Service cuts proposed to offset UMC shortfall

University Medical Center administrators are proposing to reduce or eliminate half a dozen hospital services to offset an estimated $8 million shortfall anticipated with the first wave of Medicaid cuts.

The county's only public hospital already has dropped its outpatient oncology service, sending 400 people by year's end in search of other chemotherapy providers. Today, administrators will propose to Clark County commissioners making cuts to select programs and services:

• The high-risk obstetrical unit.

• The outpatient kidney dialysis service.

• The outpatient mammography program.

• Outpatient coumadin therapy.

• The post-emergency hand clinic.

• Prenatal services at the hospital's Women's Center.

Reducing these services could affect hundreds, if not thousands, of poor Nevadans. However, these services are offered elsewhere in the Las Vegas Valley, said County Manager Virginia Valentine.

"These are services that are wonderful to provide, but we may not be able to sustain as a publicly supported hospital,'' she said. "The state's Medicaid cuts will have a serious financial impact on UMC.''

Earlier this year, state health officials announced 5 percent across-the-board cuts in Medicaid reimbursements for inpatient hospital services. These cuts were prompted by the state's own budget deficit.

The hospital also faces a 24 percent reduction in Medicaid reimbursements for Level III neonatal intensive care unit services, a department that treats preemies and newborns with major medical complications.

Nevada Medicaid provides health care to low-income Nevadans who qualify for services based on federal and state law. Eligibility for the program is based on financial need.

The state-run Medicaid program pays only 15 to 20 cents on the dollar for services, said Kathy Silver, UMC's chief executive officer. "With these cuts, we are absolutely facing a crisis,'' she said.

She said cutting the hospital's mammography program, which offers free or reduced-cost mammographies to women, saves about $230,000.

Cutting the hospital's outpatient kidney dialysis service saves about $2.5 million. Currently, there are about 24 patients who undergo dialysis on an outpatient basis at UMC and have no way to pay.

The hospital will continue to provide high-risk obstetrical care; it just won't be dedicating an entire unit to the service, Silver said.

She said the hospital would otherwise be facing losses of $6.3 million because of the expected Medicaid cuts to the service.

Silver said UMC will shift its outpatient coumadin therapy service to its Quick Care centers. Coumadin is a blood thinner given to patients to help them reduce the formation of blood clots. Redirecting this service to UMC Quick Cares saves the hospital about $60,000.

Silver said most of the staff for the proposed areas to be cut would be shifted to other departments in the hospital.

In addition to dealing with Medicaid cuts, UMC continues to face increases in the amount of free care it provides each year, estimated at $160 million. The hospital provides about 84 percent of the uncompensated care in Southern Nevada, Silver said.

Sunrise Hospital and Medical Center provides about 15 percent, she said.

After the first three months of this fiscal year, UMC has a $16 million budget deficit. In 2007-08, UMC needed $47 million from the county to make up for a budget defict. Clark County Chief Financial Officer George Stevens said that UMC's losses in July, August and September indicate the hospital may surpass its 2007-08 deficit this year.

Meanwhile, Chuck Duarte, administrator of the Health Financing and Policy Division, has said the division is likely to announce even more cuts in the near future. The division operates Nevada Medicaid and Nevada Checkup.