Regional health agency faces an uncertain future

NORFOLK

"Welcome. I don't know how long we'll be in existence, but welcome."

That was the greeting from Bernard Einhorn, chairman of the Eastern Virginia Health Systems Agency's board, to a new member at its meeting this week.

From there, the treasurer gave her report. The EVHSA - which analyzes proposed local health care projects and advises the state health commissioner on whether to approve them - had $4,236.51 in its checking and savings accounts.

The board then discussed whether it would have to shut down for lack of money.

"By Aug. 4, we will no longer be a viable agency if we don't come up with a different plan," said Mike Byrnes, executive director of the agency and its only paid employee.

The trouble began earlier this year when, after years of reduced funding for the state's five regional health agencies, the General Assembly decided to do away with support altogether. Last year, that totaled $300,000 for all five. The agencies, which date back to the 1970s, when they were part of a much larger federal planning effort, were left only with a share of health systems' application fees.

"My biggest concern is there never was a debate," said Einhorn, who is a retired dentist. "I think it's an injustice to the public and the community."

Depending on whom you talk to, the demise of regional agencies would mean the end of a meaningful local voice on new health care projects - or not much at all.

"The regional health agencies provide a measure of local input into the process from people with real-world experiences. They get stuck in the same traffic jams trying to get to the mall, and, by the way, to the hospital," said Laurens Sartoris, president of the Virginia Hospital & Healthcare Association. "It's a huge concern."

Another view comes from Del. Phillip Hamilton, R-Newport News, who has been a critic of the state's application process, in which health providers seek what's known as a certificate of public need. "I haven't been able to see the value of those planning agencies," he said. "I have no evidence to indicate that they improve the quality of health care one iota."

The agencies work like this:

Guided by state law, a health system submits major projects - or expensive machinery like MRI equipment - for state approval. The regional health agency evaluates the proposal and submits its recommendation to the state health commissioner, who has the final say. The local boards are supposed to be representative both by geography and the various segments of health care.

"Sometimes there's different market situations that need to be taken into account when you look at the need for a project," said Louise Edwards, director of marketing and planning for Bon Secours Hampton Roads Health System. "Only a local health agency can do that."

Byrnes gave the example of the cancer radiation therapy services now available at Shore Memorial Hospital in Nassawadox on the Eastern Shore. The state's medical facility plan calls for a certain level of utilization - enough people would have to be projected to use it - before it could be approved.

The Eastern Shore, with its small population, "never would have met the criteria for approval," Byrnes said. But without the services, Eastern Shore residents had to endure lengthy drives and hefty bridge tolls for daily treatments in Hampton Roads. That hardship, unique to the area, superseded the utilization numbers.

"You look at the standards, but you also have to look at the community, and that goes back to what the local health agencies do," Byrnes said.

Hamilton said he believed there would be enough opportunity for public input - which state law calls for - if the certificate-of-public-need program were centralized in the state's Health Department in Richmond.

Edwards isn't so sure. She thinks that the public hearings the local agencies hold now would be fewer and more circumscribed - and the insights of local communities would be diluted.

Edwards said Bon Secours is a strong supporter of the system even though the state health commissioner rejected the Catholic health system's proposals to build hospitals in northern Suffolk and southern Virginia Beach in recent months. Those decisions are under appeal.

Bon Secours' chief local competitor, Sentara Healthcare, also supports the program.

"We value the contributions of the Eastern Virginia Health Systems Agency and are hopeful that funding from the state would be reinstated to help preserve local input," Howard Kern, Sentara's president and chief operating officer, said in a written statement Wednesday.

The 21-member EVHSA board had considered shutting down as soon as the end of this month. On Tuesday, the board decided to try to work with its sister agencies to cobble together money to stay afloat until the next General Assembly session, at which they'll be actively lobbying for more support.

"I believe much more in the local view," said Byrnes, who has been with the agency for more than 25 years. "It's much more grass-roots. We know better what's going on in the region."

Nancy Young, (757) 446-2947, nancy.young@pilotonline.com