Protesters gather in opposition to the closure of the neonatal intensive care unit at Holston Valley Medical Center, a Ballad Health hospital, in 2019. (Photo: Dani Cook)
ennessee gets a lot of knocks on health and health care metrics, and the state shares, if not owns, responsibility for many of them. The closure of 16 hospitals since 2010 can in large part be attributed to the legislature’s refusal to accept billions of dollars earmarked for the state through the expansion of Medicaid, for instance.
One of the shameful actions of the Republican-led legislature is the creation of Ballad Health in 2018, a deal that was suspect from the start. State lawmakers used a regulatory tool called a Certificate of Public Advantage, or COPA, to approve the merger of Mountain State Health Alliance and Wellmont Health System, organizations rooted in upper East Tennessee and southwest Virginia.
The Federal Trade Commission opposes COPAs, describing them as measures designed to limit competition among health care providers: “Hospital mergers subject to COPAs can result in higher prices for patients without improvements in quality of care, reduced patient access to healthcare services, and lower wages for hospital employees who face fewer employment options.”
Higher fees, reduced access to health care and lower wages for employees: it’s difficult to find anything beneficial to consumers about COPAs like the ones responsible for Ballad.
Suspicions about the state-sanctioned monopoly appear to have been well-founded, given the information emerging about the care — or lack thereof — dispensed at Ballad’s 20 facilities.
The Lookout’s Sam Stockard and Adam Friedman and KFF Health News reporter Brett Kelman have reported over the last couple of years on Ballad’s failures, which are numerous.
Emergency room wait times have tripled at Ballad hospitals since the 2018 merger, with the median wait time now approaching 11 hours.
These Appalachia hospitals made big promises to gain a monopoly. They’re failing to deliver.
In September, Kelman and KFF’s Samantha Liss reported Ballad has failed to meet 80% of the benchmarks designed to improve quality of care for patients, including rates of infection and death. Additionally, the health care system has failed to fulfill its annual charity care obligation company leaders agreed to and has taken thousands of patients to court to collect on unpaid bills.
In October, a Carter County commissioner told Friedman that Ballad officials threatened to pull funding for a private ambulance service after community members expressed frustration about the company’s closure of the county’s only intensive care unit.
Yet, as Kelman reported this week, the Tennessee Department of Health continues to give Ballad top-notch ratings despite facilities continuing to miss targets.
And in the most recent legislative session, a bill spurred by complaints about Ballad that was intended to halt any further medical monopolies stalled out in the House Health Subcommittee due to Republican pushback.
As is the case with many Tennessee issues rooted in politics, it’s wise to follow the money.
State Sen. Rusty Crowe, a Johnson City Republican, sponsored the 2018 merger bill that created Ballad. At the time, Crowe was working for Mountain State Health Alliance and has continued to work for Ballad since the merger — although financial disclosures don’t show what role he plays for the company.
Johnson City Republican Sen. Rusty Crowe is a consultant for Ballad Health. In 2018, he sponsored the legislation creating Ballad through a merger of two healthcare companies. (Photo: John Partipilo)
Crowe has also received $6,000 in campaign donations from Ballad, which may not sound like a lot, until you consider that he serves in no legislative leadership position and that only two state lawmakers have taken in more Ballad money than he has.
The others? House Majority Leader William Lamberth, a Portland Republican, has garnered $10,000 in campaign contributions from Ballad. But Gov. Bill Lee is the big beneficiary.
According to the Lookout’s Cash for Clout political spending database Lee has taken in $77,000 in donations to his campaign and inaugural accounts collectively from the Ballad Health: Mountain States Health Alliance PAC and from Ballad CEO Alan Levine. Levine personally contributed $25,500 to Lee while the PAC kicked in $52,500.
And, Levine has benefited from the merger. According to KFF Health News, his compensation has nearly doubled from his prior role as a health care executive in Florida, reaching $4.3 million annually with Ballad. Lee appointed Levine to serve on the Tennessee Charter School Commission, created one year after the Ballad merger.
East Tennessee official says Ballad Health issued threat to care after community protest
There’s nothing unusual about elected officials appointing big donors to serve on boards and commissions, but it’s difficult not to draw conclusions about Ballad’s relationship with state officials — particularly given the health department’s apparent willingness to overlook flaws with Ballad hospitals.
In interviews, Levine has defended the 2018 merger that created Ballad, saying “Our critics say, ‘No Ballad. We don’t want Ballad.’ Well, then what?” Levine said. “Because the hospitals were on their way to being closed.”
In a way, Levine is right. I’m betting that if given the option of fewer hospitals or a monopoly, most Tennessee residents would pick the monopoly. Some health care facilities are better than none, after all, and not all outcomes at Ballad facilities are negative.
But the Ballad monopoly offers no choice of provider to residents in the 29 Tennessee and Virginia counties it serves. There’s no market incentive for Ballad to improve service, a flaw aided by the apparent reticence of the Department of Health to hold the company accountable.
Sick and injured people need to be able to trust that a visit to the hospital will give them their best shot at health and healing. But with Ballad, that’s not something patients can count on.
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