Springfield Clinic Faces Imminent Shutdown

By Susan Levine
Washington Post Staff Writer
Tuesday, July 3, 2007

A state-of-the-art clinic touted as "a bold vision" for increasing health-care access in Northern Virginia and training a much-needed workforce will probably shut down in late August amid frustration, disappointment and even anger, especially among backers who barely three years ago gave $1 million toward the project's success.

The Northern Virginia Community College's primary-care clinic has rarely come close to its goals for how many low-income and uninsured patients it would serve. Although it is located just south of the Springfield Mall, in spacious quarters in the college's Medical Education Center, it has been hampered more than helped by that address and, critics say, by poor outreach and management.

At its peak, the clinic logged 6,844 visits in a 12-month period for basic and chronic care, immunizations, lab work and women's health screenings. But the numbers fell sharply between July and December, and these days, with walk-in appointments curtailed and patients warned of its demise -- initially, this past Saturday was to be the final day -- the program's decline is accelerating.

"I'm absolutely certain the need is much greater," said Robert G. Templin Jr., the college president, who holds out some hope for emergency state funding that could sustain an additional year and allow officials to consider other rescue options. He acknowledges that the college has made bad assumptions and missteps while running the clinic.

"I think it's still a great idea, and it may still be a workable idea," Templin said. "But it's very hard, much more difficult than anyone imagined."

The primary-care clinic opened as part of a 40,000-square-foot Medical Mall that was to offer medical, dental, vision and pharmacy services on the ground floor of the college's newest center. Students in nursing and allied health classes on the second and third floors would walk downstairs and work with seasoned professionals -- a win-win-win that would add to the students' clinical opportunities, help tackle the region's critical dearth of nurses, therapists and technicians and serve a part of the population that often lacks for affordable, quality care.

The project never suffered for ambition. When the college first sought foundation backing, it contemplated 25,000 patient visits annually. By the third year, it said, the complex would have negotiated fee-for-service arrangements with outside groups, established a $2 million endowment and identified resources to sustain itself long-term.

The breadth of the proposal persuaded the Robert Wood Johnson Foundation to provide a $500,000 grant under an initiative that identifies novel approaches to addressing health disparities. Numerous local nonprofit groups committed matching dollars. The Meyer Foundation called the concept "a bold vision with tremendous implications for health care delivery and the development of workers who understand the needs of immigrant and low-income populations." The Consumer Health Foundation labeled it "the linchpin for addressing the primary health care and staffing shortages in Northern Virginia."

They offer more circumspect assessments now. "While we initially saw the promise and the challenges, we underestimated the difficulty in bringing this idea to implementation," a statement from the Meyer Foundation noted recently.

Some call the primary-care clinic's loss an avoidable tragedy. In retrospect, they say, problems probably occurred because the college ran both sides of the operation.

The broad concept, though innovative, is not completely untested. Maryland's Montgomery College built a Health Sciences Center in Silver Spring several years ago with a major clinic and the same twinned goals. Holy Cross Hospital, however, staffs and oversees the operation in a partnership with the college. The clinic anticipates 7,200 patient visits next year and 10,000 by 2010.

Northern Virginia Community College's undertaking stumbled almost from the start. "We hit a lot of bumps," from hiring staff in a competitive market to the complexities of establishing a clinical framework and data tracking, Templin said. They were not prepared for the number of patient no-shows and the outreach required. "Maybe we were naive in thinking this was just going to work," he said.

By last year, Templin and other administrators were questioning what to do. The college entered into lengthy discussions with Mary's Center for Maternal and Child Care, a District provider recognized for its health care in the city's Latino community. Ultimately, neither Mary's Center nor any other entity responded this spring with a proposal on how it might step in.

"We would love to be in there for a lot of reasons," said Maria Gomez, Mary's Center executive director. "It's the kind of population we would love to serve." But the clinic's lack of infrastructure and data systems made her leery; it was hard, she said, to determine its long-term viability.

If no additional money is secured by Aug. 1, college officials say they will begin shutting down the operation and assigning students to other sites. The dental clinic, which receives county money and charges higher fees, will remain open.

Margaret O'Bryon, chief executive of the Consumer Health Foundation, is trying to take a long view of the experience. Such projects can be risky: "You don't know until you do them because they're not tested," she said. But the risk can carry important rewards. "When you do that kind of work, you can have the breakthroughs," she stressed.

Templin, asked if the clinic's failing would mean $1 million had been wasted, paused for only a moment. "An experiment tried and lessons learned are always valuable," he answered.

© 2007 The Washington Post Company