Category Archives: Health Care

Virginia Medically Underserved Areas for General Assembly Consideration

Posted on January 14, 2023 by | 31 comments

by James C. Sherlock

We have a new General Assembly session. With that comes lots of healthcare bills.

I will not examine each one, but I have a suggestion for criteria to be applied by the Senate and House committees that do.

Ask yourselves how, if at all, each bill helps the federally designated medically underserved areas (MUAs) in Virginia.

Then ask how can any bill be a priority for funding ahead of those that do help that problem.

Then remember that providing primary care to underserved areas is proven to save a ton of Medicaid money net where it has been tried, as in Maryland, because of inpatient care avoidance.

Then ask the not-for-profit health systems that serve those areas to testify how, exactly, they can be medically underserved when that is what the health system tax exemptions are meant to prevent, and free cash flows have been extraordinary for decades.

And, finally, if you have no bills that help provide additional primary care to those areas, you aren’t doing it right. Continue reading →

31 Comments

Posted in General Assembly, Governance, Health Care, Public safety & health

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Has COVID Already Peaked for Winter 2023?

Posted on January 14, 2023 by | 29 comments

Screen capture from Virginia Department of Health website, using Virginia Hospital and Healthcare Association data. Click for larger view.

Last year in Virginia, the COVID-19 hospital count hit its winter season peak on January 12 at more than 3,700 beds occupied. Now the 7-day average is below 1.100, and Thursday’s daily count (reported Friday) dropped below 1,000 to 990. The most recent peak was Jan. 4. Flu and RSV are also on the wane, only a handful of weeks after the media scarecrows ran story after story of the coming triple-demic disaster. Being sick remains something to avoid, and the vulnerable can still die from any one of the three (or a combination, shudder). I personally give most of the credit to the vaccinations, especially among the elderly or vulnerable. Those who have actively sought to discourage them should be ashamed of themselves, but the nonsense remains rampant.

(Update:  The hospital count as of Jan. 16 is now down to 905.  The decline has lasted almost two weeks.)

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The Shooting at Richneck Elementary – Part One

Posted on January 8, 2023 by | 25 comments

Police and EMS response at Richneck Elementary.  Credit WAVY TV 10

by James C. Sherlock

There is trauma everywhere you look.

A six-year-old boy shoots his teacher in school and we first consider the trauma.

Then we look for ways to minimize its effects.

And we simultaneously ask questions about the event itself. What happened and why?

Unless we are personally involved, and even if we are, we look for all of those answers almost immediately.

This first part of a series is about what is to be done with the kid shooter and how the widespread trauma, including his own, will be dealt with. Continue reading →

25 Comments

Posted in Children and Families, Courts and law, Crime, Corrections and Law Enforcement, Discipline and Disorder, Education (K-12), Mental illness and substance abuse

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Why Law Enforcement Supports Gov. Youngkin’s Behavioral Health Transformation

Posted on January 6, 2023 by | 23 comments

Virginia Beach Sheriff’s Deputies

by James C. Sherlock

Updated Jan 6 at 13:10.

Virginia’s sheriffs and police chiefs are reasonably hardened by what they see every day.

They have very difficult jobs to do and are unlikely, either individually or in groups, to support nonsense.

Governor Glenn Youngkin has accepted the challenge of finally fixing Virginia’s behavioral health system. He is strongly supported in that effort by Virginia’s sheriffs and police chiefs.

This is a straightforward proposition for law enforcement.

  • They want people with mental health crises treated by professionals before they commit crimes, not after; and
  • They want them housed when necessary in facilities appropriate to the task of treating them, not in jails.

The Governor proposes to spend $341.6 million in the next fiscal year on that problem, including $123 million in new funding.

  • The law enforcement community sees that as a bargain.
  • Neither the Governor nor law enforcement are known to put up with failure.

The case is sufficiently compelling for small government conservatives to back this effort. Continue reading →

23 Comments

Posted in Crime, Corrections and Law Enforcement, Health Care, Mental illness and substance abuse

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Democrats Want to Raise Youngkin-Proposed Mental Health Budget Increase

Posted on January 5, 2023 by | 33 comments

Health Resources and Services Administration Mental Health Care Health Professional Shortage Areas, by State, as of September 30, 2022, data.HRSA.go.                 Courtesy Governor Youngkin

by James C. Sherlock

There is fundamental agreement in Richmond over mental health services.

From the Richmond Times-Dispatch:

Virginia’s forecasts of long-term budget surpluses mean this year’s General Assembly has a chance to catch up with years of under-funding Virginia schools and the state’s behavioral health system, General Assembly Democrats say.

To govern is to choose. “Democrats” may wish they had used different words than “years of underfunding,” considering who had control in Richmond in 2020 and 2021.

But it is actually helpful that they now think even the governor’s proposal for a 20% increase in the mental health budget approved last year is not enough. If (a big if) more money can be spent efficiently and effectively.

The governor has proposed a $230 million increase in behavioral health program spending over what was approved last year.

So, as the old saying goes, they are just discussing price.

Let’s look at the behavioral health situation to see why. Continue reading →

33 Comments

Posted in Children and Families, Education (K-12), Efficiency in Government, General Assembly, Governance, Government Finance, Health Care, Mental illness and substance abuse, Politics, Social Services and Entitlements

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Preparing for the Costs to Government of Virginia’s Generation COVID

Posted on January 4, 2023 by | 90 comments

John Littel, Virginia Secretary of Health and Human Resources

by James C. Sherlock

To justify her insistence on keeping schools closed, Randi Weingarten, the president of the American Federation of Teachers, said in February of 2021, “kids are resilient and kids will recover.”

She brought that same message to Virginia.

In one of the strangest choices in Virginia political history, Terry McAuliffe brought Weingarten to Virginia to campaign with him on the last weekend of his losing gubernatorial campaign.

Thus sealing his defeat.

It turns out, as it was always going to, that you can’t keep kids out of school for up to a year and a quarter, homebound, and expect all of them to “recover.”

I will call here those in K-12 during COVID school shutdowns Generation COVID (Gen C).

I wrote the other day of an estimate by a renowned educational economist that the 1.2 million Gen C kids in Virginia public schools would lose several hundred billion dollars in lifetime earnings because of un-repaired damages to their learning of all types.

His critics here argued into the night about study methodology, but none denied costs at some level would be there. They did not offer their own estimates.

John Littel, Virginia’s Secretary of Health and Human Resources, has the job of preparing his agencies for the lifetime social costs of those children. Continue reading →

90 Comments

Posted in Children and Families, Culture wars, Education (K-12), Governance, Government Finance, Health Care, Mental illness and substance abuse, Public safety & health, Public-Employee Unions, Resilience, Unions

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Medicare Care Compare – The Only Way to Find the Best Home Health Services in Your Area

Posted on December 29, 2022 by | 15 comments

The Medicare Compare Lady. Courtesy CMS.

by James C. Sherlock

I have been using Medicare Care Compare ratings in my research and writing for 15 years.

Regular readers are familiar with my work on hospitals. I published in this space an extensive series on Virginia nursing homes. For quality ratings and consumer survey data, there is absolutely no substitute for Medicare Care Compare.

This article is about home health services.

There are other rating “services.” Ignore them. None has the timeliness or volume of objective data available on Medicare Care Compare.

The Centers for Medicare & Medicaid Services (CMS) has built the Care Compare website as a decision aid. I find it to be the easy-to-access, convenient and up-to-date official source of information about provider quality that CMS intends. It gets better all the time.

This website displays for Medicare-certified home health agencies both data compared to national and state norms and star ratings for:

  1. clinical measures compiled from the Outcome and Assessment Information Set (OASIS) Prospective Payment System (PPS); and
  2. the results from the Home Health Consumer Assessment of Healthcare Providers & Systems (HHCAHPS) surveys.

Results are based on data from the last four quarters and are updated each quarter.

CMS assigns weights to each measure, calculates the results, adjusts for patient mix, and awards quality and consumer stars on a Bell curve. Across the country, most agencies fall in the middle with 3 or 3½ stars.

It represents a very tough cut. Which is what makes it so useful.

  • You will find 240 Medicare-certified home health agencies in Virginia;

Continue reading →

15 Comments

Posted in Health Care

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Public Education and the Management of Change

Posted on December 12, 2022 by | 14 comments

Freedom High Woodbridge

by James C. Sherlock

Peter Drucker’s famous five questions should always be asked by and of government.

What is the mission? Who is the customer? What does the customer consider valuable? What are the results sought and how are they to be measured? What is the plan, to include both abandonment and innovation?

So, in reviewing the 119-page JLARC report Pandemic Impact on Public K–12 Education 2022, we must inquire first what JLARC was asked to do by the General Assembly.

Then examine what they did with that charter.

Both were well intentioned but incomplete. Continue reading →

14 Comments

Posted in Education (higher ed), Education (K-12), Efficiency in Government, General Assembly, Health Care, Mental illness and substance abuse, Regulations and Government Oversight, Teacher Education

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How UVa Addresses Student Loneliness, Depression

Posted on December 7, 2022 by | 12 comments

A federal survey shows a 63% increase in depressive symptoms in teens and young adults in the 10 years prior to COVID. Source: “Hoos Connected: Enhancing Social belonging & Support Among UVa Students“

by James A. Bacon

A new preoccupation of college administrators across the United States is how to give students a sense of “belonging.” The concern is understandable. There is increasing awareness that America is experiencing a “loneliness” epidemic, as reflected by a 40% rate nationally of anxiety, depression and other diagnosed mental illnesses among college students. If students fail to connect with classes, professors, or other students — to feel part of a community — they are more likely to fall into a state of anxiety, depression and self-destructive behavior.

The University of Virginia is trying to address the problem of loneliness and isolation with a program called Hoos Connected. Psychology Professor Joseph P. Allen, executive director, will brief the Board of Visitors tomorrow about the program.

Hoos Connected organizes weekly small-group discussions and activities for first-year and transfer students. In a pilot program, according to a PowerPoint presentation posted on the Board website, Hoos Connected participants and a control group of non-participating students started out roughly equivalent in a measure of student loneliness. Among the goals was to get students to make inter-personal connections and recognize “how much we all have in common beneath the surface.” By the end of the semester, the Hoos Connected cohort showed a decline in loneliness, while the control group exhibited an increase, according to Allen. Continue reading →

12 Comments

Posted in Education (higher ed), Mental illness and substance abuse

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Student Mental Health Crisis Explained – By The Washington Post

Posted on December 5, 2022 by | 61 comments

Freedom High Woodbridge

by James C. Sherlock

The Washington Post, in a lengthy article, “The crisis of student mental health is much vaster than we realize,” wrote about the mental health crisis facing our school children, especially adolescents.

Nationally, adolescent depression and anxiety — already at crisis levels before the pandemic — have surged amid the isolation, disruption and hardship of covid-19.

Now, the Post tells us. They even hint that more federal money may not help. Which must have taken an extra couple of days of meetings before publication.

The article did not identify the “we” who were cited in the headline as not realizing this was happening. Who indeed could have guessed such an outcome?

Other than anyone older than 12 not blinded by a “narrative” that never included the children’s mental health.

Some even wrote about the issues when recommending that kids go back to school in person. Before the start of the 2020-21 school year.

In the Post story, not a word about the “leaders” in state and local governments and the teachers union strike threats that kept some Virginia public schools closed up to an extra year.

Not a word about the Catholic schools that opened across the state in the fall of 2020.

Not a word of apology for being a big part of the problem that needs to be fixed. Continue reading →

61 Comments

Posted in Attendance, Discipline and Disorder, Education (K-12), Health Care, Mental illness and substance abuse

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Richmond Community Hospital: Poster Child for Reforming 340B

Posted on December 2, 2022 by | 83 comments

By Dr. William S. Smith
and Chris Braunlich

Nonprofit hospitals in low-income neighborhoods should be the backbone of the American safety net system for low-income people who lack insurance. Instead, thanks to a federal program called 340B, many nonprofit hospitals have made maximizing revenue their primary goal, not providing charity care. Thanks to a New York Times investigation, Richmond Community Hospital has become the starkest example of a nonprofit hospital that exploits the 340B program while reducing medical services available to the distressed community surrounding the hospital.

The 340B program was created by Congress in 1992 and was intended to allow about 500 hospitals in low-income areas to purchase drugs at substantial discounts. It was thought that, with these discounts, nonprofit hospitals could provide more free care to the distressed communities where they were located.

However, the law was poorly written, and hospitals soon discovered that they could “arbitrage” these drug discounts into a profit center. How could they do this? In short, buy low and sell high. As The New York Times story explained, Richmond Community can buy a vial of the cancer drug Keytruda at a discounted price of $3,444, yet can bill the local Blue Cross health plan $25,425 for that same vial, for a profit of $22,000 on one patient’s prescription. Continue reading →

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Profoundly Unethical: UVa Children’s Hospital Hides Child Gender Transition Information from Public Scrutiny

Posted on December 1, 2022 by | 30 comments

UVa Children’s Hospital courtesy UVa

by James C. Sherlock

I published a series of articles earlier this year that criticized the University of Virginia Children’s Hospital on its approach to gender transition in minors as young as 11.

As a result, the hospital made at least some movement towards change by announcing it was assigning pediatric clinical psychologists to join that program, previously dominated by endocrinologists.

I saw that move as an indication that the minors who came to the clinic would be treated first for anxiety, depression and ongoing emotional issues before being considered for insertion into the hormone-to-surgery pipeline.

That now may be the case, though there is no case flow diagram published. But nothing else has apparently changed except for the elimination of the public information on which I based my criticisms.

There is growing concern among many doctors and other healthcare professionals as to whether medical transition is the best way to proceed for those under aged 18. I have written extensively that several countries have pulled back from medical treatment and instead are emphasizing psychotherapy first.

UVa Children’s is a state hospital. Hiding information from the public to avoid scrutiny cannot be an option.

I call on the Board of Visitors to direct the hospital to improve transparency in the UVa Children’s Hospital web presentations on gender transitions in minors.

Without this, the hospital is guilty of misleading the public.  The removal of previously-available public information shows they are doing this on purpose. Continue reading →

30 Comments

Posted in Children and Families, Culture wars, Ethics, Health Care, Regulations and Government Oversight

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Virginia Mental Health Services in Deep Trouble – A Survey

Posted on November 28, 2022 by | 42 comments

Eastern State Hospital. Courtesy Virginia Department of Behavioral Health and Development

by James C. Sherlock

Nov. 29 updates in blue.

Supply cannot begin to keep up with demand.

In this case, the consequences involve personal welfare and public safety. And they can be terrible in both cases.

Governor Youngkin will propose to the 2023 General Assembly additional funding and policy prescriptions for the state’s mental health system.

The state offers inpatient services, community-based government services, and Medicaid-funded services.  Medicare offers payments to participating hospitals. Private insurances offer coverage.

I say “offer,” because much of what policy prescribes has proven difficult to fill in practice.

Virginia’s mental health system is in deep trouble because of shortages of personnel and facilities to absorb the very steep rates of increases in persons needing assistance.

The personnel problems are twofold and affect both government and private services.

  1. Key personnel positions require trained specialists, the shortages of whom are manifest across the country; and
  2. Working conditions in mental health care are very stressful, physically demanding and dangerous, driving away badly needed low skilled workers who can easily find jobs elsewhere.

Medicaid programs offer services that private facilities and practitioners, facing the same labor shortages, have proven in some combination unable or unwilling to provide at Medicaid reimbursement rates. State-contracted Medicaid Managed Care Organizations (MMCOs) have not solved those problems.

So part of the answer is money, but we really don’t know how much. And in this case, money alone may not provide sufficient services to satisfy demand. Continue reading →

42 Comments

Posted in General Assembly, Governance, Government Finance, Health Care, Insurance, Mental illness and substance abuse, Public safety & health, Social Services and Entitlements

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Homelessness in Petersburg – Part 2

Posted on November 23, 2022 by | 3 comments

Travel Inn was shut down by the ACE team in June. Courtesy Joyce Chu, Progress Index.

by James C. Sherlock

I wrote yesterday about the excellent investigative reporting by the Progress-Index about the knock-on effects of the renewal of fire and building code enforcement in Petersburg.

My position is that Petersburg must enforce its codes for public safety and the livability of the city.

But I also recognize the need to provide better solutions to homelessness in that city. I am pursuing a story on that subject.

But in the meanwhile, the Progress-Index’s Joyce Chu has posted her second article in that series.  I refer to

‘A fresh can of nowhere to go’: Health and stability stumble with fewer motel rooms for those on the edge”

It consists almost exclusively of the stories of those displaced with the closure of those motels.

It is powerful stuff.

3 Comments

Posted in Charity, Philanthropy and Nonprofits, Crime, Corrections and Law Enforcement, Education (K-12), Homelessness, Infrastructure, Mental illness and substance abuse

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Virginia Should Enforce Threat Assessment Laws. Noting Lack of Compliance Not Enough.

Posted on November 22, 2022 by | 54 comments


by James C. Sherlock

I have written about the Threat Assessment Teams (TAT’s) of two state universities, the University of Virginia and Virginia Tech.

I assessed Tech to be compliant with state law. I reported that UVa is not. That of course raises the issue of the rest of Virginia’s colleges and universities.

The Virginia Department of Criminal Justice Services (DCJS) in 2014, with far more resources and access than I, found the state of the TAT’s serving the commonwealth’s fifteen four-year state institutions of higher learning (IHL), its community colleges and private IHLs to be as a group a hot mess (my term).

I will follow this article with an assessment of the compliance of the current policies of Virginia’s fifteen public IHLs.

The 2014 report did not have the intended effect of standardization and professionalization of threat assessment and intervention in Virginia. Preliminary reviews of the policies of each IHL show them still to be all over the map in terms of compliance.

I am reasonably sure that if DCJS redid its survey tomorrow, it would result in similar findings and recommendations. Perhaps at this point the government should actually enforce the law rather than just reporting on the lack of compliance.

One wishes that had occurred years earlier. Continue reading →

54 Comments

Posted in Crime, Corrections and Law Enforcement, Education (higher ed), Efficiency in Government, General Assembly, Governance, Mental illness and substance abuse, Public safety & health, Regulations and Government Oversight

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