Month: January 2024

Looking within

Sen. Creigh Deeds joined the American Civil Liberties Union of Virginia in support of Second Look legislation at the Virginia State Capitol on January 16. 

The event—held by a coalition of the ACLU, the Humanization Project, Nolef Turns, and Sistas in Prison Reform—featured a number of speakers who support the legislation. In addition to Deeds, several other state lawmakers, people impacted by crime, and formerly incarcerated individuals attended the event.

As outlined by the ACLU of Virginia, Second Look legislation would “allow people who have proven they are not a threat to public safety to petition the court to review and potentially amend their long sentences.” Proposed legislation would require petitioners to have served either 10 or 15 years of their sentence, depending on age at the time of the offense, and have several years of good behavior to qualify for review.

Criminal justice reform has long been a priority for Deeds, who is a criminal defense attorney and previously served as co-chair of the Judiciary Committee in the state Senate.

“Our Department of Corrections is supposed to be exactly that: Correction,” he said to event attendees. “It’s supposed to be about rehabilitation.”

Blast off

City of Promise is working with Charlottesville City Schools on a new program aimed at addressing and closing disparities in attendance and literacy in local elementary schools.

The project, LaunchPad, will start as a pilot program at Venable Elementary, with a goal of expanding to the city’s other elementary schools.

“Minority and under-resourced students are struggling with absenteeism and the obvious downstream effect is a negative impact on their reading proficiency and academic performance,” said City of Promise Executive Director Price Thomas in a January 10 press release. “We know how important a predictor reading is of future success, so it’s something that needs to be addressed immediately, holistically, and with concentrated resources.”

CCS Superintendent Royal Gurley also shared his optimism about the program: “LaunchPad will play a pivotal role in shaping the trajectory of students’ academic journeys.”

According to CCS and City of Promise, the LaunchPad pilot program will initially focus on getting kindergarten and first-grade students up to grade level by the end of their third and fourth grade years, respectively. The program is also supported by the University of Virginia School of Education and Human Development.

At press time, a timeline for the implementation of the Launchpad pilot program had not been announced.

In brief

Legal matter

The Charlottesville Police Department has announced that Chief Michael Kochis and Commonwealth’s Attorney Joe Platania believe Charlottesville City Schools appropriately handled an alleged sexual assault that occurred at a city school last year. The assault was brought to the attention of CPD in November after Courteney Stuart, a C-VILLE contributor and host of WINA’s “Charlottesville Right Now,” interviewed a former CCS staff member on her radio program. In the interview, Stuart’s guest claimed that CCS handled the alleged assault internally without notifying CPD. A January 9 meeting between Kochis, Platania, and CCS Superintendent Royal Gurley and his staff resulted in an announcement that the city schools “handled the alleged incident appropriately within the confines of the law.” Charlottesville police and the commonwealth’s attorney’s office have declined to discuss any details due to the juveniles involved.

Water rescue

As the weather gets wetter and colder, Albemarle County Fire Rescue is reminding drivers to avoid flooded roadways, especially after a couple vehicles recently ran into trouble. On January 9, volunteer and career fire rescue units, along with Albemarle County police officers, rescued two passengers from a vehicle on a flooded roadway. That same evening, a driver escaped from a vehicle trapped on a flooded street.

Book it

Get ready for the 2024 Virginia Festival of the Book—tickets to festival events and the Historical Fiction Breakfast are now available at vabook.org. The program includes talks with state Senator Danica Roem, Roxane Gay, Percival Everett, and Ada Limón. The festival offers both all-day passes and individual tickets to some events.

By Laura Vogel

Imagine that finding a skilled primary-care doctor in Charlottesville was a snap, that the monthly cost of a dedicated physician was less than four yoga classes, appointments were never rushed, and your doctor was available to you 24/7. 

To the doctors who practice it, Direct Primary Care is a return to health care as it should be, when you know your doc and they know you, allowing for personalized and optimal care. Sound too good to be true? It was, until the 1990s, when enterprising physicians across the country created DPC, which is sometimes called “concierge” medical care (though most of the women practitioners we spoke to eschewed the latter term), as opposed to fee-for-service (traditional insurance-based) medicine.

What claims to be the first concierge practice was opened in Seattle in 1996 by Dr. Howard Maron and Dr. I. Scott Hall, who called their practice MD2, pronounced “M.D. squared.” These concierge doctors—though they didn’t call themselves that—charged pricey annual retainers in the range of $13,200 to $20,000 per family. Since MD2 didn’t define itself as “concierge,” most credit the CooperativeMed of Florida with being the first to use the term: The Florida office opened its doors in 2002. It was different from today’s DPC practices, in that CooperativeMed didn’t have a patient base; it was formed exclusively as a concierge medical practice that provided care on-demand for a fee.

Today, the model is simple: Patients pay a retainer to have access to a doctor’s services whenever they need them. And those needs can encompass everything from medication management to stitching up minor wounds to major surgery. A flat monthly fee replaces a co-pay, because DPC docs don’t take insurance. (For the doctors in this story, rates range from $70 to $90 per month.)

“In the past three to five years, direct primary care has become a real movement, and is taking us in the right direction,” says Dr. Claire Veber, owner of Mount Pleasant Family Medicine in downtown Charlottesville. “For the physician, it offers a much better quality of life—traditional doctors are seeing a giant number of patients—20 to 30 a day. This stress makes patients feel rushed, doctors feel rushed, you could easily miss something important in an exam.”

Courtney Park, a patient of Charlottesville Direct Primary Care’s Dr. Rebecca Downey, raves about her physician’s responsiveness–even at 3am. “When my son Joshua was about 6 months old, he was sick. I brought him in to see Dr. Downey and she did a really thorough job of examining him.”

Downey told Park that if Joshua didn’t have a wet diaper overnight to call her. “So, he was dry and dehydrated and at three in the morning, I called Dr. Downey—and she called back immediately and told me to take my son to the emergency room,” says Park. “Never has a doctor gone that extra mile for me or my family. She demanded to speak to the E.R. doctor and basically went above and beyond to make sure that my baby was getting the correct care.”

Before becoming a DPC physician, Downey was in a traditional practice for many years, and it drained her both physically and emotionally. 

“I was miserable practicing within the medical-industrial complex, which is tightly regulated by insurance companies, and often called fee-for-service health care, and I was overwhelmed by the number of patients I was seeing per hour and the vast amount of insurance-mandated paperwork I was responsible for generating,” says Downey. “I gained 70 pounds rapidly when I was first practicing and cried on my way to work every day: I didn’t have time to care for myself.”

Downey is now able to focus intensely on individual visits, and she never rushes—the visits often last an hour, something unheard of in most of today’s primary-care practices. “Patients tell me how unsatisfied they were with traditional doctor’s appointments. They felt like they were not being heard, that there was a lack of continuity of care, amount of time to dive deep, and a lack of flexibility and privacy.”

Downey doesn’t advertise—she says she gets the bulk of her clients through word of mouth. Starting her DPC practice as a business, getting a license, and launching the whole operation was a challenge, but she had a significant leg up because she was able to bring 50 of her patients from a previous practice with her.

“Charlottesville is a very educated community, and a lot of people want complex answers to questions about their health, not pat instructions like: ‘You have diabetes, take this pill,’” says Downey. “My patients love that they feel cared for and that things get done in a timely manner in so many ways. I really get to know about my patients’ lives—I hear about their families, struggles, and successes—which makes it a really special way of doing business.” 

David Fairbrothers, a patient of Veber’s, much prefers the DPC model. A health-care professional based in Charlottesville, Fairbrothers says he “unfortunately know[s] too much about the consumer experience of going to a doctor’s office and waiting forever. The basic experience, and it’s not the doctor’s fault, is rushed, primary care is labored with constraints. A DPC that really engages with you and knows you as a patient and knows your overall health, having that with Claire has just been excellent.”

About a year ago, Fairbrothers says he had “a mystery ailment, and Claire decided to throw the kitchen sink of diagnostics at it, and it turned out to be an autoimmune disorder that I am managing well with medication. A relationship that you have with a DPC is nothing like a regular primary care doctor. It’s a different experience. From the outside, it probably looks kinda bougie, but if you sit back and do the math, it comes out equally from what someone’s paying to go into a primary-care clinic, waiting three weeks for an appointment—and God forbid you need a prescription.”

“DPC is a subscription-based medical mode, with a low monthly rate,” says Veber, adding that doctors who work in this mode can afford to bill less because they don’t have the same staffing overhead that most doctors’ offices have. “DPC physicians want to make medicine more affordable and personal,” says Veber.

The way Veber runs her practice, geographically, is unique. She says she is currently serving 75 patients. “Ideally, most DPC doctors want to get that number to about 200,” says Veber. “But right now, I am choosing time over money. I split my time between Charlottesville and Colorado, 70 percent of the time I’m here.” If Veber is out of town, she does telehealth appointments with her patients in Virginia, and, if someone needs to see a doctor in person while she is out West, there is a network of DPC doctors in Charlottesville she can reach out to.

Teamwork is a big part of why Veber loves practicing medicine in this way. She says the community of female DPC doctors regularly gather to share ideas and offers each other support, in addition to participating in group texts and emails. “More and more women are going into medicine—in fact, my intern class at UVA in 2003 was seven-to-one females to males,” she says. She imagines that “perhaps some patients seek or prefer female doctors for their nurturing instincts and great listening skills.”

“The most rewarding thing, to me, about this way of practicing medicine,” says Veber, “is feeling like I’ve spent enough time with my patients, not losing sleep worrying that I missed something crucial in an exam, and just being able to go that extra mile in the care that I give. I’m just really enjoying treating my patients at a humane pace.”  

Dr. Lily Hargrove, owner of Ivy Family Medicine, is called the Charlottesville-area’s “pioneer” of DPC by Veber. Hargrove worked for UVA and Crozet Family Medicine before leaving to start her solo practice in 2011, and was an insurance-accepting doctor until 2014. “I found that the amount of paperwork that was required of me was overwhelming.” 

“The verbiage ‘concierge doctor’ [has] been in common use from around the year 2000,” says Hargrove. “When I was practicing traditionally I thought about it often. Then I had a moment of truth: I sat up in bed at two o’clock one morning and said to myself ‘I want to do direct primary care.’”

“Most traditional doctors will bill the patients’ insurance companies, but my patients pay for my services,” says Hargrove. “What compelled me initially was the financial part of it. I essentially got a $16,000 raise when I became a DPC doctor since I don’t have to pay employees, I run my office by myself.” 

She adds, “If the thing flopped, it’d be okay, I had a husband who made good money. Women often have partners who can fill in the gaps. When I was in my old practice, I had 1,400 patients and when I transitioned to direct primary care I ended up with 300, which was enough to support the business.”

It takes at least 26 days (and growing) to get an appointment with a primary-care doc these days, according to Time magazine. Doctors, on average, spend two hours completing computer work for every hour they spend with a patient. “The need for accessible health care is horrifying,” says Hargrove. “It takes some people six to nine months to find a primary care doctor, and so many people are driven to get a decent general physician. Sure, primary care is not as glamorous as some medical specialties—we’re not doing dramatic surgery or anything, we just want to keep people from getting sick.”    

Dr. Denise Annie Way, owner of Skyline Family Medicine, says that a main reason she practices in the DPC model is that she wants health care to be more equitable and affordable for patients. “It is not surprising that many patients face alarming medical debt these days. In fact, according to the White House, medical debt is the top reason for bankruptcy in the U.S. today.” Way adds, “In DPC, a patient pays their doctor a low monthly fee and in return, builds a long-lasting relationship with their doctor while having the convenience of accessible care. There are no co-pays, nor hidden costs. There are reduced lab fees, reduced imaging costs, and reduced medication costs. Often patients as a result spend less on their health care.”

Way was drawn to DPC because the traditional model has so many flaws. “With traditional fee-for-service medicine, you are always rushed and the quality of your work suffers; patients are on a conveyor belt,” she says. “Doctors have a very limited amount of time for each visit, some are limited to five minutes, and what we can address falls within a narrow dimension.” She adds, “In DPC, a patient pays their doctor a low monthly fee and in return, builds a long-lasting relationship with their doctor while having the convenience of accessible care.  I was unhappy in medicine for years, and practicing as a DPC makes me happy.”

“To us who practice in this way, it’s all about balance and being true to what you studied,” says Way. “It’s not about profit, it’s about bringing quality care to patients. We went into this work because we love practicing medicine.”

“The wonderful thing about my practice is I get to be the doctor I always wanted to be,” she says, “providing excellent medical care to patients and their families.” 

Things are getting messier in the rollout of the 2024-2025 Free Application for Federal Student Aid, with a form error potentially reducing the amount of aid students will receive. As students navigate the FAFSA, C-VILLE asked area colleges and high schools how they’re advising both current and prospective enrollees on the financial aid process.

At the University of Virginia, Deputy Spokesperson Bethanie Glover says that application deadlines and the timeline for admissions offers have not been impacted due to the university’s need-blind admission process. However, problems with the FAFSA have led UVA to extend “the reply deadline for students who were offered admission through our early-decision plan and who applied for need-based financial aid,” says Glover. “If we experience delays in notifying admitted early-action or regular-decision students about their aid packages, we will be glad to work with the students in question to make sure they have enough time to consider their aid before they accept or decline our offer of admission.”

Glover says UVA does not expect delays for current students, and will assess any potential aid package impacts “once we begin receiving their aid applications later this semester.”

Dean of Student Affairs Andrew Renshaw says that Piedmont Virginia Community College has been minimally impacted by issues with the FAFSA due to its open enrollment cycle.

“We’re monitoring our students’ experience with the new FAFSA. We’ve had some students reaching out to us, mostly expressing just sort of apprehension, because … they’ve heard it’s a new process,” he says. “Whenever students feel like there’s going to be a change to something that impacts college affordability it’s something that’s of interest to them.”

PVCC offers biweekly FAFSA events hosted by its financial aid team and walk-in sessions to help students navigate the form and all of its challenges.

As the most affordable higher-education option in the area, Renshaw says it’s especially important for PVCC to monitor any potential impacts to student aid packages from the FAFSA. “We have a ‘PVCC4U 100%’ program that ensures that all of our students, or nearly all of our students, are able to qualify for free tuition and fees as they complete their educational workforce pathways, and the FAFSA plays an important role in that program,” he says. “We are hopeful that by providing the extra support that we are providing that the issues our students might face with the new FAFSA will be mitigated to some degree.”

The current issues with the FAFSA stem from bipartisan legislation passed by Congress in 2020, which was aimed at simplifying the financial aid process. Under the bill, the FAFSA was radically reworked, with changes including a decrease in questions, a new system for calculating aid eligibility, and an annual adjustment for inflation.

The new system for calculating aid eligibility and amount, the Student Aid Index, weighs an applicant’s assets against specific allowances. On top of allowances for United States income taxes paid and payroll taxes, the SAI shelters a certain amount of income from consideration, depending on the applicant’s household size. For example, a dependent student from a four-person household would have an Income Protection Allowance of $35,870 according to the 2024-2025 Draft Pell Eligibility and SAI Guide.

The Income Protection Allowance was the element of​​ the FAFSA that Congress specified should be adjusted annually for inflation.

After months of delays, the Department of Education launched the “new and improved” FAFSA on December 30, 2023. When students were finally able to access the form, it was missing one key change—the SAI/IPA adjustment for inflation.

The failure to adjust for several years of high inflation has resulted in the FAFSA undercalculating students’ aid and grant eligibility. One estimate from The Washington Post shows the form considering between $6,000 to $10,000 in additional income. The inclusion of this additional income may also exclude some students from the partial Pell Grants they are entitled to.

While UVA and PVCC are working to combat known and anticipated problems with the FAFSA, local high schools seem to be in wait-and-see mode.  

“We hope that the changes simplify the FAFSA application process for everyone,” said Melanie Key, chair of the counseling department at Charlottesville City Schools in a January 12 message to C-VILLE. “Since the form only opened on December 30, and we returned to classes on January 2, we have not assisted many families with the 2024 FAFSA yet.” In the same email, Supervisor of Community Relations Beth Cheuk said she and Key thought it may be “too soon for a story about the [FAFSA] reception.”

Albemarle County Public Schools had not responded to C-VILLE’s FAFSA questions by press time.

The Department of Education is currently weighing whether to update the FAFSA for the 2024-2025 school year, or wait until next year to adjust the form for inflation.

On January 12, the Piedmont Housing Alliance broke ground on the Hickory Hope apartments at Southwood. The apartments will add 121 new affordable units to the community, and are the latest step forward in Southwood’s years-long resident-led redevelopment effort.

Hickory Hope apartments—a joint effort of PHA, Habitat for Humanity of Greater Charlottesville, Albemarle County, and Southwood residents—will be 100-percent affordable, with units ranging in affordability between 30 and 80 percent of area median income. According to PHA Executive Director Sunshine Mathon, housing choice vouchers will also be accepted for all units, a key measure in ensuring the units’ accessibility.

“Right now, a lot of folks who have housing choice vouchers are struggling to find housing that they can actually use their vouchers in,” said Mathon at the groundbreaking. “Building more apartments like this helps actually provide people options.”

In addition to affordable housing, the Hickory Hope apartments will provide residents with access to social activities, food bank distributions, eviction prevention measures, financial assistance, and more. The Albemarle County Architectural Review Board voted 3-0 in March 2023 to grant Hickory Hope a building permit, which was necessary due to the project’s location along an entrance corridor.

The construction of Hickory Hope apartments is the latest success in the Southwood redevelopment by Habitat for Humanity. “Both of our organizations—Piedmont Housing Alliance and Habitat—are fully committed to not doing things for people or to people, but with them, to elevate the genius and the hearts, the creativity of the people who are here, so they can be the leaders in the transformation,” said Dan Rosensweig, President and CEO of Habitat for Humanity of Greater Charlottesville.

Southwood started as a mobile home park in the 1950s, and was bought by Habitat in 2007. The redevelopment of Southwood has been in the works for decades, with predominantly Latinx residents working closely with Habitat leaders to ensure the area meets the community’s needs while minimizing displacement.

When completed, the Southwood community will be a 1,000-unit mixed-income, mixed use community. The project will add 500 units of affordable housing to the local housing market.

Resident-led efforts at Southwood are part of a larger effort to combat Charlottesville’s affordable housing crisis. Most recently, City Council passed a new zoning ordinance that broadly aims to increase the supply of affordable housing through density, though critics remain skeptical of the plan’s efficacy.

At Southwood, residents are optimistic about the future of their neighborhood.

“This is like planting a seed and we will see the fruits of this very soon,” said Roger Torres through a translator. Torres has lived at Southwood for 19 years, and will soon be moving into a new home there. “We want to invite everyone to come and see the new project. And, if they have the opportunity to apply to live here, they should do it and learn more about the project.”

Construction of Hickory Hope apartments at Southwood is expected to last 16 months.