Category Archives: Health Care

Important Changes in Healthcare Billing and Price Transparency

by James C. Sherlock

A lot happened right before the New Year to change the rules for healthcare billing and pricing.

Balance Billing

In one of the events, new federal law buried in the end of year, 5,600-page $900 billion COVID-19 federal relief legislation bans balance billing to patients.

“Surprise” billing for the balance due after an insurance company pays its contracted providers occurs when patients are presented with unexpected bills from out-of-network providers who practice in in-network hospitals.

ER physicians in particular have been very active in forming practices that contract with hospitals, effectively reducing the supply of ER physicians available to work as hospital employees. Continue reading

COVID Has Exposed Massive Failures in Governance

by James C. Sherlock

In a comment to my previous post, we saw a statement “most parents are happy with the education their kids are getting.”   That is no longer true. Polls say overwhelmingly it is not.

On a personal note, my two grandsons in Albemarle County schools, twin seniors, haven’t set foot in their high school this year. Albemarle County has during this same time period declared itself the state’s first antiracist school district. Excellent timing. Shows where the superintendent’s head was. The school board rubber stamped that policy. No one noted that black students were and are unable to go to school.

COVID has exposed a fatal lack of government imagination, planning and execution in good times. It simply did not do the blocking and tackling.

Remember my story about the decades-long lack of hospital and nursing home inspectors? Remember the nursing home deaths that resulted?

Remember the University of Virginia Board of Visitors more than a decade ago fired the president of that school in part because she would not invest enough in distance learning? Remember that the board itself was then threatened with firing by the Governor and she returned triumphant? Now remember what happened when that school and others had to switch to remote learning under COVID? Continue reading

Healthcare Spending Drives Growth in Virginia Budget over Last 10 Years

by James C. Sherlock

On December 16, the Director of the Virginia Department of Planning and Budget provided a briefing for the Joint Meeting of the Senate Finance and Appropriations Committee, the House Appropriations Committee, and the House Finance Committee.  

The subject was the Governor’s proposed amendments to the 2020-2022 Biennial Budget. The Governor submitted the revised budget discussed in that briefing and it was introduced as matching bills by the chairpersons of the Senate and House appropriations committees on December 16.

There is plenty of information of interest in there.  Continue reading

Virginia Legislative Black Caucus Sits Idle While Constituents Suffer and Die

by James C. Sherlock

I have been attempting to improve healthcare access, affordability and competition, which improves both access and affordability, in Virginia for 15 years, especially for the benefit of the poor.

I have seen the Governor’s office and members of the Virginia General Assembly (especially Democrats on health care issues) continue to bow to the wishes of big healthcare industry contributors and repeatedly hurt the cause of improving healthcare for poor people.

Who are disproportionately black.

Today I am going to call out some of the worst offenders I have seen in action over those years, members of the Virginia Legislative Black Caucus. Continue reading

NoPlan Northam Readies Random Restrictions

Image by Gerd Altmann from Pixabay

By DJ Rippert

Here we go again. The Richmond Times Dispatch is reporting that Governor Ralph “NoPlan” Northam signaled a possible increase in COVID-19 restrictions during an interview with CNBC yesterday (Dec 7). Northam is quoted as saying, “We’re actively discussing on how to mitigate the numbers, and we’ll take further measures if we need to this week.”

The actual interview was even more embarrassing than the RTD article would have you believe. At about the 1:50 point in this video David Faber does something Virginia’s gutless media has so far refused to do. He asks NoPlan Northam to describe his plan. “What are the numbers that are going to trigger you, governor, to take further measures” is the specific question asked by Faber.  The same question I have been asking on this blog here, here and here.

Northam declares it to be a “great question,” insists he is “data driven,” and reminds everybody that he is a physician. He then proceeds to evade and avoid the question in a stumbling, bumbling soliloquy to nowhere. He explains that the spread is happening where people are gathering, sometimes in homes and sometimes in places of worship. He keenly cuts through the fog by declaring that places of worship will be advised to take things seriously. He concludes by insisting that “the decisions we make will be data driven in Virginia.” NoPlan Northam skates a simple question he should answer. His obviously cavalier attitude toward the people of Virginia is disgraceful. Continue reading

Bacon Bits on a Snowy Day

Another free clinic closes. Harrisonburg’s Free Clinic is going out of business after 30 years of providing medical care to low-income, uninsured adults. The clinic’s board attributed the decision in part to the decline in the number of patients resulting from Virginia’s Medicaid expansion. The clinic had 600 patients before expansion and 90 patients afterward, reports Virginia Business. Also, staffing the facility, which relied upon the contributions of 80 volunteers, became problematic during the COVID-19 epidemic. And, thus, Virginia civil society continues to shrink and Virginia’s health care system continues to consolidate under the control of monopolistic health care systems and monopsonistic, taxpayer-funded insurance programs.

Virginia’s ruling class in action. Christian Dorsey, a member of the Arlington County Board, is in hot water for fraudulently misrepresenting his liabilities while filing for bankruptcy, reports the Washington Post. Dorsey had listed a second mortgage payment as one of his obligations, which would have reduced the amount he had to pay toward his other debts. But in fact, court testimony revealed, that debt had been forgiven and Dorsey had made no payments on it. As a practical matter, that means Dorsey has no protection from creditors for at least three months. The bankruptcy came to light after a story in the Post forced Dorsey, who also serves on the Metropolitan Washington Area Transit Authority board, to return a $10,000 campaign contribution from WMATA’s largest union. Between his Arlington board pay and his consulting fees, he earns more than $120,000 a year.

Good Governance Rule #1: You don’t want people facing bankruptcy anywhere near the public till. Good Governance Rule #2: You don’t want people who misrepresent facts to federal judges anywhere near the the public till. Continue reading

Southwest VA’s Health Crisis Began Before the Pandemic

This map shows the region served by the Southwest Virginia Health Authority. (From the Virginia Letter Authorizing a Cooperative Agreement)

by Carol J. Bova

The looming COVID-19 hospital crisis in Southwest Virginia was set in motion long before the pandemic.

To begin with, the region’s health indicators and outcomes generally are much worse than the state average. Two indicators particularly impact the COVID-19 epidemic: Every county in the Southwest Virginia Health Authority service area has a higher percentage of obese adults than the state as a whole. Similarly, the diabetes rate in the counties of Lee, Scott, and Wise, and the City of Norton is 19.1%.

Against this comorbidity backdrop, a nursing shortage at the region’s largest health provider, Ballad Health, is making it impossible to staff enough hospital beds to serve Southwest Virginia’s COVID-19 patients. Continue reading

Vaccine Priorities — A Contrarian View

by Dick Hall-Sizemore

The Commonwealth is going to follow CDC guidelines and make health care workers and residents of long-term care facilities first in line for the COVID-19 vaccines. I have a different proposal.

Health care workers certainly should be first, no argument there. But, I would put teachers next in line. With teachers being vaccinated, schools could open, which would be great news for everyone.

Residents of long-term care facilities are certainly vulnerable. However, with the folks working in those facilities, i.e. health care workers, getting vaccinated, the risks for the residents are decreased significantly. Furthermore, long-term care facilities can protect these folks by continuing to isolate them and not letting anyone into the facilities except their employees who have been vaccinated. Continue reading

Shortage of Health Facilities Inspectors Puts All Virginians at Risk

Regulatory wreck

by James C. Sherlock

I have been the single fiercest public critic of the Virginia Department of Health in general and its Office of Licensure and Certification (OLC) in particular. I have been particularly critical of OLC’s inspections of nursing homes.

We need them to do better, and they agree.

This essay will report what the OLC leadership in response to my FOIA request suggests is required to meet their critical responsibilities.

Their answer is additional staffing and technology, just as reported in an Office of State Inspector General (OSIG) report in 2017.  I dealt with that office more than a decade ago when it was under different leadership and the shortfalls were the same.

The FOIA response indicates to me that the 2017 OSIG report that criticized OSIG staffing and technology shortfalls was utterly ignored.  The OSIG might wish to report on that. Continue reading

Medicaid Enrollment Reaches 1.5 Million Virginians

Annual year-over-year growth of Virginia Medicaid spending and enrollment. Eligibility expanded and provider reimbursements increased at the end of 2018. Source: Senate Finance Committee presentation. Click to view. 

By Steve Haner

Just under two years into Virginia’s Medicaid expansion, and less than one year into a pandemic-sparked economic crisis, enrollment in the program is now about 1.5 million Virginians. Enrollment has grown more than 25% in less than two years and spending more than 30%.

The financial impact on state taxpayers has been blunted by a COVID-19 related boost in the federal share of the program costs, which is expected to continue well into 2021. But the federal legislation providing the money also prohibited the state from removing recipients from the program unless they actually moved away.  Continue reading

Where Does Ralph Northam Go From Here with COVID-19?

Image by André Santana from Pixabay

by DJ Rippert

Marcel Marceau. Ralph “The COVID Mime” Northam dropped a bevy of increased Coronavirus restrictions on the state last Friday. Those new restrictions on Friday followed another rambling COVID press conference held by Northam the prior Tuesday. Anybody watching the Tuesday news conference could be forgiven for being shocked by The COVID Mime’s actions on Friday. Unlike governors such as Larry Hogan in Maryland Northam avoids any serious discussion of possible actions he might take to slow the spread of the resurgent virus in Virginia during his press conferences. Instead, Northam recites statistics about COVID-19 in Virginia and reminds people to wear masks, maintain social distance and wash their hands regularly. He also provides pithy commentary such as, “This is very concerning, especially because it is getting colder. The holidays are approaching and the temptation to gather with other people is high.” Then, as the news week winds to a close, Northam drops a COVID bomb. To say Jim Bacon was exasperated is putting it mildly. The virus has continued to spread internationally, nationally and in Virginia.  So, we get to play the next installment of the Bacons Rebellion game show “What will The Mime do next?” Continue reading

Biden, Birx and COVID Lockdowns in Virginia

by DJ Rippert

Sine wave. The third wave of COVID-19 has been spreading across the world and has come to America.  As should have been expected it has also come to Virginia. Many European countries have enacted lockdowns that would be considered draconian by most Americans. Several U.S. governors have also dramatically reversed the re-opening of their states’ economies in order to thwart the spread of the virus. Federal infectious disease experts are sounding the alarm. “We are entering the most concerning and most deadly phase of this pandemic . . . leading to increasing mortality,” said the Monday report from Deborah Birx, coordinator of the White House coronavirus task force. Birx predicts that the US will see more than 100,000 new cases per day this week.

In the Old Dominion, as WAVY reported yesterday, “Virginia’s [7-day] daily average of 1,306 cases per day is more than 100 cases per day above previous highs in August and May, mostly spurred by spikes in Southwest Virginia, and a notable increase in Northern Virginia. Virginia’s case incidence rate per 100,000 residents is now 15.3, which is considered especially high.” WAVY further reports that Virginia’s case per day total will reach 2,000 by the end of January per UVa’s COVID-19 model. Meanwhile, our governor is unconcerned, citing historical statistics that prove (to him) that Virginia has no real need for concern.

It seems that the stage is set in Virginia for a set of knee-jerk proclamations that will send our state’s economy back into the tail spin we experienced this spring.

Continue reading

The University of Virginia Eastern Virginia Medical School

by James C. Sherlock

With additional information and thoughts generated by responses to my original posts on this matter, I offer this post as a final proposal before the November 15 release of the Sentara-funded “study” of what I call the Sentara Plan for Eastern Virginia Medical school.

The nation is short of doctors and shorter yet of good doctors. The nation has to produce more of both or the situation projects to worsen.

There is an opportunity here in Virginia to deal with both objectives.

But the Sentara Plan is not it.

Continue reading

UVa Medical School Takeover EVMS – A Real Opportunity for A Lot of Good

by James C. Sherlock

Hampton Roads

I recommend the transformation of healthcare and physician training in the Hampton Roads.

I reject both the presumptions and the terms of the current study of a merger of ODU, EVMS, Norfolk State and Sentara to improve EVMS.

That study is funded by the organizations involved and the outcome is pre-ordained.

But it embarrassingly assesses a combination of some of the poorest performing institutions in Hampton Roads. From that baseline, it cannot possibly offer the best outcomes for the Commonwealth or the people of Hampton Roads. Continue reading

The Strange Case of a Proposed Medical Merger in Hampton Roads

by James C. Sherlock

Hampton Roads

There was a story  Could EVMS merge with ODU, Sentara?” – in the Virginian Pilot this morning. It was well done and rendered a major public service.

A private study is “assessing” a regional merger of Sentara, ODU, EVMS and Norfolk State.  “Its task will be to provide recommendations to Gov. Ralph Northam on new ways the schools and hospital system could combine.” Not whether they should, or if there are any better options. 

The study is paid for by the hopeful merger candidates, so no one will be waiting breathlessly for the findings, except apparently the Governor.  

Northam has already announced that the results “may lead to significant changes for Hampton Roads’ “health care ecosystem,” which serves more than 1 million people.

The whole project reeks of Sentara self interest. The merger being studied will not be optimized for the good of the people of Hampton Roads. 

Sentara wants the state to award it because the merger otherwise cannot withstand federal antitrust review.

Continue reading