Emergency room off Las Vegas Strip makes waves with new business model

Updated January 28, 2019 - 12:10 am

A doctor assured DeAnn Allen that the trace of blood in her urine after a car crash was just a little bruising, but she wouldn’t have guessed it by the size of her bill.

That urine test and visit with the doctor cost Allen, who was visiting Las Vegas, more than $1,800.

“If you care about your care, and have a choice, we urge you to go somewhere else!” Allen wrote in a review on Facebook for Elite Medical Center, Las Vegas’ newest emergency hospital, located just west of the Strip.

Just like any full-service emergency room, Elite Medical Center treats a range of urgent medical problems, from headaches to heart attacks. But unlike at the other ERs in Southern Nevada, you’ll generally pay more for your care.

That’s because the facility doesn’t contract with any insurer. So if you break a bone or your child has an earache and you go there, you’ll be paying for out-of-network care.

Unaccredited and out-of-network

Elite is licensed as a hospital by the state, but experts say it is operating similarly to free-standing emergency rooms that have become common recently in other states. It is the only unaccredited hospital in Clark County that provides emergency care but doesn’t contract with insurers.

Free-standing ERs have been scrutinized by researchers, who say they often provide services available at an urgent care clinic while charging more.

Invented in the 1970s to serve areas, often rural, where care was sparse, they have particularly proliferated in Texas over the last decade, said Dr. Jay Schuur, head of emergency medicine at Lifespan, a health system in Rhode Island affiliated with Brown University.

“If you talk to people who run free-standing emergency departments, they will point out that they can often do things more rapidly and at lower cost than on the hospital side,” said Schuur, who has spent years researching them. “But they also … don’t have access to the full range of emergency services.”

There’s no license for a free-standing ER in Nevada, though hospitals are allowed to open satellite emergency rooms that provide care at other locations.

Elite Medical Center pursued a different path by getting the state to license it as a hospital. That means the facility has the capacity to keep patients for 48 hours.

State law doesn’t mandate that these facilities be accredited by the federal Centers for Medicare or Medicaid Services or accept any insurance, private or public.

Those unaccredited, non-CMS-certified hospitals also don’t have to follow the Emergency Medical Treatment and Labor Act, University Medical Center CEO Mason VanHouweling pointed out Tuesday at a Clark County Commission meeting, meaning the facility technically could ask patients for payment or insurance information before ever stabilizing their condition.

“We don’t think that’s appropriate,” said Bill Welch, president and CEO of the Nevada Hospital Association, which represents UMC and 65 other medical facilities statewide. “We think that Elite Medical Center, if they want to operate as a hospital in the state, that they should operate as a CMS-certified center and they should be accredited and Medicare-participating. Without those things, we’re concerned.”

‘Highway robbery’

Dr. Shannon Orsak and his brother, Brian Orsak, opened St. Michael’s Emergency Room in Sugar Land, Texas, more than a decade ago. It’s a free-standing ER which, like Elite Medical Center, doesn’t contract with insurers.

The Orsak brothers are listed as managers for Elite Medical Center on the Nevada secretary of state’s website.

“Our understanding is that’s what they initially had hoped to facilitate in Nevada, but because of the way our law is written, they had to build a microhospital,” Welch said.

Vivian Ho, a Rice University researcher who studies free-standing ERs, compared the business model to “highway robbery.” While an in-network facility charges patients the copay and coinsurance at rates their insurers have negotiated, an out-of-network provider can ask for payment from an insurer, then charge the patient the rest, whatever that may be.

“There’s tremendous overlap between the diagnoses seen at urgent care centers … but the prices by diagnosis and procedures are 10 times higher in a free-standing ER,” Ho said.

One of the most common procedures, she found: urinary test. Just like the one DeAnn Allen received after her car accident.

Margot Chappel, deputy administrator for regulatory and planning services at the Nevada Department of Health and Human Services, said Elite’s placement adjacent to the Strip means it’s likely focused on serving tourists. And just as convenience stores and shopping centers charge more on the Strip, Elite Medical Center could do the same.

“Health care is still a very for-profit industry,” she said.

Rarely on the hook

In an emailed statement, Elite Medical Center CEO Butch Frazier defended the facility and pointed to its online ratings as proof it is delivering quality care.

He noted that Elite’s ratings, from 4 to 4.8 stars depending on the website, are higher than UMC’s and said he was taken aback by VanHouweling’s comments at the County Commission meeting.

Frazier said he sensed “an element of jealousy in their complaints, as we have never before elsewhere in the country seen medical providers be so vocal in trying to ‘protect’ the patients of a competing provider.”

VanHouweling did not mention Elite Medical Center by name in his Tuesday presentation. UMC officials didn’t make him available for comment Friday.

Frazier said there is “a smidgen of truth” in the statement that because Elite is an out-of-network facility, its patients could be left on the hook for their medical costs. But he said that is rare, adding that insurers are sometimes reluctant to contract with hospitals unaffiliated with chains.

“EMC tries hard to make sure that the ultimate charges paid by the patients and by the insurers to EMC are in line with what they are paying for the same services at other hospitals in the area,” Frazier said.

The facility is seeking CMS-approved accreditation, he added.

Getting legislators on board

Ho, the Rice University researcher, said elected officials can keep free-standing ERs and facilities like them from cropping up by passing laws and ordinances.

“It’s a matter of your state legislators getting a hold of this early,” she said.

Clark County Commission Chair Marilyn Kirkpatrick requested at Tuesday’s meeting that county staffers draft an ordinance that would preclude local hospitals from forgoing CMS certification.

Legislators also are looking at tackling surprise billing in the upcoming session, which begins next month, and they could effectively render out-of-network billing ineffective. The practice puts responsibility on patients for the portion of a bill their insurer didn’t cover, at a rate determined by the hospital.

“That is absolutely everything we’re trying to avoid with the balance billing legislation,” said Assemblyman Mike Sprinkle, D-Sparks, who’s leading the efforts as chair of the Assembly Committee on Health and Human Services.

Sen. Joe Hardy, R-Boulder City, is taking a stab at similar legislation, which would mandate that hospitals and insurers negotiate a charge that is deemed reasonable.

Contact Jessie Bekker at jbekker@reviewjournal.com or 702-380-4563. Follow @jessiebekks on Twitter.

Local Videos
Butterflies At The Springs Preserve
The butterfly habitat is now open at the Springs Preserve. Learn about butterflies and take in the peaceful surroundings. (Mat Luschek / Review-Journal)
The Bellagio Conservatory's spring display has a Japanese theme
The Bellagio's conservatory is hosting around 65,000 flowers, to form a Japanese theme this spring. (Mat Luschek / Review-Journal)
Bonnie Springs closes (Caroline Brehman/Kimber Laux)
Bonnie Springs Ranch near Las Vegas officially closed its gates Sunday, March 17, 2019. (Las Vegas Review-Journal)
Honoring a fallen North Las Vegas Police officer at his namesake school
The 20th Annual Raul P. Elizondo Honor Day celebrates the fallen North Las Vegas Police officer's legacy at his namesake school. (K.M. Cannon/Las Vegas Review-Journal) @KMCannonPhoto
Windy day in Las Vegas Valley
The Review-Journal's camera on the under-construction Las Vegas Stadium the was buffered by high winds on Wednesday, March 14, 2019. (Las Vegas Review-Journal)
March gloom falls on Las Vegas
After a rainy overnight, gloomy skies hover over Las Vegas Tuesday morning. (Mat Luschek/Review-Journal)
John Katsilometes gets his head shaved at St. Baldrick's
Las Vegas Review-Journal man-about-town columnist John Katsilometes gets his head shaved by former Las Vegas Mayor Oscar Goodman during St. Baldrick's Foundation shave-a-thon on the Brooklyn Bridge at New York-New York in Las Vegas Friday, March 8, 2019. (K.M. Cannon/Las Vegas Review-Journal) @KMCannonPhoto
The Blue Angels take flight over Las Vegas Strip
The Blue Angels’ U.S. Navy Flight Demonstration Squadron flew their signature Delta formation over a part of the Las Vegas Strip, McCarran International Airport and east Las Vegas and were scheduled to fly over Hoover Dam. (Michael Quine/Las Vegas Review-Journal) @Vegas88s
Gross World Records
A group of about 20 children gathered around a TV at Sahara West Library on Feb. 27 for a history lesson on the most disgusting world records.
Graduation for Renewing HOPE program
The Renewing HOPE program graduation for homeless who spend nine months in Catholic Charities program. Graduates are preparing to enter the workforce. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutesfaye
Car crashes into Starbucks near Las Vegas Strip
Lt. William Matchko of the Las Vegas Metropolitan Police gives details about a car crashing into a Starbucks at Sahara Avenue and Paradise Road, near the Las Vegas Strip, on Friday, March 1, 2019. (Jessica Terrones/Las Vegas Review-Journal)
Car crashed into PT’s Gold
A 60-year-old man who police believe was impaired drove into a PT’s Gold at Silverado Ranch and Decatur boulevards Thursday night, Metropolitan Police Department Lt. William Matchko said. The driver was hospitalized and is expected to survive. A man inside the bar was hit by debris but drove himself to the hospital, Matchko said. (Katelyn Newberg/ Las Vegas Review-Journal)
Driver crashes vehicle into PT’s tavern in south Las Vegas (part 1)
A driver suspected of impairment crashed a vehicle into the wall of a PT’s Gold tavern, at 4880 W. Silverado Ranch Blvd., in Las Vegas on Thursday, Feb. 28, 2019. (Katelyn Newberg/Las Vegas Review-Journal)
Driver crashes vehicle into PT’s tavern in south Las Vegas (pullout)
A driver suspected of impairment crashed a vehicle into the wall of a PT’s Gold tavern, at 4880 W. Silverado Ranch Blvd., in Las Vegas on Thursday, Feb. 28, 2019. (Katelyn Newberg/Las Vegas Review-Journal)
Kids Read Books To Dogs At The Animal Foundation In Las Vegas
Kids from local Las Vegas elementary schools took part, Thursday, in a program at the Animal Foundation, where they read books to dogs. (Mat Luschek/Review-Journal)
Pioneer Trail highlights historic locations in West Las Vegas
The Pioneer Trail, a 16-site route of historically significant locations in Las Vegas, starts at the Springs Preserve and snakes east until it reaches above the brim of downtown. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutefsya
Vegas Warm Weather Hits Las Vegas Valley
Between Feb. 20-21, parts of the Las Vegas Valley were hit with 7.5" of snow. Less than a week later, it was sunny with temperatures in the 70s. (Mat Luschek/Las Vegas Review-Journal)
Dr. S. Jay Hazan, a World War II veteran, talks about his arrest at the VA Hospital
Dr. S. Jay Hazan, a World War II Army veteran, was arrested in November after he caused a ruckus at the VA Hospital in North Las Vegas and stole his driver's car keys. He was arraigned on Tuesday, Feb. 26, 2019, and the charges will be dropped after 60 days. (Bizuayehu Tesfaye/ Las Vegas Review-Journal) @bizutesfaye
Claytee White talks about Black History Month
An interview with Claytee White, director of the Oral History Research Center at UNLV. (Benjamin Hager/Las Vegas Review-Journal)
Reflecting on the Moulin Rouge and a segregated Vegas
Former employees of the Moulin Rouge, the first integrated hotel-casino in Nevada, talk about what it was like in the brief six months the casino was open. (Rachel Aston/Las Vegas Review-Journal)
Las Vegas home prices
Home prices rose in every ZIP code in the Las Vegas Valley in 2018 for the second year in a row, according to SalesTraq. Prices grew fastest in older, more centrally located areas. But prices were highest in the suburbs. The top three ZIP codes for price growth were 89119 (29.8%), 89146 (25%) and 89030 (24.6%). The top three ZIP codes for median sales prices were 89138 ($464,500), 89135 ($420,500) and 89052 ($370,000).
Wagonwheel Drive overpass reopens after ice closure
Overpass at Wagonwheel Drive reopens after ice on the onramp caused the ramp to be shut down, Feb. 22, 2019. (Michael Quine/Las Vegas Review-Journal)
Keeping warm at the city of Las Vegas’ homeless courtyard
With help from the city of Las Vegas, a Salvation Army shelter stays open during the day Thursday and Friday, offering a safe place for the homeless to find respite from freezing temperatures and snow. (Chase Stevens/Las Vegas Review-Journal)
Sloppy, Slushy Road Conditions Lead to Slow Traffic
Traffic slowed to a crawl on Jones are near Russell as conditions worsened Thursday. (Mat Luschek/Review-Journal)
Winter storm blankets west side of Las Vegas Valley
On Wednesday evening through early Thursday a winter storm dumped more than 7 1/2 inches of snow on some parts of the Las Vegas Valley. (Michael Quine/Las Vegas Review-Journal)
Las Vegas snow day for children
Las Vegas kids play in the snow that fell on Feb. 21, 2019. (Belinda Englman/Las Vegas Review-Journal)
Snow closes Red Rock Canyon, residents enjoy rare snowfall
The greater Las Vegas area was hit with snowfall on Thursday, Feb. 22, 2019. This video shows the areas surrounding Red Rock Canyon and the Summerlin community. Video by: Heidi Fang/Las Vegas Review-Journal
Las Vegas kids attend school in the snow
Las Vegas children attend school during a rare snowstorm on Feb. 21, 2019. Staton Elementary School and other CCSD schools remained open. (Glenn Cook/Las Vegas Review-Journal)
People enjoying the snow in Summerlin
Fox Hill Park in Summerlin was busy Thursday morning, Feb. 21, 2019, with people enjoying the rare snow that fell overnight. (Mat Luschek/Las Vegas Review-Journal)
NHP advises motorists to take caution during Las Vegas snowstorm
NHP advised motorists to take caution during the snowstorm in Las Vegas. (Bizuayehu Tesfaye/Las Vegas Review-Journal) @bizutesfaye
It is a rainy Valentine's Day in Las Vegas - Video
These scenes come from the Las Vegas Stadium LiveCam (Las Vegas Review-Journal)
Life Videos
MAGIC fashion convention showcases men's clothing trends
The MAGIC fashion convention has come to Las Vegas at the Mandalay Bay Convention Center to showcase some of the hottest clothing trends for men. (Nathan Asselin/Las Vegas Review-Journal)
Former Army medic’s Afghanistan story told in new book
The graphic novel “Machete Squad” is based on journals written by Las Vegan Brent Dulak.
Las Vegas man talks about losing his wife
Dwayne Murray, 37, lost his wife, LaQuinta while she was at Centennial Hills Hospital. A jury awarded him $43 million last week after it said the hospital failed to perform the standard of care in administering a drug for her sickle cell disease.
Barber sets up shop in grandfather’s old shop
Andres Dominguez’s new barber shop is filled with memories of his grandfather, who ran the El Cortez landmark for more than 30 years. (John Przybys/Las Vegas Review-Journal)
Life and times of a 90-year-old horse player
Leo Polito of Las Vegas describes meeting legendary jockey and trainer Johnny Longden on the beach at Del Mar. Mike Brunker/Las Vegas Review-Journal.
Learning the history of singing bowls
Presentation at Summerlin Library teaches residents about the history of singing bowls (Mia Sims/Las Vegas Review-Journal)
Learning live-saving techniques in Stop the Bleed class
Leslie Shaffer, an AMR paramedic, shows how to control bleeding during a Stop the Bleed course at the Summerlin Library. The class is designed to teach anyone how to control and stop life-threatening bleeding. (Mia Sims/Las Vegas Review-Journal)
Vicki Richardson speaks about on the power of art
Artist and arts advocate Vicki Richardson talks about the power of art to inspire and challenge. (John Przybys/Las Vegas Review-Journal)
DressCoders pairs tech with haute couture
DressCoders is a startup focused on haute couture garments. The company uses illuminated thread that is washable and can be sewn right into the fabric. (Mat Luschek/Las Vegas Review-Journal)
CES 2019: Brava infrared oven
In cooking with the Brava infrared oven,there’s no preheating. the bulbs can reach 500 degrees in less than a second. (Heidi Knapp Rinella/Las Vegas Review-Journal)
Sinks Merge Style And Utility
Study could determine cause of Alzheimer’s, Parkinson’s diseases
Dr. Aaron Ritter, director of clinical trials at the Cleveland Clinic Lou Ruvo Center for Brain Health, discusses his research on how inflammation in the brain impacts Alzheimer’s and Parkinson’s diseases. (Jessie Bekker/Las Vegas Review-Journal)
Holocaust survivors talk about tragedy and friendship
Janos Strauss and Alexander Kuechel share their perspectives on life. (John Przybys/Las Vegas Review-Journal)
'Siegel Cares' Santa delivers toys to kids at Siegel Suites in Las Vegas
Siegel Cares, the charitable wing of The Siegel Group, delivered toys to families at their apartment complexes in Las Vegas. (K.M. Cannon/Las Vegas Review-Journal)
TOP NEWS
Home Front Page Footer Listing