What will Congress do?

Not much has changed from last year in The Big Book’s annual list of the commonwealth’s top hospitals in terms of revenue.

The top four hospitals remain VCU Health System, University of Virginia Medical Center, Inova Fairfax Hospital and Carilion Medical Center.

Each of these large hospitals had more than $1 billion in net patient revenue in 2015, the latest year that information is available from Virginia Health Information.

The health-care environment that these hospitals and others operate in, however, may change significantly in coming months, depending on Congress’ efforts to repeal and replace the Affordable Care Act (ACA).

Hospitals throughout Virginia already were worried about deductions in federal payments they faced under the ACA, also known as Obamacare. Those cuts were supposed to be offset by revenue from an increasing number of paying patients covered either by private insurance or expanded Medicaid programs. A Supreme Court decision, however, made Medicaid expansion optional for the states. Virginia never expanded its program.

Now hospital and public health officials fear that Virginia will receive less federal money for health programs than it receives today.

As this issue goes to press in mid-February, the direction that Congress will take on Obamacare remains unclear. At the beginning of the 2017 state legislative session, the Virginia Hospital & Healthcare Association urged legislators to “Do No Harm” — avoid major health-care changes — until the national pictures become clearer.

Meanwhile, two of the state’s major health-care providers, Inova Health System and the University of Virginia, are collaborating on plans that would include a  $112 million research institute and a regional U.Va. School of Medicine campus at Inova.

The new research institute, the Global Genomics and Bioinformatics Research Institute, would be located at the Inova Center for Personalized Health, the health system’s new 117-acre campus in Fairfax.

The two institutions would also form a cancer research partnership between the Inova Schar Cancer Institute and the U.Va. Cancer Center, including efforts to achieve designation by the National Cancer Institute as a Comprehensive Cancer Center.

The Inova regional campus of the U.Va. School of Medicine would enable U.Va. medical students to complete their clerkship and post-clerkship education in Northern Virginia at Inova facilities.

Health charts:

• Top hospitals by revenue

• Health and accident insurers

• Life insurers

• Virginia’s top nursing facilities by revenue