Category Archives: Government Oversight

Virginia Should Regulate Healthcare Monopolies as Public Utilities

Courtesy AP

by James C. Sherlock

I am a capitalist, but we haven’t had capitalism in the healthcare market in Virginia since the Certificate of Public Need (COPN) made its way into the Code of Virginia in 1968.

If we repealed COPN today, we’d still be left with the monopolies it has created and protected.

All that Virginians have gotten from that terrible law are a lack of competition, a lack of hospital capacity (exposed by COVID), few lower-cost ambulatory surgical and imaging centers, exorbitant hospital prices, monopoly control over healthcare labor and scandalously profitable non-profit regional healthcare monopolies.

As a direct result, Virginians paid over $1.5 billion dollars to hospitals in 2020 in excess of what they would have paid if Virginia hospitals had realized national median operating margins. That, of course drove up insurance payouts, on which the insurers based rates to make their own profits.

What the government giveth, the government can taketh away. The best way to lower prices is to lower prices.

Designate Virginia’s COPN-created regional healthcare monopolies as public utilities. Regulate their prices and margins as with the largest electric utilities. Continue reading

Infrastructure Bill, Meet Richmond’s United States Court of Appeals for the Fourth Circuit

United States Court of Appeals for the Fourth Circuit Richmond, Va.

by James C. Sherlock

The President and members of Congress have celebrated the enactment of the Bipartisan Infrastructure Act into law.

In Virginia and the other states (Maryland, North Carolina, South Carolina, West Virginia) of the federal Fourth Circuit, good luck with that.

The United States Court of Appeals for the Fourth Circuit just published two related decisions on January 29th and February 4th, 2022 decided by the same three-judge panel, all appointees of Democratic presidents.

Both decisions remanded to federal agencies for reconsideration years of federal assessments that have supported the Mountain Valley Pipeline. Those agencies are now run by Biden appointees. They won’t be back.

The court is populated with a majority of judges appointed by Democratic presidents. There is a vacancy awaiting a Biden appointment. The Chief Judge faces mandatory retirement next year.

So no relief in sight except the Supreme Court.

The decisions clearly demonstrate what will happen to Virginia public infrastructure projects that are opposed by the greens and/or protected classes or both, which will be nearly all of them.

Roads, bridges, pipelines, large solar panel projects, airport expansions, new rail lines, you name it. Flood control? Forget it. They are headed into the federal and state bureaucracies and then to court and then back again.

For years. Continue reading

COPN’s Regional Monopolies Helped Boost Virginia Hospitals’ Operating Margins to more than 3x National Median in 2020

by James C. Sherlock

Virginians have been assured forever by the hospital lobby that the non-profit regional monopolies established and protected by COPN nearly everywhere but Richmond:

  • are benign public servants with a charitable mission;
  • certainly don’t drive up costs;
  • that competition does not matter;
  • that the State Medical Facilities Plan on which COPN is based, like government 5-year industrial plans everywhere, is both well- managed and prescient; and
  • that limiting capacity is the key to cost containment. (It turned out that limiting capacity was also the key to hospitals being overwhelmed by COVID. Clearly disaster preparedness is not among COPN criteria.)

Well. The median operating margin for Virginia’s 106 hospitals in 2020, the latest year for which data are available, was 9.2%. Nationally, that margin was 2.7%.

Virginians paid over $1.5 billion more for hospital visits than they would have if our hospitals had cumulatively posted a 3% operating margin, which has been at or near the national median  for years. Continue reading

A Price of COPN — Sentara Pleads COVID Capacity Shortages

Sentara Norfolk General Hospital

by James C. Sherlock

Sentara Health, once described by The Washington Post as “playing COPN like a violin,”  yesterday went statewide with an acknowledgment that its system is out of capacity for many who seek its help.

On a Zoom press conference yesterday, Sentara reported seeing a huge surge in hospital admissions. Hospitalizations have more than tripled since Dec. 26. That is combined with a depletion in hospital staff caused by illness.

Dr. Jordan Asher, Sentara’s chief physician executive, said:

We take care of people that are sick. You’re coming around unvaccinated versus vaccinated does not come into play as we think about it. As resources get scarce, do you triage differently? Obviously the answer to that is yes … but we have a very strong way of going through all that, of looking at that. We’re used to that.… How we think about the utilization of resources and how we think about triaging is part of our everyday work. (Bolding added by author)

So you might find yourself on the down side of emergency room triage. Not good being you. Continue reading

Medical Facility State Inspector Shortfalls An Urgent Matter for the Governor and General Assembly

by James C. Sherlock

Virginians are blessed to have a person running the Department of Health Office of Licensure and Inspection (OLC) who may be the best public servant in the Commonwealth. She desperately needs help to do the work she is assigned in order to protect us.

Kim Beazley, the Director of that Office, has been quoted at length by me before. On November 30th, 2020 I published Ms. Beazley’s response to a series of FOIA requests to get an update on a 2017 Office of the State Inspector General report that found major shortfalls in the staffing levels of the OLC.

Ms. Beazley’s answers showed that nothing had changed in three years.

The shortfalls were based upon laws and budgets that purposely reduced the authorized staff significantly below that sufficient to meet its statutory inspection requirements. Continue reading

Virginia State and Local Agencies Must Spend Federal Coronavirus Relief Funds by December 31

by James C. Sherlock

State and local governments are awash in billions of dollars of federal funding with various federal expiration dates if not spent.

The General Assembly set its own deadline.

Recipients have to spend federal money allocated by the General Assembly by Dec. 31 or lose it back to the Governor for repurposing. That is not as easy as it sounds. It represents in many cases far more money that any of them have ever handled.

The budget bill from 2021 gave the outgoing Governor two weeks before the end of his term to shift unspent federal funds from the purpose for which they were allocated by the General Assembly to “other qualifying expenses.”

Thus, a Democratic majority General Assembly ensured that a Democratic governor could make the political decisions of re-allocation. Fair enough. Hard to blame them. They had already seen Terry McAuliffe. Risky bet.

We don’t know how much of the billions of dollars from multiple federal relief acts will be unspent by Jan. 1.

But we can be reasonably assured there is a scramble going on to get it spent before it has to be turned over for reclassification by the Governor. Continue reading

Loudoun Public Schools – Suitable for Economically Secure Asian and White Kids Only

by James C. Sherlock

If your kids are Asian or white and economically advantaged, Loudoun County Public Schools are worth a try.

Otherwise, forget it.

At my age I am seldom surprised. The failures of Loudoun County Public Schools (LCPS) to educate so many of their children in the wealthiest county in America have easily cleared that bar.

The Constitution of Virginia famously demands:

“The General Assembly … shall seek to ensure that an educational program of high quality is established and continually maintained.”

In Loudoun, the struggles between the school system — the school board, the superintendent and the school administration — and parents have spawned national headlines. Those have focused on COVID responses and social engineering by the schools.

The spectacular failures of the Loudoun County Public Schools seen in the academic scores of its students other than economically secure Asian and white kids is a bigger scandal.

Far too many young lives have been cut short of their promise by denial of not only an “educational system of high quality”, but even an adequate one.

It needs to stop. Continue reading

The Loudoun Way — School Rapes by a Member of a Progressive Protected Class

Loudoun County Commonwealth’s Attorney Buta Biberaj

by James C. Sherlock

Any time you think there is only one system of justice in America, consider these two stories I offer below, one a progressive dream and the other true.

The true story will show some progressives care more about their dogma than kids.

And any time you think only big city progressives don’t give a damn about child victims of crime, like in Chicago or New York, read the true one below.

It is underway in Loudoun County. Continue reading

Virginia Preschool Initiative (VPI+) Pilot – Hidden Data, Disappearing Value — Thanks for Nothing

by James C. Sherlock

This is a follow-up to my Monday report on VPI+, a federally funded four-year pilot program to assess the value of the Virginia Preschool Initiative.

Today we will discuss what was not reported to the public. We will also assess the dreadful results of the pilot participants after those kids graduated and went on the kindergarten and first grade.

Clearly, SRI International (main report) and RAND (cost-benefit report) were directed not to disaggregate the results of the data they collected by division and school. Those, of course, are the levels that give parents enough information to evaluate the program.

What was revealed, at the very end of the main report, was that disadvantaged kids participating had made learning gains compared to their disadvantaged peers who did not attend, but

“like other state public preschool programs, by spring of first grade the differences were no longer statistically different.”

That heart-breaking outcome was left un-assessed.

The mandarins at VDOE (and perhaps the federal DOE) appear to believe that pre-school is too important for parents to get involved.

If given full information, some might challenge the program or decide it is not appropriate for their own children in their local school district.

Like the domestic terrorists some of them are considered in certain circles to be. Continue reading

Big Lessons from Government Data on Virginia’s 286 Nursing Facilities

by James C. Sherlock

Nursing facilities in Virginia offer an incredible mixed bag. There are heroes and villains. Much to see here.

This column will offer expansive  views of government data on each of the 286 nursing facilities in this state.  

I found out a lot things that really matter to the quality of a nursing facility in Virginia. And a lot of things about government oversight.  nd government insurance payments.

From the visualization aids I provide, so will you.

  • You will find absolutely outstanding facilities.  
  • You will find others that have fallen so short of government standards for so long that you will wonder why Virginia does not revoke their licenses.  
  • You will see the nursing homes in your region.  
  • You will see which chains deliver excellent facilities and which do not, apparently as business models in both cases. Many chains tend to be consistently good or consistently bad. They are color coded in the “Group Ownership” column based upon the overall performance of the chain.  
  • Take a look at the staffing star ratings. Those are based on quarterly filings of data that is linked to payrolls, so it is relatively up to date and relatively accurate. One- or two-star staffing is a very bad sign.
  • You will see the stunning outperformance of nursing facilities in continuing care facilities in Virginia, also as a function of business models.
  • Nursing home inputs — people — enter nursing homes in much different physical conditions and ages. You will see that where you live is a statistical predictor of health. And therefore of the nursing home challenges in areas of poor health. Which tracks with areas of poverty. And low government insurance payments.

Finally, take a look at the Inspection activity.  

It reflects the massive understaffing of the VDH inspectors. Look at the “Last standard (full) health inspection” column. You will see coded in red that 42 (15%) of Virginia’s nursing facilities have not been fully inspected since 2018.  The federal requirement is once a year.  

You will be convinced by the data that strict and timely government oversight is required to ensure, and ensure Virginians of, of nursing facility quality.  

The state must fix the statutory and budget issues that have resulted, purposely, in Office of Licensure and Inspection staffing shortfalls. Continue reading

Nursing Home Ads Pose As Official State Advice

by James C. Sherlock

The Virginia state government has a Department for Aging and Rehabilitative Services. 

Who wouldn’t want one of those?  

But in the case of recommending nursing homes, it would be better if it would either stop or fix its broken system. Which it pays a nonprofit, VirginiaNavigator, to run.

It is offering nothing more than free, self-written advertisements for good and bad nursing homes alike under the guise of a state recommendation to seniors. Continue reading

More Proof Virginia Disclosure Laws are Crap

Former Sen. John Watkins, R-Powhatan

by Steve Haner

In 2020, according to documents filed with the State Corporation Commission, Dominion Energy Virginia paid former state Senator John Watkins $92,297 for lobbying services. At the end of the reporting period, it officially claimed spending only $1,641 for him to influence the legislative process.

In a similar manner, former Fairfax Delegate John Rust was retained over four years for a combined $265,000. But for his services in 2020, the year of the massive Virginia Clean Economy Act, Dominion’s lobbying expense disclosure listed his fee at $7,679.

The full payments to both former Republican legislators, all perfectly legal, are the subject of an online article on the Richmond Times Dispatch website, probably awaiting print publication. It also focuses on large payments made to a Hampton Roads journalist and former Democratic gubernatorial aide, which Dominion never had to disclose on any state report since buying friendly editorials isn’t covered by disclosure laws.

Add up the reported payments to all the other outside law and lobbying firms Dominion hired, compare them to the official disclosures, and a similar pattern of under reporting will be evident. The reporter missed the best part of this story — that information gap.

What do we learn here?  Anything we didn’t know? Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis – Part 4 – the Worst Facilities in Virginia

by James C. Sherlock

Today we are going to take a look today at a snapshot of Virginia’s worst nursing homes as rated by the Centers for Medicare/Medicaid services.

Medicare rates 54 of the total of 386 nursing facilities in Virginia as overall one star out of five.  By definition of the way that Medicare compiles records and assigns scores, they have been bad for a long time.

Don’t use them. If you have any friend or loved one in one of these places encourage them to re-locate if they can. Either way, visit them often. It helps.

The ratings are established in considerable part by the inspections conducted by the Virginia Department of Health Office of Licensure and Inspection.

Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis – Part 3 – McAuliffe & Herring

by James C. Sherlock

In the first two parts of this series, I wrote about the shortage of state inspectors for nursing homes in the Virginia Department of Health Office of Licensure and Certification (OLC)  and the continuing danger it poses to Virginia patients.

The problem, unfortunately, is much wider than just nursing homes.  So is the scandal.

That same office inspects every type of medical facility including home care agencies as well as managed care plans. Except it cannot meet the statutory requirements because it does not have sufficient personnel or money. And it have been telling the world about it for years.

Terence Richard McAuliffe was the 72nd governor of Virginia from 2014 to 2018. Mark Herring has been Attorney General since 2014.

We will trace below that they can reasonably be called the founding fathers of overdue inspections of medical facilities in Virginia.

VDH has been short of health inspectors since McAuliffe and Herring took office and still is .

Both of them know it. And they know that lack of inspections demonstrably causes unnecessary suffering and death.

Continue reading

Virginia’s Self-Inflicted Nursing Home Crisis — Part 2, the Business

by James C. Sherlock

Nursing homes are businesses.

Seventy percent of those in Virginia are for profit. They are run not by doctors but registered nurses with physicians on call. 

Nursing facilities very widely in size in Virginia, from the 300-bed Mulberry Creek Nursing and Rehab center in Martinsville to facilities of less than 30 beds, especially the long-term care units of a few mostly rural hospitals.

They include facilities designated as skilled nursing facilities (SNF), often post-op care and rehabilitation, and others designated as long-term-care nursing facilities (NF). Most nursing homes in Virginia have facilities and certified beds for each.

Insurer mix and staffing costs are keys to profitability.

Many of these businesses are worth what they get paid, but many are not. Continue reading