July 6, 2008

How Big Does This Hospital Need to Be?


Norfolk | A fixture in Norfolk since the time of the great yellow fever epidemic in the 1850s, what is now Bon Secours DePaul Medical Center has a long history of serving the city's needs. + But the question of how best to serve the community in the future is a matter of contention between Norfolk city officials and Bon Secours Hampton Roads Health System, which owns the hospital. + The dispute erupted publicly in June when Norfolk withdrew its official support for a Bon Secours reorganization plan that would leave DePaul with 64 beds, just over a quarter of its current size of 238 beds. The city reacted after its hired consultant recommended that DePaul should be a 134-bed hospital with more services. + Kent Stevens, president of Berkeley Medical Group in Northern Virginia, said the city came to him and said, "We're not a health care provider. ... We really would like to make heads or tails of what's being proposed here. Is this a right-sized hospital?" See Page 3

The disagreement comes while there's still time for Bon Secours to change its proposal, which is subject to approval by the state health commissioner's office. State regulations call for a public hearing on proposed health care projects, and changes to the proposals can be made before, but not after. The public hearing for Bon Secours' projects is scheduled for 10 a.m. July 18 at the Lifestyle Center on the Chesapeake Regional Medical Center campus.

But don't look for major changes in Bon Secours' plan.

"Our plans are based on a very thoughtful analysis that has taken place over quite a period of time on how best to meet the community need," said Bon Secours spokeswoman Lynne Zultanky.

While city and Bon Secours officials are looking at the same numbers, they're emphasizing different things. When looking at the number of beds and services, Norfolk stresses the impact on DePaul's service area.

"I don't think the city can afford to lose those hospital beds. That's my biggest concern," said Bruce Holbrook, a past member of the Bon Secours DePaul Health Foundation.

Holbrook also chairs the DePaul Emergency 134 Committee, a residents group started with city help that is protesting the nonprofit Catholic health system's plans .

Bon Secours emphasizes the distribution of beds throughout the region, saying there is - and will be - a greater need in growing areas such as southern Virginia Beach and northern Suffolk.

"We asked, 'Where is the population growing? Where is the population staying the same? Where is it declining?'

" said Elisabeth McNamara, vice president for strategic business development for Bon Secours Hampton Roads. "There really isn't a bed need in Norfolk, but we are committed from a mission perspective to serve that community."

The two also disagree about finances.

Norfolk says DePaul is just one hospital in a health system, based in Maryland, that is profitable overall. By city calculations, Bon Secours' Hampton Roads division - which also includes Maryview Medical Center in Portsmouth and a large outpatient center at Harbour View in northern Suffolk - averaged about $12.6 million in surplus revenue a year between 2004 and 2006. In terms of Bon Secours' Virginia operations, which include hospitals in the Richmond area, the city calculated an average of almost $70 million in excess revenues annually between 2004 and 2006.

Norfolk officials have also expressed skepticism about why DePaul began losing money precipitously only after Bon Secours announced its reorganization. Before that, said Bernard Pishko, Norfolk's city attorney, DePaul was essentially a "break-even operation."

"We don't think that the current operations are reflective of its potential," Pishko said.

Zultanky said DePaul has struggled financially for the past decade. It had an unusually profitable year in fiscal 2005, making about $3.4 million in operating revenue. But since then, DePaul has lost money at an accelerated rate.

It lost more than $5 million last year and is expected to lose about $7 million this fiscal year ending in August, Zultanky said. Between 2005 and 2007, inpatient discharges declined by 17.1 percent. Today, the number of medical and surgical beds in use is typically in the 70s.

Meanwhile, the percentage of charity care goes up each year - in fiscal 2006, $26.4 million, or 7 percent of gross revenues - with fewer paying patients to offset that.

"When that gets out of balance, that's when you see an accelerated loss, and that's what we're seeing," Zultanky said.

Additionally, the continued growth of the dominant physicians group in South Hampton Roads - Sentara Medical Group, with more than 360 physicians - has negatively affected how many patients are referred to DePaul, Zultanky said. She gave the example of how after a cardiology group joined Sentara, DePaul's cardiac catheterization lab became "under-utilized," which is one reason the reorganization proposal includes moving that unit to the proposed hospital in northern Suffolk.

"Sentara Medical Group physicians are free to admit to any hospital based on patients' needs and desires and the availability of appropriate services," said Dale Gauding, a Sentara spokesman.

The debate over DePaul's future size is set against a backdrop of Bon Secours' threat to shut down the hospital.

"If approval is not granted to build a more appropriately sized replacement facility on the existing campus, the community will be in jeopardy of having no facility there at all, as the status quo is no longer sustainable," Bon Secours officials wrote in their application to the state.

This was a somewhat softer stance than Bon Secours took in an application last year to the state health commissioner's office, which ultimately decides such things.

"There are simply two choices in order to maintain DePaul's presence in Norfolk - 54 beds or no beds at all," Bon Secours said then.

The state rejected the 54-bed DePaul, calling it "entirely inadequate to meet that public need." The state also rejected Bon Secours' plans to build new hospitals in southern Virginia Beach and northern Suffolk, which would have received the remainder of DePaul's 238 beds.

Bon Secours is appealing those decisions but in the meantime has submitted revised proposals. DePaul would have 64 beds and more services, such as obstetrics and a small intensive care unit.

In a change from last year, only 90 of DePaul's beds would be redistributed elsewhere, in this case to a proposed facility in the Princess Anne section of Virginia Beach. To build a small hospital in northern Suffolk, Bon Secours would transfer 48 beds from Maryview Medical Center in Portsmouth.

In last year's proposal, the northern Suffolk beds were supposed to come from DePaul as well. The shift to Maryview means that about 84 of DePaul's licensed beds are still in limbo.

"At this time, we don't have any plans for those beds," said Zultanky, who added that they will continue to stay "on the DePaul books as long as the hospital remains operational."

What no one disagrees with is that DePaul needs to be replaced.

"It's flat too old, too expensive to retrofit," said Stevens, Norfolk's consultant. "Too much has changed in the delivery of health care."

And no one disagrees that it could stand to be a smaller facility. But how small?

Stevens said his analysis showed that 64 beds were far too few and DePaul lacked services in key areas. Chiefly, it doesn't have enough inpatient or ICU beds. Also, the proposed emergency department wouldn't have enough treatment bays and would lack cardiac services that could necessitate ambulance services having to reroute suspected cardiac patients elsewhere, he said.

Stevens said that while there are three hospitals within Norfolk's city limits, only DePaul is truly Norfolk-centric, with 70 percent of its inpatient admissions and 85 percent of emergency visits from Norfolk residents.

"That's high. That's huge," Stevens said.

Sentara Norfolk General is more a regional hospital - with only 40 percent of its patients coming from Norfolk - in part because it has the region's only Level I trauma unit, meaning it takes the most serious emergency cases. Sentara Leigh Hospital is very close to the Norfolk-Virginia Beach line, and only 29 percent of its patients come from Norfolk, Stevens said.

McNamara said that in drawing up its plan, Bon Secours is focusing more on what will be rather than what is. Its analysis actually showed 51 beds as a good size for DePaul based on community need. She stressed that the service area for DePaul would be smaller because some of the hospital's current patients would be served at proposed facilities in Suffolk and Virginia Beach.

Before Bon Secours submitted the proposal publicly, McNamara said, DePaul added three beds for design reasons. Ten obstetrics beds were included after negotiations last year with Norfolk city officials, providing a total of 64, she said.

"How we do business today is not how we'll do business in the future," McNamara said.

National trends such as increased outpatient surgeries, better technology and other services have reduced the need for hospital beds.

"Health care should not be defined in terms of beds," McNamara said. "The bed focus almost creates a misperspective on what health care is."

In the end, Holbrook, the advocate for a larger DePaul, wishes the key players would get together with the intent to resolve this disagreement.

"The city needs to sit down with DePaul and Sentara and figure out what the best mix is for Norfolk," he said.

Nancy Young, (757) 446-2947, [email protected] And one linear accelerator (for cancer radiation treatment). Both have proposed six operating rooms.

this is what Bon Secours wants

uE06C 48 medical/surgical beds

uE06C 10 obstetrics beds

uE06C 6 ICU beds

uE06C 10 to 15 emergency room bays* this is what the city of Norfolk wants

uE06C 103 medical/surgical beds

uE06C 11 obstetrics beds

uE06C 20 ICU beds

uE06C 22 to 25 emergency room bays* 64

total beds* 134

total beds*

Originally published by BY NANCY YOUNG | THE VIRGINIAN-PILOT.

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