Behavioral health nonprofit WestCare will receive $273,000 from Clark County to help recoup uncompensated costs arising from its treatment of drug addicts and the mentally ill last year at its Las Vegas clinic, but some county commissioners are none too happy about the funding approved Tuesday.
The County Commission approved the expenditure by a 5-2 vote. But it’s unclear whether the sole detoxification center for the uninsured, underinsured and undocumented in the Las Vegas Valley can count on continued county support into the 2019 fiscal year, as some commissioners expressed an interest in funding other newcomers to the field.
“I have never hid how I feel about this because I just don’t think we should have all our eggs in one basket,” Commissioner Marilyn Kirkpatrick said during the occasionally heated board meeting.
WestCare, which operates a national chain of substance abuse centers, had threatened to close its Community Triage Center at 323 N. Maryland Parkway in May, saying it had run up a $6 million deficit in the preceding 22 months. It blamed the loss on the failure of the state Department of Health and Human Services, Las Vegas area hospitals and Southern Nevada government entities, including Clark County and the city of Las Vegas, to live up to their commitment to make $2.8 million payments to keep the center operating.
Temporary deal averted shutdown
Amid warnings that the clinics patients would overwhelm jails and hospital emergency room, the shutdown was averted by a temporary deal with many of the entities to keep the clinic running through the end of June.
The additional funding approved by the county on Tuesday was intended to help WestCare cover its preceding losses.
WestCare consultant Dan Musgrove said the triage center’s financial picture has brightened in the last three months. He said it has seen a 53 percent drop in the uncompensated care rate, from 47 percent of patients to 22 percent.
He also said the clinic had cut its recidivism rate by half — to 15 percent — since he gave a presentation to the commission on May 15.
But Kirkpatrick, a persistent critic of WestCare’s business model, cast doubt on the claims.
“You can’t tell me you’ve made a huge difference in three months; alcohol addiction (and) heroin addiction takes years,” she said, adding, “You guys have never been a good partner.”
The county’s contribution augments a $676,000 appropriation WestCare received from the state. The state’s funding equates to a $200 daily bed rate for each individual who came through center’s doors without health care insurance or some other means of paying in the 2018 fiscal year, though Musgrove said the actual cost of those patients came out to about $300 daily.
The county’s additional appropriation is “not even close” to closing that gap, Musgrove said, “but it’ll help.”
A group of private hospitals and the county-owned University Medical Center also contributed about $19,500 for services rendered in June, Musgrove said. He said the City of Henderson has will make a contribution for the 2018 fiscal year, but couldn’t specify the dollar amount. Henderson officials didn’t respond to a request for comment.
Future depends on a match
WestCare is finalizing a contract with the state for the 2019 fiscal year, which runs through June of next year. The deal promises up to $750,000 in payments for uncompensated care, though the state won’t provide those funds unless WestCare can come up with additional sources of funding.
“It’s not like we just handed them the money; they still have to earn it month-to-month,” said Julie Kotchevar, administrator for the state’s Division of Public and Behavioral Health. “I was very clear with WestCare that if you’re relevant to the community, people will pay for it.”
Commissioners, who were torn Tuesday over whether to keep their May promise to provide payments even through the end of December, said they felt their hands were tied by the state’s requirement that WestCare secure an unspecified amount of local funding as part of its contract.
“Our generosity got used against us, so now we’re restricted,” Commissioner Chris Giunchigliani said.
Kotchevar clarified that the contract could be amended to include an additional provider if another were to be granted a community triage license. Currently WestCare is the only such provider in the valley, but two behavioral health center have licensing applications pending.
WestCare’s funding request from the county for the 2019 fiscal year will be presented to the commissioners at a later date, at which point the board will vote whether it will continue to move forward with payments. Alternatively, it could open a request for proposals process for another community triage center.
Changes to leadership
It has been an eventful year for WestCare. It unexpectedly shut down two additional community triage centers — one on Fourth Street in Las Vegas on Nov. 1 and another in Reno on April 5. In both cases it gave no warning of the closures to patients or government agencies.
WestCare said in May that it hadn’t been paid for about two years under an agreement with the state Department of Health and Human Services, Clark County and local hospitals.
Meantime, a county audit showed the nonprofit, which operates in 19 states, owed it repayment of more than $1 million for services already paid through Medicaid.
WestCare’s former vice president of Nevada operations, Kevin Morss, also left the organization and became CEO for CrossRoads of Southern Nevada, a private substance abuse clinic that promises to offer operations similar to WestCare sans public funding. WestCare’s triage center also gained a new director, Frank Reagan, about a year ago.
Musgrove wouldn’t confirm whether any departures were tied to issues with the community triage centers.