Panel to decide fate of Quick Care clinics

Wednesday, Dec. 5, 2001 | 10:08 a.m.

A legislative subcommittee today will try to decide where the line should be drawn between the public sector and private enterprise, and whether University Medical Center's highly successful chain of Quick Cares has crossed that line.

The 14 Quick Cares scattered throughout the Las Vegas Valley represent one of the nation's most successful commercial ventures by a public hospital, according to the American Hospital Association. The clinics treated more than 500,000 patients last year, more than all of the other emergency rooms in the Las Vegas Valley combined. Of those patients, 10 percent were indigents. The Quick Cares also referred 70,000 patients to physicians outside the UMC system.

The Quick Cares lost $8 million last year but brought in $17 million in referrals, said William Hale, chief executive of UMC. That meant $9 million was available for other UMC programs, including indigent care, Hale said. UMC's total operating expenses for 2001 were $376 million.

But some of the Las Vegas Valley's private physicians say the Quick Cares provide unfair competition. With the county's backing, the Quick Cares can offer bigger salaries and better benefits than private doctors, said Greg Griffin, who manages two private drop-in medical clinics. As county employees, Quick Care doctors are protected from being sued for more than $50,000, which means they don't have to buy the expensive malpractice insurance private physicians are required to carry, Griffin said.

If the county opened a hotel-casino, it would have to follow the same rules as any other business in Las Vegas, Griffin said. The county hospital's commercial ventures should be no different, he said.

"We're not saying, 'Stop the Quick Cares,' we're saying, 'Let us compete," Griffin said.

Nearly 10 years ago UMC officials, concerned about overcrowding at the hospital's emergency room, proposed opening a freestanding trauma center, where the most serious cases would be rerouted.

The facility, which opened in January 1993, is one of the 10 busiest in the nation. The trauma center is also the state's only Level I facility, a designation reserved for hospitals capable of handling the most complicated medical emergencies.

The trauma center was successful at relieving some of the ER congestion, but problems related to overcrowding persisted. For many indigent patients, the emergency room was the only way to be seen by a doctor. Too much of the emergency room's time, staff and space were being wasted on colds, flus and other ailments that were not life-threatening, administrators reasoned.

The answer was the UMC Quick Cares -- drop-in medical offices in the area surrounding the ER, where patients could go for treatment.

UMC's mission statement includes an edict to provide health care to the indigent, and the public hospital's leaders say the Quick Cares are essential to meeting that goal.

"As long as UMC has a mission to provide medical care for anyone and everyone, there will never be a level playing field," Hale said.

A coalition of private doctors took their complaints to the Legislature during the past session. Sen. Ann O'Connell, R-Las Vegas, proposed an interim study of competition between the public sector and private enterprise, and the subcommittee will meet for the first time today at the Sawyer State Building in Las Vegas.

"The question of what's unfair competition isn't new," O'Connell said. "And it's not just the Quick Cares or even health care. It extends to telecommunications, real estate development and the list goes on and on."

O'Connell, a member of the subcommittee, said she has "significant concerns" about the UMC Quick Cares.

"When you have a government agency occupying space, that space is taken off the tax rolls," O'Connell said. "The government agency hasn't risked its own money to start the business, and the government agency doesn't have to worry about paying off medical school loans or supporting a family."

Sen. Michael Schneider, D-Las Vegas, chair of the subcommittee, said his political philosophy has been that government is more effective when it is run like a business.

"The electorate wants government to perform efficiently so that we don't have to rely on as many tax dollars to run essential programs," Schneider said. "Before UMC opened the Quick Cares, it seemed like every year the hospital was making cash calls, looking for $10 million to keep things running. Now it looks like taxpayers don't have to cough up as much money."

Federal policy passed in 1955 is supposed to ensure the federal government does not monopolize activities at the expense of the private sector.

The initial proposal for the Quick Cares seemed to be well within the federal guidelines. Clark County's private physicians initially supported the idea of the Quick Cares as a way to improve health care access for the indigent, said Lawrence Matheis, executive director of the Nevada State Medical Association.

But instead of focusing on underserved, poor neighborhoods, Quick Cares opened in Summerlin and Henderson, courting the same potential patients pursued by private physicians.

"UMC's marketing strategies are exactly the same as a private clinic," Matheis said. "The only thing that makes the Quick Cares different is that they are not-for-profit and subsidized by taxpayer dollars.'

Private doctors don't want to compete with UMC for the trauma and burn patients, two of the least profitable fields of medicine, Matheis said. It's too expensive for a private doctor to try to compete for such highly specialized care, since the initial outlay for equipment is enormous, Matheis said.

What the private physicians object to is UMC "crossing the line" between indigent care and seeking paying patients.

If the Quick Cares' profits were seen as a loan from the public, private doctors may feel differently, Matheis said. But UMC administrators don't reduce the amount of public funding they seek each year based on how much the Quick Cares contribute, he said.

"This isn't about UMC's mission to provide services to people that no one else is going to treat," said Matheis, who will testify at today's hearing. "This is about public money supporting what is essentially a chain of private clinics."

Additional evidence of the Quick Cares being marketed to non-indigent clientele is the lack of a sliding scale for payment, Matheis said. Only the Enterprise Quick Care location offers a sliding scale, an option that's found in most other county health facilities across the country.

Federally funded community health programs in underserved areas are required to offer a sliding scale, said Richard Levinson, associate executive director of the American Association of Public Health. Many private clinics also offer a sliding scale, Levinson said.

"With 45 million uninsured people in the United States, most patients simply can't afford to pay the full charges," he said. "If every clinic demanded full payment, not only wouldn't they get it, but they would deprive a huge number of people of treatment."

The Enterprise Quick Care offers a sliding scale, because UMC has applied for federal designation as a clinic in an underserved area, Hale said. There are no plans to add sliding scales to other locations, Hale said.

Clark County residents receive a discount for treatment at Quick Cares. People not eligible for state or federal aid are expected to pay their bills in full, Hale said.

"We have a responsibility to the taxpayers to collect whatever we can," Hale said.