County health system report not encouraging

Wednesday, March 5, 2003 | 11:21 a.m.

The Clark County Commission has received the first batch of reports and recommendations concerning the fiscally floundering county health system -- and hard decisions will have to be made, commissioners said Tuesday.

The reports came from the Virginia-based Lewin Group, which has recommended a host of changes at University Medical Center and the satellite Quick Care clinics, and from Deloitte & Touche, a national auditing consultant that is recommending a thorough overhaul of the hospital's billing practices.

The hospital system needed a $38 million infusion from the county in December and is still losing about $3 million per month, according to county officials. Much of the hemorrhaging, they say, is because of an influx of uninsured and underinsured patients since the 2001 terrorist attacks and subsequent economic downturn.

The Lewin Group's proposals include closing and consolidating some Quick Care centers, some salary and benefit reductions and other measures that the county's unionized health-care workers have said they will oppose.

The company also has recommended changing the procedures to ensure that all patients, unless they are in an emergency situation, provide payment information. The change in procedures and Deloitte & Touche's recommendations are not as problematic for the union, Service Employees International Union Local 1107.

Maryanne Salm, the union local's political director, said her union will accept changes in the hospital system that do not penalize employees or restrict access to health care for the community.

Commissioner Yvonne Atkinson Gates said she is concerned about the billing process, a comment reflected by the Deloitte & Touche report.

County Manager Thom Reilly said the 20-year-old computer system in place at the hospital is prone to breakdowns, requires additional staff for manual data entry and is designed for a much smaller hospital than UMC.

Gates said reports from the community back up the consultant's report on the billing problems.

"That is something that needs to be tackled right away."

Atkinson Gates also said she is concerned about how the cash-strapped county can find $10 million for a new computerized billing system.

"It is going to cost a lot of money to develop and implement a new system," she said. "Where are we going to get the revenue?"

Reilly said some of Deloitte & Touche's recommendations could be implemented right away, while the big-ticket items could come later. He asked the commissioners to schedule discussion on some of the billing changes for an April 1 budget workshop.

Dr. Brad Walker, a union member and UMC Quick Care physician, said The Lewin Group's report did a good job identifying the main problems facing the hospital.

He said changes to billing procedures could bring in up to $20 million per year. He said changes to the way underinsured or uninsured patients are treated at the Quick Cares could save another $5 million.

Walker is less positive about a recommendation that could "consolidate," or close, some Quick Cares. He said some of the Quick Cares with the most difficult financial situations include the centers in Laughlin and Enterprise, where the centers represent the principal medical resource for the communities.

"We think (the county) has a responsibility to care for those who don't have access to care and not just look at a profit statement," Walker said.

Dr. George Oehlsen, a physician at the McCarran Quick Care on Russell Road, said the idea of legally separating the Quick Care centers from UMC needs to be fleshed out.

He said he is concerned that it could lead to the privatization of the Quick Cares, which would increase costs and lead to fewer paying referrals to the main UMC hospital.

Both doctors also said a recommendation to replace registered nurses with licensed practical nurses is a bad idea. While registered nurses generally have higher salaries, they are needed to deal with the acute medical problems coming into the Quick Cares, they argued.

Commissioner Chip Maxfield said he believes the reports contain a lot of positive recommendations. He said the hospital has to be protected from the fiscal crisis so that it remains for a health resource for decades to come -- even if it means making difficult calls.

"I'm not going to be afraid to make the hard, tough decisions that we have to make," Maxfield said.