by James C. Sherlock
With additional information and thoughts generated by responses to my original posts on this matter, I offer this post as a final proposal before the November 15 release of the Sentara-funded “study” of what I call the Sentara Plan for Eastern Virginia Medical school.
The nation is short of doctors and shorter yet of good doctors. The nation has to produce more of both or the situation projects to worsen.
There is an opportunity here in Virginia to deal with both objectives.
But the Sentara Plan is not it.
Background
The Eastern Virginia Medical School (EVMS) already has facilities and dedicated professors but seeks to upgrade both the quantity and quality of its medical training and research. It needs a strategic partner to do it.
EVMS courted William and Mary in 2011 – 2012 to try to break through to a higher level of education. The reasons the merger didn’t work from William and Mary’s perspective included:
- William and Mary was concerned EVMS is not a well ranked medical school
- William and Mary was concerned EVMS would drain money from its own programs
- Sentara, as the incumbent affiliate hospital, would not commit more funding to the medical school.
From a new Virginian-Pilot story on EVMS and Sentara:
“EVMS seeks a new model as a means to get more capital and improve its academic reputation.”
“Sentara wants to better “align” EVMS’ medical group with its own.” … The (EVMS Medical) group composed of 150 physician-teachers and 40 other health professionals, supports the medical school and treats over 1,600 patients a day”.
(Bacon’s Rebellion author note: Sentara wants those 1,600 patients referred to Sentara specialists and most importantly, treated in Sentara facilities.)
More from the Virginian-Pilot story:
“Eastern Virginia lags behind the state and nation in infant mortality, cancer, heart disease and diabetes. Most of these poor rankings reflect disparities with minority and low-income populations.”
“For instance, the infant death rate in Virginia and the United States was 5.8 out of 1,000 live births in 2017. But in Norfolk, the rate of Black baby deaths was 18.2.”
“Regarding prostate cancer, the national death rate was 19.5 out of 100,000 lives in 2015. But in Portsmouth, Black men died at a rate of 66.5 out of 100,000 — nearly four times that of white men in the city.
Sentara, as a payback for its state-awarded healthcare monopoly in Hampton Roads, was supposed to take its profits and improve the health of the poor over the past decades, but it had what it considered more important things to do with its money.
So, the state has at least two jobs in considering at this point what to do about medicine in Hampton Roads — improve EVMS and improve the quality of the health of its minority residents.
Plan A – The Sentara Plan
Sentara, which has effectively controlled EVMS since its beginning, has put together a plan and a study that seeks to tie EVMS to Old Dominion University and perhaps Norfolk State University as well as Sentara. From the Virginian-Pilot:
“Private parties began exploring potential integrations of Eastern Virginia Medical School with Old Dominion University and Sentara Healthcare about 10 months before telling top leaders of the medical school.
Dr. Richard V. Homan, president and provost of EVMS, said [ReInvent chairman John “Dubby”] Wynne called him July 17 to tell him about the Manatt [Health Strategies] engagement and process. It was then he learned of the idea, he said in an email to Manatt representatives in August.
“Neither the Board nor I had any knowledge of the Manatt engagement and nor of the previous meetings with Manatt and other parties which occurred over the past 10 months,” he said.
Governor Ralph Northam, an EVMS grad, was apparently in on the secret deal at some point and appears preliminarily in favor.
Northam, who announced the project Aug. 5, said the results may lead to significant changes for Hampton Roads’ “health care ecosystem,” which serves more than 1 million people.
“This is an important effort to benefit Hampton Roads, and the Commonwealth as a whole,” Northam, a pediatric neurologist, said then.
Undiscussed at least in public is how that combination being assessed by a study paid for by the institutions hoping to merge with EVMS will somehow
- make EVMS a better medical school or
- improve the awful health of the region’s minorities.
Again from the Virginian-Pilot:
The consultant, Manatt Health Strategies, is expected to deliver a report Nov. 15, ahead of the General Assembly session in January. Its advice could lead to new legislation or budget amendments for lawmakers to consider that seek to make the medical school more financially stable.
In other words, this plan represents a hostile takeover of EVMS with a short deadline to get it through the General Assembly.
All of the participants — Sentara, ODU and the private think tank ReInvent — say that this plan is secret. Sentara is paying for most of the study, so we don’t have to bite our nails waiting to see how it turns out.
If the plan is adopted, EVMS will be anchored forever to Old Dominion University, a school ranked by U.S. News and World-Report #258 among national universities and perhaps Norfolk State, which on a regular basis over the years has skirted decertification.
If ODU takes EVMS as its medical school, it would be the 4th lowest ranked university in the continental United States with a medical school that itself is ranked among the top 92 medical schools for primary care.
If EVMS is tied to ODU and Norfolk State, I predict that in 10 years it will be fighting for its accreditation.
Plan B – A Plan that Can Work for Hampton Roads and Virginia
So what is a better alternative? Skeptics would say almost anything, but I have one that will make Hampton Roads a medical hub rather than a medical afterthought and move it towards solving its horrible minority health problems.
The University of Virginia School of Medicine next year will open an Inova campus in Northern Virginia. That facility was sanctioned by the State Council of Higher Education for Virginia (SCHEV), the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) and the Liaison Committee on Medical Education (LCME), a U.S. Department of Education-recognized accrediting body for programs leading to the MD degree in the United States.
It will be centered on Fairfax hospital. The partners are funding a great deal of construction to support the effort.
The Fairfax campus will host students who after their first two years in Charlottesville choose to complete their third and fourth years of training in Fairfax.
Eastern Virginia Medical School presents a completely different opportunity. It is already located on the same campus as Sentara Norfolk General and its Level One trauma center and Children’s Hospital of the Kings Daughters. EVMS already has gleaming new facilities. What they don’t have is the ability to attract top-notch students or research grants.
Adding Hampton University to the collaboration would make that grouping even more powerful. It is superbly led, and Hampton University can provide a nursing school to the collaboration and contribute its unique Hampton University Proton Therapy Institute capabilities. It hosts the largest free-standing facility of its kind in the world. Proton therapy is most popularly used in the treatment of head and neck, brain, and prostate cancer, but growing results from its application for other cancer types, including breast, lung, GI and more, have continued to prove positive.
Urban Bon Secours Hospitals in Norfolk and Portsmouth are nearby, as is the Navy’s immense Portsmouth Naval Hospital. Virginia Beach, Virginia’s largest city, is next door.
Hampton Roads is home to over 1.5 million Virginians, as well as the world’s largest naval base, the Port of Virginia, major Air Force, Army and Coast Guard installations and a huge tourism industry. What it does not have is a first rate medical school.
This plan would certainly fit the mission of the University of Virginia Medical School and would provide significant boost to medical education in the state. Additionally, the UVa Center for Health Humanities and Ethics can find no more compelling location for carrying out its mission than reversing the awful minority health numbers in Hampton Roads.
The College of William and Mary, its 2013 objections resolved, could be brought into the coalition if desired.
How to Pay for Plan B
The way to pay for this plan and for improving the healthcare of the poor in Hampton Roads would be to eliminate Sentara’s tax exemptions in Virginia.
No fair assessment of Sentara’s Forms 990 over the past 20 years would conclude that they have earned those exemptions. Sentara would still qualify for its federal exemptions since, alas, the IRS simply does not examine whether a 501(c)3 health system earns its exemptions – never has.
For-profit HCA’s five largest hospitals in Virginia paid almost $145 million in taxes in 2018, the last year public records are available from the state. Sentara’s 12 hospitals paid effectively nothing.
You might think that Sentara, a not-for-profit, would offer a lot more charity care than for-profit HCA. You would be wrong. HCA’s hospitals’ charity care in 2018, the last year before Medicaid expansion, was 17% of net patient revenue. Sentara’s was 18%.
That move would not only generate a great deal of revenue for the state, but importantly would generate considerable revenue through property taxes for the communities that are home to both Sentara’s fabulously profitable hospitals in Hampton Roads and the minority populations that have suffered with substandard healthcare.
Precautions
I have sent this essay in letter format to the State Council of Higher Education for Virginia (SCHEV), the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC), the Liaison Committee on Medical Education (LCME) and Centers for Medicare/Medicaid Services (CMS) for their perusal in advance of any report.
I included an appendix with the recent national ranking and graduation numbers for the various players so they won’t have to bother themselves.
I think they will be able to see the current Sentara-led effort for what it is and be properly prepared to receive it.
The Governor likely can influence the SCHEV, but he may not have much luck with SACSCOC, LCME or CMS.
Recommendation
The Governor might wish to study Plan B before rushing legislation to the General Assembly based on the Sentara plan “study” in 2021, a non-budget year.
