Las Vegas Sun

August 27, 2014

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Private hospitals accused of patient dumping

Private hospitals in the Las Vegas Valley are shunting indigent patients to the valley's only public hospital -- sometimes illegally -- rather than shouldering their share of the community burden, the public hospital's top official told a county task force on Tuesday.

"The majority of the hospitals in the valley are owned by for-profit corporations that are not located in Nevada," University Medical Center Chief Executive Lacy Thomas told the Clark County Community Growth Task Force.

"They are driven by a corporate mission set many thousands of miles away," Thomas said -- and as a result, they exhibit a "reluctance" to give back to the community.

A federal law requires hospital emergency rooms to triage patients and treat those whose lives are in danger regardless of their ability to pay.

Thomas said in an interview that he was not criticizing the quality of care provided by private hospitals, just their "priorities."

"Their commitment to providing services to anybody, regardless of whether or not they can pay, is limited because their priorities are set in King of Prussia, Pennsylvania, or Nashville, Tennessee," he said.

Valley Health System -- Desert Springs, Spring Valley, Summerlin and Valley hospitals -- is owned by King of Prussia-based Universal Health Services. Nashville-based Hospital Corporation of America owns Sunrise, Southern Hills and MountainView hospitals.

Private hospital representatives decried Thomas's allegations as unfair.

Patient-dumping, as it is known, "is not our business practice, and legally, federally, we cannot do that," Valley Health System spokesman Mike Tymczyn said.

When patients come to the emergency room, "regardless of their ability to pay or their insurance status, they are triaged and seen by a physician," he said.

Patients whose lives are in danger are treated immediately. But if their needs are not urgent, they are then asked for a $200 deposit, Tymczyn said.

The deposit is the result of a new policy, enacted within the last month or so to streamline the ER and keep hospital costs down. The policy may be what angered UMC, Tymczyn said, but it is not illegal.

Local ERs are under pressure from the county's mental health crisis and from an increasing amount of "bad debt" -- people who can but won't pay their hospital bill, Tymczyn said. In 2004, Valley Health System amassed $80 million in bad debt, he said.

With a huge shortage of inpatient beds for the mentally ill, one-third of the Las Vegas Valley's ER beds are taken up by mental patients, leaving less room for emergency patients.

Southern Hills, likewise, never turns away patients it has the ability to treat, spokeswoman Annette Kinsman said.

"Every patient that enters our door gets treated," she said. "We never transfer them."

The only exceptions are patients the hospital doesn't have facilities for, such as trauma victims, she said. UMC has the valley's only high-level center for the treatment of severe injuries, though other hospitals are trying to add trauma facilities.

"We never ask a patient whether they can pay before we treat them," Kinsman said. "I am just appalled that UMC would make that accusation."

The 1986 Emergency Medical Treatment and Active Labor Act sets standards for care for hospitals that receive Medicare funding.

In 2004 in Southern Nevada, the state Health Division, which administers the federal law, investigated 14 complaints that the act had been violated and substantiated eight, said Lisa Jones of the division's Bureau of Licensure and Certification.

That was an increase from 2003, in which six complaints were investigated and three were substantiated, Jones said.

UMC complains to the state when a patient comes to the emergency room in urgent need having been turned away by a private hospital, Thomas said.

Task force member Gabriel Lither said he'd heard of the patient-dumping practice and wished more could be done about it.

"I think these (private) hospitals are doing really well," Lither said. "They make so much money off those who have insurance."

Part of the problem for UMC, Thomas noted, is that it is seen as a "poor people's hospital," so those who can afford to don't go there. That means UMC doesn't get its share of the insurance reimbursements that keep other hospitals afloat, he said.

UMC is undertaking an aggressive advertising campaign to showcase its excellence, Thomas said.

"Once they've experienced being hospitalized at UMC, people realize that this is not just for the indigent," Thomas said.

UMC's finances have long been shaky, with a crisis in 2002 prompting a $38 million bailout from the county. Since then the hospital has struggled to cut costs and increase productivity.

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