DignityHealth Nevada to build 4 hospitals for underserved Las Vegas communities

Image via Wikipedia.

DignityHealth next month will break ground on one of four small hospitals in Las Vegas, part of a plan to bring more care to underserved neighborhoods of the famous desert city.

The project is a joint venture with Texas-based Emerus Health.

DignityHealth Nevada's senior vice-president Brian Brannman said the hospitals will contain eight beds in the emergency department and will have CT scan, basic radiology, laboratory and pharmacy capabilities, as well as corresponding inpatient facilities with eight to twelve inpatient beds and food services.

The two or three-story facilities will also house office space for medical groups and primary care doctors and space for community health programs like diabetes and hypertension management. Brannman predicts they'll each cost $24 to $28 million to build, totaling as much as $112 million.

[Also: DignityHealth, GoHealth to open 12 urgent care centers in Bay Area]

He said the idea behind the neighborhood model was rather than building one big-box hospital that is still a distance from many of its potential patients, they decided to create four or more smaller facilities scattered around closer to where people live.

"We are about 47th in the nation for the ratio of providers per capita and we're also very low in the number of primary care providers per capita. The American College of Emergency Medicine on and A to F scale rates us as an 'F' in terms of ER access. We are really trying to provide an attractive venue to folks to get primary care without their necessarily having to drive across town to go to a larger free-standing facility," said Brannman.

Another motivation was diverting some of the lower acuity traffic away from their larger ER's, which are often overrun by non life-threatening cases, by providing a closer and equally attractive option. That leaves more beds open at the major facilities to treat serious illness and dire emergencies.

"Going forward, our perspective is more and more care is being pushed out to less complex facilities, ambulatory surgery centers, clinics and so forth. Eventually I expect that we'll all be in some sort of at-risk or bundled payment situation where we need to have more of a continuum of care. This seems to fit that model. The bigger hospitals in town, in the years going forward, I really think the only people who are going to be admitting there are going to be people with really major illnesses. Most of the day-to-day care could really be provided at different venues. That's what we're banking on," said Brannman.

[Also: Dignity Health divests holdings in coal energy, calls climate change a public health issue]

Brannman said Las Vegas's population has grown rapidly, from around 300,000 in the 1970's to roughly 2.3 million today, but the number of healthcare facilities has not kept pace, especially when it comes to primary care. For that reason, he explained, the hospitals will all be located in underserved areas, spread out across the four corners of the city not only to improve coverage but so as not to overlap with other systems or facilities. Moreover, he said that since Medicaid expansion under the Affordable Care Act took hold in Nevada, the medicaid population has doubled from 200,000 to more than 400,000. But because reimbursement rates remain low those patients, many of whom are lower acuity, end up in the ER, which makes for long wait times.

"The first one in north Las Vegas, it's probably twenty minutes to the nearest hospital maybe. It's an area that doesn't have a lot of healthcare in general. It's a growing area with a lot of new homes going up, a lot of new businesses but it's fairly underserved," Brannman said.

The site in North Las Vegas will be located at Craig Road and Camino El Norte. Another facility will go up on the west side of town at Flamingo Road and Route 215. Farther south a third will spring up at Decatur Road and Blue Diamond. A fourth will serve the area surrounding Sahara Road and Decatur, an area Brannman said was once once depressed but is currently seeing a resurgence, making a new hospital a good contribution to the rebounding community, Brannman said.

While the plans seem like a positive through and through to Brannman, other seasoned health professionals in the area say they fall short of being a true solution.

Mitchell Forman, MD, former founding Dean of Touro University Medical School and a practicing rheumatologist at Touro University's health center, said he has mixed feelings on the plans.

He says for a community that has egregiously lagged behind for years in the number of providers per capita, anything that brings more providers and therefore access to care, especially primary care, is a good thing. Forman also agrees that drawing lower acuity patients away from the emergency departments of larger facilities is a step in the right direction.

"If anything, it allows access to healthcare where patients who are non-critical take up beds that are now made available for patients with higher acuity. I think that's a good thing. But when you look at the big picture, it seems to me to be a relatively small step," said Forman.

[Also: Dignity Health, Optum join forces]

Forman says that's because the future of Las Vegas and the state as a whole must include a rise in the number of providers to really see a positive change in healthcare access and quality of life. He says smaller neighborhood hospitals like the ones DignityHealth plans to build may provide a few more beds, but will not do much to accommodate graduate medical education or produce additional residency positions that will spawn more trained physicians. He said thanks to Medicaid expansion, a growing number of people who now have insurance will now be seeking care, so producing more clinicians and allied health professionals like nurses, nurse practitioners and physician's assistants has never been more important. This, Forman said, is where the neighborhood hospital plan falls notably short.

"The only way to ensure access to quality healthcare is to train future clinicians at hospitals that can accommodate larger numbers. The importance of graduate medical education is that you can train then retain your graduates. Studies have shown that the majority of physicians practice within 50 miles of where they train. If you train them, you'll retain them," Forman said.

The first of the four hospitals will break ground next month, and the other three will be built over the course of 2016, with completion for all expected by early to mid 2017. Emerus Health will be splitting costs with DignityHealth and will run the four hospitals, but the facilities will be branded as DignityHealth St. Rose facilities and run according to their guidelines and standards, Brannman said.

Twitter: @BethJSanborn