TDH report details successes, challenges of Ballad Health COPA

Hank Hayes • May 8, 2019 at 7:00 PM

NASHVILLE — The Tennessee Department of Health (TDH) has identified a series of successes and challenges in an annual report filed on Ballad Health’s certificate of public advantage (COPA).

The COPA governs the 2018 merger of Mountain States Health Alliance and Wellmont Health System into Ballad Health.

Things that are working well, according to the report, are hospitals that were under threat of closure remain open, as required by the TDH; there have been fewer layoffs post-merger than expected; Ballad Health’s executive staff meets frequently with the COPA monitor; Ballad Health’s Greene County hospital consolidation plan appears to be an “innovative and successful” solution; and the TDH is “particularly impressed” by the Accountable Care Community that Ballad Health is playing a lead role in establishing in the region.

The COPA-related challenges, according to the TDH, are Ballad Health’s insufficient public messaging and ineffective communication with the public; the complexity of the COPA; the public’s interest in an immediate evaluation of benefits versus disadvantages; strength of the terms of certification; change is difficult; data availability; economic development; and recruitment capabilities.

In a response, Ballad Health said: “Our merger and the COPA are an unprecedented effort to preserve rural healthcare access and improve community health in the region. We greatly appreciate the hard work of the Tennessee Department of Health in its assessment and development of the annual report, and their finding of continued public advantage. The report, in particular, highlights that hospitals that were under threat of closure remain open, there have been fewer layoffs post-merger than had been expected, the Greene County hospital consolidation appears innovative and successful, and that the Tennessee Department of Health is particularly impressed by the Accountable Care Community that Ballad Health is playing a lead role in establishing in the region. None of this would have been possible without the tireless effort of our team members, physicians, and community partners who work every day to care for the almost 1.1 million individuals who call Northeast Tennessee and Southwest Virginia home. We look forward to continuing to work with them and the department of health as we strengthen healthcare across our region, and to engaging thoughtfully with the communities we serve over the coming weeks and months.”

The TDH said it has concerns that the department has not always received what it regards as adequate advance notice of major decisions made by Ballad Health; Ballad Health needs a better plan for better interactions with independent primary care physician groups; and not receiving complete answers to written questions — but TDH now considers that issue resolved.

The following complaints, according to the TDH, have been resolved: Complaints that pay and benefits for nurses have declined and that health care prices have increased since the merger.

In the area of unexpected consequences, the TDH said the move of the Wellmont Cancer Center in Allandale to Indian Path Community Hospital is resulting in higher costs for patients and that trauma center consolidations could impact regional emergency medical services providers.

“TDH agrees that Ballad has not been successful in educating the public on the types of care that will be provided in its local hospital after trauma center consolidations are completed,” the report said.

The TDH recommended that Ballad Health engage stakeholders and the community in a public input process before finalizing and rolling out plans and revisit its current communication strategy.

“It is important to view the COPA in relation to current health care system trends,” the report concluded. “Both regionally and nationally, health care systems are becoming more regional and are consolidating. … The impact on rural communities is not positive; across Tennessee and the nation, rural hospitals are having difficulty remaining financially viable. Increasingly, if a region’s population isn’t growing, rural hospitals may have to stop providing specialty services in order to remain open.”

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