Residents of the Mount Vernon and Lee districts who depend on Inova Mount Vernon Hospital (IMVH) as their primary health-care facility got an unqualified assurance last Thursday that it was here to stay.
That promise came from Knox Singleton, president and CEO, Inova Health System, at the first meeting of the newly constituted Southeast Health Planning Task Force. It is composed of 16 members assigned the task of evaluating the viability of the hospital from a managerial, structural and service perspective.
"Is the hospital going to close?" Singleton asked rhetorically. "The answer is no." He further insisted, "This is not a back door way (the naming of the Task Force) to get the hospital to close. It is a viable way to get the hospital to become stronger."
Knox emphasized, "There have been rumors that Inova is not investing enough in Mount Vernon Hospital. Part of the future is going to be investing in this site and its programs.
"Five years ago HCA proposed a hospital in Springfield. This isn't about HCA. This is about responding to the needs of the community. It is part of our regular five-year planning process. This is not a short-term response to HCA."
The trigger to naming the Task Force and beginning a comprehensive planning analysis was the rumor that the hospital was on a slippery slope to oblivion. This was brought into the open by Mount Vernon District supervisor Gerald W. Hyland (D) at his Jan. 25 Town Meeting.
At that time, in front of a packed house in Mount Vernon High School's Little Theater, Hyland promised to do "everything I can keep Mount Vernon Hospital operating." He acknowledged Thursday night "several week ago we met here in Mount Vernon to form this committee."
Hyland noted, "This group of persons has been brought together based on the needs of the hospital. There are physicians here that have expressed the thought that the hospital might be in trouble. We need to get ahead of that. Find out the truth and get it all on the table."
At the last meeting of the Mount Vernon-Lee Chamber of Commerce, Susan Herbert, the hospital's vice president and administrator, assured that audience IMVH was not closing. She went on to state then that the hospital's staff, physicians and newly created citizen committee would be working in concert with Inova Health System to ensure the facility's long-term existence.
As he had done at the Town Meeting, Hyland reiterated his demand that "someone from Mount Vernon be named to the Inova Board of Trustees." He again stressed, "The community has not been part of the Inova planning process. I hope we are starting with a blank piece of paper to consider all the elements that will guarantee the future of Mount Vernon Hospital."
KNOX ASSURED Hyland and the Task Force members, "Our Board will have a member from Mount Vernon. I have told Gerry I will convey this to the Board." He also pointed out that at one time Mount Vernon was well-represented on the Inova Board.
Hyland exclaimed, "You can't really feel too strongly about something that is, and has been, such a part of this community. Trying to decide what services need to be added and expanded in the hospital is going to be a big job. I don't want to lose anything we now have."
Hyland did recognize, "with some chagrin, I recently learned our [IMVH] bottom line is a negative and not a positive. I hope we can reach a consensus on how to keep the hospital open and improve the facility and services." He warned, "My mind will stay open as long as Mount Vernon Hospital stays open."
Chairing the Task Force is Warren Cikens, former Mount Vernon District supervisor. He is joined by former state Sen. Joseph Gartlan; former 8th District U.S. Rep. Herbert Harris; Queenie Cox and Louise Cleveland, Mount Vernon Council of Citizens Associations; and Sharon Kelso, executive director, United Community Ministries.
Others include George Barker, Health Systems Agency of Northern Virginia; Charlene Connolly, Ph.D., Northern Virginia Community College; Kenneth P. Disselkoen, Fairfax County, Human Services, regional manager, Region 1; Jeff McKay, Hyland's chief of staff; Francis Cleveland Jr., M.D., president, IMVH medical staff; Khosrow Martini, M.D., chairman, Planning and Programming Committee, IMVH; Susan Herbert, vice president/administrator,IMVH; Anne Andrews; Harriet Piper; and Mark Sickles.
IN OPENING THE first session, Cikens emphasized the need for open cooperation among all representatives of the Task Force. He quoted Winston Churchill, saying, " If the present quarrels with the past, you lose the future."
He then noted, "A lot of people don't realize how much has been accomplished at this hospital. People come here from throughout Northern Virginia." With that he turned the floor over to Herbert and Pat Walters, Inova Health System, to present the facts relating to the hospital's services, financial status and patient universe.
Inova Health System is just completing the first phase of a regional planning study with a focus on acute outpatient health services, according to Walters. "Southeastern Fairfax County is a key focus area because there have been significant changes here in the past five years," he said.
"There are 300,000 people who live in this area now, and it is forecast to grow by another 22,000 in the next five years," Walters stressed. "One of the primary factors in the evaluation is the ease of getting to various Inova facilities."
He stated IMVH patients come from the following areas by these percentages: Mount Vernon south, 48; Mount Vernon north, 39; Kingstown, 18; Franconia, 18; and Lorton/Newington, 19. By 2010, the southeast area will need an addition 61 beds, according to Walters. Inova Mount Vernon Hospital is currently an 80-bed facility.
WALTERS SAID the needs assessment pointed up the following:
* Current configuration is not the best to meet future needs;
* There needs to be more physician development planning;
* Better access to health-care services is needed;
* Improved access to the full spectrum of outpatient services is needed.
He also emphasized, "Within a 7-mile radius of Mount Vernon Hospital, there are three health facilities. Of those living within that radius, 100,000 have good access to Mount Vernon and 100,000 have fair access."
When it came to non-outpatient services, Walters explained, "Seventy percent of cardiac patients in the area come here, but only 30 percent of them are surgery patients."
Herbert admitted there had been a decline in surgical patients. She also pointed out that between 1999 and 2002, there had been a loss of 72 doctors practicing at IMVH. Herbert told the task force that losses had occurred in the following specialties: primary care, 8; OB/GYN, 1; other medicine, 32; general surgery, 3; orthopedic surgery, 3; and other surgery, 25.
There has also been a dramatic change in annual net operating income from 1993 to 2002, according to Herbert. In 1993 the hospital had a positive net income of $200,000. By 2002, that had shifted to a negative of $300,000. The best year, as portrayed by Herbert's graphs, was 1997 with a significant drop in 1998.
HYLAND THEN queried Herbert, "What in your opinion, and Inova hospital system’s opinion, is it that needs to be done to reverse the loss trend? I would like to know what you think is needed to turn this around." Herbert answered, "The shrinkage in physicians is the major challenge."
Dr. Cleveland Francis Jr. added, "It is clear to the medical staff, if the hospital remains on its current course, we will not be able to serve the community in the best way. It has been our goal from the beginning to be a full-service facility."
In contradiction to Herbert's statement at the Chamber meeting that the closing of Woodlawn Road and its detrimental effect on the hospital "cannot be overestimated," Dr. Matini stated, Woodlawn Road is not a problem."
The closing adds only 20 minutes to the time it takes to get to the hospital. "The hospital is three miles from the George Washington Parkway and five miles from Interstate 95," he emphasized.
Matini's emphasis was on the fact that the hospital had to change its approach to become a family hospital. That was the only way it was going to entice young doctors to practice there.
"Wherever a family's first child is born, that is the hospital that will become that family's hospital," Matini stressed. "The young population in this area is growing. The older population is decreasing."
Matini implored the task force, "Please make this a community hospital. What I'm worried about is that the physicians are not coming here. It's all connected. If you don't have full facilities, people won't come here. You bring the services. You attract the doctors. You get the patients."
Matini exclaimed, "I'm not an economist, but these are common-sense approaches to building this hospital."
IN A HANDOUT from Francis and Matini, the following points were emphasized:
* Current services available at IMVH include rehabilitation, medicine, surgery, radiology, laboratory (including pathology), emergency medicine, psychiatry and wound care center;
* Services that make money for the hospital are outpatient surgery, including wound care and endoscopy; rehabilitation; radiology; laboratory; emergency medicine and wound care center;
* Services that lose money for the hospital are in-patient services regardless of whether they are medical or surgical patients, joint-replacement services and psychiatry.
They also noted, "Since opening the Springfield Healthplex facility, the number of inpatient admissions and outpatient surgeries done at Mount Vernon Hospital has decreased significantly. Studies have shown this has nothing to do with the closure of the access road through Fort Belvoir since September 2001."
Their final admonition was, "If we continue on our current course, the hospital will not be able to survive financially or be able to maintain an adequate number of medical staff to continue running the services adequately."
The doctors submitted seven recommendations from the Planning and Programming Committee to help solve the dilemma:
* Have Springfield Healthplex direct ambulances to take patients to IMVH instead of Inova Fairfax Hospital;
* Add the services of obstetrics, pediatrics, radiation oncology to IMVH;
* Increase the space of the Endoscopy Suite to 4,000 square feet and make it more physician- and patient-friendly;
* Open an outpatient laboratory adjacent to the hospital for use by patients whose insurance will not allow lab testing to be performed in a hospital setting;
* Expand the outpatient surgery facility;
* Expand the wound-care center facility;
* Advance the urology surgery to current state-of-the-art methods and equipment.
Near the conclusion of the meeting, the representatives of Inova Health System passed out a "Draft Work Plan for Task Force," which listed six activities. Hyland took exception to this pre-emptive strike.
"I would hope that the Task Force would develop its own work plan. We have to analyze any other facility that may have an impact on us," he insisted. "I would like to know what you (the Task Force) think is needed to turn this around."