Nevada’s population is growing as new businesses locate in the state, and existing businesses expand. As the population increases, it’s also shifting. Along with the rest of the nation, the state’s population is aging. At the same time, with the addition of new and startup businesses, millennials are locating within the state. To meet the different needs of varying groups, medical facilities across the state are expanding, new hospitals are being built, innovative technology is being brought in and new methodologies are being put to work.
Every healthcare system is looking for more doctors, and staffing is always a challenge for hospitals, which compete within a small, specific labor pool.
“We’re doing everything we can at UMC to help promote the healthcare profession,” said Mason VanHouweling, CEO, University Medical Center of Southern Nevada (UMC). “We’re a clinical rotation site, doing internships to allow people an opportunity to service and take care of people with healthcare needs. We have nursing shortages and shortages in health informatics individuals and I think we’re doing a good job of addressing those shortages.”
UMC is the only hospital owned and operated by Clark County and overseen by the Clark County Commission. It’s the anchor hospital for the University of Nevada, Las Vegas School of Medicine, and it’s doing its part to bring in more physicians.
“Because we’re affiliated with [UNLV] School of Medicine, we’ve got 215 residents and fellows at UMC, and we’re striving to keep those doctors in the county after they graduate,” said VanHouweling.
Changing Population Needs
Doctor shortages aren’t specific to Nevada. There’s a need for more trained, licensed physicians nationwide.
One way the medical profession is working to meet the needs of more primary care physicians in Nevada is through telemedicine or telehealth.
“UMC is getting involved in telemedicine, to be able to care for patients and bring our skill and high level care to communities that may not have those services,” said VanHouweling. “So we’re reaching out to other communities, to be able to start the telehealth process, and provide care to those people who aren’t able to actually be on our main campus. “
Telemedicine is a big advancement in the medical field and has been growing for the last 40 years. According to VanHouweling, the state has cleared the way, removing barriers for the practice of medicine to happen outside of traditional brick and mortar campuses. Five years ago legislation signed into law made it possible for doctors to establish a physician-patient relationship through telehealth communications, or even in a phone call, instead of insisting on a face-to-face visit.
To meet the needs of the growing population, and the different groups within it, healthcare networks are expanding their facilities.
Like most hospitals, St. Mary’s Regional Medical Center continues to grow its primary care providers. Unlike some hospitals, St. Mary’s doesn’t have capital improvements underway for more buildings or more room for more beds.
“The need for new hospital beds other than new hospitals being built in this community is not what’s needed,” said Helen Lidholm, CEO. “If you look at many of the new residents, they’re working for bigger companies established here and they’re millennials. Millennials tend to utilize urgent care as primary care and go to the doctor when they have a sore throat, that kind of thing. We have five locations for our urgent care, and we are expanding the hours there because that really is where the biggest need is for some of the younger folks new to the community.”
The other change in the population is the growing number of seniors. As the population ages, hospitals take steps to provide ease of access with care located closer to home. St. Mary’s partners with Access to Healthcare, a non-profit that provides transportation for seniors to get to medical appointments, pick up prescriptions, go shopping for food and to meet other transportation needs.
They’re also resurrecting the senior emergency room, implementing changes to make it easier for seniors to navigate with lowered lighting, step stools to get up onto gurneys, and everything in the rooms larger and easier to see, like clocks with bigger faces.
Most hospitals have dedicated pediatric wards. Located in Southern Nevada, Sunrise Hospital’s is the largest and most comprehensive in Nevada, and works in partnership with Children’s Heart Center of Nevada to provide pediatric cardiovascular services for children.
“We provide all the interventional cardiology, all the open heart and surgical repairs on children in the entire region,” said Todd Sklamberg, CEO, Sunrise Hospital and Medical Center.
Healthcare networks are expanding to meet general and specific population needs.
In the last 12 months UMC added three outpatient sites in Southern Nevada, and are looking at further exploration of their primary and urgent care offerings in the community, said VanHouweling.
Multiple sites for urgent care and primary care clinics mean that access to medical care can be located closer to home.
Sunrise Hospital recently initiated a $130 million expansion for Sunrise Hospital and Sunrise Children’s Hospital to include approximately 250,000 square feet of new clinical space. As the state’s largest provider of emergency care services, there’s a need to expand the emergency room, adding 72 additional beds, bringing capacity to 762 beds. The emergency room will move into the new tower expansion, and the children’s emergency room will expand.
Sunrise will also expand with a dedicated pediatric cardiovascular ICU with 14 beds, which is set to open summer 2018.
UMC is also in the midst of master planning its hospital campus for the next 20 to 30 years.
“We’re looking at bed expansion, growing with the city and the county. As the population grows, our market share has been growing at a good pace. We’re adding beds to the emergency department and the main hospital,” said VanHouweling.
In the North, Northern Nevada Medical Center (NNMC) is the only hospital in Washoe County with 100 percent private beds, and the first to achieve gold seal approval certificates for hip, knee and back pain, and advanced certifications in lower extremities. The only hospital in Sparks, NNMC is in the process of building a second hospital in South Reno, at McCarran and Longley.
“We need to grow with the market,” said Alan Olive, CEO, NNMC. “The market is growing busier, and we’re 48th in the nation in primary care physicians [per capita]. We’ll be expanding that dramatically, providing more resources, a new hospital to address the growth and give people more options for private beds, new technologies and new locations.”
In addition to the new hospital, NNMC is expanding the existing hospital.
“It’s will be more of an interior expansion versus a new wing,” said Olive. “That will be phase one, adding operating room capacity as well as patient room capacity, all private rooms again, and provide additional resources for our facility as we consider next steps.”
Rather than a need for more beds, what Lidholm sees is a need for inpatient psychiatric resources.
“We are adding to our already existing service line an inpatient psychiatric unit that will be for adults and geriatric disease, and we are planning to open that in a few weeks,” said Lidholm in late May. The 24-bed unit is a resource the community needs.
In addition to the new St. Mary’s psychiatric center, there’s a freestanding psychiatric hospital, Reno Behavioral Health, that opened in April. According to Lidholm, there’s the state mental hospital, Northern Nevada Adult Mental Health, which has difficulty keeping itself staffed because the pay scale can’t compete with hospitals that aren’t state-run. The recent closure of a community triage center and mental health clinic for Native Americans with severe mental illness left the community with fewer options for treatment.
“The biggest need in our area overall is behavioral health, mental health, because, as we lose the ability to discharge patients with good outpatient follow-up, it makes it more and more difficult to send patients out and be confident that they are going to continue to receive care,” said Lidholm. “We see that in our emergency room on a daily basis, where we’re holding anywhere from 12 to 18 patients who are medically cleared but they need a mental health consult and follow-up in the community and that’s where we’re lacking. So that’s our biggest need, along with continued access to care for the uninsured and under-insured, because they’re here and we need to make sure that we provide care for them.”
Lidholm added, “If you look at what’s changed and what’s closed, even though we are adding 24 beds in inpatient psychiatric unit, it’s not enough to fit everything that’s closed and that’s just this year.”
Twelve years ago Carson Tahoe Regional Medical Center moved from a small building to a much larger, completely new campus near downtown Carson City.
“It was, and still is, the largest construction project in Carson City,” said Ed Epperson, president, CEO. “We still manage that facility as part of our system and do our psychiatric inpatient there and also long-term acute care, and a lot of outpatient services.”
A year and a half ago the older campus became home to a crisis triage treatment center for patients and people with behavior health issues and they’ve ensured it’s well-known in the community.
“The Sheriff knows, the community knows, the ambulance folks know, the patients know,” said Epperson. “It’s a better alternative than occupying an emergency department bed, which is a national crisis.”
The facility is open 24/7 and takes the pressure off the emergency department because psychiatric patients occupy beds longer than strictly medical patients. Added to that, they don’t receive the right treatment in ER, because ER doctors aren’t psychiatrists, explained Epperson. The facility is continuously in use and, a year and a half after opening, Carson Tahoe is looking at what it will take to expand.
Trending: Mini Hospitals
Nationwide, mini or micro hospitals are designed as freestanding emergency rooms with beds, or micro hospitals that can offer inpatient services. There’s some question as to whether or not the trend will catch on in Nevada.
“It’s an interesting trend, and it will be interesting to see how successful they really are,” said Lidholm. The challenge, she said, is that most function on the idea of a freestanding emergency room with beds, and for patients coming from outside the region, there’s a need to have credentialed physicians on staff, including specialties such as cardiology, not just ER doctors.
“As a health system, our goal is to provide care as close to home in the most expert environment possible,” said Sklamberg. Southern Hills Hospital, which is part of Hospital Corporation of America, the same as Sunrise, has introduced a hospital-based freestanding emergency department off West Desert Inn Road and Fort Apache Road in Las Vegas, which allows expert emergency care to be provided in an environment close to home for many residents.
“We have not, as a health system or as Sunrise Hospital, embarked on mini or micro hospitals,” said Sklamberg. “We believe the provision of inpatient care is best provided in acute care facilities that have access to all the necessary sub-specialties and equipment to ensure the highest outcomes and quality.”
“We’re seeing some growth in neighborhood hospitals in our community,” said VanHouweling. “Dignity Health has done a good job of providing their services on a smaller scale.”
Dignity Health, which operates three acute-care hospitals in Southern Nevada, refers to the smaller facilities as neighborhood hospitals and has opened several in recent years. Some believe that, for lower income patients and seniors, adding healthcare closer to home makes access easier.
“The challenges [to mini-hospitals] are there’s a lot of transfers from those types of situations to larger hospitals,” said Olive. “That just doesn’t fit into our model at this point.”
It’s All About People
In addition to the ongoing shortage of physicians, hospitals have to find qualified staff, with every facility competing with every other facility for a limited number of people.
St. Mary’s recently gave out longevity awards to team members who had been on staff for 30, 35 and 40 years. “You come to St. Mary’s, you stay at St. Mary’s,” Lidholm said. “I believe it’s the culture of caring we have that makes people want to stay, even if someone across the street pays a couple more bucks.”
“While I wouldn’t say we have any shortages per se, we do have to continuously recruit to be able to fill clinical positions,” said Epperson; that’s in addition to the physician shortage. “One indicator for hospitals, for how well they’re filling their staff positions is how much use they have of traveler or short-term staff. We aren’t using any and haven’t for a while, so we’re doing pretty well, but that’s because of nonstop work.”
Access to healthcare is critical for a healthy population, but access can be difficult in Nevada, which ranks 50th in the United States for physicians per capita, and has a critical need of nurses and psychiatrists. To continue to grow and provide quality care, recruitment of physicians is mandatory. Without enough internship and residency opportunities, medical school graduates will leave the state.
“Data shows if a student goes to medical school in the state and has residency opportunities in the state, there’s a greater than 80 percent likelihood they’ll remain in the state,” said Sklamberg. So there has been significant commitment by the state of Nevada to help fund graduate medical education, including at Mountain View and Southern Hills Hospitals in the Hospital Corporation of America system, which have expanded their residency opportunities.
It’s clear hospitals are significant contributors to their state and local economies. They’re generally one of the largest employers in a community. In Southern Nevada, UMC has an impact on the economy with 8,567 jobs and a total economic output of $1.18 billion including net operating revenues. In addition, in the past five years, St. Mary’s has paid more than $17 million in taxes and provided more than 2,500 jobs in Northern Nevada. Improving recruitment opportunities and quality of care to support the hospital system is important for the state moving forward.
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