Local News


Sunrise Hospital: NICU reimbursement rates put services in danger

Hospital says Medicaid rate covers 57 percent of costs
Posted at 5:43 PM, May 03, 2019
and last updated 2019-05-03 23:09:33-04

LAS VEGAS (KTNV) — How can a business survive with customers paying just over half of its costs?

That's the question the head of Sunrise Hospital and Medical Center is asking as the hospital is pushing for an increase in Nevada's Medicaid reimbursement rates for NICU and PICU patients.

The current reimbursement for Medicaid is a challenge," Sunrise Hospital and Medical Center CEO Todd Sklamberg said.

Each year, about 1,000 babies are treated in the hospitals Neonatal Intensive Care Unit. The hospital says that makes up 25 percent of all babies in need of NICU care statewide.

The quality of the NICU was the reason Miriah Vergara had her son Malosi at Sunrise.

"He will get his surgery to fix and repair, and that is what we are waiting for," Vergara said.

Vergara found out her son had a heart defect about halfway through her pregnancy and said the treatment and the hospital's reputation made it easier to trust the nurses with the care of her son.

"He is doing phenomenal considering everything," Vergara said.

Malosi is one of the lucky babies who spent less than a week in the NICU. This as the average stay is 23 days in the NICU.

However, those days come with large costs that the hospital is forced to absorb on three of every four babies, because of the state's Medicaid reimbursement.

"[Medicaid] Covers approximately 57 percent of our costs, not what we charge, but the cost of providing care," Sklamberg said. "Many of the critical services that are provided at Sunrise Hospital are only provided here if they are not available families would have to leave Nevada for the care."

Governor Steve Sisolak proposed an increase to those rates - by 25 percent for NICU patients and 15 percent for PICU babies.

Lawmakers are also already looking at the move as part of the state budget.

"We are trying to get as close to the cost of those very intensive, expensive services at the same time balancing with other services," Cody Phinney, with the Division of Health Care Financing and Policy, said during a March hearing.

While balancing the budget lawmakers are asking what the increase will mean for families instead of the hospital's bottom line.

"To me, it is all about the access, not the profit center," Democratic State Assemblywoman Maggie Carlton said.

State health leaders are saying the move will allow hospitals like Sunrise to continue with current services and hopefully add more in the coming years.

But the final decision on the funding change will not be known until lawmakers approve the final budget.