Nevada lawmakers challenged officials from Las Vegas-based University Medical Center on Wednesday about their decision to end outpatient cancer treatment at the hospital.
AB433 would require county hospitals to provide outpatient cancer treatment. Officials from UMC said that their own budget crisis forced them to examine which services they could cut.
"We know that you have had to make very difficult choices, choices about what services to keep and what to cut," Kathy Silver, CEO of UMC, told the Assembly Health and Human Services committee. "That's the same exercise that UMC went through when we were faced with additional shortfall."
Silver said that in order to re-establish service, UMC would need to have an additional $3.5 million in revenue per year.
"I can't understand that in your budget, and Clark County's budget, there wasn't a way to comb through the contracts and keep that clinic open," said Assemblywoman Sheila Leslie, D-Reno.
"It's just unacceptable. People are dying. If I made that decision, I could not live with myself."
Silver said that those patients who were treated in the clinic, and who qualify for Clark County Social Services help, are still being treated, and are being transitioned to other health care providers.
SB382, also reviewed Wednesday, attempts to fix the problem by changing the way funds are distributed to hospitals who care for a "disproportionate share" of people who can not pay.
"The poor are getting care, the rich are getting care," Silver said. "The middle class are not."
Silver said that the hospital does not have plans to restore services, but is in discussions with two organizations that offered help restore the oncology service.
"I think it's a shame that UMC had to come to this decision, but I can't condemn a hospital for having to trim services," said Ann Lynch, vice president of Sunrise Hospital and Medical Center in Las Vegas.
UMC is not the only hospital enacting or considering service cuts to deal with diminished funding. Lynch said that if the state did not provide some monetary relief for uncompensated care, Sunrise would have to consider cutting patient services.
"I'm providing $77 million in uncompensated care every year, and I'm not getting a dime," Lynch said. "There's something wrong with that."
Five hospitals in the state are not currently compensated for their care of indigents, which violates federal law, said Chuck Duarte, administrator for the division of healthcare financing and policy. Currently, 18 hospitals in the state provide services to those who cannot pay.
Duarte said the five hospitals that don't receive funds are eligible, but because of the way the funding formula currently works the state runs out of money before it can pay those hospitals.
SB382, also reviewed Wednesday, attempts to fix the problem by changing the way funds are distributed to hospitals who care for a "disproportionate share" of people who can not pay.
At stake are tens of millions of dollars, distributed through a complicated funding formula involving county dollars and federal matching funds, which go to pay the cost of care to uninsured patients, and those who are on Medicaid.
Clark County contributes the lion's share of those funds, sending $60 million to the state pool. Washoe County contributes about $1.5 million. The federal government matches those funds, and distributes most to hospitals.
The system also results in a "state net benefit" of over $18 million, which is again matched by federal dollars, resulting in an influx of $55 to 60 million a year to the state general fund.
"This decision is a big chunk of the budget," said Mike Willden, director of the Department of Health and Human Resources. "Our mission is to not impact the net benefit to the state."
Currently, UMC is guaranteed $66.5 million each year. Renown Hospital in Reno is guaranteed a minimum of $4.8 million, nearly three times the amount that Washoe County contributes.
Sunrise Medical Center in Las Vegas takes care of an estimated 18 percent of the state's indigent patients, but receives no money.