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 Hospitalogists, Today we’re doing something a bit different. I had the chance to be a part of a big announcement happening today around an open letter involving physicians, clinicians, and an autonomous vehicle future. I hope you enjoy, and feel free to let me know your thoughts on the subject! Also, I'm hosting a Healthcare Happy Hour with a group of folks from health systems, physician groups, and health tech. We hosted an event like this in LA a few months ago and it was a great night. I’m looking forward to round 2 in Annapolis in a few weeks! Was this email forwarded to you? Sponsored by Navina Gain real-world insights and practical tools to navigate risk adjustment, enhance quality, and improve financial performance with confidence through VBC 202, Navina’s 3-part on-demand series. These 90-minute sessions are built for clinical and operational leaders who want to level up their VBC strategy. Session 1: Intro to VBC and risk adjustment — From payment models and policy shifts to HCC coding, RAF scoring, and the impact of CMS-HCC V28. Session 2: Delivering quality care & data-driven gap closure — How Stars, HEDIS®, and eCQMs drive rewards, and how data and AI turn care gap insights into action. Executive Summary
Add Your Signature HereThis letter was signed by a founding group of clinicians including Drs. Jonathan Slotkin, Eric Topol, Marissa Boeck, and Richard Carmona the 17th Surgeon General of the United States, along with nurses, physician assistants, and others. We welcome the signature of any licensed or certified health professional in the United States. This includes doctors, nurses, PAs, therapists, dentists, technicians, and others. The Treatment We’re Refusing To PrescribeWhat if I told you we found a treatment with the power to save 40,000 lives annually? (cue ESPN 30 for 30 voice) If I handed you a prescription for a treatment that would take any cause of death off the top 10 list, you wouldn’t ask whether the manufacturer’s stock price was fairly valued. You wouldn’t ask whether the chemists’ employer had a friendly board of directors. You’d ask how fast we could prescribe it. We have that treatment. And we’re not prescribing it…yet. If a Boeing 737 fell out of the sky every day, the FAA would ground every commercial aircraft in American airspace by sundown. There would be hearings. A presidential address (maybe even an impeachment for gross negligence). We’d see every Congressional representative from coast to coast working on a fix ASAP. Every 24 hours, roughly one 737-worth of Americans (about 115 of them) dies on our roads. In 2025, more than 36,000 fatalities. In 2023, 5.1 million crash injuries serious enough to require medical attention. Annual economic and quality-of-life toll totaled north of $1 trillion. Larger than the entire Medicare budget. This level of death and destruction is happening right under our noses every day, year in and year out, but it’s fragmented across 50 states and hidden from view in hospital trauma bays, leaving medical professionals to sort out the daily carnage. Dr. Graham Walker, an emergency physician in San Francisco and one of the letter’s founding signatories, put it to me this way: “Humans kill 40,000 Americans a year with cars and 50 times more are injured. We shrug it off as unchangeable and out of our control as the weather.”  Over 450,000 total cumulative deaths since 2014…and we’ve absorbed this. We’ve decided, as a country, that this is the price of mobility, freedom, and a regulatory architecture that has not meaningfully evolved since Eisenhower poured concrete. But now, all of a sudden, we have data suggesting we don’t have to absorb it anymore. Hospitalogists, this isn’t a story about tech. It’s a story about how a medical case becomes a policy imperative, and how an industry that prides itself on evidence-based decision-making decides what counts as evidence. When the trial ends earlyA 2025 peer-reviewed study in Traffic Injury Prevention examined 56.7 million fully driverless Waymo miles and found an 85% reduction in serious-injury-or-worse crashes versus matched human-driver baselines on the same streets. Waymo’s most recent data release, covering more than 170 million miles, shows the effect strengthening to 92%. Pedestrian injury crashes down 92%. Cyclist crashes down 85%. Intersection crashes (which trauma physicians will tell you are the worst kind we see) down 96%.  Set aside how you feel about a software stack making left turns and let’s apply medical research logic. If a drug trial showed this magnitude of mortality reduction, the data safety monitoring board would terminate the study from the standpoint that continuing the placebo arm would be unethical. Dr. Jon Slotkin, Chief Medical Officer at Geisinger, made this exact point to me. His proposed answer involves a joint NHTSA-CDC working group with statutory backing from Congress. Dr. Daniel Kraft, Founder and Chair at NextMed Health, another founding signatory and a longtime voice in digital health, goes a step further. He calls for a transportation equivalent of a data safety monitoring board. “No existing U.S. body is really built to ‘stop the trial’ in the FDA sense. NHTSA is the closest existing home, but not sufficient as currently empowered. If self-driving cars are truly a mortality-reduction intervention, Congress probably needs to create the transportation equivalent of a data safety monitoring board: one that can stop unsafe AV trials, but also stop the ‘human-driver placebo arm’ once the safety benefit is overwhelming.” Either model requires Congress to do something Congress is structurally bad at — building a body whose job is to act on aggregate mortality evidence in a domain that’s never had one. The numbers behind the numbersFor the Hospitalogy crowd, $1 trillion in annual road carnage cost should be doing something to your brain. Medicare runs around $850 billion. 5.1 million injuries needing medical attention isn’t a rounding error in the U.S. trauma system. It is, quite literally, the trauma system. Level I and II centers are organized around motor vehicle injury volume. Rehab capacity, neuro-ICU bed days, orthopedic case mix — much of the modern trauma care economy exists because we cannot keep humans from hitting each other at 45 miles an hour. A 92% reduction in serious injuries would restructure trauma economics on a timeline measured in years, not decades. And it would do so against a backdrop where every academic medical center I cover is hemorrhaging cash on premium labor and capital costs. Trauma volumes that decline because preventable injuries are actually being prevented is the rare scenario where a structural margin headwind is also unambiguously good for the country. Dr. Christine Trankiem, a trauma surgeon in D.C. and a signatory to the letter, wrote to me with her perspective inside the hospital: “As a trauma surgeon I see drivers and victims of traffic crashes every day, every night and weekend on trauma call. Many motor vehicle crashes are the result of human judgment, be it from a deer in the road, distractions such as texting and hand held devices, or impaired driving from fatigue or intoxication. More precise data regarding crash rates for autonomous vehicles will provide the information we need to decide whether autonomous vehicles are a safer option. “I don’t think any trauma surgeon would be upset to see fewer folks with life threatening or life altering injuries enter their trauma bays.” We have a treatment. We’re not prescribing it – yet. We’re not prescribing it because of a specific set of obstacles that nobody in the founding signatory group is required to name publicly, but that I am happy to. Special interests blocking autonomous vehicle deployment in Boston, D.C., New York, Washington state, and Minnesota include organized labor and the plaintiff’s bar. Less drunk driving is bad for plaintiffs’ attorneys. Fewer drivers is bad for unions whose entire economic model is collective bargaining around drivers. Neither of those groups will admit this publicly, because the optics are catastrophic. But the politics of the blockade run through both. I pushed Slotkin on this – why pull that punch if it’s such a combative, direct threat to safer roads? His response is that the letter is deliberately diplomatic. Let’s work together: “The letter is from clinicians, not lobbyists. If I want a nurse in Boston or a trauma surgeon in D.C. to put her name on it, she needs to be able to do that without taking a position on every political fight in her city.” He explained. I asked Walker something similar, and he responded with a longer list of folks who actually have skin in the game. “Are there incumbent interests resistant to change? Of course. Surprise surprise. Professional drivers. Insurance. Litigation. Repair. Municipal revenue. I mean, even trauma services at hospitals. That doesn’t make people villains. It makes transitions hard.” We need better reporting on autonomous vehicles, and this gap is where mistrust compoundsThis open letter – and my article supporting it – is intended to advance the dialogue around the autonomous driving issue. Full stop, we need to collect more data and figure this out. I don’t have all the answers. And right now, the clinical case for autonomous vehicles (or autonomous systems within vehicles) rests on data from one operator. That isn’t because the medical community is captured by Waymo. It’s because Waymo is the only operator publishing the data clinicians need to evaluate population health impact: crash counts alongside miles driven, by location, against matched human baselines. We don’t have standardized data reporting today. NHTSA’s Standing General Order requires automated driving system operators to report crashes meeting certain criteria. It does not require operators to report miles driven, or where those miles were driven. Without that denominator, crash counts cannot be normalized into rates. Without rates, you cannot compare to human baselines. And without that comparison, the medical community cannot do its job. “NHTSA owns the vehicles, the states own the roads, HHS and CDC own the mortality data. Nobody owns the whole picture,” Slotkin explained. Tesla currently redacts the crash narrative in its NHTSA filings, citing confidential business information. Zoox publishes nothing comparable. Fixing that gap, and applying consistent reporting to every operator on the road, is the letter’s core federal ask. “If Tesla is safer, publish comparable evidence. If Zoox is safer, publish comparable evidence. This is how you convince me. Publish. Comparable. Evidence.” Walker urged. This is the part of the initiative I find most defensible against the regulatory capture critique. Clinicians aren’t picking a winner here. They’re calling for an evidentiary framework that would let them evaluate every winner on the same footing. If that framework reveals other operators are equivalent or better, great. If it reveals they’re not, also great. Point being: population health policy cannot be set on the data architecture of a single company’s voluntary disclosure. Walker, when I pushed him on the regulatory capture critique, didn’t try to wave it away. He inverted it: “That’s the right answer. The letter isn’t asking other operators to copy Waymo. It’s asking them to compete on the same evidentiary footing.” The other piece of the federal ask is pretty straightforward: motor vehicle deaths get buried inside “unintentional injuries” in the standard federal ranking of leading causes of death. They don’t show up as their own line. That accounting choice is part of why we don’t see this problem clearly. Fix the line, fix the visibility, fix the policy conversation. The workforce question nobody wants to ownThe line in the letter where the signatories admit they aren't workforce economists is, in my read, the bravest and part where we need the most work. Again, the open letter is not intended to solve all of our motor vehicle accidents tomorrow. It's intended to advance the conversation in a meaningful way, and provide a framework to drive toward answers. Millions of Americans drive for a living. If autonomous vehicles deploy at the scale the safety data justifies, a meaningful slice of those jobs disappears within the decade. You can see why special interests care about this. What happens when AI automates away everything? It's existential dread manifested. Every industry will need to deal with this in one form or another. Heck, I'll probably be out of a job in 2 years as you get news and analysis from agents (it's worse, but I digress). The letter says, correctly, that "displacement that is foreseeable and unaddressed is its own kind of preventable harm." I think that's exactly right. I also think it can't be where the medical community stops. Population health includes economic security. Job loss is a determinant of mortality with its own body of literature. A coalition arguing that 39,000 preventable deaths per year is a public health emergency cannot then say "workforce displacement is somebody else's problem" with full intellectual consistency. To his credit, Slotkin doesn't dodge this when I press him on it: "Workforce planning for displaced commercial drivers should have begun years ago. The answer isn't to dismiss it." The honest version of this argument holds both sides. Yes, slow-walking the technology to protect drivers is slow-walking 39,000 deaths a year. Yes, pretending displacement isn't real is also a form of preventable harm. We have to grapple with both, and we have to do it in public. Let's Advance the Conversation"History is full of dangerous things that became culturally invisible because people grew up inside them — smoking in hospitals, riding in pickup truck beds, leaded gasoline, widespread drunk driving. We normalized them because they were familiar. Then our children look back at us and ask, 'What were you thinking?'" This framing from Walker is something I keep coming back to, and it's hard for me to put autonomous driving in those categories...but he's totally right. So I'm putting the weight of Hospitalogy behind this for both that epic quote, but also to advance the conversation, and drive real, meaningful change. Sponsored by Ursa Health Rethinking your strategies for ACO REACH, LEAD, etc., or otherwise preparing for the next phase of your VBC journey? There's a good chance your pop health analytics platform deserves a second look too. Thanks for the read! Let me know what you thought by replying back to this email. — Blake | ||||||||
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