Category Archives: Health Care

Fix the Virginia Department of Health

Credit: PBS Healthcare Management

by James C. Sherlock

Governor Youngkin and his new administration have an opportunity to fix crucial problems in the Department of Health that have been festering for decades.

The issues:

  • How can Virginia regulate effectively its state-created healthcare monopolies?
  • In a directly related matter, how can we fix the failures, famously demonstrated during COVID, of the Virginia Department of Health (VDH) in its other missions ?

The power of Virginia’s Certificate of Public Need (COPN) to control the business of healthcare in Virginia was the original sin.  Giving that power to the Department of Health made it worse.

From that point VDH was the agent of its own corruption. Never charged by the General Assembly to create regional monopolies in its administration of Virginia’s Certificate of Public Need (COPN) law, VDH did so anyway.

Actions have consequences.

Now those regional healthcare monopolies are each the largest private business in their regions, have achieved political dominance in Richmond, and effectively control VDH. Continue reading

Things Are Not Always As Intuitive As They May Seem

Photo credit: CNBC

by Dick Hall-Sizemore

Sometimes, public policy proposals can be counterintuitive.

Virginia law authorizes health insurance companies to charge smokers up to 50% greater than the premium that would otherwise be effective. The 2022 General Assembly passed legislation that would have repealed this authorization. The bills, HB 675 (Hope, D-Arlington) and SB 422 (Edwards, D-Roanoke), passed both houses with strong bipartisan majorities.

The Governor vetoed them.  His explanation for the vetoes was:

Smoking and tobacco use are among the leading causes of chronic health problems that result in higher healthcare costs. This legislation would force insurance companies to recover costs associated with tobacco users by raising premiums on non-tobacco users. The ability to reduce premiums by quitting smoking is also a valuable incentive to encourage healthier habits.

Requiring non-tobacco users to cover the increased healthcare costs associated with tobacco use is not a policy I can support.

On its face, this explanation sounds reasonable. After all, society should discourage smoking and no one wants to subsidize unhealthful habits. Continue reading

Pill-Popping Nurse Gets Three Years in Prison

by Kerry Dougherty

If there’s a special ring in hell for those who prey on children — and I hope there is — there should also be a place reserved for those who hurt the elderly.

Consider the monstrous acts of Janeen Bailey, a 57-year-old LPN with 25 years of nursing experience who stole painkillers from elderly patients in two long-term care facilities and used the drugs to relieve her own discomfort while they writhed helplessly in pain.

According to news reports, Bailey told investigators she believed the patients could cope with their own pain better than she could with hers because she was working and they were not. The nurse allegedly suffered from back pain.

Bailey denied she was an addict.

She pleaded guilty to two counts of tampering with a consumer product.

Seriously?

That’s the most serious charge prosecutors could concoct? Continue reading

Virginia’s COVID Performance Rates a D

Source: The Committee to Unleash Prosperity

by James A. Bacon

Virginia performed worse than 35 other states during the COVID-19 recession, based on an analysis that encompasses mortality rates, economic performance and educational performance. The Commonwealth fared better than average in health outcomes, worse than average in economic performance, and near the bottom in school closures. The overall ranking: D.

Nationally, there was little correlation, however, between the stringency of economic and school-related COVID lockdowns and health outcomes, finds the study, “A Final Report Card on the States’ Response to COVID-19,” published by the National Bureau of Economic Research. The authors were Phil Kerpen, Stephen Moore, and Casey B. Mulligan, all well-known free-market economists.

Former Governor Ralph Northam, a physician, can take some comfort in the fact that Virginia under his watch performed better than most other states in the COVID-related mortality rate when adjustments were made for age and the prevalence of obesity and diabetes risk factors in the population — 10th best in the nation.

However, when the perspective shifts to “all cause excess deaths,” which captures the mortality effects of lockdown policies such as higher drug and alcohol deaths, suicides, and foregone medical treatments, Virginia’s national ranking falls to 19th. Continue reading

CMS Finally Withdraws Dangerous Waivers of Nursing Home Patient Safety Regulations

by James C. Sherlock

I published a series of articles last year on the dreadful conditions in some of Virginia’s nursing homes as reported by Medicare.

Two key observations were that:

  • bad nursing homes were traceable to specific chain operators; and
  • the Virginia Department of Health had admitted it was desperately short of inspectors.

Those two things are still true.

A major problem at that time was that nursing homes were provided an extensive set of waivers of patient safety regulations by the Centers for Medicare/Medicaid Services (CMS). Those “COVID” waivers were overdone when granted and have been in place far too long.

This is a really big deal. CMS admits “mistakes were made” with waivers that endangered patients.

They are finally scheduled to be withdrawn. Continue reading

The Relentless Push for Child Gender Transition

Dr. Rachel Levine, U.S. Assistant Secretary of Health

by James C. Sherlock

On the odd chance you missed it, the Biden administration announced a flurry of new measures today, designated the Transgender Day of Visibility. (I need to keep up.)

The Washington Post reported on the festivities. What that story did not report is the celebration’s most important “feature.”

HHS today announced Biden administration support for gender transition  for children.

For transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the healthcare system.

Happy to know that HHS defines this as “gender-affirming” care — “affirming” and “care” are cute terms — “at any age or stage” of development. Continue reading

What Virginia Can Do to Temper Inflation


by James A. Bacon

Governor Glenn Youngkin has proposed using $437 million in unanticipated transportation revenues, much of it generated by the wholesale tax on gasoline, to give Virginians a three-month break on the 26-cent retail gasoline tax.

During his campaign, Youngkin ran on a platform of addressing Virginia’s high cost of living and reversing the erosion of middle-class living standards. A vacation on the gasoline tax is certainly consistent with that theme. And with inflation running at nearly 8% over the past 12 months, Virginians need help wherever they can find it. They will find no succor from Democrats, whose list of unmet societal “needs” is endless. They are delighted to spend every dime in tax revenue on one of their favored causes — which, alas, rarely includes helping financially strapped middle-class taxpayers.

While Youngkin has identified a winning issue, he needs to think bigger and more systematically. It’s fine to dial back the gasoline tax for a time, remove the sales tax on groceries, and try to repeal the Regional Greenhouse Gas Initiative (RGGI) carbon tax, but there is so much more that he can do.

Forty-one percent of the cost of living, as calculated by the Bureau of Labor Statistics, is housing, 17% transportation, 7% medical care, and almost 7% education. Each of these categories is, to some degree, influenced by state-level budgetary and regulatory policy. Continue reading

A Narrative About Virginia’s Rural Hospitals that Obscures the Facts

by James C. Sherlock

Becker’s Healthcare, a widely read medical news organization, published a story on Friday, “892 hospitals at risk of closure, state by state.” Rural hospitals were the topic.

It cited as its source a report from a non-profit named The Center for Healthcare Quality and Payment Reform (CHQPR), which presents itself as “a national policy center that facilitates improvements in healthcare payment and delivery systems.”

The CHQPR report Rural Hospitals at Risk of Closing claims that twelve of Virginia’s “27″ rural hospitals are at immediate risk of closing. It certainly engaged my interest.

Another CHQPR report, The Crisis in Rural Health Care, has an interactive map where the twelve perhaps can be found.

But the sources of both reports are a mystery, at least to me.

  • First it must be noted that the Virginia Department of Health lists only 20 rural hospitals in the state.
  • Only five of them lost money in 2020 (see the column “Revenue and Gains in Excess of Expenses and Losses”).
  • Four of those are owned by large and profitable health systems that use them to feed more profitable cases to other system hospitals.

It is dangerous to the cause of improving rural healthcare to create “reports” like this. Continue reading

Primary Care Shortages in Virginia and an HEZ solution

by James C. Sherlock

I have written here and in newspapers across the state with a recommendation that Virginia emulate Maryland in the establishment of Health Enterprise Zones (HEZs) to bring primary care to Virginia communities that lack sufficient access to treat people before their conditions require hospitalization.

Here I will provide data on Virginia primary care needs calculated separately for health outcomes and for health professional shortages.

You will not be surprised to learn the locations with the measured shortages of primary care physicians do not exactly align with the areas with the worst health outcomes. That proves what we knew already. There are other factors in play in health outcomes.

But we know absolutely that more primary care professionals in communities targeted for both criteria can both improve outcomes and greatly lower Medicaid costs. Continue reading

New York Governor Removes Mask Requirement for School Kids – Virginia Mask Advocates Confused

CDC Director Rochelle P. Walensky, MD, MPH

by James C. Sherlock

Headline: “New York City says it will end the school mask mandate and indoor vaccination requirements.AndNew York indoor school mask mandate to be lifted this week.

Progressive Virginians have been stabbed in the back. Et tu, New York?

So, imagine you have filed a law suit against Governor Youngkin on the same issue.

When you have lost New York, not to mention The New York Times, CNN and the CDC, what is a righteous science follower to do?

COVID-19 County Check

In Virginia Beach County, Virginia, community level is Low.

Watch this space for the self-flagellation, rending of garments and desperate references of the woke.

Patient Safety and You

by James C. Sherlock

In my career in private industry, I worked for a time with the testing and implementation of a hospital operational management system. My work there was shaped in considerable part by the 2000 report of the National Academy of Sciences, To Err is Human: Building a Safer Health System.

I came across a report today that I think it important to share. You would not normally see it if you are not in the health care business. It concerns patient safety. It is a Joint Commission report on sentinel event data.

This is not the kind of thing we normally write about here, but patients certainly experience sentinel events in Virginia, and I think it important enough to break that tradition.

The Joint Commission is by far the largest body evaluating health care organizations. A sentinel event is

“a patient safety event (not primarily related to the natural course of the patient’s illness or underlying condition) that results in any of the following:

  • Death
  • Permanent harm
  • Severe temporary harm and intervention required to sustain life”

Continue reading

Everybody Wins – Nurse Practitioners for Underserved Communities

by James C. Sherlock

The University of Pennsylvania School of Nursing has instituted a terrific program thanks to a wealthy alum who gave $125 million to recruit and train nurse practitioners to practice in underserved communities.

The Leonard A. Louder Community Care Nurse Practitioner Fellows program will be tuition-free and students who still need help will be granted stipends. The program will start with 10 enrollees next year, eventually reach an annual target enrollment of 40 Fellows, and will be sustained by income from the grant. (See the link above for additional details.)

What attracted me to this is the need in Virginia.

The program fits like a glove with a parallel program, Health Enterprise Zones, which in Maryland has saved enough Medicaid money to fund a Virginia Nurse Practitioner Fellows Program here. Continue reading

Virginia ACLU Sues to Keep Schoolchildren in Masks – Forever

by James C. Sherlock

The ACLU of Virginia is suing under the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act in United States District Court in Charlottesville to keep all Virginia school children in masks. Potentially forever.

The lawsuit contends that Governor Youngkin, with his EO making masks optional, “has effectively barred the schoolhouse door” to some kids with disabilities.

A victory for the plaintiffs would make the debate on current Virginia law moot. It would make the expiration of that law on July 31 moot. It could make CDC recommendations moot. Indeed, it could make COVID-19 moot.

Relief — masking for the entire school population — is sought based on the increased vulnerability of one or more kids to pathogens. The plaintiffs plead this is a reasonable accommodation. A decision based on the ADA or Section 506 cannot reasonably be limited to this particular strain of coronavirus.

The wrong decision could make the administrators and teachers, as well as kids, wear masks when any child in a school is deemed by a physician to be more vulnerable than others to any pathogen. Continue reading

The National Association of School Psychologists is Going to Get Its Members Fired

George Will

by James C. Sherlock

I had dinner with George Will once years ago aboard ship. He is very smart, uncannily observant, understatedly amusing and a terrific dinner guest.

He published yesterday in The Washington Post a column, “Witness how progressives in government forfeit the public’s trust.”

The National Association of School Psychologists (NASP) has proven that Mr. Will’s observation of progressive behavior has escaped the confines of government and infected nonprofits.

As proof of its commitment to progressive dogma, NASP has published a position statement, Promoting Just Special Education Identification and School Discipline Practices. The redefinitions of roles for and recommended assumptions of authority by school psychologists recommended in that paper are absolutely breathtaking. It unintentionally but very effectively challenges the trust of parents, teachers and principals in the very professionals it represents.

NASP wants them to devalue objectivity, the results of tests that only they are qualified to perform, and assume the roles of school sociologists, principals and assistant principals. Roles the NASP defines, of course, with — wait for it — progressive dogma.

Let’s assume they do that. Two related questions:

  • Who in the schools or among the parents will ever again trust school psychologist evaluations? The NASP has now set them up to be sued. Successfully.
  • What school principal will have them?

Continue reading

State Interest in the Operating Efficiency of Virginia’s Nonprofit Hospitals

Courtesy AP

by James C. Sherlock

Virginia’s nonprofit hospital systems are partially funded with taxpayer money, pay no taxes, and are protected from competition by the state.  

The state, having provided all of those advantages, needs to make sure its citizens reap as much benefit from them as the hospitals do.

Yesterday I wrote that the state has an obligation to regulate the regional monopoly systems it has created to ensure that their prices are kept within reasonable bounds.

One way to do that is by controlling their allowable operating margins.  

That in turn requires the government to see to it that they are operated efficiently. It must ensure that their operating margins, which are operating income divided operating revenue, reflect best practices in controlling operating expenses.  

Optimized operating efficiency has been shown to improve medical performance as well. Continue reading