Category Archives: Health Care

No PAC for Disaster Preparedness and Response

Why is this man smiling?

by James C. Sherlock

Virginia’s responses to COVID were a continuing national embarrassment. 

  • Individual Virginia department and agencies had no operational pandemic response plans. They ignored specific and prescient directions to build and exercise such plans in the dormant Virginia Pandemic Emergency Plan. VDEM then attempted a coverup.
  • No PPE stockpiles. Last in testing. Last in vaccinations. Hospitals first, physicians last in every decision by the VDH. 
  • Last in distribution of unemployment checks. 
  • The General Assembly was given and took no role in pandemic response for 15 months.
  • The Canterbury nursing home scandal. State nursing home inspections that failed to report staffing shortages. The directly related shortages in staffing of state inspectors.
  • The failure to sanction teachers unions for strike threats in Northern Virginia during COVID. The officially sanctioned lapse in school accountability.
  • Poorly prepared official press conferences that often added confusion rather than clarity.

This was in its totality the biggest government scandal in Virginia history.

Continue reading

Congrats UVa Health and Centra – the Right Kind of Healthcare Affiliation

by James C. Sherlock

Centra Health

Now for a kind word for my undergraduate alma mater, the University of Virginia.

In a press release yesterday, Lynchburg-based Centra and UVA Health announced a strategic clinical affiliation.

From what we know from the announcement, that is exactly the kind of healthcare affiliation Virginians need. Continue reading

In Virginia, Only Inova, UVa Health and VA Hospitals Mandate Vaccinations for Staff

by James C. Sherlock

Among large Virginia health systems, only Inova, UVa Health and VA Medical Centers appear currently to mandate staff vaccinations.

Inova is the only one of those that is private.

On Monday, a Joint Statement in Support of COVID-19 Vaccine Mandates for All Workers in Health and Long-Term Care was issued by a long list of signatories including the American Medical Association (AMA), American Nurses Association (ANA); and the American Public Health Association (APHA):

“We call for all health care and long-term care employers to require their employees to be vaccinated against COVID-19.”

It is a coordinated plea.

The Virginia Hospital and Healthcare Association, the lobbyist for non-profit hospitals in Virginia, on July 18 published a statement encouraging its own members to take action: Continue reading

What Would We Do Without Experts and “People Familiar with the Matter”?

by James C. Sherlock


“The CDC is expected to recommend that fully vaccinated people begin wearing masks indoors again in places with high Covid-19 transmission rates, according to people familiar with the matter.”

Einstein had it right.

But, then, he went to in-person school.

Another Bit of Nonsense in the Cost of Health Care

Image credit: Johns Hopkins University

by Dick Hall-Sizemore

I just had an experience that illustrates the bewildering complexity of the finances of the American health care system.

Yesterday, I had a colonoscopy. I’m a veteran of this procedure, having had several because there is a history of colon cancer in my family. (No polyps this time, by the way.)

The protocol for the dreaded “prep” time has changed. No longer does the patient have to consume a gallon or two of sickening sweet liquid (others who have had this procedure know what I am talking about). Now, one has to take 24 pills in two stages between 6 p.m. the night before and 6 a.m. the day of the procedure, along with a lot of water. Continue reading

Is DOJ’s Focus on Healthcare Monopolies Coming to Virginia?

by James C. Sherlock

The Acting head of the Justice Department’s Antitrust Division, Richard A. Powers, yesterday delivered a speech that described the Justice Department’s new goals, strategies and resources for criminal antitrust enforcement.

The clouds have darkened over Virginia’s healthcare monopolies.

The Commonwealth. Virginia has failed in its duty to oversee its healthcare industry.  The full extent of that failure has been detailed in previous columns.

It has failed in two major ways:

  1. The Virginia Department of Health (VDH) has been captured by the healthcare provider industry that it regulates. Indeed VDH has been actively complicit in industry evasion of antitrust statutes through its administration of Certificate of Public Need (COPN) law.
  2. The Commonwealth’s regulatory structure has a strategic vulnerability. Neither the VDH that regulates providers nor the State Corporation Commission that regulates insurers can adequately oversee integrated health care delivery and insurance companies to prevent or detect what amount to internal conspiracies in restraint of trade. In the wrong hands, integrated provider monopolies and regionally powerful insurers can serve as weapons against competitors to both.

Continue reading

Constitutionality of Vaccination Mandate

by Dick Hall-Sizemore

There has been much opposition expressed on this blog regarding UVa, and, by extension, other higher education institutions, requiring students and staff to be vaccinated against COVID as a requirement for attending class in the fall.  The policy has been said to be, among other things, unconstitutional.

Not surprisingly, a judge has spoken. Today, a federal district judge ruled in favor of Indiana University in a suit brought challenging that university’s vaccination mandate. The court said, “The Fourteenth Amendment permits Indiana University to pursue a reasonable and due process of vaccination in the legitimate interest of public health for its students, faculty and staff.”

Of course, this is only one judge and it is not unusual for judges in different parts of the country to rule differently on similar points of law. Also, a district court’s ruling is generally applicable only in that district, but the case is likely to have some precedential value elsewhere.

The challengers have vowed to take the case to the U.S. Supreme Court.

Psst! We Have Some Beds for You

by Dick Hall-Sizemore

Something just does not seem right about this.

The Richmond Times-Dispatch reports today that the state has temporarily halted admissions to its mental health hospitals. In addition to being overcrowded, on Friday, Central State Hospital in Petersburg had more patients than beds, the hospitals have lost a significant number of staff and are struggling to replace them after COVID outbreaks in the hospitals.

But, wait! The private sector is coming to the rescue! The Virginia Hospital and Healthcare Association has announced that a private health system (unidentified) will make available 58 unused mental health beds (40 for adolescents and 18 for adults) to the state. Oh, yes, and, in exchange for $8.5 million in federal American Rescue Plan Act funding to pay for staff for those beds.

I could understand the state contracting with the private sector on a per diem basis to take in these patients. But, a $8.5 million payment up front seems a bit brassy. The state would be better off using that $8.5 million to pay recruitment and retention bonuses to bolster the staff in its own facilities.

President’s Executive Order Could Bolster Healthcare Competition in Virginia

by James C. Sherlock

Yesterday President Joe Biden issued an executive order (EO) on competition that has the potential to significantly affect Virginians, especially our monopolized regional healthcare markets. 

While an EO does not have the force of law, the president as chief executive can set priorities. The executive departments will honor the EO where not barred by law.  

Federal judges appropriately will not be influenced by an EO. However, EOs put the hand of the chief executive on the scales of executive department prosecutorial decisions and regulatory actions. That will affect the cases that the the Federal Trade Commission, the Justice Department, and the targets they bring before those judges.

In the healthcare sector, a White House Fact Sheet indicates that the EO “tackles four areas where lack of competition in healthcare increases prices and reduces access to quality care.” Those are prescription drugs, hearing aids, hospitals and health insurance.  

There is already fierce competition in the pharmaceutical industry. I consider the prescription drug portions of the order a threat to future drug development, but President Biden undoubtedly has already taken account of my opinion on that. Continue reading

More Jumbled Thinking about Healthcare and Race

by James A. Bacon

The lead story in the Richmond Times-Dispatch today focuses on the findings from a new Virginia Commonwealth University study: “Life expectancy in the U.S. sees largest drop since 1943, ‘jolting’ decline for Black people and Latinos.”

The average life of Blacks fell 3.25 years and of Latinos by almost four years. The reasons? COVID was a contributing factor, of course. But according to the RTD article the underlying cause is systemic racism.

The article is an incoherent jumble of factoids and non sequiturs. Black mothers are more likely to die in pregnancy-related deaths…. Black infants have the highest mortality rates in the U.S…. Segregation from Jim Crow housing policies… Housing and job insecurity… Accidental overdoses and homicides… Actor Chadwick Boseman’s death from colon cancer at age 43… “In [Richmond’s] Mosby Court, a public housing community, the average life span is 68. Less than 6 miles away, a person born in the primarily white and affluent Windsor Farms neighborhood will live an average of 84 years.”

Not explained is how those factors, which are persistent through time, made disparities worse during the COVID epidemic. Not mentioned is the fact that a person born in a predominantly Hispanic or Asian neighborhood is likely to live longer than Whites and Blacks alike! Continue reading

Virginia’s New Ruling Class: How Exploitation Works in the Real World

Graphic credit: Axios

Medical debt, which comprises 58% of all debt collections in the U.S., is the leading cause of bankruptcy in the United States. Between January 2018 and July 2020, hospitals filed tens of thousands of lawsuits and other court against against patients, according to AXIOS,  which drew upon Johns Hopkins University data. Until a public outcry compelled them to stop suing patients last year, the two most aggressive debt collectors in the country, by a wide margin, were the VCU Medical Center in Richmond (17,806 court actions) and the University of Virginia hospital in Charlottesville (7,197 court actions).

What do the VCU and UVa hospitals have in common? Several things. First, both enjoy nonprofit status. Second, both generate significant profits. Third, both are teaching hospitals affiliated with large research universities. Fourth, both universities are governed by self-perpetuating oligarchies accountable to no one, least of all to patients. Fifth, both are incentivized to suck every dime they can out of their customers to fund the thing that confers institutional prestige — medical research.

This is what social injustice looks like in the real world: Academic elites exploit the medical patients in their care to bolster profits and research funding. The fixation on racial injustice — obsessing over memorials named after slave holders and Civil War veterans, apologizing for sins that occurred a hundred years ago — is a dodge and a distraction.

— JAB 

North Carolina AG takes on Hospitals That Fail to Publish Shoppable Prices

by James C. Sherlock

Attorney General Josh Stein of North Carolina, fresh off killing the Sentara-Cone merger, on his very busy day yesterday had an Assistant AG send a letter to North Carolina hospitals.

It demanded that hospitals comply with federal hospital pricing transparency regulations that require that hospitals make publicly available a machine-readable file containing a list of prices for all items and services as well as a consumer-friendly list with prices for shoppable services.

He told them that he looked forward to their cooperation — by the end of the month.

This is the second time today I have wished Virginia had an Attorney General.

North Carolina AG Investigation Quashes Sentara/Cone Health Merger

by James C. Sherlock

In the big merger equivalent of “spend more time with our families,” Cone and Sentara issued a joint statement on June 2 that they “have jointly decided not to move forward” with their planned merger.

“As this work progressed, we realized that each of our communities and key stakeholders require support and commitments from our respective organizations that are better served by remaining independent.

“The decision was a difficult one, but both organizations remain committed to advancing our common goal of providing outstanding care for our respective communities.”

There was that.

But then we discovered that North Carolina Attorney General Josh Stein — unlike Virginia, North Carolina actually has an AG — clearly threatened to sue to stop it. Continue reading

Sentara, Cone Health Call Off Merger

From Virginia Business:

“Sentara Healthcare and Greensboro, North Carolina-based Cone Health mutually called off a merger Wednesday, according to a statement by the Norfolk-based health care system.”

The Sentara Healthcare Board of Directors and the Cone Health Board of Trustees came to the mutual agreement to end affiliation plans late last week, according to the announcement.

In Wednesday’s statement, Sentara officials said, “As this work progressed, we realized that each of our communities and key stakeholders require support and commitments from our respective organizations that are better served by remaining independent. The decision was a difficult one, but both organizations remain dedicated to advancing our common goal of providing outstanding care for our respective communities.”

The outcome was right, whatever the reason. It will be interesting to see where Sentara trains its gaze next.

— J.S.

How VCU and Richmond Blew It Again

Bill and Alice Goodwin. Photo credit: Virginia Business

by James A. Bacon

Six years ago William H. Goodwin Jr. and his wife Alice championed the idea of building an independent children’s hospital in Richmond that would conduct research and provide state-of-the-art healthcare to the region’s children. The couple was prepared to contribute $150 million of the estimated $600 million cost in order to make it happen. But the proposal collapsed in the face of unremitting opposition from Virginia Commonwealth University, which was determined to erect its own children’s facility.

Richmond now has a specialized pediatric facility, but it doesn’t come close to matching the vision the Goodwins had.

I was hopeful that Goodwin, who is likely the wealthiest man in Richmond despite having given away hundreds of millions of dollars already, would find another local cause to shower his riches upon. And perhaps he does have other projects in mind. (He and Alice recently gave $5 million to Mary Baldwin University to establish a doctor of nursing program.) But his latest mega-gift of $250 million will not benefit any Virginia institution. It will kickstart a national cancer research foundation called Break Through Cancer… in Boston. Continue reading