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In business Q+A: Brian Brannman UMC chief on Obamacare, e-records and a UNLV med school By Conor Shine staff writer While the Affordable Care Act has been making headlines for its effect on consumers, hospitals are also making changes to comply with the new law. At University Medical Center, one of the biggest changes is in the installation of a new electronic health record that will help collect and share information across the entire organization. The Clark County-owned public hospital began installing the software system late last year and began a second phase integrating clinical operations in September. It has until 2017 to meet the deadline imposed by the Affordable Care Act; if it doesn't, reimbursement rates for Medicare patients treated at UMC would be cut. UMC CEO Brian Brannman is confident the organization will meet its deadline and anticipates the system will be fully rolled out within 18 months. The process has been slow-going due to its complexity, Brannman said, and will cost the hospital about $45 million total — $27 million for the software and $18 million in installation and training. How will the electronic health record affect the hospital? Electronic health records offer all kinds of opportunities for improving the quality of care. Delivering health care is a science, and the more data you have, the better you are able to deliver care. not be done or for the results to be overlooked. sam morris leading the transition: UMC CEO Brian Brannman speaks about implementing his hospital's new computer system and other issues. You settle disputes about which drugs are most efficacious, which treatment protocols are most efficacious. It's not cookbook medicine; it's using the data to drive you toward the best solutions and outcomes for the patient. What's the status of the implementation? The first stage we implemented was to put in the back-office functions, the finance and the record-keeping. In September, we began the real serious work on the electronic order entry piece. We're rolling that out now. It's still in an early stage — anytime you do this with any system, there's some hiccups. You're talking about 4,000 people in the hospital. We've got 1,200 nurses and over 1,200 doctors in the community that use UMC, (and) you're changing their work practices. It's a culture change, and these are very complex systems. How will it work when it's in place? It will go across the entire organization. A primary care provider at one of our outpatient clinics would be able to have complete visibility of everything that happened to you on the inpatient side. If you had a colonoscopy, he'll be able to pull up the photos the doctors took, all the X-rays and lab results could be looked at. It's a lot easier to have consistency in the care. It makes it more difficult for tests to How else is the ACA affecting UMC? The population that's served at our indigent care clinic has traditionally been through Clark County Social Services. That patient population is going to roll to Medicaid, which has a lower reimbursement rate. At the end of the day, that's part of our safety-net mission and it's just a matter of adjusting. We're also working to ensure that we educate folks about their choices. We want to help them determine whether they're part of the expanded Medicaid population or whether it makes more sense for them to find a plan on the health insurance exchange. Where does UMC fit in proposed plans to bring a medical school to Las Vegas? I'm excited about it. It seems as though we've gotten over some of our traditional north-south business and now are really focused on how do we get that fouryear campus here. How do we grow it and expand the number of residency programs so that we're really producing a volume of high-quality physicians? We've already been working with UNLV on the nursing, hospital administration and public health side. I think pulling them into the conversation on the physician piece really helps us to start rounding ourselves out as a true academic medical center. health care Small businesses have their own issues with ACA rollout By Andrew Doughman staff writer Americans now know that President Barack Obama erred when he told the nation that people can keep their health plans if they like them. In Nevada, about 25,000 people in the individual health insurance market received cancellation notices, leading to an apology from the president and a proposed fix. But this isn't over. The same principle that led to people receiving cancellation notices also applies to businesses. Workers will face a lot of changes to the health care market in late 2014 as business owners seek to comply with business-related provisions of the health care law that start Jan. 1, 2015. The timing means workers and business owners will face disruptions in 8 20131223_VI08_F.indd 8 the health insurance market right as Republicans and Democrats are competing to win votes in the Nov. 4, 2014 election. "It'll be what you're hearing now about the individual (health insurance) plans times 10," said one health insurance broker with large-business clients in Las Vegas. That's because the individual insurance market is small. Many more people get insurance through small-group or large employer health plans. Many of these plans already provide better coverage than individual health plans, but they'll still have to comply with the law come 2015. So small businesses are starting to do the math; should they continue providing insurance, or is it cheaper to dump employees onto Nevada's health insur- ance exchange, where employees could be eligible for subsidies to buy their own insurance? Some businesses may get a better deal — more coverage for less money — and some may end up paying more for insurance because of how the health care law changes the way insurers calculate the premiums they charge. All the uncertainty has led many small businesses to wait and see how the law plays out in 2014. Technically, small businesses have to comply with the law by Jan. 1, 2014, but many have opted for an "early renewal" option that allows a one-year extension for companies to keep their health insurance if they like it. "It's about rate preservation," said Chris Campbell, director of the health and benefits division of Craigin & Pike, a Las Vegas insurance agency. The insurance and benefits plan offered by the Las Vegas Metro Chamber of Commerce offered this option to its 2,700 small-business members so they could lock in coverage and current rates. "We are simply offering a renewal of the current plan," said Bill Wright, president of Chamber Insurance & Benefits. "We heard our membership saying they want to keep their current plan and their current physicians." But the Chamber will have to change its plan next year because the organization will need to fully comply with the health care law. Businesses with more than 50 employees will also have to consider providing insurance at this time or paying a penalty for not doing so. | 23 DECEMBER 2013 | 12/18/13 3:52:10 PM

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