A county-owned hospital in rural Nevada was given a one-month financial reprieve recently, but its survival beyond Feb. 28 is a crapshoot.
In fact, even the future president of the state hospital association doesn't give Nye Regional Medical Center much of a chance.
Unless another and more permanent solution is found to the hospital's financial woes, it may become the first acute-care facility in the state's history to shut down.
"We can pull this thing out of the fire if we can make some of these arrangements," said Bob Davis, chairman of the Tonopah, Nev., hospital and a member of the Nye County Board of Commissioners.
The 45-bed hospital, which is located in sparsely populated southwest Nevada, has been losing $100,000 per month, state officials said.
The hospital is owned by the county but managed by the state tax department.
On Jan. 19, the five-member county board voted 3-2 to stop subsidizing the facility with periodic disbursements that have totaled nearly $6 million over the past five years.
But on Feb. 2, the board had a change of heart, albeit a brief one. It voted 4-1 to advance the hospital $350,000 to keep it running through February.
County officials said they were swayed by a bill that two local lawmakers introduced early this month in the Nevada Legislature. The bill would guarantee that the county could recover its subsidies if the hospital was shut down. It would do so by collecting $700,000 in annual tax revenues generated by the Nye County Hospital District.
With the clock winding down, county officials are seeking private operators to take over the facility.
The county has also applied for a "critical access" designation from HCFA, which would allow Nye Regional to bill Medicare and Medicaid charges at cost and staff the emergency room with nurse practitioners. County officials are unsure when HCFA might decide on the request.
County officials said Nye County is too medically vulnerable to go without a hospital. Tonopah, with a population of about 3,600, is on the major north-south highway between Las Vegas and Reno, Nev., with more than 10,000 motorists passing through daily.
The region's primary industries-mining and nuclear waste storage-also hold the potential for a major mishap. The closest hospitals are in Hawthorne, Nev., and Bishop, Calif., both more than 100 miles away.
"It would create a real dilemma," said Bill Welch, president of the Nevada Rural Hospital project, a consortium of 11 of the state's 28 hospitals.
County and state officials paint Nye Regional as troubled since Brentwood, Tenn.-based Quorum Health Group managed it during late 1996 and early 1997, when the county terminated the contract.
When the Nevada Department of Taxation took over the facility's operation in April 1997, the hospital's physicians had left, its computer system did not function and uncollected accounts receivable averaged 300 days, according to state officials.
Quorum spokeswoman Shea Davis said the hospital had been in trouble for years before the company agreed to manage it and that its board had rejected Quorum's recommendations for improvements.
While state officials have had some success in hiring new doctors and straightening out its records, Nye Regional's average census of two patients per day is not enough to sustain the facility, according to Department of Taxation Executive Director Michael Pitlock.
For the fiscal year ended June 30, 1998, the hospital lost $713,150 on revenues of $4.7 million.
"There was a time when the census was up in the five- or six-patient range, and if we could get it back to that level, it would be self-sustaining," Pitlock said. The state has no money to fund the hospital, he added.
Locals in recent years have preferred leaving town for care, traveling to the hospitals in Hawthorne or Bishop, according to Welch and Pitlock. Out-migration has increased to 60% from 40% since the state took over the hospital, Welch said.
Davis blames the trend on local residents' lack of confidence in the facility.
"They don't want to get care in a place that's always in turmoil," he said.
And while the chairman is optimistic there will be a white knight in the hospital's future, Welch, who becomes president of the Nevada Association of Hospitals and Health Systems next month, said the lack of community support is likely to kill Nye Regional.
"In this betting state, I wouldn't give the hospital's survival high odds," he said.