Bacon's Rebellion

Democracy Thrives in Sunlight

Northam to Let Elective-Procedures Ban Lapse

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by

James A. Bacon
in

Governor Ralph Northam will let hospitals and dentist offices resume service to patients who need elective procedures starting Friday. Speaking at a press conference earlier today, he said he would not renew his public health order issued in an effort to save personal protective equipment (PPEs) and bed capacity for an anticipated spike in COVID-19 cases.

Acccording to the Virginian-Pilot, Northam said hospitalizations have remained flat, and hospitals have enough personal protective equipment to start seeing patients again. The Virginia Hospital and Healthcare Association (VHHA) COVID-19 dashboard had reported that only one hospital in the state anticipated difficulty replenishing its supplies of PPEs.

The ban had led to thousands of furloughs in the healthcare sector across Virginia, and cost hospitals “well over $200 million, said Michael P. McDermott, VHHA chairman and CEO of Mary Washington Healthcare in remarks quoted by the Pilot.

Bacon’s bottom line: While the ban arguably was necessary in the early phase of the COVID-19 epidemic, it has been obvious for some time that it was creating needless havoc in Virginia’s healthcare sector. The Governor extended the ban unnecessarily last week, but we can all be grateful that he has decided to let it expire this week. This decision was a no-brainer. Other steps will be more controversial. At least we can move on and start having those conversations.

–JAB

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36 responses to “Northam to Let Elective-Procedures Ban Lapse”

  1. Steve Haner Avatar
    Steve Haner

    As noted previously, my dentist’s office told me that yesterday. On the other hand, my wife was told today her hairdresser is assuming June 10. At the earliest.

  2. James Wyatt Whitehead V Avatar
    James Wyatt Whitehead V

    Where do we even begin the next conversation? Reopening tourism? Reopening or reimagining education? Codify social distancing? The list is lengthy. I know what George Takai would say, “oh, my!”

    1. LarrytheG Avatar
      LarrytheG

      What to re-open? I’ve got a prediction. The govt is not the one holding things back. People have got a good whiff of what contagion can be and they’re not going to go back shoulder-to-shoulder anytime soon.

      All this crying over getting the restaurants back “up”. Take a look at
      how they are going to have to operate. How many restaurants can be
      profitable with 1/2 their seating?

      Schools? Tell me what kids and what teachers are going to go back without some big changes? Is that going to cost more money to operate schools with social distancing? You bet your bippy….

      All different. Nothing will be the same. We are NOT going back to the way it was before… we are going to a place we have never been before and it’s not at all certain that a lot of things are just not coming back the way they were before or at all.

  3. Dale Harter Avatar
    Dale Harter

    Is it a coincidence that this happened one day after UVA Health announced they would be furloughing people?

  4. LarrytheG Avatar
    LarrytheG

    Geeze.. why didn’t Northam just suspend COPN and let the free market meet that need? What’s wrong with you guys? Here’s you have a prime opportunity to advocate for one of your big “wants” and look at you.

    Just pitiful.

  5. James A. Bacon Avatar
    James A. Bacon

    More comments from Mike McDermott:

    Because this is uncharted territory in many respects, we have all had to make adjustments as this pandemic has unfolded and shifted on a daily basis. Early on in the process, Virginia hospitals took the precautionary step of postponing non-emergency medical procedures to preserve PPE and to create additional treatment capacity in our facilities. This step taken by the hospitals was consistent with Governor Northam’s later order calling for a halt to such procedures throughout the Commonwealth.

    When we talk about non-emergency procedures, I think it’s important to define what we mean. They include things like cancer surgeries and many other scheduled procedures and forms of preventative care that are important to the health of patients who need these types of medical treatment.

    While those scheduled procedures have been on hold, Virginia’s hospitals and health care providers have been working diligently to care for COVID-19 patients and to secure the necessary supplies and resources, such as PPE and expanded testing capability, to support patient care during the response effort.

    Throughout this ordeal, the Commonwealth and health care providers have actively monitored the real world conditions and situational demands caused by COVID-19. As we consider the current situation, and the other medical needs of Virginia patients, we now believe the time is right to chart a path to begin providing non-emergency, scheduled procedures to people who need that care in inpatient and outpatient settings to improve their health outcomes.

    Virginia hospitals have more than 5,000 available beds to meet patient needs and continue the care for those impacted by COVID-19. Access to expanded testing continues to be an area of focus for the Governor and for health care providers, as are PPE supplies.

    Our hospitals follow best practice care and infection prevention protocols and are exceedingly safe facilities. It is important for all Virginians to know that if you need care, please do not hesitate to receive care to improve your health outcome. The hospital community will work within the federal, state, and specialty group framework to guide us as we prepare to move forward with resuming scheduled procedures. This framework positions us to safely and responsibly take these next steps in a manner that is consistent with health care best practices.

    As we proceed in this direction, we will continue to work closely with Governor Northam and his Administration to monitor the number of patients hospitalized for COVID-19 and other conditions, to track testing and PPE supplies, and to protect the safety of our frontline caregivers as we work to slow the spread of this disease. And working together, we will be ready to adjust our approach in response to new challenges we may be confronted with as we continue to fight this very serious virus while meeting the health needs of our fellow Virginians.

    1. LarrytheG Avatar
      LarrytheG

      Can you identify Mr. Mike McDermott ?

      1. James A. Bacon Avatar
        James A. Bacon

        Read the post. He’s identified there.

        1. Steve Haner Avatar
          Steve Haner

          That appears to be the full prepared statement he read from the podium beside Northam yesterday afternoon. Word for word.

    2. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Regarding Mike McDermott – I have no idea who he is. But the implication of his comment through Jim Bacon insults both Jim Bacon and those who comment on this blog. The implication is that Mr. McDermott is too important to dirty his hands by actually typing his own message, or identifying himself on this blog. Instead he by his act suggests he hires a step and fetch it, in this case Jim Bacon, to do the dirty work for him, that is send his supercilious, shallow PR message to us, the unwashed.

      Jim stop this highly offensive practice. Either Mr. McDermott steps out behind his offensive curtain, and stops hiding himself behind his false privilege, or he shuts his mouth on this blog. Why. Because Mr McDermott, you crap into own pot like all the rest of us on this blog. King George, you are not. At least he didn’t act like a sniveling, self important fool educating the unwashed.

      And if you believe I am wrong in my opinion of your action, step forward and tell me why you disagree with my opinion of your action here, and who you are, or claim to be.

      1. James A. Bacon Avatar
        James A. Bacon

        Reed, Mike McDermott is VHHA chairman and CEO of Mary Washington Healthcare, quoted in the post above! I’d say his opinion on the matter is relevant, whether you agree with him or not.

        1. LarrytheG Avatar
          LarrytheG

          I thought that is who THIS Mr. McDermott was and do very much appreciate his perspective. He’s a busy man and interesting that he’s following BR and interested enough to take the time to share his take – which as you say – is very relevant given his position.

          The “uncharted territory” is dead on – across the board – there are going to be two steps forward, on step backs.

          Next, notice he said that the hospitals PRECEDED Gov. Northams order, they were already on it and already aware and concerned with potential shortages and they AND Gov. Northam DID NOT summarily damage the economy with an inappropriate order. He’s slammed here apparently over a ONE WEEK disagreement about when to re-open elective surgeries. ONE WEEK and he’s a goat! Could this be yet another partisan rant? Do bears….. ???

          Opening back up, was not a bright line moment where it was obvious the time had come and Mr. McDermott alludes to the fact that hospitals were and are working WITH Northam on the next steps NOT laboring under bad/wrong/inappropriate “edicts”.

          Mr. McDermott alludes to cancer surgeries and “preventive care” but seems like I read somewhere that any health problem that would harm a patient if not dealt with – is NOT “elective” by definition.

          Finally, it’s a totally ODD and incongruous position of Mr. Bacon and others here who have, prior to the pandemic, excoriated the hospitals for making “profits” on elective surgeries and related and have advocated for an end to COPN and to let competitors challenge the hospitals on price and profits. MANY, MANY posts in BR have taken that position and MANY commentors on BR have supported that position even though it’s known that’s how hospitals mitigate their uncompensated costs.

          NOW, since it’s a convenient argument against Northam, the same folks seemingly switch sides on the issue and NOW side with the hospitals being able to make “profits” from elective surgery because it provides “jobs” and stuff so bad, bad NOrtham… (who by the way did try to do something about COPN).

          I just think it’s downright discordant for BR to switch positions on COPN so that they can then continue to blame Northam on the SAME issue!

          Finallly, give credit to BOTH Mr. McDermott for offering his very relevant perspective AND Mr. Bacon for apparent his flip-flops on the issue! So which is it? Are hospitals BAD for their “profitable” elective surgeries or GOOD because they provide jobs and help the economy?

          So I’m REALLY wondering as we open back up – if we’re going to see flip-flops back to the anti COPN issue with the execption of Mr. Sherlock who does appear to have maintained his original position all along and get his “Blame Northam” mojo on those “disastrous” nursing homes that REALLY ARE Northam’s fault (sic).

      2. Lift Avatar
        Lift

        Not finding transcript online, but isn’t this about same as McDermott’s press conference comment yesterday? Heard it live on radio, sounds about same in my recall?

    3. LarrytheG Avatar
      LarrytheG

      Also this would have been helpful in the original post:

      ” Dr. Michael McDermott, chairman of the Virginia Hospital and Healthcare Association’s board of directors, said the impact of the virus-related shutdowns to hospitals and health systems is “well over” $200 million. But he said Northam’s decision to stop nonemergency medical decisions last month was “absolutely the right decision at the time that it was made.”

      So this was this barely a ONE MONTH ban and the narrative here says: ” While the ban arguably was necessary in the early phase of the COVID-19 epidemic, it has been obvious for some time that it was creating needless havoc in Virginia’s healthcare sector.”

      so we have one view that says “absolutely necessary” and another that says “needless and great harm”.

      I guess there are two ways of looking at it.

  6. LarrytheG Avatar
    LarrytheG

    Here’s something else to be aware of:

    Coronavirus sparks dramatic decline in overall ER visits, job losses for hospital workers

    Southern California hospitals mirror national trend of up to a 50% decline in emergency room visits; admissions down as well

    In the weeks following Gov. Gavin Newsom’s March 19 stay-at-home order to curb the spread of the coronavirus, Dr. Brian Anderson noticed an unusual phenomenon at the eight emergency rooms he manages — a sharp decline in patient visits.

    “The volume has dropped as much as 50 percent in many of our ERs,” Anderson said. “We’ve never seen declines like this. It has caught most by surprise.”

    Like many emergency room doctors and nurses across Southern California, Anderson believes the reason for declining ER visits is mainly two-fold: strict public adherence to the government’s stay-at-home directive and fear of contracting the potentially deadly COVID-19 virus.

    But the dramatic drop in overall ER visits is only part of the story of how COVID-19 is disrupting operations at medical facilities throughout Southern California. Hospital admissions also have declined, partly because fewer patients are coming in through the ER and partly because of the ban on elective surgeries in California.”

    NOTE that other states have also banned elective surgeries…. it’s not just a Virginia thing.

    ” As a result, many hospitals have laid off, furloughed or cut pay for affiliated physicians and staff. The U.S. Bureau of Labor Statistics reported this month that, nationally, health-care employment declined by 43,000 positions in March, though 17,000 of those jobs were in dental offices.”

    Okay, so in my own case – my regular dental cleaning was cancelled and a place on my lip that was to be removed was cancelled. However, my visit to the Urology folks is still on. Getting old sucks big time.

    I just don’t know how many people are going to go do elective surgery right now… it’s not the govt ban, about 80% of people in polls are concerned about the risk.

  7. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    From Daily Progress:

    “Losing $3m a day, UVa Health furloughs employees, cuts executive and physician pay: The Daily Progress
    April 28, 2020

    Employees at the University of Virginia Medical Center will be furloughed and others will take a 20% pay cut as the UVa Health System seeks to shore up its finances following a drastic drop in surgeries and clinic visits.

    “Since the middle of March hundreds of inpatient beds have been empty (our beds are usually full), surgeries have declined by 70%, and clinic visits have been reduced by 90%,” Dr. K. Craig Kent, executive vice president for health affairs, wrote in a memo to staff Tuesday. “The result has been a fall in revenue for clinical care and related services that is producing a deficit of $85 million a month. This is a $3 million loss to the health system each day.”

    The medical center, which is a subset of the health system, had a $1.7 billion operating budget in fiscal year 2020.

    Medical center officials have asked the state to lift a ban on all non-elective surgeries that is set to expire May 1. That ban, the statewide stay-at-home order and other safety precautions in response to the COVID-19 pandemic had reduced patient volumes.

    The university’s Board of Visitors discussed the health system’s finances in closed session Monday, in the latest example of state university leadership wrestling with the impact of the coronavirus on academic and medical programs. Previously, in a discussion focused on the academic half of the university, which is financially separate from the medical center, UVa said it would avoid furloughs and layoffs for as long as possible.

    The medical center has not seen a large increase in COVID-19 patients as of this week. Staff treating COVID-19 patients will not see any adjustment to their compensation or their jobs.

    Kent said the medical center’s financial reserves are diminishing quickly.

    “… Within a few short months we will not be able to fulfill our mission of delivering expert medical care to those in need, educating and training the next generation of providers, and conducting critical research,” he wrote. “We must act now to secure our future.”

    Kent announced a range of measures to curb expenses Tuesday, including a 40% pay cut for himself. Other leaders at the medical center, the UVa Physicians Group, the School of Medicine and the School of Nursing, as well as physicians, will take a 20% pay cut through the end of July.

    Kent makes $950,000 a year, according to a board resolution authorizing his hiring. …”

    For more of Daily Progress article see:
    https://event201.com/losing-3m-a-day-uva-health-furloughs-employees-cuts-executive-and-physician-pay-the-daily-progress/

  8. sherlockj Avatar
    sherlockj

    So you will have a benchmark, Virginia acute care and critical access hospitals in 2018 realized $400 million a week in operating revenue and $32 million a week in profits. Eighty percent of them are untaxed 501c3 “not-for-profit public charities”. That was the last year before Medicaid expansion and the simultaneous rise of Virginia Medicaid reimbursements by 10%. So we can estimate that the Governor’s one week extension of the ban on “non-emergency” procedures cost the hospitals something around $500 million. Please know that is the kind of money we are talking about.
    Trust me, the hospitals will ride the COVID-19 horse for decades to make sure that their hug pillow, COPN, remains in place. COPN already costs Virginians $500 million a year in healthcare and health insurance payments. A decade is $5 billion. You read it here first.

  9. Nancy_Naive Avatar
    Nancy_Naive

    Just a place to keep a link whilst I look at this thingy

    https://www.massgeneral.org/news/coronavirus/COVID-19-simulator

    https://www.covid19sim.org/

    Loading

    1. Nancy_Naive Avatar
      Nancy_Naive

      Excuse this post or just delete it. See below. Damned iPad was balking and I needed a place to save the links while I kept trying and waiting for page loads.

  10. SGillispie Avatar
    SGillispie

    Jim Bacon,
    Thanks for keeping us informed. This continues to be the best source in Virginia for updates on relevant Wuhan virus information. You have really upped your game at BR with Sherlock, Haner, and Sizemore. Regarding Northam’s action, your observation that a ban was initially needed shows balance, your assertion that his extension was needless is confirmed by his own decision. That it has been harmful to many is irrefutable.
    This reader appreciates your insistence on presenting true facts and opinion supported with documentation and cogent argument — something apparently unwanted and anathematic to many.

  11. Nancy_Naive Avatar
    Nancy_Naive

    Found this Harvard/Mass General website. It’s a first order linear ordinary differential equation model of the infection spread in each state. It models six states of infection from healthy to dead or recovered. The parameters are set via data fitting. It allows investigations of mitigation policies by state and nationally

    https://www.massgeneral.org/news/coronavirus/COVID-19-simulator

    https://www.covid19sim.org/

    Takes awhile to load but it’s fun to compare Virginia versus, say, Florida. You can change the periods of lockdown or create your own. A PDF explains it.

  12. Peter Galuszka Avatar
    Peter Galuszka

    My my. After all that gnashing of teeth and huffing and puffing, Northam to allow elective services. And the world did not end!

    1. Nancy_Naive Avatar
      Nancy_Naive

      Of course, what was missing from Jim’s gnashing was the possibility of the “Please don’t throw me in the briar patch” position of the hospitals.

      If you enter for some elective surgery, you have an expectation, and the hospital has the responsibility and liability, not to have you exit via the morgue as a COV2 victim.

      The hospitals would have to be insane to allow any non-lifesaving in-patient surgery under the conditions of an epidemic.

      I’m beginning to suspect a persona non grata status has befallen me.

      1. LarrytheG Avatar
        LarrytheG

        Indeed – consider what is happening with the meat packers. They want waivers of liability from the Federal govt… before they go back to work.

        Is that what the hospitals also want for elective surgery?

        re: ” persona non grata status”.

        Naw….. but contrarians do get rough treatment here…sometimes
        comes with the territory.. don’t be run off… unless that is
        what you want.

        1. Nancy_Naive Avatar
          Nancy_Naive

          You may have been correct about the ” two links “. All is well, but Jim’s buddy might be able to use their formulations and assumptions to code and solve via eXcel.

          They could go nutso with it. I’m half tempted to code it up in my MatLab and play with it.

          1. LarrytheG Avatar
            LarrytheG

            Why not do it? At the least, it would present another
            perspective that is actually based on legitimate data analysis.

            There is a lot of information flying around right now – lots of different views about different data and how to interpret and understand it especially when it may confirm or rebut other data.

            in short – food for thought… good for everyone.

  13. djrippert Avatar
    djrippert

    Those who line the pockets of our political class will go to the head of the line. Given the COVID19 induced drop in electricity usage can a Dominion rate hike be far behind the reopening of hospitals to elective surgery? And Altria needs a break after its almost perfectly timed disaster of an investment in Juul. Is tobacco manufacturing a critical industry?

    Pity the poor Mom and Pop restaurants which have never organized sufficiently to bribe the General Assembly. They will be left to die on the vine as Northam works his way down the list of special interests.

    Surely there must be some “shovel ready” projects waiting for the state’s developers. They paid to play and now it’s time for payback.

    1. James Wyatt Whitehead V Avatar
      James Wyatt Whitehead V

      Mr. DJ they paid to play but forgot that the house always wins.

    2. LarrytheG Avatar
      LarrytheG

      re: ” Is tobacco manufacturing a critical industry?”

      How about Casinos in Las Vegas?

      Professional Sports?

      Cruise Ships?

      Sit down restaurants?

      Amusement Parks?

      Beach tourism?

      How about undocumented workers in meat packing plants?
      Should they be offered “sanctuary” to continue to work?

  14. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    Re Jim’s comment above:

    What is going on here is simple and obvious, in my view. In Virginia, the Coved-19 pandemic (or what is left of it) is being used as a club to consolidate the monopoly in Virginia of the big medical cartels, at the expense of patients, taxpayers, and the smaller, more entrepreneurial health care providers, particular those run by independent doctors, crushing the latter by brute government force imposing vast changes in Virginia economy, all to crush competition for benefit of established elite.

    In short, a war on a virus suddenly has morphed into a war on competition by large entrenched medical operators who now use an alleged crisis to work it in tandem with their preexisting and apparently abusive use of Virginia’s Certificate of Need laws. Regarding these pro monopoly laws, see this commentary in today’s Wall Street Journal. (Jim Sherlock’s message spreads)

    Government’s Ambulance Chasers – In most states, ‘certificate-of-need’ laws stand in the way of new medical facilities and services.By Anastasia Boden and Mollie Williams, April 29, 2020 6:13 pm ET

    One of the most essential responses to a pandemic is ensuring medical providers can adapt quickly to meet new demands. Yet recently an all-female EMT brigade in New York, a family-run ambulance business in Ohio and a fifth-generation ambulance company in Florida were all stopped from providing vital medical transportation. Why? Because they couldn’t prove to the government’s satisfaction that their services were “needed.”

    In 36 states, health-care providers must obtain a “certificate of need” before building a facility or purchasing new equipment. This is a long, tedious process that is separate from satisfying health and safety regulations. In five states, ambulance businesses must get a certificate of need before opening or expanding.

    Take Ezras Nashim, which means “Helping Women” in Hebrew. This volunteer group of female EMTs would like to operate an ambulance to serve Hasidic women in Brooklyn, N.Y. Given the community’s strong practice of modesty, many Hasidic women prefer to receive medical care from other women.

    Ezras Nashim last year applied to New York City’s Regional Emergency Medical Services Council for a certificate. But competing ambulance companies testified at the group’s hearing that another provider wasn’t needed. Despite pleas from women in the community, the council denied Ezras Nashim’s application.

    This is standard for these processes: Those who hold a certificate are invited to show up at the hearing and testify about whether they think new competition is desirable. Not surprisingly, applications are often protested, and protested applications are usually denied.

    As Covid-19 cases soared in New York, emergency workers reported lagging ambulance times and described the city as a “war zone.” Yet Ezras Nashim was forced to stand by as its community suffered. Gov. Andrew Cuomo pleaded with medical workers to come from other states to help, but the irony is that his own state’s laws prohibited local medical personnel from responding to the crisis. …” End Quote. For more of article see:

    https://www.wsj.com/articles/governments-ambulance-chasers-11588198430

    As regards furloughs of health workers at UVA, please note this headline in today’s Daily Progress

    “Northam decision to lift elective procedures ban may not ease UVa furloughs

    Area hospitals are set to resume elective operations after May 1 after Gov. Ralph Northam announced Wednesday that he’ll let the ban on non-emergency procedures expire. The decision comes a day after the University of Virginia Medical Center said it was furloughing employees and cutting pay of physicians and executives.

    Northam decision to lift elective procedures ban may not ease UVa furloughs …”

    These coercive Government policies growing out of Coved-19 are hurting massive amounts of people in Virginia, save for the entrenched elite in Virginia who are consolidating power unlike ever before in modern US history.

  15. Acbar Avatar
    Acbar

    You say: “In short, a war on a virus suddenly has morphed into a war on competition by large entrenched medical operators . . ..” You are surprised?

    “The entrenched elite in Virginia . . . are consolidating power unlike ever before in modern US history.” You didn’t expect this?

    When the entire economy is under assault and half the businesses out there are not going to survive, most of them small businesses without the financial reserves of the Big Gorillas, is it difficult to understand why the survivors will be the latter? Why even they will cry for government protections and government assistance, the better to remain on top? Or why we ordinary folk will be the losers?

    1. LarrytheG Avatar
      LarrytheG

      Long before the coronavirus , small business has always been “niche” in that they find and exploit businesses that the chains and franchises have overlooked or don’t provide all what customers want.

      But the bigger chains and franchises are forever expanding their offerings that they overlooked before and when they do – only the really good small businesses survive.

      I forget what the number is but I think only about 25% of small business start up survive longer term and 80-90 fail in the first few years, even ones with a viable business model are almost always under-capitalized.

      I don’t think it’s crony capitalism per se – it’s just that bigger companies have more resources and can and do operate at a loss for some time before they turn profitable… Just imagine how much money goes into a typical fast food location… there are probably millions of dollars up-front to get it built and up and operating. How many small businesses have that kind of financial ability?

  16. sherlockj Avatar
    sherlockj

    COPN administrators in the Virginia Department of Health have for years not only turned down requests for hospital construction, but also requests for ambulatory surgical centers, independent testing centers and anything else to which the hospitals object. As a result, Arlington County, the location of the Pentagon and the new Amazon headquarters, was rated as having the biggest shortage of hospital facilities in the country with which to deal with COVID-19. This of course will be ignored when the politically powerful hospitals demand even more protection from competition while using their monopolies to continue to crush it.

    1. LarrytheG Avatar
      LarrytheG

      Yet there is OUTRAGE that the Gov shut down those hospitals high-profit elective surgery businesses… and the “objectors” wanted the Gov to re-open them forthwith.

      Right here in BR… even though prior posts castigated the hospitals for their “profitable” operations… it’s a little Jekyll/Hyde… no?

    2. Nancy_Naive Avatar
      Nancy_Naive

      Tough to believe the worst considering there are counties in other states with zero, count’em zero, ICU beds and staff. Maybe co-worst, or knockwurst.

      1. LarrytheG Avatar
        LarrytheG

        There are rural counties in Virginia that likely also have very minimal ICU capability. An increase of 20-30 infected would overwhelm their facilities.

        That’s the thing – yes.. the rural has less people and less infection – but it don’t take much at all to overwhelm their much small hospitals.

        Then if this is an outbreak – those cases will be sent to the nearest big hospital… which thought it had plenty of capacity but was not counting on having to take cases outside of its normal service area.

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