Las Vegas Sun

October 2, 2014

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health care column:

Time is right for clinic in LV

Another nonprofit health care center could be a positive influence on Las Vegas.

Cleveland Clinic could be expanding its medical services to Southern Nevada, outside of its role with the Ruvo brain center, bringing its brand of care talked about by movers and shakers, including President Barack Obama.

Las Vegas is unusual in its health care makeup. Although most cities our size and larger have a healthy mix of for-profit and nonprofit hospitals, Las Vegas can boast of only University Medical Center and the nonprofit St. Rose Dominican Hospitals. The majority of hospitals are owned and operated by for-profit corporations, based east of the Mississippi River.

Cleveland Clinic’s CEO, Dr. Delos “Toby” Cosgrove, stopped by the Las Vegas Sun — a sister publication to In Business — to discuss health care reform and the clinic’s plans for Las Vegas.

“It’s too early to say what the range of possibilities are here,” he said. “We’re having a very serious look at it now.”

Cleveland Clinic’s attempt at opening a treatment center will be easier than the last time it attempted it five years ago, when there was a lack of enthusiasm and some downright opposition, he said. After weighing the factors against it, including a $500 million bill to build locally, the clinic stepped aside.

This time may be different. The clinic is already operating the brain center. Another bonus: It still has the support of Las Vegas Mayor Oscar Goodman, who says when doctors come to him and say the Cleveland Clinic isn’t needed here, he replies with a curt “drop dead.”

To reform health care, it comes down to increasing efficient practices and decreasing disease, Cosgrove said.

The top drivers of disease are smoking, obesity and low physical activity, he said.

“There are no incentives for patients to stay well,” he said. Doctors’ treatments have the potential being influenced by the promise of bonuses.

Until the incentives are changed, it’s going to be hard to have major reform, he said.

But he thinks there are a few ways to hold down costs.

“We need a more efficient health care system,” he said. “Doctors are the primary drivers of cost. It’s not reasonable to offer incentives to doctors to do more and still expect to control health care costs.”

Cosgrove advocates a system where doctors are salaried, bonuses are limited and tenure is eliminated.

The clinic practices what it preaches. It has what seems to be an effective weight loss program for its employees — a collective 120,000 pounds shed since its inception — offering healthy choices in its cafeteria and the free use of its gym. It doesn’t hire smokers and offers smoking cessation programs, and, as Cosgrove jokes, there isn’t a Snickers bar in sight.

He would like to see tax breaks for employers who offer wellness programs.

Cosgrove admits there is opposition to the way Cleveland Clinic operates. When the organization started in 1921, he said it was referred to by some as “medical Bolsheviks,” a reference to the revolutionary Russian Marxists.

And now, a twist to the right

Gov. Jim Gibbons hosted a health care reform panel for small-business owners recently, calling on his staff and Kathryn Serkes, spokeswoman for the Association of American Physicians and Surgeons, to disseminate his message.

Staff members stuck to their charts, numbers and budgets, but Serkes, an opponent of health care reform, mentioned she had already spoken at 12 town-hall meetings, (the group is active at anti-tax tea parties) and was quite impassioned about government’s influence on health care.

Serkes said her group does not support reform and that a mandate on small businesses and individuals to offer health insurance or carry it, respectively, would “drive out private insurance.”

Please.

My humble opinion: Health care reform should be about people’s wellness and good patient care, and not about how much return a shareholder is receiving. There is something inherently wrong with that. And yes, I do think health care is a fundamental right and NOT a privilege.

If it were up to me — and believe me, I know it’s not — there would be no for-profit in health care. What money that would have been used for profit would be shifted elsewhere, for the common good — to research, to better technologies and treatments, to wellness and prevention care, it’s limitless, really. But that money — that we are all paying already, one way or another — is ending up in the pockets of someone — a shareholder, an insurance company exec — who couldn’t care less about you and me.

And if that makes me a medical Bolshevik, so be it.

Nicole Lucht covers health care, workplace, energy and banking issues for In Business Las Vegas and its sister publication, the Las Vegas Sun. She can be reached at 259-8832 or at [email protected]

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