Bacon's Rebellion

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Quantifying the Hospital-Bed Shortage

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by

James A. Bacon
in ,

Source: ProPublica by way of Virginia Business.

by James A. Bacon

Two weeks ago, I raised the alarm: Virginia doesn’t have enough hospital beds to cope with the COVID-19 virus; capacity was most constrained in Northern Virginia. Yesterday, Bacon’s Rebellion contributor Jim Sherlock explained why: Certificate of Public Need (COPN) regulation throttled the addition of hospital beds in the Northern Virginia area. Now Virginia Business magazine — which is really stepping up its news coverage, by the way — explores the repercussions.

If only 20% of Virginia adults contracted COVID-19, hospitals in all metro regions across Virginia would be overwhelmed, according to data from the Harvard Global Health Institute.

The most staggering results from the Harvard study come from the Arlington hospital referral region (HHR) — which encompasses Fairfax County and other Northern Virginia localities. If 60% of adults were to become infected there, hospitals in the region would require an increase of nearly 600% more hospital beds to deal with the crisis. The Newport News region — which includes Williamsburg — takes a close second. Hospitals there would need nearly 500% more beds if 60% of the adult population were to be infected.

So, it is abundantly clear that Virginia does not have enough hospital beds if the COVID-19 virus continues spreading at an exponential rate. The big question is: What are we doing about it?

Virginia Business has some anecdotal answers.

  • Gov. Ralph Northam and State Health Commissioner M. Norman Oliver issued an executive order directing all hospitals to stop performing elective surgeries or procedures to help conserve supplies of personal protective equipment (PPE). A necessary step, but hospitals were acting on this anyway.
  • Alternate care sites and field hospitals are being set up by health care entities including Mary Washington Healthcare in Fredericksburg and Ballad Health in Southwest Virginia. Are those the only two, or are there others? (Virginia Commonwealth University has begun transforming empty university dormitory rooms into temporary medical sites, according to WCVE.)
  • Hospitals are developing internal modeling to predict the spread of the virus in their community and the potential demand for hospitalization. VHHA and the Virginia Department of Health (VDH) are also working on models,

One would think that the issue of acute-care hospital beds and ICU beds would be front and foremost in the minds of Northam administration officials. Maybe they’re doing something tangible to help, maybe they aren’t. We just don’t know, because they’re not saying. Listen to Peter Galuszka’s interview of state epidemiologist Lillian R. Peake (see previous post) for a exercise in vagueness. If this interview is any indication, the administration seems to be tracking and monitoring and interfacing a lot but not doing much.

Update: The Virginia Mercury reports that Virginia has asked the U.S. Army Corps of Engineers to begin looking at hotels, dorms and arenas that can be converted into temporary “alternate care sites” to handle patients suffering from COVID-19.

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28 responses to “Quantifying the Hospital-Bed Shortage”

  1. LarrytheG Avatar
    LarrytheG

    Don’t you think the bed shortage issue is across the board in almost every state whether they have COPN laws or not?

    Second, even if we did not have COPN , does anyong think that excess hospitals sufficient to deal with a pandemic would be built by the free market?

    Third. Who is responsible for pandemic capacity? Not the free market, right?

    So who should pay for that reserve capacity sufficient to deal with pandemics?

    Just looking at the bed shortage with such narrow lens is really not addressing the issue in my view.

    No one has enough beds COPN or not – and no one believes that if COPN was repealed that the competition would provide excess beds.

    So,what the real point?

    1. sherlockj Avatar
      sherlockj

      Read my comments below, Larry

  2. LarrytheG Avatar
    LarrytheG

    Don’t you think the bed shortage issue is across the board in almost every state whether they have COPN laws or not?

    Second, even if we did not have COPN , does anyong think that excess hospitals sufficient to deal with a pandemic would be built by the free market?

    Third. Who is responsible for pandemic capacity? Not the free market, right?

    So who should pay for that reserve capacity sufficient to deal with pandemics?

    Just looking at the bed shortage with such narrow lens is really not addressing the issue in my view.

    No one has enough beds COPN or not – and no one believes that if COPN was repealed that the competition would provide excess beds.

    So,what the real point?

  3. Steve Haner Avatar
    Steve Haner

    RTD had a story this morning about VCU’s steps to convert a dormitory. Convert it back, I think. It was a medical facility before if I recall correctly. Oh, right, you cancelled…..

  4. Steve Haner Avatar
    Steve Haner

    RTD had a story this morning about VCU’s steps to convert a dormitory. Convert it back, I think. It was a medical facility before if I recall correctly. Oh, right, you cancelled…..

  5. Nancy_Naive Avatar
    Nancy_Naive

    COPN. Who does it benefit? Democrats? No. Republicans? No.

    It benefits an existing hospital. Prevents some big corporation opening up in some guys territory. Now, who would push that?

  6. Nancy_Naive Avatar
    Nancy_Naive

    COPN. Who does it benefit? Democrats? No. Republicans? No.

    It benefits an existing hospital. Prevents some big corporation opening up in some guys territory. Now, who would push that?

  7. sherlockj Avatar
    sherlockj

    Go back and read my March 16 column “blame COPN for looming bed shortages”. You will see the devastation on capacity that law and its administration by VDH has wrought over the past 20 years alone. Then this discussion can proceed with those facts. Remember, that law was designed to limit capacity. It has certainly done that.

  8. sherlockj Avatar
    sherlockj

    Go back and read my March 16 column “blame COPN for looming bed shortages”. You will see the devastation on capacity that law and its administration by VDH has wrought over the past 20 years alone. Then this discussion can proceed with those facts. Remember, that law was designed to limit capacity. It has certainly done that.

  9. sherlockj Avatar
    sherlockj

    For further insight, type ‘Certificate of need laws; implications for Virginia’ into your search engine.

  10. sherlockj Avatar
    sherlockj

    For further insight, type ‘Certificate of need laws; implications for Virginia’ into your search engine.

  11. LarrytheG Avatar
    LarrytheG

    Maybe I do not understand but I don’t think any would’be competitors for SOME hospitals services would build extra beds that they don’t need and will not need until a pandemic comes along.

    No for-profit or even non-profit venture is going to build excess beds when there is no demand for them.

    It’s an unrealistic expectation and to now imply that hospitals somehow have fallen short on having enough beds – from some of the same folks who would essentially force hospitals to provide even more unompensated care while for-profit competitors skim off the profitable services that hospitals now use to cover their uncompensated care costs..

    It’s narrow-minded and creates more problems than it solves and it’s basically tied to an ideological belief about “markets” when basic health care – the kind that all hospitals are expected to provide regardless of payment – that’s NOT a “market”. It’s a public service that has to be paid for – by someone.

    We have seen in the past month what most of us expect from our hospitals. No one that I know of is calling them out for excess profits right now and virtually everyone wants them to provide unlimited beds and services no matter the cost.

    As I’ve said before, what ought to go hand in hand with changes to COPN laws is also changes in how hospitals are reimbursed for unpaid services.

    If we fixed the uncompensated care that arises from treating everyone – if we did that – in conjunction with COPN reform, I’d support it.

    I’m not going to support COPN if it ignores what happens to the hospitals especially the ones who still have to provide all service and are not “profitable”, in fact, some are closing.

    We cannot go about this in piecemeal fashion. It’s grossly irresponsible and it’s mainly to serve the folks who continue to believe that health care should be a “market”. No developed country in the world works like this. The only countries that actually do are 3rd world. We have folks who continue to believe we can be a “free market”.

    Call me a skeptic of that belief. But I’ll still support COPN IF we insure that hospitals – not just the uber profitable ones but all of them – are held harmless. Until then – there’s a real good reason why COPN reform has so many opponents… and it’s all in this comment.

    So what I’d like to hear from the COPN advocates is a bigger view of how we do that and also how do we not harm our ability to provide care to citizens – in places where hospitals are not profitable and barely hanging on financially.

    To me, to bring up the issue of not enough beds in a pandemic as part and parcel of COPN reform – just boggles the mind!

  12. LarrytheG Avatar
    LarrytheG

    Cuomo addressed the question of “enough beds” (and other stuff) yesterday. He said that they currently have PLENTY of beds, but if the scientists are correct, we’ll not have enough in the next month.

    Therein lies an issue in that Trump himself and a good number of other people on the right simply do not believe the scientists on the projections.

    Trump has maintained that view saying that we will not need all the stuff but yesterday he changed yesterday.

    Citizens are split on believing the scientists. More than a few say that this CANNOT go on for weeks or months. They’re not convinced it will and they resent all the restrictions.

    But the medical people are convinced it will and are making the case that they are close to running out of equipment and supplies right now.

    One wonders if in past emergencies the public was more or less united and believed scientific prediction but now, we have progressed to a point where we do not and we are split in whether or not we truly believe the science.

    And that goes back to the “shortage of bed” problem. Medical folks who do believe the scientists and other countries experience are saying we ARE going to run out if we don’t ramp up now. Others who are skeptical are seeing a lot of empty beds right now and believing the current urgency is overblown.

    The POTUS was in the latter group which included much of the right-leaning media which has insisted this is an overblown hoax.

    This changed yesterday when the POTUS relented and said he would order production of stuff – but he still says he believes the states should be doing this.

    If this were a regional disaster and parts of the US were not affected, then typically the unaffected states would send people and equipment to the affected states.

    But when the whole country is affected – they cannot help each other and, in fact, becomes competitors for equipment and that’s the point Cuomo has made for several days on TV that finally convinced Trump to change -reluctantly – he apparently thinks that medical folks are allied with scientists and both are largely “liberals” trying to make him look bad.

    So, our politics now affect how we respond to disasters.

  13. LarrytheG Avatar
    LarrytheG

    Maybe I do not understand but I don’t think any would’be competitors for SOME hospitals services would build extra beds that they don’t need and will not need until a pandemic comes along.

    No for-profit or even non-profit venture is going to build excess beds when there is no demand for them.

    It’s an unrealistic expectation and to now imply that hospitals somehow have fallen short on having enough beds – from some of the same folks who would essentially force hospitals to provide even more unompensated care while for-profit competitors skim off the profitable services that hospitals now use to cover their uncompensated care costs..

    It’s narrow-minded and creates more problems than it solves and it’s basically tied to an ideological belief about “markets” when basic health care – the kind that all hospitals are expected to provide regardless of payment – that’s NOT a “market”. It’s a public service that has to be paid for – by someone.

    We have seen in the past month what most of us expect from our hospitals. No one that I know of is calling them out for excess profits right now and virtually everyone wants them to provide unlimited beds and services no matter the cost.

    As I’ve said before, what ought to go hand in hand with changes to COPN laws is also changes in how hospitals are reimbursed for unpaid services.

    If we fixed the uncompensated care that arises from treating everyone – if we did that – in conjunction with COPN reform, I’d support it.

    I’m not going to support COPN if it ignores what happens to the hospitals especially the ones who still have to provide all service and are not “profitable”, in fact, some are closing.

    We cannot go about this in piecemeal fashion. It’s grossly irresponsible and it’s mainly to serve the folks who continue to believe that health care should be a “market”. No developed country in the world works like this. The only countries that actually do are 3rd world. We have folks who continue to believe we can be a “free market”.

    Call me a skeptic of that belief. But I’ll still support COPN IF we insure that hospitals – not just the uber profitable ones but all of them – are held harmless. Until then – there’s a real good reason why COPN reform has so many opponents… and it’s all in this comment.

    So what I’d like to hear from the COPN advocates is a bigger view of how we do that and also how do we not harm our ability to provide care to citizens – in places where hospitals are not profitable and barely hanging on financially.

    To me, to bring up the issue of not enough beds in a pandemic as part and parcel of COPN reform – just boggles the mind!

  14. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    In his press conference on Wednesday, Northam reported that he had asked the Army Corps of Engineers to help in identifying alternate hospital sites. https://www.virginiamercury.com/blog-va/army-corps-to-begin-identifying-virginia-locations-for-temporary-hospitals/

    I agree with Larry about the issue of COPN and excess capacity. It is unlikely that hospitals would have built that much capacity just to have it sit vacant in case a pandemic came along. If they had, our health care costs would be even higher than they are now, because they would have had to generate the income to pay for that unused capacity. Besides, they would not have the capability to staff that capacity right away now to cover the crisis.

    1. James A. Bacon Avatar
      James A. Bacon

      I’d missed Northam’s comment about the Army Corps. Thanks for pointing it out.

    2. LarrytheG Avatar
      LarrytheG

      If the idea if one tests positive is to “self-quarantine” – if you are by yourself
      or one other might be possible. If you are part of a family – even with a house, not as easy. Yeah you can get restricted to some part of the house with a bathroom… but you still got the HVAC system as well as things like dirty clothes and dishes and trash to deal with?

      In a small house, or apartment or double-wide or trailer it may be near impossible.

      And what does one do with things like doctor appointments and such? How
      does a person who tests positive get transported and who does that? Not family members and hopefully not uber, separate car if able to drive?

    3. LarrytheG Avatar
      LarrytheG

      In the interests of “constructive comments” – first to recognize that if we ARE going to have pandemic-ready facilities, equipment and alternative/reserve staffing…

      1. – it’s going to cost all of us some money – it’s going to increase costs,
      can’t get something for nothing or tax the guy behind the tree.

      2. – the free market is not going to do it unless it is made a condition of
      approval of their facilities in competition with hospitals – i.e. a
      standard fee to all facilities that pay for planning and execution.

      3. – it needs to be a government-led centralized effort not one that “suggests” different entities and facilities and businesses “consider” it.

      If we took a similar approach with COPN reform in general – i.e. address the uncompensated care issue as part of COPN reform – then do it. But to do it in such a way that more financial chunks are taken out of all hospitals in Va – regardless of their financial condition is that wrongheaded.

      my 2 cents worth as usual.

  15. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    In his press conference on Wednesday, Northam reported that he had asked the Army Corps of Engineers to help in identifying alternate hospital sites. https://www.virginiamercury.com/blog-va/army-corps-to-begin-identifying-virginia-locations-for-temporary-hospitals/

    I agree with Larry about the issue of COPN and excess capacity. It is unlikely that hospitals would have built that much capacity just to have it sit vacant in case a pandemic came along. If they had, our health care costs would be even higher than they are now, because they would have had to generate the income to pay for that unused capacity. Besides, they would not have the capability to staff that capacity right away now to cover the crisis.

  16. sherlockj Avatar
    sherlockj

    § 44-146.13. “Commonwealth of Virginia Emergency Services and Disaster Law of 2000.” grants authority and responsibility to the Governor to manage Virginia’s emergencies.
    If you want to see what courses have been offered for years on the subject of emergency medical preparedness see https://cdp.dhs.gov/find-training/discipline/emergency-medical-services This program has been in place since at least 2002 and is administered here with the assistance of the Office of Emergency Management. It would be interesting to inspect the training jackets of Virginia’s leaders to see how many of them have participated.

  17. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Another point or question: Do all these doomsday scenarios, i.e. 20% or 60% contracting covid-19, assume that all those people would need to be hospitalized? It seems they do, and if that is so, they are way off base. From what I have read, most people contracting the disease are able to self-quarantine at home and not have to go to the hospital.

    1. James A. Bacon Avatar
      James A. Bacon

      It’s a Harvard model! How dare you question its assumptions?! How DARE you?!

  18. LarrytheG Avatar
    LarrytheG

    Cuomo addressed the question of “enough beds” (and other stuff) yesterday. He said that they currently have PLENTY of beds, but if the scientists are correct, we’ll not have enough in the next month.

    Therein lies an issue in that Trump himself and a good number of other people on the right simply do not believe the scientists on the projections.

    Trump has maintained that view saying that we will not need all the stuff but yesterday he changed yesterday.

    Citizens are split on believing the scientists. More than a few say that this CANNOT go on for weeks or months. They’re not convinced it will and they resent all the restrictions.

    But the medical people are convinced it will and are making the case that they are close to running out of equipment and supplies right now.

    One wonders if in past emergencies the public was more or less united and believed scientific prediction but now, we have progressed to a point where we do not and we are split in whether or not we truly believe the science.

    And that goes back to the “shortage of bed” problem. Medical folks who do believe the scientists and other countries experience are saying we ARE going to run out if we don’t ramp up now. Others who are skeptical are seeing a lot of empty beds right now and believing the current urgency is overblown.

    The POTUS was in the latter group which included much of the right-leaning media which has insisted this is an overblown hoax.

    This changed yesterday when the POTUS relented and said he would order production of stuff – but he still says he believes the states should be doing this.

    If this were a regional disaster and parts of the US were not affected, then typically the unaffected states would send people and equipment to the affected states.

    But when the whole country is affected – they cannot help each other and, in fact, becomes competitors for equipment and that’s the point Cuomo has made for several days on TV that finally convinced Trump to change -reluctantly – he apparently thinks that medical folks are allied with scientists and both are largely “liberals” trying to make him look bad.

    So, our politics now affect how we respond to disasters.

    1. djrippert Avatar
      djrippert

      Larry the Liberal Lemming:

      Many American politicians felt that the biggest risk with Coronavirus was from panic and overreaction. Many commenters on this blog politely rebuked me when I called for Northam to take more aggressive action. Here is a timeline for arch-liberal New York Mayor Bill de Blasio’s reaction to the Coronavirus outbreak:

      https://www.nationalreview.com/2020/03/the-timeline-of-how-bill-de-blasio-prepared-new-york-city-for-the-coronavirus/

      1. djrippert Avatar
        djrippert

        You also seem to love both claiming that Trump called Coronavirus a hoax and fact-checking services like Snopes.

        From Snopes …

        “Despite creating some confusion with his remarks, Trump did not call the coronavirus itself a hoax.”

        Meanwhile, Joe Biden has been accused of sexual assault by a former staffer. The campaign of the person who once said you should always believe women is effectively calling the accuser a liar.

        Ranting and raging against Trump is often justified. However, the alternatives put forth by the Democrats are just as bad or worse. Killary? Uncle Joe from Petticoat Junction?

        And that’s Uncle Joe, he’s a movin’ kind of slow at the junction … Petticoat Junction

        https://www.snopes.com/fact-check/trump-coronavirus-rally-remark/

        1. LarrytheG Avatar
          LarrytheG

          Trump did not directly use the word hoax. He AGREED with FOX new folks who said it AND much more than that to include sitting around on his fat butt until things got bad.

          Even yesterday as he announced more ventilators, he said, once again, that he did not think they were needed – in direct contradiction to almost all the Medical folks and Cuomo.

      2. LarrytheG Avatar
        LarrytheG

        DJ – persistent dumbass (we can play the name calling game)

        If you look at ALL the governors – across the nation – Cuomo is pretty
        much unique.

        What you can grant Northam is that he is letting his delegated staff to do their job and not grandstanding on TV everyday with LIVE coverage.

        This all goes back to prior complaints against Northam – e.g. coonman, etc, et al, ad infinitum

        It’s just not a good complaint. Yeah, he could come on statewide TV and spend an hour a day droning on about everything pandemic but to be honest, I think I got all I can handle with Cuomo!

        Sounds like DJ needs to move to NY where there is a REAL Governor, eh?

        When I hear someone who did not previously refer to Northam as coonman – complain, I’ll give it due attention.

  19. sherlockj Avatar
    sherlockj

    § 44-146.13. “Commonwealth of Virginia Emergency Services and Disaster Law of 2000.” grants authority and responsibility to the Governor to manage Virginia’s emergencies.
    If you want to see what courses have been offered for years on the subject of emergency medical preparedness see https://cdp.dhs.gov/find-training/discipline/emergency-medical-services This program has been in place since at least 2002 and is administered here with the assistance of the Office of Emergency Management. It would be interesting to inspect the training jackets of Virginia’s leaders to see how many of them have participated.

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