UMC reform

There's no getting around it: University Medical Center is going to need better management to stay open in the years ahead. Expert management. With daily oversight.

On Tuesday, Clark County commissioners voted 4-3 to ask the Legislature for permission to put the valley's public hospital under the direction of a board of medical experts. Currently, the commissioners themselves serve as the governing board. Too bad their good intentions aren't currency. If they were, the hospital might break even.

UMC has lost hundreds of millions of dollars over the past decade. The hospital needs more flexibility and creativity. Putting seven to nine people who know the health care industry in charge of UMC certainly will help. It's not a financial solution, but a start toward one.

"It's not going to save UMC. There are so many pieces of the puzzle to make it sustainable. The governance is just one," Commissioner Larry Brown said.

If the bill is passed by the Legislature and commissioners follow through on its adoption, the new board would meet in public. Contracts would be open to public inspection as well. That's critical, given the amount of money county taxpayers pour into the Charleston Boulevard campus.

Tuesday's news was better than Monday's, when commissioners were informed that the full implementation of the Patient Protection and Affordable Care Act will ensure UMC loses millions of dollars per year going forward.

Although UMC slashed its operating loss for the fiscal year ending June 30 to $18.8 million - from a whopping $94.5 million the previous year - the revenue that slowed the flow of red ink might disappear. UMC received $71.8 million from a federal grant program that supplements already-low Medicare and Medicaid reimbursements. The county sent hospital subsidies directly to the state, which in turn received matching federal money.

However, those grants might be phased out once Obama­Care comes online in 2014. Meanwhile, the health care law cuts other funding for urban public hospitals and expands Medicaid, which doesn't cover patient costs to begin with. And illegal immigrants, who receive tens of millions of dollars worth of free care at UMC every year, won't be able to obtain health coverage through insurance exchanges. UMC CEO Brian Brannman estimates that ObamaCare will bring losses of at least $52 million through 2019.

If ObamaCare succeeds in reducing the number of un­insured Nevadans - if tens of thousands of low-income residents choose subsidized coverage over the IRS penalty tax for not buying insurance - UMC should see an improved payer mix. Perhaps if Congress gets around to addressing illegal immigration this year, lawmakers will address the financial burden they put on the health care system.

If none of that happens, and better management can't engineer even a modest turnaround, the options become painful.

"The only other solution we have is a significant, very significant tax increase on every citizen in Clark County, and I can't support that," Commissioner Steve Sisolak said.

The public won't, either. They'll struggle to afford their own health care under ObamaCare. Would the county dare to ask them to pay higher taxes to fund the health care of those who don't buy insurance? No. There will be other options, reducing services or selling the hospital among them.

But it's important to at least give the governance change a chance to work. UMC's staff provide phenomenal, life-saving care to our poorest, sickest and most severely injured residents. We can't afford to lose that - for now.