{"id":2849,"date":"2024-05-29T10:42:36","date_gmt":"2024-05-29T10:42:36","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=2849"},"modified":"2024-05-29T10:42:39","modified_gmt":"2024-05-29T10:42:39","slug":"tennessee-gives-this-hospital-monopoly-an-a-grade-even-when-it-reports-failure","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=2849","title":{"rendered":"Tennessee Gives This Hospital Monopoly an A Grade \u2014 Even When It Reports Failure"},"content":{"rendered":"
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A Tennessee agency that is supposed to hold accountable and grade the nation\u2019s largest state-sanctioned hospital monopoly awards full credit on dozens of quality-of-care measurements as long as it reports any value \u2014 regardless of how its hospitals actually perform.<\/p>\n

Ballad Health, a 20-hospital system in northeast Tennessee and southwest Virginia, has received A grades and an annual stamp of approval from the Tennessee Department of Health. This has occurred as Ballad hospitals consistently fall short of performance targets<\/a> established by the state, according to health department documents.<\/p>\n

Because the state\u2019s scoring rubric largely ignores the hospitals\u2019 performance, only 5% of Ballad\u2019s final score is based on actual quality of care, and Ballad has suffered no penalty for failing to meet the state\u2019s goals in about 50 areas \u2014 including surgery complications, emergency room speed, and patient satisfaction.<\/p>\n

\u201cIt doesn\u2019t make any sense,\u201d said Ron Allgood, 75, of Kingsport, Tennessee, who said he had a heart attack in a Ballad ER in 2022 after waiting for three hours with chest pains. \u201cIt seems that nobody listens to the patients.\u201d<\/p>\n

Ballad Health was created six years ago after Tennessee and Virginia lawmakers waived federal anti-monopoly laws so two competing hospital companies could merge. The monopoly agreement established two quality measures to compare Ballad\u2019s care against the state\u2019s baseline expectations: about 17 \u201ctarget\u201d measures, on which hospitals are expected to improve and their performance factors into their grade; and more than 50 \u201cmonitoring\u201d measures, which Ballad must report, but how the hospitals perform on them is not factored into Ballad\u2019s grade.<\/p>\n

Ballad has failed to meet the baseline values on 75% or more of all quality measures in recent years \u2014 and some are not even close \u2014 according to reports the company has submitted to the health department.<\/p>\n

Since the merger, Ballad has become the only option for hospital care for most of about 1.1 million residents in a 29-county region at the nexus of Tennessee, Virginia, Kentucky, and North Carolina. Critics are vocal. Protesters rallied outside a Ballad hospital for months. For years, longtime residents like Allgood have alleged Ballad\u2019s leadership has diminished the hospitals they\u2019ve relied on their entire lives.<\/p>\n

\u201cIt\u2019s a shadow of the hospital we used to have,\u201d Allgood said.<\/p>\n

Protesters gather in opposition to the closure of the neonatal intensive care unit at Holston Valley Medical Center, a Ballad Health hospital, in 2019. (Dani Cook)<\/span><\/figcaption><\/figure>\n
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And yet, every year since the merger, the Tennessee health department has reported that the benefits of the hospital merger outweigh the risks of a monopoly, and that Ballad \u201ccontinues to provide a Public Advantage.\u201d Tennessee has also given Ballad an A grade in every year but two, when the scoring system was suspended due to the covid-19 pandemic and no grade issued.<\/p>\n

The department\u2019s latest report<\/a>, released this month, awarded Ballad 93.6 of 100 possible points, including 15 points just for reporting the monitoring measures. If Tennessee rescored Ballad based on its performance, its score would drop from 93.6 to about 79.7, based on the scoring rubric described in health department documents. Tennessee considers scores of 85 or higher to be \u201csatisfactory,\u201d the documents state.<\/p>\n

Larry Fitzgerald, who monitored Ballad for the Tennessee government before retiring this year, said it was obvious the state\u2019s scoring rubric should be changed.<\/p>\n

Fitzgerald likened Ballad to a student getting 15 free points on a test for writing any answer.<\/p>\n

\u201cDo I think Ballad should be required to show improvement on those measures? Yes, absolutely,\u201d Fitzgerald said. \u201cI think any human being you spoke with would give the same answer.\u201d<\/p>\n

Ballad Health declined to comment. Tennessee Department of Health spokesperson Dean Flener declined an interview request and directed all questions about Ballad to the Tennessee Attorney General\u2019s Office, which also has a role in regulating the monopoly. Amy Wilhite, a spokesperson for the AG\u2019s office, directed those questions back to the health department and provided documents showing it is the agency responsible<\/a> for how Ballad is scored.<\/p>\n

The Virginia Department of Health, which is also supposed to perform \u201cactive supervision<\/a>\u201d of Ballad as part of the monopoly agreement, has fallen several years behind schedule. Its most recent assessment of the company was for fiscal year 2020, when it found that the benefits of the monopoly \u201coutweigh the disadvantages<\/a>.\u201d Erik Bodin, a Virginia official who oversees the agreement, said more recent reports are not yet ready to be released.<\/p>\n

Ballad Health was formed in 2018 after state officials approved the nation\u2019s biggest so-called Certificate of Public Advantage, or COPA, agreement, allowing a merger of the Tri-Cities region\u2019s only two hospital systems \u2014 Mountain States Health Alliance and Wellmont Health System. Nationwide, COPAs have been used in about 10 hospital mergers over the past three decades, but none has involved as many hospitals as Ballad\u2019s.<\/p>\n

The Federal Trade Commission has warned<\/a> that hospital monopolies lead to increased prices and decreased quality of care. To offset the perils of Ballad\u2019s monopoly, officials required the new company to agree to more robust regulation by state health officials and a long list of special conditions, including the state\u2019s quality-of-care measurements.<\/p>\n

Ballad failed to meet the baseline on about 80% of those quality measures from July 2021 to June 2022, according to a report the company submitted to the health department. The following year, Ballad fell short on about 75% of the quality measures, and some got dramatically worse, another company report shows.<\/p>\n

For example, the median time Ballad patients spend in the ER before being admitted to the hospital has risen each year and is now nearly 11 hours<\/a>, according to the latest Ballad report. That\u2019s more than three times what it was when the monopoly began, and more than 2.5 times the state baseline.<\/p>\n

And yet Ballad\u2019s grade is not lowered by the lack of speed in its ERs.<\/p>\n

Fitzgerald, Tennessee\u2019s former Ballad monitor, who previously served as an executive in the University of Virginia Health System, said a hospital company with competitors would have more reason than Ballad to improve its ER speeds.<\/p>\n

\u201cWhen I was at UVA, we monitored this stuff passionately because \u2014 and I think this is the key point here \u2014 we had competition,\u201d Fitzgerald said. \u201cAnd if we didn\u2019t score well, the competition took advantage.\u201d<\/p>\n

Midwest correspondent Samantha Liss contributed to this report.<\/em><\/p>\n