UMC physicians to be asked for contract concessions

Dr. Meena Vohra has gone nearly two decades without an increase in contract pay for providing care to children with life-threatening illnesses at University Medical Center.

The pediatric critical-care physician has received cost-of-living adjustments annually. But her contract pay, set in 1991, isn't expected to increase anytime soon.

On Monday, the Clark County Commission approved a five-year contract with Vohra's physician group, minus any fee increases. Commissioners also suggested that other physicians consider taking less to help lower UMC's growing debt.

Commission Chairman Rory Reid directed UMC's top administrator to ask other service providers about making financial concessions as the county has in recent weeks.

"We've closed the outpatient oncology unit (at UMC). We have cut back programs and eliminated other services because we're concerned about the impact the economy has on the hospital," Reid told UMC Chief Executive Officer Kathy Silver. "My question to you is, why don't we bring in all these doctors and ask them to look at Dr. Vohra's example, or maybe they can do better than she has to continue to provide the service at less money. I just think this is an area of significant expense to the hospital."

UMC now has more than $60 million in debt and that's before factoring in upcoming reductions in Medicaid reimbursement rates set by the state's Department of Health and Human Services.

The hospital spends roughly $37 million honoring about 20 professional service contracts annually, officials said. While those contracts are vital in serving the public and maintaining the state's only level I trauma center, trimming professional service contract costs by 5 percent to 10 percent could ensure other services are saved.

The hospital is looking at other areas that can be cut to reduce its financial hemorrhaging.

At minimum, Reid wants UMC providers to consider reductions in contract pay that would decrease the $37 million now paid for their services.

"I'd also offer to attend some of those meetings with you if you need someone to wag their fingers at them," Reid offered after asking Silver to speak with hospital providers.

After Monday's commission meeting, Silver said she plans to start by contacting providers whose contracts are up for renegotiation. She'll then speak to providers whose contracts already have been negotiated.

Because each contract is different, Silver said some service providers might be able to help more than others.

"I think there's some opportunity there," Silver said. "Our physicians are really loyal to us and they understand our dilemma."

Larry Matheis, executive director of the Nevada State Medical Association, said it's understandable and proper for the commission to review this option. However, he cautioned, "I don't know how much flexibility anyone has in this economic climate."

"Each practice is different," he said of physician groups. "The pediatric subspecialists are already absorbing a lot because of lower Medicaid reimbursement rates. Some of them have stopped taking Medicaid patients, which is creating a crisis in Nevada. ... I'm afraid it will be the practices that give the most that will be more vulnerable."

What he doesn't want to see is physicians not providing services, Matheis said.

Some physician groups already have restructured their contracts to help UMC save money in the near future. One new contractor, Stuart Pulmonary Associates, which will provide physicians for UMC's pulmonary and respiratory, intensive care, and intermediate care units, agreed to a four-year contract that is 5 percent less than the contract awarded to the previous provider.

The contract will increase by 5 percent in 2010 and by 3 percent in 2011 and 2012, Silver said.

Though the Stuart Pulmonary contract was negotiated prior to Reid's request and approved on Monday, he said it could be used along with Vohra's to encourage others to make similar concessions.

Vohra's contract with UMC hasn't been increased since 1991, which Silver called "rare." Her physician group — Las Vegas Pediatric Critical Care Associates — has held a contract with UMC since 1998. Its rate also has never increased, outside of cost-of-living adjustments, or COLA.

COLA allocations increased by 3 percent in 2008 for physicians.

Vohra, director of UMC's pediatric intensive care unit, said she went into medicine to take care of people, not to worry about pay.

"I could start digging my heels in and demand more money but then I think work would be more about money," she said.

On Monday, commissioners Susan Brager and Lawrence Weekly also requested an item be placed on an upcoming agenda to discuss reinstating outpatient oncology services at UMC.

UMC's outpatient oncology services was among a dozen cut late last year to make up for $20 million in anticipated revenue losses because of the Medicaid reimbursement cuts.

Those Medicaid cuts were approved by the state to offset Nevada's own budget shortfalls.

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