Proposals to designate Level 3 trauma centers at three Southern Nevada hospitals face a crucial vote Thursday as University Medical Center campaigns against what it calls an “unnecessary swell” in the number of centers.
The Southern Nevada District Board of Health will review applications from Centennial Hills Hospital Medical Center, MountainView Hospital, and Southern Hills Hospital and Medical Center to determine whether the institutions should be allowed to develop the trauma centers.
The decision of the board — consisting of political and community representatives — will be watched closely by the area’s three existing trauma centers, particularly by county hospital UMC.
UMC backers have made up a large portion of the public opposition to the addition of the trauma centers, arguing that taking Level 3 patients from the facility would severely harm it.
Approval of the applicant hospitals, meanwhile, could mean a new source of revenue in a market where the Affordable Care Act has expanded Medicaid coverage.
The board may approve some, all or none of the applications for new centers. These Level 3 facilities offer “definitive care to the less severely injured” patients of traumatic incidents including car crashes and falls, according to the Southern Nevada Trauma System.
“As the population grows, new centers can come on and assume responsibility, but what they’re proposing is to come on now and just to take half our patients,” said UMC trauma department medical director Dr. John Fildes.
Debating county’s needs
UMC is the state’s only Level 1 trauma center, meaning it can treat the most and least severely injured patients. A Level 2 center can offer comprehensive care to patients with serious and lower-level trauma injuries.
St. Rose Dominican Hospital, Siena campus is now the sole Level 3 trauma center in Southern Nevada; Sunrise Hospital and Medical Center functions as the only Level 2 facility.
UMC employees have argued that siphoning patients away from the county hospital decreases its ability to thoroughly train medical residents and hurts the bottom line of the facility, which has been praised for its financial turnaround.
Fildes, a member of the Regional Trauma Advisory Board, presented data at a February meeting showing that UMC’s admissions of moderate to severely injured patients fell by nearly 800 cases in the years following approval of Sunrise and St. Rose as trauma centers.
UMC admissions began to rebound in 2014, the data showed.
The Regional Trauma Advisory Board makes a recommendation to the health board on applications, though its decision isn’t binding.
It eventually voted not to recommend any of the hospitals for approval after hearing statistics from the health district’s Office of Emergency Medical Services and Trauma System.
During a review, the office found that MountainView’s proposed service area had the highest volume of lower-level trauma patients in 2014 at 641.
MountainView CEO Chris Mowan said there were more recorded trauma cases near MountainView. Therefore, he argued, if MountainView had had a Level 3 trauma center, those cases could be have been treated closer to home.
“I think we should stay focused on what’s right for the patient and that’s providing the care at the closest trauma facility to where the trauma activations occur,” Mowan said in February.
Staying close to home for trauma care is a theme that Hospital Corporation of America, the operator of MountainView, Southern Hills and Sunrise, has emphasized with both of its applicant hospitals.
However, the emergency services and trauma office said it couldn’t recommend adding another trauma center as it lacked sufficient evidence the county needs one.
“The data also begins to show that in the near future we probably will, and so these new centers should probably begin to prepare themselves for that,” Fildes said.
Health care consulting firm The Abaris Group, hired by HCA, argues Clark County can sustain up to three additional Level 3 centers without long-term harm to UMC, as long as only one facility is placed in the northeast, northwest and southwest portions of the valley respectively.
Abaris Senior Vice President Bill Bullard, who said his group was hired to assess overall trauma need in Clark County, not to favor one side or the other, argues the data show Centennial Hills’ proposal doesn’t include enough trauma patients to be viable.
MountainView and Centennial Hills are both considered to be in the northwest valley.
“Our report says one Level 3 trauma center in the northwest, not two. We would never support that,” he said.
Bullard said UMC would initially be affected by the addition of the Level 3 centers but argued population growth would make up for the case loss.
He also claimed UMC has diverted trauma cases to other hospitals, including a 4-year-old patient with a severe trauma injury.
“UMC Trauma called Life Flight regarding this alleged case. They stated they have no knowledge of this case,” hospital spokeswoman Danita Cohen said in response.
Rob Dyer, senior vice president for strategy and development of HCA’s Far West Division, said the company doesn’t want to harm UMC but believes it’s important that people have the option of receiving medical service in their communities.
“Is this about UMC, or is this about what’s better for the community?” he asked.
Taking different approaches
HCA and its affiliated parties have also pointed out what they say are biases in the trauma center selection process, including that the RTAB’s standing members are all representatives of the existing trauma centers, and are thus the competition.
Bullard said he’d like to see an independent group of doctors brought in to assess each applicant and make a recommendation to the Board of Health.
Meanwhile, Centennial Hills Hospital, part of The Valley Health System, has gone a different route, emphasizing its relationship with UMC.
The hospital’s trauma center application says it will “engage in a synergistic relationship” with UMC. But Karla Perez, regional vice president of The Valley Health System, told the Las Vegas Review-Journal editorial board in April that she believes the placement of HCA’s trauma centers would do the opposite.
“It’s going to be MountainView working together with Sunrise, and if you put the triangle together of Southern Hills around it, you’ve now put a triangle around the Level 1 trauma center, choking the Level 1,” she said.
The trauma center debate is further complicated by HCA’s reputation.
A 2014 Tampa Bay Times article chronicled what it described as HCA’s penchant for charging trauma fees sometimes thousands of dollars higher than those of other facilities.
Trauma centers can charge thousands of dollars in fees if a patient is designated as a trauma case.