Hospitals don’t need ‘surge capacity’

SEEKING BED REST— The latest wave of coronavirus doesn’t seem to be as bad as others we’ve endured.But people are still getting sick. And more are ending up in hospitals.

So much for a restful spring and summer for our exhausted “health care heroes.”

Each time this happens, one of the “pandemic lessons” that starts circulating is that we need more hospital beds, “surge capacity” for emergencies.

Guess what: We don’t. The reasons are surprising and important.

Nightly talked to Katherine Baicker, a leading health economist who is now dean of the University of Chicago Harris School of Public Policy, who agreed that we need to do a whole lot of things better to prepare for the next emergency, whether it’s another bad Covid variant or something else.

But having a whole lot of empty hospital beds just sitting around is not one of them.

That’s because a hospital bed isn’t, as she put it, “four posts and a mattress.” A bed has a whole system around it. Medical staff. Support staff. Pricy technology.

“It’s expensive to maintain buildings and beds,” Baicker said. “You don’t build a hospital, put in the beds, and lock the door until you need it. You have to be staffed up for it.”

And that means that there are all sorts of incentives to fill that bed — just because it’s there. And it ends up adding expense to the health care system — without necessarily improving health.

You can think of it a bit like traffic. If you build more lanes to relieve traffic jams, you often end up getting even more cars on the road. If you buy more beds in the name of “surge capacity,” you end up with more patients in them.

When hospitals talk about “bed capacity” they mean the actual bed plus the medical technology and monitoring that goes with it — and that evolves quickly. “A hospital bed today doesn’t look like a hospital bed of 10 years ago,” Baicker said. The bed — including the system around it — starts to depreciate and become obsolete fast. So then there’s incentive to replace and upgrade the bed (even one that wasn’t really needed in the first place).

And in addition to tech, beds need staff. That’s everything from physicians and respiratory therapists to food service and maintenance. Paying them is another incentive to fill those “surge” beds.

So this cycle of adding and filling beds would add to the nation’s colossal $4 trillion of health spending — without adding to the quality of our health.

In fact, doing stuff patients don’t really need done to them can harm their health (and expose them to hospital-acquired infections). Just a few days ago, the Department of Health and Human Services released a study finding that one in four Medicare patients who were hospitalized experienced some kind of harm — and a whole lot of it (43 percent) was probably preventable. And that was from 2018, before the hospitals were under the pressures of the pandemic, and the rates weren’t much better than they had been a decade earlier.

Besides outright harm, hospitalization isn’t always needed anymore. The U.S. health care system has been reducing inpatient bed capacity precisely because we now have ways of treating people safely outside the hospital — which is where most people prefer to be anyway. And those who do need inpatient care generally have shorter stays than in the past, meaning fewer beds are needed.

“The more beds you have, the more [patient] nights in the hospital you have,” Baicker said. And the health benefits for thoseare often “marginal” at best.

That doesn’t mean there aren’t some specific underserved areas, including some rural communities, that need more beds.

But that’s capacity — not surge capacity.

Welcome to POLITICO Nightly.Reach out with news, tips and ideas at [email protected]. Or contact tonight’s author on Twitter at @JoanneKenen.

Baicker said there are many, more important, lessons from the first two years of this pandemic — including improving public health data to respond to catastrophes, or even better, to prevent problems from becoming catastrophes.

Hospitals also need to deploy their resources better — to move patients or staff or personnel around more wisely (which can also mean knocking down some regulatory barriers during an emergency). Move the sickest patients to bigger, sophisticated hospitals. In the case of the coronavirus, which comes in waves that hit different parts of the country at different times, move medical staff and resources around with more agility.

Telehealth, which boomed during the pandemic, can also be put to better use within clinics and hospitals.

“You can stretch capacity, you can draw on personnel and expertise from across the country and across the globe in your clinic if you have the right relationships and connectivity,” Baicker said. That can be particularly valuable in rural or underserved hospitals — while reserving capacity in the most sophisticated hospitals for patients who need more complex or specialized care, like an organ transplant.

Fixing everything that needs to be fixed in our health care system to avoid the “tragic shortcomings” we’ve experienced in the past two years, all takes money.

And if we put all the money in loads of new beds, she said, “there’d be no money left for anything else.”

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AROUND THE WORLD

TOUGH TALK Washington wants “a strategic defeat of Russia” in Ukraine, U.S. Ambassador to NATO Julianne Smith said today, Camille Gijs and Hannah Roberts write.

“We want to see a strategic defeat for Russia. We want Russia to leave Ukraine, we want Russia to stop the violence, stop these indiscriminate brutal attacks on civilians,” Smith said during the think tank-led Strategic Ark conference in Warsaw.

The rhetoric against Moscow is also being ramped up on the other side of the Atlantic, with U.K. Foreign Secretary Liz Truss warning that Russian President Vladimir Putin “must lose in Ukraine.”

Speaking on Thursday to the Italian newspaper Corriere della Sera, in remarks that were published on Friday, she was asked about French President Emmanuel Macron’s comments on not “humiliating Putin” and whether the West should offer Putin a way out.

“I don’t agree with this idea of an exit ramp. Putin must lose in Ukraine and we must see its sovereignty and territorial integrity restored, on this we are very clear,” Truss said.

Nightly Number

Parting Words

CALLING MOM AND DAD— The parents of Los Angeles mayor Eric Garcetti have enlisted the help of prominent lobbyists to aid their son’s beleaguered nomination to serve as U.S. ambassador to India, Hailey Fuchs writes.

McGuireWoods Consulting registered to lobby on behalf of Sukey and Gil Garcetti on Thursday for the purposes of “Outreach Related to Confirmation for Ambassadorship Nomination.” The lobbyists on the account include a former chief of staff to Sen. John Hoeven (R-N.D.) Ryan Bernstein and Garcetti’s own former deputy mayor and longtime advisor, Breelyn Pete.

The registration is the latest sign that Garcetti’s allies are turning over every possible stone to get his nomination across the finish line.

Bernstein did not immediately return a request for comment.

That nomination has floundered amid accusations that the mayor’s top aide, Rick Jacobs, had sexually assault women on the staff. Garcetti has insisted that he knew nothing of Jacobs’ conduct, which came to light because of a whistleblower report and includes allegations from his former Communications Director Naomi Seligman that Jacobs grabbed and kissed her in front of other city staffers.

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