system for capturing quality and patient safety information into an aggregated data base intended to drive quality improvement. NRHP works with the Nevada Office of Rural Health to coordinate and manage the pooling of the federal Small Hospital Improvement Program. Proceeds support group effort to improve billing practices, revenue cycle and quality.
PEER GROUP SUPPORT
NRHP coordinates and supports peer groups that have common interests. The groups are intended to facilitate communication, sharing of expertise, and the development of solutions to issues affecting multiple members. Current peer groups include: CEOs, Medical Staff Coordinators and Credentialing Staff, Purchasing Managers (also breakout groups for Pharmacy Managers, Laboratory Managers and Dietary Managers), Financial Management Staff, Information Technology Managers and Quality Assurance/Risk Managers.
FINANCIAL
INSURANCE
Group Health - NRHP acts as the agent for members participating in this program. Their employees are aggregated and NRHP coordinates the purchase of employee/dependent group health coverage for the group. NRHP also serves as the liaison to the carriers, assisting members with problem resolution, and providing plan usage information for the members.
LiCON (Liability Cooperative of Nevada) - a self-funded risk retention pool. Not-for-profit and publicly owned members are eligible, along with the physicians they employ or with whom they contract. LiCON provides several types of coverage, including professional liability, directors and officers, employment practices, pollution, and property. LiCON is governed by a Council, separate from the NRHP Board. Aggressive risk management services are provided to LiCON members. LiCON also offers a shared external peer review process for its members.
TEAM - Technical Equipment Asset Management of Nevada is a self-funded pool for the preventive maintenance and repair of biomedical and electronic equipment. Hospitals are able to reduce their costs for coverage and are eligible to receive dividends at the end of the fiscal year, if costs do not exceed contributions. NRHP is the administrator of the program.
PACT - Public Agency Compensation Trust is a self-funded workers' compensation insurance pool available to public entities through an organization separate from NRHP and LiCON. Members of PACT have access to POOL/PACT HR, a comprehensive and proactive program that facilitates the development and support of each member's human resources program. NRHP facilitates communication between POOL/PACT HR and its members, and assists with problem resolution. NRHP is represented on the POOL/PACT HR Committee.
CONSULTING Balanced Scorecard - Through the Critical Access Hospital program, NRHP provides consulting services to members with strategic planning and the development of Balanced Scorecards.
CAH (Critical Access Hospital) - NRHP is a subcontractor for the Nevada Office of Rural Health, providing a range of services supporting the Nevada Rural Hospital Flexibility Program (aka NV Flex Program). The services of the NRHP Regional Chief Financial Officer and Regional Chief Information Officer are provided to CAH and CAH-eligible hospitals through the program. Key focus areas include strategic planning, financial consulting, quality and performance improvement.
Chargemaster Improvement - Through the Small Hospital Improvement Program (SHIP), NRHP has coordinated a pilot project intended to address a common problem in small hospitals - maintenance of an accurate and current chargemaster. Lessons learned through this project will be applied to a feasibility analysis for a similar project involving more NRHP members.
Coding, Billing & Claims Support -
Cost Reports -
Private Pay Management -
Revenue Cycle Improvement -
RHC Designation - NRHP staff assist members in obtaining Rural Health Clinic designation for their hospital-owned clinics. The federal RHC program is intended to increase access to primary care services for rural Medicare and Medicaid beneficiaries. Once designation is achieved, NRHP assists members with any related issues. NRHP helps: ensure that all state and federal documentation is prepared accurately; identify resources for the development of policies and procedures and other required forms; provide guidance for mock surveys and program compliance; follow-up with state and federal agencies to determine survey dates and appropriate reimbursement from Medicare / Medicaid.
GROUP DISCOUNTS
GPO (Group Purchasing Organization) - NRHP coordinates a group purchasing program through an affiliation with Health Future (a hospital-based healthcare network in Oregon), and Med Assets. Participants access national and regional pricing and have access to technology that fosters effective management of supply cost.
Long Distance Savings Program - Provides rate reductions for long distance calling, based on a volume discount. A shared group contract, NRHP members participate as a benefit of membership.
Reference Lab - This group contract provides discounted rates for reference lab services to participants. The program is available to both NRHP members and non-members on a fee-for-service basis.
LOAN POOLS
NRHP Foundation Loan Pool - NRHP developed and administers the NRHP Foundation Revolving Loan Pool which provides members with low cost loans for equipment and capital improvement.
Rural Healthcare Provider (RHP) Loan Pool - NRHP administers a fund which loans capital to rural healthcare providers and other wishing to expand services in Nevada. Low cost loans are available to providers in rural areas and designated underserved urban areas.
Benchmarking
NRHP is in the process of implementing software that will provide easy access to, and use of the MedPar (CMS Medicare) database. Using selected indicators, NRHP will run periodic reports comparing the performance of NRHP members with each other, and/or other peer groups. Results will be distributed to participating members with guidance as to how to evaluate the information and suggestions about what members might investigate within their facilities if their performance is below the norm. NRHP also prepares comparative reports for financial and volume indicators using quarterly reports submitted to the state by all hospitals in Nevada. A system for benchmarking quality indicators for participating is currently being implemented using a data base developed over the past two years.
HUMAN RESOURCES
EDUCATION AND INFORMATION
NRHP Foundation Golf Tournament - The NRHPF Golf Tournament has become a celebrated and much anticipated annual event (11th Annual - June 13, 2008). Tournament Coordinator Ann Murdoch does a superb job of enlisting sponsors and participants, all of whom look forward to plenty of fun, food and prizes. Proceeds from the tournament fund educational programs for NRHP member hospitals.
HIPAA Compliance Support Program - NRHP provided technical assistance to members via a group contract with Health Future during the assessment and implementation phases of the HIPAA Privacy and Security Rules. NRHP provides ongoing support through dissemination of information and educational opportunities, and by maintaining a listserv for risk managers, HIPAA coordinators and information technology managers to encourage communication among the membership.
APPROPRIATE SERVICES
MEMBER PERFORMANCE IMPROVEMENT
Health Data Check - Pioneer Health Network offers a web-based financial and productivity benchmarking tool for rural hospitals. HDC is dedicated to the needs of rural hospitals and rural health networks and currently receives data from over 100 rural hospitals, including 40 CAHs. Access is provided to all NRHP members at a reduced rate.
CCD (Quality Data Management)
Risk Manager Work Group
Flex Quality Improvement Network
CAH Quality Assurance Plan
Shared Credentialing Program
TELEMEDICINE NETWORK
Network enables virtually instant interpretation of diagnostic images and allows rural physicians to consult in real time with their urban counterparts.
FACILITIES & TECHNOLOGY
CONNECTIVITY SUPPORT
DISRN-DIAGNOSTIC IMAGING SOLUTION for RURAL NEVADA
Senator Harry Reid (D) NV has long been interested in access to healthcare services for rural Nevadans in their own communities. Senator Reid has been instrumental in the implementation of the DISRN program.
The purpose of DISRN is to enhance and expand telehealth capability in Nevada's rural and frontier hospitals. DISRN enables integration of patient information with diagnostic digital images, electronic transmission of those images over a secure, redundant wide area network (WAN) to a central image archive, and a centralized information system for image retrieval and management for hospital radiology departments. The program is coordinated with other NRHP information management initiatives that will ultimately enable hospitals and physicians to share clinical and administrative information in a secure electronic environment.
First funded with a HRSA/CMP grant in 2004-05, seven hospitals received equipment and software. NRHP has received notification from HRSA that a second CMP grant has been approved for 2008. Funds will be used to add PACS/RIS capability in another NRHP member hospital; improve the RIS capability at the seven existing sites, improve electronic network capability, integrate existing teleradiology capability with distant radiologists' Radiology Information Systems, and provide centralized technical support for the program.
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HRSA LEGACY SYSTEMS INTEGRATION PROGRAM
The purpose of this program was the integration of existing (legacy) software systems in grant-funded hospitals. The program also supported creation of centralized data storage and other applications.
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NETWORK SUPPORT - EMAIL
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SHARED DATA ARCHIVE
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TELEMEDICINE
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WIDE AREA NETWORK (WAN)
The NRHP wide area network was created in December 2001. The WAN serves regular NRHP members through a high-speed electronic link. The WAN serves to: enhance communication among and between members through use of the Internet and compressed video; provide a secure conduit for moving patient information such as teleradiology images; provide members with access to healthcare information and education; enable telehealth services to reach rural residents; and enable members to share software applications. Access to the WAN is available to NRHP members as a benefit of membership. New members (those who were not part of the program at its inception) may be required to fund the equipment necessary to establish the link.
