ANNUALREPORT

2019 - 2020 2019 - HIGHLIGHTS

In putting together this Annual Report Highlights publication, I, along with the 64 MEMBERS Association (NHA) staff, reflected on a chaotic time in the hospital industry. No one could have predicted the enormous impact that COVID-19 had, and continues to have, on the world and in Nevada. 8,929 Member Hospital Beds For the last eight months, the majority of the work that we have done on behalf of our members has been related to COVID-19. Daily surveys and reports, phone calls with Governor Sisolak and his team, working with FEMA and the $2,106,646 in Grant Department of Emergency Management, to name a few items. As you read this and Contract Revenue report, you will see the impact that COVID-19 had on the various NHA focus areas.

The NHA continues to proactively advocate for hospital members at the state and national levels and helps individual address their own unique challenges and opportunities. This report provides a snapshot of activities from September 2019 through September 2020. The NHA engages with our members in the following areas: 2019 - 2020 NHA Board of Directors Officers • Advocacy Chair, Erik Olson • Clinical Resources Renown Regional Medical Center • Community Resilience • Communications Past Chair, Jason Bleak • Data Analysis Battle Mountain General Hospital • Education Vice Chair, Mason Van Houweling • Patient Safety University Medical Center • Regulatory Compliance • Special Projects Treasurer, Chris Bosse • Workforce Development Renown Health

NHA Members represent 8,929 Secretary, Bill Welch Nevada hospital beds including short- Nevada Hospital Association term acute care, long-term acute Directors care, rehabilitation and behavioral Carla Adams (Nurse Executive) health. Full NHA members are part of Northern Nevada Medical Center the Policy Development Committee that meets quarterly to vote on Lawrence Barnard establishing the advocacy agenda of Dignity Health St. Rose Dominican Hospital - San Martin the Association. Tiffany Coury Saint Mary’s Regional Medical Center If you have any questions about this report, please contact me or a member Leonard Freehof of the NHA Staff. I am proud to be Medical Center associated with the hospital industry and with the life-saving work that our Rob Freymuller Medical Center members do each and every day. Steve Killian Sincerely, MountainView Hospital

Tom Maher Bill M. Welch Donald Mackay, MD (Trustee) President/CEO University Medical Center Nevada Hospital Association Peggy Nelson Encompass Health Rehabilitation Hospital of Desert Canyon

Alan Olive Northern Nevada Medical Center

Todd P. Sklamberg Sunrise Hospital & Medical Center

Vince Variale Page 2 2020 Full NHA Members (Policy Development Committee Members) • AMG Specialty Hospital of Las Vegas • Reno Behavioral Healthcare Hospital • Banner Churchill Community Hospital • Renown Regional Medical Center • Battle Mountain General Hospital • Renown Rehabilitation Hospital • Boulder City Hospital • Renown South Meadows Medical Center • Carson Tahoe Continuing Care Hospital • Saint Mary’s Regional Medical Center • Carson Tahoe Regional Medical Center • Seven Hills Hospital • Carson Valley Medical Center • South Lyon Medical Center • Centennial Hills Hospital Medical Center • Southern Hills Hospital & Medical Center • Desert Parkway Behavioral Healthcare Hospital • Spring Mountain Sahara • Desert Springs Hospital Medical Center • Spring Mountain Treatment Center • Desert View Hospital • Spring Valley Hospital Medical Center • Dignity Health - St. Rose Dominican • St. Rose Dominican Hospitals - Rose de Lima Campus Blue Diamond Campus • St. Rose Dominican Hospitals - San Martin Campus • Dignity Health - St. Rose Dominican • St. Rose Dominican Hospitals - Siena Campus North Las Vegas Campus • Summerlin Hospital Medical Center • Dignity Health - St. Rose Dominican • Sunrise Hospital & Medical Center Sahara Campus • University Medical Center of Southern Nevada • Dignity Health - St. Rose Dominican • VA Sierra Nevada Health Care System West Flamingo Campus • VA Southern Nevada Health Care System • Dignity Health Rehabilitation Hospital • Valley Hospital Medical Center • Encompass Health Rehabilitation • West Hills Hospital Hospital of Desert Canyon • William Bee Ririe Hospital • Encompass Health Rehabilitation Hospital • Willow Springs Center of Henderson • Encompass Health Rehabilitation Hospital 2020 Colleague Members of Las Vegas • Elite Medical Center • Grover C. Dils Medical Center • SNAMHS/Rawson-Neal Psychiatric Hospital • Henderson Hospital • Horizon Specialty Hospital - Henderson 2020 Associate Members • Horizon Specialty Hospital - Las Vegas Collective Medical • Humboldt General Hospital Comagine Health • Incline Village Community Hospital Desert Radiology • Infinity Hospice Care Donor Network West • Kindred Hospital Las Vegas – Flamingo Campus Global Medical • Kindred Hospital Las Vegas – Sahara Campus Response • Mesa View Regional Hospital HospitalCareers • MountainView Hospital Lancaster Pollard • Mt. Grant General Hospital Las Vegas Heals • Nathan Adelson Hospice MedX AirOne • North Vista Hospital Nevada Donor Network • Northeastern Nevada Regional Hospital Nevada System of Team members from Nevada • Northern Nevada Medical Center Higher Education Donor Network at the 2019 NHA Annual Meeting. • Pershing General Hospital SilverSummit Healthplan • PAM Rehabilitation Hospital of Centennial Hills • PAM Specialty Hospital of Las Vegas • PAM Specialty Hospital of Sparks Page 3 2020 Interim, Special Legislative Sessions and State Advocacy During the 2020 interim session, the NHA worked with the State on the regulatory implementation process. This included attending public workshops to ensure regulations were developed which were consistent with the legislative intent and involved appropriate stakeholders, as well as working with NHA members to keep them informed and offering specific workshops and guidance. Through advocacy, the NHA helps our members to continue to deliver safe, quality care in their local communities by influencing the legislative process. In 2020, we also faced two special legislative sessions.

Interim and State Advocacy • Created an NHA Patient Protection Commission (PPC) Advisory Group to assist hospital commissioners navigate the issues put in front of the PPC. The PPC developed two bill draft requests focusing on telehealth and transparency. • Met with legislators on the 2020 election cycle. • Notified NHA members of public workshops or any changes to: • Medicaid Reimbursement • Surprise Billing • Workplace Violence • Cultural Diversity and Competency • Participated in Interim Health Care and Interim Finanice Committee meetings to provide public comment and testimony. • Provided oversight to committees including NHA/Nevada State Medical Association, KODIN and the NHA Government Affairs preparing reports and identifying gaps and needs to align efforts.

31st Special Legislative Session The 31st Special Session addressed the historic $1.2 billion budget shortfall caused by the COVID-19 global pandemic. Assembly Bill 3 (AB3) implemented the vast majority of budget changes, and items impacting healthcare include: • A 6 percent across the board rate cut to Medicaid providers with hospitals being impacted the most • Roll-back of rate increases from the 2019 Legislative Session for Acute Hospital Services (2.5% Increase)

While the increases from the 2019 Legislative Session for pediatric and neonatal intensive care services were initially identified in the proposed cuts, they were restored. Efforts continue with the State on full restoration.

32nd Special Legislative Session The 32nd Special Session included Senate Bill 4 (SB4) which was introduced to provide business liability premises protection for exposure to COVID-19 by third parties. Unfortunately, this bill specifically excluded hospitals and other health services from the same liability protections granted to casinos, non-profits, and other government entities.The hospital community lobbied hard against this bill, but ultimately, it passed.

While the hospital community fully supported business liability premises protection for exposure to COVID-19 by third parties that includes all businesses, the NHA was not able to support legislation that excluded hospitals and other health care facilities from protection and unfairly targets their industry. As of this writing, efforts continue with the Governor to clarify Directive 011.

Page 4 Federal Advocacy

• Worked with Congressman Amo- dei’s office to coordinate a mee- ting between the NHA Executive Committee and CMS Administrator Seema Verma to discuss: • Medicaid Fiscal Accountability • Site neural rate cuts to grand- fathered hospital-based clinics • 340B payment cuts • Price transparency to assist consumers when making elec- tive healthcare decisions

• Provided proactive and reactive communications to Congressional delegation staff on COVID-19 for the association and members From left, NHA Vice Chairman Mason Van Houweling, NHA Treasurer Chris Bosse, CMS Administrator Seema Verma, NHA Chairman Erik Olson, and NHA President/CEO Bill Welch. including PPE, hospital reporting, bed capacity, and more. The NHA represents the interests of its • Scheduled and conducted meetin- members in government at the federal gs with Nevada’s U.S. Congres- • Coordinated letters and follow up level. The NHA participates in national sional delegation in Washington information to the Congressional public policy issues by working closely D.C. and Nevada to help articulate delegation on surprise billing and with the American Hospital Association. hospital issues and concerns at a the HEROES Act. While the NHA staff was limited in the national level. amount of personal time spent with • Participated in weekly AHA confe- Nevada’s congressional delegation, • Met with Congresswoman Susie rence calls on strategies to ensure efforts were made to interact with them Lee for a small roundtable discus- that we align our state and national remotely. sion on the 340B program and efforts. impacts to Nevada hospitals.

A Forecast for 2021 As we approach the 2021 Nevada Legislative Session, we anticipate several issues to resurface while tackling new healthcare-related items. Through issue briefs, fact sheets and in-person dialogue, we will be prepared to face: • Medicaid Reimbursement • Tort Reform • Staffing Ratios • Healthcare Workforce • Mental Health • Workplace Violence Prevention • Transparency Expansion • Rate Controls We will work with the State and others to pursue Medicaid cuts and ensure support from our members as we tackle ongoing issues and Medicaid Managed Care accountability.

Page 5 calls, attended Regional Policy Communications & Special Projects Board meetings, and prepared e-mails and letters to the Nevada Congressional delegation based on a number of federal AHA Advocacy Alerts. • Facilitated media requests for interviews with key staff on healthcare issues impacting Nevada as well as national issues.

COVID-19 • Assumed the public information officer (PIO) role responding to media requests for the Association The 2019 - 2020 NHA Board of Directors and staff participating in a retreat to determine the strategic direction of the Association. and members, participated in state and national planning calls The NHA tackles communications priorities of Nevada hospitals, and providing daily data reports to daily and works on special projects promote responsible government members. throughout the year that are of interest through education and provide • Partnered with other state to NHA members and benefit the hospitals with a greater voice hospital associations to bring broader health care community. We in policy discussions. As of NHA members Leadership and also research and identify national best September 1, 2020, the Nevada Resiliency: Navigating Through practices that can be applied at state HealthPAC raised $34,176. and Beyond COVID-19, a six- and regional levels. • Conducted the NHA Annual Salary part Virtual Leadership Series for Survey with participation from executives where six nationally • Coordinated the NHA Board of 32 Nevada hospitals. Offered known experts discussed the Directors Retreat in Las Vegas to as a web-based collection and COVID-19 crisis. Topics included: help develop the strategic plan for reporting tool, hospitals provided • Resiliency members. compensation information on • Healthy Policy • Launched and monitored an approximately 172 positions, • Financial and Strategic abbreviated 2020 Nevada including executive, administrative, Planning HealthPAC Campaign with monies clinical and support service roles. • Unconscious Bias used to advance the legislative The Salary Survey results are • Health Equity provided at no charge to the • New Healthcare Ecosystem participating hospitals. • Worked with NHA members to • Managed an advocacy campaign develop guidelines, press releases around SB4 and the detriment to and talking points for: Nevada’s hospitals. • Resuming medically necessary • Facilitated planning for the procedures surgeries Western Regional Trustee • Resuming visitation policies for Symposium in Reno. Unfortunately, non-COVID-19 patients the event was cancelled in April • Supporting the directive on due to COVID-19. wearing masks • Coordinated with the NHA • Guidelines for resuming clinical Executive Committee and the NHA rotations HR Director logistics for the NHA • Collaborated with the Nevada Nevada Hospital Association face masks that were CEO Search Process. State Medical Association on the provided to HealthPAC contributors. • Participated on AHA federal update safety of hospitals and providers through a joint social media Page 6 campaign. • Developed presentations for the Patient Protection Commission, Nevada Black Legislative Caucus The National Hospital Association’s daily reports have been and Las Vegas Chamber of instrumental to the FEMA-HHS mission in the State of Commerce on Nevada hospital Nevada. FEMA Region IX and HHS use the data to support efforts around COVID-19. fulfillment of resource requests including PPE, medicine • Coordinated and participated on a variety of member communications and testing supplies which are adjudicated and coordinated including: from both the Joint Field Office in Oakland and the National • All-member town hall meetings Response Coordinating Center in Washington D.C. FEMA- • NHA Executive and Board of HHS are very grateful for the support of the NHA. Director Committee calls ~ John Woytak, FEMA Region IX • Email and website updates Community Resilence The Nevada Hospital Association’s COVID-19 Community Resilience Program and • Began disseminating information Nevada Healthcare Preparedness regarding a novel virus in Wuhan, Partners (NHPP) provided expertise China in early January 2020. and resources throughout the At the time, there were only 44 community through exercises, cases and 11 hospitalizations. seminars and educational opportunities Fast forward a few months, and to the membership throughout the NHA Community Resilience the state. The Program expanded Program team found themselves exponentially over the past year, forced summoned to the Governor’s The Nevada Hospital Association and two key members by the state’s COVID-19 response. Office in Las Vegas to discuss were invited to participate with Governor Sisolaks expert Consultations and advising top possible scenarios for the State of discussion around COVID-19 in February 2020. officials, distributing equipment and Nevada. supplies, managing the State’s data • Provided daily updates to the collection, information dissemination Governor via virtual in-person and knowledge base, as well as grant meetings which began on April 4, management are just a fraction of 2020, and continued seven days the functions of this growing member a week for months. Attendees service. included: • Governor Sisolak and his staff • Grants allow the Program • Nevada National Guard to remain self-sufficient with • Department of Public and essentially zero dollars coming Behavioral Health from the NHA general fund or • Division of Emergency member dues. Grant management Management remains the cornerstone of the • Delivered portable structures Program including grants from: and screening tents to two rural • Assistant Secretary for facilities (Banner Churchill and Preparedness and Response Northeastern Nevada) to increase • Centers for Disease Control & surge capacity, if needed. The Nevada Hospital Association data as seen from the Prevention • Managed the master mutual aid computer of a member of the White House COVID-19 Task Force. • Division of Public and agreement (MMAA) including Behavioral Health Page 7 interfacing with emergency Data & Financial Services managers and national guard units and coordinating overnight The NHA provides health plan and hospital operations expertise to member Chief shipping supplies such as Executive Officers, Chief Financial Officers, Contract Managers and Business Office disposable gowns, masks, and staff to support their financial reporting, revenue cycle management and strategic ventilator circuits to members. planning. The NHA also provides analysis of key healthcare policy initiatives that • Managed the data collection impact the finances of members including advocacy efforts with Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services, and and health informatics of other stakeholders. COVID-19, as well as produced reports, charts and graphs. • Restructured the NHA Data & Finance Committee quarterly meetings to monthly The original 20-question survey Chief Financial Officer meetings. Issues addressed included: quickly morphed into every • DHFCF Hospital Cost survey required by AB108 (79th session). day and 64 questions to meet • Changes to the Indigent Accident Fund and Disproportionate Share Hospital federal mandates. payments • Worked with HHS, FEMA, the • Development and finalization of a Medicaid Dashboard Governor’s Office and various • Nevada Hospital Quarter Reporting (NHQR) counties, emergency managers • Provided comments to CMS Administrator Seema Verma on the Medicaid Fiscal and health districts to ensure Accountability Regulation (MFAR). that the NHA survey was the • Submitted comment letters and attended public workshops on the Nevada one survey needed to meet Medicaid Managed Care Organization request for proposal process. the needs and requests of all • Formed NHA subcomittees for Medicaid MCOs and All-Payer Claims Database. entities. • Produced eight separate reports COVID-19 every day based on the data • Submitted an 1135 waiver to CMS for relief from Medicare administrative collected from members along requirements as well expansion of CMS benefits. with weekly medical intelligence • Provided to DHCFP items for the State’s Medicaid 1135 waiver including reports and maintenance of payment of COVID-19 testing at Medicare rates which was granted. the member’s COVID-19 data • Monitored and tracked CARES Act Provider Relief funds working with members portal. to validate receipt, provide information on terms and conditions, along with sign- • Distributed over $1 million off requirements. • Worked with Noridian (NV Medicare Administrator) on billing and coding items dollars to Nevada hospitals to associated with new COVID-19 codes, accelerated payment takeback process help procure PPE supplies. and Medicare Cost Report requirements for Provider Relief funds, ASPR grants • The NHA Community Resilence and Paycheck Protection payments. Program Executive Director • Coordinated the distribution of the NHA ASPR grants funds to qualifying member was appointed to the Nevada hospitals. COVID-19 Mitigation and • In conjunction with Nevada Rural Hospital Partners, met with DXC and Nevada Management Task Force to Medicaid staff on: review county and • Medicaid FFS claim challenges jurisdictional self- experienced by members assessments and • Developed new DXC “Life of a Claim” response plans. training material • Facilitated and prepared the Nevada Hospital Community Benefit Report Bill Welch, NHA President/CEO, for hospitals with 100+ beds to meet and Chris Lake, PhD, Exec. the legislative requirements for Director of Community Resilience, particpate on a virtual call with reporting community benefits, charity Governor Sisolak, Nevada National care, collection policies and financial Guard, the State and others. information.

Page 8 Workforce & Clinical Services The NHA provides clinical expertise and serves as a resource to assist hospitals with compliance of state, federal and regulatory mandates, and reporting requirements. We collaborate with clinical leadership at member hospitals to identify opportunities to improve patient safety and quality of care driving adoption of best practices while identifying opportunities for workforce development.

• Offered workplace violence (WPV) prevention workshops to members to support efforts in WPV Prevention planning, identifying best practices and to have a better understanding of the Nevada WPV law with the passing of AB348. More than 50 hospitals participated. • Recognized nurses with the 20th Annual Statewide Nursing Essay Contest which identified the unique contributions nurses make in the care of patients and their loved ones during the COVID-19 pandemic. • Collaborated with stakeholders on safe discharge planning to determine processes for patients with limited resources. • Held the NHA Statewide Sepsis Coalition, holding statewide meetings via Zoom and included rural hospitals. As a measure of improvement, we tracked aggregated statewide data on compliance with Severe Sepsis, 3- and 6-hour bundle as well as Septic Shock, 3- and 6-hour bundle. • Coordinated the collection of Staffing Committee Summary Reports and Staffing Committee Policies and provided to the Legislative Committee on Healthcare. • Assisted member hospitals with compliance of statutory mandates, providing support to members by coordinating submission to meet regulatory deadlines with Patient Safety Checklists. • Met with CNOs to provide an overview of NHA’s role including: • Advocacy • Committees and nursing membership • Patient safety efforts and collaboratives • Regulatory requirements and review of proposed regulations • Collaborated with DHHS to help bring hospitals into compliance with reporting to the Cancer Registry. • Served as a subcontractor to Comagine Health to achieve a 20% reduction in overall patient harm and a 12% reduction in all- cause 30-day readmissions. The NHA received a total of $252,700 cumulatively over the 3-plus-year contract which ended March 30, 2020. • Provided an opportunity for North Vista Hospital to participate in a pilot study to reduce all cause 30-day hospital readmission by implementing Collective Medical’s platform, EDIE, using the utilization insights to identify core causes. • There were 84 new graduate nurses and allied health clients in the Healthcare Workforce Development program and $227,742 in on-the-job wage subsidy was provided to northern Nevada hospitals. One hundred percent of the new graduate nurses enrolled in the program have obtained and retained full-time employment as registered nurses in Nevada.

COVID-19 • Held weekly Clinical Roundtables on COVID-19-related issues including: • Best practices related to staffing challenges • Challenges with patient transfers • PPE shortages • Testing challenges • Met with the Nevada State Board of Nursing, the Board of Medical Examiners and OD Board to discuss innovative ideas to fill workforce gaps. • Worked with the Nevada State Board of Pharmacy to coordinate distribution of hydroxychloroquine to hospitals. • Participated in weekly CMS and AHA conference calls. • Worked with DHHS on Behavioral Health Crisis Standards of Care for Surg Capacity, solutions to reduce burden on ERs to improve ability to assess L2K patients. • Worked with the Nevada State Board of Nursing, Deans of the nursing schools and hospitals to developed guidelines for hospitals to resume clinical rotations. • Collaborated with the Nevada Health Care Association to safely transfer COVID-19 patients from hospitals to skilled nursing facilities.

Page 9 NHA Membership Meet- NHA Committee Memberships ings/Special Events NHA staff participate on state and national committees providing valuable input The NHA facilitated/coordinated a on health care-related matters. Some of these memberships include American number of meetings including the Association of Hospital Accountants; American College of Healthcare Executives; NHA Board of Directors; the NHA American Hospital Association Governance Group; American Hospital Associa- Board of Directors Retreat; the NHA tion Quality Committee; American Hospital Association Regional Policy Board 9; Policy Development Committee; NHA American Hospital Association Workforce Committee; American Hospital As- Government Affairs Committee; the sociation’s Allied Public Relations Executives; American Hospital Association’s NHA Data & Finance Committee; the Association of Educators; American Hospital Association CFO Committee; CMS NHA/NSMA Coalition; the NHA Patient Region IX Summer Collaborative on Patient Safety; Healthcare Financial Man- Protection Commission Advisory agement Association Nevada Chapter; Comagine Nevada Board of Trustees; Group; the NHA Hospital Patient High Sierra Area Health Education Center, Board of Directors; Nevada Associa- Safety Committee; Statewide Rural tion of Health Care Quality; Nevada Executive Healthcare Forum; Nevada Mental CNO Council; 5th Tuesday Club of Health Coalition; University of Nevada’s Healthy Hospital Initiative; University of Northern Nevada; and 5th Friday Club Nevada Project ECHO; and Western Region Alliance for Patient Safety; Northern of Southern Nevada. Nevada Infection Control; Statewide Partnership on Opioid Crisis; and the L2K Task Force. Special state committees and task forces include the Governor’s GME Nevada Hospital Association Task Force; Governor’s Behavioral 5190 Neil Road, Suite 400 Health & Wellness Council; Nevada Reno, NV 89502 Health Link; Commissioner’s Advisory 775-827-0184 • nvha.net Committee on Health Care and Insurance; Department of Health Marissa Brown Care Finance and Policy; Medicare Director of Workforce & Clinical Services Payer Relations Committee; Medicare Compliance Officers Workgroup; Leslie Cerfoglio Workers’ Comp Fee Schedule and Administrative Assistant II Trauma Activation State Advisory Sarah Hunt Committees; Nevada Homeland Director of Financial Services Security Commission; Nevada Sue James Action Coalition – Future of Nursing Controller Campaign; Nevada Homeland Security Commission Finance Subcommittee; Chris Lake Criminal Justice Advisory Committee; Executive Director, Community Resilence Mental Health Subcommittee; Sharyn Juarez Mental Health Working Group Task Program Project Coordinator & HR Director Force; State of Nevada Network Neil Nadeau Committee; TMCC Institutional Data Analyst Advisory Committee; Nevada Health Amy E. Shogren Care Sector Council; and, Nevada Director of Communications & Administration Department of Education, Training and Rehabilitation. Bill M. Welch President/CEO

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