A sign points the way Thursday to MountainView Hospital in Las Vegas. Sierra Health Services can be seen in the background. Photo by John Locher.

Today the 17-year relationship between insurer Sierra Health Services and Sunrise Health ends.

It's anybody's guess if the two sides will speak again, but what is certain is that Sunrise, MountainView, Sunrise Children's and Southern Hills hospitals will be outside the coverage network of Sierra's 600,000 Nevada policyholders.

If Nevadans insured by Sierra Health elect inpatient or specialized care at a Sunrise Health facility, such as surgery or cancer treatment, they will pay out-of-network fees. Those fees could add up to the full cost of medical care provided, experts say.

Although some health care officials say this breakup will disrupt medical care throughout the Las Vegas Valley, others say it'll all work out in the end. Either a new contract will be agreed upon or services solely provided at Sunrise Health hospitals will be matched at other hospitals, they say.

Possible disruptions include non-Sunrise Health hospitals becoming overburdened with additional patients.

Also, Sierra Health members might have to switch from a physician who has privileges at a Sunrise Health facility to one who treats patients at other hospitals that are within their insurance provider's network. Those include North Vista, University Medical Center, the Valley Health System hospitals and St. Rose Dominican Hospitals' system.

Physicians who treat Sierra Health patients but aren't credentialed at non-Sunrise Health hospitals might have to be credentialed at those facilities to keep caring for those patients.

Dr. Nick Spirtos, director of gynecological oncology services at the University of Nevada School of Medicine, said physicians, especially specialists, tend to have privileges at multiple hospitals.

Spirtos, who has followed the Sierra and Sunrise contract negotiations, said he already has seen some physicians in Southwest Medical Associates Inc., the physician-group owned by Sierra Health, apply for credentials at some hospitals in the Valley Health System.

"There is no issue, in my opinion, that will affect the quality of care in the Las Vegas Valley,'' Spirtos said. "Contract issues go on all the time.''

Sierra enrollees directly affected include those insured through these subsidiaries:

• Health Plan of Nevada, which includes Sierra Choice and Senior Dimensions.

• Sierra Health and Life Insurance Company Inc.

• Sierra Health Care Options Inc.

• Smart Choice/Nevada Check-up.

"Sierra is big in Nevada and they have some of their own facilities, so it's not the end of the world,'' said Les Funtleyder, a health care analyst for research firm Miller Tabak.

"If you have an emergency and need a (Health Corporation of America) hospital, they are not going to turn you away because you are insured by Sierra. You can't turn away patients; that would be a violation of federal law. If anything, it will cost the patient more.''

Health Corporation of America, or HCA, is the parent company of Sunrise Health.

If someone insured under a Sierra Health plan needs emergency care and a Sunrise Health hospital is closest, that's where they should go, said Dr. Anthony Marlon, chief executive officer for Sierra.

The emergency patient will be stabilized -- meaning heartbeat and blood pressure are brought within normal limits and the patient is conscious -- then transferred to a hospital within Sierra Health's network.

Marlon, a licensed cardiologist, claims pediatric cardiology is the only speciality offered at a Sunrise Health facility that isn't offered elsewhere in Nevada.

"What we will do if a child needs cardiology care or open-heart surgery is sit down with their parents and the cardiologist and give them choices: We will send you to UCLA or the Mayo Clinic. Tell me where you think they will want to go? ... I submit to you, though, that pediatric cardiology surgery will be offered at St. Rose in the very near future.''

Sunrise Health officials say it's easy to make generalizations about what Las Vegas Valley hospitals offer because most provide the same medical services. Where hospitals differ is in their ability to deal with complex medical issues, said Amy Stevens, systems vice president for Sunrise Health.

"While you can make a broad generalization, the very complex and tough cases frequently end up at Sunrise (Hospital and Medical Center) and Sunrise Children's (Hospital),'' she said.

"For example, a severe diabetic who is elderly with a heart condition. Those types of folks are going to need a broader level of services throughout the hospital, and not just the heart team, but other specialties in the disease process. We offer those services.''

Months of contract talks between Sunrise Health and Sierra ended in late November.

Marlon flew to Tennessee to try to resolve the main sticking point, reimbursement rates the insurance provider pays the hospital chain for care.

Marlon's last proposal, which he claims would have paid Sunrise Health hospitals higher rates for inpatient services than Sierra pays other Nevada hospitals, was rejected.

Stevens said Marlon's proposals during contract talks did not take into consideration modern health care costs and advances in medicine and technology available at the four hospitals.

The old contract was a dinosaur, and Sierra's proposal was oppressive, she said.

The contract, agreed upon in 1989 when Sunrise Hospital was owned by Humana, required that more than 50 percent of Sierra's members obtain inpatient care at one of the health care provider's hospitals. In exchange, Humana accepted lower reimbursement rates from Sierra. That contract expired Sunday.

"The ability for it to allow patients access to current technology options available at this hospital, it was eroding our investment,'' Stevens said.

According to the Nevada State Health Division, HCA-owned hospitals represent one-third of all acute care beds in Southern Nevada -- 1,075.

However, like Stevens, some physicians with privileges at Sunrise Health hospitals say the number of beds a hospital has isn't as important as the level of care provided.

"Sunrise is the place in Southern Nevada for taking care of the sickest kids with cancer. I think there are other facilities that are coming up to speed, but they are not there yet,'' said Dr. Ronald Kline, a pediatric oncologist with Comprehensive Cancer Centers, which operates a pediatric oncology center adjacent to Sunrise Children's Hospital. "Yes, not having Sunrise for our HPN patients is probably going to be a detriment. The next best place, we think, would be Summerlin, St. Rose Dominican Hospitals' Sienna Campus and UMC, which has children's units. They just don't have the experience that Sunrise has.''

Sunrise has had a dedicated pediatric oncology unit since 1989 that recently expanded to 14 beds. The unit is equipped with the latest technology and has about two dozen oncology nurses and technicians.

"St. Rose just started providing (pediatric oncology) services two or three years ago, and I believe Summerlin within the last six months,'' Kline said. "But, no matter what, we will make it work. We will provide care to our HPN patients.''

Amanda Abrams, a spokeswoman for St. Rose Dominican Hospitals, said the Sienna campus has a 14-bed pediatric unit which can be used for oncology patients.

"All of our pediatric nurses are certified in oncology,'' Abrams said.

The hospital chain's San Martin campus, which opened in November, has a six-bed pediatric unit, but those beds aren't used for oncology care.

UMC's Children's Center has 14 pediatric intensive care beds and 29 general pediatric beds, all of which can be used for pediatric oncology patients, a spokeswoman said.

"We are prepared,'' said David Bussone, group director of the Valley Health System which operates Summerlin Hospital. "We've been spending a lot of time with the folks at Sierra Health to try and make sure we have enough capacity to meet their members' medical needs. Sierra Health has set up a pretty sophisticated system internally to monitor what the provider's patient needs are and what each hospital is capable of providing. The goal is not to overload one hospital.''

Still, if history repeats itself, a contract between HCA and Sierra Health will likely occur, Funtleyder said. It wouldn't be unprecedented for HCA-owned hospitals to negotiate a new contract within months.

"It usually comes down to a test of market power and who is trying to get the better price. Historically, these things have resolved themselves over time. It may be a year or sometimes two or three. All markets are different.''

Funtleyder said disputes between insurance providers and hospitals over reimbursement rates will continue as hospitals become more expensive to run with uncompensated care.

"These kinds of limitations of access, that really does spook people,'' he said. "Right now, you have limited access to certain hospitals in Nevada. If people who can vote get aggravated enough, it may eventually involve some political figures. The problem has to reach that level. That's been the history.''