Bacon's Rebellion

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Bacon Bits: COVID, COVID, Cartel

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James A. Bacon
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More layoffs for healthcare workers

. Ballad Health, which provides health care in the Kingsport-Bristol metropolitan area, has announced the furlough of 1,100 employees, including 200 to 250 in Virginia, reports the Herald-Courier. The loss of business due to  federal efforts to reduce elective procedures, implemented to conserve personal protective equipment, has been financially devastating. “In the next 90 days, we face up to a $155 million loss,” said Ballad CEO Alan Levine. “We have lost up to 70% of our business, and we don’t know when it will come back.” Bon Secours, which operates multiple hospitals in the Richmond and Hampton Roads metros, also has announced significant furloughs.

Stop the spread between nursing homes! LeadingAge Virginia, an association of nonprofit senior living centers, has asked the Virginia Department of Health for a daily list of nursing homes and assisted living facilities with COVID-19 outbreaks. The request followed revelations of devastating losses at Canterbury Rehab in the Richmond area, where the death toll of residents has reached 37  “We just wanted the names of the communities,” legislative counsel Dana Parsons told the Virginia Mercury yesterday. “We’re not asking them to tell us who’s infected, but it’s helpful to know which facilities are seeing outbreaks.” Knowing where outbreaks are happening is one way to reduce the risk of transmission, the association retorts. Staff often work at more than one facility and can transmit the disease.

The Virginia Department of Health has refused, citing “long-standing policy … not to release the name of facilities unless there is a public health reason to do so.”

Another milestone for health care cartels. Norfolk based Sentara Healthcare and Richmond-based VCU Health System have finalized their joint ownership of the Virginia Premier health plan, reports Virginia Business. Sentara insurer subsidaries, Virginia Premier and Optima Health Plan, now insure more than 840,000. Said Sentara CEO Howard Kern: “It is critical we work together to optimize our health plans’ combined strength to ensure access to quality care and support services for everyone we serve.” Having successfully prevented out-of-state providers and physician groups from competing, the health systems have justified the move into insurance with the argument that vertically integrated systems can more effectively manage health care costs. Yet Virginia health plans are among the most expensive in the country.

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18 responses to “Bacon Bits: COVID, COVID, Cartel”

  1. Steve Haner Avatar
    Steve Haner

    The nursing homes want to know about the other nursing homes’ status because of transfers. If somebody is seeking a transfer from a facility with a known outbreak, they’d like to know that. Can’t say I blame them. It’s not just about staff moving between places, although that is also a concern.

    Also just saw this interesting story: Most of the cases in NYC came from people returning from Europe, not China.
    https://www.msn.com/en-us/news/us/most-new-york-coronavirus-cases-came-from-europe-genomes-show/ar-BB12m5Rk?ocid=spartandhp

  2. LarrytheG Avatar
    LarrytheG

    Why can’t nursing homes communicate with each other instead of having the govt do it?

    1. Policy Student Avatar
      Policy Student

      DSS lists 567 “Assisted Living” facilities; it may be unpractical / inefficient for them to communicate organically.

  3. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    Bacon’s says: The Virginia Department of Health has refused, citing “long-standing policy … not to release the name of facilities unless there is a public health reason to do so.”

    Yes! Secrecy, obsessive secrecy driven by deep seated innately compulsive secrecy is the Virginia Way, and has been since earliest times. One can see secrecy in the dark furtive eyes of these people, since Jamestown even.

  4. TooManyTaxes Avatar
    TooManyTaxes

    Now what might be a public health reason to release information about the identity of a facility? If not COVID-19, then what. Mindless bureaucracy.

    1. Dick Hall-Sizemore Avatar
      Dick Hall-Sizemore

      That was my thought, too. Furthermore, I am assuming that the “policy” is normally meant to apply to facilities that get dinged on their inspections. Those names should be released, as well. That would be a market incentive to maintain quality care and facilities.

      1. LarrytheG Avatar
        LarrytheG

        Agree. This is sorta like the Nursing Home version of restaurant inspections. If VDH reports vermin and roaches in a restaurant – that has an adverse effect on it.

        If you do this do a nursing home, what happens to it? What happens to all of those folks that are in the nursing home?

        Has anyone here been involved in trying to find a nursing home for someone or one that is affordable?

        Speak up if you have… what’s that experience like?

        Do folks here realize how many people in nursing homes are paid for with MedicAid? What percentage of Medicaid in Virgina goes to pay for folks in nursing homes? Is that a government responsibility?

        1. TooManyTaxes Avatar
          TooManyTaxes

          “Do folks here realize how many people in nursing homes are paid for with Medicaid? What percentage of Medicaid in Virginia goes to pay for folks in nursing homes? Is that a government responsibility?” This is an extremely important question that should be discussed.

    2. Acbar Avatar
      Acbar

      Good God, yes! Both as to inspections and COVID19 cases. If knowing what and where these facilities are under current circumstances isn’t reason enough, and public health related enough, what possibly could be? They just don’t want to make any judgment calls whatsoever, thus forcing someone higher to overrule them — a classic bureaucratic dodge!

  5. LarrytheG Avatar
    LarrytheG

    So in the case of private sector nursing homes, the Govt SHOULD not only regulate the free market, but they should tell the public about data they force nursing homes to provide to the govt?

    What’s the justification for the govt getting involved in private sector businesses?

    Does VDH report where all the other COVID19 cases are – how many at what hospitals and other providers?

    If they do, there certainly is no valid reason to exclude nursing homes.

  6. Acbar Avatar
    Acbar

    What’s the justification? The government always has an interest in public affairs such as safety, education, health (the social safety net), transportation, foreign affairs and the military. That does NOT mean the government has to perform all these functions itself, but it plainly MUST assure that these are performed, adequately, for all citizens. We argue over how to do these things but, usually, not over whether to do them. And, we expect transparency from the government in performing or overseeing these functions.

  7. LarrytheG Avatar
    LarrytheG

    So whenever citizens safety and health is concerned, the govt does have a legitimate role in regulating?

    re: ” does NOT mean the government has to perform all these functions itself, but it plainly MUST assure that these are performed, adequately, for all citizens.”

    So… Govt … COULD … REQUIRE that nursing homes publically release data such as how many who die and/or are infected from disease even though these facilities are entirely private-sector – no govt at all doing the work?

    Should agencies such as VDH be turned over to the private sector to do – (with rules of course) if the private sector could do it more efficiently with less employees and less bureaucracy?

    I’m NOT “trolling” here. I’m honestly trying to understand where the dividing line is between govt and the “free market” – and yes, I do realize that line is difference for different folks.

    As an example – a decade or two back, VDOT actually employed construction workers who did actual construction work. Now days, almost all of what is built, maintained, even operated is done by private sector companies. VDOT even contracts out the design, build, operate and maintain for toll roads… And the private sector toll road operators actually implement free-market supply/demand tolling…

    Could/should VDH do this for say… state-wide testing for coronavirus but still set the rules and control the overall process?

  8. TooManyTaxes Avatar
    TooManyTaxes

    Regulation can be problematic at two levels. First, market entry and economic regulation can serve as weapons to hobble competitors and competition itself. It can be used to obtain subsidies, crony capitalism and corporate welfare. Second, regulation can prescribe (or proscribe) details that go well beyond the expertise of the agency. It’s better to prescribe a regulatory framework with the details left to experts. Of course, the affected entities and the public need to be able to challenge the details and their application as being anti-competitive, etc.

    1. LarrytheG Avatar
      LarrytheG

      TMT – how would those problematic issues affect nursing homes?

      What regulations should be rolled back to allow nursing homes to do better?

      1. TooManyTaxes Avatar
        TooManyTaxes

        Nursing homes should be licensed (to see that the operator has sufficient capital and a business plan to handle residents). The business plan would designate staffing levels, services, etc. The financial review would ensure there’s sufficient investment to operate during startup, etc.

        It should not be subject to review to determine whether more beds are needed in a community. Health and safety rules should apply and reasonable inspections should occur. I’ve seen people opposed to senior housing in their community argue there’s no need for more capacity.

        There should be no economic regulation unless commitments were made during rezoning (X% of the rooms for lower-income people) or a condition of receiving some sort of tax dollars. For example, the Mather, a national, nonprofit chain of upscale continuous care facilities had to make a commitment for lower-income seniors as part of the process whereby the Mather received up-zoning in Tysons.

        And certainly, any violations of applicable rules, be they consumer fraud or fire safety, should be handled in the same way they do for any other business.

        Legislators need to ask what is the need for regulation beyond we always need regulation. And when that need is defined and accepted, ask whether the proposed regulations are reasonably tailored to address those needs and don’t go beyond to protect an incumbent or generate featherbedding situations, etc.

        1. LarrytheG Avatar
          LarrytheG

          so you’re supporting some significant regulation for private sector nursing homes…

          re: “First, market entry and economic regulation can serve as weapons to hobble competitors and competition itself. It can be used to obtain subsidies, crony capitalism and corporate welfare.”

          is that a concern with nursing homes? If we have regulations that look at financial plans, staffing levels, etc… is that a barrier to market entry?

          “Second, regulation can prescribe (or proscribe) details that go well beyond the expertise of the agency. ”

          is that also a potential problem with the regulation of nursing homes?

          If we do agree on these regulations and restrictions of a private sector industry – how do we say, in general, regulation is not justified for other industries also?

          Regulation seems to be the thing that many hate and oppose but when we get down to specifics like with nursing homes – folks who typically oppose regulation in general – agree that it’s needed for nursing homes.

          Also interesting is that many nursing homes – get their revenues from MedicAid and Medicaid is marginal in its reimbursements to the point where nursing homes have to hold down costs – especially on labor and staffing… which then leads to other problems.

          And the root of that problem is people who did not responsibly save for their own care and when the time came – it became the responsibility of government… those ‘free riders” you sometimes talk of…. – not only not paying taxes but having the government pay for their needs.

          1. TooManyTaxes Avatar
            TooManyTaxes

            Larry, regulation is not all or nothing. I’ve been dealing with government regulation of businesses since January 1977. We don’t need to limit ourselves to either a business is free to do whatever it wants, whenever it wants without regard to outcome or a business must clear every significant issue with a regulator.

            I agree that by requiring initial screens before a business can get a license to operate a nursing home is a barrier to entry. Neither you nor I could open on today or probably never. But there’s a big difference in the state screening for sufficient capital and staffing plans and regulating the number of nursing home bed on a COPN basis. Sunrise should not be permitted to protect its market share in Fairfax County by objecting to the Mather’s application to provide continuous care.

            And Fairfax County or the state should not be permitted to state that Sunrise and the Mather cannot charge more than $15 K per month for skilled nursing care. No one should be able to object to the fact that a senior community offers free shuttle service to doctors and shopping. Nor should the regulators direct all homes to offer this service.

            And, yes, when we pay for people without money (subject to your ongoing concern about people keeping their assets and getting taxpayer care – a valid issue in my view), there are limits as to how much service can be provided. There should be a bare minimum required based on health and safety requirements but people who can pay their own way (say by having long-term care policies or sufficient assets to self-pay) are going be able to afford places that offer more than the basics. We need to provide some assistance to those Americans who cannot take care of themselves but we probably cannot afford to go much beyond basics. Families need to step in and help add assistance.

          2. LarrytheG Avatar
            LarrytheG

            re: ” regulation is not all or nothing”, I’ve been preaching that about a LOT of issues here in BR. The world is gray not black and white.

            but in terms of Nursing homes – they are a private sector industry subject to regulation.

            Is that regulation harming them and leading to problems like we see in Henrico? Is that something Virginia should be loosening regulations so they can function better?

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