Category Archives: Health Care

LifePoint Health Credit Ratings and Outlooks Signal Additional Challenges for its Virginia Hospitals

LifePoint’s Sovah Danville Hospital

by James C. Sherlock

One thing I watch about companies in industries I cover is the ratings and outlooks on their credit.

In my experience, the SEC’S three largest nationally recognized statistical rating organizations (NRSROs), Moody’s, S&P, and Fitch, tend to know as much about company finances as their boards do.

Sometimes more.

I recently wrote about management and staffing issues at Sovah Health hospitals in Danville and Martinsburg. Both are owned by privately held LifePoint Health, headquartered in Tennessee.

Lifepoint also owns in Virginia:

  • Fauquier Hospital;
  • Clinch Valley Medical Center;
  • Twin County Regional Hospital; and
  • Wythe County Community Hospital.

The rating agencies are not in love with LifePoint’s credit.

Yes, it matters. Continue reading

Move Over Covid: Sharks Are Back

by Kerry Dougherty

Great news!

Sharks are swarming off the coast of the Outer Banks. Nine great whites so far. One, named Breton, is a 13-foot adult male weighing over 1,400 pounds according to a story in Saturday’s Virginian-Pilot.

Why is this good news?

Because it’s a sign that Covid is truly over. The general public may not be aware of this, but shark stories are a staple of digital news outlets because they generate thousands of clicks. Anyone else remember the summer of 2001? The news media were full of shark attack and Chandra Levy stories.

Until the terrorist attacks of September 11 bumped the clickbait off the front pages, that is.

We haven’t been reading a great deal about sharks for the past three years because the news media found something better to scare the bejabbers out of the public: “scary-new-variants-are-coming” and “Covid-isn’t-over” stories.

Think about it: since 2020, anything with “Covid” in the headline — especially stories stoking the fear factor — were hot tickets for news outlets. The fact that newspapers, including the all-Covid-all-the-time New York Times, have finally ditched their tedious daily Covid tracking charts is a sign that the public long ago lost interest.

In fact, Congress finally acted last week to terminate the executive emergency powers that the pandemic gave to Donald Trump and Joe Biden.

The U.S. Senate voted 68-23 to officially end the Covid emergency, even though Biden planned to “wind it down” beginning May 11. Only 23 Senate knobturners voted against the measure, including the usual far-left suspects: Bernie Sanders, Chuck Schumer, Elizabeth Warren and Cory Booker. Continue reading

Virginia Hospital Profits Soared Far Above National Averages – Again – in 2021

The Business of Healthcare

by James C. Sherlock

The predictions for hospital finances in 2021 forecast Armageddon. Then the actual financial data from 5,600 U.S. hospitals in 2021 were assessed.

Based on those data the median operating margin for U.S. hospitals in 2021 was actually a loss of 1.5%. Meanwhile, the average operating margin for hospitals was a loss of 11.7%.

Virginia hospitals blew those numbers away. Crushed them. Again.

As they do every year.

Newly posted state data show that the average 2021 operating margin in Virginia acute care hospitals was a positive 12.5% in 2021.

I don’t know how many standard deviations that is, but it is a lot. We are finally number one in something to do with health care, but the bad news is that the money is paid by Virginians one way or another.

If you lost that badly in a card game, you would think something was amiss.

It is in this case. Continue reading

Continuing Turmoil at Danville and Martinsville Hospitals Raises Questions of Oversight – Again

Sovah Health Danville Hospital

by James C. Sherlock

Beckers Hospital Review reports that Sovah Health hospitals in Danville and Martinsville have eliminated the Chief Operating Officer (COO) positions at both hospitals.

Sovah announced that the responsibilities of those two positions will now be absorbed by “other members of the existing team.” Whatever that may mean.

Management turmoil at Sovah is hardly a new issue. But those changes just never seem to work.

Not even a little.

The timing and structure of these current changes are especially unusual given Sovah’s plea agreement with the Food and Drug Administration that is still in force. Seems employees were dealing drugs from the hospital supply.

Similarly unusual, unfortunate actually, are the weak-to-non-existent oversight activities of the Virginia Department of Health and the Accreditation Council for Graduate Medical Education (ACGME).

You read that right.

Sovah Danville is a teaching hospital. Continue reading

Virginia Needs a Top Mental Health Research Hospital – UVa is Positioned Provide It Statewide

UVa Hospital

by James C. Sherlock

The Commonwealth has an ambitious and promising program to improve behavioral health services to its citizens.

One thing missing among the six pillars of that program is a top mental health research hospital system.

The top-rated mental hospital in the United States is Mass General Brigham’s McLean hospital. Many of the doctors are Harvard Medical School faculty.

Of the remaining top 40 on that list, none is in Virginia.

Virginia’s two leading mental health research hospitals are both associated with the University of Virginia medical school and UVa Health.

  • INOVA Fairfax Hospital, partnered with the medical school; and
  • the University of Virginia Hospital in Charlottesville.

There is an opportunity, if the Board of Visitors and Virginia Health choose to exercise it,

  • to invest in bringing one or both of those facilities into the ranks of the best mental health research hospitals in America; and
  • to expand UVa Health at the Wise campus to spread the benefits to that part of the state.

That, in turn, can help the state deal with its mental hospital problems. Continue reading

A More Appropriate Management Model for State Mental Health Facilities

Central State Hospital Petersburg

by James C. Sherlock

I always find it disturbing when state agencies operate institutions that they are also responsible for regulating and inspecting.

It almost cannot work.

I have brought this up with regards to the VDOE operation of a virtual learning program when that same agency oversees private providers of the exact same services.

That is small ball compared to the issues at the state’s mental health facilities.

Now we have a very recent tragic example at Central State of decades-long problems at state-run mental hospitals including overcrowding and inadequate staffing.

A 2021 Associated Press article used Central State as the leading example of overcrowding. The reporter wrote, prophetically:

Virginia sheriffs are reporting being stretched thin after responding to psychiatric emergencies that require them to hold people and transport them for treatment.

‘I’ve had deputy sheriffs tied up for days at a time,’ John Jones, executive director of the Virginia Sheriffs’ Association, told the newspaper in an interview on Tuesday. ‘We’re at a crisis point.’

Now seven sheriffs deputies and three Central State staffers are charged with murder in that same scenario.

I view the current management model in which a single state agency oversees, operates and inspects its own facilities as untenable.

There is a proven alternative. Continue reading

Crime in Virginia — the Statistics of Race and their Causes

by James C. Sherlock

Crime, especially violent crime, is a constant topic in private conversations and in public politics, and thus here on Bacon’s Rebellion.

Comments on BR crime-related articles turn quickly to race, often without basis in fact.

I will offer below the actual crime statistics by race from 2021, the latest available year, in an attempt to cure that.

Then I will write about the causes.

I will almost certainly be called a racist. Continue reading

Last Gasp for Masks

by Kerry Dougherty

A friend of mine went to the dermatologist yesterday. The medical office was in the Sentara Leigh medical complex in Norfolk and she was required to wear a face diaper.

Hey, there were a total of 5 cases of covid yesterday in Norfolk. That’s 2 cases for every 100,000 residents. There may have been more cases of TB. Of leprosy. But you can’t be too careful, am I right?

Of course if my pal had waited one more day to see the skin doctor she could have bared her pretty face. In a joint announcement from the region’s megalith health companies: Sentara, Bon Secours, Chesapeake Regional, Riverside and CHKD declared that beginning today face masks were no longer required in their facilities.

It’s about time. Continue reading

The Registered Nurse Shortage

by James C. Sherlock

I have reported often about the severe and increasing shortages of nurses both in Virginia and nationally.

At some point in nearly everyone’s life, we literally will not be able to live without the help of a nurse, whether for injury or illness or just declining overall health.

We need both the nurses and ourselves to be safe when that happens. We will have to fill the shortages, first by recruitment and retention. Perhaps simultaneously by increased legal immigration of qualified nurses from other countries.

This article will focus first on what RNs were paid in 2021, both in Virginia and nationwide. We will examine it in absolute and in relative terms. Virginia in 2021 was competitive on pay in relative terms. But wages may be insufficient in absolute terms to address the shortages.

Then we will discuss what else needs to be done to recruit, train and retain more nurses. I mentioned in an earlier article that RN instructors in training programs are one of the biggest needs.

The Census Bureau and Bureau of Labor Statistics have captured the large increases in registered nurse (RN) pay across the board and the doubling of the pay of travel nurses in 2021. Those pay surges were driven by COVID supply and demand and funded partially by federal emergency money.

You will see that, by what I consider a useful calculation, Virginia RN’s median wage compensation is 18th among the states when adjusted for each state’s cost of living index. Virginia is the top-paying state among adjacent states and the District of Columbia.

Regardless of the reason, it was past time that we paid them more. We need the pay raises to stick. It is the only way over the long run to begin increasing the supply.

I say begin because there are other factors driving nurses away. Safety is a huge factor. Continue reading

Public School Climate Lessons Terrorize Virginia’s Children

Courtesy of the BBC

by James C. Sherlock

A headline from the home page of Save the Children:

Climate Change Is a Grave Threat to Children’s Survival.” 

Climate change is thus not a “challenge.” Not a threat to children’s happiness. But rather a threat to their “survival.”

That is what children are being taught in many Virginia public school classrooms. Kids, being sponges, have learned that lesson, and are understandably severely depressed about it.

Parents and the Board of Education, take note. That cannot be allowed to continue.

For years, studies have shown the existence of psychological distress about climate change that has dimensions within feelings, emotions, cognition and behavior. That stress has been demonstrated to disproportionately affect young people.

The largest and most international study of climate anxiety in young people was peer-reviewed and posted in The Lancet in December 2021.

Regardless of one’s personal feelings about climate change, no caring adult would want, as revealed in that study, children feeling “very or extremely worried” (46% of children in the United States) or, worse, negatively affected in their ability to function (26% of children in the United States).

None would want near half or more than half of children reporting feeling “sad, anxious, angry, powerless, helpless and guilty” and “betrayed” about anything, much less a phenomenon that is measurable as a current event with which we are dealing but arguably is overstated by progressives as a future prospect.

Climate change can, and should, be taught to children. But it must be done without terrorizing them. That cannot be too much to ask.

Scaring children to turn them into political activists is child abuse per se.

It must stop. Continue reading

Virginia Hospitals Under Pressure on Finances and Personnel

By James C. Sherlock

Bon Secours’ St. Mary’s Hospital

I have written for years about Virginia hospitals and their state oversight, including Virginia’s monopolistic Certificate of Public Need (COPN) law and its administration by the Department of Health.

Virginia hospitals, and indeed those across the nation, are now under more stress than in generations.

Hospitals nationally are under financial pressures while public views of hospital finances are opaque and out of date.

Increasing shortages of qualified medical personnel are both driving up costs and challenging services in all of Virginia’s hospitals.  The worst shortages are where you think they are.  In hospitals serving poorer populations.

One study quoted by Oracle

…projects that if US workforce trends continue, more than 6.5 million healthcare professionals will permanently leave their positions by 2026, while only 1.9 million will step in to replace them, leaving a national industry shortage of more than 4 million workers.

That Oracle article is worth a read.

We will see increasing cutbacks of hospital services in Virginia.  Some may find themselves unable to maintain some or all of their inpatient services.

A few may close.

I interviewed Virginia’s Secretary of Health and Human Resources on this front-burner situation.

Continue reading

Private Hospitals show Virginia’s State Hospitals, Colleges and Universities the Way to Efficiency

Valley Health Winchester Medical Center

by James C. Sherlock

We read far too often about funding “crises” in government institutions and programs.

The general public, me included, would be far more attentive and sometimes supportive if government would follow the lead of private companies and continually right-size itself and emphasize customer-facing services.

The health care industry — or rather the private healthcare industry — consistently shows the way.

Even not-for-profits are not for losses.

Count, if you can, the number of times in your life that a government organization has announced job cutbacks in administration in order to optimize expenditures and provide better service.

Yeah, me neither.

Students at one of my favorite state schools (it is northwest of Richmond and west of Orange County) are protesting that their faculty is underpaid.

The solution to that problem, if indeed the Board of Visitors considers it a problem, writes itself. Continue reading

Government Actors Try to Deflect, Deny and “Move On” from Failures During COVID

Courtesy CBS rendering of two CDC spring of 2021 survey findings about American high school girls reported Monday, Feb 13, 2022

by James C. Sherlock

The Centers for Disease Control and Prevention (CDC) is in full self-defense mode.

CDC and the left backed, indeed insisted, upon social isolation during the pandemic.

Now they deflect and deny agency in the consequences. They continue to try to insulate themselves from the catastrophic educational and mental health effects on children and adolescents of that social isolation.

A weakened CDC Director is pledging to overhaul the agency and its culture, a backhanded admission of the unimaginably bad performance of CDC during COVID.

The entrenched bureaucracy that is that agency and its culture is admitting nothing. They are counting the days until she leaves.

So, if experience counts for anything, we pretty much know how the CDC “overhaul” will work out.

Virginia is due for the same sort of review of state actions during COVID.

The Northam administration stumbled badly at nearly every new turn after failing to either exercise or implement Virginia’s own pandemic emergency plan. Which was excellent and predicted nearly exactly the course of events.

Then they tried to cover up the existence of that plan itself.

I am not sure that such a review is forthcoming. If it is, it will be preemptively be declared political. It must be done anyway.

The federal government, under progressive management, is “moving on.”

Or trying to.

I hope Virginia government does not make the same mistake. Continue reading

Bias and Risk in Behavioral Polls and Studies – A Cautionary Tale for Public Policy

Courtesy WebIndia

by James C. Sherlock

Here at BR, both the authors and commenters spend a great deal of time discussing the outcomes of behavioral polls and studies.

Taxes, mandates, and bans are behaviorally informed. As are most public policies.

But behavioral science adds levels of risk and bias much more prevalent than in the hard sciences.

As a citizenry, we generally understand that polls that predict future behavior can prove unreliable because we see political polling.

Most expect polls about how we feel about our lives to be imperfect, but not purposely so. Yet some polls are designed to support a specific political position.

We probably understand a lot less about the risks and biases in behavioral studies that govern most public policy, because assessing them requires technical expertise most, including most elected politicians and political observers do not possess.

Which is a key reason such policies often go wrong. Continue reading

Moral Injury Is Driving Doctor Burnout

by Dr. Scott Armistead

Physician burnout is a major issue in the U.S., receiving attention in medical education, medical specialties and at various government levels. Moral injury, in my professional and teaching experience, is a significant and growing challenge to physician wellness. Moral injury happens when one’s personal convictions are unwelcomed and one is pressured to think, be silent, speak, act or not act in a way that compromises one’s conscience.

I graduated from the VCU School of Medicine (formerly Medical College of Virginia) in 1991, trained in family medicine and served in a mission hospital in Asia for 16 years. In 2015, I transitioned to a Virginia university practice and became heavily involved in the lives of medical students.

In the time that had passed since I was a medical student, I found the environment of medicine and medical education had significantly changed. One area of change was the emergence of the “provider of services model.” “Provider,” a relatively new term at the time, is now commonplace. Continue reading