Tuesday, March 4, 2003 | 11:09 a.m.
Clark County consultants and staff members suggested wholesale overhauls to some of the troubled county medical system's basic procedures in four reports released today.
Among the recommendations is separating the county's dozen Quick Care centers from the University Medical Center hospital, which would allow the county to refuse service to nonpaying patients at the satellite urgent care clinics.
The reports, one from county auditing staff, one from the district attorney's office and two from national consultants, also propose reductions in staff, pay and benefits, a conclusion certain to be opposed by the union local that represents the system staff.
Clark County Manager Thom Reilly presented the results of the consultants' work to the Clark County Commission this morning. He said the reports present options, not necessarily recommendations, for the commission.
The Lewin Group, a Virginia-based consultant specializing in health care and human-service issues, provided most of the initial options. National auditing consultant Deloitte & Touche also presented recommendations, mostly to speed up the billing and collections process.
Along with suggestions by county staff, the County Commission and a citizen task force on the hospital fiscal crisis will have hundreds of possible actions to consider.
"Not all these recommendations will be implemented," Reilly told the commissioners, noting that some options "may be mutually exclusive and in some cases different approaches to addressing or solving the same problem."
Although most changes to the Quick Cares would likely come only after a citizen task force, which met for the first time last month and is expected to release its recommendations in six months, some changes to hospital operations should come soon, Reilly said.
"If we do not act in a timely manner, I am not sure where the additional funds will come from to operate UMC," he warned.
The County Commission in December put $38 million into the hospital system, $20 million to cover past-due debts and $18 million to cover the continuing losses to the system. Reilly said the hospital is still losing $3 million a month.
He noted that the cost overruns by the hospital have almost wiped out the county's "rainy day" and capital-projects funds of more than $40 million.
Mike Walsh, acting UMC chief executive, said some changes will likely be relatively painless, with support from the staff union. Other changes will not be as easy to achieve, he said.
One change that Walsh and Reilly said they would like to see soon is the funneling of some indigent patients through several specific Quick Care centers -- centers that would have social workers standing by to help in applying for government financial assistance.
Care for nonpaying indigents is one of the main reasons cited for the hospital system's financial crises. Reilly said the county is not getting all of the funding authorized by the state -- last year, it got only about 70 percent of the funding available -- because indigent people who might have qualified for the funding were not enrolled.
The change could be instituted rapidly and potentially provide millions of dollars for the system, he said. It could lead to property owners paying a few cents more per $100 of value on their property tax bills.
Some changes are already in place. The reports unveiled today come on top of $10 million in staff cuts and hours of operation at McCarran Quick Care on Russell Road, cuts that Service Employees International Union Local 1107 opposed.
Those changes generated opposition from the union, which warned that the cuts combined with further cuts could undermine the service provided by the public hospital system, the largest in Clark County.
Union leadership is indicating that the county will have a tough time achieving some of the options suggested in today's reports. Maryanne Salm, Local 1107 political director, said the county's citizen task force has to be involved in any changes to Quick Care staffing or operations.
"There's a process in place to have a public dialogue," Salm said. "The Quick Cares serve an important function for this community. The public relies on them.
"Any changes to the Quick Cares I think would be met with significant protests from the community."
The union is not saying that it will oppose all recommendations, Salm said, but some changes will be much less welcome than others -- particularly when it ultimately affects staffing levels, pay and benefits.
Walsh said there will be battles on some issues.
"It's all part of the bargaining process," he said. "Whatever is mutually agreed upon is what we will be able to do."
While rough numbers for potential savings are available for some of the options presented today, Reilly said the county does not now know what the cumulative savings would be for the best combination of options.
"We don't know," he said. "We want to come back April 1 for the (county commission's) budget workshop, then develop a timetable for what we want to tackle first.
"Staff is just getting inundated by these reports," Reilly said. "They need some time to look at them."
The Lewin Group identified a number of issues beyond the hospital's direct control that contributed to the financial crisis, Reilly said, including increases in the number of under-insured and uninsured patients coming to the Quick Cares and hospital emergency room.
But although the contributing factors may have been out of the county's control, "I do think we have the remedies," he said.
"We should be able to put a blueprint together from these guides that addresses the short-term operational problems of the hospital," Reilly said.
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