to:                 Dr. Chris cochran

from:           ather ahmed

subject:     mgma meeting 12/9/2004

date:            12/16/2004

This memo has been drafted to inform you about the MGMA meeting which was held on December 9^th, 2004. The guest speaker was Mr. Larry Mathias, liaison for the AMA Nevada. Mr. Mathias talked about two main issues affecting the healthcare industry, mainly medical malpractice insurance and the state Medicaid system. Further more, Mr. Mathias touched on topics to be raised in the state legislature.

Medical Malpractice was the first topic to be raised. After the November elections, a huge success in the fight to keep physicians in Las Vegas has been won by having issue No. 3,4 & 5 voted in favor of healthcare professionals. However, although rates have increased slightly, it is not due to malpractice insurance. Mr. Mathias was quick to point out “gouging”, as the main problem. Since insurance companies cannot charge excessive rates, they have decided to add on surcharges, which later are reduced down the line in the form of a discount. In addition, Mr. Mathias indicated it took Californian physicians between 5-10 years for their premiums to adjust, thus medical malpractice caps were advantageous to only new physicians entering the field.

The second issue, which consisted most of the meeting time, was in regards to First Health Services. They were the company responsible for making the state Medicaid system up to date by installing a computer database system used to ease the claims process in Medicaid payouts. So far it has taken 15 months for the computer system to be up and running, with a 85% efficiency rate. The state minimum requirement is 95% efficiency rate. Due to this electronic nightmare, 600,000 claims are still pending, with 80% that cannot be processed due to poor tracking records. In order for physicians to recover those same claims, they are being submitted in writing, creating an even longer process to properly providing claims. Since claims were not paid in time, many physicians have stopped or are considering whether or not to accept Medicaid patients. In addition, some physicians have also decided to close their practices, due to pending claim funds and high expenses.

The legislature in February will now review First Health Service’s application, aim on improving Medicaid/Medicare claims in Nevada, and find a method to keep physicians from leaving Nevada, by offering better insurance programs and incentives. The first legislative session starts on the first Monday of February, which is February 5^th. A session is approximately 120 days long, and reviews new and old laws that should be added or taken off from the state law.

In conclusion, the MGMA meetings are highly valuable, and encourage others in the profession to attend these meetings on a regular basis. I feel that the MGMA meeting serves as an educational forum which introduces and points out political issues which need attention, and find methods to help solve these issues.