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Doctors Digest Inova Feedback

Response to letter shows both hope and concern.

After a letter of concern was sent by doctors of Mount Vernon Hospital to Inova Health Systems over the possible closure of the hospital, officials at Inova have responded, 43 days later.

The letter to Inova from the doctors was headed "Mt. Vernon Hospital Solutions." The return letter presented rationales for those solutions pointing out why many of them were not practical from a business sense.

The concluding sentence of the doctor's letter, signed by the officers of the IMVH medical staff, stated, "Hopefully these proposals will reverse the financial trends and make Mt. Vernon again a valued member of the Inova "family" without any change in location even being contemplated."

That hope was challenged in the second paragraph of the answering letter signed by J. Knox Singleton, president and CEO, IHS, and Susan M. Herbert, vice president, IHS Administrator, IMVH. It opened with, "From Inova Mount Vernon's first opening day (in 1976) the challenges have been there."

This was the lead-in to a list of stated problems that worked against IMVH's success from day one, according to Singleton and Herbert. Some of the obstacles they cited included the expected access to the hospital with the connection of Van Dorn Street to Lockheed Boulevard that "never materialized, and, as we know now, never will." This they blamed on patients going elsewhere for medical care. They also blamed the closing of Woodlawn Road for patients going elsewhere.

The Inova officials also said the medical staff has not grown. "We are seeing an aging of current practitioners that is not adequately being made up by younger physicians..." and they wrote to the doctors,

"We are seeing significant growth in the communities of Lorton, Newington, south Springfield, and Kingstowne. We expect that growth to continue and accelerate, particularly in the Lorton area..."

ON THE MONEY side, Singleton and Herbert asserted, the "budget pressures at the state level have cut Medicare funding by $772,000 at IMVH this year alone. Medicare cuts at IMVH will approach $1 million next year. Budget pressures at the county level have led to tightened access to Community Health Care Network pushing more unfunded indigent patients into our emergency rooms."

In spite of all these rationales, Singleton and Herbert emphasized, "Inova Mount Vernon continues to be a vital part of the Inova family ... Proper stewardship and efficient operations are essential for us to continue fulfilling our mission of serving our neighbors, regardless of their ability to pay."

When it came to the suggestion that IMVH "not be held to the standard of balancing their costs with their revenues," Singleton and Herbert argued, "an internal system of debits and credits for the flow of indigent and insured patients would be extremely complex to design and maintain and would likely not improve, and may well be detrimental to IMVH's current financial picture." The short answer is 'No.'

Singleton and Herbert insisted, "we share a common goal of short term and long term prosperity for Inova Mount Vernon Hospital ... Inova is committed to implementing any new program at IMVH that meets a community need, can be delivered with excellent clinical quality and is viable from a regulatory and economic point of view."

Three of the four doctors who signed the July 19 letter, as officers of the IMVH Medical Executive Committee, Cleveland Francis, President; Howard M. Lando, Vice-President; and Khosrow Matini, Immediate Past President, now serve on the newly constituted Citizens Alliance Rescue Effort, CARE.

It was recently constituted by Mount Vernon District Supervisor Gerald W. Hyland as a broad-based citizen organization with the primary mission of saving Inova Mount Vernon Hospital as a full service medical facility. The first meeting of the CARE Executive Committee, on which the physicians serve, was held Monday night.

LETTER HIGHLIGHTS

Singleton and Herbert entered into a point-by-point answer to each of the concerns and suggestions put forth in the doctors' letter of July 19.

* Wound Healing Center and Endoscopy Suite. —

"An architect is currently working on plans for both of these vital services, and construction is slated to begin by year-end," they wrote. As for the Endoscopy Suite, they maintained, "this past year the hospital lost a significant number of patients using this service because physicians began performing this procedure in office space near the hospital." This resulted in a 30 percent decline in patient care for this procedure, according to Singleton and Herbert.

* Emergency Department Expansion —

Renovation in this area is underway.

* Outpatient Services —

A second new state-of-the-art CT Scanner and a third nuclear medicine camera have been recently added.

* Bariatric Surgery —

"Capital plans have been approved to bring this ... to IMVH. We are currently in the process of recruiting qualified physicians to perform bariatric services ..."

* Rehabilitation Program Expansion —

"The bed complement will be reconfigured to increase the effective capacity of the rehab program, with construction due to start by mid- September."

* Psychiatric Services Center —

"Inova is exploring the feasibility of making the program at Inova Mount Vernon the designated Inova psychiatry services provider in the eastern region as a means to increase the patients served by IMVH." This was stated even though they acknowledged "more patients needing these services are uninsured or not able to pay for their care."

* Cardiac Catheterization —

"Inova has agreed to focus 100 percent of the mobile catherization lab's time at IMVH if that will meet the cardiologists' needs."

* Ophthalmology Services —

"We have invested more than $500,000 in equipment ... 13 percent of our IMVH outpatient surgeries are ophthalmology-related procedures."

* Urology and Vascular Equipment — "We provide the appropriate laser equipment needed for urological procedures as needed by renting the needed equipment."

* Obstetric Services — "Creation of obstetric services at IMVH would pose a number of significant challenges." The investment to do so was estimated by Singleton and Herbert at exceeding "$15-$20 million." They noted, "the likelihood of obtaining the Certificate of Public Need [COPN] to add obstetrics ... is minimal." They concluded, "the data does not support the idea that an obstetrics program at IMVH would be sustainable." This was one of the primary suggestions from the doctors to IHS.

* GYN Oncology Services —

"IMVH has been recruiting GYN physicians for several years now, with little success."

* Pediatric/Neonatal ICU Program —

"The other Inova community hospitals ... each have a pediatric average daily census of less than five, which is reflective of the national trend in the standard of care," they emphasized.

* Radiation Oncology —

Singleton and Herbert argued that the Virginia Commissioner of Health would not approve this due to the lack of the need for it under the standards of COPN.

* HealthPlex Referrals and the establishment of a HealthPlex at Lorton —

"In 2002, a number of patients were referred to physicians not on staff at IMVH because there was an insufficient number and specialty physicians on call at IMVH," according to Singleton and Herbert. As for a HealthPlex at Lorton they acknowledged that, "is being evaluated as part of our long-term Southeastern Strategy Planning efforts."