Valley Health, group can’t reach pact

The Health Services Coalition has failed to reach a new contract with Valley Health System, meaning almost 260,000 workers and their families will not be covered for non emergency care at the company's five Southern Nevada hospitals after March 1.

Leslie Johnstone, executive director of the Health Services Coalition, a health care advocacy group representing 22 self-funded insurance plans, said the two sides couldn't agree on reimbursement rates, or programs to improve the quality of patient care.

"We weren't able to reach an agreement," Johnstone said. "We needed to make a decision."

Without a contract, patients would have to find different hospitals or pay more of the bill out of their own pocket.

Under the current agreement, insurance covers 80 percent of a patient's costs with an annual out-of-pocket expense of $3,000, according to the Las Vegas-based non profit organization. Without a new agreement in place, patients using Valley Health hospitals could be faced with having to pay 50 percent of the hospital bill with an annual out-of-pocket expense of $10,000, the organization said.

A patient's doctor would remain the same with or without a contract, Johnstone said. She said emergency room care would not be affected.

For the fiscal year ended Sept. 30, 2009, coalition members spent more than $831 million for all medical and pharmacy services, of which $242.8 million was with Las Vegas area hospitals. Financial data for fiscal year 2010 was not available, Johnstone said.

Health Services Coalition provides coverage for some of the largest unions, including casino workers, Las Vegas city employees, firefighters and police officers.

The Culinary Workers Union Health Fund, for example, provides coverage to some 110,000 employees and their dependents. The city of Las Vegas provides insurance to about 2,470 employees and their dependents, according to a spokesman.

"We are confident there is enough access to hospital care in the community," said Bobbette Bond, public policy director for the union's health fund.

She said the union was still reaching out to inform its members of their options after March 1.

"We are still evaluating the impact, if any, this change will have on our employees," said Jennifer Schuricht, public relations manager for NV Energy Inc.

Jace Radke, public information officer with the city of Las Vegas, declined to comment.

The decision also affects the health care benefits of thousands of MGM Resorts International, Boyd Gaming Corp., Golden Nugget Hotel and Casino and Caesars Entertainment Corp. employees.

"Part of this is about rates," said Alan Feldman, senior vice president of public affairs for MGM Resorts International. "But it's also about developing collaborative quality improvement initiatives. Like any customer of any product or service, we demand quality. We have to know there is improvement in quality measurements going forward."

Feldman said health care was a
$400 million annual cost item to MGM Resorts International.

Executives with the Golden Nugget declined to comment, while messages left with Caesars Entertainment and Boyd Gaming were not returned.

Valley Health System operates Centennial Hills, Desert Spring, Spring Valley, Summerlin and Valley hospitals.

"Due to the sensitive nature of any managed care negotiation, we respectfully decline to comment at this time," said Gretchen Papez, marketing director with Valley Hospital, in an e-mailed statement.

Spokespeople with the health group and the affected companies and union groups would not discuss financial details of the negotiations or what programs the coalition wanted to improve regarding hospital care.

Johnstone said the coalition had reached out to doctors about moving their practices to hospitals with provider agreements.

Health Services Coalition has experienced previous breakdowns in contract negotiations with hospitals only to reach an agreement before or shortly after a contact expired.

In December, the coalition was in a similar situation with St. Rose Dominican Hospitals. On Feb. 8, an agreement was announced that would allow coalition members to access the St. Rose system, which includes Rose de Lima, Siena and San Martin hospitals, and Durango Outpatients and Parkway surgery centers.

The coalition also renewed its provider agreement with University Medical Center, after both sides agreed on a new initiative to improve care at the facility. Terms of those three-year contracts were not disclosed.

Contact reporter Chris Sieroty at csieroty@reviewjournal.com or 702-477-3893.