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 those are 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 nightly@politico.com. Or contact tonight’s author on Twitter at @JoanneKenen.
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