by James C. Sherlock
The question in the title is a proxy for nearly every question people ask on this blog. I will try to answer that here so that expectations for the Northam administration’s performance are not are impossible to meet.
The key thing to know about the “Virginia Way” in healthcare is that it is profoundly hospital-centric.
The reason that the government of Virginia does not have enough information to act coherently and effectively is because the integrated health systems, which control both Virginia Hospital and Healthcare Association (VHHA) and the General Assembly, have not wanted them to have that information. Information is power, and the health systems did not want the Virginia Department of Health (VDH) to have power. So VDH had no decision level information going into this crisis. They still don’t.
Don’t blame VDH alone for its failed performance. The integrated health care systems for nearly 50 years have wanted VDH to have a single function in the business of healthcare — administering the Certificate of Public Need law.
That law gave VDH the mission of restricting healthcare capacity and protecting Virginia hospitals from competition. The fact that VDH over those years created the very regional monopolies that now control it was a bonus for Virginia hospitals. The complete lack of state lack of oversight let them morph into integrated health systems that control all phases of medicine in this state.
In a crisis, asking VDH to provide decision support to the Governor is like asking a hog to compete in the high jump.
So the VHHA today put up a web page[1] that “Highlights COVID-19 Hospital Statistics.” Useful information indeed, but not comprehensive, and we note that it has been posted for the first time more than nine weeks after the President banned travel from China.
It appears that neither the VDH, VHHA nor Virginia’s powerful integrated health systems that control both comprehends what is happening outside of the hospitals, much less what is important there.
For example, the requirements for personal protective equipment (PPE) of the 50% of Virginia physicians not controlled by hospital systems have been ignored. Their medical societies have been scrambling to help, but are overwhelmed.
Now it has turned out that by far the most effective and timely test for COVID-19 has been produced for point-of-care (physicians offices, clinics, etc.) testing, not for centralized test labs. That fact has left the hospitals and the administration collectively clueless.
To get the up-to-the-minute picture of such ignorance, I refer you to Sentara Health, the largest and most powerful of Virginia’s integrated health systems. Go to their web page.
Sentara Healthcare is now processing COVID-19 tests at a newly-created laboratory in Sentara Norfolk General Hospital. The initiative will allow Sentara Laboratory Services to expand patient testing within all Sentara hospitals across Virginia and North Carolina. This will shorten wait times for results by taking some of the test volume currently being sent to commercial laboratories. The goal is to incrementally achieve the capacity to complete 1,000 tests per day within a few weeks and return test results in 24 to 48 hours.
Good to know.
What many with knowledge of America’s health system know — and it appears Sentara either does not know or is not acknowledging — is that the 24- to 48-hour response central laboratory platform hosts neither the best nor nearly the fastest test out there.
Neither Sentara’s press release nor the comments from the state lab in last Wednesday have addressed point-of-care testing with Abbott’s new COVID-19 test.
Abbott’s test will run on the company’s ID NOW™ platform, providing rapid results in a wide range of healthcare settings such as physicians’ offices, urgent care clinics and hospital emergency departments. The Abbott ID NOW platform is small, lightweight (6.6 pounds) and portable (the size of a small toaster) and is already the most widely available molecular point-of-care testing platform in the U.S. today.
Daily 50,000 of the FDA-approved COVID-19 tests that run on ID NOW are being shipped by Abbott. The test requires about 3 minutes to provide a confirmed positive, and less that 15 minutes to produce a confirmed negative. It is likely that the tests shipments are being directed to the hottest of the hot spots, but Virginians do not know if that is true or when and where they might be available here. Portions of Virginia itself will likely join hotspot lists shortly.
With 18,000 of the point-of-care test platforms in place nationwide, it is statistically likely that more than 450 of those are present in Virginia. Many of those, again statistically speaking, are likely be in Sentara’s own physicians offices, clinics and possibly emergency rooms. It is not clear that Sentara management knows whether it has them, much less how many and where. Even that statistic will be incomplete without surveys of the physicians who do not work for Sentara.
The Sentara’s of Virginia command the VHHA. If Sentara either doesn’t know this or acknowledge this, then neither will VHHA and, unfortunately, neither will the Northam Administration.
That is the Virginia Way.
[1] https://www.vhha.com/communications/new-vhha-data-dashboard-highlights-covid-19-hospital-statistics/
