Category Archives: Health Care

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

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

How to Befuddle an Old Lady

My 92-year-old mother takes this COVID business very seriously, as one would expect from someone in a high-risk group. She’s double vaxxed and boosted. And she is assiduous about testing herself and others who enter her house. At the same time, she’s frugal, and a testing two-pack costs about $25 at the drug store. So, when the federal government promised to send every American two free test kits, she jumped at the offer.

The test kits duly arrived a few days ago, and my mother had an occasion to test herself. As she pored through the instructions, she came across Step 5, pictured above, which says, “Start the timer by clicking the ‘Start Timer’ button….”

By referring to the Start Timer button, the instructions implied that such a button was to be found in the kit. But it wasn’t. 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

Unvaccinated Patients Denied Organ Transplants Everywhere

by Kerry Dougherty

It’s right there on the bottom left of my Virginia driver’s license. A little heart and the words “organ donor.”

I ticked that box years ago. I also joined the bone marrow donor list when a friend had leukemia and needed a match.

Donating our organs is the last act of kindness we can do on this earth. After all, you can’t take them with you.

But recent headlines about unvaccinated patients were being denied transplants are alarming to those of us who oppose vaccine mandates and are worried about a movement toward medical apartheid. Continue reading

A Lesson for Virginia Democrats in California’s Failed Universal Healthcare Bill

Maximilien François Marie Isidore de Robespierre

by James C. Sherlock

California is one of the five bluest states in the Union. Democrats have supermajorities in both houses of the state legislature and a sometimes-masked Democratic governor.

It can’t pass single-payer healthcare. It has not even been able to get a bill to the floor of the Assembly (lower house). It failed again today.

An object lesson for California politicians. Assembly Speaker Anthony Rendon, D-Lakewood, refused to bring a single-payer bill to a vote in 2017.

[That year]… after Assembly Speaker Anthony Rendon pulled the single-payer bill, [California Nurses Association President RoseAnn] DeMoro tweeted a picture of the iconic California grizzly bear being stabbed in the back with a knife emblazoned with Rendon’s name. The legislator — a Democrat — said he was besieged by death threats after that.

He is now a supporter.

There is a lesson for Virginia Democrats in the saga of single-payer in California. Continue reading

HB 646 on Nursing Home Staffing Misses the Mark – So Does Its Fiscal Impact Statement

Courtesy NPR

by James C. Sherlock

There is a bill, HB 646, Nursing homes; standards of care and staff requirements, regulations in the General Assembly.

I support its intent.

As written it specifies minimum hours of direct care services for each
resident per 24-hour period.

In actuality, numbers of personnel required to provide the services depend upon the physical health of the patient population of each home. Specific numbers in the current bill also make the law vulnerable to changes in Centers for Medicare & Medicaid Services (CMS) policy. Such specificity is neither necessary nor, I suggest, appropriate.

  • The law can be amended to leverage existing federal monitoring of staffing to make it much easier to administer, less vulnerable to federal policy changes and tailored to the needs of the patients of each nursing home;
  • The amendment that I recommend will also enable the fiscal impact statement to be far more precise and far lower.

These goals can be achieved with an amended bill. Continue reading

COVID, Risk, and Organ Transplants

Shamgar Connors undergoing kidney dialysis

This is the second of three posts about COVID and kidney transplants.

James A. Bacon

In January Stafford County resident Shamgar Connors, who has undergone kidney dialysis for nearly three years, engaged in an annual consultation with the University of Virginia Health system’s organ transplant team. His conversation with Dr. Karen Warburton went like this:

Warburton: [A social worker] said you’re not interested in the COVID vaccine. It is a requirement for you to be active–

Connors: I just had COVID, so I don’t know, why would I get the vaccine?

Warburton: You may have had Delta, and that may not protect you against the Omicron variant, which is what we’re seeing now. Also, our policy is, in order to have people active on the transplant list and get a transplant, you need to be fully vaccinated. You’re on the list. You’re just not on active status right now, as we tied up all these other loose ends. In order to be activated on the list, you will need to get the vaccine. … Are you willing to do it? [silence] OK, so, you don’t want to move forward?

Connors: I’d rather die of kidney failure than get the vaccine. Continue reading