Panel to seek UMC answers

Monday, Feb. 3, 2003 | 11:04 a.m.

Hospital's mission Clark County's citizens task force on University Medical Center will look at ways to stop the hospital's hemorrhaging of red ink. One focus will be on changing the basic mission statement of the hospital, which now requires:

Beginning Feb. 18, 10 Las Vegans are expected to accomplish something that no one else in the nation has been able to do.

They make up the task force charged to come up with long-term solutions for a public hospital that is running tens of millions of dollars in the red.

Locally, the fiscal crisis involves University Medical Center. The hospital, Nevada's largest, lost more than $20 million last year and is on its way to losing even more this year, at a rate of more than $2 million per month. According to early, unaudited numbers from the Nevada Health Care Financing and Policy Division, UMC is the only hospital of the state's "big six" to lose money last year.

The 10-person task force is expected to meet for about six months and is charged with redefining the county hospital's role in the community. The goal is to find a way to match responsibilities with the hospital's precarious fiscal situation.

Clark County Manager Thom Reilly said the task force has a critically important role in the efforts to reverse the disastrous two-year financial trend. The finances of the hospital need to be viewed through the prism of UMC's mission and the services that it provides the community, he said.

The problems are not unique to Clark County. Scott Moskey, spokesman for the National Association of Public Hospitals, said the slide for publicly controlled hospitals began with budget reforms passed by Congress in 1997, which cut Medicare payments for seniors and Medicaid for low-income patients.

By 2000, the majority of public hospitals -- about 100 nationwide, most in major urban centers -- were losing money, he said. Moskey predicted that when figures are available for the last three years, the situation will be worse.

It's a national trend that will accelerate with the next round of mandated federal funding cuts bite in 2004, he said.

Moskey said no one has been able to come up with a way to stop the financial bleeding.

County officials, however, say they have no choice but to find some way to at least reduce the losses. Reilly and county commissioners say there will not be any easy answers, but they must take some action.

Core responsibilities

The county stepped in to handle direct oversight of the hospital's finances last year.

"What we can do in the interim is buy us some time," Reilly said. "But the bigger question is: What are those core responsibilities or services that the county, or UMC, must deliver?"

Some of the core responsibilities are clear, he said. The hospital's trauma center, burn center and neonatal units, all geared toward serving acute, critical care, will survive, because "those are what the hospital is all about," Reilly said.

The task force will have to recommend major changes and elimination of other programs, however.

Bill McBeath, president of The Mirage, has been tabbed as the chairman of the task force.

"I still believe that UMC is the only trauma center in Southern Nevada, and clearly that is not going to change," he said. "The same is probably true with the neonatal unit and the burn center."

But beyond that, there are few sacred cows, McBeath said.

"We will look at every option. We will peel away the onion until our eyes water," McBeath said. "Then in the end, the facts will be the facts, and my role as chairman will be to build a consensus that will be in the best long-term interests of our community."

One of the issues the task force will grapple with is care for the indigent, the uninsured and underinsured.

More than half of those cases in Southern Nevada are handled by UMC and that appears to be a key to the hospital's losses, said task force member Jeff Waddoups, a University of Nevada, Las Vegas associate economics professor who has done two studies on the issue, most recently in 2000.

The task force will have to closely examine UMC's state-mandated responsibilities for the indigent as well as how Clark County's private hospitals provide that care, he said.

Maryanne Salm, political director for Service Employees International Local 1107, the union representing hospital workers, believes that UMC is overburdened with patients who do not have insurance or the ability to pay for care.

"One way to alleviate it is to spread the burden of caring for the uninsured," she said.

The private hospitals do not embrace the concept.

Allan Stipe, Sunrise Hospital and Medical Center's president and chief executive, said all the major private hospitals already take in a proportional number of uninsured and indigent patients under a state mandate.

Sunrise, like other private hospitals in Southern Nevada, is required by law to use 0.6 percent of its prior year's revenue to pay for indigent care, Stipe said.

Putting more of a burden on the private hospitals will mean greater costs for those patients who are insured because the hospitals will pass their costs on, he said.

And the private hospitals, like UMC, have already seen a similar increase in the number of uninsured and indigent patients over the last two years, Stipe said.

Stipe, however, doesn't believe that UMC's problems are due to uninsured and indigent patients -- although he is not sure what the root causes are. He said there is enough money going into the public hospital to at least break even.

"The funding mechanisms should be adequate to meet their needs," he said.

The cost of labor

Some observers have suggested that UMC's financial troubles stem from high labor costs or from a multitude of fully staffed programs, some of which could be "outsourced" to private companies or abandoned altogether.

The union, however, argues that trimming staff or cutting compensation is not a way out for the hospital.

"It would be shortsighted to take an approach to cut services," Salm said. "The right approach is to look at the uninsured problem. That's where it is important to have union at the table."

"Outsourcing is also shortsighted," she said. "Frequently when services are outsourced, you create a problem of people who are uninsured or underinsured."

And cutting staff would mean lessening the quality of care, Salm said.

Reilly agrees that the standard of care at UMC should not be compromised. But that does not mean the hospital has to be all things to all people, he said.

"If we continue to do everything, beyond core things or our legal mandate for the indigent, then we get in trouble," he said.

Another task force member, Bob Forbuss is a former Las Vegas Chamber of Commerce president, an ex-paramedic and owner of an ambulance company. He said the very survival of the hospital is at stake.

"It's an incredibly good hospital, a place that if you were sick you would want to go there," Forbuss said.