Category Archives: Transparency

Virginia Ethics Council’s Searchable Database a Dud

So much for improved conflict-of-interest transparency. The Virginia ethics council's searchable database shoots blanks.

So much for improved conflict-of-interest transparency. The Virginia ethics council’s searchable database shoots blanks.

You can imagine my excitement to read this morning in the Richmond Times-Dispatch that the Virginia Conflict of Interest and Ethics Advisory Council has finally put lawmakers’ statements-of-economic-interest filings online. That information could prove invaluable to journalists and bloggers reporting on the inner workings of the General Assembly.

The statements detail what gifts lawmakers receive, what companies they own stock in, and who employs them and members of their immediate family. For years that information has been held in state offices, available only to those who physically inspected the records in downtown Richmond. Accessing the data online is a breakthrough in transparency. I, for one, looked forward to double-checking legislation for conflicts of interest without the tedious necessity of leaving the Bacon’s Rebellion Global Command Center.

Making a beeline for the Virginia ethics council website this morning, I entered the name of a particularly conflict-afflicted legislator, and eagerly awaited the results. Here’s a screen capture of what appeared on my screen:

Thanks for nothing.

If it’s any consolation, the searchable website for registered lobbyists does work. You can find the names, for instance, of all 16 of Dominion’s registered lobbyists, and all 16 of the Virginia Education Association’s. Of course, you can get the same data over at the Virginia Public Access Project website. Indeed, the VPAP website is better — it allows you to search the lobbyist records by issues lobbied, and it reports on the newest lobbyists registered. It even displays lobbyist photos!

Hopefully, the Virginia ethics council will get its website working soon. But it would serve the public interest even better by turning its data over to VPAP, Virginia’s one-stop-shopping for data on elections, campaign contributions, legislation, candidates and legislators, and lobbyists. Adding lawmakers’ statements of financial interest to the government-transparency portal would be awesome.

Update: OK, here’s what’s going on. The search feature provides a drop-down menu with two options: “June 2016” and “2017.” The June 2016 option is the default option. I used that default option when conducting my search. However, when I switched the option to “2017,” I was able to reach the most current filing. Not a complete dud, but confusing to say the least.

Fostering the TNC Revolution

Starship robot: Now legal in Virginia.

It’s always refreshing when Republicans and Democrats in the General Assembly play well together. We don’t hear about such instances very often — reporters are drawn to conflict — but I suspect they occur more frequently than we hear about.

An illuminating instance is how legislators from the two parties collaborated to create what Sen. Jennifer McClellan, D-Richmond, calls a “comprehensive legal framework” for Transportation Network Companies (or TNCs) popularized by Uber and Lyft.

Writing in Sunday’s Richmond Times-Dispatch, McClellan detailed several bills enacted in the 2017 session with bipartisan input. If signed by the governor, the legislation will accomplish the following:

  • Lower up-front fees. TNCs will have a new option for applying for certificates. Instead of paying the existing up-front fee of $100,000 upon application, businesses can pay a $20 surcharge per record when purchasing driver transcripts. This measure will make it easier for smaller, less capitalized companies.
  • Less red tape for drivers. A requirement will be removed for TNC drivers to register personal vehicles for use as a TNC partner vehicle. State Police can recognize another state’s annual motor vehicle safety inspection in lieu of Virginia’s.
  • Brokering rides. Third-party companies will be allowed to broker TNC rides. This measure responds to a request by Richmond-area startup, UZURV, which piggybacks on Uber and Lyft by allowing passengers to reserve rides with specific drivers.
  • Robot deliveries. London-based Starship Technologies wants to make deliveries in cooler-sized robots, which can travel up to four miles (round trip) and can navigate sidewalks, shared-use paths and crosswalk. These “Electronic Personal Delivery Devices” will become legal.
  • Less red tape for property carriers. Some requirements regarding property carriers and bulk property carriers will be eliminated.

The TNC revolution will prove a fertile field for innovation, and the more Virginia does to loosen regulatory restrictions (within the bounds of protecting public safety and creating a level playing field), the more innovation we will see. Companies like Starship will set up shop in Virginia before investing in states where their service is illegal. Entrepreneurs like UZURV will spring up to build on the Uber revolution. And Virginia consumers will benefit from options they never imagined having before.

Now, if the legislature can just figure out what to do with AirBnB…

Three Land Use Trends to Watch

Construction booming in Tysons despite 17.5% office vacancy rate.

Three articles today may help us divine the future of residential and commercial development in Virginia:

Rebound of the exurbs? For many years, I was committed to the proposition that metropolitan development had reached a tipping point in which the forces favorable to urban re-development were stronger than the forces driving suburban sprawl. The exurbs — low-density tract development on the metropolitan fringe — seemed to be in full retreat as market preferences shifted toward walkable, mixed-use development in central cities and inner suburbs.

There still seems to be an unfulfilled demand for walkable urbanism, but I may have been to quick to write off the exurbs. Jonathan Fox, a principle at the Fox Group, argues in the Washington Post that median home prices in Washington’s inner suburbs flat-lined in 2016 while prices in outlying communities such as Marshall, Warrenton, Lorton and Middleburg have experienced double-digit increases in median home prices and strong gains in cost per square foot.

“As home prices and the cost of living continue to increase in Washington,” writes Fox by way of explanation, “there will be more demand for affordable housing which is often found in farther out regions of the counties.

My question for Fox: Is he focusing on real estate prices in the oases of small-town walkability in outlying communities — Warrenton, for instance, is highly walkable — or does his analysis include the surrounding tract development? If so, are walkable communities out-performing tract communities?

Tysons redevelopment is booming. But… The Tysons area may have a 17.5% office-vacancy rate, but re-development is going gangbusters. Traditional supply-and-demand logic does not seem to apply, says Gerald Gordon, president of the Fairfax County Economic Development Authority, as reported by Inside Nova.

Tysons tenants are engaged in a “flight to quality,” moving from older buildings to new ones with the latest amenities. “The new space is more expensive, but it sits right on top of a Metro station,” Gordon said.

But redevelopment away from the Metro stops may prove a challenge. “We’re going to have to work hard just to stay in place,” Gordon said. “When I first got here, office users were taking an average of 265 square feet per employee. Today, it’s anywhere between 80 and 140. So you have to bring in twice as many jobs to fill the same space.”

Moral: As employers figure out how to use less office space — more collaborative space, more mobile office technology, more “hoteling” — high commercial vacancy rates will continue to be an issue. There will be a lot of obsolete office space on the market.

Bifurcation of retail. Everyone knows that Amazon.com and other online retailers are gutting the traditional retail industry. But that doesn’t mean everything will be purchased online. People still like to shop as part of an entertainment or social experience. My wife’s cousin calls it “retail therapy.” A related phenomenon is what I call “girlfriend shopping” — shopping as a bonding experience. While Amazon.com makes shopping ridiculously easy, it’s not what you’d call an enjoyable experience.

Tom Goodwin, head of innovation for Zenith Media, argues in Bloomberg that physical retailers can create a competitive advantage that trumps price and convenience.

“Shopping is the world of adding experiences,” he writes. “It’s the interactive perfume lab in Selfridge’s, the selfie opportunities in Harvey Nichols, the Hardware club experiences in Harrod’s or the extravagant laboratories of Le Labo. Coffee shops seem to have learned this, it’s the unnecessarily long wait, the drama of the brew, the theatre of the leather bound menu in Intelligensia coffee.”

Market forces will push retailers in one of two directions — more frictionless, low-cost shopping online or more experience-rich shopping in the physical world.

Bacon’s bottom line: I don’t get the sense that local governments in Virginia have absorbed two important lessons. First, technology has rendered obsolete the space-intensive offices of yesteryear, and the demand for commercial space is shrinking. Old office parks will rapidly lose their market appeal. Counties will see their tax bases shrivel. Second, retail activity continues to move moving online, which is rendering shopping centers obsolete and redundant. Again, counties will see their tax bases shrivel.

The future belongs to those who can adapt. Office activity will shift to centers of walkable urbanism; access to mass transit is a major bonus (although, in an Uberized world, I’m not persuaded it is absolutely essential). Retail activity likely will do the same. When people want to enjoy shopping as an experience, they want to enjoy the experience outside the store as well. Strip shopping centers and aging malls don’t have much to offer.

Nobody knows where all this heading. (That includes your humble futurist and prognosticator). Things are changing too fast for planners and politicians to figure it out. How will self-driving cars alter the equation? How will Transportation-as-a-Service change the way think about where they live, work and play? There’s lots of speculation, but nobody knows. We won’t know until the market figures it out. The communities that prosper will be those that are the most flexible, adaptable and willing to experiment with new forms of transportation and land use.

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.

Too Many Deaths from Surgical Complications at UVa

Feds penalize UVa hospital for too many surgical complications.

The UVa medical center has focused in recent years in bringing down the rate of deaths from surgical complications.

Here’s the good news: 75 fewer people have died from surgical complications at the University of Virginia Medical Center so far this year than last year.

Here’s the bad news: The public doesn’t know how many people did die from surgical complications.

UVa assuredly knows, but the figure did not appear in a Daily Progress article on the subject, presumably because hospital administrators did not care to share it.

Whatever the number, it was high enough to warrant recognition of the federal government. The hospital had higher-than-average death rates from surgical complications from 2013 to 2015, according to Centers for Medicare and Medicaid Services (CMS) data. The UVa hospital has been punished for the third consecutive year for high rates of hospital-acquired infections and other medical complications. As a result, the facility will receive an estimated $1.8 million less in Medicaid reimbursements this fiscal year.

UVa officials said that the hospital has launched a turn-around effort and that their data show big improvements, even if gains are not reflected yet in government data. “We are three years into a major transformation,” said Dr. Tracey Hoke, chief of quality and performance improvement at UVa. “It takes time for these efforts to be borne out in the national benchmarking services.”

Bacon’s bottom line: I’m not singling out UVa for special attention. I focus on UVa only because the Daily Progress happened to write about it. But it strikes me that the number of fatalities due to “surgical complications” is critical data that the public has a right to know. That data should be reported by every hospital in Virginia.

The fact is, hospitals are dangerous places. You don’t want to go into one unless you’re really sick. According to the Centers for Disease Control and Prevention, on any given day, about one in 25 hospital patients acquires at least one healthcare-associated infection. In 2011, the most recent data reported, there were 722,000 hospital-acquired  infections (HAIs); 75,000 patients with HAIs died during their hospitalization.

(The Daily Press refers to “surgical complications.” Could that also include medical malpractice? Between 2005 and 2015 there were roughly 450,000 medical malpractice payments and adverse actions taken nationally against health care providers, according to the National Practitioner Database.)

The idea of reporting mortality rates generally for hospitals is controversial because some institutions — UVa is probably among them — get handed the hardest of the hard cases. It wouldn’t be fair to judge them based on mortality without adjusting for the acuity of the patients, which is exceedingly difficult to do in a manner that everyone agrees upon. But that logic doesn’t apply to hospital-acquired infections. That indicator reflects the quality of hospital management and medical practice. Before submitting to surgery at any given hospital, patients should know the odds of contracting a debilitating infection there.

Transparency is sorely lacking in the health-care sector, and Virginia’s hospital industry is no exception. Patients cannot function as effective consumers of health care services without this information. Hospitals already have the data, so it’s not as if government would impose some onerous and expensive new obligation to require them to gather it. Virginians should insist that data on hospital-acquired infections be made readily available to the media and the public.

Update: The UVa medical center isn’t the only institution with a problem. From today’s Roanoke Times: “The federal government will again dock Carilion Roanoke Memorial Hospital millions of dollars for having too many readmissions and hospital-acquired infections despite progress in lowering both rates.”