The Legislature created of the state’s Patient Protection Commission in 2019. Sisolak appointed its eleven members. (Nevada Current file photo)
Gov. Steve Sisolak’s appointment of industry-friendly members to the state’s Patient Protection Commission could thwart his effort to lower healthcare costs and improve accessibility.
“We have hospitals closing beds. We have doctors leaving the workforce. We have nurses leaving the workforce,” Dr. Anthony Slonim, president and CEO of Renown Health in Reno, said of fiscal pressures on the hospital industry at a recent PPC meeting, where he tried to derail Sisolak’s late December executive order to “ensure healthcare costs do not outpace wages…”
Sisolak’s order places a target on cost growth of 3.19% in 2022, with gradual annual decreases to 2.37% in 2026.
Slonim reeled off a number of reasons the pandemic is no time to put the brakes on the rising cost of care, from federal mandates that insurers cover Covid tests, to the lack of mental health care providers in the state at a time of turmoil.
“Addressing costs is certainly an important thing, but we’re doing it while the world around us is moving in chaos,” he said, suggesting the commission ask the governor to back off his executive order.
“This is a 10-year effort to try to at least get our arms around what’s going on with healthcare cost escalation,” commission member Bobbette Bond of the Culinary Union Health Fund objected, noting concerns about staffing and quality of care are legitimate. “They are acute right now, but I don’t think that you change the foundation of the pillars that we’re trying to put in place for healthcare management in an acute situation.”
“It seems to me that the focus right now on addressing cost is a chronic issue. It’s almost like dealing with constipation in a patient while we’re doing CPR,” Slonim said. “It’s almost as if we’re in a different place than when we started the conversation.”
That conversation on righting Nevada’s troubled health care industry began in 2019, with the legislative creation of the state’s Patient Protection Commission. Sisolak appointed its eleven members.
“Are we still talking about the executive order and Dr. Sloan’s opposition to the executive order?” Bond asked, requesting Chairman Ikram Khan close the agenda item. “I think that the health care system is largely in crisis, because of the escalating healthcare costs that have been unchecked, unmanaged and non transparent for, you know, a couple of decades. … And I think that ignoring that is something we’ve done for a long time.”
“While I appreciate the latent effects of this pandemic, I want to say that should not be in competition with us having some aspirations for the quality of care or affordability,” commission member Dr. Tiffany Tyler Garner added.
Members of the commission who asked not to be named say the PPC was meant to fill a gap in Nevada, which lacks strong consumer or patient advocacy programs, and that credibility in the membership is essential to achieving its goals of lowering costs and increasing accessibility.
Slonim’s interests, they fear, appear to be focused not on cutting costs but protecting the interests of Renown Hospital, a non-profit facility. Slonim, according to the Renown Medical Center’s tax return, earned $1.86 million from the hospital and affiliated companies in 2020.
Slonim did not agree to an interview. A spokeswoman said he was busy.
Initially, Slonim occupied the seat on the commission designated for a hospital representative, and PhARMA lobbyist Flo Kahn, who does not live in Nevada, filled the seat reserved for a representative of the pharmaceutical industry. The commission lacked any representation from the public.
That changed in 2021, when Assemblywoman Maggie Carlton sponsored legislation to diversify the commission’s membership and shift the focus from for-profit providers by reducing the number of industry representatives and adding a member to represent the public.
“They will bring specific and much-needed expertise that is so crucial to this Commission’s work,” Carlton said at the time. The measure also moved the PPC from the governor’s purview to the Department of Health and Human Services.
Kahn of PhARMA stated her opposition at the time during a meeting of the PPC.
“Commissioner Kahn wanted everyone to know PhRMA submitted (sic) written suggestion saying removal of some key members of this commission will take away expertise and valuable voices,” read the minutes from a PPC meeting in 2021. “She thinks it’s a huge mistake to take away these experts and suggested the PPC needs to send this message to the Legislators.”
Despite opposition from the healthcare industry, including the Nevada Hospital Association, AB 348 passed and Sisolak signed it into law.
Sisolak again appointed members, this time designating Slonim, the hospital CEO, to fill one of two patient advocacy positions, and Kahn to the sole spot representing the public.
“That was up to the governor,” says Carlton. “He did the reshuffling.”
One member, who asked not to be identified, worries if the “cynical way that a couple of roles were filled damages the long term potential for a patient-centered voice in Nevada.”
“The Governor has always recognized the importance of ensuring patients and their voices are prioritized in his healthcare agenda, that’s why he created the Patient Protection Commission to begin with,” Sisolak’s spokeswoman, Meghin Delaney, said in a statement to the Current. “His appointments since its inception represent a diverse collective of individuals who have and continue to work and advocate in the healthcare space. Current Commissioners are no exception.”
Delaney would not address the governor’s insistence on reappointing industry representatives, whose posts were intentionally eliminated, to slots reserved for a patient advocate and member of the public.
“This commission was created by Gov. Sisolak to comprehensively examine access to quality and affordable health care for all Nevada residents, in all communities across the state, and includes a wide array of individuals representing multiple areas of expertise and experience,” Kahn said in a statement. She declined to address the inherent conflict in representing the interests of PhRMA and the public.
“We tried to restructure it. We got the bill through both houses, got a signature on the bill, but ultimately it’s up to the governor as to what positions he wants to put people,” says Carlton. “Change happens slowly.”
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