Which medicine to give UMC?

By Tony Cook

Wednesday, April 11, 2007 | 7:31 a.m.

As Clark County commissioners discuss University Medical Center's future during a workshop today, lawmakers in Carson City are discussing what kind of state intervention is appropriate at the troubled public hospital.

A group of senators will have to decide by Friday, the deadline for bills to be voted out of committee, whether they want to hold a hammer or a magnifying glass over the county's head.

The hammer is Senate Bill 533, which would strip UMC oversight from the county and put it in the hands of an appointed hospital board. The bill also would require the board to hire a hospital management company to run UMC.

The fact that such a measure has even been proposed sends a strong message to county leaders: Find a way to better manage UMC or have one forced on you.

"We are not expecting UMC to be in the black or even make a profit, but it can run a lot more efficiently," said Sen. Maurice Washington, R-Sparks, who proposed the bill as chairman of the Human Resources and Education Committee.

Commissioners need to make some major changes, "or else we will figure out a way to get it done," Washington said.

But with opposition from the county and many Democratic lawmakers, including Assembly Speaker Barbara Buckley, that threat is unlikely to materialize during this legislative session.

Instead, legislators are more likely to pursue an alternative, which calls for a state audit of UMC and regular reports about progress at the hospital.

Such a move would combat the county's argument that SB533 is a knee-jerk reaction to publicity about UMC's problems. But the watered down version also would set up state lawmakers to take more dramatic action next session if they don't like what they see.

"The one provision I want to keep is an audit of the hospital," Washington said. "If we see the same issues and problems, we will do something to fix it."

Such monitoring is much more palatable to commissioners as well.

Commission Chairman Rory Reid has argued that the Senate bill as proposed rushes to a premature conclusion about what kind of changes would be best for UMC.

"There isn't enough evidence to suggest that is the appropriate thing to do," Reid said. "This is a very complicated and difficult issue."

The county, Reid said, has been studying the issue since last year, when it hired the Lewin Group, a health care consulting firm, to study what kind of oversight structure would be best at UMC.

Although Reid thinks the county is best equipped to handle UMC issues, he said he wouldn't oppose the state taking a closer look at the hospital.

"I wouldn't object to a study," he said. "The more eyes that look at it the better off we'll be."

Commissioners plan to take the next steps in their own evaluation of the hospital during a workshop session today, when they discuss options laid out in the Lewin Group report, which concluded that if changes are not made, the hospital's multimillion-dollar annual losses could double by 2011.

The report describes possible changes that include expanding the hospital, establishing a hospital board with more expertise and focus than commissioners, leasing the hospital to a nonprofit, establishing a hospital district or conveying the hospital to another organization.

UMC loses money every year, partly because it treats many of the valley's indigent patients. But recently, the hospital has been an especially strong drain on the county's $5.9 billion budget. The hospital lost $34.3 million last fiscal year and has lost nearly $36 million in the first seven months of the current fiscal year. The drastically higher-than-expected losses resulted in commissioners approving a $60 million bailout for UMC last month.

Still, commissioners say rushing to a hasty fix could be worse in the long run. They want to hear from hospital staff during today's workshop before making any decisions.

"I think we want to hear what the options are and what hospital management has been doing and is proposing," Commissioner Bruce Woodbury said. "Until we get that, it's difficult to know where we want to go."

One question is whether UMC administrators plan to make any cuts.

"There is some concern on the part of various departments and constituents about cutbacks," Woodbury said. "I am sure there will be some recommendations for changes, and part of that would be cutting back some services. But we have to be very careful about that."

Meanwhile, commissioners will be watching the Senate's Human Resources and Education Committee closely this week to see which object will be hanging over members' heads as they search for solutions at UMC.