Bacon's Rebellion

Democracy Thrives in Sunlight

Regulated States Have Fewer Hospital Beds

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by

James A. Bacon
in

Hospital beds: Not enough

by James C. Sherlock

Virginians have read my complaints for years that Virginia’s Certificate of Public Need (COPN) law has artificially reduced supply of healthcare facilities in Virginia, driving up prices and reducing access. Legislators who believe as I do have not won the argument for the past 30 years in Richmond.

Unfortunately, I offer the tragic proof that the hospital industry can figure out how many hospitals, hospital beds and ICU beds are needed far better than bureaucrats can.

From Becker’s Hospital Review[1] 22 hours ago:

The demand for hospital beds in the U.S. is projected to far exceed capacity by mid-April, according to an analysis from the University of Washington’s Institute for Health Metrics and Evaluation in Seattle.  … According to the model, 20 states will face a shortage of ICU beds when COVID-19 peaks.

Thirty five states and Washington, D.C., operated a Certificate of Public Need[2] program as of December 2019.

Seventeen of the 20 states that are projected to have ICU shortages have COPN programs, including Virginia.[3] Those 17 states are projected to be short 20,405 ICU beds, including the projection of 231 too few in Virginia.

The three states which have no COPN laws and projected shortages need 240 ICU beds.

You might think, “Well, all the biggest states have CON laws and that skewed the results.” You would be wrong. Neither California nor Texas has a COPN law, and neither projects a shortage.

You may also think that numbers like this will automatically result in Virginia’s repeal of COPN next session. You are wrong there, too. It will be a bitter fight and if I had to bet, I’d wager COPN emerges either unscathed or strengthened. Such is the power of the state-protected incumbent hospitals in Virginia.

[1]

https://www.beckershospitalreview.com/patient-flow/20-states-to-face-icu-bed-shortages-when-covid-19-peaks-analysis-finds.html

[2] https://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx

[3] Ibid.

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15 responses to “Regulated States Have Fewer Hospital Beds”

  1. Nancy_Naive Avatar
    Nancy_Naive

    Nothing exists in a vacuum, who’s making the money? Aetna? Sentara?

  2. sherlockj Avatar
    sherlockj

    Read the last line of my essay for your answer.

    1. Nancy_Naive Avatar
      Nancy_Naive

      Should have taken advantage of the “edit” capability to add “Which Delegate? Senator?”

      1. sherlockj Avatar
        sherlockj

        Nancy, I have a very accurate list of which politicians, including the Governor, Lt. Governor and Attorney General and each of the 140 members of the General Assembly, have taken how much money from the two major hospital lobbyist PACs, VHHA and HCA. I will publish it at the most inconvenient time for them. For AG Herring, that will be just after he starts in earnest his run for Governor.

        1. Nancy_Naive Avatar
          Nancy_Naive

          I’m not interested in which war chests accepted campaign contributions; that’s always slanted to the incumbent, and if he loses, that money will just go to the new guy the next time.

          I wanna see the Rolexs.

  3. Steve Haner Avatar
    Steve Haner

    So, Jim S. I was just on that VHHA tracker that Jim B. pointed us to the other day (or was it you…). As of yesterday, it actually wasn’t showing stress on the hospital assets, even the ventilators. Are we just still two weeks away from the peak demand? Or are things less dire than predicted? Are they underplaying it to protect themselves from reform? Granted, in NY, especially NYC, and other hotspots things have gotten badly out of hand, and Virginia may still get there. But the signs are the mitigation is now taking hold well.

    And with your military connections, I wonder if you’ve seen info on another topic. No question the whole situation is being exacerbated by supply chain problems (the sister of a friend works at a major medical supply company). Is the DOD being used to solve that problem? A C-17 or C-5 can carry a whole lot of vital supplies from point A to point B….(Will China let us send a C-17 to load up?) I saw that the story about the NE Patriots plane and thought, gee, what about the AF cargo planes – much larger.

  4. sherlockj Avatar
    sherlockj

    The model referenced here has our peak demand on April 20. I used to use models a bit. They are as good as the embedded algorithms (assumptions) and the data fed them. This one illuminates a relative scarcity of ICU beds in Virginia whether the modeled demand is reached or not. Whether it turns out to be an absolute scarcity in this crisis we will see.
    I do not know what aircraft the U.S. is using other than the Boeing Dreamlifter, which can hold three times the volume of a 747-400F freighter. But, like Europe, which has a similar air bridge to China, there is no reason to use military cargo aircraft right now. The amount of materials being transported don’t require that kind of effort, which can get messy diplomatically.

    1. Steve Haner Avatar
      Steve Haner

      Yes, and excellent side debate going forward will be whether this exercise increases or decreases confidence in the climate models, which are infinitely more complicated than the epidemiological models.

      1. djrippert Avatar
        djrippert

        Good point. I spent years working with models of things that could be modeled (because hey were relatively simple) like networks and computer systems. Even when the models were empirically inaccurate they were almost always directionally correct. The climate models may be alarmist but the planet is almost certainly heating up.

  5. matthurt92 Avatar
    matthurt92

    I’m not aware of any instance in which centralized planning and control leads to positive outcomes without unintended negative consequences. It seems that the market is much better at allocating resources than bureaucrats.

    1. djrippert Avatar
      djrippert

      No kidding. A friend sent me an e-mail from his country club. The members are still paying their dues (almost all by automatic credit card charges) so the club originally decided to continue employing and paying its non-working employees. However, the aid package provides for $600 per week for 4 months. Given the rural area where this club sits the $15 / hour is more than most of the non-working employees make, especially in April. So, the club laid off all the non-working employees with a promise to re-hire them when operations resume. The money saved will be used for sand bunker improvements. In other words, the bailout is essentially paying for better sand bunkers at a private country club. What was it that my Dad used to say? The best laid plans of mice and men often go astray.

  6. johnrandolphofroanoke Avatar
    johnrandolphofroanoke

    What has been Ralph’s reaction and efforts to the disaster at the Canterbury Nursing Home in Richmond? 32 dead and 80 plus positive tests. No commotion whatsoever… Surely if we can build expensive field hospitals across the state something more could be done for these vulnerable Virginians trapped in a petri dish?

    1. Steve Haner Avatar
      Steve Haner

      It will be somebody’s PhD dissertation at some point, I’m sure, but odds are everybody inside that closed environment was exposed before the first symptomatic case appeared. The dissertation question will be, given the publicized example in Washington State, what did the hundreds of other facilities do right that this place did wrong. One thing that was done is apparently everybody was tested and the results are now known. Nothing to do now but treat the sick and monitor the (many) who tested positive but have no symptoms to date. One of the first Richmond reports was Westminster Canterbury (different place) and it has been out of the news since then.

      The stricken facility is a rehab, not technically a nursing home, but in both cases most patients are in the vulnerable categories.

      1. djrippert Avatar
        djrippert

        Yes, wide scale testing is so valuable in fighting this epidemic. Pity Virginia can’t get its act together. Even yesterday Maryland conducted more tests than Virginia despite having less than three quarters of our population. But Maryland has an advantage Virginia lacks – a Republican governor.

  7. TooManyTaxes Avatar
    TooManyTaxes

    Section 214 of the Communications Act of 1934, as amended, requires FCC permission to construct and operate interstate and international lines.

    Here’s what the FCC rules (47 CFR sec. 63.01) addresses interstate lines.

    §63.01 Authority for all domestic common carriers.
    (a) Any party that would be a domestic interstate communications common carrier is authorized to provide domestic, interstate services to any domestic point and to construct or operate any domestic transmission line as long as it obtains all necessary authorizations from the Commission for use of radio frequencies.
    (b) Domestic common carriers subject to this section shall not engage in any line construction that may have a significant effect on the environment as defined in §1.1307 of this chapter without prior compliance with the Commission’s environmental rules. See §1.1312 of this chapter.

    Applications must still be filed and granted to provide international services. Why doesn’t Virginia take the same approach for medical facilities as the FCC does for interstate services?

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