Category Archives: Health Care

Health Care as Entitlement for All

State involvement in health care can be traced back to 1773 when the "Public Hospital for Persons of Insane and Disordered Minds" opened in Williamsburg.

Virginia”s state involvement in health care can be traced back to 1773 when the “Public Hospital for Persons of Insane and Disordered Minds” opened in Williamsburg.

by Allen Barringer

For seven years now we have lived with “Obamacare,” the Affordable Care Act, and now we are engaged in rewriting it as the American Health Care Act, and, yes, it’s “all very complicated.” One thing already is clear: both Democrats and Republicans talk about “affordable, quality health coverage for all Americans” — but neither the ACA nor the proposed ACHA truly lives up to that description.

I understand that standards of health care are contentious. We don’t agree on what is “quality” or “adequate” care, let alone “humane,” and we don’t even agree how limited medical resources, such as transplantable organs, should be allocated. But until this year, I thought we did agree on equal access to whatever it is the government provides. If there is a health entitlement at all, it should be available to all.

Health care has long been a government responsibility. From medieval times, the established Church organized hospitals and administered the poor house and other components of the social safety net, while the King dealt with public sanitation, quarantines and military health. The Enlightenment brought about a greatly expanded government role in public improvements, including public health, during the 17th and 18th centuries. Those traditions were brought to the American Colonies; indeed, persons drafted for their medical skills were among the earliest settlers in Virginia and in New England. By the 19th century, and particularly after the Civil War, public health (including, individual care for the ill and the indigent) was generally recognized as a concern and a responsibility of the States.

In Virginia, the first mental hospital was built in Williamsburg in 1773 at the urging of Governor Fauquier, and Western State opened in Staunton in 1825. Jefferson’s Anatomical Hall, completed in 1826, was an early building for medical instruction at the University of Virginia. The Hampden-Sydney “Richmond Department of Medicine” opened in 1834, becoming the Medical College of Virginia in 1854. After the Civil War health activity in Virginia exploded due to the legacy of military health care and new learning about the importance of cleanliness, the source of infections and epidemics, and use of anesthesia.

Virginia’s State Board of Health came in 1872. Virginia mandated vaccinations and sanitary sewers and quarantine regulations in its port cities. In 1889, a young doctor recently trained in Vienna, Austria, in the latest medical and public health practices, was hired as Professor of Medicine at the University of Virginia. He quickly convinced Charlottesville and university authorities that to maintain the good health of university students and faculty it was necessary to address the health of the whole community they lived in. Eventually he persuaded the General Assembly to support this approach also. Teaching students through the practice of public health was the hospital’s mission. Teaching better health practices to the community and abating communicable disease at the source was its outreach.

Health care for the community means everyone in the community. Disease afflicts rich and poor and all races and occupations alike; every occupation has its hazards. The University hospital which Professor Barringer, my grandfather, founded and promoted so tirelessly was from its inception open to the Charlottesville community without regard for university affiliation, status, gender, race, or ability to pay. Many medical professionals and hospital administrators in Virginia still provide medical care on those principles, although they try to obtain payment when they can. And health remains an object of State concern and appropriations. For example, just a few months ago, Governor Terry McAuliffe announced State measures to make counteragents available at little or no charge aimed at combating the growth of opioid addiction, which he described as “a public health emergency” in Virginia.

The involvement of our state and federal governments in providing health care is so pervasive that we cannot pretend this is, “by default,” a private responsibility. The details of how the government goes about providing “affordable, quality health coverage for all Americans” are not as important as the affordability, the quality, the coverage offered. And this is a Virginia issue, not just a federal one.

Medicaid has a state budget impact, and there is talk of turning the entire health entitlement spectrum into federal block grants to the States. When McAuliffe tried to expand Medicaid under the ACA (essentially “free” to Virginians for a time, at the expense of the federal government), the General Assembly turned him down. That seemed to many observers (including me) to be more a partisan rejection of Obamacare than a vote against the public health and economic welfare of Virginians — but it certainly had the latter effect. And according to the Congressional Budget Office, the ACHA as proposed would substantially aggravate that effect.

Government support for health care has two rationales. One is economic. A healthy community is more productive, with less missed work, less down-time, less family distraction and dysfunction, and less threat of a catastrophic epidemic. Even if it isn’t you who is ill, you have an economic stake in the health of those around you, and you receive a direct benefit from the investment of your tax dollars in health care for others, not to mention the indirect benefit of a higher quality of community life. There is no distinction between individual health and public health in this regard.

The other rationale, of course, is compassion. Compassion is a moral imperative, and while I hear very little about compassion from Republicans these days it’s high time they re-discover it. The parable of the Good Samaritan is in the Bible, not a book of etiquette. Working in health care is an intensely rewarding endeavor, which attracts churches, charities, and all those many individual volunteers who devote their time to helping others. Not incidentally, compassionate policies also appeal to voters. Continue reading

Tech, Carilion Launch VTC Innovation Fund

The VTC Innovation Fund will build the innovation ecosystem centered on the Jefferson College of Health Science.

The VTC Innovation Fund will build the innovation ecosystem centered on the Jefferson College of Health Science.

Virginia Tech and Carilion Clinic have teamed up to form a $15 million venture capital fund in the hope of accelerating the growth of biotech companies taking root around Blacksburg and Roanoke, reports the Roanoke Times.

The VTC Innovation Fund aims to close seven to 10 deals over the next 10 years. By leveraging its money from other financial sources, managers hope the average startup will be able to raise between $2 million and $10 million. About 60% of the deals will be in life sciences. Although the main focus will be the Roanoke-Blacksburg area, the fund will consider investments elsewhere in Virginia or enterprises with strong ties to Tech or Carilion.

“When we looked at our grand vision going forward, we see that the innovation ecosystem has a few holes in it,” Virginia Tech President Timothy Sands said. “One is in the venture capital area. It’s not the only one, but it’s one we identified that we could do something about.”

Virginia Tech and Carilion are partnering to build a medical school and research institute in Roanoke, the Jefferson College of Medical Sciences, which stands at the center of what they hope will evolve into a biomedical industry cluster. Tech also is building a cutting-edge interdisciplinary program in neuroscience.

The Tech/Carilion duo is following a parallel path to Inova Health System in Northern Virginia, which is collaborating with George Mason University and the University of Virginia to build an biomedical cluster at the Center for Personalized Medicine. Inova has pledged to put $100 million in to venture capital in support of the innovation ecosystem there.

A third partner in the VTC Innovation Fund is Middleland Capital, a Washington, D.C.-based investment firm, which will manage the Roanoke fund and invest $500,000 to $1.5 million of its own capital, reports the Washington Business Journal. Connections with experienced Washington-area venture investors likely will provide a depth of expertise and access to outside capital that entrepreneurs in the Roanoke-Blacksburg area previously lacked.

“We want to focus on the absolute best and the absolute brightest and the shining stars of the region,” said Scott Horner, managing director of Middleland. “We want groups from outside the region to be able to look here and say, ‘Yes there is good stuff in the region.’”

How Inova Hopes to Reinvent Health Care

Inova is betting that personalized medicine + big data can transform health care.

Inova is betting that personalized medicine + big data can transform health care. Illustration credit: Richmond Times-Dispatch

Published this morning in the Richmond Times-Dispatch.

As Republicans and Democrats brace for a battle royal over Obamacare and what might replace it, they would do well to pay heed to an important experiment south of the Potomac.

In Congress the debate centers on who pays for health care and how costs can be shifted to someone else — a zero-sum game. At Inova Health System, the dominant health-care provider in Northern Virginia, the focus is on improving peoples’ health at lower cost by practicing medicine differently. If Inova is successful, everyone wins.

The plan at Inova’s Center for Personalized Health, located across the road from Inova’s flagship hospital in Fairfax County, is to draw upon diverse data — electronic health records, user-generated data (such as fitness trackers and other wearable devices), family history, social milieu, and a patient’s genetic and biochemical make-up — to develop wellness and treatment strategies tailored to the individual.

“Take a cancer drug that’s effective 30 percent of the time,” says Todd Stottlemyer, CEO of the center. “A better way to understand it is that the drug is 100 percent effective for 30 percent of the people who possess certain genes or proteins.”

If physicians can target the treatment to the patient’s unique biochemistry, they can avoid giving drugs that don’t work. That leads to better health for the patient and saves society a lot of money.

***

Inova is building its Center for Personalized Medicine on the old Exxon-Mobil corporate campus, and adapting it for use as a medical research center. Construction is underway there for the Schar Cancer Institute, a multidisciplinary institute where precision medicine will be practiced.

The Inova Clinic will provide genomic testing and consultations. Other centers, institutes and incubators will conduct research, crunch data and, hopefully, spin off new business enterprises. Meanwhile, the Center has already begun recruiting national-caliber scientists.

Many other medical colleges and research centers around the country are doing similar things. What sets Inova apart is not just treating disease but keeping people well in the first place.

Let’s say a 48-year-old woman has breast cancer. Here’s how Stottlemyer sees things working: Physicians will want to understand her genetic make-up. They’ll want to know the biomarkers of the particular type of cancer she has. They will design a treatment, based upon the unique facts of her case, that will target the biomarkers and offer a higher probability of success than conventional approaches.

But the work doesn’t end there. What if the woman’s daughters have the same genetic markers? Should they screen more aggressively? Should they have mastectomies before getting the disease themselves? Inova will have genetic counselors trained in interpreting the scientific data and then walking patients through the complex decision-making process. Says Stottlemyer: “We want to empower good, informed choices.”

***

Inova will draw upon Northern Virginia’s strength in information technology. Harnessing so-called “Big Data” will help researchers and practitioners gain insight into not only individual patients but entire demographic groups.

The Center will cobble together health records, family histories, genome sequences, and sociodemographic statistics, and then compare the data against its database that houses more than 10,000 genome sequences from 134 countries of birth around the world.

The nonprofit health system is sinking hundreds of millions of dollars of its own money into the Center — acquiring the Exxon-Mobil building, funding venture capital, setting up the institutes and centers — and supplementing it with state dollars, philanthropic dollars, and funds from corporations and academic partners.

Late last year, Inova inked a $112 million deal with the University of Virginia School of Medicine allowing U.Va. medical students to participate in the discovery and commercialization of treatments for cancer and other diseases.

Stottlemyer sees the launch of a new center of research and innovation as a booster shot for Northern Virginia’s economy, which is still staggering under the impact of sequestration-related cuts in defense spending. Building bridges to U.Va., Virginia Tech, and Virginia Commonwealth University should provide a stimulus to downstate economic development, too, he says.

But the ultimate justification for a nonprofit enterprise like Inova to spend millions on an initiative like the Center for Personalized Health is to help the people of Northern Virginia and the commonwealth to enjoy better health at lower cost. When the center opens for business next year, health teams will disseminate insights from the center’s research to Inova hospitals throughout Northern Virginia.

The U.S. health care system is organized around treating people when they get sick, not keeping them well. “It’s a transactional system,” says Stottlemyer. Doctors and hospitals get paid only when they conduct a test or procedure or other service. “We’re trying to change the game.”

The Legislative Logic of Proton Therapy

Proton therapy delivers precise doses of radiation, resulting in fewer side effects and less damage to surrounding tissues.

Proton therapy delivers precise doses of radiation, resulting in fewer side effects and less damage to surrounding tissues.

I just love it when legislators tell insurance companies whose services they should insure. Lawmakers are obviously so much more qualified to judge the efficacy of different medical treatments — why shouldn’t we trust their judgment?

Pardon my snark. A bill has passed the House of Delegates and moved to the state Senate that would forbid insurance companies from holding proton therapy to a higher standard of clinical evidence than other radiation treatments.

Del. David Yancey, R-Newport News, submitted the bill on behalf of Hampton University (HU), which just happens to have a Proton Therapy Institute. HU complains that the procedure is still treated as experimental despite decades of research, explains Travis Fain with the Daily Press.

To tug at legislators’ heart strings, the bill’s supporters brought in Carolyn Lambert, wife of Benjamin Lambert, who served in the Senate more than 20 years and died in 2014. The Lamberts’ son is fighting prostate cancer now. Speaking in a halting voice, she said, the insurers “have abandoned him.”

Insurance lobbyists counter that they use blind studies to make coverage decisions, and that proton therapy makes the cut in some cases, such as pediatric and skull cancers, but not in others. “The bottom line is we don’t evaluate them differently,” said Doug Gray, executive director of the Virginia Association of Health Plans.

The Senate Commerce and Labor Committee passed the bill on what appeared to be a unanimous voice vote, reports Fain. Sen. John Cosgrove, R-Chesapeake, a motioned “as a cancer survivor” to send the bill to the floor.

Bacon’s bottom line: This illustrates the worst of everything about the way the General Assembly works. Anecdotal information and sentimentality demolish reason and empirical evidence. The legislature is well on its way to passing a law that could well nudge the cost of insurance policies higher. The prostate cancer of Sen. Lambert’s son is a tragedy. What we will never see is the tragedy of the “third man,” the invisible victim for whom the cost of medical insurance will be put just out of reach.

Nonprofit Hospitals, Market Power and Charity Care

Medical campus of VCU hospital, one of the largest providers of charity care in Virginia.

Medical campus of VCU hospital, one of the largest providers of charity care in Virginia.

A new study of California hospitals between 2001 and 2011 has found no evidence that nonprofit hospitals provide more charity care when they gain market power. Nationally, 58% of all non-federal, general hospitals are nonprofit. Nonprofits dominate the health care sector in Virginia as well.

“Economic theory indicates that a balancing of social benefits against harm from market power may be appropriate under the assumption that nonprofits will provider greater social benefits when they have greater market power,” write Cory Caps, Guy David, and Dennis W. Carlton in a study undertaken as part of the National Bureau of Economic Research’s health care initiative.

They conducted the study to see if the theory held up in practice. In the case of California, it didn’t.

The study, “Antitrust Treatment of Nonprofits: Should Hospitals Receive Special Care,” could have implications for the debate over the Certificate of Public Need (COPN) in Virginia. Under the COPN law, the state must give its approval for major capital outlays such as new buildings, expansions and purchases of expensive equipment. The law is widely acknowledged to reduce competition and bolster profits for hospitals, but is justified on the grounds that helping hospitals maintain market share enables them to spend money on uncompensated care.

California is not Virginia, and the authors were exploring the relationship between a hospital’s market power and uncompensated care in the context of antitrust laws, not COPN. So, the findings may not be replicated in the Old Dominion. But insofar as the authors developed a methodology for examining the relationship between market power and uncompensated care, it would be worth conducting the same exercise in Virginia.

Virginia nonprofits receive exemptions from state, local and federal taxes. If it turns out that they aren’t using their revenue “surplus” to provide charity care and cover bad debts any more than their for-profit peers are, Virginians might legitimately ask what public benefits they are using their “surplus” for.

Cost Cuts Coming in a Post-Obamacare Health System

he University of Virginia medical center will have to adapt to survive in a post-Obamacare world.

The University of Virginia medical center will have to adapt to survive in a post-Obamacare world.

The University of Virginia Health System will need to dramatically cut costs to adapt to a post-Obamacare world, Dr. Richard P. Shannon, UVa’s executive vice president for health affairs, said yesterday.

As the Daily Progress reports, Shannon briefed members of the Medical Center Operating Board:

Republican plans, written to replace the Affordable Care Act, likely would favor a market-based approach that forces insurers into a price war. Though it may lower insurance costs for consumers, it would mean lower reimbursements to hospitals that could add up to hundreds of millions of dollars over several years, Shannon said.

“Take it all together and I think you can predict there will be enormous pressure on cost in the health care enterprise over the course of the next iteration of the Affordable Care Act,” he said. “The honest answer is we have to get more efficient and we have to get more productive.”

Shannon highlighted some of the tools the health system might use to drive down costs. Artificial intelligence might be used to diagnose some types of cancer. Big data can help doctors predict health problems before they arise. Telehealth can extend healthcare into outlying rural areas. Last year, UVa made 11,000 health visits; Shannon wants to increase that number to 60,000.

The UVa Health System will have to change, as market pressures wipe out hospitals that fail to adapt, he said. “You’re going to see hospitals disappear. The question is, who are the 50 percent who are going to survive?”

Bacon’s bottom line: I wouldn’t want to be a hospital in a post-Obamacare world, but as a health care consumer, I find Shannon’s analysis heartening. As a nation (and a state) we need to shift our focus from who pays for health care, invariably a win-lose proposition involving wealth transfers from one group to another, to a focus on productivity and innovation, which will drive down costs for everyone. If we want to make health care more affordable and accessible, we need to make it less expensive.

Shannon approaches the challenge from the perspective of what UVa can do to drive down costs. Virginia policy makers need to think about what the Virginia health system can do to drive down costs. And that might require thinking previously unthinkable things.

First, if emerging federal policy relies upon competition to drive down costs, state healthcare policy should do so as well. Not just competition between insurers but between all kinds of delivery platforms, from hospitals to independent, ambulatory surgery centers. If Congress passes the kind of legislation Shannon anticipates, it is imperative that Virginia repeal the Certificate of Public Need (COPN) regulations that protect hospitals from competition.

Second, we must come to peace with the prospect of some hospitals going out of business. Frankly, many rural hospitals may no longer make economic sense. In their place, we might well see more clinics, more nurse practitioners, more outpatient surgery centers, more telemedicine, and more travel to regional hospitals for complex procedures. If done properly, the result could be better and cheaper health care for rural Virginians.

Michael D. Williams, UVa’s Center for Health Policy, also told the medical center board that a big cost saver could be the sharing of medical information to avoid duplicate tests and scans. Reforms to patient-privacy laws and more effective data sharing could reduce redundancy. By necessity, some of those data-sharing reforms will come from the federal government, but Virginia should be looking at what can be done on a state level to foster the efficiencies.

Shannon has given the warning. Big change is coming. Will Virginia be prepared?

State Oversight of Physicians Needs Tightening

State officials are lax when it comes to disciplining doctors for infractions of the law.

State officials are lax when it comes to disciplining doctors for infractions of the law.

by Victoria Nicholls

State Sen. Diobhan S. Dunnavant, R-Henrico, a Henrico County physician, broke federal health privacy laws when she sent a political solicitation to her patients during her 2015 campaign, the Richmond Times-Dispatch reported two weeks ago. And what were the consequences? Nothing.

The first-term senator won’t face fines or penalties, according to a letter from the U.S. Department of Health and Human Services’ civil rights office. And that should concern every Virginian and American.

In the Times-Dispatch article, Dunnavant stated that her campaign solicitation letter was approved by a medical practice board and lawyers. Really? Did she chastise her lawyers for malpractice? Did any of her advisers suggest that she consult the Health Insurance Portability and Accountability Act (HIPAA) specialists first? No? Why not?

Patients should be alarmed that Dunnavant was willing to transfer their data to a political campaign without their permission. If a nurse or admin had done the same, would the public agree that it was of no consequence for them to mine patients’ info for volunteer help and votes? What if another doctor or nurse used patients’ data for political purposes? Would they get the same hand-spanking?

“For me, it’s really all about the fact that none of my patients were harmed,” said Dunnavant.

What does Dunnavant have to say about her patients’ loss of data? What about their loss of privacy, which she was obligated by law and public/social agreement to protect? What about the loss of trust in the system? What other “enterprises” do doctors conduct on the side that we, the patients, are sacrificing our privacy for?

Authorities said Dunnavant, when aware of the potential privacy violation, moved quickly to “mitigate the damage” by deleting the protected data from a campaign computer.”

I’d like to know who else might have that data now. Was it backed up? If so, where? Who had access to it? Who else saw it? Did they sign confidentiality agreements? Are they even bound by HIPAA laws? No they aren’t. This is what makes this a huge, huge issue. Most people do not realize how much their personal data is sold on the market.

The system in Virginia isn’t willing to hold physicians accountable. In July 2016, I SENT Virginia physician-legislators including Dunnavant and Del. John O’Bannon, R-Henrico, information that a convicted Tennessee pill-mill doctor was working in a hospital in Virginia. Federal law mandates that convicted drug traffickers be jailed pending sentencing. No response. I asked the Virginia Department of Health Professions how either (a) he got a license or (b) the State Medical Board missed the fact that he had no license.

Still no response.

Victoria Nicholls describes herself as a concerned Virginia citizen living in Chesapeake.

Virginia Hospital profits in 2015: $1.89 billion

Virginia hospital profits remained stable in 2015, down only a smidgeon from the previous year.

Virginia hospital profits remained stable in 2015, down only a smidgeon from the previous year.

The Virginia hospital industry remained highly profitable in fiscal 2015, according to a report issued yesterday by the Thomas Jefferson Institute for Public Policy (TJI). Although profit margins were not as juicy as the previous year, the absolute level of profits remained stable, declining a mere 0.6% to $1.89 billion.

Thanks to the reinvestment of profits, or “surplus” in the case of non-profit enterprises, the combined net worth of Virginia’s hospitals increased by $1.1 billion to a total of $17.8 billion.

“Last year our report showed a year-over-year profit of 8.6% for our hospitals statewide,” states Michael W. Thompson, author of the report. “This is on top of the 10.7% profit in the previous year. Not bad for an industry bemoaning its financial troubles.”

TJI has been publishing the hospital data, compiled from the Virginia Health Information website, for several years. Hospital profits are an especially contentious issue in the 2017 General Assembly session as legislators push to roll back the Certificate of Public Need (COPN) law, which requires state approval of major capital investments by hospitals and surgical centers.

Critics say the law restricts competition and preserves monopoly profits. Hospitals say they need COPN in order to continue providing charity care to hundreds of thousands of Virginians. The question inevitably arises: Are Virginia hospitals profitable enough that they could continue providing charity care even without COPN protections?

The Virginia Hospital and Healthcare Association (VHHA) objects to TJI’s methodology for tabulating profits, arguing that the fiscally conservative/free market think tank skews its numbers by counting surgical centers and non-hospital affiliates of hospital companies. Also, the association contends that average profits obscure differences between hospitals, some of which are very healthy and others of which earn  less than the 4% profit margin to maintain reserves, cover depreciation and invest in growth. Half the state’s rural hospitals operate at margins below that level, according to the VHHA’s own spin on the Virginia Health Information numbers.

However, TJI has found that the number of money-losing hospitals has declined in recent years — from 42 in 2012 to 27 in 2015. “Clearly, when the numbers are reviewed, the hospital industry is once again substantially healthier than it was a year previously,” says Thompson.

The hospital association responds that the current level of profitability may not last. Congressional threats to repeal Obamacare, or at least to roll it back, create enormous uncertainty. “Cuts related to the Affordable Care Act … are forecast to deprive Virginia’s local hospitals and health systems of roughly $1 billion annually by 2022,” stated a VHHA press release commenting upon the 2015 numbers.

Bacon’s bottom line: Everybody wants profitable hospitals, even if they are “non-profits.” The HCCA says 4% operating profit margins is a reasonable standard for hospitals to maintain their financial health while continuing to invest in their operations. While many hospitals fall short of that goal, several exceed it — by a wide margin.

The public needs to know the level of hospital profits. It also needs to know what hospitals are doing with those profits. I have reviewed the annual reports of the big health care systems — Inova, Sentara, Carilion — and find them uniformly unhelpful. All corporate annual reports are P.R. pieces, but those of Virginia’s health care systems have more fluff than a down pillow.

We know that Virginia hospitals are plagued by hospital-acquired infections, which afflict one out of twenty-five patients entering a hospital nationally. How much money are Virginia’s big hospitals investing in controlling those infections? Hospital annual reports won’t tell you. By comparison, how many millions are hospitals pouring into prestige-building medical research programs like Inova’s center for personalized medicine that may be great for humanity but are being funded, at least in part, by profits derived from patients? The annual reports don’t tell us that either.

If you count only hospital profits over and above the VHHA’s recommended 4% margin, that still leaves about $1 billion sloshing around, mostly generated by non-profit hospitals. Where is that money going? What are hospitals doing to justify their non-profit status? Does anyone really know? Where’s the accountability?

Who’s Treating the Infectious Diseases?

Click for larger image. Graphic credit: Virginia Business

I apologize for being obsessive on the subject of hospital-acquired infections recently (see here and here) but I just heard a story today of someone who went into Duke University hospital for a routine colonoscopy and contracted a case of flesh-eating bacteria. This was Duke! Supposedly one of the top hospitals in the country!!

Virginia Business magazine has published data on the volume of infectious diseases treated at Virginia’s larger hospitals in 2015. The data comes from the Virginia Health Information Foundation.

Note: The data does not necessarily reflect infectious diseases acquired in the hospital. Here’s how VHIF describes the data set:

These diseases can be transmitted from human to human, from animal to human, by direct or indirect contact; e.g., fevers of unknown origin, sexually transmitted diseases (including HIV infection), herpes, central nervous system (CNS) infections, measles, rubella, mumps, hepatitis, rabies, and rickettsial infections (such as Rocky Mountain spotted fever). Bacterial infections such as streptococcal and chlamydial infections also fall under this classification, as well as those of spirochetal, protozoal, helminthic and mycotic causes.

The total is not quite 38,000. That strikes me as a remarkably low number for all infectious diseases. Perhaps most of these diseases are treated by primary care doctors. The million-dollar question: How many of these cases, if any, were contracted in a hospital setting?

More Data on Hospital-Acquired Infections, Please

Pneumonia is among the more common hospital-acquired infections.

Pneumonia is among the more common hospital-acquired infections. The public deserves more transparency.

Hospitals are dangerous places. Americans acquired 722,000 infections in a hospital setting in 2011, the most recent year cited by the Center for Disease Control and Prevention. About one out of twenty-five patients fell victim to preventable hospital-acquired infections.

In the interest of controlling infectious disease, health care officials have begun tracking the data more closely in recent years. In November the Virginia Department of Health published its Virginia-specific findings for 2015. Overall, hospitals in the Old Dominion compare fairly favorably with their peers nationally based on a methodology that adjusts for the acuity of patients and other relevant factors.

But that conclusion is tempered by (a) significant weak spots in Virginia hospital performance, and (b) the fact that the methodology compared only five categories of common infections, not all infections.

That said, here follow the statewide conclusions from the consumer version of the study based on 2015 data. Virginia hospitals exhibited:

  • Fewer bloodstream infections than predicted based on the national experience in 2006-2008.
  • Fewer urinary tract infections than predicted based on the national experience from 2009.
  • More infections following abdominal hysterectomies and about the same number following colon surgeries based on the national experience from 2006-2008.
  • Fewer methicillin-resistant Staphylococcus aureus bacteremia laboratory-identified events than predicted based on the national experience from 2010-2011.
  • About the same number of hospital-onset Clostridium difficile laboratory-identified events as predicted based on the national experience from 2010-2011.

Bacon’s bottom line: As I argued previously, Virginia consumers/patients should have full transparency into the risks they are taking when they enter a hospital. When I wrote previously, I was unaware that the Virginia Department of Health collected the data. The department deserves kudos for publishing its report in a form comprehensible to the public. But it should go further.

The report lists every hospital in the state and gives it a green star (better than expected compared to national norms) a red X (worse than expected), an equal sign or a “No Conclusion.” This really isn’t very helpful. Does the Depaul Medical Center, to pick a random example, outperform national norms for bloodstream infections by a razor-thin margin or a wide margin? Do Virginia Commonwealth University patients undergoing colon surgeries experience many more infections or just a few?

More to the point, why doesn’t the health department tell us the total of all hospital-acquired infections at each institution and how the numbers compare to national norms?

It also would be helpful to get a sense of what’s happening to hospital-acquired infections over time. To pick an example, it’s nice to know that Virginians incurred fewer bloodstream infections in 2015 compared to the national baseline of 8- to 10-years previously. But that’s a long period of time. How much progress has been made? How rapid has the progress been — have Virginia hospitals made big gains, or are they doing only marginally better than a decade previously?

The cost of health care poses one of the greatest challenges to 21st-century American society. Eliminating hospital-acquired infections should be low-hanging fruit for controlling costs and improving medical outcomes. While Congress argues over Obamacare and the zero-sum question of who subsidizes whom, Virginia needs to take the lead in driving down costs and improving medical outcomes to the benefit of all. Greater transparency can help by making hospitals more attentive to patients’ concerns and by shining a spotlight on under-performers. If  hospital managements fear looking bad in the eyes of the public and its board of directors, they will make the control of infections a top priority.