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November 23, 2014

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J. Patrick Coolican:

State officials: Las Vegas hospitals sloughing off patients on UMC

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Sam Morris / File photo

University Medical Center is Clark County's only publicly funded hospital.

Updated Wednesday, July 17, 2013 | 12:18 p.m.

J. Patrick Coolican

J. Patrick Coolican

I recently reported on a state investigation into improper patient transfers from St. Rose Dominican Hospitals - Siena Campus to the region’s only public hospital, University Medical Center.

The investigation found a systemic pattern of shifting patients from the St. Rose Siena campus in Henderson to UMC, where officials there long suspected they were victims of inappropriate transfers.

It turns out, St. Rose was not the only local hospital improperly moving patients to the taxpayer-supported UMC, which is running a deficit this year of about $30 million.

Valley Hospital Medical Center, Spring Valley Hospital Medical Center, Sunrise Hospital & Medical Center and Desert Springs Hospital also were found to have “inappropriately transferred” patients to UMC. Inappropriate, because in most cases the hospitals didn’t have the sort of doctors under contract that they were required by law to have.

For those hospitals to then send their patients to UMC has consequences for UMC — and thus, taxpayers. They exacerbate the overcrowding in the UMC emergency room, overburden certain medical specialists there and potentially cost taxpayers money if the patients are uninsured or underinsured, which is often the case.

In no case was patient safety put at risk, the state found. But the transfers were frequent, occurring at each hospital at least 10 times during the separate investigations that lasted a month or so, according to state documents.

The biggest reason: The hospital ERs didn’t have the kind of physicians on duty that the state requires, especially urologists and ear, nose and throat doctors.

University Medical Center, which is Clark County's only publicly funded hospital.

University Medical Center, which is Clark County's only publicly funded hospital.

If specialists are not available, the hospital is required to transfer the patient to another hospital that can provide the care, which is typically UMC. But these transfer agreements with UMC are not a license to fail to provide specialty services such as urology and automatically send patients away.

In fact, UMC officials believe many of the patients transferred there — supposedly in need of a specialist — did not actually need one and should have been handled by ER doctors at the originating hospitals.

Between August 2011 and May 2012, Universal Health Services hospitals — the for-profit chain that includes Valley, Spring Valley, Desert Springs and two others — transferred 191 patients to UMC, according to data compiled by UMC officials. More than one-third were uninsured, while another 13 percent were patients on Medicaid, the government insurance for the poor and disabled that offers notoriously inadequate compensation rates.

This means nearly half the patients would be considered financially undesirable.

During the same time, area HCA Health Care hospitals — the parent company of Sunrise and several other hospitals in the valley — sent 119 patients to UMC, with more than one-third either Medicaid or uninsured.

All told, UMC was the recipient of 545 patients from area hospitals during just that single 10-month period; 46 percent of them were either Medicaid or uninsured patients.

As UMC CEO Brian Brannman said to me, “The reason these private hospitals can be so profitable is because we’re here to take the losses.”

But believe it or not, this is a good-news story. All this scrutiny from state investigators — and perhaps even annoying newspaper columnists — may be having an effect.

The hospitals in question are now in discussions with UMC to work out a long-term solution to the issue of patient transfers.

After I contacted them, I received this rather remarkable joint statement from the hospital executives, including Brannman, as well as Todd Sklamberg of Sunrise, Karla Perez of Valley and Rod Davis of St. Rose.

“The major Southern Nevada hospital systems, including Sunrise Hospital, The Valley Health System, St. Rose Dominican Hospitals and University Medical Center, are collaborating to develop an effective plan that will ensure access for patients who require emergent specialty care. The hospitals are committed to creating both short- and long-term solutions, in collaboration with the Nevada Department of Health and Human Services, to provide the highest level of care to our patients.”

I’m sure there’s a way to go to work out a solution. But this is a good start.

CORRECTION: This story was corrected to reflect that emergency room doctors are not on hospital staffs, but are outside doctors contracted by hospitals to work in emergency rooms. | (July 17, 2013)

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  1. JPC: could you interpret the behavior as trying to SURVIVE when so many patients are non-paying? Perhaps the powers that be need to address why patients seek treatment when they have NO INTENTION OF PAYING for the treatment. The transfers for want of physician specialists includes numerous "emergency" patients who are not having an emergency--but are seeking free care in the ER's rather than fully participating in taking care of themselves, rather than allocating income to health care, rather than supporting themselves.

  2. A good report of a poorly kept secret. It is all about money. UMC, often used as a scapegoat for rising public medical costs, has no choice but to accept these patients, and the other area hospitals know that. Hopefully the Affordable Care Act will reduce the number of uninsured patients, leading to fewer patient transfers to unload a financial problem.

  3. Good report! I wonder what percentage of those transferred did not have health insurance which would put payment at risk to those for profit hospitals?

  4. oops, sorry, missed that paragraph - its in the story!

  5. Maybe if we stopped treating UMC as a human Garbage Disposal for unwanted patients, we could turn Vegas' medical abilities and reputation around.

  6. Once we take the profit motive out of health care this won't happen.

    BUT greedy corporate executive run this country.
    And since rich people pay very little taxes-due to tax loop holes- they have no incentive to care if us middle class tax payers have to pay more taxes.

    What this country needs is national health care to catch up with the rest of the developed world.

    Only 3rd world countries don't have national health care.

    Of course, the US infant mortality rate is the same as 3rd world countries, so this is no surprise.

  7. I absolutely agree with "Bob 635" and will add this.

    Sunrise Hospital like all the other for-profit hospitals goes out of their way to order procedures for patients for one purpose only, To pump up the bill.
    And if they can't do that, they'll send the patient elsewhere.

    It's all about the Money for these so-called care givers and nothing else.

  8. So the fault lies with the ER contractors not fulfilling their contracts by providing an array of required services 24 hours each and every day. If the State is not going to hold these contractors accountable with fines or the inability to make contracts with area hospitals, nothing will change.

  9. The state should make sure UMC has the legal authority to bill the hospital sending patients if they cannot provide due to intentional understaffing, etc.

    Force them to comply or face costs of care plus penalty assessments.

  10. The question we have to answer is whether health care is a social service or a business. This article would seem to indicate, in at least some instances, it has more to do with business than healing.

  11. If you look at Hospital Rankings - UMC is the Best Hospital in Las Vegas. The Others are in it purely for the Money. And YES St. Rose that includes YOU.
    Look at the Link on the Bottom.

    Having said that, Las Vegas does not have a Single Hospital with an "A" rating. None will Disclose Infection Rates Publicly. Pricing is like a "Wheel of Fortune" spin for your Cash Price - in the Hospitals favor of course. Some are cleaner, shinier and have prettier Offices, however it's just "Lipstick on a PIG".
    There are many excellent people in Las Vegas Health care - however their support system on the job looks very shallow and until Top U.S. Hospitals establish "Outposts" in Las Vegas, it will be difficult to recruit more top doctors. Politicians could help by insisting on a Top Tier University Medical School with research capabilities, however it seems most of their time is spent in developers offices.

    http://health.usnews.com/best-hospitals/...