Area hospitals will look for ways to balance
their books in 2009 as people put off routine
care but then require expensive emergency
services.Meanwhile, as unemployment numbers
rise, more people shift to government funded
programs, which don't cover the cost of
services consumers receive.
Patient loads have dropped up to 20 percent
at the Reno area's three hospitals in recent
months, say chiefs at Saint Mary's, Renown
and Northern Nevada Medical Center.
Even the ambulance service REMSA has
seen up to a 20 percent decline, says Mike
Uboldi, chief executive officer at Saint Mary's,
partly because of a decline in tourists, who
also use the service.
Meanwhile, cash procedures such as plastic
surgery are down as much as 50 percent.
"People are postponing electives like plastic
surgery and creaky joints," says Mark
Crawford, chief executive officer and managing
director at Northern Nevada Medical
Center in Sparks.
Jim Miller, chief executive officer at
Renown, says patients figure,"If it's been
chronic and I've lived with it this long, I'll wait
and decide."
One reason, people wait, says Uboldi, is
because they think: "How will the procedure
affect by ability to keep my job?" Those who
need a hip or knee replacement wonder if
they'll lose their jobs if they're out for a few
weeks.
But a dearth of patients doesn't immediately
translate into job cuts at the hospitals,
partly because nurses often work on-call or in
some sort of flex-time schedule.
Still, says Crawford,"When I talk to the
staff I can tell everybody is worried. They're on
pins and needles wondering, what's going to
happen next?"
Miller says,"We don't want to lay off, but
will be cautious about hiring."Renown gets
300 or 400 applications a month as a matter of
course.
"Many people think healthcare is recession
proof," says Miller."It's not."
People who lose their jobs lose their health
insurance. People begin to put things off.
But in some cases, care postponed results
in a more serious illness that
lands patients in the emergency
room, costing more all
the way around. But regardless
of patients' ability to pay, says
Miller,"We must cover our
costs."
Costs at NNMC, says
Crawford,weigh in at $4 million
a year for services, equipment
and maintenance of the
100,000-square-foot building.
"When people lose jobs
and health insurance, they
become bad debt or qualify for
Medicaid.And people coming
to the emergency room are
much sicker because they
ignored their symptoms for so
long," he adds.
While costs are tough to
trim at a hospital, recession caused
changes in patient load
can't be diverted.
"To participate in Medicare
and Medicaid, a hospital must
take all comers," says Crawford.
"And if you can break even on
a Medicare patient, that's considered
a good position."
Miller says some 60 percent
of care is delivered through
some sort of government program.
A breakdown shows 42
percent use Medicare and 12
percent use Medicaid. None of
these programs pay for the full
cost of care, say providers.
Yet hospitals operate under
the federal mandate to provide
care to all comers.
So costs get shifted to businesses
to the one-third of
patients insured through private
insurance policies.
And business, says Miller,
is the only player who doesn't
tell a hospital how much it will
pay for services."For every $1
that costs go up, business pays $3," he says.
Renown's operating costs continue to rise 7
percent per year, says Miller. That's driven, in
part, by the nursing shortage.Nurses'wages
rise 8 percent a year.
"In times like this there are a lot of tough
decisions to make," he says.
Financial uncertainty has caused Renown
to postpone new facilities which were already
planned, says Miller, such as additional children's
services, urgent care facilities and a hospital
at Spanish Springs. The new plan, he
says, is "Wait and see."
Exacerbating the situation, says Uboldi, is
a surplus of capacity.He cites a study of northern
Nevada done a year ago that showed the
region had 50 percent more hospital beds than
it needs and that was before the deepening
recession. The problem, he says, is how to
digest capacity in light of current reduced
demand.
Despite the many financial challenges, area
hospitals look to provide increased services.
Northern Nevada Medical Center is adding
insurance plans by Cigna,United, and Aetna,
says Crawford. The hospital also formed
Northern Nevada Medical Group to contract
with physicians to work in its clinics, the first
of which opened in September. It may add
three or four more clinics next year.
At Renown, new technology includes da
Vinci robotic surgery, a technology allowing a
tiny incision that results in earlier patient
release. Other additions include a non-surgical
treatment of brain aneurism, using catheters
and Tomo therapy, a focused radiation treatment.
The hospital also plans to expand its
infusion service center.
Saint Mary's looks to build urgent care
centers in the high-growth areas north of
Interstate 80. And plans to bring new technology
in house such as the new cyber knife, a
computer-controlled radiation treatment. To
spread the cost, it partnered with the manufacturer
and radiation oncologist, says Uboldi.
And he looks forward to completion of the
new emergency room early this year.
Saint Mary's Health Plans for small and
large groups will expand into the eastern
Sierra and other parts of Nevada. By mid-year,
says Uboldi, it hopes to also offer individual
plans."Due to the recession, job loss leads to
demand for that," he says.
