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In perhaps its final push to stop a looming merger, the Service Employees International Union Local 1107 again voiced its opposition to UnitedHealth Group's proposed $2.6 billion acquisition of Sierra Health Services.
The union sent a white paper to the Justice Department on Dec. 11 detailing its objection to the merger.
Federal antitrust regulators are expected to issue a decision on the proposed merger by the end of this month or the first quarter of 2008.
Along with the SEIU, opponents to the merger include the American Medical Association, Nevada State Medical Association and Clark County Medical Society.
As a union that represents 17,000 registered nurses, health care workers and public employees, the main issue SEIU's white paper focused on is the expected negative impact on nurses employed in Las Vegas hospitals.
The white paper was signed by the local's executive director, Jane McAlevey.
The merger, the white paper said, "will create a dominant health insurer in Clark County."
The merger's opposition has long said that a merged United/Sierra Health company would increase United's share of health maintenance organizations to 94 percent. If preferred provider organizations are included in the market count, the white paper stated, the merged company would control 60 percent of the market.
"With such a dominant position, UnitedHealth will be able to unilaterally reduce reimbursement rates to hospitals," the paper said.
But Sierra Health spokesman Peter O'Neill said the union and other merger opponents are only looking at a portion of the health insurance market in Clark County.
Sierra Health's HMO product, Health Plan of Nevada, already holds 80 percent of the HMO market, but, as O'Neill points out, Health Plan of Nevada is a product and should not be indicative of the entire market.
"(Sierra Health's)HMO should be viewed as one product among many products," he said. "It's like saying Toyota has 100 percent of the Camry market ¦ There are all types of options available to employer groups."
And although Sierra and United combined have 100 percent of the Medicare Advantage market with their Senior Dimensions and Secure Horizon products, Anthem Blue Cross Blue Shield and Aetna have both announced they will begin offering Medicare Advantage plans at the start of the new year.
United has been offering its Medicare Advantage product for 20 years. Thirty percent of seniors eligible for Medicare have signed up for United's Medicare Advantage optional product.
"For the union to say this would be a monopoly is not giving us credit for staying in the market" after regulatory changes 10 years ago led several other carriers to abandon their products, United spokesman Tyler Mason said.
All told, a merged United/Sierra Health company would carry 35 percent of the overall health insurance market, O'Neill said, not the 60 percent that the SEIU said it would.
"It's a bit disingenuous to look at the market that way," he said.
Mason said, "You have to watch these numbers and how they present those numbers."
O'Neill declined to comment further on the white paper since he had not read it yet, but took issue with the letter's contention (as read by a reporter)that patient care would decline as the merged company could control payments to providers.
"That's completely incorrect. There will be no reduction to payment to providers as a result of this merger," O'Neill said, adding that Nevada Insurance Commissioner Alice Molasky-Arman, in her approval of the merger, conditioned that United could not increase insurees' premiums or decrease payments to providers for two years unless costs to the company increase.
"At the end of the day, we're not changing anything with Sierra," Mason said.
New to the opposition is Clark County. Commissioners voted Dec. 18 to authorize the spending of public funds to fight the merger.
The cost of hiring Washington, D.C., antitrust attorney David Balto would be shared by the county and other groups opposing the merger.
The county's 12.5 percent share would be about $20,000.
In a memorandum to County Manager Virginia Valentine from the county's intergovernmental relations office, several options were proposed "targeted at improving health care quality and access."
The proposals include "certain dollar contributions" for local government public health agencies for purposes such as uninsured prenatal care, grants to fund technology improvements and medical education proposals, distribution for indigent care in local hospitals, or distributions to public hospitals (such as University Medical Center)to expand its services.
In other health news:
"I have mixed emotions about leaving MountainView Hospital," Howard said in a statement. "The physicians, staff, volunteers and patients have been wonderful to us and a very large part of our lives during the past 13 years."
Howard led the hospital since it opened in 1996 and was instrumental in expanding it, Sunrise Health System President Sylvia Young said in a statement. He presided over the growth of the medical staff to more than 1,200 physicians and validation from the Joint Commission on Accreditation of Healthcare Organizations.
"We are grateful for his contributions and wish him the absolute best," Young said in the statement.
Howard has served on several boards and committees, including the Las Vegas Chamber of Commerce, University of Southern Nevada and Boy Scouts of America. He was the president of the American College for Healthcare Executives and the Nevada Hospital Association.
Howard's legacy of jogging to the hospital and visiting staff and patients daily, including weekends, will be remembered for many years to come, the statement said.
"We were able to accomplish many things, but I am most proud of our high scores in patient, physician and employee satisfaction and that out of the original 275 employees, 110 are still working at MountainView today," he said.
There will be a nationwide search for Howard's replacement, who is slated to depart in the spring.
The prostate institute reviewed post-implant CT scans on 20 of the cancer institute's seed implant patients. The review found that Nevada Cancer Institute meets its affiliation criteria for quality, a release from the cancer institute said. It will maintain its affiliation by continuing to submit its cases for ongoing review.
"Combined with our American College of Radiation Oncology Accreditation and our new TomoTherapy unit, Nevada Cancer Institute continues to prove that we are able to offer patients the highest quality care in a high-tech environment," said Dr. David Pomerantz, director of Clinical Radiation Oncology. "This accreditation has been the result of substantial teamwork throughout the department and the institute."
The children's area has a bookcase of books, video games, Disney movies played on a flat screen TV and comfy chairs. Every child will receive a special emergency department kit including a "My Day in the ER" coloring book, crayons and other items.
The hospital has plans to offer wireless connections throughout the hospital once the second phase of its renovations is complete.
"We pride ourselves on our quick ER turn around times, Steve Dixon, chief executive of Southern Hills Hospital, said in a statement. "Committed to serving our patients with efficient quality care, these changes to the emergency department will only complement our short ER waiting times."
Nicole Lucht covers health care, workplace and banking issues for In Business Las Vegas and its sister publication, the Las Vegas Sun. She can be reached at (702) 259-8832 or nicole.lucht@lasvegassun.com.
