Providers say Huntridge clinic’s temporary closure highlights need for legislative reforms 

The Huntridge Family Clinic, the largest LGBTQ+-centered medical clinic in Southern Nevada, announced its temporary closing in April after a decade because of increased staffing costs, but hopes to be able to reopen by the end of the month.

Each year, the federal Department of Health and Human Services Ryan White grant, which aims to prevent AIDS/HIV infections, comes to a close and it takes about two months to renew, but the clinic usually absorbs the costs for those two months, said Rob Phoenix, the family nurse practitioner who owns and operates the clinic.

“This year we couldn’t do it,” he said. 

Phoenix laid off the entirety of his staff on April 7 after he couldn’t make payroll, and started redirecting patients to other providers in the community. He said he hoped renewed grant funding will allow the clinic to reopen by the end of May. The Huntridge Family Clinic is in active negotiations with a “like-minded, vision-oriented” partner to resume operations as soon as possible, Phoenix said.

While Nevada law prohibits insurers from denying coverage for transgender-related health services, three of its surrounding neighbor states don’t (Arizona, Utah, and Idaho), and both Utah and Idaho passed laws this year restricting trans health care, with Idaho making it a  felony to provide gender-affirming health care — a trend happening at the state and national level with 129 bills introduced this year alone.

A national history of discrimination and mistrust

The Huntridge Family Clinic’s history is rooted in providing trans-affirming care amid a lack of options.   

“The way that I actually started doing this is that I had a mom who called me and said ‘My son is transitioning and we’re having trouble finding someone to manage testosterone and his transition, can you help us?’ that’s patient zero for me, he is still my patient and I see him about every six months and he’s done amazing,” Phoenix said. 

The Huntridge Family Clinic provides HIV prevention, HIV treatment, transgender health care, and  primary care that’s culturally competent, safe, affordable, and accepting of major commercial insurances like Cigna, Blue Cross, and Aetna, but also all Medicaid and more recently the Culinary Insurance. It was also the largest provider in Southern Nevada of the medication Pre-Exposure Prophylaxis Prevention (PrEP) which reduces the risk of contracting HIV from sex by 99% and by injection drug use by 74% 

While the clinic is working with other providers in the area to ensure that all patients receive the continuum of care they need, there is mistrust in the LGBQT+ community of the health care system. More than one in six LGBTQ+ adults reported avoiding health care due to anticipated discrimination. More than half reported experiencing slurs, microaggressions, violence, and harassment in health care encounters, according to a 2019 Health Services Research study on discrimination in America.

“The big pieces are around historical and current concerns in our community. Many people have experienced discrimination when in the past or currently when they tried to access health care,” said Jason Flatt, an assistant professor at the UNLV School of Public Health’s Department of Social & Behavioral Health. 

Discrimination against the LGBTQ+ community has been prominent throughout the history of health care in America — from being diagnosed as a mental illness in the DSM5, the diagnostic manual for behavioral health needs, until the 1970s, to the AIDs epidemic, where physicians were threatened with eviction for treating people with AIDS and the Florida home of three teenage boys with HIV was burned down after they were allowed to enroll in school, to LGBTQ+  gender dysphoria not replacing gender identity disorder in the DSM5 until 2013. 

The discrimination is exasperated for people who are trans and non-binary, Flatt said, noting that it can range from the front desks at hospitals using the wrong pronouns or saying the wrong name to asking if a patient needs to be tested for an STI when going in for an injured shoulder. 

“There are resources but we need to invest in them and make them bigger so they can handle the demand, Flatt said. ”My hope is that Huntridge will come back, and if so, we need to make sure this never happens again, that they have the resources and the financial support that they will never have to close their doors again,” they said.  

Costs, payments and policy

The costs of services, the burden of getting payments from insurance companies, and the unequal reimbursement rates between nurse practitioners and physicians for the same services all contribute to the financial stresses of the clinic, Phoenix said, citing how Medicaid pays 80% reimbursement for the same services he provides as a nurse practitioner compared to the full reimbursement rate for a physician.

“Right off the bat, I’m in the hole 20%. My office cost is the same, my visit level is the same, the services are the same,” he said, noting that it’s not just Medicaid he struggles with. “The system is broken against the patient and you and me, but broken in favor of Anthem, Blue Shield.” 

Phoenix said that it isn’t just his private clinic that’s struggling with the cost of health care, but that private practices throughout the entire spectrum of health care are declining across the nation. For the first time since 2012, the number of physicians working in private practice dropped below 50% in 2020, according to the American Medical Association. 

The benefits of being in a private practice allowed Phoenix to choose his staff — many of whom were a part of the LGBTQ+ community. The clinic could select the insurance it wanted to work with, provide the health care practices that were needed, and change operations to meet the needs of the LGBTQ+ community in Nevada without concerns or control of larger hospital systems. 

But more of the hospital and health care system is being increasingly consolidated, the result typically being higher costs to patients and lower compensation to providers, according to the Health Care Pricing Project. 

“The day of the single provider all by themselves is drying up and going away,” Phoenix said. 

Phoenix wants people to become more involved with health care policy during this legislative session. A bill expanding parity for telehealth services,  another providing parity to pharmacists when they provide the same services as other health care workers, and a bill that advocates for provider parity and continuous services for those with HIV are currently making their way through the Nevada legislative session, each with bipartisan support . Such measures would have helped the Huntridge Family Clinic avoid the financial strains, Phoenix said. 

Flatt agreed that advocating in the legislature for healthcare policy change is the most beneficial way to help the Huntridge Family Clinic. 

“Us being visible gives people hope,” Flatt said.