Task Force Agrees to Disagree With Inova's Consultant

Task Force Agrees to Disagree With Inova's Consultant

At its first open meeting since its initial gathering, the Southeast Health Planning Task Force was assured, "There is no proposal for a new hospital anywhere near Mount Vernon Hospital in the immediate future."

That statement came from George Barker, the Task Force representative of the Health System Agency of Northern Virginia. However, when pressed to define "immediate," he said, "Immediate means not in this six month period."

Barker emphasized that applications for new hospitals are accepted only once every six months. He did verify that three applications had been received by the agency. "They were all variations of applications previously filed," he explained.

"HCA is again proposing a hospital in the western portion of the county," according to Barker. "Inova Fairfax Hospital has been approved to expand."

Barker went on to explain to the Task Force at their July 10 meeting at Inova Mount Vernon Hospital that there are several factors that influence planning for health services. Each of these revolved around the volume of services which "correlates to the quality of care," Barker said.

"There is an extremely strong correlation between volume and costs," Barker insisted. "If there is high volume the costs are reduced. If there is low volume the costs are high." This is the same concept as followed by mass marketers in the retail field.

AS AN EXAMPLE he cited obstetrics as "an area where there is a very high cost factor." He cautioned the Task Force, "Don't authorize any new obstetric services unless you are going to have at least 3,000 deliveries."

Barker pointed out that in an analysis of both Northern Virginia and statewide facilities done by the agency, the other question asked was, "How much does obstetrics generate in other business?" He stated, "The answer is 'it is not a generator.'"

The study looked at both delivery and nursery facilities at various hospitals, Barker noted. "There is a 20 percent cost difference between large and small volume hospitals. And, in every category the hospitals of high volume had 10 percent less baby deaths statewide."

He also maintained that quality of care in general is correlated to volume. "In service after service, what you see is that those types of services that have high volume have a better quality. There is more correlation between physicians and staff as to assessing patient situations in high volume facilities as compared to low volume ones," Barker stressed.

"The real difference is not necessarily in the medical procedure but rather in the follow up nursing care. The more patients the nursing staff cares for, the more they are able to spot problems more quickly," he emphasized.

IN FOCUSING on the relationship between volume, quality of care, and hospital income, Dr. Khosrow Matini, a Task Force member and practicing physician at Inova Mount Vernon Hospital, asked Patrick Walters, senior vice president, Inova Health System, about the proposal by U.S. Rep. James P. Moran (D-8) to bring services offered military veterans and their families at DeWitt Army Hospital, Fort Belvoir, to Inova Mount Vernon Hospital.

"The possibility of a marriage between DeWitt and Mount Vernon is an extraordinarily positive proposal," Walters responded. "Combining these two hospitals would be a godsend."

Gerald Hyland, Mount Vernon District Supervisor, pushed Walters by asking, "Is there an interest on the part of Inova to respond to the opportunity in Moran's proposal pertaining DeWitt and to joint replacement procedures. Is Inova interested in either or both, and what have you done to encourage this?"

Walters answered, "We have responded to both proposals. We are now waiting for Walter Reed Hospital to respond." Hyland suggested to Walters that "we be a bit more proactive. Get the various parties around a table. I heard from Walter Reed they are waiting for us."

FOR THE FIRST TIME since the Task Force's inception a cohesion within the group seemed to materialize when The Lewin Group, a management consulting firm hired by Inova Health System, gave its first report. There was a consensus of indignation that the Task Force had not been thoroughly consulted before the report's presentation.

When Keith W. Hearie, vice president, The Lewin Group, opened his remarks by stating, "We are working for you," he was immediately corrected by former State Sen. Joseph Gartlan.

"Since your group is not paid by us and hasn't presented the report to us before now, how can you say you work for us?" Gartlan asked.

Hearie acknowledged the report had been pre-submitted to Inova Health System and that they had suggested "minor" changes. Hyland requested that, as the report is presented, those changes be pointed out to the Task Force.

Hearie outlined those areas where there seemed to be agreement by all parties studying the Inova Mount Vernon situation and those areas where there are serious questions. In the first category he listed such items as:

*Inova Mt. Vernon is a valued community asset,

*The hospital should remain,

*Charity care is increasing,

*Medical staff is decreasing,

*The entire Inova Health System is having financial difficulty, and

*Medicaid is reducing reimbursements.

When he got to the point, "There is a critical market risk in Southeastern Fairfax County," Hearie explained, "This is code for another hospital is possible."

He then explained, "In any scenario Inova Mount Vernon would remain in its present location until at least 2008. It would take that long to build a new facility if the decision were made tonight to close this hospital."

THAT BROUGHT forth an angry response from Task Force member former U.S. Rep. Herbert E. Harris III, who pointed out that the object was to keep the hospital where it is "and expand its service; not focus on a possible closing date."

Harris insisted, "Inova Health System should say in the paper they are doing everything to preserve Mount Vernon Hospital." Walters said that had been done in a recent advertisement signed by Susan Herbert, administrator, Inova Mount Vernon, and Knox Singleton, CEO, Inova Health System. Hyland pointed out, "The ad did not make that categorical statement."

In the category of questions where there is no consensus, Hearie cited:

*Can Inova Mount Vernon be a viable facility in its present location?

*Has Inova Health System done everything it can to assure the hospital's long term viability?

*What new services would be viable?

*Can Inova Health System tolerate a certain level of loss at Inova Mount Vernon as part of its not-for-profit mission?

Hearie admitted, "The Task Force and Inova Health System have different questions as to the hospital. The Task Force is asking how the hospital can be viable and Inova is asking can the market risks be managed."

Walters interjected, "We are looking at the best way to provide health services to this part of the county." That's when Anne Andrews, another Task Force member, stated, "Your definition of this part of the county is far different from ours."

Dr. Matini inquired of Walters, "Why do you want to build another facility when you already have the market right here?" He was joined in interrogating Walters by Jeffrey McKay, another Task Force member and chief of staff to Lee District Supervisor Dana Kauffman.

"Are you saying Mount Vernon Hospital doesn't have the capacity to meet the demands of the future?" McKay asked Walters.

"That's a good question," was Walters only response.

Harris pointed out, "Inova Health System has never told us the real cost factors at play here. Is that due to things here at the hospital or things happening at headquarters?"

Barker interjected, "This hospital has had a real financial change since 2001. That financial information is critical to finding out what is actually happening here."

Matini emphasized, "The major portion of the income for this hospital goes to Inova Health System. If that were not so this hospital would be in the black."

He also questioned a previous assertion by Inova Health System that Inova Mount Vernon had a location problem that was working to its disadvantage.

"People will travel great distances if the services and expertise are there. That is what patients base their decisions on," he said.

HYLAND THEN ASKED what new services were being considered for Inova Mount Vernon. The answer from Herbert and other hospital officials were additional rehabilitation, mental health, geriatric surgery, doubling the capabilities of the wound center with longer hours, a low vision center, a pain management program, radiation therapy, and specialty surgical procedures.

After hearing the answer, Hyland queried, "If all these services were implemented, or if only 75 percent were, would this affect the bottom line positively? Also, are you looking at getting rid of services to impact the bottom line?"

There was no definitive answer given by Herbert, Walters, Barker, or the management consultants. But, Gartlan noted, "In the last 15 minutes I see emerging the role of the consultant (The Lewin Group) to give us the necessary information to preserve this hospital."

Hyland also asked Walters, "Does Mr. Singleton intend to continue to participate with this group? Is he ever coming back?"

Walters indicated that the decision about Singleton's attendance is made at the time of each Task Force meeting.

Earlier in the meeting Hyland had noted that, after a long period of nonrepresentation, the Mount Vernon District now has a representative on the Inova Health Care Services Board which oversees operations at the various facilities of the Inova Health System. He is John Ribble III.

Hyland also inquired of Walters, "Has any effort been made to have the new Mount Vernon representative on the Inova Board come to these meetings? Having him here would be very helpful."

There was no answer.