‘It’s a problem’

These primary care and hospital challenges have their own ripple effects.

The mines and other large employers, looking to avoid the hospital’s high prices, have contracted with a surgery management company that coordinates out-of-town care, often in Salt Lake, to save money. Patients who have the means travel on their own.

Doctors argue this exacerbates the community’s specialist workforce shortage. With many of the best-insured patients traveling out of town, it’s harder to attract physicians who might give people a reason with good insurance to stay.

“Basically, that keeps out the possibility of some new gastroenterologist coming in and setting up his own shingle. ‘Well, wait, the paying portion of the procedures are now being sent to Salt Lake,’ so you’re left with just the Medicare and no one else,” said Dr. David Hogle, a private practice primary care doctor in Elko.

An out-of-state company that in March opened an outpatient surgery center in town could improve access to some specialty care. It accepts the insurance and surgery management plan offered by the mines, Medicare, and veterans and Indian Health Services benefits and eventually expects to take all plans, including Medicaid, according to Angela Browning, the center’s business office manager.

Kevin Lutz, executive vice president of health care operations, policy and research at Community Health Development Partners, said the company chose Elko for its first surgery center because of the community’s needs and its high rate of commercial insurance. Lutz said people shouldn’t have to travel for care the community could support.

“The good thing about Elko, and probably most mining communities, is they have good benefits, and that could keep a business solvent,” Lutz said. “If you only took 80 percent Medicaid or Medicare, you couldn’t operate.”

Surgery center staff said they’re trying to recapture the population leaving town for surgeries, not compete with the hospital. But Ackerman, the assistant dean of rural health at the University of Nevada, Reno School of Medicine, worries that’s what could happen. For instance, if fewer people go to the hospital for outpatient cardiology, that’s less reason to keep around a cardiologist who could also provide emergency cardiac care — something the surgery center, by definition, cannot do.

“We will have an emergency in this community at some point in time, like we’ve had in the past where you have a mine bus accident or something like that, and then all of a sudden the services that you expect at your hospital to take care of your emergency aren’t there,” Ackerman said. “It’s a problem, and I don’t know what to do about it.”