An Inova Health Systems representative expressed surprise and frustration at last week's demonstration by the Tenants and Workers Support Committee asking for increased financial help for low income families receiving care at Inova’s Alexandria Hospital.
"We were very surprised by this march because we have been working with them for a year and half to meet the needs of their people," said Elita Rosillo-Christiansen, assistant vice president for Community Health and Cultural Competence, Inova Health System.
The march’s main purpose, according to Jon Liss, director of TWSC, was to increase charity care at the hospital and gain an audience with the hospital's board of directors to address what he described as "the health care crisis of Northern Virginia's uninsured."
The hospital has met with Liss and his group on these issues, Rosillo-Christiansen said. "We have met at the hospital or in the Tenants and Workers offices. We had a public forum which 100 individuals attended. And we had one of our board member physicians at that meeting to answer their questions," she said.
ACCORDING TO ROSILLO-CHRISTIANSEN, Inova Health Systems provides more charity care than most other health facilities in Virginia. "Throughout the Inova system we have provided nearly $58 million in charity care. We review the charges of any case brought to our attention," she said.
She noted that the Inova Health System, which includes Alexandria Hospital, goes above and beyond the federal guidelines for poverty income in assessing charity care cases. "We have studied 34 cases submitted by TWSC and have written off an additional $87,000 in care costs based on those reviews," she said.
She offered two examples of how the hospital uses federal poverty guidelines: a family of four, with an annual income of $36,000; and a family of eight, with an annual income fo $74,325.
"In the first case we will discount the bill 45 percent and in the latter 25 percent. If the eight person family had an income of only $52,000 their bill would be discounted up to 70 percent," she said.
"In many instances we find that the applicants have insurance and don't even know it. It's primarily a language and cultural issue," Rosillo-Christiansen said.
A FAMILY OF FOUR with an income of 125 percent of the federal poverty level should have their bill covered 100 percent according to the Tenants and Workers Committee. But the committee wants higher levels of income covered.
"Jon Liss is demanding free care for all individuals, up to 250 percent of the federal guidelines. I told him that this is not the way it's done in this country, Rosillo-Christiansen said. “Everyone, to some degree, depending on individual circumstances, has to carry their own weight. Nobody is simply entitled to free care.”
But the national guidelines are not realistic for the Washington area, Liss argued. "If they want to use national guidelines, they have to be greatly increased based on the Northern Virginia economy," he said.
Rosillo-Christiansen said that cases from TWSC come through Liss' office. "We have told the patients that they can come directly to us with any complaint they have. In many cases going through the Tenants' and Workers' office slows the process,” she said. “TWSC also charges the patient $25 for their help, which is an additional unnecessary expense."
UNDER THE PRESENT SYSTEM, TWSC gives Inova Alexandria 10 cases at a time for reevaluation. "We then do the research on each case and meet with the patient or their representative individually. In the last group, seven didn't even show up," she said.
"Another frustration for us is that this group [TWSC] acts like they're speaking for the whole Hispanic community in Northern Virginia. They're not," Rosillo-Christiansen said. "We are working with the Hispanic Community of Northern Virginia and they do represent the entire Hispanic community."
Liss wrote a letter to Yolanda Partida, program director of the Tomas Rivera Policy Institute in Claremont, Calif., dated Jan. 30, 2002, in support of a grant being sought by Inova Health Systems.
Inova Health System has applied to the institute for a $150,000 one-year grant, awarded to 10 health care systems nationwide, to test interpretive systems designed to improve communications between patients and health care providers.
Inova’s partners in applying for the grant are The Alexandria and Fairfax County Health Departments, Northern Virginia Community College, Hispanic Communities of Northern Virginia, and the Northern Virginia Health Education System, according to Rosillo-Christiansen.
In the letter, Liss wrote that the TWSC “is pleased to add this letter in support for the Inova Community Health/Cultural Competence Division's Letter of Intent for Hablamos Juntas: Improving Patient-Provider Communications for Latinos.
"As a community-based organization serving the northern Virginia community,” Liss wrote, “we value and share Inova's Commitment to linguistically and culturally competent services for our members and community. As a Hablamos Juntos grantee, Inova Health System will provide effective leadership to harness the participation of all community stakeholders."
"His attack on us is not consistent with his letter," Rosillo-Christiansen said.
SHE SAID THAT one of Liss' inquiries was whether or not Inova Alexandria Hospital had interpreters available to aid in patient/provider communications.
"All our hospitals are equipped with Cyracom telephone systems,” she said. “This gives patients and providers immediate access to 150 languages. You just punch in a code for a specific language and a translator comes on line.”
In a news release dated March 29, reacting to the TWSC march, Inova Alexandria hospital said, "Funding for the uninsured and underinsured is a national problem which federal and state governments must address. We have done as much as we are able to do as a community hospital."
Liss says that he has worked with Rosillo-Christiansen and Inova Alexandria Hospital.
"But if we can't crack through to the Board we have to do what we have to do. We are dealing with the largest employer in Northern Virginia. Eighty percent of the Latinos in our community don't have insurance," he said.