Category Archives: Consumer protection

Consumer protection

If Assembly Wants SMR Bill, Then Fix It

By Steve Haner

This is progress. Only twenty members of the Virginia Senate voted Tuesday to ignore a key tenet of utility ratemaking and put utility stockholders and profits ahead of consumer protection. Usually when the utilities persuade the General Assembly to do that to Virginia consumers, they get a bigger vote margin than 20-16.*

Senate Bill 454 allows Virginia’s two monopoly electricity providers to spend undetermined millions of dollars on planning and developing small modular nuclear reactor projects and get it all paid by consumers, with a profit margin. But there is no guarantee any such plants will ever be built, and no other power plants built in Virginia have gotten this kind of up-front financial guarantee before the State Corporation Commission ruled them in the public interest. Continue reading

Will Dominion Fool Us Again with SMR Cost Bill?

Artist rendering of a NuScale small modular reactor plant, proposed but now not being built in Idaho.

By Steve Haner

Fool me once, shame on you.  Fool me twice, shame on me.  A utility-backed bill to stick electricity ratepayers with the high-risk costs of developing small (modular) nuclear reactors, approved by a Senate committee Friday, is a “fool me twice” example.  Shame on the General Assembly if it falls for it. Continue reading

Two Excellent Nominees Emerge for SCC

Kelsey A. Bagot, now nominated for the Virginia State Corporation Commission.

By Steve Haner

The new Democratic majority in the Virginia General Assembly is moving rapidly to fill the two State Corporation Commission vacancies with excellent, qualified choices. One is well known in Virginia and the second is new to our hallowed Capitol, but with a decade of energy law experience on the federal level.

Former Virginia Deputy Attorney General Samuel T. Towell has degrees from Massachusetts Institute of Technology (engineering) and the University of Virginia (law).  Kelsey A. Bagot just got her Harvard Law degree a decade ago, but she had the opportunity at the Federal Energy Regulatory Commission to work for former SCC Chairman Mark Christie.

Former Deputy Attorney General Sam Towell, also nominated today.

Both appeared this afternoon before a brief, perfunctory really, joint meeting of the relevant House and Senate committees. Within a couple of minutes, with only one question asked, both were unanimously certified as qualified. Which they are.

It will be up to the full House and Senate to formally elect them at some point in the next few days. The two seats they will fill have been vacant for a long time and they will start with desks piled high. Members of the SCC are actually judges, subject to Virginia judicial canons. The pending state budget sets the salaries as of next July 1 at $214,000 for the chair and $212,000 for the other two members. Continue reading

Norfolk Hipsters & Lefties Try to Block a Military-Themed Brewery

by Kerry Dougherty

Now is the time. If you believe that cities ought to be open for business, regardless of the viewpoints of the business owners, if you support the military and don’t consider flag-waving a provocative act, you might want to let Norfolk’s City Council hear from you.

On December 12th it is scheduled to vote on the application of Armed Forces Brewery to open its doors on the same premises that housed O’Connor Brewing in the so-called Railroad District of Norfolk.

The business was lured to Virginia by Gov. Glenn Yougnkin who helped the founders secure tax incentives to open their craft brewery in Norfolk rather than in Florida. The owners have pledged that 70% of their employees will be veterans.

Normally, that would be seen as good news in this military town. Continue reading

The Impact of Virginia’s Certificate of Public Need Laws on Nursing Home and Home Health Care Availability and Expenditures

by James C. Sherlock

I have come across a major study in the National Institute of Health’s National Library of Medicine that made a point that I have not explored sufficiently to this point.

It discusses the intersection of nursing homes, home health care, CON laws like Virginia’s Certificate of Public Need (COPN) law, and Medicaid expenditures.

I have shown over time in a series of columns how bad many of Virginia’s nursing homes are.

Antitrust authorities at the Federal Trade Commission (FTC) and at the US Department of Justice (DOJ) have long taken the position that CON laws are anticompetitive.

This study, conducted prior to COVID, indicates that COPN administration will ensure that nursing facilities not only have little competition from other facilities, which it was designed to do, but also will limit home health care expansion, which the COPN law does not mention.

That is very good for the Virginia nursing home industry.

It is bad for every other Virginian, every one of whom may need at least post-operative recovery and rehabilitation if not long term care.

Some will need it in a dedicated facility, others can be better served at home.

The study indicated that COPN will tend to make home health care less available and potentially raise total Medicaid spending. It also showed that market forces unconstrained by CON laws like COPN will tend to reverse those trends.

So this article is dedicated to our politicians and their constituents.

You. Continue reading

NY Ratepayers Better Protected Than Virginia’s

Illustration of planned Equinor offshore wind installation off the coast of New York State. Equinor was one of the developers asking for a price increase, which was rejected.

By Steve Haner

The New York State Public Service Commission (PSC) last week told several offshore wind developers it would not approve changes in their state contracts, putting several planned ocean turbine projects into jeopardy.  The story is important for its contrast to how Virginia faces the same future. Continue reading

An Overdue New Federal Rule to Improve Nursing Home Staffing

By James C. Sherlock

What would happen if the federal government were to propose for the first time specific nursing home staffing minimums?

We are about to find out.

A new rule.  A new federal proposed rule introduced yesterday has already survived fierce opposition from the industry, which tried to kill it in the womb.  They are not done opposing, but the administration seems to have its course set.

And the new rule is clearly within the letter and spirit of the Social Security Act that requires safe, quality care.

The new proposed federal rule consists of three core staffing proposals:

  1. minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for Registered Nurses (RNs) and 2.45 HPRD for Nurse Aides (NAs);
  2. a requirement to have an RN onsite 24 hours a day, seven days a week (currently 8 hours a day); and
  3. enhanced facility assessment requirements.

While the final rule minimums will be phased in over a three-year period, five for rural facilities, they would, if in force today, render non-compliant 245 of the 281 Virginia nursing homes that are rated for staffing by CMS.

There are also groundbreaking provisions for transparency on the percentage of Medicare and Medicaid payments spent on direct care staff, not just for nursing homes but also for community and home care.

The new proposed rule is potentially a great improvement for prospective patients coming out of the hospital to recuperate and rehabilitate or entering long term care.

Which includes a lot of very vulnerable Virginians.

Continue reading

Politicians Back Interest-Heavy Fuel Debt Payoff

Better yet, how about ten years from now? With a decade of interest added on, of course.

By Steve Haner

Several Virginia legislators have encouraged the State Corporation Commission to allow Dominion Energy Virginia to convert a $1.3 billion unpaid fuel debt into a ten-year revenue stream for the utility, adding up to $370 million in additional costs onto its customers.

The SCC will open a hearing Tuesday on the utility’s pending application to convert the unpaid fuel costs for the past three years into a bond. A public comment period on the application just ended, and four legislators and the Virginia Chamber of Commerce filed letters supporting Dominion’s request. The 2023 General Assembly created the bonding option during session as part of an omnibus regulatory change.

The issue is simple. Dominion failed to foresee the explosion in fuel costs caused by the Russian invasion of Ukraine and the generalized wave of inflation. A year ago the SCC approved a plan to cover the first batch of those unpredicted costs that accrued through June 2022, with a three-year payoff schedule.

But the second year of unexpected fuel expenses added almost $700 million more to the unpaid balance by June 2023. Years two and three of the original payment schedule and the new additional costs combine to the total of about $1.275 billion, not including interest. And the interest is what this is all about, with the trade-off being smaller installment payments but a decade of interest charges. Continue reading

Nursing Shortages Require Better Oversight of Virginia Nursing Homes – Part Two – State Action Required

by James C. Sherlock

Patterns of understaffing, medical harm and abuse in nursing homes are traceable:

  • in some cases to a business model of understaffing to increase profits. Federal fines are built into the business models of the bad actors. Some of the worst post double-digit annual operating margins;
  • in some to other systemic chain-wide issues, perhaps financial instability; and
  • in yet others to local management incompetence and other site-specific issues.

Regardless of the reason, Virginia regulators and law enforcement agencies must execute the roles they are legally charged to perform.

State sanctions must be levied.

  • The Health Commissioner can block the admission of new patients until staff levels support them or shut down those facilities that do not meet standards over a long period of time;
  • The Department of Medical Assistance Services (DMAS) can suspend or halt Medicaid payments;
  • The Attorney General can prosecute for civil or criminal violations.

Enforcement will result in fewer, but better and safer options. Continue reading

Nursing Shortages Require Better Oversight of Virginia Nursing Homes – Part One – The Problem

By James C Sherlock

We have some great nursing facilities in Virginia. We also have far more than our share of bad ones.

Virginia has a decision to make about the latter.

The federal government sets standards for those that are paid with federal funds.  It both levies fines and denies payments as it feels appropriate.

But more direct action to assure quality of and safety in nursing homes is left to the states, who both license and regulate them.

There are simply not enough nurses nationwide or in Virginia to staff all of the nursing homes currently operating.  And that shortage is not temporary.

The decision Virginia needs to make is straightforward:

  • do we want to keep open to new patients the 289 certified nursing facilities currently in operation; or
  • do we want to ensure patient safety.

We cannot have both.

The nursing shortage cannot be a reason for government to leave open to new patients grossly understaffed nursing homes.  If that understaffing is sufficiently chronic, some must be closed.

Among the bad facilities, some owners are scoundrels.  Others are just not able to get it done.  Better enforcement will reduce the number of both.

Actions must be taken to assure that when citizens need a nursing home, the state license can be trusted as a sign that basic standards are maintained.

That they will be safe.

Continue reading

Predatory Virginia Nursing Home Owners

by James C. Sherlock

Merriam Webster:

Pred*a*tor: (noun) one who injures or exploits others for personal gain or profit.

The most medically vulnerable of us reside in skilled nursing facilities (SNF).

Nobody plans to be there, but that is where about thirty thousand Virginians find themselves at any one time. People who are moved from hospitals to save money for the insurers but are too sick or injured to go home yet.  

They are supposed to get the skilled nursing the name suggests. Many don’t.

Most are covered by Medicare. The rest by Medicaid or private insurance. It could be any one of us tomorrow.

These patients are at risk by design in some of these SNF’s. Put in danger by a perverted business model, a model that shows that returns can be juiced into double digits by stripping staff. The facilities can then be flipped in a couple of years at a profit based upon increased cash flows.

We will track their investments using government data. We will see a ritual, system-wide understaffing.  We will also see that the government accumulated and publishes staffing data but there is no evidence they use it for anything.

There are nursing homes in Virginia, for example, that provide less than 30% of the registered nurse hours per patient per day that CMS assesses they require.  Weekend statistics are worse. Nothing happens.

Today there are large systems not one of which is staffed to CMS norms.

There are real people who are harmed by those calculated violations.  Exceptionally vulnerable people are regularly denied at least their dignity, often their health and sometimes their lives.

The owners injure and exploit patients for personal gain or profit.

They are predators. Continue reading

Past Time for Serious Sanctions for the Commonwealth’s Worst Nursing Homes

by James C. Sherlock

Effective May 1 of this year, Karen Shelton M.D. became Virginia’s Health Commissioner. Dr. Shelton is now the licensor and regulator of Virginia’s nursing homes.

By law, state-licensed nursing homes must comply with federal and state laws and standards. By regulation, the Health Commissioner “may impose such administrative sanctions or take such actions as are appropriate for violation of any of the standards or statutes or for abuse or neglect of persons in care.”

It is time.

I hope that she will pose a challenge to her Office of Licensure and Certification (OLC), of which I am a public admirer, that goes something like this.

Too many Virginia nursing homes are measured objectively by CMS (the Centers for Medicare/Medicaid Services) to be dangerous to the health and welfare of their patients through a combination of:

  • inspections that we ourselves conduct;
  • staffing measures linked to payroll data; and
  • medical quality measures from federal records.

Many have been that way for a very long time.

Current staffing far below CMS requirements seems to indicate that too many have no apparent path to improvement.

Come and see me in a couple of weeks with a list of the absolute worst of them.

And tell me why I should not shut them down to let the rest know that there are minimum standards beneath which they will not be permitted to operate in Virginia.

And one more thing.

Please let me know if there are organizations or individuals, current or recent, whose facilities have appeared regularly enough with the lowest staffing rating to indicate that understaffing may constitute a business model rather than a local exigency.

That too will not be tolerated.

We will take on those challenges here as if they are our own.

This article will identify the absolute worst of the facilities, using government records. The next will look at understaffing trends among owners. Continue reading

Lee Enterprises Newspapers in Virginia Combine Huge Online Subscription Price Increases with Difficult Cancellations

Notice from The Roanoke Times subscriber services. https://subscriberservicesdsi.lee.net/subscriberservices/Content/Leaving.aspx?Domain=roanoke.com&_mather=2864cc43d3f9efd3

by James C. Sherlock

Lee Enterprises, in a bold move, has massively raised prices for online subscriptions to its Virginia newspapers, to some of which I subscribe.

Lee’s “brands”  here include:

  1. The Daily Progress – Charlottesville
  2. The Free Lance Star – Fredericksburg
  3. Danville Register Bee/Go Dan River – Danville
  4. Bristol Herald Courier – Tricities – Bristol
  5. Martinsville Bulletin – Martinsville
  6. The News and Advance – Lynchburg
  7. The News Virginian – Waynesboro
  8. Richmond Times-Dispatch – Richmond
  9. The Roanoke Times – Roanoke
  10. Culpeper Star-Exponent – Culpeper
  11. SWVA Today – Wytheville
  12. The Franklin News-Post – Rocky Mount

I have for years subscribed to the ones in bold above.  Online ad sales must not be going well.  Lee in a sudden move has roughly tripled online subscription prices.

It also has made it very difficult for customers to cancel.

Perhaps someone should look into this to see if the difficulty of the cancellation is legal. Continue reading

No New Law or Regulation is Needed for VDH to Sanction Bad Nursing Homes

By James C. Sherlock

This is Part 2 of this series.  Part 1 is here.

I will offer here a deeper sense of Virginia’s bad nursing homes.  And of the historic lack of adequate regulation by the state.

Start with the fact that even the worst of them are still open.

Centers for Medicare & Medicaid Services (CMS) conduct and update at least quarterly a system of nursing home (and other facilities) assessments that is worthy of your trust.  I am cautious with all things government, but it has earned mine.

Nationally, 20% of nursing homes are rated one star overall by CMS.  In Virginia, 34% of nursing homes have that rating.

Don’t be mollified by the official designation of such facilities as “well below average.”  Many are places persons as vulnerable as nursing home residents should not be permitted to reside.

We are disgraced by having let that happen.   Virginians, through our state government, need to assure it does not continue.

Continue reading

Scandal in Plain Sight – Virginia’s Failed Regulation of Law-Avoiding Nursing Home Owners

by James C. Sherlock

One of the most important and heart-wrenching decisions families make for their elderly loved ones is whether they are able to keep them in their homes as they get older and sicker.

Sometimes that is not feasible for a long list of reasons in each case.

More than 30,000 Virginians live in nursing homes.

Both the federal government and Virginia regulate them.  The Virginia Department of Health, for both the Commonwealth and the federal government, inspects.

We should be able to expect patients to receive at least basic standards of care. A high percentage in Virginia have not .

In a five-star system, the Centers for Medicare and Medicaid Services (CMS) rates 98 of Virginia’s 289 nursing homes at one star – defined as much below average. More than a third.

Nationwide, only the worst 20 percent receive a one-star rating.

The last time I reported, in October of 2021, those figures were 54 one-star facilities out of 288. Nineteen percent.  So some of our nursing homes have gotten precipitously worse.

The ratings are backward-looking a couple of years, so the measured declines discussed here did not start recently.   By definition of the way that Medicare compiles records and assigns scores, some have been bad for a long time.

People have suffered and died from the lack of proper care and effective oversight. Continue reading