Cleveland Clinic to offer urology services

Cleveland Clinic, recognized as having the nation’s top heart and urologic programs and well-known to Southern Nevadans and Alzheimer’s disease researchers for its operation of the Lou Ruvo Center for Brain Health, will start offering urology services in Las Vegas in mid-April.

The expansion by the $6 billion nonprofit health care operation, lauded during the presidential debates by President Barack Obama and Republican contender Mitt Romney as an example of how health care should be delivered, could be the medical center’s first step toward opening a facility in Nevada that offers many types of specialty care.

“I think the grand vision is to have another Cleveland Clinic hospital next to the Ruvo Center downtown,” Dr. Scott Slavis said.

He and Dr. Laurie Larsen will be the first to offer urological services in Southern Nevada for the 92-year-old institution, which has 43,000 employees in Cleveland; Las Vegas; Weston, Fla.; Toronto; and the United Arab Emirates.

In U.S. News & World Report’s Best Hospitals 2013, Cleveland Clinic’s heart, nephrology (kidney) and urology programs were ranked No. 1 in the nation, with 14 specialties placing in the top 10. Overall, the Ohio medical center ranked fourth nationwide.

Dr. Eric Klein, chairman of the Cleveland Clinic’s Glickman Urological and Kidney Institute, who will oversee the urology operation in Las Vegas, expects two more full-time urologists to join Slavis and Larsen –– the Cleveland Clinic acquired their Las Vegas practice . Klein said many of the institute’s 40 urologists will get licensed in Nevada .

Operations, including those for prostate cancer and female incontinence, will be performed at Sunrise Hospital and Medical Center. The most complex cases could be sent to Cleveland, Klein said.

The Cleveland Clinic’s new offices in Las Vegas will be in Doctors Pavilion, 3131 La Canada St., near Sunrise Hospital.

“The community has welcomed our brand of medical care at the Ruvo Center, and we want to recapitulate that success in urology in Las Vegas,” Klein said, stressing that while further plans for expansion are uncertain, a positive response to the Cleveland Clinic’s medical model would make it more likely.

Las Vegas Mayor Carolyn Goodman said Wednesday she is overjoyed by the Cleveland Clinic’s expansion. “It is superior in everything it does and gives our people a wonderful medical option right here in our community.”

Dr. George Alexander, president of the Clark County Medical Society, said his organization welcomes well-trained physicians to the valley, and urologist Joseph Candela said, “There’s plenty of work for everyone. There’s a two-month wait to see me.”

But Dr. Mark Leo, the Las Vegas Urological Society president who trained at the Mayo Clinic, takes a different tack. He said people should remember that when institutions such as the Mayo Clinic and Cleveland Clinic expand, “it’s part of a business model,” not for altruistic purposes.

“They go into a growing population center and make inroads to help the mother ship. They’re not coming here to save the day. There’s not a lack of care here. Many of our doctors have trained at places with great reputations.”

Some notable Nevada residents have left the state for urologic medical care. In 2008, Jim Rogers, then head of the state’s higher education system, went to California for bladder reconstruction surgery. In 2002, then-Gov. Kenny Guinn had prostate cancer surgery at the University of California, Los Angeles. Six years earlier, then-Gov. Bob Miller went to California for prostate cancer treatment.

“Our specialty care is outstanding here,” Leo said, suggesting that there are times when patients don’t end up with the local physicians best able to care for their particular conditions. “I don’t think they’ll bring technology or training here that we don’t have.”

Some urology specialists in Nevada have had problems.

In 2011, the license of one of the best-known urologists in the Las Vegas Valley, Dr. Michael Kaplan, was suspended after he admitted reusing medical devices during prostate biopsies that were intended for only a single use. Patients were tested for HIV and hepatitis C, and none contracted either disease.

A second urologist, Dr. Lawrence Newman reported himself to the board for reusing single-use medical devices. No board action was taken against him.

Later in 2011, Kaplan, a defendant in at least nine medical malpractice cases, had his license reinstated with the provision that a third party monitor his infection control.

Slavis, who did much of his clinical training at the Cleveland Clinic, said he has worked hard for many of his 20 years in practice to help bring the Ohio institution’s “superior medical culture” to Las Vegas

“Believe me, the reason this came about is to improve the quality of urologic care in Las Vegas,” he said. “We’ll have new subspecialists here and the most up-to-date equipment. We can consult with the best in the world on complex cases.”

Cleveland Clinic physicians have been meeting regularly with Slavis and Larsen and their staffs, orienting them to their electronic medical records systems and protocols.

“It’s great to just concentrate on medicine, not the business of health care,” Larsen said.

He specializes in female urology, which is often concerned with urinary incontinence and pelvic floor prolapse, voiding dysfunction and recurrent urinary tract infection.

The Cleveland Clinic pays its doctors a flat fee no matter how many consultations or procedures they perform, as opposed to the normal fee-for-service model. Doctors have no tenure, and their performance is evaluated annually.

To become more patient-centric, the Cleveland Clinic reorganized about four years ago by grouping doctors in institutes such as the Glickman Urological and Kidney Institute, so specialists in everything from treatment for benign prostate enlargement and prostate cancer to kidney stones and testicular cancer can trade ideas for better results.

Larry Ruvo, the philanthropist businessman who founded the Cleveland Clinic Lou Ruvo Center for Brain Health in honor of his father, who died of Alzheimer’s, believes a strong presence by the Cleveland Clinic in Las Vegas can mean medical tourism is realized in Southern Nevada.

“You need something like the Cleveland Clinic brand to get people here from all over the world,” he said.

That brand can help patients stay in Nevada, according to Dr. Nicholas Vogelzang, the world-renowned urology oncology specialist who works for Comprehensive Cancer Centers of Nevada.

“We already have talented doctors here,” he stressed, “but the Cleveland Clinic will consistently bring a level of surgical expertise not perceived to be here. That will help everybody, help keep cases in the valley. It’s not going to happen overnight. But in the long run they will probably help the valley’s economy.”

Contact reporter Paul Harasim at pharasim@
reviewjournal.com or 702-387-2908.