UMC cancer care in flux

Only two weeks after University Medical Center's kidney transplant program was jeopardized, the county hospital's oncology services is taking a hit.

The Nevada Cancer Institute has ended its contract to provide oncology services to the county hospital's cancer patients starting Dec. 31. That leaves in doubt where the county's uninsured patients will go for outpatient care. That's because the hospital announced late Thursday those services would be discontinued.

Hospital officials said the decision to end outpatient cancer care is a result of reductions in reimbursement rates from the state-run insurance plan for the poor.

"Medicaid can't continue to cut reimbursements and not expect to have an impact on patient access to medical services,'' UMC Chief Executive Officer Kathy Silver said in a statement. "It's very expensive to provide oncology services and UMC has a fiscal responsibility to the taxpayers of Clark County. The hardest decision is one that impacts patient services, but unfortunately, we had no alternative.''

UMC officials said Medicaid cuts would result in an estimated $20 million loss in revenue and could affect other programs and services offered by the hospital, though additional details were not provided.

However, some Las Vegas oncologists say if UMC discontinues outpatient cancer services, the larger issue is with the uninsured, not Medicaid patients.

Oncology groups such as Comprehensive Cancer Centers of Nevada accept Medicaid patients.

"No medical oncologist can afford to take care of a patient without insurance, not because we're not unwilling to donate our time, but because we can't afford to donate the expensive drugs,'' said Dr. Ronald Kline, a Las Vegas pediatric oncologist.

Kline said the majority of care provided to cancer patients is done on an outpatient basis.

Nevada Cancer Institute officials expressed concerns about UMC's cancer patients.

"We are concerned about these patients and the future of these patients,'' said Lisa Stark, a spokeswoman for the institute. "It's kind of their (UMC's) decision if they want to continue oncology services, but we never anticipated UMC ending the service.''

Stark would not say why the state's flagship cancer research facility decided to end its contract with UMC. All she would say is the matter is being handled by attorneys for both parties.

However, Stark did say the agreement had been in the works for about a month and that the institute had been working with UMC to help transition care for its cancer patients. It wasn't until this week that officials with the institute learned UMC did not plan to continue oncology services and might have to end other services, Stark said.

Nevada Cancer Institute was awarded the contract, which went out for bid, in November 2007. The contract began Jan. 1 and was set to expire in 2010. At the time, the contract was billed as an chance to increase opportunities for patients to have access to clinical trials.

UMC has the state's only Teacher Hospital Cancer Program, and all of the institute's physicians and researchers are faculty members at the University of Nevada School of Medicine.

The institute also has a contract with UMC to provide radiation oncology services to UMC patients. That three-year contract is still intact at this point, Stark said.

Radiation oncology services are provided to UMC patients at the institute's facility in Summerlin because the hospital doesn't have the equipment.

In its statement, UMC officials said the hospital would "be working with current patients for a smooth transition to other community services."

However, hospital officials did not say where those services might be.

This latest development comes after the Centers for Medicare and Medicaid Services said it would be decertifying the kidney transplant program at UMC because of problems identified during two recent inspections.

The program was facing closure, or losing its Medicare reimbursements, on Dec. 3. However, members of Nevada's congressional delegation stepped in and urged CMS to change its mind, noting that some 200 people awaiting kidney transplants in Nevada would be impacted.

UMC officials also shared with CMS changes it plans to make to improve the program, especially patient outcomes.

Last week, CMS decided to extend its deadline to decertify the program until Jan. 8, giving the hospital several more weeks to prove it could provide adequate care to transplant recipients.

Starting next week, UMC is expected to provide some answers to questions CMS had about the transplant program, including how UMC officials plan to use three transplant surgeons from the University of Utah.

Contact reporter Annette Wells at awells@ reviewjournal.com or 702-383-0283.