Las Vegas Sun

October 26, 2014

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Health care facility inspections to be cut if fees not raised

State inspections are one of the few tools to protect patients from harm in hospitals, nursing homes and other health care facilities.

But inspections cost money.

If a panel of elected officials rejects a proposal to increase health care facility licensing fees today — as it did in October — some inspectors will lose their jobs and the health care facility inspections will be greatly reduced, state officials said.

The proposed fee increases are exponential in some cases, which has caused sticker shock for the facilities. Their lobbyist argues that the state, not the businesses, should bear the financial weight of protecting the public.

“This amounts to what somebody calls a ‘sick tax,’ ” said Charles Perry, president and CEO of the Nevada Health Care Association, the lobbying group for long-term care facilities.

A Sun investigation found that 3,689 patients suffered preventable harm in Las Vegas hospitals in 2008 and 2009. In the past two years, those patients, and others injured in health care facilities, have been able to file complaints with the Nevada State Health Division to have their cases investigated by calling 486-6515. The findings are reported publicly and represent one of the few sources of accountability and information that patients have.

The Sun created a searchable interactive graphic with the hospital complaints from 2008 to 2010.

But if the Legislative Commission’s Subcommittee to Review Regulations does not approve the fee increase, state officials said, it will be difficult to investigate.

Inspections of health care facilities became a priority after 2008’s hepatitis C crisis, where a Las Vegas colonoscopy clinic reused syringes and single-use medicine vials, infecting an estimated 106 patients and required more than 50,000 people to be tested for infectious diseases.

The last time the clinic had been inspected was 2001.

In 2009 the Legislature required the Nevada State Health Division, which licenses the facilities, to conduct routine inspections every year or 18 months, depending on the type of facility. Inspectors respond within 24 hours to urgent complaints. For example, when a patient who was known to be suicidal hanged himself in his MountainView Hospital bathroom in May, inspectors were on the scene within hours.

The Health Division used financial reserves to increase its inspectors from about 50 to 70 to inspect about 1,100 facilities. State records show that in 2010 there were 2,354 inspections compared with 1,656 in 2007 — a 42 percent increase.

Without the fee increase, state officials said they will be unable to meet the mandate of the 2009 laws.

“The calculations we’ve done show it would basically decimate our workload, including our whole state infection team,” said Marla McDade Williams, deputy administrator for the Health Division.

The state does not pay for inspections out of its general fund, so the cost is borne by the industry. That means continuing the regular inspections as they are mandated by law requires increasing the licensing fees, state officials said. Under the proposed new fees:

• Hospital fees will rise from $10,000 plus $60 per bed to $14,606 plus $110 per bed.

• Ambulatory surgical center fees will increase from $3,570 to $9,784.

• Rural clinic fees will rise from $2,160 to $4,058.

Williams said the fee increases are drastic because they have not been revised since 2003, and hospitals and nursing homes formerly subsidized the costs of other facility types. Now the actual costs are being passed on to the facilities, she said.

Perry said the industry values the inspection process but should not be responsible for the financial burden.

“They’re putting more of a burden on the private sector than they should,” Perry said.

The facilities have no way to pass the fee increases on to patients or insurance companies because most of them deal with government insurance payers, and their reimbursement fees are fixed, Perry said. The fee increase threatens access to care because the corporations that own the facilities might decide to pull out of Nevada, he added.

The panel of legislators, led by state Sen. Steven Horsford, D-North Las Vegas, rejected the proposed fee increases at its October meeting.

“It’s just too much,” Horsford said at the meeting. “The amounts are too much.”

Horsford would not comment for this story.

The panel will consider the fee increases for probably the final time at today’s meeting. Assemblyman Marcus Conklin, D-Las Vegas, chairman of the subcommittee, said he knows the facilities must be inspected and that he intends to support the fee increases.

“I think we all recognize this as important and that it needs to get done,” Conklin said.

Assemblyman Lynn Stewart, R-Henderson, said he had not studied the issue in depth, but that “it sounds like the fees are justified.”

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  1. So, privatize the inspection of health care facilities by making liability insurance mandatory. The insurance companies will monitor the facilities to make sure they keep their risk of exposure at the lowest possible level and will drop those who do not meet their standards. The state will be notified of the insurance cancellation and then will have cause to suspend the facilities business license, putting it out of business. Problem solved with no need to raise fees, taxes or add additional unelected, unaccountable bureaucrats to the states payroll.

  2. That comes to 34 inspections per inspector per year "rounded up". Thats less than 3 per month per inspector, a little work more production from these inspectors might justify their current funding.

  3. I would hate to be a regulator of any industry in Nevada--health, environment, gaming. The industry hates you for identifying problems, the Governor has halted you, and legislators talk out both sides of their mouths ("we must protect the public" vs "we must not do harm to businesses"). It's a perfect environment for the profit-making health care industry to slither along. Shameful!

  4. I agree DeNye. The regulatory function has so many influences. If it wasn't for the Las Vegas Sun and other media outlets making the outcomes of inspections public none of us would know the risk and issues we face. I work in a local hospital that is regulated and we welcome the State coming in because it's one of the only ways employees can get the hospital administration to respond to problems. They were in our hospital just last week. What they find will help us provide better patient care. As a RN, I am professionally regulated by the Nursing Board. The Nursing Board doesn't oversee the hospital. I wish the State came in more often. Keep this in the public Las Vegas Sun. Pat

  5. "Privatize the inspection of health care facilities.." so that Managers of the Health Care inspection teams can get bonuses for 'zero defects'.

    You will soon see that the "inspectors" will be finding few problems.

    Even the Republican Governor will be happy with the results, which will make the inspection team Managers qualified for Cushy Government jobs in the future.

    Great! What next? Privatize the highway system with toll booths every 15 miles?

  6. will nevada eventually be known as the hepatitis state???

  7. Force people or business's to buy insurance and if they don't then penalize them.

    How can we achieve the above with out it looking like the national health care reform model.

  8. One glaring omission from this article is the fines levied against these facilities the Sun has covered lately. What happens to that $$?

    Such an increase in fees of course is passed right on to we the consumers. I hope the legislature takes a long look under the skirts when it considers the proposed increases.

    "The nine most terrifying words in the English language are 'I'm from your government. I'm here to help.'" -- the late President Ronald Reagan

  9. Not to defend the surveyors (and no I am not one,) but one thing I'd point out is 3 or less surveys per month per surveyor isn't necessarily that big of a deal in terms of too light a workload, IMHO. Most surveys take the better part of a week (at least 3-4 days,) then there is additional admin work related to each survey to be done remotely. Then factor in vaca time, etc and now the additional unpaid one furlough day per month. I think there may be some travel time involved also to more remote areas such as tonopah, etc.

  10. If the State manages and is responsible for the inspections and they don't do an adequate job to keep the public safe, then isn't the State to blame when a member of the public is harmed? And isn't the State one of the parties named in the lawsuit? Cutting inspectors or privitizing the service doesn't mitigate the State's responsibility to the public.

  11. I had no problem paying to use I-294 to get to or around Chicago when I lived in the Midwest. There were alternate "free" roadways (such as US Hwy 41) to use, but I chose to pay. If there was a tollroad to Phoenix or to Reno from LV, I'd pay to use it if it meant saving time, fuel, wear & tear on my car and the aggravation of having to go through whistlestop towns.

  12. Besides mandated surveys these state workers conduct licensed and unlicensed facility complaint investigations. You'd be surprised some of the horrible care that is being provided to vulnerable citizens that has been discovered by surveyors. We're talking medications not given, bed sores, crowded over census homes, and owners turning the heat off to save money. Yes, there are some great places out there, but without these hard working state employees who will protect the public?