Doctors Question Nevada Medicaid Cuts

LAS VEGAS (AP) - Nevada's medical community is raising concerns
about plans to cut state Medicaid reimbursements to hospitals for inpatient services by 14 percent, a figure likely to dwarf the shortfall that already has forced some hospitals to eliminate key services.

"We're witnessing the unwinding of a very thin safety net," said Larry Matheis, executive director of the Nevada State Medical Association. "The costs to the state are going to be greater than the savings; it's just a matter of the costs showing up a little later."

The 14 percent reduction is nearly three times the 5 percent cut that resulted in this week's elimination of outpatient oncology and kidney dialysis programs at University Medical Center in Las Vegas.

The additional Medicaid cuts could lead to closures of some rural hospitals, delays in care to the sick, emergency room overcrowding and the elimination or reduction in services at for-profit hospitals, said Bill Welch, executive director of the Nevada Hospital Association.

"If we thought the hospital wait times a few years ago were bad, we haven't seen anything yet," said Welch, referring to a period in 2004 when a state of emergency was declared in Clark County because of emergency room overcrowding.

Hospitals in Nevada with more than 100 beds provided a combined $533 million in uncompensated care last year, Welch said. Most of that care was provided in southern Nevada.

Welch said only 34 percent of Nevadans are able to pay for provided medical care services. The other 66 percent cannot, he said.

Hospitals have also been advised that unless there's a fix to the state's cash flow problem, Medicaid reimbursements might stop altogether by mid-March or early April until the next fiscal year, Welch said.

Chuck Duarte, administrator of the Health Financing and Policy Division, said the division is expected to cut Medicaid reimbursements for inpatient hospital services by 10 percent in the 2010 fiscal year. But, that could change depending on the state's budget.

The Health Financing and Policy Division manages Nevada Medicaid and Nevada Checkup programs.

Earlier this year the state's Department of Health and Human Services announced 5 percent "across the board" cuts for inpatient hospital services to offset the state's budget deficiencies. Because the 5 percent is an average, some services saw deeper cuts.

For example, reimbursements for care provided in Level III neonatal intensive care units were cut by 24 percent. Obstetrics was cut by 11 percent, officials said.

Nevada Medicaid also reduced rates for home-based, long-term care services and eliminated eyeglasses as a covered benefit for adults.

Medicaid reimbursements in some pediatric subspecialties such as heart, orthopedic, kidney, cancer and psychiatric, were cut by up to 41 percent.

Some specialists, including nearly all pediatric orthopedic surgeons, have dropped Medicaid patients as a result, officials say.

Nevada is already last in the nation in per capita spending for Medicaid, according to a report from the state's Legislative Committee on Health Care

The report, which is based on 2005 figures, found Nevada spends $490.26 per person versus the national average of $1,027.
Information from: Las Vegas Review-Journal,

(Copyright 2008 by The Associated Press. All Rights Reserved.)

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