Tag Archives: James Sherlock

by James C. Sherlock

I re-publish here a communication from the Medical Society of Northern Virginia Board of Directors on matters of importance to its member physicians. Their concerns are the public’s concerns.

Dear members,

First, on behalf of the board of directors, I would like to thank our first line responders; primary care physicians, hospital-based physicians and their ancillary staff, who are risking exposure to COVID-19 daily, while taking care of sick patients. In keeping with all the recent advisories and regulation waivers from CMS and the state, we offer the following recap and added recommendations to protect yourself and your practice.

We support Governor Northam’s recent executive order, issuing temporary restrictions to public gatherings to less than 10 people for non-essential business and adherence to social distancing recommendations. Medical services are excluded since we are essential services. However, the shortage of PPEs and COVID-19 testing pose serious impediments to mitigating the spread of this virus. As we indicated to the Governor last week, most independent practices are not equipped to handle specimen collections. Our offices are generally not set up for dealing with the aerosols associated with this highly communicable disease.  Continue reading →

by James C. Sherlock

The President has just demonstrated strategic command of two ideas, combating the virus and preventing economic disaster, and is pursuing them in parallel.

His background as a successful leader of a large business gives him understanding of the complexity, interdependence and fragility of the economy. He knows that already some businesses will remain shuttered forever. More the longer we wait. Those businesses provide livelihoods not only to their owners, but also to their employees. Not all of them we see. While some are consumer-facing, others supply goods and services without which downstream production and retail can be brought to a halt and the food supply can suffer.

He described wide swaths of the country — the farm belt and many western states — far less impacted by the virus than the great international cities, media centers all, on the coasts.

The President wants the governors, including Virginia’s, to begin to open the economy in their states or parts of their states as soon medical data suggest it is relatively safe to do so. To wait for a declaration of absolute safety by scientists is to misunderstand the standards of scientists. Continue reading →

by James C. Sherlock

I provide here an update on the status of waivers of federal health care laws in response to the COVID-19 crisis. All of the source materials are official government websites.

On March 13, the President declared a public health emergency under the authority vested in him by the Constitution and the laws of the United States of America, including the National Emergencies Act and consistent with section 1135 of the Social Security Act (SSA).

Under that proclamation, the Secretary of HHS has exercised the authority under section 1135 of the SSA to temporarily waive or modify certain requirements of the Medicare, Medicaid, and State Children’s Health Insurance programs and of the Health Insurance Portability and Accountability Act Privacy Rule throughout the duration of the public health emergency declared in response to the COVID‑19 outbreak. Continue reading →

by James C. Sherlock

I was asked yesterday by Christian Braunlich, president of the Thomas Jefferson Institute for Public Policy in Alexandria, to prepare a list of recommended state actions to cope with the emergency. I produced the attached list. The recommendations are offered here as requested with no attempt to prioritize. No attempt has been made to keep up with rapidly changing federal and state actions that may affect this list. I hope it may help.

Subject: COVID-19 Emergency Actions for Consideration by Virginia’s Governor, Attorney General, Insurance Commissioner and General Assembly^[1]

A. Health-care and health insurance-related recommendations

1. Department of Medical Assistance Services (DMAS) request from CMS Section 1135 waivers as appropriate. Continue reading →

by James C. Sherlock

The Kaiser Family Foundation today reported state COVID-19 policy actions through March 17.  Virginia is one of only 18 of 50 states and the District of Columbia to have taken none of the listed policy actions other than an emergency declaration.

The actions not taken include:

• Waive cost sharing for COVIC-19 testing
• Waive cost sharing for COVID-19 treatment
• Free cost vaccine when available
• Waiver of prior authorization requirements
• Early prescription refills
• Marketplace special enrollment period (N/A in Virginia)
• Section 1135 waiver^[1]
• Paid sick leave

(To view raw policy action data for each state and the District of Columbia, click here.)

To that list of actions not taken I would personally add two more. Continue reading →

by James C. Sherlock

We can’t click our heels like Dorothy in the Wizard of Oz to avoid the consequences of COVID-19. We have to do the hard work of reducing the spread and working intelligently with what we have.

Two military axioms apply directly:

• Surprise attacks are come-as-you-are events.
• Operational plans seldom survive the first contact with the enemy.

But strategic planning does survive first contact. Leadership at all levels does.  Experience does. Training does. Forces held in reserve do. Logistics does. All of those win battles.

The pandemic virus plans are in place or are at least required to be. Inspections of readiness have been done regularly or at least were required to have been done. I have listed those plans and inspections in this space as a public service. We will discover whether leadership, training, staffing, and logistics are sufficiently robust. Continue reading →